Exercise prescription

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Exercise prescription commonly refers to the specific plan of fitness-related activities that are designed for a specified purpose, which is often developed by a fitness or rehabilitation, or Exercise medicine specialist for the client or patient. Due to the specific and unique needs and interests of the client/patient, the goal of exercise prescription should focus on motivation and customization, thus making achieving goals more likely to become successful. [1] Exercise prescription should take into account the patient's medical history, and a pre-examination of a patient's physical fitness to make sure a person has the capacity to perform the exercises. [2]

Contents

Patient referral

In the United Kingdom there is a scheme called "Exercise on prescription" or "Exercise Referral" in which doctors are able to prescribe exercise to those with conditions that benefit from it, such as asthma, depression, or obesity. The initiative particularly aimed to lower the rate of heart disease. National standards for such initiatives from doctors were established by the Department of Health in 2001. Exercise on prescription aims to prevent deterioration of conditions, and views exercise as a preventative health measure. Fitness classes or a course at the local gym are available on prescription at a reduced rate to people who might benefit from them. It aims to make it easier for people to follow their doctors' advice about taking more exercise or losing weight. [3] Such preventative measures hope to lead to savings for the National Health Service. [4]

Researchers in New Zealand have also discussed the benefits of exercise referral by medical practitioners there. [5] In New Zealand it is known as a green prescription, while in the United States a similar initiative is known as Exercise is Medicine. A green prescription is a referral given by a doctor or nurse to a patient, with exercise and lifestyle goals written on them. The term, used by health practitioners in New Zealand draws parallel to the usual prescriptions given to patients for medications, and emphasizes the importance of exercise in improving their condition, and not relying on drugs. The green prescription is written after discussing the issues and goals in the consultation. Studies have shown that an increase in exercise, better sense of well-being, and a decrease in blood pressure results from using the method. A decreased risk of coronary heart disease has not been shown. This was shown in two studies, one by Swinburn (1998), that surveyed patients in Auckland and Dunedin. [6] The other was Elley (2003) and was done in 42 practices in the same region of New Zealand. [7]

General practitioners like the idea as it formalizes what they are telling the patient about how their lifestyle changes are necessary (Swinburn 1997). [8] There has previously not been sufficient education of general practitioners on Exercise Prescription, compared to drug and procedural education, although the need to confidently prescribe exercise increases as the evidence shows of its benefits. If not confident or in difficult cases, General practitioners can refer on to Exercise physiologists, Physiotherapists or Sport & Exercise medicine specialists. [9]

Research in Australia has suggested that an exercise prescription program would be very beneficial and many ICU physiotherapists are already performing this practice, however there is no national standards to govern how this practice is administered so there is great variety in the ways this is administered therefore more research is needed. [10] [11]

For specific diseases

Osteoarthritis

Studies show that exercise prescription aids in both preventing and minimizing the effects of joint disorders such as osteoarthritis. Evidence shows that in addition to the general physiological, psychological and functional benefits gained from exercise, greater quadriceps strength has a mitigating effect on knee joint pain. [12]

Depression

A large body of research indicates that exercise prescription has beneficial effects for patients with depression. One study shows a significant improvement for a randomized group of women with major depressive disorder engaging in a twice-weekly resistance training program compared to a control group. The reasons for this marked change is thought to have biochemical, physiological and psychosocial aspects. [13]

Migraine

Although routine physical activity could be an aggravating factor for migraine, physical exercise is considered to be part of a non-pharmacological strategy for migraine prevention. [14] Migraine patients tend to have less pleasure in physical activity [15] due to fear-avoidance and anxiety sensitivity. [16]

Peripheral arterial disease (PAD)

Blockage or closing of the arteries of the lower limbs impairs blood flow to the legs and results in significant reduction in physical capacity. Alternate exercise prescriptions to walking are considered. Aerobic exercises such as arm-cranking or cycling are recommended. Risk factors for disease progression should also be taken into account when aiming to improve waling ability. Functional capacity should be determined prior to commencement of prescribe exercise programs. [17]

Diabetes mellitus

The number of individuals diagnosed with diabetes mellitus are rapidly increasing and a lot of evidence suggests this is due to an insufficiently active lifestyle. [18] Benefits of exercise include stress reduction, reduced risk of heart disease, lowers blood pressure, helps control weight and aids insulin in improving management of diabetes. Exercise that is not too strenuous is recommended. Such activities may include walking, swimming, gardening, cycling or golfing. [19] Incidental activities are encouraged, such as using the stairs instead of an escalator/lift or walking short distances instead of driving. Dr. Gebel, who works at James Cook University's Centre for Chronic Disease Prevention, conducted a study reporting increased health benefits through incorporation of more vigorous exercise. He stated that this could include 'vigorous gardening', not necessarily meaning going to the gym. [20] Diabetes Australia suggest 30 minutes of exercise daily as a suitable target, which can be divided into three 10-minute sessions throughout the day. [19] Exercise programs however should be tailored and delivered by individuals with appropriate qualifications.

Cancer

Exercise is not only recommended for preventing many types of cancer, but is now recommended as part of treatment for many cancers based on the results of scientific trials. [21] [22] [23]

Chronic obstructive pulmonary diseases (COPD)

Patients with COPD can have an improved quality of live if the correct exercise program is prescribed to them. This program should help increase aerobic capacity (rate that a person can take oxygen from the air), increase endurance, and decrease dyspnea (shortness of breath). [24]

Exercise recommendations

According to Exercise and Sport Science Australia, a minimum amount of 210 minutes of moderate intensity exercise or 125 minutes of vigorous intensity exercise should be performed per week. Exercise should include both aerobic and resistance training. For greater health benefits, exercise should be performed regularly with no more than a two-day gap between training sessions. [18] Exercise that improves cardiorespiratory fitness should be done 5–7 days a week for 30 to 60 minutes at a moderate intensity. If the exercise is done at a vigorous intensity the training sessions only have to be performed 3–5 days a week for 20 to 60 minutes each session. Flexibility should be trained for at least 10 minutes after a training session and should be done at least twice a week.

[24]

Elderly

Research has found that having a well planned exercise routine can greatly benefit the elderly. It an reduce the risks of coronary heart disease, diabetes mellitus and insulin resilience, hypertension and obesity as well as vast improvements in bone density and muscle mass. [25]

Exercise program development

Exercise prescription is designed to modulate acute exercise programming variables to create the adaptations desired by the individual or sport. With aerobic exercise prescription, the type of exercise, duration of exercise, frequency, and duration is adjusted. For resistance exercise prescription, the type of exercise, total session volume, rest period, frequency, and intensity are determined. [26] Prescription of stretching and other activities is also commonly seen. Exercise prescription can be divided into 5 components: [1]

Education

Individuals interested in pursuing a career in exercise prescription have access to a range of educational options that provide the necessary knowledge and skills to design and implement effective exercise programs. These programs and courses offer comprehensive training in exercise physiology, kinesiology, biomechanics, and other related areas. Here are some notable educational options for aspiring exercise prescription professionals:

University Programs

Bachelor's Degree Programs: Many universities around the world offer Bachelor of Science (BS) or Bachelor of Applied Science (BASc) degrees in exercise science, exercise physiology, kinesiology, or related fields. These programs provide a solid foundation in exercise prescription, human anatomy, physiology, and biomechanics. Examples of universities offering such programs include the University of Florida, University of Texas at Austin, and Australian Catholic University.

Master's Degree Programs: For individuals seeking advanced education in exercise prescription, various universities offer Master of Science (MS) or Master of Exercise Physiology (MEP) programs. These programs delve deeper into exercise physiology, research methodologies, and specialized areas such as clinical exercise physiology or performance enhancement. Noteworthy institutions offering master's degree programs in exercise prescription include the University of Connecticut, University of California, Los Angeles (UCLA), and University of Sydney.

Doctoral Programs: Doctoral programs, such as Doctor of Philosophy (PhD) or Doctor of Exercise Science (EdD), are available for those aspiring to pursue research or academic careers in exercise prescription. These programs focus on advanced research, critical analysis of exercise interventions, and leadership in the field. Universities such as Loughborough University in the United Kingdom and the University of Western Ontario offer reputable doctoral programs in exercise physiology and related disciplines.

Certification and Professional Courses

American College of Sports Medicine (ACSM): ACSM offers various certifications and courses, including the Certified Exercise Physiologist (EP-C) and the Exercise is Medicine initiative. These certifications and courses validate expertise in exercise prescription and provide a recognized professional credential.

National Academy of Sports Medicine (NASM): NASM offers certification programs such as the Certified Personal Trainer (CPT) and Corrective Exercise Specialist (CES). These certifications equip individuals with the knowledge and practical skills necessary for designing and implementing exercise programs tailored to specific client needs.

Continuing Education Courses: Numerous organizations and institutions provide continuing education courses and workshops focused on exercise prescription. These short-term programs enable professionals to stay updated with the latest research and advances in the field, enhancing their skills and knowledge.

Online and Distance Learning

In addition to traditional university programs and certifications, online and distance learning options have become increasingly popular for individuals seeking flexibility in their education. Several universities and professional organizations offer online courses and programs that cover exercise prescription, physiology, and related topics. These online programs often provide interactive learning experiences and access to experienced instructors.

It is important for individuals interested in pursuing educational options in exercise prescription to thoroughly research and assess the credibility, accreditation, and curriculum of the programs or certifications they are considering. Seeking out programs affiliated with reputable institutions and professional organizations can help ensure a high-quality education and enhance career prospects in the field of exercise prescription.

See also

Related Research Articles

<span class="mw-page-title-main">Physical therapy</span> Profession that helps a disabled person function in everyday life

Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. Physical therapists are known as physiotherapists in many countries.

<span class="mw-page-title-main">Personal trainer</span> Individual who provides others with fitness training and instruction

A personal trainer is an individual who creates and delivers safe and effective exercise programs for healthy individuals and groups, or those with medical clearance to exercise. They motivate clients by collaborating to set goals, providing meaningful feedback, and by being a reliable source for accountability. Trainers also conduct a variety of assessments beginning with a preparticipation health-screening and may also include assessments of posture and movement, flexibility, balance, core function, cardio-respiratory fitness, muscular fitness, body composition, and skill-related parameters to observe and gather relevant information needed to develop an effective exercise program and support client goal attainment.

<span class="mw-page-title-main">Exercise</span> Bodily activity intended to improve health

Exercise is intentional physical activity to enhance or maintain fitness and overall health.

<span class="mw-page-title-main">Aerobic exercise</span> Low to high intensity physical exercise

Aerobic exercise is physical exercise of low to high intensity that depends primarily on the aerobic energy-generating process. "Aerobic" is defined as "relating to, involving, or requiring oxygen", and refers to the use of oxygen to meet energy demands during exercise via aerobic metabolism adequately. Aerobic exercise is performed by repeating sequences of light-to-moderate intensity activities for extended periods of time. Examples of cardiovascular or aerobic exercise are medium- to long-distance running or jogging, swimming, cycling, stair climbing and walking.

<span class="mw-page-title-main">Exercise physiology</span>

Exercise physiology is the physiology of physical exercise. It is one of the allied health professions, and involves the study of the acute responses and chronic adaptations to exercise. Exercise physiologists are the highest qualified exercise professionals and utilise education, lifestyle intervention and specific forms of exercise to rehabilitate and manage acute and chronic injuries and conditions.

<span class="mw-page-title-main">Physical fitness</span> State of health and well-being

Physical fitness is a state of health and well-being and, more specifically, the ability to perform aspects of sports, occupations and daily activities. Physical fitness is generally achieved through proper nutrition, moderate-vigorous physical exercise, and sufficient rest along with a formal recovery plan.

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<span class="mw-page-title-main">High-intensity interval training</span> Exercise strategy

High-intensity interval training (HIIT) is a training protocol alternating short periods of intense or explosive anaerobic exercise with brief recovery periods until the point of exhaustion. HIIT involves exercises performed in repeated quick bursts at maximum or near maximal effort with periods of rest or low activity between bouts. The very high level of intensity, the interval duration, and number of bouts distinguish it from aerobic (cardiovascular) activity, because the body significantly recruits anaerobic energy systems. The method thereby relies on "the anaerobic energy releasing system almost maximally".

The metabolic equivalent of task (MET) is the objective measure of the ratio of the rate at which a person expends energy, relative to the mass of that person, while performing some specific physical activity compared to a reference, currently set by convention at an absolute 3.5 mL of oxygen per kg per minute, which is the energy expended when sitting quietly by a reference individual, chosen to be roughly representative of the general population, and thereby suited to epidemiological surveys. A Compendium of Physical Activities is available online, which provides MET values for hundreds of activities.

<span class="mw-page-title-main">Physical activity</span> Any voluntarily bodily motion produced by skeletal muscles and requires energy expenditure

Physical activity is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity encompasses all activities, at any intensity, performed during any time of day or night. It includes both exercise and incidental activity integrated into daily routine. This integrated activity may not be planned, structured, repetitive or purposeful for the improvement of fitness, and may include activities such as walking to the local shop, cleaning, working, active transport etc. Lack of physical activity is associated with a range of negative health outcomes, whereas increased physical activity can improve physical and mental health, as well as cognitive and cardiovascular health. There are at least eight investments that work to increase population-level physical activity, including whole-of-school programmes, active transport, active urban design, healthcare, public education and mass media, sport for all, workplaces and community-wide programmes. Physical activity increases energy expenditure and is a key regulator in controlling body weight.

Cardiorespiratory fitness (CRF) refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Scientists and researchers use CRF to assess the functional capacity of the respiratory and cardiovascular systems. These functions include ventilation, perfusion, gas exchange, vasodilation, and delivery of oxygen to the body's tissues. As these body's functions are vital to an individual's health, CRF allows observers to quantify an individual's morbidity and mortality risk as a function of cardiorespiratory health.

Interval training is a type of training exercise that involves a series of high-intensity workouts interspersed with rest or break periods. The high-intensity periods are typically at or close to anaerobic exercise, while the recovery periods involve activity of lower intensity. Varying the intensity of effort exercises the heart muscle, providing a cardiovascular workout, improving aerobic capacity and permitting the person to exercise for longer and/or at more intense levels.

Circuit training is a form of body conditioning that involves endurance training, resistance training, high-intensity aerobics, and exercises performed in a circuit, similar to high-intensity interval training. It targets strength building and muscular endurance. An exercise "circuit" is one completion of all set exercises in the program. When one circuit is completed, one begins the first exercise again for the next circuit. Traditionally, the time between exercises in circuit training is short and often with rapid movement to the next exercise.

The American College of Sports Medicine (ACSM), headquartered in Indianapolis, Indiana, is a sports medicine and exercise science membership organization. Founded in 1954, ACSM holds conferences, publishes books and journals, and offers certification programs for personal trainers and exercise physiologists.

Continuous Training, also known as continuous exercise or steady state training, is any type of physical training that involves activity without rest intervals. Continuous training can be performed at low, moderate, or high exercise intensities, and is often contrasted with interval training, often called high-intensity interval training. Some training regimens, such as Fartlek, combine both continuous and interval approaches.

Exercise is Medicine (EIM) is a nonprofit initiative co-launched on November 5, 2007, by the American College of Sports Medicine and the American Medical Association, with support from the Office of the Surgeon General and the 18th Surgeon General Regina Benjamin.

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The benefits of physical activity range widely. Most types of physical activity improve health and well-being.

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<span class="mw-page-title-main">Exercise medicine</span> Branch of medicine as it relates to Exercise

Exercise medicine is a branch of medicine that deals with physical fitness and the prevention and treatment of injuries and illness with exercise. In some countries, Sport and Exercise Medicine (SEM) is a recognized medical specialty. Exercise medicine is therefore an emerging physician (non-surgical) specialty, but there is also a belief that exercise is treatment of such fundamental benefit that it should be incorporated into all medical specialties. Allied health practitioners also can specialize in exercise such as exercise physiologists, physiotherapists, athletic trainers and podiatrists.

References

  1. 1 2 Exercise Prescription at eMedicine
  2. ↑ "Exercise prescription and basic principles of therapeutic exercise – PM&R KnowledgeNow". 14 March 2017. Retrieved 2021-10-21.
  3. ↑ "Exercise on prescription". BBC News. April 5, 2001.
  4. ↑ Exercise on prescription (Times)
  5. ↑ "Could a Green Prescription be the answer to NZ's obesity crisis?". www.noted.co.nz. Retrieved 21 August 2019.
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  12. ↑ O'Grady, Michael; Fletcher, Jacquelyn; Ortiz, Susan (2000). "Therapeutic and physical fitness exercise prescription for older adults with joint disease: an evidence-based approach". Rheumatic Disease Clinics of North America. 26 (3): 617–46. doi:10.1016/S0889-857X(05)70159-9. PMID   10989515.
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  15. ↑ Oliveira, Arão Belitardo; Bachi, Andre Luis Lacerda; Ribeiro, Reinaldo Teixeira; Mello, Marco Túlio; Vaisberg, Mauro; Peres, Mario Fernando Prieto (2017). "Exercise-Induced Change in Plasma IL-12p70 Is Linked to Migraine Prevention and Anxiolytic Effects in Treatment-Naïve Women: A Randomized Controlled Trial". Neuroimmunomodulation. 24 (6): 293–299. doi:10.1159/000487141. PMID   29597198. S2CID   4470777.
  16. ↑ Farris, Samantha G; Thomas, J Graham; Abrantes, Ana M; Lipton, Richard B; Burr, Emily K; Godley, Frederick A; Roth, Julie L; Pavlovic, Jelena M; Bond, Dale S (July 2019). "Anxiety sensitivity and intentional avoidance of physical activity in women with probable migraine". Cephalalgia. 39 (11): 1465–1469. doi:10.1177/0333102419861712. PMID   31260336. S2CID   195772686.
  17. ↑ Askew, Christopher D.; Parmenter, Belinda; Leicht, Anthony S.; Walker, Philip J.; Golledge, Jonathan (2014). "Exercise & Sports Science Australia (ESSA) position statement on exercise prescription for patients with peripheral arterial disease and intermittent claudication". Journal of Science and Medicine in Sport. 17 (6): 623–9. doi: 10.1016/j.jsams.2013.10.251 . PMID   24315956.
  18. 1 2 Hordern, Matthew D.; Dunstan, David W.; Prins, Johannes B.; Baker, Michael K.; Singh, Maria A. Fiatarone; Coombes, Jeff S. (2012). "Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia". Journal of Science and Medicine in Sport. 15 (1): 25–31. doi:10.1016/j.jsams.2011.04.005. PMID   21621458.
  19. 1 2 "Diabetes and Exercise - Keeping Active". Diabetes Australia. Retrieved 17 April 2015.
  20. ↑ Walton, Alice. "Vigorous Exercise Linked To Longer Life, Study Says". Forbs. Retrieved 17 April 2015.
  21. ↑ Christensen, JF; Simonsen, C; Hojman, P (13 December 2018). "Exercise Training in Cancer Control and Treatment". Comprehensive Physiology. 9 (1): 165–205. doi:10.1002/cphy.c180016. PMID   30549018. S2CID   56492477.
  22. ↑ Ashcraft, KA; Warner, AB; Jones, LW; Dewhirst, MW (January 2019). "Exercise as Adjunct Therapy in Cancer". Seminars in Radiation Oncology. 29 (1): 16–24. doi:10.1016/j.semradonc.2018.10.001. PMC   6656408 . PMID   30573180.
  23. ↑ Cormie, P; Trevaskis, M; Thornton-Benko, E; Zopf, EM (April 2020). "Exercise medicine in cancer care". Australian Journal of General Practice. 49 (4): 169–174. doi: 10.31128/AJGP-08-19-5027 . PMID   32233341.
  24. 1 2 Medicine., American College of Sports (2005). ACSM's resource manual for guidelines for exercise testing and prescription. Lippincott. ISBN   0-7817-4591-8. OCLC   876919973.
  25. ↑ Mazzeo, Robert S.; Tanaka, Hirofumi (2001). "Exercise Prescription for the Elderly". Sports Medicine. 31 (11): 809–18. doi:10.2165/00007256-200131110-00003. PMID   11583105. S2CID   8494841.
  26. ↑ Kraemer, William J.; Fleck, Steven J.; Deschenes, Michael R. (2011). "Exercise Testing for Health, Physical Fitness, and Predicting Sport Performance". Exercise Physiology: Integrating Theory and Application. Lippincott Williams & Wilkins. pp. 385–414. ISBN   978-0-7817-8351-4.
  27. ↑ Vogiatzis, Ioannis (1999). "Physiological Response to Moderate Exercise Workloads in a Pulmonary Rehabilitation Program in Patients With Varying Degrees of Airflow Obstruction". Chest. 116 (5): 1200–7. doi:10.1378/chest.116.5.1200. PMID   10559076.
  28. ↑ "Can you sing while you work out?". Mayo Clinic .
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