Original Editor - Karen Wilson Show Top Contributors - Karen Wilson, Kim Jackson, Lucinda hampton, Wendy Walker, Tarina van der Stockt, Shaimaa Eldib, Admin, Tony Lowe, Simisola Ajeyalemi, Vidya Acharya, Claire Knott, Wanda van Niekerk, Lauren Lopez and Manisha Shrestha Physical activity prescription is an under-utilised tool for improving community health.[1] In the right dose, physical activity can help to prevent, treat, and manage a range of chronic health conditions that increasingly impact the quality of life and physical function of individuals on a global scale.[2] Safe and effective exercise prescription requires careful consideration for the target individual's health status, baseline fitness, goals and preferences. Several national and international organisations provide clinicians and allied health professionals with guidelines for how to screen, assess, and, when appropriate, prescribe exercise for the benefit of their patients/clients. Pre-exercise Screening[edit | edit source]Before starting a physical activity program, the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) recommend screening to identify cardiovascular risk factors.[3] Screenings help mitigate the risk for adverse responses to exercise, as even moderate physical activity can trigger cardiac events in individuals who are largely sedentary.[3] With this in mind, two instruments are recommended to facilitate the risk screening process for fitness professionals. The most commonly used questionnaire is the PAR-Q, followed by the Fitness Facility Pre-participation Screening Questionnaire.[3]
Screening results in stratifying prospective participants into 3 levels of risk: low, moderate, and high.
Signs and symptoms that automatically lead to high risk stratification include:
From this information, a decision about the need for medical clearance/consultation can be made prior to further testing. Below is a summary of medical clearance and testing recommendations based on the risk level of the individual and the intensity of exercise in which he or she wishes to participate.[4]
Assessment of Exercise Capacity[edit | edit source]Multiple protocols for measuring baseline exercise capacity exist. For aerobic capacity, exercise testing falls into 2 categories: maximal and sub-maximal testing.
Exercise Prescription[edit | edit source]Exercise prescription is based on 5 principles: type, duration, frequency, intensity, and volume.
Each measure has guidelines for what parameters denote vigorous, moderate, and low intensity exercise. The following table offers a comparison of intensity across multiple measurement methods.[4][6][7]
With moderate intensity the patient will have a faster heart beat, feel warmer, and breath harder. An example is brisk walking.[8] With vigorous intensity the patient will get warm quickly, perspire, breath much harder, and will struggle to maintain a conversation. [8] The final principle of exercise prescription is volume. Volume is a sum of the intensity, frequency, duration, and longevity of a physical activity program. Recommendations regarding frequency, time, and intensity have been established for each type of exercise training.[4]
The way in which these recommendations are applied depends on multiple factors. In developing a program prescription, health professionals must consider fitness level, fitness goals, exercise preferences, equipment availability, and other personal factors that may impact participation. For example, if a patient or client is starting at a low level of fitness, an initial program may include low to moderate intensity, aerobic exercise that the individual enjoys and fits his or her time schedule to encourage adherence. In addition, the patient or client may have to work up to meeting the recommended 150 minutes per week. Apply the FITT principle when prescribing exercise:[8]
Exercise Progression[edit | edit source]Progression is way in which frequency, intensity, and duration of an exercise program are increased. Advancement of an exercise program should be incremental to encourage participant adherence and avoid injury. Recommendations for progressing aerobic exercise include increasing the duration of sessions 5 to 10 minutes every 1-2 weeks for the first 4-6 weeks.[4] Frequency and intensity can be progressed as tolerated. Overall volume should be monitored for adverse effects decreased if necessary. In the case of resistance exercise, increasing repetitions is favoured before increasing load. Once the maximum repetitions for a target range have been achieved, load can be increased by approximately 5% so that no more than the lower limit of repetitions can be performed.[9] Implications for Physical Therapist Practice[edit | edit source]As experts in exercise across the life span, physical therapists stand to play an important role in promoting, prescribing and managing exercise programs. A randomized control trial suggests home-based exercise and nutrition strategies have a positive outcome on the frailty score and physical performance in the pre-frail or frail older adults[10]. In addition to being a tool to remediate impairments, activity limitations, and participation restrictions, exercise prescription should also be used to improve the fitness and well being of patients and clients. References[edit | edit source]
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