Exercise prescription

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Exercise prescription is the referral of patients to exercise programmes. The term is also used to describe the development of exercise programs.

Patient Referral[edit]

In the United Kingdom there is a scheme called "Exercise on prescription" 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.[1] Such preventative measures hope to lead to savings for the National Health Service.[2]

Researchers in New Zealand have also discussed the benefits of exercise referral by medical practitioners there.[3] In New Zealand it is known as a green prescription, while in the United States a similar initiative is known as Exercise is Medicine.

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.[4][5]

Exercise Prescription for Specific Diseases[edit]

Osteoarthritis[edit]

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.[6]

Depression[edit]

A large body of research indicates that exercise prescription has beneficial effects for patients suffering 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.[7]

Peripheral Arterial Disease (PAD)[edit]

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.[8]

Diabetes Mellitus[edit]

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.[9] 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.[10] Incidental activities are encouraged, such as using the stairs instead of an escalator/lift or walking short distances in stead 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.[11] Diabetes Australia suggest 30 minutes of exercise daily as a suitable target, which can be divided into three 10 minute sessions throughout the day.[12] Exercise programs however should be tailored and delivered by individuals with appropriate qualifications.

Exercise Recommendations[edit]

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.[13]

Elderly[edit]

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.[14]

Exercise Program Development[edit]

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.[15] Prescription of stretching and other activities is also commonly seen.

References[edit]

  1. ^ http://news.bbc.co.uk/1/hi/health/1261950.stm Exercise on prescription (BBC)
  2. ^ [1] Exercise on prescription (Times)
  3. ^ http://www.hi-mag.com/healthinsurance/article.do?articleid=20001764961 Analysis: Workplace Wellbeing
  4. ^ "Rehabilitation and exercise prescription in Australian intensive care units". linkinghub.elsevier.com. Retrieved 2015-04-16. 
  5. ^ O’Hagan, Ciara; Vito, Giuseppe De; Boreham, Colin A. G. (2012-11-28). "Exercise Prescription in the Treatment of Type 2 Diabetes Mellitus". Sports Medicine 43 (1): 39–49. doi:10.1007/s40279-012-0004-y. ISSN 0112-1642. Retrieved 2015-04-16. 
  6. ^ "Therapeutic and physical fitness exercise prescription for older adults with joint disease: an evidence-based approach". 17 April 2015. 
  7. ^ "http://informahealthcare.com.ipacez.nd.edu.au/doi/abs/10.3109/01612840.2012.758207". 17 April 2015. 
  8. ^ Askew, Christopher; Parmenter, Belinda; Leicht, Anthony; Walker, Philip; Golledge, Jonathan (November 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). Retrieved 17 April 2015. 
  9. ^ Hordern, Matthew; Dunstang, David; Prins, Johannes; Baker, Michael; Fiatarone Singh, Maria; Coombes, Jeff (28 May 2011). "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). Retrieved 17 April 2015. 
  10. ^ "Diabetes and Exercise - Keeping Active". Diabetes Australia. Retrieved 17 April 2015. 
  11. ^ Walton, Alice. "Vigorous Exercise Linked To Longer Life, Study Says". Forbs. Retrieved 17 April 2015. 
  12. ^ "Diabetes and Exercise - Keeping Active". Diabetes Australia. Retrieved 17 April 2015. 
  13. ^ "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. 16 April 2015. 
  14. ^ Mazzeo, Robert S.; Tanaka, Hirofumi (2012-11-02). "Exercise Prescription for the Elderly". Sports Medicine 31 (11): 809–818. doi:10.2165/00007256-200131110-00003. ISSN 0112-1642. Retrieved 2015-04-16. 
  15. ^ Kraemer, W.J., Fleck, S.J., Deschenes, M.R. Exercise Physiology: Integrating Theory and Application. 2012 Lippincott Williams & Wilkins. Chapter 12. (pages 353-384)

See also[edit]