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 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 be focused on motivation and customization, thus making achieving goals more likely to become successful. The prescription of exercise came about because of the major impact that exercise can have on our health and the many benefits it brings to our body. Exercise benefits our mind, body and emotional state. It can also benefit our social life as well. Exercising daily can help to prevent various illnesses, which is another reason why physicians prescribe exercise to their patients. Many people don't get the adequate amount of exercise or don't exercise at all which leads to them contracting harmful ailments.[1]

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.[2] Such preventative measures hope to lead to savings for the National Health Service.[3]

Researchers in New Zealand have also discussed the benefits of exercise referral by medical practitioners there.[4] 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 emphasises 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.[5] The other was Elley (2003) and was done in 42 practices in the same region of New Zealand.[6]

General practitioners like the idea as it formalises what they are telling the patient about how their lifestyle changes are necessary (Swinburn 1997).[7]

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.[8][9]

Mental and Emotional Benefits[edit]

Exercise is a great stress relief whether you go for a jog or hit the gym. Both physical and mental stress are reduced by daily exercise. Working out can also make you feel happier and more joyful due to the fact that endorphins are released which create feelings of jubilation. The release of endorphins can alleviate symptoms of depression and anxiety. Even just exercising for 30 minutes a few times a week can enhance overall mood. Self-confidence and self-worth can also be enhanced with exercise by promoting self-love and taking care of ones health. Exercising outdoors can also increase self-love even more by getting much needed vitamin d, getting fresh air, and enjoying the beautiful outdoor scenery. People start to gain a more positive mood and outlook on life through working out and become more emotionally stable. They become more emotionally stable because they are less consumed by responsibilities and commitments while enjoying their physical activity.

As humans age and get older, their brain cells start to shrink and people start to lose many important brain functions. Exercise can't cure decline in functions of the brain but it can prevent degenerations of cognitive processes that usually occur after age 45. Studies have also demonstrated that cardiovascular exercise can improve brain performance and enhance levels of a brain-derived protein that assist with decision-making, higher thinking, and learning. Regular physical activity can also sharpen memory, assist in controlling addiction, and increase levels of relaxation. Memory is sharpened because there is an increase in production of cells in the hippocampus, which is responsible for memory and learning. For example, a study demonstrated how running sprints improved vocabulary retention among healthy adults. Some people can become addicted to the chemical dopamine and the substances that produce it such as drugs and alcohol. Physical activity can help addicts recover by distracting them from their addictions and make them think less about their cravings. Physical activity restarts the circadian rhythm and allows addicts to fall asleep at the right time and stay up all night. While working a few hours before bedtime raises body temperature, then few hours later the body temperature cools down and signals to the body that its time to relax and fall asleep which initiates better relaxation and fulfilling sleep.

Physical Benefits[edit]

Physical activity is a widely known as one of the main ways of losing weight along with a health diet. Certain studies have shown that inactivity played a major role in obesity and weight gain. Frequent exercise increases metabolic rate, which leads to burning more calories and weight loss. Combination of aerobic exercise with strength training can boost fat loss and muscle mass maintenance. Through regular exercise, strong muscles and bones can be developed. It is essential to build bone density when you're younger in order to prevent muscle mass loss and to build and maintain bone density and muscle strength. For some people suffering from severe fatigue such as chronic fatigue syndrome or other illnesses would benefit from regular exercise by increased energy levels. For instance, "a study found that six weeks of regular exercise reduced feelings of fatigue for 36 healthy people who had reported constant fatigue" (Healthline).

Frequent physical activity decreases chances of getting a chronic disease and decreases belly fat. Frequent physical activity has also been proven to enhance insulin sensitivity, cardiovascular fitness and body composition, while lowering blood pressure and blood fat levels. Exercise boosts the overall health of your skin by reducing oxidative stress in the body. Oxidative stress in the body is when there is an imbalance between free radicals and antioxidants in the body. When the antioxidants are not strong enough to counteract the damaging free radicals then oxidative stress occurs. Moderate exercise increases levels of antioxidants and produces more blood flow, which protects skin and hinders signs of aging. Chronic pain may be controlled and reduced by frequent exercise as well. Physical activity may also increase pain tolerance which will lessen pain interpretation.

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.[10]

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.[11]

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.[12]

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.[13] 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.[14] 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.[15] Diabetes Australia suggest 30 minutes of exercise daily as a suitable target, which can be divided into three 10-minute sessions throughout the day.[16] Exercise programs however should be tailored and delivered by individuals with appropriate qualifications.

Cancer[edit]

According to the Center for Disease Control and Prevention, regular exercise may lower your risk of various cancers. Studies have found that working out can reduce risk of recurrence or death by as much as 50% in people with colorectal cancer. Physical activity may also decrease the risk of recurrence for breast cancer patients, by regulating hormone levels. Exercise also has the ability to reduce side effects of cancer treatments such as nausea and fatigue.

Heart Disease[edit]

Frequent physical activity lowers blood pressure, helps maintain a healthy body weight, and reduces cholesterol levels which all lower the chance of getting heart disease.

Sleep Apnea[edit]

Sleep apnea is a blockage in the upper airway of the throat that prevents proper breathing. Normally, the brain would immediately wake you up to continue normal breathing patterns. People identified as obese have a higher chance of contracting this disease, exercise can help to prevent this disease by lowering weight before problems arise.

Obesity[edit]

Obesity is a complex health condition where a person is excessively overweight. People who exercise regularly and eat a healthy diet are much less likely to become obese and experience the health complications it can bring. Any physical activity that you can enjoy week after week will assist in losing weight along with a change in diet.

Dementia[edit]

Several studies have shown that aerobic exercise in middle-aged and older adults have reported improvements in thinking and memory, reduced chances of dementia. A study done on 2,000 men in Wales over 35 years were examined on five behaviors (regular exercise, not smoking, moderate alcohol intake, healthy body weight, and healthy diet), exercise had the greatest effect in lowering the risk of dementia(Alzheimer's Society). In another study of 716 people with an average age of 82 years old, people who were in the bottom 10 percent were more than twice as likely to develop Alzheimer's disease than those in the top 10 percent. Aerobic exercise has also been proven to affect the brains of older people. For example, in a modest-size trial, one year of aerobic exercise resulted in a small increase in the size of the hippocampus, which was equal to reversing one to two years of age-related shrinkage (Alzheimer's Society).

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.[17]

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.[18] Prescription of stretching and other activities is also commonly seen. Exercise prescription can be divided into 5 components:[1]

  • Type of exercise or activity (eg, walking, swimming, cycling)
  • Specific workloads (eg, watts, walking speed)[19]
  • Duration and frequency of the activity or exercise session
  • Intensity guidelines – Target heart rate (THR) range and estimated rate of perceived exertion (RPE)[20]
  • Precautions regarding certain orthopedic (or other) concerns or related comments

Steps to a Healthier You[edit]


1. Before beginning any exercise program it is best to assess your fitness level. This can be done by:

  • Checking your pulse rate before and immediately after walking 1 mile
  • Seeing how long it takes to walk a mile
  • Count how many half situps, standard pushups, and modified pushups you can do at a time
  • Measuring your waist circumference
  • Measuring body mass index

2. After assessing your fitness level then create a fitness program.

  • Think about what your fitness goals are: ensure clear fitness goals are declared so that you stay motivated and can determine progress
  • Design a balanced routine: According to the Department of Health and Human Services, "it is recommended that you get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous".
  • Begin slowly and progress slowly: if your just starting to exercise then start slowly and gingerly. If you have any pre-existing health conditions or injuries then meet with a doctor before beginning to exercise.
  • Incorporate activity into daily routine: Schedule time to workout like any appointment and have it written down on a calendar or a planner.
  • Incorporate different types of activities: Participating in the same activity over and over again again can get boring. To prevent boredom, try different types of activities such as walking, biking, swimming, and strength training.
  • Have adequate amount of recovery time: Set time in between workout sessions that allow the body to rest and recuperate.
  • Write goals and plans on paper: having plans written may help people stick to their goals

3. Get started

  • Start slowly and progress gradually: Give enough time to warm up and cool down. Try to start working out for at least 30 minutes then build up to 60 minutes.
  • Break a session up: If you don't have time for a full 30 minute or 60 minute session then break it up throughout the day. You can do one 15 minute session in the morning and one 15 minute session in the night.
  • Creativity: Include fun activities that also add to your workout regimen such as scuba diving with friends or going for a hike with family.
  • Listen to your body: If you're feeling any kind of pain, dizziness, or nausea then take a break and don't over do it. If you're not feeling well and have the flu then take a few days off and give your body the proper time to rest.

Overcoming Psychological Barriers[edit]

Low Self Motivation[edit]

If it is hard to motivate yourself to go to the gym or to just workout period, then it may be best to find a workout buddy or buddies. Joining fitness groups or classes would be beneficial as well to help motivate you and push you to your highest potential. Working out with a group or a friend can also make it a more enjoyable experience.

Fear of injury[edit]

If you have been injured in the past and are afraid of being re-injured then participate in a low-impact activity such as using the elliptical. The fear of re-injury is not a good enough reason to stop exercising which will prolong and benefit your life in the long run.

Poor Self Image[edit]

Millions of people have low self-esteem and poor self image. Going to the gym for the first time may be intimidating for some because they are surrounded by people who they feel are fitness experts and that are looking down on them and criticizing them. However, they were all beginners too and there's a high chance that they are not watching you and are focusing on their own workout. Going with a friend for the first time may help or meeting with a therapist may help as well.

Lack of Confidence[edit]

For many beginners, the gym equipment may seem daunting but there are fitness coaches available at the gym that can assist with any confusions. Along with fitness coaches, there are online fitness resources as well that will explain all the different fitness techniques to be successful in the gym and on your new fitness journey.

Self-Management Skills[edit]

To overcome this obstacle of not being able to manage yourself then you should set specific goals for your self.

  • Set reachable goals
  • Be specific
  • Have mini goals
  • Write down all goals and when you want to meet them by
  • Identify what your motives are for working out
  • Reward yourself after achieving each goal
  • Inability to Enjoy Exercise

Some people love working out while others completely despise it. If your are someone that finds it hard to enjoy exercise then try more creative activities such as rock climbing or playing a game of basketball or soccer. Another fun way of getting your cardio in is dancing instead of just running on the treadmill.

4 Types of Exercise[edit]

Endurance[edit]

Endurance/aerobic activities enhance breathing and heart rate. They keep your heart, lungs, and circulatory system healthy. Endurance exercises include:

  • Jogging
  • Working in the yard
  • Dancing

Strength[edit]

Strength exercises make muscles stronger, protect bone and muscle mass, keeps extra weight off, develop better body mechanisms, and more calories burned. These exercises can help you to become stronger and make doing everyday activities easier. Strength exercises include:

  • Weight lifting
  • Working out with a resistance band
  • Exercising using your own body weight

Balance[edit]

Balance exercises aid in preventing falls which is common among older adults. Balance exercises include:

  • Standing on one foot
  • Heel-to-toe walk
  • Tai Chi

Flexibility[edit]

Flexibility exercises stretch your muscles and helps the body to stay agile.You experience less pain, fewer injuries, and improved posture and balance. Being more limber gives more freedom of movement for other types of activities and everyday activities. Flexibility exercises include:

  • Yoga
  • Calf stretch
  • Shoulder and upper arm stretch

See also[edit]

References[edit]

  1. ^ a b Exercise Prescription at eMedicine
  2. ^ "Exercise on prescription". BBC News. April 5, 2001.
  3. ^ [1] Exercise on prescription (Times)
  4. ^ http://www.hi-mag.com/healthinsurance/article.do?articleid=20001764961 Analysis: Workplace Wellbeing[dead link]
  5. ^ Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG (1998). "The green prescription study: a randomized controlled trial of written exercise advice provided by general practitioners". Am J Public Health. 88 (2): 288–91. doi:10.2105/ajph.88.2.288. PMC 1508188. PMID 9491025.
  6. ^ Elley CR, Kerse N, Arroll B, Robinson E (2003). "Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial". BMJ. 326 (7393): 793. doi:10.1136/bmj.326.7393.793. PMC 153098. PMID 12689976.
  7. ^ Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG (1997). "Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise". Br J Gen Pract. 47 (422): 567–9. PMC 1313106. PMID 9406491.
  8. ^ Skinner, Elizabeth H.; Berney, Susan; Warrillow, Stephen; Denehy, Linda (2008). "Rehabilitation and exercise prescription in Australian intensive care units". Physiotherapy. 94 (3): 220–9. doi:10.1016/j.physio.2007.11.004.
  9. ^ O’Hagan, Ciara; De Vito, Giuseppe; Boreham, Colin A. G. (2013). "Exercise Prescription in the Treatment of Type 2 Diabetes Mellitus". Sports Medicine. 43 (1): 39–49. doi:10.1007/s40279-012-0004-y. PMID 23315755.
  10. ^ 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 Diseases Clinics of North America. 26 (3): 617–46. doi:10.1016/S0889-857X(05)70159-9. PMID 10989515.
  11. ^ Stanton, Robert; Happell, Brenda M. (2013). "An Exercise Prescription Primer for People with Depression". Issues in Mental Health Nursing. 34 (8): 626–30. doi:10.3109/01612840.2012.758207. PMID 23909675.
  12. ^ 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.
  13. ^ a b 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.
  14. ^ "Diabetes and Exercise - Keeping Active". Diabetes Australia. Retrieved 17 April 2015.
  15. ^ Walton, Alice. "Vigorous Exercise Linked To Longer Life, Study Says". Forbs. Retrieved 17 April 2015.
  16. ^ "Diabetes and Exercise - Keeping Active". Diabetes Australia. Retrieved 17 April 2015.
  17. ^ 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.
  18. ^ 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.
  19. ^ 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.
  20. ^ http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887[full citation needed]