The Exercise Prescription

1
The ExercisePrescription

• Michael Tuggy, MD
• Swedish Family Medicine
• Seattle, WA

2
Why write exercise prescriptions?

• Patient knows exactly what you want them to do.
• They take it more seriously.
• More likely to comply.
• Lays out the program for the patient (Clarity).

3
Components of the Exercise Prescription

• F Frequency how often
• I - Intensity how hard
• T Type what kind of activity
• T Time how long

4
Frequency

• How many days is enough?
• Depends on the desire of the patient.
• 3 days VO2 max of 45 (moderately good fitness)
• 5-7days VO2 max of 60 is possible (very high
  fitness level)

5
IntensityTarget Heart Rate

• Old method Max HR
• 220 age max HR
• Take 55 to 90 of rate for targets
• New Method - Heart Rate Reserve
• (Max HR Resting HR) x .40 Resting HR lower
  limit of exercise HR.
  
• (Max HR Resting HR) x .85 Resting HR upper
  limit of exercise HR.
  

6
IntensityBorg Scale and METs

• Borg Scale
• Self-perceived work rated 10-20 (very light to
  maximal)
  
• Subjective
• METs multiples of metabolic equivalents
• 1 MET 3.5mg O2 per Kg per minute
• 1 liter O2 5 Kcal.
• Targets Young (
• Elderly 1-5 METs

7
Intensity and Duration

• Obviously, the more intense the harder to go the
  desired duration
  
• Minimum of 20 min, 30 more ideal.
• Up to 1 hour.
• Low intensity, long duration is the goal for
  non-athletes.
  
• What does the patient like to do and how long
  will they do the exercise for?

8
Strength Training

• High intensity has the most benefit
• 2-3 sets of 8-12 reps.
• 20 minutes to do 1 set
• 50 minutes to do 3 sets

9
Stretching

• 2-3 days per week
• All major muscle groups
• 20-30 sec holds.

10
Pacing Your Patient

• First 4 weeks target 20-30 minutes of aerobic
  activity (walking).
  
• Full program at 5 weeks.
• After 7-8 weeks, see back in clinic to monitor of
  overuse injuries, correct regimen, etc.
  
• If overuse problems develop, adjust workout lower
  temporarily to allow healing.

11
Proven Benefits of Exercise

• Depression, anxiety
• Obesity
• Osteopenia/-porosis
• Cancer
• ASCVD
• DM
• Falls

• Hyperlipidemia
• Low back pain
• ASPVD
• COPD
• CVA

12
Special Considertions

• Pregnancy target HR
• Duration 30-45 minutes
• Breastfeeding reports of failure of milk
  production in strenuously exercising women

13
ASCVD

• Risk categories for exercise
• Class A Individuals who are apparently healthy
  and in whom there is no clinical evidence of
  increased cardiovascular risk with exercise.
  
• Class B Individuals with established CHD that
  is clinically stable. These individuals are at
  low risk of cardiovascular complications of
  vigorous exercise.
• Class C Individuals who are at moderate or high
  risk of cardiovascular complications during
  exercise. Examples of people who would be in this
  category are those who have had several heart
  attacks and those who have chest pain at a
  relatively low level of exercise. Patients with
  certain positive findings on an exercise test may
  also be in this group.
• Class D Individuals with unstable disease who
  should not participate in an exercise program.

14
ASCVD

• Class A No prescreening recommended
• Class B ECG monitored for the first 6 sessions
  (hx. of known ASCVD)
  
• Class C Monitored exercise until 8-12 weeks.
• Class D not able to exercise
• Warm up and cool down periods monitored for B
  C.

15
KISS Principle

• Keep It Simple Stup
• Tailor the exercise to the persons goals and
  preferences
  
• Start slow
• Lots of positive encouragement
• Schedule Follow-up!

16
Writing your prescription

• Personalize it
• Target rate calculated
• Specific time goals (not distance)
• Include stretching and warm up time.
• Gradual program

17
This is one prescriptionevery patient needs.