Chapter 4_ Prescribing physical activity_ the written prescription

Introduction

Exercise is often considered one of the most effective and beneficial interventions for health and wellness. Dr. Robert Butler emphasized that if exercise were a medication, it would be widely prescribed due to its significant health benefits compared to conventional pharmaceuticals.
Despite evidence supporting the impact of physical activity on health and quality of life, many clinicians tend to underutilize exercise prescriptions in favor of medications.

Providing verbal recommendations, such as "do more exercise," often lacks specificity and effectiveness. A written prescription formalizes the recommendation, reinforcing that exercise is a legitimate therapeutic intervention.
Only 16% of Canadian primary care physicians reportedly use written physical activity prescriptions, demonstrating a gap in effective patient counseling practice.
Written prescriptions are vital components of structured physical activity promotion programs in various countries, such as New Zealand and Sweden.

The Green Rx initiative, started in 1998, allows healthcare providers to prescribe physical activity and nutritional guidance in a comprehensive health plan.
Patients receiving Green Rx support benefit from personalized encouragement to improve their activity levels, tracking progress alongside healthcare providers, resulting in sustained activity increases.

Sweden's PAP program offers individualized exercise prescriptions, emphasizing adherence over long-term periods.
Written prescriptions detail the exercise type, dosage, patient activity levels, and personal goals, supported by the FYSS guide.
The program has seen substantial growth in use, with around 50,000 prescriptions issued annually as of 2010.

The FITT principle (Frequency, Intensity, Time, Type) helps structure exercise prescriptions, while ACSM extends this to include Volume and Progression (FITT-VP).

A well-rounded exercise prescription includes aerobic, resistance, flexibility, and balance training tailored to patient interests to enhance adherence. Examples include:
- Aerobic: Walking, running, cycling, and dancing.
- Resistance: Weight training, climbing stairs, Pilates.
- Flexibility and Balance: Yoga and tai chi.

Adults should engage in at least 150 minutes of moderate-intensity exercise weekly, ideally progressing beyond the minimum. Even short bouts of 10-15 minutes can count towards activity goals.

Exercise intensity varies and can be quantified using subjective measures (RPE), heart rate, and VO2max. Recommendations typically suggest aiming for at least moderate-intensity activity weekly.

The frequency of exercise sessions varies by goal, with resistance training recommended at least twice a week, incorporating rest for muscle recovery.

Total exercise volume combines intensity and time, aiming for 500-1000 MET minutes per week, correlating with various health benefits.

Use a gradual increase in FITT components. ACSM recommends an increase of 5-10 minutes every 1-2 weeks for the first month or two of a physical activity plan.

Encourage tracking progress using mobile apps for training guidance or physical activity diaries to sustain motivation and support.
Recognize that every small amount of activity contributes to health benefits and should be acknowledged to motivate continual movement.

Reducing periods of sedentary behavior and implementing simple changes (e.g., standing during calls, taking stairs) can complement prescribed exercise.

Tailoring exercise prescriptions to specific health conditions (e.g., low back pain) can lead to effective rehabilitation, integrating aerobic, resistance, and flexibility exercises as recommended by health guidelines.