How to Write an Exercise Prescription MAJ Robert L. Gauer, MD LTC Francis G. O’Connor, MD, FACSM Department of Family Medicine Uniformed Services University of the Health Sciences How to Write an Exercise Prescription MAJ Robert L. Gauer, MD LTC Francis G. O’Connor, MD, FACSM Department of Family Medicine Uniformed Services University of the Health Sciences CONTENTS Section Page INTRODUCTION............................................................................................................... 1 EPIDEMIOLOGY OF INACTIVITY .............................................................................. 3 REASONS FOR INACTIVITY ......................................................................................... 5 ROLE OF THE HEALTH CARE PROVIDER............................................................... 7 BENEFITS OF EXERCISE ............................................................................................... 9 I. All-Cause Mortality.............................................................................................. 9 II. Atherosclerotic Vascular Disease ......................................................................... 9 III. Cancer ................................................................................................................... 10 IV. Diabetes Mellitus.................................................................................................. 10 V. Hypertension......................................................................................................... 11 VI. Osteoporosis ......................................................................................................... 11 VII. Dyslipidemia......................................................................................................... 12 VIII. Obesity.................................................................................................................. 12 IX. Mental Health ....................................................................................................... 13 X. Economic Benefits................................................................................................ 13 RISKS OF PHYSICAL ACTIVITY.................................................................................. 15 I. Exercise Related Sudden Death............................................................................ 15 II. Musculoskeletal .................................................................................................... 19 III. Miscellaneous Risks ............................................................................................. 20 CURRENT RECOMMENDATIONS ............................................................................... 21 I. Evolution of Physical Activity Recommendations............................................... 21 II. Current Recommendations ................................................................................... 22 A. ACSM recommendations................................................................................ 22 B. CDC/ACSM recommendations....................................................................... 23 C. AHA Scientific Statement............................................................................... 24 D. AMA Guidelines for Adolescent Preventive Services.................................... 24 E. Department of Health and Human Services.................................................... 25 F. United States Preventive Services Task Force ................................................ 25 III. Summary of Recent Physical Activity Recommendations ................................... 25 EXERCISE PRESCRIPTION ........................................................................................... 27 I. Approach to Recommending Exercise ................................................................. 27 II. Pre-exercise Evaluation ........................................................................................ 31 III. Graded Exercise Testing....................................................................................... 33 IV. Writing the Exercise Prescription......................................................................... 37 A. Activity Selection............................................................................................ 37 B. Frequency........................................................................................................ 40 C. Duration .......................................................................................................... 40 D. Intensity........................................................................................................... 41 E. The Exercise Session....................................................................................... 44 i Section Page F. Rate of Progression.......................................................................................... 45 G. Muscle Conditioning....................................................................................... 47 SPECIAL POPULATIONS................................................................................................ 49 I. Cardiovascular Disease......................................................................................... 49 General Principles of Exercise Prescription in Secondary Prevention ................. 53 A. Prescription in the Absence of Ischemia or Significant Arrhythmias............. 53 B. Prescription in the Presence of Ischemia or Arrhythmias ............................... 54 C. Summary ......................................................................................................... 55 II. Diabetes Mellitus.................................................................................................. 57 A. Exercise in Type 1 Diabetes Mellitus ............................................................. 57 B. Exercise in Type 2 Diabetes Mellitus ............................................................. 59 C. Complications ................................................................................................. 60 III. Osteoarthritis......................................................................................................... 61 IV. Pregnancy.............................................................................................................. 63 V. Asthma.................................................................................................................. 67 VI. Pulmonary Disease ............................................................................................... 71 VII. Obesity.................................................................................................................. 75 VIII. Exercise in the Elderly.......................................................................................... 79 IX. Army Personnel .................................................................................................... 85 CONCLUSION.................................................................................................................... 87 GLOSSARY......................................................................................................................... 89 APPENDICES A - EXERCISE ASSESSMENT FORM............................................................................... A-1 B - NATIONAL CHOLESTEROL EDUCATION PROGRAM: EXPERT PANEL GUIDELINES FOR DIAGNOSIS AND TREATMENT OF HIGH CHOLESTEROL............................................................................................. B-1 C - EFFECTS OF MEDICATIONS ON HEART RATE, BLOOD PRESSURE, AND EXERCISE CAPACITY ............................................................. C-1 D - CARDIOVASCULAR PRESCRIPTION FORM........................................................... D-1 E - BEGINNER’S PROGRAM TRAINING LOG ............................................................... E-1 F - INTERMEDIATE PROGRAM TRAINING LOG........................................................ F-1 G - BODY MASS INDEX TABLE .................................................................................... G-1 RESOURCES/REFERENCES Individual Guidelines for Cardiovascular Exercise...................................................... REF-3 Exercise Guidelines for Patients with Diabetes Mellitus............................................. REF-5 Exercise Guidelines for Pregnancy and Post-partum ................................................... REF-7 Weight Training Guidelines for Healthy Adults and “Low-Risk” Cardiac Patients.... REF-9 ii RESOURCES/REFERENCES (continued) Page Aquatic Exercise Workout ........................................................................................... REF-11 Training for the Army Physical Fitness Test (APFT) .................................................. REF-13 Getting Out of Your Chair ........................................................................................... REF-15 How to Start a Walking Program ................................................................................. REF-17 Exercising in Cold Weather ......................................................................................... REF-19 Sensible Shoes.............................................................................................................. REF-21 Fitness injury prevention.............................................................................................. REF-23 Conditioning Exercises ...............................................................................................