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. Intensity:Target 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 MET’s • Borg Scale • Self-perceived work rated 10-20 (very light to maximal) • Subjective • MET’s – multiples of metabolic equivalents • 1 MET = 3.5mg O2 per Kg per minute • 1 liter O2 = 5 Kcal. • Targets – Young (<65 yrs) – 2-10 MET’s • Elderly = 1-5 MET’s

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 < 140 (60-70% MaxHR) • 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….