Writing an “Exercise Prescription”

According to exercise physiologist Michael Hewitt, PhD, health can be viewed as a four-legged stool.  The four legs are physical activity, optimal nutrition, stress management and sleep.  If any one of them is missing, the stool will wobble.  If two are missing, it will fall.  For practicing physicians and trainees, sleep is often the hardest of the four to manage.  Stress is next – it is part of our job, but can be reduced with with meditation and exercise.  Paying attention to what you eat (especially on call) and cooking your own food will help improve your nutrition.  The fourth “leg” may be the most important (and most neglected) aspect of physician health – physical activity.

It doesn’t matter how healthy (or not) you are  – if you add more physical activity to your week you will improve your health.  We all learn this in medical school – exercise helps prevent and treat a wide variety of chronic diseases like diabetes, hypertension, myocardial ischemia, arthritis… the list goes on and on.  Exercise is medicine! The message is clear, we should be increasing our own physical activity and “prescribing” activity for our patients.

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Dr. Hewitt suggests that it’s not that hard to write an actual prescription for exercise.  First, decide what “dose” is needed – disease prevention, basic health level, enhanced fitness level, or performance level and then – literally – write a prescription that includes each of the 5 components of exercise.

Here is what the prescriptions would look like (below).  You can actually write them on prescription pads for your patients. (Don’t forget to write one for yourself… this is a really good exception to the rule that we shouldn’t write prescriptions for ourselves or our families.)

Disease Prevention

Cardiovascular Exercise: Accumulate 30-60 minutes of physical activity most days

Strength Training: Include weight-bearing activity most days

Flexibility: Maintain range of motion by bending and stretching in daily activities

Body Composition: Men <25% body fat, Women <38% body fat

Balance and Agility:

Basic Health Level

Cardiovascular Exercise: Play or large muscle repetitive activity 20+ minutes 3 times a week

Strength Training: Leg press or squat,chest press, lat pull down or row 1-2 sets 2x/week with enough weight to challenge your muscles

Flexibility: 2-4 limitation-specific stretches after activity, hold 20-30 seconds

Body Composition: Men <25% body fat, Women <38% body fat

Balance and Agility: “Act like a child” – balance line, “step on a crack”, brush teeth standing on one foot

Enhanced Fitness Level

Cardiovascular Exercise: Play or aerobic activity 40-60+minutes 4-6 times per week

Strength Training:  Balanced whole-body machine or free weight program, 2-3 sets, 3x/week to “functional failure”

Flexibility: 6-10+ whole-body stretches after activity, 1-2 reps

Body Composition: Men: 12-20% body fat, Women 20-30% body fat

Balance and Agility: Recreational sports:  tennis, bicycle, tai chi, dancing, stability ball training

Performance Level

Cardiovascular Exercise: Add interval training and/or competition

Strength Training: Add muscle endurance or power training, add pilates work, add ascending or descending pyramids

Felixibility: Add yoga, pilates, facilitated stretching with a partner

Body Composition: Men 8-15% body fat, Women 17-25% body fat

Balance and Agility: High level sports: ski, skate, surf, yoga, martial arts

Other resources:

How to Write an Exercise Prescription – Uniformed Services University of Health Sciences

Measuring body fat (caliper and tape measure calculators)

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