How Exercise Prescription should Work
Writing an exercise prescription for a patient, exercise provided with the specific instructions on frequency, intensity, time, and type, should be common practice for physicians (Phillips & Kennedy, 2012). Physical activity has numerous health benefits and is strongly linked to disease prevention. The amount of physical activity or inactivity gets is responsible for 50% of health status and is one of three modifiable behaviors that impact health (Sallis, 2014). It would make sense for physicians to be knowledgeable about how to perform a variety of different exercise modalities, the effects of exercise on the their patients’ health, and how to write specific prescriptions for patients.
Unfortunately, most physicians and healthcare professionals are not well versed in exercise prescription. In a survey of Canadian family medicine residents rated their knowledge of physical activity guidelines as low, self reported themselves as not very competent to prescribe exercise to prevent disease, and had low confidence in their ability to prescribe exercise for those with chronic disease (Solomundson, Kohle, & McKenzie, 2016). Many healthcare workers are very knowledgeable about their specific area and how to treat pathologies with either medicine or surgical interventions. Their long and in depth education tends to exclude the basics of exercise and how to recommend it. A full 90% of pharmacy schools in the United States do not have coursework dedicated to exercise prescription, or the basics of designing physical fitness programs (Dirks-Naylor, Griffiths, Gibson, & Luu, 2016). It is likely most medical school curricula do not emphasize exercise program design as well.
Instead of being the ones to prescribe exercise physicians and other medical professionals should have a referral network of those skilled in exercise prescription. These professions include primarily physical therapists, personal trainers, and strength and conditioning coaches. Physical therapists are highly educated health care professionals, who work with patients to improve functional mobility and reduce chronic pain. Most physical therapists are experts at designing purposeful exercise programs that improve strength, power, flexibility, balance, and know how to treat any meaningful pathophysiology of the musculoskeletal system (Moffat et al., 2012). Physical therapists are exercise experts, know how to work with patients with reduced function, and know how to work with patients across the lifespan. For older or patients with reduced functional capacity due to injury, physicians should refer to a physical therapist for exercise prescription.
If a patient is relatively healthy based on a screening they can be referred to a personal trainer or strength coach. Personal trainers and coaches should at least possess a bachelor’s degree and a reputable certification from well credentialed organization like NASM, ACSM, or NSCA to ensure that fitness professionals use an individualized approach, asses the client’s needs and limitations, train clients regarding their health and fitness needs, design safe and effective exercise programs, and provide the guidance to help clients achieve their personal health fitness goals (Waryasz, Daniels, Gil, Suric, & Eberson, 2016). Physicians should make sure that the trainers they refer out too are well qualified, as there is very little standardization in quality of care in the fitness industry.
Soon we will see doctors and health care professionals write a general prescription for the frequency, intensity, type, and time amount for exercise. The prescription will give the exercise professional guidance on how the patient’s needs and limitations, and the personal trainer will be responsible for implementing the prescription. Exercise prescription should ultimately be a collaborative process with health and fitness professionals and the medical community.
Dirks-Naylor, A. J., Griffiths, C. L., Gibson, J. L., & Luu, J. A. (2016). The prevalence of exercise prescription-related course offerings in United States pharmacy school curricula: Exercise is Medicine. Advances in Physiology Education, 40(3), 319-322.
Moffat, M., Hegenscheidt, S., Ng, S., Reid, D., Rotem-Lehrer, N., & Tremblay, M. (2012). Evidence-based exercise prescription: Raising the standard of delivery. International Musculoskeletal Medicine, 34(1), 21-36. Phillips, E. M., & Kennedy, M. A. (2012). The exercise prescription: A tool to improve physical activity. Pm&r, 4(11), 818-825.
Sallis, R. (2014). Exercise is medicine: A call to action for physicians to assess and prescribe exercise. The Physician and Sportsmedicine, 43(1), 22-26.
Solomundson, K., Kohle, M., & McKenzie, D. (2016). Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription. Canadian Medical Education Journal, 7(2), E79-E96.
Waryasz, G. R., Daniels, A. H., Gil, J. A., Suric, V., & Eberson, C. P. (2016).
Personal trainer demographics: Current practice trends and common trainee injuries. Orthopedic Reviews, 8(3), 98-105.