Episode 186: Exercise Prescriptions
Dr. Sandhu and future Dr. Daoud explain the way to prescribe exercise, what are the general guidelines for exercise and how to overcome barriers to exercise. Dr. Arreaza emphasized the importance to screen our patients before exercise and using the term “physical activity” to improve receptivity by patients.
Written by Wessam Daoud, MSIV, Ross University School of Medicine. Edits and comments by Ranbir Sandhu, MD, and Hector Arreaza, MD.
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Arreaza: I’m Dr. Arreaza, and today, we will talk about a topic that is both simple and powerful: exercise. Previous episodes: 158, 100 (sexercise), 95, We all know exercise is good for us, but how do we prescribe it like we do medications? How can we tailor exercise recommendations to our patients' needs and lifestyles? To help us unpack this, I’m joined today by Dr. Ranbir Sandhu, and Medical Student, Wessam Daoud, who has a passion for preventive medicine. Welcome to the show!
Ranbir: Thanks, Dr. Arreaza! We’re excited to be here and to discuss something so fundamental to health.
Segment 1: Understanding Exercise Prescription
Arreaza: Let’s start with the basics. In medicine, we prescribe medications with precise instructions—dosage, frequency, duration. But how do we apply this concept to exercise?
Ranbir: Great question! Before we prescribe exercise, we have to make sure that it is not contraindicated. We can use a system to stratify our patients based on risk factors, such as older age, smoking, baseline level of activity, etc. For example, a patient who had a heart attack within the last 6 weeks should not exercise yet, a person with heart failure exacerbation, asthma exacerbation, uncontrolled heart arrhythmia, etc.
Wes: Exercise prescription follows a structured approach, similar to medications. We use the FITTE mnemonics to guide recommendations:
Frequency – How often?
Intensity – How hard should the patient work?
Time – How long should each session last?
Type – What kind of exercise is best?
Enjoyment – Does the patient enjoy this activity?
By adjusting these components, we can tailor exercise to each patient’s needs, whether it’s improving cardiovascular health, managing chronic disease, or building strength.
Segment 2: How Much Exercise Do Adults Need?
Arreaza: Now, when we talk about exercise, there’s a lot of conflicting advice out there. What do the official guidelines say about how much adults should exercise?
Ranbir: The American College of Sports Medicine (ACSM) and CDC provide clear guidelines:
Aerobic Exercise: At least 150 to 300 minutes of moderate-intensity exercise per week, OR 75 to 150 minutes of vigorous-intensity exercise (or a mix of both).
Muscle Strengthening: At least two days per week of resistance training targeting major muscle groups.
Balance & Flexibility: Particularly important for older adults to reduce fall risk.
These guidelines are adaptable, meaning patients can break them into shorter sessions throughout the week.
Arreaza: For weight regain, you may need to exercise a little bit more, about 300 minutes/week, and >2 days of resistance activity.
Segment 3: Choosing the Right Type of Exercise
Arreaza: With so many options—cardio, strength training, yoga—how do you guide patients in choosing the right type of exercise for them?
Wes: It depends on the patient’s goals, health conditions, and personal preferences. Here’s how we might break it down:
For cardiovascular health: Activities like brisk walking, jogging, cycling, or swimming.
For strength and bone health: Resistance exercises, bodyweight exercises, or weightlifting.
Ranbir: For flexibility and balance: Yoga, Pilates, or tai chi, especially for older adults.
For chronic disease management: Customized plans—e.g., low-impact options for arthritis or supervised exercise for heart disease.
The key is finding something they enjoy, because sustainability is the most important factor.
Arreaza: We can use our physical therapy friends to design an appropriate plan for our patients.
Segment 4: Overcoming Common Barriers to Exercise
Arreaza: I hear this all the time in the clinic—patients want to exercise but struggle to stay consistent. What are the biggest barriers, and how do we help patients overcome those barriers?
Wes: Absolutely. Some common barriers include:
Lack of time: Patients think they need hours at the gym, but even short bouts of 10 minutes throughout the day add up.
Low motivation: Encouraging goal setting and accountability, such as a workout buddy or an activity tracker, helps.
Arreaza: Instagram post from Ranbir: Go to the gym even if you don’t want to go.
Wes: Pain or chronic illness: We can adapt exercises—low-impact options like swimming or chair exercises work well.
No access to a gym: Many exercises require no equipment—walking, stair climbing, bodyweight exercises.
Ranbir: As physicians, we need to normalize movement as part of daily life rather than an all-or-nothing approach.
Segment 5: The Role of Healthcare Providers in Exercise Counseling
Arreaza: We often focus on medications and procedures, but exercise is one of the best treatments we have. What role should physicians play in promoting physical activity?
Ranbir: Our role is critical! Exercise is preventive medicine and can reduce the risk of heart disease, diabetes, obesity, and even depression. As physicians, we can:
-Ask about exercise levels at routine visits.
-Provide specific, personalized exercise prescriptions rather than just saying 'you should exercise more.'
-Address patient concerns by modifying recommendations to their abilities.
-Follow up and reinforce progress like we would with any other treatment.
-Even a brief conversation about physical activity can significantly impact patient motivation and adherence.
Arreaza: Exercise vs physical activity. Ask your patients as a routine.
Closing Thoughts & Call to Action
Arreaza: Ranbir andWessam, this has been a fantastic discussion. Any final thoughts for our listeners?
Ranbir: My biggest takeaway is that any movement is better than none. Exercise doesn’t have to be perfect—it just has to be consistent. Start small, find an activity you enjoy, and build from there!
Arreaza: Any take-home message, Wes?
Wes: Same for me, find an activity you enjoy, start where you are, and keep moving!
Arreaza: Great advice! If you found this episode helpful, share it with your colleagues and patients.
Ranbir: Until next time—stay active and stay healthy!
Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!
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Sources:
- Some information in this podcast was inspired by conferences from the Obesity Medicine Association, https://obesitymedicine.org/.
- Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
