THE EXERCISE PRESCRIPTION:

AN ESSENTIAL ELEMENT OF THE

PRIMARY CARE VISIT

Margaret Johnston, MSN, RNP

Learning Objectives
• Review national statistics and trends
• Describe exercise benefits
• Examine essential steps in patient assessment
and counseling
• Delineate four components of exercise
prescription
• Address special population needs in preparing
the exercise prescription
• Evaluate community and other resources
Current Physical Activity
Recommendations
• 30-40 minutes/day moderate intensity PA, on
most days of the week
• 150 minutes of moderate or 75 minutes of
vigorous activity weekly
• 60 minutes per day for children
• Can be incorporated into all daily activities
including work and leisure activities in short
bouts of 10 to 15 minutes
US Department of Health & Human Services. Physical Activity Guidelines for
Americans. http://www.health.gov/paguidelines//guidelines/default/aspx.
Accessed January 7, 2015.
Current National Statistics: PA
Adherence Rates
• 47 % of adults met PA guidelines for aerobic
activity
• 22.4% of adults met the guideline goals for
muscle strengthening
• 18.8% of adults 18 years old and over met both
aerobic and muscle strengthening standards
• Approximately, 1/3 of adults do no exercise in
their leisure time
Centers for Disease Control and Prevention. Health United States, 2010. http//:
www..cdc.gov/nchs/data/hus/hus10.pdf. 2011:260. Accessed January 7, 2015
Other National Data
• PA is less common among women than men
• PA participation declines with advancing age
• Non-Hispanic blacks and Hispanic adults
more likely to be inactive than Non-Hispanic
whites
• Higher education levels associated with PA
guideline adherence

Roger, VL. Circulation. 2012;125(22):e2-e220.

Summary of Major Research Findings
• Any physical activity is better than none
• Both aerobic and resistance exercise are helpful
• Many health risks are reduced and health
outcomes improved
• Most benefits occur with at least 150 minutes of
moderate activity
• Additional benefits with more frequent, longer
lasting and more intense PA
• Benefits of PA far outweigh risks
US Department of Health and Human Services. 2008 Physical Activity Guidelines
for Americans. http://health.gov/PAguidelines.pdf/paguide.pdf. 2008. Accessed
January 8, 2015.
Health Benefits with Strong Evidence

CVD-Related Benefits Other Benefits

• Lower CAD, HTN and CVA • Lower risk off early death
risk • Lower risk of breast and
• Lower dyslipidemia risk colon cancer
• Lower risk for metabolic • Reduced depression
syndrome and DM2 • Better cognitive function in
• Prevention of weight gain older adults
• Improved fitness and sense
of well-being

US Department of Health and Human Services. 2008 Physical Activity Guidelines

for Americans. http://health.gov/PAguidelines.pdf/paguide.pdf. 2008. Accessed
January 8, 2015.
Benefits of Increasing Exercise for the
Aging Population
• Improved conditioning, strength, flexibility, and
overall physical fitness
• Improved mobility and reduced onset of
mobility-related disability
• Reduced risk of cardiovascular disease,
thromboembolic stroke, hypertension, type 2
diabetes mellitus, osteoporosis, obesity, colon
cancer, breast cancer, anxiety, depression, and
cognitive decline
Benefits of Increasing Exercise for the
Aging Population
• Reduced likelihood of falls and related
injuries
• Possible decreased incidence and severity of
functional limitations
• Improved patient outcomes in several chronic
conditions, including mood disorders,
dementia, chronic pain, congestive heart
failure, stroke, constipation, and sleep
disorders
Relevant Citations
• Hamer M, Lavoie, KL, Bacon SL. Taking up physical activity in later life and health ageing:
the English longitudinal study of ageing. Br J Sports Medi 2014; 48:230
• Mänty M, Heinonen A, Leinonen R, et al. Long-term effect of physical activity counseling on
mobility limitation among older people: a randomized controlled study. J Gerontol A Biol Sci
Med Sci 2009; 64:83.
• King AC, Guralnik JM. Maximizing the potential of an aging population. JAMA 2010;
304:1944
• Morey, M.C. (Oct 20, 2014). Physical activity and exercise in the elderly. UpToDate (On-
line).
• Morey MC, Sloane R, Pieper DF, et al. Effect of physical activity guidelines on physical
function in older adults. J AM Geriartr Soc 2008; 56: 1873.
• Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
• Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical function
in obese older adults. N Engl J Med 2011; 364: 1218.
Value of Initiating Exercise for the
Aging Population
• Benefits occur with initiation and maintenance
of exercise
• Even previously sedentary who start to exercise
as late as age 85 demonstrate a significant
survival improvement
• Patients with physical limitations experience an
attenuation of the onset of mobility-related
disability
• Improved fitness with exercise has been noted
even among institutionalized older adults
Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability
in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311:2387.
Stessman J, Hammerman-Rozenberg R, Cohen A, et al. Physical activity, function, and longevity among the very old. Arch
Intern Med 2009; 169:1476.
Exercise is a free medicine available to
just about anyone.
Starting the Process
• Office-based short intervention as the nexus
of change
• Majority of patients have greatest number of
visits with PCP
• Lost opportunity for patient education as
many providers do not take the time to have
this discussion
Jacobson DM, Strohecker L, Compton MT, Katz DL. Physical activity
counseling in the adult primary care setting: position statement of the
American College of Preventive Medicine. Am J Prev Med 2005; 29:158.
Cognitive-Behavioral Strategies –
Class 1 Recommendations

• Goal setting (A)

• Self-monitoring (A)
• Frequent and prolonged contact (B)
• Feedback and reinforcement (A)
• Self-efficacy enhancement (A)
• Motivational interviewing (A)

Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical

activity and dietary lifestyle changes for cardiovascular risk factor reduction in
adults: a scientific statement from the American Heart Association. Circulation
2010; 122:406.
The Five A Approach for Lifestyle
Counseling
• Assess
• Advise
• Agree
• Assist
• Arrange

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.
Assess
• Current exercise and PA level
• Awareness of exercise resources and health
benefits
• Perceived barriers and confidence in ability to
change
• Identification of one strategy to increase
activity level
Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.
Advise
• Discuss risk factors/biochemical markers as a
basis to increase activity
• Promote exercise as the best medicine for
many problems
• Be specific about what behaviors will reduce
risk factors

Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.

Agree
• Collaborate in goal setting
• Provide alternative ways to meet
objectives
• Form a plan
– Record in medical documentation
– Have patient write down interim goals

Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.

Assist
• Take realistic stock of patient’s situation
• Recount perceived barriers
• Offer several approaches and resources
as solutions
• Be aware of evolving community,
internet and digital resources
Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.
Arrange
• Make necessary referrals
• Provide information regarding resources and
handouts
• Ensure follow up appointment
• Use friendly phone call or text to encourage
change
• Review exercise plan and progress next visit

Meriwhether RA, et al. Am Fam Phys. 2008;77(8):1129-1136.

Health Screening Prior to PA Initiation
• CV event risk is increased during vigorous
activity; however absolute risk of cardiac event
is low in healthy people
• Exercise confers CV benefits that far outweigh
risks for light to moderate intensity exercise
programs
• Exercise testing poor predictor of CVD events in
asymptomatic individuals
• Conflicting recommendations among major
organizations

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
ACSM Recommendations

• Vast majority do not require exercise testing

prior to initiating a moderate intensity PA
program
• Use a self-guided screening tool such as the
Physical Activity Readiness Questionnaire
(PAR-Q) or the modified AHA/ACSM
Health/Fitness Facility Preparticipation
Screening Questionnaire
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
ACSM Recommendations for
Adolescents and Adults
• Identify those with symptoms/signs that
suggest CV, pulmonary or metabolic disease
– Chest pain
– SOB with mild exertion
– Dizziness or syncope
– Orthopnea/PND
– Ankle edema
– Arrhythmias or known heart murmur
– Intermittent claudication
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
PAR-Q
• Has your healthcare provider ever said that you have a heart
condition and that you should only do physical activity
recommended by a healthcare provider?
• Do you feel pain in your chest when you do physical activity?
• In the past month, have you had chest pain when you were
not doing physical activity?
• Do you lose your balance because of dizziness or do you ever
lose consciousness?
• Do you have a bone or joint problem (for example, back,
knee or hip) that could be made worse by a change in your
physical activity?
Exercise is Medicine. Health Care Provider’s Action Guide.
http://www.exerciseismedicine.org/documents/HCPActionGuide_LR.pdf.
Acessed February 15, 2015
PAR-Q Score Interpretation
All ‘no’ answers ‘Yes’ answers
• Can begin independent PA • Use clinical judgment to
program determine if person needs
• Exercise rx based on 2008 supervision or can be
guidelines started slowly
• Referrals to professional • High risk individuals need to
certified trainer or other be referred to clinical
fitness specialist exercise program such as
cardiac or pulmonary
rehabilitation
Exercise is Medicine. Health Care Provider’s Action Guide.
http://www.exerciseismedicine.org/documents/HCPActionGuide_LR.pdf.
Acessed February 15, 2015
ACSM Recommendations for
Adolescents and Adults
• For those with diagnosed disease, determine
who would benefit from a physical exam with
exercise testing
• Individualize recommendations regarding
starting and progression of exercise program
to minimize potential for CV event
• Preparticipation health screening is different
than a periodic medical exam
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
ACSM Recommendations for Older
Adults
• Most do not require exercise testing prior to
initiating a moderate intensity PA program
• Presence of multiple risk factors indicates
need for physical exam and exercise testing
for prior to strenuous exercise

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Risks of Exercise
• Musculoskeletal injury due to overuse most
common
• Others:
– Reactive airway disease
– Arrhythmias
– SCD/MI
– Rhabdomyolysis
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Preparing the Exercise
Prescription
Exercise Prescription and Referral
Form

Exercise is Medicine. Health Care Provider’s Action Guide.

http://www.exerciseismedicine.org/documents/HCPActionGuide_LR.pdf.
Acessed February 15, 2015
Aerobic Activity
• 150 minutes or more of moderate intensity
exercise per week
• 75 minutes or more of strenuous exercise per
week
• Combination of the above to achieve
targeted exercise volume
• Exercise may be accumulated in bouts of 10
minutes or more over the day
US Department of Health & Human Services. Physical Activity Guidelines for Americans.
http://www.health.gov/paguidelines//guidelines/default/aspx. Accessed January 7, 2015.
OHSU Cardiac Rehabilitation Exercise
Progression Plan
• FREQUENCY
– Week 1-3: Three times per day
– Week 4-6: Two times per day
– Week 7-10: Once per day

http://www.ohsu.edu/xd/health/services/heart-vascular/services/cardiac-
rehabilitation/health-information/upload/CAR-3064469-Sample-Walking-
Program.pdf
OHSU Cardiac Rehabilitation Exercise
Progression Plan
• WEEK WARM-UP BRISK WALK COOL DOWN
• Week 1 - 5 minutes 5 minutes 5 minutes
• Week 2 - 5 minutes 8 minutes 5 minutes
• Week 3 - 5 minutes 11 minutes 5 minutes
• Week 4 - 5 minutes 14 minutes 5 minutes
• Week 5 - 5 minutes 17 minutes 5 minutes
• Week 6 - 5 minutes 20 minutes 5 minutes
• Week 7 - 5 minutes 23 minutes 5 minutes
• Week 8 - 5 minutes 26 minutes 5 minutes
• Week 9 - 5 minutes 29 minutes 5 minutes
• Week 10 - 5 minutes 30 minutes 5 minutes
http://www.ohsu.edu/xd/health/services/heart-vascular/services/cardiac-
rehabilitation/health-information/upload/CAR-3064469-Sample-Walking-
Program.pdf
Resistance Training
• Major muscle group training 2-3 times
weekly using ‘whole body’ approach
• Selected muscle group training using the
‘split’ approach 3 times weekly
• 48 hours between training the same muscle
group

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Flexibility
• Exercises targeting major muscle groups
• 10-30 second hold to point of tightness
effective for joint ROM enhancement in
younger adults
• 30-60 second hold may benefit older adults
• Minimum 2-3 times weekly improves stretch
hold; most effective when done daily
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing
and prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Neuromotor Exercise – Functional
Fitness
• Involves balance, coordination, gait, agility
and proprioreceptive training
• May be beneficial for young and middle age
adults; definitively helpful for aging persons
• Optimal frequency not known; some support
for 2-3 times a week for a total of 60 minutes
or more a week
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Foam Rolling or Myofascial Release
• Perform both before and after exercise
• Engage all major muscle groups especially
those that are painful or are cramping
• Roll slowly over each muscle group pausing
for 2-5 seconds over muscle segments
• Pause for longer periods up to 30 seconds
over muscle ‘knots’
• Repeat twice over troublesome areas
http://breakingmuscle.com/mobility-recovery/what-is-a-foam-roller-how-do-i-
use-it-and-why-does-it-hurt
Calf Rolling for Cramps/Knots

http://breakingmuscle.com/mobility-recovery/what-is-a-foam-roller-how-do-
i-use-it-and-why-does-it-hurt
Iliotibial Band Rolling

http://breakingmuscle.com/mobility-recovery/what-is-a-foam-roller-how-
do-i-use-it-and-why-does-it-hurt
Hip Extensor Rolling

http://breakingmuscle.com/mobility-recovery/what-is-a-foam-roller-how-do-i-
use-it-and-why-does-it-hurt
Exercise Progression Summary
ExRx for the Aging Population
Exercise Program Components
• Aerobic exercise
• Muscle strengthening
• Flexibility
• Neuromotor exercise including balance

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise

testing and prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott
Williams & Wilkins.
Current AHA/ACSM Activity
Recommendations
• More intensity and longer exercise duration lead to
greater health benefits
• Recommended aerobic activity levels are in
addition to ADL
• 3 options:
– Minimum of 30 minutes of moderate-intensity aerobic
activity on five days each week
– Minimum of 20 minutes of vigorous-intensity activity
on three days each week
– Combination of the two
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults:
recommendation from the American College of Sports Medicine and the American Heart
Association. Circulation 2007; 116:1094.
Initiating Aerobic Exercise
• Exercise can be spread throughout the day to
achieve recommended activity levels
• Obese individuals may need 300 minutes of
activity in addition to diet to manage weight
control
• Chronically ill may not be able to achieve
minimal levels of recommended activity but
should be as active as possible
Assessing Exercise Intensity
• Use of absolute METS inappropriate for ageing
population
• Self reported effort better for determining activity
intensity
• Borg Scale
– Moderate exertion rated 5-6/10; associated noticeable
increase in respiratory and heart rate
– Strenuous exertion rated 7-8/10 associated with large
increase in heart and respiratory rate
– Should be able to carry on conversation while exercising;
if not, activity is too strenuous
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Muscle-Strengthening for Increased
Performance
• Strengthening activities should be done at least two non-
consecutive days per week
• Exercises should target 8 to 10 major muscle groups at an
appropriate exertion level
• 10 to 15 repetitions of each exercise at a moderate to high
level of intensity with gradually increase in resistance ideal
• Muscle soreness is normal at first and should subside in a
few weeks
• More gradual incremental strengthening best for those
with chronic pain to maximize tolerance and exercise
adherence
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
 Muscle-Strengthening – Helpful
Hints
• Initial weight should be one that an individual can lift
about eight times
• When able to perform 10-15 repetitions, weight can
be increased again until only 8 repetitions can be done
• Breathing should be normal while lifting weights,
exhaling as the weight is lifted
• Movements should be slow through a repetition: two
to three seconds to lift, hold for one second, and three
to four seconds to return to the starting position
• Avoid locking the joints in a tightened position.

Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Flexibility
• Little research on impact on physical wellness
but basis for performing all activities
• Helpful tips:
– Do twice a week for at least 10 minutes
– Perform after aerobic or strengthening activities
after warm up
– Breathe normally; do not bounce into a stretch.
– Stretch slowly into the desired position and hold;
hold for 10 to 30 seconds
– Should feel a slight pull but should not stretch to the
point of pain.
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Chest Stretch

http://exerciseismedicine.org/YourPrescription.htm
Thigh Stretch

http://exerciseismedicine.org/YourPrescription.htm
Neuromotor Exercise
• Balance problems common in elderly adults
• Balance exercise improve stability and may prevent
falls and related injuries
• Participation in group classes improves stability and
may prevent falls and associated injuries
• Selected activities:
– Tai Chi
– Gait pattern challenges such as heel-to-toe walking
– One foot balancing to increase center of gravity
awareness
– Often combined with strengthening exercises
Lin HW, Bhattacharyya N. Balance disorders in the elderly: epidemiology and
functional impact. Laryngoscope 2012; 122:1858.
Sherrington C, Lord SR, Finch CF. Physical activity interventions to prevent falls
Neuromotor Exercise – Balance Walk

http://exerciseismedicine.org/YourPrescription.htm
Neuromotor Exercise – One Foot
Stand

http://exerciseismedicine.org/YourPrescription.htm
Patients with Multiple Morbidities
• Chronic conditions increase with age
• Likely 50 percent of patients with diabetes will
also have arthritis
• 30 percent will have coronary disease, or both.
• The American College of Sports Medicine’s
initiative, Exercise is Medicine provides patient
handouts with specific exercise prescriptions
available at:
http://exerciseismedicine.org/YourPrescription.htm
Obesity
• Start with non-weightbearing exercise
• Avoid high impact activity due to
possible orthopedic stress
• Duration and frequency as tolerated
• Premeal exercise prior to breakfast best
due to increase in lipolysis
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Arthritis
• Select exercises that minimize joint stress
• Start strengthening at low intensity; progress as
pain level permits
• Emphasize flexibility and full ROM
• Avoid during acute flares
• Warn that joint pain may increase after activity;
ice area to prevent inflammation
• Moderate physical activity if pain persists/work
with pain med timing
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing and
prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams & Wilkins.
Osteoporosis
• Standard PA recommendations apply but greater
placed on weight-bearing, balance and
strengthening activities
• Excessive weight bearing with the initiation of
exercise may increase the risk of fractures
• Individuals with previous osteoporotic fractures
require more individualized program
• Should avoid sudden movements, jarring or
twisting movement and heavy lifting
• Best to consult a professional therapist for activity
plan after a fracture to relieve pain and regain
mobility initially
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing
and prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Diabetes
• Monitor blood sugar because hypoglycemia or
hyperglycemia can occur with exercise
• Consume a meal 1-3 hours before exercising,
administer insulin at least 1 hour before exercise, and,
if the blood glucose level is greater than 250 mg/dL,
check urine for ketones
• Supplement energy (caloric) intake every 30 minutes
and maintain adequate fluid replacement
• Monitor the glucose level, increase energy (caloric)
intake for 12-24 hours following activity, and expect
postexercise hypoglycemia; thus, appropriately adjust
insulin dosing
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing
and prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Functionally Limited or Frail
• Go slow and start low, e.g., walk for 5 minutes daily to
start
• Training specificity – focus on doing a necessary
activity with confidence
• Even modest activity/strengthening helps improve
functional capacity
• Dose response – association between intensity and
outcome
– Higher intensity will yield better outcomes
– Older institutionalized adults had improvement in knee
strength, six-minute walk distance, chair stands, stair
climbing with low-intensity training
Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for exercise testing
and prescription (9th ed). Baltimore, M.D.: Wolters Kluwer/Lippincott Williams &
Wilkins.
Aging Adult Exercise
Recommendation Bibliography
• Dubbert PM, Morey MC, Kirchner KA et al. Counseling for home-based
walking and strength exercise in older primary care patients. Arch Intern
Med. 2008; 168:979.
• Hamer M, Lavoie KL, Bacon SL. Taking up physical activity in later life and
healthy ageing: the English longitudinal study of ageing. Br J Sports
Med. 2014; 48: 239.
• Pescatello, L.S, Arena, R. et al.(Eds.). (2014). ACSM’s Guidelines for
testing and prescription (9th ed). Baltimore, M.D.: Wolters
Kluwer/Lippincott Williams & Wilkins.
• Morey, M.C. (Oct 20, 2014). Physical activity and exercise in the elderly.
UpToDate (On-line). Available :
http://www.uptodate.com/contents/physical-activity-and-exercise-in-
older-adults?
• Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and
physical function in obese older adults.N Engl J Med. 2011; 364: 1218
ExRx.Net
• Exercises in all four categories of exercise
• Calculators for exercise testing and
progression
• Suggests programs for specific exercise
goals
• Patient friendly handouts and links to
trackers
Exercise is Medicine
• Exercise is Medicine
– Address: http://exerciseismedicine.org
– Resources
• Health Care Provider Toolkit
• Physical Activity Readiness Questionnaire
• Risk Assessment Form
• Risk Management Decision Tree
• Exercise /Prescription and Referral Form
• Links to local resources
Other Resources
• Commmunity resources
• Walking programs
– For patients:
http://www.startwalkingnow.org/why_start_wal
king.jsp
– For organizations:
http://www.heart.org/HEARTORG/GettingHealth
y/WorkplaceWellness/Workplace-
Wellness_UCM_460416_SubHomePage.jsp
Leveraging for Success
• Make it mutual
• Individualize the prescription
• Make it real; life does get in the way
• Practice what you preach
Take Home Message
• Exercise as a free medicine is available to just
about everyone
• An exercise prescription provides the
structure so that the patient can realize real
health benefits no matter what their baseline
condition
QUESTIONS?