Exercise Prescription

Exercise Prescription Principles - Fitness Fun-damentals

• Core framework: FITT-VP guides exercise prescription.
  • Frequency: How often (e.g., aerobic 3-5 days/week; resistance 2-3 days/week).
  • Intensity: How hard (exertion level).
    • Methods: % Heart Rate Reserve (HRR), %HRmax, Rating of Perceived Exertion (RPE 6-20 scale), METs.
    • Moderate: 40-59% HRR; RPE 12-13; 3-<6 METs.
    • Vigorous: ≥60% HRR; RPE ≥14; ≥6 METs.
  • Time (Duration): Length of session (e.g., 20-60 min for aerobic).
  • Type (Mode): Aerobic, muscle-strengthening, flexibility, neuromotor.
  • Volume (Quantity): Total amount (e.g., MET-min/week; target ≥500-1000 MET-min/week).
  • Progression: Gradual increase in F, I, T, or V.

⭐ General recommendation: 150-300 minutes/week of moderate-intensity OR 75-150 minutes/week of vigorous-intensity aerobic activity, or an equivalent combination for adults for substantial health benefits.

Types of Exercise - Movement Menu

• Range of Motion (ROM): Maintains/improves joint mobility.
  • Passive (PROM): External force moves joint.
  • Active-Assisted (AAROM): Patient + external aid.
  • Active (AROM): Patient moves joint independently.
• Strengthening: Increases muscle power.
  • Isometric: Muscle contracts, no joint movement (plank).
  • Isotonic: Constant tension, joint movement.
    • Concentric: Muscle shortens.
    • Eccentric: Muscle lengthens under load.
  • Isokinetic: Constant speed, variable resistance (machine-based).
• Endurance (Aerobic): Improves cardiorespiratory fitness.
  • E.g., brisk walking, cycling. Target: 60-80% MHR.
• Flexibility (Stretching): Increases tissue extensibility.
  • Types: Static, Dynamic, PNF.
• Balance & Coordination: Enhances stability, proprioception.
  • E.g., single-leg stance, wobble board.
• Functional: Task-specific, mimics ADLs.

⭐ Eccentric exercises are highly effective for muscle hypertrophy and are crucial in tendinopathy rehabilitation.

Prescription Pointers - Patient Power-Plans

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Screening & Safety - Gains & Groans

• Screening: PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone); ACSM algorithm. Identify red flags (e.g., chest pain during exertion, syncope, dyspnea at rest).
• Safety First: Essential warm-up & cool-down. Gradual FITT (Frequency, Intensity, Time, Type) progression. Monitor for adverse symptoms.

  ⭐ The most common adverse event associated with exercise is musculoskeletal injury (MSI).

• Gains (Benefits): Improved cardiovascular health (↓BP, ↑HDL), ↑muscle strength & bone density, enhanced mood & cognitive function.
• **Groans (Risks & Contraindications):
  • Absolute: Acute MI (<2 days), unstable angina, uncontrolled symptomatic arrhythmias, symptomatic severe aortic stenosis, acute pulmonary embolism.
  • Relative: Severe arterial hypertension (systolic BP ≥200 mmHg or diastolic BP ≥110 mmHg at rest), significant electrolyte abnormalities.

High‑Yield Points - ⚡ Biggest Takeaways

• FITT principle (Frequency, Intensity, Time, Type) is fundamental for exercise prescription.
• Monitor intensity via Target Heart Rate (Karvonen) or Borg RPE scale (6-20).
• Aerobic exercise (e.g., walking) for cardio fitness; aim 150 mins/week moderate.
• PRE (e.g., DeLorme, Oxford) builds muscle strength; DeLorme uses increasing weight.
• Stretching improves Range of Motion (ROM); balance exercises prevent falls.
• Key contraindications: acute MI, unstable angina, acute systemic illness.