Question of the week
We often hear exercise called “medicine,” and for good reason. Its benefits are wide-ranging, from cardiovascular health to improved well-being, better sleep, and even potential weight loss. Walking, for example, is an unbeatable prescription: low cost, minimal side effects when started gradually, and universally accessible with no co-pay.
But when it comes to putting an exercise prescription for patients into practice, questions remain: How should the “dose” be tailored, and how can adherence be monitored? Practitioners on Healthcasts weighed in on how they prescribe exercise to their patients.
How do you handle prescribing exercise to patients? Log in or sign up to share your approach and see the consensus.
Post:
We always hear about using exercise as a potential medication, and in fact, that you can "prescribe" it. In fact, walking as a prescription is unbeatable - it costs virtually nothing, has few adverse side effects when started at a low dose, and is always covered by insurance with no co-pay!
We tell patients that, because of cardiovascular benefits, it may increase longevity. Because of psychological benefits, it may improve well-being. If done early in the day, it may also improve sleep quality.
But how can we apply this in practice as a "prescription"? How do we monitor adherence, and how do we "adjust the dose"?
We tell patients that, because of cardiovascular benefits, it may increase longevity. Because of psychological benefits, it may improve well-being. If done early in the day, it may also improve sleep quality.
But how can we apply this in practice as a "prescription"? How do we monitor adherence, and how do we "adjust the dose"?
Questions for consult
1. Have you prescribed exercise for your patients and followed up to "titrate" the dose?
2. What are the best ways to "monitor" adherence to exercise? Do you review fitness tracker information (Apple Watch, Strava, Garmin, etc.)?
Comments
Key takeaways about exercise prescriptions for patients:
- Start slow, then build
Encourage patients to gradually increase exercise intensity, frequency, and duration, often tailoring plans to individual abilities. - Track progress where you can
Fitness trackers, apps, or self-reported activity help monitor adherence, while wellness coaches can provide additional support. - Follow-up and titration are key to long-term success
Regular check-ins, whether every few weeks or months, allow clinicians to adjust exercise recommendations safely and encourage sustainable behavior change.
Internal Medicine
"1. I have not actually written a prescription, but I always discuss this with patients, and we always talk about cardio and weight training both. We always talk about starting slow to avoid injury and increasing the amount of movement or the amount of weights they are doing.
2. There really isn’t a good way to monitor this, especially with the time constraints and general practice. Those who do have a Garmin or fitness tracker, however, will sometimes report back to me. The changes they have made from one visit to the next, as far as their step count. Other than that, it is not really Something that can be monitored."
Internal Medicine
"1. Yes, I have prescribed exercise therapy, which usually recommends 20 minutes of brisk walking three times a week and then titrating up the duration of exercise, type of exercise (brisk walking to jogging), or frequency in the week, depending on the patient's tolerance and level of mobility.
2. The best ways to monitor exercise adherence include Fitbit or Apple Watch, or the Health app on an iPhone."
Family Practice
"1. I recommend to patients that they should eventually exercise 150 minutes/week at moderate intensity, but of course start with 'baby steps' such as doing a sustained activity for 15-20 minutes several times per week, and increase slowly. I work with Wellness Coaches who are better trained at guiding patients about exercise, etc.
2. Working with Wellness Coaches helps keep patients accountable to their own progress. Patients also need to learn to take responsibility for their own health. I don't review patients' fitness tracker info unless they offer it to me to review with them."
Family Practice
"1. Sometimes I write this on a script pad so they feel it’s more official. I will follow up with them every 3 months to monitor progress and increase the length or intensity of exercise as tolerated.
2. I have them track their exercise - whether it’s in an app or with Apple Watch."
Endocrinology/Diabetes
"1. I discuss exercise all the time with patients, but I don't actually write out a prescription. I do discuss the benefits of exercise, the amount of time they should spend on exercise each week, etc. I don't usually talk about titration except to tell some patient to start slow and build up with time.
2. [I monitor adherence with] improvement in health (better BS and A1C in diabetics, weight loss, etc), and asking patients if and how long they are exercising each week. If they have a tracer, I will look at it, but I don't ask patients to get one."
Have you ever prescribed exercise for a patient? Review the full post on Healthcasts to see other practitioner perspectives and share your experience.
