GUIDELINES FOR EXERCISE PRESCRIPTION

♦ Exercise prescription can be designed to:

1) Improve or maintain aerobic fitness, muscle strength, body composition, flexibility, balance,
coordination and proprioception, or
2) Promote health by reducing the risk factors for chronic disease.
♦ American College of Sports Medicine (ACSM) recommended in 1995 that: ‘every adult should accumulate
at least 30 minutes of moderate intensity physical activity on most, preferably all, days of the week’. This
general message can be applied to all for health benefits.
♦ In 1998 the ACSM produced a position stand ‘The recommended quantity and quality of exercise for
developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults’, which
states:
→ The combination of frequency, intensity and duration of chronic exercise has been found to be
effective for producing a training effect.
→ In general, the lower the stimulus the lower the training effect, and the greater the stimulus the
greater the effect.
→ A well rounded training programme including aerobic and resistance training, and flexibility
exercises is recommended.
→ Many health benefits from physical activity can be achieved at lower intensities of exercise if
frequency and duration of training are increased appropriately.
→ Physical activity can be accumulated through the day in shorter bouts of ten minute durations.

PRINCIPLES OF EXERCISE PRESCRIPTION

• The principle of Overload and Specificity are followed in exercise prescription
• OVERLOAD:
o Tissue to improve its function it must be exposed to a load to which it is not normally
accustomed.
o Exposing the tissue to this load repeatedly, results in an adaptation that leads to increased
functional capacity.
o The interaction of Intensity, Frequency and Duration of exercise results in the cumulative
overload required.
• SPECIFICITY:
o The effects gained are specific to the type of exercise performed and muscles involved.
o Low resistance, high repetition exercises cause an increase in the number of mitochondria in the
active muscles leading to increased muscle endurance with little change in strength, whereas
heavy resistance exercises lead to increases in muscle strength.

♦ The prescribed amount of any type of exercise is based on intensity, duration, type and frequency.
♦ Goal with exercise prescription is to enable people to exercise safely, obtaining health and/or fitness
benefits which they will maintain throughout their lives.

I. INTENSITY:
 Intensity of an exercise is the degree of difficulty experienced during the exercise.
 ACSM (2000) General guidelines: Exercise should be prescribed at an intensity of
 o Between 40 and 50% to 85% of Oxygen Uptake Reserve (VO2R) or Heart Rate Reserve(HRR),
or
o Between 55 and 65% to 90% of Maximum Heart Rate (HRmax).
VO2R= VO2MAX -Resting VO2,
HRR= maximum heart rate - resting heart rate.

 Exercise intensity can also be prescribed in terms of RPE (rating of perceived exertion). Scales such as
the Borg can be used.
II. DURATION:
 The Cardiorespiratory endurance(CR) phase usually includes 20 to 60 minutes of continuous or
intermittent activity
 The ACSM position stand recommends a min of 20 min of CR exercise for improvement of aerobic
capacity
 People training at low intensities should conduct exercise for longer period of time
 For example : Exercising at 60% to 80% HRR or 77% to 90% HRMAX for 20-30min, excluding time
spent warming up and cooling down
III. FREQUENCY:
ACSM RECOMMENDATIONS
3 to 5 days per week for 77% to 90% HRMAX
Functional capacities less than 3 METs :- 1 or 2 short sessions daily
Functional capacities more than 5 METs:- 3-5 sessions per week

 FITT Principles
 The overall training stimulus can be described in terms of Frequency (F), Intensity (I), Duration or
Time (T) and Type of exercise (T).
 Recommended Frequency (F) of exercise is usually 3–5 days per week,
 Intensity (I) is set at 50–85% of VO2 max or 60–90% of Maximal Heart Rate and
 Time (T) of each exercise bout is 20–60 minutes.
 Type (T) of activity should be aerobic in nature, involving large muscle groups, such as walking, brisk
walking, jogging, cycling or swimming.

 WARM UP, COOL DOWN AND STRETCHING:

 Both warm up and cool down should be included in any exercise session.
 Warm up : 10min, ( Walking, slow jogging, slow stretch, calisthenics)
 Cool down : 5-10min.( Calisthenics and static stretching are appropriate)
 Training or Exs phase: 20-60 min.

 MUSCLE STRENGTHENING EXERCISES:

 INTENSITY
→ In resistance training intensity is synonymous with amount of load lifted or overcome
→ Intensity is expressed in terms of a percentage of an individual’s one repetition maximum (1 RM)
→ Studies have shown that strength is maximized by employing heavy resistance between approx 80-90%
of 1 RM
 → A moderate intensity of 70-80% of 1 RM is also effective means of developing musculoskeletal
strength.

 VOLUME
Training volume for any given exercise is determined by multiplying the total number of sets, repetitions and
load
As volume increases intensity decreases
The following exercise training guidelines are recommended:
→ Choose a mode of exercise that is comfortable throughout the full pain free range of motion
→ Perform 8-10 separate exercises that train the major muscles of the hips, thigh, legs, back, chest,
shoulders, arm and abdomen
→ Perform one set of each exercise to the point of volitional fatigue for healthy individuals while
maintaining good form
→ Choose a range of repetitions between 3 and 20 that can be performed at a moderate repetition duration

 FREQUENCY
→ Exercise each muscle group 2-3 nonconsecutive days per week and perform a different exercise for the
muscle group every 2 or 3 sessions
→ Adhere as closely as possible to specific techniques for performing a given exercise
→ Allow time between exercises to perform next exercises in proper form
→ For people with high cardiovascular risk or those with chronic disease terminate each exercise as
concentric portion of exercise becomes difficult (15 to 16 RPE)
→ Perform both lifting (concentric) and lowering (eccentric) portion of resistance exercise in a controlled
manner
→ Maintain normal breathing pattern
→ If possible exercise with a training partner

Exercise Prescription for Obese and Type 2 Diabetes Patients

 Primary goal:
• For obese patients a weight reduction of 5–10% significantly decreases the risk of co-morbidities such
as type 2 diabetes and cardiovascular disease.
• Research has shown that weight reduction improves insulin sensitivity in patients with type 2 diabetes
• Primary aim for the exercise professional is to help control and reduce blood glucose.
 Screening prior to exercise prescription:
• Physician clearance
• A detailed medical history and physical examination.
• In the case of type 2 diabetes it is important to check for glucose control
• Exercise stress test
• Screening for other risk factor such as cardiovascular disease, microvascular disease, peripheral vascular
disease or autonomic neuropathy
 Exercise Prescription for Type2 diabetes: (ACMC 2001)
 • Strategies for weight loss and prevention of weight regain: American College of Sports Medicine
recommends an energy expenditure of greater than 2000 kcal/week from leisure time physical activity
for weight loss and maintenance (Jakicic et al., 2001).
• For Type 2 diabetes, ACSM recommends a minimum of 1000 kcal/week energy expenditure.
• Frequency: It is recommended that patients should exercise a minimum of every second day(i.e. 3
day/week), or 7 sessions in two weeks, to improve insulin sensitivity.
• Intensity: Exercise at 75% VO2max has a greater increase in insulin-mediated glucose disposal.
• Duration: Physical activity greater than 150 minutes/week is effective. An average exercise time of 280
minutes per week had the greatest effect, resulting in a weight loss of approximately 13 kg, which was
maintained for between 6 and 18 months.
• Type: Aerobic type exercise including cycling, swimming, jogging, bicycle ergometer.

 Exercise Prescription for Obesity:

• Duration: 200–300 minutes of exercise a week to promote an energy deficit of > 2000 kcal per week.
Undertaking exercise in 10–15 minute bouts several times a day may be as beneficial as one long bout
of exercise.
• Intensity: Moderate intensity, that is, 55–69% of maximal heart rate.
• Type: Moderate resistance exercises involving major muscle groups (UL,LL,Trunk)such as curl ups,
pushups, leg press, bunch press, Shoulder press. etc and aerobic exercise such as running, jogging,
swimming, cycling etc.