Academic literature on the topic 'Exercise prescription'

Physical inactivity is a major risk factor in chronic disease and Canadians are insufficiently active. Exercise prescription has been shown to be effective but few physicians prescribe it. The purpose of this study was to determine family medicine residents’ perceived importance of exercise prescription, and to assess the factors associated with residents who indicate the strongest conviction to prescribe exercise. All 396 family medicine residents registered in first or second year at the University of British Columbia, during June 2013 - August 2013, were eligible to complete the cross-sectional 49-item survey. The outcome measures were (1) the importance of exercise prescription in future practice (2) perception of their training in exercise medicine (3) change of the importance of exercise prescription over the course of residency. The data were analyzed using descriptive and inferential statistics to assess significant relationships between each independent variable, resident physical activity levels, attitudes/beliefs, current counselling/prescribing behaviours, awareness/knowledge of physical activity guidelines, self-perceived competence in exercise prescription, and perception of training received, to their perceived importance of exercise prescription in future practice. The data were analyzed as continuous or categorical variables primarily using bivariate analysis with statistical significance set at the level of 0.05. The response rate was 80.6% (319/396). 95.6% of residents indicated exercise prescription would be important in their future practice with 37.5% strongly agreeing (termed "prescribers"). Prescribers had stronger beliefs in the importance of physical activity in health (p<0.001), physical inactivity in disease (p<0.001), and higher rates of current exercise counselling (p=0.001), exercise prescription (p=0.001), and competence prescribing exercise (p=0.005) compared to their colleagues. There was no difference between prescribers and non-prescribers regarding their levels of physical activity, knowledge, or perception of training. The importance of exercise prescription did not change over the course of residency. Only 18.6% of all residents feel they receive adequate training and 91% desire more training in exercise medicine. Exercise prescription is important to residents, but residency is not sufficiently preparing them to prescribe exercise effectively.<br>Education, Faculty of<br>Kinesiology, School of<br>Graduate

It has been well-documented in the literature that there are many physical and psychological benefits to be derived from regular aerobic exercise. It has also been noted that adherence/compliance to aerobic exercise regimens tends to be quite low. Investigators have found that a number of factors tend to correlate with adherence, but it has been difficult thus far to determine a mechanism which underlies a tendency to adhere versus a tendency to drop-out. This study examined the problem of non-adherence from the perspective of Self-Efficacy Theory (Bandura, 1977). Subjects for this investigation included all patients seen during a four week period in the Cooper Clinic at the Aerobics Center in Dallas, Texas. Patients at the clinic receive a complete physical examination and health prescriptions based upon the results of their examination. During this four week period, half were administered a Self-Efficacy Questionnaire. Approximately three months later all patients seen during this four week period received a followup (adherence questionnaire in the mail). It was hypothesized that there would be a positive relationship between responses on the Self-Efficacy Questionnaire and responses on the Adherence Questionnaire. A second hypothesis stated that there would be a positive relationship between items which specifically pertained to exercise on each of the questionnaires. In addition, it was expected that there would be no difference in adherence rates between those who made self-efficacy judgments and those who did not. Results of a t-test conducted between the group which made self-efficacy judgments and the group that was not asked to make such an evaluation demonstrated no significant difference in adherence rates. A correlational analysis revealed that there was not a statistically significant relationship between total self-efficacy scores and total adherence scores. There was, however, a statistically significant relationship between levels of exercise self-efficacy and levels of exercise adherence. In addition to these main variables of interest, correlations between other variables (sex, age, percent bodyfat, etc.) were examined and discussed.

<p> Cardiac rehabilitation is a multifaceted intervention aimed to enhance health and wellness in patients with cardiovascular disease and chronic heart failure. Many books on cardiac rehabilitation primarily focus on pathology, risk stratification, and patient assessment while giving less attention to designing an exercise regimen. <i>Exercise Prescription for Cardiac Rehabilitation: A Guide for Clinicians</i> concentrates on developing exercise programs for individuals with chronic heart disease based on recommendations from current research to meet a patient&rsquo;s personal goals. The purpose of this project is to present health care providers with comprehensive recommendations for treatment plans appropriate for each phase of recovery during rehabilitation. Through this guide, readers can better create individualized programs to help patients progress based on their skills, abilities, and physical capabilities. Physical activity will ultimately lead to short and long term benefits while increasing overall health and quality of life in patients with cardiovascular disease.</p><p>

Following a spinal cord injury (SCI), participation in regular exercise can enhance physical capacity and performance in activities of daily living. With this in mind, the use of subjective ratings of perceived exertion (RPE) may provide an easy-to-administer alternative to traditional methods of regulating exercise intensity (e.g. heart rate and power output (PO)). A physically active lifestyle is also associated with a reduced risk of cardiovascular disease, in part because exercise exerts anti-inflammatory effects. Examining the plasma response of inflammation-mediating chemical messengers, known as cytokines, to traditional and novel exercise modalities may help maximise the anti-inflammatory potential of regular exercise. Participants with a cervical level SCI successfully self-regulated a 20 min bout of moderate intensity wheelchair propulsion (Chapter three). No differences in physiological or PO responses were observed during the imposed-intensity and self-regulated wheelchair propulsion in the trained population group. In a non-SCI group of novice wheelchair-users, a differentiated RPE specific to the exercising muscle mass (RPEP) was the dominant perceptual signal during submaximal wheelchair propulsion (Chapter four). The novice group successfully self-regulated a 12 min bout of moderate intensity wheelchair propulsion, comprising of a discontinuous 3 x 4 min protocol, using differentiated RPEP. In contrast, a more accurate self-regulation of light intensity wheelchair propulsion was observed when employing traditional overall RPE compared to RPEP. Following strenuous wheelchair propulsion, plasma concentrations of the inflammation-mediating cytokine interleukin-6 (IL-6) were significantly elevated in non-SCI and thoracic level SCI participants (Chapter five). Impaired sympathetic nervous system (SNS) function was associated with a reduced IL-6 response in participants with a cervical level SCI. The plasma IL-6 response to 30 min moderate intensity (60% VO2peak) arm-crank ergometry (ACE) was associated with an elevation in the anti-inflammatory cytokine IL-1 receptor antagonist (IL-1ra) independent of SNS activation (Chapter six). Light intensity ACE resulted in a small, significant plasma IL-6 response but no IL-1ra response. The addition of functional electrical stimulation-evoked lower-limb cycling to concurrent hand cycling, termed hybrid exercise, resulted in a greater plasma IL-6 response compared to moderate intensity hand cycling alone in participants with a thoracic level SCI (Chapter seven).

Exercise has been shown to improve mood, anxiety, stress, and promote neuroplasticity (Conn, 2010; Donaghy, 2007; Josefsson, Lindwall, & Archer, 2014; Silveria et al., 2013; Stathopoulou et al., 2006). However, limited research on the topic suggests that many psychologists and mental health providers are not incorporating exercise into psychological treatment, and many lack the confidence to do so (Burton, Pakenham, & Brown, 2010; Weir, 2011). The purpose of this study was to evaluate current exercise prescription trends among practicing psychologists and trainees, including identifying their current beliefs, attitudes, training, and the perceived barriers hindering psychotherapists from recommending and prescribing exercise. Psychologists and trainees (N = 146), completed the Exercise in Mental Illness Questionnaire – Health Practitioner Version (EMIQ-HP). Results revealed: a) 40.4% (n = 59) of psychotherapists prescribed exercise only occasionally and recommended clients exercise “most days of the week,” at moderate intensity; b) older psychotherapists’ (t[163] = -2.15, p = .038) and trainees further along in training (t[163] = 2.26, p = .029)were both more likely to prescribe exercise (F[9, 36] = 9.27, p = .011, R2= .42); c) exercise habits of respondents were not significant predictors of exercise prescription; d) a small number of respondents (22.6%; n = 33) reported previous formal training in exercise prescription; and formal training (β = .39, p < .001) was positively correlated with exercise prescription [F(1, 144) = 26.99, p < .001, R2= .16]; and e) therapist barriers (β = -.39, p < .001; e.g., “Prescribing exercise to people with a mental illness is not part of my job…I do not know how to prescribe exercise to people with a mental illness…I don’t believe exercise will help people with a mental illness,” etc.) were inversely related with exercise prescription, F[2, 145] = 27.03, p < .001; R2= .27. In conclusion, psychotherapists’ age, year in graduate school (for trainees; n = 55), and formal training in exercise prescription were significant predictors of exercise prescription, while higher perceived therapist barriers to exercise prescription hinder prescription practices. Study findings, limitations, and future research directions are discussed.

Implantable cardioverter defibrillators are highly effective in the management of life threatening ventricular arrhythmias and implanted for secondary and primary prevention of sudden cardiac death. However, 40% of patients fail to adapt to implantation, developing phobic anxiety states, depression and a fear of arrhythmia and defibrillator therapy (shock) during physical activity. Antecedent behaviour associated with defibrillator therapy and physical activity contributes to a sedentary lifestyle and a concomitant reduction in functional capacity (FC), both of which are associated with an increase in all cause mortality and a greater morbidity. A specific cardiac rehabilitation (CR) programme was developed to address these needs. Method: An initial aspect of the study reviewed 2000 conventional clinical exercise tests (ET) to developed criteria for ET selection. Sixteen patients were randomly selected from 34 who agreed to attend CR and all consented to be included in the study. The mean age was 57.7 years (SD 10.3), mean defibrillator implant period was 20.4 months (SD 13.8) and the mean left ventricular ejection fraction was 38% (SD 17). FC was defined as the outcome from sub maximal exercise tests using an incremental walking treadmill protocol. ET termination was based on a target heart rate of appropriately 75% of age-adjusted maximum heart rate or within 10 beats of the defibrillator detection threshold or the patients desire to stop. The reliability of the new ET protocol was incorporated within the study design. Patients attended CR exercise sessions twice weekly for 12 weeks and performed mainly aerobic exercise using a circuit-training approach with four intensity levels. The prescription, monitoring and adjustment of exercise intensity were achieved by telemetry heart rate and 'rate of perceived exertion'. Heart rate monitors were worn for all exercise sessions. Once weekly home exercise and regular walking was encouraged between sessions. Educational sessions on diet, medication, psychology and the benefits of an active lifestyle were provided. The primary outcome measures were ET results and the Hospital Anxiety&Depression scale scores. Analysis of variance was utilised statistically. Results: All 16 patients completed pre-base and baseline ETs with a mean ET time (mm:ss) increase of 01:04 (SD 01:10), a 3rd ET with 8 patients found no significant increase in ET time. Thirteen patients completed the CR exercise programme and showed significant increases in the intensity of exercise performed without significantly increasing heart rate or blood pressure. A baseline comparison between compliant and non-compliant patients found that the non-compliant patients were younger with greater FC and less psychological distress. Eleven patients completed a further evaluation 12-weeks post CR; two were unable to attend due to exacerbation of co-morbidity. ET time (mm:ss) post CR showed a mean improvement of 01:02 (95% CI, 01:36 to 00:27 p= 0.002). Clinically significant anxiety and depression scores existed at baseline with mean anxiety scores of 13.4 (SD 3.6) reduced post CR to 8.1 (SD 3.6) (95% CI, 3.5 to 7.0, p=0.001). Mean depression scores of 10.0 (SD 3.4) reduced to 6.7 (SD 3.0) (95% CI, 2.0 to 4.4, p=0.002) post CR. Improvements in ET times and HADS scores were maintained at 12 week. No defibrillator therapy occurred during ETs or the exercise sessions. Conclusion: The new treadmill ET protocol was reliable after a formal pre-test and considered safe and effective due to no complications or defibrillator therapy. Exercise circuit training with heart rate and rate of perceived exertion monitoring was safe and lead to increased exercise capacity. Efficacy of cardiac rehabilitation was evident with improvement in functional capacity and psychosocial health and the outcomes were maintained at 12 weeks without the use of formal exercise. Generalisations beyond this pilot study are limited and a multi-centred control trial is needed to establish the external validity of the intervention effect.

It is accepted that exercise plays a significant role in breast cancer rehabilitation, but there has been limited emphasis on control and measurement of the intensity of exercise in cancer research. It is unknown how intensities achieved by different methods of intensity prescription compare, which complicates the interpretation and comparison of studies. The accuracy of these methods in achieving the prescribed intensity is also unknown; and methods that are inaccurate could be unsafe or ineffective in this population. Therefore, a cross-sectional study was performed to compare the achieved intensity and accuracy of four common methods of intensity prescription within and between three post-menopausal groups: breast cancer patients recently finished chemotherapy, survivors finished treatment and healthy controls (N=30). In randomized order, the metabolic equation for walking (MET equation), heart rate reserve (HRR), direct heart rate (direct HR) and rating of perceived exertion (RPE) methods were used to prescribe an intensity of 60% of oxygen consumption reserve (VO₂R) in separate 10-minute bouts, with recovery between bouts. Expired gas analysis was used to measure the intensity achieved during each bout. Accuracy was defined as: [60%VO₂R-achieved intensity]. In ranked order, the average achieved intensity (%VO₂R) and accuracy (percentage points (+/-ppts)) of the methods in the patient group were: HRR: 61%, 3 ppts; MET equation: 56%, 4 ppts; direct HR: 60%, 8 ppts; RPE: 53%, 9 ppts. The HRR method is recommended in this population based on accuracy and feasibility (no expired gas analysis or re-testing required). The MET equation method is also recommended, with re-testing to account for changes in peak oxygen consumption. The direct HR method could be unsafe, as it achieved intensities much higher than intended (77%), and would be ineffective in research where the effect of exercise is measured, as there was a large range of achieved intensities (42%). In the survivor group results were: MET equation: 59%, 3 ppts; HRR: 63%, 5 ppts; direct HR: 64%, 5 ppts; RPE: 47%, 13 ppts. The top three methods were comparable in accuracy in this group, and appear to be safe and effective, while the RPE method was inaccurate and is not recommended.