Prescriptions for physical activity and exercise are one way for primary care physicians and other health care providers to give patients physical activity advice and information. Prescriptions for physical activity outline an exercise plan that can safely meet a patient’s needs based on their current physical condition and the recommended daily Physical Activity Guidelines for Americans (US DHHS-PAG). Such prescriptions set achievable goals, and may also include counseling, activity logs, and exercise testing. Providers check progress at each office visit and may also follow-up via phone, internet, or mail. Individuals at high risk of injury with complex health conditions are referred to certified exercise professionals to receive individually tailored plans.
Expected Beneficial Outcomes (Rated)
Increased physical activity
Improved physical fitness
Other Potential Beneficial Outcomes
Improved health outcomes
Improved mental health
Evidence of Effectiveness
There is strong evidence that medical prescriptions for physical activity increase physical activity and physical fitness (Muller-Riemenschneider 2008*, Senter 2013*). Prescriptions for physical activity, especially aerobic exercise and resistance training, have been shown to maintain mobility among older adults (Yeom 2009*).
Exercise prescriptions increase the number of patients that meet recommended physical activity targets (Muller-Riemenschneider 2008*). Exercise prescriptions combined with telephone counseling have been shown to increase physical activity and physical function, and improve mental health and health outcomes, especially for physically inactive women (Senter 2013*). Prescriptions to walk 5-7 days/week can increase walking (Williams 2008).
Individually tailored exercise prescriptions are more effective than generic prescriptions. Many successful interventions use exercise prescriptions in conjunction with exercise counselling, planning and activity logs, and exercise testing that allows prescriptions to target safe heart rate zones. Combining exercise prescriptions with additional interventions such as phone, mail, or internet follow-up can improve prescription adherence and long-term effectiveness (Muller-Riemenschneider 2008*).
Exercise prescriptions can be tailored for patients with medical conditions such as coronary artery disease, osteoporosis, diabetes, or hypertension with consultations from certified exercise specialists (Senter 2013*). Exercise prescriptions are a suggested strategy to improve the health of patients with diabetes who can safely exercise, since supervised exercise can improve blood pressure control, lower LDL cholesterol levels, and elevate HDL cholesterol levels for diabetic patients (Hayashino 2012*).
Impact on Disparities
In many areas of the country, physicians use prescriptions to refer patients to local Exercise is Medicine programs, for example, in Pinehurst, NC (FirstHealth-EIM); Wesley Chapel, FL (Florida hospital-EIM); and East Texas (ETMC-EIM). Many cities also support health care provider exercise prescription programs, as in Indianapolis, IN and Chicago, IL (IGG-Park prescriptions 2010).
Through the Prescribing Parks program, health care practitioners prescribe healthy outdoor activities to adults and children, for example, in Baltimore, MD; Greenville, SC; Portland, OR; the County of San Diego, CA; Washington DC (NRPA-Prescribing parks); and the Quad Cities in IA and IL (IGG-Park prescriptions 2010). Exercise prescriptions are also supported by the Prescription Trails Program in New Mexico (IGG-Park prescriptions 2010) and the Prescribe a Bike Program in Boston (BMC-Prescribe a bike).
Partnerships can also support efforts to prescribe exercise and refer patients to places for physical activity (IGG-Park prescriptions 2010). New Jersey introduced legislation in 2014 that would authorize park prescription programs and allow medical practitioners to prescribe free state park access passes to patients with obesity-related conditions such as heart disease, diabetes, or high blood pressure (NJ AB 1569).
The Centers for Disease Control and Prevention (CDC), the Institute at the Golden Gate (IGG), and the National Recreation and Park Association (NRPA) are collaborating to evaluate and refine best practices for park prescriptions and related programs (ALR-Wheeler 2014).
ACSM-EIM - American College of Sports Medicine (ACSM), Exercise is Medicine (EIM) Initiative. Exercise is medicine: Your prescription for health.
MBC-Health care toolkit - Mary Bridge Children’s (MBC) Hospital-Clinics-Foundation. Health care toolkit: Ready, set, go! 5210.
MCDP-Rx resources - Montgomery County Department of Parks (MCDP). Park prescription.
Citations - Evidence
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Muller-Riemenschneider 2008* - Müller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: A systematic review. Preventive Medicine. 2008;47(4):354-368.
Senter 2013* - Senter C, Appelle N, Behera SK. Prescribing exercise for women. Current Reviews in Musculoskeletal Medicine. 2013;6(2):164-172.
Yeom 2009* - Yeom HA, Keller C, Fleury J. Interventions for promoting mobility in community-dwelling older adults. Journal of the American Academy of Nurse Practitioners. 2009;21(2):95-100.
Williams 2008 - Williams DM, Matthews C, Rutt C, Napolitano MA, Marcus BH. Interventions to increase walking behaviour. Medicine and Science in Sports and Exercise, 2008;40(7):S567-S573.
Hayashino 2012* - Hayashino Y, Jackson JL, Fukumori N, Nakamura F, Fukuhara S. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice. 2012;98(3):349-360.
Citations - Implementation Examples
* Journal subscription may be required for access.
FirstHealth-EIM - FirstHealth Fitness. Exercise is medicine (EIM): Frequently asked questions.
Florida hospital-EIM - Florida Hospital Wesley Chapel. Exercise is medicine (EIM).
ETMC-EIM - East Texas Medical Center Regional Healthcare System (ETMC). Exercise is medicine program (EIM).
IGG-Park prescriptions 2010 - Institute at the Golden Gate (IGG). Park prescriptions: Profiles and resources for good health from the great outdoors.
NRPA-Prescribing parks - National Recreation and Park Association (NRPA). Prescribing parks for better health: Success stories.
BMC-Prescribe a bike - Boston Medical Center (BMC). America's Essential Hospitals: Prescribe-a-Bike gives patients control over access, exercise.
NJ AB 1569 - New Jersey Assembly Bill 1569. Introduced in the 2014 session: Park prescription program authorizing medical practitioners to prescribe free state park access passes to patients with obesity-related conditions.
ALR-Wheeler 2014 - Wheeler K, Razani N, Bashir Z. Park prescriptions in practice: The community driven way. 2014 Active Living Research (ALR) Annual Conference. 2014.
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