Chapter 4: Prescribing physical activity: the written prescription

INTRODUCTION

Over 30 years have passed since Robert Butler, the founder of the US National Institute on Aging, made what seemed like an audacious claim—that the benefits of exercise (physical activity, in fact) outweighed the products produced by the multibillion dollar pharmaceutical giants. Our level 5 evidence belief is that clinicians today still underappreciate physical activity’s prodigious effects on health and quality of life. Too often, clinicians turn to their prescription pads to prescribe medication when physical activity may be as, or more, effective for many conditions,^{1, 2} at less cost and with fewer adverse effects.

Writing an appropriate exercise prescription (R_x) can and should be simple. Like a drug prescription, it has a type and dose, a dosing frequency, a duration of treatment and a therapeutic goal.³ This is true whether the exercise is walking for increased aerobic fitness, or whether it consists of several functional resistance exercises designed to emulate activities of daily living.

The exercise R_x should be individualised and tailored to each patient, based on the clinical assessment (Chapter 3) and common prescription principles. Exploring each patient’s physical activity goals should be central to the exercise R_x, as personalising the exercise R_x substantially increases the likelihood that it will lead to action and sustainable change.

WHY A WRITTEN PRESCRIPTION?

Many clinicians argue that they already prescribe their patients physical activity. However, what exactly is a patient to do with the throwaway recommendation ‘You should do more exercise’ and nothing else? In reality, too few clinicians are counselling their patients effectively. Out of over 13 000 Canadian primary care physicians, only 16% reported regularly using written physical activity prescriptions.⁴

To complete effective physical activity counselling using the 5As model of behaviour change (Chapter 3), it is essential to provide patients with a written prescription they can take away with them from the consultation (Fig. 4.1). A tangible prescription conveys to the patient that exercise is therapeutic, and it should be considered medicinal in its preventive and curative properties.⁵ It formalises the notion that the lifestyle change advised by a clinician is necessary and that a patient should not rely on drugs for results.⁶

It is increasingly common to find physicians providing personalised written physical activity prescriptions. Following the lead of New Zealand and Sweden, many countries have adopted exercise R_x as part of their ‘physical activity on prescription’ schemes—national physical activity ...