Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL, is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and https://ihopeyoufindthishumerusblog.wordpress.com/
Neelam Charania, BSc, MSc (OT), has a Masters in Occupational Therapy from Boston University.

Abstract
Sedentarianism raises multiple health concerns. In an effort to provide safe options this article will include a short primer on types of exercises along with a step-by-step approach to exercise prescription in the adult population.
Key Words: exercise, sedentarianism, exercise prescription.

Introduction
This article will briefly review the epidemiology of sedentarianism and the general benefits and risks of exercise, and will include a short primer on types of exercises along with a step-by-step approach to exercise prescription. The aim of this article is to help you increase the level of activity among your adult patients safely and to work through the basics of exercise prescription. The medical approach to dealing with more advanced levels of physical activity is beyond the scope of this article.

Epidemiology
There has been a reduction in the level of physical activity and a converse increase in obesity and weight gain in the general population over the last decade.^1-3,10 This raises concerns about the prospect of obese, sedentary, adults with multiple medical concerns.

Benefits
The benefits of exercise are multiple and there is an abundance of clinical research devoted to this topic. Interestingly enough, this field of medical research was essentially nonexistent prior to 1980.⁴ My intention is to provide a brief review of the literature. Firstly, increasing fitness levels has empirically been shown to reduce the effects of aging associated with declining health and function.^5,6,29 Secondly, increasing fitness levels has been associated with longer lives and a decrease in all types of mortality including deaths due to certain cancers and cardiovascular events.^4-9 Thirdly, exercise has been shown to improve both physical and mental well-being through the following mechanisms: improved body physique (including increased muscle mass, strength, flexibility, bone density, and reduction in body fat),^4,6,11,12,18 reduced disability associated with arthritis,^13,14 improved balance and a reduction in falls,^6,15 and improved psychological health.^16,17 Fourthly, in more specific terms, exercise has been shown to improve glucose tolerance and reduce insulin resistance, improve abnormal lipoprotein profiles, reduce hypertension and left ventricular hypertrophy, improve resting metabolic rate, and reduce abdominal obesity.⁴

Risks
This section is to be further subdivided into risks associated with physical activity and risks associated with exercise testing. The risks associated with light to moderate intensity physical activity can be categorized as follows: The risks are highest for those individuals with established cardiac disease or poorly managed condition(s) like "brittle" diabetes or high ventolin-use asthma. They are lower for those individuals with coronary artery disease (CAD) and risk factors of undetermined significance like smoking or hypercholesterolemia. They are lowest for those in the healthy non-smoking category, up to and including, stable well-managed medical conditions like controlled atrial fibrillation or stable chronic obstructive pulmonary disease.¹⁹ A history and physical examination can be used to differentiate between these categories. There is, however, a more objective evaluation of exercise-associated risk. The Canadian Society for Exercise Physiology (CSEP)* through Health Canada has developed the Physical Activity Readiness Questionnaire (PAR-Q) which can easily identify adults for whom physical activity might be inappropriate or those who should have a more thorough medical work-up prior to starting an exercise programme.^20-21 The PAR-Q is specifically designed for use on those individuals aged 15 to 69. Patients can be further evaluated with the use of (sub)maximal graded exercise testing (GXT). Exercise testing by maximal GXT carries a risk of death of less than 0.01% and a risk of myocardial infarction (MI) of less than 0.04%.¹⁹ The risks from submaximal GXT are lower. Finally, there are contraindications for exercise testing that must be noted.¹⁹