Start Exercising Already! A Physician's Step-by-step Guide to Prescribing Exercise for All Patients


Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,1
Neelam Charania, BSc, MSc (OT),2

1 is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and
2 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.
1. Exercise has been shown to improve both physical and mental well-being through the following mechanisms: improved body physique, reduced disability associated with arthritis, mproved balance and a reduction in falls, and improved psychological health.
2. Most physicians are aware of the two most common types of exercise training; aerobic/cardiovascular endurance training and muscular strength/resistance training. Other types of exercise are performed to improve flexibility, balance and coordination.
3. The exercise programme's duration should begin at about 10 minutes and progress to 20-30 minutes (it is possible to divide this into tenminute aliquots).
4. The latest research confirms that only one set per exercise or strength training is required to have the same benefit as multiple sets
5. The most important caveat is not to progress if pain, discomfort, or interposing illness is encountered. Sometimes a holding pattern or regression is required
1. 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.
2. Every attempt should be commended, and any indiscretion should not be belaboured. The patient should be veered back to his goals without guilt.
3. I ask each patient to record their heart rate upon waking and their post-exercise heart rate. This is the beginning of their exercise log, which will include the type of exercise, duration, intensity, and frequency. Patients should be be encouraged to bring it to each appointment. This serves two purposes— ONE, it helps familiarize the patient with his or her level of exertion and progress, and TWO, it helps, within the actual exercise regimen, to target appropriate intensity levels.
4. The simplified calculation for determining MHR is MHR = (220-age). Intially target 40-60% MHR over 1-2 months, then improve to 70-75% MHR over 6months, then maintain.
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