Patient referral
In the United Kingdom there is a scheme called "Exercise on prescription" in which doctors are able to prescribe exercise to those with conditions that benefit from it, such as asthma, depression, or obesity. The initiative particularly aimed to lower the rate of heart disease. National standards for such initiatives from doctors were established by the Department of Health
in 2001. Exercise on prescription aims to prevent deterioration of
conditions, and views exercise as a preventative health measure. Fitness
classes or a course at the local gym are available on prescription at a
reduced rate to people who might benefit from them. It aims to make it
easier for people to follow their doctors' advice about taking more
exercise or losing weight. Such preventative measures hope to lead to savings for the National Health Service.
Researchers in New Zealand have also discussed the benefits of exercise referral by medical practitioners there. In New Zealand it is known as a green prescription, while in the United States a similar initiative is known as Exercise is Medicine.
A green prescription is a referral given by a doctor or nurse to a patient, with exercise and lifestyle goals written on them.
The term, used by health practitioners in New Zealand draws parallel to the usual prescriptions
given to patients for medications, and emphasises the importance of
exercise in improving their condition, and not relying on drugs.
The green prescription is written after discussing the issues and goals
in the consultation.
Studies have shown that an increase in exercise, better sense of
well-being, and a decrease in blood pressure results from using the method. A decreased risk of coronary heart disease has not been shown. This was shown in two studies, one by Swinburn (1998), that surveyed patients in Auckland and Dunedin. The other was Elley (2003) and was done in 42 practices in the same region of New Zealand.
General practitioners
like the idea as it formalises what they are telling the patient about
how their lifestyle changes are necessary (Swinburn 1997).
Research in Australia has suggested that an exercise prescription
program would be very beneficial and many ICU physiotherapists are
already performing this practice, however there is no national standards
to govern how this practice is administered so there is great variety
in the ways this is administered therefore more research is needed.
Mental and Emotional Benefits
Exercise
is a great stress relief whether you go for a jog or hit the gym. Both
physical and mental stress are reduced by daily exercise. Working out
can also make you feel happier and more joyful due to the fact that
endorphins are released which create feelings of jubilation. The release
of endorphins can alleviate symptoms of depression and anxiety. Even
just exercising for 30 minutes a few times a week can enhance overall
mood. Self-confidence and self-worth can also be enhanced with exercise
by promoting self-love and taking care of ones health. Exercising
outdoors can also increase self-love even more by getting much needed
vitamin d, getting fresh air, and enjoying the beautiful outdoor
scenery. People start to gain a more positive mood and outlook on life
through working out and become more emotionally stable. They become more
emotionally stable because they are less consumed by responsibilities
and commitments while enjoying their physical activity.
As humans age and get older, their brain cells start to shrink
and people start to lose many important brain functions. Exercise can't
cure decline in functions of the brain but it can prevent degenerations
of cognitive processes that usually occur after age 45. Studies have
also demonstrated that cardiovascular exercise can improve brain
performance and enhance levels of a brain-derived protein that assist
with decision-making, higher thinking, and learning. Regular physical
activity can also sharpen memory, assist in controlling addiction, and
increase levels of relaxation. Memory is sharpened because there is an
increase in production of cells in the hippocampus, which is responsible
for memory and learning. For example, a study demonstrated how running
sprints improved vocabulary retention among healthy adults. Some people
can become addicted to the chemical dopamine and the substances that
produce it such as drugs and alcohol. Physical activity can help addicts
recover by distracting them from their addictions and make them think
less about their cravings. Physical activity restarts the circadian
rhythm and allows addicts to fall asleep at the right time and stay up
all night. While working a few hours before bedtime raises body
temperature, then few hours later the body temperature cools down and
signals to the body that its time to relax and fall asleep which
initiates better relaxation and fulfilling sleep.
Physical Benefits
Physical
activity is a widely known as one of the main ways of losing weight
along with a health diet. Certain studies have shown that inactivity
played a major role in obesity and weight gain. Frequent exercise
increases metabolic rate, which leads to burning more calories and
weight loss. Combination of aerobic exercise with strength training can
boost fat loss and muscle mass maintenance. Through regular exercise,
strong muscles and bones can be developed. It is essential to build bone
density when you're younger in order to prevent muscle mass loss and to
build and maintain bone density and muscle strength. For some people
suffering from severe fatigue such as chronic fatigue syndrome or other
illnesses would benefit from regular exercise by increased energy
levels. For instance, "a study found that six weeks of regular exercise
reduced feelings of fatigue for 36 healthy people who had reported
constant fatigue" (Healthline).
Frequent physical activity decreases chances of getting a chronic
disease and decreases belly fat. Frequent physical activity has also
been proven to enhance insulin sensitivity, cardiovascular fitness and
body composition, while lowering blood pressure and blood fat levels.
Exercise boosts the overall health of your skin by reducing oxidative
stress in the body. Oxidative stress in the body is when there is an
imbalance between free radicals and antioxidants in the body. When the
antioxidants are not strong enough to counteract the damaging free
radicals then oxidative stress occurs. Moderate exercise increases
levels of antioxidants and produces more blood flow, which protects skin
and hinders signs of aging. Chronic pain may be controlled and reduced
by frequent exercise as well. Physical activity may also increase pain
tolerance which will lessen pain interpretation.
For specific diseases
Osteoarthritis
Studies show that exercise prescription aids in both preventing and minimizing the effects of joint disorders such as osteoarthritis.
Evidence shows that in addition to the general physiological,
psychological and functional benefits gained from exercise, greater
quadriceps strength has a mitigating effect on knee joint pain.
Depression
A
large body of research indicates that exercise prescription has
beneficial effects for patients suffering depression. One study shows a
significant improvement for a randomized group of women with major depressive disorder
engaging in a twice-weekly resistance training program compared to a
control group. The reasons for this marked change is thought to have
biochemical, physiological and psychosocial aspects.
Peripheral arterial disease (PAD)
Blockage or closing of the arteries of the lower limbs impairs blood
flow to the legs and results in significant reduction in physical
capacity. Alternate exercise prescriptions to walking are considered. Aerobic exercises
such as arm-cranking or cycling are recommended. Risk factors for
disease progression should also be taken into account when aiming to
improve waling ability. Functional capacity should be determined prior
to commencement of prescribe exercise programs.
Diabetes mellitus
The number of individuals diagnosed with diabetes mellitus are rapidly increasing and a lot of evidence suggests this is due to an insufficiently active lifestyle.
Benefits of exercise include stress reduction, reduced risk of heart
disease, lowers blood pressure, helps control weight and aids insulin in
improving management of diabetes. Exercise that is not too strenuous is
recommended. Such activities may include walking, swimming, gardening,
cycling or golfing.
Incidental activities are encouraged, such as using the stairs instead
of an escalator/lift or walking short distances instead of driving.
Dr Gebel, who works at James Cook University's Centre for Chronic
Disease Prevention conducted a study reporting increased health benefits
through incorporation of more vigorous exercise. He stated that this
could include 'vigorous gardening', not necessarily meaning going to the
gym.
Diabetes Australia suggest 30 minutes of exercise daily as a suitable
target, which can be divided into three 10-minute sessions throughout
the day.
Exercise programs however should be tailored and delivered by individuals with appropriate qualifications.
Cancer
According
to the Center for Disease Control and Prevention, regular exercise may
lower your risk of various cancers. Studies have found that working out
can reduce risk of recurrence or death by as much as 50% in people with
colorectal cancer. Physical activity may also decrease the risk of
recurrence for breast cancer patients, by regulating hormone levels.
Exercise also has the ability to reduce side effects of cancer
treatments such as nausea and fatigue.
Heart Disease
Frequent
physical activity lowers blood pressure, helps maintain a healthy body
weight, and reduces cholesterol levels which all lower the chance of
getting heart disease.
Sleep Apnea
Sleep
apnea is a blockage in the upper airway of the throat that prevents
proper breathing. Normally, the brain would immediately wake you up to
continue normal breathing patterns. People identified as obese have a
higher chance of contracting this disease, exercise can help to prevent
this disease by lowering weight before problems arise.
Obesity
Obesity
is a complex health condition where a person is excessively overweight.
People who exercise regularly and eat a healthy diet are much less
likely to become obese and experience the health complications it can
bring. Any physical activity that you can enjoy week after week will
assist in losing weight along with a change in diet.
Dementia
Several
studies have shown that aerobic exercise in middle-aged and older
adults have reported improvements in thinking and memory, reduced
chances of dementia. A study done on 2,000 men in Wales over 35 years
were examined on five behaviors (regular exercise, not smoking, moderate
alcohol intake, healthy body weight, and healthy diet), exercise had
the greatest effect in lowering the risk of dementia(Alzheimer's
Society). In another study of 716 people with an average age of 82 years
old, people who were in the bottom 10 percent were more than twice as
likely to develop Alzheimer's disease than those in the top 10 percent.
Aerobic exercise has also been proven to affect the brains of older
people. For example, in a modest-size trial, one year of aerobic
exercise resulted in a small increase in the size of the hippocampus,
which was equal to reversing one to two years of age-related shrinkage
(Alzheimer's Society).
Exercise recommendations
According
to Exercise and Sport Science Australia, a minimum amount of 210
minutes of moderate intensity exercise or 125 minutes of vigorous
intensity exercise should be performed per week. Exercise should include
both aerobic and resistance training. For greater health benefits,
exercise should be performed regularly with no more than a two-day gap
between training sessions.
Elderly
Research
has found that having a well planned exercise routine can greatly
benefit the elderly. It an reduce the risks of coronary heart disease,
diabetes mellitus and insulin resilience, hypertension and obesity as
well as vast improvements in bone density and muscle mass.
Exercise program development
Exercise
prescription is designed to modulate acute exercise programming
variables to create the adaptations desired by the individual or sport.
With aerobic exercise prescription, the type of exercise, duration of
exercise, frequency, and duration is adjusted. For resistance exercise prescription, the type of exercise, total session volume, rest period, frequency, and intensity are determined. Prescription of stretching and other activities is also commonly seen.
Exercise prescription can be divided into 5 components:
- Type of exercise or activity (eg, walking, swimming, cycling)
- Specific workloads (eg, watts, walking speed)
- Duration and frequency of the activity or exercise session
- Intensity guidelines – Target heart rate (THR) range and estimated rate of perceived exertion (RPE)
- Precautions regarding certain orthopedic (or other) concerns or related comments
Steps to a Healthier You
1. Before beginning any exercise program it is best to assess your fitness level. This can be done by:
- Checking your pulse rate before and immediately after walking 1 mile
- Seeing how long it takes to walk a mile
- Count how many half situps, standard pushups, and modified pushups you can do at a time
- Measuring your waist circumference
- Measuring body mass index
2. After assessing your fitness level then create a fitness program.
- Think about what your fitness goals are: ensure clear fitness goals are declared so that you stay motivated and can determine progress
- Design a balanced routine: According to the Department of Health and Human Services, "it is recommended that you get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous".
- Begin slowly and progress slowly: if your just starting to exercise then start slowly and gingerly. If you have any pre-existing health conditions or injuries then meet with a doctor before beginning to exercise.
- Incorporate activity into daily routine: Schedule time to workout like any appointment and have it written down on a calendar or a planner.
- Incorporate different types of activities: Participating in the same activity over and over again again can get boring. To prevent boredom, try different types of activities such as walking, biking, swimming, and strength training.
- Have adequate amount of recovery time: Set time in between workout sessions that allow the body to rest and recuperate.
- Write goals and plans on paper: having plans written may help people stick to their goals
3. Get started
- Start slowly and progress gradually: Give enough time to warm up and cool down. Try to start working out for at least 30 minutes then build up to 60 minutes.
- Break a session up: If you don't have time for a full 30 minute or 60 minute session then break it up throughout the day. You can do one 15 minute session in the morning and one 15 minute session in the night.
- Creativity: Include fun activities that also add to your workout regimen such as scuba diving with friends or going for a hike with family.
- Listen to your body: If you're feeling any kind of pain, dizziness, or nausea then take a break and don't over do it. If you're not feeling well and have the flu then take a few days off and give your body the proper time to rest.
Overcoming Psychological Barriers
Low Self Motivation
If
it is hard to motivate yourself to go to the gym or to just workout
period, then it may be best to find a workout buddy or buddies. Joining
fitness groups or classes would be beneficial as well to help motivate
you and push you to your highest potential. Working out with a group or a
friend can also make it a more enjoyable experience.
Fear of injury
If
you have been injured in the past and are afraid of being re-injured
then participate in a low-impact activity such as using the elliptical.
The fear of re-injury is not a good enough reason to stop exercising
which will prolong and benefit your life in the long run.
Poor Self Image
Millions
of people have low self-esteem and poor self image. Going to the gym
for the first time may be intimidating for some because they are
surrounded by people who they feel are fitness experts and that are
looking down on them and criticizing them. However, they were all
beginners too and there's a high chance that they are not watching you
and are focusing on their own workout. Going with a friend for the first
time may help or meeting with a therapist may help as well.
Lack of Confidence
For
many beginners, the gym equipment may seem daunting but there are
fitness coaches available at the gym that can assist with any
confusions. Along with fitness coaches, there are online fitness
resources as well that will explain all the different fitness techniques
to be successful in the gym and on your new fitness journey.
Self-Management Skills
To overcome this obstacle of not being able to manage yourself then you should set specific goals for your self.
- Set reachable goals
- Be specific
- Have mini goals
- Write down all goals and when you want to meet them by
- Identify what your motives are for working out
- Reward yourself after achieving each goal
Some people love working out while others completely despise it. If
your are someone that finds it hard to enjoy exercise then try more
creative activities such as rock climbing or playing a game of
basketball or soccer. Another fun way of getting your cardio in is
dancing instead of just running on the treadmill.
4 Types of Exercise
Endurance
Endurance/aerobic
activities enhance breathing and heart rate. They keep your heart,
lungs, and circulatory system healthy. Endurance exercises include:
- Jogging
- Working in the yard
- Dancing
Strength
Strength
exercises make muscles stronger, protect bone and muscle mass, keeps
extra weight off, develop better body mechanisms, and more calories
burned. These exercises can help you to become stronger and make doing
everyday activities easier. Strength exercises include:
- Weight lifting
- Working out with a resistance band
- Exercising using your own body weight
Balance
Balance exercises aid in preventing falls which is common among older adults. Balance exercises include:
- Standing on one foot
- Heel-to-toe walk
- Tai Chi
Flexibility
Flexibility
exercises stretch your muscles and helps the body to stay agile.You
experience less pain, fewer injuries, and improved posture and balance.
Being more limber gives more freedom of movement for other types of
activities and everyday activities. Flexibility exercises include:
- Yoga
- Calf stretch
- Shoulder and upper arm stretch
