As you scribble out a patient's prescription for hypertension medication, consider also prescribing some exercise, says Russell White, MD, director of the Bayfront Family Practice Residency's sports medicine fellowship in St. Petersburg, FL.
"An exercise prescription is appropriate for just about everyone," Dr. White says. "It's something people can do to increase their well-being, and it can be an adjunct in treating their underlying diseases. Often we resort to testing and giving medications, but nutrition and exercise are not always addressed."
The first step, he says, is to conduct a cardiac stress test when indicated. Women older than 50, men older than 40, and anyone with risk factors should be tested prior to beginning an exercise program. As the patient uses a treadmill or stationary bicycle, you can conduct gas analysis--measuring the amount of oxygen breathed in and the amount of carbon dioxide breathed out. Or you can estimate the fitness level based on the distance or amount of time the patient was able to exercise.
An exercise prescription should include components to improve cardio-respiratory fitness, body composition, and flexibility and muscle strength, Dr. White says. Regardless of whether you're writing an exercise prescription for an elite athlete or for a patient in cardiac rehabilitation, the program will follow the same structure:
- Warm up, five to 10 minutes.
Do a low-level aerobic activity for a few minutes to warm up muscles and then gently stretch each muscle group.- Resistance training/strength training, 15-30 minutes.
Lift weights, use exercise bands, or do exercises that use the body as resistance.- Aerobic training, 20-60 minutes.
Perform an activity--walking, jogging, cycling, swimming, aerobic dancing, in-line skating, using a step machine or treadmill, for example--that gets the heart rate up to about 80 percent of its maximum rate.- Cool down, five to 10 minutes.
Decrease the rate of exertion, continuing a low level of aerobic activity for a few minutes before stretching.
An exercise prescription should include not only the format, but also what type of exercise the patient will do, how often he or she will do it, how intense the exercise will be, and how the patient will progress to higher levels of fitness.
The biggest challenge may be convincing patients to make time in their busy schedules to incorporate an exercise program. Dr. White says the key is to talk to patients, find out what their interests are, and combine exercise with something else they like to do. "For example, if it's a hard-driving person who likes to get up early in the morning and watch the news, have them set the treadmill or bicycle in front of the television and watch the news while exercising," he says. Or, encourage them to exercise with their children: ride bikes, play soccer in the backyard, or swim laps while youngsters play in the pool
Other patients may respond more readily to the "pocketbook approach," Dr. White says. Inform patients of financial incentives to exercise offered by their health insurance plans or employers, or explain that weight loss could reduce the need for expensive prescription drugs. The growth of managed care makes those incentives more common as MCOs funnel resources into preventive care, says Dr. White.
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