Generating an Exercise Prescription from the Exercise Test

  • Kevin Edward Elder

Thus far we have examined the importance of exercise testing by primary care physicians and discussed the physiology behind the test, including indications and interpretation of the results. These results are used for purposes of risk stratification. The formulation of an exercise prescription is another application of the exercise test results, which will be examined here. Primary care physicians need to be prepared to recommend and structure an exercise program for many different types of patients, including the healthy as well as those with chronic medical conditions. The exercise test can be used to prescribe appropriate activity levels to these patients, including recommendations for specific exercise regimens.


Physical Activity Resistance Training Exercise Program Rest Heart Rate Exercise Prescription 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    US Public Health Service. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD, US Department of Health and Human Services, Public Health Service; Washington, DC, Office of the Surgeon General, 2001.Google Scholar
  2. 2.
    US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC, UD Department of Health and Human Services, Government Printing Office, 2000.Google Scholar
  3. 3.
    Walsh JM, Swangard DM, Davis T, et al. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med 1999;16(4):307–313.PubMedCrossRefGoogle Scholar
  4. 4.
    US Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: Recommendations and rationale. Guide to Clinical Preventive Services, 3rd ed. Rockville, MD, 2002.Google Scholar
  5. 5.
    Nawaz H, Adams ML, Katz DC. Weight loss counseling by health care providers. Am J Public Health 1999;89:764–767.PubMedCrossRefGoogle Scholar
  6. 6.
    Wee C, McCarthy E, Davis R, et al. Physician counseling about exercise. JAMA 1999;282:1583.PubMedCrossRefGoogle Scholar
  7. 7.
    Vaitkevicius PV, Stewart KJ. Postmyocardial infarction care, cardiac rehabilitation, and physical conditioning. In: Barker LR, Burton JR, Zieve PD (eds), Principles of Ambulatory Medicine. Williams & Wilkins, 1999, pp. 744–767.Google Scholar
  8. 8.
    American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscle fitness in healthy adults. Med Sci Sports Exerc 1990;22:265–274.Google Scholar
  9. 9.
    Whaley MH, Brubaker PH, Otto RM, Armstrong LE, for The American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription, 7th ed. Philadelphia, PA, Lippincott Williams & Wilkins, 2006.Google Scholar
  10. 10.
    Pollock ML, Schmidt DH (eds). Heart Disease and Rehabilitation, 2nd ed. Champaign, IL, Human Kinetics, 1995.Google Scholar
  11. 11.
    Pollock ML, Welsch MA, Graves JE. Exercise prescription for the rehabilitation of the cardiac patient. In: Pollock ML, Schimidt DH (eds), Heart Diease and Rehabilitation, 3rd ed. Champaign, IL, Human Kinetics, 1995.Google Scholar
  12. 12.
    Pollock ML, Wilmore JH. Exercise in Health and Disease: Evaluation and Prescription for Prevention and Rehabilitation, 2nd ed. Philadelphia, WB Saunders, 1990, pp. 485–620.Google Scholar
  13. 13.
    Stephens MB. Exercise prescription. In: O’Connor FG, Sallis RE, Wilder RP, St. Peirre P (eds), Sports Medicine: Just the Facts. New York, McGraw-Hill, 2005, pp. 91–94.Google Scholar
  14. 14.
    Morrison CA, Norenberg RG. Using the exercise test to create the exercise prescription. In: Evans CH (guest ed), Exercise Testing. Primary Care Clin Office Prac. Philadelphia, WB Saunders, 2001;28(1):137–158.Google Scholar
  15. 15.
    McDermott AY, Mernitz H. Exercise and older patients: Prescribing guidelines. Am Fam Phys 2006;74(3):437–444.Google Scholar
  16. 16.
    Pollock ML, et al. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in adults. Med Sci Sports Exerc 1998;30:975.CrossRefGoogle Scholar
  17. 17.
    Davies CT, Knibbs AV. The training stimulus, the effects of intensity, duration and frequency of effort on maximum aerobic power output. Int Z Angew Physiol 1971;29:299–305.PubMedGoogle Scholar
  18. 18.
    Gettman LH, Pollock ML, et al. Physiological responses of men 1, 3, and 5 days, and 5 day per week training programs. Res Q Exerc Sports 1976;47:638–646.Google Scholar
  19. 19.
    Olree HD, Corbin B, Penrod J, et al. Methods of achieving and maintaining physical fitness for prolonged space flight. In: Final Progress Report to NASA. Grant No. NGR-04-002-004, 1969.Google Scholar
  20. 20.
    Pollock ML. The quantification of endurance training programs. In: Wilmore JH (ed), Exercise and Sports Sciences Reviews. New York, Academic Press, 1973, pp. 155–188.Google Scholar
  21. 21.
    Shephard RJ. Intensity, duration, and frequency of exercise as determinants of the response to a training regime. Int Z Angew Physiol 1969;26:272–278.Google Scholar
  22. 22.
    Wenger HA, Bell GJ. The interactions of intensity, frequency, and duration of exercise training in altering cardiorespiratory fitness. Sports Med 1986;3:346–356.PubMedCrossRefGoogle Scholar
  23. 23.
    Blair SN, Kohn HW, Paffenberger RS Jr, et al. Physical fitness and all-cause mortality: A prospective study of healthy men and women. JAMA 1989;262:2395–2401.PubMedCrossRefGoogle Scholar
  24. 24.
    Mazzeo RS, Cavanagh P, Evans WJ. Exercise and physical activity for older adults. Med Sci Sports Exerc 1998;30:1002.Google Scholar
  25. 25.
    Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.Google Scholar
  26. 26.
    Williams PT. Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners: The national runner’s health study. Ach Int Med 1997;3:346–356.Google Scholar
  27. 27.
    Graves JE, Pollock ML. Exercise testing in cardiac rehabilitation: Role in prescribing exercise. Cardiol Clin 1993;11:253–256.PubMedGoogle Scholar
  28. 28.
    Zimmerman GL, Olsen CG, Bosworth MF. A “stages of change” approach to helping patients change behavior. Am Fam Phys 2000;61:1409–1416.Google Scholar
  29. 29.
    Borg GA. Psychological basis of perceived exertion. Med Sci Sports Exerc 1982;14:337–381.Google Scholar
  30. 30.
    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402–407.PubMedCrossRefGoogle Scholar
  31. 31.
    Balady GJ, Ades PA, Comoss P, et al. Core components of cardiac rehabilitation/secondary prevention programs: A statement for healthcare professionals from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group. Circulation 2000;102(9):1069–1073.PubMedGoogle Scholar
  32. 32.
    Welsh M, Pollack M. Using the exercise test to develop the exercise prescription in health and disease. In: Evans CH (ed), Primary Care. Philadelphia, WB Saunders, 1994;21(3).Google Scholar
  33. 33.
    Hirvensalo M, Heikkmen E, Lintunen T, Rantenen T. The effect of advice by health care professionals on increasing physical activity of older people. Scand J Med Sci Sports 2003;13:231–236.PubMedCrossRefGoogle Scholar
  34. 34.
    Epstein RM, Alper BS, Quill TE. Communicating evidence for preparticipatory decision making. JAMA 2004;291:2359–2366.PubMedCrossRefGoogle Scholar
  35. 35.
    Teutch C. Patient-doctor communication. Med Clin North Am 2003;87:1115–1145.CrossRefGoogle Scholar
  36. 36.
    Verrill D, Shroup E, McElveen G, et al. Resistive exercise training in cardiac patients. Sports Med 1992;13:171–193.PubMedGoogle Scholar
  37. 37.
    Berger RA. Effect of varied weight training programs of strength. Res Q Exer Sports 1962;33:168–181.Google Scholar
  38. 38.
    Edstrom L, Grimby L. Effect of exercise on the motor unit. Muscle Nerve 1986;9:104–126.PubMedCrossRefGoogle Scholar
  39. 39.
    Fleck SJ, Kraemer WJ. Designing Human Resistance Training Programs, 2nd ed. Champaign, IL, Human Kinetics Publishers, 1997, pp. 15–29, 131–163, 230–317.Google Scholar
  40. 40.
    Sale DG. Influence of exercise and training on motor unit activation. In: Pandolf DB (ed), Exercise and Sports Sciences Review. New York, MacMillan, 1987, pp. 95–152.Google Scholar
  41. 41.
    Delorme TL. Restoration of muscle power by heavy resistance exercise. J Bone Joint Surg 1945;22:645–667.Google Scholar
  42. 42.
    American College of Sports Medicine. Guidelines for Graded Exercise Testing and Exercise Prescription, 4th ed. Philadelphia, PA, Lea and Febinger, 1991.Google Scholar
  43. 43.
    Pollock ML. Prescribing exercise for fitness and adherence. In: Dishman RK (ed), Exercise Adherence: Its Impact on Public Health. Champaign, IL, Human Kinetics Books, 1998.Google Scholar
  44. 44.
    Butler RM, Beierwaltes WH, Rodgers FJ. The cardiovascular response to circuit weight training in patients with cardiac diseases. J Cardiac Rehabil 1987;7:402–409.CrossRefGoogle Scholar
  45. 45.
    Ghilarducci LE, Holly RG, Amsterdam EA. Effects of high resistance training in coronary artery disease. Am J Cardiol 1989;64:866–870.PubMedCrossRefGoogle Scholar
  46. 46.
    Squires RW, Muri AJ, Anderson LJ, et al. Weight training during phase II (early outpatient) cardiac rehabilitation: Heart rate and blood pressure responses. J Cardiac Rehabil 1991;11:360–363.CrossRefGoogle Scholar
  47. 47.
    Graves JE, Pollock ML, Jones AE, et al. Specificity of limited range of motion variable resistance training. Med Sci Sports Exerc 1989;21:84–89.PubMedCrossRefGoogle Scholar
  48. 48.
    Crozier-Ghilarducci LE, Holly RG, Amsterdam EA. Effects of high-intensity resistance training on coronary artery disease. Am J Cardiol 1989;64:866–871.CrossRefGoogle Scholar
  49. 49.
    Borms J, Vanroy P, Santens JP, et al. Optimal duration of static stretching exercises for improvement of coxofemoral stability. J Sports Sci 1987;5:39–47.PubMedGoogle Scholar
  50. 50.
    Gillam GM. Effects of frequency of muscle strength training on muscle strength enhancement. J Sports Med 1981;21:432–436.Google Scholar
  51. 51.
    Berger RA. Effect of varied weight training programs of strength. Res Q Exer Sports 1962;33:168–181.Google Scholar
  52. 52.
    Hettinger T. Physiology of Strength. Springfield, IL, Charles C. Thomas, 1961, pp. 18–40, 65–73.Google Scholar
  53. 53.
    Astrand PO, Rodahl K. Textbook of Work Physiology, 3rd ed. New York, McGraw-Hill, 1986, pp. 412–485.Google Scholar
  54. 54.
    Sale DG. Neural adaptation to resistance training. Med Sci Sports Exerc 1988;20:S131–S145.CrossRefGoogle Scholar
  55. 55.
    Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care 2006;29:1433–1438.PubMedCrossRefGoogle Scholar
  56. 56.
    Hubley CL, Kozey JW, Stanish WD. The effect of static exercises and stationary cycling on range of motion at the hip joint. J Orthop Sports Physiol Ther 1984;6:104–109.Google Scholar
  57. 57.
    Raab DM, Agre JC, McAdam M et al. Light resistance and stretching exercise in elderly women: Effect upon flexibility. Arch Physiol Med Rehabil 1988;69:268–272.Google Scholar
  58. 58.
    Bosco C, Tarkka I, Komi PV. Effect of elastic energy and myoelectrical potentiation of triceps surae during Stretch-shortening exercise. Int J Sports Med 1982;3:137–140.PubMedCrossRefGoogle Scholar
  59. 59.
    Wilson GJ, Elliot BC, Wood GA. Stretch shorten cycle performance enhancement through flexibility training. Med Sci Sports Exerc 1992;24:116–123.PubMedGoogle Scholar
  60. 60.
    Worrell TW, Smith TL, Winegardner J. Effect of stretching on hamstring muscle performance. J Orthop Sports Phys Ther 1994;20:154–159.PubMedGoogle Scholar
  61. 61.
    Doucette SA, Goble EM. The Effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med 1992;20:434–440.PubMedCrossRefGoogle Scholar
  62. 62.
    Hilyer JC, Brown KC, Sirles AT, et al. A flexibility intervention to reduce the incidence and severity of injuries among municipal firefighters. J Occup Med 1990;32:631–637.PubMedCrossRefGoogle Scholar
  63. 63.
    O’Brien M. Functional anatomy and physiology of tendons. Clin Sports Med 1992;11:505–520.PubMedGoogle Scholar
  64. 64.
    Stephens MB, O’Connor FC, Deuster PA. Exercise and Nutrition, Monograph, 283 ed., AAFP Home Study. Leawood KS, American Academy of Family Physicians, December2002.Google Scholar
  65. 65.
    Anish EJ. The senior athlete. In: Mellion MB, Walsh WM, Madden C, et al. (eds), Team Physician’s Handbook, 3rd ed. Philadelphia, Hanley & Belfus, 2002, pp. 95–108.Google Scholar
  66. 66.
    Foldvari M, Clark M, Laviolette LC, et al. Association of muscle power with functional status in community-dwelling elderly women. J Gerontol A Biol Sci Med Sci 2000;55:M192–M199.PubMedGoogle Scholar
  67. 67.
    Fielding RA, LeBrasseur NK, Cuoco A, et al. High-velocity resistance training increases skeletal muscle peak power in older women. J Am Geriatr Soc 2002;50:655–662.PubMedCrossRefGoogle Scholar
  68. 68.
    Li F, Harmer P, Fisher KJ, et al. Tai chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187–194.PubMedGoogle Scholar
  69. 69.
    Sherington C, Lord SR, Finch CF. Physical activity interventions to prevent falls among older people: update of the evidence. J Sci Med Sport 2004;(suppl 1): S43–S51.Google Scholar
  70. 70.
    Sacheck JM, Roubenoff R. Nutrition in the exercising elderly. Clin Sports Med 1999;18:565–584.PubMedCrossRefGoogle Scholar
  71. 71.
    MacDonald MJ. Post-exercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care 1987;10:584–588.PubMedCrossRefGoogle Scholar
  72. 72.
    Devlin JT. Exercise therapy in diabetes. In: Leahy JL, Clark NG, Cefalu WT (eds), Medical Management of Diabetes Mellitus. New York, Marcel Dekker, 2000, pp. 255–266.Google Scholar
  73. 73.
    American Diabetes Association (ADA). Physicians Guide to Non-Insulin Dependent (Type 2) Diabetes (ADA Clinical Education Program), 2nd ed. ADA, 1998, pp. 36.Google Scholar
  74. 74.
    American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:S50–S60.Google Scholar
  75. 75.
    Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2 diabetes. Diabetes Care 2006;29(6);1433–1438.PubMedCrossRefGoogle Scholar
  76. 76.
    Sigal RJ, Wasserman DH, Casteneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care 2004;27:2518–2539.PubMedCrossRefGoogle Scholar
  77. 77.
    American College of Sports Medicine “Exercise is Medicine” Campaign. www.exerciseismedicine. org/about.htmGoogle Scholar
  78. 78.
    American College of Obstetricians and Gynecologists: Committee opinion. Exercise during pregnancy and the postpartum period. ACOG Tech Bull 2002;267.Google Scholar
  79. 79.
    Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies: what we know and what we need to know. Circulation 2006;114:2739–2752.PubMedCrossRefGoogle Scholar
  80. 80.
    US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Your guide to physical activity and your heart. NIH Publication No. 06-5714, 2006.Google Scholar
  81. 81.
    American Heart Association ( Accessed September 15, 2006. (click on Healthy Lifestyle, then Exercise and Fitness).Google Scholar
  82. 82.
    American College of Sports Medicine and the American Heart Association. Physical activity and public health: Updated recommendation for adults from the ACSM and the AHA. Circulation 2007;116;1081–1093.Google Scholar

Suggested Reading

  1. 1.
    ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;106(14):1883–1892.Google Scholar
  2. 2.
    Ades PA, Wasserman ML, Meyer WL. Skeletal muscle and cardiovascular adaptations to exercise conditioning in older patients. Circulation 1996;94:323–330.PubMedGoogle Scholar
  3. 3.
    Barry HC. Activity for older person and mature athletes. In: Safran MR, McKeag DB, Van Camp SP (eds), Manual of Sports Medicine. Philadelphia, Lippincott-Raven, 1998, pp. 184–189.Google Scholar
  4. 4.
    Beaver WL, Wasserman K, Whipp BJ. A new method for detecting the anaerobic threshold by gas exchange. J Appl Physiol 1986;60:2020–2027.PubMedGoogle Scholar
  5. 5.
    Belardinelli R, Georgiou D, Scocco V. Low intensity exercise training in patients with severe chronic heart failure. J Am Coll Cardiol 1995;26:975–982.PubMedCrossRefGoogle Scholar
  6. 6.
    Buchfuhrer MJ, Hansen JE, Robinson TE. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol 1983;55:1558–1564.PubMedGoogle Scholar
  7. 7.
    Carter JB, Banister EW, Blaber AP. Effect of endurance exercise on autonomic control of hear rate. Sports Med 2003;33:33–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Campbell AJ, et al. Randomized controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997;315:1065–1069.PubMedGoogle Scholar
  9. 9.
    Fiatrone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330:1769–1775.CrossRefGoogle Scholar
  10. 10.
    Fletcher GF, Mills WC, Taylor WC. Update on exercise stress testing. Amer Fam Phys 2006;74(10)Google Scholar
  11. 11.
    Gulati M, McBride PE. Functional capacity and cardiovascular assessment: Submaximal exercise testing and hidden candidates for pharmacologic stress. Am J Cardiol 2005;96(8A)xGoogle Scholar
  12. 12.
    Hambrecht R, Fien E, Weigl C. Regular exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 1998;98:2709–2715.PubMedGoogle Scholar
  13. 13.
    Houts PS, et al. Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns 1998;35:83–88.PubMedCrossRefGoogle Scholar
  14. 14.
    Kenney WL. Thermoregulation at rest and during exercise in healthy older adults. Exerc Sports Sci Rev 1997;25:41–76.CrossRefGoogle Scholar
  15. 15.
    Kessels RP. Patients’ memory for medical information. J R Soc Med 2003;96:219–222.PubMedCrossRefGoogle Scholar
  16. 16.
    Kinderman W, Simon G, Keul J. The significance of the aerobic-anaerobic threshold transition for the determination of work load intensities during endurance training. Eur J Appl Physiol 1979;42:25–34.CrossRefGoogle Scholar
  17. 17.
    Kraemer WJ, Adams K, Cafarelli E, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364–380.Google Scholar
  18. 18.
    Meyer T, et al. An alternative approach for exercise prescription and efficacy testing in patients with chronic heart failure: A randomized controlled training study. Am Heart J 2005;149(5):e1–e7.PubMedCrossRefGoogle Scholar
  19. 19.
    Shrier I, Gossal K. Myths and truths of stretching: Individualized recommendations for healthy muscles. Phys sports Med 2000;28:57–63.Google Scholar
  20. 20.
    Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with severe left ventricular dysfunction: Hemodynamic and metabolic effects. Circulation 1988;78:506–515.PubMedGoogle Scholar
  21. 21.
    Pate RR, Davis MG, Robinson TN, et al. Promoting physical activity in children and youth: A leadership role for schools. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in Collaboration with the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation 2006;114:1214–1224.}Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kevin Edward Elder
    • 1
  1. 1.Department of Family MedicineUniversity of South FloridaTampaUSA

Personalised recommendations