- The mnemonic “FITT” (Frequency, Intensity, Type,
Time) is a useful aid for guiding clinicians when writ-
ing an exercise prescription.
FREQUENCY
- All patients should be encouraged to engage in at least
30 min of moderate to vigorous physical activities on
most and preferably all days of the week (Stephens,
O’Connor, and Deuster, 2002).
INTENSITY
- There are many ways to prescribe exercise intensity.
The intensity of the exercise session should be tai-
lored to the individual’s preexisting state of health and
individual goals. - Individuals wishing to improve health and lower dis-
ease-specific risk should be advised that sufficient
levels of physical activity can be accumulated through
small bouts of activity throughout the day. A dedi-
cated activity or training session is not necessary.
•The target heart rate is the most common method of
prescribing exercise intensity. The training heart rate
is based on an age-predicted maximal heart rate
(based on the formula HRmax=220 – patient age).
Patients are instructed to exercise at a range of
40–80% of HRmaxbased on their specific goals.
•A modification of the target heart rate includes calcu-
lation of the heart rate reserve. This method takes into
account the patient’s resting heart rate. To calculate
the target heart rate based on this method:
a. HRreserve={(220 – patient age) – HRresting}
b. HRtarget={(HRreserve* training intensity) +
HRresting} - The talk testprovides another safe and easy way to
counsel individuals about exercise intensity. Patients
should exercise at an intensity where they are able to
carry out a conversation without undue shortness of
breath.
TYPE
- The type of activity should be based on the individ-
ual’s fitness level and interests. - Activities involving repetitive movement of large
muscle groups are recommended. Walking is the eas-
iest activity on which to base an exercise prescription.
Non-weightbearing activities, such as swimming,
rowing, and cycling should be considered for individ-
uals with orthopedic concerns.
DURATION (TIME)- All individuals should strive to accumulate 30–60 min
of physical activity on each and every day of the week
(Stephens, O’Connor, and Deuster, 2002).
THE EXERCISE PRESCRIPTIONS:
OVERCOMING BARRIERS
TO ACTIVITY- Time:Patients commonly cite lack of time as a signif-
icant barrier to physical activity. Small bouts of physi-
cal activity scattered through the day help overcome
this barrier. An alternative is to remind patients that to
achieve the recommended 30 min of daily activity,
they need only forego one television show per day. - Convenience:Patients also cite lack of convenience
as a common obstacle. Patients should be encouraged
to seek alternative forms of physical activity, such as
parking farther away from the store, or using the stairs
instead of the elevator. - Fatigue:Patients should be reminded that physical
activity actually improves their energy level. - Boredom:Exercising with a friend or family member
increases accountability and reduces boredom.
THE EXERCISE PRESCRIPTION:
ASSESSING READINESS TO CHANGE- Not all patients are immediately ready to embark on a
program of increased physical activity. The likelihood
of sustaining an active lifestyle can be quickly assessed
using the stages-of-change model (Zimmerman, Olsen,
and Bosworth, 2000).
Precontemplation- Individuals who are in the precontemplative stage
have not seriously considered participating in regular
physical activity. They are unlikely to significantly
change their current pattern of behavior. Informing
patients about risks associated with physical inactivity
and encouraging them to be more active are useful
counseling points for patients who are in the precon-
templative stage.
Contemplation
•Patients who are contemplating change are ready for
an exercise prescription, but often will present barri-
ers or excuses for not adopting an active lifestyle.
Steady encouragement with suggestions for overcom-
ing predictable barriers is helpful for patients in the
contemplative stage.92 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE