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Before determining a plan of care including prescriptive exercise, the therapist must take into consideration the individual's health history, which requires documentation of the client's physical activity and exercise (type, frequency, intensity, and duration). This is a good opportunity to educate all clients about the importance of exercise as therapy for the many medical conditions discussed in this book. Counseling individuals on exercise has been shown effective in increasing physical activity and improving quality of life.1

Although many studies suggest that exercise provides various health benefits, the optimal type, frequency, intensity, and duration remain unknown for many specific conditions. These parameters may vary given the gender, age, personal and family health history, presence of variable comorbidities, current level of fitness, and so on. We envision that someday, as a result of careful research, it may be possible to outline specific and optimal dimensions for exercise taking these factors into consideration.

At the heart of the exercise prescription will be the physical therapist's knowledge of exercise physiology; energy metabolism; and cardiovascular, respiratory, musculoskeletal, and other systemic responses to exercise and training. Exercise prescription is a dynamic process requiring changes to maintain or advance training goals, to avoid overtraining, and provide optimal outcomes to targeted program (or health) goals.

The therapist begins with a single workout that is designed to reflect the goals through the type of exercise(s), and when appropriate the number of repetitions, sets used for each exercise, and intensity of each exercise. When exercise is new to an individual or the individual is starting again after an absence due to hospitalization, surgery, or some other reason, it may be necessary to encourage the person to go slow. The old adage of "No pain, no gain" is no longer valid. Rather, the new mantra is "No pain, big gains."

How Much Exercise Is Enough?

The key word is moderate. Moderate, painless, and enjoyable exercise is the best way to influence health and well-being. Clear health benefits have been shown with moderate exercise in lowering cholesterol, blood sugar, blood pressure, and body fat; slowing the effects of aging; reducing morbidity and mortality rates, and reducing the risk of many diseases.

For the overweight or obese individual, the importance of exercise should be stressed regardless of whether exercise results in weight loss. For anyone who is poorly motivated, overweight, or disabled, the idea that exercise must include an hour in the gym breathing hard and sweating should be dispelled and replaced with a program that will work (i.e., result in actual exercise) for the individual.

In fact, there is a broad spectrum of activities that contribute to health without being an intense workout at the gym. These activities fall into two categories: daily activities and recreational activities (e.g., gardening, dancing, yoga, washing the car by hand, golfing, dusting, ...

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