Exercise as Medicine: Find Your Step


Role of the Physician: Evaluate, Educate, Motivate, Repeat!

1)   Evaluate: 

Consider baseline bloodwork, treadmill testing/Holter monitoring, medication review, significant past or present injuries.screenshot

 Clarify their needs—general conditioning, strength training, core strength/stability, cardiovascular endurance, flexibility; exercise for specific medical conditions

Record exercise parameters such as BMI, current exercise patterns: exercise type, intensity, frequency, and total numbers of hours per week

What keeps them from exercising now?  Identify barriers, likes and dislikes

2)   Educate:

What do we want to get accomplished?  What is possible?

a) The physiological effects of exercise are specific:



If you train for speed you get faster



If you train for balance, you get steadierscreenshot





If you train for strength, you get stronger




screenshotIf you train for endurance, you get more stamina

b) The physiological effects of exercise are also general:

Improved sleep, improved self esteem, improved self efficacy, improved coping with stressors, improved mental health and happiness (less depressive symptoms, less anxiety, less attention deficit/hyperactivity symptoms, improved libido), improved control over appetite, blood sugar, and hypertension, lower cancer, stroke, obesity, osteoporosis, arthritis and cardiovascular risk.  Exercise holds out the best mechanism to get off medications and improve wellbeing and quality of life—there is no pill anywhere near as powerful.  It is a great way to improve social contacts with others interested in creating healthy lifestyles.   No matter what your fitness level, there is an entry point for all of us.  The health risks of a sedentary lifestyle are GREATER than the health risks of an active lifestyle.


c) Outline what has to be done:  Something most days, vigorous when possible, break a sweat regularly, recognize any unique barriers, modify as necessary.  Integrate where possible into your life—Ride your bike to work; hike to get some great photographs; learn to swim with your kids; go for a walk to get your lunch.  Balance exercise with strength, balance and flexibility components.  It has to be enjoyable to work long term, but, warning, exercise can be addictive!  Find a friend to share the journey with.

Discuss The FIT principle for Aerobic Exercise:  Frequency: 3-5 x/week    Intensity: 60-90% of max HR   Time: 20-60 minutes/session

Mode:  any exercise that uses large muscle groups in a continuous, rhythmic fashion: walking, hiking, running, snowshoeing, downhill/cross country skiing, cycling, swimming, dancing, yoga, tai chi, rowing, etc.

The FIT principle for Strength Training:  Frequency: 2-3x/week  Intensity: 10-15 repetitions/set  Time: 2-3 sets/ session

Mode: “Fully body” workouts

Avoid the Weekend Warrior Phenomenon:  Work on frequency first, gradually ramp up the length of each session, last, ratchet up the intensity (to avoid injury). For runners: start with long, slow distance, then fartlek, then higher intensity intervals.


3) Motivate!  a) Challenge their beliefs:

screenshotYou are never too old!  Check out Fauja Singh, the 100 year old marathoner.  Or Sister Madonna Buder, the nun who completed an Ironman race 45 times between ages 55-80.


You don’t have to be skinny to be healthy and fit.

Check out the 9 minute video by Dr. Mike Evans called 23 ½ hours: http://www.youtube.com/watch?v=aUaInS6HIGo

Fitness has to be fun.  Play is the process.  Fitness is merely the product.”  Dr. George Sheehan, cardiologist, runner, author



We were all born to exercise—our ancestors all ran for their lives!  “Everyone is an athlete.  The only difference is, some of us are in training, and some are not.”  Dr. George Sheehan


“Champions are all around us.  All we have to do is train them.”

 “It’s just a matter of understanding what’s necessary and discipline yourself to do it.”  Arthur Lydiard,  running author, legendary NZ running coach

Exercise is vital for “successful aging”.

screenshotShow them the “Geriatric Curve”.

b) Enable the process: Check out the exerciseismedicine.org website, and start with The keys to exercise success, and the exercise time finder.  You must find windows in your week to pursue exercise.   http://www.myexerciseplan.com/assessment/ExerciseTimeFinder.pdf

Some recent studies of interest.

First a systematic review on the health benefits of nordic walking published in January 2013: 16 RCTs confirm beneficial effects on blood pressure, exercise capacity and quality of life in patients with various diseases.