Exercise Prescription Certificate Course

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Exercise Prescription Certificate Course

Session 5: Getting Active and Practising Exercise Prescription

Mr. Sam WONG, Executive Director, HKPFA


Outline of this Session• Recap of Key Principles of Exercise Prescription• Available Forms and Tools• Case Studies• Get active!


Do You Remember?


Recap of What We’ve Learnt…• Types of PA

– Aerobic Exercise– Resistance Exercise– Stretching Exercise

• Components of an exercise session• Pre-participation health screening

– Self-guided Screening: PAR-Q– Professionally Guided Screening: ACSM Risk Stratification Scheme

• Exercise-related Musculoskeletal Injury


Recap of What We’ve Learnt…• FITT Principles of Prescribing PA– To assess intensity of PA (Talk test, RPE, %HRR, %HRmax, etc)

– Know the different modalities of resistance exercise

• Improving Exercise Adoption and Maintenance– The Stages of Change Model– Patient-Centred Counselling– Five-A's Model


Recap of What We’ve Learnt…• Recommendations for Prescribing Exercise to– Healthy Adults– Older Adults– Patients with Diabetes Mellitus– Patients with Hypertension– Overweight and Obese Patients– Patients with Heart Disease– Patients with Osteoarthritis – Prescribing Exercise to Patients with Osteoporosis


Available Forms and Tools


Available Forms and Tools• Stages of Change Assessment Form

– Self-Administered by Client• Pre-participation Screening:

– Physical Activity Readiness Questionnaire (PAR-Q)– Physical Activity Readiness Medical Examination (PARmed-X)– AHA / ACSM Health / Fitness Facility Pre-participation Screening

Questionnaire• Exercise Prescription Form (EP Form)• Exercise Prescription Decal• Application Form for Getting Patient Leaflets• Application Form for the "Registration Card for Persons with

Disabilities"


Exercise Prescription Form


How to Use the EP Form• To be issued by a Doctor/ trained health care

professional• Issue to a client/patient, who an exercise

prescription is indicated• Just need to fill in the dosage of exercise

prescribed• Advise the client/patient to mark his/her progress

and bring the form back in next consultation



Prescribed Time (T) of Aerobic Ex Prescribed Frequency (F)of Aerobic Ex

Prescribed Intensity (I) of Aerobic Ex Prescribed Type (T) of Aerobic Ex


Prescribed Type (T) of Resistance ExPrescribed Frequency (F)of Resistance Ex

Prescribed Time or volume(T) of Resistance ExPrescribed Type (T) of Resistance Ex


Dosage of Stretching Ex



Exercise Prescription Decal• To be posted at the entrance of clinic


Registration Card for Persons with Disabilities• Issued to persons who have been found to have suffered

from a disability (including chronic illnesses) which is permanent in nature, or of a temporary nature

• Could enjoy confessionary rates in sports facilities under LCSD

• Application also requires:– documentary evidence for disability/chronic illness, e.g.

certificates issued by doctors or allied health personnel– specifying the type(s) and degree of disability/chronic illness

and the duration for which the condition is likely to last


Case Studies


Case 1: CY CHAN• M/43• Smoker (1.5 p/d X 25 yrs)• PMH: HT on med under good

control• FH: Father died from a heart

attack at age 60• Works as a construction site

labourer

• No SSx of cardiorespiratory disease

• Body height = 173cm; Body weight = 80kg

• Total cholesterol = 8 mmol/L • Fasting glucose = 5.4 mmol/L

You want to suggest CY to perform aerobic and resistance ExYou would like to stratify his risk to see if he should need further medical workup or exercise testing before increasing his PA level


Case 1: Risk StratificationFOUR Risk Factors• Cigarette smoking• HT • Hypercholesterolaemia • Obesity (BMI 26.7kg/m2)

CY CHAN is not:• Sedentary his physically ∵

active job • Having FH of heart

disease his father’s ∵heart attack occurred >55

• Hyperglycemic


According to the ACSM Risk Stratification Scheme• Although Mr. CHAN is considered to be young (<45),

he is in the moderate-risk category• For performing low- to moderate-intensity PA– Further medical workup and exercise testing not necessary– A sub-maximal exercise test can offer a comprehensive

appraisal of his condition• For embarking on a vigorous exercise programme, he

would need further medical clearance from specialists or equivalent professionals


Case 2: KC CHAN • M/56, moderate-risk• He is worried about his own health His old friend suffered ∵

a heart attack a week ago • He wants to control his body weight

to reduce his risk of heart disease • You are going to advise him to embark on moderate-

intensity aerobic exercises on regular basis. • His resting HR = 86 bpm

What would be an appropriate target HR range for Mr. CHAN?


Case 2: Prescribing Exercise Intensity • KC’s maximal heart rate (HRmax)

= 220 – 56 = 164bpm

(A) %HRmax Method

Target HR range= 64 –76% of HRmax

= 164(0.64) to 164(0.76)= 105bpm - 125bpm

(B) %HRR MethodTarget HR range= 40 –59% of HRR= (0.4)(164-86)+86 to (0.59)(164-86)+86= 117bpm - 132bpm


Case 3: WM CHAN• M/68• Enjoy a sedentary lifestyle• Unremarkable past medical history• Moderate risk category for exercise participation

Using FITT principles to design a comprehensive Ex prescription for Mr. CHAN


Time For Role Play

15 min


Case 3: Prescribing Exercise to Sedentary Old Man Aerobic Physical Activity

Frequency, Intensity, Time and Type Muscle-strengthening Physical Activity

Frequency, Intensity, Volume (Time) and Type Stretching exercise

Frequency, Volume, Type Neuromuscular exercises

Frequency Progression of PA FU Arrangements


End of Presentation

Please refer to Doctor’s Handbook: Chapters 14 for further reading


Questions and Answers


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