Doctors Say “Exercise.” Here’s What That Should Mean
It may be the most common advice in medicine: eat better and exercise more. It’s also some of the least specific. A prescription for blood pressure medication comes with a dose, a schedule and a follow-up. Exercise deserves the same.
- Only about 1 in 4 U.S. adults meets the guidelines for both aerobic and strength exercise.
- About 1 in 3 adults who see a clinician are advised to exercise, and medical training includes little on how.
- A useful exercise prescription is specific, based on a measurement and followed by a recheck.
The advice gap
Federal guidelines are clear: adults should get 150 to 300 minutes of moderate aerobic activity a week and do muscle-strengthening activities at least two days a week. Older adults should add balance training.1 Yet in 2020, only 24.2% of U.S. adults met both the aerobic and strength guidelines, and among adults 65 and older the share was lower still.2
Part of the gap is advice. In 2010, about 1 in 3 adults who had seen a doctor or other health professional in the past year were advised to exercise.3 And when they are, the advice is often general.
Why it’s not the doctor’s fault
Most clinicians were never taught to prescribe exercise in detail. A review of U.S. medical school curricula found that 51% of schools with published curricula offered no physical activity-related coursework, and most didn’t require any.4 Clinicians know exercise matters. Many simply weren’t given the tools to make it specific.
“Exercise more” is a wish. A prescription has a dose, a schedule and a follow-up.
What a real exercise prescription includes
Exercise professionals build plans around four simple variables, often called FITT:
Frequency
How many days a week. For example, strength work twice a week and balance practice most days.
Intensity
How hard. Moderate effort means you can talk but not sing. Strength sets should feel challenging by the last few reps.
Time
How long. Ten-minute sessions count, and they add up toward the weekly goal.
Type
What kind. Chosen to match what the person needs most: strength, balance, mobility or endurance.
The missing first step: measure
A medication dose depends on a lab result. An exercise prescription should depend on a measurement too. Knowing whether someone’s weakest area is balance, leg strength or endurance turns generic advice into a plan that fits them, and gives both the patient and the clinician something to recheck.
- Measure. A quick functional check shows where someone stands for their age.
- Prescribe. Frequency, intensity, time and type, aimed at the weakest area.
- Recheck. Every few weeks, so both sides can see what’s working and adjust.
For patients: what to ask
Next time you hear “exercise more,” ask a few follow-up questions: What kind? How often? How hard? And how will we know if it’s working? Good clinicians welcome the questions.
The bottom line
Exercise is one of the most powerful tools in medicine, and one of the least specifically prescribed. Measuring first, prescribing clearly and rechecking regularly turns well-meant advice into something patients can actually follow.
Measure it. Prescribe it. Recheck it. That’s exercise as medicine.
Common questions
How much exercise do adults need?
U.S. guidelines recommend 150 to 300 minutes of moderate aerobic activity a week plus muscle-strengthening activities at least two days a week. Older adults should also include balance training.
What is an exercise prescription?
A specific plan covering how often, how hard, how long and what type of exercise, ideally based on a measurement and followed by a recheck.
My doctor just said to exercise more. What should I do?
Ask what type, how often and how hard, and how you’ll both know it’s working. A functional fitness check can give you a starting point to discuss.
References
- Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–2028. doi.org/10.1001/jama.2018.14854
- Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief No. 443. 2022. www.cdc.gov/nchs/products/databriefs/db443.htm
- Barnes PM, Schoenborn CA. Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional. NCHS Data Brief No. 86. 2012. www.cdc.gov/nchs/products/databriefs/db86.htm
- Cardinal BJ, Park EA, Kim M, Cardinal MK. If Exercise is Medicine®, where is exercise in medicine? Review of U.S. medical education curricula for physical activity-related content. J Phys Act Health. 2015. synergies.oregonstate.edu/2015/exercise-largely-absent-from-u-s-medical-school-curriculum-study-shows/
This article is general information about functional fitness, not medical advice. If you have a health condition, have had a recent fall, injury or surgery, or a clinician has told you to avoid certain exercise, check with them first.