ACSM's Exercise is Medicine™: A Clinician's Guide to Exercise Prescription

274 Pages·2009·2.62 MB·English

by  Steven Jonas

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ACSM’S EXERCISE
IS MEDICINE™:
A Clinician’s Guide to Exercise Prescription
EDITED BY
Steven Jonas, MD, MPH, MS, FNYAS
Professor, Dept. of Preventive Medicine and the Graduate Program in Public Health
School of Medicine, Stony Brook University, Stony Brook, NY
Edward M. Phillips, MD
Director, Outpatient Medical Services, Spaulding Rehabilitation Hospital Network
Assistant Professor, Department of Physical Medicine and Rehabilitation
Harvard Medical School
Assistant Physiatrist, Massachusetts General Hospital
Adjunct Scientist
Jean Mayer USDA Human Nutrition Research Center on Aging
Tufts University
Founder and Director, Institute of Lifestyle Medicine, Boston, MA
Published in cooperation withHarvard Medical School’s Institute of Lifestyle Medicine;
www.instituteoflifestylemedicine.org • American College of Preventive Medicine; www.acpm.org
Supported byKaiser Permanente; www.kaiserpermanente.org • Apollo Hospitals Group;
www.apollohospitals.com; www.ewellnessrx.com • American College of Sports Medicine; www.acsm.org
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Acquisitions Editor: Sonya Seigafuse
Managing Editor: Kerry Barrett
Project Manager: Alicia Jackson
Senior Manufacturing Manager: Benjamin Rivera
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Designer: Terry Mallon
Cover Designer: Scott Rattray
Production Service: Circle Graphics
ACSM’s Publications Committee Chair: Jeffrey L. Roitman, Ed.D., FACSM
ACSM’s Group Publisher: Kerry O’Rourke
Copyright © 2009 American College of Sports Medicine
530 Walnut Street
Philadelphia, PA 19106 USA
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All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any
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Printed in China
978-1-58255-739-7
1-58255-739-X
Library of Congress Cataloging-in-Publication Data
ACSM’s exercise is medicine : a clinician’s guide to exercise prescription /
edited by Steven Jonas, Edward M. Phillips.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58255-739-7
1. Exercise therapy. 2. Physical fitness. I. Jonas, Steven. II.
Phillips, Edward M. III. American College of Sports Medicine. IV. Title:
Exercise is medicine.
[DNLM: 1. Exercise—psychology. 2. Motivation. QT 255 A1865 2009]
RM725.A27 2009
615.8’2—dc22
2008054013
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted
practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any con-
sequences from application of the information in this book and make no warranty, expressed or implied, with
respect to the currency, completeness, or accuracy of the contents of the publication. Application of the informa-
tion in a particular situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in
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mended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clear-
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D E D I C A T I O N
For Chezna, and all of the other regular exercisers, past, present
and future, for whom this book has been written.
S.J.
To Alison,
My exercise partner and personal prescription
for health, love, and happiness.
E.P.
iii
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C O N T R I B U T O R S
Jennifer Capell, PT, MSc, MPH Edward M. Phillips, MD
Institute of Lifestyle Medicine Director, Outpatient Medical Services
Boston, Massachusetts Spaulding Rehabilitation Hospital Network
Boston, Massachusetts
Steven Jonas, MD, MPH, MS, FNYAS
Assistant Professor
Professor of Preventive Medicine and Department of Physical Medicine and
the Graduate Program in Public Health Rehabilitation
School of Medicine Harvard Medical School
Stony Brook University Assistant Physiatrist
Stony Brook, New York Massachusetts General Hospital
Adjunct Scientist
Evonne Kaplan-Liss, MD, MPH, FAAP
Jean Mayer USDA Human Nutrition Research
Director, Pediatric Environmental Center of
Center on Aging
Clinical Excellence at Stony Brook
Tufts University
Research Assistant Professor in the Graduate
Boston, Massachusetts
Program in Public Health, Preventive
Medicine, Pediatrics, and Journalism Mary Ellen Renna, MD, FAAP
School of Medicine Physician Nutrition Specialist
State University of New York at Stony Brook Woodbury, New York
Stony Brook, New York
iv
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CONTRIBUTORS v
The following organizations have endorsed this project:
• Institute of Lifestyle Medicine, Harvard Medical School
• American College of Preventive Medicine
• Kaiser Permanente
• Apollo Hospitals Group
• American Alliance for Health, Physical Education,
Recreation and Dance
• American Council on Exercise
• American Physical Therapy Association
• IDEA Health & Fitness Association
• Medical Fitness Association
• National Association for Health and Fitness
• National Athletic Trainers’ Association
• National Coalition for Promoting Physical Activity
• National Strength and Conditioning Association
The following organization supports this project:
• President’s Council on Physical Fitness and Sports
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C O N T E N T S
Foreword vii
Preface ix
Introduction: What This Book is About 1
1.On Clinician Engagement and Counseling . . . . . . . . . . . . . . . .13
STEVEN JONAS
2.On Organizing the Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
STEVEN JONAS
3.Risk Assessment and Exercise Screening . . . . . . . . . . . . . . . . . .31
EDWARD M. PHILLIPS AND JENNIFER CAPELL
4.Mobilizing Motivation: Basic Concepts . . . . . . . . . . . . . . . . . . .48
STEVEN JONAS
5.Mobilizing Motivation: The Wellness Pathway . . . . . . . . . . . .61
STEVEN JONAS
6.Mobilizing Motivation: Behavior Change Pyramid . . . . . . . . .70
EDWARD M. PHILLIPS
7.Getting Started as a Regular Exerciser . . . . . . . . . . . . . . . . . . . .84
EDWARD M. PHILLIPS, JENNIFER CAPELL, AND STEVEN JONAS
8.The Exercise Prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
EDWARD M. PHILLIPS AND JENNIFER CAPELL
9.Staying Active . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134
EDWARD M. PHILLIPS, JENNIFER CAPELL, AND STEVEN JONAS
10.TSTEP: Training Programs by the Minute . . . . . . . . . . . . . .151
STEVEN JONAS
11.Choosing the Activities, Sport, or Sports . . . . . . . . . . . . . . . . .168
STEVEN JONAS
12.Technique and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . .181
STEVEN JONAS
13.Special Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
EDWARD M. PHILLIPS
14.Exercise in Children: “Exercise is a Family Affair” . . . . . . . .230
EVONNE KAPLAN-LISS AND MARY ELLEN RENNA
15.Finding the Fun in Regular Exercise . . . . . . . . . . . . . . . . . . . .245
STEVEN JONAS
Appendix I: Glossary 253
Appendix II: Resources 255
Index 259
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F O R E W O R D
Exercise is Medicine™: A Clinician’s Guide to Exercise Prescription
By Robert E. Sallis, MD, FACSM
“Eating alone will not keep a man well; he must also take exercise. For food
and exercise ... work together to produce health.” Wise words. I was reminded
that this prescription is credited not to the American College of Sports Medi-
cine (ACSM), or the American Medical Association (AMA), or numerous other
stakeholders who advance health daily for mankind. As ACSM’s Historian,
Jack W. Berryman, PhD, FACSM, so pointedly noted, it was none other than
Hippocrates who gave this advice in his book Regimenin 400 B.C.E.
Today, ACSM, the AMA and many other supporting organizations are
calling on all physicians and healthcare workers to make physical activity and
exercise a standard part of a disease prevention and treatment medical para-
digm in the United States ... and the world.
Asanation,wehavealotatstakeingettingourcitizenstotakethe“Exercise
Pill.” The cost of inactivity is staggering, with an estimated 250,000 prema-
ture deaths annually in the U.S. directly attributed to inactivity and the costs
of medical care for inactive patients dwarfing that required to care for active
ones. Further, we are looking at a generation of children who are much less
fit than their parents and with the potential to be the first not to live longer
than their parents. I believe that physical inactivity will become the greatest
public health problem of our time if we do not take action.
This book is an important educational tool for physicians and other clin-
ical healthcare professionals committed to advancing the principles of the
Exercise is Medicine™ initiative. This book will help guide doctors to pre-
scribe exercise to their patients. A recent survey conducted of the public by
ACSM found that nearly two-thirds of patients (65%) would be more interested
in exercising to stay healthy if advised by their doctor and given additional
resources. However, only four out of ten physicians (41%) talk to their patients
about the importance of exercise, but don’t always offer suggestions on the
best ways to be physically active.
The time has come for physicians to become strong advocates for exercise.
They must ask about it at every patient visit and a patient’s activity level
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viii FOREWORD
should be looked at as a vital sign, because it is one of the best indicators of a
person’s health and longevity. Patients should be advised to engage in the
ACSM’s recommended 30 minutes of moderate exercise (such as a brisk walk)
on most (five or more) days each week. This is especially important in patients
who have, or are risk for, chronic diseases like diabetes or heart disease. This
message should be the same, regardless of medical provider or specialty and
this concept should be embraced and reinforced throughout all of organized
medicine.
On behalf of the American College of Sports Medicine, I want to thank
the American Medical Association for joining ACSM in making this program
an important joint effort. I also want to thank this book’s authors—Steven
Jonas, MD, MPH, MS, FNYAS, and Edward M. Phillips, MD—for dedicating
their time and talents to produce this book. I thank Evonne Kaplan-Liss MD,
MPH, FAAP, and Mary Ellen Renna, MD, FAAP, for lending their expertise
in authoring the chapter on pediatric exercise. And, as no successful project is
so without much support, ACSM duly recognizes the organizations that
cooperatively present this work: Harvard Medical School’s Institute of
Lifestyle Medicine and the American College of Preventive Medicine. You can
also find an impressive and extensivelist of supporting organizations and com-
panies on page v.
I hope this book will encourage you to prescribe exercise to all of your
patients!
Sincerely
Robert Sallis, MD, FACSM
President, American College of Sports Medicine
2007–2008