Exercise prescription and patient outcomes

Abstract

Exercise is frequently prescribed yet our understanding of how to best optimize exercise prescription is limited, and we do not know which patient outcomes are most important. In this editorial, we outline challenges, innovations and future directions, and invite contributions to BMC Primary Care’s “Exercise Prescription and Patient Outcomes” Collection.

Main body

Exercise is one of the most underused treatment options in western healthcare systems [1]. Exercise prescription comprises therapeutic exercise, or that which is prescribed by an exercise instructor or health care professional and may or may not include physical activity. Exercise prescription as a component of healthcare is increasingly recognized for its potential to enhance patient outcomes across various populations and clinical conditions [2, 3]. By integrating physical activity into treatment plans within primary care settings, healthcare providers can effectively address a range of health concerns, such as chronic diseases, mental health disorders, and recovery from injuries. BMC Primary Care welcomes submissions to its new “Exercise Prescription and Patient Outcomes” Collection to expand our understanding of conditions that may benefit from the screening and delivery of exercise prescription in primary care, including how best to deliver exercise prescription, assessment for safe participation readiness, and capturing patient outcomes of greatest importance.

Impact of exercise medicine on chronic disease management

Exercise has been shown to improve heart and respiratory function [4], reduce cancer-related fatigue [5], improve pain levels and cognitive function [6], to name a few. The integration of exercise as medicine in primary care settings may help to address conditions like osteoarthritis [7], heart disease [4], diabetes [8], and low back pain [9], potentially reducing healthcare costs and improving quality of life. Recognition of the role of individual tailoring, shared decision-making and goal-setting discussions may help to improve outcomes and adherence to exercise prescription. However, there is limited understanding of the mechanisms that underpin effective exercise prescription. As awareness and acceptance of exercise prescription grows, so too does the need for robust research to elucidate its benefits further, alongside a deeper understanding of methods to facilitate adoption and adherence to prescribed exercise programs.

Primary care providers are in a unique position to assess exercise participation and include exercise prescription as part of their consultation. Primary care providers can build therapeutic relationships over time, and understand the complex interplay of patients’ medical, social and psychological histories. As such, they are in a unique position to provide individualized exercise prescription recommendations, maximizing proposed mechanisms such as trust, motivation and confidence [10]. However, there are significant limitations within primary care settings which vary globally and may influence the ability to effectively prescribe exercise as part of core treatments. Increasing patient demand, time constraints, funder requirements, and uncertainties over exercise dosage and duration may prevent primary care providers from engaging with this potentially beneficial intervention [2, 11]. We welcome research that explores mechanisms, effectiveness and implementation of different methods of exercise prescription in chronic disease management.

Tailoring exercise prescriptions for individual needs

There is a plethora of evidence supporting the need for exercise prescriptions to be individualized and tailored for optimal outcomes [1, 3, 12]. However, although the physical activity recommendations consider intensity and duration, the optimal exercise prescription for different conditions remains unknown. Within just the field of persistent low back pain, it is unclear what the best exercise type, dosage or duration is for optimal improvements in pain or function [13]. Digital prescription tools, mobile applications, online communities and monitoring programs are increasingly used by the general public, but it appears that few health care practitioners are routinely using these for monitoring of adherence or engagement, and we welcome research exploring digital platforms to increase exercise prescription engagement and adoption.

Physical activity and mental health benefits

Regular exercise promotes health and well-being in addition to lowering the risk of developing chronic disease. Despite compelling evidence and widespread recommendations for the role of physical activity in preventing and managing mental health disorders such as depression and anxiety, there is little evidenced implementation of this as a first line intervention [11, 12]. Raising awareness of the benefits of physical activity does not appear to be enough motivation: consistent messaging, assessment and encouragement from health care professionals may support integration into health consultations and treatments [12]. We welcome research that explores adoption, adherence and implementation strategies to support physical activity assessment and discussion within primary care consultations to prevent and manage mental health disorders.

Implementation challenges and establishing evidence-based approaches

Finally, exercise works through a multi-system approach, with possible different mechanisms underpinning effect in different conditions. Selecting the most relevant outcome to capture a clinically meaningful change can be difficult when these may vary across different populations, clinical conditions and settings. There is a need to establish evidence-based practices, interventions and implementation strategies facilitating exercise prescription in different disease and population settings. Across primary care, the assessment of physical activity in children and older adults, and healthy individuals needs to become an integral part of our health assessments to ensure disease prevention as well as assessment and treatment. Understanding how best we as researchers and clinicians can facilitate these system-level changes can only be achieved through partnering with the populations of interest, to understand how to better design care to meet their specific needs and improve relevant outcomes. We invite submissions to BMC Primary Care’s “Exercise Prescription and Patient Outcomes” Collection. We hope this collection will showcase new developments in exercise and physical activity research which further advances the growing evidence base for the improved prescription of exercise and capturing meaningful outcomes.

Authors’ contributions

LW and GIA conceived the manuscript, LW wrote the original manuscript, GIA and LW edited the manuscript. All authors read and approved the final manuscript.

Funding

No funding for this manuscript has been received. However, LW’s time is funded by the National Institute for Health and Care Research (NIHR) Exeter Biomedical Research Centre (BRC), NIHR School for Primary Care Research Post-doctoral fellowship (Award C111), and a NIHR Programme Development Grant (NIHR205671). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. GIA was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health under a mentored research scientist development award (K01DK129441).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable. Both authors have written and edited this manuscript and approved it for publication.

Competing interests

Both authors are Guest Editors of this collection. GIA is a scientific advisor for WellModeled LLC, has a provisional patent filed for a digital system for lifestyle medicine (047162-5346-P1US), and receives professional services from Calm.com (nominal fee), Labfront (full fee), and GlucoseZone (full fee). GIA. attests that none of these entities supported the work and none of them influenced the work, its design, or outcomes. GIA conducted the work outside of his responsibilities and affiliations with these entities.