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My medical specialty (physical medicine and rehabilitation) has always attracted the jocks in medical school who not only appreciate exercise, but LOVE talking to their patients about it. Now more than ever, I see just about every type of physician, not just physiatrists (physicians specializing in physical medicine and rehabilitation), actively advocating exercise through organizations such as The American College of Sports Medicine, which is the largest sports medicine and exercise science organization in the world. Since 2007, the American College of Sports Medicine (which this year updated their recommendations on selecting running shoes), in combination with the American Heart Association has recommended that:

To promote and maintain health, all healthy adults aged 18 to 65 years need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 minutes on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 minutes on three days each week.

Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. For example, you can meet the recommendation by walking briskly for 30 minutes twice during the week and then jogging for 20 minutes on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-minute minimum by performing bouts each lasting 10 or more minutes.

Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, you should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week.

So that’s the minimum amount of exercise you should be doing.

Because of the dose-response relation between physical activity and health, if you wish to further improve your personal fitness, reduce your risk for chronic diseases and disabilities or prevent unhealthy weight gain you may benefit by exceeding the minimum recommended amounts of physical activity.

Increasingly, physicians are talking to their patients about exercise. Not just “are you exercising?” Rather they are having conversations about the specific types, amount, and intensity of exercises that their patients are engaging in. The Institute of Lifestyle Medicine, directed by my physical medicine and rehabilitation physician colleagues at Harvard Medical School, Edward “Eddie” Phillips, M.D. and Elizabeth “Beth” Pegg Frates, M.D., has been educating physicians and working with U.S. medical schools to incorporate exercise prescription into their curricula. Eddie and Beth who have been working on this for seven years now, have also helped spearhead the American College of Sports Medicine initiative, “Exercise is Medicine,” promoting physicians to regularly prescribe exercises in the same way that they prescribe medicines. That is, physicians should be able to prescribe the dose, amount, and how many times per week a patient should exercise.

Physicians are becoming increasingly knowledgeable about the musculoskeletal injuries that can occur with exercise and how to avoid them. A general guideline used by several of my colleagues is the 24-hour rule. It’s fine to get sore with exercise, but if you develop soreness or pain in a particular part of your body that stays for a full 24 hours after you did the exercise, that is a signal that you’ve done too much. Wait another 24 hours and cut back on the intensity and/or duration of the exercise.

Of course you don’t need to wait for your physician to ask you about exercise. I encourage you to engage him or her in a conversation about what you are doing. Try to be as specific as possible so he/she can help you best. Talk about all the different physical activities you’re doing – not just being at the gym – but housework, gardening, waiting tables, making rounds, etc. And talk about activities you’d like to try – running, swimming, hiking, etc.

Okay, so are you exercising as much as the American College of Sports Medicine recommends?

Haskerll WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-34.

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