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The Exercise Prescription.

Making shaping up a top priority in the health-care industry.

"Take two aspirin and call me in the morning." This well-known prescription characterizes an outdated role of doctors. Typically, we see a physician when we are ill, injured or in need of medicine or other treatment to ease symptoms.

Providing health care and guidance for the prevention of ailments is still a low priority for both professionals and the public. In 1988, physicians provided exercise counseling for only 30% of sedentary patients, according to the U.S. Department of Health and Human Services.

Today, with the creation of Healthy People 2000: National Health Promotion and Disease Prevention Objectives, there is a new trend developing that will benefit all of us. Comprised of a consortium of organizations, including the U.S. Public Health Service, Healthy People 2000 strategizes to improve Americans' health by the next decade. Its focus is on preventive medicine.

One of the campaign's objectives--increase to at least 50% the proportion of primary care providers who assess and counsel patients regarding physical activity--is addressed in a book entitled The Exercise Prescription (W.B. Saunders, 1991). The latest edition in a quarterly book series called "Clinics in Sports Medicine," The Exercise Prescription encourages doctors, physical therapists and other health care providers to think in terms of disease prevention, not just treatment.

Nicholas A. DiNubile, M.D., an orthopaedic surgeon at the Graduate Hospital Human Performance and Sports Medicine Center in Wayne, Pennsylvania, chose the subject matter for The Exercise Prescription and recruited several co-workers to help write the book. Exercise specialists from the U.S. Olympic Committee and the Institute for Aerobics Research in Dallas, Texas also contributed information.

The director of the center's human performance division, Michael H. Cox, Ph.D., who is internationally known for work with elite athletes and broad research in exercise science, contributed a chapter entitled "Exercise Training Programs and Cardiorespiratory Adaptation." In his chapter, Cox details how proper exercise methods can improve the efficiency of the cardiorespiratory system. He recommends an exercise stress test to establish safe exercise prescriptions, evaluate patients at risk and determine the effectiveness of an exercise program.

The dilemma of how to keep fit when you are injured is covered in a chapter co-written by physical therapist Pat Croce and orthopaedic surgeon John R. Gregg, M.D. The authors stress the importance of not only treating and protecting the injured area, but also keeping the rest of the body as fit as possible. Through alternative sports, cross training or water exercise, the patient can preserve the integrity of an injured joint, keep the non-injured muscles active and maintain cardiovascular fitness. According to the authors, any exercise prescription for the injured athlete should emphasize the body's most vital muscle, the heart.

For overall muscle maintenance, weight training is an effective means of building up resilience. DiNubile recommends a program of full-range isotonic exercise using a combination of free weights, variable resistance machines and cable-weight machines. DiNubile explains the dynamics of weight training through principles of "overload" and "specificity." Without adherence to these principles, gains cannot be expected, says DiNubile, who also serves as orthopaedic consultant for the Pennsylvania Ballet.

Exercise relates directly to pulmonary disease, the prevention of coronary artery disease, healthy body development in children and adolescents, healthy reproductive systems and pregnancy, longevity, weight control, back pain and even mental health. But, like any prescription for health, a patient's therapeutic benefits will depend on overall behavior rather than a miracle cure. Other aspects of exercising, flexibility and stretching, play a role in preventing injury or pain.

Arnold Schwarzenegger, chairman of the President's Council on Physical Fitness and Sports, echoes many of the same concerns. "My hope is that each time physicians, regardless of their specialty, meet a patient, a category of treatment in their mental checklist is exercise, and a page of their prescription pad reflects this," he has said.

For more research on working out for preventive wellness, The Exercise Prescription ($31) can be ordered by calling (800) 654-2452.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Long, Betsy Dru
Publication:American Fitness
Article Type:Book Review
Date:May 1, 1992
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