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Physical activity for patients: an exercise prescription
  1. D Gerrard

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    Edited by A Young, M Harries. London: Royal College of Physicians, 2001, £15.00, pp 159. softcover. ISBN 1860161286

    This informative book addresses an important contemporary issue. It focuses on the prescription of exercise, a concept stimulated by the 1996 announcement by the US Surgeon General, of the benefits of regular physical activity to the community at large. A geriatrician and a respiratory physician are joint clinical editors of this publication with its genesis in a conference held at the Royal College of Physicians in 2000. It attracted a group of clinicians, researchers, and healthcare providers to address the positive influence of exercise on a range of common clinical conditions.

    The first few chapters provide evidence based arguments for the benefits of physical activity in osteoarthritis, chronic heart failure, obesity management, diabetes, the preservation of health in old age, and in injury rehabilitation. Following this section is a group of papers that offer sound guidelines for the delivery of exercise to specific groups including children, the disabled, the chronically fatigued, and the vulnerable aged population.

    If asked to choose the two most valuable contributions in this book, I would unhesitatingly highlight the sections on prescribing exercise for preadolescents and establishing a basis for the training of exercise practitioners. Several authors make particularly relevant comments on the implementation of programmes of physical activity through a consistent standard of training, combined with frequent monitoring of exercise prescribers. Accredited providers demand a consistent standard of undergraduate education in sound clinical principals taught by recognised tertiary institutions. The weekend certification of the “fitness instructor” must be discouraged and replaced by a professional course under the aegis of a national educational accreditation system. Graduates from acknowledged tertiary courses in health sciences would seem most appropriately qualified to work in this area. A robust professional agency of oversight must set standards of competency, ethical behaviour, and clinical practice. The continuing maintenance of professional standards and collaboration with other healthcare professional groups are additional requisites. For exercise prescription to have impact there must be a process of delivery that meets the needs of practitioners and ensures safety and efficacy for patients. This is neither the sole preserve of the physiotherapy profession nor the singular domain of the physical educator.

    This book provides a welcome addition to the library of those clinicians with an interest in exercise prescription. It offers informed statements on the clinical benefits of an active lifestyle and describes treatment protocols highlighting the benefit of combining physical therapy with medical and pharmacological agents. Examples include the contemporary management of asthma, diabetes, and certain forms of cancer that routinely include exercise prescription. Many psychological disorders are also often managed in a similarly active milieu.

    This book underscores the need for well trained, accredited health professionals. I recommend this publication by the College of Physicians and congratulate the editors for reminding us how important exercise is to our increasingly more sedentary mechanised society.

    Presentation16/20
    Comprehensiveness15/20
    Readability15/20
    Relevance18/20
    Evidence basis18/20
    Total82/100

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