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Their motto for determining an exercise prescription is 'FITT-PRO':

- Frequency - Intensity - Type - Time - Progression

According to FITT-PRO principles, an exercise prescription must explicitly instruct the patient regarding what type of exercise to do, how often, how hard, and for how long. The exercises must also progress over time as the patient becomes more physically fit. McDermott and Mernitz caution that, as with medication prescriptions, these exercise parameters must be personalized to suit each patient's health status and goals.

McDermott, who is also a licensed nutritionist, points out that fewer than half of older adults report ever having received a suggestion to exercise from their physicians. "Clinicians shouldn't feel like they have to be fitness experts to discuss exercise with their patients," she says. "These guidelines are intended to serve as a how-to manual for health care providers." The article provides sample prescriptions, as well as instructive tables and figures for clinicians to follow in creating individualized exercise prescriptions for their patients.

The authors explain, "There are four ways to improve physical fitness: aerobic exercise, resistance training, flexibility, and lifestyle modification." All programs should include combinations of these types of activities, and be tailored toward the individual's fitness goals. "For example," McDermott says, "when the goal is to improve functional capacity in activities of daily living, a cross-training program emphasizing the core muscle groups of the back, thighs, and abdomen is preferred."

"Only 30 percent of America's senior citizens engage in regular exercise," notes McDermott, "yet there is compelling evidence suggesting that people in all conditions of health and at all fitness levels benefit from regular physical activity. In fact, the most de-conditioned individuals have the greatest and fastest response." Mernitz adds, "Seniors tend to have less access than other demographic groups to physical activity information and programming. In contrast, they have relatively more contact with their health care providers."

"Starting an exercise program later in life can significantly modify risk factors, even if a person has been sedentary in prior years," McDermott concludes. "Health care providers can play a major role in offering effective and inexpensive primary or adjunct therapies, encourage appropriate physical activity, and dispel myths that persist as barriers to exercise in the elderly."

Among the useful resources McDermott and Mernitz reference is a book created by colleagues at the John Hancock Center for Physical Activity and Nutrition at the Friedman School of Nutrition Science and Policy at Tufts University, along with experts from the Centers for Disease Control and Prevention (CDC). The book (citation below), available as a PDF on the CDC web site, is called Growing Stronger: Strength Training for Older Adults, and contains detailed explanations and useful illustrations of strength-training exercises. It is intended to help seniors make strength training part of a regular exercise routine.

Contact: Siobhan Gallagher siobhan.gallagher@tufts.edu 617-636-6586 Tufts University

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