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You know the drill: You go to the doctor. The doctor checks your pulse, your blood pressure, your cholesterol. If you are at risk, he or she scribbles out a prescription. Take two tablets twice a day with food.



But imagine a check-up with a different kind of prescription: Walk briskly; do some push-ups and lunges. Repeat.



It's called an exercise prescription. "It's very similar to any prescription. It's a specific dose of exercise, individualized to the patient and signed off by the doctor," says Dr. Robert Petrella, assistant director of the Lawson Health Research Institute and a University of Western Ontario professor who holds chairs in aging and health.

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Dr. Petrella's research reveals that the exercise prescription is a powerful and effective way to improve people's health. "We know it is effective. We've proven it using sophisticated measures of cardiovascular health," he says.



Mary and Tony Vanden Hengel received an exercise prescription last September: Walk at least 10,000 steps a day (measured using a pedometer) and add higher intensity at intervals to get your heart rate up to 23 beats per 10 seconds. Gradually work toward 60 minutes of exercise a day.



Mary is 52-years-old and says she is overweight, with high blood pressure that fluctuates. Her husband, Tony, is 61 and also overweight, with high cholesterol. They live in Seaforth, Ont., where they are both real estate agents. The Vanden Hengels received their exercise prescription when they enrolled in the ARTEMIS study, an international randomized trial led by Dr. Petrella that is assessing the effects of exercise on health.



"We are walking from 5,000 to 12,000 steps a day. We have a stationary bike, which we use two to three times a week. The pedometer motivates us to step more because we know exactly how many steps we have taken in a day. So by 7 p.m., if we have only stepped 4,000 steps, it gives us a good reason for a walk after supper," says Mary.



In only six months since they received their exercise prescription, Tony has lost 4.5 kilograms and his cholesterol has gone down 0.7 points. Mary has lost 5.4 kilograms and her blood pressure is more stable. They are not on as much medication as they were before. "We feel we know more about our health and feel confident we are as healthy as we can be," says Mary.



Dr. Petrella is pumped about the amazing health benefits of exercise. "No other treatment we can give can increase health to the same degree as exercise," he says. "No drug, no technology. It's the least amount of effort, and not expensive. There is nothing else like that."



He and colleagues found in a recently completed study of 360 patients at 40 doctors' offices across Canada that following an exercise prescription not only improved factors such as blood pressure, blood glucose and weight, but also blood flow to the heart and brain. The study was published in the May, 2010, issue of Canadian Family Physician.

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Right now in Canada, inactivity is an epidemic. Statistics Canada's latest figures show only 21 per cent of adults are physically active. That number dips to 17 per cent in those over 55. A sedentary lifestyle is linked to obesity, heart disease, stroke, diabetes, some types of cancer, and many other diseases.



Most family doctors (85 per cent) do ask patients about their physical activity levels and about 70 per cent provide verbal counselling about exercise.



But a much smaller number actually test fitness levels and only 16 per cent provide an exercise prescription, according to Dr. Petrella's research.



He has found the best advice from doctors is customized and exact. "Patients respond to their physicians but they need very tailored advice. This means physicians providing specific advice about what to do, at what effort and for how long." To get more doctors across the country using exercise assessments and prescriptions requires long-term funding by health ministries and large-scale adoption by local health networks and teams, he says. "That is the next step."



Recognizing that not all Canadians have a family doctor and not all family doctors prescribe exercise, Dr. Petrella and his team are piloting a project in rural Ontario using smart phones to deliver exercise prescriptions to folks who are at risk for diabetes and heart disease. "We are experimenting with remote technology so that patients can receive input wherever and whenever from their health team."



The program is interactive. Patients receive advice; they measure their activity levels using a pedometer and input their results; the health team then tells them what to work toward next. The project is funded by the Canadian Institutes of Health Research, the Canadian Diabetes Association and the Heart and Stroke Foundation. Results are due next year.

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Until more of us receive personalized advice on physical activity, we asked Dr. Petrella for an exercise prescription generalized to the entire population. "In an ideal world," he answered, "Exercise three or more times per week, for 30 or more minutes a day. Make it something you enjoy, at an intensity that challenges you. Come back in three months."

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