Exercise Prescription and Program Design
Program design principles
Exercise prescription applies specificity, overload, progression, reversibility, individualization, and recovery. Use the FITT-VP framework: frequency, intensity, time, type, volume, and progression. Anchor the plan to baseline capacity, goals, preferences, and constraints. Include warm-up, conditioning, cool-down, and mobility or strength work as appropriate. Define progression criteria in advance. Adherence improves when the plan fits the client's schedule, resources, and preferences.
Monitoring and adjustment
Monitor response with symptoms, perceived exertion, performance, and adherence. Progress one variable at a time and avoid large jumps. Modify for pain, fatigue, illness, or schedule disruption. Document the rationale for changes.
Traps
Questions often feature a practitioner who copies a generic program, ignores medical clearance, or progresses too quickly. Another trap is assuming that more exercise is always better. Watch for plans that lack a baseline, measurable goal, or reassessment. Do not promise outcomes you cannot control.
Worked example
A sedentary client can walk 10 minutes comfortably. Rather than starting at 30 minutes, begin with 10 to 15 minutes at a moderate pace, two to three days weekly, and add 5 minutes when the client reports stable effort and no adverse symptoms. Reassess after two weeks.
Rule of thumb
Start below capacity, progress one variable, and make the next step explicit.
Health Promotion
Health promotion foundations
Health promotion addresses determinants of health, not just individual choices. Understand upstream factors such as income, housing, education, social support, and access. Use behaviour-change approaches such as the transtheoretical model, social cognitive theory, and self-determination theory. Motivational interviewing supports autonomy and builds discrepancy without confrontation. Goals should be client-owned, specific, and realistic. Health promotion also includes policy, environmental change, and community capacity building.
Equity and prevention
Avoid victim blaming. A person's environment can make healthy choices easier or harder. Tailor education to health literacy and culture. Link clients to community resources and consider population-level strategies as well as individual counselling.
Traps
Common distractors give advice before assessing readiness, argue with ambivalence, or set practitioner-driven goals. Another trap is treating health as a matter of willpower alone. Also avoid promising that one program will prevent all disease.
Worked example
A client says they know they should exercise but cannot start. Instead of listing benefits, you explore what matters to them, what has worked before, and what small step feels possible. The client chooses a 10-minute walk after lunch. You affirm autonomy and plan a review. Document the agreed goal and follow-up.
Rule of thumb
Ask before advising; explore before educating; let the client choose the first step.
Disease Prevention and Condition Management
Prevention levels
Disease prevention includes primary prevention (reducing risk before disease), secondary prevention (early detection and risk reduction), and tertiary prevention (limiting complications and improving function). Primary prevention often targets modifiable risk factors such as inactivity, tobacco use, poor diet, and stress. Condition management uses exercise, education, self-monitoring, and referral within an interprofessional plan. Know common precautions for cardiovascular, metabolic, musculoskeletal, and mental-health conditions.
Monitoring and referral
Monitor symptoms, medication effects, glucose, blood pressure when appropriate, and exercise tolerance. Recognize warning signs and refer promptly. Promote self-management with action plans and adherence support.
Traps
Questions often imply exercise is always safe or that one condition exists alone. Watch for missed hypoglycemia risk, uncontrolled hypertension, chest pain, or disproportionate fatigue. Avoid giving medication advice or changing treatment plans. Do not ignore mental-health flags or social barriers.
Worked example
A client with diabetes reports shakiness and sweating during exercise. Stop activity, check glucose if possible, provide fast-acting carbohydrate according to their plan, and seek help if symptoms do not resolve. Document and review the plan with the care team.
Rule of thumb
Prevention is not a single prescription; match the intervention to risk, condition, and setting, and refer when risk exceeds your scope.