Quick Exercise PDF Prescriptions
Exercise Prescription in General Practice
A comprehensive, evidence-based resource for GPs and clinical staff at Bayview Family Practice. Structured using ICGP lifestyle advice guidelines, CMO physical activity recommendations, and NICE frameworks. Navigate by patient population using the condition cards below.
📋 UK/Irish Chief Medical Officers' Physical Activity Guidelines at a Glance
≥150 min moderate OR ≥75 min vigorous aerobic activity per week, plus muscle-strengthening on ≥2 days/week. Reduce sedentary time.
Same aerobic targets. Add balance and coordination activities on ≥2 days/week. Fall prevention is a priority. Even light activity is beneficial.
Some physical activity is better than none. Start low, progress gradually. Break up prolonged sitting with light movement every 30 minutes.
Begin with 10 min/day and progress. The greatest health gains occur when moving from completely sedentary to even lightly active.
ICGP & Brief Intervention Framework
The 5 A's of Brief Physical Activity Counselling (ICGP) — Structured approach for GP consultation — takes 2–3 minutes
🩺 For the Clinician
The ICGP recommends the 5 A’s framework for lifestyle brief interventions within the time constraints of general practice. It aligns with motivational interviewing principles and supports behaviour change readiness.
- Assess — Current activity level, barriers, readiness to change
- Advise — Clear, personalised advice on benefits and targets
- Agree — Collaborative, achievable goals with the patient
- Assist — Resources, referral, written prescription if needed
- Arrange — Follow-up appointment or review
🌿 Key Messages for Patients
- Even a small increase in activity has real health benefits
- You don’t need to go to a gym — brisk walking counts
- Breaking up sitting time every 30 minutes helps your health
- Start with what feels achievable, then build gradually
- Doing something you enjoy means you’ll keep doing it
Pre-Exercise Safety Screening — When to assess before recommending exercise — PAR-Q+ and red flags
Red Flags — Seek Assessment Before Exercise
- Recent MI, unstable angina, or uncontrolled arrhythmia
- Uncontrolled heart failure (NYHA III–IV)
- Severe aortic stenosis
- Acute systemic illness or fever
- Resting BP >180/100 mmHg (uncontrolled)
- Acute DVT or PE
- Acute musculoskeletal injury or fracture
- Proliferative retinopathy (limit Valsalva/heavy lifting)
General Safety Guidance
- Stop and seek help if you develop chest pain, dizziness, or breathlessness at rest
- Pain during exercise that is new or severe — stop and report
- Start slowly and build up — “talk test” is a safe intensity guide
- Stay hydrated, especially if on diuretics or in hot weather
- Wear supportive footwear
Sedentary & Insufficiently Active Adults
For patients currently doing little or no regular physical activity. The primary goal is to help them get moving — any increase from baseline has significant health benefit.
FITT Prescription — Getting Started — Evidence-based starting programme for sedentary adults
🩺 Clinician and Patient Notes
- Use validated tools: GPPAQ (GP Physical Activity Questionnaire) to assess baseline
- Record activity level in notes — enables monitoring
- The greatest mortality benefit is the shift from inactive → slightly active
- Social prescribing referral may support engagement in deprived areas
- Consider Written Exercise Prescription handout (see resources)
- Exercise on prescription (EOP) schemes available through HSE in some areas
🌿 Your Exercise Plan — Starting Out
- Week 1–2: Walk briskly for 10 minutes, 3 times a week
- Week 3–4: Increase to 15–20 minutes each time
- Month 2: Aim for 30 minutes, 5 days a week
- Choose a time that suits your routine and stick to it
- A walking buddy or podcast makes it enjoyable!
- Track your steps — aim for 7,000–10,000/day over time
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Behaviour Change Strategies — Motivational approaches for the GP consultation
- Explore motivation — “What matters most to you about your health right now?”
- Link activity to their goals — energy for grandchildren, managing blood pressure, mood improvement
- Identify barriers — time, pain, confidence, weather — and problem-solve collaboratively
- Start small — agree on one concrete, achievable action before next visit
- Build self-efficacy — celebrate small wins; every step counts
- Follow up — schedule a 4–6 week review to monitor progress and adjust
Patient-Facing Video & Digital Resources — Free, accessible resources to share directly with patients
Older Adults (65+ years)
Falls prevention, balance, strength, and maintaining independence are priorities. Exercise is one of the most effective interventions to prevent frailty, reduce falls risk, and improve quality of life in older age.
FITT Prescription — Older Adults — CMO-aligned multicomponent exercise for older adults
🩺 Clinician and Patient Notes — Key Priorities
- Falls risk: Use TUG (Timed Up and Go) or FRAT to assess falls risk
- Balance + strength exercises (e.g. Otago programme) reduce falls risk by ~35%
- Consider physiotherapy/ICTOP referral for targeted falls prevention programme
- Chair-based exercise appropriate for frail/limited mobility patients
- Rockwood CFS ≥5: tailor activity to function; frail patients still benefit from light activity
- Reassess regularly — activity can improve frailty scores
- Avoid sedentary time — even standing/light movement is beneficial
🌿 Exercise Guidance for Older Adults
- Try to move a little every day — walks, gardening, or housework all count
- Balance exercises: stand on one leg near a wall or chair for safety
- Strength: sit-to-stand from a chair (10 reps) is an excellent starting exercise
- Tai Chi classes (many available free for over-65s) are excellent for balance
- Swim or water aerobics if joint pain limits land-based exercise
- Age UK and HSE have free local programmes — ask your GP or nurse
Specific Exercise Programmes — Evidence-based structured programmes for older adults
| Programme | What It Is | Evidence | Suitable For |
|---|---|---|---|
| Otago Exercise Programme | Home-based strength & balance, 17 exercises, 3x/week | 35% fall reduction in RCTs | Community-dwelling older adults, mild–moderate frailty |
| Tai Chi (e.g. Sun style) | Slow, flowing movements improving balance and posture | Cochrane review: reduces falls risk | All older adults, especially those fearful of falling |
| Chair-Based Exercise | Seated aerobic, strength, and flexibility exercises | Improves strength, mood, and function | Frail, limited mobility, nursing unit residents |
| Nordic Walking | Walking with poles — engages upper body, aids balance | Improves cardiovascular fitness and balance | Active older adults, those with mild balance issues |
| Resistance Band Training | Progressive upper and lower body strengthening | Reduces sarcopenia, improves function | All older adults including BCNU patients |
Video & Digital Resources for Older Adults — Patient-accessible, free online resources
Type 2 Diabetes
Exercise is a cornerstone of T2DM management. Regular physical activity improves insulin sensitivity, HbA1c, cardiovascular risk, and weight. Both aerobic and resistance training are effective and complementary.
FITT Prescription — Type 2 Diabetes — Combined aerobic and resistance training for optimal glycaemic control
🩺 Clinician and Patient Safety Considerations
- Hypoglycaemia risk: Exercise may lower BGL — patients on insulin or sulfonylureas need monitoring
- Advise patients to check BGL before exercise if on insulin/SU; target >5.5 mmol/L before starting
- Carry fast-acting carbohydrate (glucose tablets) during exercise
- Foot care: Inspect feet before and after exercise; ensure appropriate footwear
- Cardiovascular screening before vigorous exercise in those with CVD risk factors
- Retinopathy: avoid Valsalva manoeuvres and very high-intensity resistance
- Autonomic neuropathy: impaired HR response — use RPE rather than HR targets
- SGLT2 inhibitors: risk of DKA during prolonged intense exercise — sick day rules apply
🌿 Exercise Tips for T2 Diabetes
- A 10-minute walk after each meal can significantly reduce blood sugar
- Aim for 30 minutes of brisk walking most days
- Try strength exercises 2 days a week — squats, resistance bands, or gym weights
- Check your feet before and after exercise for any sore spots
- Always carry glucose tablets if you take insulin or certain diabetes tablets
- Staying hydrated is important — especially in warm weather
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Diabetes-Specific Resources — NICE, Diabetes Ireland, and NHS patient resources
Cardiovascular Disease
Exercise is both preventive and therapeutic for cardiovascular disease. For stable CVD, structured exercise reduces mortality by 20–30%. Exercise should be guided, graduated, and regularly reviewed.
Safety First — Cardiovascular Contraindications — Do not prescribe exercise without reviewing these first
Recent MI (<6 weeks without cardiac rehab clearance) · Unstable angina · Uncontrolled arrhythmia · Severe aortic stenosis · Decompensated heart failure · Active endocarditis · Acute aortic dissection · Resting SBP >200 or DBP >110 mmHg
Moderate aortic stenosis · Hypertrophic cardiomyopathy · Controlled arrhythmia · Electrolyte abnormalities · Pacemaker · Known left main coronary artery stenosis · Moderate or severe systemic hypertension
FITT Prescription — Stable CVD / Post-Cardiac Rehab — After formal cardiac rehabilitation completion or for stable CVD without contraindications
Clinician and Patient Notes
- Post-MI/CABG: refer to structured cardiac rehabilitation programme (Phase II/III) before independent exercise
- GTN should be accessible during exercise for angina patients
- Beta-blockers blunt HR response — use RPE rather than HR targets
- For hypertension: aerobic exercise reduces SBP by ~5–8 mmHg; isometric hand-grip exercise also effective (NICE NG136)
- Heart failure (stable NYHA I–III): exercise training is safe and recommended (refer to cardiac rehab)
- Stop exercise if new chest pain, palpitations, dizziness, or excessive dyspnoea
Exercise After Heart Disease
- Exercise is safe and good for your heart when done at the right level
- Start with short, gentle walks and gradually increase duration and pace
- You should be able to hold a conversation during exercise — this is the right pace
- Always carry your GTN spray if prescribed
- Stop and rest if you feel chest tightness, dizziness, or severe shortness of breath — and contact your GP
- Cardiac rehabilitation classes are very effective — ask your GP for a referral
Hypertension — Exercise Prescription — Exercise as an adjunct to pharmacological management
Obesity & Weight Management
Exercise is essential for weight maintenance and cardiometabolic health, though diet provides the primary caloric deficit. Higher volumes of activity are needed for weight loss — but any activity improves health outcomes even without weight change.
FITT Prescription — Obesity — Higher volume exercise targets for weight management
Clinician and Patient Notes
- Low-impact exercise preferred to protect joints (knee, hip, ankle)
- Exercise for cardiometabolic benefit even if weight loss is minimal
- Resistance training preserves lean mass during caloric restriction
- Consider structured programme referral: Tier 3 obesity service, physiotherapy
- Obese patients with OSA: exercise improves AHI independently of weight loss
- For BMI >40 or joint pain: hydrotherapy/pool exercise is especially beneficial
- NICE NG187 (2022): multicomponent weight management programmes combining diet, exercise and behaviour change
Getting Active at Any Size
- You don’t need to run — brisk walking, cycling, or swimming are excellent
- Water exercise is gentle on joints but great for fitness
- Build gradually — 10 minutes more each week is a safe progression
- Any activity helps your blood pressure, blood sugar, and mood even before weight changes
- Strength exercises help preserve muscle and boost metabolism
- Chair exercises are a great starting point if mobility is limited
Resources — Obesity & Weight Management — Free, practical patient and clinician resources
Mental Health — Depression & Anxiety
Exercise is recommended by NICE as a first-line intervention for mild-to-moderate depression and anxiety. Evidence supports equivalent effectiveness to antidepressants in mild cases. Regular physical activity reduces the risk of depression by 25–35%.
FITT Prescription — Depression & Anxiety — NICE-recommended structured exercise for mental health
🩺 Clinician and Patient Notes
- NICE NG222 (Depression in Adults): structured supervised exercise recommended as part of Step 2/3 management
- Group or socially-facilitated exercise (walking groups, classes) has additional social benefit
- Social Prescribing may be an option
- For severe depression: exercise is adjunctive — not a replacement for clinical treatment
- Outdoor/green exercise has additional mood benefit (“green prescribing”)
- Yoga and mindfulness-based movement (e.g. Tai Chi) effective for anxiety
- Consistent scheduling helps — morning exercise particularly effective for mood regulation
🌿 Exercise for Mood & Mental Wellbeing
- Exercise releases natural mood-boosting chemicals in the brain
- Even a 10-minute walk outside can noticeably lift your mood
- Choose something you enjoy — you’re more likely to stick with it
- Group activities can help with social connection, which also helps mood
- Try to exercise at a regular time each day — routine is helpful
- Be gentle with yourself — on difficult days, even light stretching or a short walk counts
Resources — Mental Health & Exercise
Musculoskeletal Conditions
Exercise is the primary recommended treatment for osteoarthritis, non-specific low back pain, and osteoporosis. Many patients believe they should rest — the evidence strongly supports the opposite.
Osteoarthritis — Exercise Prescription — Hip and knee OA — exercise is first-line treatment
🩺 Clinician and Patient Notes — OA
- NICE NG226 (2022): Exercise is a core treatment for OA — above all pharmacological options
- Aerobic + strengthening + neuromuscular exercise all have evidence
- Physiotherapy referral for supervised, progressive programme
- Hydrotherapy particularly beneficial for severe joint pain limiting land exercise
- Pain during exercise is expected and does not indicate harm — counsel patients about this
- Weight loss of 5–10% of body weight significantly reduces knee OA symptoms
🌿 Exercise and Joint Pain
- Movement actually helps arthritis — it reduces pain and stiffness over time
- Water exercise is excellent if land-based exercise is painful
- Strengthening the muscles around your knee or hip protects the joint
- Some discomfort is normal when you start — it should settle. Sharp pain means stop
- Try not to stay completely still — short walks are better than bed rest
- Ask your GP about a referral to physiotherapy for a guided programme
Non-Specific Low Back Pain — Exercise is first-line — bed rest is harmful
Osteoporosis — Exercise Prescription — Bone-loading and balance to prevent fractures
Clinical Resources Library
All guidelines, patient-facing tools, video resources, and Irish-specific materials consolidated in one place. All resources are publicly available and free to access.