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.

ICGP Aligned CMO Guidelines 2019 NICE NG187 / NG58 FITT Framework February 2026

📋 UK/Irish Chief Medical Officers' Physical Activity Guidelines at a Glance

Adults (19–64 yrs)

≥150 min moderate OR ≥75 min vigorous aerobic activity per week, plus muscle-strengthening on ≥2 days/week. Reduce sedentary time.

Older Adults (65+ yrs)

Same aerobic targets. Add balance and coordination activities on ≥2 days/week. Fall prevention is a priority. Even light activity is beneficial.

Key Message

Some physical activity is better than none. Start low, progress gradually. Break up prolonged sitting with light movement every 30 minutes.

Inactive Patients

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

 

🩺 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
 

 

🩺 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.

Age 19–64 Behaviour Change Focus CMO 150 min Target

 

F
Frequency
3–5 days/week initially, building to daily activity
I
Intensity
Moderate: can talk but not sing (“talk test”). RPE 12–14/20
T
Time
Start 10 min/session. Build to 30 min. Total 150 min/week
T
Type
Brisk walking, cycling, swimming. Any sustained movement

🩺 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

NHS Couch to 5K The NHS C25K app is an excellent free resource for sedentary adults beginning a running programme. 9-week structured plan. Available on iOS and Android via NHS.uk C25K
  1. Explore motivation — “What matters most to you about your health right now?”
  2. Link activity to their goals — energy for grandchildren, managing blood pressure, mood improvement
  3. Identify barriers — time, pain, confidence, weather — and problem-solve collaboratively
  4. Start small — agree on one concrete, achievable action before next visit
  5. Build self-efficacy — celebrate small wins; every step counts
  6. Follow up — schedule a 4–6 week review to monitor progress and adjust
🔗
NHS Better Health Campaign Free patient-facing resources, apps, and tools: nhs.uk/better-health/get-active — includes the Active 10 walking app and One You resources.
Motivational Interviewing Social Prescribing Brief Intervention GPPAQ Assessment

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.

Falls Prevention Balance Training Strength for Function BCNU Relevant

 

F
Frequency
Aerobic: 5 days/week. Strength + balance: 2–3 days/week
I
Intensity
Moderate aerobic. Strength: working to mild fatigue. Balance: challenging but safe
T
Time
150 min/week aerobic. 20–30 min strength/balance sessions. Short bouts acceptable
T
Type
Walking, water aerobics, Tai Chi, yoga, resistance bands, chair exercises

🩺 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
 

 

ProgrammeWhat It IsEvidenceSuitable For
Otago Exercise ProgrammeHome-based strength & balance, 17 exercises, 3x/week35% fall reduction in RCTsCommunity-dwelling older adults, mild–moderate frailty
Tai Chi (e.g. Sun style)Slow, flowing movements improving balance and postureCochrane review: reduces falls riskAll older adults, especially those fearful of falling
Chair-Based ExerciseSeated aerobic, strength, and flexibility exercisesImproves strength, mood, and functionFrail, limited mobility, nursing unit residents
Nordic WalkingWalking with poles — engages upper body, aids balanceImproves cardiovascular fitness and balanceActive older adults, those with mild balance issues
Resistance Band TrainingProgressive upper and lower body strengtheningReduces sarcopenia, improves functionAll older adults including BCNU patients

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.

HbA1c Reduction ~0.5–0.7% Aerobic + Resistance NICE NG28 Aligned

 

F
Frequency
Aerobic: ≥3 days/week (no more than 2 consecutive rest days). Resistance: 2–3 days/week
I
Intensity
Moderate to vigorous. RPE 12–16. Mix HIIT if tolerated (reduces HbA1c effectively)
T
Time
150–300 min moderate/week or 75–150 min vigorous/week. Resistance: 2–4 sets, 8–12 reps
T
Type
Walking, cycling, swimming + resistance bands, bodyweight exercises, weights

🩺 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

Post-meal Walking Research shows a 10–15 minute brisk walk within 30 minutes of eating can significantly blunt post-prandial glucose spikes. This is highly practical for T2DM patients.

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.

Cardiac Rehab Hypertension Heart Failure (Stable) Post-MI
🛑
Absolute Contraindications to Exercise Testing/Vigorous Exercise
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
⚠️
Relative Contraindications — Assess Individually
Moderate aortic stenosis · Hypertrophic cardiomyopathy · Controlled arrhythmia · Electrolyte abnormalities · Pacemaker · Known left main coronary artery stenosis · Moderate or severe systemic hypertension

 

F
Frequency
3–5 days/week aerobic. 2 days/week resistance
I
Intensity
40–80% HRmax OR RPE 11–14. “Can talk in short sentences.” Stay below angina threshold
T
Time
Start 15–20 min, build to 30–45 min sessions. Minimum 150 min/week moderate
T
Type
Walking, cycling, swimming. Light-moderate resistance. Avoid isometric heavy lifting

🩺 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

 

F
Frequency
5–7 days/week aerobic. 2–3 days/week resistance
I
Intensity
Moderate aerobic (40–60% HRR). Avoid high-intensity isometric exercise
T
Time
30–60 min/day. Can be broken into 10-min bouts
T
Type
Walking, cycling, swimming, resistance training. Isometric hand-grip 4x2min, 3x/week
📊
Evidence Summary Regular aerobic exercise reduces SBP by ~5–8 mmHg and DBP by ~3–5 mmHg. Isometric handgrip exercise (4×2 min at 30% MVC) reduces SBP by ~10 mmHg in hypertensive patients (NICE NG136, 2023 update). Exercise should be started when BP <180/110 mmHg.
❤️
BHF Exercise with Heart Condition British Heart Foundation patient guide

 


📄
NHS CVD Lifestyle Guidance NHS patient-facing CVD exercise advice

 


📋
NICE CG172 — MI Rehabilitation Includes cardiac rehab exercise guidance

 

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.

BMI ≥30 NICE NG187 Aligned Joint Protection 200–300 min/week Target

 

F
Frequency
5–7 days/week aerobic. 2–3 days/week resistance
I
Intensity
Moderate initially (RPE 12–14). Build to moderate-vigorous as fitness improves
T
Time
200–300 min/week for weight loss. Start with 150 min/week and progress
T
Type
Low-impact: cycling, swimming, water aerobics, walking. Resistance for muscle preservation

🩺 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

📌

Key Message for Patients Exercise improves blood pressure, blood sugar, mood, and fitness — even before significant weight loss occurs. Frame exercise as a health behaviour, not just a weight loss tool. This improves long-term adherence.

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%.

NICE CG90 / NG222 First-Line Mild-Moderate Social Prescribing

 

F
Frequency
3–5 days/week. Consistency is more important than intensity for mental health
I
Intensity
Moderate aerobic preferred. Even gentle walking is effective. Avoid very high intensity if anxiety-prone
T
Time
30–45 min/session. Short bouts acceptable. Build gradually from current level
T
Type
Any enjoyable activity: walking, yoga, cycling, group classes, swimming, dancing

🩺 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
🌿
Green Prescribing / Social Prescribing Referral to local walking groups, parkrun, gardening groups, or outdoor activity through a link worker/social prescriber has evidence for mild-moderate depression and social isolation. Ask your practice about social prescribing referral pathways.

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 Low Back Pain Osteoporosis NICE NG226 Aligned

 

F
Frequency
3–5 days/week aerobic. Strength 2–3 days/week
I
Intensity
Moderate. Low-impact activities preferred. “Good pain” (muscle ache) is OK; sharp/joint pain is not
T
Time
150 min/week aerobic. 8–12 reps x 2–3 sets strength. Progress gradually
T
Type
Water aerobics, cycling, walking, quad strengthening, resistance bands

🩺 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

 

F
Frequency
Daily movement. Structured exercise 3–4 days/week
I
Intensity
Begin gently. Progress to moderate. Avoid provocative positions initially
T
Time
20–40 min/session. Core stability and mobility daily
T
Type
Walking, swimming, yoga, Pilates, core stability, McKenzie exercises
Key Clinical Message Advise patients that staying active is safe and helps recovery. Bed rest prolongs disability. Psychosocial factors (fear avoidance, catastrophising) are the strongest predictors of chronicity — address these directly. NICE NG59: exercise therapy is first-line treatment for LBP.
📄
NHS Back Pain ExercisePatient guide to treating and managing back pain

 


▶️
Back Pain Exercises (NHS YouTube)Guided exercises for low back pain

 


📋
NICE NG59 — Low Back PainGuideline recommending exercise as first-line

 

 

F
Frequency
Weight-bearing 4–5 days/week. Balance training 2–3 days/week
I
Intensity
Moderate to vigorous impact loading where safe. Progressive resistance
T
Time
30–60 min weight-bearing activity. Short bouts acceptable
T
Type
Walking, jogging, dancing, stair climbing, resistance training. Avoid swimming alone (non-impact)
⚠️
Fracture Risk Caution For patients with established osteoporosis and high fracture risk (e.g. FRAX score, previous vertebral fracture), avoid high-impact loading and forward spinal flexion under load. Refer to physiotherapy for tailored programme. Falls prevention is a priority — see Older Adults tab.
🦴
Royal Osteoporosis SocietyExercise recommendations for bone health

 


▶️
Bone Strength Exercise (ROS)YouTube — exercises for osteoporosis

 

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.

Guidelines Patient Tools Video Resources Irish Resources

Clinical Guidelines & Frameworks


Patient-Facing NHS & Irish Resources


🎬 Free Patient-Facing Video Resources (YouTube)


Clinical Assessment Tools

ℹ️
Note on URLs All links above were verified as publicly accessible at time of document preparation (March 2026). URLs for NICE, NHS, and ICGP guidance may update. If a link is broken, search the title directly at nice.org.uk, nhs.uk, or icgp.ie.