Aerobic Exercise Prescription in Rehabilitation: FITT-VP, Monitoring and Progression

FITT-VP framework

• Frequency: how often exercise is performed.
• Intensity: how hard the work is.
• Time: duration of each bout or accumulated session.
• Type: walking, cycling, swimming or another mode.
• Volume: total work across sessions.
• Progression: how the dose changes over time.

Intensity selection

Heart-rate methods can be useful when rhythm and medications permit, while rating of perceived exertion and talk-based monitoring are valuable when heart-rate response is altered. Intensity should match the patient’s clinical status and goal.

Starting dose

• Choose a mode the person can perform safely and consistently.
• Use shorter accumulated bouts when continuous exercise is not yet tolerated.
• Monitor symptoms, perceived exertion and recovery.

Progression

• Increase duration or weekly volume before large intensity jumps in deconditioned patients.
• Progress one major variable at a time.
• Add intervals, incline or speed when base tolerance is stable.
• Reassess functional capacity periodically.

Stop and reassess

• Chest pain, syncope, acute severe dyspnoea, new neurological symptoms or other clinically concerning responses require appropriate assessment.

Common mistakes

• Prescribing the same target heart rate to everyone.
• Progressing by calendar rather than response.
• Ignoring medication effects and comorbidity.

Clinical pearls

• The best dose is one that is safe, repeatable and progressive.
• RPE is a clinical tool, not a backup for poor programming.
• Track participation and functional capacity.

Concise summary

FITT-VP turns aerobic exercise into a modifiable prescription. Intensity, duration and progression should be individualized using clinical status, symptoms, recovery and meaningful functional outcomes.