From Physical Activity Guidelines to Individual Exercise Prescription

Start with the guideline, then individualize

WHO recommends adults accumulate 150–300 minutes/week of moderate aerobic activity or 75–150 minutes/week vigorous activity, or an equivalent combination, plus muscle strengthening of major muscle groups on at least two days/week. These are population targets, not a starting dose for every rehabilitation patient.

• Establish baseline activity, medical status, symptoms, function, preferences and goals.
• Use talk test, RPE, heart-rate response or workload as appropriate to guide aerobic intensity.
• For resistance training, document exercise, load, sets, repetitions, effort and technique.

Safety and screening

• New exertional chest pain, syncope, severe unexplained dyspnea or acute illness warrants medical assessment rather than routine progression.
• Adapt for medications, cardiovascular/metabolic disease, neurological impairment, pregnancy, pain and other relevant conditions.
• When deconditioned, starting below public-health targets and progressing gradually is appropriate.

FITT prescription and progression

• Frequency: distribute sessions to permit both stimulus and recovery.
• Intensity: choose a level that is challenging enough to adapt but sustainable for the person's health and goals.
• Time: increase duration or accumulated bouts when continuous exercise is not initially tolerated.
• Type: select modes the person can perform consistently and that transfer to their goals.
• Progress one or two variables at a time; for resistance exercise, add repetitions within a target range before increasing load when appropriate.

Common mistakes and clinical pearls

• Do not prescribe only '30 minutes walking' without intensity or progression criteria.
• Do not assume soreness equals an effective session.
• Build adherence by reducing friction: accessible mode, realistic frequency and a clear backup plan.
• Reassess objective capacity and participation every few weeks, not only body weight or pain.

Summary

Guidelines provide the destination; clinical exercise prescription defines the route. A good program specifies FITT, monitoring, progression and reassessment while remaining flexible enough to sustain long-term participation.