Wellness Protocol: Physical Fitness Program

PHILOSOPHY:   Research shows that even low level exercise improves one's health status, although at least a moderate level of exercise is necessary for cardiovascular fitness. The intent of this fitness program is to promote physical activity among all individuals by:

1. Positively reinforcing any increase in physical activity, no matter how minimal, that is not injurious to the participant.



2. Suggesting various ways that activity could be incorporated into daily lifestyle, i.e., walking with children or walking the dog.



3. Recommending a gradual exercise program, adjusted to the individual, that would eventually meet the guidelines for physical fitness established by the American College of Sports Medicine (ACSM).

FORMAT:   The overall time frame of this program is from 8-12 weeks to a lifetime. The initial visit serves to acquaint the client with the benefits of exercise, record physiological measures, and aid the client in designing a program that takes into consideration the client's physical history and schedule. The next two visits occur at one-month intervals. During these visits, physiological measures will be re-assessed and appropriate program changes will be made. After this time, the client can be checked on a quarterly basis. Beginning exercisers should be contacted on a weekly basis to ensure that they have not encountered any difficulties and to lend support.

Participants are encouraged to return to the office at any time they desire further information, are having difficulties, or need support. If someone relapses, the cause should be established and recommendations made to get the client exercising again.

ONE-TO-ONE LOW/ MODERATE/ EXERCISE: SAMPLE PROGRAM

Complete physical fitness evaluation form. Refer client to physician if recommended in the ACSM guidelines.

1. Suggest increased activity in daily routine, I .e., park the car farther from the door at work or shopping mall.



2. Establish weekly exercise schedule---3 to 5 days per week. Have client increase walk time by 5 minutes per week for one month.



3. Counsel on proper walking pace and clothing/shoes. Helpful if client has buddy that walks at same pace.



4. Caution client not to consume any alcohol before exercising, because of its immediate effects on physical co-ordination and on the cardiovascular system.



5. Discuss signs of overexertion and the effects of temperature and humidity on exercise (Include information on altitude when appropriate).



6. Advise physician contact if client experiences symptoms related to cardiopulmonary disease, i.e., chest pain.

WEEKS 2-4

Check with client to see how his/her program is progressing. Address any concerns. If client has had difficulty starting an exercise program, ask about current time-of-day and level of alcohol consumption, explaining that for many people, taking a drink to relax makes them feel too sluggish to want to exercise. Suggest that if the drink is saved for later, it will be easier to exercise--and they may feel refreshed enough not to need it.

WEEK 5

Check the client's fitness regimen.

1. Re-evaluate weight, RHR, BP, waist/hip ratio.



2. Ask about current drinking patterns. (If client is drinking some alcohol, ask whether the amount or the timing of drinking is affecting ability to carry out the exercise program?) If client has changed timing or amount of alcohol consumption, congratulate the client on finding ways to make an exercise program work better for him or her.



3. Address any concerns. Review items 4,5 and 6 from Week 1.



4. Have client maintain comfortable pace and increase session from 20 min. to 30 min. during the next month.

Progress update (see Week 2).

WEEK 9

Check client's fitness regiment.

1. Re-evaluate physiological measures.



2. If client drinks alcohol, ask about consumption levels. Remind client about avoiding drinking before exercising. If consumption levels are above NIAAA guidelines, remind client of long-range damage to various organ systems if more alcohol is consumed in an hour than the liver can digest.



3. Address any concerns. Discuss fluid replacement. Review item 5. from Week 1.



4. Client has option of either:



• sustaining 30 minute session
• increasing session to 45 minutes
• splitting exercise into two 20 minute sessions per day. A comfortable pace should still be maintained.

WEEK 10-12

Progress update (See Week 2).

WEEK 13

Check client's fitness regimen.

1. Re-evaluate physiological measures



2. Ask about alcohol consumption and respond as needed.



3. Address any concerns



4. Client option dependent on decision made in week 9. Options:



• sustain 30 minutes session 3 to 5 days per week
• increase session to 60 minutes 3 days per week
• combination of duration possible but important to maintain exercise regiment.

Try to maintain this level. Allow individual to decide best time to fit into schedule; strongly suggest lunchtime walk. If possible, follow-up visits to re-evaluate physiological measures every 3 to 6 months.

Materials:

• Any standard textbook on exercise physiology.
• American College of Sports Medicine. Guidelines for Exercise Testing and Prescription. 6^th edition.
• American College of Sports Medicine. Resource Manual for Guidelines for Exercise Testing and Prescription. 4^th edition.