Prescribing Physical Activity for Cardiovascular and Metabolic Health

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Abstract
More than half of all Americans do not engage in regular physical activity of even moderate intensity, with nearly 1 in 4 reporting no leisure-time physical activity. Despite the well-known benefits of regular exercise, fewer than half of physicians counsel their patients on increasing physical activity. Aerobic exercise of a minimum intensity of only 30% to 40% of heart rate reserve is sufficient to improve cardiovascular fitness in most individuals, with a goal of gradually progressing to 60% to 80% heart rate reserve. Exercise duration and frequency are also gradually increased to maximize cardiovascular stimulus. The goal is a minimum weekly energy expenditure of 1000 kcal per week, and 2000 kcal per week or more may be needed for weight loss and/or management. Strength training 2 to 3 days per week is recommended as an adjunct to regular aerobic exercise, especially for those with impaired glucose/insulin metabolism. It is safe for most elderly individuals to follow these guidelines, including strength training, as long as appropriate precautions are taken.