Medical-Fitness Technician
Certification Course
Part D: Medical-Fitness Training
Learning Modules: 35-​38
Learning Module 35:
The Exercise Rx
Study the Module and take the Quiz.
Learning Objectives
  • Understand the F.I.T.T. Formula for writing an Exercise Rx.
  • Know how to write a medically appropriate Exercise Rx.
Issuing a medically appropriate Exercise Rx for your client is a primary objective of each Medical-Fitness Assessment. Your client's Exercise Rx serves as the foundation of his/her Therapeutic Fitness Training Program.

The variables of each client's personalized Exercise Rx needs to specify the Frequency, Intensity, Duration (Time), and Type of exercises. This is referred to as the F.I.T.T. Formula for writing Exercise Rx's.
The starting exercises may seem too light to generate any real improvement in fitness, but as a Therapeutic Fitness Trainer you need to realize that your low-fit clients have not exercised for many years. The objective is to simply get these clients off the couch -- and to start moving.

Start Low, Go Slow: Not only are the rep counts low and the pace slow, many clients will need to be shown how to modify the calisthenic exercises, so that they can do a version of the movements without getting discouraged or injured. These clients will appreciate your concern and caution.

Err on the Side of Caution: Many of your other Therapeutic Fitness Training clients will not be as de-conditioned and are allowed to exceed their Exercise Rx by progressing to faster speeds and higher reps. These clients will perceive your services with a high level of value and satisfaction.

Most of the Exercise Rx's that you issue should include instructions for your client to do the prescribed exercises "as a minimum" and to "advance as tolerated." Exercise is powerful medicine, but unlike regular pharmaceuticals, more is better -- up to a point (more about that below).

Your Exercise Rx's should be up-dated every 1-3 months, depending on your client's health status and personal fitness goals.
  • If your client is following the prescription, his/her fitness is improving and the Exercise Rx will need to be up-dated based on his/her new Fitness Test Scores.
  • If your client is not following the prescription, his/her fitness is not improving, or even getting worse, and the client is unlikely to follow-up, but if they do, they will realize that their fitness level decreases over time from their lack of exercise.
  • Be sure to contact your clients that fail to follow-up and encourage them to continue (resume) their Therapeutic Fitness Program.
  • Try to discover the reason your client is having difficulty adhering to the Exercise Rx and offer some simple solutions.
Fitness Training Progression
In the Exercise Rx Chart above, notice the gradual progressions based on the Fitness Scores. This not only helps ensure safe and effective fitness development, it also helps ensure:
  • Less DOMS - Delayed-Onset Muscle Soreness.
  • Greater Adherence to the Exercise Rx for better results.
  • More confidence and internal motivation.

The different progressions are described below. These are important because as your client's level of fitness improves, he/she will notice having more energy, not only for their "activities of daily living," but also to start developing a more active lifestyle.

Most of your clients will have a long history of a very sedentary-lifestyle. Expecting them to be enthusiastic about working out is not realistic. Most of your clients will not enjoy exercise for exercise's sake. Their goal is to regain some level of health and fitness at "as low an effective dose as possible." Many hope to continue in their sedentary lifestyle, but with less shame and guilt.

Your most challenging objective is to help your clients discover the value of fitness by experiencing a variety of recreational activities and to simply start enjoying a higher quality of life, without having to endure overly demanding workouts every day.
Adjusting the F.I.T.T. Formula
Consider the following variables when writing and up-dating your client's Exercise Rx.

​T = Type:
  • The types of exercise for the lower fitness levels (0-59) is walking and modified calisthenics.
  • The types of exercise for the higher fitness levels (60-100+) is jogging and standard calisthenics.
  • After your client has developed a basic fitness foundation, he/she can start adding an endless variety of different types of exercises for more variety and fitness benefits.

T = Time (Duration):
  • The duration for the lower fitness levels (0-59) is 10-15 minutes per session at a low intensity (slower pace and fewer reps), but  for three sessions per day.
  • The duration for the higher fitness levels (60-100+) is 15-20 minutes per session, and at a gradually increasing intensity (faster pace and more reps), but for only two sessions per day.
  • The first goal of every Therapeutic Fitness Training Program is to establish a daily pattern of exercising 30+ minutes per day.

F = Frequency:
  • The second goal of every Therapeutic Fitness Training Program is to establish a weekly pattern of exercising 5-6 days per week.

The recommendation to quickly establish a frequency of 6 days per week greatly improves your client's success in making a permanent therapeutic lifestyle change because exercise becomes part of their daily routine.
  • Having 1 day of rest from formal exercise is extremely important, because it improves long-term adherence to an on-going Therapeutic Fitness Training (Maintenance) Program.
  • The client should be encourage to participate in recreational outdoor physical activities such as a casual walk or a more strenuous hike on their weekly rest day.
  • More demanding or skill-based activities, such as swimming, cycling, kayaking, or recreational sports such as pickle ball, basket ball, or soccer should be deferred until their health and fitness level will allow safe participation and an enjoyable experience.

I = Intensity:
  • Although the duration of each aerobic session remains constant (10 minutes), the amount of work done within that time gradually increases in intensity (speed) for greater distance in the same amount of time.
  •  The time for strength training (calisthenics) also remains relatively constant (5-10 minutes per session), but the work accomplished in this time increases dramatically from 40 modified reps to 240 standard reps.
  • Prescribing an adequate, but safe level of intensity uses the overload principle to ensure fitness gains are achieved efficiently while avoiding counter-productive over-training and the risk of injury.
  • Adjusting the intensity, rather than the duration, in fitness training is not only more effective physiologically, it also improves adherence because it allows more consistent scheduling of the exercise sessions by remaining fairly constant.
​Ensuring Medical Appropriateness
Although research clearly shows a dose-dependent response to exercise for a wide variety of chronic, sedentary-related diseases, more exercise is not always better. Exercise has a high safety margin, but it is possible to overdose (over train).

The Medical-Fitness Technician must be especially careful when using exercise as "medicine,"  because it is indeed powerful. The fitness industry's unqualified recommendation of "the more, the better" should be avoided -- even in the case of basic exercises. A more appropriate guideline is "the more, the better -- up to a point," and that point is different for each individual.

As a team member with other professionals in the healing sciences, Medical-Fitness Technicians must always abide by the primary directive to "do no harm." In order to help ensure that the Therapeutic Fitness Training Programs you prescribe are medically appropriate, keep the variables listed below in mind for each and every individual client:
  • Always screen your client to determine if Medical Clearance is indicated.
  • If Medical Clearance is indicated, always obtain written instructions from your client's personal physician.
  • Your client's Medical Clearance is usually conditional, so be careful to follow the physician's instructions. 
  • Always consider your client's age, gender, and health status, plus any physical disability or mental impairment.
  • If you have a question or concern, obtain permission from your client to contact his/her personal physician.
  • If your client is Class 2 or 3 Obese (BMI > 35), limit physical activity to walking or some other safe, aerobic, low-intensity, low-impact exercise until enough weight has been lost.
  • If your client has a significant weight-loss goal, refer him/her to a certified Medical-Nutrition Cullinarian as an adjunct therapy (additional to your Fitness Training) for maximum results.
  • Use the Med-Fit Exercise Rx Guidelines based on your client's Medical-Fitness Assessment, but "error on the side of caution" and encourage your client to "progress as tolerated." (Start Low, Go Slow)
  • If your client is < 18, always keep a parent or legal guardian informed about all Therapeutic Fitness Training recommendations.
  • Modify exercises as needed and verify your client's ability to perform them during a Therapeutic Fitness Training session.
  • Limit your Exercise Rx's to a 4-12 week "therapeutic trial" and have your client follow-up frequently, especially when close monitoring is indicated, such as with concurrent medical treatment or sudden changes in health status.
  • Closer monitoring (4 weeks) is more often indicated in the earlier phases of clients who are obese or significantly de-conditioned, chronically ill, advanced age or frail, have limited social support, and/or are less familiar with exercise.
Sample Exercise Rx for a Low-Fit Client:
Med-Fit Score = 40-49
Your goal is to Exercise 30 minutes per day, 6 days per week, but start low and go slow:
  • Gradually increase your exercise duration to 15 minutes per session.
  • Walk for 10 minutes and do Calisthenics for 5 minutes per daily session.
  • Quickly increase your weekly frequency to 6 days per week.
  • Have a consistent rest day once a week.
  • Gradually increase your daily frequency to 2 sessions per day.
  • Gradually increase your walking intensity to 3.5 mph.
  • That is a distance of 0.58 miles in 10 minutes.
  • Use an App to measure your distance, such as "MapMyWalk."
  • Gradually increase the Calisthenic Reps per session to:
  • 20 Squats,
  • 10 Leg-Raises,
  • 5 Push-Ups,
  • 5 Inverted-Rows
  • Gradually advance your movements from modified to standard.
  • Be sure to log each exercise session!