Medical-Fitness Technician
Certification Course
Part D: Medical-Fitness Training (LM: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. The client's Exercise Rx serves as the basis of their Medical-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.

Your client's Total Fitness Score is a composite of the client's four separate Fitness Scores:
  • Aerobic Fitness Score (4-minute Shuttle or Treadmill)
  • Leg Muscle Fitness Score (3-minute Squats)
  • Core Muscle Fitness Score (2-minute Leg-Raises)
  • Arm Muscle Fitness Score (1-min Push-Ups + 1-min Rows)

Your client's Exercise Rx is based on their Total Fitness Score, because our Med-Fit Assessment was designed to correlate as closely as possible to the client's real-life Functional Capacity. By adhering to their Exercise Rx, the client's improvement in their Functional Capacity is accurately reflected in their new Total Fitness Score of their next Follow-Up Med-Fit Assessment.
Note: The Exercise Rx does NOT need to take into consideration the client's personal health and fitness goals. It is safe and reasonable to assume that prescribing a lifestyle therapy to "move more" or to "keep moving" is medically indicated. This is the easier "science" part of your role as a health and fitness professional. However, you will need to consider the client's personal fitness goals if/when the client is unable to adhere to the Exercise Rx and schedules an optional Follow-Up Consult to review their Fitness Logs and adjust their Trining Program. That is where the "art" of your profession will take place as explained in the next Learning Module.
Fitness Training Progression
In the chart above, notice the gradual progressions in the Exercise Rx is based on the Total Fitness Score. This helps ensure safe and effective fitness improvement. The different progressions are described below:

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, an endless variety of different types of exercises can be added or substituted to further improve overall fitness or target special areas.
  • As your client's level of fitness improves, they will notice having more energy for all their "tasks of daily living."
  • More energy will allow your client to start developing a more active lifestyle.
  • They can also take up a variety of recreational activities for personal enjoyment and a higher quality of life. 

T = Time (Duration):
  • The duration for the lower fitness levels (0-59) is 25 minutes per session at a low intensity (slower pace and fewer reps) for one session per day and increases from 2 to 6 days per week as the individual's level of fitness gradually improves.
  • The duration for the higher fitness levels (60-100+) is 15 minutes per session, but at a higher intensity (faster pace and more reps) for two sessions per day and increases from 4 to 6 days per week as the individual's level of fitness continues to gradually improve.
  • In total minutes per week, the duration for the lower fitness levels (0-59) gradually increases from 50 to 150 minutes of low to moderate intensity exercise.
  • In total minutes per week, the duration for the higher fitness levels (60-100+) gradually increases from 120 to 180 minutes of moderate to high intensity exercise.
  • Limiting the daily duration to 30 minutes greatly improves your client's adherence to their Fitness Training Program by avoiding an overly demanding time commitment.

F = Frequency:
  • The frequency for the lower fitness levels (0-59) is only 1 session per day and increases from 2 to 6 days per week as the individual's level of fitness gradually improves.
  • The frequency for the higher fitness levels (60-100+) is 2 sessions per day and increases from 4 to 6 days per week as the individual's level of fitness continues to gradually improve.
  • The recommendation to gradually increase frequency to 6 days per week greatly improves your client's success in making a permanent therapeutic lifestyle change that includes exercise as part of their daily routine.
  • Having 1 day of rest from their daily formal exercise sessions is extremely important and greatly improves long-term adherence to an on-going Fitness Training (maintenance) Program.
  • The client should be encourage to participate in casual outdoor physical activities such as a walk or hike on their weekly rest day.

I = Intensity:
  • Although the duration of each exercise session remains constant (25 minutes) for the lower fitness levels (0-59), the amount of work done within that time gradually increases in distance walked, 0.5 - 1.0 miles in the 20 minutes of aerobic exercise time and increases from a total of 33 reps to 99 reps in the 5 minutes of anaerobic exercise time.
  • Although the duration of each exercise session remains constant (15 minutes) for the higher fitness levels (60-100+), the amount of work done within that time gradually increases in distance jogged, 0.75 - 1.25 miles in the 10 minutes of aerobic exercise time and increases from a total of 132 reps to 198 reps in the 5 minutes of anaerobic exercise time.
  • Prescribing an adequate, but safe, level of intensity uses the overload principle to ensure fitness gains are effective and efficient while avoiding the risk of injury or counter-productive over-training.
  • 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 their exercise sessions.
​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. The Medical-Fitness Technician must be especially careful when using exercise as "medicine"  because it is indeed very powerful medicine. The fitness industry's standard recommendation of "the more, the better" should be avoided -- even in the case of exercise. 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 Fitness Training Programs you prescribe are medically appropriate, keep the variables listed below in mind when consulting each and every individual client:
  • Always screen your client to determine if Medical Clearance is indicated.
  • Always obtain a written authentic Medical Clearance from your client's personal physician if one is indicated.
  • Always follow the physician's instructions when your client's Medical Clearance is conditional.
  • Obtain permission from your client to contact their personal physician if there is any question or concern.
  • Use the guidelines for Exercise Rx's based on your client's Medical-Fitness Assessment (listed above), but "error on the side of caution" and allow your client to "gradually progress as tolerated."
  • Always consider your client's age, gender, and health status, plus any physical disability or mental impairment.
  • If your client is < 18, always keep a parent or legal guardian informed about all medical-fitness recommendations.
  • Modify exercises as needed and verify your client's ability to perform them during their Medical-Fitness Training sessions.
  • Limit your Exercise Rx's to a 1-4 week "therapeutic trial" and have your client follow-up frequently if close monitoring is indicated.
  • If your client has a significant weight-loss goal, refer your client to a Medical-Nutrition Technician as an adjunct therapy to your their Fitness Training Program for maximum results.
  • 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.