Exercise Prescription for Chronic Disease Management

The beneficial role of exercise in chronic disease management is well recognized, but the challenge of effective exercise prescription within primary care persists. Initiatives requesting clinicians to prescribe specific exercises to their patients has left two underlying questions: 1) Who is the most appropriate clinician to prescribe exercise to meet the unique needs of individuals living with more than one disease; 2) How does this clinician ensure appropriate and safe exercise prescriptions are provided? Three studies were completed to begin addressing the aforementioned questions. A nationally distributed survey compared exercise curricula between physiotherapy, nursing, and medical programs, while a systematic literature review showed overlapping physiological and subjective markers that clinicians may use to define safe exercises for individuals living with multiple chronic diseases. Finally a novel approach and a preliminary tool are presented to help guide how exercise prescription could be implemented in primary care. Findings suggest that PTs should lead the exercise prescription movement in primary care with nurses and physicians as exercise advisors or facilitators. Evidence from this thesis supports improving access to PT in primary care. Also, exercise prescription in individuals with multiple chronic diseases from a body-systems perspective is proposed, rather than solely relying on the dominantly available single-disease exercise guidelines. Finally, a newly developed exercise prescription approach is presented, which takes into account the advisors role in exercise prescription, while a preliminary tool is proposed that considers physiological and personal profiles of individuals who have more than one chronic disease, to guide clinicians in developing tailored exercise prescriptions in the primary care context