Trending Clinical Topic: Exercise Prescription

Ryan Syrek


December 16, 2022

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The fact that exercise is good for you isn't newsworthy. However, research into which forms are best, for how long, and for what conditions in particular has received much interest of late. Given the reluctance of many patients to follow time-consuming or complicated exercise prescriptions, perhaps the most notable recent news is how little time per day may be needed (see Infographic).

Researchers in the United Kingdom analyzed data from fitness trackers worn by more than 71,000 individuals. The findings suggest that short, vigorous exercise may be more beneficial than longer, moderate exercise. The data showed that although more exercise time generally led to improved health, the protective events did eventually plateau. Experts suggest that a brief but challenging workout can shrink artery-clogging plaques, improve blood pressure, and boost overall fitness.

This shorter-than-expected workout time may help patients with adherence to exercise prescriptions. The Centers for Disease Control and Prevention currently recommends at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise each week. However, only 54% of Americans get their weekly 150 minutes of aerobic activity. "Lack of time is one of the main reasons people have reported for not engaging in exercise," says study author Matthew Ahmadi, PhD. Thus, the hope is that needing only 8 minutes a day instead of 30 minutes could convince busy patients to get the exercise they need.

Beyond exercise prescriptions for improving general health and preventing cardiovascular disease (CVD), several new studies identified specific benefits in specific conditions. Brief aerobic exercise was found to augment the benefits of exposure therapy in patients with posttraumatic stress disorder (PTSD). Researchers randomly assigned 130 adults with PTSD (mean age, 39 years; 61% female; 76% White) to receive nine 90-minute sessions of exposure therapy with either aerobic exercise or passive stretching (n = 65 in each group). The exposure therapy sessions were identical. After these sessions, participants engaged in 20 minutes of their respective exercises. Greater reductions in PTSD severity were found in the aerobic exercise group vs the stretching group at 6-month follow-up (mean difference, 12.1; 95% CI, 2.4-21.8; P = .023), pointing to a "moderate effect size" (d = .6 [.1-1.1]). Superior benefits were also seen in depression severity at 6 months (a secondary outcome), with a mean difference in Beck Depression Inventory-2 score of 5.7 (95% CI, 0.5-10.9; P = .022), yielding a "moderate effect size" (0.5; 95% CI, 0.1-1.0]).

Migraine is another condition for which exercise may be particularly beneficial. Recent research showed that strength training reduced migraines better than the top-line medications topiramate and amitriptyline. The systemic review with network meta-analysis included 21 clinical trials with an exercise regimen arm and a comparison control arm. The total combined sample size was 1195 patients with migraine (mean age, 35.5 years; female-to-male ratio, 6.7:1). All exercise interventions were more effective than placebo in reducing the migraine frequency. In terms of ranking, strength training was best, with a mean difference in monthly migraine days of -3.55 (95% CI, -6.15 to -0.95) compared with placebo. The next most effective interventions were high-intensity aerobic exercise (--3.13; 95% CI, -5.28 to −0.97) and moderate-intensity aerobic exercise (-2.18; 95% CI, -3.25 to -1.11), followed by topiramate, placebo, and amitriptyline.

For patients who experienced a stroke, exercise may significantly improve cognitive function. Results of a new proof-of-concept trial showed that patients with mild to moderate cognitive impairment returned to near-normal cognition with the intervention. The new single-center, single-blinded study included 120 patients (mean age, 70 years; 62% men) who had had an ischemic or hemorrhagic stroke. They were randomly assigned to a more vigorous exercise training program, a program of cognitive training and social activities, or a balance and toning exercise program.

At the end of the intervention, participants in the exercise group had significantly better cognitive scores compared with the balance and toning group (estimated mean difference, -0.24; 95% CI, -0.43 to 0.04; P = .02). However, this difference did not persist at the end of follow-up (estimated mean difference, -0.08; 95% CI, -0.29 to 0.12). "It's intuitive and biologically sound to say that if you're not going to continue to do the exercises, the benefits over time will disappear; it's the notion of use it or lose it," said study investigator Teresa Liu-Ambrose, PhD, PT. "The takeaway here is that any basic exercise could be beneficial for people in the chronic phase of stroke and improving some of the most basic motor functions such as balance etc could translate to people's capacity and willingness to engage in further physical activity."

From findings about specific conditions in which exercise prescriptions may provide substantial benefits, to recent investigations into general advice to be passed along to patients, fitness was a major focus of interest lately and was this week's top trending clinical topic.

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