Exercise prescription deserves the same rigour as a medication dose

No physician would write "take some blood pressure medication, a few times a week."

Yet "get 150 minutes of moderate exercise" is a prescription written at roughly that level of precision, and it's what most patients walk out with.

I understand why. There's no time in a visit to specify it further, and specifying it isn't what you were trained for. But it's worth naming what the patient actually receives: a category of intervention with no dose, no frequency, no progression, and no follow-up on response.

If we wrote medication that way, we'd call it malpractice. Because it's exercise, we call it advice.

What a real prescription would specify:

Dose.
Intensity is the variable that is lost. "Moderate" means something different for a deconditioned 58-year-old than a 58-year-old athlete, and the only way to know is to measure — heart rate response, ventilatory thresholds, actual capacity rather than assumed.

Frequency and duration.
Not a weekly total the patient has to distribute themselves. A schedule.

Progression.
A dose that doesn't change stops working. Somebody has to decide when and by how much.

Contraindications and interactions.
Orthopedic history, autonomic response, what their medications do to heart rate. A patient on a beta blocker cannot use a standard heart rate zone chart, and most of them have no idea.

Monitoring.
Did the dose produce a response? If not, adjust. Same logic you'd apply to anything else you prescribe.

This is our entire job. You establish that a patient needs to move. We determine at what intensity, how often, with what progression, and against what constraints — then we measure whether it worked and tell you.

I'm not suggesting exercise is medicine as a slogan. I'm suggesting that if we mean it, the prescription deserves the same rigour as any other, and it needs somebody whose job is to write it.

— Heather