Exercise as Medicine: The Prescriptions Doctors Should Write

Physical activity is no longer merely a lifestyle choice—it is increasingly recognized as a potent therapeutic intervention capable of preventing, managing, and even reversing a spectrum of chronic diseases. Modern medicine, however, often relies heavily on pharmacological interventions while underutilizing one of the most effective, low-cost, and low-risk treatments available: exercise. Just as a physician might prescribe insulin for diabetes or stations for hypercholesterolemia, they should consider structured exercise as a formal prescription—tailored, monitored, and evidence-based.

The concept of exercise as medicine has gained traction over the past few decades, supported by robust research demonstrating its physiological, biochemical, and psychological benefits. From cardiovascular health to mental well-being, from metabolic regulation to musculoskeletal integrity, exercise functions as a multi-system therapeutic agent. Despite this, integration into routine clinical practice remains limited, often due to barriers in training, time constraints, and patient adherence.

This guide explores the rationale for exercise prescriptions, mechanisms of action, evidence across health conditions, recommended protocols, and strategies to overcome implementation barriers, emphasizing why every doctor should consider writing exercise prescriptions as routinely as medications.

Historical Context of Exercise in Medicine

Early Recognition

The link between physical activity and health dates back millennia. Ancient civilizations recognized exercise as a cornerstone of well-being:

Hippocrates (c. 460–370 BCE) emphasized walking and moderate activity as vital to maintaining health.
In Eastern traditions, I Gong and yoga integrated movement, breath, and mental focus for holistic wellness.

However, for centuries, Western medicine treated exercise primarily as a preventive or recreational practice rather than a formal therapy.

Emergence of Scientific Evidence

The 20th century marked a turning point. Landmark epidemiological studies highlighted the protective effects of physical activity:

Harvard Alumni Study (Paffenbarger et al., 1978) demonstrated that men with higher physical activity levels had lower mortality rates from cardiovascular disease.
London Bus Studies (Morris et al., 1953) revealed that physically active conductors had significantly lower rates of heart disease compared to sedentary drivers.

These studies laid the groundwork for modern exercise prescription, showing that physical activity is a measurable, dose-dependent intervention for chronic disease prevention.

Modern Integration into Medicine

Today, organizations like the American College of Sports Medicine (ACSM) and the Exercise is Medicine (EIM) initiative advocate for systematic integration of exercise into clinical practice. The EIM framework encourages physicians to assess physical activity at every visit, provide individualized recommendations, and refer patients to exercise professionals when needed. Yet, despite these guidelines, exercise remains under prescribed relative to its benefits.

Exercise as a Preventive Measure

Exercise has well-documented preventive effects across multiple domains of health. Regular physical activity reduces risk factors and incidence of chronic diseases, often rivaling pharmacological interventions.

Cardiovascular Disease

Mechanisms: Exercise improves cardiac output, endothelial function, arterial compliance, and lipid profiles. It also reduces systemic inflammation and improves autonomic balance.
Evidence: Studies show that 150 minutes per week of moderate-intensity aerobic activity can reduce the risk of coronary heart disease by up to 30% (Myers et al., 2002).
Prescription: Brisk walking, cycling, or swimming for 30 minutes, 5 days per week, combined with resistance training twice weekly, is effective for primary prevention.

Type 2 Diabetes and Metabolic Syndrome

Mechanisms: Exercise enhances insulin sensitivity, facilitates glucose uptake in skeletal muscle, and promotes weight management.
Evidence: The Diabetes Prevention Program (DPP, 2002) found that lifestyle interventions, including 150 minutes of moderate-intensity exercise per week, reduced the risk of type 2 diabetes by 58%.
Prescription: Moderate-intensity aerobic activity (e.g., brisk walking) for 30–60 minutes daily, resistance training 2–3 times per week, and flexibility or mobility exercises to support joint health.

Obesity

Mechanisms: Exercise increases energy expenditure, preserves lean muscle mass during weight loss, and improves metabolic rate.
Evidence: Even modest activity (e.g., walking 10,000 steps daily) contributes to meaningful weight loss and maintenance.
Prescription: Combine aerobic and resistance training with dietary guidance for sustainable results.

Mental Health

Mechanisms: Exercise modulates neurotransmitters (serotonin, dopamine), brain-derived neurotrophic factor (BDNF), and HPA axis activity, supporting mood regulation.
Evidence: Aerobic exercise is effective in reducing symptoms of depression and anxiety, with comparable effect sizes to psychotherapy in mild-to-moderate cases (Blumenthal et al., 2007).
Prescription: 30–45 minutes of moderate-intensity aerobic activity, 3–5 days per week, can improve mood and cognitive function. Yoga and tai chi are effective adjuncts.

Cancer Prevention

Mechanisms: Physical activity improves immune surveillance, hormonal balance, and inflammation control.
Evidence: Higher levels of physical activity are associated with lower risk of breast, colon, and endometrial cancers. Survivors who remain active experience improved prognosis and quality of life.
Prescription: At least 150 minutes per week of moderate aerobic activity, strength training 2–3 times weekly, and flexibility/mobility work.

Exercise for Treatment

Beyond prevention, exercise functions as a treatment modality for established diseases.

Cardiovascular Rehabilitation

Mechanisms: Exercise improves ventricular function, endothelial health, and exercise tolerance, reducing rehospitalization risk.
Evidence: Cardiac rehabilitation programs incorporating aerobic and resistance training reduce all-cause mortality and improve quality of life.
Prescription: Supervised sessions, typically 3× per week, gradually progressing from 20–30 minutes to 60 minutes of aerobic activity, plus resistance training.

Diabetes Management

Mechanisms: Exercise improves glycolic control, insulin sensitivity, and body composition.
Evidence: Combining aerobic and resistance training reduces HbA1c by 0.6–0.8% on average (Colbert et al., 2010).
Prescription: 150–300 minutes of moderate-intensity aerobic activity weekly, resistance training 2–3 times weekly, ideally including functional mobility exercises.

Neurodegenerative Diseases

Mechanisms: Exercise enhances cerebral blood flow, neurogenesis, and synaptic plasticity, potentially slowing cognitive decline.
Evidence: Physical activity delays onset and progression of Alzheimer’s and Parkinson’s disease. Regular aerobic and strength training improves executive function and motor performance.
Prescription: Combination of aerobic (walking, cycling) and resistance training, 3–5 days per week, plus balance and mobility exercises.

Musculoskeletal Disorders

Mechanisms: Exercise strengthens muscles and connective tissues, improves joint mechanics, and reduces pain perception.
Evidence: Resistance and mobility training reduce chronic low back pain, osteoarthritis symptoms, and risk of falls in older adults.
Prescription: Targeted resistance exercises, joint mobility routines, and functional movement drills 3–4 times weekly.

Mental Health Conditions

Mechanisms: Exercise reduces HPA axis hyperactivity, inflammation, and enhances neuroplasticity.
Evidence: Aerobic exercise and mind-body interventions (yoga, tai chi) significantly reduce symptoms of depression, anxiety, PTSD, and ADHD.
Prescription: Moderate-intensity aerobic exercise 3–5 times weekly, complemented by mind-body practices 2–3 times weekly.

Mechanisms of Action

Exercise exerts therapeutic effects through multifactorial physiological pathways:

Cardiovascular Adaptations

Increased stroke volume and cardiac output
Improved endothelial function and nitric oxide production
Reduced blood pressure and resting heart rate
Enhanced lipid metabolism

Metabolic Effects

Increased GLUT4 expression in skeletal muscle for glucose uptake
Enhanced mitochondrial density and oxidative capacity
Improved insulin sensitivity
Regulated adipokines to reduce chronic inflammation

Musculoskeletal Effects

Muscle hypertrophy and strength gains
Improved tendon stiffness and ligament resilience
Joint range of motion through mobility and stretching
Bone density enhancement via mechanical loading

Neuroendocrine Effects

Increased BDNF supporting neuroplasticity
Regulation of cortisol and catecholamine’s reducing stress
Enhanced serotonin and dopamine signaling improving mood

Immune Modulation

Reduced chronic inflammation through cytokine regulation
Enhanced natural killer cell activity
Improved vaccine responses in older adults

Prescriptive Guidelines

The “Exercise Prescription” Model

Just as medications require a dose, frequency, and duration, exercise prescriptions should specify:

Type: Aerobic, resistance, mobility, or mixed
Intensity: Light, moderate, or vigorous
Frequency: Sessions per week
Time: Duration per session
Progression: Gradual increases to avoid injury

ACSM Recommendations

Aerobic: ≥150 minutes of moderate-intensity or ≥75 minutes of vigorous-intensity activity weekly
Resistance: 2–3 non-consecutive days per week, 8–10 exercises covering major muscle groups
Flexibility/Mobility: ≥2–3 times per week, dynamic stretches before exercise, static stretches post-exercise
Balance/Neuromotor: Especially for older adults, 2–3 sessions per week

Tailoring for Individuals

Co morbidities: Adjust intensity and mode based on cardiovascular, orthopedic, or metabolic conditions
Age: Emphasize balance and mobility in older adults, strength and power in younger adults
Preferences: Enhancing adherence through enjoyable, sustainable activities

Special Populations

Older Adults

Goals: Maintain independence, prevent falls, reduce sarcopenia
Prescription: Resistance training 2–3 times weekly, walking or swimming for 150 minutes/week, balance and mobility exercises 3×/week

Pregnant Women

Goals: Support maternal health, fetal growth, prevent gestational diabetes
Prescription: Moderate-intensity aerobic activity 20–30 minutes daily, low-resistance strength training, flexibility exercises

Chronic Illness Patients

Goals: Manage disease, improve quality of life, reduce complications
Prescription: Supervised aerobic and resistance sessions, tailored to functional capacity, with monitoring for safety

Pediatric Populations

Goals: Support growth, motor development, metabolic health
Prescription: ≥60 minutes of daily moderate-to-vigorous activity, strength exercises 3×/week, flexibility and neuromotor activities

Barriers and Solutions

Common Barriers

Time constraints
Lack of knowledge or confidence
Physical limitations
Access to facilities
Motivational issues

Strategies to Overcome

Brief interventions: 10–15 minute bouts integrated into daily routines
Referral to exercise professionals for guidance
Behavioral strategies: Goal setting, self-monitoring, social support
Technology: Wearable’s, apps, telehealth coaching

Case Studies and Evidence-Based Recommendations

Cardiac Rehabilitation: Patients completing supervised exercise programs had 25% lower all-cause mortality compared to usual care.
Type 2 Diabetes: Combined aerobic and resistance training reduced HbA1c significantly and improved lipid profiles.
Depression: Randomized trials show exercise as effective as SSRIs in mild-to-moderate depression.
Cancer Survivors: Physical activity improves fatigue, quality of life, and survival outcomes.

Conclusion

Exercise is a powerful, multifaceted therapeutic tool that should be recognized as a standard component of medical care. Its preventive and treatment effects span cardiovascular, metabolic, musculoskeletal, neurological, and psychological health domains. The emerging paradigm of “Exercise as Medicine” emphasizes the need for physicians to assess, prescribe, and monitor physical activity in the same way as pharmacological therapies.

By implementing structured exercise prescriptions—tailored to type, intensity, frequency, duration, and individual capabilities—doctors can harness the full potential of movement to prevent disease, manage chronic conditions, enhance mental health, and improve quality of life. Integration requires overcoming barriers through education, referral systems, behavioral strategies, and accessible programs. The evidence is compelling: exercise is medicine, and doctors are increasingly responsible for writing this essential prescription.

SOURCES

Blumenthal, J. A., Baby, M. A., Doraiswamy, P. M., et al. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine.

Paffenbarger, R. S., Hyde, R. T., Wing, A. L., & Hsieh, C. C. (1978). Physical activity and longevity. New England Journal of Medicine.

Morris, J. N., Heady, J. A., Raffle, P. A., et al. (1953). Coronary heart-disease and physical activity of work. Lancet.

Colbert, S. R., Sigel, R. J., Fern hall, B., et al. (2010). Exercise and type 2 diabetes. Diabetes Care.

Myers, J., Parkas, M., Frolicker, V., et al. (2002). Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine.

Pedersen, B. K., & Saltine, B. (2015). Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25(S1), 1–72.

Booth, F. W., Roberts, C. K., & Layer, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211.

Sallies, R. E. (2015). Exercise is medicine: a call to action for physicians to assess and prescribe exercise. Current Sports Medicine Reports, 14(4), 248–250.

Lobelia, F., Sallies, R. E., Franklin, B. A., & McKenzie, T. L. (2014). Evaluation of the exercise is medicine global health initiative. Progress in Cardiovascular Diseases, 57(4), 314–321.

Cowan, R. E., Sallies, R. E., & Franklin, B. A. (2016). Exercise is medicine: a vital sign. American Journal of Lifestyle Medicine, 10(1), 1–6.

Myers, J., Parkas, M., Frolicker, V., Do, D., & Parrington, S. (2002). Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine, 346(11), 793–801.

Blumenthal, J. A., Baby, M. A., Doraiswamy, P. M., Watkins, L., & Hoffman, B. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine, 69(7), 587–596.

Rezoned, L. F. M., As, T. H., Markozannes, G., Lee, I. M., & Tildes, K. K. (2018). Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770,000 cancer cases. British Journal of Sports Medicine, 52(12), 826–833.

Schacht, F. B., Vancampfort, D., Firth, J., Meyer, B., & Stubbs, B. (2018). Physical activity and incident depression: a meta-analysis of prospective cohort studies. American Journal of Psychiatry, 175(7), 631–648.

Colbert, S. R., Sigel, R. J., Fern hall, B., Rothschild, B., & Ray, C. A. (2010). Exercise and type 2 diabetes. Diabetes Care, 33(12), e147–e167.

Sallies, R. E., Matuszak, J. M., Waggish, A. L., Franklin, B. A., & Franklin, B. A. (2016). Call to action on making physical activity assessment and prescription a medical standard of care. Current Sports Medicine Reports, 15(3), 207–214.

Thornton, J. S., Fremont, P., Khan, K., & Reilly, T. (2016). Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Clinical Journal of Sport Medicine, 26(4), 259–265.

American College of Sports Medicine. (2018). ACSM’s Guidelines for Exercise Testing and Prescription (10th Ed.). Walters Lower.

World Health Organization. (2010). Global recommendations on physical activity for health.

World Health Organization. (2018). More active people for a healthier world.

Bowen, P. G., Sallies, R. E., Franklin, B. A., & Franklin, B. A. (2019). Exercise is medicine: a vital sign. American Journal of Lifestyle Medicine, 13(3), 250–257.

Oregano, A., Breen, L., & McCarthy, P. (2021). ABC of prescribing exercise as medicine: a narrative review. BMJ Open Sport & Exercise Medicine, 7(2), e001050.

Zhu, W. (2024). Who could and should give exercise prescriptions. Journal of Exercise Science & Fitness, 22(1), 1–7.

Pinto, B. M., Sati, Z., & Di Loreto, C. (2019). Health care provider action guide. Exercise is Medicine.

Lobelia, F., Young, D. R., Sallies, R. E., & McKenzie, T. L. (2018). Routine assessment and promotion of physical activity in healthcare settings: a scientific statement from the American Heart Association. Circulation, 137(24), e495–e522.

American Medical Association. (2007). Exercise is Medicine Initiative: Physical Activity as a Vital Sign.

Cowan, R. E., Sallies, R. E., & Franklin, B. A. (2016). Exercise is medicine: a vital sign. American Journal of Lifestyle Medicine, 10(1), 1–6.

HISTORY

Current Version
Sep 9, 2025

Written By:
ASIFA

Our Connection with

Nature