Exercise is Medicine

  1. What is the EiM initiative?
    1. Background: 
      1. About EIM – Exercise is Medicine
      2. EIM Foundational Slide Deck.pptx | Powered by Box
    2. “The Miracle Drug” 
      1. EIM-miracle-drug-handout.pdf (exerciseismedicine.org)
    3. Why are we focused on it: 
      1. EIM-Fact-Sheet.pdf (exerciseismedicine.org)
      2. The economic burden of physical inactivity: a global analysis of major non-communicable diseases – The Lancet
  3. National Guidelines
    1. Physical Activity Recommendations
      1. Physical Activity Guidelines for Americans, 2nd edition (health.gov)
      2. Physical Activity | CDC
      3. Physical Activity Guidelines for Americans | health.gov
  4. Basics For Healthcare Providers
    1. Overview
      1. EIM-Health-Care-Providers-Action-Guide-clickable-links.pdf (exerciseismedicine.org)
      2. Making Physical Activity Counseling a Priority in Clinical Practice: The Time for Action Is Now | Cardiology | JAMA | JAMA Network
      3. Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association | Circulation (ahajournals.org)
      4. Materials for Professionals | health.gov
    2. The Physical Activity Vital Sign
      1. EIM-Physical-Activity-Vital-Sign.pdf (exerciseismedicine.org)
    3. Implementing EiM in clinic
      1. EIM-Health-Care-Providers-Action-Guide-clickable-links.pdf (exerciseismedicine.org)
        1. EMR Integration
        2. How to have difficult conversations/Motivational interviewing
      2. Billing/Coding:
        1. EIM-Provider-Coding-Tip-Sheet.pdf (exerciseismedicine.org)
    4. Exercise Prescription
      1. Rx for Health Series – Exercise is Medicine
      2. EIM-Prescription-2018-e-form.pdf (exerciseismedicine.org)
      3. EIM-Prescription-2018-pad-2-up.pdf (exerciseismedicine.org)
      4. Move Your Way® Community Resources | health.gov
    5. COVID Caveats
      1. COVID-19 and Exercise – Exercise is Medicine
    6. Pre-participation Testing: 
      1. ACSM-101-PrescreeningInfographicColorLegal-2015-12-15-V02 
      2. Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc. 2015;47(11):2473-2479.
    7. Paid resources
      1. ACSM’s Complete Guide to Fitness & Health 2nd Edition – Human Kinetics
  5. Engaging other resources
    1. Dieticians
      1. ExerciseIsMedicine_v8.pdf
    2. Exercise Professionals
      1. EIM-initial-fitness-assessment-physical-activity-plan.pdf (exerciseismedicine.org)
    3. EiM on Campus
      1. EIM On Campus – Exercise is Medicine
    4. Community Resources
      1. EIM-Community-Exercise-Resources_d2.pdf (exerciseismedicine.org)
  6. Exercise Recommendations 
    1. Available Resources
      1. Rx for Health Series – Exercise is Medicine
      2. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359.
      3. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462.
    2. Specific condition prescriptions (as many or as few as we want to give specific examples of)
      1. HTN
        1. EIM_Rx-for-Health_Hypertension.pdf (exerciseismedicine.org)
      2. CAD
        1. Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018;7(4). doi:10.1161/JAHA.117.007725
      3. Hyperlipidemia
        1. EIM_Rx-for-Health_Blood-Lipids-Disorders.pdf (exerciseismedicine.org)
      4. Diabetes
        1. EIM_Rx-for-Health_Diabetes.pdf (exerciseismedicine.org) 
        2. Colberg SR, Sigal RJ, Yardley JE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079.
      5. Asthma
        1. EIM_Rx-for-Health_Asthma.pdf (exerciseismedicine.org)
      6. COPD
        1. EIM_Rx-for-Health_COPD.pdf (exerciseismedicine.org)
      7. Weight Loss
        1. EIM_Rx-for-Health_Overweight_Obesity.pdf (exerciseismedicine.org)
        2. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459-471.
      8. Children
        1. How much physical activity do children need? | Physical Activity | DNPAO | CDC
        2. Help your kids get more physical activity – Move Your Way | health.gov
        3. Materials for Kids and Teens | health.gov
        4. Materials for Parents | health.gov
        5. EIM_Rx-for-Health_Being-Active-with-Your-Young-Child.pdf (exerciseismedicine.org)
        6. West SL, Banks L, Schneiderman JE, et al. Physical activity for children with chronic disease; a narrative review and practical applications. BMC Pediatr. 2019;19(1):12.
      9. Pregnancy
        1. EIM_Rx-for-Health_Pregnancy.pdf (exerciseismedicine.org) 
        2. Mottola MF, Davenport MH, Ruchat SM, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346.
        3. Physical Activity Recommendations for Pregnant and Postpartum Women | Physical Activity | DNPAO | CDC
      10. Mental Health
        1. EIM_Rx-for-Health_Anxiety-and-Depression.pdf (exerciseismedicine.org)
      11. Cancer
        1. Moving Through Cancer – Exercise is Medicine.

Exercise physiology

  1. Basics of Bodily Function for Exercise
    1. Nervous System
      1. Fu, Qi, and Benjamin D Levine. “Exercise and the autonomic nervous system.” Handbook of clinical neurology vol. 117 (2013): 147-60. doi:10.1016/B978-0-444-53491-0.00013-4
    2. Skeletal Muscle
      1. Widmann, Manuel et al. “Physical Exercise and Epigenetic Modifications in Skeletal Muscle.” Sports medicine (Auckland, N.Z.) vol. 49,4 (2019): 509-523. doi:10.1007/s40279-019-01070-4
    3. Circulation
      1. Bruning, Rebecca S, and Michael Sturek. “Benefits of exercise training on coronary blood flow in coronary artery disease patients.” Progress in cardiovascular diseases vol. 57,5 (2015): 443-53. doi:10.1016/j.pcad.2014.10.006
    4. Respiratory System
      1. McKenzie, Donald C. “Respiratory Physiology: Adaptations to High-Level Exercise.” British Journal of Sports Medicine, vol. 46, no. 6, 2012, pp. 381–384., https://doi.org/10.1136/bjsports-2011-090824.
    5. Hematology
    6. Metabolism
      1. Swift, Damon L et al. “The Effects of Exercise and Physical Activity on Weight Loss and Maintenance.” Progress in cardiovascular diseases vol. 61,2 (2018): 206-213. doi:10.1016/j.pcad.2018.07.014
      2. Muscella, Antonella et al. “The Regulation of Fat Metabolism During Aerobic Exercise.” Biomolecules vol. 10,12 1699. 21 Dec. 2020, doi:10.3390/biom10121699
    7. Temperature Regulation
      1. Lim, Chin Leong et al. “Human thermoregulation and measurement of body temperature in exercise and clinical settings.” Annals of the Academy of Medicine, Singapore vol. 37,4 (2008): 347-53.
      2. Falk, B. “Effects of thermal stress during rest and exercise in the paediatric population.” Sports medicine (Auckland, N.Z.) vol. 25,4 (1998): 221-40. doi:10.2165/00007256-199825040-00002
  2. Adaptations to training – aerobic and resistance training
    1. Nervous System
      1. Morgan, J.A., Corrigan, F. & Baune, B.T. Effects of physical exercise on central nervous system functions: a review of brain region specific adaptations. J Mol Psychiatr 3, 3 (2015). https://doi.org/10.1186/s40303-015-0010-8
    2. Skeletal Muscle
      1. Hamilton MT, Booth FW. Skeletal muscle adaptation to exercise: a century of progress. J Appl Physiol (1985). 2000;88(1):327-331. doi:10.1152/jappl.2000.88.1.327
    3. Circulation
      1. Laughlin MH, Oltman CL, Bowles DK. Exercise training-induced adaptations in the coronary circulation. Medicine and Science in Sports and Exercise. 1998 Mar;30(3):352-360. DOI: 10.1097/00005768-199803000-00004. PMID: 9526880.
      2. Laughlin MH, Bowles DK, Duncker DJ. The coronary circulation in exercise training. Am J Physiol Heart Circ Physiol. 2012;302(1):H10-H23. doi:10.1152/ajpheart.00574.2011
    4. Respiratory System
      1. (Abstract) McKenzie DC. Respiratory physiology: adaptations to high-level exercise. Br J Sports Med. 2012;46(6):381-384. doi:10.1136/bjsports-2011-090824
    5. Hematology
      1. Branch, J. D., et al. “Effects of exercise mode on hematologic adaptations to endurance training in adult females.” Aviation, space, and environmental medicine 68.9 (1997): 788-794.
      2. Sawka, Michael N., et al. “Blood volume: importance and adaptations to exercise training, environmental stresses and trauma sickness.” (2000).
    6. Metabolism
      1. Gibala MJ, McGee SL. Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain?. Exerc Sport Sci Rev. 2008;36(2):58-63. doi:10.1097/JES.0b013e318168ec1f
    7. Temperature Regulation
      1. Sawka, Michael N., William A. Latzka, and Kent B. Pandolf. “Temperature regulation during upper body exercise: able bodied and spinal cord injured.” (1989).
  3. Assessing Exercise Capacity
    1. VO2Max
      1. Hogg, James S., James G. Hopker, and Alexis R. Mauger. “The self-paced VO2max test to assess maximal oxygen uptake in highly trained runners.” International journal of sports physiology and performance 10.2 (2015): 172-177.
      2. Hosseini, Sattar, Mohammad Reza Ghotbi Ravandi, and Narges Khanjani. “Estimating aerobic capacity (VO2-max) using a single-stage step test and determining its effective factors.” International Journal of Occupational Hygiene 9.4 (2017): 201-206.
    2. Anaerobic Capacity
      1. Noordhof, Dionne A., Philip F. Skiba, and Jos J. de Koning. “Determining anaerobic capacity in sporting activities.” International Journal of Sports Physiology & Performance 8.5 (2013).
      2. Green, Simon. “Measurement of anaerobic work capacities in humans.” Sports Medicine 19.1 (1995): 32-42.
    3. Anaerobic Power
      1. Zagatto, Alessandro M., Wladimir R. Beck, and Claudio A. Gobatto. “Validity of the running anaerobic sprint test for assessing anaerobic power and predicting short-distance performances.” The Journal of Strength & Conditioning Research 23.6 (2009): 1820-1827.
      2. Seiler, Steve, et al. “Assessing anaerobic power in collegiate football players.” Journal of Applied Sport Science Research 4.1 (1990): 9-15.
    4. Pulmonary Function Testing
      1. Pineda, Horacio, et al. “Accuracy of pulmonary function tests in predicting exercise tolerance in chronic obstructive pulmonary disease.” Chest 86.4 (1984): 564-567.
      2. Pelletier, Clarence, Linda Lapointe, and Pierre LeBlanc. “Effects of lung resection on pulmonary function and exercise capacity.” Thorax 45.7 (1990): 497-502.
    5. 1 Rep Max Muscular Strength (Bench Press, Squat, Hand grip, etc)
      1. (Abstract) Verdijk, Lex B., et al. “One-repetition maximum strength test represents a valid means to assess leg strength in vivo in humans.” Journal of sports sciences 27.1 (2009): 59-68.
      2. Grgic, Jozo, et al. “Test–retest reliability of the one-repetition maximum (1RM) strength assessment: a systematic review.” Sports medicine-open 6.1 (2020): 1-16.
    6. AMRAP Muscular Endurance (Hang test, pushups, partial curl ups, etc)
      1. Wibowo, Sapto, et al. “The effect of a short term high intensity functional strength training on strength and endurance in recreational runners.” Journal of Physical Education and Sport 21 (2021): 2332-2336.
  4. Assessing Fitness
    1. Cardiovascular Endurance
      1. Committee on Fitness Measures and Health Outcomes in Youth. “Health-Related Fitness Measures for Youth: Cardiorespiratory Endurance.” https://www.ncbi.nlm.nih.gov/books/NBK241309/.
    2. Muscular Strength
      1. Castro-Piñero J, Ortega FB, Artero EG, et al. Assessing muscular strength in youth: usefulness of standing long jump as a general index of muscular fitness. J Strength Cond Res. 2010;24(7):1810-1817. doi:10.1519/JSC.0b013e3181ddb03d
    3. Muscular Endurance
      1. Vaara JP, Kyröläinen H, Niemi J, et al. Associations of maximal strength and muscular endurance test scores with cardiorespiratory fitness and body composition. J Strength Cond Res. 2012;26(8):2078-2086. doi:10.1519/JSC.0b013e31823b06ff
    4. Flexibility
    5. Body Composition
      1. Lohman, Timothy G., et al. “Relationships among fitness, body composition, and physical activity.” Medicine and Science in Sports and Exercise 40.6 (2008): 1163.
      2. Mattila, Ville M., et al. “Physical fitness and performance. Body composition by DEXA and its association with physical fitness in 140 conscripts.” Medicine and science in sports and exercise 39.12 (2007): 2242-2247.
    6. Metabolic Efficiency
    7. Lactate threshold
      1. Using Lactate Threshold Data (nsca.com)
      2. Lactate Threshold: Definition, Role and Measurement in Athletes (exercise-science-guide.com)
    8. Agility
      1. (PDF) Assessment of power, speed, and agility in athletic, preadolescent youth (researchgate.net)
      2. (Abstract) Physical fitness assessment: an update – PubMed (nih.gov)
      3. Assessing Speed and Agility Related to Sport Performance (nsca.com)
    9. Reaction Time
      1. (PDF) EXERCISE AND REACTION TIMES (researchgate.net)
  5. Other Factors
    1. Nutrition
      1. (PDF) Nutrition and Athletic Performance (researchgate.net)
      2. Relationship between Nutrition Knowledge and Physical Fitness in Semiprofessional Soccer Players (nih.gov)
      3. (available with free account) Nutrition and Physical Fitness | JAMA | JAMA Network
    2. Hydration
      1. Reviewing the current methods of assessing hydration in athletes | Journal of the International Society of Sports Nutrition | Full Text (biomedcentral.com)
      2. Assessment of hydration status in a large population | British Journal of Nutrition | Cambridge Core
      3. Assessing Hydration Status: The Elusive Gold Standard: Journal of the American College of Nutrition: Vol 26, No sup5 (tandfonline.com)
      4. Pee color test
        1. Assessment of hydration status of elite young male soccer players with different methods and new approach method of substitute urine strip (nih.gov)
        2. (PDF) Assessment of hydration status by urinary analysis of elite junior taekwon-do athletes in preparing for competition (researchgate.net)
        3. Assessment of Hydration Status at a Single Time Point in Athletes (biomedres.us)
      5. Sweat composition testing
        1. Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine (nih.gov)
        2. Hydration Status, Fluid Intake, Sweat Rate, and Sweat Sodium Concentration in Recreational Tropical Native Runners (nih.gov)
    3. Altitude Training
      1. Heat Versus Altitude Training for Endurance Performance at S… : Exercise and Sport Sciences Reviews (lww.com)
    4. Heat adaptation
      1. (abstract) The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis – PubMed (nih.gov)
      2. Adaptations and mechanisms of human heat acclimation: Applications for competitive athletes and sports – Périard – 2015 – Scandinavian Journal of Medicine & Science in Sports – Wiley Online Library
      3. Induction_and_decay_of_short_term_heat_a (1).pdf – Google Drive
    5. Heat Illness
      1. Korey Stringer Institute – Home | Korey Stringer Institute (uconn.edu)
      2. Heat-Related Illnesses (aafp.org)
      3. (Abstract) Heat-Related Illnesses (aafp.org)
    6. Exercise in the Cold
      1. (Abstract) Myra Nimmo (2004) Exercise in the cold, Journal of Sports Sciences, 22:10, 898-916, DOI: 10.1080/0264041400005883
      2. EXERCISING IN THE COLD : ACSM’s Health & Fitness Journal (lww.com)
      3. (Abstract) Physiology of Exercise in the Cold | SpringerLink
    7. Exercise and the Immune System
      1. Does Exercise Boost the Immune System? (healthline.com)
      2. Exercise and the immune system: taking steps to improve responses to cancer immunotherapy | Journal for ImmunoTherapy of Cancer (bmj.com)
    8. Ergogenic Aids
      1. (free download) Ergogenic aids in athletics : Medicine & Science in Sports & Exercise (lww.com)
      2. (free download) Ergogenic Aids in Aerobic Activity : Current Sports Medicine Reports (lww.com)
      3. Nutritional ergogenic aids and exercise performance (cambridge.org)

Editors and Contributors

  • Last Updated: 8/22/22
  • Contributors (Summer 2022)
    • Elizabeth Albright, DO, CAQSM, RMSK, University of Michigan Health-West/Michigan State University College of Osteopathic Medicine
    • Gabriela Elias, BS, St. George’s University School of Medicine
    • Bari Madureira, DO, MPH, Cornerstone Orthopedics & Sports Medicine
    • Cecilia Córdova Vallejos, MD, Montefiore PM&R
    • Rehal A. Bhojani, MD, FAAFP, CAQSM, McGovern Medical School / Memorial Hermann Rockets Sports Medicine Institute