Exercise prescription template 2025

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  1. Click ‘Get Form’ to open the exercise prescription template in our editor.
  2. Begin by entering the patient’s name, date of birth, and the current date in the designated fields at the top of the form.
  3. Next, fill in the health care provider’s name and provide their signature to validate the prescription.
  4. In the 'Physical Activity Recommendations' section, select the type of physical activity recommended (e.g., Aerobic or Strength) by checking the appropriate box.
  5. Specify the number of days per week and minutes per day for each type of activity. Ensure that these align with physical activity guidelines for optimal health benefits.
  6. Complete the referral section by providing details such as name, phone number, address, and website of the health & fitness professional.
  7. Finally, set a follow-up appointment date and add any additional notes that may be relevant for future reference.

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Physicians are able to prescribe an individually adapted, written prescription of physical activity know as the FaR.
ACSM and CDC recommendations state: All healthy adults aged 1865 years should participate in moderate intensity aerobic physical activity for a minimum of 30 minutes on five days per week, or vigorous intensity aerobic activity for a minimum of 20 minutes on three days per week.
Exercise Prescription Examples The following is an example of an exercise prescription for an apparently healthy young adult: Warm-up: five to ten minutes of plyometrics. Conditioning: 20 to 40 minutes of aerobic exercise or anaerobic exercise. Cool-down: five to ten minutes of walking or light bicycling.
Apply the FITT principle when prescribing exercise: Frequency. How many times a week for an activity? For sedentary individuals, start with 2-3 days/week of aerobic exercise and build up to 5 days/week. Intensity. How hard to exert? Type. Which type of activity agreed with the patient? Time. How long in minutes.