January 2022


Figure. Clinical decision support system for prioritizing the cardiovascular risk factor or chronic disease or health condition to design the FITT ExRx.
AHA = American Heart Association; BMI = body mass index; CVH = cardiovascular health; CVD = cardiovascular disease; DBP = diastolic blood pressure; ExRx = exercise prescription; FITT = frequency, intensity, time, and type; SBP = systolic blood pressure; WC = waist circumference.

Exercise is recognized as the most efficient, cost-effective, and accessible “polypill” to prevent and treat more than 35 chronic diseases and health conditions that include cardiovascular disease (CVD) and its major risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity, and physical inactivity). Yet, 82% of adults in the United States do not engage in the recommended amounts of exercise to achieve these health benefits. It has been proven that a physician’s recommendation is a strong incentive for patients to exercise, but only 30% of physicians recommend exercise to their patients. Clinicians lack guidance on how to design an exercise prescription (ExRx) for patients with multiple CVD risk factors. To address this unmet need, we developed a novel clinical decision support system to prescribe exercise (prioritize personalize prescribe exercise [P3-EX]) for patients with multiple CVD risk factors founded upon the evidenced-based recommendations of the American College of Sports Medicine (ACSM) and American Heart Association. To develop P3-EX, we integrated (1) the ACSM exercise preparticipation health screening recommendations; (2) an adapted American Heart Association Life’s Simple 7 cardiovascular health scoring system; (3) adapted ACSM strategies for designing an ExRx for people with multiple CVD risk factors; and (4) the ACSM frequency, intensity, time, and time principle of ExRx. We have tested the clinical utility of P3-EX within a university-based online graduate program in ExRx among students that includes physicians, physical therapists, registered dietitians, exercise physiologists, kinesiologists, fitness industry professionals, and kinesiology educators in higher education. The support system P3-EX has proven to be an easy-to-use, guided, and time-efficient evidence-based approach to ExRx for patients with multiple CVD risk factors that has applicability to other chronic diseases and health conditions. Further evaluation is needed to better establish its feasibility, acceptability, and clinical utility as an ExRx tool.

Excerpted from: Pescatello LS, Wu Y, Panza GA, Zaleski A, Guidry M. Development of a novel clinical decision support system for exercise prescription among patients with multiple cardiovascular disease risk factors. Mayo Clin Proc Inn Qual Out 2021;5(1):193-203. Use is per CC BY 4.0.

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