Swing Sets for Unlimited Weight for Family Leisure
Am Fam Physician. 2006 Aug 1;74(3):437-444.
Commodity Sections
- Abstract
- References
A combination of aerobic activity, forcefulness training, and flexibility exercises, plus increased general daily activity tin can reduce medication dependence and health care costs while maintaining functional independence and improving quality of life in older adults. However, patients often practice non benefit fully from practise prescriptions considering they receive vague or inappropriate instructions. Effective exercise prescriptions include recommendations on frequency, intensity, type, fourth dimension, and progression of exercise that follow disease-specific guidelines. Changes in physical action require multiple motivational strategies including exercise instruction every bit well every bit goal-setting, self-monitoring, and problem-solving education. Helping patients identify emotionally rewarding and physically appropriate activities, contingencies, and social support will increment exercise continuation rates and facilitate desirable wellness outcomes. Through patient contact and community advocacy, physicians can promote lifestyle patterns that are essential for good for you crumbling.
Bear witness suggests that regular physical activeness provides substantial health benefits, reducing the adventure of many chronic diseases.1 Concrete action is associated with reduced medical costs, especially for women, and these cost reductions become more than significant with increasing historic period.2 Current recommendations encourage activity on almost or all days of the week, but just 31 percent of persons 65 to 74 years of age report regularly engaging in moderate physical activity for 20 minutes or more three days a week; this rate drops to xx per centum by 75 years of historic period.one Women are more likely than men to written report engaging in no physical activity. These trends have not improved over the past decade.1 In add-on, less than 50 percentage of older adults study that their physicians accept recommended practise.3
SORT: KEY RECOMMENDATIONS FOR Practise
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Tailor exercise prescriptions to include FITT-PRO (Frequency, Intensity, Type, Time, and Progression of exercise) and cantankerous-grooming guidelines to promote desired outcomes. | C | 13–fifteen,18,19 |
| Exercise prescriptions should be considered a valuable adjunct therapy for patients regardless of their historic period, health, or frailty status. | C | 25,26 |
| Practice prescriptions and associated health benefits should exist communicated in a way that is meaningful to patients including keeping the language simple and checking for understanding and agreement. | C | 22,24,thirty,31 |
| Physicians should provide patients with the tools necessary to safely initiate a wellness-specific program (eastward.g., communicating a consistent message and providing ongoing patient support through partnerships with hospital- and community-based resource). | C | 22,23 |
Enquiry has consistently shown that older adults who remain or become active take a significantly decreased risk of all-cause and cardiovascular mortality compared with their sedentary counterparts.4–6 Starting an practice program subsequently in life can significantly reduce risk factors even if a person was sedentary when he or she was younger. By understanding the specifics of affliction prevention and handling through practice, physicians can play a significant role in offering patients effective and cheap primary or adjunct therapies, encouraging appropriate concrete action, and eliminating barriers that forbid older adults from exercising regularly.7 Table i defines common practise terminology.
Table i
Exercise Terminology
| Term | Definition |
|---|---|
| Aerobic exercise | Exercise that involves repetitive motions, uses large muscle groups, increases middle rate for an extended period, and raises core body temperature (due east.g., walking, dancing, swimming) |
| Balance training | Practise that helps maintain stability during daily activities and other exercises, preventing falls. Information technology can be static (east.chiliad., stand up on one leg) or dynamic (e.g., walk a tightrope), with hand support as needed |
| Exercise | Structured, planned, and repetitive physical action with the intent of improving physical fitness |
| Flexibility or stretching practise | Exercise that lengthens muscles to increase a joint'due south capacity to movement through a total range of motion. Stretches tin can be static (assume position, hold stretch, then relax); dynamic (fluid motion [e.grand., tai chi]); agile (rest while belongings stretch, then moving [e.g., yoga]); or a combination (proprioceptive neuromuscular facilitation). |
| Lifestyle modification | Utilise opportunities in a person'southward daily routine to increase energy expenditure (e.g., manually open doors, carry groceries, utilize stairs) and substitute active for sedentary leisure time |
| Physical fettle | The summation of 4 factors: cardiorespiratory endurance, musculus power, flexibility, and body limerick |
| Power | How quickly a muscle contracts (eastward.g., apace hoisting a grocery pocketbook versus slowly lifting the bag) |
| Progressive resistance preparation | Do that requires muscles to generate force to motion or resist weight, with the intensity increasing as physical capacity improves (e.chiliad., strength training) |
STRUCTURED Physical Action AND LIFESTYLE MODIFICATION
At that place are iv ways for patients to better physical fitness: aerobics, resistance training, flexibility preparation, and lifestyle modification. Repetitive aerobic exercise that uses large muscle groups (due east.chiliad., walking, dancing, cycling, swimming) increases the middle rate (Table 28) for an extended period.
TABLE 2
American Centre Association Target Heart Rate Ranges
| Age (years) | Target HR (bpm)* | Average maximum HR (bpm) |
|---|---|---|
| lx | 80 to 120 | 160 |
| 65 | 78 to 116 | 155 |
| seventy | 75 to 113 | 150 |
| 75 | 73 to 109 | 145 |
Progressive resistance training requires muscles to generate the force to move or resist a given weight. Weight resistance can be created using elastic bands, weight cuffs, gratuitous weights, weight machines, or the patient's body weight. Progressive resistance training maintains or improves musculus mass, strength, and endurance. It improves balance, allowing the patient to exercise and perform daily activities (e.g., rising from a seated position, carrying groceries, preparing meals) more than safely. Although data9 on tai chi are emerging, the strongest data10 on effective balance training methods support combination programs that include progressive resistance training. Emphasis on muscle power (how fast the muscle contracts) rather than strength solitary may help patients retain the greatest corporeality of functional capacity as they historic period.11,12 Regardless of age or health condition, continual improvement requires a progressively increasing resistance as the patient becomes stronger.13,14
Flexibility is the ability to move a articulation through a complete range of motion.15 Flexibility facilitates motility and can aid foreclose injury throughout life. Poor lower back and hip flexibility may contribute to pain in the lower back muscles.15 Express range of motion in the hip, knee, and talocrural joint joints may increase the run a risk of falls and contribute to age-related gait changes.16,17 Lifestyle modifications include finding opportunities within patients' existing daily routines to increase activity (e.g., manually opening doors, taking stairs rather than elevators, parking farther from entrances).
COMPONENTS OF AN Practise PRESCRIPTION
A successful exercise prescription is succinct, measurable, patient-appropriate, and in a form that allows the medico to accost compliance expectations and barriers. Exercise prescriptions will vary depending on the desired outcomes; nevertheless, they should include cross-training (combinations of activities) to optimize wellness outcomes, reduce injury risk, and encourage program continuance. Cross-training programs emphasizing core muscle groups (i.e., back, thighs, abdomen, and other weight-begetting muscles) are preferred. An exercise prescription should include the following components: Frequency, Intensity, Type, Time, and Progression (FITT-PRO) of exercise. Table iii13–xv,18,19 provides recommendations for prescribing aerobic, resistance, and flexibility training for older adults. The activities and intensity levels should depend on the patient'south daily health and energy needs, and the preparation routine should vary to maintain interest and promote optimal gains. Chair- and bed-based exercise should be considered equally a starting indicate and used by frail patients.
Tabular array 3
Guidelines for the FITT-PRO Approach to Exercise Prescriptions*
| Frequency and fourth dimension | Intensity | Progression | ||
|---|---|---|---|---|
| General exercise | ||||
| xxx minutes or more of continuous or accumulated physical activity, seven days per week | Moderate intensity assessed by one of the following criteria:
|
| ||
| Aerobics training | ||||
| twenty to 60 minutes of continuous or intermittent practice (minimum of 10 minutes per episode), iii to seven days per week | Moderate intensity (see above criteria) |
| ||
| Frequency depends on intensity; seven days per week is preferred | ||||
| Resistance training‡ | ||||
| The following regimen should be performed two or three days per calendar week:
| Weight intensity:
|
| ||
| Flexibility training‖ | ||||
| The following regimen should be performed two or three times per week:
| Include static and dynamic techniques to stretch all major musculus groups. |
| ||
| Hold stretch in a position of balmy discomfort. | ||||
Constructive exercise prescriptions should consider comorbidities and be reevaluated and adjusted periodically to maintain the desired therapeutic consequence. Physicians tin can evaluate patients' physical activity levels during wellness maintenance examinations and chronic disease visits. Prescriptions should encourage patients to limit sedentary activities such every bit television watching and estimator apply. Table 4 is a sample patient-based exercise prescription that addresses lifestyle modification and aerobic, strength, and flexibility training. Many activity selections (e.grand., circuit preparation, yoga) can fulfill multiple requirements.
TABLE 4
Practise Prescription
| Lifestyle modification |
| Brisk canis familiaris walk: fifteen minutes each morning and evening, regardless of atmospheric condition, seven days per week with wife; Borg RPE* at 13 to 14 |
| Take the stairs: I flight up, ii flights down |
| Park at perimeter of parking lots: Walk to entrances |
| M work: I day per week, weather condition permitting |
| Aerobic practice |
| Brisk dog walk: See higher up |
| Group excursion grooming class: l minutes, ii mornings per week of bicycle or elliptical grooming at the local senior center |
| Flexibility preparation |
| Residual ball: Stretch back, chest, hamstrings, gastrocnemius, and Achilles tendon for v minutes each morning and 10 minutes each evening, 7 days per week using physician-provided, illustrated handouts with stretch variations |
| Introductory yoga video: 60 minutes each Sunday morn for i month, and so reassess with physician |
| Progressive resistance preparation |
| Group excursion training class: l minutes, ii mornings per week of total body force and range-of-motility training at the local senior center; Borg RPE* at 12 to 15 |
| Balance brawl: Core muscle training (intestinal curls and back extensions) every other 24-hour interval while watching telly: i set of 10 repetitions for each exercise |
Communication BARRIERS
Quality doctor-patient communication, including shared conclusion making, improves patient satisfaction and clinical outcomes associated with exercise prescriptions. More 33 percent of patients 65 years or older and up to 80 pct of patients in public hospitals have poor health literacy.twenty Written, disease-specific handouts containing simple language and diagrams can reduce misinterpretation. Physicians should keep directions explicit and measurable and conspicuously define activeness intensity and multifariousness. For case, a dr. can tell the patient, "Take a 10-minute walk, three times a day, every twenty-four hours of the calendar week. Choose a speed that allows y'all to talk but that is moderately hard work. The distance is not important, but make sure to walk for the entire 10 minutes."
Practice AND COMORBIDITIES
In older adults, medical clearance and advisable follow-upwardly are important parts of practice programs.15 Past following the American College of Sports Medicine's assessment guideline, medical and trained exercise professionals can determine the appropriate components for the patient'southward private do program. Exercise testing protocols specific to the patient's historic period, health status, current action level, and desired exercise intensity are available.15 Maximal practice testing (a stress examination) is recommended for older adults (men 45 years or older, women 55 years or older) who are starting vigorous training programs.15
Chance factors besides should be identified using a screening tool; however, some patients crave a more thorough examination.xv Screening tools from the American College of Cardiology and the American Heart Clan are bachelor athttp://www.acc.org/clinical/guidelines/exercise/exercise_clean.pdf.15,21 Table 515 lists affliction-specific exercise considerations.
TABLE 5
Illness-Specific Exercise Considerations*
| Arthritis | |
| Special considerations | |
| Focus on improving functionality through cantankerous-training; functional exercises include sitting and standing and stair climbing. | |
| First with repeated short bouts of depression-intensity practise every solar day, progressively increasing the duration. | |
| Do affected joints using a pain-complimentary range of move for flexibility training. | |
| PRT should begin using the patient's hurting threshold as an intensity guide; begin with as little every bit two or three repetitions and work upwards to 10 to 12 repetitions, two or 3 days per week. | |
| Cardiovascular practise initially should be cursory (10 minutes), adding five minutes per session until 30 minutes is reached; cardiovascular exercises may be weight bearing (walking) or nonweight bearing (cycling, hydrotherapy). | |
| Contraindications | |
| Avoid vigorous, repetitive exercises that use unstable joints; overstretching; and forenoon exercise if rheumatoid arthritis–related stiffness is present. | |
| Avoid exercising joints during flare-ups. | |
| Discontinue practise if patient has unusual or persistent fatigue, increased weakness, or decreased range of motion, or if joint swelling or pain lasts for more than than one hour later exercise. | |
| Diabetes | |
| Special considerations | |
| Aim to expend at least 1,000 kcal per calendar week (equivalent to walking 10 miles). If weight loss is a goal, aim for more than 2,000 kcal per week. | |
| PRT should include lower resistance (twoscore to 60 percentage of 1-RM†) and lower intensity; utilize major muscle groups; repetition goal should exist 15 to twenty, focusing on proper form and breathing to prevent Valsalva maneuver. | |
| Before kickoff an exercise program, patients should undergo a medical evaluation to appraise cardiovascular, nervous, renal, and visual systems and the risk of diabetic complications. | |
| Contraindications | |
| Intense PRT may crusade an acute hyperglycemic consequence; basic PRT may cause postexercise hypoglycemia, especially in patients taking insulin or oral hypoglycemic agents. | |
| Patients with diabetes and concomitant retinopathy and overt nephropathy may have reduced exercise capacity. | |
| Peripheral neuropathy may be associated with gait and remainder abnormalities; consider limiting weight-bearing exercises and addressing patient human foot care. | |
| With autonomic neuropathy, emphasize the Borg RPE‡; monitor patient for center charge per unit and blood pressure response to practice, thermoregulation, signs of silent ischemia, and postexercise plasma glucose levels. | |
| Polyuria may contribute to dehydration and compromised thermoregulation. | |
| Hypertension | |
| Special considerations | |
| Focus on aerobic activities that use large muscle groups. | |
| Patients should do 30 to 60 minutes, three to 7 days per week to finer lower claret pressure; daily exercise may be virtually effective. | |
| Intensities of 40 to 70 percent 1-RM† announced to exist every bit constructive as higher intensities in lowering blood pressure. | |
| PRT should be combined with aerobic activity using lower resistance and more repetition; patients should follow proper form and breathing to prevent Valsalva maneuver. | |
| Beta blockers may attenuate heart charge per unit response and reduce practice chapters, and other medications may impair thermoregulation; therefore, patients should cool down gradually after do to forestall hypotension. | |
| Obesity | |
| Special considerations | |
| Focus on daily activities that use large musculus groups and increase total free energy expenditure. | |
| Patients should exercise 45 to lx minutes, five to vii days per week. | |
| Initial intensity should be 40 to 60 percent VO2 reserve with an emphasis on increased duration and frequency; progression to 50 to 75 per centum VO2 reserve volition help the patient expend calories faster; a vigorous program may non be necessary if moderate activities such as walking are preferred and volition promote compliance. | |
| Contraindications | |
| To forbid orthopedic injury, aerobic intensity and duration may be maintained at or below usual recommendations and modified as needed; nonweight-bearing aerobic activities or frequent rotation of modalities may be required. | |
| Equipment modifications may be required, because treadmills accept weight limits and cycle or rowing seats may be too minor; free weights may be used instead of weight machines, if needed. | |
| Considering risk of hyperthermia during exercise is increased in patients who are obese, hydration and proper attire should be emphasized. | |
| Osteoporosis | |
| Special considerations | |
| Focus should be on improving remainder and functionality. | |
| Frequency should include weight-bearing aerobic activities four days per calendar week; PRT two or iii days per week; flexibility five to 7 days per week; and functional exercise (e.1000., chair stand, stair-climbing, vigorous walking). | |
| Intensity should be 40 to seventy percentage VO2 reserve for aerobic activities; PRT (Borg RPE‡ at 13 to 15) should include one or 2 sets of eight to x repetitions. | |
| Hurting status will dictate the do plan; patients severely limited past pain should consult a doctor before initiating an exercise program. | |
| Contraindications | |
| Avoid explosive movements and high-touch loading (e.g., jumping, jogging) and dynamic abdominal exercise with excessive trunk flexion and twisting (e.grand., sit-ups, golf game swing, bending while picking up objects). | |
| Peripheral arterial disease | |
| Special considerations | |
| Because patients with peripheral arterial disease are at a high risk of cardiovascular disease, an do stress test should be performed before the doc creates an exercise prescription; many patients are extremely deconditioned. | |
| Pulmonary illness | |
| Special considerations | |
| The minimum frequency goal should be three to five days per week; those with impaired functional capacity may benefit virtually from daily exercise; patients should initially practice intermittently for x to 30 minutes per session until they progress to twenty to 30 minutes of continuous practise. | |
| An practise subspecialist should monitor initial training sessions, and modifications should be made in response to symptoms; patients may exist taught to use a heart rate or a dyspnea calibration to assess intensity. | |
| Walking is strongly recommended; stationary bicycling may exist an culling | |
| PRT with accent on shoulder girdle and inspiratory and upper extremity muscles is important. | |
THE V A's
To support behavior change, physicians should use the five A'south model (i.east., Assess, Suggest, Concord, Assist, and Arrange) when helping a patient with an exercise regimen. Physicians should brainstorm by assessing the patient's current fitness level and willingness to begin an exercise programme. Activity readiness questionnaires from the Canadian Society for Exercise Physiology are available athttp://www.csep.ca/forms.asp.15 These questionnaires can be given to patients in the waiting room before their appointments.
During the office visit, the md should stress the importance of physical activity and introduce exercise options and guidelines. Support networks within the family and community are key to long-term exercise compliance and should exist discussed. Physicians tin meliorate compliance by making practise programs social activities. Physicians may provide a take-dwelling house data packet including handouts on exercise-associated health benefits; resistance, aerobic, and flexibility preparation; and lifestyle modification, plus illustrations and guidelines for balance balls or other specialized exercise equipment.22,23
The patient and doc should collaboratively select long- and short-term fitness goals, including how the patient will come across the goals (e.g., social support, time management, beliefs changes).24 Physicians should counsel patients on performing some form of activity every solar day, problem solving, and gradual incorporation of additional do to meet patient-specific goals. The patient can keep a log, including questions and barriers to exercise, that tin can exist discussed at follow-upward visits. For example, if the patient does not do because of inclement weather, the dr. tin discuss advisable clothing, moving exercise indoors, or changing activities. Curt-term support tin can include a brief phone telephone call i week after the program begins. Finally, the dr. should provide referrals for physical therapy or special assistance, if needed.
Age should not limit practise training25,26; however, experts recommend a more than gradual approach in older patients.18 Before arranging for an exercise program, physicians should consider social preferences (e.g., solitude or socialization), cultural norms, practise history, instructional needs, readiness, motivation, self-subject area, curt- and long-term goals, and logistics. For example, dwelling-based do can be effective for physically or financially limited patients,27,28 whereas patients who are frail or who take balance and agility problems may do good more from supervised activities. Patients who usually do not exercise may enjoy moderately vigorous activities such as dancing or walking.
PRACTICAL TIPS
A Scandinavian study29 suggests that older patients whose physicians had advised them to do were five to half-dozen times more likely to participate in supervised practise classes, and men were more than 12 times more than likely to perform calisthenics at home.29 Incorporating activeness counseling into routine patient care involves the following:
-
Confirm that the patient understands the exercise prescription and its expected health benefits (e.g., enquire what activeness the patient is doing, how oft and how intensely he or she is active, and what wellness benefits are expected).
-
Interpret new do-related information that is presented in the media.
-
Recommend credible resource from which patients can become information well-nigh exercise.
-
Encourage affordable community-based exercise and support programs.
-
Foster a continued do and health message.
-
Serve as a resource for the nonmedical personnel who implement community and home-based do programs (e.yard., offer annual question-and-answer or medical update sessions).
Successful exercise prescriptions require collaboration between the doctor and the patient.xxx,31 Physicians should consider offering grouping visits and workshops to address the whys and hows of exercise. Collaboration with hospital-sponsored or hospital-approved exercise programs and concrete therapy and community-based programs increases exercise accessibility and provides patient back up while cutting costs. Physicians also should support personal, local, and federal initiatives that encourage increased physical activeness. Table vi includes resources for more information on creating exercise programs; many of these Web sites offer downloadable handouts.
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REFERENCES
show all references
one. Agency for Healthcare Enquiry and Quality. Centers for Disease Control and Prevention. Physical activity and older Americans: benefits and strategies. June 2002. Accessed March fifteen, 2006, at: http://www.ahrq.gov/ppip/activity.htm. ...
2. Pratt M, Macera CA, Wang G. College direct medical costs associated with physical inactivity. Phys Sports Med. 2000;28:63–seventy.
iii. Damush TM, Stewart AL, Mills KM, Rex AC, Ritter PL. Prevalence and correlates of physician recommendations to do amongst older adults. J Gerontol A Biol Sci Med Sci. 1999;54:M423–7.
four. Gregg EW, Cauley JA, Stone Grand, Thompson TJ, Bauer DC, Cummings SR, et al., for the Study of Osteoporotic Fractures Research Grouping. Relationship of changes in physical activity and mortality among older women. JAMA. 2003;289:2379–86.
5. Blair SN, Kohl HW 3, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fettle and all-cause bloodshed. A prospective study of healthy men and women. JAMA. 1989;262:2395–401.
6. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee IM, Jung D, Kampert JB. The clan of changes in physical-activeness level and other lifestyle characteristics with mortality amongst men. Northward Engl J Med. 1993;328:538–45.
7. Sheppard L, Senior J, Park CH, Mockenhaupt R, Chodzko-Zajko West, Bazzarre T. The National Pattern Consensus Briefing summary study: strategic priorities for increasing physical activity among adults anile ≥ 50. Am J Prev Med. 2003;25(3 suppl 2)S209–13.
8. American Centre Association. Target centre rates. AHA recommendation. Accessed September 22, 2005, at: http://www.americanheart.org/presenter.jhtml?identifier=4736.
9. Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom East, et al. Tai chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:187–94.
x. Sherrington C, Lord SR, Finch CF. Physical action interventions to foreclose falls among older people: update of the evidence J Sci Med Sport. 2004;(suppl ane):S43–51.
xi. Foldvari K, Clark M, Laviolette LC, Bernstein MA, Kaliton D, Castaneda C, et al. Association of muscle power with functional status in community-domicile elderly women. J Gerontol A Biol Sci Med Sci. 2000;55:M192–ix.
12. Fielding RA, LeBrasseur NK, Cuoco A, Bean J, Mizer K, Fiatarone Singh MA. High-velocity resistance grooming increases skeletal muscle peak power in older women. J Am Geriatr Soc. 2002;fifty:655–62.
13. American College of Sports Medicine position stand. Exercise and concrete action for older adults. Med Sci Sports Exerc. 1998;30:992–1008.
14. Kraemer WJ, Adams Chiliad, Cafarelli Due east, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand. Progression models in resistance grooming for salubrious adults. Med Sci Sports Exerc. 2002;34:364–80.
fifteen. Whaley MH, Brubaker PH, Otto RM, Armstrong LE, for the American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia, Pa.: Lippincott Williams & ; Wilkins, 2006.
16. Gehlsen GM, Whaley MH. Falls in the elderly: part II, residue, strength, and flexibility. Arch Phys Med Rehabil. 1990;71:739–41.
17. Judge JO, Davis RB Three, Ounpuu S. Step length reductions in advanced historic period: the part of ankle and hip kinetics. J Gerontol A Biol Sci Med Sci. 1996;51:M303–12.
18. American College of Sports Medicine position stand up. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:975–91.
19. Constitute of Medicine. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Physical activity. In: Dietary Reference Intakes for Energy, Saccharide, Cobweb, Fat, Fat Acids, Cholesterol, Protein and Amino Acids. Washington, D.C.: National Academy Printing, 2005:880–935. Accessed March xv, 2006, at: http://www.nap.edu/books/0309085373/html/.
20. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient-physician advice. Fam Med. 2002;34:383–ix.
21. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Centre Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883–92.
22. Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96:219–22.
23. Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns. 1998;35:83–viii.
24. Harrington J, Noble LM, Newman SP. Improving patients' advice with doctors: a systematic review of intervention studies. Patient Educ Couns. 2004;52:7–xvi.
25. Singh MA. Do comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci. 2002;57:M262–82.
26. Heath JM, Stuart MR. Prescribing exercise for frail elders. J Am Board Fam Pract. 2002;15:218–28.
27. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a full general practice programme of home based exercise to forestall falls in elderly women. BMJ. 1997;315:1065–nine.
28. Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. J Rheumatol. 2000;27:2215–21.
29. Hirvensalo Thousand, Heikkinen E, Lintunen T, Rantanen T. The result of advice by health care professionals on increasing physical activeness of older people. Scand J Med Sci Sports. 2003;13:231–six.
30. Epstein RM, Alper BS, Quill TE. Communicating prove for participatory decision making. JAMA. 2004;291:2359–66.
31. Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87:1115–45.
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