Exercise: The new vital sign

Physical Activity as a Vital Sign

Becoming more physically active may be the most beneficial thing you can do to improve your health.  The least fit get the most benefit from starting an exercise program and building more physical activity into  their lives. This information is adapted from the Preventative Cardiovascular Nurses Association (www.PCNA.Net) and meant to provide guidance, tools and confidence needed to get started with a safe and effective exercise program.

Steps you can take to become more physically active:

Make exercise a vital sign.

Discuss with your healthcare provider your exercise status  at your next  office visit

  • Do you exercise?
  • If so, what type?, how long?, how hard?, and how often?

Many health systems have added this question to their electronic medical record to ensure a place to conveniently record.  Documenting physical activity at every visit allows you to track your progress over time.If  your answer is no you don’t exercise, do you understand the benefits of exercise?

You can help prevent heart attack and stroke by:

  • lowering blood pressure, or chance of getting high blood pressure
  • improving cholesterol
  • lowering  blood sugar and my chance for getting diabetes
  • burning calories to maintain or lose weight
  • reduce stress, depression or anxiety
  • improving my heart and lung function

Exercise can improve your:

  • ability to play sports
  • muscle strength
  • flexibility and range of motion of joints
  • balance
  • energy level
  • sleep

Exercise can lower your  risk for:

  • some kinds of cancers (colon, breast and lung)
  • osteoporosis (thinning of bones)

The best exercise is the one you will do!
• Start slowly and increase activity over time.
• You may feel sore and more tired when you first start.
• Something is better than nothing.

Be encouraged to move more throughout the day even if you don’t feel ready to start an exercise program.
“Move More, Sit Less!” suggestions to for increasing daily activity.

  • Park farther away from any store or place you go—or get off the bus or out of the taxi a few blocks
  • before you get to where you are going.
  • Avoid the drive-through. Park your car and walk into the grocery store, drugstore, bank, or restaurant.
  • When you are stopped in traffic or at a stop light, tighten, then relax your stomach, arm or leg muscles.
  • Lift your grocery or shopping bags like weights.
  • Take the stairs! Climb up a flight or two whenever you can.
  • Walk around or march in place while you talk to someone on your mobile phone.
  • Clean your house, wash your car, or rake leaves. Maybe start gardening!
  • Try doing some exercises when doing chores where you don’t normally move. Examples include
  • small squats when ironing or folding clothes and calf raises while brushing your teeth.
  • Do some quick exercises during the break of your favorite TV show. Try some push ups,
  • sit ups, or do some light weight training.
  • Instead of watching TV or a movie—go window shopping, walking at a zoo or visit a museum.

Getting Started

If you  are considering starting an exercise program, are you healthy enough to exercise independently? If you have no cardiovascular symptoms and are low risk, get an exercise prescription from your health care practitioner and advice on starting an exercise program.

If you have heart disease or other health concerns, talk with your nurse or doctor before starting an exercise program. They may take a health history, perform a physical exam or request a monitored stress test. This information will be used to make sure exercise is safe for you and to develop an exercise prescription.

Exercise Prescription

There are four parts to an exercise prescription. These four things are sometimes known as F.I.T.T.
F: Frequency (Number of Times Per Week You Exercise)

  •  Try to exercise or be physically active on most, and ideally all, days of the week.
  •  If every day is not possible, work to get in at least 3 days a week. Try to spread out the days you are active (every other day is better than three days in a row).
  • Remember—something is better than nothing.

I: Intensity (How Hard You Exercise)
You may need to work with your nurse or doctor to figure out the best way to measure your exercise
intensity. A few ways are:

  •  Target Heart Rate (THR, or pulse)
  • The “Talk Test”
  •  Rated Perceived Exertion (RPE)

More about these 3 ways to measure the intensity of the exercise you do:
You can  count your heart rate (or pulse) and give you a target heart rate to reach during exercise. Your pulse is the number of times your heart beats in one minute. Pulse rates vary from person to person. Your pulse is lower when you are sitting still and gets faster when you exercise. Knowing how to take your pulse can help you evaluate your exercise program.

Remember some medications or conditions can limit how high your heart rate can go. Be sure to  discuss this  with your healthcare provider.  If taking your pulse is difficult, there are other ways to figure out if you are working as hard as you need to.

  • The “Talk Test” is simple. If you can talk while exercising, the intensity of your activity is considered tobe safe and appropriate for improving your health. If you are exercising so hard that you cannot easily talk to the person next to you, this means you are exercising pretty hard. Ask your healthcare provider  if this is safe for you.
  • You can also measure how hard you are working using the Rated Perceived Exertion (RPE) Scale

T Time: (How long you do the exercise) 

How long you should exercise—usually measured in minutes per day. While a minimum of 30 minutes of endurance exercise daily is recommended for most adults, it may take some time to increase to that level if you haven’t been exercising for a while. You may be advised to start with 5 minutes a day and add a few minutes each day as time goes on.
T Type: (What kind of exercise you do)
Walking, jogging, bicycling and swimming are examples of exercise that use large muscles and cause your body to use more oxygen than it would while resting. These types of activities are called endurance and they help the heart.

Strength exercises help to increase strength and muscle tone. They may also help with balanceand fall prevention. Examples of strength exercises are pushups, sit ups, and using weight lifting machines or free weights.

Flexibility exercises stretch and lengthen your muscles to help prevent soreness and injury Start slow and add a little more over time.

Tricks of the Trade

1. Some is better than none, so start slowly.

Don’t expect results overnight, but do take small steps each day. You might not notice any big changes— especially in your  weight—for a few weeks or even months. It is still good for your heart health!

2 .  Get a partner or join a class

Be active with a friend or a group to make it more fun! You are less likely to cancel an exercise date with a friend than one with yourself!

3.  Change your routine around

  • You will be less likely to get bored or injured if you change your activities.
  • Walk one day; bike the next.
  • Mix in fun sports like golf or tennis to stay active and keep exercise fun.
  • Learn to dance or garden.
  • Even chores like mowing the lawn and cleaning your house can keep you moving.

4.  Make exercise fun

  • Plan your walking route to see new sights—change up the neighborhoods you walk through.
  • Take awalk through the zoo or park.
  • Listen to music oran audiobook to help pass the time.
  • Exercise on a treadmill or stationary bike while reading or watching TV.

5.  Write it down

  • Keep an activity journal or diary.
  • Write down what you did, how long you did it, and how you felt. This helps to track your progress. Keeping a journal can also be a good way to set future goals.
  • Write down where you want to be next week, month or year.

6.  Try something new

It may be that jogging is not for you. Try a swimming program instead or sign up for a yoga class or tennis lesson. Find things you enjoy.

7.  Make exercise a habit

  • Choose a regular time for exercise each day.
  • Sign a contract with yourself to exercise.
  • Put exercise “appointments” on your calendarand keep them!
  • Change into workout clothes before you leave work.

8.  Make exercise a priority

  • You have to believe that exercise is important enough to make it happen.
  • Pay attention to your mood, how your body feels, and your stress levelAFTER you are active.
  • Think about your reasons for becoming active.

9.  Come up with solutions to reasons you may not want to be active

  • If you don’t like to sweat—set up a fan or split it up into three 10-minute walks.
  • If you feel too tired, try to be active earlier in the day.
  • Write down your solutions.

10.  Every little bit counts

  • Take a walk on your lunch break or a longer path back to your desk.
  • Walk your dog twice a day.
  • Take the stairs instead of the elevator.
  • Split your activity up into two 15-minute sessions

These are the 4 kinds of exercise that you can pick from:

  •  Endurance
  •  Strength
  •  Balance
  •  Flexibility

Endurance: activities that increase your breathing and heart rate (pulse)

Endurance activities  keep you healthy and more fit, help you do the things you need to do every day  improve the health of your heart and lungs delay or prevent diseases such as diabetes, colon and breast cancers, and heart disease.
Examples of endurance activities:

  •  fast walking
  •  dancing
  •  biking
  •  playing tennis
  • yard work
  •  jogging
  •  climbing stairs or hills
  •  swimming
  •  playing basketball

Strength:activities that increase your muscle strength Strength exercises help you stay independent in your daily activities like                                 climbing stairs and carrying things. Strength exercises include lifting weights and using a resistance band.

Balance: activities that make you more stable. These help improve your balance and prevent falls. Balance exercises include standing on one foot,heel-to-toe walk, and tai chi.
Flexibility: activities that keep your body flexible. These give you more freedom of movement for everyday activity. Flexibility exercises include shoulder and upper arm stretches, calf stretches, and yoga.


You have many choices

When you travel…

• Stay at a hotel that has an exercise room.
• Ask locals or the front desk of the hotel where you can walk or run safely.
• Walk to dinner instead of taking a taxi.
• Do your sightseeing on a bike or on foot.
Do some stretching, yoga or use a strength band in your room.

When the weather isn’t the best…

• Walk at the mall.
• Find stairs at your work or apartment building.
• Use a video or TV exercise program.
• Dance to your favorite music.
When you can’t afford a fitness center…
• Use household items for weights such as milk cartons or canned foods.
• Use your own body weight: squats, push-ups or sit ups.
• Join a walking group with friends.
• Find fun activities through a local community center.
When you feel tired…

• Try yoga, light weights or stretching—this will still help your balance,
strength and flexibility.
• Exercise early in the day.
• Start walking—you may start to have more energy with each step.

When it doesn’t seem fun...

• Do an activity while watching TV or a movie, reading a book or a magazine, listening to music, a book or podcasts.
• Consider it “play time” like kids do: play with the dog, play with grandkids.
• Try a new class or activity.
• Find a friend to be active with you.
• Help out a neighbor or friend with moving or housework.

 Get  Assistance if needed

If you need more support in starting an exercise program, consider a referral to a health and fitness professional. Your health systems cardiac rehabilitation or physical therapy programs may be good resources. Become familiar with other local resources. Senior centers and the YMCA may offer chair or water based exercise programs for your patients that have orthopedic or balance problems.
The tool, “It’s Never Too Late!” is a resource for older patients as well as those with health concerns.


Report your results!

At your  follow up  report any exercise-induced symptoms such as shortness of breath, chest pain, excessive fatigue or orthopedic concerns. Discuss your progress with exercise and to update their exercise prescription as needed. This is a good time to problem solve any barriers to exercise and help problem solve ways to stick with the plan.

About PCNA

The Preventive Cardiovascular Nurses Association (PCNA) is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals. The current state of health care demands that nurses and advanced practice nurses play a leading role in identifying and implementing cardiovascular risk reduction strategies. PCNA is committed to the continued education and support of nurses so they may successfully rise to this challenge. We do this by educating and supporting nurses through the development of professional and patient education, leadership, and advocacy.


  • To increase public and political awareness of the critical role nurses play in comprehensive cardiovascular risk reduction.
  • To promote individual and community education in cardiovascular risk reduction and disease management across the lifespan.
  • To provide opportunities for education and professional development for nurses.
  • To advocate for professional certification and development for nurses specializing in cardiovascular disease prevention and management.
  • To disseminate information on innovative, fiscally responsible models of cardiovascular care delivery.
  • To foster productive liaisons with professional organizations sharing similar goals.
  • To support the utilization and dissemination of research and support evidence-based practice in cardiovascular risk reduction and disease management.


Visit the American College of Sports Medicine’s Exercise is Medicine Web Site
for more resources and tips regarding helping your patients become and stay active!
Professional Resources: Assessment and Exercise Prescription

Based on 2008 U.S. Department of Health and Human Services Physical Activity Guidelines for Americans.

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