Nutrition Prescriptions Should Also Include Exercise Recommendations

November 16, 2018   /



Anne Danahy, MS, RDN

RDNs are aware of the impact of physical activity on health and wellness. Although our focus is on food and helping patients make and maintain diet modifications, exercise can have a synergistic effect on disease prevention or management. It is important to assess physical activity, and in patients who are not meeting the minimum weekly goal, include a specific recommendation as part of a patient’s nutrition plan or prescription.

Chances are, your patients live or work near a health club or fitness studio, but most are not utilizing them as much as they can and should. In a recent study, led by the World Health Organization, researchers determined that even though health professionals advocate for exercise as part of a healthy lifestyle, 1.4 billion, or at least one-quarter, adults worldwide are not getting enough exercise.1

Findings from the Centers for Disease Control and Prevention are even worse for adults in the US.2 The CDC determined that only 22.9% of Americans aged 18-64 years are achieving their recommended 2 days of strength training plus 150 minutes of moderate exercise (or 75 minutes of vigorous exercise) each week. Women are worse than men, with only 18.7% of women meeting exercise goals compared with 27.2% of men. The “lack of time” argument does not appear to hold much weight due to the fact that nonworking adults get even less physical activity than those who work.2

Motivating patients to move more       

Whatever the reason for not being physically active, it is important to inform patients about the downside of sitting too much, especially the fact that it puts them at increased risk of developing chronic diseases, problems managing their disease, and a greater risk for premature death.

In addition to addressing the negatives, RDNS should consider framing an exercise recommendation in terms of what the client will gain from a healthy lifestyle as most people are more receptive to hearing about the upside. Rather than speaking about general health risks, framing an exercise recommendation in terms of “what’s in it for you” may resonate more with a client, and have a greater impact in terms of motivating them to take that first step. While Everyone can benefit from any type of exercise, adding an exercise prescription to the care plan for the following groups of patients can have exceptional benefits:

  • Breast cancer survivors: Engaging in regular physical activity can result in up to a 50% reduction in cancer recurrence, and 40% lower risk of death from cancer.3 In addition, participating in group strength training programs during chemotherapy results in less fatigue and improved quality of life.4
  • Patients with colon cancer: Even if started after a diagnosis, regular exercise results in a 31% lower risk of death compared to those who don’t exercise.3
  • Men with prostate cancer: In those with non-metastatic cancer, 3 hours of weekly exercise can lower the risk of death by 61%.3
  • Successful losers: Those who work out for at least 200 minutes each week are more likely to maintain most of the weight they have lost.5
  • Women with polycystic ovarian syndrome (PCOS): Every hour of vigorous (but not moderate) aerobic activity a woman with PCOS engages in reduces her risk of metabolic syndrome by 22%.6
  • Anyone with prediabetes or metabolic diseases: The American Diabetes Association advises a minimum of 150 minutes of moderate exercise each week as part of their lifestyle recommendations to prevent diabetes. Lifestyle intervention that includes this amount of exercise is more effective at preventing diabetes than metformin.7

Disease improvement and management aside, older adults especially, should be aware about the many ways exercise can enhance quality of life. First, exercise can prevent age-related muscle and bone loss, weight gain, and joint pain, allowing them to remain stronger, more independent and active for longer. Physical activity also improves cognitive function8 and reduces the risk of dementia.9 Finally, exercise puts more money in your patients’ pockets as they age. Many gym memberships are subsidized by health insurance plans, but even for those without this benefit, the cost of a gym membership is easily offset by the savings in healthcare costs, medications, and hospitalizations. Although it is difficult to quantify an exact savings, studies have shown that being physically active most days of the week, may result in as much as a 25% reduction in medical costs.10

The World Health Organization has a goal of reducing insufficient physical activity by at least 10% by 2025,1,11 but they admit that progress toward that goal has been too slow. All clinicians, including RDNs, should prescribe specific exercises and think creatively with their patients to find ways to help them meet their physical activity goals.


  1. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077-e1087.
  2. Blackwell DL, Clarke TC. State variation in meeting the 2008 federal guidelines for both aerobic and muscle-strengthening activities through leisure-time physical activity among adults aged 18–64: United States 2010–2015. Natl Health Stat Report. 2018(112).
  3. Physical activity and cancer. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet. Accessed November 13, 2018.
  4. Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. International journal of cancer. 2015;137(2):471-80.
  5. Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56(4):441-7.
  6. Greenwood EA, Noel MW, Kao CN, et al. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertil Steril. 2016;105(2):486-93.
  7. American Diabetes Association. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018; 41(Suppl 1): S51-S54. 
  8. Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2017;52(3):154-160.
  9. Trigiani LJ, Hamel E. An endothelial link between the benefits of physical exercise in dementia. J Cereb Blood Flow Metab. 2017;37(8):2649-2664.
  10. Carlson SA, Fulton JE, Pratt M, Yang Z, Adams EK. Inadequate physical activity and health care expenditures in the United States. Prog Cardiovasc Dise. 2015;57(4):315-23.
  11. Target 3: Reduce prevalence of physical inactivity. World Health Organization. http://www.who.int/nmh/ncd-tools/target3/en/. Accessed November 13, 2018.