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Structured clinical reasoning for exercise prescription in patients with comorbidity

24-05-2019
In different chronic diseases, exercise therapy is an effective intervention. It can be explained by the fact that it improves physical functioning and reduces morbidity and mortality. In most chronic diseases, however, coexisting diseases (called co-morbidities) are common and can affect the ability to exercise (e.g. due to reduced exercise tolerance in the case of comorbid diabetes). The recipe for exercise therapy is usually focused on an index disease. The presence of comorbidity may require adjustments to the exercise program as intended for the index disease. Advanced clinical reasoning of health professionals (HPs) is required to provide an effective and safe exercise program for patients with multiple morbidity. This article provides a guide to structuring the clinical reasoning process of health professionals when prescribing exercise therapy for the individual patient with an index disease and comorbidity.

For the development of guidelines and protocols on exercises adjusted to co-morbidity, the already published strategy has been adapted to a version that can be used for an individual exercise prescription. Essential steps and considerations when prescribing an exercise program to an individual patient with comorbidity are described. A case description is used as an example of how proposed strategy leads to clinical decisions.

Although the need to adapt exercise therapy to comorbidity is clear from a clinical perspective, there is remarkably little attention in studies on this topic. The proposed strategy can play a role in educational and professional development. The advanced clinical expertise needed for safe and effective exercise therapy in patients with complex health status is emphasized. Presence of comorbidity may require adjustments to exercise therapy. Essential steps and considerations when prescribing an exercise program to an individual patient with an index disease and comorbidity are described. The proposed strategy can be used to structure the clinical reasoning process of health professionals. Factors such as patient preferences, costs and adequate professional encouragement are important for a successful exercise program. Adequate clinical decisions require HP's advanced clinical expertise, which can be supported by a structured clinical reasoning process.

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