I completely agree. I don’t think the exercise science behind any Olympic athlete’s training has ever been directly applied to managing chronic diseases. Regarding “Stratified Exercise Prescription,” I would really appreciate it if you could clarify exactly what you mean — when I hear this term, what comes to mind are concepts like periodization in sports science and the phased return-to-play protocols used after injuries. But I’m not sure if I’m interpreting it correctly.

At the last conference I attended, many experts were discussing how the optimal exercise prescription and dosing are still not clearly defined for various clinical contexts.

From a different perspective, I was thinking — maybe there isn’t one single “optimal” prescription. Perhaps this is a process that needs to be individualized and guided by various biomarkers, tailored to the person’s condition and the trajectory of their disease.

Another point I’ve noticed is that many exercise professionals don’t seem to have a strong background in molecular physiology — as you would appreciate. It made me wonder whether, as exercise prescribers, we really have a comparable level of theoretical and educational foundation as, say, a physician does when prescribing medication. @Eleftherios Dimitros

When crafting an exercise prescription for individuals living with chronic diseases, it is essential to tailor the approach to each person’s unique circumstances, taking into account their specific condition, fitness levels, and potential limitations. Here is a comprehensive guide to consider:

1. Medical Clearance: Before embarking on any exercise regimen, it is crucial for individuals to seek guidance from their healthcare provider. This ensures that the chosen activities are safe and appropriate given their medical history and current health status.

2. Assessment: Begin with a thorough assessment of the individual’s existing fitness level. This may include evaluating cardiovascular endurance through walking tests, assessing muscle strength with resistance exercises, and measuring flexibility and balance. Understanding the starting point is essential for effective goal-setting.

3. Type of Exercise:

- Aerobic Exercise: Consider activities that elevate the heart rate and improve cardiovascular health. Walking briskly, cycling, swimming, or even dancing can be enjoyable options. It is beneficial to encourage low to moderate intensity, making the exercises accessible and safe.

- Strength Training: Integrate resistance exercises that focus on major muscle groups. This helps preserve muscle mass, enhances metabolism, and improves overall functional capacity. Lightweight resistance bands or body-weight exercises can be excellent starting points.

- Flexibility and Balance: Incorporate stretching routines and balance exercises to enhance mobility and prevent falls. Practices like yoga or tai chi not only improve flexibility but also promote relaxation and mindfulness.

4. Frequency: Aim for a goal of at least 150 minutes of moderate-intensity aerobic activity each week, strategically spread out across several days. Additionally, encourage strength training to be included at least two times a week to build and maintain muscle strength.

5. Duration: For those who are new to physical activity, starting with shorter exercise sessions of about 10 to 15 minutes can help ease the transition. Gradually increasing the duration as fitness levels improve can build confidence and competence.

6. Intensity: Utilize the Rating of Perceived Exertion (RPE) scale, which allows individuals to self-assess how hard they feel they are working during exercise. Alternatively, heart rate monitoring can help ensure that the intensity stays within a safe and effective range, allowing for a tailored exercise experience.

7. Progression: As individuals become more conditioned, it is important to introduce gradual modifications to their exercise routine. This could mean increasing the intensity, duration, or frequency of workouts, always encouraging them to listen to their bodies and make adjustments as needed.

8. Monitoring: Regularly track the individual’s response to the exercise program by discussing how they feel during and after workouts. This not only helps in determining the program's effectiveness but also fosters open communication about any challenges or discomfort.

1. Medical Clearance: Before starting any exercise regimen, individuals need to consult their healthcare provider. This ensures that the chosen activities are safe and appropriate given their medical history and current health status.ience.rience.etwork.

Personalization is the cornerstone of effective exercise prescription for individuals with chronic diseases. By focusing on each person's unique journey, we can promote a healthier lifestyle that emphasizes safety, enjoyment, and long-term commitment to physical activity.

This is why we need to adapt the exercise intervention tailored to the participants' individual capabilities and comfort levels, to avoid unnecessary physical or psychological burden while maximizing intervention effectiveness

stratified exercise prescription is important, and it has several benefits. Heterogeneity in response to exercise among individuals with chronic diseases is well-documented. For instance, studies show that while many people with type 2 diabetes improve glycemic control with aerobic training, a subgroup does not respond significantly. Furthermore, Stratification improves adherence and safety. These tailored interventions help reduce adverse events (such as cardiac episodes in heart failure patients) while maximizing benefits (VO₂ peak improvement). Multimorbidity and aging further emphasize the need for stratification. Patients with multiple chronic conditions respond differently, requiring nuanced programming to avoid overtraining or exacerbating conditions.