A Comprehensive Approach to Diagnose, Treat, and Prevent Pain With Exercise Science

The next step is stratifying patients by risk level, according to Dr. Mignosa. Moderate-to-low risk patients include men aged older than 45 years and women aged older than 55; smokers; and patients with hypertension, high cholesterol, prediabetes, a sedentary lifestyle, obesity, or family history of myocardial infarction or cardiovascular disease. High risk patients include those with a known cardiovascular, pulmonary or metabolic disease.

Moderate risk patients require medical clearance to participate in a vigorous exercise program and should undergo a maximal exercise test before participation. High-risk patients require medical clearance for both low-to-moderate exercise programs and vigorous exercise programs and require both sub maximal and maximal exercise tests prior to participation in an exercise program.

“Finding out what works for your patient and understandjng your patient’s support group is important,” said Dr. Mignosa. He suggested offering patients a variety of  exercise choices and encouraging them to increase the duration, frequency, and intensity of exercise slowly in order to prevent injury. Exercise should fall into four categories: cardiovascular, strength, flexibility, and neuromotor.

“Recommend that patients get between 30 and 90 minutes of exercise daily, and avoid sitting for more than three hours per day,” Dr. Mignosa advised. “The single most important factor determining patient’s participation in exercise was receiving a strong recommendation from their primary care physician.”


1. Mignosa R. “The Panacea of Exercise.” Presented at: AAPM 2015. Sept. 17-20; National Harbor, Maryland.

2. Naci H et al. “Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.” BMJ. 2013; 347:f5577.