What is the FITT principle recommendation for the time that will give you the most benefit from your card?

The FITT principles are an exercise prescription to help participants understand how long and how hard they should exercise.

FITT is acronym that stands for Frequency, Intensity, Time, and Type. FITT can be applied to exercise in general or specific components of exercise. For example, below are some general FITT guidelines for weekly exercise.

Frequency: Daily moderate exercise is ideal, but try to exercise a minimum of 3-5 days per week.

Intensity: Moderate to vigorous intensity exercise is recommended for adults.

Time: 30-60 minutes per day.

Type: To maintain a well-balanced fitness level, perform a variety of exercises included cardio, strength, and flexibility training.

Papers of particular interest, published recently, have been highlighted as:

• Of importance

•• Of major importance

1••. Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2014 This scientific statement from the American Heart/American Stroke Association has been updated from the original 2004 statement. This version not only provides exercise guidelines for stroke survivors, caregivers, and health care providers but also discusses when exercise should begin for people after stroke. Physical activity and exercise are beneficial and should be incorporated into daily routine. [PubMed] [Google Scholar]

2. Mackay-Lyons MJ, Makrides L. Exercise capacity early after stroke. Arch Phys Med Rehabil. 2002;83(12):1697–702. [PubMed] [Google Scholar]

3. Billinger SA, Taylor JM, Quaney BM. Cardiopulmonary response to exercise testing in people with chronic stroke: a retrospective study. Stroke Res Treat. 2012;2012:987637. [PMC free article] [PubMed] [Google Scholar]

4. Sandroff BM, Motl RW, Pilutti LA, et al. Accuracy of StepWatch and ActiGraph accelerometers for measuring steps taken among persons with multiple sclerosis. PLoS One. 2014;9(4):e93511. [PMC free article] [PubMed] [Google Scholar]

5. Pharr JR, Bungum T. Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study. Glob J Health Sci. 2012;4(6):99–108. [PMC free article] [PubMed] [Google Scholar]

6. Hackam DG, Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study. Stroke. 2007;38(6):1881–5. [PubMed] [Google Scholar]

7. Pang MY, Eng JJ, Dawson AS, Gylfadottir S. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil. 2006;20(2):97–111. [PMC free article] [PubMed] [Google Scholar]

8•. Veerbeek JM, Kwakkel G, van Wegen EE, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke. 2011;42(5):1482–8. Articles that reviewed acute stroke activities of daily living predictive outcome measures were analyzed. At this time, the predictive value of these measures needs further research as current research is not thorough enough to draw decisive conclusions. [PubMed] [Google Scholar]

9. Bernhardt J, Chitravas N, Meslo IL, Thrift AG, Indredavik B. Not all stroke units are the same: a comparison of physical activity patterns in Melbourne, Australia, and Trondheim, Norway. Stroke. 2008;39(7):2059–65. [PubMed] [Google Scholar]

10. Askim T, Bernhardt J, Salvesen O, Indredavik B. Physical activity early after stroke and its association to functional outcome 3 months later. J Stroke Cerebrovasc Dis. 2014;23(5):e305–12. [PubMed] [Google Scholar]

11. MacKay-Lyons MJ, Makrides L. Cardiovascular stress during a contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect? Arch Phys Med Rehabil. 2002;83(10):1378–83. [PubMed] [Google Scholar]

12. Prajapati SK, Mansfield A, Gage WH, Brooks D, McIlroy WE. Cardiovascular responses associated with daily walking in subacute stroke. Stroke Res Treat. 2013;2013:612458. [PMC free article] [PubMed] [Google Scholar]

13. ACSM. Guidelines for exercise testing and prescription. 8. Philadelphia: Lippincott Williams & Wilkins; 2010. [Google Scholar]

14. Tang A, Marzolini S, Oh P, McIlroy WE, Brooks D. Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial. BMC Neurol. 2010;10:40. [PMC free article] [PubMed] [Google Scholar]

15. Prior PL, Hachinski V, Unsworth K, et al. Comprehensive cardiac rehabilitation for secondary prevention after transient ischemic attack or mild stroke: I: feasibility and risk factors. Stroke. 2011;42(11):3207–13. [PubMed] [Google Scholar]

16. Marzolini S, Leung YM, Alter DA, Wu G, Grace SL. Outcomes associated with cardiac rehabilitation participation in patients with musculoskeletal comorbidities. Eur J Phys Rehabil Med. 2013;49(6):775–83. [PubMed] [Google Scholar]

17. Ryan AS, Ivey FM, Prior S, Li G, Hafer-Macko C. Skeletal muscle hypertrophy and muscle myostatin reduction after resistive training in stroke survivors. Stroke. 2011;42(2):416–20. [PMC free article] [PubMed] [Google Scholar]

18. Billinger SA, Tseng BY, Kluding PM. Modified total-body recumbent stepper exercise test for assessing peak oxygen consumption in people with chronic stroke. Phys Ther. 2008;88(10):1188–95. [PMC free article] [PubMed] [Google Scholar]

19. Rimmer JH, Rauworth AE, Wang EC, Nicola TL, Hill B. A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors. Arch Phys Med Rehabil. 2009;90(3):407–12. [PubMed] [Google Scholar]

20. Duncan P, Studenski S, Richards L, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke. 2003;34(9):2173–80. [PubMed] [Google Scholar]

21. Billinger SA, Mattlage AE, Ashenden AL, Lentz AA, Harter G, Rippee MA. Aerobic exercise in subacute stroke improves cardiovascular health and physical performance. J Neurol Phys Ther. 2012;36(4):159–65. [PMC free article] [PubMed] [Google Scholar]

22. Yates JS, Studenski S, Gollub S, et al. Bicycle ergometry in subacute-stroke survivors: feasibility, safety, and exercise performance. J Aging Phys Act. 2004;12(1):64–74. [PubMed] [Google Scholar]

23•. Tang A, Sibley KM, Thomas SG, et al. Effects of an aerobic exercise program on aerobic capacity, spatiotemporal gait parameters, and functional capacity in subacute stroke. Neurorehabil Neural Repair. 2009;23(4):398–406. This paper presents information regarding physical therapists’ comfort level with prescribing exercise to patients with neurologic conditions including stroke. Most therapists agree exercise is important but few utilize in clinical practice. [PubMed] [Google Scholar]

24. Biasin L, Sage MD, Brunton K, et al. Integrating aerobic training within subacute stroke rehabilitation: a feasibility study. Phys Ther. 2014 [PMC free article] [PubMed] [Google Scholar]

25. Doyle L, Mackay-Lyons M. Utilization of aerobic exercise in adult neurological rehabilitation by physical therapists in Canada. J Neurol Phys Ther. 2013;37(1):20–6. [PubMed] [Google Scholar]

26••. Ammann BC, Knols RH, Baschung P, de Bie RA, de Bruin ED. Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. BMC Neurol. 2014;14(1):167. This meta-analysis reviewed 28 articles that used randomized controlled trials. The authors concluded that cardiorespiratory fitness can be improved through aerobic exercise in stroke survivors. [PMC free article] [PubMed] [Google Scholar]

27. Marsden DL, Dunn A, Callister R, Levi CR, Spratt NJ. Characteristics of exercise training interventions to improve car-diorespiratory fitness after stroke: a systematic review with meta-analysis. Neurorehabil Neural Repair. 2013;27(9):775–88. [PubMed] [Google Scholar]

28. Katz-Leurer M, Sender I, Keren O, Dvir Z. The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial. Clin Rehabil. 2006;20(5):398–405. [PubMed] [Google Scholar]

29. Quaney BM, Boyd LA, McDowd JM, et al. Aerobic exercise improves cognition and motor function poststroke. Neurorehabil Neural Repair. 2009;23(9):879–85. [PMC free article] [PubMed] [Google Scholar]

30. Globas C, Becker C, Cerny J, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair. 2012;26(1):85–95. [PubMed] [Google Scholar]

31. Luft AR, Macko RF, Forrester LW, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke. A randomized controlled trial. Stroke. 2008 [PMC free article] [PubMed] [Google Scholar]

32. Macko RF, Ivey FM, Forrester LW, et al. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke. 2005;36(10):2206–11. [PubMed] [Google Scholar]

33. Jin H, Jiang Y, Wei Q, Wang B, Ma G. Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: discordance between improved cardiovascular fitness and walking ability. Disabil Rehabil. 2012;34(19):1665–71. [PubMed] [Google Scholar]

34. Jin H, Jiang Y, Wei Q, Chen L, Ma G. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke. NeuroRehabilitation. 2013;32(2):327–35. [PubMed] [Google Scholar]

35. American College of Sports M. ACSM’s guidelines for exercise testing and prescription. Vol. 9. Philadelphia: Lippincott Williams & Wilkins; 2014. [Google Scholar]

36. Gellish RL, Goslin BR, Olson RE, McDonald A, Russi GD, Moudgil VK. Longitudinal modeling of the relationship between age and maximal heart rate. Med Sci Sports Exerc. 2007;39(5):822–9. [PubMed] [Google Scholar]

37. Brawner CA, Ehrman JK, Schairer JR, Cao JJ, Keteyian SJ. Predicting maximum heart rate among patients with coronary heart disease receiving beta-adrenergic blockade therapy. Am Heart J. 2004;148(5):910–4. [PubMed] [Google Scholar]

38. MacKay-Lyons MJ, Howlett J. Exercise capacity and cardiovascular adaptations to aerobic training early after stroke. Top Stroke Rehabil. 2005;12(1):31–44. [PubMed] [Google Scholar]

39. Pang MY, Charlesworth SA, Lau RW, Chung RC. Using aerobic exercise to improve health outcomes and quality of life in stroke: evidence-based exercise prescription recommendations. Cerebrovasc Dis (Basel, Switzerland) 2013;35(1):7–22. [PubMed] [Google Scholar]

40. Tang A, Marzolini S, Oh P, McIlroy WE, Brooks D. Factors associated with change in aerobic capacity following an exercise program for individuals with stroke. J Rehabil Med. 2013;45(1):32–7. [PubMed] [Google Scholar]

41. Mezzani A, Hamm LF, Jones AM, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. J Cardiopulm Rehabil Prev. 2012;32(6):327–50. [PubMed] [Google Scholar]

42. Tang A, Eng JJ, Krassioukov AV, et al. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial. Int J Stroke. 2014;9(7):883–9. [PMC free article] [PubMed] [Google Scholar]

43. Manns PJ, Dunstan DW, Owen N, Healy GN. Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability? Phys Ther. 2012;92(4):614–25. [PubMed] [Google Scholar]

44. Ivey FM, Hafer-Macko CE, Ryan AS, Macko RF. Impaired leg vasodilatory function after stroke: adaptations with treadmill exercise training. Stroke. 2010;41(12):2913–7. [PMC free article] [PubMed] [Google Scholar]

45. Ivey FM, Ryan AS, Hafer-Macko CE, Goldberg AP, Macko RF. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors: a preliminary report. Stroke. 2007;38(10):2752–8. [PubMed] [Google Scholar]

46. Lennon O, Carey A, Gaffney N, Stephenson J, Blake C. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population. Clin Rehabil. 2008;22(2):125–33. [PubMed] [Google Scholar]

47. Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. Arch Phys Med Rehabil. 2003;84(11):1609–14. [PubMed] [Google Scholar]

48. Kuys SS, Brauer SG, Ada L. Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial. Clin Rehabil. 2011;25(4):316–26. [PubMed] [Google Scholar]

49. Ivey FM, Ryan AS, Hafer-Macko CE, Macko RF. Improved cerebral vasomotor reactivity after exercise training in hemiparetic stroke survivors. Stroke. 2011 In press. [PubMed] [Google Scholar]

50. Outermans JC, van Peppen RP, Wittink H, Takken T, Kwakkel G. Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study. Clin Rehabil. 2010;24(11):979–87. [PubMed] [Google Scholar]

51. Guazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126(18):2261–74. [PMC free article] [PubMed] [Google Scholar]

52. Ekkekakis P, Parfitt G, Petruzzello SJ. The pleasure and displeasure people feel when they exercise at different intensities: decennial update and progress towards a tripartite rationale for exercise intensity prescription. Sports Med (Auckland, NZ) 2011;41(8):641–71. [PubMed] [Google Scholar]

53. Lam JM, Globas C, Cerny J, et al. Predictors of response to treadmill exercise in stroke survivors. Neurorehabil Neural Repair. 2010;24(6):567–74. [PMC free article] [PubMed] [Google Scholar]

54. Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. High-intensity interval training in stroke rehabilitation. Top Stroke Rehabil. 2013;20(4):317–30. [PubMed] [Google Scholar]

55. Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. Within-session responses to high-intensity interval training in chronic stroke. Med Sci Sports Exerc. 2014 In press. [PubMed] [Google Scholar]

56. Askim T, Dahl AE, Aamot IL, Hokstad A, Helbostad J, Indredavik B. High-intensity aerobic interval training for patients 3–9 months after stroke. A feasibility study. Physiother Res Int: J Res Clin Phys Ther. 2013 [PubMed] [Google Scholar]

57. Daussin FN, Ponsot E, Dufour SP, et al. Improvement of VO2max by cardiac output and oxygen extraction adaptation during intermittent versus continuous endurance training. Eur J Appl Physiol. 2007;101(3):377–83. [PubMed] [Google Scholar]

58. Helgerud J, Hoydal K, Wang E, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665–71. [PubMed] [Google Scholar]

59. Freyssin C, Verkindt C, Prieur F, Benaich P, Maunier S, Blanc P. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Arch Phys Med Rehabil. 2012 [PubMed] [Google Scholar]

60. Fu TC, Wang CH, Lin PS, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol. 2011 [PubMed] [Google Scholar]

61. Moholdt T, Aamot IL, Granoien I, et al. Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study. Clin Rehabil. 2012;26(1):33–44. [PubMed] [Google Scholar]

62. Moholdt T, Aamot IL, Granoien I, et al. Long-term follow-up after cardiac rehabilitation: a randomized study of usual care exercise training versus aerobic interval training after myocardial infarction. Int J Cardiol. 2011;152(3):388–90. [PubMed] [Google Scholar]

63. Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J. 2009;158(6):1031–7. [PubMed] [Google Scholar]

64. Rognmo O, Hetland E, Helgerud J, Hoff J, Slordahl SA. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. 2004;11(3):216–22. [PubMed] [Google Scholar]

65. Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115(24):3086–94. [PubMed] [Google Scholar]

66. Ciolac EG. High-intensity interval training and hypertension: maximizing the benefits of exercise? Am J Cardiovasc Dis. 2012;2(2):102–10. [PMC free article] [PubMed] [Google Scholar]

67. Guiraud T, Nigam A, Gremeaux V, Meyer P, Juneau M, Bosquet L. High-intensity interval training in cardiac rehabilitation. Sports Med (Auckland, NZ) 2012;42(7):587–605. [PubMed] [Google Scholar]

68. Rankin AJ, Rankin AC, Macintyre P, Hillis WS. Walk or run? Is high-intensity exercise more effective than moderate-intensity exercise at reducing cardiovascular risk? Scott Med J. 2012;57(2):99–102. [PubMed] [Google Scholar]

69. Wisloff U, Nilsen TI, Droyvold WB, Morkved S, Slordahl SA, Vatten LJ. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? ‘The HUNT study, Norway’ Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. 2006;13(5):798–804. [PubMed] [Google Scholar]

70. Hornby TG, Straube DS, Kinnaird CR, et al. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil. 2011;18(4):293–307. [PubMed] [Google Scholar]

71. Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet. 1999;354(9174):191–6. [PubMed] [Google Scholar]

72. Lau KW, Mak MK. Speed-dependent treadmill training is effective to improve gait and balance performance in patients with sub-acute stroke. J Rehabil Med. 2011;43(8):709–13. [PubMed] [Google Scholar]

73. Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery. Stroke. 2010;41(1):129–35. [PubMed] [Google Scholar]

74. Pohl M, Mehrholz J, Ritschel C, Ruckriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. Stroke. 2002;33(2):553–8. [PubMed] [Google Scholar]

75. Rose D, Paris T, Crews E, et al. Feasibility and effectiveness of circuit training in acute stroke rehabilitation. Neurorehabil Neural Repair. 2011;25(2):140–8. [PubMed] [Google Scholar]

76. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83(5):683–91. [PubMed] [Google Scholar]

77. Macko RF, Smith GV, Dobrovolny CL, Sorkin JD, Goldberg AP, Silver KH. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil. 2001;82(7):879–84. [PubMed] [Google Scholar]

78. Patterson SL, Rodgers MM, Macko RF, Forrester LW. Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev. 2008;45(2):221–8. [PMC free article] [PubMed] [Google Scholar]

79. Peurala SH, Airaksinen O, Huuskonen P, et al. Effects of intensive therapy using gait trainer or floor walking exercises early after stroke. J Rehabil Med. 2009;41(3):166–73. [PubMed] [Google Scholar]

80. Cumming TB, Thrift AG, Collier JM, et al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial. Stroke. 2011;42(1):153–8. [PubMed] [Google Scholar]

81. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke. 2008;39(2):390–6. [PubMed] [Google Scholar]

82. Mackay-Lyons M, McDonald A, Matheson J, Eskes G, Klus MA. Dual effects of body-weight supported treadmill training on cardiovascular fitness and walking ability early after stroke: a randomized controlled trial. Neurorehabil Neural Repair. 2013 [PubMed] [Google Scholar]

83. Kluding PM, Tseng BY, Billinger SA. Exercise and executive function in individuals with chronic stroke: a pilot study. J Neurol Phys Ther. 2011;35(1):11–7. [PMC free article] [PubMed] [Google Scholar]

84. Macko RF, Ivey FM, Forrester LW. Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects. Top Stroke Rehabil. 2005;12(1):45–57. [PubMed] [Google Scholar]

85. Palmer-McLean K, Harbst K. ACSM’s exercise management for persons with chronic diseases and disabilities. Vol. 3. Champaign: Human Kinetics; 2009. [Google Scholar]