ChatGPT

Original for exercise prescription

Paper DOI: https://doi.org/10.5114/biolsport.2024.133661
© Institute of Sport – National Research Institute

Using artificial intelligence for exercise prescription in personalised

health promotion: A critical evaluation of OpenAI’s GPT-4 model
AUTHORS: Ismail Dergaa 1,2,3*#, Helmi Ben Saad 4,5#, Abdelfatteh El Omri 6†, Jordan M. Glenn 7†, Corresponding author:
Cain C. T. Clark 8,9†, Jad Adrian Washif 10†, Noomen Guelmami 3,11‡, Omar Hammouda 12,13‡, Ismail Dergaa
Primary Health Care Corporation
Ramzi A. Al-Horani 14‡, Luis Felipe Reynoso-Sánchez 15‡, Mohamed Romdhani 12, Laisa Liane (PHCC), Doha, P.O. Box 26555,
Paineiras-Domingos 16, Rodrigo L. Vancini 17, Morteza Taheri 18, Leonardo Jose Mataruna-Dos- Qatar.
Santos 19, Khaled Trabelsi 2, Hamdi Chtourou 2, Makram Zghibi 3, Özgür Eken 20, Sarya Swed 21, Email: [email protected];
[email protected]
Mohamed Ben Aissa 11, Hossam H. Shawki 22, Hesham R. El-Seedi 23,24,25, Iñigo Mujika 26,27,
Stephen Seiler 28, Piotr Zmijewski 29, David B. Pyne 30, Beat Knechtle 31, Irfan M Asif 32, Jonathan A
Drezner 33, Øyvind Sandbakk 34§, Karim Chamari 35§ Affiliations and ORCID are listed
at the end of the paper.
#
These authors contributed equally as first author
†
These authors contributed equally as second author
‡
These authors contributed equally as third author
§
These authors contributed equally as senior author.

ABSTRACT: The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for
personalized health management. AI-based fitness applications are becoming more common, facilitating the
opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert
supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly
in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise
prescriptions generated by OpenAI’s Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient
profiles with diverse health conditions and fitness goals. Our focus was to assess the model’s ability to generate
exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was
conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each
representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details
of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived
exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The
evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type;
integration of perceived exertion levels; consideration for medication intake and the respective medical condition;
and the extent of program individualization tailored to each hypothetical profile. The AI model could create general
safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked
precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness
of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training
load and intensity, but the model’s potential to fine-tune its recommendations through ongoing interaction was
not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription,
particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, Key words:
AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition- AI Challenges
specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more AI Evaluation
Chatbot
interactive use of AI models and integration of real-time physiological feedback. ChatGPT
Digital Health
CITATION: Dergaa I, Ben Saad H, El Omri A et al. Using artificial intelligence for exercise prescription in personalised Exercise Optimization
Fitness Algorithms
health promotion: A critical evaluation of OpenAI’s GPT-4 model. Biol Sport. 2024;41(2):221–241. Machine Learning
Personalized Medicine
Received: 2023-10-15; Reviewed: 2023-11-15; Re-submitted: 2023-11-21; Accepted: 2023-11-28; Published: 2023-12-13. Real-time Monitoring

INTRODUCTION
The growth of artificial intelligence (AI) has generated countless applications, the ability of these technologies to deliver person-
possibilities in various fields, including healthcare and fitness [1–4]. alised, effective and, most importantly, safe exercise regimens for
With the ability to process vast amounts of data and generate individuals with specific health conditions involving varying sever-
personalised recommendations, AI has emerged as a captivating ity or co-morbidities remains largely unexplored. Adherence to
and promising tool in exercise prescription [1]. However, despite physical activity (PA) guidelines is indisputably a key determinant
the rapid development and implementation of AI-driven fitness of health, with a profound impact on the prevention and

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 Ismail Dergaa et al.

FIG. 1. Graphical Abstract AI-sports

management of a range of health conditions, including cardiovas- including nutrition [18], mental health [19, 20], and fitness [4, 21].
cular diseases [5], respiratory diseases [6], diabetes mellitus [7], Nevertheless, these technologies also harbour their own set of limi-
mental health disorders (eg; anxiety [8, 9], depression [10]), and tations [22–24], such as the lack of empathetic human touch, pri-
Alzheimer disease [11, 12]. However, exercise prescription is not vacy concerns, and challenges in transforming broad guidelines into
a one-size-fits-all approach or solution [13]. Numerous factors, individualised recommendations.
such as individual health status, age, lifestyle, and personal fitness The aim of the study was to critically assess the efficacy of exer-
goals, influence the effectiveness and safety of an exercise regimen, cise prescriptions generated by OpenAI’s Generative Pre-Trained Trans-
thereby necessitating personalised exercise programs [13]. While former 4 (GPT-4) model. These prescriptions, tailored for five hypo-
a multitude of fitness applications aiming to offer a degree of in- thetical individuals with diverse health conditions and fitness goals,
dividualisation in exercise prescription have entered the mar- were subjected to evaluation by several leading experts in exercise
ket [14, 15], they often fail to encompass the complexity of spe- prescription.
cific health conditions and the influence of medications [16], and
an individual’s psychosocial factors [17]. Accordingly, this sce- MATERIALS AND METHODS
nario represents a notable limitation of these applications in their This research was a simulation study designed to assess the poten-
current form, potentially restricting their safe usability for indi- tial of OpenAI’s GPT-4 model in producing individualised exercise
viduals with specific health concerns. programs for hypothetical patients with diverse health conditions and
The emergence of AI chatbots shows promise in filling the need fitness goals. The study comprised four main phases: i) Scenario
for more automated exercise prescriptions. By integrating large-scale Creation, ii) GPT-4 prompt, iii) Exercise program generation (pre-
data analytics with machine learning algorithms, these AI-powered sented in the results section) and iv) Expert evaluation (presented in
systems can generate personalised recommendations in various fields, the Discussion section).

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Scenario Creation of Authors and Contributors” as outlined by the International Com-

Five hypothetical patient profiles were created by the principal investi- mittee of Medical Journal Editors guidelines [27]. Only those who
gators (ID, HBS, KC in the authors’ list) with formal training and exper- made substantial contributions to the study were listed as authors.
tise in sports medicine, exercise science, and exercise physiology (Fig- Contributors who made less significant contributions or improve-
ure 1). The profiles included variables such as sex, age, height, weight, ments to the manuscript were duly acknowledged.
body mass index (BMI), medical conditions, medications intake, mean In the methodology of our research, we adopted an innovative ap-
calorie intake, basal metabolic rate (BMR, estimated using the Harris- proach consistent with the study’s pioneering spirit. While conven-
Benedict equations for females [25] and males [26]), motivations (ie; tional methodologies favour traditional evaluation scales, we inten-
specific fitness goals), level of PA, and profession or occupation. The tionally chose a quasi-qualitative direction. This decision was made
scenarios were intentionally diverse to represent a wide range of health to benefit from the collective expertise and insights of our interna-
conditions and fitness objectives prevalent in the general population. tional panel of experts in exercise prescription. Rather than restrict-
ing ourselves to a quantitative scale, our methodology leaned towards
GPT-4 Prompt this richer approach, aptly aligning with the unique scope of our
We tasked GPT-4 with crafting a consistent fitness program suited study. It is pertinent to note a potential limitation here: the absence
for five distinct scenarios. The unified directive was as follows: “Cre- of a traditional scale, which some might anticipate in evaluations of
ate a well-rounded 30-day fitness program table that seamlessly this nature. Under the supervision of lead investigators (ID, HBS,
integrates workout sessions and rest days. To optimize the effective- and KC in the authors’ list), our evaluation strategy was subjected to
ness of this routine, pay special attention to the FITT concept, which a rigorous three-stage refinement process. The initial phase involved
dictates the Frequency (how often), Intensity (how hard), Time (how sharing a draft with co-authors for feedback. This was followed by
long), and Type (what kind) of exercises to incorporate. Use the rate stages of iterative refinement based on collective insights, and the
of perceived exertion (RPE) scale, a measure of how intense the process concluded with a final review for accuracy and complete-
exercise feels, to tailor the program to individual comfort levels. ness. For brevity, certain GPT-4 outputs were reformatted into 10 ta-
For the cardiovascular exercises, apply heart rate (HR) monitoring, bles without any other modification.
a reliable method to adjust the exercise intensity, ensuring it is just
right for each individual. For the strength-building exercises, adopt Single-Prompt Approach: Our Methodology Behind AI Interaction
the one repetition maximum (1RM) principle, a standard that in- In the process of generating exercise programs using the GPT-4
dicates the maximum weight someone can lift for one repetition, model, our approach was designed to mirror a typical patient expe-
to set the appropriate workout intensity.” rience with ChatGPT. The prompts provided to the AI model contained
basic information that any sports enthusiast or beginner might read-
Exercise Program Generation and Evaluation ily find on the internet. This methodology was chosen to simulate
Upon generating the programs, a comprehensive evaluation was a real-world scenario where individuals might seek exercise advice
undertaken by a panel of experts in exercise prescription. This dis- without the benefit of multiple rounds of expert interaction.
tinguished panel comprised academic professors and doctors from As sports scientists and exercise medicine specialists, we recognize
the fields of sports medicine, exercise science, clinical exercise that iterative interactions with the model, refining and adjusting inputs,
physiology, and rehabilitation. could potentially yield a more precise and tailored exercise program.
The evaluators were from a diverse set of twenty countries, in- Such a program would inevitably reflect the unique background, exper-
cluding: Australia, the Basque Country, Brazil, Chile, China, France, tise, and preferences of a practicing sports scientist. However, two pri-
Iran, Italy, Japan, Jordan, Malaysia, Mexico, Norway, Poland, Qatar, mary reasons guided our decision against this approach: i) Iterative in-
Syria, Switzerland, Tunisia, the United Kingdom, the United Arab teractions were not the primary objective of our study. Our focus was
Emirates, and the United States of America. This broad geographic on assessing the model’s capability to generate exercise prescriptions
representation ensured a reflection of varied national norms and prac- based on a singular, initial interaction, akin to a typical, lay person user
tices in exercise prescription. Each evaluator held a Ph.D. in exer- experience; and ii) the scope and length of our study, already extensive
cise science and/or medicine and occupied a significant role in aca- (with over 7700 words and 10 tables), limited the feasibility of con-
demia, with many serving as editors, associate editors or editor-in-chief ducting multiple rounds of interactions and evaluations for each sce-
for one or more esteemed academic journals in the field. nario. Engaging in such a detailed iterative process would have been
To mitigate subjective judgments and enhance the study’s objec- feasible for a single case report, but not for the five diverse scenarios
tivity, we intentionally selected evaluators from different countries, we chose to present in this study. For clarity and precision, it is vital to
backgrounds, and educational experiences. We aimed to minimize note that the creation of the scenarios and the responses from GPT-4
subjectivity, ensuring a comprehensive and accurate evaluation by occurred on 25 June 2023. Given that ChatGPT’s performance can
consolidating feedback from all contributors. Furthermore, to bolster evolve over time, underscoring this specific date ensures the context
the study’s reliability, we followed the criteria of “Defining the Role and accuracy of our study are well-documented.

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RESULTS B. GPT-4 response

Scenario 1 Given John’s hypertensive condition and goals, a combination of
A. Author Prompt cardio, strength, and flexibility training would be beneficial. Cardio
John – Cardiovascular Health Focus exercise helps lower blood pressure, strength training can aid in
– Sex: Male weight management, and flexibility exercises improve overall body
– Age: 45 years functions. All exercises should be performed at a moderate intensity
– Height: 178 cm (RPE 4–6 out of 10). Here is a sample 30-day exercise program
– Weight: 84 kg (Table 1). This program alternates between cardio- and strength-
– BMI: 26.5 kg/m² training days, with one day of rest every third day. The “strength
– Medical Condition: Arterial hypertension training (whole body)” refers to a mix of exercises that target all
– Medications: John is currently taking Amlodipine, a calcium chan- major muscle groups. For example, it could include squats, lunges,
nel blocker, to manage his blood pressure. push-ups, seated rowing, and core exercises. As always, John should
– Mean calorie intake: 2,200 calories per day consult with his doctor before starting this or any other exercise
– BMR: Approximately 1,800 calories per day program. He should also monitor his blood pressure regularly and
– Motivation: Improve cardiovascular health, reduce reliance on pay attention to how he feels during exercise, especially if he experi-
medication, and enhance overall well-being through regular PA. ences any discomfort or unusual symptoms.

TABLE 1. Scenario 1: John’s 30-day exercise program generated by generative pre-trained transformer 4.
Day Exercise Duration (min) Intensity
1 Walking 30 Moderate (60–70% MHR)
2 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
3 Rest day
4 Cycling 30 Moderate (60–70% MHR)
5 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
6 Rest day
7 Walking 30 Moderate (60–70% MHR)
8 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
9 Rest day
10 Cycling 30 Moderate (60–70% MHR)
11 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
12 Rest day
13 Walking 30 Moderate (60–70% MHR)
14 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
15 Rest day
16 Cycling 30 Moderate (60–70% MHR)
17 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
18 Rest day
19 Walking 30 Moderate (60–70% MHR)
20 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
21 Rest day
22 Cycling 30 Moderate (60–70% MHR)
23 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
24 Rest day
25 Walking 30 Moderate (60–70% MHR)
26 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
27 Rest day
28 Cycling 30 Moderate (60–70% MHR)
29 Strength Training (Whole body) 30 Moderate (60–75% 1RM)
30 Rest day
1RM: One repetition maximum. MHR: Maximal heart rate.

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C. Interaction with GPT-4 B. GPT-4’s response

C.1. Author Prompt Given Sarah’s osteoarthritis condition, a combination of strength
Could you consider elaborating on the workout sessions, perhaps by training, low-impact cardio, and flexibility exercises would be ben-
detailing changes in intensity within a single session? Also, it might eficial. Strength training can help strengthen the muscles surround-
be beneficial to incorporate the RPE scale as an additional measure ing her joints, which can alleviate some of the pressure and reduce
of exercise intensity. pain. Low-impact cardio exercises are easier on the joints while
helping improve cardiovascular health. Flexibility exercises can help
C.2. GPT-4’s response maintain joint mobility and function. Here is a sample 30-day exer-
Absolutely, I can definitely provide a more detailed session breakdown. cise program, including more detailed session breakdowns for strength
I will provide an example for a walking session and a strength train- and cardio sessions (Table 3). “Strength Training (Whole body)” refers
ing session (Table 2). to a mix of exercises that target all major muscle groups, focusing
on controlled movements to avoid joint strain. For example, it could
Scenario 2 include leg press, seated row, chest press, lat pull-down, and core
A. Author Prompt exercises.
Sarah – Musculoskeletal Strength Emphasis For strength training and swimming (Table 4), let’s use a similar
– Sex: Female structure to the previous detailed sessions but adapted for Sarah.
– Age: 35 years Sarah should adjust the intensity of her exercises based on her own
– Height: 168 cm perceived exertion, comfort level, and any joint pain. As always, she
– Weight: 68 kg should consult with her doctor before starting this or any other ex-
– BMI: 24.1 kg/m² ercise program, especially due to her osteoarthritis condition.
– Medical condition: Osteoarthritis
– Medications: Sarah occasionally takes over-the-counter anti-in- Scenario 3
flammatory medication, like Ibuprofen, to alleviate joint A. Author Prompt
discomfort. Emily – Mental Health and Flexibility Target
– Mean calorie intake: 1,800 calories per day – Sex: Female
– BMR: Approximately 1,500 calories per day – Age: 27 years
– Motivation: Strengthen muscles to support joints, overcome phys- – Height: 163 cm
ical challenges, and lead a more active lifestyle. – Weight: 59 kg
– BMI: 22.2 kg/m²
– Medical condition: Anxiety and stress-related issues

TABLE 2. Scenario 1: Interaction with generative pre-trained transformer 4 (GPT-4).

Detailed walking session generated by GPT-4
Time (min) Activity Intensity Rate of perceived exertion
0–5 Warm-up: slow walking Low (50% MHR) 2 to 3
5–10 Walking Moderate (60% MHR) 4 to 5
10–20 Walking Moderate-High (70% MHR) 6 to 7
20–25 Walking Moderate (60% MHR) 4 to 5
25–30 Cool-down: slow walking Low (50% MHR) 2 to 3
Detailed strength training session (whole body) generated by GPT-4
Time (min) Exercise Sets × Reps (second); Intensity Rate of perceived exertion
0–5 Warm-up: light cardio, dynamic stretching Not applied; Low 2 to 3
5–10 Squats 3 × 10; Moderate (60% 1RM) 5 to 6
10–15 Lunges 3 × 10; Moderate (60% 1RM) 5 to 6
15–20 Push-ups 3 × 10; Moderate (60% 1RM) 5 to 6
20–25 Seated Row 3 × 10; Moderate (60% 1RM) 5 to 6
25–30 Core exercises (eg; planks) 3 × 30; Moderate 5 to 6
30–35 Cool-down: static stretching Not applied; Low 2 to 3
1RM: One repetition maximum. MHR: Maximal heart rate.

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TABLE 3. Scenario 2: Sarah’s 30-day exercise program generated by generative pre-trained transformer 4.
Day Exercise Duration (min) Intensity
1 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
2 Rest day
3 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
4 Rest day
5 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
6 Rest day
7 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
8 Rest day
9 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
10 Rest day
11 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
12 Rest day
13 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
14 Rest day
15 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
16 Rest day
17 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
18 Rest day
19 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
20 Rest day
21 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
22 Rest day
23 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
24 Rest day
25 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
26 Rest day
27 Low-impact Cardio (Swimming) 30 Moderate (60–70% MHR)
28 Rest day
29 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
30 Rest day
1RM: One repetition maximum. MHR: Maximal heart rate.

TABLE 4. Scenario 2: Interaction with generative pre-trained transformer 4 (GPT-4).

Detailed strength training session generated by GPT-4
Time (min) Exercise Sets × Reps (seconds); Intensity Rate of perceived exertion
0–5 Warm-up: light cardio, dynamic stretching Not applied; Low 2 to 3
5–10 Leg Press 3 × 10; Moderate (60% 1RM) 5 to 6
10–15 Seated Row 3 × 10; Moderate (60% 1RM) 5 to 6
15–20 Chest Press 3 × 10; Moderate (60% 1RM) 5 to 6
20–25 Lat Pull-Down 3 × 10; Moderate (60% 1RM) 5 to 6
25–30 Core exercises (eg; planks) 3 × 30; Moderate 5 to 6
30–45 Cool-down: static stretching Not applied; Low 2 to 3
Detailed swimming session generated byGPT-4
Time (min) Activity Intensity Rate of perceived exertion
0–5 Warm-up: slow swimming Low (50% MHR) 2 to 3
5–10 Swimming Moderate (60% MHR) 4 to 5
10–20 Swimming Moderate-High (70% MHR) 6 to 7
20–25 Swimming Moderate (60% MHR) 4 to 5
25–30 Cool-down: slow swimming Low (50% MHR) 2 to 3
1RM: One repetition maximum. MHR: Maximal heart rate.

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TABLE 5. Scenario 3: Emily’s 30-day exercise program generated by generative pre-trained transformer 4.
Day Exercise Duration (min) Intensity
1 Yoga 45 Moderate
2 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
3 Yoga 45 Moderate
4 Rest day
5 Yoga 45 Moderate
6 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
7 Yoga 45 Moderate
8 Rest day
9 Yoga 45 Moderate
10 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
11 Yoga 45 Moderate
12 Rest day
13 Yoga 45 Moderate
14 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
15 Yoga 45 Moderate
16 Rest day
17 Yoga 45 Moderate
18 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
19 Yoga 45 Moderate
20 Rest day
21 Yoga 45 Moderate
22 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
23 Yoga 45 Moderate
24 Rest day
25 Yoga 45 Moderate
26 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
27 Yoga 45 Moderate
28 Rest day
29 Yoga 45 Moderate
30 Low-impact Cardio (Walking/Cycling) 30 Moderate (60–70% MHR)
MHR: Maximal heart rate.

TABLE 6. Scenario 3: Interaction with generative pre-trained transformer 4 (GPT-4).

Rate of perceived
Time (min) Activity Intensity
exertion
Detailed yoga session generated by GPT-4.
0–10 Warm-up: simple stretching and breathing exercises Low 2 to 3
Yoga: sequences including a mix of standing, seated and
10–35 Moderate 5 to 6
supine postures
35–45 Cool-down: relaxation and meditation Low 2 to 3
Detailed low-impact cardio session (walking/cycling) generated by GPT-4
0–5 Warm-up: slow walking/cycling Low (50% MHR) 2 to 3
5–10 Walking/Cycling Moderate (60% MHR) 4 to 5
10–20 Walking/Cycling Moderate-High (70% MHR) 6 to 7
20–25 Walking/Cycling Moderate (60% MHR) 4 to 5
25–30 Cool-down: slow walking/cycling Low (50% MHR) 2 to 3
MHR: Maximal heart rate.

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– Medications: Emily is under the care of a psychiatrist and is pre- it could include leg press, seated row, chest press, lat pull-down, and
scribed Sertraline, an antidepressant, to manage her anxiety. core exercises.
– Mean calorie intake: 1,600 calories per day For strength training and cardio sessions (Table 8), let’s use a sim-
– BMR: Approximately 1,350 calories per day ilar structure to the previous detailed sessions but adapted for Mike.
– Motivation: Improve mental health, find inner peace, and achieve
emotional balance through yoga and mindfulness practices. Scenario 5
A. Author Prompt
B. GPT-4’s response Lisa – Respiratory Health and Pulmonary Function
Given Emily’s goal of improving mental health and increasing flexibil- – Sex: Female
ity, incorporating practices such as yoga, meditation, and low-inten- – Age: 40 years
sity cardio exercise such as walking, or cycling can be highly benefi- – Height: 162 cm
cial. Yoga has been shown to improve flexibility, balance, and strength, – Weight: 70 kg
while also having positive effects on mental health, reducing anxiety, – BMI: 26.7 kg/m²
and stress. Here is a sample 30-day exercise program, including – Medical condition: Asthma and reduced pulmonary function
more detailed session breakdowns for yoga and cardio sessions – Medications: Lisa uses an inhaler (Albuterol) as a bronchodilator
(Table 5). to manage her asthma symptoms.
For yoga and walking/cycling (Table 6), let’s use a similar struc- – Mean calorie intake: 1,900 calories per day
ture to the previous detailed sessions but adapted for Emily. Emily – BMR: Approximately 1,600 calories per day
should adjust the intensity of her exercises based on her own per- – Fitness objective: Improve respiratory health and lung capacity,
ceived exertion, comfort level, and any mental or physical discom- manage asthma effectively, and lead an active lifestyle.
fort. As always, she should consult with her doctor before starting
this or any other exercise program, especially given her mental health B. GPT-4’s response
condition. Given Lisa’s objective of improving her respiratory health and pul-
monary function, a combination of regular low-impact cardio and
Scenario 4 resistance exercises, along with breathing exercises, could be very
A. Author Prompt beneficial. Regular PA can help increase lung capacity, improve car-
Mike – Diabetes mellitus management and weight loss objective diovascular health, and enhance overall fitness. Additionally, spe-
– Sex: Male cific breathing exercises can help strengthen the respiratory muscles,
– Age: 50 years increase lung function, and manage asthma symptoms effectively.
– Height: 175 cm Here is a sample 30-day exercise program for Lisa (Table 9). “Re-
– Weight: 95 kg sistance Training (Whole body)” refers to a mix of exercises that
– BMI: 30.9 kg/m² target all major muscle groups, focusing on controlled movements
– Medical Condition: Type 2 diabetes mellitus and proper breathing techniques to avoid respiratory strain.
– Medications: Mike takes Metformin, an oral diabetes medication, Here is a detailed breakdown of Lisa’s resistance training session
to manage his blood sugar levels. (Table 10). For each exercise, Lisa should take slow, deep breaths,
– Mean calorie intake: 2,000 calories per day exhaling on the exertion phase and inhaling on the return. If she feels
– BMR: Approximately 1,850 calories per day any shortness of breath, she should slow down or take a break, and
– Motivation: Manage diabetes effectively, lose weight to improve use her inhaler if necessary. Breathing exercises are also an integral
overall health, and enhance well-being through PA and proper part of her program. Pursed-lip breathing involves inhaling through
nutrition. the nose and exhaling slowly through puckered lips, while diaphrag-
matic breathing focuses on fully engaging the diaphragm, not just
B. GPT-4’s response the chest, during breaths. These exercises can help increase lung ca-
Given Mike’s objective of managing his diabetes mellitus and losing pacity and improve respiratory muscle function, thereby helping to
weight, a combination of regular cardio exercise, strength training, manage asthma symptoms. As always, she should consult with her
and dietary adjustments can be very beneficial. Regular PA can help doctor before starting this or any other exercise program, especially
improve insulin sensitivity, while a healthy diet can help manage given her asthma condition.
blood glucose levels and contribute to weight loss. Here is a sample
30-day exercise program, including more detailed session breakdowns DISCUSSION
for strength and cardio sessions (Table 7). “Strength Training (Whole The primary objective of this study was to critically assess the effi-
body)” refers to a mix of exercises that target all major muscle groups, cacy of exercise prescriptions generated by OpenAI’s GPT-4 model
focusing on controlled movements to avoid joint strain. For example, for five hypothetical patient profiles with diverse health conditions

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TABLE 7. Scenario 4: Mike’s 30-day exercise program generated by generative pre-trained transformer 4.
Day Exercise Duration (min) Intensity
1 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
2 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
3 Rest day
4 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
5 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
6 Rest day
7 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
8 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
9 Rest day
10 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
11 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
12 Rest day
13 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
14 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
15 Rest day
16 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
17 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
18 Rest day
19 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
20 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
21 Rest day
22 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
23 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
24 Rest day
25 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
26 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
27 Rest day
28 Cardio (Walking/Running) 30 Moderate (60–70% MHR)
29 Strength Training (Whole body) 45 Moderate (60–75% 1RM)
30 Rest day
1RM: One repetition maximum. MHR: Maximal heart rate.

TABLE 8. Scenario 4: Interaction with generative pre-trained transformer 4 (GPT-4).

Detailed strength training session generated by GPT-4
Time (min) Exercise Sets × Reps (second); Intensity Rate of perceived exertion
0–5 Warm-up: light cardio, dynamic stretching Not applied; Low 2 to 3
5–10 Leg Press 3 × 10; Moderate (60% 1RM) 5 to 6
10–15 Seated Row 3 × 10; Moderate (60% 1RM) 5 to 6
15–20 Chest Press 3 × 10; Moderate (60% 1RM) 5 to 6
20–25 Lat Pull-Down 3 × 10; Moderate (60% 1RM) 5 to 6
25–30 Core exercises (eg; planks) 3 × 30; Moderate 5 to 6
30–45 Cool-down: static stretching Not applied; Low 2 to 3
Detailed cardio session (walking/running) generated GPT-4
Time (min) Activity Intensity Rate of perceived exertion
0–5 Warm-up: slow walking Low (50% MHR) 2 to 3
5–10 Walking/Running Moderate (60% MHR) 4 to 5
10–20 Walking/Running Moderate-High (70% MHR) 6 to 7
20–25 Walking/Running Moderate (60% MHR) 4 to 5
25–30 Cool-down: slow walking Low (50% MHR) 2 to 3
1RM: One repetition maximum. MHR: Maximal heart rate.

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TABLE 9. Scenario 1: Lisa’s 30-day exercise program generated by generative pre-trained transformer 4.
Day Exercise Duration (min) Intensity
1 Cardio (Swimming) 30 Moderate (60–70% MHR)
2 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
3 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
4 Rest day
5 Cardio (Cycling) 30 Moderate (60–70% MHR)
6 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
7 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
8 Rest day
9 Cardio (Swimming) 30 Moderate (60–70% MHR)
10 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
11 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
12 Rest day
13 Cardio (Cycling) 30 Moderate (60–70% MHR)
Breathing Exercises
14 15 Low
(Pursed-lip and Diaphragmatic Breathing)
15 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
16 Rest day
17 Cardio (Swimming) 30 Moderate (60–70% MHR)
18 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
19 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
20 Rest day
21 Cardio (Cycling) 30 Moderate (60–70% MHR)
22 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
23 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
24 Rest day
25 Cardio (Swimming) 30 Moderate (60–70% MHR)
26 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
27 Resistance Training (Whole body) 45 Moderate (60–75% 1RM)
28 Rest day
29 Cardio (Cycling) 30 Moderate (60–70% MHR)
30 Breathing Exercises (Pursed-lip and Diaphragmatic Breathing) 15 Low
1RM: One repetition maximum. MHR: Maximal heart rate.

TABLE 10. Scenario 5: Detailed resistance training session generated by generative pre-trained transformer 4.
Time (min) Exercise Sets × Reps (second); Intensity Rate of perceived exertion
0–5 Warm-up: light cardio, dynamic stretching Not applied; Low 2 to 3
5–10 Leg Press 3 × 10; Moderate (60% 1RM) 5 to 6
10–15 Seated Row 3 × 10; Moderate (60% 1RM) 5 to 6
15–20 Chest Press 3 × 10; Moderate (60% 1RM) 5 to 6
20–25 Lat Pull-Down 3 × 10; Moderate (60% 1RM) 5 to 6
25–30 Core exercises (eg; planks) 3 × 30; Moderate 5 to 6
30–45 Cool-down: static stretching Not applied; Low 2 to 3
1RM: One repetition maximum.

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and fitness goals. Our focus was on assessing the model’s capabil- practitioners bring to exercise prescription, balancing evidence-based
ity to generate exercise prescriptions based on a singular, initial in- practice with individualized care.
teraction, akin to a typical user experience. This evaluation was While the HR-based approach for managing workout intensity is
conducted by leading experts in the field of exercise prescription. noteworthy, it would have been beneficial to incorporate specific HR
Through this assessment, we aimed to understand the potential and zones for each cardio session [33]. For hypertensive patients like
limitations of AI, specifically GPT-4, in crafting personalised exercise John, individualized HR zone training could prove particularly ben-
programs, juxtaposing its outputs against the insights and expertise eficial [34]. A common approach to establishing these zones involves
traditionally provided by human professionals in the domain. first estimating the predicted maximal HR (MHR) (usually using the
“220-age” formula [35]). Then, the Karvonen formula [36] [target
Evaluation and Review: Scenario 1 – John training HR = resting HR + (0.6 × (MHR – resting HR))] is applied,
John’s case represents a typical middle-aged individual suffering from followed by calculating different training zones as percentages of this
arterial hypertension, aiming to enhance his cardiovascular health target HR [37]. However, one should be cautious with the use of
and reduce medication dependence through a structured exercise predicted MHR calculations as several estimation issues should not
program. The generated 30-day regimen shows a commendable be overlooked; ideally, the real MHR of the individual should be mea-
application of the FITT principles, incorporating a blend of cardio- sured by qualified practitioners [38]. Indeed, if a patient estimates
vascular exercises, resistance training, and flexibility routines, all of his/her HR zones using an inappropriate formula, it could lead to an
which are demonstrably beneficial for hypertensive individuals and inadequate exercise intensity. GPT-4 did not mention any details
cardiovascular health in general [28, 29]. about how to calculate those HR zones, and predicted MHR. This
The program’s heavy reliance on moderate-intensity workouts is shortcoming might not only hinder the effectiveness of the exercise
in line with recommendations for hypertensive patients, reducing the program but also pose potential health risks, particularly for individ-
likelihood of excessive spikes in blood pressure during exercise [30]. uals with underlying medical conditions such as arterial hyperten-
This approach aligns with a conservative strategy that prioritizes un- sion. Accurate calculation and understanding of HR zones are essen-
derstanding how the individual reacts to moderate-intensity exercise tial for tailoring an exercise regimen that is both safe and effective
before exploring more intense options. for the individual’s specific needs and goals.
While emerging research indicates that high-intensity interval Resistance training has sensibly been included in the program,
training (HIIT) could offer substantial cardiovascular and hyperten- aligning with research demonstrating its positive impact on blood
sive benefits [31, 32], the decision to exclude HIIT from the initial pressure and cardiovascular health [39, 40]. Nonetheless, high-re-
30-day program is consistent with a personalized and cautious ap- sistance strength training may lead to a significant transient increase
proach. A human practitioner might rationalize current decisions in systolic and diastolic blood pressure [41]. Consequently, a pro-
based on prior experiences, successes, and failures. For instance, if gram design leaning towards lower resistance with higher repetitions
a practitioner had previously observed a patient with similar health might be a safer alternative for John, while still providing the bene-
conditions to John experiencing adverse reactions to HIIT, they might fits of resistance training, without the associated acute blood pres-
be more cautious and exclude HIIT from John’s program. In this con- sure elevation [42].
text, the exclusion of HIIT seems prudent, reflecting the practitio- An evident progression in terms of exercise duration is a strong
ner’s accumulated knowledge and experience over time. The Chat- point of the program. However, it appears to overlook the progres-
GPT-formulated program, while based on prevalent information from sion in other crucial areas, such as workout intensity, the weight used
the Internet, might prioritise information that is more abundant or in resistance training, and the complexity of exercises. A program in-
historically prevalent over newer, potentially more relevant expert in- corporating systematic progression in these elements might stimu-
sights. This means that while GPT-4 can access a vast amount of late continual adaptation and improvement, offering greater benefits
information, it may not always prioritise the most recent or expert- for John. Another element seemingly absent from the program is RPE
endorsed data. As a result, traditional practices with a wealth of on- monitoring [43]. RPE could provide a more reliable measure of work-
line information might be favoured over newer, updated methodolo- out intensity than HR alone [44].
gies. This highlights a limitation in the model’s ability to discern the The program effectively integrates rest days, underscoring their
quality and relevance of the information it accesses. importance in facilitating recovery and adaptation. However, the cur-
Introducing HIIT might be a valuable addition to the program in rent placement of these rest days, predominantly after strength train-
the future, but only after careful monitoring and assessment of the ing sessions, raises questions. Strategically positioning rest days af-
individual’s response to the initial regimen. This approach recognis- ter high-intensity workouts or after a series of consecutive
es that exercise prescription can be subjective and based on individ- moderate-intensity sessions can optimize muscle recovery and re-
ual preferences and needs, and emphasises the importance of per- duce the risk of overtraining [45]. Thus, re-evaluating the sequenc-
sonalised care in managing hypertensive conditions. A prudent ing of rest days in this context may enhance the overall effectiveness
approach also acknowledges the nuanced judgment that human of the program. Furthermore, it is essential to note the increase in

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self-paced exercise recommendations, especially for specific popu- specificity in terms of the intended load, repetitions, and sets for each
lations. Such exercises allow individuals to adjust their workout in- exercise, which might influence the therapeutic effectiveness.
tensity based on their comfort and capability, which can be partic- To illustrate, a typical exercise prescription for someone like Sar-
ularly beneficial for those taking certain medications that might affect ah might specify that she should perform leg presses at 60% of her
their physiological response to exercise. The GPT-4 program also 1RM, for three sets of 10 repetitions, with a 2-minute rest in-be-
seemed limited by meeting (but not surpassing) the PA guideline of tween. This level of detail ensures that the exercise is tailored to her
150 minutes per week of moderate to vigorous PAs. The necessity current strength level, providing a clear progression path. However,
of two rest days per week should also be questioned as some pa- there was no instruction for how she safely determine her 1RM for
tients may prefer to exercise in smaller “doses” more than 5 times each exercise. The AI’s recommendation might have been more ge-
per week. neric, indicating leg presses while specifying the weight, repetitions,
Additionally, the importance of isometric exercises and varied con- and sets. Such a lack of specificity, while more general and perhaps
traction regimens cannot be overlooked. Different health disorders easier to adopt, could however lead to suboptimal results and even
may necessitate specific contraction patterns to maximize therapeu- potential injury if Sarah were to guess the appropriate weight or
tic benefits. A recent network meta-analysis reported that isometric overexert herself.
exercise may provide the largest improvement in resting blood pres- Secondly, the AI model rightly includes flexibility exercises in the
sure [40]. For instance, isometric exercises, which involve muscle program, which are crucial for maintaining joint range of motion and
contractions without any significant movement, can be especially reducing stiffness associated with osteoarthritis [48]. However, the
beneficial for individuals with certain joint or muscular disorders. model could have suggested exercises for enhancing proprioception
The program could benefit from integrating these exercises, tailoring and neuromuscular control exercises, such as balance and agility
the contraction regimen to the specific needs of the individual’s health training, which are often compromised in individuals with
condition. However, patients should be warned to avoid the Valsal- osteoarthritis [49].
va manoeuvre while performing isometric exercises to avoid any over- Regarding cardiovascular exercises, the model adequately intro-
load on the cardiovascular system, and there were no cautions high- duces low-intensity activities (ie; walking). This aspect is critical
lighted on this aspect by the proposed program [46]. considering the load-bearing nature of osteoarthritis, particularly as
Lastly, even if not prompted for, we believe that the proposed pro- it affects Sarah’s lower limbs. Nevertheless, the model could have
gram should have touched on the patient diet with at least a list of suggested non-weight-bearing activities such as cycling, which may
food to avoid in association with arterial hypertension. Indeed, any reduce joint stress while promoting cardiovascular fitness [50].
clinical practitioner if confronted with suggesting an exercise-based Furthermore, the program could have been further individualised
program for hypertensive patient will most probably consider asso- by considering the affected joints and tailoring the exercises accord-
ciated risk factors like nutrition or sleep. ingly. For example, if Sarah’s osteoarthritis affects her knees, cer-
The exercise program generated by GPT-4 exhibits a solid grasp tain exercises such as deep squats shall be avoided due to exces-
of fundamental exercise prescription principles. However, there is sive knee joint load [51, 52]. It is worth noting that while there were
room for refinement in areas like individualised intensity measures, traditional reservations about land-based exercises for individuals
systematic progression, nuanced application of resistance training with osteoarthritis, recent research and clinical practices have
guidelines, and incorporation of RPE as a training monitoring tool. evolved. Land-based exercises, when performed with proper tech-
With these adjustments, the program could potentially provide fur- nique and under expert guidance, can be beneficial for osteoarthri-
ther health benefits for John. tis patients [51, 52]. They can help improve joint mobility, muscle
strength, and overall functional capacity. Moreover, these exercises
Evaluation and Review: Scenario 2 – Sarah can be adapted to ensure minimal joint stress while maximizing
Sarah, a 35-year-old female diagnosed with osteoarthritis, aspires therapeutic benefits. For instance, shallow squats or partial range
to augment her musculoskeletal strength, mitigate her joint discom- movements can be introduced to reduce undue strain on affected
fort, and live a more active lifestyle. The AI model’s proposed exercise joints. The key lies in the correct execution, progression, and indi-
plan, designed around FITT principles, provides a suitable starting vidualisation of these exercises to suit the specific needs and limi-
point for such objectives. However, the program warrants a more tations of the osteoarthritis patient. This aspect is overlooked by the
detailed critique, particularly in the context of osteoarthritis manage- model.
ment and the potential therapeutic benefits of PA. The information provided to Sarah also recommended an evalu-
First, the model appropriately prescribes strength-training exer- ation by a doctor before commencing her exercise program. This
cises, a cornerstone of non-pharmacological management for osteo- recommendation, which is based on older guidelines, is incorrect
arthritis [47]. Not only does resistance training improve muscular since new guidelines support that low-risk patients do not require
strength, but enhances joint stability and function and alleviating os- a screening examination or “medical clearance” to begin an exer-
teoarthritis symptoms [47]. However, the prescription lacks cise program [53]. Of course, Sarah could pursue this for added

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safety, but the GPT-4 model could have presented this option with- be entirely suitable for yoga, where intensity can vary significantly
out making it a barrier for those with poor access to care. based on the type of Yoga and individual postures [55]. A more ap-
Finally, the model logically incorporates rest days into the pro- propriate measure might be a discomfort or difficulty scale, particu-
gram, which are essential for promoting tissue healing and recovery, larly suited to the slower pace and holding postures of yoga. Lastly,
thus reducing the risk of exacerbating Sarah’s osteoarthritis symp- the model does not incorporate any form of aerobic or strength train-
toms. However, Sarah could engage in light activities such as stretch- ing exercises in Emily’s program [56, 57]. While her primary focus
ing or yoga on “rest” days, thus promoting flexibility and relaxation, is on mental health and yoga practices, including these forms of ex-
adding value without hampering recovery. A more detailed, tailored, ercises could provide complementary benefits. Aerobic exercises, for
and multifaceted approach that considers the specific nuances of her instance, are known to promote endorphin release, aiding in mood
osteoarthritis could better cater to Sarah’s needs, and help her achieve improvement [58], while strength training can boost self-esteem and
her fitness objectives more effectively and safely. body image, providing an additional mental health benefit [59].

Evaluation and Review: Scenario 3 – Emily Evaluation and Review: Scenario 4 – Mike
Emily is a 27-year-old individual grappling with anxiety and stress- Mike, a 50-year-old male diagnosed with type 2 diabetes mellitus,
related issues, and managed with Sertraline, an antidepressant. Her aims to manage his disease effectively, lose weight, and improve his
objective was to enhance her mental health, find inner peace, and overall health and well-being. The AI model recommends a program
achieve emotional balance through yoga and mindfulness practices. that combines cardiovascular, strength, and flexibility exercises, abid-
Given the increasing popularity and frequent requests for yoga as ing by FITT principles. While this program aligns with general recom-
a potential solution for such health conditions, the AI model suggests mendations for managing diabetes mellitus and promoting weight
a detailed yoga-centric program, constructed in adherence to FITT loss, it lacks specificity and a more nuanced understanding of exer-
principles. While Yoga is a commonly sought-after intervention, it is cise prescription in the context of diabetes management.
essential to acknowledge that many other behavioral and cognitive The model correctly prescribes cardiovascular exercise as a vital
interventions have shown beneficial results. However, an in-depth component of Mike’s program, given its well-documented benefits in
analysis reveals some areas for potential improvement. Moreover, enhancing insulin sensitivity, aiding glucose control, and promoting
the program seems to overlook crucial factors like sleep quality and weight loss [60]. However, it misses a crucial point: the potential
chronotype, which play a pivotal role in managing anxiety and stress. rare risk of hypoglycemia during and following prolonged aerobic ex-
The model appropriately emphasizes yoga and meditation, both ercise for individuals on glucose-lowering medications [61, 62]. It is
of which are well-documented for their beneficial effects on mental essential for patients like Mike, especially if they are on metformin,
health, stress reduction, and overall well-being [54]. The model cor- to be cognizant of exercise-induced glucose fluctuations. While met-
rectly provides for a gradual increase in session length, permitting formin generally reduces the risk of exercise-induced hypoglycemia
Emily to adapt progressively to the increasing demands of the pro- due to its mechanism of action on liver glucose production, some
gram. However, the program could have been improved by provid- nuances need to be considered. A more personalised approach for
ing specific details about the yoga poses and sequences suitable for metformin users would involve monitoring blood glucose levels pre-
stress relief, such as restorative or Yin Yoga, along with guidance on and post-exercise to understand any unexpected fluctuations. Indi-
proper alignment and modification options to suit Emily’s comfort viduals should also be made aware of the potential for gastrointes-
and skill level. This outcome may be possible through links to other tinal side effects of metformin, which might be exacerbated with
resources and instructional videos. In addition, as with scenario 2, exercise. As always, it is advisable to consult with a healthcare pro-
the GPT-4 model recommended a medical evaluation before begin- vider for individualised guidance, especially when initiating a new
ning the exercise program which is not necessary in an otherwise exercise regimen while on metformin [63, 64]. Furthermore, the in-
healthy young adult. clusion of high-intensity low-volume endurance exercises, such as
The prescription of daily yoga sessions, coupled with mindfulness HIIT or moderate-intensity interval training, could offer additional
exercises, shows the model’s understanding of the importance of benefits, and should be considered in the exercise prescription.
consistency in mental health-related physical activities. However, the Strength training exercises are appropriately included, given their
prescription does not adequately account for the rest and recovery role in improving muscle mass and insulin sensitivity, thereby aiding
necessary to prevent potential physical and mental fatigue associat- in glucose control [65]. However, the program could be improved by
ed with daily yoga practices [55]. Incorporating rest days or days specifying the types of resistance exercises to be performed, their or-
with lighter, restorative practices could potentially improve this as- der, and the amount of resistance (in relation to Mike’s actual or es-
pect of the program. timated 1RM), how to safely determine one’s 1RM, and facilitating
The model’s program also includes a ‘perceived exertion’ mea- the safe and effective execution of these exercises.
sure, the Borg scale, to self-assess the intensity of the yoga sessions. The program’s inclusion of flexibility exercises, which aid in main-
While this can be a useful tool for cardio-based workouts, it may not taining joint health and overall mobility, is also commendable [48].

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However, the model does not provide any specific stretching exer- Lisa ensure her inhaler remains near-by, showing that the model con-
cises or guidance on how these should be performed, which could sidered her condition and the potential associated issues that the
be helpful for preventing potential injury [66]. patient might encounter while exercising.
Given that both hypoglycemia and hyperglycemia can occur in
individuals with diabetes mellitus due to exercise, education about Overall Evaluation and Interpretation
self-monitoring of blood glucose and guidance on appropriate re- This study has explored the application of the GPT-4 model for per-
sponses to abnormal glucose levels are vital [67]. sonalised exercise prescription for five-example patient profiles with
Furthermore, the model could have incorporated education about various health conditions. The GPT model’s responses were able to
the signs of hypoglycemia and foot care in the exercise program, giv- produce generally safe exercise programs grounded in the general
en that individuals with diabetes mellitus are often at increased risk FITT principles and RPE guidelines, demonstrating the potential
of hypoglycemia and foot ulcers [68]. utility of AI in generating basic exercise recommendations. However,
the analysis revealed several limitations and areas for improvement.
Evaluation and Review: Scenario 5 – Lisa The programs suggested by ChatGPT placed a significant empha-
Lisa, a 40-year-old female with asthma and impaired pulmonary sis on safety, often prescribing moderate-intensity exercises rather
function, has the objective of improving her respiratory health and than high-intensity ones. While such a cautious approach is under-
lung capacity. The AI model proposes a program combining cardio- standable, especially when introducing a new exercise regimen to
vascular, strength, and flexibility exercises, framed within the FITT individuals, it might be perceived as overly conservative. For a short-
guidelines. The program captures a broad range of PAs beneficial for term intervention over a month, this level of caution in the initial
overall health; however, the specificity and customization to cater to weeks might be excessive. Ideally, after establishing a baseline in
Lisa’s specific condition seem to be lacking in certain aspects. the first couple of weeks, the intensity could be gradually increased.
The model appropriately prescribes cardiovascular exercise, giv- Starting from the third or fourth week, a small increase in intensity
en its proven benefits in enhancing overall cardiorespiratory fit- could better balance the goals of improving the patient’s health con-
ness [69]. However, the program could have been enhanced by in- dition while still maintaining safety. However, this progression also
corporating exercises particularly known for their positive impacts depends on the level of fitness of the individual prior to the program
on respiratory health [70]. Additionally, considering the benefits of (see more below). For an extremely unfit individual, a more prolonged
eccentric exercises, which are less stressful on the cardiorespirato- preparation/transition period is warranted to diminish the likelihood
ry system compared to other contraction regimens, their inclusion of dropping out.
could be advantageous for Lisa. The inclusion of strength training is The model’s inability to monitor an individual’s physiological re-
also pertinent, considering that improved muscle strength can help sponse and adjust in real-time is a limitation. While some emerging
reduce the overall work of breathing and enhance Lisa’s exercise tol- technologies are beginning to offer this capability, ChatGPT, as used
erance [71]. Still, a more targeted approach could involve addition- here, cannot independently provide real-time feedback or adjust-
al exercises to specifically strengthen her respiratory muscles, such ments. This caution restricts the potential for optimal progress and
as incentive spirometry or breathing against resistance [72–74], be- adaptation, which are essential for health improvement and the at-
yond the pursed-lip and diaphragmatic breathing suggested by GPT-4. tainment of specific goals [77].
The model’s program incorporates flexibility exercises, beneficial Furthermore, the program’s lack of preliminary patient assess-
in maintaining overall joint and muscle health [75]. However, the ment is a notable shortcoming. If the AI system were to request in-
program could be better tailored by suggesting exercises to help en- formation such as the subject’s current physical condition, exercise
hance thoracic mobility and lung function. experience, or the length of time suffering from the health condition,
The model correctly uses RPE as a method for Lisa to gauge her it could plan the exercise in a more individualised and effective man-
exertion levels. However, given Lisa’s condition, additional guidance ner. In practice, a human practitioner, with the ability to assess the
on recognising the signs of exercise-induced bronchoconstriction [76], individual’s responses in real-time, would likely provide a more var-
such as unusual shortness of breath, chest tightness, or prolonged ied, dynamic, and intense program, challenging the individual while
recovery, would have been beneficial. ensuring safety and effectiveness with an appropriately individual-
Furthermore, the program does not address the importance of ized prescription [77].
a proper warm-up and cool-down in preventing exercise-induced The monotony in program design, highlighted in the present anal-
bronchoconstriction symptoms, an oversight that could negatively ysis, points towards the lack of variability, another crucial principle
influence Lisa’s exercise experience and potentially increase the like- of training, in the GPT’s prescribed plans. While maintaining a cer-
lihood of drop out due to exercise related issues/discomfort. The tain level of consistency is necessary for habit formation and gradu-
model also did not review proper use of a rescue inhaler for symp- al adaptation, introducing regular changes in exercise modes, inten-
tom exacerbations during exercise, or the potential need for prophy- sities, and volumes is essential to prevent plateaus in progress,
lactic use before exercise. However, the model did recommend that enhance motivation, and foster long-term adherence [78].

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It seems that unless a patient is extremely unfit, the exercise reg- professionals rather than replacing them. This evolution emphasiz-
imens developed by GPT-4 generally will allow individuals to main- es the potential of AI to act as a collaborative tool, enriching the hu-
tain their current health status but fall short of providing the neces- man element in the domain of fitness and health.
sary stimuli for significant advancements in their health or fitness.
Moreover, the holistic approach that leads to personalisation and cre- Limitations
ativity in exercise prescription goes beyond what AI-generated plans In evaluating the application of AI, specifically the GPT-4 model, for
can currently offer. This approach considers unique user attributes crafting personalized exercise programs, this study has uncovered
and adapts in ways that resonate with their individual preferences both promising avenues and significant limitations. These constraints
and needs. Even with technological advances, the prospect of AI sys- in addition to the limitations of our study must be carefully considered
tems fully replacing human expertise in the exercise prescription field when interpreting the findings.
seems distant as of now (ie; August 2023). One primary limitation was the static nature of the interaction with
Despite its shortcomings, the GPT model’s approach offers a cost- the AI model. While personal and medical details were provided, along
effective alternative for individuals who cannot afford personal train- with a request for a 30-day exercise program, the model’s ability to
ers, yet it falls short of replicating the personalised service and ex- refine and expand upon its initial recommendations through contin-
pertise that human trainers provide. While “digital humans” may ued dialogue was not fully investigated. This approach led to some-
provide a potential solution to facilitate knowledge transfer, motiva- what generic recommendations, reflecting the study’s focus on a wide
tion, and adherence, this study was designed only to evaluate the array of medical conditions rather than an in-depth exploration of
content and appropriateness of the exercise recommendations. Al- a single case. Other studies should consider examining iterative inter-
though not directly investigated in our study, the authors contend actions with AI throughout the course of an exercise program.
that the nuances of human interaction, motivation, and real-time ad- Our patient profiles were intentionally simplistic with a singular
justment of training plans based on various factors likely remain un- medical condition. Thus, our results may not be fully generalizable
paralleled by AI in its current state. As indicated in the methodolo- to the performance of AI in formulating an exercise program for pa-
gy section, the decision to conduct this analysis without significant tients with multiple co-morbidities or more severe medical disorders.
interaction with the GPT model was deliberate and guided by sever- This opportunity represents an important area of future research.
al considerations. Primarily, the study sought to assess ChatGPT’s Another significant limitation is the quasi-qualitative aspect of the
ability to tailor training programs to specific patient requirements, study. While this approach offers some advantages, especially given
simulating the experience of a typical untrained layperson lacking the pioneering nature of our research, the lack of a recognised and
sports science knowledge. This approach allowed for critical evalu- validated scale is a substantial concern for such evaluations. This
ation of the program from the perspective of sports medicine and gap underscores the necessity for future research dedicated to the
sports science specialists. Further iterative interactions with AI and development of validated scales for evaluating chatbots-generated
text expansion were beyond the scope of this study. We also assert programs, whether in sports medicine or broader medical science
that a broader investigation of multiple health profiles would yield contexts.
more valuable insights than a narrow focus on a single profile with Furthermore, the current technological limitations of AI, which
numerous interactions. To ensure clarity, some evaluations, which preclude real-time physiological monitoring and responsive adjust-
are common between scenarios, were addressed in the overall eval- ments to exercise prescriptions, were evident in the model’s tenden-
uation to avoid redundancy. Despite these limitations, the study- cy to prescribe extremely conservative programs. Without real-time
maintained objectivity by adopting an observational approach, avoid- feedback, safety has been prioritised over challenge and progression,
ing external factors that might alter the model’s responses. This potentially hindering fitness and health improvements. This limita-
method facilitated a clear differentiation between the model’s inher- tion is underscored by the contrast with other technological advance-
ent knowledge and potential external influences. ments, such as the “precision motion technology “offered by “Hinge
Future research should explore the interactive capabilities of AI Health” [79], which can provide the real-time monitoring currently
models, including ChatGPT, to determine if they can be harnessed beyond the reach of AI models like GPT-4.
to enhance the specificity and effectiveness of prescribed exercise The lack of specificity and customisation in addressing individu-
programs. Such studies may also consider focusing on individual pa- al health conditions and goals also emerged as a limitation, impact-
tient cases with multiple interactions to assess the model’s ability to ing the effectiveness of the programs and possibly influencing users’
generate better-tailored training programs over successive rounds of motivation and adherence. Additionally, the study’s omission of fac-
interaction. As AI technology advances, subsequent iterations of these tors such as ethnicity, exercise preferences, profession, lifestyle hab-
models may overcome existing limitations, enabling patients and fit- its, and other personal details further constrained the model’s abili-
ness professionals to utilize these tools for crafting more accessible, ty to provide tailored fitness programs. Although attempts were made
personalized, and effective exercise prescriptions. Such advance- to incorporate these details, the model’s unresponsiveness led the
ments can serve as valuable aids, amplifying the expertise of fitness authors to retain the original approach.

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 Ismail Dergaa et al.

The model’s inclination towards safety over progression, while Consent for publication
understandable given the lack of real-time feedback, could obstruct Not applicable
significant long-term fitness and health gains, especially for individ-
uals with specific health conditions requiring more targeted program- Availability of data and materials
ming. Finally, there are some individuals that will need the continu- The data that support the findings of this study are openly available
ous presence of a coach next to them to exercise [80, 81], and for upon request from the corresponding author.
these persons AI may never provide an adequate solution.
Future research should pursue more dynamic and interactive de- Conflict of interest declaration
signs, exploring continued dialogue with AI models, and integration The authors declare no conflict of interest. The authors wish to affirm
of real-time physiological monitoring technology. Such advancements that this research was executed with complete academic integrity,
could enhance the specificity and effectiveness of AI-generated ex- free of any commercial or financial biases. Specifically, while we
ercise programs, opening new possibilities for personalised fitness employed the paid version of ChatGPT 4.0 for its advanced capa-
and health interventions. bilities in exercise prescription, this was not done with any intention
to promote or encourage its use. Our choice of this platform was
CONCLUSIONS strictly to assess its potential in the realm of exercise prescription,
Our findings indicate that AI technology (in this case OpenAI’s GPT-4) without any sponsorship or incentives from the developers or associ-
can provide a baseline for safe exercise recommendations. However, ated entities of ChatGPT. No author has affiliations with OpenAI or
the technology may not offer the degree of complexity and adapt- any other commercial entities related to the content of the manuscript.
ability required for optimized long-term fitness and health improve- Our sole commitment remains to transparent, unbiased evaluations
ment. The exercise regimens developed by GPT-4 permit individuals that serve to advance the intersection of sports medicine and artificial
with average fitness to maintain their current health status, but do intelligence.
not provide sufficient stimuli for obtaining substantial advancements
in their health or fitness. This conclusion highlights the irreplaceable Funding
value of human expertise and experience in the realm of exercise This research received no specific grant from any funding agency in
prescription. Live fitness specialists, with their ability to dynami- the public, commercial or not-for-profit sectors.
cally adjust and personalise workout plans, maintain a decisive ad-
vantage over current AI technology in fostering meaningful physio- Authors’ contributions
logical adaptations and health benefits. I.D: conception and design.
Chatbots AI technology, as it stands (mid 2023), appears to pos- I.D, H.B.S, A.E.O, J.M.G, C.C.T.C, J.A.W, N.G, O.H, R.A.A, L.F.R.S,
sess limitations that restrict its potential within the realm of person- M.R, L.L.P.D, R.L.V, M.T, L.J.M.D.S, K.T, H.C, M.Z, Ö.E, S.S, M.B.A,
alised exercise prescription. Despite offering generally safe recom- H.H.S, H.E, I.M, P.Z, S.S, B.K, I.M.A, Ø.S, J.A.D, K.C: analysis and
mendations, AI-generated fitness plans seem to lack the personalisation, interpretation of the data. I. D and H.B.S: drafting of the paper.
creativity, and variability that a fitness specialist can provide. For in- I.D, H.B.S, A.E.O, J.M.G, C.C.T.C, J.A.W, N.G, O.H, R.A.A, L.F.R.S,
stance, a fitness specialist could consider the patient’s fluctuating M.R, L.L.P.D, R.L.V, M.T, L.J.M.D.S, K.T, H.C, M.Z, Ö.E, S.S, M.B.A,
energy levels and tailor the intensity of workouts, accordingly, ensur- H.H.S, H.E, I.M, P.Z, S.S, B.K, I.M.A, Ø.S, J.A.D, K.C: revising it
ing that the user remains engaged and motivated while avoiding critically for intellectual content.
burnout. This level of holistic approach leads to personalization and All authors gave their final approval to the version that will be pub-
creativity beyond what AI-generated plans can offer, as it takes into lished.
account unique user attributes and adapts in ways that resonate with
their individual preferences and needs. Even with technological ad- Declaration
vances, the full replacement of human expertise in the exercise pre- We want to emphasize that the interpretation of the results in this
scription field by AI systems seems distant. This study highlights ar- study is somewhat subjective, as it relies on the authors’ experience
eas of improvement for AI systems, such as enhancing real-time with advanced language models. Although we endeavoured to main-
interactions, improving personalisation and adaptability algorithms, tain objectivity, it is important to acknowledge that different reviewers
and integrating a greater degree of progression in exercise intensity may hold varying interpretations of the findings. In an effort to mitigate
and variability in training. Only through such advancements can AI this limitation, we sought the feedback of a substantial number of
provide exercise recommendations that come closer to matching the highly active experts in sports medicine, exercise sciences, and exer-
quality and effectiveness of a live fitness specialist. cise physiology, as indicated in the author list. Their insights pro-
vided a nuanced critical evaluation of chatGPT-4’s capabilities in
Ethics approval and consent to participate exercise prescription for individuals living with medical conditions and
Not applicable seeking exercise programs.

236
 ChatGPT for exercise prescription

In the interest of transparency, it’s essential to clarify our author- Acknowledgements

ship criteria. The listed authors are those who have made significant In alignment with our commitment to transparency and rigorous col-
and sustained contributions to the study. Others, who made valuable laboration, we extend our deepest gratitude to several individuals who
but intermittent contributions, are duly recognized in the ‘Acknowl- have significantly contributed to the refinement of this manuscript. As
edgements’ section. Additionally, while many specialists were ap- previously outlined in the declaration section, while their inputs have
proached and expressed initial interest, not all were able to contrib- been invaluable, the nature and extent of their contributions varied.
ute to a degree that warranted formal recognition. Those who neither We’d like to specifically acknowledge: Amine Ghram, Amine Souissi,
made significant contributions nor responded within the agreed-up- Anissa Bouassida, Asma Aloui, Ghouili Hatem, Khadijeh Irandoust,
on timeframe have not been acknowledged in the manuscript. Mohamed Saifeddin Fessi, Mouna Saidane, Nadhir Hammami, Nico-
Throughout this endeavor, our primary goal has been to maintain la Luigi Bragazzi, Nidhal Jebabli, Nizar Souissi, Oumaima Mechraoui,
integrity, transparency, and an unwavering commitment to academ- Ramdan Abdelmoez Farhat, Rebhi Mahmoud, and Tore Bonsaksen.
ic rigor. Their expertise, insights, and feedback have been crucial in ensuring
the quality and depth of this work. We greatly appreciate their dedica-
tion and collaborative spirit throughout this academic endeavor.

AFFILIATIONS
1
Primary Health Care Corporation (PHCC), Doha, Qatar
2
Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of
Sfax, Sfax 3000, Tunisia
3
High Institute of Sport and Physical Education of Kef, Jendouba, Kef, Tunisia
4
University of Sousse, Farhat HACHED hospital, Research Laboratory LR12SP09 «Heart Failure», Sousse, Tunisia
5
University of Sousse, Faculty of Medicine of Sousse, laboratory of Physiology, Sousse, Tunisia
6
Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
7
Neurotrack Technologies, Redwood City CA, USA
8
College of Life Sciences, Birmingham City University, Birmingham, B15 3TN, UK
9
Institute for Health and Wellbeing, Coventry University, Coventry, CV1 5FB, UK
10
Sports Performance Division, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
11
Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
12
Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS (Faculty of
Sport Sciences), UPL, Paris Nanterre University, Nanterre, France
13
Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Tunisia
14
Department of Exercise science, Yarmouk University, Irbid, Jordan
15
Department of Social Sciences and Humanities, Autonomous University of Occident, Los Mochis, Mexico
16
Departamento de Fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Brazil
17
Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
18
Department of Motor Behavior, Faculty of Sport Sciences, University of Tehran, Tehran, Iran
19
Department of Creative Industries, Faculty of Communication, Arts and Sciences, Canadian University of Dubai, Dubai, United Arab Emirates
20
Department of Physical Education and Sport Teaching, Inonu University, Malatya 44000, Turkey
21
University of Aleppo Faculty of Medicine: Aleppo, Aleppo Governorate, Syria
22
Department of Comparative and Experimental Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
23
Department of Chemistry, Faculty of Science, Islamic University of Madinah, Madinah, 42351, Saudi Arabia
24
International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
25
International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
26
Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Basque Country
27
Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
28
Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
29
Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland
30
Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
31
Institute of Primary Care, University of Zurich, Zurich, Switzerland
32
Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
33
Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
34
Center for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim,
Norway
35
Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Tunisia

Biology of Sport, Vol. 41 No2, 2024 237

 Ismail Dergaa et al.

Author’s ORCID: Khaled Trabelsi: 0000-0003-2623-9557

Ismail Dergaa: 0000-0001-8091-1856 Hamdi Chtourou: 0000-0002-5482-9151
Helmi Ben Saad: 0000-0002-7477-2965 Makram Zghibi: 0000-0001-5500-930X
Abdelfatteh El Omri: 0000-0003-4112-7924 Özgür Eken: 0000-0002-5488-3158
Jordan M. Glenn: 0000-0002-2563-4291 Sarya Swed: 0000-0002-9983-2020
Cain C. T. Clark: 0000-0002-6610-4617 Mohamed Ben Aissa: 0000-0001-7694-1059
Jad Adrian Washif: 0000-0001-8543-4489 Hossam H. Shawki: 0000-0002-1962-9701
Noomen Guelmami: 0000-0002-4959-9726 Iñigo Mujika: 0000-0002-8143-9132
Omar Hammouda: 0000-0002-5002-687X Stephen Seiler: 0000-0001-8024-5232
Ramzi A. Al-Horani: 0000-0002-6915-816X Piotr Zmijewski: 0000-0002-5570-9573
Luis Felipe Reynoso-Sánchez: 0000-0001-9008-5105 David B. Pyne: 0000-0003-1555-5079
Mohamed Romdhani: 0000-0002-1715-1863 Beat Knechtle: 0000-0002-2412-9103
Laisa Liane Paineiras-Domingos: 0000-0003-3451-5056 Irfan M Asif: 0000-0003-0655-6264
Rodrigo L. Vancini: 0000-0003-1981-1092 Jonathan A Drezner: 0000-0003-3519-9120
Morteza Taheri: 0000-0001-8031-3792 Øyvind Sandbakk: 0000-0002-9014-5152
Leonardo Jose Mataruna-Dos-Santos: 0000-0001-9456-5974 Karim Chamari: 0000-0001-9178-7678

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