Goran Sporiš¹, Aida Mohammadi², Navid Moravej³, Parham Jalali⁴

¹Department of General and Applied Kinesiology, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
²Sport and Health Promotion Program, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
³Islamic Azad University, Iran
⁴Wellness, Sport and Health Program, University of Bologna, Rimini Campus, Rimini, Italy

From Prescribed Exercise to Realized Adaptation: Dose, Specificity, Context, and Transfer Across Health and Performance

J. Anthr. Sport Phys. Educ. 2026, 10(4), | DOI: 10.26773/jaspe.261002

Abstract

Exercise prescriptions are commonly summarized by mode, intensity, frequency, and duration, yet the same nominal prescription can yield markedly different biological, functional, and performance outcomes. This critical integrative review examined a predefined corpus of 34 full-text evidence syntheses spanning resistance and endurance training, rehabilitation, cardiometabolic and respiratory disease, neurodegeneration, musculoskeletal conditions, athletic performance, injury prevention, and nutritional or respiratory adjuncts. Rather than re-pooling overlapping primary trials, we used cross-review integration to identify recurring conditions that alter the pathway from prescribed exercise to meaningful outcome. Five themes converged. First, dose is multidimensional and outcome-specific: higher volume or intensity can improve some adaptations, but plateaus, thresholds, and minimum effective doses are common. Second, specificity acts as a transfer gate; adaptations are strongest when the training stimulus, tissue demand, and outcome test share relevant mechanical or metabolic features. Third, baseline state changes the meaning of a given dose, with initial fitness, sarcopenia, inspiratory weakness, disease severity, and training status repeatedly modifying response. Fourth, adjuncts are not inherently additive. Protein and creatine can augment selected resistance-training outcomes, respiratory support can enable greater training tolerance in severe chronic obstructive pulmonary disease, and concurrent aerobic training can coexist with hypertrophy and maximal-strength development, yet some adjuncts show little added value and close-proximity concurrent training may attenuate explosive- strength gains. Fifth, statistical improvement does not guarantee clinically or practically meaningful transfer; several reviews reported small effects, failure to reach minimal clinically important differences, uncertain quality-of-life effects, or limited durability. We integrate these findings into a Realized Adaptation Cascade in which prescription is translated through internal exposure, biological adaptation, task-specific transfer, and meaningful outcome, while baseline state, adjunct exposures, recovery, and measurement architecture modify each transition. The practical implication is not to maximize exercise dose indiscriminately, but to identify a minimum sufficient, context-matched stimulus and verify that the desired adaptation transfers to the outcome that matters.

Keywords

exercise prescription; dose-response; specificity; resistance training; aerobic training; rehabilitation; performance; adaptation; precision exercise; clinical relevance

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