Before Changing an Exercise Prescription: A Delivery-First Approach to Apparent Nonresponse

A training outcome below expectation creates an immediate decision: continue the program, change its delivery, repeat the assessment, alter the prescription, or seek clinical review. These actions require different evidence. This perspective specifies a candidate six-step review for that decision episode. The proposed review uses established records of exercise prescription, completed exercise, internal load, and measured outcomes as its primary inputs. The six steps confirm safety and the target, verify the apparent shortfall, reconstruct the completed exercise, assess strain and feasibility, select a justified action, and set the next review or stopping point. Each step defines an output and conditions for proceeding, pausing for information, or leaving the decision unresolved. Additional monitoring is justified by whether its possible results could change the action at acceptable cost. Constructed pulmonary rehabilitation and warm-up examples show how missing exercise records and uncertain measurements can lead to different decisions from the same initial report of poor response. A proposed three-arm evaluation compares usual care with scheduled review, a simple checklist and the full review, with common care resources, information access and scheduled assessments. The primary contrast estimates functional benefit over the checklist across all enrolled participants; a prespecified secondary analysis addresses participants with a confirmed shortfall before allocation. Interpretation incorporates the frequency of triggered reviews, uncertainty, harms and monitoring burden. The contribution is an operational decision intervention and a design for testing its incremental value. Its effectiveness remains unknown; failure to demonstrate worthwhile benefit should lead to simplification or rejection.