AI-Generated Exercise Prescriptions for At-Risk Populations: Safety and Feasibility of a Large Language Model Assessed by Expert Evaluation

Abstract

<b>Background/Objectives:</b> In exercise science and sports medicine, the potential use of large language models for generating personalized exercise programs is being explored. However, the practical applicability of AI-generated exercise prescriptions has not yet been sufficiently validated, particularly in complex clinical contexts. This study aimed to evaluate their practical utility under expert supervision. <b>Methods:</b> Exercise prescription outputs generated by a large language model (Gemini 2.5, Google LLC) were analyzed using clinical cases incorporating complex exercise-related considerations. Three levels of prompt structuring were applied. Experts evaluated the outputs using a structured rubric assessing safety, feasibility, guideline alignment, and personalization. Inter-expert agreement was assessed using intraclass correlation coefficients (ICC), and expert-specific internal consistency was evaluated using Cronbach's alpha. <b>Results:</b> AI-generated exercise prescriptions demonstrated a certain level of structural completeness. However, inter-expert agreement was low (ICC (2,3) = 0.139), whereas expert-specific internal consistency was high (Cronbach's alpha > 0.92). Prompt structuring from Stage 1 to Stage 2 was associated with improved mean scores in safety and guideline alignment. Additional structuring did not consistently yield further improvements. <b>Conclusions:</b> AI-generated exercise prescriptions may have practical potential as supportive decision-making tools when expert involvement is assumed. Nonetheless, expert judgments did not converge toward a single evaluative standard, reflecting the inherently expert-dependent nature of exercise prescription.

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