Prescription of Exercise for Health, Wellness, and Fitness

Medical Clearance Identify high-risk individuals Information used for exercise

prescription For motivation (BP, body fat, etc.) Baseline values To identify illnesses at early stages

Medical Clearance

Recommended for: Men > 40 Women > 50 People at high risk

CAD Risk Factors

AgeFamily hxSmokingHTNHypercholesterolemiaDMSedentary

CAD Risk Factors

Negative Risk Factor

High serum HDL

Cardiopulmonary Disease Signs & Symptoms Pain, discomfort in chest, neck,

jaw, arm SOB w/ mild exertion Dizziness or syncope Orthopnea or paroxysmal

nocturnal dyspnea

Cardiopulmonary Disease Signs & Symptoms Ankle edema Palpitations or tachycardia Intermittent claudication Known heart murmur Unusual fatigue or SOB w/ usual

activities

CAD Risk Factors

ECG

any individual in a high-risk category

Initial Risk Stratification

1. Apparently Health: asymptomatic & apparently healthy w/ 1 major coronary risk factor (CRF)

2. Increased Risk: signs or symptoms suggestive of possible C-P or metabolic disease and/or 2 major CRF

3. Know disease: known cardiac, pulmonary, or metabolic disease

Prior to Exercise

ACSM Guidelines Medical examination and exercise

test might not be necessary if moderate exercise is undertaken gradually in people without symptoms of cardiopulmonary disease

Comprehensive Exercise Program Cardiovascular - Aerobic training

Resistance Training

Flexibility

Exercise Prescription - Aerobic Mode or type Frequency Duration Intensity

Exercise Prescription

Overload - exercise @ intensity higher than normal

frequency intensity duration

Specificity

Exercise Prescription - Mode Walking Running Hiking Cycling Rowing Swimming etc.

Exercise Prescription - Frequency

Optimal - return on investment

Progression

Exercise Prescription - Duration

Minimum

Optimal

Intensity and Duration

Inverse relationship

Considerations

Intensity Considerations

Level of fitness Medications that influence HR Risk of CV or orthopedic injury Exercise preference Program objectives

Exercise Prescription - Intensity

Percentage of HRmax

HR reserve method

plotting HR vs VO2 or exercise intensity during exercise test

Percentage of HRmax

Target or Training HR (Range)

Max HR = 220 - Age

70 - 85% of HRmax

Exercise Prescription - Intensity

For most - 70% HRmax

threshold with training

Monitoring Exercise Intensity

40 y.o.

Max HR = 220 - 40 = 180 bpm

THR70% = .70 * 180 = 126 bpm

THR90% = .90 * 180 = 162 bpm

HRR Method - Karvonen Formula

Obtain standing resting HR (HRrest)

HRR = HRmax - HRrest

Calculate 60% and 80% of HRR

HRR Method - Karvonen Formula

Add each of these values to HRrest

THR = HRrest + 0.60(HRmax - HRrest)

THR = HRrest + 0.80(HRmax - HRrest)

HRR Method

Age: 40 HRrest : 50 bpm

THR60% = 50 + 0.60(180 - 50) THR60% = 128 THR80% = 154

Exercise Prescription - Percentage of HRmax

70 - 85% of HRmax

60 - 80% of VO2max/HRR

45% of VO2max or less is effective for some

%HR %VO2max

50 2860 4070 5880 7090 83100 100

HR and VO2 Relationship

% HRmax %VO2max

50 2860 4070 5880 7090 83100 100

%VO2max = 1.43 %HRmax – 44.2

HR vs. VO2max

Monitoring Exercise Intensity Utilize HR Method (70-85%)

Create a range of 10-15% (e.g. 70-85%)

Strive for 70%

Lower intensities may be effective

Other Methods of Monitoring Exercise Intensity Metabolic Equivalent - MET

Rest = 1 MET (3.5 ml O2/kg min)

MET Method of Monitoring Exercise Intensity 70% HRmax = 60% VO2max

Age 40 / VO2max = 50 O2/kg min

Target: 30 O2/kg min

METS: 30/3.5 = 8.6 METS

Various MET Values Sitting: 1.0 Walking (2.5 mph): 3.0 Walking (3.5 mph): 4.5 Mopping: 4.5 Mowing Lawn: 6.5 Swimming (crawl - 2.5 ft/sec): 15.0 Horseback riding (gallop): 8.0

Other Methods of Monitoring Exercise Intensity

6 No exertion at all7 Very, very light Extremely light89 Very light Very light

1011 Fairly light Light1213 Somewhat hard Somewhat hard1415 Hard Hard (Heavy)1617 Very hard Very hard1819 Very, very hard Extremely hard20 Maximal exertion

Exercise Intensity

% HRmax %VO2max RPE Classification orIntensity

<35 <30 <10 Very light35-59 30-49 10-11 Light60-79 50-74 12-13 Moderate80-89 75-84 14-16 Heavy>90 >85 >16 Very heavy

Exercise Program Warm-up Flexibility / Stretching Training Aerobic Training Cool Down Flexibility Training

Resistance Training

Principles of Training

Overload Higher level of exercise Induce a training effect Achieved thru manipulating Athletes, sedentary, pathological

Principles of Training

Specificity Aerobic capacity Local changes Motor patterns/performance

Specificity - Aerobic Capacity

Running Test Swimming TestPre-Training

Post-Training

%Change

Pre-Training

Post-Training

%Change

VO2max(mL/kgmin)

54.9 55.7 +1.5 46.6 51.8 +11.0

Specificity - Local Changes O2 transport/utilization

Generate ATP

Local blood flow

Specificity - Local Changes vascularization

more efficient distribution of CO

Specificity - Motor Performance

Concrete vs. Abstract Tasks

Neuromuscular Adaptation

Types of Aerobic Training (Athletes)

Long, slow distance (LSD) Pace/Tempo Interval Repetition Fartlek