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Chapter 2
Introduction (Framework)
Exercise Management Principles
Chapter 2
Exercise Management Principles
Problem

– Oriented Exercise Management
Consists of Five Steps (SOAP)
• S – Collection of Subjective Data
• O – Collection of Objective Data
• A – Assessment and Generation of a Problem List
• P – Formulation of a Diagnostic and / or Therapeutic
Plan
• Follow-up – Periodic Reassessment
Chapter 2
Exercise Management Principles

(SOAP)
 S – Getting Subjective Data
• Subjective history of physical activity and medical
problems
•What are the complaints and symptoms?
•What are their perceived limitations?
•Why does the subject want to exercise?
•Why is their exercise history?
•What are the current medications and medical
treatment?
Subjective assessment can help you to determine which type of
exercise tests may be warranted.
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Exercise Management Principles

(SOAP)
 O – Getting Objective Data
• Includes information gathered during medical / physical
examinations and lab tests
• Medical exams and lab tests can confirm or refute causes of
symptoms and be used for diagnostic purposes.
•Collected objective data may help to determine the types of
exercise test(s) that may be helpful in prescribing an exercise
program. (see families of exercise test types p.10, text)
•The exercise test should be individualized to meet the special
needs of each subject while allowing for the assessment required
for designing an individualized exercise program.
•Thus, the exercise leader will have to “estimate” the exercise
capacity of the subject when selecting an exercise test protocol.
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Exercise Management Principles

(SOAP)
 A – Making the Assessment
• Subjective and Objective Data collected can be used
to determine specific types of problems that need to be
addressed via exercise programming
•Exercise testing may reveal additional underlying
problems not determined during resting assessment,
and/or confirm the presence of observed problems
during the resting assessment
•Several testing measurements may be required to
fully address the underlying problem(s).
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Exercise Management Principles

(SOAP)
 P – Formulating a Plan
• The plan of action is the path that will lead to
diagnosis and treatment of the problem
•Treatment of the problem will be addressed through
the exercise prescription
•The prescription musty have short and long term
goals
•The subject should understand the associated risks
vs. the benefits of exercise programs. You should
explain the risk vs. benefits of physical activity as it
pertains to the individual health problem(s) of the
subject.
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Exercise Management Principles

S.M.A.R.T. GOALS
S: goals must be specific and clearly defined
M: goals must use real endpoints to measure
success (ex. 15% reduction in body fat)
A: goals should be “Actionable”, something the
individual truly believes and desires
R: goals should be realistic
T: goals should be time oriented

Chapter 2
Exercise Management Principles

Reassessment (follow-up)
•You should have a reassessment plan in place to
determine the effectiveness of the exercise program
•Reassessment will determine the therapeutic effect of
the exercise program
•Reassessment should be scheduled when enough
time has elapsed from the original assessment for the
therapeutic effects of the exercise program to occur.
•Reassessment will assist in determining the
effectiveness of the exercise program, and if the
exercise goals have been met.
Chapter 2
Exercise Management Principles

Families of Exercise Tests Measures
Permit Evaluation for Exercise Prescription
 Families of Tests

• Aerobic Exercise
• Anaerobic Exercise
• Endurance Exercise
• Strength Exercise
• Flexibility Exercise
• Neuromuscular Exercise
• Functional Performance
Chapter 2
Exercise Management Principles
Aerobic
Exercise Test Terminology
VO2 max – the maximum amount of oxygen
utilized by the muscles during exercise. VO2 max
is determined during a maximal exercise test.
During a maximal exercise test the only limitation
to further exercise performance should be oxygen
delivery or uptake.
 Peak VO2 – is the highest rate of oxygen
consumption measured during the exercise test,
regardless of whether or not VO2 max is attained.
peak VO2 maybe higher, lower, or equal to VO2
max.1

Chapter 2
Exercise Management Principles
Aerobic
Exercise Test Terminology
VO2 MSS – the maximum sustainable speed
(workload) that can be maintained (indefinitely)
during an exercise test.

Ramp Protocols – Graded exercise tests that
are individualized and provide continuous,
frequent (every 10-20 seconds) increments of
work rate so that VO2 increases linearly.1

Chapter 2
Exercise Management Principles
Aerobic
Exercise Test
Maximal Oxygen Consumption is important to
determine but people with chronic disease and
disability may have other limitations that disallow
the measurement of maximal oxygen
consumption
 Peak VO2 is usually assessed
 For persons with chronic disease and disability,
the usual range of sustainable work (MSS) is 40
to 70% of their actual maximal oxygen
consumption.

Chapter 2
Exercise Management Principles
Aerobic
Exercise Test
Ramp Protocols are preferred because VO2 can
be assessed in a linear fashion, and signs /
symptoms of disease can be determined at
submaximal workloads.
 It is important to choose a ramp protocol that will
allow the subject to complete the test in 8-10
minutes.

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Exercise Management Principles
Anaerobic
Exercise Test
Are used to determine maximum energy
expenditure (high intensity work) in a short period
of time
 The exercise intensity generated during an
anaerobic test will meet or exceed that of the
aerobic test.
These types of tests are appropriate for athletes
who are preparing for competition.

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Exercise Management Principles
Endurance
Tests
Are used to determine submaximal energy
expenditure (high intensity work) over a longer
period of time.


Strength Tests
Are used to determine the relative strength (or
weakness) of a muscle or muscle group.

Chapter 2
Exercise Management Principles
Flexibility
Tests
Are used to determine range of movement
within a joint or a series of joints in a segment.


Neuromuscular Tests
Are used to determine coordination and motor
skill performance.

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Exercise Management Principles
Functional
Performance Tests
Designed to determine the capacity of a person
to perform ADL (Activities of Daily Living).

Functional performance tests should mimic real
tasks.

It is possible to assess physical functioning
using a self-report questionnaire as a predictive
model.
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Exercise Management Principles
No
Exercise Test
Sometimes exercise programs must be
developed without exercise testing.
 Predictive exercise intensity equations (Heart
Rate Reserve) or Scales (RPE) can be used to
guide the intensity of the exercise session.
 If using a predictive equation, you should err on
the “low” end of the estimate, then work towards a
higher intensity of exercise, if warranted.
 RPE scales should be used when heart rate is
not a good predictor of exercise intensity ( drugs
that blunt heart rate response)

Chapter 2
Exercise Management Principles
Exercise
Dose - Response
Exercise prescription is both an art and a
science
 The science is in the tests, measurements,
collection, and analysis of exercise data
 The art is in fine tuning the exercise program to
meet the individuals needs while observing their
physical limitations.
The exercise leader should help the patient
develop reasonable exercise goals for exercise
therapy

Chapter 2
Exercise Management Principles
Exercise
Dose - Response
The balance of Frequency, Intensity, Time, and
Type of exercise should determine the rate of
progress towards meeting the exercise goals
 Exercise progression (dose loads) depend upon
the type of disease or disability the patient has,
recovery time required, and upon their initial
fitness or functional level.
High doses of exercise increase the risk of
exhaustion, and high frequency of exercise
superimposes more training on incomplete
recovery and risks overtraining.

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Exercise Management Principles
Risk,
Cost, and Benefit
Risk is the chance of something “bad”
happening.
 Exercise involves two types of risk:

• Disease-Dependent Risk
Risks that are inherent because of the presence of the
disease.

• Activity Dependent Risk
Risks that may occur ( injury) because of the participation in
physical activity
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Exercise Management Principles
Risk,
Cost, and Benefit
The costs of physical activity include time,
energy, and money put into the program.

The benefits of an exercise program are usually
focused on the improvements in quality of life,
physical and/or functional performance, and the
treatment / regression of disease and aging.

Chapter 2
Exercise Management Principles

End Note: please review the information on Exercise
and Medications at you leisure (pp.16-17). You will not
be examined on this material.
Chapter 2