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Physiologic
Data – plot HR
and VO2 data
from stress test
Yes
Direct
Plot HR
vs VO2
No
Is patient on
a medication
that affects
HR?
Do you have an
accurate resting
HR?
yes
Do you know
maximal HR
and RHR?
Yes
Use
HRR
Yes
No
Maximal
HR only
Use
HRR
Use % MHR
Use
%MHR
No
Use
RPE
EXERCISE PRESCRIPTION
• ACSM defines it as an ART.
• The successful integration of exercise science
with behavioral techniques that result in longterm program compliance and attainment of the
individual's goals.
• Although the methods for prescribing exercise
are based on scientific principles, the unique
characteristics of each individual will impact the
prescription.
• Give the client a road map. Alter as needed.
• SET GOALS
• Clinical Benefits of Exercise - Table 7.1
page 107
• Specificity of Training • Progressive Overload- Father of this?
• Reversibility - includes deconditioning or
detraining.
• Deconditioning can be avoided by decreasing
the load and altering the FITT principle.
PRINCIPLE OF PROGRESSIVE OVERLOAD
•
•
•
•
•
•
•
Principle of Progressive Overload
Physical training involves the use of this.
...that for a tissue or organ to improve its
function, it must be exposed to a stimulus
greater than it normally is accustomed to.
Causes: Improved Functional Capacity &
Efficiency.
Variations of the FITT principle
3 stages of General Adaptation Syndrome:
1) Alarm reaction
2) Adaptation
3) Exhaustion
Gains and Risks of Increasing Physical Activity
From Powers and Howley, 1997. Drawing based on Dehn and Mullins, 1977, and Hellerstein and
Franklin, 1984.
Analysis of GXT
for Exercise Prescription (continued)
• If ECG was monitored, itemize the person’s
ECG changes as indicated by the physician.
• Examine the HR and BP responses to see if
they are normal.
• List the symptoms reported at each stage.
• List the reasons why the test was stopped.
Designing an Exercise
Program Based on a GXT
• Decide either to refer for additional medical
care or to initiate an exercise program.
• Identify the THR range and the approximate
MET intensities of selected activities that
are needed to achieve that THR range.
• Specify the frequency and duration of
activity needed to meet the goals of
increased cardiorespiratory fitness and
weight loss.
(continued)
Designing an Exercise
Program Based on a GXT (continued)
• Recommend that the person participate in a
supervised or an unsupervised program, be
monitored or unmonitored, do group or
individual activities, and so forth.
• Select a variety of activities at the
appropriate MET level that allow the person
to achieve THR. Consider environmental
factors, medication, and any physical
limitations of the participant when making
this recommendation.
OTHER FACTORS
• AGE
• MEDICATIONS & DISEASE
• ORTHOPEDIC PROBLEMS
• PREFERENCES & MOTIVATION
• GOALS OR OUTCOME - TARGET
TAILOR THE PRESCRIPTION TO THE
INDIVIDUAL - ART.
Stage
Length
Days/ Time
wk
(min)
HRR
VO2/
MET
Reserve
Direct
Method
HR/VO2
Initial
4 weeks
3-4
15-30
Improvement
4-5 mo.
3-5
Maintenance
depends
3-5
%MHR
R
P
E
(15
pt)
R
P
E
(10
pt)
40/50-60% 55/6470%
1213
3-4
2545+
60-85%
77-94%
1416
4-6
3045+
70-85%
84-94%
1516
5-6
. R
Relationship of %HRR and %VO
2
From D.P. Swain, B.C. Leutholtz, M.E. King, L.A. Haas. and J.D. Branch, 1998,
“Relationship between % heart rate reserve and % VO2 reserve in treadmill
exercise,” Medicine and Science in Sports and Exercise 30: 318-321.
Relationship .of %HRmax
and %VO2max
From B.R. Londeree and S.A. Ames, 1979, “Trend analysis of the % VO2maxHRregression,” Medicine and Science in Sports and Exercise 8: 122-125.
Figure 8.5
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
COMPONENTS
• WARMUP: 5-10 MINS OF LOW INTENSITY
EXERCISE (10-30%VO2max) & PROGRESS
TO THE LOWER LIMIT OF THE EXERCISE
PRESCRIPTION.
• STRETCH MUSCLE GROUPS LATER IN
WARMUP TO REDUCE CHANCE OF INJURY.
Stretching During WU
• Static Stretching = most common
• Slow constant speed then hold for 30
seconds. More than 30 yields no additional
benefit.
• Beginners may wish to hold for 15-20 secs
Muscle Structure
Reprinted from A.J. Vander, J.H. Sherman, and D.S. Luciano, 1980, Human physiology, 3rd ed.
(New York: McGraw-Hill, Inc.), 212, 216, with permission of The McGraw-Hill Companies.
• Only stretch to minor discomfort.
• At holding position the discomfort should
diminish. If not ease back.
• Avoid activating the STRETCH REFLEX:
• NO BALISTIC STRETCHING
• Ballistic may exceed the extensiblity limits of
the tissue and activate the SR.
Stretch Reflex
• Muscle spindles are located within the
muscle.
• Spindle not stimulated = relaxation
• Bouncing = spindles respond by contracting
to protect themselves from overstretching =
tension=decrease ROM.
• Ex: Patellar Tendon and Knee Reflex
CONDITIONING PHASES
•
•
•
•
15-45 MINS DEPENDING UPON STAGE
MODE: Best for the client.
WALKING: Easy, accessible, tolerable.
<2mph = 2 METS = Aerobic Fitness for lowerfit subjects
• Use weights, pools, hills.
INTIAL PHASE
• Minimum number of sessions that are
spaced out evenly.
• Intensity low at first to reduce chance of
injury and increase duration.
• Intermittent bouts of exercise may help get
client started.
Improvement Phase
Increase Time or Frequency first and Intensity
second.
• Rule of thumb: 10% per week on increases in
Frequency, Intensity or Time.
• Risk of injury high after 5 days/week with
little improvement in VO2max.
• 7 days/week should be avoided.
Maintenance Phase
• Maintenance Phase: Easier to do than
Improvement Phase.
• Can a client maintain CRE by reducing the
Frequency but maintaining the Intensity &
Duration.
• Change Mode to keep client motivated.
• Time Off: May reduce total volume of
aerobic exercise for a few weeks by as much
as 70% without negatively affecting VO2max.
Cool Down
• Gradually recovery = 5 minutes of
diminished activity.
• 5 minutes of stretching
• CD stretching may illicit more chronic
flexibility improvements.
• CD is important to maintain adequate venous
return and have the HR and BP decrease to
resting values.
• Hypotension, dizziness, reduced body heat,
LA removal.
• Heart abnormalities = arrhythmias
• Decreased VR=Decreased coronary blood
flow=O2 demands still high=ischemia.
Calculating Exercise Intensity
• MET method
– Estimate VO2max from an exercise test, and multiple
by
desired exercise intensity.
• Disadvantages: must consult table of MET values for physical
activities; environmental factors can alter workload; with improvement
in fitness, desired workout MET values change.
• Training heart rate method or Heart Rate Reserve
– % HRmax: Underestimates training HR
– HRR (Karvonen formula), %HRR. This methods relates best to
VO2maxR, not %VO2max.
• Training HR = [(Maximum HR - resting HR) x intensity %] + resting
HR
• Best to measure maximum HR and resting HR
– VO2maxR method: Calculate by subtracting 1 MET from subject’s
exercise VO2 (e.g., 24-3.5), and divide by difference of VO2max and 1
MET (e.g., 35-3.5), and multiply by 100 [(24-3.5)/(35-3.5) x 100 = 65%].
% VO2R corresponds to %HRR
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
%MAX HEART RATE METHOD
•
•
•
•
%MHR
LEAST RELIABLE
USED ONLY AS A LAST RESORT
USED WHEN NO TRUE MHR OR RHR IS NOT
AVAILABLE
• RANGE: 55/64-94%
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
Rating of Perceived Exertion
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
very, very light
very light
fairly light
somewhat hard
hard
very hard
very, very hard
•
•
•
•
•
•
•
•
•
•
1 not tired at all
2
3 a little tired
4
5 tired
6
7 really hard
8
9
10 so tired I cant go
anymore
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
1. Design an exercise prescription to improve
functional capacity utilizing ACSM
Guidelines.
• The following is an example for calculating
the entire THR range for a variety of
methods.
• Example: Keith, age 27, maximal HR = 195
bpm,
• RHR = 65 bpm, VO2max = 43 ml/kg/min
HEART RATE RESERVE METHOD
• MORE ACCURATELY DEPICTS HR AT
KNOWN VO2MAX - LINEAR
• MEASURED MAX HR DIFFERENT THAN
PREDICTED
• MHR DIFFERENT DEPENDING ON MODE
• REQUIRES A TRUE RHR
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
HEART RATE RESERVE METHOD
MHR - RHR = HRR
195-65 = 130 (HRR)
130
130
X0.60
X0.85
78
111
+65
+65
THR = 143 - 176
HEART RATE RESERVE METHOD
MHR - RHR = HRR (RHR = 95)
195-95 = 100 (HRR)
100
100
X0.60
X0.85
60
85
+95
+95
155
180
THR =155-180 vs. THR = 143-176
%MAX HEART RATE METHOD
•
•
•
•
%MHR
LEAST RELIABLE
USED ONLY AS A LAST RESORT
USED WHEN NO TRUE MHR OR RHR IS NOT
AVAILABLE
• RANGE: 55/64-94%
%MHR METHOD
AGE = 27, PMHR = 220-27=193
193
193
X0.77
X0.94
149
181
THR = 149 - 181
COMPARISON
• HRR = 143-176
• *HRR = 155-180
• %MHR = 149-181
VO2MAX METHOD
•
•
•
•
•
PLOTTING HR VS. MEASURED VO2
ACCURATE
LOW FITNESS LEVELS
CAD OR COPD
MEDICATIONS
VO2 DIRECT METHOD
• plot HR vs VO2
• 43 ml/kg/min X 0.5 = 21.5 ml/kg/min determine heart rate at level of VO2 - 117 bpm
• 43 ml/kg/min X 0.85 = 36.6 ml/kg/min determine heart rate at level of VO2- 160 bpm
Determining HR Zone From a GXT
VO2MAX Reserve TO METS
• Example: Keith, age 27, maximal HR = 195
bpm,
• RHR = 65 bpm, VO2max = 43 ml/kg/min
• VO2/MET reserve method
• (43 ml/kg/min – 3.5 ml/kg/min) X (0.5) + 3.5 =
23.3 ml/kg/min or 6.6 METs
• (43 ml/kg/min – 3.5 ml/kg/min) X (0.85) + 3.5 =
37.1 ml/kg/min or 10.6 METs
Rating of Perceived Exertion
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
very, very light
very light
fairly light
somewhat hard
hard
very hard
very, very hard
•
•
•
•
•
•
•
•
•
•
1
not tired at all
2
3
a little tired
4
5
tired
6
7
really hard
8
9
10 so tired I cant go
anymore
RPE SCALE
•
•
•
•
RATING OF PERCIEVED EXERTION
USE FOR ALTERED HR - MEDICATIONS
UNPALPABLE PULSE
INITIAL 3-4
- IMPROVEMENT 4-6
MAINTENANCE: 5-6
• A LITTLE TIRED -TIRED = 3-4
RPE SCALE
• INITIAL 12-13
• LIGHT-SOMEWHAT HARD
• IMPROVEMENT 14-16
• SOMEWHAT HARD - HARD
An Exercise Program To Build Muscular
Strength and Endurance
• Step 1 Warm-up aerobically
– Never strength train unless the muscles and joints are
warm from 5-15 minutes of moderate aerobic activity.
• Step 2 Follow these minimum strength training
program guidelines:
– Frequency: Strength train at least 2-3 days per week.
– Set and Reps: Perform a minimum of one set of 8 to 12
repetitions to the point of volitional fatigue for each
exercise.
– Strength exercises: Perform a minimum of 8 to 10
different exercises that condition all of the major muscle
groups. Perform each exercise through a full range of
motion. Perform both the lifting and lowering portion of
each exercise in a controlled manner.
Systems of Muscular Strength and Endurance
Training
• Repetitions to fatigue
– When reps are low (3-6), they build greater
strength; when high (15-25), they promote
endurance (Figure 8.17)
• Set
– One set is good for beginners, but 3-5 are optimal.
• Rest between sets
– 1-2 minutes is typical (bodybuilders use less,
power lifters more)
• Order of exercises
• Type of exercise
– Single joint or multiple joints. Examples?
Nieman DC. Exercise Testing and Prescription: A Health-Related Approach. 6/e.
Copyright ©2007 McGraw-Hill Higher Education. All rights reserved.
End of Lecture
Order of Exercises
• Large to small – a maximal stimulus is
placed on all muscles involved in an
exercise
–
–
–
–
–
–
–
–
Upper legs and hips
Chest and upper arms
Posterior legs
Upper back
Lower legs
Shoulders
Arms
Abdomen/low back
Assigning Load & Reps Based on
Training Goal
Table 15.6 pg.378, NSCA
•
•
•
•
Endurance: < 67%, > 12 Reps, < 30 secs
Hypertrophy: 67-85%, 6-12 Reps, 30-90 secs
Strength:
> 85%, < 6 Reps, 2-5 mins
Note for Strength: < 6 reps for core exercises
only, assistance exercises > 8RM