Exercise Prescription

1
Exercise Prescription

• Aerobic Fitness

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Principles of Training

• Overload Harder work than the body is
  accustomed to.
• Training Variables (FIT Principle)
• Frequency - number of times per week
• Intensity - level of the effort at any given
  time speed, weight, hills, water resistance,
  etc.
• Time - duration, reps/sets in weight training
• Frequency and duration together are often
  referred to as training volume. In weight
  training volume is often reps/sets (volume per
  exercise session).

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Principles of Training

• Specificity - Adaptations that occur are specific
  to the type of training performed.

4
Principles of Training

• Progression
• Gradually increase the overload in an exercise
  program over time.
• Prevents possible injury and frustration.
• NOTE Increase training volume first, then
  intensity.

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Principles of Training

• Progression Sedentary but low risk
• Table 7-1, Page 149
• Initial Stage 4 wks.
• Improvement Stage - 20 wks.
• Maintenance Stage lifelong !

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Principles of Training

• Reversibility
• Training adaptations (improvements) will be lost
  if training is stopped for a prolonged period of
  time.
• In general, the faster the adaptation occurred,
  the sooner it will be lost once training stops.

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• Target Heart Rate
• Target HR range 55/65 90 HRmax
• Heart Rate Reserve (Karvonen) Method
• Target HR range 40/60 80 HRR
• THRR (HRmax RHR) x .40/.50 to .85 RHR

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• Target VO2
• VO2 Reserve
• (VO2 max VO2 rest) x intensity VO2 rest

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• 3. Metabolic Equivalents (METs)
• One MET 3.5 ml/kg/min (VO2)
• Target METs Target VO2 (ml/kg/min)/3.5
  ml/kg/min
• Target VO2 based on reserve (R) concept
• VO2R (VO2max VO2rest) x intensity
  VO2rest
• Note current ACSM recommendations suggest using
  of VO2R instead of of VO2max

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• RPE Rating of Perceived Exertion
• Category Scale (6-20) Borg Scale
• Category-Ratio Scale (0-10)
• Table 4-7, Page 77.

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• General Points for THR, METs, and RPE
• These all represent exercise intensity.
• THR and RPE are most commonly used.
• METs (target VO2) can be problematic because
• METs cannot be easily monitored in many exercise
  settings.
• METs will vary with skill level and conditioning
  in various exercises (e.g., running vs.
  swimming).
• THR can be problematic if it is based upon
  predicted HRmax (220 age error of 10 bts/min)

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Aerobic Fitness

• Target Heart Rate, METs, and RPE
• Caloric Expenditure Guidelines
• Another guide for exercise prescription
• Expend 150 400 Kcal/day (150 for low fitness
  level)
• Caloric cost of exercise
• Kcal/min METs x 3.5 x BW (kg)/200
• Note Caloric expenditure takes into account all
  three components of overload (FIT).

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Aerobic Fitness

• Exercise Duration and Frequency
• Duration
• The duration is dependent upon the intensity.
• To achieve health/fitness benefits, ACSM
  recommends 20 60 min of continuous or
  intermittent (10-min bouts) of exercise at 60
  80 of HRR (VO2R).
• Higher intensity can allow for less time.
• Lower intensity should be accompanied by a longer
  duration.

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Aerobic Fitness

• Exercise Duration and Frequency
• Frequency
• ACSM recommends 3 5 days per week.
• If intensity is low, greater than 3 days/week may
  be necessary to achieve weight loss goals.

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Aerobic Fitness

• Metabolic Calculations
• Metabolic calculations are used to
• Determine predicted maximal exercise aerobic
  capacity (VO2max)
• Determine exercise intensities based on test data
  (THRR, VO2R/METs, RPE)
• Establish treadmill, cycle, and stepper settings
  to achieve target exercise intensities.
• Appendix D!!

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Aerobic Fitness

• Metabolic Calculations
• Key Terms
• Gross VO2 represents both the resting and
  exercise VO2 components.
• Net VO2 represents only the exercise VO2
  component.
• Absolute VO2 represents the oxygen consumption
  for the total person (l/min).
• Relative VO2 represents the oxygen consumption
  per unit of body weight (ml/kg/min).

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Maintenance of Training Effect

• Training adaptations are maintained if intensity
  is maintained, even if frequency and duration are
  reduced.
• This applies to both muscular adaptations and
  aerobic adaptations.
• Training improvements begin to decline relatively
  quickly with complete inactivity (as soon as two
  weeks). Principle of reversibility.

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Special Populations

• Cardiopulmonary Patients (Chapters 8)
• Primary goal is to regain functional capacity
  (i.e. return to work status, ability to perform
  tasks of daily living).
• Primary consideration is to establish exercise
  intensity below threshold for onset of problems.
• Cardiac patients
• Pulmonary Patients

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Special Populations

• 2. The Obese (Chapter 9)
• Primary goal is likely fat reduction while trying
  to maintain lean body mass.
• Obese individuals will likely lose lean body mass
  along with fat mass, but the goal is to minimize
  this.
• Focus will be on aerobic activity.
• Generally recommended to reduce/expend 500 1,000
  kcal/day to lose body fat. Acceptable loss is 1
  of body weight/week (1.0 2.0 lbs/week for avg.
  person).
• Exercise objective is to expend gt300 kcal/day.
• Should not reduce total kcal/day intake below
  1,200 kcal.

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Special Populations

• 3. Diabetics (Chapter 9)
• Goal is to follow general fitness guidelines and
  maintain blood glucose homeostasis.
• Monitor blood glucose before, during, and after
  exercise if taking insulin or oral medication.
• Avoid exercise at peak insulin times.
• Do not exercise if blood glucose is gt 300 mg/dl
  or gt240 mg/dl with urinary ketone bodies.
• Take CHO if blood glucose is lt 80 mg/dl.
• Note Table 9-2 (page 209) provides summary of
  extreme glycemic signs and symptoms.

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Special Populations

• 4. Hypertensives (Chapter 9)
• General goal is to provide well-rounded fitness
  program that minimizes risks associated with
  hypertension.
• Follow general recommendations for aerobic FIT,
  with slight reduction in intensity (40 - 70
  VO2R).
• Emphasis on aerobic activity.
• Monitor blood pressure before, during, and after
  exercise.
• Avoid high-intensity resistance training (lower
  intensity, higher repetitions).
• Clients should maintain hypertensive medications,
  if prescribed.
• Do not exercise if resting SBP gt 200 mm Hg or DBP
  gt 115 mm Hg.
• Stage 3 hypertensives should begin
  pharmacological treatment prior to starting
  exercise program (controlled BP prior to
  starting).

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Special Populations

• 5. Pregnant Women (Chapter 9)
• Exercise is generally O.K. for pregnant women
  with no complications.
• Intensity should be moderate (high intensity not
  recommended).
• Factors to consider
• Avoid high-impact activities vertical or
  horizontal!
• Be cautious with activities requiring balance as
  center of gravity changes during pregnancy.
• Avoid large increases in body temperature.
• Proper hydration and increased caloric intake for
  exercise and fetal needs are important.

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Special Populations

• 6. Children (Chapter 10)
• Primary goal is to have participate in regular
  physical activity (not necessarily exercise).
• Attention should be paid to avoid injuries due to
  improper exercise/activity.
• Overuse injuries, often the most common form of
  injuries in children.
• Be cautious of too much activity (volume) and
  high intensity.
• Be cautious of exercise in heat and cold
  environments. Children do not respond to
  extremes as well as adults.

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Special Populations

• 7. Elderly (Chapter 10)
• Generally follow the same prescription guidelines
  for the regular adult population.
• Consider mode orthopedic and balance friendly
• Consider accessibility
• Consider group setting for adherence
• Duration vs. intensity frequent shorter bouts

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Questions?
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End Prescription

• Aerobic Fitness