Exercise Prescription

1. Exercise Prescription Aerobic Fitness

2. 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).

3. 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.

5. Principles of Training • Progression – Sedentary but low risk • Table 7-1, Page 149 • Initial Stage – 4 wks. • Improvement Stage - ~ 20 wks. • Maintenance Stage – lifelong !

6. 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.

7. 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

8. Aerobic Fitness Target Heart Rate, METs, and RPE • Target VO2 • VO2 Reserve = [(VO2 max – VO2 rest) x % intensity] + VO2 rest

9. 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

10. 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.

11. 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)

12. 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).

13. 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.

14. 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.

15. 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!!

16. 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).

17. 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.

18. 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:

19. 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 >300 kcal/day. • Should not reduce total kcal/day intake below 1,200 kcal.

20. 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 > 300 mg/dl or >240 mg/dl with urinary ketone bodies. • Take CHO if blood glucose is < 80 mg/dl. • Note: Table 9-2 (page 209) provides summary of extreme glycemic signs and symptoms.

21. 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 > 200 mm Hg or DBP > 115 mm Hg. • Stage 3 hypertensives should begin pharmacological treatment prior to starting exercise program (controlled BP prior to starting).

22. 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.

23. 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.

24. 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

25. Questions?

26. End Prescription Aerobic Fitness