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chapter 5

chapter 5. chapter. 5. Designing Cardiorespiratory Exercise Programs. Author name here for Edited books. Objectives. Identify the basic components of a cardiorespiratory (CR) exercise program Tailor exercise prescriptions to meet an individual’s goals

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chapter 5

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  1. chapter5 chapter 5 Designing Cardiorespiratory Exercise Programs Author name here for Edited books

  2. Objectives • Identify the basic components of a cardiorespiratory (CR) exercise program • Tailor exercise prescriptions to meet an individual’s goals • Identify exercise modalities for CR programming • Differentiate between various CR programming techniques • Identify the physiological benefits of CR program adherence • Understand dose–response relationships for frequency, intensity, and duration as they pertain to aerobic fitness

  3. The Art of Exercise Prescription • Exercise program must meet client’s needs and interests; what is the client’s goal? • Programming for improved health is different than programming for cardiorespiratory fitness. • The key is individualization.

  4. Elements of CR Workout • Warm-up: increase blood flow (5-10 min) • Endurance: aerobic conditioning (20-60 min) • Cool-down: reduce cardiovascular complication risk (5-10 min) • Stretching: reduce chance of soreness and cramps (≥10 min)

  5. Prescription for Improved Health • FITT Principle • Frequency:most, preferably all days of the week • Intensity:moderate-intensity (3-6 METs) • Time:150 to 300 minutes/week; varies related to intensity • Type:modality of endurance-type activities

  6. Prescription for CR Fitness • Frequency: 3 to 5 days a week • Intensity: related to initial fitness status; use %heart rate reserve (HRR) or VO2 reserve (VO2R) • Time: 20 to 60 minutes continuous exercise • Mode: rhythmic, aerobic, large muscle groups • Progression: based on conditioning effect . .

  7. Modalities for CR prescriptions • Large muscle groups • Rhythmic • Provide mechanism to initially monitor intensity • Progress from type A modalities to types B and C as skill and fitness levels increase • Include type D modalities in addition to regular program; great for adding variety

  8. Classification of Aerobic Exercise Modalities

  9. Alternative CR Modalities • Options are available beyond traditional CR modalities. • Varying levels of perceived exertion (RPE) exist for a given HR or %VO2max response. • Cycling has high localized fatigue in legs. • Some result in higher HR than when on a treadmill exercising at a similar %VO2max. • At the same RPE, a treadmill produces greater energy expenditure. . .

  10. Figure 5.1

  11. Figure 5.2

  12. How to Progress CR Workload • Increase treadmill speed and incline. • Increase cycling rpm and resistance. • Increase step cadence and height for aerobic or bench stepping. • Include upper body component or use light hand weights with lower body exercise. • Increase velocity for in-line skating.

  13. Selecting CR Modality for Older Adults • Focus on functional, enjoyable, convenient exercises. • Walking and tai chi are good options. • Consider the following: • Deteriorating vision • Neuromuscular coordination challenges • Musculoskeletal challenges

  14. Selecting Intensity . • ACSM recommends using %VO2 reserve (%VO2R) over other options. • What is VO2R? • VO2R = (VO2max (or peak) – VO2rest) • Directly related to aerobic fitness • Forms the basis of exercise prescription • Equates (1:1) with Heart Rate Reserve (HRR) • Can also substitute METS for VO2 • Rest = 3.5 ml/kg/min = 1 MET . . . . . .

  15. . Prescribing Exercise by VO2R . • For sedentary or individuals with poor initial fitness: Start in range 30% to 45% VO2R. • For healthy individuals: Start in range 40% to 85% VO2R. • To improve CR fitness: Exercise in range 55% to 80% VO2R. • To keep improving CR fitness: Systematically increase % VO2R. . . .

  16. . Example Using VO2R . . • Assume VO2max = 50 ml/kg/min and target intensity is 60% to 80%VO2R. • VO2R = 50 – 3.5 = 46.5 ml/kg/min • Target VO2 = (.60 x 46.5) + 3.5 • Target VO2 = 27.9 + 3.5 = 31.4 ml/kg/min • Target VO2 = (.80 x 46.5) + 3.5 • Target VO2 = 37.2 + 3.5 = 40.7 ml/kg/min . . . . .

  17. Example Using METs . . • Assume VO2max = 10 METs and target intensity is 50% of VO2R. • Target VO2 = [.50 x (10 – 1)] + 1 • Target VO2 = (.50 x 9) + 1 • Target VO2 = 4.5 + 1 = 5.5 METs • Can now convert METs to ml/kg/min. . . .

  18. Calculating Running Speed at 8 METs • 8 METs = 8 x 3.5 = 28 ml/kg/min • 28 ml/kg/min = [(speed m/min) x 0.2] + 3.5 • Isolate speed • 28 – 3.5 = [(speed m/min) x 0.2] • 24.5 ÷ 0.2 = (speed m/min) • 122.5 m/min = speed • Convert to mph. • 122.5 ÷ 26.8 = 4.57 mph

  19. Calculate Running Pace From MPH • Pace = [(60 min/hr)/mph] • Pace = 60 ÷ 4.57 (from previous example) • Pace = 13.1 min/mi (or 8.1 min/km)

  20. Words of Caution About METs • MET values in Compendium. • MET values differ for youth and adults. • Values are estimates of energy expenditure. • Environmental factors and skill level can influence actual energy expenditure. • Better to use METs plus either HR or RPE to keep client safe.

  21. Exercise Intensity Using HR • Prescribing exercise based on HR is easy, but comes with limitations—especially when estimating maximal HR (HRmax) from age or given certain environmental or medical factor. • Three methods to choose from: • HR versus MET graphing method • HRR method • %HR max method

  22. HR Versus MET Graphing • While conducting a GXT, do the following: • Record and plot steady-state HR for each stage. • Plot HR on y-axis; MET levels or VO2 on x-axis. • If not a maximal exertion GXT, extrapolate to HRmax. • Determine desired %VO2R range. • Locate corresponding HRs. • Can now determine HR range. • Remember, some modalities produce higher HR responses. . .

  23. Figure 5.3

  24. Heart Rate Reserve (HRR) • No actual GXT for HRmax? Use this method! • Target HR = [% exercise intensity x (HRmax – HRrest)] + HRrest • HRR also called Karvonen method • %HRR approximates %VO2R. • Set programs in range 40 to 85 %HRR. .

  25. %HRmax • Can also just use a percentage of maximal HR. • Set program in range 64% to 94% HRmax. • Approximates 45% to 85% VO2R or HRR. • Program in lower end of range for those of lower levels of CR fitness. • This method gives lower values than does %HRR, but recommended for older clients. • If no actual HRmax is available, you must estimate it. .

  26. Exercise Intensity Using RPE • RPE values are valid and reliable measures. • Subjective interpretation of effort by client. • Client “scores” effort required by each stage of GXT using an RPE or Omni scale value. • RPE range of 12 to 16 approximates 40% to 84% HRR. • May use RPE instead of or with HR.

  27. Monitoring Exercise Intensity • Necessary to maintain client’s safety • HR • RPE • Talk test: If client can’t talk comfortably while exercising, the intensity is too high.

  28. Exercise Frequency • Depends on client’s goals, fitness level, preferences, and time availability • Health benefits at 5 days a week • If CR fitness is low, 5 days a week of low- to moderate-intensity exercise • To improve moderate to excellent CR fitness, 3 to 5 days a week of moderate- to vigorous-intensity exercise • May incorporate several short-duration (10 min) bouts in same day

  29. Exercise Duration • Duration is inversely related to intensity. • ACSM recommends 20 to 60 minutes continuous or discontinuous exercise. • In improvement stage, increase duration every 2 or 3 weeks until reaching 30 minutes continuous exercise. • Alternatively, use the caloric cost of exercise to determine duration. • Target caloric threshold is 150 to 400 kcal/day for minimum of 1,000 kcal/week.

  30. Exercise Duration by Caloric Cost • Initial conditioning phase: long enough to expend 200 to 600 kcal/day • Improvement stage: long enough to expend 1,000 to 2,000 kcal/day • Gradually change intensity, frequency, duration.

  31. Net Caloric Cost of Exercise • kcal/min = METs x 3.5 x body mass (in kg) ÷ 200 • Remember, for net value, subtract resting value (e.g., MET expenditure – 1). • For a 60 kg woman exercising at 7 METs: • kcal/min = (7 – 1) x 3.5 x 60/200 • kcal/min = 6.3 • To reach 300 kcal/day target, must work out 43 minutes (300/6.3) at 7 METs

  32. Progression of Exercise • Improvement of CR fitness is a result of overload. • Greatest improvement in first 6 to 8 weeks. • Overload comes from adjustments in intensity and duration. • Extent of improvement is on individual basis. • Must continually overload the CR system. • The lowest starting point equals the highest gain. • Common gains in VO2max range from 5% to 20%. .

  33. Stages of Progression • Initial conditioning: 1 to 6 weeks, based on individual • Improvement: usually 4 to 8 months • Maintenance: for the rest of their life

  34. Initial Conditioning • Low- to moderate-intensity exercise early on • Include warm-up and cool-down (emphasize stretching) • 3 to 5 days a week • 1 to 6 weeks, depending on rate of adaptation • Target is 20 to 30 continuous minutes • Once client exercises for 30 continuous minutes at 55% to 60% HRR, client is ready to move to improvement stage.

  35. Improvement Stage • See rapid changes in CR function and aerobic capacity. • Continue changing intensity, duration, and frequency independently of each other. • Increase duration and frequency before intensity. • Goal is minimum of 20 continuous minutes of moderate- to vigorous-intensity exercise 5 days a week. • Then increase 5% HRR every 6th session. • May last 4 to 8 months. • When target fitness level is attained, progress to maintenance stage.

  36. Maintenance Stage • Goal is to maintain all that was attained in improvement stage. • If intensity stays the same, you can reduce frequency to 3 days a week. • Use type C and D activities for the other 2 days. • Include variety to reduce the possibility of boredom.

  37. Methods or Modes of Aerobic Exercise • Continuous or discontinuous • Walking, jogging, cycling • Aerobic dance • Step aerobics • Step ergometry and stair climbing • Elliptical trainers • Water-based exercise • Numerous new options (continued)

  38. Methods or Modes of Aerobic Exercise (continued) • Continuous exercise maintains an elevated HR. • Discontinuous exercise allows higher exercise intensity and higher total caloric expenditure. • Discontinuous exercise is also called intermittent training.

  39. Discontinuous Aerobic Exercise • Examples: • Interval training • Spinning • Circuit resistance training • Treading (continued)

  40. Discontinuous Aerobic Exercise (continued) • Circuit resistance exercise • Results in fewer improvements in aerobic fitness compared to other modalities • Should not be used to improve aerobic fitness • Good for maintenance phase • Can add cardio stations between resistance stations (super circuit resistance training)

  41. Personalizing an Aerobic Program • Must meet client’s goals and incorporate client’s interests. • Need to consider client’s demographic profile (age, gender, fitness level, exercise preferences). • Start by evaluating client’s risk factor profile then stratify client’s CVD risk level. • Round out picture via lifestyle evaluation. • Conduct GXT and record the data. (continued)

  42. Personalizing an Aerobic Program (continued) • Must meet client’s goals and incorporate client’s interests • Needs to consider client’s demographic profile (age, gender, fitness level, exercise preferences) • Start by evaluating client’s risk factor profile • Then stratify client’s CVD risk level • Round out picture via lifestyle evaluation • Conduct GXT and record the data (continued)

  43. Personalizing an Aerobic Program (continued) . • Use their measured (or estimated) VO2max. • Determine if initial conditioning period is required. • Compute target range for exercise intensity (%VO2R or %HRR). • Determine range of HRs that match exercise intensity anchor points. • Progress exercise prescription by increasing duration first. • Then increase exercise intensity. . (continued)

  44. Personalizing an Aerobic Program (continued) • Compute caloric cost of prescribed exercise. • At initial conditioning phase target is 752 to 1,040 net kcal/week. • At improvement phase target 1,040 to 1,874 net kcal/week. • During improvement phase client meets ACSM’s >1,000 kcal/wk recommendation. • During maintenance phase, add variety. (continued)

  45. Personalizing an Aerobic Program (continued) • Multimodal exercise (cross-training) programs are popular methods for increasing CR fitness. • Difficult to prescribe program based on specific MET levels; use range of MET levels. • HR will vary based on modality utilized. • HR response during weight-bearing exercise at same exercise intensity is higher compared to nonweight-bearing modalities. • RPE is good way to monitor intensity.

  46. Benefits of Multimodal Training • Encourages adherence to safe, effective program • High levels of client enjoyment in exercise • Increased client understanding of their body’s response to exercise • Client’s sense of some control in their program • Increased incorporation of exercise and physical activity into lifestyle

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