Prescribing Exercise (Chapter 4)

1. Prescribing Exercise (Chapter 4) PE 254

2. Terms • Exercise: Planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness • Physical Activity: Bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure

3. How much Physical Activity is Recommended? U.S.: • everyone should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all days of the week (ACSM, CDC). http://www.questia.com/googleScholar.qst;jsessionid=Kc9WYGhLbG9JrQvFz7G91hgNMN31jdcm2XT69z8JQfrk2Q42JRDN!1009331972!-1854981251?docId=5002326128

4. What Does Counseling Have To Do With Exercise Prescription? • Need to take into account the psychological, emotional, and affective components of exercise as well as the physical aspects • Psychological and socio-emotional aspects of problems surface frequently during exercise consultation

5. General Exercise Counseling Roles • Provide a climate for change and arrive at a prescription that is best for the client while meeting the requirements of the prescription • Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers

6. First Steps Medical Clearance Men over 40 and women over 50 Basic Principles of physical Training Specificity Progressive overload Frequency Intensity Time Type Reversibility Individual differences Selecting Activities 12

7. Pre-exercise Evaluation History • Current and past exercise habits (mode, frequency, intensity, duration) • Current motivation and barriers to exercise • Preferred forms of physical activity • Beliefs about benefits and risks of exercise • Risk factors for heart disease (hypertension, diabetes mellitus, hyperlipidemia, smoking, family history of heart disease before 55 years of age) • Physical limitations precluding certain activities • Exercise-induced symptoms • Concurrent disease (cardiac, pulmonary, musculoskeletal, vascular, psychiatric, etc) • Social support for exercise participation • Time and scheduling considerations • Medication profile

8. Indications for Exercise Stress Testing • 1. Evaluation of patients with suspected coronary artery disease Typical angina pectoris Atypical angina pectoris • 2. Evaluation of patients with known coronary artery disease After myocardial infarction After intervention • 3. Screening of healthy, asymptomatic patients Persons in high-risk occupations (e.g., pilots, firefighters, law enforcement officers, mass transit operators) Men over age 40 and women over age 50 who are sedentary and plan to start vigorous exercise Persons with multiple cardiac risk factors or concurrent chronic diseases • 4. Evaluation of exercise capacity in patients with valvular heart disease (except severe aortic stenosis) • 5. Patients with cardiac rhythm disorders Evaluation of exercise-induced arrhythmia and response to treatment Evaluation of rate-adaptive pacemaker setting

9. How to Approach and Get Past Roadblocks: • I do not have time. • We’re only talking about three 30 minute sessions each week. Can • you do without three television shows a week? • I am usually too tired to exercise. • Regular activity will improve your energy level. Try and see for • yourself. • The weather is too bad. • There are many activities you can do in your home, in any weather. • Exercise is boring. • Listening to music during your activity keeps your mind occupied. • Walking, biking, or running can take you past lots of interesting scenery. • I do not enjoy exercise. • Do not exercise.. Start a hobby or an enjoyable activity that gets • you moving. • I get sore when I exercise. • Slight muscle soreness after physical activity is common when you • are just starting. It should go away in 2 to 3 days. You can avoid this by building up gradually and stretching after each activity.

10. Principles of Conditioning and Training SAID: Specific Adaptation to Imposed Demand

11. Warm-up • Precaution against unnecessary musculoskeletal injury and soreness • May enhance certain aspects of performance • Prepares body physiologically for physical work • Stimulates cardiorespiratory system, enhancing circulation and blood flow to muscles • Increases metabolic processes, core temperature, and muscle elasticity

12. Cool-down • Essential component of workout • Bring body back to resting state • 5-10 minutes in duration • Often ignored • Decreased muscle soreness following training if time used to stretch after workout

13. Exercise Intensity • Beginner or low fitness level: 50% to 60% • Intermediate or average fitness level: 60% to 70% • Advanced or high fitness level: 75% to 85%

14. Basic Elements of the Exercise Prescription • Frequency • Intensity • Time • Type

15. Exercise Intensity by Heart Rate

16. Exercise Intensity by Rating of Perceive Exertion (RPE) Why use RPE? Monitoring exercise intensity with the RPE scale is beneficial because: • 1. It provides a double-check on heart rate, especially when the target heart-rate zone is estimated from age. • 2. Assessing RPE can be performed without stopping to ''check'' it, as is necessary with heart-rate monitoring. • 3. There is no equipment you can buy to accurately describe your perception of intensity (whereas heart-rate monitors can be expensive for accurate pulse count).

17. Exercise Intensity by Rating of Perceive Exertion (RPE) 6 No exertion at all 7 Extremely light 8 9 Very light - (easy walking slowly at a comfortable pace) 10 11 Light 12 13 Somewhat hard (It is quite an effort; you feel tired but can continue) 14 15 Hard (heavy) 16 17 Very hard (very strenuous, and you are very fatigued) 18 19 Extremely hard (You can not continue for long at this pace) 20 Maximal exertion

18. Exercise Intensity by Rating of Perceive Exertion (RPE) • Level 1: I'm watching TV and eating bon bons • Level 2: I'm comfortable and could maintain this pace all day long • Level 3: I'm still comfortable, but am breathing a bit harder • Level 4: I'm sweating a little, but feel good and can carry on a conversation effortlessly • Level 5: I'm just above comfortable, am sweating more and can still talk easily • Level 6: I can still talk, but am slightly breathless • Level 7: I can still talk, but I don't really want to. I'm sweating like a pig • Level 8: I can grunt in response to your questions and can only keep this pace for a short time period • Level 9: I am probably going to die • Level 10: I am dead

19. Rate of Progression ACSM defines three stages: • Initial conditioning stage (1 – 4 weeks) • Improvement conditioning stage (4 – 5 months) • Maintenance conditioning stage (6 months and beyond)

20. Benefits of Exercise • Improved cardiorespiratory function • More efficient metabolism • Improved body composition 6

21. Disease Prevention and Management Cardiovascular Disease Metabolic Syndrome Insulin resistance High blood pressure Abnormal blood fats Abdominal fat deposits Type 2 diabetes Blood clotting abnormalities Blood vessel inflammation Prevention Improves blood fat levels - improves HDL’s Improves blood pressure Hypertension Coronary heart disease Stroke Cancer Osteoporosis Type II Diabetes 8

22. Improved Psychological and Emotional Wellness • Reduced stress • Reduced anxiety and depression • Improved self-image • Learning and memory • Enjoyment 9

23. Additional Benefits of Exercise • Improved immune function • Prevention of injures and low-back pain • Improved wellness for life 10

24. Walking for Fitness

25. Video Segments • http://www.youtube.com/watch?v=YusqoiXLJkU • http://www.youtube.com/watch?v=3SHdSbPPjms