Exercise Prescription Certificate Course

1. Exercise Prescription Certificate Course Session 5: Getting Active and Practising Exercise Prescription Mr. Sam WONG, Executive Director, HKPFA

2. Outline of this Session • Recap of Key Principles of Exercise Prescription • Available Forms and Tools • Case Studies • Get active!

3. Do You Remember?

4. Recap of What We’ve Learnt… • Types of PA • Aerobic Exercise • Resistance Exercise • Stretching Exercise • Components of an exercise session • Pre-participation health screening • Self-guided Screening: PAR-Q • Professionally Guided Screening: ACSM Risk Stratification Scheme • Exercise-related Musculoskeletal Injury

5. Recap of What We’ve Learnt… • FITT Principles of Prescribing PA • To assess intensity of PA (Talk test, RPE, %HRR, %HRmax, etc) • Know the different modalities of resistance exercise • Improving Exercise Adoption and Maintenance • The Stages of Change Model • Patient-Centred Counselling • Five-A's Model

6. Recap of What We’ve Learnt… • Recommendations for Prescribing Exercise to • Healthy Adults • Older Adults • Patients with Diabetes Mellitus • Patients with Hypertension • Overweight and Obese Patients • Patients with Heart Disease • Patients with Osteoarthritis • Prescribing Exercise to Patients with Osteoporosis

7. Available Forms and Tools

8. Available Forms and Tools • Stages of Change Assessment Form • Self-Administered by Client • Pre-participation Screening: • Physical Activity Readiness Questionnaire (PAR-Q) • Physical Activity Readiness Medical Examination (PARmed-X) • AHA / ACSM Health / Fitness Facility Pre-participation Screening Questionnaire • Exercise Prescription Form (EP Form) • Exercise Prescription Decal • Application Form for Getting Patient Leaflets • Application Form for the "Registration Card for Persons with Disabilities"

9. Exercise Prescription Form

10. How to Use the EP Form • To be issued by a Doctor/ trained health care professional • Issue to a client/patient, who an exercise prescription is indicated • Just need to fill in the dosage of exercise prescribed • Advise the client/patient to mark his/her progress and bring the form back in next consultation

12. Prescribed Time (T) of Aerobic Ex Prescribed Frequency (F)of Aerobic Ex Prescribed Intensity (I) of Aerobic Ex Prescribed Type (T) of Aerobic Ex

13. Prescribed Frequency (F)of Resistance Ex Prescribed Type (T) of Resistance Ex Prescribed Time or volume(T) of Resistance Ex Prescribed Type (T) of Resistance Ex

14. Dosage of Stretching Ex

16. Exercise Prescription Decal • To be posted at the entrance of clinic

17. Registration Card for Persons with Disabilities • Issued to persons who have been found to have suffered from a disability (including chronic illnesses) which is permanent in nature, or of a temporary nature • Could enjoy confessionary rates in sports facilities under LCSD • Application also requires: • documentary evidence for disability/chronic illness, e.g. certificates issued by doctors or allied health personnel • specifying the type(s) and degree of disability/chronic illness and the duration for which the condition is likely to last

18. Case Studies

19. Case 1: CY CHAN • M/43 • Smoker (1.5 p/d X 25 yrs) • PMH: HT on med under good control • FH: Father died from a heart attack at age 60 • Works as a construction site labourer • No SSx of cardiorespiratory disease • Body height = 173cm; Body weight = 80kg • Total cholesterol = 8 mmol/L • Fasting glucose = 5.4 mmol/L • You want to suggest CY to perform aerobic and resistance Ex • You would like to stratify his risk to see if he should need further medical workup or exercise testing before increasing his PA level

20. Case 1: Risk Stratification FOUR Risk Factors • Cigarette smoking • HT • Hypercholesterolaemia • Obesity (BMI 26.7kg/m2) CY CHAN is not: • Sedentary ∵ his physically active job • Having FH of heart disease ∵ his father’s heart attack occurred >55 • Hyperglycemic

21. According to the ACSM Risk Stratification Scheme • Although Mr. CHAN is considered to be young (<45), he is in the moderate-risk category • For performing low- to moderate-intensity PA • Further medical workup and exercise testing not necessary • A sub-maximal exercise test can offer a comprehensive appraisal of his condition • For embarking on a vigorous exercise programme, he would need further medical clearance from specialists or equivalent professionals

22. Case 2: KC CHAN • M/56, moderate-risk • He is worried about his own health ∵ His old friend suffered a heart attack a week ago • He wants to control his body weight  to reduce his risk of heart disease • You are going to advise him to embark on moderate-intensity aerobic exercises on regular basis. • His resting HR = 86 bpm What would be an appropriate target HR range for Mr. CHAN?

23. Case 2: Prescribing Exercise Intensity • KC’s maximal heart rate (HRmax) = 220 – 56 = 164bpm (A) %HRmax Method Target HR range = 64 –76% of HRmax = 164(0.64) to 164(0.76) = 105bpm - 125bpm • (B) %HRR Method • Target HR range • = 40 –59% of HRR • = (0.4)(164-86)+86 to (0.59)(164-86)+86 • = 117bpm - 132bpm

24. Case 3: WM CHAN • M/68 • Enjoy a sedentary lifestyle • Unremarkable past medical history • Moderate risk category for exercise participation Using FITT principles to design a comprehensive Ex prescription for Mr. CHAN

25. Time For Role Play 15 min

26. Case 3: Prescribing Exercise to Sedentary Old Man • Aerobic Physical Activity • Frequency, Intensity, Time and Type • Muscle-strengthening Physical Activity • Frequency, Intensity, Volume (Time) and Type • Stretching exercise • Frequency, Volume, Type • Neuromuscular exercises • Frequency • Progression of PA • FU Arrangements

27. End of Presentation Please refer to Doctor’s Handbook: Chapters 14 for further reading

28. Questions and Answers

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