Overview of exercise prescription
Fitness benefit: physiological adaptation (increased lactate threshold, vertical jump, or maximal strength) that increases performance in sport or activity
Health benefit: physiological adaptation (decreased blood pressure) that reduces the risk of diseas
Prevalence of cardiovascular disease
Deaths from cardiovascular disease declined from 50% in 1970s to 36.3% in 2004
Factors related to decline in prevalence:
Lifestyle changes: nutrition, stopping smoking, exercise
Improved medical techniques & diagnosis
Improved emergency care & treatment f
Coronary artery disease
Coronary Artery Disease: disease process resulting in blockage & hardening of arteries supplying cardiac tissue
Accounts for 50% of all deaths from CV problems
Ischemia (from CAD)
Insufficient blood to tissue due to partial artery block
Often during exerc
Stroke
Lack of blood supply to part of brain, brain tissue death
Leading cause of disability in USA
Region of brain dictates symptoms; paralysis common
Ischemic stroke: blockage of vessel, may be due to thrombus from another area of the body
Hemorrhagic stroke:
Heart failure
Ventricular contraction impaired, cardiac output insufficient
Acute heart failure is caused by heart attack resulting from:
Toxic substance or drug
Coronary artery blockage
Chronic heart failure is caused by:
Hypertension
Multiple minor heart attacks
Vira
Effect of chronic heart failure on body
Fluid retention at kidneys
Purpose is to increase blood volume, thereby compensating for decreased cardiac output
Increases blood pressure
Increases work for ventricles.
Ventricular hypertrophy
Fluid accumulation (edema)
Ankles, legs
Lungs (pulmonary edem
Hypertension
Chronic high blood pressure at rest
?140/90 mm Hg
Heart must work harder to pump
Increased oxygen demand of cardiac tissue
Increased strain on arteries & arterioles
Increases risk of heart failure, atherosclerosis, peripheral vascular disease, kidney fail
Risk factors for hypertension
90% idiopathic (unknown cause) but risk factors include:
Physical inactivity
Overweight & obesity
Heredity, including racial ancestry
Being of male sex
Increasing age
Sodium sensitivity
Use of tobacco products or excessive alcohol consumption
Psychologica
Peripheral Artery Disease (PAD)
Atherosclerosis in peripheral circulation resulting in reduction of blood flow to area
6.6x greater chance of death from CV disease
Development/risk factors similar to CAD
Primary symptom is intermittent claudication, or muscle pain during exercise (parti
CAD risk factors
Major or primary risk factors: strongly associated with CA
Major uncontrollable risk factors:
Increased age (82% of deaths from CAD over 65 yr)
Being of male sex (particularly but not exclusively before female menopause)
Heredity (family history of any ca
Blood lipid profile
Lipoproteins: clusters of lipids and proteins that transport lipids through blood
Proteins more dense than lipids
Low-density lipoprotein cholesterol (LDL-C): produced by liver, transport cholesterol and triglycerides to body tissues
High-density lipoprot
Hypertension
Increases work and oxygen needs of heart as it pumps against high blood pressure in peripheral circulation
High oxygen needs and blood pressure during exercise, too
Associated with development of atherosclerosis and CAD
Risk of heart attack
Obesity and overweight
Year 2012 in USA:
35% adults overweight (BMI 25-29.9 kg*m-1)
28% obese (BMI > 30 kg*m-1)
Note that BMI does not account for body composition (e.g. increased muscle mass in athletes)
Excess body fat increases risk of heart attack or stroke
Increases heart'
Diabete mellitus
2012 USA, 9% adults diabetic
All types increase risk of cardiovascular disease (e.g. CAD, heart disease, & stroke) even when blood glucose controlled by diet, exercise, drugs (worse if uncontrolled); 65% of diabetics die from blood vessel or heart disease
Physical inactivity
Major CAD risk factor
Physical activity decreases CAD due to positive physiological adaptations that affect onset and severity of CAD
Aerobic & resistance exercise decrease cardiovascular risk
Aerobic training increases HDL-C, may reduce triglycerides and
Use of medical clearance
Required for Clients With the Following Conditions:
Severe medical contraindications
Increased risk for cardiovascular disease (age, symptoms)
Diagnosis of certain diseases
Useful for:
Obtaining information to prescribe appropriate type of exercise
Determ
Medical evaluation
Apparently healthy, sedentary people can begin low to moderate exercise program without much medical eval
American Heart Association/American College of Sport Medicine Health/Fitness Facility Preparticipation Screening Questionnaire or PAR-Q: determine wh
ECG
Measures cardiac electrical conductivity
Used to determine cardiac rhythm or contraction & relaxation
Electrical conductivity: movement of ions during contraction & relaxation of cardiac tissue
Atrial contraction (P wave), ventricular contraction (QRS com
ECG testing and pathology
ECG is normal part of graded exercise test (recommended part of medical evaluation for CVD before exercise)
Speed and elevation of motorized treadmill (or workload of cycle ergometer) gradually increased
ECG and BP monitored for abnormality
Abnormalities
Notes on ECG evaluation
Graded exercise testing with ECG correctly identifies only 66% of individuals with CAD
Not recommended before beginning exercise in men over 45 yrs and women over 55 yrs except when high risk for disease
Purposes of aerobic training guidelines
Improve fitness and health in those with little to no history of performing endurance exercise
When improving aerobic fitness, health benefits improve (protection from CV disease, osteoporosis, cancers)
Based on evidence for health-promotion and disease p
Aerobic exercise prescription
Type of Exercise
Duration of Exercise Session
Frequency of Training
Intensity of Exercise
Typically the minimal threshold for aerobic fitness gains is given in recommendations
May vary by individual
May change over time with training
Types of aerobic exercise
Jogging
Running
Cycling
Spinning
Elliptical machines
Swimming
Aerobic dance
Rowing
Should be enjoyable for adherence throughout life, appropriate to individual
Cross-training: inclusion of several types of aerobic exercise in training program; may minimiz
Duration of each exercise session
Multiple short exercise sessions equivalent to longer (e.g. 3x 10 min sessions comparable to one 30 min session)
As long as min. thresholds are met, similar gains achieved with:
Short-duration, high-intensity exercise
Long-duration, low-intensity exercise
Frequency of training
Related to intensity (as previously mentioned)
Minimal threshold (majority of increases in peak oxygen consumption): 3 d�wk-1
Increased frequency up to 5 d�wk-1 increases aerobic capabilities further, but may not be important to some
Training frequencies
Intensity of exercise
Most important variable for aerobic fitness
Normally prescribed by heart rate
Most adults: moderate (40-60% Heart Rate Reserve or VO2 reserve)
Low fitness: improvements even at 30-40%
Athletes: greater needs
HR and VO2 max
Each % of HRmax corresponds to a % of VO2 max
Exercise heart rate
Linear relationship with workload and oxygen consumption and plateaus at maximal oxygen consumption, thus used to determine exercise intensity
If HRmax not directly obtained, equations used to calculate:
HRmax = 220 ? age in years [typically used]
HRmax =
HRR Method (Karvonen method)
Used to estimate the HR needed to exercise at a specific % of peak O2 consumption
Intensity depends on population:
Moderate (40-60% HRR) to Vigorous (60-90% HRR) appropriate for most healthy adults
Low fitness adults need only 30-40% HRR
Moderately-traine
Perceived exertion
Rating of perceived exertion (RPE): subjectively rating how hard working
Borg scale 6-20
RPE of 12-16 - aerobic adaptations
Generally relates to peak oxygen consumption, HRmax, etc
OMNI Perceived Exertion Scale also used
RPE should not be the primary mean
Metabolic equivalents
Metabolic equivalents: how many times greater than resting oxygen consumption required to perform activity
1 metabolic equivalent task = rate of O2 consumption at rest
Resting O2 consumption typically 3.5 mL�kg�min-1
E.G. 3 METs = 3 � 3.5 mL�kg�min-1 = 10
Talk test
For individuals just beginning an exercise program
Based on the idea that at the lower range of intensities for fitness gains, participants will still be able to hold a normal conversation while exercising
Not a primary means of determining exercise inten
Progression of Aerobic Fitness Training
Necessary if continued fitness gains are desired, slow to prevent injury, fatigue, overtraining
Type of exercise:
From low impact (walking, cycling, elliptical) to high impact (jogging, running)
Especially for those just starting or overweight
Duration:
P
Resistance Exercise Prescription Guidelines
Type of Exercise
Free weights or barbells & dumbbells
Resistance (weight) training machines
Body weight and rubber cords
Volume of an Exercise Session
# of exercises
# of sets in each exercise
# of repetitions in each set
Rest Period Length Between Sets a
Type of exercise (resistance training)
At least one exercise for each major muscle group
Multi-muscle group exercises (multi-joint exercises): movement of >1 joint /force development by >1 muscle group (bench press or leg press)
Also called "major" or "core" exercises
Single-muscle group exerc
Volume of exercise
Total amount work performed
Changing volume changes focus: strength, hypertrophy, power, local muscular endurance
Novice can start with 1 set, progress to 2-4 sets per muscle group (not necessarily of each exercise)
Basic guidelines is 8-12 repetitions/se
Rest Period Length Between Sets and Exercises
Longer rest --> more time for recovery:
Replenish anaerobic energy stores (ATP & PC)
Decrease blood and muscle acidity
Decrease fatigue
Shorter rest increases growth hormone and other hormones
Longer rest (2-3 minutes) for strength and power, particularly
Frequency of training (resistance training)
# of times per week a muscle group is exercised
Each muscle group trained 2-3 times per week
Total body resistance training program: all muscles trained each session
Split routine: some muscles on some days, others on others
Body part program: particular
Intensity of exercise (resistance)
One repetition maximum (1RM): greatest amount of weight a person can lift in the exercise for one repetition
Resistance training exercise intensity is represented by the % of 1RM
The higher the %1RM, the heavier the weight and fewer the repetitions
Each s
Progression of resistance training
Gradual increases in intensity, volume, or shorter rest periods
Most common method is to increase intensity
Interval training overview
Interval training: higher intensity bouts interspersed w. rest
Using greater intensity = greater fitness; can improve peak oxygen consumption more than steady-state training
Interval training variables to change:
Distance or duration of the interval
Train
Training intensity and duration
Training intensity:
% of best time for length of interval (shorter distances)
% of Hrmax
Guidelines based on desired focus:
ATP-PC: 90-100% of best time or HRmax
Glycolytic: 80-95% best time or HRmax
Aerobic/Endurance: 75-85% best time or HRmax
Interval D
Programming interval training
Number of Intervals depends on # of repetitions per set, # of sets. Changes depending on fitness & goals.
Rest Period Length can be determined by Recovery HR, or when HR returns to desired level (e.g. 140 bpm (20?29 yr); 130 bpm (30?39 yr)
Can also by det
Stretching
If included in warm-up, should be at end with increased body temperature
Proprioceptive neuromuscular facilitation (PNF): contraction of a muscle or antagonist before stretching - greater relaxation and range of motion
Ballistic stretching: rapid, bouncy
Use of stretching
Stretching is used for extreme ROM for some sports, including gymnastics and high hurdling
Although thought to prevent injury, most research does not support that stretching prevents injury
Static stretching immediately prior to maximal effort bouts has b
Affect of warm up and cool down
Active Warm-Up: physical activity performed before training to increase performance via psychological factors & increased body temp.
General: activity not related to task or training to follow (low-intensity 60% aerobic activity 10-15 mins, stretching, ca
Rational for warm up
Increased Body Temperature:
Decreased muscle and tendon stiffness
Increased nerve conduction velocity
Altered force-velocity relationship of muscle
Increased anaerobic (glycogen) energy availability
Increased temp not be desirable for endurance activity-
Warm ups and performance
Active warm-ups increase short-term, high-power performance
Must not be too intense and must provide enough recovery after warm-up
May improve intermediate-length and long-term tasks if person is not fatigued
Cool down
Light aerobic activity (below lactate threshold) for 10-15 minutes after training
Prevent blood from pooling in legs - lightheadedness, dizziness, fainting
Lower blood acidity
Aid recovery
Detraining
Loss of physiological adaptations with complete cessation of training or reduction in volume or intensity
Occurs in off-seasons or on vacations
Health benefits of exercise also decrease with detraining and is worse with increasing age
Detraining (strength training)
Cessation:
Loss of strength & power (particularly power)
Particular loss of Type II fiber area (although comes back far sooner with retraining)
Faster declines with age
Lower intensity of training before --> greater loss strength
Reduced volume:
Strength
Detraining (endurance training)
Cessation:
Rapid decrease in peak O2 consumption
Highly trained individuals appear to lose greater %
Decline in blood volume, stroke volume, maximal cardiac output, blood supply, oxygen delivery to tissue
Decreased end-diastolic volume, stroke volume, lef
Periodization
:planned variation in training to optimize physical performance over long training periods
Changes in training volume, intensity, exercise selection, and type of training (resistance, aerobic, interval, plyometric) for variation
For athletes, changes in s
Classic Strength-Power Periodized Training
Classic periodization begins with high-volume, low-intensity training and progresses to low-volume, high-intensity training
Each phase lasts about 4-6 weeks with different training goals; some 1-2 week active recovery phase after last phase, followed by s
Non linear periodized training
Nonlinear periodization uses successive training sessions in recurring pattern of differing volume and intensity
Different repetition zones (strength, power, hypertrophy, etc) within a single week
Substantial differences in volume and intensity throughout
Aerobic Training Periodization
Training volume often measured by distance, intensity by %HR or best time
Typical periodized program, training volume gradually increased over several weeks followed by 1-week recovery
Variations in intensity daily, but generally intensity increases over