chapter 5 and 6: general principles of ExRx and healthy populations

upper body (50% stronger)

differences in gender for strength and power are the greatest in the

20-30% higher

vo2 max in males is approximately

sufficient to improve CRF

ExRx consisting sole of 150 min of moderate intensity exercise may not be

>3days per week, moderate 40-59%HRR or vigorous 60-89%HRR, 30-60min/day (moderate) or 20-60min/day (vigorous)

FITT general principle for aerobic exercise

vigorous (>6METs)

intensity exercise that is more effective at increasing VO2

A, all adults

Group _ exercise: endurance activities requiring minimal skill or physical fitness

• walking, leisurely cycling, aqua aerobics, slow dancing

recommended for:

B, adults who are habitually active/average fitness

Group _ exercise: vigorous intensity endurance activities requiring minimal skill

• jogging running rowing, aerobics, elliptical, stepping, fast dancing

recommended for:

C, adults with skill or at least average fitness

Group _ exercise: endurance activities requiring skill to perform

• swimming, cross country skiing, skating

recommended for:

D, adults with regular exercise program and average fitness

Group _ exercise: recreational sports

• racquet sports, basketball, soccer, downhill skiing, hiking

volume

product of frequency, intensity and duration

300 min/week moderate or 150min/week vigorous

goal of increasing aerobic exercise to

>500-1,000 (MET-min-wk)

total EE of __ is consistently associated with lower rates of CVD

5-10 minutes every 1-2 weeks over the first 4-6 weeks

increase in exercise time/duration per session for average adult

48-72 hours

time between bouts of heavy resistance that repeatedly target same muscle groups

difficulty, number of muscle groups/joints, speed and ROM

intensity should not be used interchangeably with load because intensity should also consider

recruit one or more large muscle groups and involve multiple joints

exercise chosen for 1RM testing should:

• better able to handle heavy loads and more practical indication of one’s abilities

0 (no further reps can be completed)

RIR maximal effort =

30s to 1 min

muscular endurance rest periods

90s-3 min

strength endurance and hypertrophic rest periods

2-5 minutes

max strength and power rest periods

large muscle multijoint, small muscle multipoint, large muscle single joint, small muscle single joint, trunk stability

order of exercise implementation

foundational technique, 2-3, 6-10, 1-2, 8-12

resistance training recommendations for general public - untrained individuals:

1. objective:

2. frequency:

3. number of exercises:

4. sets:

5. reps:

introduce moderately complex exercises, 3-4, 5-10, 2-5, goal dependent

resistance training recommendations for general public - intermediate individuals:

1. objective:

2. frequency:

3. number of exercises:

4. sets:

5. reps:

highly complex exercises, 4-7, 4-5, goal dependent, goal dependent

resistance training recommendations for general public - advanced individuals:

1. objective:

2. frequency:

3. number of exercises:

4. sets:

5. reps:

3-4, 2-3

joint ROM has shown chronic improvement after about __ weeks of regular stretching __times per week

major joints/muscle tendon groups

goal of flexibility program should be to develop ROM in

PNF

isometric contraction of muscle/tendon group followed by a static stretching of same group or isometric contraction of muscle and concentric contraction of opposing muscle

• contract-relax

vigorous activity or daily, full ROM, 3-6 sets of 30-90s with 15s rests in between

general FITT recommendations for dynamic stretching:

prior to _or _

full

_ sets of _seconds

rest period

>2-3 days/week (daily), slight discomfort, static for 10-30/30-60s in older adults, each major muscle group

general FITT recommendation for flexibility

METs/kilocalories, RPE (1-10)

not translatable to children

use __ for intensity

relative oxygen uptake, HR, respiratory rate

responses to exercise that are higher in children

daily, moderate to vigorous, (as part of) >60m/day, developmentally appropriate

FITT aerobic recommendations for children

• vigorous intensity >3 days

• noticeable increase in HR/breathing

>3days/week, 1-2 sets of 8-12reps, (as part of) >60min/day, structured or unstructured

FITT resistance recommendations for children

>3d/wk, moderate to high, (as part of) >60min/day

FITT bone strengthening recommendations for children:

_ days/week

__ intensity bone loading through impact or force production

__ time/day

heat related illness

children are at a greater risk for

be referred

children with diseases or disabilities should

get active questionnaire for pregnancy

if a pregnant female answers yes to any questions she should get a health care provider consultation form

modified Balke

most common submax test during pregnancy is

increase, SBP and DBP (no change or decrease)

physiologic response to acute exercise during pregnancy all __ except for _ and _

20-30min

ACOG recommends __ of moderate intensity exercise on most or all days of the week throughout pregnancy

>150 min (spread throughout the week), light to moderate, 5-6, (continue with vigorous if done prior), aerobic and muscle strengthening

FITT guidelines for pregnant women

(RPE for intensity)

supine

exertion and prolonged periods in the __ position might reduce venous return and cardiac output to fetus

valsava maneuver, prolonged isometric contraction and motionless standing

in any PA for pregnant women, avoid

specific spinal cause, radiculopathy or spinal stenosis, nonspecific LBP (85% of cases)

3 categories for classifying LBP based on cause

mobility deficits, radiating pain, referred LE pain, movement coordination impairments, related generalized pain

five categories of LBP

LBP with:

within pain limits, bed reset, return to work

to reduce probability of disability, individuals with LBP should continue ordinary activity _, avoid _, and _ as soon as possible

harmful/disabling, fear/avoidance, passive not active, low morale and social withdrawal, financial or social

psychosocial factors for long-term disability and work loss associated with LBP:

1. negative attitude that back pain is

2. __ behavior and reduced activity levels

3. expectation that _ treatment will be beneficial

4. tendency for depression ,_, and _

5. problems

symptom of another serious pathology

exercise testing/prescription in individuals with LBP should be performed in consultation with health care team when LBP is a

extended bed rest, anatomical specific cause of LBP

clinicians should not engage in pt education strategies that increase perceived threat or fear associated with LBP such as:

1. promote

2. provide in-depth explanations of

of spine, neuroscience, favorable prognosis, active pain coping strategies (that decrease fear), experiencing pain, activity levels not just pain

pt education in those with LBP should emphasize:

1. understanding of anatomical/structural strength of _

2. _ as it relates to pain perception

3. _ prognosis

4. _ _use of coping strategies that

5. resumption of normal activities even when

6. emphasize importance of improvement in

core/trunk

improvements in _ strength have been linked to improved pain and disability in those with LBP

none

relationship between spinal flexibility and LBP or associated disability

in the first few days after an acute/severe episode (within 2 weeks activities can be introduced)

when may it be best to avoid exercise in pts with LBP

regular walking

suggested activity to encourage individuals with LBP to participate in activity that does not exacerbate symptoms

3-5 or 9-14

“safe zone” of symptoms for LBP

downhill, on inclined treadmill, flexion

walking __ may exacerbate symptoms in those with LBP

walking _ or cycling with lumbar _ may be helpful

peripheralization

spread of pain to lower limbs with certain sustained or repeated movements of the lumbar spine

• limits should be placed on these activities

centralization

reduction of pain in lower limb from distal to proximal observed in repeated movements like prone press ups or knees to chest in supine position

• encouraged to reduce symptoms

with, without

low intensity aerobic exercise for individuals with chronic LBP __ generalized pain

vigorous intensity aerobic exercise for individuals with chronic LBP _ generalized pain

posterior

strength training for the _ chain can be helpful for LBP

such as yoga, pilates, aquatic therapy

traditional

__ strength training movements have been shown to improve pain

>65, 50

older adults include individuals aged __ and individuals aged greater than _ with clinical significant conditions

older adults

greatest range of physical function

sarcopenia

loss of muscle function seen with age

frailty

multifactorial loss of physical function

residual volume, BP, %body fat, and resting HR(unchanged)

variables that increase as a result of aging

variable that remains unchanged

(ALL OTHERS DECREASE)

SARC-F, low to moderate and high, >4

screening for sarcopenia:

_ sensitivity _ specificity

a score of _ = suggestive of sarcopenia

fatigue (fatigued?), resistance (cannot walk up one flight of stairs?), aerobic (cannot walk one block?), illnesses (more than 5 illnesses?), loss of weight (more than 5% in last 6 months?)

FRAIL scale

robust, pretrial, frail

FRAIL scale: 0=

1-2=

3-5=

higher sensitivity, lower specificity, false positive

ECG for older adults has (when compared to younger adults) for CAD

producing a higher proportion of _ results

<3, 0.5-1.0

MET initial workload and increments for exercise testing in older adults

underpredict

220-age tends to _ HRmax in older adults

know floor and ceiling effects

least robust participants score lower or most robust to score higher on the performance test

lower extremity function, 1.0

short physical performance battery (SPPB) test assesses _

change of _ is considered substantial

• known ceiling effects

0.05, 0.1

a change in usual gait speed of _m-s is small but meaningful change and _m-s is considered substantial

>5days/week for moderate intensity, >3days/per week for vigorous (3-5 for combo)

aerobic frequency recommendations for older adults

moderate RPE=12-13 progressing to vigorous 14-17

(3-4 and>5 on CR10)

aerobic intensity RPE recommendations for older adults

>2days/week

FITT recommendations for older adults - frequency of resistance training

40-50%1RM, 60-80%1RM, last two reps are challenging

FITT recommendations for older adults - intensity of resistance training

for beginners: light to moderate _%

progress to moderate to vigorous _%

adjust resistance so

8-10 involving major muscle groups, >1 set of 10-15 repetitions, 1-3 sets of 8-12 repetitions

FITT recommendations for older adults - resistance training

for beginners

number of exercises

progress to

3 sets of 6-10 repetitions, high, 12 sets of 2 reps, or 6 sets of 4 reps (cluster set)

FITT recommendations for older adults - power

sets, reps

with _ velocity

excessive orthopedic stress

FITT recommendations for older adults -type any modality that does not impose

>2days/week, slight discomfort, 30-60s

FITT recommendations for older adults - flexibility

slow, static

type of flexibility exercises for older adults:

maintain and increase flexibility using _ movements that end in _ stretching for each muscle

• not ballistic

vigorous and moderate to low

alternating _ and _ over the course of a season promotes a more rapid and substantial training benefits

falls

leading cause of fatal injury and trauma-related hospitalization in older adults

balance, agility, proprioceptive training

neuromotor training combines

2-3days/week

frequency of neuromotor training

postures, base of support, dynamic, stability, base of support, postural, sensory

general recommendations for balance training include

1. progressively difficult _ that reduce _

2. _ movements that challenge limits of _ and _

3. stressing _ muscle groups

4. reducing _ input

5. tai chi

Nordic walking

effective in improving dynamic balance, functional balance, muscle strength of lower limb and aerobic capacity

daily

balance exercise should be performed

power

declines most rapidly with age

greater risk of functional decline, falls and frailty

less, shorter, 4

power training is more effective with _ reps per set and _ recovery times

• limit each set to no more than _ reps

cluster set

_ set had higher enjoyment and adherence in adults