GW BGZ 2025 Case 5 - Move, exercise, train

What is physical activity?

Physical activity is any bodily movement produced by skeletal muscles that increases energy expenditure above resting levels. It includes all movement during daily life such as walking, working, household tasks, sports, and exercise.

Energy expenditure is commonly expressed in kilocalories or METs.

• 1 MET = resting metabolic rate

• 1 MET = 3.5 mL O₂/kg/min

Examples:

• Sitting quietly ≈ 1 MET

• Walking ≈ 2–4 METs

• Running ≈ 8+ METs

Physical activity can be classified by:

• Intensity (light, moderate, vigorous)

• Domain (work, leisure, transport)

• Frequency and duration

Physical activity is broader than exercise.

What is exercise?

Exercise is a subset of physical activity that is:

• Planned

• Structured

• Repetitive

• Performed with the goal of improving or maintaining physical fitness

Examples:

• Strength training

• Running programs

• Cycling sessions

Unlike general physical activity, exercise has a specific training purpose.

What is physical training?

Physical training is a systematic process of repeated and progressive exercise aimed at improving physical fitness or athletic performance.

Training causes physiological adaptations such as:

• Increased VO₂max

• Increased muscular strength

• Improved endurance

• Improved metabolic efficiency

A training program should include:

• Specific goals

• Progressive overload

• Recovery periods

• Appropriate frequency and intensity

Training is more specific and long-term than general exercise.

What is physical fitness?

• Defined as the ability to:

  • Perform daily tasks with energy and alertness

  • Avoid excessive fatigue

  • Handle emergencies and enjoy leisure

• Two main categories: health- and performance-related fitness

What are the health-related components of fitness?

Health-related fitness components are associated with health and disease prevention.

They include:

1. Cardiorespiratory endurance

• Ability of heart and lungs to supply oxygen during exercise

2. Muscular strength

• Maximal force production

3. Muscular endurance

• Ability to perform repeated contractions over time

4. Flexibility

• Range of motion around a joint

5. Body composition

• Relative amount of fat mass and lean mass

These components are important for:

• Daily functioning

• Health outcomes

• Reduced disease risk

What are the performance-related components of fitness?

Performance-related fitness components are mainly linked to athletic ability and sports performance.

They include:

• Isometric Strength

  • Ability to exert force without movement

• Power

  • Ability to generate force quickly (strength + speed)

• Speed / Agility

  • Speed: rapid movement

  • Agility: quick direction changes

• Balance

  • Ability to maintain stability

• Arm–Eye Coordination

  • Ability to synchronize visual input with movement

• Reaction time

  • How quickly you respond to a stimulus

Examples:

• Sprinting → speed

• Vertical jump → power

• Shuttle run → agility

These components are especially important in competitive sports.

How can physical fitness be measured?

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Physical fitness can be measured using field tests or laboratory tests.

Health-related fitness tests

• VO₂max test → cardiorespiratory fitness

• Handgrip or 1RM → strength

• Push-ups/sit-ups → muscular endurance

• Sit-and-reach → flexibility

• BMI/skinfolds → body composition

Performance-related fitness tests

• Sprint tests → speed

• Vertical jump → power

• Balance tests

• Agility shuttle runs

Laboratory testing

CPET (cardiopulmonary exercise testing) is the gold standard for aerobic fitness.

It measures:

• VO₂max/VO₂peak

• Ventilation

• Heart rate

• Gas exchange

What are the principles of physical training?

Overload Principle

To improve fitness, the body must work harder than normal.

• Optimal workload: Training should be challenging but manageable.

• Supercompensation: After recovery, the body adapts and becomes stronger than before.

• Law of diminishing returns: Beginners improve quickly, while advanced athletes gain improvements more slowly.

Individuality Principle

Everyone responds differently to training because of factors like genetics, age, fitness level, and recovery ability.

• Training should be tailored to the individual.

Specificity Principle

Training adaptations are specific to the activity performed.

• Train according to the muscles, movements, and energy systems needed for the sport.

• “Train the way you want to perform.”

Reversibility Principle

Fitness decreases when training stops or is reduced.

• Detraining: Loss of strength, endurance, and skills due to inactivity.

Variation / Periodization

Training should change over time to avoid plateaus and overtraining.

• Variation: Regular changes in intensity, volume, or exercises.

• Periodization: Structured training phases (preparation, competition, recovery) designed to maximize performance.

What is the optimal workload?

• Optimal workload: Training should be challenging but manageable.

What is the supercompensation principle?

Supercompensation describes the process where performance temporarily improves above baseline after recovery from training.

Phases:

1. Training stress → fatigue and reduced performance

2. Recovery phase

3. Adaptation and performance increase

4. Return to baseline if no new stimulus occurs

Correct timing of the next training session is important:

• Too early → overtraining/fatigue

• Too late → adaptation lost

This principle forms the basis of training periodization.

What is the law of diminishing returns?

The law of diminishing returns states that training improvements become smaller as fitness level increases.

Beginners

• Large and rapid improvements (“newbie gains”)

Trained athletes

• Smaller improvements

• Require more specific and intensive training

This occurs because the closer someone gets to their genetic potential, the harder it becomes to improve further.

What are “newbie gains”?

Newbie gains are the rapid improvements seen during the first months of training.

Causes:

• Neural adaptations

• Improved coordination

• Rapid muscular adaptation

Beginners can quickly improve:

• Strength

• Endurance

• Technique

Progress slows later due to the law of diminishing returns.

What is the reversibility principle?

The reversibility principle states that fitness improvements are lost when training stops or is significantly reduced.

Detraining

Detraining refers to the partial or complete loss of training adaptations due to inactivity.

Effects of detraining may include:

• Reduced cardiovascular fitness

• Loss of strength and muscle mass

• Decreased flexibility and coordination

• Reduced sport-specific skills

The rate of fitness loss depends on:

• The athlete’s training history

• The duration of inactivity

• The fitness component involved

Generally:

• Aerobic fitness declines relatively quickly.

• Strength and skill decline more gradually.

What is the variation/periodization principle?

Variation

• Training variables are regularly adjusted to prevent boredom, plateaus, and overuse injuries.

• Changes may involve:

  • Intensity

  • Volume

  • Exercises

  • Recovery periods

Periodization

• Periodization is the systematic planning of training over time.

• Training is divided into phases or cycles.

Common phases include:

1. Preparation phase

   • Builds general fitness and foundational skills.

2. Competition phase

   • Focuses on peak performance and sport-specific preparation.

3. Transition/recovery phase

   • Allows physical and mental recovery after competition.

Benefits of periodization:

• Improves long-term performance

• Reduces risk of injury and burnout

• Helps athletes peak at the right time

• Balances workload and recovery

What is the relationship between recovery and tissue type?

Different tissues recover at different speeds.

Muscle

• Faster recovery

• Higher protein turnover

• Muscle protein synthesis (MPS) increases after exercise

Tendons and connective tissue

• Slower turnover

• Slower adaptation

• Require longer recovery periods

This is important because:

• Muscles may feel recovered before tendons are fully adapted

• Excessive loading increases injury risk

What is muscle protein synthesis (MPS)?

Muscle protein synthesis is the process of building new muscle proteins after exercise.

Resistance training stimulates MPS, especially when combined with protein intake.

Effects:

• Muscle repair

• Muscle hypertrophy

• Training adaptation

MPS remains elevated for hours to days after exercise depending on:

• Training status

• Nutrition

• Exercise intensity

What are the current guidelines for physical activity levels?

Children (4–18 years)

• At least 1 hour per day of moderate to vigorous physical activity

• At least 3 times per week activities that strengthen muscles and bones

• Avoid prolonged sitting

Adults and Older Adults

• At least 150 minutes per week of moderate to vigorous physical activity, spread over several days

• At least 2 times per week muscle- and bone-strengthening activities

• For older adults: include balance exercises

• Avoid prolonged sitting

What are the principles of training?

Specificity

Training adaptations are specific to the type of exercise performed.

• Endurance training → improves aerobic fitness

• Strength training → improves muscle strength

Overload

The body must be challenged beyond its normal level to improve.

Methods:

• heavier weights

• longer duration

• higher intensity

Progression

Training load should increase gradually over time.

Too fast → injury risk

Too slow → little improvement

Reversibility

Fitness decreases when training stops.

Individualization

Training should match the individual:

• age

• fitness level

• goals

• health status

Variation

Changing training helps:

• prevent plateaus

• reduce boredom

• reduce overuse injuries

Recovery hoort deze erbij?

Recovery is the time the body needs to repair and adapt after exercise.

Importance of Recovery

• Repairs muscles

• Restores energy stores

• Reduces fatigue

• Prevents injury

• Improves performance

What is overtraining?

Overtraining happens when exercise exceeds the body’s ability to recover.

Signs of Overtraining

• Constant fatigue

• Poor performance

• Muscle soreness

• Increased injuries

• Poor sleep

• Lack of motivation

• Elevated resting heart rate

Prevention

• Include recovery days

• Vary training intensity

• Get enough sleep

• Eat properly

• Avoid excessive training loads

What is workload and overload?

Workload

Total stress placed on the body during exercise.

Depends on:

• intensity

• duration

• frequency

Overload

Applying more stress than the body is used to in order to stimulate adaptation.

Examples:

• increasing weight

• running faster

• increasing sessions

What are the FITT factors?

1. Frequency

How often you train

• Example: 3–5 sessions per week

• More frequent training = more stimulus, but also more recovery needed

2. Intensity

How hard you train

• Can be measured by:

  • Heart rate (cardio)

  • Weight lifted (% of max) (strength)

  • Perceived effort (how hard it feels)

• Higher intensity = greater stress per session

3. Time (Duration)

How long each session lasts

• Example: 30–60 minutes per workout

• Includes total time spent doing the activity

4. Type (Mode)

What kind of exercise you do

• Examples:

  • Running, cycling (cardio)

  • Weight training (strength)

  • Stretching (flexibility)

• Should match your goal (specificity principle)

What is volume?

falls under the type of training

Volume = the total amount of work performed in a training program.

It is determined by combining:

• Frequency

• Intensity

• Time / duration

Volume depends on the type of training being performed.

Endurance training: measured as total distance/duration

Is strongly linked to:

• Training pattern

  • how sessions are organized

• Progression / regression

  • gradually increasing or decreasing workload

Resistance training: described as sets, reps and resistance

• Progression and regression: increasing/decreasing weight, reps, sets

What is progression?

falls under the type of training

How the program is gradually made harder

• Example:

  • Increasing weight

  • Running longer distances

  • Adding extra training days

• Prevents plateaus and drives improvemen

Why is a personal training program important?

People differ in:

• fitness level

• goals

• health status

• recovery ability

A personal program:

• improves results

• reduces injury risk

• improves motivation

• allows safe progression

No single value determines fitness:

• training status

• body composition

• age

• weight

• endurance

• strength
  all matter.

What determines training stimulus?

Training stimulus = intensity × time

Examples:

• High intensity + short duration → ATP-PCr + anaerobic glycolysis dominant

• Low intensity + long duration → aerobic metabolism dominant

Both can improve fitness differently.

What is the three-phase intensity model?

Intensity zones based on ventilatory/lactate thresholds:

1. Below VT1

   • Low intensity

   • Mainly aerobic fat metabolism

2. Between VT1 and RCP

   • Moderate intensity

   • More carbohydrate oxidation

3. Above RCP

   • High intensity

   • Large anaerobic glycolysis contribution

   • Rapid lactate accumulation

What is the difference between classic lactate and polarized training models?

Classic lactate model

• Much training between thresholds

• Moderate intensity focus

• Common in patients/beginners

Polarized model

• Mostly low intensity + small amount very high intensity

• Little moderate training

• Common in endurance athletes

• Helps reduce injury and fatigue risk

HIT vs endurance training for VO₂peak?

• Both improve VO₂peak

• Some studies show similar effects

• Polarized/HIT approaches may produce greater improvements in trained athletes

HIT vs endurance training for BMI and weight loss?

High-intensity training often:

• burns more calories post-exercise

• improves fat loss more efficiently

• may reduce BMI more effectively than traditional endurance training

What are ACSM endurance training recommendations?

• Cardiorespiratory fitness

• Target volume of 500-1000 MET-min/wk

  • Build up to this recommendation in injured or inactive people

  • This is more an end goal

  • It is a broad range

• Gradually progressive

How to set/monitor intensity?

• Different options…

  • Heart rate, HR

  • (Percentage) of maximum HR, (%)HRmax

  • (Percentage) of heart rate reserve, (%)HRR

    • Most accurate

  • Target (training) HR, THR

  • (Percentage) of maximum oxygen uptake, (%)VO2max

    • Not really doable with the mask

  • Metabolic equivalent, MET

    • Convenient

  • Rating of perceived exertion, RPE

    • Least accurate

What is the heart rate reserve

• HRR = HRmax – HRrest

  • Easy

  • HRmax: measure, do not estimate, not trainable, personal

  • HRrest: resting pulse, the lower – the better trained, personal

• Determine training intensity

• THR = (%HRR × HRR) + HRrest

• Example:

  • HRmax = 190 bpm

  • HRrest = 50 bpm

  • HRR = 140 bpm

What are ACSM resistance training recommendations?

• Muscle strength

• Major muscle groups: chest, shoulders, upper- and lower back, abdominal muscles, hips, legs

  • Multi-articular, agonist and antagonist

• Minimal 48 h between two sessions of specific muscle group

  • Or shift between major muscle groups

• To improve muscular

• Strength

  • Expressed as (percentage of) 1RM (in kg)

• Endurance

  • Expressed as the ability to sustain repeated muscle contractions

• Power

  • Expressed as strength × speed

What are ACSM flexibility training recommendations?

• Stretch 10–30 seconds

• 2–4 repetitions

• ≥2–3 days/week

Best performed when muscles are warm.

• To improve range of motion

  • Joints (capsule, ligaments)

  • Muscles

• Important in daily activities

What are ACSM neuromotor exericse recommendations?

Training focused on:

• balance

• agility

• coordination

• gait

Especially important in older adults.

What should a complete exercise program include?

• Cardiorespiratory training

• Strength training

• Muscular endurance

• Flexibility

• Neuromotor training

• Reduced sedentary behavior

What should be considered when designing a program?

• Goals

• Fitness level

• Health status

• Time availability

• Motivation

• Barriers

• Exercise history