(ExRx) CHAP 6- Exercise Rx

• Statistical process to determine those characteristics associated with an increased chance of experiencing unwanted outcomes

  • Heart attack or stroke

• Identifies contributing factors before the occurrence

  • Risk factors

• Same goals – protection of client

• Exercise is safe for most people (caution with vigorous)

• Know their medical history, know current fitness levels

• Exercise is safe if you start slow

health risk appraisal

• Statistical process to determine those characteristics associated with an increased chance of experiencing unwanted outcomes

  • Heart attack or stroke

• Identifies contributing factors before the occurrence

  • Risk factors

health risk appraisal

• Identifying and controlling CVD risk factors – important

  • Not used as determinant of medical clearance for exercise

• Current guidelines may be too conservative

• Prescreening may be a barrier to physical activity

• Exercise-related CV events often have warning signs

• More effective ways to prevent exercise-related CV events

  • Exercise prescription – employ progressive transitional phase 

  • WHAT IS YOUR CURRENT LEVEL OF PHYSICAL ACTIVITY?

    • 2-3 months

    • Warm up and cool down

    • Familiarize clients with warning signs/symptoms 

• Before: Low-mid-high heart disease/diseases

• WHAT IS YOUR CURRENT LEVEL OF PHYSICAL ACTIVITY?

• Can work up to vigorous workout in 2-3 months

new pre-participation Health Screening

• Exercise prescription – employ progressive transitional phase 

• WHAT IS YOUR CURRENT LEVEL OF PHYSICAL ACTIVITY?

  • 2-3 months

  • Warm up and cool down

  • Familiarize clients with warning signs/symptoms 

• Before: Low-mid-high heart disease/diseases

• WHAT IS YOUR CURRENT LEVEL OF PHYSICAL ACTIVITY?

• Can work up to vigorous workout in 2-3 months

effective ways to prevent exercise related cv events

major signs or symptoms of cardiovascular, metabolic, and renal disease

• is a hallmark of heart disease and indicates the blood supply to the heart is insufficient (i.e., ischemia).

• Key features include

  • a constricting or heavy feeling in the middle of the chest, shoulders, back, or arms, or in the neck, cheeks, or teeth.

  • These sensations may be provoked by exercise or exertion and other forms of stress, cold temperature, or after meals.

angina

• ________ is the unpleasant awareness of a forceful or rapid heartbeat, which may indicate an irregular heartbeat.

• The fitness professional may be able to sense the _________ by taking the HR manually at the carotid or radial artery.

• _______can originate from unusual stress, fever, anemia, or a high cardiac output. Tachycardia is a common palpitation, and it can be due to recent actions (e.g., caffeine ingestion) or a sign of other cardiovascular problems.

• (i.e., RHR >100 bpm)

Palpitations, tachycardia

• Shortness of breath at rest or with mild exertion

• is an abnormally uncomfortable awareness of breathing and is a principal symptom of cardiac and pulmonary disease.

• It occurs naturally during heavy exertion in individuals with high CRF and during mild exertion in untrained individuals.

• _______may be considered abnormal when it occurs at an atypical (e.g., low-intensity) level of exertion for an individual.

dyspnea

• ______is the loss of consciousness and occurs most often due to lack of blood flow to the brain.

• Dizziness and especially _______during exercise can be the product of cardiac disorders that prevent the normal increase or decrease in cardiac output.These cardiac output disorders are potentially life threatening.

• Dizziness or ______ can occur in healthy individuals after completing an exercise bout and should be addressed.

• These symptoms may occur because of reduced blood flow back to the heart.

dizziness or syncope

• ______ ______is an unnatural accumulation of fluid surrounding the ankles and is characteristic of congestive heart failure (CHF), a common form of CVD.

• Individuals with CHF may exhibit generalized edema, whereas swelling in one limb may result from a venous thrombosis or blockage in the lymphatic system.

ankle edema

• ______ _________ is a burning or cramping pain in the lower extremities that is exacerbated by exertion.

• It occurs in a muscle with inadequate blood supply secondary to localized atherosclerosis.

• The pain should be consistent at a given exertion level and should resolve within 1-2 minutes after exercise cessation.

• Intermittent claudication is more prevalent in individuals with CHD and type 1 or 2 diabetes.

Intermittent claudication

• ________is dyspnea that occurs when lying at rest, with relief occurring by sitting upright or standing.

• _______ __________ dyspnea occurs during sleep, with relief by sitting up or standing.

• Both conditions reflect left ventricular dysfunction; ______dyspnea also may be seen in individuals with chronic obstructive pulmonary disease.

orthopnea or paroxysmal nocturnal dyspnea

• ______ _______ may be of no concern or may indicate cardiovascular disease.

• Realize that common causes of exertion-related sudden cardiac death, including hypertrophic cardiomyopathy and aortic stenosis, must be ruled out.

heart murmur

Unusual fatigue or shortness of breath with usual activities

beginning or sign of the onset or change in status of cardiovascular or metabolic

• Educate your clients on these

• Atherosclerosis= thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery. Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.

atherosclerotic cardiovascular risk factor thresholds

thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery. Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.

atherosclerosis

• Emotional Stress – Type A personality

• Alcohol

• High Triglycerides >150 mg/dl.  

• Alcohol – 1 drink = 12 oz beer, 1.5 oz hard liquor, 5 oz. wine

  • >1 drink/day women          

  • >2 drinks/day men

• Risk vs Benefit

secondary risk factor

• Common exercise goals

  • Improving appearance

  • Improving quality of life

  • Managing weight

  • Preparing for competition

  • Improving general health 

  • Reducing the burden of a chronic disease or condition

• Current Public Health Recommendations is that adults should Obtain 8 MET hours per week of exercise.

• Aerobic, long continuous activity 

• 5-10 for warmsups, longer with people w CV

• 10-30% of light activity 

• 30 mins of aerobic exercise

• Cooldown, can be done naturally, longer for people with CV

  • stretch 

• Can’t sit down after working out → cause of muscles tightening and lactic acid

goal setting

• Improving appearance

• Improving quality of life

• Managing weight

• Preparing for competition

• Improving general health 

• Reducing the burden of a chronic disease or condition

common exercise goals

• recommendations is that adults should Obtain 8 MET hours per week of exercise.

• Aerobic, long continuous activity 

• 5-10 for warmsups, longer with people w CV

• 10-30% of light activity 

• 30 mins of aerobic exercise

• Cooldown, can be done naturally, longer for people with CV

  • stretch 

• Can’t sit down after working out → cause of muscles tightening and lactic acid

current public health recommendations

• ACSM defines it as an ART

• The successful integration of exercise science with behavioral techniques that result in long-term program compliance and attainment of the individual's goals.

• Although the methods for prescribing exercise are based on scientific principles, the unique characteristics of each individual will impact the prescription.

exercise prescription

T = time or duration (e.g., 150 min/wk)

T = type or mode of exercise (e.g., walking, biking)

FITT principle for cardiorespiratory endurance

• Warm-up 4 to 5 min

• Aerobic session or

• Resistance session

• Static (no ballistic) stretching

• Cool down – 5 minutes

• What is the primary focus of the day’s training?

exercise training sequence

• Cool down

  • Gradually recover = 5 minutes of diminished activity.

  • 5 minutes of stretching

• CVD is important to maintain adequate venous return and have the HR and BP decrease gradually to resting values. 

• Hypotension, dizziness, reduced body heat, LA removal.

• Without fluids, calorie restriction body is gonna pass out

exercise prescription

• Progressive overload – work done above and beyond normally done

• Increase…

  • Frequency

  • Intensity

  • Duration

  • Volume 

  • Progression

• Duration→ Intensity→ Frequency increase by 10%

principles of exercise prescription

work done above and beyond normally done

progressive overload

to progress exercising you must increase…

frequency, intensity, duration, volume, progression

Physiologic adaptations are specific to the cardiorespiratory, neurologic, and muscular responses called upon to perform the exercise.

specificity of training

• Reversilibility 

  • some exercise is better than none 

  • Loss of previously acquired exercise training adaptations because of inactivity

• Training period of 8 to 12 wk

  • Untrained: 10%-30% improvement in function capacity

  • Increase Frequency and Duration first, Intensity last

  • 25%-30% increase in muscle strength

• Minimal training volume not maintained

  • Training effects erode

• Resting HR will change and get lower with training because of increase in SV and strength in left ventricle (Athletes) 

principles of exercise prescription

to increase cardiac output increase…

stroke volume or heart rate or both

• Body Composition

  • increase of body fat

  • decrease of lean body mass

  • increase in body weight

• Cardiovascular Function

• Decrease in…

  • RBC mass

  • End diastolic volume

  • Plasma volume

• Skeletal Muscle

• Decrease in…

  • Mitochondrial density

  • Capillary density

  • Muscular strength

• Pulmonary Function

  • Decrease in respiratory muscle strength+endurance

• Other

  • Loss of heat acclimation

• Important→ People get injured→ Laying and healing→ Atrophy occurs

detraining

• F = frequency of exercise (e.g., 5 days/wk)

• I = intensity of exercise

• Objective: V ̇O2, heart rate, caloric expenditure, mass, watts

• Heart rate–based method: use heart rate reserve (HRR) method

  • (HRR × desired percentages) + HRrest = target HR range

  • Common percentages used: 60% (0.6) and 80% (0.8)

  • Subjective: rating of perceived exertion (e.g., 11-14 on Borg 6-20 scale)

• Talk Test – Carry on a conversation

• RPE Scale

FITT principle for cardiorespiratory endurance

• How did gunnerboard come up with a 10-20 scale

• Tracked people exercising in his gym 

• Tracked what they were feeling and tracked with their HR

RPE Rate of perceived exertion

• 220-age not as efficient but works and used in hospitals etc

• Strength of the left ventricle declines- can be steep or gradual

ExRx

• PMHR = 220 – age.  Always used measured max heart rate if possible

• Other methods include VO2Reserve, MET Reserve

practical application

• Increase Time or Frequency first and Intensity second. 

• Rule of thumb: 10% per week on increases in Frequency, Intensity or Time.

• Risk of injury high after 5 days/week with little improvement in VO2max.

• 7 days/week should be avoided.

exercise prescription

• Muscular strength= Maximum ability of a muscle to develop force or tension

• Muscular power= Maximal ability to apply a force or tension at a given velocity

• Improved muscular strength and power

• Improved muscular endurance

• Improved flexibility

• Improved body composition

• Reduced risk of falling

• Reduced effort for ADL

• Reduced skeletal muscle fatigue

• Improved bone mineral density and content

• Improved glucose tolerance

• F = frequency of exercise (e.g., 1-3 days/wk)

• I = intensity of exercise

  • Objective:  70%-80% of 1RM, begin with 40% to 60% of 1RM.  RPE 11-13

  • Subjective: 8RM to 12RM to near maximal exertion

• T = time or duration (e.g., one to three sets of 8-12 repetitions per set, with 2 min rest between sets)

• T = type or mode of exercise: concentric and eccentric muscle actions involved in multijoint exercises and single-joint exercises

skeletal muscle strength and endurance

Maximum ability of a muscle to develop force or tension

muscular strength

Maximal ability to apply a force or tension at a given velocity

muscular power

• Flexibility 

  • Ability to move a joint throughout a full ROM

  • Associated with good postural stability and balance

• Assessment tools

  • Goniometer

  • Leighton flexometer

  • Sit-and-reach box

flexibility training

• Ability to move a joint throughout a full ROM

• Associated with good postural stability and balance

• Scar tissue buildup

• Issues with pain, and surgery 

• These get in the way of exercise and flexibility

flexibility

• Goniometer

• Leighton flexometer

• Sit-and-reach box

assessment tools

• Static= Stretch of the muscles surrounding a joint that is held without movement

• Ballistic= Method of rapidly moving a muscle to stretch and relax quickly for several repetitions

• Proprioceptive neuromuscular facilitation (PNF)= A muscle is isometrically contracted, relaxed, and subsequently stretched

• Flexibility gains→ Flexibility and recovery 

• Ballistic

  • Done with professional→ Issues with whiplash 

• PNF→ Muscle contraction with no movement 

modes of flexibility training

stretch of the muscles surrounding a joint that is held without movement

static

method of rapidly moving a muscle to stretch and relax quickly for several repetitions

ballistic

A muscle is isometrically contracted, relaxed, and subsequently stretched

proprioceptive neuromuscular facilitation (PNF)

• Frequency: 2 or 3 days/wk

• Static and PNF stretches should be held for 10 to 30 s.

• Stretches should be performed to mild discomfort. 

• Each stretch should be performed for 3 to 5 reps.

flexibility training

Any type of exercise training routine, whether it be cardiorespiratory conditioning, resistance training, or ROM training, should follow the _____ _________ to ensure an optimal rate of improvement and safety during training.

FITT principle

is an acronym that represents, Frequency, Intensity, Time, and Type. It can be prescribed to people to improve health, similar to pharmacologic intervention.

FITT principle