21790117 Exercise And Physical Activity[1]

Regie A. Layug, MD Department of Family and Community Medicine San Beda College of Medicine

A

patient of yours consulted you because of shortness of breath doing moderately heavy activity like climbing up the stairs or walking distances. She also has been steadily gaining weight and her blood pressure has been a little high. She wants you to help her develop a cardiovascular exercise program so she may be able to improve her fitness status.

 How

are you going to help your patient?  What are the things that you have to consider in formulating an exercise regimen?

At the end of the session, the student-learners are expected to: 1. Review certain principles and definitions related to exercise and fitness 2. Discuss the benefits of cardio respiratory activities and fitness 3. Enumerate and discuss the components of an exercise aerobic program 4. Discuss the FITTE factors for increasing fitness 5. Formulate a personal fitness plan catering to their individual needs and assessment



Any bodily movement produced by skeletal muscles that results in energy expenditure



Planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness



Those that cause an increase in the transport and uptake of oxygen by skeletal muscle

 Principle

of Adaptation

 If a specific physiological capacity is

taxed by a physical training stimulus within a certain range and on a regular basis, this physiological capacity usually expands  Dependent on two correlated principles: ▪ Threshold ▪ Overload

 Training

threshold

 Minimal level to which a physiologic

capacity must be challenged to in order to elicit adaptation

 Overload  Once training stimulus exceed the

threshold level, and the process of physiological adaptation occurs

 Progression  Workload must increase in order to

maintain overload

 Regression  Refers to the transience of physiological

enhancement from training that occurs when training ceases and the physiological capacities regress toward pretraining levels



Retrogression  Excessive taxing of

physiological capacities leading to their diminution

DEADAPTATIO N

ADAPTATION

Optimum Load

Threshold

Progressi ve Overload Low

Retrogressi on

High

Very High

OVERLOAD Disuse

Adam WC. Foundations of Physical Education, Exercise and Sports Sciences. Philadelphia: Lea & Febiger, 1991.

HEALTHRELATED ASPECTS OF FITNESS Muscular Strength

Muscula r Enduran ce

Body Composition

Flexibility

Cardio respiratory Endurance

 Refers

to the constellation of improvements that enhance VO2max and/or aerobic work capacity  Ability to persist or sustain activity for prolonged periods  Describes the capacity of the lungs to exchange oxygen and carbon dioxide with the blood, and the circulatory system’s ability to transport blood and nutrients to metabolically active tissues for sustained periods without undue fatigue

 Reduction in blood pressure  Increased HDL-cholesterol  Decreased total cholesterol  Decreased body fat stores  Increased aerobic work capacity  Decreased clinical symptoms of

anxiety, tension and depression  Reduction in glucose-stimulated insulin secretion  Increased heart function  Reduction in mortality in post myocardial infarction patients

      

Increased lactate threshold Decreased resting heart rate Increased heart volume Increased resting and maximum stroke volume Increased maximum cardiac output Increased maximum oxygen consumption Increased capillary density and blood flow to active muscles

      

Increased total blood volume Increased maximal ventilation Increased lung diffusion capacity Increased mobilization and utilization of fat Reduced all-cause mortality Decreased anxiety and depression Decreased incidence of some cancers

 

Warm-up and cool down Primary cardio respiratory activity criteria (FITTE)  Mode of exercise  Frequency of exercise

session  Duration of exercise session  Intensity of exercise session

  

Supportive conditioning exercise Progression plan Safety and cautions

Heart rate Blood pressure Oxygen consumption  Dilation of the blood vessels  Elasticity of the active muscles  Heat produced by the active muscle groups   

1. 2. 3. 4. 5. 6. 7. 8. 9.

Permits a gradual metabolic adaptation, which enhances cardiorespiratory performance Prevents the premature onset of blood lactic acid accumulation and fatigue during higher level aerobic exercise Causes a gradual increase in muscle temperature which decreases the work of contraction and reduces the likelihood of muscle injury Facilitates neural transmission for motor unit recruitment Improves coronary blood flow in early stages of the conditioning exercise, lessening the potential for myocardial ischemia Allows a gradual redistribution of blood flow to active muscles Increases the elasticity of connective tissue and other muscle components Provides a screening mechanism for potential musculoskeletal or metabolic problems that may increase at higher intensities Provides a psychological warm-up to higher levels of work

McArdle, et. Al. Exercise Physiology: Energy, Nutrition and Human Performance, 5th edition

1.

Graduated aerobic warm-up activity   

1.

Walking Slow tempo rhythmic callisthenic movements 5-8 minutes low level aerobic activity

Flexibility exercise specific to the biomechanical nature of the primary conditioning activity 

Calf, quadriceps and Achilles stretching – prior to running or hiking

 Purpose

is to slowly decrease the heart rate and overall metabolism  Low-level aerobic exercise, similar to that of the conditioning exercise, is recommended  Length of cool-down is proportional to the intensity and length of the conditioning phase ▪ Example: A typical 30-40 minute conditioning phase at 70% MHR would warrant a 5-10 minutes of cool down ▪ The aerobic component of the cool down phase should be followed by several minutes of stretching those muscle groups active in the conditioning phase

1.

2. 3.

Prevents post-exercise venous blood pooling and too rapid a drop in blood pressure  reducing the likelihood of post exercise lightheadedness or fainting Reduces the immediate post exercise tendency for muscle spasm or cramping Reduces the concentration of exercise hormones (NE) that are at relatively high levels immediately after vigorous aerobic exercise  lowers the probability of post exercise disturbances in cardiac rhythm McArdle, et. Al. Exercise Physiology: Energy, Nutrition and Human Performance, 5th edition

Primary Conditioning Exercise

Warm-up/Cool-down Activity

Aerobics (Group exercise)

Graduated low-level aerobic activity utilizing same muscle groups

Circuit weight training Low-level aerobic activity (e.g. walking or cycling, and/or beginning the circuit training session with a set of relatively high-repetition, low-resistance exercises) Jogging and running

Walking, walk-jogging, or jogging at a slower pace

Outdoor cycling

Begin with relatively flat terrain in lower gears; gradually shift to higher gears and steeper terrain

Stationary cycling

Start with cycling against little or no resistance

Stair-climber/elliptical cross-trainer

Low-level aerobic activity (e.g. walking or cycling and/or relatively low-tempo step exercise)

Swimming

Begin with slow crawl and gradually increase arm stroke and pace, and/or begin with short one- or two-lap slow intervals

 Exercise

Frequency

 Number of exercise sessions per week  Depends on the duration and intensity of

the exercise session

▪ Lower-intensity exercise performed for shorter periods  more sessions per week To improve both cardio respiratory fitness and maintain body fat at near optimum level: •A client should exercise at least 3 days a week with no more than 2 days between sessions (ACE) •3-5 days per week for most aerobic programs (ACSM)



Exercise Frequency (ACE)  For otherwise healthy

individuals  start aerobic programs every other day for at least eight weeks  For those with poor functional capacity  1-2 daily sessions per week  Those with average capacities  exercise at least 3/week on alternate days

 Exercise

Intensity

 Refers to the speed or exercise workload  55-90% of maximal heart rate (ACSM) ▪ Approximates 40-85% of heart rate reserve and maximal oxygen uptake ▪ Lower intensities are advised for beginners  4050% O2 max ▪ Apparently healthy individuals  75-85% O2 max

Intensity

RELATIVE INTENSITY O2 max, %

Maximum Heart Rate, %

RPE

<20

<35

<10

Light

20-39

35-54

10-11

Moderate

40-59

55-69

12-13

Hard

60-84

70-89

14-16

Very hard

≥85

≥90

17-19

Maximum

100

100

20

Very light

American Heart Association’s Exercise Standards for Testing and Training (2001). Circulation, 104, 1694.

 Moderate

intensities in exercise (40-60% maximum oxygen uptake) can lead to:       

Increased HDL cholesterol Decreased blood pressure Improved glucose tolerance Reduced blood clotting tendency Reduced anxiety Decreased cardiovascular disease risk Decreased potential for the development of diabetes and all-cause mortality

 Heart

rate

 Percentage of maximal heart rate ▪ May be determined by a maximal functional capacity test using a bicycle or treadmill ergometer ▪ Age-predicted maximal heart-rate tables ▪ Maximum heart rate = 220 – Age (years)

TRAINING HEART RATE

=

220 – AGE (years)

X

Desired percent of MHR

A

40-year old man for whom an intensity of 70% of maximum heart rate is desired: TRAINING HEART RATE

=

220 – AGE (years)

X

Desired percent of MHR

=

220 – 40

X

0.70

=

126 beats/mi nute

± 10 -12 beats per minute

 Heart

rate

 Percentage of heart-rate reserve

(Karvonen formula)

▪ The difference between the resting and maximal heart rates for a given client represents the reserve of the heart for increasing its cardiac output TRAINING HEART RATE

=

220 – AGE (years)

-

Resting HR

X

Desired % of MHR

Resting HR

+



Rating of Perceived Exertion (RPE)  Takes into account all the

exercising client is perceiving in terms of exercise fatigue, including psychological, musculoskeletal, and environmental factors ▪ RPE 12-13 corresponds to approximately 55-69% MHR



Talk-test method  Subjective  Useful in determining a

“comfort zone” of aerobic intensity  Clients should be able to breathe comfortably and rhythmically throughout all phases of a workout to ensure a safe and comfortable level of exercise



Intensity measured by METS  Assessed by a graded

exercise test (bicycle or treadmill) ▪ Based on time the client stays on the machine, the maximal oxygen consumption can be estimated and then converted into MET ▪ 3.5 mL/kg/min

 Exercise Duration (or Time)  Refers to the number of minutes of exercise

during the conditioning period

▪ Exclusive of warm-up and cool-down ▪ May vary from as little as 5-60 or more minutes ▪ 20-60 or more minutes per session, continuous or intermittent activity (ACSM)

▪ Dependent upon the exercise intensity Beginners  10-20 minutes aerobic conditioning Very deconditioned individuals  5-10 minutes Average classification  15-45 minutes High fitness classification  30-60 minutes



Exercise Mode (or Type)  Criteria: ▪ Activity that uses large muscle groups ▪ Rhythmic and repetitive in execution ▪ Cardio respiratory in nature  Selection is made on the

basis of the client’s functional capacity, interests, time availability, equipment and facilities, and personal goals



All cardio respiratory exercise programs must be supported by:  Flexibility exercises ▪ Add several separate sessions of stretching per week that improve the strength of the back, legs and abdomen  Strength exercise ▪ Weight-bearing types  Neuromuscular fitness

exercises

▪ Relaxation techniques, yoga  especially in the cool down periods

 Static

stretching

 Slow, gradual, and controlled elongation

through a full range of motion  Low intensity, long duration stretch technique

▪ Position is maintained for 15-30 seconds

UPPER TRAPEZIUS

ANTERIOR SHOULDER

POSTERIOR SHOULDER

TRICEPS

LOW BACK

OUTER HIP

ADDUCTOR

QUADRICEPS

HAMSTRINGS

GASTROCNEMIUS

 2 sets of exercise sessions  At least 10 exercises

per week

 At least one exercise to target all of the

major muscle groups

 At

least one set of 8-12 repetitions completed to fatigue  Active recovery between sets

LOWER BODY

HIP ABDUCTORS

LOWER BACK

PECTORALIS MAJOR

SHOULDERS

LATISSIMUS DORSI

TRICEPS

BICEPS

NECK

ABDOMINALS

Provides details for a graduated progression in the frequency, duration, and intensity of the exercise  Written plan recommended  Should be periodically evaluated 

 Depends        

on several factors:

Individual level of fitness (aerobic capacity) Age Health status Cardio respiratory response to exercise Individual preferences and goals Social and family support Level of exercise initiative and motivation Access to appropriate facilities and equipment

 Initial conditioning stage  Usually lasts 4-6 weeks or longer  Includes low-level aerobic activities, stretching, and

light calisthenics  Exercise frequency should begin every other day  Duration may start with 10-20 minutes and gradually increase according to the client’s response ▪ For those with low-level functional capacity  low-level aerobic interval exercise of 2-5 minutes at a time

 Intensity: start with 40-60% of functional capacity

(approximately 40-60% of MHR)

 Improvement

Conditioning Stage

 The primary conditioning stage for most   



aerobic-training programs May last from 8-20 weeks Exercise intensity: 50-85% functional capacity (60-90% of MHR) Duration should be increased every 2-3 weeks according to client’s response and goals Review progress at 2-4 week intervals

 Maintenance

Stage

 Usually reached after the first 6 months of

training

▪ May be delayed as long as 12 months, depending upon goals

 Clients should have reached their target

functional capacity or primary goals (reassess goals)  Engage client in a variety of endurancerelated activities that are fun and enjoyable to maintain cardio respiratory fitness



Identify and list any personal and environmental information that reduces the risk of exercise injury or that may compromise exercise safety

 Do

not exercise for at least 90 minutes after a meal  Avoid continuing exercise with chest discomfort, lightheadedness, or dizziness  Reduce exercise intensity in response to very hot or humid environments  Avoid exercise with tenderness in a joint that tends to worsen with activity  Avoid strenuous aerobic exercise during viral infections

 Make

a personal cardio respiratory fitness activity for yourself.

 What

are your goals in exercising? How much time do you have?  A fitness goal should be: ▪ Specific – “What exactly do you want to accomplish?” ▪ Measurable – “How much body fat, or pounds do you want to shed?” or “How far do you want to go in a run without getting tired?” ▪ Attainable – goals should be not TOO difficult or not TOO easy ▪ Relevant – look into your personal interests, needs and abilities ▪ Time-bound – identify a “deadline” for each goal

 Write

down your goal and post in areas which you often look into. “I want to be able to walk three miles in 45 minutes by March 20, 2010..” “I want to lose 25 pounds by the end of the year..”

 What

are your resources at the moment? Take into consideration:  How much time are you willing to spend

for the activity?  What activities do you enjoy the most that may count as exercise? Remember the general criteria.  What equipment or facilities are readily available for you?  Financial resources

 Be

specific in formulating the following parameters. Bear in mind the ACSM recommendations that you have just learned:  Warm-up and cool down  Primary conditioning exercise: ▪ Frequency ▪ Intensity (in terms of %MHR) ▪ Type or mode ▪ Time or duration

 What

supportive exercise would you add in order to address other healthrelated fitness areas? Be specific in writing each activities and the frequency of each exercise within the week:  Flexibility  Muscular strength  Neuromuscular exercise

 Identify

dates and the criteria that would enable you to progress throughout each stage. Encircle them in your personal calendar. What would you have attain in your goals before you “upgrade” a stage?  Initial conditioning stage  Improvement conditioning stage  Maintenance stage

 Identify

what cautions should you take before you start exercising

“…Look to your health; and if you have it, praise God and value it next to conscience; for health is the second blessing that we mortals are Izaac Walton capable of, a blessing money can’t buy…”

 ACSM

Resource Manual for Guidelines for Exercise Testing and Prescription, 5th edition  ACSM Guidelines for Exercise Testing and Prescription  American Council on Exercise Personal Trainer Manual