principles of exercise prescription art and science l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Principles Of Exercise Prescription …… Art and Science PowerPoint Presentation
Download Presentation
Principles Of Exercise Prescription …… Art and Science

Loading in 2 Seconds...

play fullscreen
1 / 68

Principles Of Exercise Prescription …… Art and Science - PowerPoint PPT Presentation


  • 266 Views
  • Uploaded on

Principles Of Exercise Prescription …… Art and Science. David Arnall, Ph.D., PT. General Principles : Mode of exercise Intensity of exercise Duration of exercise Frequency of exercise Rate of progression.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Principles Of Exercise Prescription …… Art and Science' - JasminFlorian


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2
General Principles :
    • Mode of exercise
    • Intensity of exercise
    • Duration of exercise
    • Frequency of exercise
    • Rate of progression
slide3
The general parameters of exercise prescription hold true for individuals who are healthy as well as those patients who have disease pathology. However, there must be some special considerations for those that have disease.
some acute chronic disease pathologies of concern
Some Acute & Chronic Disease Pathologies Of Concern
  • Cardiac Disease - MI’s, CAD, IHD
  • Vascular Disease - PVD, HTN, Stroke Arteriosclerosis, Atherosclerosis
slide5
Cancer
  • Metabolic Disease - Diabetes, Neuro-Endocrine Disorders
patient s with pathology
Patient’s With Pathology
  • Exercise is not prescribed for these individuals until the patient has undergone a graded exercise stress test (GXT) under the direction of their physician.
graded exercise tests
Graded Exercise Tests
  • Low Level Graded Exercise Test
  • Regular Graded Exercise Test

Some examples ……...

low level exercise stress test
Low Level Exercise Stress Test

Stage Speed Grade Dur. METS

I 1.7 mph 0 % 3 min 2.3

II 1.7 mph 5 % 3 min 3.5

III 1.7 mph 10 % 3 min 4.6

IV 2.5 mph 12 % 3 min 6.8

slide9
The low level GXT is given to patient’s with significant cardiac damage and who have an exercise capacity lower than 8 METs
bruce protocol gxt
Bruce Protocol GXT

Stage Speed Grade Dur.

I 1.7 mph 10 % 3 min

II 2.5 mph 12 % 3 min

III 3.4 mph 14 % 3 min

IV 4.2 mph 16 % 3 min

V 5.0 mph 18 % 3 min

VI 5.5 mph 20 % 3 min

modified bruce protocol gxt
Modified Bruce Protocol GXT

Stage Speed Grade Dur.

I 1.7 mph 0 % 3 min

II 1.7 mph 5 % 3 min

III 1.7 mph 10 % 3 min

IV 2.5 mph 12 % 3 min

V 3.4 mph 14 % 3 min

VI 4.2 mph 16 % 3 min

VII 5.0 mph 18 % 3 min

usafsam gxt
USAFSAM GXT

Stage Speed Grade Dur.

I 2.0 mph 0 % 3 min

II 3.3 mph 0 % 3 min

III 3.3 mph 5 % 3 min

IV 3.3 mph 10% 3 min

V 3.3 mph 15% 3 min

VI 3.3 mph 20% 3 min

question
Question ?
  • Are the same aerobic activities appropriate for both the cardiac patient and the healthy individual ?
answer
Answer
  • No !! Cardiac patients have some special concerns such as :
    • Intensity of the exercise
    • Static and dynamic balance
    • Syncope and falling
    • Degree of cardiovascular pathology
    • Medications
mode of exercise
Mode of Exercise
  • Any activity :
    • that uses large muscle groups
    • that is rhthymic
    • that is sustained below the patient’s anaerobic threshold for 15-60 minutes
exercise mode aerobic
biking

light rowing

rebounding

ballroom dance

walking

water aerobics

nordic track

slow jogging

slow jarming

skating

slow wogging

Exercise Mode - Aerobic
met equivalents
MET Equivalents
  • Archery : 4 METs
  • Canoeing & Rowing : 6-8 METs
  • Cycling : 5 - 8 METS
  • Ballroom Dancing : 5 - 9 METs
  • Fishing : 4 - 6 METs
  • Golf : 4 - 7 METs
slide19
Hiking & Walking : 4 - 8 METs
  • Judo & Tae Kwon Do : 10 - 16 METs
  • Raquetball : 8 - 14 METs
  • Rope Jumping : 9 - 12 METs
  • Rebounding : 6 - 10 METs
  • Shuffleboard : 3 - 4 METs
slide20
Ping Pong : 3 - 6 METs
  • Tennis : 4 - 12 METs
  • Swimming : 4 - 12 METs
  • Sailing : 4 - 9 METs
  • Running 12 min/mile : 9 Mets
  • Running 10 min/mile : 11 METs
  • Running 8 min/mile : 13 - 15 METs
slide21
The various modes of exercise must be specifically tailored to the patient’s physical needs such as :
    • aerobic work capacity
    • physical condition & disease state
    • availability of equipment
    • patient’s interest & family support
intensity of exercise
Intensity Of Exercise
  • Exercise intensity is calculated from the results of the GXT

Some examples …...

the gxt report should have
The GXT Report Should Have
  • Resting heart rate
  • Maximum ex. heart rate
  • Resting blood pressure
  • Maximum ex. blood pressure
  • Maximum METs achieved
how do i use the gxt data
How Do I Use The GXT Data ?
  • Use the Modified Karvonen’s Formula to set the training exercise heart rate or the training exercise blood pressure for the population with pathology.
the karvonen formula
The Karvonen Formula

Karvonen’s Formula to determine target exercise heart rate was:

(HRmax - HRrest) x(.6 - .8) + HRrest

This formula needs to be modified for use in diseased populations.

slide26
The target exercise heart rate should look like this for special populations:

(HRmax - HRrest) X[.4 - .8 + Max METs/100]+ HRrest

The bracketed portion of the formula containing the Max METs value is called the Activity Fraction.

advantages of this modified karvonen s formula
Advantages Of This Modified Karvonen’s Formula
  • Advantage # 1 : The modified Karvonen’s Formula has a low starting activity fraction to accommodate exercising patients with cardiac disease.
slide28
Advantage # 2 : The adjusted target heart rate for the patient with disease is calculated on the heart rate, blood pressure and Max METs achieved during the symptom limited GXT .
what is a symptom limited gxt
What Is A Symptom Limited GXT ?
  • A symptom limited GXT is a stress test in which the physician recorded the onset of symptoms (angina, ST segment depression) at the specific heart rate, blood pressure and stage of the GXT.
slide30
What value is a symptom limited GXT to the Exercise Specialist ?
    • It provides a maximum exercise HR and BP at which significant signs and symptoms of ischemia begin to appear.
slide31
All exercise prescriptions are written using the modified Karvonen’s Formula to insure that the patient’s exercise training intensity is significantly lower than the maximum symptom limited exercise HR & BP values avoiding the onset of myocardial ischemia.
however
However………...

Seldom does the prescription ever have all of the ideal data!!

slide33
So ……...

How do I write the exercise prescription with only part of the GXT information ?

what if
What If……...
  • Only the blood pressure data is available :
    • Max. Exercise Systolic BP = 180 mm Hg
    • Resting Systolic BP = 88 mm Hg

Target Ex. Systolic BP = (180-88) x (.6) + 88

= 143 mm Hg

what if35
What If……...
  • Only the heart rate data is available :
    • Max. Ex. HR = 140 BPM
    • Rest HR = 80 BPM

Target Ex. HR = (140 - 80) x (.6) + 80

= 116 BPM

what if36
What If……...
  • Only the Max METs data is available :
    • Max METs Achieved = 7 METs

Ex. MET level = 7 METs x (.6 + 7/100)

= 4.69 METs

what is a met
What Is A MET ?
  • A MET is a metabolic equivalent and has the value of :

3.5 ml O2/Kg/min

slide38
So…...
  • If I am performing a 10 MET activity, the oxygen utilization for this activity is :

10 METs x 3.5 = 35 ml O2/Kg/min

examples
Examples…...
  • A MET is a measure of energy cost for a particular activity.
    • Fishing In A Stream = 5-6 METs
    • Social Dancing = 6-9 METs
    • Touch Football = 6-10 METs
    • Scuba Diving = 10-12 METs
slide40
METs can be a useful measure for a variety of calculations particularly in terms of helping patients to understand physical work capacity (VO2 = ml/Kg/min measurements) or in terms of loosing weight (see next slide).
slide41
The ACSM recommends minimal thresholds of 300 kcals per exercise session performed 3 days/week or 200 kcals per exercise session performed 4 days/week.
slide42
This minimum recommendation suggests that exercise prescription target a weekly exercise caloric expenditure of about 1,000 kcals.
slide43
For optimal results in physical fitness, the ACSM recommends bringing the weekly caloric expenditure up to 2,000 kcals as health and fitness permits.
how can i transform mets into calories expended
How Can I Transform METs Into Calories Expended ?

Kcal/min = (METs) x 3.5 x (Weight in Kg)

200

problem
Problem …...

Goal : To expend 1,000 Kcals/wk

Ex. : Walking @ 3.5 mph (6.1 METs)

Weight : 70 Kg (154 lbs.)

(6.1 x 3.5) x 70 = 7.47 kcals/min

200

practical application prob 1
Practical Application - Prob. # 1

Take 1,000 kcals/week = 134 min/week

7.47 kcals/min

  • Prescription :

45 min per day/3 days/week

33 min per day/4 days/week

27 min per day/5 days/week

22 min per day/6 days/week

19 min per day/7 days/week

problem 2
Problem # 2
  • Goal : To expend 2,000 Kcals/wk
  • Ex. : Walking @ 3.5 mph = 6.1 METs
  • Weight : 127 Kg ( 279 lbs.)

(6.1 x 3.5) x 127 = 13.6 kcal/min

200

slide48
2,000 kcals/week = 148 min ex./week

13.5 kcals/min

Prescription :

49 min of exercise 3 days/week

37 min of exercise 4 days/week

30 min of exercise 5 days/week

25 min of exercise 6 days/week

21 min of exercise 7 days/week

duration of exercise
Duration of Exercise
  • Duration of exercise should ideally be between 15 - 60 minutes
slide50
If the patient is unable to perform 15 minutes of steady state exercise, break the time into two 7-8 minute stages.
slide51
Research has shown that multiple small bouts of exercise added together have the same training effect as a single bout of exercise of the same total duration.
frequency of exercise
Frequency Of Exercise
  • Frequency begins with 3days/week and progresses to 5-7days/week.
  • How often a person exercises/week depends on their pathology and its severity.
examples53
Examples…...
  • A Type I Insulin-Dependent Diabetic should exercise 7 days per week for glucose regulation.
  • A Type II Non-Insulin-Dependent Diabetic should exercise 4-5 days per week for weight control.
rate of progression the art of exercise prescription
Rate Of Progression….The Art Of Exercise Prescription
  • Rate of progression is impacted by many factors :
    • type of pathology
    • severity of pathology
    • aerobic work capacity
some thoughts
Some Thoughts …….
  • Increase duration to 45 - 60 min
  • Next, increase frequency
  • Lastly, increase intensity
slide56
Once, you are up to 45 - 60 minutes per exercise session, increase frequency from 3 times/week to 4 times/week.
  • Then back off to 30 min/session to allow the patient to adjust to an increase in the frequency of exercise.
slide57
When the patient’s exercising 45 - 60 minutes/session for 5 times/week, it is time to increase the intensity.
  • Once you increase intensity, the duration and frequency may need to be adjusted to let the patient accommodate to the new intensity.
warm up cool down
Warm Up & Cool Down
  • All patients with pathology as well as the healthy individual should have a 4-6 minute warm up period and a 6-10 minute cool down period.
longer cool down periods
Longer Cool Down Periods
  • It is smart to have the patient cool down for 6-10 minutes after a steady-state exercise bout.
  • Many cardiac events occur after cessation of exercise.
monitoring the patient
Monitoring The Patient
  • There are a number of ways to monitor the patient during exercise.
    • Anginal Scale
    • Borg Scale
    • Dyspnea Scale
    • Blood Pressure
    • Heart Rate
anginal scale
Anginal Scale
  • 1+ Light, barely noticeable
  • 2+ Moderately bothersome
  • 3+ Severe, very uncomfortable
  • 4+ Most severe pain ever experienced - must stop !!!
stopping points with angina
Stopping Points With Angina
  • When a person is exercising and they complain of 2+ or 3+ angina, you must stop the exercise (ACSM).
  • It would be better to stop at 2+ angina rather than allow the patient to get to level 3 angina.
anginal equivalents
Anginal Equivalents
  • Umbilical pain
  • Jaw or tooth pain
  • Tingling/numbness in fingers/hands
  • Shoulder pain
  • Low back pain
  • Chest pressure
borg s ratings of perceived exertion rpe
Borg’s Ratings Of Perceived Exertion (RPE)

7 = Very, Very Light

9 = Very Light

11 = Fairly Light

13 = Somewhat Hard

15 = Hard

17 = Very Hard

dyspnea scale
Dyspnea Scale

1+ Light Breathlessness

2+ Moderate Breathlessness

3+ Severe Breathlessness

4+ Most Severe Breathlessness Ever Experienced

blood pressure
Blood Pressure
  • Stop Exercise If BP Is >260/115
  • If BP Is >200/115 At Rest, Don’t Exercise - Refer The Patient To Their Physician
slide67
Sometimes the diastolic pressure rises 8 - 10 mm Hg pressure during exercise. If it rises more than this, consider referring the patient to their physician. In most cases, diastolic pressure remains the same or falls during exercise from its pre-exercise rest value.
heart rate
Heart Rate
  • Initially, for a couple of weeks, HR should remain within the calculated target training zone determined from the HR values of the symptom limited GXT. It can be advanced in blocks of 5-6 beats as the patient tolerates this increase in intensity.