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Exercise Training for Health and Fitness: Guidelines and Benefits

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  1. Chapter 20 • Prescription of Exercise for Health and Fitness

  2. Chapter 20 Overview • Health benefits of exercise • Medical clearance • Exercise prescription • Monitoring exercise intensity • Exercise program • Exercise and rehabilitation of people with diseases

  3. Health Benefits of Exercise • 1960s: Dr. Kenneth Cooper • 1970s to 1980s: fitness boom • 1990s: The Great Awakening • 1992: inactivity major risk for CAD (AHA) • 1994: exercise public health initiative (CDCP/ACSM) • 1995/1996: statement on exercise and cardiovascular health (NIH) • 1996: report on health benefits of exercise (Surgeon General) • 2000: identification of sedentary death syndrome

  4. Health Benefits of Exercise • Exercise not a priority in US population • Awareness of health benefits high • Application of knowledge low • Exercise should not intimidate • 30 min brisk walking, 15 min running • Every day or almost every day • Health benefits  as duration and intensity 

  5. Medical Clearance • Medical evaluation useful and important prior to starting exercise program • Medical information can be used to develop exercise prescription • Provides baseline to measure progress • High-risk individuals should exercise only under medical supervision

  6. Medical Clearance • Medical evaluation provides motivation • Blood pressure • Percent body fat • Blood lipid values • Periodic medical evaluations can identify dangerous conditions earlier

  7. Medical Clearance:Medical Evaluation • Low-risk/healthy individuals • Medical evaluation not required • Medical system could not handle patient load • Moderate-risk individuals • 2+ risk factors for cardiovascular, pulmonary, or metabolic disease, no signs or symptoms • Medical evaluation recommended • High-risk individuals • 1 or more signs or symptoms of disease • Medical evaluation recommended

  8. Table 20.1

  9. Medical Clearance:Risk Stratification • Used by health and fitness professionals during screening process • Risk stratification helps identify • Individuals with medical contraindications • Individuals with clinical conditions who need a medically supervised exercise program • Individuals at  risk for disease who need medical evaluation and exercise testing prior to exercise • Special needs that affect testing and prescription

  10. Risk Stratification for Exercise Prescription

  11. Medical Clearance:Graded Exercise Testing • Graded exercise test (GXT) • Treadmill most common • Increase intensity gradually to maximal • Monitor subject for discomfort, warning signs • Exercising ECG necessary • Resting ECG may not reveal all abnormalities • Exercising ECG can unmask coronary artery disease (CAD)

  12. Medical Clearance: Graded Exercise Testing • Can detect • Arrhythmias • ST segment changes (myocardial ischemia) • Results positive or negative, possibility of false negative or false positive • Positive ECG requires follow-up tests • Coronary arteriogram • CT, MRI scans of heart

  13. Figure 20.3

  14. Figure 20.4

  15. Medical Clearance:Graded Exercise Testing • Sensitivity of exercise ECG • Can GXT correctly identify clinical populations? • Low (66% identified) for asymptomatic CAD • Specificity of exercise ECG • Can test correctly identify healthy individuals? • Higher (84%) specificity • Predictive value of abnormal exercise ECG • Do abnormal results actually indicate disease? • Low (~24%) for asymptomatic CAD

  16. Medical Clearance:Graded Exercise Testing • GXT has limited value in young and healthy • Accuracy of ECG questionable • Actual risk of cardiac arrest low • Expensive, less accessible test • GXT recommended for • Moderate-risk cohorts • High-risk cohorts

  17. Exercise Prescription • Exercise program designed to improve aerobic capacity in untrained individuals • Four basic factors of exercise prescription • Mode or type of exercise • Frequency of participation • Duration of each exercise bout • Intensity of exercise bout

  18. Exercise Prescription • Minimum threshold • Point below which no improvements occur • Exists for frequency, duration, and intensity • Varies with each individual • Once minimum threshold exceeded, aerobic capacity increases

  19. Exercise Prescription:Mode • Modes most frequently prescribed • Walking/hiking/jogging/running • Cycling • Rowing • Swimming • Less common modes • Spinning, aerobic dance • Racket sports

  20. Exercise Prescription:Mode • For competitive sports, precondition using common modes • Improves aerobic fitness prior to sport training • Improves success in sport performance • Preconditioning required for several weeks or months before sport training starts • Sport maintains aerobic fitness • Sport may further improve aerobic fitness

  21. Exercise Prescription:Mode • Mode should be enjoyable and motivating • Mode should be challenging • Mode should produce needed benefits • Multiple modes helpful • Inclement weather • Boredom

  22. Exercise Prescription:Frequency and Duration • Frequency • Optimal: 3 to 5 days per week • Start gradually, avoid burnout/fatigue • Less important than intensity or duration • Duration • Optimal: 20 to 30 min per day • One long bout or multiple shorter bouts • Inverse relationship between duration and intensity

  23. Exercise Prescription:Intensity • Intensity most important factor • Minimum recommended: 50 to 60% VO2max • Upper limit depends on purpose of training • Upper limit seldom exceeds 80% VO2max • High-intensity, low-volume interval training • Markedly increases aerobic capacity • Results seen in 2 weeks

  24. Monitoring Exercise Intensity • Training heart rate (THR) • Based on linear relationship between HR, VO2 • Use target HR corresponding to target % VO2max • 75% VO2max = 87% HRmax (not 75% HRmax) • Karvonen method for THR • Maximal HR reserve = HRmax – HRrest • THR calculated as percent of maximal HR reserve • THR75% = HRrest + 0.75(HRmax – HRrest)

  25. Figure 20.5

  26. Monitoring Exercise Intensity • Training HR range • Example: 50 to 75% maximal HR reserve • Will ensure training response • Start at low end and move up • HR correlated with cardiac work • THR ensures constant rate of work done by heart regardless of environmental conditions • Safe for high-risk patients • Allows for improved aerobic fitness

  27. Monitoring Exercise Intensity • Metabolic equivalent (MET) • Gauges intensity based on O2 consumption • 1 MET = 3.5 ml O2/kg/min • 1 MET = resting metabolic rate • Published MET values for activities but • MET can vary considerably among individuals • Values fail to account for environmental conditions • Values fail to account for physical conditioning

  28. Monitoring Exercise Intensity • VO2 reserve (VO2R) method • ACSM position stand • VO2R = VO2max – VO2rest • Prescribe exercise as % VO2R • Assumes 1 MET = universal resting VO2 • % Maximal HR reserve versus % VO2R

  29. Monitoring Exercise Intensity • Ratings of perceived exertion (RPEs) • Individuals rate how hard exercise feels • Numerical rating scale • Borg RPE scale • Scale 6 to 20 • Corresponds with HR • Very accurate when used correctly

  30. Table 20.3

  31. Exercise Program • Total exercise program includes 1. Warm-up, stretching activities 2. Endurance training 3. Cool-down, stretching activities 4. Flexibility training 5. Resistance training 6. Recreational activities • First three activities, 3 to 4 times per week

  32. Exercise Program • Warm-up and stretching activities • Start with low-intensity calisthenics, stretching • Gradually increase HR, breathing • Prepare exerciser for more vigorous exercise • Can reduce muscle soreness • Sample warm-up • 5 to 10 min stretching • 5 to 10 min low-intensity activity

  33. Exercise Program • Endurance training • Develops cardiovascular endurance • Improves capacity and efficiency of cardiovascular, respiratory, and metabolic systems • Controls body weight • Best modes: walk/jog/run, cycle, swim, row • Poor modes: golf, bowling, softball

  34. Exercise Program • Cool-down and stretching • Should conclude every endurance workout • Reduced intensity • Do not stop abruptly • Stretching after exercise   flexibility

  35. Exercise Program • Flexibility training • Supplements warm-up and cool-down periods • Useful for those with poor flexibility, joint pain • Should be performed slowly • Timing of flexibility training • Best after workout • Tissues may be more adaptable and responsive after exercise

  36. Exercise Program • Resistance training • Starting point: 10 repetitions at 1/2 1RM • Proper starting weight: fatigue at repetitions 8 to 10 • If 15 repetitions reached, increase weight • 2 to 3 sets per day, 2 to 3 times per week • Can reduce to 1 to 2 sets if needed (still see results in untrained people)

  37. Exercise Program • Recreational activities important aspect of comprehensive exercise program • Guidelines for selecting recreation: Will the activity • Be learned and performed with moderate success? • Provide opportunities for social development? • Keep costs within budget? • Maintain long-term interest? • Be safe given health and age?

  38. Exercise and Rehabilitation for People With Diseases • Exercise a major component of rehabilitation • Used in rehabilitation programs for • Cardiopulmonary disease • Cancer • Obesity, diabetes • Renal disease • Osteoporosis • Arthritis, chronic fatigue, fibromyalgia • Cystic fibrosis

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