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Designing Cardiorespiratory

Exercise Program

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develop maintain

Cardiorespiratory endurance

Aerobic exercise program

improve

Health status

reduce

Disease risk

needinterestsagegenderphysical fitness levelexercise habits

US Dept. of Health& Human Service, 1996 Guidelines For Exercise Prescription For Improved Health

1. Mode: Select endurance-type physical activities, including formal aerobic exercise training, house and yard work, and physical active, recreational pursuits.

2. Intensity: Prescribe at least moderate intensity physical activities (≥ 45% Vo2max).

3. Frequency Schedule physical activity for most, preferably all, days of the week.

4. Duration: Accumulate at least 30 minutes of activity each day. Duration varies depending on type of activity.

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Successful Programming

• Leadership, education and motivation from YOU are very important to a successful program

• YOU teach your client why regular exercise necessary, how the exercise is performed safely and effectively and help them to incorporate regular exercise into their life

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Successful Programming• 35% of adults, 18-64 yrs, engage in regular physical activity

• 50% will drop out within 6 months

• The most common reasons– overweight– low self-motivation– anxiety– no spousal support– inconvenient exercise facility– exercise intensity is too high– no social support during and after exercise

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Exercise prescription for cardiorespiratory fitnessMode of exerciseIntensity of exerciseDuration of exerciseFrequency of exerciseRate of progressionStages of progression

Essentials of a cardiorespiratory exercise workoutAerobic training methods and modes

Continuous trainingDiscontinuous training

Personalized exercise programsCase study

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Modes of exerciseLarge muscles groups in continuous, rhythmical activities

Initial and improvement stage :*easy to maintain a constant exercise intensity*not highly dependent on participant’s skill

Maintenance stage: *rate of energy costs highly related to skill level*exercise highly variable in terms of energy costs & skill: limited for fun not emphasize the competitive - high risk & symptomatic

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Classification of Aerobic Exercise Modalities1998, V.H. Heyward

Classification of Aerobic Exercise Modalitiesa

Group I activitiesCycling (indoor)JoggingRunningWalkingRowingb

Stair climbingb

Simulated climbingb

Nordic skiingb

Aerobic ridingbc

Group II activitiesAerobic dancingBench step aerobicNordic skiing (outdoor)HikingRope skippingSwimmingWater aerobic

Group II IactivitiesBasketballCountry and western dancingHandballRacquet sportVolleyballSuper circuit resistance training

a Group I activites provide constant intensity and are not dependent on skill; Group II activities may provide constant or variable intensity, depending on skill. Group III activities provide variable intensity and are highly dependent on skills.b Machine-based activiesc May not provide adequate training intensity for above-average fitness levels

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Thomas et al (1995) :* treadmill jogging, skiing, stepping, rowing, cycling - higher PER in cycling (Fig 5.2)* subjects exercising on 7 different exercise at a somewhat hard intensity (RPE = 13 -14) for 15 -20 minutes experienced a greater total O2 consumption for treadmill jogging compared to stepping, rowing, skiing, cycling aerobic riding. (Fig 5.2)Heyward (1996), Hoffman (1996) :* treadmill jogging may be superior to other aerobic exercise in term of energy costs when exercise modes are equated using subjective rating RPE.* steady-state exercise HR higher for treadmill jogging compared to cycling and aerobic riding (Fig 5.2)

Which mode of exercise leads to the greatest improvement?

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How easy the exercise intensity can be graded andadjusted in order to overload the cardiorespiratory systemthroughout the improvement stage aerobic dance / bench step : quicker cadences, increase heights,

Some comments about rope skipping:* 60-80 skips/min = 9 METs > maximum MET capacity of most sedentary individuals* not easy to graded because doubling the rate of skipping increase the energy requirement by only 2 to 3 METs* average energy costs of 11.7 to 12.5 METs for skipping at rate 125, 135, 1nd 145 skips/min. Rope skipping is a strenuous exercise that may not be well suited as a form of graded, aerobic exercise.

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Intensity of exercise* expressed as a percentage of maximal aerobic capacity VO2 max* intensity and duration are inversely related* low to moderate intensities of longer duration are recommended for most cases

Higher intensityRisk of injury

Discourage continued participation

ACSM - initial exercise intensity for apparently healthy adults - 50-85 % VO2max (60-90 % of HRmax)

lower intensity, 40-50 %VO2max may be sufficient to provide health benefits for sedentary people with lowinitial cardiorespiratory fitness level.

intensity can be prescribed using MET, HR, or RPE methods

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MET methodstep1. Asses VO2max using a graded exercise teststep 2. Determine the minimum, average, and maximum intensity

For example: VO2max is 35 ml/kg/min 35 ml/kg/min = 10 METs

Minimum40% - 4 METs

Average60-70% - 6-7 METs

Maximum85% - 8.5 METs

The exercise prescription for this case, an apparently healthy,active person should include activities that produce an averageintensity of 6 -7 METs.

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Now, you have the required exercise intensity in METs. How touse this required METs to tell your client how fast is the running speed.

A woman should jog on a level course to be exercising at an intensity of 8 METs, how fast she should run?1. Convert METs to ml/kg/min VO2 = 8 METs x 3.5 ml/kg/min = 28 ml/kg/min2. Substitute known values into the ACSM running equation VO2 = (speed m/min x 0.2) + 3.5 ml/kg/min 28 - 3.5 ml/kg/min = speed m/min x 0.2 speed = 122.5 m/min3. Convert speed to mi/hr 122.5 ÷ 26.8 = 4.57 mi/hr4. Convert mi/hr to minute per mile pace Pace = 60 min/hr ÷ 4.75 mi/hr = 13.1 min.mi

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Heart Rate methodBased on the assumption that HR is a linear function ofexercise intensity

HR vs. MET graphing method

Percentage of maximal HR reserve (% HRR) method

Percentage of maximal HR (% HRmax) method

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HR vs. MET graphing method

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Percentage of maximal HR reserve (% HRR) method

Target HR=(% HRR) x (HR max - HR rest) + HR restACSM : 50-85 % HRR

Age 42 HR max 220 - 42 = 178 bpm Resting HR = 68 bpmExercise intensity = 60% HRRTarget exercise HR = 60% x (178 - 68) + 68 = 134 bpm For people at different initial fitness level, use deVries (1980) guidelines

Prescription of Exercise Intensity

Using % HRR Method for Various Fitness Levels Low (%) Average (%) High (%) Minimum HR 40 60 70Average HR 50-60 70-75 80-85 Maximum HR 75 85 90

Target HR = % HRR (HRmax –HRrest) + HRrest

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Percentage of maximal HR (% HRmax) method

% of HR max is related to % of VO2max69-89 % HR max correspond to 50-80 % VO2max

ACSM : 60-90 % HRmax

% HRR70% x (180 - 80) + 80= 150 bpm

% HRmax70 % X 180= 126 bpm

age 40, HR rest 80 bpmACSM% HRmax x 1.15

126 x 1.15 =145 bpm

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Comparison of Methods forPrescribing Exercise Intensity for Healthy Adults

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Limitations of HR methods

Using HR exclusively to develop intensity recommendationsfor your clients’ exercise prescriptions may lead to large errors in estimating relative exercise intensity (% VO2max) for someindividuals. This is especially true when HRmax is predicatedfrom age (220-age) instead of being directly measured. In about30% of population, an age-predicted prescription of 60% HRRmay be as low as 70% and as high as 80% of the actual HRmax(Dishman 1994). Also, medication, emotional state, andenvironmental factors such as temperature, humidity, and airpollution can affect your clients’ exercise training heart rate. Please consider alternative methods for monitoringexercise intensity - combination of HR and RPE

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Rating of Perceived Exertion (RPE) method

The RPE scales are valid and reliable tools for assessing the level of physical exertion during continuous, aerobic exercise (Birk and Birk 1987; Borg and Linderholm 1967; Dunbar etal. 1992)

RPE Intensity HRR

11 light 50%

12 minimum13 somewhat hard 60%

16 hard maximum 85%17 very hard

Advantage do not needto check HR

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Duration of exercise

ACSM - 20-30 minutes of continuous aerobic activity

Apparently healthcan sustain 60-85%VO2max20-30 minutes

Poorly conditioned40% VO2max 10 minutes

Multiple sessions/ dayto accumulate 20 to 30 min

Sedentary40-60% VO2max20-30 min

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Caloric cost of exercise can be used to estimate the duration of exerciseACSM - minimal thresholds of 150 - 300 kcal /session or 800 -900 kcal / weekInitial stage : 200 - 600 kcal / weekThrough improvement stage :goal is increase from 800 to 2000 kcal / week by gradually increasingfrequency, duration and intensity of exercise

Woman, 60-kg (132 lb.) exercise intensity of 7 METs, 5 times / week,goal:1500 kcal / week, or 300 kcal / session

1MET = 1 kcal/kg/hr 7 METs for 60-kg 420 kcal/hr 7 kcal/min300 kcal ÷7 kcal/min = 43 minExercise Prescription: duration 43 min, frequency 5 / week intensity 7 METs anything else?

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Frequency of exerciseACSM : 3- 5 times /week* sedentary (functional capacity = 5-8 METs) should exercise a minimum of 3 / week to produce significant changes in cardio.)* increase to 5/week as the fitness level increases* in term of improving VO2max, the sequence of exercise sessions seems to be less important than the total work performed during the training.* similar improvement, trained every other day (M-W-F) and 3 consecutive days (M-T-W)* ACSM : exercising on alternate days during the initial stage of training to lessen the chance of bone or joint injury

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Rate of progression* the greatest conditioning effects : first 6-8 weeks

improvement 1st month 3% per week 2nd month 2% per week thereafter 1% or less per week

For continued improvement, the cardiorespiratory systemmust be overloaded by adjusting the intensity and duration of exercise to the new level of fitness

* for average person, 5-20% increase inVO2max* inactive : may 40%* elite athletes may only 5% because they begin at a level much close to their genetic limits

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Physiological Changes Induced byCardiorespiratory Endurance Training

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Stages of progression

I, F, D periodically

Overload to cadio. / mus. progressively

Continued improvementsgraduallyone element at a time

Older / less fit D, not I

Initial conditioning stageImprovement stageMaintenance stage

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Initial conditioning stage

lasts 4 - 6 weekstime to familiar with exercise trainingprescribe stretching exercise low-intensity aerobic exercise low-intensity resistance exerciseACSM : 40-60%VO2max; at least 12-15 min; 20 min in 4 - 6 weeks; 2 - 3 times / weekHave your clients progress slowly by increasingexercise duration first, followed by small increasesin exercise intensity.

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Improvement stage

lasts 4 to 5 months (16 - 20 weeks) duration every 2 - 3 weeks frequency from 3 - 5 times

*Frequency, intensity and duration systematically and slowly progress, increasing one element at a time, until the client’s fitness goal is reached. * Cardiac patients, elderly, less fit - ACSM : duration should be at least 20 - 30 minutes before increasing intensity

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Maintenance stage*for maintaining the level of fitness achieved by the client at the end of the improvement stage*begins 6 months after the exercise program begins and should be continued on a regular, long-term basis if the client has made a lifetime commitment to exercise

amount of exercise in this stage < in improvement stage

frequency can be decreased, for example, jogging 5 / week to2-3 / week

a variety of enjoyable physical activities helps to counteractboredom and to maintain the client’s interest level

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Essentials of a cardiorespiratory exercise workout

Warm-up 5 - 10 min

blood flow to working muscle

body temperature

Chance of muscle and joint injury

Chance of abnormal cardiac rhythms

Conditioning phase - 20 - 60 min

Cool-down5 min

low intensity

Prevents pooling of blood in extremitiesReduces possibility of dizziness / faintingStretching exercises reduce chance of musclecramps / muscle soreness

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Personalized Exercise Programs

Training goal

age

gender

Physical fitness level

Exercise preferences

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Medical history

Physical condition

Lifestyle characteristics

interests

Designingexercise program

Prior to

Summarize info in

Case study Accurate / safeindividualizedexercise program

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