(8)aerobic exercises - kgm

8/3/2019 (8)Aerobic Exercises - KGM

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AEROBIC EXERCISES

Kristofferson G. Mendoza, PTRP

Department of Physical Therapy College of Allied Medical Professions

University of the Philippines Manila

PT153: Therapeutic Exercises 2



Learning Objectives

At the end of the session, students should be able to

Determine the components of an aerobic exerciseprogram

Apply principles of a conditioning program for

patients with Coronary Artery Disease

Stroke and/or history of Hypertension

Peripheral Vascular Disease

COPD

Diabetes Mellitus

Well population



Objectives

Determine criteria for initiating an exercise session for

different clients / patients.Decide when to terminate an exercise session based

on established protocols and guidelines



Background Knowledge

Cardiovascular physiology

Exercise physiology

Muscle physiology

Knowledge of different conditions presenting with

impaired aerobic capacity



Endurance

Ability to work for prolonged periods of time and

resist fatigue

Types

Cardiovascular endurance Cardiorespiratory fitness, aerobic endurance aerobic power Ability to perform large muscle dynamic exercises More of a general total body endurance

Muscle endurance

Local muscle endurance

Ability of a muscle group to perform repeated contractions over aperiod of time without fatigue



Determinants of an AerobicExercise Program

INTENSITY DURATION

FREQUENCY

MODE



Intensity

Overload principle

Stress on an organism is greater than the one regularlyencountered during daily life

Exercise must be above the training stimulus threshold for

adaptation to occur stimulus that elicits a training or conditioning response

Specificity principle

Adaptations in metabolic and physiologic systems depending

on the imposed demand



Intensity

Quantifying intensity

Heart Rate

VO2 Max

Rating of Perceived Exertion



IntensityHeart Rate

Karvonens Formula

For UE work

Maximum Heart Rate = 220 - age

Target Heart Rate = RHR + (MHR - RHR) (60-80%)

Maximum Heart Rate = 220 – age - 11



Intensity


Useful for patients with heart rate suppressors e.g.

Beta blockers

Original

Revised




Original version ( 6-20 )



Intensity



IntensityRating of Perceived Exertion

Revised version ( 0-10 )



Intensity



IntensityExercising at a high intensity elicits a greater

improvement of the VO2 max

The higher the intensity, the longer the exercise

intervals, the faster the training effect

Exercising at high intensities increases the risk for CVcomplications and musculoskeletal injury

Maximum oxygen consumption (VO2 Max) BESTmeasure of exercise intensity



Intensity

Goal

Achievement of intensity 60-90% MHR OR

50-85% VO2 Max

Beginners: 50-60% VO2 Max

Average: 60-70% VO2 Max

Fit: 75-85% VO2 Max



Duration

Dependent on

Total work performed

Intensity

Frequency

Fitness level

HIGH intensity SHORT durationLOW intensity LONG duration



Duration

Poor functional capacity

5 - 10 minutes

Beginners

10 - 20 minutes

Average 15 - 45 minutes

Fit

30 – 60 minutes



Duration

Moderate to Minimal intensity

20 – 30 minutes

High intensity

10 – 15 minutes

Exercise longer than 45 minutes increases the risk for

musculoskeletal complications



Frequency

Dependent on the health and age of the individual

LOW intensity HIGH frequency

HIGH intensity LOW frequency



FrequencyPOOR

DailyBeginner

Every other day

Optimal frequency 3-4 times a week

2 times a week does not generally evoke CV changes for well

population Increase in frequency beyond optimal range, increases risk

for musculoskeletal complications

30-45 mins 3x a week protects against CV disorders



Frequency

3 – 5 sessions / week

Greater than 5 METS

Daily or multiple daily sessions

Less than 5 METS



Mode

Large muscles

RhythmicLong duration

Lower extremity versus Upper extremity exercise



Mode

Lower Extremity

• Larger muscle mass

• Higher VO2 max

• HR increases linearly as a

function of increasedworkload / VO2 max

• HR plateaus just beforemaximal VO2 max

• Systolic BP increases

• Diastolic BP remains thesame

Upper extremity

• Smaller muscle mass

• Lower VO2 max than LE

exercise

• HR higher

• Stroke volume lower

• Systolic AND Diastolic BP

higher



EXERCISE PROGRAM

Warm-up

Aerobic exercise period

Cool-down



Warm-up

Muscle temperature

Nerve conduction velocity

Vasodilation

Adaptation of respiratory centers

Venous return



Warm-upComponents

Graduated low intensity warm-up (5-10 minutes) of totalbody movement

HR increase 20bpm

Flexibility exercises



Warm-upShould NOT cause fatigue

Decreases Risk for ECG changes (arrythmias)

Musculoskeletal disorder



Aerobic exerciseContinuous

IntervalCircuit

Circuit-interval



ContinuousSubmaximal and sustained

Achievement of the steady stateDuration: 20 – 60 minutes

Intensity: 60 – 85% VO2 Max

Most effective in increasing endurance for healthy

individuals



ContinuousTwo types:

Intermediate Slow Distance 20-60 minutes continuous exercise

Most commonly used for managing weight

Long Slow Distance Longer than 60 minutes for athletic training

Provided after 6 months of successful ISD



IntervalDesigned to improve strength and power more than

endurance Incorporates recovery after continual exercise

Useful for beginners

work - rest - work



IntervalExercise period is followed by rest interval

Rest relief (Passive recovery) Work relief (Active recovery)

Work recovery ratio

1:1 to 1:5

1 : 1.5 work interval allows the succeeding exercise

interval to begin before recovery is complete



IntervalAerobic Interval Training

For patients with poor CV fitness2-15 minutes at 50-80% functional capacity

Anaerobic Interval Training

For patients with high CV fitness

30 sec – 4 minutes at 85-100% functional capacity

Usually results in greater lactic acid concentrations



CircuitSeries of exercise activities

Several exercise modes Improves both strength and endurance



Circuit intervalStresses both aerobic and anerobic systems

Delays the need for glycolysis and lactic acidproduction



Cool-downPrevents

Pooling of blood Post-exercise syncope

Ischemia, arrythmias, and other complications

Increases oxidation of metabolic waste



Cool-downLength of cool-down phase proportional to intensity

and length of the conditioning phaseTypical 30-40 aerobic exercise period

Warrants a 5-10 minute cool-down phase



AEROBIC CONDITIONINGPROGRAM DESIGN

Coronary Artery Disease

Stroke and/or history of Hypertension

Peripheral Vascular Disease

COPD

Diabetes Mellitus Well population



Coronary Artery Disease In-patient phase

Out-patient phaseMaintenance phase



In – patient phase3 - 5 days

Objectives Initiate early return to independence

Prevent deleterious effect of bed rest

Help allay anxiety and depression Promote risk factor modification



In – patient phaseRole of PT

Sit- to- stand 1-3 days post-op Orthostatic challenge to the CV system 3-5 days post-op

Low-level exercise program (1-3 METS)



In – patient phaseExercise recommendations

Intensity 2-3 METS progressing to 3-5 METS by d/c

RPE < 13 (6-20)

Post-MI: HR <120 bpm or RHR + 20 bpm To tolerance, if asymptomatic



In – patient phase

Exercise recommendations

Duration

Begin with intermittent bouts lasting 3-5 minutes, as

tolerated

Rest periods can be slow walk or complete rest

Attempt 2:1 exercise/rest ratio

Frequency

Early mobilization: 3-4 times / day (days 1-3)

Later mobilization: 2 times/day (beginning on day 4) with

increased duration



Out-patient phase Initiated 6-8 weeks upon discharge

Objectives Improve functional capacity

Promote early return to normal activity

Promote positive lifestyle changes9 METS functional capacity: suggested exit point

Weaned from continuous monitoring to self-

monitoring



Maintenance phase3 - 6 months post-cardiac patient

Objectives Maintenance of function

Compliance with exercise program

Risk factor modificationEntry-level criteria

Functional capacity of 5 METS

Clinically stable angina Medically controlled arrhythmias during exercise



Maintenance phaseExercise recommendations

Intensity 40-75% MHR

Duration

45 minutes to tolerance / session

Frequency

3 – 5 days / week

Mode: Continuous / Interval



Coronary artery diseaseMode of exercise

Patient preferenceSkill required for proper performance

Potential for carryover at home

Availability of exercise equipment



Stroke and HypertensionAvoid valsalva maneuver

Avoid isometric componentCircuit training (weight training + endurance)

RPE when patient is taking anti-HTN

Instruct patients to move slowly



Stroke and HypertensionExercise recommmendations

Intensity: 40-70% VO2 Max / 40-65% MHRDuration: Gradual warm-ups and cool-down / 30-60

minute/session (aerobic training)

Frequency: 3-7 days/weekMode: Large muscle group aerobic exercise, walking,

swimming



Stroke and HypertensionSpecial considerations

NO exercise if resting systolic BP > 200 mmHg ordiastolic BP > 110 mmHg

Risk of heat intolerance for patients taking beta

blockers and diureticsAnti-HTN may provoke syncope post-exercise: good

cool-down

Individuals with BP > or equal 160/100 should addendurance exercise after initiating pharmacologic

therapy



Peripheral Vascular Disease (PVD)Relieve claudication

Improve walking capacity and qolEnsourage daily exercise with frequent rest periods

Low impact, NWB activities (swimming, cycling)

Add WB exercise as condition improves

Avoid exercising in COLD air or water

Interval training is appropriate

FEET care



Peripheral Vascular Disease (PVD)

Grade Subjective Grading for PVD

I Definite discomfort or pain but only at initial

level

II Moderate discomfort from which patients

attention CAN be diverted by conversation

III Intense pain CANNOT be diverted

IV Excruciating and unbearable pain



Peripheral Vascular Disease (PVD)Exercise recommmendation

Intensity: Grade II – III on the claudiaction painFrequency: 3-5 days / week

Duration: initial: 35 minutes of intermittent walking;

increased 5 minutes each session until 50 minutes of intermittent walking can be completed

Goal: 35-50 minutes of continuous walking

Mode: non-impact aerobic exercise



COPDKeep the exercise intensity low and gradually increase

over time

Reduce intensity if symptoms occur

Mind the environment

Use of supplemental oxygen / bronchodilatorsBreathing exercises

Walking strongly recommended



COPDExercise recommendations

Intensity: low intensity, adjust according to patient’sresponse

Duration: maximal limits tolerated by the symptoms

Frequency: 3 – 5 times / week; if reduced functionalcapacity , daily

Mode: walking, staionary cycling progress with upper

body resistive exercises



Diabetes MellitusExercise improves glucose control and circulation

Reduces cardiovascular riskAssists in weight control

Reduces stress

Patients should undergo exercise testing prior toinitiation of an exercise program



Diabetes MellitusExercise recommendations

Intensity: 50 – 80% HR ReserveDuration: 20 – 60 minutes

Frequency: 3 – 4 /week

Mode: walking, treadmill, stationary cycle



Diabetes Mellitus

Considerations

Monitor glucose levels prior to and following exercise

Should exercise with glucose level between 100 – 200 mg /dl

Have carbohydrate snack readily available during exercise

Do not exercise when

Fasting glucose > 250mg/dl + ketosis

Use caution when glucose > 300 mg/dl

Maintain hydration during exercise session



Diabetes MellitusDo not exercise alone

Avoid exercising body part injected by insulinDo not exercise patients with poorly controlled

complications

Do not exercise in extreme environmentaltemperatures

Late-onset hypoglycemia can occur up to 48 hours

following exercise especially when beginning ormodifying program



Diabetes Mellitus Ingest 20 – 30 grams of additional carbohydrates if

pre-exercise glucose is <100 mg/dl

Avoid valsalva and jarring/pounding activities

Monitor for signs of autonomic neuropathy

(hypoglycemia / hyperglycemia)Proper feet care

Limit WB activities for patients with peripheral

neuropathy



Well PopulationMode

Season



Long Slow Distance Intensity

Achievement of 70% VO2

max (80% MHR)

Duration

Training distance > race distance

Lasts from 30 minutes – 2 hours

Frequency

1-2 per week

Conversation exercise



Long Slow DistanceBenefits: Increase

CV and thermoregulatory functionMitochondria

Oxidative capacity

Fat utilization and lactate clearance



Long Slow DistanceDisadvantages

Not specific with lower intensity sportsDoes not stimulate neurologic pattern



Pace / Tempo Intensity: At the lactate threshold or slightly above the

race pace

Duration: 20 -30 minutes

Frequency: 1 -2 / week

“Threshold training”



Pace / TempoBenefits

Develops race paceEnhance body to sustain exercise

Increases running economy

Increases lactate threshold



Interval Intensity: Close to the VO2 Max

Duration: 3 – 5 minutes; Work/Rest ratio 1:1Frequency: 1 – 2 / week

Benefit

Increase VO2 max

Not to be performed if unfit



Repetition Intensity: Greater than VO2 Max

Duration: 30 – 90 seconds; Work/Rest ratio 1:5Frequency: Once a week

High reliance on anaerobic metabolism

Benefits Increases running speed

High capacity for anaerobic metabolism

Beneficial for final kick / push



Fartlek Intensity: Varies between LSD and pace

Duration: 20 – 60 minutesFrequency: Once a week

Benefits

Challenges all the system Increases VO2 max

Reduce boredom

Increases lactate threshold Increases running conomy



Sports SeasonSeason Objective Freq Duration Intensity

Off-season(Base training)

Develop soundconditioning base

5-6 Long Low-mod

Preseason

Improve factors important

to aerobic endurance and

performance

6-7 Long-mod Mod-high

In –season

(Competition)Maintain factors 5-6

Short

Race

distance

Low-training

High-racing

Postseason

(active rest )Recovery 3-5 Short Low



References Rothstein, J.M., Roy, S.H., & Wolf, S.L. (2005). The rehabilitation

specialist’s handbook. Philadelphia: F.A. Davis.

Whaley, M.H., Brubaker, P.H., & Otto, R.M. (2005). ACSM’s guidelinesfor exercise testing and prescription. Philadelphia: LippincottWilliams & Wilkins.

Kisner, C., & Colby, L.A. (2007). Therapeutic exercise: Foundationsand techniques. Philadelphia: F.A. Davis.

Seigelman, R.P., & O’ Sullivan, S.B. (2006). National physical therapyexamination review and study guide. Philadelphia: InternationalEducation Resources.

Encabo, Michelle. 2008. Powerpoint presentation on Aerobic

Exercise. UP-CAMP

Basco, Mmark David. 2009. Lecture Notes on Aerobic Exercise. UP-CAMP



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(8)aerobic exercises - kgm

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