applied exercise prescription: why planning and

Applied Exercise Prescription: Why planning and programming of the exercise dose

is so important to improve health outcomes in inactive populations?

From Linear to Undulating Periodization Models

Prof. Alfonso Jimenez PhD, CSCS, NSCA-CPT, FLF

A “natural” Evolution in Sport & Exercise Science

Frustrated athlete

Interested student

Motivated professional

Overwhelmed academic

Luis J. Gonzalez-Fanega 1992 European Indoor Champion 800m Genoa (1´46”80)

Personal best: 1’44″84

London 2012 David Rudisha WR 1'40"91!!

Workshop plan…

Background and fundamental knowledge linked to exercise prescription (20min).

Models for planning and programming of the exercise dose (20min). Moving into practice: Case studies and the “3-Questions Law” (20 min). 10min Break Group exercise, solving case studies by applying methodology (45 min). Sharing the outcomes and open discussion (30 to 45 min).

http://www.who.int/nutrition/topics/obesity/en/index.html

• Globally, there are more than 1 billion overweight adults, at least 300 million of them obese. • The key causes are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.

WHO’s Childhood Obesity Surveillance Initiative (COSI), around 1 in 3 children in the EU aged 6-9 years old were overweight or obese in 2010. This is a worrying increase on 2008, when estimates were 1 in 4…

What if there was one prescription

that could prevent and treat dozens of diseases,

such as diabetes, hypertension and obesity?

Robert E. Sallis, M.D., M.P.H., FACSM, Exercise is Medicine™ Task Force Chairman

Physical Inactivity and Health

(Risk high if Activity low)

Activity

Prevention of Weight Gain

Type 2 Diabetes

Musculoskeletal Injury

Functional Health Status

CHD

Stroke

Osteoporosis

Public Health Transitions

1900 2000 1960

Decisions about the Environment and Public Policies !!!

Ainsworth, 2006

Cancer

1900 1960 1990 2000

Obesity

1970 1980

Infectious

Diabetes

CVD

Chronic Diseases Impact

The introduction of the IBM PC marked a major milestone in 1980's computing, and led to the growth of the PC compatible market ...

IBM PC / XT / AT

To change the behaviour of anyone we have to ... Provide evidences,

Create opportunities,

And Facilitate positive experiences, specially at the beginning.

Delivering CHANGE!!!

The main role of an Exercise Professional is to serve as a FACILITATOR on this behavioural change,

by providing a customized optimal exercise dose to

improve health in a safe and healthy environment.

Prof. J.N. Morris Prof. R. Paffenbarger Jr.

Physical Activity at Work and Coronary Artery Disease, 31,000 London Transport Workers

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Coronary Occlusion Early Mortality*

DriversConductors

Morris JN et al. Lancet 1953

Rate/1000

*Within 3 days of MI

< 500 500 1000 1500 2000 2500 > 3000

40

%

30

%

20

%

10

%

K/cal burned weekly (walking)

Ris

k re

duct

ion

There is a relation between regular physical activity and death risk reduction. From Paffenbarger et al. modified

RES

ULT

S O

F TH

E H

AR

VA

RD

ALU

MN

Y S

TUD

Y

Main Limitation: Measurement of physical activity level was based on questionnaires

Aerobic Center Longitudinal Study (ACLS)

• Cohort of 21,199 men examined at the Cooper Clinic in Dallas, Texas, since 1970 • Complete preventive medical exam, including a maximal exercise treadmill test • Identified 832 all-cause deaths from baseline through 1994 during 180,293 man-years of follow-up among men from 45-94 years of attained age

Blair SN et al. JAMA 1996; 276:205-10

Age-Adjusted All-Cause Mortality (10.000/PY) by Fitness Groups, Men

0

10

20

30

40

50

60

70

Low 2 3 4 High

ACLS

RES

ULT

S

Fitness Groups

Early investigations examining the relative risks of allEarly investigations examining the relative risks of all--cause cause mortality as a function of physical activity/fitness level. mortality as a function of physical activity/fitness level.

A: Harvard Alumni Study (A: Harvard Alumni Study (PaffenbargerPaffenbarger et al. 1986). et al. 1986). B: Aerobic Center Longitudinal Study (Blair et al. 1989).B: Aerobic Center Longitudinal Study (Blair et al. 1989).

Energy Expenditure (kcal/week)

<500 500-900 1000-1499 1500-1999 2000-2499 2500-2999 3000-3499 >3500

Rel

ativ

e R

isk

of A

ll-C

ause

Mor

talit

y

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Physical Fitness Quintile

Q1 Q2 Q3 Q4 Q5

Rel

ativ

e R

isk

of A

ll-C

ause

Mor

talit

y

0

1

2

3

4

5

MEN WOMEN

A B

0

20

40

60

80

100

SED LOW MOD HIGH

Leon et al (1987) Morris et al (1990) Shaper et al (1991)

Ekelund et al (1988) Lie et al (1993) Sandvik et al (1993)

Activity/Fitness level

Adapted from Sallis & Owen, 1998

Reduction in coronary mortality with activity/fitness

Reduction in coronary

mortality (%)

Thirds of Muscle Strength and Mortality, 8.762 Men, ACLS

05

10152025303540

Age adj death rate/10,000

MY

All-Cause CVD

LowMiddleHigh

503 deaths (145 CVD) during average follow-up of 18.9 years

Ruiz J et al. BMJ 2008

40.842 males & 12.943 females, ACLS

But, LET’s talk about EXERCISE.... Physical Activity: Bodily movement produced by the contraction of skeletal muscles that requires energy expenditure in excess of resting energy expenditure. Exercise: a subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness.

Moore SC, et al. (2012) Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. PLoS Med 9(11): e1001335.

N: 650.000 personas!!!

PA vs Exercise PA is good, but…

Exercise is BETTER!!

Black: CG; Blue: PA (walk); Red: AER; Green: AER+RT

Lab research: • Large number of published

studies • Conclusive: Exercise IS Medicine

Real world research:

• Low number of published studies

• Reliance on weak metrics (body weight, adherence, self report)

• Lack of control group (was it the exercise or something else that drove the positive effects……..?)

Evidence

Reports

Application!!

The Research Challenge**

… and Health improvement???

Hass, C.J. (2001). Sports Medicine 31 (14), 953 - 964

“Despite innovations in clothing and equipment design, modern trends in

nutrition and suplementation for athletes, and the genesis of drug taking in

sports,

the major factor influencing athletic performance is still TRAINING!!!”

(Rowbottom 2000, in Garret WE, Kirkendall DT. Exercise and Sport Science, LWW)

“The Power of Training”… 1) It can produce great changes!!!

2) It really cares HOW do you train…

General Adaptation Syndrome

Alarm reaction - the body detects and prepares to mount a response to an external stimuli or training stress; last days to weeks; athlete may experience short term soreness, stiffness and a drop in performance Adaptation - the body protectively responds and adapts to the training stress; neurological, structural and biochemical adaptations occur; supercompensation occurs in this stage

Exhaustion - Failure of the body to fully adapt to the stress; can occur as a result of sub-optimal training variety or when training stress is too great; monotony, overtraining and other training maladaptations may occur; non-training stresses may also contribute to exhaustion

Supercompensation

• Supercompensation refers to the desired, beneficial training effect that occurs in direct response to the applied training stress, and following a recovery period.

• Supercompensation is the return of the performance level from a point of reduced capacity that follows a training episode, beyond the pre-training level and to a new, higher performance baseline.

Supercompensation & Adaptation

Positive Adaptation Negative Adaptation

Figure 1 Figure 2

Figure 1 - note that the training effect brings the performance capacity back to a higher level

Figure 2 - note the inadequate recovery stage and its’ effect on adaptation

Planned variation in program variables.

Periodization: prevent overtraining and optimize peak performance through training cycles.

Periodization

Periodization

• Periodization – systematic variation of training specificity, intensity, and volume organized into planned periods or cycles within an overall program

• Training programs need to be varied in order to continually presenting the athlete with new demands and challenges

• Training variation helps to avoid plateauing of physical adaptations and psychological adjustments

• The positive outcome gained through a successful training program cannot continue indefinitely unless the training stimulus is constantly changed

“Traditional“ Periodization Model Matveyev’s Model (optimal for novice athletes)

Example of annual plan

Traditional Periodization model

Phase How long? Frequency Duration Intensity Volume

Prep 4-8 weeks High Short-Medium Very little Low

Base 12-24 weeks High Medium- High Moderate Moderate to

High

Build 4-8 weeks Moderate-High High Heavy Moderate

Peak/Race 3-5 weeks Moderate Short Heavy Low

Periodization Cycles

A Periodized training

program is divided into a number of different specific time periods;

Each with specific training goals and training emphasis

Macrocycle

Mesocycle Mesocycle Mesocycle Mesocycle

Micro Micro Micro Micro Micro Micro Micro Micro

Macrocycle – entire training period; typically one year but may last from months to 4 years

Mesocycle – lasts several weeks to months, depending on the goals of training and/or number of competitions within period

Microcycle – typically 1 week long, possibly up to 4 weeks; focuses on daily and weekly training variations

Example of Mesocycle

Periodization Periods

The planned implementation of the meso- and microcycles within an overall macrocycle is the basis for varying the training program design

Training Intensity & Volume are the most often manipulated variables

To avoid overtraining and to optimize performance, the concept of periodization involves shifting training priorities:

Conventional Periodization models include four distinct periods:

Non-sport-specific

High Volume

Low Intensity

Sport-specific

Low Volume

High Intensity

Preparatory 1st Transition Competition 2nd Transition

Linear Periodization

• Set 2 to 4 week phases of a given intensity and a given volume within a small range

8-12 cycle

6-8 cycle

3-5 cycle

1-3 cycle

Competition

Or Active Rest Cycle

Non-Linear (Undulating) Periodization

Non-Linear Periodized Program ___________________________________________________________ This protocol uses a 4 day rotation. Monday Wednesday 2 sets 12-15 RM (light day) 3 sets of 8-10 RM (Moderate Day) Friday Monday 3 sets of 4-6 RM (Heavy Day) Power day- 10 sets of 1-2 reps at 30% 1RM ____________________________________________________________

This systematic review identified 21 research studies that tested the impact of periodized exercise programs on health outcomes in sedentary adults.

The majority of studies assessed overweight and obese adults

Traditional periodization being the most prevalent method.

Health status/function

PA/Exercise

Health & Fitness

Cardiorrespiratory disorders

Metabolic disorders

Musculoskeletal disorders

Mental disorders

Active lifestyle Exercise!!

AER RT COMB

Epidemiology/prevalence Effects of PA/Exercise Evidence-based dose/response

Contraindications Assessment Exercise prescription!!

Public Health & Clinical Exercise Framework

Drugs effects

PA is good, Exercise is BETTER, but ...

We NEED more and better research and more clear evidences.

In the meantime, we have to be able to offer a customized exercise solution for any individual, evidence-based, safe and effective.

So, we will need to make us the proper questions...

Exercise Programme design Decision-making process Flow-chart (Jimenez, Esteve, 2008)

Sedentary individual needs

Needs related to Optimal dose

Personal, espatial and temporal

conditional factors

Optimal dose Identification??

Exercise specific priority goals Exercise content definition

Evidence-based Knowledge

Applying effective exercise to inactive population ... The “3 key Questions Law”!!!

#1

#2

#3

Initial tailored exercise intervention

Planning and Programming the Exercise load

Exercise Mode

Variable M1 RM1 M2 RM2 M3 RM3 M4 RM4 M5 RM5 M6 RM6

AT Int %

Vol RT Int RM

Vol. Flex Int PT

Vol TOTAL Time

0102030405060708090

m1 m2 m3 m4 m5 m6

Microciclos

Sum

ator

io d

el ti

empo

/mic

roci

clo

(min

) cardiofuerzaflex

Example of Training Log for Hypertensive individual (combination of PA + Exercise)

Date HR SH Walking (PA)

BP1 AER RT Other BP2 T.T. BP/hour V.Sub. (0-10)

Drug Dose/time Observations

Time Distance Comments PA AER RT Total

Weekly Summary Report

METs Kcal/hour Kcal/week

Let’s put everything in practice….

Case study: Inactive male 54 years old (bank employee).. 106kg BW. 1,72m high. SBP 142 mm Hg / DBP 96 mm Hg. Tcol: 225 mg/dl DHL: 35mg/dl; LDL: 138 mg/dl Glucose (fasting): 126 mg/dl Refers chronic pain in right knee. Medication: Ommeprazol for local inflammation of stomach

entry…

Initial 12 weeks of exercise

3 sessions/week 75min/session

Factor #1: Attitude

Factor #2: Ambition/+Stress

(positive activation threshold)

Factor #3: Training!!!

(learning-by-doing)

Thank you very much...

alfonso.jimenez@coventry.ac.uk