Prepared and presented byMohammad H. Kraizem

The study of the effects of exercise on the body. E Clinical Exercise Physiology-Involves the

application of exercise science to prevent and delay the onset of chronic disease in healthy participants or provide therapeutic or functional benefits to patients with underlying pathologies.

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Clinical Exercise physiologists are healthcare professionals who use fundamental principles of exercise physiology in clinical settings to minimize the risk of chronic diseases associated with physical inactivity and to treat those already afflicted.

Services may be provided in several medical settings such as: hospitals, rehabilitation centers, and outpatient clinics.nd delay the onset of chronic disease in healthy participants or provide therapeutic or functional benefits to patients with underlying pathologies

Specialized area of study mid 1960s and 1970s.

Late 1800s, the use of anthropometry to measure changes in students’ development after training programs.

McKenzie: Investigating effects of exercise on various systems of the body and the idea of preventative medicine (early 1900s)

After WWII: increased interest in fitness as a result of youth fitness tests and the results of the physicals of men in the military.

1970s: American Physiological Society recognized exercise physiology as a specialized area of physiology.

1974: ACSM: Guidelines for Graded Exercise Testing and Prescription

1980s and 1990s: Understanding of the relationship between physical activity and health. 1996:

2000: 1st certification exams for Clinical Exercise Physiologists

Effects of various exercises on various systems of the body

Relationship of energy metabolism to performance

Effectiveness of training programs Effects of environmental factors Effects of individual differences on fitness

development and performance

Identification of factors that limit performance

Effectiveness of various rehabilitation programs

Ergogenic aids and exercise Health and therapeutic effects associated

with exercise Effects of nutrition on performance

Services are also offered in community, corporate, commercial, university fitness and wellness centers, nursing homes, and senior citizen centers.

The scope of practice ranges from apparently healthy individuals with no known medical problems to patients with documented cardiovascular, pulmonary, metabolic, rheumatoid, orthopedic, and/or neuromuscular diseases and conditions.

Clinical exercise physiologists are responsible for: Exercise testing and evaluation and supervision of safe and effective exercise programs in a healthcare setting .

A knowledge of normal physiological responses to acute and chronic exercise is essential before attempting to prevent, manage, or rehabilitate disease.

Exercise Therapy may be altered by specific treatments such as drugs and medications, surgical procedures, radiation therapy, orthopedic bracing, casting, or splinting; dialysis, and diet therapy.

For example heart rate and blood pressure responses to exercise can be reduced significantly by a drug called Beta Adrenergic Blocking Agent which is commonly used to manage angina or hypertension.

itself can produce effects requiring alterations in other therapies the patient is receiving.

For example: It is often necessary for insulin dosages to be reduced in patients with Type I Diabetes because exercise changes the pharmacokinetics of subcutaneously injected drugs.

Clinical exercise Physiologists should have a solid background in basic exercise physiology combined with more advanced training, including pathophysiology of chronic diseases, pharmacology of drugs and medicines, medical terminology, medical record keeping and charting, ECG interpretation, exercise testing, business management and marketing, and nutrition and diet therapy

Cardiac rehabilitation Assessment of cardiovascular functioningPrevention of cardiovascular disease Rehabilitation of individuals with the disease

ä Effects of exercise at the cellular level ä Exercise epidemiology: Relationship

between physical activity and mortality ä Pediatric exercise science: Scientific

study of the response of the body to exercise during childhood and maturation.

ä Ability of the body’s systems to function efficiently and effectively.

ä One is “physically fit” if they have the ability to:

“carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies.”

An important tool in clinical settings to clear individuals for safe participation in physical activity and also as a basis for exercise prescription

Two broad classifications of exercise testing:

1. Diagnostic Testing- performed to see how sick someone is

2. Functional Capacity Testing- performed to see how well someone is

In other words the diagnostic test is performed to uncover underlying disease while the functional test is performed to determine the capacity for exercise.

Exercise tests, weather for diagnostic or functional purposes, are usually incremental in nature and as such are referred to as a graded exercise test (GXT).

Graded-means that the exercise is progressed in a stepwise fashion from light to maximum levels.

A number of Exercise Protocols are usually performed on the treadmill or cycle ergometer are available to the examiner, depending on the purpose of the test and the population being tested.

For example: The same GXT test would not be performed on a young adult as would be performed on a 70 year old person

Is extremely important in determining an individual’s suitability for an exercise program.

Exercise may not be safe for everyone especially people with pre-existing medical conditions, such as coronary artery disease.

For a limited number of individual, exercise TESTING alone could be harmful to them and should not be done for medical reasons.

Many patients require a physician’s referral before they can undergo exercise testing or enter into an exercise program.

The ACSM has developed guidelines to aid the healthcare professional in determining the safety of exercise for individuals.

These guidelines suggest that it is unnecessary for men under the age of 40 and women under the age of 50 who have no symptoms of heart disease and are apparently healthy, and have fewer than two risk factors for Coronary Artery

Disease to have a medical evaluation by a physician before starting an exercise program.

Exercise programs conducted in non-medical settings require a physician’s referral for anyone over the age of 35

Heart Rate Blood Pressure Blood Glucose Serum cholesterolResting ECG (before diagnostic test) Abnormalities in any of these measurements

may indicate underlying health problems such as heart disease, hypertension, or diabetes, which may warrant further medical evaluation before proceeding with the actual test. (Often expected in diagnostic testing)