guidelines for exercise prescription at the...
TRANSCRIPT
Guidelines for Exercise Prescription at the Office
Joseph Ihm, MD Assistant Professor
Rehabilitation Institute of Chicago Northwestern University Feinberg School
of Medicine
Disclosures
Nothing to disclose
Topics to be discussed ! Does a physician’s health
matter? ! Does counseling matter? ! How active are we? ! Screening prior to exercise ! Guidelines for fitness and
health ! Ways to communicate with
patients about activity, health and fitness
Physician habits and counselling What we do and know affects our patients ! 23-42% familiar with ACSM guidelines (Williford, 1992;
Costello 2012) ! 96% felt it was responsibility but only 28% felt confident
in their skills to prescribe exercise (Rogers, 2002) ! If exercises more likely to counsel patients (Rogers, 2005;
Abramson, 2000 (OR 4.55-5.72)) ! If healthy more likely to counsel (Wells, 1984) ! If trying to improve exercise habits more likely to counsel
(Frank, 2000) ! 70% more likely to comply if physician active (Harsha,
1996) ! More likely to comply if well dressed or well groomed
(Harsha, 1996)
Does counseling matter? ! Number who counsel
is increasing (Barnes, 2012)
! After 3-5 minutes of counseling moved from contemplator to active (Calfas, 1996)
! Improved fitness levels (JAMA, 2001)
How many are active?
! 48% meet 2008 Physical Activity Guidelines (activity and resistance training)
! 2010 – 64.5% active ! 2010 – 24.5% inactive CDC website
Screening prior to starting exercise MAJOR SIGNS OR SYMPTOMS SUGGESTIVE OF CARDIOVASCULAR, PULMONARY, OR METABOLIC DISEASE ! Pain, discomfort (or other anginal equivalent) in the
chest, neck, jaw, arms, or other areas that may result from ischemia
! Shortness of breath at rest or with mild exertion ! Dizziness or syncope ! Orthopnea or paroxysmal nocturnal dyspnea ! Unusual fatigue or shortness of breath with usual
activities ! Ankle edema ! Palpitations or tachycardia ! Intermittent claudication ! Known heart murmur
Screening prior to starting exercise Cardiovascular risk factors ! Age ! Family history ! Cigarette smoking ! Sedentary lifestyle ! Obesity ! Hypertension ! Dyslipidemia ! Prediabetes
ACSM risk stratification for CVD
! Low risk -- asymptomatic with < 2 risk factors
! Moderate risk -- asymptomatic with >1 risk factor
! High risk -- individuals with known cardiovascular, pulmonary, or metabolic disease, or one or more sign or symptom
and circumstances, the health status of the patient, and the training and experi-ence of the laboratory staff. Physicians responsible for supervising exercise test-ing should meet or exceed the minimal competencies for supervision and inter-pretation of results as established by the AHA (21). In all situations in whichexercise testing is performed, site personnel should at least be certified at a level
32 GUIDELINES FOR EXERCISE TESTING • www.acsm.org
RiskStratification
Low Risk Moderate RiskAsymptomatic Asymptomatic
≤1 Risk Factors ≥ 2 Risk Factors
High RiskSymptomatic, orknown cardiac,pulmonary, or
metabolic disease
Medical Exam & GXTbefore exercise?
Mod Ex - Not NecVig Ex - Not Nec
Medical Exam & GXTbefore exercise?
Mod Ex - Not NecVig Ex - Rec
Medical Exam & GXTbefore exercise?
Mod Ex - RecVig Ex - Rec
MD Supervision of Exercise Test?
Submax - Not NecMax - Not Nec
MD Supervision of Exercise Test?
Submax - Not NecMax - Rec
MD Supervision of Exercise Test?
Submax - RecMax - Rec
Mod Ex:
Vig Ex:
Not Nec:
Rec:
Moderate intensity exercise; 40-60% of VO2max; 3-6 METs; “an intensitywell within the individual’s capacity, one which can be comfortablysustained for a prolonged period of time (~45 minutes)”
Vigorous intensity exercise; > 60% of VO2max; > 6 METs; “exercise intenseenough to represent a substantial cardiorespiratory challenge”
Not Necessary; reflects the notion that a medical examination, exercisetest, and physician supervision of exercise testing would not be essentialin the preparticipation screening, however, they should not be viewed asinappropriate
Recommended; when MD supervision of exercise testing is“Recommended,” the MD shold be in close proximity and readily availableshould there be an emergent need
•
•
FIGURE 2.4. Exercise Testing and Testing Supervision Recommendations Based on RiskStratification.
LWBK119-3920G_CH02_18-40.qxd 10/20/08 11:25 AM Page 32 Aptara Inc.
and circumstances, the health status of the patient, and the training and experi-ence of the laboratory staff. Physicians responsible for supervising exercise test-ing should meet or exceed the minimal competencies for supervision and inter-pretation of results as established by the AHA (21). In all situations in whichexercise testing is performed, site personnel should at least be certified at a level
32 GUIDELINES FOR EXERCISE TESTING • www.acsm.org
RiskStratification
Low Risk Moderate RiskAsymptomatic Asymptomatic
≤1 Risk Factors ≥ 2 Risk Factors
High RiskSymptomatic, orknown cardiac,pulmonary, or
metabolic disease
Medical Exam & GXTbefore exercise?
Mod Ex - Not NecVig Ex - Not Nec
Medical Exam & GXTbefore exercise?
Mod Ex - Not NecVig Ex - Rec
Medical Exam & GXTbefore exercise?
Mod Ex - RecVig Ex - Rec
MD Supervision of Exercise Test?
Submax - Not NecMax - Not Nec
MD Supervision of Exercise Test?
Submax - Not NecMax - Rec
MD Supervision of Exercise Test?
Submax - RecMax - Rec
Mod Ex:
Vig Ex:
Not Nec:
Rec:
Moderate intensity exercise; 40-60% of VO2max; 3-6 METs; “an intensitywell within the individual’s capacity, one which can be comfortablysustained for a prolonged period of time (~45 minutes)”
Vigorous intensity exercise; > 60% of VO2max; > 6 METs; “exercise intenseenough to represent a substantial cardiorespiratory challenge”
Not Necessary; reflects the notion that a medical examination, exercisetest, and physician supervision of exercise testing would not be essentialin the preparticipation screening, however, they should not be viewed asinappropriate
Recommended; when MD supervision of exercise testing is“Recommended,” the MD shold be in close proximity and readily availableshould there be an emergent need
•
•
FIGURE 2.4. Exercise Testing and Testing Supervision Recommendations Based on RiskStratification.
LWBK119-3920G_CH02_18-40.qxd 10/20/08 11:25 AM Page 32 Aptara Inc.
8th Edition, 2009
9th Edition, 2013
Differentiate activity and exercise ! Activity
! Any bodily movement produced by skeletal muscles that results in increased energy expenditure
! May not change fitness level greatly ! Exercise
! Planned, structured and repetitive activity ! Should improve or maintain fitness
Recommendations for Adults ! 150 minutes per week mod
intensity ! 75 minutes per week of
vigorous intensity ! Combinations of mod and
vigorous can be done ! If exceeded then greater
fitness and health benefits
-2008 Physical Activities Guidelines for Americans -Haskell, et al. Med Sci Sport and Exercise, 2007
Copyright @ 200 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.7
The health benefits of various combinations of moderate-and vigorous-intensity activity have not been sufficientlyexamined in observational studies nor investigated usingrandomized controlled trials. However, based on healthoutcome data from observational studies and an extensivedatabase on the energy costs of various activities, thefollowing approach is recommended for determining whatcombinations of moderate- and vigorous-intensity activitiesmeet the dose recommendation.
A shorthand method for estimating energy expenditureduring physical activity is the MET or metabolic equivalent(1). One MET represents an individual’s energy expenditurewhile sitting quietly. An adult walking at 3 mph on a flat,hard surface is expending about 3.3 METs and whilejogging/running on a similar surface at 5 mph (12 min permile pace) is expending approximately 8 METs (see Table 2for the MET values of selected activities). Thus, if aman or women walked at 3 mph (moderate-intensity) for30 min they would accumulate 99 METImin of activity(3.3 MET ! 30 min = 99 METImin), but if they joggedat 5 mph for 20 min they would accumulate 160 METImin(8 MET ! 20 min = 160 METImin). So, if a man or womenwas to meet the minimum moderate intensity recommenda-tion by walking for 30 min at 3 mph on 5 days of the week,they would accumulate about 495 METImin (99 ! 5), or tomeet the minimum vigorous-intensity recommendation byjogging at 5 mph for 20 min on 3 days they would accumu-
late about 480 METImin (160 ! 3). Also, they could meetthe recommendation by walking at 3.0 mph for 30 min on2 days (3.3 MET ! 60 min = 198 METImin) and thenjogging at 5 mph for 20 min on 2 other days (8 MET !40 min = 320 METImin) for a total during the week ofabout 518 METImin (320 + 198).
Using METs as an indicator of activity intensity allowsgenerally healthy adults to accumulate credit for thevarious moderate or vigorous intensity activities theyperform during the week. When combining moderate andvigorous intensity activity to meet the current recommen-dation, the minimum goal should be in the range of 450 to750 METIminIwkj1. These values are based on the METrange of 3 to 6 for moderate-intensity activity and150 minIwkj1 (3 ! 150 = 450 and 5 ! 150 = 750).Individuals should start at the lower end of this rangewhen beginning an activity program and progress towardsthe higher end as they become more fit. Listed in Table 2are the MET values for a variety of physical activities thatare of light, moderate or vigorous intensity. For acomprehensive listing of MET values see tabulation byAinsworth and colleagues (1) or the following Web site:http://prevention.sph.sc.edu/tools/compendium.htm. It isrecognized that actual MET values can vary from personto person depending on a variety of factors (e.g., how theyperform the activity, skill level, body composition), but thevalues provided in the compendium are sufficiently accurate
TABLE 2. MET equivalents of common physical activities classified as light, moderate or vigorous intensity.
Light G3.0 METs Moderate 3.0 – 6.0 METs Vigorous 96.0 METs
Walking Walking Walking, jogging & runningWalking slowly around home,store or office = 2.0*
Walking 3.0 mph = 3.3* Walking at very very brisk pace (4.5 mph) = 6.3*
Walking at very brisk pace (4 mph) = 5.0* Walking/hiking at moderate pace and grade with no orlight pack (G10 lb) = 7.0
Hiking at steep grades and pack 10–42 lb = 7.5–9.0Jogging at 5 mph = 8.0*Jogging at 6 mph = 10.0*Running at 7 mph = 11.5*
Household & occupationSitting — using computer work at desk usinglight hand tools = 1.5
Cleaning — heavy: washing windows, car,clean garage = 3.0
Shoveling sand, coal, etc. = 7.0
Standing performing light work such asmaking bed, washing dishes, ironing,preparing food or store clerk = 2.0–2.5
Sweeping floors or carpet, vacuuming,mopping = 3.0–3.5
Carrying heavy loads such as bricks = 7.5
Carpentry — general = 3.6 Heavy farming such as bailing hay = 8.0Carrying & stacking wood = 5.5 Shoveling, digging ditches = 8.5Mowing lawn — walk power mower = 5.5
Leisure time & sportsArts & crafts, playing cards = 1.5 Badminton — recreational = 4.5 Basketball game = 8.0Billiards = 2.5 Basketball — shooting around = 4.5 Bicycling — on flat: moderate effort (12–14 mph) = 8.0;
fast (14–16 mph) = 10Boating — power = 2.5 Bicycling — on flat: light effort (10–12 mph) = 6.0 Skiing cross country — slow (2.5 mph = 7.0;
fast (5.0–7.9 mph) = 9.0Croquet = 2.5 Dancing — ballroom slow = 3.0;
ballroom fast = 4.5Soccer — casual = 7.0; competitive = 10.0
Darts = 2.5 Fishing from river bank & walking = 4.0 Swimming — moderate/hard = 8–11†Fishing — sitting = 2.5 Golf — walking pulling clubs = 4.3 Tennis singles = 8.0Playing most musical instruments = 2.0–2.5 Sailing boat, wind surfing = 3.0 Volleyball — competitive at gym or beach = 8.0
Swimming leisurely = 6.0†Table tennis = 4.0Tennis doubles = 5.0Volleyball — noncompetitive = 3.0–4.0
Ainsworth, et al. 2000 (1). * On flat, hard surface. † MET values can vary substantially from person to person during swimming as a result of different strokes and skill levels.
http://www.acsm-msse.org1428 Official Journal of the American College of Sports Medicine
SPEC
IALCO
MMUNICAT
IONS
Haskell, 2007
ACSM Position Stand, 2011
fixedexercise
volumes
onfitness
andbiom
arkersof
dis-ease.
Chu
rchet
al.(76)
evaluatedthe
effectof
varyingex-
ercisevolum
esat
afixed
intensity(50%
V̇O2max )
insedentary,
overweight,
orobese
postm
enopausal
wom
enrandom
izedto
exercisevo
lumes
of50%
,10
0%,or
150%
ofthe
recommended
weekly
energyexpenditure
(4,8,
and12
kcalIkgj1Iw
kj1,respectively;
orapproxim
ately330,
840,and
1000kcalIw
kj1,
respectively).A
dose–responseeffect
acrossthe
threevolum
eswas
observed,and
modest
im-
provements
incardiorespiratory
fitness(4%
–8%)occurred
at6months
atexercisetraining
volumesas
lowas
one-halfoftherecom
mended
weekly
volume.Aprelim
inaryreport
suggeststhatinitialleveloffitness
may
affectthetraining
responsestoa
setvolum
eof
exercise(18),
butmore
definitiveevidence
isneeded
beforethe
resultsof
thesestudies
canbe
generalizedto
personsof
higherfitness
levels.
HOW
AREEXERCISEIN
TENSITYAND
VOLUMEESTIM
ATED?
Most
epidemiologic
andmany
laboratorystudies
provid-ing
evidenceof
thebeneficial
effectsof
exercisehave
clas-sified
intensityaccording
tothe
absoluteenergy
demands
ofthe
physicalactivity
(323).Measured
orestim
atedmeasures
ofabsolute
exerciseintensity
includecaloric
expenditure(kcalIm
inj1),absolute
oxygenuptake
(mLIminj1or
LIminj1),
andMETs.These
absolutemeasures
canresult
inmisclassi-
ficationof
exerciseintensity
(e.g.,moderate,
vigorous)be-
causethey
donot
considerindividual
factorssuch
asbody
weight,
sex,and
fitnesslevel
(4,58,173).Measurem
ent—and
consequentlymisclassification—
erroris
greaterwhen
usingestim
atedrather
thandirectly
measured
absoluteenergy
ex-penditure,
andunder
free-livingcom
paredwith
laboratoryconditions
(4,58,173).For
example,
anolder
personworking
at6METsmay
beexercising
atavigorous
tomaxim
alin-
tensity,while
ayounger
personworking
atthe
sameabsolute
intensitywill
beexercising
moderately
(173).Therefore,
forindividual
exerciseprescription,
arelative
measure
ofinten-
sity(i.e.,
theenergy
costof
theactivity
relativeto
theindi-
vidual’smaxim
alcapacity)ismore
appropriate,especiallyfor
olderand
deconditionedpersons
(173,264).There
areseveral
commonly
usedmethods
ofestim
atingrelative
exerciseintensity
duringcardiorespiratory
exercise:V̇O2 R
,HRR,percent
ofthe
maxim
umHR
(%HRmax ),
%V̇O2max ,
and%METmax .
Each
ofthese
methods
forpre-
scribingexercise
intensityhas
beenshow
nto
resultin
improvem
entsin
cardiorespiratoryfitness
when
usedfor
exerciseprescription,
thencecan
berecom
mend
edwhen
prescribingexercise
foran
individual(12).
Table
5show
sthe
approximate
classificationof
exerciseintensity
usingrelative
andabsolute
methods
commonly
usedin
practice.
No
studieshave
compared
allof
themethod
sof
measurem
entof
exerciseintensity
simulta-
neously;therefore,
itcannot
beassum
edthat
onemethod
ofdeterm
iningexercise
intensityis
necessarilyequivalent
tothat
derivedusing
anothermethod.
Itis
prudentto
keepin
TABLE 5. Classification of exercise intensity: relative and absolute exercise intensity for cardiorespiratory endurance and resistance exercise.
Cardiorespiratory Endurance Exercise Resistance Exercise
Relative IntensityIntensity (%V̇O2max)) Relative to
Maximal Exercise Capacity in METsAbsoluteIntensity
Absolute Intensity(MET) by Age Relative Intensity
Intensity%HRR or%V̇O2R %HRmax %V̇O2max
Perceived Exertion(Rating on 6–20 RPE Scale)
20 METs%V̇O2max
10 METs%V̇O2max
5 METs%V̇O2max METs
Young(20–39 yr)
Middle-aged(40–64 yr) Older (Q65 yr) % 1RM
Very light G30 G57 G37 GVery light (RPE G 9) G34 G37 G44 G2 G2.4 G2.0 G1.6 G30Light 30–39 57–63 37–45 Very light–fairly light
(RPE 9–11)34–42 37–45 44–51 2.0–2.9 2.4–4.7 2.0–3.9 1.6–3.1 30–49
Moderate 40–59 64–76 46–63 Fairly light to somewhathard (RPE 12–13)
43–61 46–63 52–67 3.0 to 5.9 4.8–7.1 4.0–5.9 3.2–4.7 50–69
Vigorous 60–89 77–95 64–90 Somewhat hard to veryhard (RPE 14–17)
62–90 64–90 68–91 6.0–8.7 7.2–10.1 6.0–8.4 4.8–6.7 70–84
Near–maximalto maximal
Q90 Q96 Q91 QVery hard (RPE Q 18) Q91 Q91 Q92 Q8.8 Q10.2 Q8.5 Q6.8 Q85
Table adapted from the American College of Sports Medicine (14), Howley (173), Swain and Franklin (344), Swain and Leutholtz (346), Swain et al. (347), and the US Department of Health and Human Services (370).HRmax, maximal HR; %HRmax, percent of maximal HR; HRR, HR reserve; V̇O2max, maximal oxygen uptake; %V̇O2max, percent of maximal oxygen uptake; V̇O2R, oxygen uptake reserve; RPE, ratings of perceived exertion (48).
QUANTITYANDQUALIT
YOFEXERCISE
Med
icine&Science
inSports
&Exercise
d1341
SPECIALCOMMUNICATIONS
Copyright ©
2011 by the Am
erican College of S
ports Medicine. U
nauthorized reproduction of this article is prohibited.
fixedexercise
volumes
onfitness
andbiom
arkersof
dis-ease.
Church
etal.
(76)evaluated
theeffect
ofvarying
ex-ercise
volumes
ata
fixedintensity
(50%V̇O2max )
insedentary,
overweight,
orobese
postmenopau
salwom
enrandom
izedto
exercisevolum
esof
50%,100%
,or
150%of
therecom
mended
weekly
energyexpenditure
(4,8,
and12
kcalIkgj1Iw
kj1,respectively;
orapproxim
ately330,
840,and
1000kcalIw
kj1,
respectively).A
dose–responseeffect
acrossthe
threevolum
eswas
observed,and
modest
im-
provements
incardiorespiratory
fitness(4%
–8%)occurred
at6months
atexercisetraining
volumesas
lowas
one-halfoftherecom
mended
weekly
volume.Aprelim
inaryreport
suggeststhatinitialleveloffitness
may
affectthetraining
responsestoa
setvolum
eof
exercise(18),
butmore
definitiveevidence
isneeded
beforethe
resultsof
thesestudies
canbe
generalizedto
personsof
higherfitness
levels.
HOW
AREEXERCISEIN
TENSITYAND
VOLUMEESTIM
ATED?
Most
epidemiologic
andmany
laboratorystudies
provid-ing
evidenceof
thebeneficial
effectsof
exercisehave
clas-sified
intensityaccording
tothe
absoluteenergy
demands
ofthe
physicalactivity
(323).Measured
orestim
atedmeasures
ofabsolute
exerciseintensity
includecaloric
expenditure(kcalIm
inj1),absolute
oxygenuptake
(mLIminj1or
LIminj1),
andMETs.These
absolutemeasures
canresult
inmisclassi-
ficationof
exerciseintensity
(e.g.,moderate,
vigorous)be-
causethey
donot
considerindividual
factorssuch
asbody
weight,
sex,and
fitnesslevel
(4,58,173).Measurem
ent—and
consequentlymisclassification—
erroris
greaterwhen
usingestim
atedrather
thandirectly
measured
absoluteenergy
ex-penditure,
andunder
free-livingcom
paredwith
laboratoryconditions
(4,58,173).For
example,
anolder
personworking
at6METsmay
beexercising
atavigorous
tomaxim
alin-
tensity,while
ayounger
personworking
atthe
sameabsolute
intensitywill
beexercising
moderately
(173).Therefore,
forindividual
exerciseprescription,
arelative
measure
ofinten-
sity(i.e.,
theenergy
costof
theactivity
relativeto
theindi-
vidual’smaxim
alcapacity)ismore
appropriate,especiallyfor
olderand
deconditionedpersons
(173,264).There
areseveral
commonly
usedmethods
ofestim
atingrelative
exerciseintensity
duringcardiorespiratory
exercise:V̇O2 R
,HRR,percent
ofthe
maxim
umHR
(%HRmax ),
%V̇O2max ,
and%METmax .
Each
ofthese
methods
forpre-
scribingexercise
intensityhas
beenshow
nto
resultin
improvem
entsin
cardiorespiratoryfitness
when
usedfor
exerciseprescription,
thencecan
berecom
mend
edwhen
prescribingexercise
foran
individual(12).
Table
5show
sthe
approximate
classificationof
exerciseintensity
usingrelative
andabsolute
methods
commonly
usedin
practice.No
studieshave
compared
allof
themethod
sof
measurem
entof
exerciseintensity
simulta-
neously;therefore,
itcannot
beassum
edthat
onemethod
ofdeterm
iningexercise
intensityis
necessarilyequivalent
tothat
derivedusing
anothermethod.
Itis
prudentto
keepin
TABLE 5. Classification of exercise intensity: relative and absolute exercise intensity for cardiorespiratory endurance and resistance exercise.
Cardiorespiratory Endurance Exercise Resistance Exercise
Relative IntensityIntensity (%V̇O2max)) Relative to
Maximal Exercise Capacity in METsAbsoluteIntensity
Absolute Intensity(MET) by Age Relative Intensity
Intensity%HRR or%V̇O2R %HRmax %V̇O2max
Perceived Exertion(Rating on 6–20 RPE Scale)
20 METs%V̇O2max
10 METs%V̇O2max
5 METs%V̇O2max METs
Young(20–39 yr)
Middle-aged(40–64 yr) Older (Q65 yr) % 1RM
Very light G30 G57 G37 GVery light (RPE G 9) G34 G37 G44 G2 G2.4 G2.0 G1.6 G30Light 30–39 57–63 37–45 Very light–fairly light
(RPE 9–11)34–42 37–45 44–51 2.0–2.9 2.4–4.7 2.0–3.9 1.6–3.1 30–49
Moderate 40–59 64–76 46–63 Fairly light to somewhathard (RPE 12–13)
43–61 46–63 52–67 3.0 to 5.9 4.8–7.1 4.0–5.9 3.2–4.7 50–69
Vigorous 60–89 77–95 64–90 Somewhat hard to veryhard (RPE 14–17)
62–90 64–90 68–91 6.0–8.7 7.2–10.1 6.0–8.4 4.8–6.7 70–84
Near–maximalto maximal
Q90 Q96 Q91 QVery hard (RPE Q 18) Q91 Q91 Q92 Q8.8 Q10.2 Q8.5 Q6.8 Q85
Table adapted from the American College of Sports Medicine (14), Howley (173), Swain and Franklin (344), Swain and Leutholtz (346), Swain et al. (347), and the US Department of Health and Human Services (370).HRmax, maximal HR; %HRmax, percent of maximal HR; HRR, HR reserve; V̇O2max, maximal oxygen uptake; %V̇O2max, percent of maximal oxygen uptake; V̇O2R, oxygen uptake reserve; RPE, ratings of perceived exertion (48).
QUANTITYANDQUALIT
YOFEXERCISE
Med
icine&Science
inSports
&Exercise
d1341
SPECIALCOMMUNICATIONS
Copyright ©
2011 by the Am
erican College of S
ports Medicine. U
nauthorized reproduction of this article is prohibited.
Increase aerobic fitness ! 60-70% of max heart rate
! 30y/o – 114-133 bpm ! 50y/o – 102-119 bpm
! 20-30 minutes at 70% or 45-60 minutes at 60%
! 3+ days per week ! Higher the intensity the
greater the improvement ! If more fit then more
calories per workout
Measuring intensity ! Borg rated perceived exertion scale ! Talk test (Quinn, 2009) ! Counting Talk Test (Loose, 2012) ! Heart rate (by palpation or monitor) ! Pedometer – steps/min and recommended time
Resistance training ! Most or all muscle
groups (8-10 exercises) ! 2 or more days per week ! 1-3 sets per exercise ! 65-75% of 1 rep max ! 10-15 reps per set ! Screen for orthopedic
and cardiac conditions ! Variable motivation and
tolerance
Flexibility ! Two or three days each
week ! Hold for 10-30 seconds to
the point of tightness ! Accumulate 60 seconds
per stretch ! Static, dynamic, ballistic
and PNF ! Most effective when the
muscle is warm
From ACSM website
Discussing activity with patients ! Assess current activity level ! Discuss ways to increase
activity ! Provide options for
increasing fitness level ! Do not accept “I walk
everywhere” or “My house has a lot of stairs” as confirming adequate activity
! Try to impress consequences of inadequate activity
Conclusions ! Encourage patients to be active ! Use other resources for patients
! Exercise is Medicine website ! www.health.gov/paguidelines/guidelines/ ! www.cdc.gov/physicalactivity/everyone/
guidelines/index.html