Designing Cardiorespiratory Exercise Program

Guidelines For Exercise Prescription For Improved Health Aerobic exercise program develop maintain improve reduce Cardiorespiratory endurance Health status Disease risk US Dept. of Health& Human Service, 1996 need interests age gender physical fitness level exercise habits 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.

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

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

Exercise prescription for cardiorespiratory fitness Mode of exercise Intensity of exercise Duration of exercise Frequency of exercise Rate of progression Stages of progression Essentials of a cardiorespiratory exercise workout Aerobic training methods and modes Continuous training Discontinuous training Personalized exercise programs Case study

Modes of exercise Large 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

Classification of Aerobic Exercise Modalities 1998, V.H. Heyward Classification of Aerobic Exercise Modalitiesa Group I activities Cycling (indoor) Jogging Running Walking Rowingb Stair climbingb Simulated climbingb Nordic skiingb Aerobic ridingbc Group II activities Aerobic dancing Bench step aerobic Nordic skiing (outdoor) Hiking Rope skipping Swimming Water aerobic Group II Iactivities Basketball Country and western dancing Handball Racquet sport Volleyball Super 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 activies c May not provide adequate training intensity for above-average fitness levels

Which mode of exercise leads to the greatest improvement? 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)

How easy the exercise intensity can be graded and adjusted in order to overload the cardiorespiratory system throughout 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.

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 Risk of injury Higher intensity 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 low initial cardiorespiratory fitness level. intensity can be prescribed using MET, HR, or RPE methods

MET method step1. Asses VO2max using a graded exercise test step 2. Determine the minimum, average, and maximum intensity For example: VO2max is 35 ml/kg/min 35 ml/kg/min = 10 METs Minimum 40% - 4 METs Maximum 85% - 8.5 METs Average 60-70% - 6-7 METs The exercise prescription for this case, an apparently healthy, active person should include activities that produce an average intensity of 6 -7 METs.

Now, you have the required exercise intensity in METs. How to use 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/min 2. 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/min 3. Convert speed to mi/hr 122.5 ÷ 26.8 = 4.57 mi/hr 4. Convert mi/hr to minute per mile pace Pace = 60 min/hr ÷ 4.75 mi/hr = 13.1 min.mi

Heart Rate method Based on the assumption that HR is a linear function of exercise intensity HR vs. MET graphing method Percentage of maximal HR reserve (% HRR) method Percentage of maximal HR (% HRmax) method

HR vs. MET graphing method

Prescription of Exercise Intensity Percentage of maximal HR reserve (% HRR) method Target HR=(% HRR) x (HR max - HR rest) + HR rest ACSM : 50-85 % HRR Age 42 HR max 220 - 42 = 178 bpm Resting HR = 68 bpm Exercise intensity = 60% HRR Target 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 70 Average HR 50-60 70-75 80-85 Maximum HR 75 85 90 Target HR = % HRR (HRmax –HRrest) + HRrest

Percentage of maximal HR (% HRmax) method % of HR max is related to % of VO2max 69-89 % HR max correspond to 50-80 % VO2max ACSM : 60-90 % HRmax age 40, HR rest 80 bpm ACSM % HRmax x 1.15 126 x 1.15 =145 bpm % HRR 70% x (180 - 80) + 80 = 150 bpm % HRmax 70 % X 180 = 126 bpm

Comparison of Methods for Prescribing Exercise Intensity for Healthy Adults

Please consider alternative methods for monitoring Limitations of HR methods Using HR exclusively to develop intensity recommendations for your clients’ exercise prescriptions may lead to large errors in estimating relative exercise intensity (% VO2max) for some individuals. This is especially true when HRmax is predicated from age (220-age) instead of being directly measured. In about 30% of population, an age-predicted prescription of 60% HRR may be as low as 70% and as high as 80% of the actual HRmax (Dishman 1994). Also, medication, emotional state, and environmental factors such as temperature, humidity, and air pollution can affect your clients’ exercise training heart rate. Please consider alternative methods for monitoring exercise intensity - combination of HR and RPE

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 et al. 1992) RPE Intensity HRR 11 light 50% 12 minimum 13 somewhat hard 60% 16 hard maximum 85% 17 very hard Advantage do not need to check HR

Duration of exercise ACSM - 20-30 minutes of continuous aerobic activity Apparently health can sustain 60-85%VO2max 20-30 minutes Sedentary 40-60% VO2max 20-30 min Poorly conditioned 40% VO2max 10 minutes Multiple sessions/ day to accumulate 20 to 30 min

Caloric cost of exercise can be used to estimate the duration of exercise ACSM - minimal thresholds of 150 - 300 kcal /session or 800 -900 kcal / week Initial stage : 200 - 600 kcal / week Through improvement stage : goal is increase from 800 to 2000 kcal / week by gradually increasing frequency, 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/min 300 kcal ÷7 kcal/min = 43 min Exercise Prescription: duration 43 min, frequency 5 / week intensity 7 METs anything else?

Frequency of exercise ACSM : 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

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 system must 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

Physiological Changes Induced by Cardiorespiratory Endurance Training

Initial conditioning stage Improvement stage Maintenance stage Stages of progression I, F, D periodically Overload to cadio. / mus. progressively Continued improvements gradually one element at a time Initial conditioning stage Improvement stage Maintenance stage Older / less fit D, not I

Initial conditioning stage lasts 4 - 6 weeks time to familiar with exercise training prescribe stretching exercise low-intensity aerobic exercise low-intensity resistance exercise ACSM : 40-60%VO2max; at least 12-15 min; 20 min in 4 - 6 weeks; 2 - 3 times / week Have your clients progress slowly by increasing exercise duration first, followed by small increases in exercise intensity.

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

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 to 2-3 / week a variety of enjoyable physical activities helps to counteract boredom and to maintain the client’s interest level

Conditioning phase - 20 - 60 min Essentials of a cardiorespiratory exercise workout blood flow to working muscle body temperature Warm-up 5 - 10 min Chance of muscle and joint injury Chance of abnormal cardiac rhythms Conditioning phase - 20 - 60 min Cool-down 5 min low intensity Prevents pooling of blood in extremities Reduces possibility of dizziness / fainting Stretching exercises reduce chance of muscle cramps / muscle soreness

Personalized Exercise Programs Training goal age gender Physical fitness level Exercise preferences

Medical history Physical condition Prior to Designing exercise program Lifestyle characteristics interests Summarize info in Accurate / safe individualized exercise program Case study Supply info for