Prescribing Exercise (Chapter 4) PE 254

Terms Exercise: Exercise: Planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness Physical Activity: Physical Activity: Bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure

How much Physical Activity is Recommended? U.S.: everyone should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all days of the week (ACSM, CDC). everyone should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all days of the week (ACSM, CDC). MN31jdcm2XT69z8JQfrk2Q42JRDN! ! ?docId=

What Does Counseling Have To Do With Exercise Prescription? Need to take into account the psychological, emotional, and affective components of exercise as well as the physical aspects Need to take into account the psychological, emotional, and affective components of exercise as well as the physical aspects Psychological and socio- emotional aspects of problems surface frequently during exercise consultation Psychological and socio- emotional aspects of problems surface frequently during exercise consultation

General Exercise Counseling Roles Provide a climate for change and arrive at a prescription that is best for the client while meeting the requirements of the prescription Provide a climate for change and arrive at a prescription that is best for the client while meeting the requirements of the prescription Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers

First Steps Medical Clearance Medical Clearance Men over 40 and women over 50 Men over 40 and women over 50 Basic Principles of physical Training Basic Principles of physical Training Specificity Specificity Progressive overload Progressive overload Frequency Frequency Intensity Intensity Time Time Type Type Reversibility Reversibility Individual differences Individual differences Selecting Activities Selecting Activities 12

Pre-exercise Evaluation History Current and past exercise habits (mode, frequency, intensity, duration) Current and past exercise habits (mode, frequency, intensity, duration) Current motivation and barriers to exercise Current motivation and barriers to exercise Preferred forms of physical activity Preferred forms of physical activity Beliefs about benefits and risks of exercise Beliefs about benefits and risks of exercise Risk factors for heart disease (hypertension, diabetes mellitus, hyperlipidemia, smoking, family history of heart disease before 55 years of age) Risk factors for heart disease (hypertension, diabetes mellitus, hyperlipidemia, smoking, family history of heart disease before 55 years of age) Physical limitations precluding certain activities Physical limitations precluding certain activities Exercise-induced symptoms Exercise-induced symptoms Concurrent disease (cardiac, pulmonary, musculoskeletal, vascular, psychiatric, etc) Concurrent disease (cardiac, pulmonary, musculoskeletal, vascular, psychiatric, etc) Social support for exercise participation Social support for exercise participation Time and scheduling considerations Time and scheduling considerations Medication profile Medication profile

Indications for Exercise Stress Testing 1. Evaluation of patients with suspected coronary artery disease 1. Evaluation of patients with suspected coronary artery disease Typical angina pectoris Atypical angina pectoris 2. Evaluation of patients with known coronary artery disease 2. Evaluation of patients with known coronary artery disease After myocardial infarction After intervention 3. Screening of healthy, asymptomatic patients 3. Screening of healthy, asymptomatic patients Persons in high-risk occupations (e.g., pilots, firefighters, law enforcement officers, mass transit operators) Men over age 40 and women over age 50 who are sedentary and plan to start vigorous exercise Persons with multiple cardiac risk factors or concurrent chronic diseases 4. Evaluation of exercise capacity in patients with valvular heart disease (except severe aortic stenosis) 4. Evaluation of exercise capacity in patients with valvular heart disease (except severe aortic stenosis) 5. Patients with cardiac rhythm disorders 5. Patients with cardiac rhythm disorders Evaluation of exercise-induced arrhythmia and response to treatment Evaluation of rate-adaptive pacemaker setting

How to Approach and Get Past Roadblocks: I do not have time. We’re only talking about three 30 minute sessions each week. Can you do without three television shows a week? I am usually too tired to exercise. Regular activity will improve your energy level. Try and see for yourself. The weather is too bad. There are many activities you can do in your home, in any weather. Exercise is boring. Listening to music during your activity keeps your mind occupied. Walking, biking, or running can take you past lots of interesting scenery. I do not enjoy exercise. Do not exercise.. Start a hobby or an enjoyable activity that gets you moving. I get sore when I exercise. Slight muscle soreness after physical activity is common when you are just starting. It should go away in 2 to 3 days. You can avoid this by building up gradually and stretching after each activity.

Principles of Conditioning and Training SAID: Specific Adaptation to Imposed Demand

Warm-up Precaution against unnecessary musculoskeletal injury and soreness Precaution against unnecessary musculoskeletal injury and soreness May enhance certain aspects of performance May enhance certain aspects of performance Prepares body physiologically for physical work Prepares body physiologically for physical work Stimulates cardiorespiratory system, enhancing circulation and blood flow to muscles Stimulates cardiorespiratory system, enhancing circulation and blood flow to muscles Increases metabolic processes, core temperature, and muscle elasticity Increases metabolic processes, core temperature, and muscle elasticity

Cool-down Essential component of workout Essential component of workout Bring body back to resting state Bring body back to resting state 5-10 minutes in duration 5-10 minutes in duration Often ignored Often ignored Decreased muscle soreness following training if time used to stretch after workout Decreased muscle soreness following training if time used to stretch after workout

Exercise Intensity Beginner or low fitness level: 50% to 60% Beginner or low fitness level: 50% to 60% Intermediate or average fitness level: 60% to 70% Intermediate or average fitness level: 60% to 70% Advanced or high fitness level: 75% to 85% Advanced or high fitness level: 75% to 85%

Basic Elements of the Exercise Prescription Frequency Frequency Intensity Intensity Time Time Type Type

Exercise Intensity by Heart Rate

Exercise Intensity by Rating of Perceive Exertion (RPE) Why use RPE? Monitoring exercise intensity with the RPE scale is beneficial because: 1. It provides a double-check on heart rate, especially when the target heart-rate zone is estimated from age. 1. It provides a double-check on heart rate, especially when the target heart-rate zone is estimated from age. 2. Assessing RPE can be performed without stopping to ''check'' it, as is necessary with heart-rate monitoring. 2. Assessing RPE can be performed without stopping to ''check'' it, as is necessary with heart-rate monitoring. 3. There is no equipment you can buy to accurately describe your perception of intensity (whereas heart-rate monitors can be expensive for accurate pulse count). 3. There is no equipment you can buy to accurately describe your perception of intensity (whereas heart-rate monitors can be expensive for accurate pulse count).

Exercise Intensity by Rating of Perceive Exertion (RPE) 6 No exertion at all 7 Extremely light 8 9 Very light - (easy walking slowly at a comfortable pace) Light Somewhat hard (It is quite an effort; you feel tired but can continue) Hard (heavy) Very hard (very strenuous, and you are very fatigued) Extremely hard (You can not continue for long at this pace) 20 Maximal exertion

Exercise Intensity by Rating of Perceive Exertion (RPE) Level 1: I'm watching TV and eating bon bons Level 1: I'm watching TV and eating bon bons Level 2: I'm comfortable and could maintain this pace all day long Level 2: I'm comfortable and could maintain this pace all day long Level 3: I'm still comfortable, but am breathing a bit harder Level 3: I'm still comfortable, but am breathing a bit harder Level 4: I'm sweating a little, but feel good and can carry on a conversation effortlessly Level 4: I'm sweating a little, but feel good and can carry on a conversation effortlessly Level 5: I'm just above comfortable, am sweating more and can still talk easily Level 5: I'm just above comfortable, am sweating more and can still talk easily Level 6: I can still talk, but am slightly breathless Level 6: I can still talk, but am slightly breathless Level 7: I can still talk, but I don't really want to. I'm sweating like a pig Level 7: I can still talk, but I don't really want to. I'm sweating like a pig Level 8: I can grunt in response to your questions and can only keep this pace for a short time period Level 8: I can grunt in response to your questions and can only keep this pace for a short time period Level 9: I am probably going to die Level 9: I am probably going to die Level 10: I am dead Level 10: I am dead

Rate of Progression ACSM defines three stages: 1. Initial conditioning stage (1 – 4 weeks) 2. Improvement conditioning stage (4 – 5 months) 3. Maintenance conditioning stage (6 months and beyond)

Benefits of Exercise Improved cardiorespiratory function Improved cardiorespiratory function More efficient metabolism More efficient metabolism Improved body composition Improved body composition 6

Disease Prevention and Management Cardiovascular Disease Cardiovascular Disease Metabolic Syndrome Metabolic Syndrome Insulin resistance Insulin resistance High blood pressure High blood pressure Abnormal blood fats Abnormal blood fats Abdominal fat deposits Abdominal fat deposits Type 2 diabetes Type 2 diabetes Blood clotting abnormalities Blood clotting abnormalities Blood vessel inflammation Blood vessel inflammation Prevention Prevention Improves blood fat levels - improves HDL’s Improves blood fat levels - improves HDL’s Improves blood pressure Improves blood pressure Hypertension Hypertension Coronary heart disease Coronary heart disease Stroke Stroke Cancer Cancer Osteoporosis Osteoporosis Type II Diabetes Type II Diabetes 8

Improved Psychological and Emotional Wellness Reduced stress Reduced stress Reduced anxiety and depression Reduced anxiety and depression Improved self-image Improved self-image Learning and memory Learning and memory Enjoyment Enjoyment 9

Improved immune function Improved immune function Prevention of injures and low- back pain Prevention of injures and low- back pain Improved wellness for life Improved wellness for life Additional Benefits of Exercise 10

Walking for Fitness

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