Natalia Fernandez, PT, MS, MSc, CCS University of Michigan Health Care System Department of Physical Medicine and Rehabilitation.

Exercise Prescription Exercise Prescription is based on: Test Interpretation -Person’s Initial Fitness Goal of training Intensity Duration Frequency Mode

Exercise Prescription Principles

CDC Handout on Moderate and Vigorous Intensity Activities

Exercise Prescription FitnessHealthSeverely Deconditioned Sport or Competition 10+ METS Min+ 3-5 Days per week 70-85% HR Max RPE: Health 8-10 METS Accumulate Min Most Days per Week 50-70% HR Max RPE: Build Stamina <4-5 METS Tolerated Activity 3-5 Minutes Several Times per Day <50% of HR Max Gradual  time

Exercise Prescriptions Training HR Rate Range-Methods Age Adjusted Predicted Training Heart Rate Range [220- age] x (.50 to.70) HRR – Heart Rate Reserve/Karvonen Method HR threshold = HR rest (HR max - HR rest )

Methods of Prescribing Exercise Intensity

Level of Intensity

Cardiovascular Adaptations Heart Size Plasma Volume Heart Rate Cardiac Output Oxygen Extraction (a-v O2 difference) Blood Flow & Distribution Blood Pressure Pulmonary Function (TV RR) Body Composition Body Heat Transfer Performance Changes Psychological Benefits Immune Function All cause mortality Disease Risk Profile

Reversibility Principle Training is transient & reversible Detraining occurs rapidly Saltin et al., %  VO2 max following 20 days of bedrest in 5 college aged students

Reversibility Principle Detraining Consequences Cardiac output  8-10% Stroke Volume  10-13%  HR 4% Plasma Volume  12% a-v O2 difference  2-7% CP  27% ATP  15% Muscle glycogen  50% Oxidative enzymes  29-32% Lactate Threshold  7-18% Lipolysis  52%

Energy Conversions Power 1 Watt = 6 Kg meters/minute 1 Watt = 6 kpm 425 kpm = 1 Kcal 5 Kcals = 1 L O2 Exercise Time and Energy Cost for Health (150 kcals per day) 150kcals/#METS=minutes of exercise E.g. 150kcals/5 mets= 30 minutes of exercise

Submaximal Exercise Testing Submaximal Exercise Testing: Clinical Application and Interpretation, Vanessa Noonan and Elizabeth Dean, Physical Therapy, 2000;80:

References ACSM’s Guidelines for Exercise Testing and Prescription. 9 th Ed Monitoring Clinical Responses to Exercise, Joanne Watchie American Physical Therapy Association – Cardiovascular & Pulmonary Section Essentials of Cardiopulmonary Physical therapy, Ellen Hillegrass, 3 rd Ed, ACLS Provider Manual Supplementary Material, 2006 American Heart Association.