Author name here for Edited books chapter 5 5 Designing Cardiorespiratory Exercise Programs chapter

Objectives Identify the basic components of a cardiorespiratory (CR) exercise program Tailor exercise prescriptions to meet an individual’s goals Identify exercise modalities for CR programming Differentiate between various CR programming techniques Identify the physiological benefits of CR program adherence Understand dose–response relationships for frequency, intensity, and duration as they pertain to aerobic fitness

The Art of Exercise Prescription Exercise program must meet client’s needs and interests; what is the client’s goal? Programming for improved health is different than programming for cardiorespiratory fitness. The key is individualization.

Elements of CR Workout 1.Warm-up: increase blood flow (5-10 min) 2.Endurance: aerobic conditioning (20-60 min) 3.Cool-down: reduce cardiovascular complication risk (5-10 min) 4.Stretching: reduce chance of soreness and cramps (≥10 min)

Prescription for Improved Health FITT Principle –Frequency: most, preferably all days of the week –Intensity: moderate-intensity (3-6 METs) –Time: 150 to 300 minutes/week; varies related to intensity –Type: modality of endurance-type activities

Prescription for CR Fitness Frequency: 3 to 5 days a week Intensity: related to initial fitness status; use %heart rate reserve (HRR) or VO 2 reserve (VO 2 R) Time: 20 to 60 minutes continuous exercise Mode: rhythmic, aerobic, large muscle groups Progression: based on conditioning effect..

Modalities for CR prescriptions Large muscle groups Rhythmic Provide mechanism to initially monitor intensity Progress from type A modalities to types B and C as skill and fitness levels increase Include type D modalities in addition to regular program; great for adding variety

Classification of Aerobic Exercise Modalities

Alternative CR Modalities Options are available beyond traditional CR modalities. Varying levels of perceived exertion (RPE) exist for a given HR or %VO 2 max response. Cycling has high localized fatigue in legs. Some result in higher HR than when on a treadmill exercising at a similar %VO 2 max. At the same RPE, a treadmill produces greater energy expenditure...

Figure 5.1

Figure 5.2

How to Progress CR Workload Increase treadmill speed and incline. Increase cycling rpm and resistance. Increase step cadence and height for aerobic or bench stepping. Include upper body component or use light hand weights with lower body exercise. Increase velocity for in-line skating.

Selecting CR Modality for Older Adults Focus on functional, enjoyable, convenient exercises. Walking and tai chi are good options. Consider the following: –Deteriorating vision –Neuromuscular coordination challenges –Musculoskeletal challenges

Selecting Intensity ACSM recommends using %VO 2 reserve (%VO 2 R) over other options. What is VO 2 R? VO 2 R = (VO 2 max (or peak) – VO 2 rest) –Directly related to aerobic fitness –Forms the basis of exercise prescription –Equates (1:1) with Heart Rate Reserve (HRR) –Can also substitute METS for VO 2 –Rest = 3.5 ml/kg/min = 1 MET

Prescribing Exercise by VO 2 R For sedentary or individuals with poor initial fitness: Start in range 30% to 45% VO 2 R. For healthy individuals: Start in range 40% to 85% VO 2 R. To improve CR fitness: Exercise in range 55% to 80% VO 2 R. To keep improving CR fitness: Systematically increase % VO 2 R......

Example Using VO 2 R Assume VO 2 max = 50 ml/kg/min and target intensity is 60% to 80%VO 2 R. VO 2 R = 50 – 3.5 = 46.5 ml/kg/min Target VO 2 = (.60 x 46.5) Target VO 2 = = 31.4 ml/kg/min Target VO 2 = (.80 x 46.5) Target VO 2 = = 40.7 ml/kg/min

Example Using METs Assume VO 2 max = 10 METs and target intensity is 50% of VO 2 R. Target VO 2 = [.50 x (10 – 1)] + 1 Target VO 2 = (.50 x 9) + 1 Target VO 2 = = 5.5 METs Can now convert METs to ml/kg/min......

Calculating Running Speed at 8 METs 8 METs = 8 x 3.5 = 28 ml/kg/min 28 ml/kg/min = [(speed m/min) x 0.2] Isolate speed 28 – 3.5 = [(speed m/min) x 0.2] 24.5 ÷ 0.2 = (speed m/min) m/min = speed Convert to mph ÷ 26.8 = 4.57 mph

Calculate Running Pace From MPH Pace = [(60 min/hr)/mph] Pace = 60 ÷ 4.57 (from previous example) Pace = 13.1 min/mi (or 8.1 min/km)

Words of Caution About METs MET values in Compendium. MET values differ for youth and adults. Values are estimates of energy expenditure. Environmental factors and skill level can influence actual energy expenditure. Better to use METs plus either HR or RPE to keep client safe.

Exercise Intensity Using HR Prescribing exercise based on HR is easy, but comes with limitations—especially when estimating maximal HR (HRmax) from age or given certain environmental or medical factor. Three methods to choose from: 1.HR versus MET graphing method 2.HRR method 3.%HR max method

HR Versus MET Graphing While conducting a GXT, do the following: –Record and plot steady-state HR for each stage. –Plot HR on y-axis; MET levels or VO 2 on x-axis. –If not a maximal exertion GXT, extrapolate to HRmax. –Determine desired %VO 2 R range. –Locate corresponding HRs. –Can now determine HR range. –Remember, some modalities produce higher HR responses...

Figure 5.3

Heart Rate Reserve (HRR) No actual GXT for HRmax? Use this method! Target HR = [% exercise intensity x (HRmax – HRrest)] + HRrest HRR also called Karvonen method %HRR approximates %VO 2 R. Set programs in range 40 to 85 %HRR..

%HRmax Can also just use a percentage of maximal HR. Set program in range 64% to 94% HRmax. Approximates 45% to 85% VO 2 R or HRR. Program in lower end of range for those of lower levels of CR fitness. This method gives lower values than does %HRR, but recommended for older clients. If no actual HRmax is available, you must estimate it..

Exercise Intensity Using RPE RPE values are valid and reliable measures. Subjective interpretation of effort by client. Client “scores” effort required by each stage of GXT using an RPE or Omni scale value. RPE range of 12 to 16 approximates 40% to 84% HRR. May use RPE instead of or with HR.

Monitoring Exercise Intensity Necessary to maintain client’s safety HR RPE Talk test: If client can’t talk comfortably while exercising, the intensity is too high.

Exercise Frequency Depends on client’s goals, fitness level, preferences, and time availability Health benefits at 5 days a week If CR fitness is low, 5 days a week of low- to moderate-intensity exercise To improve moderate to excellent CR fitness, 3 to 5 days a week of moderate- to vigorous-intensity exercise May incorporate several short-duration (10 min) bouts in same day

Exercise Duration Duration is inversely related to intensity. ACSM recommends 20 to 60 minutes continuous or discontinuous exercise. In improvement stage, increase duration every 2 or 3 weeks until reaching 30 minutes continuous exercise. Alternatively, use the caloric cost of exercise to determine duration. Target caloric threshold is 150 to 400 kcal/day for minimum of 1,000 kcal/week.

Exercise Duration by Caloric Cost Initial conditioning phase: long enough to expend 200 to 600 kcal/day Improvement stage: long enough to expend 1,000 to 2,000 kcal/day –Gradually change intensity, frequency, duration.

Net Caloric Cost of Exercise kcal/min = METs x 3.5 x body mass (in kg) ÷ 200 Remember, for net value, subtract resting value (e.g., MET expenditure – 1). For a 60 kg woman exercising at 7 METs: –kcal/min = (7 – 1) x 3.5 x 60/200 –kcal/min = 6.3 –To reach 300 kcal/day target, must work out 43 minutes (300/6.3) at 7 METs

Progression of Exercise Improvement of CR fitness is a result of overload. Greatest improvement in first 6 to 8 weeks. Overload comes from adjustments in intensity and duration. Extent of improvement is on individual basis. Must continually overload the CR system. The lowest starting point equals the highest gain. Common gains in VO 2 max range from 5% to 20%..

Stages of Progression Initial conditioning: 1 to 6 weeks, based on individual Improvement: usually 4 to 8 months Maintenance: for the rest of their life

Initial Conditioning Low- to moderate-intensity exercise early on Include warm-up and cool-down (emphasize stretching) 3 to 5 days a week 1 to 6 weeks, depending on rate of adaptation Target is 20 to 30 continuous minutes Once client exercises for 30 continuous minutes at 55% to 60% HRR, client is ready to move to improvement stage.

Improvement Stage See rapid changes in CR function and aerobic capacity. Continue changing intensity, duration, and frequency independently of each other. Increase duration and frequency before intensity. Goal is minimum of 20 continuous minutes of moderate- to vigorous-intensity exercise 5 days a week. Then increase 5% HRR every 6 th session. May last 4 to 8 months. When target fitness level is attained, progress to maintenance stage.

Maintenance Stage Goal is to maintain all that was attained in improvement stage. If intensity stays the same, you can reduce frequency to 3 days a week. Use type C and D activities for the other 2 days. Include variety to reduce the possibility of boredom.

Methods or Modes of Aerobic Exercise Continuous or discontinuous Walking, jogging, cycling Aerobic dance Step aerobics Step ergometry and stair climbing Elliptical trainers Water-based exercise Numerous new options (continued)

Methods or Modes of Aerobic Exercise (continued) Continuous exercise maintains an elevated HR. Discontinuous exercise allows higher exercise intensity and higher total caloric expenditure. Discontinuous exercise is also called intermittent training.

Discontinuous Aerobic Exercise Examples: –Interval training –Spinning –Circuit resistance training –Treading (continued)

Discontinuous Aerobic Exercise (continued) Circuit resistance exercise –Results in fewer improvements in aerobic fitness compared to other modalities –Should not be used to improve aerobic fitness –Good for maintenance phase –Can add cardio stations between resistance stations (super circuit resistance training)

Personalizing an Aerobic Program Must meet client’s goals and incorporate client’s interests. Need to consider client’s demographic profile (age, gender, fitness level, exercise preferences). Start by evaluating client’s risk factor profile then stratify client’s CVD risk level. Round out picture via lifestyle evaluation. Conduct GXT and record the data. (continued)

Personalizing an Aerobic Program (continued) Must meet client’s goals and incorporate client’s interests Needs to consider client’s demographic profile (age, gender, fitness level, exercise preferences) Start by evaluating client’s risk factor profile Then stratify client’s CVD risk level Round out picture via lifestyle evaluation Conduct GXT and record the data (continued)

Personalizing an Aerobic Program (continued) Use their measured (or estimated) VO 2 max. Determine if initial conditioning period is required. Compute target range for exercise intensity (%VO 2 R or %HRR). Determine range of HRs that match exercise intensity anchor points. Progress exercise prescription by increasing duration first. Then increase exercise intensity. (continued)..

Personalizing an Aerobic Program (continued) Compute caloric cost of prescribed exercise. At initial conditioning phase target is 752 to 1,040 net kcal/week. At improvement phase target 1,040 to 1,874 net kcal/week. During improvement phase client meets ACSM’s >1,000 kcal/wk recommendation. During maintenance phase, add variety. (continued)

Personalizing an Aerobic Program (continued) Multimodal exercise (cross-training) programs are popular methods for increasing CR fitness. Difficult to prescribe program based on specific MET levels; use range of MET levels. HR will vary based on modality utilized. HR response during weight-bearing exercise at same exercise intensity is higher compared to nonweight- bearing modalities. RPE is good way to monitor intensity.

Benefits of Multimodal Training Encourages adherence to safe, effective program High levels of client enjoyment in exercise Increased client understanding of their body’s response to exercise Client’s sense of some control in their program Increased incorporation of exercise and physical activity into lifestyle