1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 12: Aerobic and Strength Training Prescription for Health and Performance

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease Prevalence of Cardiovascular Disease –Deaths from cardiovascular disease declined from 50% in 1970s to 36.3% in 2004 –Factors related to decline in prevalence: Lifestyle changes: nutrition, stopping smoking, exercise Improved medical techniques & diagnosis Improved emergency care & treatment Improved drugs

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Coronary Artery Disease –Blockage of arteries supplying cardiac tissue –Ischemia Insufficient blood to tissue due to partial blockage of artery Most common during physical activity or times of stress Results in angina pectoris (severe chest pain) –Myocardial infarction (heart attack): severe or complete blockage, leading to cell death in heart –Atherosclerosis: progressive narrowing of artery due to plaque –Arteriosclerosis: thickening & loss of elasticity of arterial wall

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Percentage of deaths in US due to various types of CAD.

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Coronary arteries.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Stroke –Lack of blood supply to part of brain, causing brain tissue death –Types Ischemic: blockage of vessel Hemorrhagic: rupture of vessel Cerebral hemorrhage (cerebral artery) Subarachnoid hemorrhage (on surface of brain) –Predisposing factors Hypertension Atherosclerotic damage, leading to weak spot

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Heart Failure –Ventricles cannot contract, so cardiac output is insufficient –Acute heart failure is caused by heart attack resulting from: Toxic substance or drug Coronary artery blockage –Chronic heart failure is caused by: Hypertension Multiple minor heart attacks Viral infection

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Hypertension –Chronic high blood pressure at rest –≥140/90 mm Hg –Heart must work harder to pump –Increased oxygen demand of cardiac tissue –Increased strain on arteries & arterioles –Increases risk of heart failure, atherosclerosis, peripheral vascular disease, kidney failure –More common in the overweight & obese –One in three adult Americans is hypertensive

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Classification of Adult Resting Blood Pressure ClassificationSystolic Pressure (mm Hg) Diastolic Pressure (mm Hg) Normal<120<80 Prehypertension120−13980−89 Stage 1 hypertension140−15990−99 Stage 2 hypertension≥160≥100

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) Risk Factors for Hypertension –Physical inactivity –Overweight & obesity –Heredity, including racial ancestry –Being of male sex –Increasing age –Sodium sensitivity –Use of tobacco products –Excessive alcohol consumption –Psychological stress –Diabetes –Use of oral contraceptives –Pregnancy

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Exercise and Prevention of Cardiovascular Disease (cont’d) CAD: Risk Factors –Uncontrollable factors Age Being of male sex Heredity –Controllable factors Smoking tobacco Blood lipid profile Hypertension Obesity & overweight Diabetes mellitus Physical inactivity Psychological stress Alcohol consumption Diet & nutrition

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Level of CAD due to Selected Risk Factors Risk FactorLittle RiskSome RiskSerious Risk Blood lipid profile Total cholesterol (mg/dL)<200200−239≥240 LDL-C (mg/dL)<130130−159≥160 HDL-C (mg/dL)≥6040−59<40 Triglycerides (mg/dL)<150150−199≥200 Resting hypertension Systolic press. (mm Hg)<120120−139≥140 Diastolic press. (mm Hg)<8080−89≥90 Overweight/obesity (BMI)<2525−29.9≥30 Plasma glucose (mg/dL)<100100−125≥126 Physical activity (min/d)30−6015−29<15

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Clearance Required for Clients With the Following Conditions: –Severe medical contraindications –Increased risk for cardiovascular disease (age, symptoms) –Diagnosis of certain diseases Useful for: –Obtaining information to prescribe appropriate type of exercise –Determining initial health status & progress –Motivating athlete & increasing adherence to exercise program –Early diagnosis of diseases

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Clearance (cont’d) Electrocardiogram (ECG) –Measures cardiac electrical conductivity –Used to determine cardiac rhythm or contraction & relaxation –Electrical conductivity: movement of ions during contraction & relaxation of cardiac tissue –Normal part of graded exercise test & medical evaluation –Abnormalities Cardiac arrhythmias ST-segment depression (myocardial ischemia) –Can indicate CAD

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Clearance (cont’d) Waveforms in an ECG represent contraction & relaxation of atria & ventricles.

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Clearance (cont’d) Graded exercise test.

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Clearance (cont’d) ST-segment depression indicates CAD.

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines Types of Aerobic Exercise –Jogging –Running –Cycling –Spinning –Elliptical machines –Swimming –Aerobic dance –Rowing

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Duration of Each Exercise Session –Minimal duration threshold: 20 to 30 min. per session –As long as min. thresholds are met, similar gains achieved with: Short-duration, high-intensity exercise Long-duration, low-intensity exercise –Longer sessions of moderate intensity recommended for most –High-intensity exercise is associated with: Greater cardiovascular risk Greater chance of orthopedic injury Lower adherence to training

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Frequency of Training –Minimal threshold: 3 d·wk -1 –Most increases in peak O 2 consumption occur with 3 d·wk -1 –Increased frequency up to 5 d·wk -1 increases aerobic capabilities –Training frequencies >5 d·wk -1 increase incidence of injury

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Intensity of Exercise –Most important variable –Minimal threshold: 55% to 65% of maximal heart rate (HR max ) –Upper end of range for health & fitness gains: 94% of HR max –Range for near-optimal gains: 77% to 90% HR max

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Exercise Heart Rate –Used to determine exercise intensity –Equations used to calculate HR max HR max = 220 − age in years HR max = 207 − (0.7 × age in years) [more accurate] –For 20-year-old: HR max = 207 − (0.7 × 20) = 193 bpm 77% of HR max = 193 bpm × 0.77 = 148.6 bpm 90% of HR max = 193 bpm × 0.90 = 173.7 bpm

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) A specific % of HR max represents a lower % of peak O 2 consumption.

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) HRR Method (Karvonen method) –Used to estimate the HR needed to exercise at a specific % of peak O 2 consumption –For fitness gains, train at 40% to 85% peak O 2 consumption –HRR = HR max − HR rest –Target HR (THR) is HR needed to exercise at a specific % of peak O 2 consumption

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Borg scale of perceived exertion.

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Metabolic Equivalents –1 metabolic equivalent task = rate of O 2 consumption at rest –Measure intensity of activity in how many times greater than resting O 2 consumption is required to perform it –Resting O 2 consumption = 3.5 mL·kg·min -1 –3 METs = 3 × 3.5 mL·kg·min -1 = 10.5 mL·kg·min -1 –The greater the METs, the greater the intensity –Has limitations, due to variance in environmental conditions & hydration status

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Guidelines (cont’d) Progression of Aerobic Fitness Training –Necessary if continued fitness gains are desired –Type of exercise may progress from: Low impact (walking, cycling, elliptical) to High impact (jogging, running) –Duration may progress from: Minimal threshold (20 to 30 min·day -1 ) to Upper limit for aerobic fitness (60 min·day -1 ) –Intensity may progress from 55% HR max to 90% HR max

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Resistance Training Guidelines Type of Exercise –Free weights or barbells & dumbbells –Resistance (weight) training machines Volume of an Exercise Session –# of exercises –# of sets in each exercise –# of repetitions in each set Rest Period Length Between Sets and Exercises

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Resistance Training Guidelines (cont’d) Frequency of Training –# of times per week a muscle group is exercised –Total body resistance: all muscles trained each session –Split routine: some muscles on some days, others on others Intensity of Exercise –Measured as % of max. weight possible for 1 complete repetition Progression of Resistance Training –Gradual increases in intensity & volume –Shortening/lengthening rest periods

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Interval Training Concept –Greater intensity is possible when exercise is interspersed w. rest –Greater intensity = greater fitness Training Intensity –% of best time for length of interval or % of HR max Interval Duration –5−10 sec for short-term sprint –30 sec−2 min for intermediate sprint –>2 min for aerobic/endurance

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Interval Training (cont’d) Number of Intervals –Depends on # of repetitions per set, # of sets, & fitness goals Rest Period Length –Recovery HR: 140 bpm (20−29 years); 130 bpm (30−39); etc. –Work-to-rest ratio Type of Rest Interval –Passive (for high-intensity, short intervals) –Active (for low-intensity, long intervals) Training Frequency: depends on training goals & sport

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure of a Training Session Warm-Up –Physical activity performed before training to increase performance via psychological factors & increased body temp. –General: activity not related to task or training to follow –Sport-specific: activity related to task or training to follow Stretching –Flexibility training performed at end of warm-up (ballistic stretching) or any form in a cool-down –Types: proprioceptive muscular facilitation, ballistic, static Cool-Down: light aerobic activity for 10−15 min

33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Detraining Effects on Strength Training –Cessation: loss of strength & power –Reduced volume: strength is maintained if intensity is maintained Effects on Aerobic Training –Cessation: rapid decrease in peak O 2 consumption –Reduced volume: aerobic capabilities are maintained if intensity is maintained

34. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Classic Strength-Power Periodized Strength Training Training Variable HypertrophyStrengthPowerPeaking Sets3−5 1−5 Repetitions/ set 8−122−62−31−3 VolumeVery highHighModerateLow IntensityLowModerateHighVery high

35. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Aerobic Training Periodization An endurance training periodization training plan.