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

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

4. Exercise Prescription Principles

8. CDC Handout on Moderate and Vigorous Intensity Activities

9. Exercise Prescription FitnessHealthSeverely Deconditioned Sport or Competition 10+ METS 30-45 Min+ 3-5 Days per week 70-85% HR Max RPE: 13-17 Health 8-10 METS Accumulate 30-60 Min Most Days per Week 50-70% HR Max RPE: 11-13 Build Stamina <4-5 METS Tolerated Activity 3-5 Minutes Several Times per Day <50% of HR Max Gradual  time

10. 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 + 0.60 (HR max - HR rest )

11. Methods of Prescribing Exercise Intensity

12. Level of Intensity

15. 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

16. Reversibility Principle Training is transient & reversible Detraining occurs rapidly Saltin et al., 1968 25%  VO2 max following 20 days of bedrest in 5 college aged students

17. 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%

18. 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

19. Submaximal Exercise Testing Submaximal Exercise Testing: Clinical Application and Interpretation, Vanessa Noonan and Elizabeth Dean, Physical Therapy, 2000;80: 782-807.

20. References ACSM’s Guidelines for Exercise Testing and Prescription. 9 th Ed. 2013. Monitoring Clinical Responses to Exercise, Joanne Watchie American Physical Therapy Association – Cardiovascular & Pulmonary Section Essentials of Cardiopulmonary Physical therapy, Ellen Hillegrass, 3 rd Ed, 2011. ACLS Provider Manual Supplementary Material, 2006 American Heart Association.