Download - Health fitness and promotion
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Health fitness and promotion
D.A. Asir John Samuel, BSc (Psy), MPT (Neuro Paed), MAc, DYScEd, C/BLS, FAGE
Lecturer, Alva’s college of Physiotherapy, Moodbidri
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Health fitness and promotion
• Fitness evaluation
• Analysis of body composition
• Evaluation and prescription of exercise
• Factors affecting exercise performance
• Exercise prescription for specific groups
- Elderly
- Women
- children
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Fitness evaluation
• History
- Work history
- Exercise history (FITS)
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Pre Exercise Evaluation
• Medical History
• Physical Evaluation
• Laboratory Tests
• Informed Consent
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Evaluation
• Resting measurements are taken first
- HR
- BP
- Height
- Weight
- Body composition
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Evaluation
• Resting measurements are followed by,
- Cardiac endurance
- Muscular fitness
- Flexibility
• Test environment
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Analysis of body composition
• Anthropometric methods
- BMI
- WHR
- SFT
• Densitometry
- Hydrodensitometry
- plethysmography
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BMI
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BMI
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Interpret axis of heart
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Interpret position of heart
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WHR
• Waist – horizontal measure taken directly
above the iliac crest/narrowest of torso
• Hip – legs slightly apart, a horizontal measure
taken at maximal circumference of hip or
proximal thigh, just above the gluteal fold
• Male < 0.75
• Female < 0.85
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SFT
• Seven sites (common for both male and female)
- Chest
- Midaxillary
- Triceps
- Subscapular
- Abdomen
- Suprailiac
- Thigh
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SFT - men
• Chest, abdomen and thigh
• Chest, triceps and subscapular
• Body density = 1.10938-0.0008267 (sum of 3
SF)+0.0000016(sum of 3 SF)2 -0.0002574(age)
• % fat = (495/Body density)-450
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SFT - women
• Triceps, surpailiac, thigh
• Triceps, suprailiac, abdominal
• Body density = 1.099421-0.0009929 (sum of 3
SF)+0.0000023(sum of 3 SF)2 -0.0001392(age)
• % fat = (495/Body density)-450
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Cardiorespiratory Fitness
• Ability to perform large muscle, dynamic,
moderate-to-high intensity exercise for
prolonged periods
• Depends on functional state of respiratory,
cardiovascular and skeletal muscle systems
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Maximal oxygen uptake (VO2max)
• VO2max is accepted as criterion measure of CR
fitness
• VO2max = max cardiac output x arterial-venous
oxygen difference
• Open-circuit spirometry is used to measure
VO2max
• Direct measurement of VO2max is not feasible
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Maximal Vs submaximal exercise testing
• Maximal exercise tests have the disadvantage
of maximal volitional fatigue and might
require medical emergencies
• Commonly rely on submaximal exercise tests
• Aim is to determine HR response and predict?
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Exercise
Tolerance
Testing
Prognostic Testing
Indications for Exercise Testing
VO2max Ex- Duration,
Max Workload,
BP response
Symptoms, ST-T
changes, Arrhythmia
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Submaximal exercise testing
• Practitioner uses various submaximal measures
- HR
- BP
- Workload
- Rating of perceived exertion (RPE)
- Functional response
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Modes of testing
• Field tests
• Treadmill tests
• Cycle ergometry
• Step tests
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Field tests
• Walking or running a certain distance in a
given time
• Easy to administer to large number of
individuals at one time and little equipment
• Cooper 12-minute test
• Rockport One-Mile fitness walking test
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Rockport One-Mile fitness walking test
• Peak VO2 = (0.02 x distance) - (0.191 x age)-
(0.07 X weight) + (0.09 X height) + (0.26 X RPP
X10-3) + 2.45
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Treadmill and ergometer
1. Exercise Equipment
– Treadmill
– Cycle Ergometer • Mechanically braked cycle
• Electrically braked cycle
– Arm Crank Ergometers
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2. Airflow or Volume Transducers
3. Gas Analysers
4. Electrocardiograph
5. Non invasive Blood Pressure
6. Pulse Oximetry
7. Intraarterial Blood Pressure
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Protocols
1. Single stage (constant work rate) Protocol
2. Multistage Protocol
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Multistage Exercise Protocols • Bruce Protocol
• Balke – Ware Protocol
• Naughton Protocol
• USAFSAM Protocol
• Dukes Protocol
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Constant Work Rate Protocol
• Treadmill or cycle ergometry exercise maybe used at levels
approximate to subject’s functional activity i.e. 3.0 mph on
treadmill or upto 50 W on a cycle ergometer.
• 6 minutes of continuous exercise.
• Constant work rate test for 5 -10 minutes achieves about 70
– 90% of VO2max achieved during incremental exercise
testing.
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Arm Ergometry
• Work rate increments of 10 W every 2 -3 minutes with a cranking rate of 50 – 60rpm
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correlation
• Used for Testing patients with vascular, orthopaedic or neurologic conditions that prevent them from doing leg exercise.
• Correlation between arm exercise and leg exercise
r = 0.37
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Subjective Ratings & Symptoms
• Rate of percieved exertion (RPE)
• Angina 1. Mild, barely noticeable
2. Moderate, bothersome
3. Moderately Severe, Very uncomfortable
4. Most Severe or Intense pain ever experienced
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Step test
• Step height
- 30.5 cm (12 inch)
- Rate of 24 steps/min
- After test, immediately sit down and HR is
counted for 1 min.
- Counting must start within 5 seconds
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Test sequence
• Obtain resting HR & BP before exercise in
exercise posture
• Familiarized with ergometer or treadmill. If
using cycle ergometer 5° knee bend in max Ext
• 2-3 min. warm-up
• Monitor HR at least 2 times during each stage
• BP monitored in last minute of each stage
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Test sequence
• PRE and additional rating scales
• Client appearance and symptoms
• Terminate when subject reaches 70% HRR or
85% of HRmax
• Cool-down/recovery period (passive/cont.ex)
• Continue physiologic observations for 5 min
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Test termination criteria
• Onset of angina or angina like symptoms
• Drop in systolic BP > 10 mm Hg from baseline
BP despite an increase in workload
• Excessive rise in BP: SBP > 250 mm Hg or DBP
> 115 mm Hg
• Shortness of breath, wheezing, leg cramps or
claudication
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Test termination criteria
• Signs of poor perfusion
• Failure of heart rate to increase with increased
exercise intensity
• Noticeable change in heart rhythm
• Subjects requests to stop
• Manifestations of severe fatigue
• Failure of testing equipment
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Interpretation
• HR
• Heart rate recovery
• Systolic BP
• Diastolic BP
• ST-segment depression
• ST-segment elevation
• Aerobic fitness
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Heart rate
• Progressive linear increase with exercise
• Each MET increase 10 ± 2 beats
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Heart rate recovery
• An abnormal slowed HRR is associated with a
poor prognosis
• Decrease ≤ 12 beats/min at 1 min (walking)
• Decrease ≤ 22 beats/min at 2 min (supine)
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Systolic BP
• Progressive increase in SBP at 10 ± 2 mm
Hg/MET
• Discontinue with SBP values of > 250 mm Hg
• Exertional hypotension (> 10 mm Hg) may
signify myocardial ischemia or LV dysfunction
• Maximal exercise SBP of < 140 mm Hg
suggests a poor prognosis
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Diastolic BP
• Normal response is no change or decrease in
DBP
• DBP of > 115 mm Hg is considered an
endpoint for exercise testing
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ST-segment depression
• Common manifestation of exercise induced
myocardial ischemia (Mi)
• Horizontal or downsloping ST-segment
depression is more indicative of Mi
• ≥1 mm of horizontal or downsloping ST
segment at J point extending 60-80 msec
• In recovery true positive
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ST-segment elevation
• Early repolarization
• Indicate wall-motion abnormalities
• Significant myocardial ischemia and localizes
ischemia to specific area of myocardium
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Aerobic fitness
• Average values of VO2max is expressed as METs
Men = (57.8-0.445[age])/3.5
Women = (41.2-0.343[age])/3.5
• RPE > 17 (abnormal)
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Muscular fitness
• Muscular strength
- Ability of muscle to exert force
• Muscular endurance
- Ability to continue to perform for successive
exertions or many repetitions
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Muscular strength
• Maximum voluntary contraction (MVC)
• Bench press or leg press
• 1-RM, the greatest resistance that can be
moved through full ROM in controlled manner
with good posture
• Find 1-RM within 4 trials of 3-5 min rest b/w
trials
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Muscular endurance
• Curl-up (Crunch test)
• Push-up
• Females in modified “knee push-up”
• Maximum number of repetitions performed
without rest
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Flexibility
• Depends on several specific variables
- Distensibility of joint capsule
- Adequate warm-up
- Muscle viscosity
Sit-and-reach test
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Exercise prescription
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Exercise training session
• Warm-up - (5-10 min) < 40% VO2R
• Stretching (10 min)
• Conditioning or sports related exercise (20-60
min)
• Cool-down (5 min)
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Conditioning
• FITT principle
• Frequency
• Intensity
• Time (duration)
• Type (Mode)
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Cardiovascular endurance
• Frequency
- 3-5 days/week
- > 5 days/week reaches plateau
• Intensity
- 40-60% VO2R – moderate
- ≥ 60% VO2R – vigorous
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Cardiovascular endurance
• Time duration
- At least 20-30 min
- 50-60 min – vigorous
• Mode
- Jogging
- Cycling
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Selection Of Sports
Shoe
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Selection Of Sports Shoe
• Time of purchase
• Based on Midsole
• 5 pound pressure principle
• Thumb rule
• Shoe Life span
• For female
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TIME OF PURCHASE
• End of the day
• Soon after running or exercise
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BASED ON MIDSOLE
• Inert gas encapsulated in a ployurethane shell
(air pads) – NIKE
• Communicating air chambers (suspension
fibres) – REEBOK
• LD ethylene vinyl acetate pads – ADIDAS
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5 POUND PRESSURE PRINCIPLE
• When the shoe is held vertically & 2.27 kg wt is
applied only 40º to 60º bend
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THUMB’S RULE
• Thumb’s width of space between the end of the
longest toe and the front end of the shoe.
• Narrow shoe leads to blisters and to forefoot
and toe pain
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SHOE LIFE SPAN
• 300 to 500 miles ¹
• 6 months ²
• Whichever comes first ²
• Sensing small rocks
• Slapping sensation
1.Clin J Sports Med 1985;4(4):619-626
2.Clin J Sports Med 2005;15(3):172-176
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LADY’S SPECIAL
• Narrow heel
• Vertical ground reaction force
• Peak tibial acceleration
• Maximal pronation
• Peak pronation velocity
• Peak pressures 65 8/24/2012
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Volume of resistance training
• Each muscle group should be trained for total
of 2-4 sets
• 8-12 repetitions per set
• Resistance is 60-80% of 1RM
• Each set should be performed to the point of
muscle fatigue not failure
• 2-3 min rest between sets
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For muscular endurance
• Higher number of repetitions of 15-20 reps.
• Shorter rest intervals (< 2min)
• Fewer sets (Preferably 1-2 sets per muscle
group)
• RPE of 5-6 on 10-point scale
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Resistance exercise technique
• Proper technique
• Minimizes chances of injury
• Proper body positioning and breathing
• Full ROM in controlled manner
• Emphasis on lifting and lowering phase
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Progression
• Overload or greater stimuli to continue to
increase muscular strength and mass
• Perform more sets per muscle group
• Increasing number of days per week
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Progressive overload
Progressive overload
Muscle fatigue
catabolism
Body responds
With aid of nutrition & rest
Builds up affected muscle
Anabolism
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Maintenance
• Muscular strength may be maintained by
training muscle groups as little as 1 day/week
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Flexibility exercise
• Injury prevention
• At least 10 min. duration involving major
muscle groups of body
• > 4 repetitions per muscle group
• Static stretch should be held for 15-60 seconds
• Minimum 2-3 days/week
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Exercise prescription for elderly
• Initial workload should be low and work
increments should be small
• Preferable to cycle ergometer
• Consider prescribed medications
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Exercise prescription for elderly
• Aerobic activity
- Aquatic exercise and stationary-cycle exercise
- 20-30 min/day to 75-100 min/day walk
- Minimum 5 days/week
- 5-6 on RPE
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Exercise prescription for elderly
• Muscle-strengthening
- At least 2 days/week
- 10-15 repetitions of low resistance
• Flexibility
- 2 days/week
- < 30 seconds hold for 3 repetitions
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Exercise prescription for children
• Aerobic activity
- At least 3-4 days/week, preferably daily
- Moderate (5-6 RPE)
- 30 min/day to 60 min/day
- Dance, sporting
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Exercise prescription FITT Diabetes HT Renal
failure Obesity
Frequency A- 3-7 d/wk; R-2-3 d/wk
A- all days; R- 2-3d/wk
A- 3-5d/wk; R-2-3d/wk
≥ 5d/wk
Intensity A-50%-80% VO2R; R-60%-80% 1RM
A-40%-<60% VO2R; R-60%-80% 1RM
A-40%-<60% VO2R; R-60%-75% 1RM
A-40%-<60% VO2R or HRR
Time 20-60 min to 150 min/wk; 2-3 sets 8-12 rp
30-60 min/d; 1set 8-12 rp
20-60 min/d; 1set 10-15 rp
30-60 min to 150 min/wk
Type Aeroic ex.; proper handling
Walking, jogging; 8-10 major ms
Walking and cycling
Walking, jogging, cycling,swim