Prescribing Exercise Prescribing Exercise (Chapter 4)(Chapter 4)

PE 254PE 254

Terms Terms

Exercise: Exercise: Planned, structured, and Planned, structured, and repetitive bodily movement done repetitive bodily movement done to improve or maintain one or to improve or maintain one or more components of physical more components of physical fitness fitness

Physical Activity: Physical Activity: Bodily movement that is Bodily movement that is produced by the contraction of produced by the contraction of skeletal muscle and that skeletal muscle and that substantially increases energy substantially increases energy expenditure expenditure

How much Physical Activity is How much Physical Activity is Recommended?Recommended?

U.S.: U.S.: everyone should accumulate everyone should accumulate

30 minutes or more of 30 minutes or more of moderate-intensity physical moderate-intensity physical activity on most, preferably activity on most, preferably all days of the week (ACSM, all days of the week (ACSM, CDC). CDC).

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What Does Counseling Have To What Does Counseling Have To Do With Exercise Prescription? Do With Exercise Prescription?

Need to take into account the Need to take into account the psychological, emotional, and psychological, emotional, and affective components of affective components of exercise as well as the physical exercise as well as the physical aspects aspects

Psychological and socio-Psychological and socio-emotional aspects of problems emotional aspects of problems surface frequently during surface frequently during exercise consultation exercise consultation

General Exercise Counseling General Exercise Counseling Roles Roles Provide a climate for change Provide a climate for change

and arrive at a prescription that and arrive at a prescription that is best for the client while is best for the client while meeting the requirements of the meeting the requirements of the prescription prescription

Help clients recognize their own Help clients recognize their own strengths and weaknesses, and strengths and weaknesses, and discover how to overcome their discover how to overcome their barriers barriers

First StepsFirst Steps

Medical ClearanceMedical Clearance Men over 40 and women over 50Men over 40 and women over 50

Basic Principles of physical TrainingBasic Principles of physical Training Specificity Specificity Progressive overloadProgressive overload

FrequencyFrequency IntensityIntensity TimeTime TypeType

ReversibilityReversibility Individual differencesIndividual differences

Selecting ActivitiesSelecting Activities

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Pre-exercise Evaluation HistoryPre-exercise Evaluation History Current and past exercise habits (mode, frequency, intensity, Current and past exercise habits (mode, frequency, intensity,

duration)duration) Current motivation and barriers to exerciseCurrent motivation and barriers to exercise Preferred forms of physical activityPreferred forms of physical activity Beliefs about benefits and risks of exerciseBeliefs about benefits and risks of exercise Risk factors for heart disease (hypertension, diabetes mellitus, Risk factors for heart disease (hypertension, diabetes mellitus,

hyperlipidemia, smoking, family history of heart disease before 55 hyperlipidemia, smoking, family history of heart disease before 55 years of age)years of age)

Physical limitations precluding certain activitiesPhysical limitations precluding certain activities Exercise-induced symptomsExercise-induced symptoms Concurrent disease (cardiac, pulmonary, musculoskeletal, Concurrent disease (cardiac, pulmonary, musculoskeletal,

vascular, psychiatric, etc)vascular, psychiatric, etc) Social support for exercise participationSocial support for exercise participation Time and scheduling considerationsTime and scheduling considerations Medication profileMedication profile

Indications for Exercise Stress TestingIndications for Exercise Stress Testing 1. Evaluation of patients with suspected coronary artery disease1. Evaluation of patients with suspected coronary artery disease

Typical angina pectorisTypical angina pectoris

Atypical angina pectorisAtypical angina pectoris 2. Evaluation of patients with known coronary artery disease2. Evaluation of patients with known coronary artery disease

After myocardial infarctionAfter myocardial infarction

After interventionAfter intervention 3. Screening of healthy, asymptomatic patients3. Screening of healthy, asymptomatic patients

Persons in high-risk occupations (e.g., pilots, firefighters, law enforcement officers, Persons in high-risk occupations (e.g., pilots, firefighters, law enforcement officers, mass transit operators)mass transit operators)

Men over age 40 and women over age 50 who are sedentary and plan to start Men over age 40 and women over age 50 who are sedentary and plan to start vigorous exercisevigorous exercise

Persons with multiple cardiac risk factors or concurrent chronic diseasesPersons with multiple cardiac risk factors or concurrent chronic diseases 4. Evaluation of exercise capacity in patients with valvular heart 4. Evaluation of exercise capacity in patients with valvular heart

disease (except severe aortic stenosis)disease (except severe aortic stenosis) 5. Patients with cardiac rhythm disorders5. Patients with cardiac rhythm disorders

Evaluation of exercise-induced arrhythmia and response to treatmentEvaluation of exercise-induced arrhythmia and response to treatment

Evaluation of rate-adaptive pacemaker settingEvaluation of rate-adaptive pacemaker setting

How to Approach and Get Past Roadblocks:

• I do not have time. We’re only talking about three 30 minute sessions each week. Canyou do without three television shows a week?

• I am usually too tired to exercise. Regular activity will improve your energy level. Try and see foryourself.

•The weather is too bad. There are many activities you can do in your home, in any weather.

• Exercise is boring. Listening to music during your activity keeps your mind occupied.Walking, biking, or running can take you past lots of interesting scenery.

• I do not enjoy exercise. Do not exercise.. Start a hobby or an enjoyable activity that getsyou moving.

• I get sore when I exercise. Slight muscle soreness after physical activity is common when youare just starting. It should go away in 2 to 3 days. You can avoid this by building up gradually and stretching after each activity.

Principles of Conditioning Principles of Conditioning and Trainingand Training

SAID: Specific Adaptation to Imposed Demand

Warm-upWarm-up

Precaution against unnecessary Precaution against unnecessary musculoskeletal injury and sorenessmusculoskeletal injury and soreness

May enhance certain aspects of May enhance certain aspects of performanceperformance

Prepares body physiologically for Prepares body physiologically for physical workphysical work

Stimulates cardiorespiratory system, Stimulates cardiorespiratory system, enhancing circulation and blood flow enhancing circulation and blood flow to musclesto muscles

Increases metabolic processes, core Increases metabolic processes, core temperature, and muscle elasticitytemperature, and muscle elasticity

Cool-downCool-down

Essential component of workoutEssential component of workout Bring body back to resting stateBring body back to resting state 5-10 minutes in duration5-10 minutes in duration Often ignoredOften ignored Decreased muscle soreness Decreased muscle soreness

following training if time used to following training if time used to stretch after workoutstretch after workout

Exercise IntensityExercise Intensity

Beginner or low fitness level: Beginner or low fitness level: 50% to 60% 50% to 60%

Intermediate or average Intermediate or average fitness level: fitness level: 60% to 70% 60% to 70%

Advanced or high fitness Advanced or high fitness level: level: 75% to 85% 75% to 85%

Basic Elements of the Basic Elements of the Exercise Prescription Exercise Prescription Frequency Frequency Intensity Intensity Time Time Type Type

Exercise Intensity by Heart Exercise Intensity by Heart RateRate

Exercise Intensity by Rating of Exercise Intensity by Rating of Perceive Exertion (RPE)Perceive Exertion (RPE)Why use RPE? Why use RPE?

Monitoring exercise intensity with the RPE Monitoring exercise intensity with the RPE scale is beneficial because: scale is beneficial because:

1. It provides a double-check on heart rate, 1. It provides a double-check on heart rate, especially when the target heart-rate zone especially when the target heart-rate zone is estimated from age.is estimated from age.

2. Assessing RPE can be performed 2. Assessing RPE can be performed without stopping to ''check'' it, as is without stopping to ''check'' it, as is necessary with heart-rate monitoring.necessary with heart-rate monitoring.

3. There is no equipment you can buy to 3. There is no equipment you can buy to accurately describe your perception of accurately describe your perception of intensity (whereas heart-rate monitors can intensity (whereas heart-rate monitors can be expensive for accurate pulse count).be expensive for accurate pulse count).

Exercise Intensity by Rating of Exercise Intensity by Rating of Perceive Exertion (RPE)Perceive Exertion (RPE)

6 No exertion at all 6 No exertion at all 7 Extremely light 7 Extremely light 8 8 9 Very light - (easy walking slowly at a comfortable 9 Very light - (easy walking slowly at a comfortable pace) pace) 10 10 11 Light 11 Light 12 12 13 Somewhat hard (It is quite an effort; you feel 13 Somewhat hard (It is quite an effort; you feel tired but can continue) tired but can continue) 14 14 15 Hard (heavy) 15 Hard (heavy) 16 16 17 Very hard (very strenuous, and you are very 17 Very hard (very strenuous, and you are very fatigued) fatigued) 18 18 19 Extremely hard (You can not continue for long at 19 Extremely hard (You can not continue for long at this pace) this pace) 20 Maximal exertion 20 Maximal exertion

Exercise Intensity by Rating of Exercise Intensity by Rating of Perceive Exertion (RPE)Perceive Exertion (RPE) Level 1: I'm watching TV and eating bon bons Level 1: I'm watching TV and eating bon bons Level 2: I'm comfortable and could maintain this Level 2: I'm comfortable and could maintain this

pace all day long pace all day long Level 3: I'm still comfortable, but am breathing a bit Level 3: I'm still comfortable, but am breathing a bit

harder harder Level 4: I'm sweating a little, but feel good and can Level 4: I'm sweating a little, but feel good and can

carry on a conversation effortlessly carry on a conversation effortlessly Level 5: I'm just above comfortable, am sweating Level 5: I'm just above comfortable, am sweating

more and can still talk easily more and can still talk easily Level 6: I can still talk, but am slightly breathless Level 6: I can still talk, but am slightly breathless Level 7: I can still talk, but I don't really want to. I'm Level 7: I can still talk, but I don't really want to. I'm

sweating like a pig sweating like a pig Level 8: I can grunt in response to your questions Level 8: I can grunt in response to your questions

and can only keep this pace for a short time period and can only keep this pace for a short time period Level 9: I am probably going to die Level 9: I am probably going to die Level 10: I am deadLevel 10: I am dead

Rate of ProgressionRate of Progression

ACSM defines three stages:ACSM defines three stages:

1.1. Initial conditioning stage (1 – 4 Initial conditioning stage (1 – 4 weeks)weeks)

2.2. Improvement conditioning Improvement conditioning stage (4 – 5 months)stage (4 – 5 months)

3.3. Maintenance conditioning Maintenance conditioning stage (6 months and beyond)stage (6 months and beyond)

Benefits of ExerciseBenefits of Exercise

Improved cardiorespiratory Improved cardiorespiratory functionfunction

More efficient metabolismMore efficient metabolism Improved body compositionImproved body composition

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Disease Prevention and Disease Prevention and ManagementManagement

Cardiovascular DiseaseCardiovascular Disease Metabolic SyndromeMetabolic Syndrome

Insulin resistanceInsulin resistance High blood pressureHigh blood pressure Abnormal blood fatsAbnormal blood fats Abdominal fat depositsAbdominal fat deposits Type 2 diabetesType 2 diabetes Blood clotting abnormalitiesBlood clotting abnormalities Blood vessel inflammationBlood vessel inflammation

PreventionPrevention Improves blood fat levels - improves HDL’s Improves blood fat levels - improves HDL’s Improves blood pressureImproves blood pressure

HypertensionHypertension Coronary heart diseaseCoronary heart disease StrokeStroke

CancerCancer OsteoporosisOsteoporosis Type II Diabetes Type II Diabetes

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Improved Psychological and Improved Psychological and Emotional WellnessEmotional Wellness

Reduced stressReduced stress Reduced anxiety and Reduced anxiety and

depressiondepression Improved self-imageImproved self-image Learning and memoryLearning and memory EnjoymentEnjoyment

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Improved immune functionImproved immune function Prevention of injures and Prevention of injures and

low-back painlow-back pain Improved wellness for lifeImproved wellness for life

Additional Benefits of ExerciseAdditional Benefits of Exercise

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Walking for FitnessWalking for Fitness

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