Differences include: increased HR, VO2, SV,
Cardiac output, TV, VE, VE/Vo2, VE/VCO2
**SBP and DBP may not change or decrease
**Possible balance or fatigue issues
Participant fills out the form and gives it to health provider monitoring the pregnancy.
No max testing during
pregnancy, maybe submax
They include: Relative- severe anemia, unevaluated maternal cardiac dysrhythmia, chronic bronchitis, type 1 diabetes, morbid obesity, extreme underweight, extreme sedentary lifestyle, intrauterine growth restriction, hypertension, orthopedic limitations, seizure disorder, hyperthyroidism, heavy smoker.
Intensity-Moderate (40-60% VO2R), RPE or talk test.
Age HR Range
HR Ranges: <20 140-155 bpm 20-29 135-150 30-39 130-145 >40 125-140
Time-At least 15 min a day increasing to 30 min, totaling 150 min a week.
Type- Dynamic, rhythmic physical activities that use the large muscle groups- walking cycling
Pay close attention to balance issues.
No supine work after the first trimester
Avoid valsalva maneuver during exercise
Only exercise to point of moderate fatique
Use major muscle groups 12-15 reps
Avoid Supine position after 1st trimester
Be well hydrated, and avoid exercise in heat
Increase food intake-200-300 kcal a day
May exercise 4-6 weeks post with no complications.
Those with CVD risk factors in adolescence usually continue them through adulthood.
In general, adult guidelines apply however, physiologic differences apply
Intensity- Moderate (increase breathing, sweating, HR)
Time- 30 min of moderate, and 30 min of vigorous to total 60 min a day.
Exercise in the heat
Children with diseases
**Intensity-as VO2 R or HRR
**Time-minutes in a day/ week
Stretching- 10 min and can follow warm up or after cool down
Conditioning – 20 to 60 min of aerobic, resistance, neuromuscular or sports activities (bouts of 10 min are acceptable)
Cool- down – 5 to 10 min of low to mod intensity cardio or muscular activities
At least 3 d/wk vigorous intensity > 60% VO2R- aerobic, weight bearing, flexibility
3-5 d/wk – combination of mod to vigorous, aerobic, weight bearing, flexibility
2-3 d/wk muscular strength and endurance, resistance, calisthenics, balance and agility
****Note ACSM recommends 3-5 d/wk
**** there is an attentuation of improvements beyond 3 d/wk, and a plateau beyond 5 d/wk
****there is an increase in injury risk beyond 5 d/wk with vigorous activity. However if a variety of activities are performed this reduces the risk.
Karvonen Formula = 220 -age, take percentage of it to determine exercising range.
*** Underestimates for people younger than 40 years of age
*** Overestimates for people older than 40 years of age
HR max = 206.9 – (.67 x age)
Peak HR method
Peak VO2 method
** However, not always possible to assess HRmax, or VO2 In these cases use age predicted. .
** Always use a range of intensity
Examples Figure 7.2
Can also list total calorie expenditure
Inverse dose relationship exists. If accumulate at least 1,000 kcals per week will receive health/fitness benefits.
****1,000 kcals per week is minimum recommended by ACSM, Surgeon General, AHA.
– 150 min per week or 30 min per day
*** 250-300 min per week or 50-60 min/day
***beyond 3,500-4,000 not recommended due to increased risk of injury
Moderate intensity for 30 min > 5 d/wk, totaling 150 min per week.
Or vigorous intensity for 20-25 min > 3 d/wk
Or combination of mod and vig 20-30 min for 3-5 d/wk
To promote weight loss or maintain – 50-60 min per day totaling 300 min per week of moderate, 150 min vigorous or equivalent combination.
10 minute bouts accepted
Walking, leisure cycle, aqua aerobic, slow dance
Vigorous – Adults with regular Jog, run, row, aerobics, spin, elliptical exercise, step, dance
exercise program or avg Fitness
Endurance – Adults with acquired skill, avg fitness
Swim cross country ski, skating
Recreational Sports-Adults, avg Fitness. Racquet sports, basketball soccer, down hill skiing, hiking
Initial phase should increase duration:
5 to 10 min every 1 -2 weeks, over the first
4 -6 weeks
–After this, frequency,
intensity, and/or time
of exercise increased
Train for strength, endurance, power
Strength and endurance most
important in general training
focusing on health/fitness
48 hours separating training sessions for the same muscle group.
Split sessions are options
Intensity – 60-80% of 1 – RM, where 1 – RM is the greatest amount of weight that can be lifted in a single repetition.
Volume – 2 -4 sets of 8 – 12 repetitions. There should be a 2-3 minute rest between sets. Older adults 1or more sets of 10-15 reps at 60-70% 1 – RM
Types of Resistance exercises – multi joint or compound. Examples: leg press, dips, bench press. Exercises that affect more than one muscle group.
Also, single joint such as biceps, triceps, quad extensions, calf raises.
Train opposing muscle groups
Or, increase the number of sets or the number of times per week the muscle is trained.
Static, dynamic, or ballistic, or PNF
Occurs after muscle is warmed (after warm up) or after cool down
> 4 reps per muscle group, static held for 15-60 seconds
Stretching may be preferable for sports where muscular strength, power or endurance are important
May not prevent injury
Should stretch for 10 minutes involving the major muscle tendons of the body (neck, shoulder, upper and lower back, pelvis, hips and legs)
Table 8.2 Physiologic responses
Relative VO2 higher
Cardiac Output, SV lower
SBP, DBP lower
Respiratory rate higher
TV,VE, RER lower
Ability to analyze and interpret information from the cardio respiratory fitness test, and the muscular strength and endurance, flexibility and body composition assessments for apparently healthy individuals and those with controlled chronic disease.
Depends on the functional state of the cardiovascular system, muscle and skeletal system.
Increased CRF is associated with decreased death from all causes
High levels of CRF associated with high levels of habitual levels of physical activity
Skill related is agility, balance, coordination, speed, power, reaction time
The 5 components of physical fitness are more important than the components related to athletic ability.
Therefore, purpose is to focus on health related physical fitness in adults
Submax-YMCA Cycle, Astrand Ryhming Cycle
Max tests-Graded Exercise tests
Modified Sit and Reach
YMCA Bench press
Identify, diagnose, and prognosing health/medical situations
VO2 max considered the best measure of CRF
VO2 max product of max CO (L.min -1) and arterio-venous oxygen difference (ml.O2 per L of blood) AVO2 difference.
Functional capacity of the heart is the primary predictor of VO2 max.
age, sex, fitness level,
and primarily by differences in Cardiac Output (CO).
–mouthpiece, nose occluded, while pulmonary ventilation and expired fractions of oxygen and CO2 are measured or calculated.
Because of expensive equipment, experienced personnel this is usually done in lab setting.
Can estimate VO2 max from Submax test by using prediction equations (chap 7) Also, consider population being tested and Standard error associated with equation.
Max tests require person to exercise to point of volitional fatigue. Often require medical personnel and emergency equipment. However, they are more sensitive in diagnosing CAD and provide better estimate of VO2max. Also, can give accurate assessment of anaerobic threshold.
Also need to obtain additional indices of client’s responses to exercise
Should also measure HR, BP, RPE and workloads.
Subjects with diabetes may have blunted HR response to exercise and may not have age-normal max HR.
Valid and reliable when done in lab setting
Cycle most preferred due to ability to reproduce work output
Accurate assessment of HR is key. Typically palpate radial artery. May vary with experience and technique of fitness professional.
Could use HR monitor, ECG, or stethoscope
Can be affected by humidity, heat, caffeine, smoking, previous activity, time since last meal, anxiety.
General procedures box 4.4
1) Steady state HR achieved and is consistent for
each work rate
2) HR and work rate exists as a linear relationship
3) VO2 max is indicated by maximal workload
4) mechanical efficiency is the same for everyone
5) Subject is not on medications that alter HR
Familiarize participant with equipment
2-3 min warm up
Protocol should consist of 2 or 3 min stages with approp. increments in workload
HR monitored 2 times during each stage-near the end of 2nd and 3rd stage
BP monitored last min of each stage
RPE taken last min of each stage
Client signs and appearance noted
Terminate test when subject reaches 70% HRR or 85% APMHR, fails to conform to protocol, adverse signs and symptoms, requests to stop, other emergency situations
Appropriate cool down is at a work rate approx to 1st stage of test or passive
All physiologic measurements continue for 5 min
-easy to administer to large group with little
time and equipment
– VO2 can be estimated
-a disadvantage is that it could be a max test
because BP and HR are not monitored.
-not good for sedentary or those at increased
risk of CVD
– is expensive, hard to transport, hard to get BP and HR
-some individuals not as familiar, localized fatigue is a limiting factor
-easy to transport, inexpensive, easy to do
-good for mass testing
-short duration, less anxiety
– not good for those with balance issues or de-
– also possible localized fatigue in less fit individual
Requires the individual to step up and down on standardized step height of 16.25 inches for 3 minutes
Step rate is 24 per minute for men and 22 for women. (up one leg, up the other leg, down one leg, down the other leg- is one complete cycle)
Set metronome 96 beats per min for men & 88 for women.
After 3 min subject stops and pulse is taken at radial site while standing, within first 5 seconds of stopping.
15 second pulse is taken, multiply by 4 to get BPM
VO2 max(mL.kg-1.min-1)= 111.33 – (.42 x HR)
VO2 max(mL.kg-1.min-1) = 65.81 – (.1847 x HR)
Ideal to use quarter mile track
Go over purpose of test to participant and the need to pace over the distance
Start stop watch with beginning of test.
Record total time to complete test use formula to calculate VO2max. (Box 19-14)
Use distance in equation to determine VO2max. (box 19-14)
Subject walks as fast as possible for 1 mile. Count recovery HR for 15 seconds and multiply by 4 to get BPM. Use formula box 19-15.
Uses 2 to 4, 3 minute stages of continuous exercise. The test was designed to raise steady state HR between 110 bpm and 85% of APMHR for at least two stages.
***must have two consecutive heart rate measurements within this range in order to predict VO2 max.
Determine 85% APMHR
Position subject properly ( upright, 5 degree bend in knee at maximal leg extension, hands in position on handle bar)
Metronome set at 100 bpm. Pedal rate is 50 rpm
2-3 min warm up
HR is monitored at least two times during each stage-last 30 sec of stage 2 and 3
Pulse counted for 15 seconds
BP monitored last part of each stage
RPE monitored end of each stage, table 4.7
Client appearance noted
Test terminated when reach 85% of APMHR or other listed criteria
Appropriate cool down
If HR in 3rd min of first stage is:
<80, set second load to 750kgm (2.5kp) 80-89, set to 600 kgm (2.0kp) 90-100, set to 450 kgm (1.5 kp) > 100, set to 300 kgm (1.0 kp)
-set 3rd and 4th following the figure 4.2
Take 85 % of that number
Drop in SBP of >10mm Hg from baseline despite increase in workload
Excessive rise in BP, SBP >250 mmHg or DBP > 115
SOB, wheezing, leg cramps, claudication
Signs of poor perfusion, light-headedness, confusion, pallor, nausea, or cold clammy skin
Failure of HR to rise with increased exercise intensity
Noticeable change in heart rhythm
Subjects requests to stop
Physical or verbal manifestations of severe fatigue
Failure of equipment
Moderately severe angina (3 on standard scale)
Increasing nervous symptoms (syncope)
Signs of poor perfusion-pallor
Subject desires to stop
Sustained ventricular tachycardia
ST elevation (+1 mm) in leads without diagnostic Q waves
Also called GXT-graded exercise test
Incremental change in workload until peak exhaustion or exertion is achieved
Purpose: 1) screen for the presence of disease 2) diagnosis of disease when symptoms are present 3) prognosis of the patient relative to their CAD and/or other disease history 4)management of individual or exercise prescription
Cycle ergometers typically result in lower VO 2 max
Common protocols: Bruce, Bruce Ramp, Balke
(Figure 19-3 )
Monitor HR, BP, RPE, ECG, signs & symptoms, expired gases
Error is reduced with maximal testing
Two sets of standards are used utilized for comparisons: Criterion referenced and Normative standards.
Vo2 max below the 20th percentile is associated with increased risk of death by all causes
Maybe error when estimating Vo2 max from submax test
Accuracy of classification depends on population and methodology
While V0 2 max not as accurate, also lower risk, decreased assessment time, decreased effort on part of subject
***If test is repeated over time and HR response to the fixed work rate decreases over time, can conclude that CRF has improved.
Use words like “poor or excellent”
Used in CFR and body fat analyses
Open to subjectivity
Compare how subject performs vs. other like individuals
Typically use percentile values
Typically use this measurement in fitness arena