fitness final

exercise and pregnancy
Physiological responses to exercise are different during pregnancy: (table 8.1)
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

pre screening (figure 8.1)
Would you know how to interpret these questions?

Participant fills out the form and gives it to health provider monitoring the pregnancy.

No max testing during
pregnancy, maybe submax

exercise prescription-preggers
Similar to adult healthy population, with special attention to symptoms and contraindications. (Box 8.1)
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.
preggers FITT
Frequency- at least 3, preferably most days of the week.
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

preggers muscular prescription
FITT- yes can lift weights.
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
preggers special considerations
Discontinue exercise with bleeding, dyspnea, headache, dizziness, chest pain, calf pain or swelling, preterm labor, fluid leakage, decreased fetal movement.

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.

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children and adolescents
Special consideration deals with growth issues and physiologic regulatory systems.

Those with CVD risk factors in adolescence usually continue them through adulthood.
In general, adult guidelines apply however, physiologic differences apply

children and adolescents FITT
Frequency- at least 3-4 days per week
Intensity- Moderate (increase breathing, sweating, HR)

Time- 30 min of moderate, and 30 min of vigorous to total 60 min a day.
Type-developmentally approp.
& enjoyable.

special considerations children and adolescents
Resistance exercise is appropriate provided proper instruction and form. 8-15 reps with moderate intensity
Hydration
Exercise in the heat
Overweight
Children with diseases
General Principles for Apparently Healthy Adults (Chapter 7)
Follow the FITT Guidelines
**Frequency-how often

**Intensity-as VO2 R or HRR

**Time-minutes in a day/ week

**Type-mode

components
Warm up- 5 -10 min of low to moderate intensity (40 to 60% VO2R)cardiovascular and muscular endurance activities.
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
General Exercise Recommendations for Healthy Adults– Frequency
At least 5 d/wk – mod intensity 40 to 60%VO2R- aerobic, weight bearing, flexibility

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

Surgeon General Recommendations:
Physical activity on most days of the week. Defined as > 5 d/wk
****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.
purpose of prescription
Enhance fitness level of participant

Promote Health

Ensure Safety

Maximize Benefits

Minimize Risks

intensity
Minimum for healthy adults to derive benefits is 40 to 60% VO2R or HRR (moderate) or combination of vigorous (> 60% VO2R) and moderate activities.
Intensity Continued
To determine HR range or max typically used
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

intensity formula
Gellish et al.

HR max = 206.9 – (.67 x age)

intensity
HRR
VO2 R
Peak HR method
Peak VO2 method
METS
RPE
Talk Test
Preferred methods
HRR and VO2R are best methods because they reflect rate of energy expenditure more accurately.
** 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

FITT-time
Quantity of exercise is usually in minutes per day or week.
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
Time Continued
For most adults > 2000 kcals per week results in greater benefits and may be necessary to maintain or lose weight.
*** 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

type of exercise
Endurance – For all adults
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

progression
Recommended rate depends on health status, exercise tolerance, exercise program goals.

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
gradually

muscular fitness
Resistance training-weights, machines, rubberbands
Train for strength, endurance, power

Strength and endurance most
important in general training
focusing on health/fitness

Muscular Prescription
Frequency – each major muscle group 2-3 d/wk. (chest, shoulders, upper & lower back, abdomen, hips, legs)

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

muscular progression
Progressive Overload Principle – can increase the amount of weight lifted so that no more than 12 reps can be lifted

Or, increase the number of sets or the number of times per week the muscle is trained.

(box 7.3)

flexibility
Frequency – 2-3 d/wk

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)

exercise testing -children and adolescents
Generally no exercise testing for children unless it is a health concern
Table 8.2 Physiologic responses
Variable Response
VO2 lower
Relative VO2 higher
HR higher
Cardiac Output, SV lower
SBP, DBP lower
Respiratory rate higher
TV,VE, RER lower
cardiorespiratory KSAs
Knowledge of and ability to discuss the physiologic basis of the major components of physical fitness: flexibility, cardiovascular fitness, muscular strength and endurance, and body composition
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.
cardiac output
The product of HR times stroke volume, the volume of blood pumped by the heart in 1 minute.
cardiorespiratory endurance
The ability to perform large muscle, dynamic, moderate to high intensity exercise for prolonged periods.
maximal oxygen consumption
the maximal rate of oxygen that can be used for production of adenosine triphosphate (ATP) during exercise
stroke volume
the volume of blood ejected per heart beat.
cardiorespiratory fitness
Related to the body’s ability to perform large muscle dynamic moderate to high intensity exercise for prolonged periods of time.

Depends on the functional state of the cardiovascular system, muscle and skeletal system.

cardiorespiratory fitness considered related to health because
Low levels of CRF associated with increased risk of premature death from all causes and most specifically CV disease
Increased CRF is associated with decreased death from all causes
High levels of CRF associated with high levels of habitual levels of physical activity
Health related physical fitness vs. skill related physical fitness
More emphasis placed on health related physical fitness
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
crf tests
Field tests- step, 1.5 mile walk/run, 1 mile walk test
Submax-YMCA Cycle, Astrand Ryhming Cycle
Max tests-Graded Exercise tests
body comp tests
Ht/wt and BMI
Circumference, WHR
Skinfolds
BIA
Underwater weighing
flexibility tests
Sit and Reach
Modified Sit and Reach
muscular strength
Handgrip test
One RM
muscular endurance
Sit ups
Curl ups
Pushups
YMCA Bench press
why assess crf
Use to determine intensity, duration, and mode of exercise

Motivate subject

Identify, diagnose, and prognosing health/medical situations

crf details
Measured and expressed by maximal oxygen uptake (VO2max)
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.
crf
Variations in CRF are due to:

age, sex, fitness level,
and primarily by differences in Cardiac Output (CO).

Why???

vo2 max
Measured by open circuit spirometry
–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.

submax vs max tests
Depends on reasons for the test, availability of equipment and personnel.
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.
submax tests
Aim to determine HR response to one or more sub maximal workloads and use results to predict VO2max.
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

estimates from vo2 max
From HR response to sub max exercise are based on these factors:
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
general procedures for submax
Obtain resting HR and BP in exercise posture
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
field tests
Step, 1.5 mile walk/run, 1 min walk test
-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
treadmill tests
good for diagnostic information, most individuals comfortable with walking, good for fit and unfit
– is expensive, hard to transport, hard to get BP and HR
mechanically braked ergometers
good for sub max and max, inexpensive, transportable, easy to assess BP and HR, less anxiety, workloads easy to administer

-some individuals not as familiar, localized fatigue is a limiting factor

step test
is sub-maximal test. Work rate is fixed and cadence set. Step height preset and measure post exercise HR.
-easy to transport, inexpensive, easy to do
-good for mass testing
-short duration, less anxiety
– not good for those with balance issues or de-
conditioned
– also possible localized fatigue in less fit individual
queens college step test
Also known as McArdle Test
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

For men:
VO2 max(mL.kg-1.min-1)= 111.33 – (.42 x HR)

For women:
VO2 max(mL.kg-1.min-1) = 65.81 – (.1847 x HR)

1.5 mile run
not good for unconditioned or those with known disease. Should be able to jog for 15 min in order to complete this test.
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)
12 min run/walk
patient covers the maximal amount in 12 minutes by walking, running or combination. Distance covered is measured and expressed in meters
Use distance in equation to determine VO2max. (box 19-14)
rockport 1 mile walk
– good for those unable to run or low level of fitness. Should be able to get HR above 120 bpm for 1 mile to complete this test.
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.
cycle tests
YMCA sub maximal cycle ergometer protocol
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.
ymca
Obtain HR, BP, ht and wt
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
Calculations

ymca protocol
At end of warm up workload set at 150 kgm/min(.5kp)
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
apmhr
220 -age
Take 85 % of that number
General indications for stopping an exercise test in low risk adults
Onset of angina or angina like symptoms
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
Absolute indications to stop a test (relative and absolute box 19-17)
Drop in SBP >10 mm Hg from baseline despite increase in workload when accompanied by other evidence of ischemia
Moderately severe angina (3 on standard scale)
Increasing nervous symptoms (syncope)
Signs of poor perfusion-pallor
Technical difficulties
Subject desires to stop
Sustained ventricular tachycardia
ST elevation (+1 mm) in leads without diagnostic Q waves
max tests
Most challenging
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
when is a physician required?
For females <55 years of age and males < 45 years of age, maximal test is not required before starting an exercise program. Those at moderate to high risk for disease should have one before starting vigorous exercise program. Personnel should be skilled at HR, BP, RPE, and ECG (typically exercise physiologists, nurses who are trained)
protocols for max testing
Treadmills most utilized mode of testing-(use large muscle mass enabling subject to achieve a greater physiologic maximum)

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

interpretation of results
Use comparative published norms

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.

criterion
Standards that are considered desirable to achieve based on external criteria.
Use words like “poor or excellent”
Used in CFR and body fat analyses
Open to subjectivity
normative
Based on previous performance by a similar group
Compare how subject performs vs. other like individuals
Typically use percentile values
Typically use this measurement in fitness arena