Metabolic Final Practice Problems

How do you calculate %HRR?

%HRR = %VO2R %HRR = (HR exercise - HR rest) / HRR

How do you calculate %HRmax?

%HRmax = 0.64 * % VO2R + 37

How do you calculate %VO2R?

%VO2R = (VO2 exercise - VO2rest) / VO2R

Joyce is 68 years old with a VO2max = 25 ml/kg/min. Her resting HR is 75 bpm and is cleared for vigorous exercise. Joyce wants to train to improve her CRF. For beginning stages, set %VO2R and %HRmax. Set the target exercising values for VO2 from %VO2R and HR from %HRmax. Set RPE. Joyce says she walks about 15 min/day and covers about a 1/2 miles. What is her VO2 and %VO2R at this pace? What are your general plans for helping Joyce progress intensity over 6 months?

%VO2R = 60 and %HRmax = 76 Target VO2 = 16.4 ml/kg/min Target HR = 96 bpm RPE = 14 When walking, her VO2max is 8.86 ml/kg/min or 25% VO2R We should increase the duration of walking by 5 minutes/week. After about a month, we should increase the intensity 5% of her VO2R each month by increasing the speed or having her walk on an incline.

Pip is 30 years old with VO2max = 48 ml/kg/min. She weighs 120 lbs, RHR = 55, and is cleared for vigorous exercise. She wants to train for a 10k. She is interested in performance. For beginning sessions of improvement stage, set %VO2R, %HRR, and %HRmax. Set the target exercising values for VO2 from %VO2R, HR from %HRR. What would be a reasonable exercising RPE? Piper says she likes to run at 10 minute/mile pace for 30 minutes. What is her approximate VO2 and %VO2R at this pace? At the end of month 5, estimate her expected CRF change. How will you help Piper maintain her optimal relative intensity when the environmental temperature and relative humidity are elevated?

%VO2R = 85, %HRR = 85, %HRmax = 91 Target VO2 = 41.3 ml/kg/min Target HR = 160 bpm RPE = 17 While running, her VO2 = 35.66 ml/kg/min = 72% VO2R At the end of 6 months, there will be an increase of 1-2 ml/kg/min in VO2. In the heat and humidity, use THR to maintain optimal intensity.

How do you calculate %VO2max?

%VO2max = VO2 exercise / VO2max

Your client is a 73 year old male on multiple medications to control blood pressure and cholesterol. What are your best options for monitoring his exercise intensity? Explain.

%VO2max will be better, but RPE will probably be the best option since %VO2R doesn't work as well in the older population. He also should be in a supervised environment at first at light-moderate intensity since he is on multiple medications and has a high blood pressure

What are 3 measures produced by the Wingate test and what do they reflect? Do the same with RAST.

*Wingate* •Peak anaerobic power: highest power output for any 5 second window of the test, usually in the first 5 seconds. It reflects the output of the PCr system •Mean anaerobic power: average power output over the entire 30 seconds. It reflects the output of the lactic/anaerobic system •Fatigue index: reflects the ability to resist fatigue caused by the accumulation of acid *RAST* •Max power: highest power output. Provides information about strength and max sprint speed •Minimum power: lowest power output achieved in sprints. Used to calculate fatigue index •Average power: provides indication of athlete's ability to maintain power over time •Fatigue index: the rate at which power declines. <10 shows ability to maintain anaerobic performance. <7 is the best.

What is 1 L/min equal to?

1 L/min = 1 kcal/min

What is 1 MET equal to?

1 MET = 1 kcal/kg/hr = 3.5 ml/kg/min

What is the general order of periodization goals?

1. CRF/endurance/work capacity 2. Strength 3. Speed/power/special application

How does RPE relate to %VO2R?

11-12 = 40-60% VO2R 13-14 = 60-70% VO2R 15 = 75% VO2R 16-17 = 75-80% VO2R >17 = 85+%

What rating of perceived exertion (6-20 scale) best corresponds to 40-50% VO2R during aerobic activity for an adult of average fitness?

12-13

What is the risk of CV events with stage 1 hypertension?

2-4x the risk compared to healthy BP

An individual has a VO2max of 40 ml/kg/min. She is exercising on a cycle ergometer at 25 ml/kg/min. Approximately what %VO2R intensity is he working at?

59% VO2R

John is 50 years old, weighs 180 lbs, and walks 45 min/day 4 days/week at 17 min/mile pace. What is his volume of exercise in MET*min/week, MVPA min/week, gross and net kcal per week? Is he meeting federal health guidelines?

666 MET min/week 180 MVPA min/week Gross kcal burned = 908 Net kcal burned = 666 He is meeting PAG

An individual has an HRmax of 180 bpm and a resting HR of 65 bpm. He is exercising on a cycle ergometer at 145 bpm. Approximately what %VO2R is here working at?

70% VO2R

If your client wishes to train for aerobic performance and is already fit, what intensity would you use for her most intense workouts?

85-100% of their VO2R since they are very fit, meaning they are likely very active

What are good RPE cutpoints?

9: comfortable walk but have a feeling of exertion 13: moderate intensity, can tell you're working, increased breathing and sweating, but not uncomfortable 15: vigorous intensity, a little uncomfortable, but sustainable 17: anaerobic threshold, as hard as you can work and still maintain effort for 15 minutes

Which of the following is not true regarding RMR? a. Large individuals have smaller RMRs than people of smaller stature b. RMR decreases with age c. Muscle tissue is metabolically more active than fat tissue d. RMR may account for a smaller % of daily kcal in people who do regular, vigorous exercise

A

What is the difference between sudden cardiac arrest and a heart attack?

A heart attack is a circulation problem that doesn't usually kill, it just damages the heart tissue. The most common reason for cardiac arrest Sudden cardiac arrest is an electrical problem that causes the heart to stop beating

What are the ACSM dietary guidelines for % fat in the diet? DGA guidelines? What is mean by "focusing on food as opposed to specific macronutrients?"

ACSM recommends that fat should make up <30% of your daily calories. The DGA recommends that fat make up 20-35% of daily calories, and that saturated fats should be <10% of daily calories. Focusing on foods means that it's more about where the fat is coming from than the macronutrient content (is the food fried, processed, or natural?)

What are the risk factors for exercise screening?

Age (>45 for men, >55 for women) Family history (heart attack, bypass surgery, or sudden death <55 years for men, <65 years for women) Smoking, quit in the last 6 months, or live in an environment with it Sedentary lifestyle (not 30 minutes a day 3x/week for 3 months) Obesity (BMI >30, waist circumference >102 men or >88 for women) Hypertension (>130 or >80) Dyslipidemia (LDL >130, HDL <40, total cholesterol >200, or meds) Prediabetes (IFG >100) Want HDL >60

When does exercising heart rate differ from target heart rate? Should you use target hear rate or target VO2 when they differ?

Biking = 6-8 bpm higher than walking. This is due to more muscular fatigue and metabolite buildup. Use target heart rate because it reflects the physical stress of the load. Adjust prescribed VO2 Swimming = 8-12 beats lower than walking. This is due to laying down, so SV increases because blood is easier to diffuse. Use prescribed VO2 and adjust target heart rate

Bob is 40 years old (RHR = 70 bpm, RBP = 130/85 mmHg, max HR = 180 bpm [determined by max Balke GXT]) and weights 170 lbs at 5'7". His VO2max = 35 ml/kg/min = 10 METS. He has a %BF of 25% and is sedentary. No other ACSM risk factors. He lives in Iowa and prefers to exercise outside during the summer and indoors during the winter. His goal is to get back in shape and improve his aerobic fitness so that he has more energy. How would you assess Bob's overall risk? How would you interpret his fitness level? What factors should Bob consider in selecting his program type (clinic based supervision, fitness professional supervision, education, referral to other health professionals)? Does he need an initial stage?

Bob has Stage 1 hypertension and is sedentary. He is likely at a moderate risk due to his high blood pressure. His fitness level is fair to average considering his age and sex. He will not need any supervision during exercise. Since he is sedentary and has elevated BP, she should be educated by a fitness professional or a physician. He is likely okay for both moderate and vigorous exercise, but should probably be seen by a physician if he finds moderate exercise is too strenuous. Because of his high BP and is sedentary, he should have an initial stage. Since he has an average CRF and has fitness goals, the stage should be relatively short, probably 2 weeks or less. It would likely consist of learning technique for strength training and experimenting with different modes of exercise.

What RPE ranges would correspond to vigorous aerobic intensity for the 6-20 and 0-10 scales?

Borg scale = 14-16 0-10 scale = 7-8

What is ST depression?

Comes from injury currents and is a common sign of myocardial ischemia. Usually occurs at constant RPP for a given patient.

How do heart attacks occur?

Complete occlusion of coronary artery

When considering non-traumatic sports death in young adults, the cause is almost always ____?

Congenital conditions

Explain the difference between criterion based standards and normative standards?

Criterion based standards are evidence based, direct measurements that have been validated. Normative standards are based off of the general population and is developed and validated from criterion standards. Normative standards are usually in percentiles and used as a comparison to others with your demographics.

Janice has an estimated %BF of 30 and wants to lose weight. She currently weights 150 lbs and is 18 years old. Assume her target BF = 20% and she will be only losing fat. What is her current fat weight, current FFM weight, target weight range, and pounds she will need to lose (all in lbs)? More realistically, about what proportion of her weight loss will be FFM?

Current fat = 45 lbs Current FFM = 105 lbs Target weight = 131-132 lbs Pounds she needs to lose = 18-19 lbs Realistically, about 25% of weight will be lost in FFM if she loses weight slowly. The faster the weight loss, the more FFM she will lose.

How does FFM change in older adults?

Decreases 3% every decade in 40-60 year old males, 4% in females Decreases 6% every decade in 60-80 year old males, 10% in females Type 2 fibers are lost the most, so adults lose speed/power as they age

What are differences in acute effects of exercise in children compared to adults?

Don't generate as much ATP from glycolysis Can't thermoregulate as well Lower BP response Higher HRmax and ventilation

What are steady state tests and examples of them?

Ebbeling walk test and Astrand Rhyming test Ebbeling: SS HR (2 consecutive HR +/- 5 bpm that are greater than 110 bpm and <85% HRmax) Astrand Rhyming: SS HR (2 consecutive HR +/- 5 bpm that is between 125 and 175)

What is the maintenance stage of progression?

Everybody does this Starts after 6 months Vary activities, decrease the frequency if desired, consider multi-modal exercise

What is the criterion reference for children?

FitGram

What is the improvement stage of progression?

For people with average fitness 0-6 months Expect a 5-25% increase in CRF Most improvements are accomplished here

What are appropriate goals for volume?

Health goals: 500 MET min/week Fitness goals: 1000 MET min/week Performance goals >1000 MET min/week

What are the BP cutpoints and treatment options?

Healthy: <120 and <80 Elevated (120-129 and <80): nonpharmacological treatment and reassess in 3-6 months Stage 1 (130-139 or 80-89): nonpharmacological treatment and reassess in 3-6 months or 1 month with meds Stage 2 (>140 or >90): need to go see a doctor

What are premature ventricular contractions?

Heartbeat starts in the ventricle. Common result of CAD

What conditions do exercise physicians work with?

Hypertension, osteoarthritis, osteoporosis, asthma, pregnancy

When is hypoglycemia during exercise a risk for Type II diabetes?

Hypoglycemia is a risk if they are on medications that lower their blood sugar and haven't eaten enough that day.

What are 2 different ways that RMR can be predicted?

It can be predicted using age, sex, height, and weight using Mifflin-St. Jeor or Harris-Benedict equations It can be predicted using FFM with the Cunningham equation

What are barriers to PA during pregnancy?

Lack of time, fatigue, tiredness, nausea, pregnancy discomfort/pain, laziness, lack of childcare support, fear that exercise will hurt the baby

What is the biggest reason older adults lose their independence?

Loss of muscular strength/endurance

What is the threshold intensity to improve fitness for someone with very low CRF? Average CRF? What is considered the optimal intensity range to improve fitness for someone who is reasonably fit (general population)?

Low: 40-50% VO2R Average: 60% VO2R Improvement: 60-80% VO2R

How is one diagnosed with Metabolic Syndrome? What risks are associated with Metabolic Syndrome?

Metabolic syndrome is a cluster of risk factors associated with CVD/CAD: Abdominal obesity (weight circumference >102 cm for men, >88 cm for women) Triglycerides >150 mg/dL or on prescriptions Low HDL <50 or prescriptions Elevated BP >130/85 or prescriptions High fasting glucose >100 mg/dL

What %VO2max do moderate, vigorous, and anaerobic thresholds correspond to?

Moderate = 40-60% VO2max Vigorous = 60+% Anaerobic threshold = 75+%

How are moderate and vigorous intensity defined in an absolute sense, and what are the pros and cons of using absolute definitions?

Moderate intensity = 3-5 Vigorous intensity = 6+ Pros: it's easy to use Cons: it assumes everyone has average fitness levels

What is the approximate heritability of common obesity? Explain what this means with respect to how it governs an individuals ultimate %BF?

Monogenic obesity is extremely rare. Polygenic obesity has a heritability of 30-70%, meaning that that amount of someones obesity is explained by genetics

What is ventricular fibrillation?

No discernible P or QRS waves, so the heart contracts in a disorganized manner, basically just shaking without beating. It's a life threatening condition and requires immediate defibrillation to restore coordinated ventricular contraction

What is the initial stage of progression?

Only for people with very low fitness or experience with exercise 2-4 weeks of light intensity exercise Focus on teaching how to exercise, creating a positive experience, and develop some experience

How do you read an ECG?

P wave: atrial depolarization QRS wave: bundle of his, bundle brances, purkinje fibers, ventricular depolarization T wave: ventricular repolarization

What are studies on PA in pregnant women?

PRAMS: is sedentary behavior in pregnancy an independent risk factor for adverse pregnancy outcomes? INSPIRE: are mobile health interventions effective for increasing physical activity levels among women during pregnancy? Bedrest in pregnancy: what are the health implications of bedrest prescriptions for women pregnant with twins?

What are the primary goals of Phase I cardiac rehab?

Phase 1 is to start rebuilding skills like sitting up and walking. It is also for becoming educated on risk factors for cardiac events

What are the primary goals of Phases II and III cardiac rehab? What physiological adaptations will help to bring about these goals?

Phases II and III are primarily to increase CRF and decrease myocardial VO2 demands by making muscles more aerobic with exercise. By increasing upper and lower body strength, muscles won't be as aerobically exerted

What are youth exercise guidelines?

Preschool (3-5 year olds): should be active throughout the day, minimize screen time, 3 hours/day of movement, active play that includes a variety of activities to help motor development so PA is easier later on Children and adolescents (6-17 year olds): 1 hr/day moderate-vigorous PA. Strength training counts and should be 3 days/week. Most activity should be vigorous aerobic activity at least 3 days/week. Bone strengthening activities as well 3 days/week

What are the main factors relating to individual and/or exercise that are most likely to predict elevated risk for an adverse cardiac event during exercise?

Presence of major disease, very unfit/sedentary, high risk, congenital conditions, older adults, no warmup/cooldown, and strenuous exercise

What increases the thermic effect of food?

Protein and carbs

List the three factors that contribute to an individual's total daily caloric need. In the normal population, which one of these factors is the largest component of an individual's daily caloric need?

RMR, TEF, and PA make up TDEE. In general, RMR is the biggest part

How do you calculate RPP?

RPP = SBP * HR

Why is snow shoveling relatively dangerous for individuals with underlying heart disease when compared to other activities of similar MET loads?

Snow shoveling is straining and not rhythmic compared to other exercises of the same intensity. It causes an increase in resistance which causes a large increase in BP, HR, and metabolites. This makes your heart work much harder.

What are indirect max tests and examples of them?

Storer Davis and Balke Ware Balke Ware: walk until you can't walk anymore Storer Davis: cycle to exhaustion or until you can't keep 50 rpm cadence

What is ventricular tachycardia?

Succession of 3+ PVCs in a row. Extremely dangerous and precipitate ventricular fibrillation

Susan is a secretary who has been sitting behind her desk at work for the last 20 years. Over the years, she has gradually gained weight due to her sedentary lifestyle, food choices, and changing metabolism. At her last physical exam, her fasting glucose was elevated (120 mg/dL). She contacted you to assess her body comp and plan a weight management program. What is her target %BF based upon her desired weight of 150 lbs? Is this an appropriate goal? How long will it take for her to lose weight? Does she have metabolic syndrome? What is her BMI? What will her new BMI be at 150 lbs? What is her RMR using Cunningham? What is her predicted energy needs using Cunningham and a 1.12 multiplier for low activity. What is an appropriate exercise prescription? What are the most effective strategies for exercise adherence? What are some pitfalls? What are 3 different strategies for weight maintenance?

Target BF% = 27%. This is an appropriate goal because it puts her in a healthy range. She has Metabolic Syndrome based on her risk factors. Her current BMI is 28.4, so she's overweight. Her new BMI will be 25, so she will be right on the border of healthy and overweight. Her RMR is 2894. Her needed energy is 3241 calories. She should start walking at 3 mph for 30 minutes 3x/week. She will increase duration by 5 minutes/week for 1 month, then increase speed or grade every month for 6 months with a goal of increasing VO2R 10% each month. Get up to 5 days/week. An effective strategy for exercise adherence is intrinsic motivation. If she wants to be more active and lose weight for health, she will be effective. A pit fall could be her job. She should decrease fat consumption in her diet. She should walk for transportation and try to stand and move around her job more. To maintain her weight loss, she should count calories, cook from home more often, and find an activity she likes doing.

How do you calculate target HR exercise?

Target HR exercise = (%HRR * HRR) + HRrest Target HR exercise = %HRmax * HRmax

How do you calculate target VO2 exercise?

Target VO2 exercise = %VO2R * VO2R + VO2rest

How do you determine target body weight?

Target body weight = current FFM / %FFM

Bob has an HRmax = 185 bpm and resting HR = 65 bpm. He wants to bike at 70% VO2R. What is his THR using the Karvonen method? Because he will be biking, how will his actual %VO2R at this THR compare to his desired %VO2R? Should we adjust to account for this?

Target heart rate = 149 bpm Actual %VO2R: 68%

Linda (20 years, VO2max = 52 ml/kg/min) is swimming at 75% VO2R. What is her appropriate HR (justify your estimation)?

Target heart rate = 164 bpm Since she's swimming, her heart rate will actually be about 10 bpm lower

A client (female, 5'1", 45 years) wishes to use a pedometer to monitor exercise duration and intensity during a walking program. You plan to have her walk several times during the day at an exercise speed (4 mph) and accumulate 60 minutes of exercise steps during the course of the day. How will you do this?

Tell the client that 4000 steps in 30 minutes is equal to 4 mph, so she should be able to get around 8000 steps in 1 hour

What does the ACSM recommend as the best way to predict HRmax and what is the SEE of this prediction?

The best way to predict HRmax is 220-age with an SEE = 10-15 bpm.

When is it necessary to make distinctions between %VO2R and %VO2max, and when is it okay to assume they are essentially equivalent?

The closer you get to 100%, VO2R and VO2max can be presumed equal, as well as when someone has high fitness levels. There is a difference between VO2R and VO2max at 0% intensity VO2R matters more in people with low fitness and at a low intensity because it is conservative.

What is the primary risk with exercise in Type I diabetics? What are additional risks if advanced complications are present?

The primary risk for PA is an increased risk for a cardiac event if valsalva maneuvers or dehydration occurs. They also need to make sure that they don't get sores/blisters on their feet because if neuropathy is present, they won't notice until it is infected.

What are the PAG for pregnant women?

The same as non-pregnant women except without vigorous PA and medical clearance should be given first

How does exercise Rx for obesity/type II dm/metabolic syndrome differ from a healthy, non-obese population?

They have the same principles for exercise prescription. The difference is that greater volume gives better results, and frequency should be 5-7 days/week. Intensity starts around 40-60% VO2R and progresses to high intensity. Duration should progress to 45-60 minutes/day. It should be aerobic and use large muscle groups, as well as be low impact.

What are the differences in the causes of Type I vs Type II diabetes? What are the differences in the phyisological consequences of these disorders?

Type 1 diabetes means you don't produce insulin, causing sugar buildup in the blood. This can increase the risk for CVD and neuropathy. Type 2 diabetes means your body resists the effects of insulin or doesn't produce enough insulin, causing sugar to build up in the bloodstream. This also increases the risk for CVD and neuropathy.

When should you use an intensity = 40% VO2R?

Use it with individuals whose VO2max < 40 ml/kg/min

When are clinical exercise programs used?

Used for people with CV, chronic pulmonary disease, chronic metabolic disease, renal disease, or malignant diseases

A client (260 lb, 5'9", VO2max = 11 METS) with multiple risk factors for CVD but no known disease or signs/symptoms wants to begin an exercise program. He likes biking and you want to start him at 50% of his VO2max. If your available equipment is a Monark cycle ergometer, what cadence and resistance would you use? If you had a goal of burning 1500 kcal/week through exercise, what would be the necessary total exercise volume per week?

VO2max = 11 METS = 38.5 ml/kg/min —> fair CRF Body mass = 118 kg Target VO2 = 19.5 ml/kg/min or 5.5 METS Use cadence of 50 rpm Power = 1050 kg*m/min = 3.5 kg At 5.5 METS, burning 649 kcal/hr Volume = 138 min/week

What are general guidelines for progressing exercise volume, duration, frequency, and intensity?

Volume is the biggest part. Start by increasing duration by 5 min/week. After 1 month, start progressing intensity by 5% VO2R each month. Add another day if wanted every 1-2 months. Volume should increase 10% each month

Design an exercise program for Bob that will improve his aerobic capacity. Start at the improvement stage. Bob hates to run and group exercise (like Zumba). He enjoys swimming, walking, and bowling. For his prescription, determine the appropriate starting volume, intensity, proxy measures to determine intensity, duration, frequency, and mode. How will you progress his training? Propose a 6 month plan with clear progression targets for each variable.

Volume: 500 MET min/week Intensity: 60% VO2R Target METS = 6.4 RPE = 14 Frequency and time 78 min/week 1x week swimming for 30 minutes at comfortable pace 1x week walking for 30 minutes at slight grade at 3.5 mph 1x week bowling a game Progression: increase the duration for walking and swimming by 5 minutes per week. At month 4 increase the frequency of either walking or swimming by 1 day/week, at month 5 increase the frequency of the other. Increase the speed or grade of walking at month 3 (either 3% increase in grade or 1 mph increase in speed) and the speed of swimming. Bowl more if he would like at any time.

Explain why warmup and cooldown are especially important in individuals with elevated risk for CVD or known existing CVD. Explain the AHA flow chart pertaining to consequences of abrupt cessation of exercise?

Warming up mitigates the risk of a cardiac event by slowly increasing sympathetic activity, which will cause gradual BP increase instead of rapidly. Cooldown mitigates risk by gradually decreasing venous return and cardiac output which gradually decreases BP and perfusion

When is medical clearance needed before exercise?

When someone is sedentary and have a known disease or signs/symptoms, medical clearance is recommended If someone is symptomatic and active with no known disease, medical clearance is necessary If some has a known disease, is asymptomatic, and active, clearance is only needed for vigorous exercise

Describe in general what the Wingate test looks like. Do the sam for RAST.

Wingate is an anaerobic fitness test that lasts for 30 seconds. Intensity is BM*0.09 for males, or BM*0.075 for females. The participant pedals as fast as possible to reach max RPM, then weight is applied. The participant then has to continuously pedal all out for 30 seconds. RAST is an anaerobic fitness test involving six 35 m sprints at max speed with 10 second rest periods.

Howard is a 38 year old white male (6', 220 lbs, 33% BF, VO2max = 45 ml/kg/min). He spends much time sitting each day (>6 hours) but also walks 1-2 miles/day 3 days/week and he bikes 2 days/week (about 75 min/day, approximately 60% VO2R). How could you determine a simple estimate of total daily energy expenditure that does not account for the volatility of daily physical activity throughout the week? How would you determine TDEE in a way that accounts for this volatility?

Without accounting for volatility, you could use a multiplier with the Cunningham equation for their average fitness and multiply is by BMR. To account for volatility, you could either add in calories burned on days he exercises, or you could do a multiplier for activity each day

A client (160 lb, 5'5", VO2max = 10 METS) likes graded walking. Her physician asked you to select a speed and grade to allow her to exercise at 6 METS. Ultimately, the goal is to improve her aerobic fitness. What speed? What grade? How will this work feel to her?

Working at 60% VO2max. Walking at 6 METS = 3 mph = 80.4 m/min 6 METS * VO2rest = 21 ml/kg/min Grade = 6-7% Walking at a speed of 3 mph at a 7% grade should be challenging, but not exhausting since she has a good VO2max regardless of her age.

What are submaximal GXTs and examples of them?

YMCA Cycle test and Bruce Treadmill test YMCA: 2 stages with HR between 110 bpm and 150 bpm when at HRmax is at least 75% Bruce: 2 stages with HR greater than 110 bpm and at least 75% HRmax

Detail the important considerations for prescription when working with someone in Phase II or III cardiac rehab?

You have to start with light or lower moderate exercise and it is important to have a warm up and cooldown. It should take place in a clinical setting with emergency procedures in place