ExPhys- exercise prescription + testing

modes of testing

- field tests (1.5mi run/walk test, cooper 12 min test, Rockport one mile fitness walking test, 6 min walk test) - motor driven treadmills - mechanically braked cycle ergometers - step testing

what are the 3 components of overload

- frequency (how often) - intensity (how hard) - time (duration or how long)

what does a pre-participation health screening identify?

- individuals who are at risk for adverse exercise-related CV events and which individuals should be referred for medical clearance

what are signs/symptoms of CV, metabolic, renal disease

- pain/discomfort in the chest, neck,, jaw, arms, or other areas - shortness of breath at rest or with mild exertion - dizziness or syncope - orthopnea or paroxysmal nocturnal dyspnea -ankle edema - palpations or tachycardia -intermittent claudication - known heart murmur - unusual fatigue or shortness of breath with usual activities

way to measure exercise volume

- pedometers

what can medical and CV screening help with

- provides valuable information for designing individualized exercise programs to lower or reduce known health risks - uncover a need for other health or medical referrals

tapering/unloading regeneration (macrocycle)

- systematic decreases in overload to facilitate a physiological fitness peak/supercompensation - breaks between other macrocycles and basis of active transition phase

what should happen after the initial screening process

baseline measurements should be obtained prior to the start of the exercise test

4) transition/active rest (periodization)

begins immediately after final competitive event of the year; few days of complete rest, then active rest (cross-training); low volume and intensity

ACSM pre-participation screening algorithm

designed to identify individuals at risk for CV complications during or immediately after aerobic exercise.

1) general preparation/off season (periodization)

preceded by evaluation to guide exercise prescription; emphasizes total body health-related physical fitness as well as muscular strength/power/endurance

shock (macrocycle)

primarily used during preparatory phases; sudden increase in training demands •Should always be followed by unloading regeneration cycle (drastically reduced training load)

what does the ACSM pre-participation and pre-exercise screening emphasize

public health message of physical activity for all

health benefits of improving muscular fitness

significantly better cardiometabolic risk factor profile, lower risk of all-cause mortality, fewer CVD events, lower risk of developing physical function limitations, and lower risk for nonfatal disease

periodization

•Organizing training into cycles (periods) •Manipulation of specificity, intensity, volume of exercise based on the specific period •Goal: maximally develop physical ability

progression

•increasing the physiological demands of the exercise over time to continue to produce training adaptations

steploading

•incremental increase in training load with a decrease in load every 3rd-4th step to allow recovery & adaptation

musculoskeletal injury

•most common exercise-related complication; often associated with exercise intensity, the nature of the activity, preexisting conditions, and musculoskeletal anomalies

cardiac events

•sudden cardiac death (SCD) and acute myocardial infarction (AMI) are associated with vigorous intensity; much less common than MSK injury but may lead to long-term morbidity and mortality

maintenance

•training at a level that allows the individual to stay at the current level of physical fitness/performance *intensity is key

individualization

•training program should be designed based on each individual's current fitness level and goals. - factors to consider: age, sex, genetics, disease processes, lifestyle

retrogression/plateau/reversibility

•decrease/"leveling off"/loss of adaptations

ACSM pre-participation screening algorithm components

- Classifying individuals who do (Yes) or do not (No) currently participate in regular exercise - Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease - Identifying desired exercise intensity

exercise prescription

- Designed to meet individual health and physical fitness goals - intended to guide exercise professionals in the development of an individually tailored Ex Rx for the apparently healthy adult whose goal is to improve physical fitness and health

what is the minimum of what should be measured during exercise tests

- HR - BP - RPE

what should occur prior to engaging in physical activity or structured exercise programs

- Informed consent - Exercise preparticipation health screening - Health history - Cardiovascular (CV) risk factor analysis

what should be monitored during exercise testing

- electrocardiagram - heart rate - blood pressure - signs + symptoms - RPE

what are common aspects of physical exam assessed before, during, and after exercise testing

-HR -BP -ECG -RR/breath sounds -Temperature

using maximal vs submaximal exercise testing

- Maximal tests require participants to exercise to the point of volitional fatigue, which may be inappropriate for some individuals and may require the need for emergency equipment - Exercise professionals often rely on submaximal exercise tests to assess CRF because maximal exercise testing is not always feasible in the health/fitness setting

participant instructions for exercise testing

- Participants should refrain from ingesting food, alcohol, or caffeine or using tobacco products within 3 h of testing. - Participants should be rested for the assessment, avoiding significant exertion or exercise on the day of the assessment. - Clothing should permit freedom of movement and include walking or running shoes. - patient should be told that the test could be fatiguing - patient should continue their medication regimen - patient should be hydrated

indications for terminating a symptom limited maximal exercise test **

- ST elevation

transition (macrocycle)

- also called regression macrocycles - significant decrease in activity to minimize overload •Goals: decrease fatigue, emphasize relaxation, prevent overtraining •Some regression of conditioning is expected •**Just as important as the other macrocycles!**

how to prevent exercise-related cardiac events?

- appropriate health care screening/evaluation - Education of patients/athletes on early warning signs/symptoms of cardiac events - Health care providers appropriately trained in management of cardiac events, including resuscitation - Education of active individuals to modify intensity of exercise according to changes in health, risk factors, and habitual activity.

components of an exercise testing session

- warm-up (5-10min) - conditioning (20-60min) - cool-down (5-10min) - stretching (at least 10min)

specificity/SAID principle

-"specific adaptations to imposed demands" •WHY: identify the goal(s) of training •WHAT physiological system(s) is(are) being challenged?

methods of estimating relative intensity of exercise (aerobic)

-%HRR -%HRmax -%VO2R - %VO2 - %METs -Rating of perceived exertion (RPE) -OMNI Scale -Talk Test -Feeling Scale

general indications for stopping an exercise test

--Onset of angina or angina-like symptoms --Drop in SBP of ≥10 mm Hg with an increase in work rate or if SBP decreases below the value obtained in the same position prior to testing ---Excessive rise in BP: systolic pressure >250 mm Hg and/or diastolic pressure >115 mm Hg --Shortness of breath, wheezing, leg cramps, or claudication --Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin --Failure of HR to increase with increased exercise intensity --Noticeable change in heart rhythm by palpation or auscultation --Subject requests to stop --Physical or verbal manifestations of severe fatigue --Failure of the testing equipment

FITT-VP principle of exercise prescription

-Frequency (how often) -Intensity (how hard) -Time (duration or how long) -Type (mode or what kind) -Total Volume (amount) -Progression (advancement)

general considerations for exercise prescription

-cardiorespiratory (aerobic) fitness -muscular strength and endurance -flexibility -body composition -neuromotor fitness

2 stage process of pre-participation health screening

1. The need for medical clearance before initiating or progressing exercise programming is determined using the ACSM screening algorithm a)Self-guided screenings can be an acceptable substitute for this method. 2. If indicated during screening, medical clearance should be sought from an appropriate health care provider. a)The manner of clearance should be determined by the clinical judgment and discretion of the health care provider.

what is the pre-participation health screening based on

1.) individual's current level of structured physical activity 2.) the presence of major signs or symptoms suggestive of CV, metabolic, renal diseases 3.) the desired exercise intensity

types of macrocycles

1.Developmental 2.Shock 3.Competitive 4.Tapering/Unloading Regeneration 5.Transition

developmental (macrocycle)

improve general or specific fitness (ex: strength) gradually •Step-wise progression to achieve overload over 3 cycles •Followed by a regeneration cycle—back to 2nd load •Regeneration cycle is used as "base" for next loading cycle

interval training

involves varying the exercise intensity at fixed intervals during a single exercise session, which can increase the total volume and/or average exercise intensity performed during that session

exercise snack

isolated bouts of vigorous exercise lasting less than 1 min and performed throughout the day

competitive (macrocycle)

maintain physical fitness and optimize performance

3) competitive/in season (periodization)

maintenance of sport-specific fitness; rest without detraining before major competitions

2) specific preparation/pre season (periodization)

vsport-related physical fitness is primary goal; heavy training; at least 6-8 weeks before start of season/competition; intensity may become more important than volume in 2nd half of this phase