KIN 569 FINAL
Goal Weight Formula
(current weight)(1- current %fat in decimal) / ( 1 - desired %fat)
Pregnancy - Concerns with exercise
- 02 or nutrient availability for both exercising muscle of mother and fetus - hyperthermia-induced fetal distress or birth abnormalities - Increased uterine contraction
Pregnancy Exercise Prescription - Resistance Training
- 2 - 3 nonconsecutive d/wk - 8-10 or 12 - 15 reps to point of moderate fatigue - 1 set for beginners, 2 - 3 sets for intermediate
Cardiac - Resistance Training
- 2-3 days/week (nonconsecutive) - 10-15 reps, RPE 11-13 (40-60% 1 RM) - 1-3 sets, 8-10 exercises, focus on major muscle groups, avoid breath holding.
Pregnancy Exercise Prescription - Aerobic
- => 3-5 d/wk - moderate intensity; vigorous for those who were highly active prior to pregnancy or for those who progress - for HR - see pg. 198 or 200 for HR ranges depending on age, fitness, BMI - 30 min/d - weekly total 150 min of moderate or 75 min of vigorous.
Cardiac - Intensity
- Based on results from baseline exercise test, 40-80% HRR or VO2R (without an exercise test use HRrest + 20-30bpm) - RPE: 12-16 - 10 bpm below ischemic threshold (if known) - Consider signs and symptoms below which an upper limit for exercise intensity should be set.
Diabetes - Blood Glucose Goals
- Before meals: 90-130 mg/dl - 1.5 - 2 hours after meal: 100-160 mg/dl - Bedtimes:100 - 140 mg/dl
Pulmonary Overview:
- COPD: Chronic Obstructive Pulmonary Disease - Obstructive Pulmonary conditions obstruct airflow within the lungs leading to less resistance to inspiration and more resistance to expiration.
Diabetes - Diagnosis
- Fasting blood glucose > 126 mg/dl - symptoms plus casual plasma glucose > 200 mg/dl - 2-hr glucose > 200 mg/dl during an oral glucose tolerance using 75 gram glucose load
Cardiac - Exercise Testing
- GXT: Symptom-limited, use standard protocol, conduct when stable on guideline based medications. - Lowest Risk - Continuous monitoring, decrease to intermittent after 6-12 sessions or sooner as deemed appropriate. - Highest Risk - " " 12 sessions.
Diabetes - Exercise testing (Type 1)
- Goal of Prescription: exercise safely, decrease risk of CVD
PAD - Exercise Prescription
- Good to enroll in medically supervised program - Claudication scale - 0-4, 4 is most painful
Cardiac - Progression
- Individualize (consider initial fitness, motivation/goals, symptoms, musculoskeletal limitations)
Diabetes - Type 1
- Insulin dependent (5-10%) - Autoimmune destruction of the insulin producing beta cells of the pancreas. - Lack of insulin. - Rapid development, usually younger, thin or overweight, catabolic state (recent weight loss)
Pregnancy Exercise Testing
- Maximal is not recommended (unless is a clinical condition which warrants it). If warranted, the test should only be performed with physician supervision after have checked for contraindications to exercise. - Assumptions for submax tests may be compromised (use to chart progress rather than expect accurate estimate of aerobic fitness.
Pulmonary Exercise Testing
- Measure exercise capactiy and exercise tolerance - Measure disease progression and treatment response - Determine other reasons for dyspnea and or exercise limitations - may need to modify protocol (smaller increments, slower progression) - 8-12 min or duration 5 - 9 minutes for those with more severe disease
Diabetes - Intensity
- Moderate, 40-59% VO2R (RPE 11-12) to vigorous, 60-89% VO2R (RPE 14-17). - 150 min/wk of moderate or 75 min of vigorous or combination - 150 min/wk of moderate-to-vigorous intensity
Diabetes - Exercise testing (Type 1) Blood Glucose Regulation:
- Monitor before and after exercise (and potentially during if possible to establish trend) - ok with 1--=250 mg/dl to exercise. - Delay exercise if blood glucose is >250-300 mg/dl with ketones in urine. - Use caution if blood glucose is >250-300 mg/dl without ketones - Consume carbs if < 100 mg/dl (low) - Need to determine individual responses to exercise
Diabetes - Overview
- The total direct and indirect estimated cost of diagnosed diabetes in the US in 2012 was $245 billion.
Diabetes - Concerns
- There is a greater risk of hypoglycemia B(low blood glucose) for people who are treated with insulin, whether type 1 or 2 diabetes. - If blood glucose stays high for a long time (hyperglycemia), problems with the eyes, kidneys and heart could develop regardless of the type of diabetes.
Diabetes - Exercise testing (Type 2) Insulin:
- Treatment normally includes weight loss and oral hypoglycemic agents (help restore insulin recptor sensitivity and stimulate pancreatic insulin release)
Diabetes - Signs and Symptoms
- Urinating often, feeling very thirsty, feeling very hungry, extreme fatigue, blurry vision, cuts/bruises that are slow to heal. - Weight loss even when eating more (Type 1) - Tingling, pain, numbness in hands/feet (Type 2)
Pregnancy - Warning signs to stop exercise
- Vaginal bleeding or amniotic fluid leakage - SOB prior to exertion - Chest pain - Muscle weakness - Calf pain or swelling - Preterm Labor - Decreased fetal movement
PAD (peripheral arterial disease) Overview:
- Walking-induced pain in legs that does not go away with continued walking. (relieved only by rest) - Goal: Relieve exertional symptoms, improve walking capacity, improve quality of life, reduce atherosclerosis risk - Manifestations: Burning, searing, aching, tightness, cramping (often disappear when stop exercising) - Stenosis of vessels may result in tissue death (necrosis) in the dependent tissue and may result in the need to amputate the limb.
Diabetes - Resistance Training
- minimum of 2, but preferably 3 nonconsecutive d/wk - 1-3 sets of 10-15 reps early in training and progress to heavier weights using 1-3 sets of 8-10 reps -moderate (50-69% 1 RM) to vigorous (70-85% 1 RM) - exercises including all major muscle groups - Complete resistance training prior to aerobic to lower risk of hypoglycemia for those with T1DM
cardiac disease
- plaque forming on the inside of the coronary vessels can rupture allowing clot formation to occur, potentially blocking the vessel. - chest discomfort - It is typical angina if all 3 components are present, if only two then atypical angina, which is more common in women. -Location and type of sensation. If it occurs with myocardial stress - If it is relieved by nitroglycerin or rest.
stimulus for strength improvements
1 set minimum. 8-12 reps. 2-3 days per week
Diabetes - Exercise Prescription - Cardio
-Large muscle group (walk, jog, cycle, stairclimb, etc)
PAD resistance training
At least 2 days/wk; 60-80% 1 RM, 2-3 sets of 8-12 reps; 6-8 exercises targeting major muscle groups
CAD risk factors: obesity
BMI greater than 30. waist girth greater than 102cm (40in) in men and 88cm (35in) in women
CAD risk factor: hypertension
145/90+ confirmed on two separate occasions or on antihypertensive medications
what is FITT-VP?
Frequency, Intensity, Time, Type, Volume, Pattern, Progression how to put together a concrete workable workout program for a client.
Pregnancy Exercise Prescription - Flexibility
General Recs
Pregnancy Physiological Responses
Everything increases besides systolic and diastolic (no change or decrease)
CAD risk factor: high cholesterol (dyslipidemia)
LDL greater than 130, HDL less than 40, total cholesterol greater than 200. or on cholesterol medications
Mr. Please
Medical History Review Risk Factor Assessment Prescribed Medication Level of Physical Activity Establish Need for Physician Consent Administer and Evaluate fitness tests Set up exercise prescription Evaluate Progress with follow up tests
Pulmonary Exercise Testing Termination Criteria
Saturation of O2 less or = 80%
exercise in children vs adults: decrease
VO2max (L/min), cardiac output, stroke volume, SBP and DBP, tidal volume, minute ventilation, RER
exercise in children vs adults: increase
VO2max (mL/min), heart rate, respiratory rate
Pulmonary - Type
Walking or stationary cycling
PAD - Mode
Weight-bearing (walking) intermittent; seated rest when moderate pain is reached until pain is completely alleviated.
CAD risk factors: age
men 45+. women 55+
ACSM guidelines for ages 18-65
moderate aerobic- 30 mins, 5 d/week = 3-6 METS vigorous aerobic- 20 mins 3 d/week = >6 METS strength training- 8-10 exercises, 8-12 reps, 2 d/week (heavier weight) *can do bouts of 10 mins*
ACSM guidelines for ages 65+
moderate- 30 min, 5 d/week vigorous- 20 min, 3 d/week strength training- 8-10 exercises 10-15 reps, 2 d/week flexibility- 10 mins, 2 d/week include exercises for balance
isometric
no change in muscle length with tension development
CAD risk factors: physical activity
no physical activity for 30 mins at least 3 days a week for 3 months
special populations for exercise testing, exercise prescription
cardiac, pulmonary, PAD, diabetes, pregnancy, arthritis, cancer
informed consent
explanation of test (plus verbal), potential risks and discomforts, responsibilities of participant, benefits, inquires (specific questions on form along with responses), freedom of consent
physiological changes: posture
has effect on venous return and preload. EDV is highest when recumbent and decreases as a shift to sitting then standing. post exercise hypotensive- blood pooling from decrease in venous return
CAD risk factors: family history
history of MI, coronary revascularization, sudden death before ages 55 (men) or 65 (women)
CAD risk factors: smoking
current smoker or have quit in the past 6 months or exposure to smoke
purpose of cool down
decrease risk of ischemic effect or dysrhythmia, helps clear metabolic waste, good for aerobic and muscular endurance activities, period of metabolic and cardiorespiratory adjustment
purpose of warm up
decrease risk of ischemic effort of dysrhythmia, improves ROM, reduces risk of injury, good for transitional phase (physiological, biomechanical, and bioenergetic), period of metabolic and cardiorespiratory adjustment
medication list for exercise
if diagnostic-often discontinue CV medication with physician approval only. if functional or for prescription, typically continue with medication regimen.
isotonic
involves moving a given resistance through a ROM (dumbbells, free weights)
physiological changes: exercise
larger amount of muscle mass activated, the higher VO2 will be. treadmill shows higher values, test specificity
eccentric
lengthen during contraction while resisting a constant load. still requires ATP
what to do for warm up
light to moderate (30-60% of HRR). lasting 5-10 mins "dynamic, cardiorespiratory endurance exercise warm up is superior to static flexibility exercise" for enhancing performance of cardiorespiratory endurance, aerobic exercise, sports, or resistance exercise.
what to do for cool down
light to moderate intensity, lasting 5-10 minutes.
physiological changes: VO2 max
lower for women by 15-25% due to lower hemoglobin, different body composition, and smaller heart
criteria for VO2max
plateau with increased work load (failure to increase VO2 by 150mL/min), HR does not increase with the increase in work load, post-exercise venous blood lactate >8.0mmol/L, RPE >7 (on 0-10 scale), RPE >17 (on 6-20 scale), peak RER >1.10
exercise testing
pre-exercise instructions and informed consent, criteria for VO2max, test termination criteria
exercise prescription
principles of training. specificity, overload, adaption, reversibility, maintenance. FITT-VP factors
pros vs cons of isometric
pros- can overload, good in rehab where joint motion is limited due to injury cons- joint angle specificity, increases intrathoracic pressure from holding breath
pros vs cons of eccentric
pros- easier, may place less strain on joints cons- produces more muscle soreness, actin and myosin are being torn apart
pros vs cons of isotonic
pros- movement through ROM cons- strength gains at weakest angle in ROM
isokinetic pros vs cons
pros- train muscle across a range of velocities, train concentric and eccentric modes, develop max throughout ROM cons- application of full tension over ROM depends on motivation of the performer
pre-exercise instructions
refrain from ingesting food, alcohol, caffeine, or tobacco products within 3 hours of testing. be rested, avoid significant exertion on day of testing. clothing- freedom of movement. drink fluids to ensure normal hydration
isokinetic
same speed, movement under constant angular velocity, same training procedures are isotonic
CAD risk factors: diabetes
fasting glucose greater than 126. oral glucose test greater than 200. HbA1C greater than 6.5%
physiological changes: sex
females have larger cardiac output at any given submax workload due to lower hemoglobin concentration
Pulmonary - Resistance Training
2-3 days/wk; 60-70% 1 RM for beginners and 80%+ for experienced for strength and <50% for endurance; 2-4 sets of 8-12 reps for strength and =<2 sets of 15-20 reps for endurance; use weight machines, free weights, or body wt exercise
Pulmonary - Duration
20-60 min as tolerated; intermittent rest periods may be needed
PAD - Cardio - Frequency
3-5 days/wk
Pulmonary exercise prescription - Frequency
3-5 days/wk
Diabetes - Frequency
3-7 days a week
PAD - Cardio - Duration
30-45 min/d, may progress to 60 min/d
ACSM in 2011
500-1000 METS per min per week. minimum of 450-750 per week. those wanting to lose weight= 60-90 min per day
PAD (peripheral arterial disease) - Exercise Testing
- Ankle and brachial artery BP should be measured after 5-10 minutes of rest in supine position (to calculate ABI - this is also done in recovery) - Protocol: Use standardized treadmill protocol to ensure reproducibility of pain free max walking time. - 6 minute walk test can also be used to asses function
Cardiac - Frequency and Duration
- At least 3 days, preferably > 5days/week - 20-60 minutes of aerobic activity - Consider total calories burned: 1500-2100 kcal-week
Cardiac - Mode:
- Multiple activities for total physical conditioning - High Intensity Interval Training: Alternate 3-4 min at 80-90% HHR with 60-70% HRR.
Diabetes - Type 2
- Non-insulin dependent diabetes (90-95%) - Resistant to insulin with an insulin secretory effect - Slow development, usually affects those > 30 yo, obese, overweight, or normal.
pulmonary signs and symptoms
- Ongoing cough or a cough that produces a lot of mucus - SOB, especially with PA - Wheezing - Chest tightness
Diabetes - Exercise testing (Type 1) Insulin:
- Rapid acting (30-60 min), short acting (2-3 hr), intermediate acting (4-10 hr peak), long acting (sustained for 20-24 hr) - Insulin Pump - adjust dosage - Avoid exercising muscles where injected - Do not exercise at time of peak insulin action.
Diabetes
Disease characterized by a chronically elevated blood glucose concentration.
Diabetes - Flexibility
For general fitness program reasons
Pulmonary - Intensity
Moderate to vigorous intensity (50-80% peak work rate or 4-6 on Borg CR10 Scale - see pg. 257
PAD - Cardio - Intensity
Moderate-intensity (40-<%60 VO2R) that allows wlaking to the point of moderate pain (3 out of 4 on the claudication pain scale)
Pulmonary - Flexibility
Same as for general program
PAD - Flexibility
Same as general recs
concentric
shortnen while overcoming resistance
physiological changes: bed rest
significant reduction in VO2 man during first month, stroke volume, and cardiac output, increase in heart rate. decrease in plasma volumes. decrease in enzymes of metabolism but still better than those who are sedentary
Cardiac - Flexibility
typical (>2-3 d/wk or best daily, 15s hold with >4 reps, static and dynamic, consider PNF)