Chapter 6: General Principles of Exercise Prescription

Cardiovascular: 1.5-Mile Walk-Run Test

General: •Generally indicated for those who are most fit and able to run •Client must complete the 1.5 miles in the shortest time possible wither by running the whole distance(preferable) or by combining periods of running and walking Equipment: •Stopwatch •Heart Rate monitor(optional) Necessary Data: •1.5-mile completion time(in minutes) Procedure: •Inform client to find a pace that allows the completion of the distance in the shortest time possible(it may be beneficial to perform the test more than once) •Fit client with HR monitor(if available) •Start stopwatch once client begins the 1.5-mile test •Record 1.5-mile completion time(in minutes) Estimate VO2max(ml/kg/min) using the following formula VO2max = 3.5 + 483 / completion time

Another Conversion to Know

1 L/min O2 = 5 kcal/min

General Considerations for Exercise Prescription

•The optimal Ex Rx should address the health-related physical fitness components of -cardiorespiratory(aerobic) fitness -muscular strength and endurance -flexibility -body composition -neuromotor fitness •Separately, a reduction in the time spent in sedentary activities is important for the health of both physically active and inactive individuals and a plan to decrease periods of physical inactivity should be included in the Ex Rx -Long periods of sedentary activity are associated with elevated risks of cardiovascular disease(CVD) mortality, worsened cardiometabolic disease biomarkers, and depression -The adverse health effect of prolonged sedentary activity is more pronounced in inactive adults, but also applies to those adults who are currently meeting the PA guidelines •Musculoskeletal injuries may be reduced by including a warm-up and cool-down, stretching exercises, and gradual progression of volume and intensity

FITT Box: Aerobic Exercise Time(Duration) Recommendation

•Most adults should accumulate 30 - 60 min/day(≥150 min/wk) of moderate intensity exercise, 20 - 60 min/d(≥75 min/wk) of vigorous intensity exercise, or a combination of moderate and vigorous intensity exercise daily to attain the recommended targeted volumes of exercise, The recommended amount of exercise may be accumulated in one continuous exercise session or in bouts of ≥10 min over the course of a day, Durations of exercise less than recommended can be beneficial in some individuals

Neuromotor Exercise

•Neuromotor exercise training involves motor skills, such as balance, coordination, gait, and agility, and proprioceptive training and is sometimes called functional fitness training •Neuromotor exercise training results in improvements in balance, agility, and muscle strength and reduces the risk of falls and the fear of falling among older adults •The optimal effectiveness of the various types of neuromotor exercise, doses(i.e., FIT), and training regimens are not known for adults of any age, Studies that have resulted in neuromotor improvements have mostly employed training frequencies of ≥2 - 3 d/wk with exercise sessions of ≥20 - 30 min duration for a total of ≥60 min of neuromotor exercise per week

FITT Box: Neuromotor Exercise Recommendations

•Neuromotor exercises involving balance, agility, coordination, and gait are recommended on ≥2 - 3 d/wk for older individuals and are likely to beneficial for younger adults as well, The optimal duration or number of repetitions of these exercises is not known, but neuromotor exercise routines of ≥20 - 30 min in duration for a total of ≥60 min of neuromotor exercise per week are effective

Aerobic (Cardiovascular Endurance) Exercise: Exercise Time(Duration)

•Prescribed as a measure of the amount of time PA is performed •It is recommended that most adults accumulate 30 - 60 min/d(≥150 min/wk) of moderate intensity exercise, 20 - 60 min/d(≥75 min/wk) of vigorous exercise, or a combination of moderate and vigorous exercise per day •For weight management, longer durations of exercise(≥60 - 90 min/d) may be needed, especially in individuals who spend large amounts of time in sedentary behaviors •The recommended time/duration of physical activity may be performed continuously(i.e., one session) or intermittently and can be accumulated over the course of a day in one or more sessions of physical activity that total at least 10 min/session •Exercise bouts of less than 10 min may yield favorable adaptations in very deconditioned individuals or when done as part of a high intensity aerobic interval program

Aerobic (Cardiovascular Endurance) Exercise: Exercise Volume(Quantity)

•Product of Frequency, Intensity, and Time(duration) or FIT of exercise •Exercise volume may be used to estimate the gross EE of an individual's Ex Rx •MET-min/wk and kcal/wk can be used to estimate exercise volume in a standardized manner •There is a dose-response association between the volume of exercise and health/fitness outcomes(i.e., with greater amounts of physical activity, the health/fitness benefits also increase) •A total EE of ≥500 - 1,000 MET-min/wk is consistently associated with lower rates of CVD and premature mortality, this is a reasonable target volume for an exercise program for most adults •Pedometers are effective tools for promoting physical activity and can be used to approximate exercise volume in steps per day •The goal of 10,000 steps/d is often cited, but it appears that achieving a pedometer step count of at least 5,400 - 7,900 steps/d can meet recommended exercise targets

FITT Box: Flexibility Exercise Recommendation

•ROM is improved acutely and chronically following flexibility exercises, Flexibility exercises are most effective when the muscles are warm, Static stretching exercises may acutely reduce power and strength so it is recommended that flexibility exercises be performed after exercise and sports where strength and power are important for performance

FITT Box: Resistance Training Frequency Recommendation

•Resistance training of each muscle group 2 - 3 d/wk with at least 48 h separating the exercise training sessions for the same muscle groups is recommended for all adults

FITT Box: Aerobic Exercise Type Recommendation

•Rhythmic, aerobic exercise of at least moderate intensity that involves large muscle groups and requires little skill to perform is recommended for all adults to improve health and CRF, Other exercise and sports requiring skill to perform or higher levels of fitness are recommended only for individuals possessing adequate skill and fitness to perform the activity

Aerobic (Cardiorespiratory Endurance) Exercise: Type(Mode)

•Rhythmic, aerobic type exercises involving large muscle groups are recommended for improving cardiorespiratory fitness •The specificity principle states that the physiologic adaptations to exercise are specific to the type of exercise performed

Sedentary Behavior and Brief Activity Breaks

•Sedentary behaviors can have adverse health effects, even amongst those who regularly exercise •There is increasing evidence that concurrently reducing sedentary time results in health benefits that are additive to exercise •Sedentary behavior negatively impacts cardiometabolic markers, body composition, and physical function, and these effects might be attenuated by interspersing brief PA(e.g., 1 - 5 minutes of standing and walking) •Although the frequency, intensity, time(duration), and type of brief PA breaks have not been clearly identified, standing or engaging in light to moderate walking or other PA ≥ once per hour to breakup sedentary stretches may be encouraged

Muscular Fitness

•The ACSM uses the phrase "muscular fitness" to refer collectively to muscular strength, endurance, and power •Muscular strength and endurance are often the foundation of a general training regimen focusing on health/fitness outcomes for young and middle-aged adults, however, muscular power should be equally emphasized •Older adults(≥65 yr) may particularly benefit from power training because this element of muscle fitness declines most rapidly with aging, and insufficient power has been associated with a greater risk of accidental falls, Importantly, aged individuals can safely perform the fast-velocity muscular contractions, or repetitions, that optimally develop muscular power

FITT Box: The FITT-VP Principle of Ex Rx Summary

•The FITT-VP principle of Ex Rx features an individually tailored exercise program that includes specification of the Frequency(F), Intensity(I), Time or duration(T), Type or mode(T), Volume(V), and Progression(P) of exercise to be performed, The exact composition of FITT-VP will vary depending on the characteristics and goals of the individual, The FITT-VP principle of Ex Rx will need to be revised according to the individual response, need, limitation, and adaptations to exercise as well as evolution of the goals and objectives of the exercise program

Box 6.1: Components of the Exercise Training Session

We need all of these, In our clinical class they will look at this •Warm-up: at least 5 - 10 min of light-to-moderate intensity cardiorespiratory and muscular endurance activities •Conditioning: at least 20 - 60 min of aerobic, resistance, neuromotor, and/or sport activities(exercise bouts of 10 min are acceptable if the individual accumulates at least 20 - 60 min/day of daily aerobic exercise) •Cool-down: at least 5 - 10 min of light-to-moderate intensity cardiorespiratory and muscular endurance activities •Stretching: at least 10 min of stretching exercises performed after the warm-up or cool-down phase

Guide to Setting Workloads on Bicycle Ergometer for YMCA Submaximal Bike Test

1st workload •150 kgm(0.5 kp) for everyone, For the entire test, keep at 50 rpm, each stage is three minutes, once we get their first HR, we must go down that road for the rest of the test, stages, The first HR is taken after the first 3 minutes, try taking a practice HR at about 2 minutes to see where they're headed, 2nd workload lasts until 6 minutes, 3rd workload lasts until 9 minutes, and the final, 4th workload lasts until 12 minutes, unless more than 5 bpm difference, then would perform test for an extra minute HR < 80 •2nd workload: 750 kgm(2.5 kp) •3rd workload: 900 kgm(3.0 kp) •4th workload: 1050 kgm(3.5 kp) HR 80 - 90 •2nd workload: 600 kgm(2.0 kp) •3rd workload: 750 kgm(2.5 kp) •4th workload: 900 kgm(3.0 kp) HR 90 - 100 •2nd workload: 450 kgm(1.5 kp) •3rd workload: 600 kgm(2.0 kp) •4th workload: 750 kgm(2.5 kp) HR > 100 •2nd workload: 300 kgm(1.0 kp) •3rd workload: 450 kgm(1.5 kp) •4th workload: 600 kgm(2.0 kp) Directions: 1. Set the first workload at 150 kgm/min(0.5 kp) 2. If the HR in the third min is •less than (<) 80, set the second load at 750 kgm(2.5 kp) •80 - 89, set the second load at 600 kgm(2.0 kp) •90 - 100, set the second load at 450 kgm(1.5 kp) •greater than (>) 100, set the second load at 300 kgm(1.0 kp) 3. Set the third and fourth(if required) loads according to the loads in the columns below the seconds loads Also, on the other side, the YMCA VO2 Max Estimation Graph, Look at graph in notes

Conversions Table

Conversions •To get from body weight(lbs) to body weight(kg): Divide by 2.2 lbs/kg •To get VO2 from L/min to ml/kg/min: Divide by body weight(kg) and multiply by 1000 ml / 1 L •To get from VO2(ml/kg/min) to METs: Divide by 3.5 ml/kg/min / 1 MET •To get from VO2(L/min) to kcal/min: Multiply by 5 kcal/min / 1 L/min O2 •Note: Do the opposite to go in the other direction Table: Body Weight, VO2(L/min), VO2(ml/kg/min), METs, kcal/min •168 lbs = 76.4 kg, 3.21, 42, 12, 16 •70 kg, 2.45, 35, 10, 12.3 •90 kg, 4.4, 48.9, 14, 22 •220 lbs = 100 kg, 2.5, 25, 7.1, 12.5

Six-Minute Walk Test

Designed for senior citizens, who we wouldn't put on a treadmill for exercise testing, some of our healthy titans may prefer this, may need a portable chair for them to sit down in afterwards, there is an equation that can be used to calculate their VO2max, this would be done in between cones on the gym floor, Whereas the 1-mile walk test and 1.5-mile walk-run(can jog, if able) test would be done in an indoor track Description: The 6-Minute Walk test is a sub maximal measure of aerobic capacity, The person may use an ambulation aid and oxygen if they do so normally, The 6MWT is a useful measure of functional capacity targeted at people with at least moderately severe impairment, The test has been widely used for preoperative and postoperative evaluation and for measuring the response to therapeutic interventions for pulmonary and cardiac disease Equipment: stethoscope, BP cuff, Borg RPE, dyspnea scale, stopwatch, tape measure, portable chair Absolute contraindications: •unstable angina during the previous month •myocardiacl infarction during the previous month Relative contraindications: •Resting HR > 120 •SBP > 180 mmHg •DBP > 100 mmHg Terminate exercise if: Angina, light-headedness, confusion, ataxia, staggering unsteadiness, pallor, cyanosis, nausea, marked dyspnea, unusual fatigue, claudication or other significant pain, facial expressions signifying distress, Notify physician if test is terminated for any of the above reasons Instructions to the Participant: The object of this test is to walk as far as possible for 6 minutes, You will walk back and forth in this hallway, Six minutes is a long time to walk, so you will be exerting yourself, You will probably get out of breath or become exhausted, You are permitted to slow down, to stop, and to rest as necessary, You may lean against the wall while resting, but resume walking as soon as you are able, You will be walking back and forth around the cones, You should pivot briskly around the cones and continue back the other way without hesitation, Now I'm going to show you, Please watch the way I turn without hesitation, We will avoid having a conversation so that you can save your wind for walking, You can being when I say go Guidelines for the Tester: Do not walk with the patient, however if balance is an issue, the tester may walk behind and to the side, After the first minute, tell the patient the following(in even tones): "You are doing well, You have 5 minutes to go", Repeat this message at every minute(4, 3, 2, 1), Do not use other words of encouragement(or body language to speed up), If the patient stops walking during the test and needs a rest, say this: "You can lean against the wall if you would like, then continue walking whenever you feel able", Do not stop the timer, If the patient stops before the 6 minutes are up and refuses to continue(or you decide that they should not continue), the chair over for the patient to sit on, discontinue the walk, and note on the worksheet the distance, the time stopped, and the reason for stopping prematurely At the end of the 6 minutes: •Have participant sit down(portable chair) •Immediately take vital signs, starting with HR(because it drops more quickly than SBP) •Have patient rate their Borg Rate of Perceived Exertion(RPE), and dyspnea •Calculate and record the distance walked •Ask: "What, if anything, kept you from walking farther?" Safety: Monitor vital signs before and after the test, If there is an unexpected vital sign response, continue monitoring and documenting every 5 minutes until SBP and HR returns to within 10 - 20 of pre-exercise values, Note heart rhythm, especially if it changes from a regular rhythm in pre-exercise to an irregular rhythm in post-exercise, If participant has congestive heart failure profile(ankle edema, dyspnea at rest or with minimal exertion): ausculate the lung bases for new or increased crackles, and also ausculate the heart apically to see if you detect an S3 heart sound Aging of the Cardiovascular system: •Resting HR in elderly does not vary significantly from resting HR in normal, young population •In the elderly population, HR response to exercise can be less brisk, and also will not rise to as high of a maximal HR(compared to young normal) •For the person with cardiac risk factors, if graded exercise stress test results are not available(the gold standard for establishing a target HR), keep the peak exercise HR under 120 - 130 bpm, Alternatively, only allow a HR rise of 20 bpm •If participant is taking a Beta Blocker it will blunt their HR response to exercise, therefore HR is not a reliable measure, Rely on RPE and dyspnea scales and their BP response Prognosis: •Prediction formula for VO2max: Peak VO2 = 0.03 X distance(in meters) + 3.98 •CHF: 6MW distances of < 300 meters have both a poorer short term and long term survival rate

Cardiovascular: YMCA Submaximal Bike Test - Page 2

Estimating VO2max •Calculation Method: -Use the metabolic equations for leg cycling to estimate VO2 for both final work-stages(VO21 and VO22) -VO2(ml/kg/min) = [(work rate (kgm/min) X 1.8) / (body mass(kg))] + 7 -Calculate the slope ("m") of the HR and VO2 relationship -m = (VO22 - VO21) / HR2 - HR1) -VO21: submaximal predicted VO2 from stage 1 (ml/kg/min) -VO22: submaximal predicted VO2 from stage 2 (ml/kg/min) -HR1: HR from stage 1 (bpm) -HR2: HR from stage 2 (bpm) -Include the calculated slope(m) in the following equation, Note: HRmax = 220 - age -VO2 max (ml/kg/min) = m X (HRmax - HR2) + VO22 (ml/kg/min) •Graphing Method: -Plot the two HR and corresponding work rate data points on a graph -HR on y axis -Work rate on x axis -Draw a horizontal line across the graph to intersect the y axis (HR) at the age predicted HRmax -Draw a line connecting the two data points, extending the line to intersect the horizontal line indicating the HRmax -Draw a perpendicular line down from the intersection of HRmax and data points lines -This represents the predicted work rate for predicted VO2max -Use this work rate and the metabolic equation for leg cycling to calculate predicted VO2max Example •A 30 year old male(75 kg) completed two stages (450 and 600 kgm/min) with HR values of 116 and 130 bpm, respectively -Calculate VO21 and VO22 -VO21 = [(450 kgm/min X 1.8) / (75 kg)] + 7 = 17.8 ml/kg/min -VO22 = [(600 kgm/min X 1.8) / (75 kg)] + 7 = 21.4 ml/kg/min -Calculate the slope ("m") of the HR and VO2 relationship -m = (21.4 - 17.8) / (130 - 116) -m = 3.6 / 14 = 0.2571 -Calculate predicted VO2max -VO2max (ml/kg/min) = 0.2571 X (190 - 130) + 21.4 = 36.83 ml/kg/min

Cardiovascular: 1-Mile Walk Test

General: •Generally indicated for those who are sedentary, been mostly non-active, or unable to run •Client must be able to walk briskly for 1 mile -Walking defined as having one foot in contact with the ground at all times Equipment: •Scale •Stopwatch •Heart Rate monitor(optional) Necessary Data: •Gender (women = 0, men = 1) •Age •Accurate bodyweight(kilograms) •1-mile walk time(in minutes) •Heart Rate(15 sec recovery HR X 4, beats per minute) Procedure: •Record client gender and age •Weight client at time of walk(kilograms) •Fit client with HR monitor(if available) •Start stopwatch once client begins the 1-mile test •Client must walk as quickly as possible through the 1-mile •Record 1-mile time upon completion of the test(in minutes) •Record HR(HR monitor) or take a 15 second recovery HR and multiply by 4 -Client should keep the legs moving -If palpation is used: achieve 15 second HR within 20 - 30 seconds after the test completion Estimate VO2max(ml/kg/min) using the following formula VO2max = 132.853 - (0.1692 X wt) - (0.3877 X age) + (6.315 X gender) - (3.2649 X time) - (0.1565 X HR)

Karvonen Formula

HR is the most common way to estimate one's exercise intensity •Target HR = [(MHR - RHR) X %Intensity] + RHR -MHR = 220 - age •What is the target HR of a 47 yr. with a resting heart rate of 60 bpm, at an exercise intensity of 75% -[(173 - 60) X 0.75] + 60 = 145 bpm, this is the HR they'll exercise at •50% is a good intensity for a sedentary client working out for the first time, 40 - 45% may even be necessary if also elderly(60s, 70s, 80s) and/or obese •If our clients are regularly active, then they can engage in higher intensity exercise at 75% - 80%

Six-Minute Walk Test: Norms for 6 Minute Walk Distances - 3 Studies

Look at diagram in notes Brown M, Exercise Specificity in Physical Frailty •Mean age of frail elder participants: 84, Number of participants: n = 95 -Excluded subjects if scored > 30 on the Modified Physical Performance Test(mPPT) -Also excluded if blind, dementia, progressive neurological disease •6 minute walk distance: Mean - 264 m(865 ft), SD - 95 m(313 ft) Lusardi M, Functional Performance in Community Living Older Adults, Journal of Geriatric Physical Therapy •Participants: 76(22 men, 54 women), Mean age: 83 ± 8 •Exclusion criteria: unstable angina, cardiac event, cardiac surgery last 6 mo, use of O2 or inhalers, neuro disease •6 minute walk distances: Age, Gender(N), Mean, SD -60 - 69, Male(1) and Female(5), 498 m(1634 ft) and 405 m(1329 ft), None and 110 m -70 - 79, Male(9) and Female(10), 475 m(1558 ft) and 406 m(1332 ft), 93 m and 95 m -80 - 89, Male(9) and Female(24) and No Assist Device(24) and Assist Device(9), 320 m(1050 ft.) and 282 m(922 ft) and 328 m(1076 ft) and 197 m(646 ft), 80 m and 123 m and 102 m and 82 m -90 - 101, Male(2) and Female(15) and No Assist Device(7) and Assist Device(10), 296 m(971 ft) and 261 m(856 ft) and 324 m(1063 ft) and 224 m(735 ft), 15 m and 81 m and 70 m and 51 m Steffen T.M., Age and Gender Related Test Performance in Community-Dwelling Elderly People: 6MWT, BBS, TUG, and Gait Speed •Subjects included needed to be able to walk 6 minutes without shortness of breath, chest pain, or joint pain in the legs, neck, or back that would limit 6MW •Subjects were excluded if: smokers, history of dizziness, used an assistive device •6 minute walk distances: Age, Gender(N), Mean, SD, Normal Range(2SD) -60 - 69, Male(15) and Female(22), 572 m(1877 ft) and 538 m(1765 ft), 92 m and 92 m, 388 - 756 m and 354 - 722 m -70 - 79, Male(14) and Female(22), 527 m(1729 ft) and 471 m(1545 ft), 85 m and 75 m, 357 - 697 m and 321 - 621 m -80 - 89, Male(8) and Female(15), 417 m(1386 ft) and 392 m(1286 ft), 73 m and 85 m, 271 - 563 m and 222 - 562 m

Metabolic Equations: Stepping

Metabolic equations enable us to compute exercise intensity levels based on a percentage of peak oxygen uptake or METs from an exercise test, Additionally, calculating an estimate of the actual oxygen uptake of an exercise session enables you to determine whether a person is exercising at an intensity level high enough to result in physiological improvements in aerobic capacity, These calculations will also enable you to estimate that total caloric expenditure of an exercise session, These equations convert mechanical work into metabolic equivalents, They will allow you to calculate an estimate of the oxygen consumption(VO2) of various workloads for the most commonly used exercise modalities Equations are relatively accurate only if the following assumptions are true •Exercise is in steady state •Subject isn't holding the handrail •Subject has normal oxygen kinetics(normal HR-O2 relationship) •Exercise is in a neutral environment •Subject is at least 18 years old Each equation as the following 3 components •Horizontal component -Energy cost or oxygen consumption of the work required to move horizontally •Vertical or resistive component -Energy cost or oxygen consumption of the work required to move against gravity or resistance •Resting component -Energy cost or oxygen consumption of sitting quietly, equivalent to 1 MET or 3.5 mlO2/kg/min Conversions •lb to kg: 0.454 •in to cm: 2.54 •ft to m: 0.3048 •miles to km: 1.609 •mph to m/min: 26.8 •kgm/min to W: 0.164 •W to kgm/min: 6.12 •VO2max(L/min) to kcal/min: 4.9 •VO2max(ml/kg/min) to MET: 3.5

Metabolic Equations: Stepping - Continued

Stepping Equation •Most accurate for stepping rates of 12 - 30 steps/min •This is a weight-bearing activity so relative oxygen consumption is used •O2 consumption depends upon -stepping rate -step height -whether the person is stepping up and down Calculation •Convert step height to meters •Horizontal component -Refers to stepping speed or rate(steps/min) and is multiplied by a constant of 0.2 •Vertical component -Multiply step height(meters) by the step rate(steps/min) by a constant of 2.394(constant is derived by multiplying the O2 vertical component(1.8) by the cost of going up and down(1.33)) •Resting component -3.5 mlO2/kg/min Example: what is the relative O2 consumption of stepping up and down using a bench 8 inches high at a rate of 30 steps/min? •Step height: 8''(8'' X 0.0254 = 0.2 meter) •Step rate: 30 steps/min •Horizontal component -Step rate/min X 0.2 -30 steps/min X 0.2 = 6 mlO2/kg/min •Vertical component -(1.8 X step height(m) X step rate(steps/min) X 1.33 -(1.8 X 0.2 m X 30 steps/min) X 1.33 = 14.364 mlO2/kg/min •Resting component -3.5 mlO2/kg/min •Total -6 + 14.364 + 3.5 = 23.864 mlO2/kg/min •There are multiple more examples in the packet to try

Exercise Order is Important During Fitness Assessments

There is a reason for the specific order •Paper work, Resting HR and BP, Height and Weight, the Sit and Reach test, Circumference Measures or Skinfolds for Body Composition, Cardiorespiratory Fitness via the YMCA 3 Minute Step Test or the Astrand-Rhyming Submaximal Cycle Ergometer Test, and finally, Muscular Strength via the Grip Strength Test, and Muscular Endurance via the Push-Up Test -This is important to have strength tests done last, If they did them right before their cardiorespiratory tests, their HR might be much higher than it should be, decreasing the validity of those tests

Cardiovascular: Queens(McArdle) Step Test

This is different from the YMCA 3 Minute Step Test, which only ranks your fitness, whereas this can be used to determine your VO2max General •Description -The test requires a participant to step up and down off the bench for 3 minutes at a cadence specific to the client's gender •Equipment/Instrumentation -16.25 inch(41.25 cm) bench -Metronome •Stepping Rate -Men: 24 steps/min(metronome set to 96 bpm) -Women: 22 steps/min(metronome set to 88 bpm) •Measurement -15 second recovery heart rate taken with subject standing(multiplied X 4 to get bpm) ideally started within 5 seconds of test completion(15 second recovery heart rate must be completed by 30 seconds post-test) Procedure •Practice locating the pulse on the participant •Set the metronome proper cadence •Orient the subject to the procedures and allow them to practice stepping to the cadence -Each beat is an "up" or a "down" with both feet coming all the way up onto the bench and both feet stepping back down(i.e., "up, up, down, down") •At your signal, the participant should begin stepping as the administrator starts the watch •Immediately after the 3 minutes of stepping the administrator will take a 15 second heart rate ideally starting 5 seconds after the completion of the stepping(i.e., 3:05 to 3:20 on the stopwatch) •Multiply 15 second recovery HR by 4 to get bpm and record Calculation of Estimated VO2max •Men -VO2max(ml/kg/min) = 111.33 - (0.42 X HRrecovery) •Women -VO2max(ml/kg/min) = 65.81 - (0.1847 X HRrecovery) Example: a man finished the test with a recovery HR of 144 bpm(36 beats in 15 seconds) •VO2max(ml/kg/min) = 111.33 - (0.42 X 144) •VO2max(ml/kg/min) = 111.33 - 60.48 •VO2max(ml/kg/min) = 50.85 ml/kg/min

Cardiovascular: YMCA Submaximal Bike Test - Page 1

We'd only do this for young and fit populations, not the elderly or unfit, If too small, even if they're fit, it may become anaerobic and shoot their HR way up, so it may not be the best for certain individuals that are fit as well, as the resistance is too much for them General •Protocol involves a branching, multistage procedure to acquire data to establish a relationship between heart rate(HR) and work rate -Requires at least two, possibly four exercise stages(3 minute stages) Equipment/Instrumentation •Cycle ergometer •Heart Rate Monitor •BP Cuff and Stethoscope Requirements •Complete two separate workloads that result in HR values between 110 and 150 beats/minute •Each 3-minute stages requires a steady-rate HR -Defined as heart rates taken at the end of the 2nd and 3rd minutes that do not differ more than 5 beats/minutes -If the two heart rates differ by more than 5 beats/minute, this indicates that the client has not reached steady-state in that stage and should continue for an additional minute •Blood pressure is not required, but is advised to be taken at each stage -Data would be used to end the test early due to a hypertensive response -If present, significantly elevated BP response to submaximal exercise would be valuable for the client's healthcare professional Procedure •Stage 1: Every person begins with a work rate of 150 kgm/min(0.5 kp at 50 rpm) •Stage 2: If the HR in the 3rd minute of the stage is: -< 80, set the 2nd stage at 750 kgm/min(2.5 kp at 50 rpm) -80 - 89, set the 2nd stage at 600 kgm/min(2.0 kp at 50 rpm) -90 - 100, set the 2nd stage at 450 kgm/min(1.5 kp at 50 rpm) -> 100, set the 2nd stage at 300 kgm/min(1.0 kp at 50 rpm) •Set the 3rd and 4th stages according to the work rates in the columns below the 2nd stage loads(i.e., stay in the same column) -1st Stage, 150 kgm/min(0.5 kp) for everyone to get a HR -HR < 80: 2nd stage, 750 kgm/min(2.5 kp), 3rd stage, 900 kgm/min(3.0 kp), 4th stage, 1050 kgm/min(3.5 kp) -HR 80 - 89: 2nd stage, 600 kgm/min(2.0 kp), 3rd stage, 750 kgm/min(2.5 kp), 4th stage, 900 kgm/min(3.0 kp) -HR 90 - 100: 2nd stage, 450 kgm/min(1.5 kp), 3rd stage, 600 kgm/min(2.0 kp), 4th stage, 750 kgm/min(2.5 kp) -HR > 100: 2nd stage, 300 kgm/min(1.0 kp), 3rd stage, 450 kgm/min(1.5 kp), 4th stage, 600 kgm/min(2.0 kp)

Aerobic (Cardiorespiratory Endurance) Exercise: Methods of Estimating Intensity

•Methods of estimating the absolute intensity exercise -Caloric expenditure(kcal/min) -Absolute oxygen uptake(VO₂, mL/min, or L/min) -Metabolic equivalents(METs) •Methods of estimating the relative intensity of exercise -%HRR -%HRmax -%VO₂R -%VO₂ -%METs •Methods of estimating the intensity of exercise -Rating of perceived exertion(RPE) -Affective valence -OMNI scale -Talk Test -Feeling scale

FITT Box: Aerobic Exercise Frequency Recommendation

•Moderate intensity, aerobic exercise done at least 5 d/wk, or vigorous intensity, aerobic exercise done at least 3 d/wk, or a weekly combination of 3 - 5 d/wk of moderate and vigorous intensity exercise is recommended for most adults to achieve and maintain health/fitness benefits

METs or Metabolic Equivalent

•1 met = 3.5 mlO2/kg/min -This is a way to quantity exercise intensity, but is not used that much, clients don't understand it •What is 25.8 mlO2/kg/min in METs? -25.8 / 3.5 = 7.4 METs, this can be classified as vigorous intensity exercise

FITT Box: Aerobic Exercise Intensity Recommendation

•Moderate(e.g., 40% - 59% heart rate reserve [HRR] or VO₂R) to vigorous(e.g., 60% - 89% HRR or VO₂R) intensity aerobic exercise is recommended for most adults, and light(e.g., 30% - 39% HRR or VO₂R) to moderate intensity aerobic exercise can be beneficial in individuals who are deconditioned, Interval training may be an effective way to increase the total volume and/or average exercise intensity performed during an exercise session and may be beneficial for adults

Aerobic (Cardiorespiratory Endurance) Exercise: Rate of Progression

•A recommended rate of progression in an exercise program depends on the individual's health status, physical fitness, training responses, and exercise program goals •Progression may consist of increasing any of the components of the FITT principle of ExRx as tolerated by the individual •During the initial phase of the exercise program, applying the principal "Start Low and Go Slow" is prudent to reduce risks of adverse cardiovascular events and musculoskeletal injury as well as to enhance adoption and adherence to exercise •An increase in exercise time/duration per session of 5 - 10 min every 1 - 2 wk over the first 4 - 6 wk of an exercise training program is reasonable for the average adult •After the individual has been exercising regularly for at least 1 month, the FIT of exercise is gradually adjusted upward over the next 4 - 8 months, or longer for older adults and very deconditioned individuals, to meet the recommended quantity and quality of exercise presented in the Guidelines

FITT Box: Aerobic Exercise Volume Recommendation

•A target volume of ≥500 - 1,000 MET-min/wk is recommended for most adults, This volume is approximately equal to 1,000 kcal/wk of moderate intensity, physical activity, ~150 min/wk of moderate intensity exercise, or pedometer counts of ≥5,400 - 7,900 steps/d, Because of the substantial errors in prediction when using pedometer step counts, use steps/d combined with currently recommended time/durations of exercise, Lower exercise volumes can have health/fitness benefits for deconditioned individuals, and greater volumes may be needed for weight management

FITT Box: Flexibility Volume Recommendation

•A total of 60 s of flexibility exercise per joint is recommended, Holding a single flexibility exercise for 10 - 30 s to the point of tightness or slight discomfort is effective, Older adults can benefit from holding the stretch for 30 - 60 s, A 20% - 75% maximum voluntary contraction held for 3 - 6 s followed by a 10 - 30 s assisted stretch is recommended for PNF techniques, Performing flexibility exercises ≥2 - 3 d/wk is recommended with daily flexibility exercise being most effective

FITT Box: Volume of Resistance Exercise(Sets and Repetitions) Recommendation

•Adults should train each muscle group for a total of 2 - 4 sets with 8 - 12 repetitions per set with a rest interval of 2 - 3 min between sets to improve muscular fitness, For older adults and very deconditioned individuals, ≥1 set of 10 - 15 repetitions of moderate intensity(i.e., 60% - 70% of 1-RM), resistance exercise is recommended

Aerobic (Cardiorespiratory Endurance) Exercise: Frequency of Exercise

•Aerobic exercise is recommended on 3 - 5 d/wk for most adults, with the frequency varying with the intensity of exercise •Improvements in cardiorespiratory fitness(CRF) are attenuated with exercise frequencies more than 3 d/wk and a plateau in improvement with exercise done more than 5 d/wk •Vigorous intensity exercise performed more than 5 d/wk might increase the incidence of musculoskeletal injury, so this amount of vigorous intensity, physical activity is not recommended for adults who are not well conditioned

FITT Box: Resistance Exercise Technique Recommendations

•All individuals should perform resistance training using correct technique, Proper resistance exercise techniques employ controlled movements through the full ROM and involve concentric and eccentric muscle actions

Muscular Fitness: Progression/Maintenance

•As muscles adapt to a resistance exercise training program, the participant should continue to subject them to overload or greater stimuli to continue to increase muscular strength and mass •The most common approach is to increase the amount of resistance lifted during training •Other ways to progressively overload muscles include performing more sets per muscle group and increasing the number of days per week the muscle groups are trained •Increasing the overload by adding resistance, sets, or training sessions per week is not required during a maintenance resistance training program •Muscular strength may be maintained by training muscle groups as little as 1 d/wk as long as the training intensity or the resistance lifted is held constant

FITT Box: Progression/Maintenance of Resistance Training Recommendation

•As muscles adapt to a resistance exercise training program, the participant should continue to subject them to overload to continue to increase muscular strength and mass by gradually increasing resistance, number of sets, or frequency of training

Box 6.4: Types of Flexibility Exercises

•Ballistic methods or "bouncing" stretches use the momentum of the moving body segment to produce the stretch •Dynamic or slow movement stretching involves a gradual transition from one body position to another, and a progressive increase in reach and range of motion as the movement is repeated several times •Static stretching involves slowly stretching a muscle/tendon group and holding the position for a period of time(i.e., 10 - 30 s), Static stretches can be active or passive •Active static stretching involves holding the stretched position using the strength of the agonist muscle as is common in many forms of yoga •Passive static stretching involves assuming a position while holding a limb or other body part of the body with our without assistance of a partner or device(such as elastic bands or a ballet barre) •Proprioceptive neuromuscular facilitation(PNF) methods take several forms but typically involve an isometric contraction of the selected muscle/tendon group followed by a static stretching of the same group(i.e., contract-relax)

An Introduction to the Principles of Exercise Prescription

•Designed to meet individual health and physical fitness goals •The principles of exercise prescription(Ex Rx) are intended to 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

Muscular Fitness: Types of Resistance Exercises

•Many types of resistance training equipment can effectively be used to improve muscular fitness including free weights, machines with stacked weights or pneumatic resistance, and even resistance bands •Resistance training regimens should focus on multijoint or compound exercises that affect more than one muscle group(e.g., chest press, shoulder press, pull-down, rows, push-ups, leg press, squats, deadlifts) •Single joint exercises targeting major muscle groups(e.g., biceps curls, triceps extensions, quadriceps extensions, leg curls, and calf raises) and exercises that affect core muscles should also be included in a resistance training program •To avoid creating muscle imbalances that may lead to injury, opposing muscle groups(i.e., agonists and antagonists), such as the chest and upper back or the quadriceps and hamstrings muscles, should be included in the resistance training routine

Muscular Fitness: Volume of Resistance Exercise(Sets and Repetitions)

•Each muscle group should be trained for a total of two to four sets •These sets may be derived from the same exercise or from a combination of exercises affecting the same muscle group •A reasonable rest interval between sets is 2 - 3 min •Using different exercises to train the same muscle group adds variety, may prevent long-term mental "staleness" •Four sets per muscle group is more effective than two sets, however, even a single set per exercise will significantly improve muscular strength, particularly among novices •The resistance training intensity and number of repetitions performed with each set are inversely related •To improve muscular strength, mass, and, to some extent, endurance, a resistance exercise that allows an individual to complete 8 - 12 repetitions per set should be selected, This repetition number translates to a resistance that is ~60% - 80% of the individual's one repetition maximum (1-RM) •Each set should be performed with proper form and to the point of muscle fatigue but not failure, because exerting muscles to the point of failure increases the likelihood of injury or debilitating residual muscle soreness, particularly among novices •If the objective of the resistance training program is mainly to improve muscular endurance rather than strength and mass, a higher number of repetitions, perhaps 15 - 25, should be performed per set along with shorter rest intervals and fewer sets(i.e., 1 or 2 sets per muscle group) •Older and very deconditioned individuals who are more susceptible to musculotendinous injury should begin a resistance training program conducting more repetitions(i.e., 10 - 15) at a very light-to-light intensity at 40% - 50% of 1-RM, or an RPE of 5 - 6 on a 10-point scale assuming the individual has the capacity to use this intensity while maintaining proper lifting technique •Subsequent to a period of adaptation to resistance training and improved musculotendinous conditioning, older individuals may choose to follow guidelines for younger adults(higher intensity with 8 - 12 repetitions per set)

Muscular Fitness: Resistance Exercise Technique

•Each resistance exercise should be performed with proper technique regardless of training status or age •The exercises should be executed using correct form and technique, including performing the repetitions deliberately and in a controlled manner, moving through the full ROM of the joint, and employing proper breathing techniques(i.e., exhalation during the concentric phase and inhalation during the eccentric phase and avoid the Valsalva maneuver)

Table 6.4: Modes of Aerobic (Cardiorespiratory Endurance) Exercise to Improve Physical Fitness

•Exercise Group, Exercise Description, Recommended for, Examples -A, Endurance activities requiring minimal skill or physical fitness to perform, All adults, Walking, leisurely cycling, aqua-aerobics, slow dancing -B, Vigorous intensity endurance activities requiring minimal skill, Adults(as per the pre-participation screening guidelines in Chapter 2) who are habitually physically active and/or at least average physical fitness, Jogging, running, rowing, aerobics, spinning, elliptical exercise, stepping exercise, fast dancing -C, Endurance activities requiring skill to perform, Adults with acquired skill and/or at least average physical fitness levels, Swimming, cross-country, skiing, skating -D, Recreational sports, Adults with a regular exercise program and at least average physical fitness, Racquet sports, basketball, soccer, downhill skiing, hiking

An Introduction to the Principles of Exercise Prescription: FITT-VP Principle

•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) •Based on application of existing scientific evidence •Intended as guidelines for apparently healthy adults

Table 6.6: Resistance Exercise Evidence-Based Recommendations

•FITT-VP: Evidence-Based Recommendation -Frequency: Each major muscle group should be trained on 2 - 3 d/wk -Intensity: 60% - 70% 1-RM(moderate-to-vigorous intensity) for novice to intermediate exercises to improve strength, Experienced strength trainers can gradually increase to ≥80% 1-RM(vigorous-to-very vigorous intensity) to improve strength, 40% - 50% 1-RM(very light-to-light intensity) for older individuals beginning exercise to improve strength, 40% - 50% 1-RM(very light-to-light intensity) may be beneficial for improving strength in sedentary individuals beginning a resistance training program, <50% 1-RM(light-to-moderate intensity) to improve muscular endurance, 20% - 50% 1-RM in older adults to improve power -Time: No specific duration of training has been identified for effectiveness -Type: Resistance exercises involving each muscle group are recommended, Multijoint exercises affecting more than one muscle group and targeting agonist and antagonist muscle groups are recommended for all adults(these are becoming more common), Single-joint exercises targeting major muscle groups may also be included in a resistance training program, typically after performing multijoint exercise(s) for that particular muscle group, A variety of exercise equipment and/or body weight can be used to perform these exercises -Repetitions: 8 - 12 repetitions are recommended to improve strength and power in most adults, 10 - 15 repetitions are effective in improving strength in middle-aged and older individuals starting exercise, 15 - 25 repetitions are recommended to improve muscular endurance -Sets: 2 - 4 sets are recommended for most adults to improve strength and power, A single set of resistance exercise can be effective especially among older and novice exercisers, ≤2 sets are effective in improving muscular endurance -Pattern: Rest intervals of 2 - 3 min between each set of repetitions are effective, A rest of ≥48 h between sessions for any single muscle group is recommended -Progression: A gradual progression of greater resistance, and/or more repetitions per set, and/or increasing frequency is recommended

Table 6.8: Neuromotor Exercise Evidence-Based Recommendations

•FITT-VP: Evidence-Based Recommendation -Frequency: ≥2 - 3 d/wk is recommended -Intensity: An effective intensity of neuromotor exercise has not been determined -Time: ≥20 - 30 min/d may be needed -Type: Exercises involving motor skills(e.g., balance, agility, coordination, gait), proprioceptive exercise training, and multifaceted activities(e.g., tai chi, yoga) are recommended for older individuals to improve and maintain physical function and reduce falls in those at risk for falling, especially important for elderly individuals, The effectiveness of neuromotor exercise training in younger and middle-aged individuals has not been established, but there is probable benefit -Volume: The optimal volume(e.g., number of repetitions, intensity) is not known -Pattern: The optimal pattern of performing neuromotor exercise is not known -Progression: Methods for optimal progression are not known

Table 6.7: Flexibility Exercise Evidence-Based Recommendations

•FITT-VP: Evidence-Based Recommendation -Frequency: ≥2 - 3 d/wk with daily being most effective -Intensity: Stretch to the point of feeling tightness or slight discomfort -Time: Holding a static stretch for 10 - 30 s is recommended for most adults, In older individuals, holding a stretch for 30 - 60 s may confer greater benefit, For proprioceptive neuromuscular facilitation(PNF) stretching, a 3 - 6 s light-to-moderate contraction(e.g., 20% - 75% of maximum voluntary contraction) followed by a 10-to 30-s assisted stretch is desirable -Type: A series of flexibility exercises for each of the major muscle-tendon units is recommended, Static flexibility(i.e., active or passive), dynamic flexibility, ballistic flexibility, and PNF are each effective -Volume: A reasonable target is to perform 60 s of total stretching time for each flexibility exercise -Pattern: Repetition of each flexibility exercise 2 - 4 times is recommended, Flexibility exercise is most effective when the muscle is warmed through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths -Progression: Methods for optimal progression are unknown

FITT Box: Types of Resistance Exercises

•Many types of resistance training equipment can effectively be used to improve muscular fitness, Both multijoint and single-joint exercises targeting agonist and antagonist muscle groups are recommended for all adults as part of a comprehensive resistance training program

Table 6.5: Aerobic (Cardiovascular Endurance) Exercise Evidence-Based Recommendations

•FITT-VP: Evidence-Based Recommendation -Frequency: ≥5 d/wk of moderate exercise, or ≥3 d/wk of vigorous exercise, or a combination of moderate and vigorous exercise on ≥3 - 5 d/wk is recommended -Intensity: Moderate and/or vigorous intensity is recommended for most adults, Light-to-moderate intensity exercise may be beneficial in deconditioned individuals, There are guidelines on this w/ HR, etc. -Time: 30 - 60 min/d of purposeful moderate exercise, or 20 - 60 min/d of vigorous exercise, or a combination of moderate to vigorous exercise per day is recommended for most adults, <20 min of exercise per day can be beneficial, especially in previously sedentary individuals -Type: Regular, purposeful exercise that involves major muscle groups and is continuous and rhythmic in nature is recommended, such as walking, biking, swimming -Volume: A target volume of ≥500 - 1,000 MET-min/wk is recommended, Increasing pedometer step counts by ≥2,000 steps/d to reach a daily step count ≥7,000/d steps is beneficial, lower risk of CVD, cancers, obesity, etc., Exercising below these volumes may still be beneficial for individuals unable or unwilling to reach this amount of exercise -Pattern: Exercise may be performed in one continuous session, in one interval session, or in multiple sessions of ≥10 min to accumulate the desired duration and volume of exercise per day, No difference if broken up, Exercise bouts of <10 min may yield favorable adaptations in very deconditioned individuals -Progression: A gradual progression of exercise volume by adjusting exercise duration, frequency, and/or intensity is reasonable until the desired exercise goal(maintenance) is attained, This approach of "start low and go slow" may enhance adherence and reduce risks of musculoskeletal injury and adverse cardiac events, This is about adjusting the above principles, Just getting our clients out on walks can do so much for sedentary individuals and clients

Goals for a Health-Related Resistance Training Program

•For adults of all ages, the goals of a health-related resistance training program should be to (a) make activities of daily living(ADL) (e.g., stair climbing, carrying bags of groceries) less stressful physiologically and (b) effectively manage, attenuate, and even prevent chronic diseases and health conditions such as osteoporosis, Type 2 diabetes mellitus, and obesity, For these reasons, although resistance training is important across the age span, its importance becomes even greater with age

Muscular Fitness: Frequency of Resistance Exercise

•For general muscular fitness, particularly among those who are untrained or recreationally trained(not engaged in formal training program), an individual should resistance train each major muscle group(the muscle groups of the chest, shoulders, upper and lower back, abdomen, hips, legs) 2 - 3 d/wk with at least 48 h separating the exercise training sessions for the same muscle group •All muscle groups to be trained may be done so in the same session(i.e., whole body), or each session may "split" the body into selected muscle groups so that only a few of groups are trained in any one session •This split weight training routine entails 4 d/wk to train each muscle group 2 times/wk •The split and whole body methods are effective as long as each muscle group is trained 2 - 3 d/wk

An Introduction to the Principles of Exercise Prescription: Continued

•For most adults, an exercise program including aerobic, resistance, flexibility, and neuromotor exercise training is indispensable to improve and maintain physical fitness and health •Some individuals will want to or need to include only some of the health-related components of physical fitness in their training regimen or exercise less than suggested by the guidelines presented in this chapter -Performing some exercise is beneficial, especially in inactive or deconditioned individuals, and, for that reason, should be encouraged except where there are safety concerns

Aerobic (Cardiorespiratory Endurance) Exercise: Interval Training

•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 -Improvements in CRF and cardiometabolic biomarkers with short-term(≤3 mo) interval training are similar or superior to steady state moderate to vigorous intensity exercise in healthy adults and individuals with metabolic, cardiovascular, or pulmonary disease training can increase the total volume and/or average exercise intensity performed during an exercise session •During interval training, several aspects of the Ex Rx can be varied depending on the goals of the training session and physical fitness level of the client(e.g., exercise mode, the number, duration, and intensity of the work and recovery intervals, the number of repetitions of the intervals, and the duration of the between-interval rest period) •Studies of high intensity interval training(HITT) and sprint interval training(SIT) demonstrate improvements in CRF, cardiometabolic biomarkers and other fitness and health-related physiological variables when including repeated alternating short(<45 - 240 seconds) bouts of vigorous to near maximal intensity exercise followed by equal or longer bouts(60 - 360 seconds) of light to moderate intensity aerobic exercise

Flexibility Exercise(Stretching)

•Joint ROM or flexibility can be improved across all age groups by engaging in flexibility exercises •The ROM around a joint is improved immediately after performing flexibility exercise and shows chronic improvement after about 3 - 4 wk of regular stretching at a frequency of at least 2 - 3 times/wk •Postural stability and balance can also be improved by engaging in flexibility exercises, especially when combined with resistance exercise •The goal of a flexibility program is to develop ROM in the major muscle/tendon groups in accordance with individualized goals •Static stretching exercises may result in a short-term decrease in muscle strength, power, and sports performance when performed immediately prior to the muscle strength and power activity is important to performance, especially with longer duration(>45 s) stretching

Box 6.2: Summary of Methods for Prescribing Exercise Intensity Using Heart Rate(HR), Oxygen Uptake(O₂), and Metabolic Equivalents(METs)

•Look at box in Book, p. 150 •Look at box in Notes, p. 11

Box 6.3: Calculations of METs, MET/Min, and Kcal/Min

•Look at box in Book, p. 159 •Look at box in Notes, p. 20

Figure 6.1: Examples of the Application of Various Methods for Prescribing Exercise Intensity

•Look at figure in Book, pgs. 153 - 156 •Look at figure in Notes, pgs. 12 - 16

Table 6.2: Commonly Used Equations for Estimating Maximal Heart Rate

•Look at table in Book, p. 149 •Look at table in Notes, p. 11

Table 6.3: Metabolic Calculations for the Estimation of Energy Expenditure(VO₂max[mL/kg/min] During Common Physical Activities

•Look at table in Book, p. 152 •Look at table in Notes, p. 12

Table 6.1: Methods of Estimating Intensity of Cardiorespiratory and Resistance Exercise

•Look at table in Book, pg. 146 •Look at table in Notes, pg. 9

General Considerations for Exercise Prescription: Continued

•The risk of CVD complications, which is of particular concern in middle-aged and older adults, can be minimized by -following the preparticipation health screening and evaluation procedures outline in Chapters 2 and 3, -beginning a new program of exercise at light-to-moderate intensity, and -employing a gradual progression of the quantity and quality of exercise •Bone health is of great importance to younger and older adults, especially among women -Loading exercises(i.e., weight bearing and resistance exercise should be part of the exercise program, especially in individuals at risk for low bone density •An individual's goal, physical ability, physical fitness, health status, schedule, physical and social environment, and available equipment and facilities should be considered when designing the FITT-VP principle of Ex Rx for a client or patient

Aerobic (Cardiorespiratory Endurance) Exercise: Intensity of Exercise

•There is a positive dose response of health/fitness benefits that results from increasing exercise intensity •The minimum threshold of intensity for benefit seems to vary depending on an individual's CRF level and other factors such as age, health status, physiologic differences, genetics, habitual physical activity, and social and psychological factors

Stair Step Equation Example

•This is useful for people who are home bound, We need to get them moving, such as going downstairs steps in their own home, many do not want to leave their homes, but may still be interested in exercising •What is the relative O2 consumption of someone walking up/down 6 inch steps at 40 steps per minute -Horizontal: 40(spm) X 0.2(constant) = 8 mlO2/kg/min -Vertical: [1.8(constant) X 0.15 m(6 inches X 0.0254 to get into meters) X 40(spm)] X 1.33(constant) = 14.3 mlO2/kg/min -Resting: 3.5 mlO2/kg/min -Total: 8(horizontal) + 14.3(vertical) + 3.5(resting) = 25.8 mlO2/kg/min

Push-Up Test Variation

•Used in male firefighter article, if they were able to do 40 or more push-ups, it was a better indicator of preventing CVD and other disease compared to VO2max, HR, and BP, etc. -Compared best to worst, but the one's in the middle followed similar patterns, These are pretty fit individuals for being 40 and doing this many, probably make a lot of other healthy life-decisions •They used a metronome set at 80 bpm, which makes you go up with a beep and then down with a beep, making the pace slower than normal, so people would most likely get less than with the normal push-up test •Will possibly include this one instead in our clinical class next semester, gathering research on females, because the study only did it on males

Stair Step Equation Example# 2

•What is the relative oxygen consumption of someone going of 8 inch steps at 30 steps/minute -Horizontal: 30 spm X 0.2 = 6 mlO2/kg/min -Vertical: (1.8 X 8 in X 0.0254 X 30 spm) X 1.33 = 14.6 mlO2/kg/min -Resting: 3.5 mlO2/kg/min -Total: 6 + 14.6 + 3.5 = 24.1 mlO2/kg/min •How much is this value in METs -24.1 / 3.5 = 6.9 METs