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)