Prescription of Exercise for

Health, Wellness, and Fitness

Medical Clearance
 Identify high-risk individuals
 Information used for exercise
prescription
 For motivation (BP, body fat, etc.)
 Baseline values
 To identify illnesses at early stages
Medical Clearance
Recommended for:
 Men > 40

 Women > 50

 People at high risk

CAD Risk Factors
Age
Family hx
Smoking
HTN
Hypercholesterolemia
DM
Sedentary
CAD Risk Factors
Negative Risk Factor

 High serum HDL

Cardiopulmonary Disease
Signs & Symptoms
 Pain, discomfort in chest, neck, jaw,
arm
 SOB w/ mild exertion
 Dizziness or syncope
 Orthopnea or paroxysmal nocturnal
dyspnea
Cardiopulmonary Disease
Signs & Symptoms
 Ankle edema
 Palpitations or tachycardia
 Intermittent claudication
 Known heart murmur
 Unusual fatigue or SOB w/ usual
activities
CAD Risk Factors
ECG

 any individual in a high-risk category

Initial Risk Stratification
1. Apparently Health: asymptomatic &
apparently healthy w/  1 major
coronary risk factor (CRF)
2. Increased Risk: signs or symptoms
suggestive of possible C-P or metabolic
disease and/or  2 major CRF
3. Know disease: known cardiac,
pulmonary, or metabolic disease
Prior to Exercise
ACSM Guidelines
 Medical examination and exercise test
might not be necessary if moderate
exercise is undertaken gradually in
people without symptoms of
cardiopulmonary disease
Comprehensive Exercise
Program
 Cardiovascular - Aerobic training

 Resistance Training

 Flexibility
Exercise Prescription - Aerobic
 Mode or type
 Frequency
 Duration
 Intensity
Exercise Prescription

Overload - exercise @ intensity higher

than normal
 frequency

 intensity

 duration

Specificity
Exercise Prescription - Mode
 Walking
 Running
 Hiking
 Cycling
 Rowing
 Swimming
 etc.
Exercise Prescription - Frequency

 Optimal - return on investment

 Progression
Exercise Prescription - Duration

 Minimum

 Optimal
Intensity and Duration

 Inverse relationship

 Considerations
Intensity Considerations

 Level of fitness
 Medications that influence HR
 Risk of CV or orthopedic injury
 Exercise preference
 Program objectives
Exercise Prescription - Intensity

 Percentage of HRmax

 HR reserve method

 plotting HR vs VO2 or exercise intensity

during exercise test
Percentage of HRmax

Target or Training HR (Range)

 Max HR = 220 - Age

 70 - 85% of HRmax
Exercise Prescription - Intensity

 For most - 70% HRmax

 threshold  with training

Monitoring Exercise Intensity

 40 y.o.

 Max HR = 220 - 40 = 180 bpm

 THR70% = .70 * 180 = 126 bpm

 THR90% = .90 * 180 = 162 bpm

 HRR Method - Karvonen Formula

 Obtain standing resting HR (HRrest)

 HRR = HRmax - HRrest

 Calculate 60% and 80% of HRR

 HRR Method - Karvonen Formula

 Add each of these values to HRrest

 THR = HRrest + 0.60(HRmax - HRrest)

 THR = HRrest + 0.80(HRmax - HRrest)

HRR Method

 Age: 40
 HRrest : 50 bpm

 THR60% = 50 + 0.60(180 - 50)

 THR60% = 128
 THR80% = 154
 Exercise Prescription - Percentage
of HRmax
%HR %VO2max
50 28
 70 - 85% of HRmax 60
70
40
58
80 70
90 83
 60 - 80% of VO2max/HRR 100 100

 45% of VO2max or less is effective for

some
HR and VO2 Relationship
% HRmax %VO2max
50 28
60 40
70 58
80 70
90 83
100 100

%VO2max = 1.43 %HRmax – 44.2

HR vs. VO2max
Monitoring Exercise Intensity
 Utilize HR Method (70-85%)

 Create a range of 10-15% (e.g. 70-

85%)

 Strive for 70%

 Lower intensities may be effective

Other Methods of Monitoring
Exercise Intensity
 Metabolic Equivalent - MET

 Rest = 1 MET (3.5 ml O2/kg min)

MET Method of Monitoring
Exercise Intensity
 70% HRmax = 60% VO2max

 Age 40 / VO2max = 50 O2/kg min

 Target: 30 O2/kg min

 METS: 30/3.5 = 8.6 METS

Various MET Values
 Sitting: 1.0
 Walking (2.5 mph): 3.0
 Walking (3.5 mph): 4.5
 Mopping: 4.5
 Mowing Lawn: 6.5
 Swimming (crawl - 2.5 ft/sec): 15.0
 Horseback riding (gallop): 8.0
Other Methods of Monitoring
Exercise Intensity
6 No exertion at all
7 Very, very light Extremely light
8
9 Very light Very light
10
11 Fairly light Light
12
13 Somewhat hard Somewhat hard
14
15 Hard Hard (Heavy)
16
17 Very hard Very hard
18
19 Very, very hard Extremely hard
20 Maximal exertion
 Exercise Intensity

% HRmax %VO2max RPE Classification or

Intensity
<35 <30 <10 Very light
35-59 30-49 10-11 Light
60-79 50-74 12-13 Moderate
80-89 75-84 14-16 Heavy
>90 >85 >16 Very heavy
Exercise Program
 Warm-up
 Flexibility / Stretching Training
 Aerobic Training
 Cool Down
 Flexibility Training

 Resistance Training
Principles of Training
Overload
 Higher level of exercise

 Induce a training effect

 Achieved thru manipulating

 Athletes, sedentary, pathological

Principles of Training
Specificity
 Aerobic capacity

 Local changes

 Motor patterns/performance
 Specificity - Aerobic Capacity
Running Test Swimming Test
Pre- Post- % Pre- Post- %
Training Training Change Training Training Change
VO2max
(mL/kg 54.9 55.7 +1.5 46.6 51.8 +11.0
min)
Specificity - Local Changes
 O2 transport/utilization

 Generate ATP

  Local blood flow

Specificity - Local Changes
  vascularization

 more efficient distribution of CO

Specificity - Motor Performance
 Concrete vs. Abstract Tasks

 Neuromuscular Adaptation
Types of Aerobic Training
(Athletes)
 Long, slow distance (LSD)
 Pace/Tempo
 Interval
 Repetition
 Fartlek