EXERCISE PRESCRIPTION

EXERCISE PRESCRIPTION
minimal threshold must be reached for
frequency, duration and intensity of exercise
EXERCISE PRESCRIPTION to gain aerobic benefits
varies from one individual to the other
University of Santo Tomas
College of Rehabilitation Sciences
Therapeutic Exercise 1 Lecture

EXERCISE TESTING EXERCISE TESTING

For young and middle-aged individuals who For individuals who are not physically active:
have been screened and have been jogging or 1 mile walk test
running for some time: 6-minute walk test
Timed 1.5 mile run Step test
12 min run
Multi-stage testing
4-6 stages, 3-6 mins long
Take ECG and oxygen expired

EXERCISE TESTING EXERCISE TESTING

For individuals at risk and those who are Stress test:
convalescing: Purpose:
Do the Stress test Diagnose heart disease
Do physical exam first Evaluate CV functional capacity
Monitor ECG at rest, during exercise and during Determine METs
recovery Evaluate response to exercise training and/or
Sign a consent form preventive programs
Assist in selection and evaluation of treatment program
Motivation
Used clinically to evaluate patients for CAD and
functional capacity for patients with chronic disease

THERAPEUTIC EXERCISE 1 1
EXERCISE PRESCRIPTION

EXERCISE TESTING EXERCISE TESTING

Stress test: Stress test
Precautions: Termination:
Monitor pulse Progressive angina
BP increase 7-10 mmHg per MET Significant drop in systolic BP while increasing workload
Systlolic should not > 220-240 mmHg Lightheadedness, confusion, pallor, cyanosis, nausea or
Diastolic should not > 120 mmHg peripheral circulatory insufficiency
Rate and depth of respiration increases Abnormal ECG response including ST segment
Breathing should not be labored depression >4mm
No preception of SOB
Excessive rise in BP
Subject wishes to stop
Read Box 7.6 Precautions for Stress Testing

CORONARY ARTERY DISEASE RISK FACTORS FOR

EXERCISE PRESCRIPTION TARGETING HIGH-RISK PEOPLE

for developing and maintaining aerobic Positive Defining criteria

risk factor
capacity, the American College of Sports
Age Men > 45 years; women > 55 or premature
Medicine recommends training intensity of: menopause without estrogen replacement
55/60 90% of maximum heart rate (HRmax) or therapy
40/50 85% of VO2max Family Myocardial infarction or sudden death before 55
history years in father or other male 1st degree relative,
or before 65 years in mother or other female
relative
Current
cigarette
smoking

CORONARY ARTERY DISEASE RISK FACTORS FOR CORONARY ARTERY DISEASE RISK FACTORS FOR
TARGETING HIGH-RISK PEOPLE TARGETING HIGH-RISK PEOPLE

Positive Defining criteria

Positive Defining criteria risk factor
risk factor
Sedentary People comprising the least active 25% of the
Hypertensio BP >140/90mmHg, confirmed by measurements lifestyle / population, as defined by the combination of
n on at least 2 separate occasions, or on physical sedentary jobs involving sitting for a large part of
antihypertensive medication inactivity the day and no regular exercise or active
Hypercholes Total serum cholesterol >200mg/dl (if lipoprotein recreational pursuits
terolemia profile is unavailable) or HDL <35mg/dl
Diabetes People with insulin-dependent diabetes mellitus
Negative Defining criteria
mellitus (IDDM) who are >30 years old, or have had
risk factor
IDDM for >15 years, and people with non-insulin
dependent diabetes (NIDDM) who are >35 years High serum >60 mg/dl
HDL
cholesterol

THERAPEUTIC EXERCISE 1 2
EXERCISE PRESCRIPTION

EXERCISE PRESCRIPTION FREQUENCY

3 4 times a week
Frequency
can be increased only if activity is enjoyed and
Intensity
physically tolerated
Time or Duration
Recommendations:
Type or Mode
AHA and CDC : 30 mins moderate intensity aerobic
exercise on most if not all days of the week
ACSM : 20 60 continuous or intermittent
minutes 3 5 days/week at 65-90% MHR
Multiple bouts of >10 mins may be accumulated

INTENSITY INTENSITY
most important VO2max is the best measure of exercise
based on principle of specificity and overload intensity
should be at a level of at least 70% MHR for Can be quantified by:
healthy individuals but exercise benefits can Training heart rate (THR)
still occur below this level Metabolic equivalent (MET)
Rating of perceived exertion (RPE)
*VO2 reserve (VO2R)

INTENSITY INTENSITY
Training heart rate (THR) / Exercise heart rate Metabolic equivalent (MET)
Why heart rate? 1 MET = 3.5 ml O2/kg body weight/minute
Karvonen method of maximal heart rate reserve useful as guideline for training
maximal heart rate reserve
MHR = HRmax HRrest
HRmax = 220 age
THR% = HRrest + % (MHR)
THR range

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EXERCISE PRESCRIPTION

INTENSITY
Rating of perceived exertion (RPE)
subjective measure of exercise intensity
Borg Scale of Perceived Exertion
should fall bet 12/13 (somewhat hard) to 15/16
(hard)

BORG SCALE OF PERCEIVED EXERTION

Rati 15-pt scale A 15-pt scale B Rat 10-pt scale INTENSITY
ng ing
6
7 Very, very light
No exertion at all
Extremely light
0
0.5
Nothing at all
Very, very weak
VO2 reserve
8 1 Very weak VO2max VO2rest
9 Very light Very light 2 Weak (light)
10 3 Moderate
11 Fairly light Light 4 Somewhat strong
12 5 Strong (heavy)
13 Somewhat hard Somewhat hard 6
14 7 Very strong
15 Hard Hard (heavy) 8
16 9
17 Very hard Very hard 10 Very, very strong
18
19 Very, very hard Extremely hard
20 Maximal exertion

CLASSIFICATION OF EXERCISE INTENSITY BASED ON 20-60

MINS OF ENDURANCE ACTIVITY INTENSITY
HRmax / VO2max or RPE Classificati Talk test / talk and sing test
MHR HRmax on of
reserve intensity
<35% <30% <9 Very light
High intensity, short duration exercises elicit a
35-59% 30-49% 10-11 Light greater improvement in VO2max but may
60-79% 50-74% 12-13 Moderate increase risk of CV complications and
musculoskeletal injury.
80-89% 75-84% 14-16 Heavy

>90% >85% >16 Very heavy

THERAPEUTIC EXERCISE 1 4
EXERCISE PRESCRIPTION
DURATION
duration at level of specified intensity
dependent on total work performed, exercise
intensity and frequency and fitness level
20 30 mins per day at 60-70% MHR:
45-minute continuous exercise if below heart rate
threshold
10-15-minute exercise periods for high-intensity
exercise
MODE OR TYPE
selection of activity:
should involve large muscle groups
can be maintained continuously
should be rhythmical and aerobic in nature using
dynamic exercises
*motivation
Stationary bicycling vs. jogging vs. swimming
vs. brisk walking vs. aerobics
DETRAINING
Partial or complete loss of training-induced
adaptation in response to cessation of training
or a substantial decrement in the training load
Based on reversibility principle
Frequency and duration of physical activity
required to maintain a certain level of fitness
is less than that required to improve it
THERAPEUTIC EXERCISE 1
MODE OR TYPE
for unfit individuals, preconditioning is
necessary prior to switching to sport and
recreational activities to bring up the level of
conditioning and to prevent or reduce risk of
injury
Specificity principle
MODE OR TYPE
patients need to realize that some discomfort
is required to success but should also
recognize the difference between an
appropriate level of discomfort and signal of
over zealousness
changes may not occur in a few days or weeks
DETRAINING
Decreased muscle strength and power due to
atrophy
Need minimal stimulation to maintain
Decreased muscle endurance
2 weeks of inactivity
Decreased oxidative enzymes, muscle glycogen
storage, blood supply to the muscles impairing O2
delivery and disturbance in acid-base balance
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EXERCISE PRESCRIPTION

DETRAINING RETRAINING
Loss of speed and agility small Recovery of conditioning after a period of
Loss of flexibility quickly lost inactivity
Decreased cardiorespiratory endurance Affected by fitness level and duration and
Most affectation extent of inactivity
Decreased VO2 max, cardiac size, blood volume The earlier the resumption of active motion,
leads to decreased SV the quicker the recovery
Training at least 70% of regular intensity 3x/week
maintains CV endurance

General Recommendations: General Recommendations:

Children aged 6-17
60 minutes of moderate to vigorous physical
activity per day
Adults aged 18-65
30 minutes of moderate intensity activity (3-6
METS) 5 days/week or 20 minutes of vigorous
intensity activity (>6 METS)
Can be accumulated in small bouts of continuous
activity of at least 10 minutes
Older adults age 65 or older or adults 50-65
with chronic health conditions
30 minutes of moderate intensity activity 5
days/week or 20 minutes of vigorous intensity
activity 3 days/week or a combination of both
Based on a 10 point scale = moderate 5-6;
vigorous 7-8
Can be accumulated in small bouts of continuous
activity of least 10 minutes

THE EXERCISE PROGRAM WARM-UP AND STRETCHING

increase both heart rate and breathing to
Warm-up and stretching
prepare for efficient and safe functioning of
Endurance/aerobic exercise training heart, blood vessels, lung and muscles
Cool-down and stretching increase muscle temperature:
Flexibility training Increase efficiency of mm contraction
Resistance training Hemoglobin extraction is greater
Recreational activities Dilatation of capillaries
Adaptation in sensitivity of neural respiratory
center to exercise
Increase in venous return

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EXERCISE PRESCRIPTION
WARM-UP AND STRETCHING
reduces the susceptibility of musculoskeletal
injuries and occurrence of ECG changes and
arrhythmias
AEROBIC EXERCISE
designed to improve capacity and efficiency of
cardiovascular, respiratory and metabolic
systems
May control and/or reduce body weight
AEROBIC EXERCISE
Interval training
exercise followed by properly prescribed relief or
rest interval:
Rest relief (passive recovery)
Work relief (active recovery)
less demanding than continuous training
improves strength and power more than
endurance in healthy individuals
Total work that can be competed is greater than
that of continuous training
THERAPEUTIC EXERCISE 1
WARM-UP AND STRETCHING
Should be gradual and sufficient without
causing fatigue and reducing energy stores
10 mins of total body movement exercises like
calisthenics and walking (may use the
endurance training mode of exercise)
attain a heart rate that is within 20 beats/min
of the target heart rate
AEROBIC EXERCISE
Continuous training
submaximal energy requirement that is sustained
throughout the training period
Primarily trains the slow twitch fibers
20-60 mins
most effective way to improve endurance in
healthy individuals
AEROBIC EXERCISE
Circuit training
uses a series of exercise activities that is repeated
several times
may use several exercise modes
can improve both strength and endurance
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EXERCISE PRESCRIPTION

AEROBIC EXERCISE
Circuit-interval training
combined circuit and interval training
interaction of aerobic and anaerobic production of
ATP
Delays lactic acid production
COOL-DOWN AND
STRETCHING ACTIVITIES
prevents pooling of blood in the lower extremities
by maintaining venous return
prevents fainting by increasing return of blood to
heart and brain
prevents cardiac arrhythmia, myocardial ischemia
and other cardiovascular complications
enhance recovery period with oxidation of
metabolic waste and replacement of energy
stores

COOL-DOWN AND
STRETCHING ACTIVITIES FLEXIBILITY TRAINING
similar to warm-up : calisthenics and stretching supplementary to warm-up and cool-down
since muscle is still warm period especially for those with poor flexibility
5 to 10 minutes and muscle and joint problems
should be performed slowly

RESISTANCE TRAINING RESISTANCE TRAINING

heart rate at submaximal exercise is reduced - increase good cholesterol ratio (HDL:LDL)
> improved CP fitness increase insulin sensitivity and improve
hypertrophy of heart -> increase contractility glucose tolerance
of LV and enhance SV reduce risk of obesity
decrease BP of hypertensive prevent osteoporosis

THERAPEUTIC EXERCISE 1 8
EXERCISE PRESCRIPTION

RECREATIONAL ACTIVITIES
for enjoyment and relaxation

THANK YOU!

THERAPEUTIC EXERCISE 1 9