Principles Of Exercise Prescription …… Art and Science


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Principles Of Exercise Prescription …… Art and Science

General Principles :

The general parameters of exercise prescription hold true for individuals who are healthy as well as those patients who have disease pathology. However, there must be some special considerations for those that have disease.

Some Acute & Chronic Disease Pathologies Of Concern


Patient’s With Pathology

Graded Exercise Tests

Low Level Exercise Stress Test

The low level GXT is given to patient’s with significant cardiac damage and who have an exercise capacity lower than 8 METs

Bruce Protocol GXT

Modified Bruce Protocol GXT


Question ?


The Exercise Prescription

Mode of Exercise

Exercise Mode - Aerobic

MET Equivalents

Hiking & Walking : 4 - 8 METs

Ping Pong : 3 - 6 METs

The various modes of exercise must be specifically tailored to the patient’s physical needs such as :

Intensity Of Exercise

The GXT Report Should Have

How Do I Use The GXT Data ?

The Karvonen Formula

The target exercise heart rate should look like this for special populations:

Advantages Of This Modified Karvonen’s Formula

Advantage # 2 : The adjusted target heart rate for the patient with disease is calculated on the heart rate, blood pressure and Max METs achieved during the symptom limited GXT .

What Is A Symptom Limited GXT ?

What value is a symptom limited GXT to the Exercise Specialist ?

All exercise prescriptions are written using the modified Karvonen’s Formula to insure that the patient’s exercise training intensity is significantly lower than the maximum symptom limited exercise HR & BP values avoiding the onset of myocardial ischemia.


So ……...

What If……...

What If……...

What If……...

What Is A MET ?



METs can be a useful measure for a variety of calculations particularly in terms of helping patients to understand physical work capacity (VO2 = ml/Kg/min measurements) or in terms of loosing weight (see next slide).

The ACSM recommends minimal thresholds of 300 kcals per exercise session performed 3 days/week or 200 kcals per exercise session performed 4 days/week.

This minimum recommendation suggests that exercise prescription target a weekly exercise caloric expenditure of about 1,000 kcals.

For optimal results in physical fitness, the ACSM recommends bringing the weekly caloric expenditure up to 2,000 kcals as health and fitness permits.

How Can I Transform METs Into Calories Expended ?

Problem …...

Practical Application - Prob. # 1

Problem # 2

2,000 kcals/week = 148 min ex./week

Duration of Exercise

If the patient is unable to perform 15 minutes of steady state exercise, break the time into two 7-8 minute stages.

Research has shown that multiple small bouts of exercise added together have the same training effect as a single bout of exercise of the same total duration.

Frequency Of Exercise


Rate Of Progression….The Art Of Exercise Prescription

Some Thoughts …….

Once, you are up to 45 - 60 minutes per exercise session, increase frequency from 3 times/week to 4 times/week.

When the patient’s exercising 45 - 60 minutes/session for 5 times/week, it is time to increase the intensity.

Warm Up & Cool Down

Longer Cool Down Periods

Monitoring The Patient

Anginal Scale

Stopping Points With Angina

Anginal Equivalents

Borg’s Ratings Of Perceived Exertion (RPE)

Dyspnea Scale

Blood Pressure

Sometimes the diastolic pressure rises 8 - 10 mm Hg pressure during exercise. If it rises more than this, consider referring the patient to their physician. In most cases, diastolic pressure remains the same or falls during exercise from its pre-exercise rest value.

Heart Rate

Author: Microsoft Corporation

Email: David.Arnall@NAU.EDU

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