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
Cancer
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
USAFSAM GXT
Question ?
Answer
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.
However………...
So ……...
What If……...
What Is A MET ?
So…...
Examples…...
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
Email: David.Arnall@NAU.EDU
Home Page: http://jan.ucc.nau.edu/~daa/heartlung
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