Chapter 8 Exercise Prescription

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Chapter 8Exercise Prescription
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Exercise Prescription the process of designing
a regimen of physical activity in a systematic
and individualized manner.

• Five essential components of exercise
  prescription (see Box 8.1 for glossary Table 8.1
  for recommendations)
• Frequency
• Duration
• Intensity
• Mode
• Progression

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Box 8.1 Selected Terms

• Activity Pyramid A graphic summary of
  guidelines underlying both the lifestyle and
  formal exercise approaches to physical fitness.
• aerobic fitness The ability to continue or
  persist in strenuous tasks involving large muscle
  groups for extended periods of time. Heart and
  lung fitness based on performing such activities
  as running, cycling, swimming, and sports, 3-5
  days per week, at 50-85 VO2max, for 20-60
  minutes each session.
• cool-down The transition period after the
  aerobic session where one slowly decreases the
  heart rate by keeping the feet and legs moving
  for 5 to 15 minutes through mild aerobic
  activity.
• F.I.T. guidelines Frequency, intensity, and time
  guidelines for building aerobic fitness.
• flexibility exercises A system of exercises
  that improve the range of motion around the
  bodys joints.
• formal exercise program An approach to building
  physical fitness based on specific guidelines for
  aerobic and muscular fitness. A specific time
  and place is designated to exercise.

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Glossary (continued)

• Frequency of exercise The number of exercise
  sessions per week recommended for building
  aerobic fitness in the exercise program. To
  build both aerobic fitness and keep body fat at
  healthy levels, one needs to exercise at least
  3-5 days each week. The lifestyle approach
  recommends at least 30 minutes of physical
  activity on most days of the week.
• high intensity weight lifting Development of
  muscular strength when the weight is heavy and
  the repetitions to maximum are low, about 4 to 6.
  
• high or vigorous intensity 75 and higher of the
  maximum heart rate reserve or VO2max. This level
  of effort is for athletes desiring a high level
  of fitness.
• intensity of exercise The intensity of effort
  needed to build aerobic fitness between 50 and
  85 of the maximum heart rate reserve. If the
  fitness level is low, intensity of effort can
  start at 40, with a gradual progression towards
  a higher intensity.
• lifestyle approach to physical activity
  Emphasizes that everyone should attempt to
  accumulate 30 minutes or more of
  moderate-intensity physical activity over the
  course of most if not all days of the week.
• light intensity 40 to 59 of the maximum heart
  rate reserve or VO2max. This intensity range is
  reserved for those starting an exercise program
  after years of inactivity.

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Glossary (continued)

• low intensity weight lifting Development of
  muscular endurance when the weight is somewhat
  light and the repetitions to fatigue are high,
  about 15 to 20.
• maximum heart rate The maximum attainable heart
  rate at the point of exhaustion from all-out
  exertion. The maximum heart rate can be
  estimated by using the formula 220 minus the age.
  
• maximum heart rate reserve The difference between
  the maximum heart rate and the resting heart
  rate.
• moderate intensity weight lifting Development of
  both muscular strength and endurance when the
  weight is moderate and the repetitions are 8-15.
• moderate intensity 60 to 74 of the maximum
  heart rate reserve or VO2max. This is the normal
  training range for most people.
• muscular fitness Muscular strength, muscular
  endurance, and flexibility, gained by lifting
  weights, doing calisthenics, engaging in physical
  labor, and stretching 2 to 3 times per week.
• overload principle To develop muscular strength
  and endurance, push the muscles to fatigue,
  lifting weights that are heavier than one is
  accustomed to.
• overtraining Defined as pushing exercise
  training beyond ones ability to recover, leading
  to incapacitating fatigue, injury, and a loss of
  desire to exercise.

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Glossary (continued)

• progressive resistance principle The resistance
  or pounds of weight against which muscles work
  should be increased periodically as gains in
  strength and endurance are made until one reaches
  the desired level.
• repetition One weight-training or calisthenic
  movement
• repetitions maximum The maximum number of
  repetitions that one can lift a certain weight.
• RPE scale The rating (R) of perceived (P)
  exertion (E) scale is a number scale between six
  and 20 that indicates how the exercise feels to
  an individual at a given moment.
• set A certain number of weight-training or
  calisthenic repetitions.
• static stretching Exercises that slowly apply a
  stretch to a muscle group, with this position
  held for 10 to 30 seconds.
• training heart rate The exercise heart rate,
  estimated with this formula Training heart rate
  (maximum HR - resting HR) x 0.50 to 0.85
  resting HR.
• training heart rate zone The heart rate range
  between 50 and 85 of maximum heart rate range
  for all age groups.
• warm-up The 5 to 20 minute transition period
  that precedes the aerobic exercise session. The
  primary purpose of the warm-up is to prepare the
  body for vigorous exercise by performing
  mild-to-moderate aerobic activity.

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Table 8.1
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Systems for building fitness

• The lifestyle approach
• Seeks to increase opportunities for physical
  activity throughout the daily routine and
  accumulate 30 minutes or more over the course of
  most if not all days of the week. This is the
  minimum amount of physical activity that improves
  the quality of life while decreasing the risk of
  most chronic diseases. Additional health and
  fitness benefits can be achieved by adding more
  time in moderate-intensity activity, or by
  substituting more vigorous activity.
• The formal exercise program
• Builds aerobic and muscular fitness to high
  levels through an exercise system based on
  specific frequency, intensity, and time
  guidelines.

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Physical Activity Pyramid

• The CDC-ACSM lifestyle approach and ACSM formal
  approach to exercise prescription are components
  of the same continuum of physical activity
  recommendations that meet the needs of almost all
  individuals to improve health status. Review
  Figure 8.2.

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Physical Activity Pyramid

• The lifestyle approach to fitness is at the base
  of the Activity Pyramid. This is a good start and
  brings basic health and fitness benefits. But
  higher levels of aerobic and muscular fitness can
  be achieved by working up the Activity Pyramid.
• The formal exercise program is summarized on
  levels 2 and 3 of the Activity Pyramid.
• The aerobic or cardiorespiratory stage of a
  comprehensive physical fitness program consists
  of three segments
• Warm-up---the 5 to 20 minute transition period
  that precedes the aerobic exercise session.
• Aerobic exercise---brisk walking, swimming,
  cycling, running, or active sports for 20-60
  minutes, 3-5 days per week.
• Cool-downthe warm-up in reverse. Keep the feet
  and legs moving for 5 to 15 minutes after intense
  exercise by walking, jogging lightly, or cycling
  slowly.

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Physical Activity Pyramid (Continued)

• Muscular fitness means having strong and enduring
  muscles, and flexible joints.
• Muscular strength and endurance---gained by
  lifting weights, doing calisthenics, and engaging
  in hard physical labor (e.g., chopping wood).
  Perform a minimum of 8-10 separate exercises that
  train the major muscle groups. Perform one set
  of 8-12 repetitions of each of these exercises to
  the point of fatigue, and do this at least 2-3
  days per week.
• Flexibility---stretch at least 2-3 days a week
  and involve at least four repetitions of several
  stretches that are held 10-30 seconds at a
  position of mild discomfort.
• Reduce sitting time. Americans spend far too
  much time sitting watching TV, playing video
  games, viewing the Internet, driving cars, and
  watching other people play sports.

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Figure 8.2
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Ways to Increase Lifestyle Physical Activity (Box
8.4)

• Walk, cycle, jog, or skate to work, school, or
  the store
• Park the car farther away from your destination
• Get on or off the bus several blocks away
• Take the stairs instead of the elevator or
  escalator
• Walk the dog
• Play sports with the kids
• Take fitness breaks instead of coffee breaks
• Perform gardening, landscaping, or home repair
  activities
• Avoid labor-saving devices as much as practical
• Take a walk after supper instead of watching TV

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Cardiorespiratory Endurance (Box 8.2)

• Step 1 Warm-up
• Slowly elevate the pulse and body temperature to
  an aerobic training level by first engaging in
  5-20 minutes of easy-to-moderate aerobic
  activity.
• Step 2 Aerobic Exercise
• F.I.T. guidelines Based on current fitness
  level, follow the F.I.T. guideli
• Low Fitness
  Average High Fitness
• Frequency (sessions/week) 3 3-4
  5 or more
• Intensity ( HR reserve) 40-59 60-74
  75-85
• Time (minutes/session) 10-19
  20-29 30-60
• Intensity Calculate personal training heart rate
  using this formula
• Training heart rate (Maximum HR - resting HR)
  x intensity resting HR
• Aerobic Exercise Mode Select 2-3 exercise modes
  based on personal goals.
• Step 3 Cool-down
• Slowly decrease the heart rate and body
  temperature by engaging in mild-to-moderate
  aerobic activity for 5-15 minutes.

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Box 8.3
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Figure 8.5
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Figure 8.6
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Intensity

• For healthy adults to develop and maintain
  cardiorespiratory fitness, ACSM recommends that
  the intensity of exercise be between 50 and 85
  of maximum heart rate reserve (HRR), which is
  approximately the same as 50-85 of maximum
  oxygen uptake reserve (VO2R) (calculated from the
  difference between resting and maximum heart rate
  and resting and maximum VO2, respectively).
• If improved health and lowered disease risk is
  the goal, intensity of exercise can drop to 40,
  with duration and frequency becoming the more
  important standards.
• For athletes, the greatest improvements in
  aerobic power occur when intensity is high
  (90-100 VO2R).

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Calculating Exercise Intensity

• MET method
• Estimate VO2max from an exercise test, and
  multiple by desired
  exercise intensity.
• Disadvantages must consult table of MET values
  for physical activities environmental factors
  can alter workload with improvement in fitness,
  desired workout MET values change.
• Training heart rate method
• HRmax Underestimates training HR (see Table
  8.2).
• Karvonen formula, HRR (see Figure 8.8). This
  methods relates best to VO2maxR, not VO2max.
• Training HR (Maximum HR - resting HR) x
  intensity resting HR
• Best to measure maximum HR and resting HR
• VO2maxR method Calculate by subtracting 1 MET
  from subjects exercise VO2 (e.g., 24-3.5), and
  divide by difference of VO2max and 1 MET (e.g.,
  35-3.5), and multiply by 100 (24-3.5)/(35-3.5) x
  100 65. VO2R corresponds to HRR (see
  Table 8.2).

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Table 8.2
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Figure 8.8
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Figure 8.9
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Assessment of Training Heart Rate

• The metabolic method (use of METS) (use values
  from appendix).
• Measurement of the pulse for 10 seconds (see
  Table 8.3).
• Use of the Borg rating of perceived exertion
  (RPE) scale (see Table 8.5).

Note medications can influence exercise HR
see Table 8.4
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Table 8.3
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• Time
• See Box 8.2 and Figure 8.2 for summary.
• See Chapter 16 for more information on
  overreaching and overtraining.

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Mode of Exercise

• If frequency, intensity, and duration of training
  are similar, and a minimum of 200-400 Calories
  are expended during the session, the training
  result is independent of the mode of aerobic
  activity.
• See Table 8.6 for a rating of cardiorespiratory
  exercises, using a total fitness emphasis.
• See Figure 8.15 from the Surgeon Generals report.

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Figure 8.15
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Flexibility 3 basic types of flexibility

• Static flexibility
• Ability to hold a stretched position (e.g.,
  touching the floor with the fingers with legs
  straight or performing a leg split).
• Dynamic flexibility
• Ability to engage in slow, rhythmic movements
  throughout the full range of joint motion (e.g.,
  the ability of a ballet dancer to raise and hold
  her leg above the head).
• Ballistic flexibility
• Ability to engage in bobbing, bouncing,
  rebounding, and rhythmic motions (e.g., touching
  ones toes by bobbing up and down). This type of
  movement is generally not recommended due to
  injury potential except when included as an
  inherent part of a sporting endeavor (e.g.,
  certain gymnastic and dance movements).

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Flexible Benefits (claims)

• More graceful body movements.
• Enhanced performance of sport skills.
• Relaxation of mental stress and tension.
• Muscular relaxation, and relief of muscular
  cramps and soreness.
• Improved body fitness, posture, symmetry, and
  self-image.
• Reduced risk of low-back pain and other spinal
  aches and pains.
• Prevention of injury.
• Rehabilitation/treatment of pain and injury.

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An Exercise Program To Build Flexibility (Box 8.8)

• Step 1 Warm-up aerobically
• Never stretch unless the muscles and joints are
  warm from 5-15 minutes of
  moderate aerobic activity.
• Step 2 Follow these minimum flexibility program
  guidelines
• Frequency 2-3 days per week, or after each
  aerobic workout.
• Time hold each position short of the pain
  threshold for 10-30 seconds, and repeat four
  times (total time, about 15 minutes). Relax
  totally, letting your muscles slowly go limp as
  the tension of the stretched muscle slowly
  subsides. Be sure that you do not stretch to the
  point of pain to avoid injury and a tightening
  recoil of the muscle.
• Stretching positions Improve flexibility in
  several body areas with 8 specific stretching
  exercises (Appendix).

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Muscular Strength and EnduranceTotal Fitness
Workout

• A good total fitness workout routine that would
  take about 1 to 1.5 hours to complete could be
  organized as follows
• Warm-up 5-10 minutes of easy-to-moderate aerobic
  activity.
• Aerobic exercise 20-30 minutes of
  moderate-to-vigorous aerobic activity.
• Cool-down 5-10 minutes of mild-to-moderate
  aerobic activity.
• Stretching 5-15 minutes of static stretching,
  emphasizing all major muscle groups and joints.
• Weight lifting 20-30 minutes of weight lifting,
  one set of 8-12 repetitions of 8-10 different
  exercises covering all the major muscle groups.

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Muscular Strength and Endurance

• ACSM recommends this minimum muscular fitness
  training program (see Table 8.7, Box 8.10, and
  Box 8.11)
• 2-3 d/wk, minimum of 1 set of 8-12 reps of 8-10
  different exercises.
• Older people (50-60 yrs of age and above) may
  want to emphasize lighter weights and more reps
  (10-15).
• Table 8.8 summarizes 2002 ACSM guidelines for
  novice, intermediate, and advanced resistance
  training.
• Box 8.9 summarizes advanced systems of resistance
  training.

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An Exercise Program To Build Muscular Strength
and Endurance (Box 8.11)

• Step 1 Warm-up aerobically
• Never strength train unless the muscles and
  joints are warm from 5-15 minutes of moderate
  aerobic activity.
• Step 2 Follow these minimum strength training
  program guidelines
• Frequency Strength train at least 2-3 days per
  week.
• Set and Reps Perform a minimum of one set of 8
  to 12 repetitions to the point of volitional
  fatigue for each exercise.
• Strength exercises Perform a minimum of 8 to 10
  different exercises that condition all of the
  major muscle groups. Perform each exercise
  through a full range of motion. Perform both the
  lifting and lowering portion of each exercise in
  a controlled manner.

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Principles of Weight Training

• Overload principle
• Strength, endurance, and size of muscle increase
  only when the muscle performs for a given period
  of time at its maximal strength and endurance
  capacity (against workloads that are above those
  normally encountered).
• Progressive resistance principle
• The resistance against which the muscle works
  should be increased periodically until the
  desired state is reached.
• Principle of specificity
• The development of muscular fitness is specific
  to the muscle groups that is exercised, its type
  of contraction, and the training intensity.

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Systems of Muscular Strength and Endurance
Training

• Repetitions to fatigue
• When reps are low (3-5), they build greater
  strength when high (15-25, they promote
  endurance (Figure 8.17)
• Set
• One set is good for beginners, but 3-5 are
  optimal.
• Rest between sets
• 1-2 minutes is typical (bodybuilders use less,
  power lifters more)
• Order of exercises
• Many systems (see Box 8.9)
• Type of exercise
• Single joint or multiple joints

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Figure 8.17
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3 Classifications of Muscle Contractions

• Isometric
• Muscle group contracts against a fixed, immovable
  resistance
• Isotonic
• Muscular contraction with movement (Box 8.11
  Figure 8.19).
• Concentric muscle contraction with shortening
• Eccentric muscle contraction with lengthening
• Isokinetic
• Maximal muscle contraction throughout the entire
  range of motion (see Figures 8.19 and 8.20).

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Figure 8.19