The Exercise Prescription: The Basics to Get You Going. David M Systrom, M.D. June 20, 2014

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1 The Exercise Prescription: The Basics to Get You Going David M Systrom, M.D. June 20, 2014

4 Harvard Fatigue Lab Wallace Donham, Business School Dean Lawrence J. Henderson, HMS, Director David T. Edsall, HMS Dean, MGH

5 Harvard Fatigue Lab David Dill

6 Harvard Fatigue Lab J Physiol 1928; 66:136

7 Exercise Response After Wasserman, et al 2000

8 Types of Training Static Dynamic High-Intensity Interval (HIT)

9 Static component Classification of training type by sport (adapted from Mitchell et al2) Dynamic component Low Medium High Low Medium High Golf Baseball Hockey Cricket Fencing Long distance running Bowling Volleyball Football (soccer) Tennis Archery American football Middle distance running Diving Jumping events Swimming Equestrian Sprinting Basketball Rugby Figure skating Ice hockey Throwing events Downhill skiing Cycling Weight lifting Body building Triathlon Gymnastics Snowboarding Rowing Martial arts Wrestling Boxing Cross country skiing Canoe/kayak

10 VO 2 max 3.0 Trained. VO 2 (L/min) 1.0 Detrained.. VO 2 = Qt (Ca-vO - 2 ) Work (watts) 300

11 VO 2 max Trainability and High Intensity Interval Training in Humans: A Meta-Analysis. -healthy sedentary/recreationally active humans -<45 yrs old, - training duration 6-13 weeks - e3 days/week - e10 minutes of high intensity work - e1 1 work/rest ratio

12 VO2max Trainability and High Intensity Interval Training in Humans: A Meta-Analysis. Bacon AP, Carter RE, Ogle EA, Joyner MJ. PLoS One Sep 16;8(9):e doi: /journal.pone

13 Cardiac Output 30 Trained. Nl slope = 5-6 ml/ml Q t (L/min) 6 Detrained.. VO 2 = Qt (Ca-vO - 2 ). VO 2 (L/min)

14 Dynamic Static Cardiac Output MAP SVR Load Volume Pressure Remodeling Eccentric Concentric Ventricular compliance LVEF 0 0

15 David L Prior, Andre La Gerche. The athlete's heart. Heart 2012;98: doi: /heartjnl

17 Biventricular Filling Pressures as a Function of Training Michael K. Stickland, et al.does fitness level modulate the cardiovascular hemodynamic response to exercise?j Appl Physiol 100: , 2006.

18 Minute Ventilation MVV }. VE 140 (L/min) 40 Reserve Detrained } Trained 1.0. VO 2 (L/min) 3.0

19 Effects of high-intensity interval training on pulmonary function Cali Dunham Craig A. Harms Eur J Appl Physiol (2012) 112: DOI /s

20 Respiratory Muscle Blood Flow Steal Dempsey JA.New perspectives concerning feedback influences on cardiorespiratory control during rhythmic exercise and on exercise performance. J Physiol Sep 1;590(Pt 17): doi: /jphysiol Epub 2012 Jul 23.

21 Arterial Oxygenation 100 Normal ml/dl 75 Endurance Athlete.. VO 2 = Qt (Ca-vO - 2 ). VO 2 (L/min)

22 Figure 1. Individual arterial blood gas response to maximal exercise test, arterial oxygen tension;, arterial carbon dioxide tension;, alveolar-to-arterial oxygen difference;, arterial oxyhaemoglobin saturation;, oxygen consumption. Dominelli P B et al. J Physiol 2013;591: by The Physiological Society

23 Distribution of Cardiac Output High VEmax./MVV Blood Flow (L/min) Muscle Other Renal Splanchnic Coronary 0 Rest VO2max

24 Skeletal Muscle.. - VO 2 = Qt (Ca-vO 2 ) 15 _ CvO 2 (ml/dl) Detraining VO 2 (L/min) Normal 3.0

25 Muscle metabolic responses during high-intensity intermittent exercise measured by 31 P-MRS Tlim (s) 304 ± ± 240 Weerapon, C et al. Am J Physiol Regul Integr Comp Physiol (September 25, 2013). doi: /ajpregu

26 Cardiac output max and skeletal muscle oxygenation after 2 weeks of HIT Jacobs, et al. J Appl Physiol 115: , doi: /japplphysiol

27 Muscle oxidative enzymes after low volume sprint interval and traditional endurance training in humans. Kirsten A Burgomaster, et al. J Physiol January 1; 586(Pt 1): PMCID: PMC

28 Muscle fuel oxidation after low volume sprint interval and traditional endurance training in humans. Kirsten A Burgomaster, et al. J Physiol January 1; 586(Pt 1): PMCID: PMC

29 Training Adaptations Cardiac Good: Increased Qt via stroke volume Increased LVEDV LVEF same to lower Filling pressures decreased SVR decreased

30 Training Adaptations Cardiac Bad: Electrical remodeling Arrhythmias Orthostatic HoTN?RV fibrosis

31 Training Adaptations Pulmonary Good: Increased respiratory muscle strength Decreased RM metaboreflex Less respiratory muscle steal Increased perfusion of limb muscle Bad Arterial O 2 desaturation

32 Training Adaptations Skeletal Muscle Good: Increased mitochondria Increased capillary density Increased oxidative capacity Fat > CHO Increased endurance

33 Training Response After Wasserman, et al 2000

34 Training Guidelines (FITT) - training duration > 6 weeks days/week - e10 minutes of high intensity work - e1 1 work/rest ratio - <10h week?

Dr. K.D.C. Upendra Wijayasiri (MBBS (SL), Dip.Spo.Med (col))

CARDIO- RESPIRATORY EXERCISE FITNESS What does it really mean? Dr. K.D.C. Upendra Wijayasiri (MBBS (SL), Dip.Spo.Med (col)) Sports Physician, Head - Sports Medicine Unit, Colombo South Teaching Hospital,