The Exercise Prescription: The Basics to Get You Going David M Systrom, M.D. June 20, 2014
Harvard Fatigue Lab Wallace Donham, Business School Dean Lawrence J. Henderson, HMS, Director David T. Edsall, HMS Dean, MGH
Harvard Fatigue Lab David Dill
Harvard Fatigue Lab J Physiol 1928; 66:136
Exercise Response After Wasserman, et al 2000
Types of Training Static Dynamic High-Intensity Interval (HIT)
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
VO 2 max 3.0 Trained. VO 2 (L/min) 1.0 Detrained.. VO 2 = Qt (Ca-vO - 2 ) Work (watts) 300
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
VO2max Trainability and High Intensity Interval Training in Humans: A Meta-Analysis. Bacon AP, Carter RE, Ogle EA, Joyner MJ. PLoS One. 2013 Sep 16;8(9):e73182. doi: 10.1371/journal.pone.0073182.
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)
Dynamic Static Cardiac Output MAP SVR Load Volume Pressure Remodeling Eccentric Concentric Ventricular compliance LVEF 0 0
David L Prior, Andre La Gerche. The athlete's heart. Heart 2012;98:947-955 doi:10.1136/heartjnl-2011-301329
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: 1895 1901, 2006.
Minute Ventilation MVV }. VE 140 (L/min) 40 Reserve Detrained } Trained 1.0. VO 2 (L/min) 3.0
Effects of high-intensity interval training on pulmonary function Cali Dunham Craig A. Harms Eur J Appl Physiol (2012) 112:3061 3068 DOI 10.1007/s00421-011-2285-5
Respiratory Muscle Blood Flow Steal Dempsey JA.New perspectives concerning feedback influences on cardiorespiratory control during rhythmic exercise and on exercise performance. J Physiol. 2012 Sep 1;590(Pt 17):4129-44. doi: 10.1113/jphysiol.2012.233908. Epub 2012 Jul 23.
Arterial Oxygenation 100 Normal ml/dl 75 Endurance Athlete.. VO 2 = Qt (Ca-vO - 2 ). VO 2 (L/min)
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;591:3017-3034 2013 by The Physiological Society
Distribution of Cardiac Output 35 30. High VEmax./MVV Blood Flow (L/min) 25 20 15 10 5 Muscle Other Renal Splanchnic Coronary 0 Rest VO2max
Skeletal Muscle.. - VO 2 = Qt (Ca-vO 2 ) 15 _ CvO 2 (ml/dl) Detraining 5 1.0. VO 2 (L/min) Normal 3.0
Muscle metabolic responses during high-intensity intermittent exercise measured by 31 P-MRS Tlim (s) 304 ± 68.. 847 ± 240 Weerapon, C et al. Am J Physiol Regul Integr Comp Physiol (September 25, 2013). doi:10.1152/ajpregu.00406.2013
Cardiac output max and skeletal muscle oxygenation after 2 weeks of HIT Jacobs, et al. J Appl Physiol 115: 785 793, 2013. doi:10.1152/japplphysiol.00445.20 13.
Muscle oxidative enzymes after low volume sprint interval and traditional endurance training in humans. Kirsten A Burgomaster, et al. J Physiol. 2008 January 1; 586(Pt 1): 151 160. PMCID: PMC2375551
Muscle fuel oxidation after low volume sprint interval and traditional endurance training in humans. Kirsten A Burgomaster, et al. J Physiol. 2008 January 1; 586(Pt 1): 151 160. PMCID: PMC2375551
Training Adaptations Cardiac Good: Increased Qt via stroke volume Increased LVEDV LVEF same to lower Filling pressures decreased SVR decreased
Training Adaptations Cardiac Bad: Electrical remodeling Arrhythmias Orthostatic HoTN?RV fibrosis
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
Training Adaptations Skeletal Muscle Good: Increased mitochondria Increased capillary density Increased oxidative capacity Fat > CHO Increased endurance
Training Response After Wasserman, et al 2000
Training Guidelines (FITT) - training duration > 6 weeks - 3-5 days/week - e10 minutes of high intensity work - e1 1 work/rest ratio - <10h week?