Exercise Prescription Certificate Course Session 2: Principles and Frameworks for Exercise Prescription Dr. Raymond CHAN Hoi-fai MBChB (DUNDEE), MSc Sports Medicine (Glasg), MScSMHS(CUHK), MSpMed (New South Wales), DFM (HKCFP), PGDipMSM (Otago)
Outline of this Session Overview of Exercise Prescription Principles of Prescribing Aerobic Physical Activity (PA) The FITT Principle including assessments on Activity Intensity Principles of Prescribing Resistance Exercise Recommendations for Prescribing Exercise to Healthy Adults Practical Examples of Resistance Exercise
Overview of Exercise Prescription
What We Know from Research Regular PA reduces the risk of many adverse health outcomes Health benefits occur for all age and racial group, as well as people with disabilities Benefits of PA far outweigh the possibility of adverse outcomes Some physical activity is better than none Both aerobic and muscle-strengthening (resistance) PA are beneficial Most health benefits occur with at least 150 mins a week of moderate-intensity PA. Additional benefits occur as the amount of PA increases
What is Exercise Prescription? The process of designing a regimen of PA for a client/patient in a systematic and individualized manner for a specified purpose Based on specific and unique needs and interests of the client/patient, as well as results of their clinical assessments The goal should be successful integration of exercise principles and behavioral techniques that motivates the participant to be compliant, thus achieving their purpose
Principles of Prescribing Aerobic Exercise
Definition of Aerobic Exercise Any activity that uses large muscle groups, can be maintained continuously, and is rhythmical in nature
FITT FIVE Essential Components of Prescribing Aerobic Exercise Frequency Intensity Time (Duration) Type Progression Dosage of Exercise
The Frequency of Prescribed Aerobic Exercise Usually expressed as the number of days per week dedicated to an exercise session E.g. 5 times per week FITT
The Intensity of Prescribed Aerobic Exercise Refers to how hard a person works to do the activity Moderate-intensity: can talk, but not sing Vigorous-intensity: cannot say more than a few words without pausing for a breath Other Common Methods for Assessing Aerobic Intensity: Ratings of perceived exertion (RPE) %HR max OR %HRR Other Methods that Used in Specialised Clients %VO 2max OR %VO 2 R Metabolic equivalents (METs) FITT
The Intensity of Prescribed Aerobic Exercise by RPE An index of how hard the person feels he or she is exercising (e.g. a 0 to 10 scale) Borg RPE Scale A scale ranges from 6 to 20, where 6 means "no exertion at all" and 20 means "maximal exertion Preferred method to assess intensity among those individuals who take medications that affect heart rate or pulse FITT
The Intensity of Prescribed Aerobic Exercise by RPE (a 0 to 10 scale) FITT
FITT The Intensity of Prescribed Aerobic Exercise by %HRR or %HR max Aerobic intensity can be expressed as a % of one s: Maximum heart rate (%HR max ) OR Heart rate reserve (%HRR) HR max : estimated by person s age by 220 age (applied to adults 19 year-old only), or some other prediction equation HRR: HRR = HR max Resting HR
The Intensity of Prescribed Aerobic Exercise by %HRR or %HR max %HR max Method Simple to use and very popular BUT does not account for resting HR Clients with a slower resting HR would have a relatively higher exercise intensity compared to those with a faster resting HR %HRR Method Take resting HR into account when calculation Avoids the problems association with these variations in resting HR FITT
The Intensity of Prescribed Aerobic Exercise by %HRR or %HR max FITT
The Intensity of Prescribed Aerobic Exercise by %VO 2max /%VO 2 R Aerobic intensity can be expressed as a percentage of a person s: Maximal oxygen uptake/aerobic capacity (%VO 2max ) Oxygen uptake reserve (%VO 2 R) (the difference between resting VO 2 and VO 2max ) The person s VO 2max or VO 2 R could be estimated by an exercise testing FITT
What is VO 2max? VO 2max (Maximal Oxygen Uptake) - ml O 2 /kg/min Highest rate of oxygen consumption attainable during maximal/exhaustive exercise (no more in rate of O 2 consumption despite Ex intensity) A Product of: Maximal Cardiac Output (L Blood/min) Arterio-venous Oxygen Difference (ml O 2 / L Blood) Accepted as the standard gauge of cardiorespiratory fitness HR responses to submaximal exercise tests could be used to predict VO 2max
LINEAR Relationship between HR and Work Rate (O 2 Consumption)
The Intensity of Prescribed Aerobic Exercise by %VO 2 R FITT
FITT Common Modes of Testing to Measure/Estimate VO 2max Open-circuit Spirometry Gold Standard for VO 2max measurement High cost and requires expertise skills Treadmill Test The most common mode of test and can accommodate the least fit to the fittest Cycle Ergometry Test A non-weight bearing test that allows BP and ECG to be measured easily Step Test Measuring HR response to steeping at a fixed rate and/or a fixed step height
FITT The Intensity of Prescribed Aerobic Exercise - METs METs express aerobic intensity as ml/kg of body weight/min of oxygen being consumed Eqv: How many times harder than rest 1 MET is the rate of energy expenditure while sitting at rest (by convention: VO 2 oxygen uptake of 3.5 ml/kg/min) Intensity Classification by METs: Light 1.1-2.9 METs Moderate 3-5.9 METs Vigorous 6 METs
The Intensity of Prescribed Aerobic Exercise by METs FITT
The Intensity of Prescribed Aerobic Exercise by METs FITT
The Intensity of Prescribed Aerobic Exercise by METs FITT
The Time of Prescribed Aerobic Exercise Refers the length of time in which an activity or exercise is performed Time (Duration) is generally expressed in minutes e.g. 30 min/day or 150 min/week FITT
The Type of Prescribed Aerobic Exercise The mode of exercise performed FITT Some require little skill to perform e.g. brisk walking, leisure cycling, swimming, aquaaerobics and slow dancing Some generally perform at a higher activity intensity e.g. jogging, running, aerobics dance, stepping exercise, fast dancing
The Progression of Prescribed Aerobic Exercise Recommended Sequence of Progression of Aerobic Exercises
FITT FIVE Essential Components of Prescribing Aerobic Exercise Frequency Intensity Time (Duration) Type Progression Dosage of Exercise
Principles of Prescribing Resistance Exercise
Definition of Resistance Exercise Exercise that increases skeletal muscle strength, power, endurance, and mass Include strength training, resistance training, or muscular strength and endurance exercises
FITT FIVE Essential Components of Prescribing Resistance Exercise Frequency Intensity (i.e. Load/ Weight) Time (i.e. Volume: Sets & Reps) Type Progression Dosage of Exercise
The Frequency of Prescribed FITT Resistance Exercise The number of days per week dedicated to an exercise of EACH muscle group All muscle groups may be trained in the same session (i.e. whole body) or each session may split the body into selected muscle groups so that only a few of them are trained in any one session E.g. lower body muscles trained on Monday and Thursday while upper body muscles trained on Tuesday and Friday (i.e. each muscle group is trained on 2 days/ wk)
FITT The Intensity of Prescribed Resistance Exercise Refers to the amount of weight or resistance assigned to a set of resistance exercise for each muscle group Expressed as % of a person s one-repetition Maximum for that particular exercise (i.e. %1-RM): 1-RM: the greatest resistance or weight that a particular muscle group can move through the full range of motion for a single repetition in a controlled manner with good posture
The Time of Prescribed Resistance FITT Exercise No specific amount of time is recommended for resistance exercise, while Repetitions (Reps) and Sets are standard ways to refer to the working time needed A Rep" is one performance of a single exercise for a particular muscle group A Set comprises a group of reps performed without stopping
The Time of Prescribed Resistance Exercise A reasonable rest interval btw sets is 2-3 min The number of rep performed with each set and the load of exercise are inversely related load, no. of rep that needed FITT
The Type of Prescribed Resistance FITT Exercise Resistance exercises count if they involve a moderate to high level of intensity and work the major muscle groups of the body: legs, hips, back, chest, abdomen, shoulders, and arms, etc. Best to include multi-joint/ compound exercises usually take the form of free weights or weight machines, but also working with resistance bands and doing calisthenics (using body weights) Individuals who are new to resistance exercises should receive instructions from trained personnel before engaging in these exercises
The Progression of Prescribed Resistance Exercise Rate of Progression of Resistance Exercises An initial increase in the number of rep is recommended before an increase in load When the participant can comfortably achieve the upper limit of the prescribed repetition range, for example, 12 to 15 reps, training loads may be increased (e.g. by 5%) So that no more than 15 reps are completed without volitional fatigue
FITT FIVE Essential Components of Prescribing Resistance Exercise Frequency Intensity (i.e. Load/ Weight) Time (i.e. Volume: Sets & Reps) Type Progression Dosage of Exercise
Recommendations for Prescribing Exercise to Healthy Adults
Recommendations for Prescribing Aerobic Activities to Healthy Adults Frequency: Perform moderate-intensity aerobic PA on at least 5 days/wk or vigorous PA on at least 3 days/wk, or a weekly combination of 3-5 days/wk of moderate- and vigorous exercise Intensity: A combination of moderate and vigorous-intensity aerobic exercise is recommended
Recommendations for Prescribing Aerobic Activities to Healthy Adults Time: Perform moderate-intensity exercise for at least 30 min/d to a total of at least 150 min/wk OR vigorous intensity exercise for at least 20 min/d to a total of at least 75 min/wk. (in bouts of 10 min) To health benefits, increase duration to 300 min/wk of moderate-intensity, OR 150 min/wk of vigorousintensity exercise (or an eq. combination of both) PA beyond this amount may further health benefits
Recommendations for Prescribing Aerobic Activities to Healthy Adults Type: *Typically performed in vigorous intensity
Recommendations for Prescribing Resistance Exercise to Healthy Adults Frequency: Each muscle group on 2 to 3 day/wk with at least 48 hours separating the training sessions for the same muscle group Intensity: A load of 60 to 80% 1-RM for each set of exercise
Recommendations for Prescribing Resistance Exercise to Healthy Adults Time: Each target muscle group should be trained for a total of 2 to 4 sets with 8 to 12 reps /set Rest interval of 2-3 minutes in between Type: 8 to 10 resistance exercises working major muscle groups of the body Multi-joint exercises involving >1 muscle group and targeting both agonist and antagonist muscle groups are preferable
Progression & Special Considerations physical activity gradually over time whenever more activity is necessary to meet recommendations Inactive people should start low and go slow Terminate exercise immediately and seek prompt medical care if warning signs or symptoms develop during or after exercise
Some Practical Examples of Resistance Exercise
End of Presentation Please refer to Doctor s Handbook: Chapters 4-5 for further reading
Questions and Answers