chapter 3- Cardiorespiratory fitness assessments and exercise programming for apprarently healthy particpants

Question 1

Cardiorespiratory fitness (CRF)

Answer 1

the ability of the circulatory and respiratory systems to supply oxygen to the muscles to perform dynamic physical activity. High CRF is associated with increase health benefits, and it has been well established that individuals who do moderate- or vigorous-intensity aerobic physical activity have significantly lower risk of cardiovascular disease than inactive people. A dose-response relationship exists between aerobic fitness and health outcomes, as increased levels of CRF are associated with numerous positive health outcomes and reductions in chronic disease and all-cause mortality

Question 2

Goal of the Cardiovascular System

Answer 2

Works in synchrony with respiratory system to provide oxygen and remove waste from the body.

• responsible for the delivery of oxygenated blood and nutrients to the cell to make energy in the form of adenosine triphosphate (ATP).
• The cardiovascular system is also responsible for the removal of “waste” from the cell, so it can be transported to its appropriate destination for elimination or recycling

Question 3

Respiratory system

Answer 3

supports gas exchange, promoting the movement of oxygen and carbon dioxide from the environment into the blood and from the blood back into the environment.

Question 4

Four chambers of the heart

Answer 4

Upper chambers
-Right and left atria

Lower chambers
-right and left ventricle

Question 5

Process of the heart

Answer 5

• RV is responsible for pumping deoxygenated blood to the lungs for oxygen loading and carbon dioxide unloading
• After gas exchange occurs in the pulmonary circulation, blood returns to the left atria
• The left ventricle is then responsible for generating the force necessary to drive the blood out of its chamber and through the vasculature

-The right and left atria act to provide
support to their respective ventricles, serving as a reservoir of blood that
eventually moves into the ventricles.

-The vasculature consists of arteries,
arterioles, capillaries, venules, and veins; they can be thought of as a series of tubes that branch and become smaller in diameter as they move away from the heart

-

Question 6

systemic circulation

Answer 6

-(aorta to vena cava), the arteries and
arterioles carry oxygenated blood, whereas in the pulmonary circulation
(pulmonary artery to pulmonary vein), the arteries and arterioles carry
“deoxygenated blood,” or blood that contains less oxygen than arterial
blood.

-Deoxygenated blood and metabolic
byproducts move out of capillaries into venules, which consolidate into
veins as they move closer to the heart.

Question 7

capillaries

Answer 7

e smallest and most numerous of the blood vessels and is the location of gas and nutrient exchange.

Question 8

Veins

Answer 8

responsible for delivering the deoxygenated blood back to the right side of the heart, where the cycle then repeats endlessly.

Question 9

Order of blood movement

Answer 9

Right atrium> right ventricle> pulmonary artery> lungs> pulmonary vein> left atrium> left ventricle> aorta> organs> tissues> vena cava> right atrium

Question 10

Adenosine Triphosphate Production (ATP)

Answer 10

-composed of carbon, hydrogen, nitrogen, oxygen, and phosphorus atoms and is found in all living cells.

-Nervous transmission, muscle contractions, formation of nucleic acids, and many other energy-consuming reactions of metabolism are possible
because of the energy in ATP molecules.

-Cells break down the food we eat with the ultimate goal of producing ATP, which is the cellular form of energy used within the body to fuel work. Muscle cells are very limited in the amount of ATP they can store.

To support muscle contraction during continuous exercise, cells must
continuously create ATP at a rate equal to ATP use through a combination
of three primary metabolic systems: creatine phosphate (CP), anaerobic
glycolysis, and the oxidative system

Question 11

Three metabolic systems

Answer 11

• Creatine phosphate
• anaerobic glycolysis
• oxidative system

Question 12

Creatine phosphate

Answer 12

-most immediate source of ATP
- Small amounts of CP are stored within each cell, and one CP donates a phosphate group to adenosine diphosphate (ADP) to create one ATP, or a simple one-to-one trade-off. This simplicity allows for the rapid production of ATP within the cell; however, this production is short-lived.
- CP
system can provide ATP to fuel work only during short-intense bouts of
exercise, owing to the limited storage capacity of CP within each cell.
Therefore, the CP system is the primary source of ATP during very short,
intense movements, such as discus throw, shot put, and high jump, and any
maximal-intensity exercise lasting less than approximately 10 seconds.

Question 13

Anaerobic glycolysis

Answer 13

-The primary source of ATP during medium-duration, intense exercise, such as the 200-m and 400-m sprint events or any exercise of an intensity that cannot be continued for more than approximately 90 seconds
- next most immediate energy source and
consists of a metabolic pathway that breaks down carbohydrates (glucose
or glycogen) into pyruvate
-. The bond energy produced from the
breakdown of glucose and glycogen is used to phosphorylate ADP and create ATP. The net energy yield for anaerobic glycolysis, without further oxidation through the subsequent oxidative systems, is two ATPs if glucose is the substrate and three ATPs if glycogen is the substrate

Question 14

Anaerobic energy systems

Answer 14

• produce ATP quickly, but they are limited in the duration for which they can continue to produce ATP

-For longer duration exercise or low- intensity exercise regardless of duration,
the body relies most heavily on the oxidative metabolic energy systems.

Question 15

T/F: Anaerobic energy systems can produce ATP quickly, but they are
limited in the duration for which they can continue to produce ATP. For longer duration exercise or low-intensity exercise regardless of duration, the body relies most heavily on the oxidative metabolic energy systems.

Answer 15

True

Question 16

aerobic or oxidative energy system

Answer 16

• does not contribute much energy
  at the onset of exercise but is able to sustain energy production for a longer
  duration. As exercise intensity decreases, allowing for longer exercise duration, the relative contribution of the anaerobic energy systems decreases and the relative contribution of the aerobic energy systems increases

-The oxidative system includes two metabolic pathways: the Krebs cycle (aerobic glycolysis) and the electron transport chain. Unlike the anaerobic energy systems mentioned earlier, the oxidative systems require the presence of oxygen to produce ATP, which takes place in the mitochondria of the cell. This is why the mitochondria are known as the
“powerhouse of the cell,” as that is where the majority of ATP is generate

Question 17

Krebs cycle

Answer 17

-requires the presence of carbohydrates, proteins, or fats. These macronutrients are broken down through a series of chemical reactions with their subsequent energy collected and used to create ATP independently and within the electron transport chain

–system is the primary source of ATP used during low- to moderate intensity aerobic exercise lasting longer than 1 to 2 minutes all the way up to long-distance endurance events.

Question 18

ATP process summary

Answer 18

-The anaerobic and aerobic energy systems work together to create ATP
to fuel exercise.

• The ATP stored within the muscle cell will be used during the first few seconds of exercise onset.
• As stored ATP decreases, the contribution of ATP production via the CP system increases.

-Subsequently, as the stores of CP are reduced, anaerobic glycolysis
becomes the primary contributing energy system to ATP creation.

• Aerobic ATP production becomes the primary fuel source in exercise lasting more than approximately 1 to 2 minutes.
• depicts the relative contribution of each source for exercise lasting between 1 and 160 seconds. Although the contribution of energy production differs on the basis of intensity and duration of exercise within the CP system, anaerobic glycolysis, and the oxidative systems, all of these primary metabolic pathways work in synchrony to produce the energy required to sustain the biological work of the human body.

Question 19

Upon the transition from rest

to submaximal exercise, what happens to VO2

Answer 19

VO2 increases and reaches a steady state in 1–4 minutes

Question 20

Steady state

Answer 20

point at which O2 plateaus during
submaximal aerobic exercise, and energy production via the aerobic energy systems is equal to the energy required to perform the set intensity of work

Question 21

Oxygen deficit

Answer 21

-Prior to steady state

-VO2 is lower than required to create
adequate energy for the given task primarily via the oxidative energy
systems

-anaerobic energy systems are responsible for providing the energy to make up for the difference between the energy produced via the aerobic energy systems and the energy required to perform the work required

Question 22

Effects of Aerobic training on steady state

Answer 22

Aerobic exercise training decreases the time required to reach steady-state, thus reducing the oxygen deficit. This is beneficial because less ATP production will be required and therefore less anaerobic byproducts from the anaerobic energy systems at the start of exercise and upon transition to a higher workload of exercise

Question 23

After cessation of exercise (EPOC)

Answer 23

O2 remains elevated because of the
increased work associated with the resynthesis of ATP and CP within
muscle cells, lactate removal, and elevated body temperature, hormones,
heart rate (HR), and respiratory rate.

-This elevation after exercise was first called oxygen debt (54) but is now commonly referred to as excess
post exercise oxygen consumption (EPOC)

Question 24

Effect of incremental exercise

Answer 24

• VO2 increases slowly within the first few
  minutes of exercise and eventually
  reaches a steady state at each submaximal exercise intensity.

-Steady-state O2 continues to increase
linearly as workload increases until maximal O2 ( O2max) is reached. O2max
is the highest volume of oxygen the body can consume. It is often used as an indicator of aerobic fitness and endurance exercise performance because a higher VO2max indicates a greater capacity to create ATP via oxidative energy production and a greater ability to supply the energy required to support higher intensity exercise workloads.

Question 25

The Fick equation

Answer 25

VO2max = HRmax × SVmax × a- VO2 difference

-HR= heart rate
SV=Stroke volume
avO2 difference= arteriovenous oxygen difference

Question 26

Arteriovenous Oxygen Difference Response to Graded Intensity Exercise

Answer 26

-difference in oxygen content between the arterial and the venous blood. The a- O2 difference provides a measure of
the amount of oxygen taken up by the working muscles from the arterial blood. Resting oxygen content is approximately 20 mL ∙ dL−1 in arterial blood and 15 mL ∙ dL −1 in venous blood, yielding an a- O2 of about 5 mL ∙ dL−1.

-During exercise, venous oxygen content decreases as a result of the increased consumption of oxygen by the working muscles, thus resulting in an increase in a- O2 difference with increasing exercise intensity.

Question 27

Heart Rate Responses to Graded Intensity Exercise

Answer 27

Heart Rate
- increases linearly with increasing workload until HR maximum is reached, which is also typically the point of exercise maximum.

-Although maximal HR (HRmax) declines with age, trained athletes have lower
resting HRs throughout the lifespan. Training itself has little impact on HRmax.

-However, training can decrease an individual’s HR at a given submaximal workload from pre- to post aerobic exercise training as a sign of increased fitness.

Question 28

Stroke Volume Responses to Graded Intensity Exercise

Answer 28

-volume of blood the heart ejects with each beat. Similar to HR, SV increases with workload but only up to approximately 40%–60% of O2max in the general population.

Beyond 40%–60% of VO2max, SV has been shown to decrease slightly in
sedentary individuals while continuing to increase beyond 40%–60% of O2max
in highly trained individuals.

-As SV increases with training, resting HR tends to decrease, as more blood being pumped per beat allows the heart to beat less often at rest.

Question 29

Cardiac Output Responses to Graded Intensity Exercise

Answer 29

-product of SV and HR and is also a measure of blood pumped per minute.

-Cardiac output increases steadily during graded intensity exercise because of the linear rise in HR and curvilinear rise in
SV.

-Increases in cardiac output beyond ~50% of O2max are primarily mediated by increases in HR in untrained individuals.

-Trained individuals also have the capacity to increase cardiac output via increases in HR, but because they can see continued increase in SV past that of an untrained
individual, they have a greater capacity to increase cardiac output.

Question 30

Pulmonary Ventilation Response to Graded Intensity Exercise

Answer 30

-volume of air inhaled and exhaled per minute. It is calculated by multiplying the frequency of breathing by the volume of
air moved per breath (tidal volume). Pulmonary ventilation increases linearly with work rate until 50%–80% of VO2max, at which point it reaches the ventilatory threshold and ventilation begins to increase exponentially

-Ventilatory threshold has been used as an indicator of performance and training intensity; trained subjects can reach higher workloads than untrained subjects before reaching their ventilatory threshold

Question 31

Blood Pressure Response to Graded Intensity Exercise

Answer 31

Blood pressure (BP) is proportional to the product of cardiac output and total peripheral resistance (TPR) (the overall resistance to blood flow by the blood vessels).

Question 32

Systolic blood pressure (SBP)

Answer 32

pressure in the arteries during ventricular contraction, or systole, and is heavily influenced by changes in cardiac output.

Question 33

Relationship between Systolic blood pressure and cardiac output

Answer 33

as cardiac output increases

linearly with increasing workload, so does SBP.

Question 34

Diastolic blood pressure

DBP

Answer 34

pressure in the arteries when the heart is relaxed, or diastole and is heavily influenced by TPR.

-During dynamic, large muscle mass exercise, vascular beds within active muscle vasodilate, decreasing resistance within these blood vessels. In contrast, blood vessels in less metabolically active tissues constrict, increasing resistance within these
blood vessels

Question 35

total peripheral resistance (TPR)

Answer 35

• overall resistance to blood flow by the blood vessels
• determined by the systemic resistance throughout the entire vasculature and is thus determined by the relative proportion of the vasculature that has undergone vasodilation versus vasoconstriction during exercise

Question 36

Effect of graded exercise on TPR

Answer 36

TPR may drop slightly because of the large muscle vasodilation. As a result of this and the contrasting
increase in cardiac output, DBP remains relatively stable

Question 37

Mean arterial pressure (MAP)

Answer 37

average BP in the arterial system over one complete cardiac cycle (MAP = DBP + 0.33 [SBP − DBP]).

-MAP is not a critical value to assess during regular exercise and instead is
more commonly used in a clinical or diagnostic setting.

However, it is worth noting that as a result of training, SBP, DBP, and MAP are all
reduced slightly at submaximal workload

Question 38

During graded intensity exercise what increases and what remains stable

Answer 38

HR, pulmonary ventilation, a- VO2 difference, SV, cardiac output, SBP, and mean arterial BP increase during graded intensity exercise, whereas DBP remains stable
or decreases slightly during aerobic type exercise.

-These cardiovascular and pulmonary adaptations support greater oxygen uptake to allow for the
increase in aerobic energy production required during exercise.

Question 39

Rate Pressure Product

Answer 39

In addition to checking for appropriate cardiovascular responses, the EP-C
can use these data to calculate an individual’s “rate pressure product”
(RPP). RPP, also referred to as double product, is the product of HR and
SBP that occurs concomitantly and serves as an estimate of myocardial
oxygen demand (M O2
) (RPP = HR × SBP). At rest, the heart consumes
approximately 70% of the oxygen delivered to the cardiac muscle. During
exercise, the cardiac muscle performs more work because of increased HR
and increased contractility, and thus, M O2
increases during exercise in
direct proportion to exercise intensity (12). Therefore, if HR and SBP are
lower at a given submaximal exercise intensity, the M O2 will be lower,
indicating increased fitness. The RPP can be useful to the EP-C when
performing exercise testing or prescribing exercise to clients with
cardiovascular disease who have been medically cleared for exercise

Question 40

Assess Resting Blood Pressure

Answer 40

1. Patients should be seated quietly for at least 5 min in a chair with back support (rather than on an examination table) with their feet on the floor and their arm supported at heart level. Patients should refrain from smoking cigarettes or ingesting caffeine for at least 30 min preceding the measurement.
2. Measuring supine and standing values may be indicated under special circumstances.
3. Wrap cuff firmly around upper arm at heart level; align cuff with brachial artery.
4. The appropriate cuff size must be used to ensure accurate measurement. The bladder within the cuff should encircle at least 80% of the upper arm. Many adults require a large adult
   cuff.
5. Place stethoscope chest piece below the antecubital space over the brachial artery. Bell and diaphragm side of chest piece seem
   to be equally effective in assessing BP (15). Avoid using the thumb to secure the stethoscope against the arm as this may allow the evaluators pulse to be detected through the
   stethoscope.
6. Quickly inflate cuff pressure to 20 mm Hg above first Korotkoff
   sound.
7. Slowly release pressure at rate equal to 2–5 mm Hg ∙ s −1.
8. SBP is the point at which the first of two or more Korotkoff sounds is heard (phase 1), and DBP is the point before the disappearance of Korotkoff sounds (phase 5).
9. At least two measurements should be made (minimum of 1 min
   apart), and the average should be taken.
10. BP should be measured in both arms during the first
    examination. Higher pressure should be used when there is consistent interarm difference.
11. Provide to patients, verbally and in writing, their specific BP numbers and BP goals.

Question 41

Cardiorespiratory Fitness Assessments Benefits

Answer 41

CRF is an umbrella term that serves as an indicator of the functional
capacity of the heart, lungs, blood vessels, and muscles to work in synchrony to support dynamic, large muscle mass exercise (10). CRF assessment is regularly performed in both healthy and clinical populations.
In clinical populations, CRF testing is used for screening, diagnosis, and
prognosis of medical conditions. CRF testing is also used in both clinical
and healthy populations to gain insight into the most appropriate
frequency, intensity, duration, and mode of exercise to prescribe when
127
creating individualized exercise programs, and as a motivational tool to
help track progress and continually set obtainable, short-term goals

Question 42

Maximal oxygen uptake VO2max

Answer 42

Intensity-maximal

Specific test protocols
-open circuit spirometry during graded exercise test to volitional fatigue

Major equipment needed
-treadmill, cycle, ergometer, arm ergometer, etc

Question 43

Submaximal oxygen uptake

Answer 43

Intensity- submaximal

Specific test protocols
-Astrnd-Rhyming Cycle Ergometer Test

Major equipment needed
-cycle ergometer

Question 44

Step test

Answer 44

a widely utilized form of CRF assessment because of the
practicality of this technique. They are short in duration, require little equipment yet are easily portable, and allow for assessment of large groups. Various step test protocols range from submaximal to maximal,
giving the EP-C a wide range of choices that he or she should critically assess before determining which is most appropriate for the client.
Intensity is determined by step height and step cadence. Most step tests
predict O2max from recovery HR (20,22,70), whereas some step tests use steady-state exercise HR to estimate CRF (69). The lower the exercise HR and the greater the rate of recovery, the higher the estimated O2max.

intensity- maximal/ submaximal

Specific test protocols
-queens college/mcardle step step, harvard step test, astrand-rhyming step test

Major equipment needed- aerobic step or specific height bench, metronome

Question 45

Field test

Answer 45

widely utilized to assess CRF. The most common forms of field tests include assessment of the amount of time required to cover a set distance or assessment of the distance covered in a set amount of time. Field tests are versatile, in that they can utilize many modes of exercise, such as walking, running, cycling, and swimming. Field tests have many of the same benefits as step tests, in that they are short in duration, require little equipment, can be used for large groups, and can be
performed wherever a safe, flat, known distance is available. However, field tests can be more subjective in nature, largely because of the dependency on client effort, and therefore are not as reliable as laboratory
tests for assessing CRF.

intensity- maximal/ submaximal

Specific test protocols-rockport walk, 12-minute walk/ru test, 1.5 mile-run test

Major equipment needed- level walking/ running surface

Question 46

assumptions must be met during submaximal exercise testing

Answer 46

(a) steady-state HR is achieved within 3–4 minutes at each workload,
(b)HR increases linearly with work rate,
(c) a consistent work rate should be maintained throughout each stage of testing, and
(d) estimation/prediction
of should be accurate

Question 47

Selecting the Appropriate Cardiorespiratory Fitness

Assessment

Answer 47

When choosing which cardiorespiratory assessment to utilize, the EP-C should consider intensity, length, and expense of the test; type and number of personnel needed; equipment and facilities needed; physician
supervision needs and safety concerns; information required as a result of the assessment; required accuracy of results; appropriateness of mode of
exercise; and the willingness of the participant to perform the test (10).

The EP-C should review the Physical Activity Readiness Questionnaire, health history, and risk assessment documents collected during the prescreening visit to help determine which assessment will be best (see Chapter 2 on prescreening and risk classification).

On the basis of the
client’s risk classification category, the intent of the exercise test, and the other considerations, the EP-C should think critically to determine whether a submaximal or maximal test is most appropriate on a case-by-case basis and to avoid a “one size fits all” approach. Although maximal testing may be quite precise, it has many drawbacks, including first and foremost the increased risk of exercising to exhaustion, especially in clients presenting with any level of risk other than “low”.
Other drawbacks to maximal testing include increased costs and time, specialized personnel and
supplies, and the discomfort of asking the client to exercise to complete
exhaustion. Submaximal tests may therefore be more appropriate for many
individuals and, when conducted appropriately, result in a reasonable
estimate of O2max

Question 48

Assess Cardiorespiratory Fitness in Adults of Low

Fitness Level: The Rockport Walking Test

Answer 48

Equipment Needed

1. Track or level surface
2. Stopwatch
3. HR monitor (optional)
4. Scale to measure body weight
5. Clipboard, recording sheet, and pencil
6. Calculator

Important Information and Tips

1. Although many CRF assessments require the individual to run/jog, these types of tests may be contraindicated for individuals with orthopedic concerns or of low fitness level. Therefore, the EP-C may choose to utilize the Rockport Walking Test to assess maximal aerobic capacity.
2. The procedure for the Rockport Walking Test is as follows:
   a. Locate a level surface, preferably a track and determine the distance or lap that is equivalent to 1 mile.
   b. After a proper warm-up, instruct the client to walk 1 mile as fast as possible, without jogging or running.
   c. Immediately after 1 mile has been completed, record the walk time in minutes.
   d. If the individual is wearing an HR monitor, record the HR achieved immediately upon reaching the 1-mile mark. If an HR monitor is not available, upon completion of the mile, take the client’s pulse for 15 seconds and multiply by 4 to determine peak HR.
   e. Data may now be entered into the following formula: O2max (mL ∙ kg−1
   ∙ min−1) 5 = 132.853 − (0.0769 × body
   weight in lb) − (0.3877 × age in yr) + (6.315 × gender [1 for
   men, 0 for women]) − (3.2649 × 1 mile walk time in minutes)− (0.1565 × HR)
   f. Data may be compared with normative tables listed in Suggested Reading.

Example
1. What is the predicted maximal aerobic capacity for a 64-yr-old woman, who weighs 155 lb, completes the Rockport test in 16
min with an HR of 142 bpm?
O2max= 132.853 − (0.0769 × 155) − (0.3877 × 64) + (6.315 × 0) − (3.2649 × 16) − (0.1565 × 142) = 21.7 mL ∙ kg
−1∙min−1
2. Normative data suggest that this individual would be rated as “low average” for her age.

Question 49

Cardiorespiratory Fitness in Pregnant Women

Answer 49

If exercise is not contraindicated, pregnant women can follow the ACSM and Surgeon General’s recommendations to accumulate a minimum of 150 minutes of moderate-intensity exercise weekly

-Exercise intensities of 60%–70% of HRmax or 50%–60% of O2max (on the low end of moderate-intensity exercise) are advised for pregnant
women who were not physically active before pregnancy.

-Women who were active before exercise can exercise at a higher workload. If exercise testing is warranted in a pregnant woman, maximal exercise
testing should be avoided unless absolutely necessary for medical reasons.

Although submaximal exercise testing is more appropriate for this
population (9), there is usually little need to conduct fitness assessments in pregnant women.

Special consideration should be given to the mode of exercise to ensure that the subject feels comfortable and that there is low risk of injury and falls. The EP-C should also ensure that exercise testing is performed in a thermoneutral environment and during a state of adequate hydration.

During testing, the EP-C should closely monitor the
pregnant woman so as not to miss any test termination signs or symptoms

Question 50

Interpreting Results of Cardiorespiratory Fitness
Assessments, Including Determination of VO2
and VO2max

Answer 50

Low CRF levels have been shown to be an independent predictor of
cardiovascular disease and all-cause mortality.

-The EP-C should discuss this relationship with clients, as it may bring added meaning to the
test results and help motivate clients to improve their CRF. Both maximal
and submaximal tests can be used to evaluate CRF at a given point in time as well as changes in CRF that result from physical activity participation A higher VO2max, lower HR at a given intensity of submaximal exercise, or a lower recovery HR indicates an overall improvement in CRF

Question 51

Oxygen consumption

Answer 51

rate at which oxygen is consumed by the body. It can be expressed in absolute (L ∙ min−1) or relative (mL ∙kg−1∙ min−1) terms.

Absolute oxygen consumption is the raw volume of oxygen consumed by the body, whereas relative oxygen consumption is the volume of oxygen consumed relative to body weight and can serve as a useful measure of fitness between individuals

Question 52

METs

Answer 52

energy cost of exercise in a simple format that can be easily used by the general public to gauge exercise intensity. One MET is equal to the relative oxygen consumption at rest, which is approximately 3.5 mL ∙ kg−1 ∙ minute−1

-Using METs as energy cost units allows for the energy cost of exercise to be presented in multiples of rest.

For example, if an individual is working at an energy cost of 10 METs, he or she is completing approximately 10 times the amount of work and using 10 times the amount of energy of that at rest. The Compendium of Physical Activity provides a list of the energy cost for different forms of physical activity using METs (2–4). In addition, METs can be used to calculate energy expenditure over time ([MET × kg × 3.5] / 200 = kcal ∙ min
−1).

Question 53

Kilocalorie

Answer 53

estimate of energy cost that can be related directly to physical activity and exercise, and the EP-C can calculate the number of kilocalories expended during an exercise bout if oxygen consumption is measured or estimated using previously mentioned methods. The EP-C can then estimate weight gain, loss, or maintenance, depending on a client’s goal, remembering that 3,500 kcal equals 1 lb of fat.

As an EP-C, understanding the conversion of energy between units is crucial.

Question 54

Walking metabolic calculation

Answer 54

Resting component: 3.5

Horizontal component: 0.1x speed

Vertical component/ resistance component: 1.8 x speed x grade

Limitations: Most accurate for speeds of 1.9-3.7 min/h (50-100 m/min)

Question 55

Running metabolic calculation

Answer 55

Resting component: 3.5

Horizontal component: 0.2x speed

Vertical component/ resistance component: 0.9 x speed x grade

Limitations: Most accurate for speeds >5min/h (134mxmin)

Question 56

Stepping metabolic calculation

Answer 56

Resting component: 3.5

Horizontal component: 0.2x steps x min-1

Vertical component/ resistance component: 1.33 x (1.8 x step height x step/min-)

Limitations: Most accurate for stepping rates of 12-30 steps/min

Question 57

Leg Cycling Metabolic calculation

Answer 57

Resting component: 3.5

Horizontal component: 3.5

Vertical component/ resistance component: (1.8 x work rate) / body mass

Limitations: Most accurate for work rates of 300-1200 kg m/min (50-200W)

Question 58

Arm cycling Metabolic calculation

Answer 58

Resting component: 3.5

Horizontal component: N/A

Vertical component/ resistance component: (3 x work rate) / body mass

Limitations: Most accurate for work rates between 150-750 kgx.min-1 (25-125 W)

Question 59

Metabolic equation example- walking: You advise Tracy to walk at 3.0 mph on a treadmill at 10% grade.
What is her O2?

METS?

Answer 59

Walking VO2 mL ∙ kg−1∙ minute−1 = (0.1 × speed) + (1.8 × speed × fractional grade) + 3.5 mL ∙ kg−1∙minute−1

3.0 mph × 26.8 = 80.4 m ∙minute−1

10% grade = 0.10

Walking VO2 mL ∙ kg−1∙ minute−1 = (0.1 × 80.4) + (1.8 × 80.4 × 0.10) + 3.5 mL ∙ kg
−1∙ minute−1

Walking VO2 mL ∙ kg−1∙ minute−1 = 26 mL ∙ kg−1∙ minute−1

METs = VO2 mL ∙ kg−1 ∙ minute−1/ 3.5

METs = 26/3.5

METs = 7.432

Question 60

Metabolic equation example- Leg cycling: . What would be the equivalent work rate on the cycle ergometer?

Answer 60

Leg cycling O2max mL ∙ kg−1∙ minute−1 = (1.8 × work rate / body weight) + (3.5) + (3.5 mL ∙ kg ∙ minute−1)

26 mL ∙ kg−1∙ minute−1 = (1.8 × work rate / 58) + (3.5) + (3.5 mL ∙ kg−1∙ minute−1)

19 mL ∙ kg−1∙ minute−1 = (1.8 × work rate / 58)

612 kg ∙ m ∙ minute−1 = work rate

Question 61

If Tracy exercises as prescribed for 30 minutes, 5 days ∙ week −1, for 5 weeks, how much fat mass weight will Tracy lose?
(Assume that her caloric intake stays consistent.)

Answer 61

30 minutes ∙ day−1 × 5 days∙ week−1 = 150 minutes week−1

150 minutes ∙ week −1 × 5 weeks = 750 total minutes

VO2 = 26 mL ∙ kg−1 ∙ minute−1

26 mL ∙ kg−1 ∙ minute −1 × 58 kg = 1,450 mL ∙ minute −1

1,450 mL ∙ minute−1 / 1,000 = 1.450 L ∙ minute −1

1. 450 L ∙ minute −1 × 5 kcal = 7.25 kcal ∙ minute −1
2. 25 kcal ∙ minute −1 × 750 minutes = 5,437.5 kcal

5,437.5 / 3,500 = 1.55 lb of fat

Question 62

FITT-VP (F = frequency, I = intensity, T = time or duration,

T = type or mode, V = volume or amount of exercise, P = progression or advancement

Answer 62

Frequency
- Moderate-intensity aerobic exercise should be done at least 5 days ∙ week
or
-vigorous-intensity aerobic exercise done at least 3 days ∙ week
or
a combination of moderate- and vigorous-intensity aerobic exercise done
at least 3–5 days ∙ week

Intensity
-A combination of moderate- (40%–59% O2R) and/or vigorous-intensity (60%–84% O2R) exercise is recommended for most healthy individuals.

Intensity may be prescribed using multiple methods such as, but not limited to, HR reserve (HRR), rating of perceived exertion (RPE),
percentage O2max, and percentage of age-predicted maximal HR.

Time
-For substantial health benefits, individuals should accrue at least 150 minutes ∙ week of moderate-intensity exercise
or
-75 minutes ∙ week of vigorous-intensity exercise or an equivalent combination of moderate and vigorous aerobic exercise. For additional and more substantial health
benefits such as weight management or fitness goals, moderate-intensity
exercise may be increased to at least 300 minutes ∙ week, or vigorous intensity exercise may be increased to at least 150 min ∙ week, or an equivalent combination of moderate and vigorous physical activity.

Type
-All types of physical activity are beneficial as long as they are of sufficient
intensity and duration. Rhythmic, continuous exercise that involves major
muscle groups is the most typical choice; however, for more advanced individuals, intermittent exercise such as interval training or stop-and-go sports may be used to accumulate the recommended frequency, intensity, and time needed for CRF.

Volume
Exercise volume is the product of the FIT (frequency, intensity, time)
components of exercise prescription. A dose-response relationship exists
between physical activity and health outcomes, in which greater amounts
of physical activity are associated with greater health benefits.

Recommended target volumes include ≥500–1,000 MET-min ∙ week
−1, which is roughly equivalent to an energy expenditure of 1,000 kcal ∙ week.

Progression
The recommended rate of progression of an exercise program is dependent
on the individual’s health status, physical fitness, training responses, and
exercise program goals. Therefore, progression may consist of increasing
any of the components of the FITT-VP principles as tolerated by the individual. Any progression should be made gradually, avoiding large increases in any of the FITT-VP components to minimize risks. The progression of exercise may be from a single session per day, or in multiple sessions of ≥10 minutes. An increase in exercise time/duration
per session of 5–10 minutes every 1–2 weeks is reasonable to advance
toward the recommended quantity and quality of exercise.

Question 63

Progressive Overload

Answer 63

The overload principle is at the foundation of all exercise prescription. To
improve CRF, the individual must exercise at a level greater than accustomed to induce adaptation.

The EP-C can implement the overload principle by manipulating the frequency, intensity, or time of the exercise prescription. For example, if an EP-C is working with a client who
typically runs on a treadmill at 75% HRmax, for 30 minutes, 3 days ∙ week−1, the overload principle may be adhered to by increasing the intensity of the run to 80% of HRmax, increasing the time spent running to 40 minutes, or increasing running to 4 days ∙ week.

It is important for the EP-C to
understand that all variables should not be increased simultaneously, as
small incremental progression allows the body to adapt, which is key to
reducing the risk of overuse injuries

Question 64

Reversibility

Answer 64

Commonly referred to as the “use it or lose it” principle, the reversibility principle dictates that once cardiorespiratory training is
decreased or stopped for a significant period (2–4 weeks), previous improvements will reverse and decrease, and the body will readjust to the demands of the reduced physiological stimuli (80).

-Hard-earned gains in CRF can be lost if the training stimulus is removed, and the EP-C should be aware that prior gains made with clients who have taken long breaks
from training will necessitate readjusting previous exercise prescriptions.

Question 65

Individual Diferences

Answer 65

all individuals will not respond similarly to a given training stimulus. The EP-C will encounter a wide range of individuals of varying age and fitness levels, each of whom will demonstrate varied responses to a given exercise stimulus. Within an exercise prescription for CRF, the EP-C will encounter
high and low responders because of the large genetic component that
affects the degree of potential change in VO2max.

The variation in fitness levels necessitates a personalized exercise prescription based on the
unique needs of the individual

Question 66

Specificity of Training

Answer 66

(specific adaptations to
imposed demands) principle, is dependent on the type and mode of exercise. The specificity principle states that specific exercise elicits specific adaptations, creating specific training effects (70).

For example, if an EP-C is working with a client who wishes to improve his or her time in an upcoming half-marathon, the principle of specificity dictates that in
order to improve, the EP-C needs to select a training stimulus specific to the activity in question. Thus, running would be the appropriate mode to select, as activities such as cycling or swimming do not train the specific muscles and movement patterns needed to complete a half- marathon.

Question 67

Interval Training

Answer 67

Definition: when a period of intense activity is interspersed with a period of low to moderate activity

Interval training, traditionally in the form of sprints ranging from 10 s to 5min, has long been utilized in the conditioning of athletes for energy system development and performance enhancement purposes.

From an exercise efficiency standpoint, the lower exercise volume and subsequent time commitment needed for interval training could be very appealing to individuals with limited time, a common barrier to exercise participation.

When prescribing interval training, the EP-C is encouraged to consider
the interval training nomenclature first proposed by Weston et al. that
differentiate high-intensity interval training (HIIT) from sprint interval training (SIT).

HIIT is traditionally performed at an intensity that is greater than the anaerobic threshold and is often performed at an intensity close to that which elicits ≥80–100% peak heart rate, whereas SIT is characterized by an all-out, supramaximal effort equal to or greater than the pace that elicits ≥100% O2peak. Of potential great interest to the EP-C is a recent systematic review and meta-analysis of HIT of patients with lifestyle-induced chronic diseases, which recommended that a 4 × 4 protocol (work = 4 intervals at 4 min at 85%–95% peak HR; rest = 3 intervals at 3 min at 70% peak HR, 3 d/wk) demonstrated the
biggest changes in O2peak, was well tolerated, and had excellent adherence.

Furthermore, there is emerging research for the
consider as to the value of low volume interval training (LVIT), in which a
total exercise time commitment of >15 min can provide a potent stimulus
to physiological adaptations associated with improved health. LVIT protocols range from the extraordinarily demanding (8 bouts of all-out 20 s efforts with 10 s rest in between, 4 d/wk) (67,90,91) to much less severe protocols (2–3 bouts of all-out 20 s efforts with 2–3 min rest in between, 3 d/wk), all of which yielded significant changes in indices of metabolic health and aerobic capacity.

When prescribing interval training, the EP-C can manipulate at least nine different variables that could impact the desired metabolic,
cardiopulmonary, or neuromuscular responses; however, the primary factors of interest concern (a) the intensity and duration of the exercise and recovery interval and (b) the total number of intervals performed.

Consistent with the principles of ExRx and FITT-VP framework, the decision for the EP-C to implement interval training will be dependent on initial CRF assessments, the specific goals of the clientele, and selecting the exercise modality that will best lead to exercise adherence and self efficacy.

Question 68

Heart Rate Reserve Method

Answer 68

HRR, or Karvonen method, requires the EP-C to determine the resting HR and maximum HR of the client. Resting HR is optimally measured in the
morning while the client is in bed before rising, whereas maximum

HR is best measured during a progressive maximal exercise test but can also be estimated via age-predicted formulas. The HRR is the difference between maximum HR and resting HR. Target HR will be determined by considering the habitual physical activity, exercise level, and goals of the client. To assign a target HR, use the following formula:
Target HR = (Maximum HR − Resting HR) × % intensity desired] + Resting HR

For example, if your client has a maximum HR of 200 bpm and a resting HR of 60 bpm, and wishes to exercise at 65%–75% of HRR, the HR range would be 151–165 bpm:

[(200 − 60) × 65%] + 60 = Target HR of 151 bpm
[(200 − 60) × 75%] + 60 = Target HR of 165 bpm

Question 69

Peak Heart Rate Method

Answer 69

The peak HR method requires the EP-C to determine the client’s HRmax. This may be accomplished from direct measurement, such as a O2max treadmill test, or maximum HR may be estimated from age-predicted
formulas. Common estimation equations that the EP-C may consider include the following:

Maximum HR = 220 − age in years
Maximum HR = 207 − (0.7 × age in years) 
Maximum HR = 200 − (0.5 × age in years) 
Maximum HR = 208 − (0.7 × age in years) 
Maximum HR = 206.9 − (0.67 × age in years) 

The EP-C should be aware that each of the earlier equations might overestimate maximum HR in certain populations, while underestimating in others . The EP-C is advised to use maximal HR estimations only as
a guide and to realize that estimates may not be accurate for certain individuals. Once HRmax has been determined, the EP-C may assign a target HR by following the formula:

Target HR = Maximum HR × % intensity desired
For example, if a client is 40 years old and has a selected workload of
85% of maximum HR, and the EP-C chooses the equation, Maximum HR
= 206.9 − (0.67 × age) to estimate maximum HR, the calculations would
be as follows:
206.9 − (0.67 × 40) = Estimated maximum HR of 180 bpm
180 × 85% = Target HR of 153 bpm

Question 70

Peak VO2 Method

Answer 70

The peak O2 method may be used if the EP-C has measured or estimated the VO2max of the client in a laboratory or field setting. However, one should be cautious when assigning workload on the basis of estimated because of the expected error in extrapolating HR (e.g., 220 − age = standard deviation of 12−15 bpm). Once the O2max has been determined, the formula below may be followed:
Target VO2 = VO2max X %Intensity desired

For example, an EP-C working with an individual with a measured VO2max of 60 mL ∙ kg−1∙ minute−1, with an exercise prescription of 90% maximum, would calculate the target VO2 as follows:

60 × 90% = Target VO2max of 54 mL ∙ kg−1∙ min−1

Question 71

Peak Metabolic Equivalent Method

Answer 71

In some instances, the EP-C may choose the peak MET method to guide intensity. Whereas VO2max
is a relative measure of intensity, METs provide an absolute measure, allowing the intensity of various physical activity options to be compared with each other. Resources such as the Compendium of Physical Activity (2–4) feature extensive MET listings for a wide array physical activity options.

Because 1 MET is equivalent to 3.5 mL ∙ kg−1∙ minute −1, an individual’s peak MET level can be determined
simply by dividing one’s measured or estimated

VO2max by 3.5. For
example, an individual with a O2max of 35 would have a peak MET level
of 10 METs. Once an individual’s peak MET has been determined, the EPC can prescribe exercise at an appropriate workload by using a target MET
level. The formula for determining target METs is as follows (12):
Target METs = (% intensity desired) [( O2max
in METs) − 1] + 1
For example, for an individual with a O2max of 35 mL ∙ kg
−1
∙ minute
−1 and who wants to exercise at an intensity of 70% the target METs can
be calculated as follows:
Step 1: O2max
in METs = 35 mL ∙ kg
−1
∙ minute
−1
/ 3.5 mL ∙ kg
−1
∙
minute
−1 = 10 METs
Step 2: Target METs = (0.70) (10 − 1) + 1
Step 3: Target METs = (0.70) (9) + 1
Step 4: Target METs = 6.3 + 1 = 7.3 METs
155
Thus, the EP-C could select activities from the compendium of
physical activities that correspond with a MET level between 7.0 and 7.5.