Exercise prescription

Question 1

Define physical activity

Answer 1

Any bodily movement produced by skeletal muscles that results in energy expenditure

Question 2

Define exercise

Answer 2

a subset of physical activity that is planned, structured and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness

Question 3

What is exercise prescription?

Answer 3

the process by which a person’s recommended exercise program is designed in a systematic and individualised manner

Question 4

Describe the systematic approach to exercise testing and prescription in clinical populations

Answer 4

Assessment
Interpretation
Prescription
Mode Frequency Duration Intensity (precautions and progression)

Question 5

How can intensity be expressed?

Answer 5

Relative to the patients maximum ability
Measured by VO2
VO2 surrogates include WR, HR, RPE

Question 6

Name the principles of training

Answer 6

Overload - induce adaptations
Specificity - ability
Reversibility - use or lose
Progression - adapt to new level
Maintenance

Question 7

Describe the FITT principle

Answer 7

Start at a low frequency, small duration and low intensity and gradually increase over the weeks

Question 8

Describe the dose response relationship

Answer 8

Individuals who do less physical activity survive for fewer years
Fitness is an important independent predictor of mortality

Question 9

Describe moderate intensity

Answer 9

Frequency: 5-7 d/week
Intensity: 40-59% of VO2 or HRR
Time: 30 - 60 min/day
Type: continuous and rhythmic using large muscle groups

Question 10

Describe vigorous intensity

Answer 10

Frequency: 3-5 d/week
Intensity: 60-89% of VO2 or HRR
Time: 20 - 60 min/day
Type: continuous and rhythmic using large muscle groups

Question 11

How do you calculate HRR?

Answer 11

Max HR - resting HR, multiply by the desired exercise intensity, add resting HR

Question 12

Describe the importance of exercise in pulmonary rehabilitation

Answer 12

Lung disease causes a ventilatory limitation
Symptoms cause a reduction in physical activity and a sedentary lifestyle leads to deconditioning
Therefore there is a deterioration in exercise capacity

Question 13

Describe the effects of swimming

Answer 13

Hydrostatic pressure of the water may strengthen the respiratory muscles
Help breathing control
Ideally performed in a non-chlorinated poor as it triggers bronchoconstriction
Chronic exercise hyperpnoea performed in noxious environments implicated in the development of airway pathophysiology in elite athletes

Question 14

How would you optimise intensity for COPD patients?

Answer 14

1. establish difference between RPE and dyspnoea
2. avoid sustained load close to ventilatory capacity
3. aim for constant WR intensity of 60-80% WR peak during continuous exercise or >70-80% WR peak during intervals
4. if too high causes muscle fatigue and exhaustion
5. provide sufficient rest breaks

Question 15

Describe the exercise considerations you need to take into account

Answer 15

Prescribe an intensity below the VT associated with dyspnoea, lactic acidosis and bronchoconstriction (monitor VE/VCO2 , PETCO2)
In more severe cases must measure the O2 saturation to ensure >88%
Asthmatics: bronchodilators

Question 16

Describe chronotropic incompetence

Answer 16

When HR doesn’t increase during exercise
non-medicated: failure to achieve > or equal to 85% APMHR
medicated: failure to achieve > or equal to 62%

Question 17

Describe the BP responses to exercise in exertion hypertension and hypotension

Answer 17

SBP > 210mmHg in males , > 190mmHg females
DBP >100 - 115mmHg or sig increase
SBP drop of > 10mmHg despite increase in workload

Greater increase in BP wither upper body exercise

Question 18

Describe how you would identify slow HR recovery

Answer 18

1 minute post exercise = < 12 bpm
2 minute post exercise = < 22 bpm
HR recovery is an independent prognostic marker of mortality in healthy and CVD patients

Question 19

Describe the characteristics of dyslipidemia

Answer 19

reduced SNS activity
reduced inflammation
improved endothelial function
reduced likelihood of further increases even if no significant reductions
HIIT; needs a minimum of 8 weeks to increase HDL conc

Question 20

Describe the characteristic of hypertension

Answer 20

BP reduces even without weight loss
Reduced SNS activity - improved vascular stiffness, reduced TPR
Reduced inflammation
Improved endothelial function - vasodilation
HIIT; needs a minimum 12 weeks to improve BP but only is not medicated

Question 21

Describe the outcomes of disease progression

Answer 21

No exercise = plaque progression after 1yr
Less disease progression of >1500 kcal/day compared to <1000 kcal/day
>2200 kcal/day = plaque regression

Question 22

What are the key aspects of the patient as a performing athlete?

Answer 22

Fitness testing
Goal setting
Personal needs and preferences
Re-evaluation
Progression
Attendance and adherence

Question 23

What is overload and how does it apply to exercise prescription in clinical populations?

Answer 23

Overload induced adaptations
By causing a disturbance in homeostasis
Too much overload can cause injury

Question 24

Provide an example of application of the FITT principle over a month of an exercise programme

Answer 24

Week: 0. 2. 4.
Frequency: 2. 3. 3.
Duration: 20. 20. 26.
Intensity: 50. 55. 60.