Week 1 - Exercise prescription Flashcards
Physical activity definition?
Body movement that uses skeletal muscles and results in an increase in calories required.
This should be over and above the resting energy expenditure.
Exercise
A type of physical activity but is planned and includes repetitive movements to improve or maintain 2 components of physical fitness (ACSM,2016)
Physical fitness
The ability to meet the planned and unplanned tasks in day-to-day life.
These should be undertaken with ‘vigour and alertness’ (ACSM,2016)
Skill-related components of physical fitness?
→ Agility
→ Co-ordination
→ Balance
→ Power
→ Speed
→ Reaction time
Health-related components of physical fitness?
→ Cardiorespiratory endurance
→ Body composition
→ Muscular strength
→ Muscular endurance
→ Flexibility
What can exercise prevent?
- Premature morality
- Cardiovascular disease
- Hypertension
- Stroke
- Osteoporosis
- Type II diabetes
- Obesity
- 13 cancer types
- Depression
- Functional health
- Falls
Direct benefits on regular PA/exercise?
→ Improved cardiovascular and respiratory function
→ Reduced cardiovascular disease risk factors
→ Decreased all cause Morbidity and mortality
→ Reduced depression and anxiety
→ Improves cognitive function
Why is exercise medicine?
It requires prescription in:
- healthy individuals
- chronic disease
- those w/risk factors for chronic diseases
What does the ACSM (2016) say about exercise prescription?
→ Should consider key aspects such as current activity levels, physiological response, pathology and preferences
→ Exercise prescription should commence w/exercise testing (where possible) to ensure the exercise is safe + effective
What does the ACSM (2016) say about exercise testing?
→ Provide preparticipation health screening questionnaires e.g. PARQ
→ Recommends the exercise preparticipation health screening process reviews a ppts. :
- current PA level
- presence of any pre-existing cardiovascular, metabolic or renal disorder
- intended exercise intensity
What are the risks of exercise?
Increased risk for MSK injury
→ exercise intensity, nature of activity, pre-existing conditions, MSK abnormalities
Cardiovascular complications
→ acute myocardial infarction, sudden cardiac death
What do the ACSM guide about exercise prescription in those who DO NOT participate in reg. PA?
No CV, metabolic or renal disease / no symptoms → no medial clearance needed→ light to moderate → gradually progress to vigorous following ACSM guidelines
Known disease BUT asymptomatic → medical clearance → light to moderate → progress as tolerated following ACSM guidelines
Symptoms of disease → medical clearance → light/moderate → progress as tolerated following ACSM guidelines
What do the ACSM guide about exercise prescription in those who DO participate in reg. PA?
No CV, metabolic or renal disease / no symptoms → no medial clearance → continue moderate/vig. exercise → may gradually progress following ACSM guildelines.
Known disease BUT asymptomatic → MC for moderate intensity nit necessary (if no change in symptoms in last 12 months) recommended before vig. → continue with moderate - after MC may gradually progress
Symptoms → discontinue exercise and seek MC → after, may return - progress as tolerated following ACSM guidelines
Physiological markers for exercise testing?
→ BP
→ HR
→ RR
→ SpO2 - O2 saturations
→ Body composition
→ Various lab results e.g. LDLs/HDLs
These measures can be utilised pre-testing, during prescription an in post-training programmes as a way of monitoring progression.
Example of body composition measure?
Skin fold measuring
BMI - body mass index
BMI = weight (kg) / height in m2 → interpreted using standard weight status categories
<18.5 underweight
18.5-24.9 healthy weight
25-29.9 overweight
30+ obesity
What types of exercise tests are there?
Maximal
Sub-maximal
→ less accurate as it requires calculation to estimate VO2 max
→ however are safer to conduct
→ can be undertaken faster
Things to consider when exercise testing?
→ Purpose - what? why?
→ Pathology - relevant to test
→ Physical fitness element being tested
→ Equipment needed
→ Space required (e.g. 20m-30m space)
Examples of exercise tests?
Chester step test
MSFT
6 minute walk test
What is the Chester step test?
→ Submaximal
→ Step on and off 30cm step @set rate
- Multi-staged - every 2 ins increase in the rate of the step
- Requires: HR monitor, CD and player, approx height step
↳Rate is set by metronome disc
↳80% HR
↳Aerobic capacity and fitness rating calculated
What is the MSFT?
→ Submaximal
→ Run shuttles between beeps which become increasingly faster paced
- Multi-staged
- Requires: 20m distance, CD + player
What is the 6 minute walk test?
American thoracic society, 2002
→ Submaximal test of aerobic capacity + endurance
→ Used for an array of populations
- Standardised instructions/encouragement
- Requires: stopwatch, 30m distance, cones/marking tape, pulse oximeter + RPE scale
What is RPE
Rate of perceived exertion
e.g. in 6 minute walk test individuals rate their breathlessness whilst taking the test
When may the 6 minute walk test be used?
Within pulmonary rehabilitation + within patients w/respiratory conditions eg. COPD (chronic obstructive pulmonary disease)
Principles of exercise prescription?
Exercise prescription…
→ prescribes exercise that is specific, structured + individualised for the person
→ forms a training programme
→ utilised common principles, known as the FITT and SPORT principles
What does FITT stand for?
Frequency
Intensity
Time
Type
(principles of exercise training)
Key points about frequency?
Should always be included
Aerobic exercise → moderate/vigorous intensoty should be done 3-5 times a week
Resistance training → each muscle group 2-3 times a week
Flexibility → 2-3 times a week
Extremely weak/deconditioned patients = more frequency, reduce intensity - reduce load recommended
What does the ACSM say about resistance training frequency?
At least 48 hours separating exercise training sessions for same muscle group
Key points about intensity?
- Training is effective when it specifically targets the individual athlete
- One way of achieving this is by targeting the most relevant training threshold
Max heart rate = 220-age
What is Borg’s rating of perceived exertion (RPE) scale and how does it work?
6-20
6 = No exertion. Sitting and resting
20 = Maximal exertion
→ Estimate of HR
→ Add 0 on rating of PE
→ Most pateints’ max = 15
→ May be combined w/6 min walk test
Key points about time?
Depends on patient + goal, type + intensity of exercise prescribed
- 150 mins a week → moderate intensity exercise e.g. brisk walk, swim, cycle
- 75 mins a week → vigorous e.g. run, stairs, sport
- 30-60 mins a day
Key points about type?
→ What physical fitness element do you wish to improve?
→ Health-related?
→ Skill-related?
→ Elements of overlap
→ Must consider function aspects also as a physiotherapist
What are additional aerobic principles?
S → Specifiity - specific response you wish to occur in response to training
PO → Progressive overload - Gradual increase in weight/freq/num. of reps
R → Reversibility - don’t use it, lose it
I → Individuality - each person responds diff. to same stimuli being applied
+ variability - needs to be a variety in training to prevent boredom + stress fractures
What does the principle of reversibility mean for exercise prescription?
It is important to prescribe sustainable exercise/ exercises
What does progressive overload prevent?
A plateau in results
What does the CMO physical activity guidance (2019) say that moderate exercise is?
Where you have noticed an increase in BR but you are still able to talk.
Components of an exercise training session?
Warm up
Conditioning
Cool down
Stretching
Whats involved in a warm-up?
ACSM recommends warm-up should be at least 5-10 minutes of light to moderate intensity.
Should be cardiorespiratory + muscular activities in particular.
Allows body to adjust slowly to changing demands
Improved ROM - reduces risk of MSK injury
What is involved in the conditioning phase?
May be 20-60 mins of aerobic/resistance activites
What is involved in a cool down?
- 5-10 mins of light/moderate intensity inc. cardio + ME activities
- allows gradual recovery period fro physiological markers e.g HR + RR
- provides period of time for removal of metabolic products e.g. lactate
What is involved in stretching?
At least 10 mins
Should be after warm up or cool down
Ballistic if advanced
Progressions + regressions key points?
→ Always consider in line with patient’s physiological responses and in line with the principles of exercise prescription
→ Sit to stand from higher chair - sit to stand from lower seat - sit to stand quicker
In clinical population, important to note that there is a delicate balance between the illness that is occurring and progession - varies day to day so may need to regress.
