Week 1 - Exercise prescription

Question 1

Physical activity definition?

Answer 1

Body movement that uses skeletal muscles and results in an increase in calories required.

This should be over and above the resting energy expenditure.

Question 2

Exercise

Answer 2

A type of physical activity but is planned and includes repetitive movements to improve or maintain 2 components of physical fitness (ACSM,2016)

Question 3

Physical fitness

Answer 3

The ability to meet the planned and unplanned tasks in day-to-day life.
These should be undertaken with ‘vigour and alertness’ (ACSM,2016)

Question 4

Skill-related components of physical fitness?

Answer 4

→ Agility
→ Co-ordination
→ Balance
→ Power
→ Speed
→ Reaction time

Question 5

Health-related components of physical fitness?

Answer 5

→ Cardiorespiratory endurance
→ Body composition
→ Muscular strength
→ Muscular endurance
→ Flexibility

Question 6

What can exercise prevent?

Answer 6

• Premature morality
• Cardiovascular disease
• Hypertension
• Stroke
• Osteoporosis
• Type II diabetes
• Obesity
• 13 cancer types
• Depression
• Functional health
• Falls

Question 7

Direct benefits on regular PA/exercise?

Answer 7

→ Improved cardiovascular and respiratory function
→ Reduced cardiovascular disease risk factors
→ Decreased all cause Morbidity and mortality
→ Reduced depression and anxiety
→ Improves cognitive function

Question 8

Why is exercise medicine?

Answer 8

It requires prescription in:
- healthy individuals
- chronic disease
- those w/risk factors for chronic diseases

Question 9

What does the ACSM (2016) say about exercise prescription?

Answer 9

→ 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

Question 10

What does the ACSM (2016) say about exercise testing?

Answer 10

→ 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

Question 11

What are the risks of exercise?

Answer 11

Increased risk for MSK injury
→ exercise intensity, nature of activity, pre-existing conditions, MSK abnormalities

Cardiovascular complications
→ acute myocardial infarction, sudden cardiac death

Question 12

What do the ACSM guide about exercise prescription in those who DO NOT participate in reg. PA?

Answer 12

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

Question 13

What do the ACSM guide about exercise prescription in those who DO participate in reg. PA?

Answer 13

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

Question 14

Physiological markers for exercise testing?

Answer 14

→ 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.

Question 15

Example of body composition measure?

Answer 15

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

Question 16

What types of exercise tests are there?

Answer 16

Maximal

Sub-maximal
→ less accurate as it requires calculation to estimate VO2 max
→ however are safer to conduct
→ can be undertaken faster

Question 17

Things to consider when exercise testing?

Answer 17

→ Purpose - what? why?
→ Pathology - relevant to test
→ Physical fitness element being tested
→ Equipment needed
→ Space required (e.g. 20m-30m space)

Question 18

Examples of exercise tests?

Answer 18

Chester step test

MSFT

6 minute walk test

Question 19

What is the Chester step test?

Answer 19

→ 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

Question 20

What is the MSFT?

Answer 20

→ Submaximal
→ Run shuttles between beeps which become increasingly faster paced

• Multi-staged
• Requires: 20m distance, CD + player

Question 21

What is the 6 minute walk test?

Answer 21

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

Question 22

What is RPE

Answer 22

Rate of perceived exertion

e.g. in 6 minute walk test individuals rate their breathlessness whilst taking the test

Question 23

When may the 6 minute walk test be used?

Answer 23

Within pulmonary rehabilitation + within patients w/respiratory conditions eg. COPD (chronic obstructive pulmonary disease)

Question 24

Principles of exercise prescription?

Answer 24

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

Question 25

What does FITT stand for?

Answer 25

Frequency
Intensity
Time
Type

(principles of exercise training)

Question 26

Key points about frequency?

Answer 26

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

Question 27

What does the ACSM say about resistance training frequency?

Answer 27

At least 48 hours separating exercise training sessions for same muscle group

Question 28

Key points about intensity?

Answer 28

• 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

Question 29

What is Borg’s rating of perceived exertion (RPE) scale and how does it work?

Answer 29

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

Question 30

Key points about time?

Answer 30

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

Question 31

Key points about type?

Answer 31

→ What physical fitness element do you wish to improve?
→ Health-related?
→ Skill-related?
→ Elements of overlap
→ Must consider function aspects also as a physiotherapist

Question 32

What are additional aerobic principles?

Answer 32

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

Question 33

What does the principle of reversibility mean for exercise prescription?

Answer 33

It is important to prescribe sustainable exercise/ exercises

Question 34

What does progressive overload prevent?

Answer 34

A plateau in results

Question 35

What does the CMO physical activity guidance (2019) say that moderate exercise is?

Answer 35

Where you have noticed an increase in BR but you are still able to talk.

Question 36

Components of an exercise training session?

Answer 36

Warm up
Conditioning
Cool down
Stretching

Question 37

Whats involved in a warm-up?

Answer 37

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

Question 38

What is involved in the conditioning phase?

Answer 38

May be 20-60 mins of aerobic/resistance activites

Question 39

What is involved in a cool down?

Answer 39

• 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

Question 40

What is involved in stretching?

Answer 40

At least 10 mins
Should be after warm up or cool down
Ballistic if advanced

Question 41

Progressions + regressions key points?

Answer 41

→ 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.