Exerc Prescription 1

-Prolonged periods of sitting or other sedentary activity may have deleterious effects on health, even if PA guidelines are met
-Deleterious effects on health can include increased risk of cardiovascular disease, diabetes, and cancer, and increased risk of mortality
-Study of "sedentary time" will be a growing research emphasis in the future

PT role w PA

health care providers can play a vital role in helping healthy adults increase their PA levels to maintain good health & decrease risk of developing several chronic health conditions

PA vs exercisePA: any bodily movement produced by skeletal muscles that results in energy expenditure above resting levels (ADL, exercise, etc) Exercise: PA that is planned, structured & repetitive an dhas a final or intermediate objective for the improvement or maintenance of physical fitnessMETAn index of energy expenditure--ratio of rate of energy expended during an activity to rate of energy expended at rest 1 MET=rate of energy expenditure while sitting at rest = oxygen uptake of 3.5 mL/kg/minExercise Prescription componentsWhy? requires initial assessment - need to know why we are doing this What? (aerobics, strength training, etc) How much? (intensity) How often? (Frequency, duration, how many times/day, how many days) How to progress? (increase, decrease, stop)-how to progress the med Other: contraindications, precautions, revisions/adjustments -allergies, other meds, indiv sensitivities, amputee adjustment.. Follow-up Plan -want to know if it workedExercise prescription: "Why's"-Goals of client (needs initial eval) -Generalized getting in shape will understandably be different from wanting to train for a triathlon, etc -Need to take into account prior levels of activity and conditioningExercise prescription: "What's"-Aerobic exercise -Muscle fitness exercise (strength, power, endurance) -Flexibility -Neuromotor functionAerobic exerciseaka endurance exercise Emphasizes aerobic metabolism to generate ATP Focus: heart, lungs, vascular system Terms: VO2, HR, RR, VE, SV, CO, a-VO2 diff; max, peak, rest Characteristics: large muscle groups, low resistance over long periods of time (generally) Ex: Running, swimming, cycling, dancing, rowing, zumba HIIT may still get aerobic benefits w/o going for as long of a timeAcute aerobic exercise adaptationsHR increase BP increase SV increase CO increase VE increase VO2 increase a-VO2 diff Muscle strength: no changeChronic aerobic exercise training effectHR decreases (rest & exercise) BP decreases (rest & exercise) SV increases CO increases (max) VE increases (max) O2 extraction increases VO2 max increases Muscle strength: no change/decrease Increased aerobic enzymes (muscles become better able to aerobically work--krebs cycle enzymes improve)Anaerobic exerciseExercise emphasizing anaerobic (non-O2 requiring) metabolism to generate ATP -Focus: heart, lungs, vascular system, muscle -Duration: </= 60 sec -Characteristics: large muscle groups, higher resistance for short periods (bursts) -Examples: sprinting, powerlifting, sit-to-standIsometric contractionMuscle force is equal to the resistanceConcentric contractionMuscle force is greater than the resistanceEccentric contractionMuscle force is less than the resistanceAcute resistance exercise adaptationBP increase due to resistance from muscle contractionChronic (training effect) resistance exercise adaptations-Muscle strength increase (at 1st bc neural adaptations), hypertrophy later (depends on stimulus) -Generally minimal cardiovascular effectsMuscular power-Combines strength & velocity (how fast can muscle produce force) -Max benefit @ ~1/3 to 1/2 of max contraction velocity and max contraction strength -Can be involved in anaerobic tasks mentioned above -another example: plyometricsFlexibilityTarget: CT, myotendinous junction -Does NOT prevent injury when done before other PA -may actually hinder performances in certain instancesNeuromotor exercise (functional fitness)-balance -coordination -gait -agility -proprioceptionACSM 2011 PA recommendations Key Components-Aerobic -Muscle fitness: strength, endurance, power -Flexibility -Neuromotor function (not emphasized for healthy adults)HHS 2018 PA recommendations Key Components-Aerobic -Muscle strengthening -FlexiblityGeneral Exercise Principles-Overload -Specificity -Individual differences -ReversibilityOverloadpushed beyond baselineSpecificitySAID principle specific adaptations to imposed demandsIndividual differencesguidelines may be diff for individualsReversibilitydetraining. if you don't use it, you lose it. Continue exercise program over time! Make programs that are do-ableAerobic activity ACSM recommendationsPhysical activity + Exercise: -150 min/wk, moderate intensity -75 min/wk, vigorous intensity -Bouts of 10 mins or longer, to total 30 min/day -Progress as tolerated to meet desired goalsaerobic activity Progression, HHS 2018-If inactive, gradually increase over weeks or longer -Increase duration and frequency before increasing intensity (Do only 1 at a time tho so you know which could be causing pt a problem) -Too great an amount of progression increases risk of injury -Take into account: age, baseline fitness, prior responses to progressionIntensity, aerobic activity%VO2max %HR max Karvonen method (heart rate reserve): training HR(%)=HR rest + %intensity*(HRmax-HRrest) Borg rating of perceived exertion (RPE) Other estimates: Talk test, etcMuscle fitness ACSM recommendations-dynamic motions, both concentric & eccentric -all major muscle groups (including trunk, abdomen, & scapular muscles) -agonist & antagonist -full AROM in good form (controlled mvmts) -proper breathing (exhale concentric, inhale eccentric) -Strength: 60-80% 1RM 8-12 reps/set, 2-4 sets -Endurance: <50% 1RM, 15-25 reps/set, 1-2 sets -2-3 min rest btwn sets, 2-3 sesh/wk, at least 48 hrs apartResistance progression, hhs, 2018if inactive, gradually increase over weeks or longer -increase duration and frequency before increasing intensity -too great an amount of progression increases risk of injury -Take into acct: age, baseline fitness, prior responses to progressionFlexibility ACSM recommendationsstatic, ballistic, PNF -major muscle tendon units for total of ~60 sec/unit, 2-4 reps w 10-30 sec hold each -2-3x/wk, may be more effective if daily -may be more effective if muscle temp raised (mildly) -may decrease some aspects of sport performanceFlexibility HHS 2018 recommendationsUnknown health benefits, Injury risk reduction unclear, may improve ability to do tasks requiring flexibility, Flexibility exercise doesn't contrib to recommended quantity of aerobic/strength activitiesNeuromotor func ACSM recommendationsNot much evidence for young/middle aged adults so no specifics offered for this age groupLight levels of PA-dose response w increasing PA volumes (w/ plateau @ higher vol) -light PA has health & fitness benefits espec in insufficiently active people -add'l health & benefits gained from moderate to high intensity PA -reducing sedentary time has health beneftis -light PA may be substituted for sedentary time & a way to increase overall PA