1. Assess resting values 2. 1-2 min warm up 3. Measurements at regular intervals 4. Extend stage to reach steady stat if necessary 5. Cool down until close to baseline

Exercise Testing and Prescription Flashcards by Jacob Loucks

Training

Series of practices, the object of which is to render a man or animal as completely and quickly as possible, fit for the performance of a given work

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Physical Activity

Bodily movement produced by skeletal muscles that result in energy expenditure

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Exercise

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

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VO2 Peak

Limited by subject tolerance, which may or may not be physiological max

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ACSM Recommendation

30 min of moderate physical activity on most/all days of week
4/10 adults work in light activity jobs (US spend 70% of their time sitting)
Total screen time > 8 hr/day

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Excuses for Physical Activity (Young)

Time
Fatigue
Active at work
Lack of results
Cost
Lack motivation

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Excuses for Physical Activity (Older)

Fear of falling
Inertia/never tired
Negative affect
Time
Physical ailments

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Excuses for Physical Activity (Universal)

Fear of looking stupid
Being watched
Physiologic changes

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Getting Patients Physical Activity

Education: disease/dx/disability
Prescription: FITT
Testing: medical eval, submax test

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Pre-Exercise Assessment

Risk classification - high needs med eval
Exercise limitation/modification - HR/BP, blood sugar, orthopedic/neuro issues
Baseline for comparison
Test or not to test: sub vs max, sensitive vs specific, not necessary to low/mod activity

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Graded Exercise Testing

Monitor HR, BP, EKG, VO2 while incrementally increasing workload

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GXT Outline

Assess resting values
1-2 min warm up
Measurements at regular intervals
Extend stage to reach steady stat if necessary
Cool down until close to baseline

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GXT Normal Responses

Linear increase with SBP and HR proportionate to workload
Min change in DBP
Shortened QT interval
Reduced R wave amp
ST-segment elevation

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GXT Abnormal Responses

No increase in HR or SPB with increasing workload
SBP > 250, DBP > 120
ST segment depression (MI?)
Increased R wave amp
V-tach or multiple PVC

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Treadmill vs Cycle Ergometer vs Stepper for GXT

Treadmill yields higher VO2, higher risk of falling

BW has decreased effect on cycle ergometer

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Sub-Max Testing Assumptions

Linear relationship between HR and VO2
Max HR at give age is uniform
HR at given workload varies according to fitness level
Steady state HR obtained at each level
Mechanical efficiency is uniform

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Sub-Max Advantages

Safe
Controlled pace
Not population specific
Quick
Easily to administer
Inexpensive

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Sub-Max Disadvantages

Indirect measure of VO2

Estimation of max HR may be inaccurate

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Sub-Max General Rule

Under predicts older/deconditioned subjects

Over predicts younger/well-conditioned subjects

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Sub-Max Cycle Ergometer Tests

YMCA (3-4 3 min stages, 110-115 HR at 2 workloads)
ACSM bike test
Astrand rhyming (6 min, single stage)

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Sub-Max Treadmill Tests

Submax Bruce - larger work increment, appropriate for young/healthy subjects
Balke-Ware - smaller work increments (

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Direct Calorimetry

Measures heat expenditure to determine EE

Ambient air - expired air = oxygen consumption

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Indirect Calorimetry

Uses RER to calculate EE

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RER

Ratio between CO2 release and O2 consumed
0.7 - primary fuel from fat
1 - primary fuel from carbs
0.78-0.8 - resting
1.05-1.15 - max

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Max Exercise Testing Assumptions

Test progresses until subject reaches volitional exhaustion | Subject is motivated and able to provide max effort

What is "Max"

``` Plateau in VO2 with increasing workload RER > 1.05 Blood Lactate > 8mmol/L (most reliable but difficult to assess) Max HR RPE ```

Max Testing Advantages

Accuracy

Max Testing Disadvantages

Higher risk Time intensive Resource intensive Expensive

Principle of Individuality

Respond to exercise differently

Principle of Specificity

More pervasive than given credit | Done in home, they might do better

Principle of Reversibility

Use it or lose it

Principle of Overload

Continually overload the system

Principle of Hard/Easy

Alternate between hard and easy works

Principle of Periodization

Ramp up and peak when ready to compete | Peaks and valleys in training

All prescriptions include

Warm-up and stretching (5-10 min) Conditioning Cool-down (5-10 min)

Condition Components

Endurance Strength/resistance Flexibility Recreational activities

Exercise Prescription (Frequency)

Generally 3-5 days/wk

Exercise Prescription (Intensity)

Light: 30-40% HR or VO2 reserve Moderate: 40-60% HR or VO2 reserve Vigorous: 60-90% HR or VO2 reserve

Exercise Prescription (Time)

30-60 minutes/day of moderate activity | 20-60 minutes/day of vigorous activity

Exercise Prescription (Type)

Aerobic and/or resistance | Walking, running, tennis, swimming, resistance, yoga

Exercise Prescription (Volume)

Product of frequency, intensity, and time 150 minutes/week 5,400-7,900 steps/day 500-1,000 METS/week

Exercise Prescription (Progression)

Increase time 5-10 minutes every 1-2 weeks for first 4-6 weeks

Exercise Prescription Target HR

{(HR max - HR rest) x % intensity} + HR rest

Exercise Prescription RPE

12-13 - moderate | 15-16 - vigorous

MET

Does not account for differences in metabolic efficiency | Used in cardiac rehab

Muscular Strength

Max force generated | 1 RM or isokinetic testing

Muscular Power

Rate of work performance

Muscular Endurance

Ability to sustain repeated contractions

Resistance Frequency

2-3 non-consecutive days/wk

Resistance Intensity

40-50% of 1-RM (Beginner) 60-70% of 1-RM (Intermediate) >80% of 1-RM (Experienced)

Resistance Types

Isometric Isotonic Eccentric - resist force, promote hypertrophy Isokinetic - keeps movement speed constant Plyometrics - uses stretch reflex to bridge gap between speed and strength E-Stim

Resistance Repetitions

8-12 if strength/power 10-15 for older/novice 15-20 for endurance

Resistance Sets

2-4 for strength/power 1 for older/novice 1-2 for endurance

Resistance Pattern

2-3 minute rest interval between sets | 48 hour rest between session

Resistance Progression

Increase resistance, repetitions per set and frequency

Flexibility Frequency

> 2-3 days/wk

Flexibility Intensity

To point of tightness or slight discomfort

Flexibility Time

Static: 10-60 sec PNF: 2-6 sec @ 20-75% of MVC followed by 10-30 sec assisted stretch

Flexibility Type

Static Dynamic Ballistic PNF

Flexibility Volume

60 seconds per activity

Flexibility Pattern

Warm-up prior to stretch | 2-4 reps of each activity