Week 1 - Exercise prescription Flashcards by Beth Wilkinson

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.

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Exercise

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

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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)

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Skill-related components of physical fitness?

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

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Health-related components of physical fitness?

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

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What can exercise prevent?

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

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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

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Why is exercise medicine?

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

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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

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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

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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

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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

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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

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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.

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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

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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

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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.