question

exercise and pregnancy

answer

Physiological responses to exercise are different during pregnancy: (table 8.1) Differences include: increased HR, VO2, SV, Cardiac output, TV, VE, VE/Vo2, VE/VCO2 **SBP and DBP may not change or decrease **Possible balance or fatigue issues

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pre screening (figure 8.1)

answer

Would you know how to interpret these questions? Participant fills out the form and gives it to health provider monitoring the pregnancy. No max testing during pregnancy, maybe submax

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exercise prescription-preggers

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Similar to adult healthy population, with special attention to symptoms and contraindications. (Box 8.1) They include: Relative- severe anemia, unevaluated maternal cardiac dysrhythmia, chronic bronchitis, type 1 diabetes, morbid obesity, extreme underweight, extreme sedentary lifestyle, intrauterine growth restriction, hypertension, orthopedic limitations, seizure disorder, hyperthyroidism, heavy smoker.

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preggers FITT

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Frequency- at least 3, preferably most days of the week. Intensity-Moderate (40-60% VO2R), RPE or talk test. Age HR Range HR Ranges: 40 125-140 Time-At least 15 min a day increasing to 30 min, totaling 150 min a week. Type- Dynamic, rhythmic physical activities that use the large muscle groups- walking cycling

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preggers muscular prescription

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FITT- yes can lift weights. Pay close attention to balance issues. No supine work after the first trimester Avoid valsalva maneuver during exercise Only exercise to point of moderate fatique Use major muscle groups 12-15 reps

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preggers special considerations

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Discontinue exercise with bleeding, dyspnea, headache, dizziness, chest pain, calf pain or swelling, preterm labor, fluid leakage, decreased fetal movement. Avoid Supine position after 1st trimester Be well hydrated, and avoid exercise in heat Increase food intake-200-300 kcal a day May exercise 4-6 weeks post with no complications.

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children and adolescents

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Special consideration deals with growth issues and physiologic regulatory systems. Those with CVD risk factors in adolescence usually continue them through adulthood. In general, adult guidelines apply however, physiologic differences apply

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children and adolescents FITT

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Frequency- at least 3-4 days per week Intensity- Moderate (increase breathing, sweating, HR) Time- 30 min of moderate, and 30 min of vigorous to total 60 min a day. Type-developmentally approp. & enjoyable.

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special considerations children and adolescents

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Resistance exercise is appropriate provided proper instruction and form. 8-15 reps with moderate intensity Hydration Exercise in the heat Overweight Children with diseases

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General Principles for Apparently Healthy Adults (Chapter 7)

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Follow the FITT Guidelines **Frequency-how often **Intensity-as VO2 R or HRR **Time-minutes in a day/ week **Type-mode

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components

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Warm up- 5 -10 min of low to moderate intensity (40 to 60% VO2R)cardiovascular and muscular endurance activities. Stretching- 10 min and can follow warm up or after cool down Conditioning - 20 to 60 min of aerobic, resistance, neuromuscular or sports activities (bouts of 10 min are acceptable) Cool- down - 5 to 10 min of low to mod intensity cardio or muscular activities

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General Exercise Recommendations for Healthy Adults-- Frequency

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At least 5 d/wk - mod intensity 40 to 60%VO2R- aerobic, weight bearing, flexibility At least 3 d/wk vigorous intensity > 60% VO2R- aerobic, weight bearing, flexibility 3-5 d/wk - combination of mod to vigorous, aerobic, weight bearing, flexibility 2-3 d/wk muscular strength and endurance, resistance, calisthenics, balance and agility

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Surgeon General Recommendations:

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Physical activity on most days of the week. Defined as > 5 d/wk ****Note ACSM recommends 3-5 d/wk **** there is an attentuation of improvements beyond 3 d/wk, and a plateau beyond 5 d/wk ****there is an increase in injury risk beyond 5 d/wk with vigorous activity. However if a variety of activities are performed this reduces the risk.

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purpose of prescription

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Enhance fitness level of participant Promote Health Ensure Safety Maximize Benefits Minimize Risks

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intensity

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Minimum for healthy adults to derive benefits is 40 to 60% VO2R or HRR (moderate) or combination of vigorous (> 60% VO2R) and moderate activities.

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Intensity Continued

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To determine HR range or max typically used Karvonen Formula = 220 -age, take percentage of it to determine exercising range. *** Underestimates for people younger than 40 years of age *** Overestimates for people older than 40 years of age

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intensity formula

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Gellish et al. HR max = 206.9 - (.67 x age)

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intensity

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HRR VO2 R Peak HR method Peak VO2 method METS RPE Talk Test

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Preferred methods

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HRR and VO2R are best methods because they reflect rate of energy expenditure more accurately. ** However, not always possible to assess HRmax, or VO2 In these cases use age predicted. . ** Always use a range of intensity Examples Figure 7.2

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FITT-time

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Quantity of exercise is usually in minutes per day or week. Can also list total calorie expenditure Inverse dose relationship exists. If accumulate at least 1,000 kcals per week will receive health/fitness benefits. ****1,000 kcals per week is minimum recommended by ACSM, Surgeon General, AHA. - 150 min per week or 30 min per day

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Time Continued

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For most adults > 2000 kcals per week results in greater benefits and may be necessary to maintain or lose weight. *** 250-300 min per week or 50-60 min/day ***beyond 3,500-4,000 not recommended due to increased risk of injury Moderate intensity for 30 min > 5 d/wk, totaling 150 min per week. Or vigorous intensity for 20-25 min > 3 d/wk Or combination of mod and vig 20-30 min for 3-5 d/wk To promote weight loss or maintain - 50-60 min per day totaling 300 min per week of moderate, 150 min vigorous or equivalent combination. 10 minute bouts accepted

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type of exercise

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Endurance - For all adults Walking, leisure cycle, aqua aerobic, slow dance Vigorous - Adults with regular Jog, run, row, aerobics, spin, elliptical exercise, step, dance exercise program or avg Fitness Endurance - Adults with acquired skill, avg fitness Swim cross country ski, skating Recreational Sports-Adults, avg Fitness. Racquet sports, basketball soccer, down hill skiing, hiking

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progression

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Recommended rate depends on health status, exercise tolerance, exercise program goals. Initial phase should increase duration: 5 to 10 min every 1 -2 weeks, over the first 4 -6 weeks --After this, frequency, intensity, and/or time of exercise increased gradually

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muscular fitness

answer

Resistance training-weights, machines, rubberbands Train for strength, endurance, power Strength and endurance most important in general training focusing on health/fitness

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Muscular Prescription

answer

Frequency - each major muscle group 2-3 d/wk. (chest, shoulders, upper & lower back, abdomen, hips, legs) 48 hours separating training sessions for the same muscle group. Split sessions are options Intensity - 60-80% of 1 - RM, where 1 - RM is the greatest amount of weight that can be lifted in a single repetition. Volume - 2 -4 sets of 8 - 12 repetitions. There should be a 2-3 minute rest between sets. Older adults 1or more sets of 10-15 reps at 60-70% 1 - RM Types of Resistance exercises - multi joint or compound. Examples: leg press, dips, bench press. Exercises that affect more than one muscle group. Also, single joint such as biceps, triceps, quad extensions, calf raises. Train opposing muscle groups

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muscular progression

answer

Progressive Overload Principle - can increase the amount of weight lifted so that no more than 12 reps can be lifted Or, increase the number of sets or the number of times per week the muscle is trained. (box 7.3)

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flexibility

answer

Frequency - 2-3 d/wk Static, dynamic, or ballistic, or PNF Occurs after muscle is warmed (after warm up) or after cool down > 4 reps per muscle group, static held for 15-60 seconds Stretching may be preferable for sports where muscular strength, power or endurance are important May not prevent injury Should stretch for 10 minutes involving the major muscle tendons of the body (neck, shoulder, upper and lower back, pelvis, hips and legs)

question

exercise testing -children and adolescents

answer

Generally no exercise testing for children unless it is a health concern Table 8.2 Physiologic responses Variable Response VO2 lower Relative VO2 higher HR higher Cardiac Output, SV lower SBP, DBP lower Respiratory rate higher TV,VE, RER lower

question

cardiorespiratory KSAs

answer

Knowledge of and ability to discuss the physiologic basis of the major components of physical fitness: flexibility, cardiovascular fitness, muscular strength and endurance, and body composition Ability to analyze and interpret information from the cardio respiratory fitness test, and the muscular strength and endurance, flexibility and body composition assessments for apparently healthy individuals and those with controlled chronic disease.

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cardiac output

answer

The product of HR times stroke volume, the volume of blood pumped by the heart in 1 minute.

question

cardiorespiratory endurance

answer

The ability to perform large muscle, dynamic, moderate to high intensity exercise for prolonged periods.

question

maximal oxygen consumption

answer

the maximal rate of oxygen that can be used for production of adenosine triphosphate (ATP) during exercise

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stroke volume

answer

the volume of blood ejected per heart beat.

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cardiorespiratory fitness

answer

Related to the body's ability to perform large muscle dynamic moderate to high intensity exercise for prolonged periods of time. Depends on the functional state of the cardiovascular system, muscle and skeletal system.

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cardiorespiratory fitness considered related to health because

answer

Low levels of CRF associated with increased risk of premature death from all causes and most specifically CV disease Increased CRF is associated with decreased death from all causes High levels of CRF associated with high levels of habitual levels of physical activity

question

Health related physical fitness vs. skill related physical fitness

answer

More emphasis placed on health related physical fitness Skill related is agility, balance, coordination, speed, power, reaction time The 5 components of physical fitness are more important than the components related to athletic ability. Therefore, purpose is to focus on health related physical fitness in adults

question

crf tests

answer

Field tests- step, 1.5 mile walk/run, 1 mile walk test Submax-YMCA Cycle, Astrand Ryhming Cycle Max tests-Graded Exercise tests

question

body comp tests

answer

Ht/wt and BMI Circumference, WHR Skinfolds BIA Underwater weighing

question

flexibility tests

answer

Sit and Reach Modified Sit and Reach

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muscular strength

answer

Handgrip test One RM

question

muscular endurance

answer

Sit ups Curl ups Pushups YMCA Bench press

question

why assess crf

answer

Use to determine intensity, duration, and mode of exercise Motivate subject Identify, diagnose, and prognosing health/medical situations

question

crf details

answer

Measured and expressed by maximal oxygen uptake (VO2max) VO2 max considered the best measure of CRF VO2 max product of max CO (L.min -1) and arterio-venous oxygen difference (ml.O2 per L of blood) AVO2 difference. Functional capacity of the heart is the primary predictor of VO2 max.

question

crf

answer

Variations in CRF are due to: age, sex, fitness level, and primarily by differences in Cardiac Output (CO). Why???

question

vo2 max

answer

Measured by open circuit spirometry --mouthpiece, nose occluded, while pulmonary ventilation and expired fractions of oxygen and CO2 are measured or calculated. Because of expensive equipment, experienced personnel this is usually done in lab setting.

question

submax vs max tests

answer

Depends on reasons for the test, availability of equipment and personnel. Can estimate VO2 max from Submax test by using prediction equations (chap 7) Also, consider population being tested and Standard error associated with equation. Max tests require person to exercise to point of volitional fatigue. Often require medical personnel and emergency equipment. However, they are more sensitive in diagnosing CAD and provide better estimate of VO2max. Also, can give accurate assessment of anaerobic threshold.

question

submax tests

answer

Aim to determine HR response to one or more sub maximal workloads and use results to predict VO2max. Also need to obtain additional indices of client's responses to exercise Should also measure HR, BP, RPE and workloads. Subjects with diabetes may have blunted HR response to exercise and may not have age-normal max HR. Valid and reliable when done in lab setting Cycle most preferred due to ability to reproduce work output Accurate assessment of HR is key. Typically palpate radial artery. May vary with experience and technique of fitness professional. Could use HR monitor, ECG, or stethoscope Can be affected by humidity, heat, caffeine, smoking, previous activity, time since last meal, anxiety. General procedures box 4.4

question

estimates from vo2 max

answer

From HR response to sub max exercise are based on these factors: 1) Steady state HR achieved and is consistent for each work rate 2) HR and work rate exists as a linear relationship 3) VO2 max is indicated by maximal workload 4) mechanical efficiency is the same for everyone 5) Subject is not on medications that alter HR

question

general procedures for submax

answer

Obtain resting HR and BP in exercise posture Familiarize participant with equipment 2-3 min warm up Protocol should consist of 2 or 3 min stages with approp. increments in workload HR monitored 2 times during each stage-near the end of 2nd and 3rd stage BP monitored last min of each stage RPE taken last min of each stage Client signs and appearance noted Terminate test when subject reaches 70% HRR or 85% APMHR, fails to conform to protocol, adverse signs and symptoms, requests to stop, other emergency situations Appropriate cool down is at a work rate approx to 1st stage of test or passive All physiologic measurements continue for 5 min

question

field tests

answer

Step, 1.5 mile walk/run, 1 min walk test -easy to administer to large group with little time and equipment - VO2 can be estimated -a disadvantage is that it could be a max test because BP and HR are not monitored. -not good for sedentary or those at increased risk of CVD

question

treadmill tests

answer

good for diagnostic information, most individuals comfortable with walking, good for fit and unfit - is expensive, hard to transport, hard to get BP and HR

question

mechanically braked ergometers

answer

good for sub max and max, inexpensive, transportable, easy to assess BP and HR, less anxiety, workloads easy to administer -some individuals not as familiar, localized fatigue is a limiting factor

question

step test

answer

is sub-maximal test. Work rate is fixed and cadence set. Step height preset and measure post exercise HR. -easy to transport, inexpensive, easy to do -good for mass testing -short duration, less anxiety - not good for those with balance issues or de- conditioned - also possible localized fatigue in less fit individual

question

queens college step test

answer

Also known as McArdle Test Requires the individual to step up and down on standardized step height of 16.25 inches for 3 minutes Step rate is 24 per minute for men and 22 for women. (up one leg, up the other leg, down one leg, down the other leg- is one complete cycle) Set metronome 96 beats per min for men & 88 for women. After 3 min subject stops and pulse is taken at radial site while standing, within first 5 seconds of stopping. 15 second pulse is taken, multiply by 4 to get BPM For men: VO2 max(mL.kg-1.min-1)= 111.33 - (.42 x HR) For women: VO2 max(mL.kg-1.min-1) = 65.81 - (.1847 x HR)

question

1.5 mile run

answer

not good for unconditioned or those with known disease. Should be able to jog for 15 min in order to complete this test. Ideal to use quarter mile track Go over purpose of test to participant and the need to pace over the distance Start stop watch with beginning of test. Record total time to complete test use formula to calculate VO2max. (Box 19-14)

question

12 min run/walk

answer

patient covers the maximal amount in 12 minutes by walking, running or combination. Distance covered is measured and expressed in meters Use distance in equation to determine VO2max. (box 19-14)

question

rockport 1 mile walk

answer

- good for those unable to run or low level of fitness. Should be able to get HR above 120 bpm for 1 mile to complete this test. Subject walks as fast as possible for 1 mile. Count recovery HR for 15 seconds and multiply by 4 to get BPM. Use formula box 19-15.

question

cycle tests

answer

YMCA sub maximal cycle ergometer protocol Uses 2 to 4, 3 minute stages of continuous exercise. The test was designed to raise steady state HR between 110 bpm and 85% of APMHR for at least two stages. ***must have two consecutive heart rate measurements within this range in order to predict VO2 max.

question

ymca

answer

Obtain HR, BP, ht and wt Determine 85% APMHR Position subject properly ( upright, 5 degree bend in knee at maximal leg extension, hands in position on handle bar) Metronome set at 100 bpm. Pedal rate is 50 rpm 2-3 min warm up HR is monitored at least two times during each stage-last 30 sec of stage 2 and 3 Pulse counted for 15 seconds BP monitored last part of each stage RPE monitored end of each stage, table 4.7 Client appearance noted Test terminated when reach 85% of APMHR or other listed criteria Appropriate cool down Calculations

question

ymca protocol

answer

At end of warm up workload set at 150 kgm/min(.5kp) If HR in 3rd min of first stage is: 100, set to 300 kgm (1.0 kp) -set 3rd and 4th following the figure 4.2

question

apmhr

answer

220 -age Take 85 % of that number

question

General indications for stopping an exercise test in low risk adults

answer

Onset of angina or angina like symptoms Drop in SBP of >10mm Hg from baseline despite increase in workload Excessive rise in BP, SBP >250 mmHg or DBP > 115 SOB, wheezing, leg cramps, claudication Signs of poor perfusion, light-headedness, confusion, pallor, nausea, or cold clammy skin Failure of HR to rise with increased exercise intensity Noticeable change in heart rhythm Subjects requests to stop Physical or verbal manifestations of severe fatigue Failure of equipment

question

Absolute indications to stop a test(relative and absolute box 19-17)

answer

Drop in SBP >10 mm Hg from baseline despite increase in workload when accompanied by other evidence of ischemia Moderately severe angina (3 on standard scale) Increasing nervous symptoms (syncope) Signs of poor perfusion-pallor Technical difficulties Subject desires to stop Sustained ventricular tachycardia ST elevation (+1 mm) in leads without diagnostic Q waves

question

max tests

answer

Most challenging Also called GXT-graded exercise test Incremental change in workload until peak exhaustion or exertion is achieved Purpose: 1) screen for the presence of disease 2) diagnosis of disease when symptoms are present 3) prognosis of the patient relative to their CAD and/or other disease history 4)management of individual or exercise prescription

question

when is a physician required?

answer

For females <55 years of age and males < 45 years of age, maximal test is not required before starting an exercise program. Those at moderate to high risk for disease should have one before starting vigorous exercise program. Personnel should be skilled at HR, BP, RPE, and ECG (typically exercise physiologists, nurses who are trained)

question

protocols for max testing

answer

Treadmills most utilized mode of testing-(use large muscle mass enabling subject to achieve a greater physiologic maximum) Cycle ergometers typically result in lower VO 2 max Common protocols: Bruce, Bruce Ramp, Balke (Figure 19-3 ) Monitor HR, BP, RPE, ECG, signs & symptoms, expired gases

question

interpretation of results

answer

Use comparative published norms Error is reduced with maximal testing Two sets of standards are used utilized for comparisons: Criterion referenced and Normative standards. Vo2 max below the 20th percentile is associated with increased risk of death by all causes Maybe error when estimating Vo2 max from submax test Accuracy of classification depends on population and methodology While V0 2 max not as accurate, also lower risk, decreased assessment time, decreased effort on part of subject ***If test is repeated over time and HR response to the fixed work rate decreases over time, can conclude that CRF has improved.

question

criterion

answer

Standards that are considered desirable to achieve based on external criteria. Use words like \"poor or excellent\" Used in CFR and body fat analyses Open to subjectivity

question

normative

answer

Based on previous performance by a similar group Compare how subject performs vs. other like individuals Typically use percentile values Typically use this measurement in fitness arena

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