1. Exercise Prescription

2. Selected Terms
Activity Pyramid A graphic summary of guidelines underlying both the lifestyle and formal exercise approaches to physical fitness.
aerobic fitness The ability to continue or persist in strenuous tasks involving large muscle groups for extended periods of time. Heart and lung fitness based on performing such activities as running, cycling, swimming, and sports, 3-5 days per week, at 50-85% VO2max, for minutes each session.
cool-down The transition period after the aerobic session where one slowly decreases the heart rate by keeping the feet and legs moving for 5 to 15 minutes through mild aerobic activity.
F.I.T. guidelines Frequency, intensity, and time guidelines for building aerobic fitness.
flexibility exercises A system of exercises that improve the range of motion around the body’s joints.
formal exercise program An approach to building physical fitness based on specific guidelines for aerobic and muscular fitness. A specific time and place is designated to exercise.

3. Glossary (continued)
Frequency of exercise The number of exercise sessions per week recommended for building aerobic fitness in the exercise program. To build both aerobic fitness and keep body fat at healthy levels, one needs to exercise at least 3-5 days each week. The lifestyle approach recommends at least 30 minutes of physical activity on most days of the week.
high intensity weight lifting Development of muscular strength when the weight is heavy and the repetitions to maximum are low, about 4 to 6.
high or vigorous intensity 75% and higher of the maximum heart rate reserve or VO2max. This level of effort is for athletes desiring a high level of fitness.
intensity of exercise The intensity of effort needed to build aerobic fitness: between 50% and 85% of the maximum heart rate reserve. If the fitness level is low, intensity of effort can start at 40%, with a gradual progression towards a higher intensity.
lifestyle approach to physical activity Emphasizes that everyone should attempt to accumulate 30 minutes or more of moderate-intensity physical activity over the course of most if not all days of the week.
light intensity 40% to 59% of the maximum heart rate reserve or VO2max. This intensity range is reserved for those starting an exercise program after years of inactivity.

4. Glossary (continued)
low intensity weight lifting Development of muscular endurance when the weight is somewhat light and the repetitions to fatigue are high, about 15 to 20.
maximum heart rate The maximum attainable heart rate at the point of exhaustion from all-out exertion. The maximum heart rate can be estimated by using the formula 220 minus the age.
maximum heart rate reserve The difference between the maximum heart rate and the resting heart rate.
moderate intensity weight lifting Development of both muscular strength and endurance when the weight is moderate and the repetitions are 8-15.
moderate intensity 60% to 74% of the maximum heart rate reserve or VO2max. This is the normal training range for most people.
muscular fitness Muscular strength, muscular endurance, and flexibility, gained by lifting weights, doing calisthenics, engaging in physical labor, and stretching 2 to 3 times per week.
overload principle To develop muscular strength and endurance, push the muscles to fatigue, lifting weights that are heavier than one is accustomed to.
overtraining Defined as pushing exercise training beyond one’s ability to recover, leading to incapacitating fatigue, injury, and a loss of desire to exercise.

5. Glossary (continued)
progressive resistance principle The resistance or pounds of weight against which muscles work should be increased periodically as gains in strength and endurance are made until one reaches the desired level.
repetition One weight-training or calisthenic movement
repetitions maximum The maximum number of repetitions that one can lift a certain weight.
RPE scale The rating (R) of perceived (P) exertion (E) scale is a number scale between six and 20 that indicates how the exercise feels to an individual at a given moment.
set A certain number of weight-training or calisthenic repetitions.
static stretching Exercises that slowly apply a stretch to a muscle group, with this position held for 10 to 30 seconds.
training heart rate The exercise heart rate, estimated with this formula: Training heart rate = [(maximum HR - resting HR) x 0.50 to 0.85] + resting HR.
training heart rate zone The heart rate range between 50% and 85% of maximum heart rate range for all age groups.
warm-up The 5 to 20 minute transition period that precedes the aerobic exercise session. The primary purpose of the warm-up is to prepare the body for vigorous exercise by performing mild-to-moderate aerobic activity.

6. What to do with what you’ve got…
So far you’ve:
Met the client, obtained consent, conducted a health history, and ascertained their goals
Risk stratified
Chosen appropriate tests to conduct based on goals and health history
Calculated the results of their tests
Where do you go from here????
Let’s look at some different types of training for each of the areas we’ve assessed.

7. Systems for building fitness
The lifestyle approach
Seeks to increase opportunities for physical activity throughout the daily routine and accumulate 30 minutes or more over the course of most if not all days of the week. This is the minimum amount of physical activity that improves the quality of life while decreasing the risk of most chronic diseases. Additional health and fitness benefits can be achieved by adding more time in moderate-intensity activity, or by substituting more vigorous activity.
The formal exercise program
Builds aerobic and muscular fitness to high levels through an exercise system based on specific frequency, intensity, and time guidelines.

8. Physical Activity Pyramid
The CDC-ACSM lifestyle approach and ACSM formal approach to exercise prescription are components of the same continuum of physical activity recommendations that meet the needs of almost all individuals to improve health status.

9. Physical Activity Pyramid
The lifestyle approach to fitness is at the base of the Activity Pyramid. This is a good start and brings basic health and fitness benefits. But higher levels of aerobic and muscular fitness can be achieved by working up the Activity Pyramid.
The formal exercise program is summarized on levels 2 and 3 of the Activity Pyramid.
The aerobic or cardio-respiratory stage of a comprehensive physical fitness program consists of three segments:
Warm-up---the 5 to 20 minute transition period that precedes the aerobic exercise session.
Aerobic exercise---brisk walking, swimming, cycling, running, or active sports for minutes, 3-5 days per week.
Cool-down—the warm-up in reverse. Keep the feet and legs moving for 5 to 15 minutes after intense exercise by walking, jogging lightly, or cycling slowly.

10. Physical Activity Pyramid (Continued)
Muscular fitness means having strong and enduring muscles, and flexible joints.
Muscular strength and endurance---gained by lifting weights, doing calisthenics, and engaging in hard physical labor (e.g., chopping wood). Perform a minimum of 8-10 separate exercises that train the major muscle groups. Perform one set of 8-12 repetitions of each of these exercises to the point of fatigue, and do this at least 2-3 days per week.
Flexibility---stretch at least 2-3 days a week and involve at least four repetitions of several stretches that are held seconds at a position of mild discomfort.
Reduce sitting time. Americans spend far too much time sitting watching TV, playing video games, viewing the Internet, driving cars, and watching other people play sports.

12. Ways to Increase Lifestyle Physical Activity
Walk, cycle, jog, or skate to work, school, or the store
Park the car farther away from your destination
Get on or off the bus several blocks away
Take the stairs instead of the elevator or escalator
Walk the dog
Play sports with the kids
Take fitness breaks instead of coffee breaks
Perform gardening, landscaping, or home repair activities
Avoid labor-saving devices as much as practical
Take a walk after supper instead of watching TV

13. Exercise Prescription = the process of designing a regimen of physical activity in a systematic and individualized manner, based on results of fitness tests.
Five essential components of exercise prescription
Frequency
Intensity
Time
Type
Progression

14. Cardio-respiratory Endurance
Step 1 Warm-up
Slowly elevate the pulse and body temperature to an aerobic training level by first engaging in 5-20 minutes of easy-to-moderate aerobic activity.
Step 2 Aerobic Exercise
F.I.T. guidelines: Based on current fitness level, follow the F.I.T. guidelines
Fitness Low Fitness Average High
Frequency (sessions/week) or more
Intensity (% HR reserve) % % %
Time (minutes/session)
Intensity Calculate personal training heart rate using this formula:
Training heart rate = [(Maximum HR - resting HR) x intensity %] + resting HR
Aerobic Exercise Mode (Type) Select 2-3 exercise modes based on personal goals.
Step 3 Cool-down
Slowly decrease the heart rate and body temperature by engaging in mild-to-moderate aerobic activity for 5-15 minutes.

16. Mode (Type) of Exercise
If frequency, intensity, and duration of training are similar, and a minimum of Calories are expended during the session, the training result is independent of the mode of aerobic activity.

18. An Exercise Program To Build Flexibility
Step 1 Warm-up aerobically
Never stretch unless the muscles and joints are warm from 5-15 minutes of moderate aerobic activity.
Step 2 Follow these minimum flexibility program guidelines:
Frequency: 2-3 days per week, or after each aerobic workout.
Time: hold each position short of the pain threshold for seconds, and repeat four times (total time, about 15 minutes). Relax totally, letting your muscles slowly go limp as the tension of the stretched muscle slowly subsides. Be sure that you do not stretch to the point of pain to avoid injury and a tightening recoil of the muscle.
Stretching positions: Improve flexibility in several body areas with 8 specific stretching exercises.

19. Muscular Strength and Endurance:Total Fitness Workout
A good “total fitness” workout routine that would take about 1 to 1.5 hours to complete could be organized as follows:
Warm-up: 5-10 minutes of easy-to-moderate aerobic activity.
Aerobic exercise: minutes of moderate-to-vigorous aerobic activity.
Cool-down: 5-10 minutes of mild-to-moderate aerobic activity.
Stretching: 5-15 minutes of static stretching, emphasizing all major muscle groups and joints.
Weight lifting: minutes of weight lifting, one set of 8-12 repetitions of 8-10 different exercises covering all the major muscle groups.

20. Muscular Strength and Endurance
ACSM recommends this minimum muscular fitness training program:
2-3 d/wk, minimum of 1 set of 8-12 reps of 8-10 different exercises.
Older people (50-60 yrs of age and above) may want to emphasize lighter weights and more reps (10-15).