1. Chapter 05 Designing Cardiovascular Exercise Programs

2. Designing Cardiovascular Exercise Programs Client Centered Approach What are your client’s needs and interests in an exercise program? What are your client’s needs and interests in an exercise program? What are the desired outcomes of the exercise prescriptions? What are the desired outcomes of the exercise prescriptions? What are the agreed upon exercise long and short term goals? (see online handout - writing goals) What are the agreed upon exercise long and short term goals? (see online handout - writing goals)

3. Designing Cardiovascular Exercise Programs Elements of the Exercise Workout Each exercise workout of the aerobic exercise prescription and program should include the following phases: Each exercise workout of the aerobic exercise prescription and program should include the following phases: –Warm-up (5-10 min) –Stretching (≥10 min) –Endurance conditioning (20-60 min) –Cool-down (5-10 min) –Stretching (≥10 min)

4. Designing Cardiovascular Exercise Programs Guidelines for Health Guidelines for Health –Mode (Type) –Intensity (How Hard) –Frequency (How Often) –Duration (Time) Guidelines for Fitness Guidelines for Fitness –Mode –Intensity –Frequency –Duration These components may also be expressed as F.I.T.T. Components of Exercise Prescription

5. Designing Cardiovascular Exercise Programs Guidelines for Improved Health (p. 104, text) Guidelines for Improved Health (p. 104, text) –Mode Various Endurance-Type Activities, preferably weight bearing Various Endurance-Type Activities, preferably weight bearing –Intensity 3-6 METS (moderate intensity) 3-6 METS (moderate intensity) –Frequency and Duration Frequency and duration: Schedule at least 150 to 300 min per week (e.g., 30 min, 5 days per week or 60 min, 3 days per week). Duration varies according to the mode and intensity of activity. Frequency and duration: Schedule at least 150 to 300 min per week (e.g., 30 min, 5 days per week or 60 min, 3 days per week). Duration varies according to the mode and intensity of activity.

6. Designing Cardiovascular Exercise Programs ACSM Guidelines for Fitness (2010), p.105, text. ACSM Guidelines for Fitness (2010), p.105, text. –Mode Rhythmical, continuous, large muscle groups, require little skill Rhythmical, continuous, large muscle groups, require little skill –Intensity Prescribe moderate-intensity (3.0 to 6.0 METs or 40% to 6.0 METs or ≥60% VO 2 R) or a combination of moderate-and vigorous-intensity exercise. Intensity varies depending on client’s cardiorespiratory fitness classification. Prescribe moderate-intensity (3.0 to 6.0 METs or 40% to 6.0 METs or ≥60% VO 2 R) or a combination of moderate-and vigorous-intensity exercise. Intensity varies depending on client’s cardiorespiratory fitness classification. –Frequency 3-5 Days / Week moderate intensity; 3 Days / Week vigorous intensity; or a combination of moderate –and vigorous-intensity exercise 3 to 5 days/week. 3-5 Days / Week moderate intensity; 3 Days / Week vigorous intensity; or a combination of moderate –and vigorous-intensity exercise 3 to 5 days/week. –Duration 20 – 60 minutes continuous or intermittent activity, depending on intensity. Intermittent exercise bouts of at least 10 min may be accumulated throughout the day to reach the target duration of 20 to 60 min. 20 – 60 minutes continuous or intermittent activity, depending on intensity. Intermittent exercise bouts of at least 10 min may be accumulated throughout the day to reach the target duration of 20 to 60 min. Progression (see next slide) Progression (see next slide)

7. Designing Cardiovascular Exercise Programs ACSM Guidelines for Fitness (2010), p.105, text. ACSM Guidelines for Fitness (2010), p.105, text. Progression – –For apparently healthy adults, the aerobic exercise prescription consists of three stages: initial conditioning, improvement, and maintenance. –Adjust the exercise prescription for each client in accordance with the conditioning effect, participant characteristics, new exercise test results, or performance du –Adjust the exercise prescription for each client in accordance with the conditioning effect, participant characteristics, new exercise test results, or performance during the exercise sessions. ring the exercise sessions.

8. Designing Cardiovascular Exercise Programs MODE (see also next slide) MODE (see also next slide) –Initial stage or low fitness, use Type A Activities –You may prescribe Type B activities in the initial and improvement stages for individuals who exercise regularly. –Type C activities include endurance activities that require both skill and average physical fitness levels –Type D activities are recreational sports that may improve physical fitness and should be performed in addition to the person’s regular aerobic exercise program. You should consider using type C and D activities to add variety in the later stages (maintenance stage) of your client’s exercise program.

9. Designing Cardiovascular Exercise Programs Classification of Aerobic Exercise Modalities

10. Designing Cardiovascular Exercise Programs MODE MODE –Important considerations for ExR x : What types of activities appeal to the client? What types of activities appeal to the client? What types of activities require additional expense or time preparing for (or travel to) the activity? What types of activities require additional expense or time preparing for (or travel to) the activity? Does a particular activity pose a higher risk for injury, and does the client have sufficient training and skills to safely participate in the activity? Does a particular activity pose a higher risk for injury, and does the client have sufficient training and skills to safely participate in the activity? Is the activity concordant with the goal of the exercise program? ( if the major goal of the program is to lose body fat, then an activity choice that is LSD [long slow distance] may be preferable) Is the activity concordant with the goal of the exercise program? ( if the major goal of the program is to lose body fat, then an activity choice that is LSD [long slow distance] may be preferable)

11. Designing Cardiovascular Exercise Programs MODE MODE –Important considerations for ExR x : How easily can the mode be adjusted for changes in exercise intensity as the client progresses in the exercise program? How easily can the mode be adjusted for changes in exercise intensity as the client progresses in the exercise program? How difficult (RPE) is a particular mode of exercise for a given improvement in VO 2 ? How difficult (RPE) is a particular mode of exercise for a given improvement in VO 2 ?

12. Designing Cardiovascular Exercise Programs INTENSITY INTENSITY –Defined as “How Hard” one is exercising. –A percentage of VO 2 reserve (VO 2 max – VO 2 rest) may be used to guide the intensity of the exercise session, and approximates %HRR, and vice versa. –Intensity and duration are interdependent. The lower the initial fitness level, the more emphasis that should be placed on lower intensity and longer duration. More fit individuals may prefer higher intensity and lower duration.

13. Designing Cardiovascular Exercise Programs INTENSITY INTENSITY –For most individuals lower intensity and longer duration exercise is recommended. This increases the probability of adherence and decreases the risk of injury. –The “Art” of prescribing an appropriate exercise intensity is to engage the principle of overload without overuse. Again, this is dependent upon the client’s initial level of fitness and skill ability ( hence, the purpose of exercise testing). –Exercise Intensity can be prescribed by VO 2 Reserve, Heart Rate methods, and RPE.

14. Designing Cardiovascular Exercise Programs INTENSITY : VO 2 Reserve INTENSITY : VO 2 Reserve –First determine VO 2 max or VO 2 peak from GXT. –Calculate VO 2 reserve in relative terms and in METS. This is called the target VO 2, and you will need a range (ex. 50-85% of VO 2 reserve). –Formula : Target VO 2 = [relative exercise intensity (%) ] X VO 2 reserve + VO 2 rest Target VO 2 = [relative exercise intensity (%) ] X VO 2 reserve + VO 2 rest Remember exercise intensity is rest plus the activity above rest (ex. 1 MET = resting VO 2, whereas 3 METS = 3x Rest) Remember exercise intensity is rest plus the activity above rest (ex. 1 MET = resting VO 2, whereas 3 METS = 3x Rest)

15. Designing Cardiovascular Exercise Programs INTENSITY – VO 2 Reserve INTENSITY – VO 2 Reserve Practice Formula –Client has VO 2 max of 45.5 ml/kg/min –Resting VO 2 = 3.5 ml/kg/min –Reserve = 42.0 ml/kg/min –Target range = 50-65% Target 1 VO 2 = [0.5] X 42 ml/kg/min+ 3.5 ml/kg/min = 24.5 ml/kg/min. Target 1 VO 2 = [0.5] X 42 ml/kg/min+ 3.5 ml/kg/min = 24.5 ml/kg/min. Target 2 VO 2 = [0.65] X 42 ml/kg/min+ 3.5 ml/kg/min = 30.8 ml/kg/min. Target 2 VO 2 = [0.65] X 42 ml/kg/min+ 3.5 ml/kg/min = 30.8 ml/kg/min. ExR x range = 24.5 - 30.8 ml/kg/min ExR x range = 24.5 - 30.8 ml/kg/min

16. Designing Cardiovascular Exercise Programs INTENSITY – VO 2 Reserve INTENSITY – VO 2 Reserve Practice Formula ExR x range = 24.5 - 30.8 ml/kg/min ExR x range = 24.5 - 30.8 ml/kg/min –METS = 24.5 / 3.5 = 7 METS (lower end of range) –METS = 30.8 / 3.5 = 8.8 METS (upper end of range) –VO and MET values can be used to guide the intensity of exercise using the ACSM equations (see pg. 73, text). Example using walking equation (chose 3 mph – comfortable for client, solve for grade) : Example using walking equation (chose 3 mph – comfortable for client, solve for grade) : 24.5 ml/kg/min = ( 80.4 m/min *.01 ml/kg/min ) + ( 80.4 m/min * grade *1.8 ml/kg/min) + 3.5 ml/kg/min 24.5 ml/kg/min = ( 80.4 m/min *.01 ml/kg/min ) + ( 80.4 m/min * grade *1.8 ml/kg/min) + 3.5 ml/kg/min

17. Designing Cardiovascular Exercise Programs INTENSITY – VO 2 Reserve INTENSITY – VO 2 Reserve Practice Formula 24.5 ml/kg/min = ( 80.4 m/min * 0.1 ml/kg/min ) + ( 80.4 m/min * grade *1.8 ml/kg/min ) + 3.5 ml/kg/min 24.5 ml/kg/min = ( 80.4 m/min * 0.1 ml/kg/min ) + ( 80.4 m/min * grade *1.8 ml/kg/min ) + 3.5 ml/kg/min 24.5 ml/kg/min = (8.04 ml/kg/min) + ( 144.72 m/min * grade) + 3.5 ml/kg/min 24.5 ml/kg/min = (8.04 ml/kg/min) + ( 144.72 m/min * grade) + 3.5 ml/kg/min 24.5 ml/kg/min = 11.54 ml/kg/min * ( 144.72 m/min * grade) 24.5 ml/kg/min = 11.54 ml/kg/min * ( 144.72 m/min * grade) 24.5 -11.54 ml/kg/min = ( 144.72 m/min * grade) 24.5 -11.54 ml/kg/min = ( 144.72 m/min * grade) 12.96 = 144.72 * grade 12.96 = 144.72 * grade. 08955 or 9 % = grade. 08955 or 9 % = grade

18. Designing Cardiovascular Exercise Programs INTENSITY – VO 2 Reserve INTENSITY – VO 2 Reserve Practice Formula –Check formula: X = (80.4 m/min * 0.1 ml/kg/min) + ( 80.4 m/min * 0.09) *1.8 ml/kg/min + 3.5 ml/kg/min X = (80.4 m/min * 0.1 ml/kg/min) + ( 80.4 m/min * 0.09) *1.8 ml/kg/min + 3.5 ml/kg/min X = 8.04 + 13.0248 + 3.5 X = 8.04 + 13.0248 + 3.5 X = 24.5 X = 24.5 Thus, if your client needed to exercise at a 7 MET equivalent on the treadmill with the speed set at 3.0 mph the grade should be adjusted to 9% ( see also example on p.109, text)

19. Designing Cardiovascular Exercise Programs INTENSITY – Heart Rate Methods INTENSITY – Heart Rate Methods –Assumption: HR is a linear function of exercise intensity. –Heart rate may be measured during exercise by palpation (10 or 15 sec count), or by HR monitor –Again, HR is used to guide the intensity of exercise. –Different modes may evoke higher heart rate responses for a given percentage of oxygen consumption and RPE (see figure 5.1 and 5.2 respectively, p. 107, text), thus you should consider matching the testing and training modes on a relative (VO2 –HR – RPE ) for exercise.

20. Designing Cardiovascular Exercise Programs INTENSITY – Heart Rate Methods INTENSITY – Heart Rate Methods –If HR data is available from the exercise test, you can match the heart rates to the desired % max VO 2 from the exercise test. Thus, if you want the client to exercise at 60% of VO 2 max then find the corresponding HR on the treadmill test, and prescribe the HR to guide the intensity of the exercise session. –If there is no HR data from a GXT, us can use Heart Rate Reserve (HRR). See online handout for prescribing exercise by HRR.

21. Designing Cardiovascular Exercise Programs INTENSITY – Heart Rate Methods INTENSITY – Heart Rate Methods –If there is no HR data from a GXT, us can use percent Heart Rate Maximum (%HRmax, p 111, text) –When comparing HRR and %HRmax, the latter tends to give a lower HR value for the same prescribed exercise intensity. Thus, %HRmax is probably a safer method of prescribing exercise intensity for older clients. However, one should directly measure HR response and provide GXT’s to older individuals, because of the increased variability in HRmax of older individuals, and many are on meds that limit HR.

22. Designing Cardiovascular Exercise Programs INTENSITY – Heart Rate Methods INTENSITY – Heart Rate Methods –There is a large variability in actual exercise intensity and prescribed exercise intensity when using HR formulas for guiding the exercise intensity. –Age-predicted HR formulas are not precise, especially if max HR is not known, but predicted. –Because HR can vary based on mode of exercise, emotional state, medications, etc., you can advise your client to also use RPE as a guide to exercise intensity in conjunction with the training HR range.

23. Designing Cardiovascular Exercise Programs INTENSITY – Rating of Perceived Exertion. (RPE) (Table 4.2, p. 69, text, also see Lab One) INTENSITY – Rating of Perceived Exertion. (RPE) (Table 4.2, p. 69, text, also see Lab One) –Is based upon an “overall body feeling” –Is a valid and reliable tool –Again, one can locate the desired VO 2 from the exercise test and match these data with the RPE collected. The corresponding RPE can then be used for the upper and lower limits to guide the exercise session. –If these data are not available, then typically an RPE or 12-16 is used (Omni Scale = 6). RPE is especially useful when the HR response is questionable / invalid.

24. Designing Cardiovascular Exercise Programs INTENSITY – Monitoring INTENSITY – Monitoring –The best case scenario is to undergo a GXT, determine the pace / exercise load to elicit the predetermined exercise training intensity, correlate the predetermined exercise intensity with a training HR range, and match with the corresponding RPE values. Thus all prescription values are directly linked to the values obtained to the exercise test. This is the best case scenario for test-retest model. –When training in the field each client should monitor their own exercise intensity, unless they are high risk clients and must be supervised for medical purposes.

25. Designing Cardiovascular Exercise Programs INTENSITY – Monitoring INTENSITY – Monitoring –Clients may guide the intensity of exercise by monitoring their pulse, and utilizing RPE. –Another good method of maintaining a desired exercise intensity is to used the “Talk Test” (see the explanation on ventilatory mechanics on p 112, text). Thus, if you cannot talk, you need to not exercise so hard, if you can sing, you need to exercise harder

26. Designing Cardiovascular Exercise Programs Frequency Frequency of exercise depends on the goals of the exercise prescription, and is interrelated with exercise intensity. For example, if the client is focused on fat loss, exercise at a higher frequency and lower intensity. If the client is focused on rapidly increasing aerobic capacity, less frequency may be used with higher intensity and longer duration sessions. Frequency of exercise depends on the goals of the exercise prescription, and is interrelated with exercise intensity. For example, if the client is focused on fat loss, exercise at a higher frequency and lower intensity. If the client is focused on rapidly increasing aerobic capacity, less frequency may be used with higher intensity and longer duration sessions. For health benefits, individuals should exercise at a moderate intensity on at least 5 days per week. More frequent sessions may follow increases in fitness levels. For health benefits, individuals should exercise at a moderate intensity on at least 5 days per week. More frequent sessions may follow increases in fitness levels. Individuals with fair to excellent cardiorespiratory fitness levels should exercise at a moderate to vigorous intensity a minimum of three to five times per week to produce significant changes in aerobic endurance Individuals with fair to excellent cardiorespiratory fitness levels should exercise at a moderate to vigorous intensity a minimum of three to five times per week to produce significant changes in aerobic endurance

27. Designing Cardiovascular Exercise Programs Frequency Frequency Frequency Individuals with poor cardiorespiratory fitness levels should exercise at light to moderate intensities a minimum of 5 days a week. Multiple daily exercise bouts of at least 10 min duration each may be prescribed for sedentary clients having poor aerobic fitness. Individuals with poor cardiorespiratory fitness levels should exercise at light to moderate intensities a minimum of 5 days a week. Multiple daily exercise bouts of at least 10 min duration each may be prescribed for sedentary clients having poor aerobic fitness. The ACSM (2010) recommends exercising on alternate days during the initial stages of training to lessen the chance of bone or joint injury. Also, older adults who can tolerate vigorous exercise should work out at least 3 days/wk with a day of rest between each exercise session. The ACSM (2010) recommends exercising on alternate days during the initial stages of training to lessen the chance of bone or joint injury. Also, older adults who can tolerate vigorous exercise should work out at least 3 days/wk with a day of rest between each exercise session.

28. Designing Cardiovascular Exercise Programs Duration Duration of exercise depends on the goals of the exercise prescription, and is inversely related with exercise intensity. Duration of exercise depends on the goals of the exercise prescription, and is inversely related with exercise intensity. The ACSM (2010) recommends 20 to 60 min of continuous or intermittent activity. Apparently healthy individuals usually can sustain exercise intensities of 60% to 85% VO 2 R for 20 to 30 min. The ACSM (2010) recommends 20 to 60 min of continuous or intermittent activity. Apparently healthy individuals usually can sustain exercise intensities of 60% to 85% VO 2 R for 20 to 30 min. During the improvement stage, duration can be increased every 2 to 3 week until participants can exercise continuously for 30 min at a mode During the improvement stage, duration can be increased every 2 to 3 week until participants can exercise continuously for 30 min at a mode Poorly conditioned and older individuals may be able to exercise continuously at a low intensity (<40% VO 2 R) for only 5 to 10 min. They may need to perform multiple sessions (e.g., two to three 10 min exercise bouts) in a given day to accumulate 20 to 30 min of aerobic exercise. Poorly conditioned and older individuals may be able to exercise continuously at a low intensity (<40% VO 2 R) for only 5 to 10 min. They may need to perform multiple sessions (e.g., two to three 10 min exercise bouts) in a given day to accumulate 20 to 30 min of aerobic exercise.

29. Designing Cardiovascular Exercise Programs Duration An alternate method of measuring duration is via caloric threshold. An alternate method of measuring duration is via caloric threshold. Caloric threshold is the predetermined caloric expenditure required to meet the health and fitness goals of the exercise prescription Caloric threshold is the predetermined caloric expenditure required to meet the health and fitness goals of the exercise prescription An alternative way of estimating the duration of exercise is to use the caloric cost of the exercise. To achieve health benefits, ACSM (2010) recommends target caloric thresholds of 150 to 400 kcal·day −1, and a minimal weekly caloric threshold of 1000 kcal from physical activity or exercise. An alternative way of estimating the duration of exercise is to use the caloric cost of the exercise. To achieve health benefits, ACSM (2010) recommends target caloric thresholds of 150 to 400 kcal·day −1, and a minimal weekly caloric threshold of 1000 kcal from physical activity or exercise.

30. Designing Cardiovascular Exercise Programs Progression In the untrained individual, the greatest rates of progression occur in the initial stages of the program. In the untrained individual, the greatest rates of progression occur in the initial stages of the program. The degree and rate of progression depend on the initial level of fitness, age, and health status. The degree and rate of progression depend on the initial level of fitness, age, and health status. For the ordinary person, progression in fitness may be anywhere from 5-20 % increase in aerobic capacity, for the very unfit, perhaps up to 40%. For the ordinary person, progression in fitness may be anywhere from 5-20 % increase in aerobic capacity, for the very unfit, perhaps up to 40%. There are three stages of progression: 1) Initial Conditioning, 2) Improvement, and 3) Maintenance. There are three stages of progression: 1) Initial Conditioning, 2) Improvement, and 3) Maintenance.

31. Designing Cardiovascular Exercise Programs Progression During the initial stage of the exercise program, however, weekly exercise caloric expenditure may be considerably lower (200 to 600 kcal·wk −1 ). Throughout the improvement stage, the goal is to increase your client’s caloric expenditure from 1000 to 2000 kcal·wk −1 by gradually increasing the frequency, intensity, and duration of the exercise. During the initial stage of the exercise program, however, weekly exercise caloric expenditure may be considerably lower (200 to 600 kcal·wk −1 ). Throughout the improvement stage, the goal is to increase your client’s caloric expenditure from 1000 to 2000 kcal·wk −1 by gradually increasing the frequency, intensity, and duration of the exercise. Calculate Calories from METS ( 4 METS = 3.5 X 4 = 14 ml/kg/min. ; 14 ml/kg/min mass in kg = Absolute Gross VO 2 in ml/min; Absolute Gross VO 2 ml/min / 1000 ml/L = Absolute VO 2 Gross in L/min; Gross VO 2 in L/min * 5 kcals / L = Kcals/min; Total Kcal expenditure required / Kcal min = Total exercise time for caloric expenditure. Calculate Calories from METS ( 4 METS = 3.5 X 4 = 14 ml/kg/min. ; 14 ml/kg/min mass in kg = Absolute Gross VO 2 in ml/min; Absolute Gross VO 2 ml/min / 1000 ml/L = Absolute VO 2 Gross in L/min; Gross VO 2 in L/min * 5 kcals / L = Kcals/min; Total Kcal expenditure required / Kcal min = Total exercise time for caloric expenditure.

32. Designing Cardiovascular Exercise Programs Maintenance The goal of this stage is to maintain the cardiorespiratory fitness level and the weekly exercise caloric expenditure achieved during the improvement stage. The goal of this stage is to maintain the cardiorespiratory fitness level and the weekly exercise caloric expenditure achieved during the improvement stage. Have your client accomplish this goal by engaging in aerobic activities 3 to 5 days/week at the intensity and duration that were Have your client accomplish this goal by engaging in aerobic activities 3 to 5 days/week at the intensity and duration that were Reducing the training frequency from 5 to 3 days/week does not adversely affect VO 2 max as long as the training intensity remains the same. Reducing the training frequency from 5 to 3 days/week does not adversely affect VO 2 max as long as the training intensity remains the same.

33. Designing Cardiovascular Exercise Programs Continuous and Discontinuous Methods Either may be used to improve fitness Either may be used to improve fitness Discontinuous is easier for those with low fitness Discontinuous is easier for those with low fitness Discontinuous with high intensity (interval work) is effective in rapidly increasing aerobic fitness, but is has a higher attrition rate for those beginning an exercise program with lower levels of fitness. Discontinuous with high intensity (interval work) is effective in rapidly increasing aerobic fitness, but is has a higher attrition rate for those beginning an exercise program with lower levels of fitness. See p.106– All exercise modes in Type A and B are generally considered continuous types of exercise modes. See p.106– All exercise modes in Type A and B are generally considered continuous types of exercise modes. Generally, continuous exercise at lower intensities is safer, and more time efficient (less total workout time) Generally, continuous exercise at lower intensities is safer, and more time efficient (less total workout time)

34. Designing Cardiovascular Exercise Programs Exercise Volume Exercise Volume is the caloric expenditure associated with exercise. Energy expenditure is measured in Kcals. –Determine VO 2 of specific activity ACSM Equations ACSM Equations –Determine caloric cost Determine VO 2 in Liters ( ml /kg/min X kg X1000) Determine VO 2 in Liters ( ml /kg/min X kg X1000) ( ml /kg/min X kg X1000) = L/min ( ml /kg/min X kg X1000) = L/min 5 kcals expended per L of O 2 5 kcals expended per L of O 2 –Determine caloric goal for week –Divide by number of sessions / week –Arrive at number of calories per session Variable = Frequency, Intensity, Duration and Mode. Variable = Frequency, Intensity, Duration and Mode.

35. Designing Cardiovascular Exercise Programs Putting it all together (PEP – personalized exercise program) Putting it all together (PEP – personalized exercise program) –Case Study Review (see pg. 119) Observe the steps required through screening, testing, exercise prescription, and programming. Observe the steps required through screening, testing, exercise prescription, and programming. See handout on writing exercise goals See handout on writing exercise goals –You should help the client formulate both short term, and long term goals.

36. Designing Cardiovascular Exercise Programs End of Presentation