1. Copyright © 2011 American College of Sports Medicine Clinical Exercise Physiology Chapter 4

2. Copyright © 2011 American College of Sports Medicine What is Clinical Exercise Physiology? Uses physical activity and exercise to prevent or delay the onset of chronic disease in healthy individuals Provides therapeutic or functional benefits to individuals with disease conditions or physical disabilities Requires an understanding of how the body responds to acute and chronic physical activity and exercise in both a healthy and diseased condition

3. Copyright © 2011 American College of Sports Medicine Development of Clinical Exercise Physiology First use of physical activity and exercise in disease recovery can be traced to the 18 th and 19 th centuries Morris and colleagues studied coronary heart disease in London bus drivers and conductors –Demonstrated the relationship between physical activity and the risk of developing heart disease –Initiated interest in disease risk reduction and public health epidemiology

4. Copyright © 2011 American College of Sports Medicine Development of Clinical Exercise Physiology Cardiac rehabilitation programs first developed in the 1950s AHA and ACSM developed testing and training procedures for healthy and diseased individuals Late 1950s pulmonary rehabilitation programs began to use exercise

5. Copyright © 2011 American College of Sports Medicine Development of Clinical Exercise Physiology Additional landmark events –Publication of the Journal of Cardiopulmonary Rehabilitation –Founding of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

6. Copyright © 2011 American College of Sports Medicine Development of Clinical Exercise Physiology

7. Copyright © 2011 American College of Sports Medicine Clinical Exercise Physiology Duties and responsibilities: –Conducting pre-exercise screening –Performing exercise testing and evaluation –Developing exercise prescriptions –Instructing individuals in proper training techniques –Supervising exercise programs in various settings

8. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation Used to clear individuals for safe participation in physical activity and exercise Serves as a basis for developing exercise prescriptions Diagnostic testing helps assess the presence of cardiovascular or pulmonary disease Functional capacity helps assess an individual’s capacity to participate in physical activity and exercise

9. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation A diagnostic exercise test

10. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation Pretesting Procedures –Pretest Screening for Health Risk –Physical Examination –Health History –Informed Consent

11. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation Performing the Test –Heart Rate –Blood Pressure –Rating of Perceived Exertion –Electrocardiogram –Echocardiography –Oxygen Consumption and Functional Capacity

12. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation Assessments made during a GXT

13. Copyright © 2011 American College of Sports Medicine Exercise Testing and Evaluation Performing the Test –Submaximal Graded Exercise Tests –Maximal Graded Exercise Testing

14. Copyright © 2011 American College of Sports Medicine Health-Related Physical Fitness Testing and Interpretation

15. Copyright © 2011 American College of Sports Medicine Exercise Prescription Plan for physical activity and exercise Achieve specific outcomes – improvement in fitness, reduction in disease risk, or weight loss Meets the interests, goals, health needs, and clinical condition of an individual Based on sound principles and innovative programming

16. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Cardiovascular Disease –Myocardial Infarction –Coronary Artery Disease –Angina Pectoris –Cardiac Arrhythmia –Valvular Heart Disease –Chronic Heart Failure –Peripheral Vascular Disease –Hypertension

17. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Prevalence of cardiovascular diseases in 2005 in the United States

20. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Progression of peripheral artery disease

21. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Respiratory Disease –Obstructive Pulmonary Disease –Restrictive Pulmonary Disease –Asthma –Cystic Fibrosis

22. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Chronic obstructive pulmonary disease as a result of emphysema

23. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Metabolic Disease –Diabetes Mellitus –Hyperlipidemia –Obesity –Metabolic Syndrome

24. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Prevalence of the three most common metabolic disease conditions: high blood cholesterol, diabetes mellitus, and overweight and obesity

25. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Orthopedic and Neuromuscular Disease –Arthritis –Osteoporosis –Muscular Dystrophy –Multiple Sclerosis –Cerebral Palsy

26. Copyright © 2011 American College of Sports Medicine Specific Disease Conditions Prevalence of the two most common orthopedic and neuromuscular diseases: arthritis and osteoporosis

27. Copyright © 2011 American College of Sports Medicine Summary Clinical exercise physiology is used to help promote health and reduce disease risk in both healthy and diseased individuals.