1. Copyright © 2013. F.A. Davis Company Part II: Applied Science of Exercise and Techniques Chapter 7 Principles of Aerobic Exercise

2. Copyright © 2013. F.A. Davis Company Key Terms and Concepts  Physical Activity  Exercise  Physical Fitness  Maximum Oxygen Consumption  Endurance  Aerobic Exercise Training (Conditioning)  Adaptation  Myocardial Oxygen Consumption  Deconditioning

3. Copyright © 2013. F.A. Davis Company  Energy Systems – Phosphagen, or ATP-PC system – Anaerobic glycolytic system – Aerobic system – Recruitment of motor units – Functional implications Energy Systems, Energy Expenditure, and Efficiency

4. Copyright © 2013. F.A. Davis Company  Energy Expenditure – Quantification of energy expenditure – Classification of activities  Efficiency Energy Systems, Energy Expenditure, and Efficiency (cont'd)

5. Copyright © 2013. F.A. Davis Company  Cardiovascular Response to Exercise – Exercise pressor response – Cardiac effects – Peripheral effects Net reduction in total peripheral resistance Increased cardiac output Increase in systolic blood pressure Physiological Response to Aerobic Exercise

6. Copyright © 2013. F.A. Davis Company  Respiratory Response to Exercise  Responses Providing Additional Oxygen to Muscle – Increased blood flow – Increased oxygen extraction – Oxygen consumption Physiological Response to Aerobic Exercise (cont'd)

7. Copyright © 2013. F.A. Davis Company Signs & Symptoms of Excessive Effort  Persistent dyspnea  Dizziness/confusion  Pain  Severe leg claudication  Excessive fatigue  Pallor, cold sweat  Ataxia  Pulmonary rales  Lack of SBP increase  Hypertensive BP > 200/110  Progressive fall in SBP by 10-15mmHg  Change in rhythm Delayed Responses: Prolonged fatigue Insomnia Sudden weight gain due to fluid

8. Copyright © 2013. F.A. Davis Company  Fitness Testing of Healthy Subjects  Stress Testing for Convalescing Individuals and Individuals at Risk – Principles of stress testing – Purpose of stress testing – Preparation for stress testing – Termination of stress testing  Multistage Testing Testing as a Basis for Exercise Programs

9. Copyright © 2013. F.A. Davis Company  Frequency  Intensity – Overload principle – Individuals at risk – Variables – Specificity principle  Time (Duration)  Type (Mode) – Reversibility principle Determinants of an Exercise Program

10. Copyright © 2013. F.A. Davis Company  ACSM, AHA, CDC, Surgeon General – Children: Age 6–17 – Adults: Age 18–65 – Older adults: Age 65 or older – Adults age 50–65 with chronic health conditions General Recommendations for Aerobic Physical Activity

11. Copyright © 2013. F.A. Davis Company  Warm-Up Period  Aerobic Exercise Period – Continuous training – Interval training – Circuit training – Circuit-interval training  Cool-Down Period  Application Exercise Program

12. Copyright © 2013. F.A. Davis Company  Cardiovascular  Respiratory  Metabolic  Other Systems Physiological Changes That Occur With Training

13. Copyright © 2013. F.A. Davis Company  For the Patient With Coronary Disease – Inpatient phase (Phase I) – Outpatient phase (Phase II) – Outpatient program (Phase III) – Special considerations – Adaptive changes Application of Principles of an Aerobic Conditioning Program

14. Copyright © 2013. F.A. Davis Company  For the Deconditioned Individual and the Patient With Chronic Illness – Deconditioning – Reversal of deconditioning – Adaptations for participation restrictions (disabilities), activity restrictions (functional limitations), and deconditioning – Impairments, goals, and plan of care Applications of Aerobic Training

15. Copyright © 2013. F.A. Davis Company Age Differences  Children  Young Adults  Older Adults  Heart Rate  Stroke Volume  Cardiac Output  Arteriovenous Oxygen Difference  Maximum Oxygen Uptake  Blood Pressure  Respiration  Muscle Mass and Strength  Anaerobic Ability

16. Copyright © 2013. F.A. Davis Company Hypertension  Prehypertensive  Stage I  Stage II  SBP 120-130; DBP 80-89  SBP 130-140; DBP 90- 100  SBP 140-160; DBP 100- 110  SBP > 160; DBP >110

17. Copyright © 2013. F.A. Davis Company  General Goals of PT intervention – Increase aerobic capacity – Increase ability to perform physical tasks related to self care, home management, community & work integration & leisure activities – Improve physiological response to increased O2 demand – Increased strength, power & endurance – Decreased symptoms associated with increased O2 demand PT Intervention for Pts with CAD

18. Copyright © 2013. F.A. Davis Company  Increase ability to recognize recurrence & intervention is sought sooner  Reduce risk of recurrence  Acquire behaviors that foster healthy habits, wellness, & prevention  Enhance decision making regarding health, use of health care resources by pt, family, caregivers, etc. PT Intervention - continued

19. Copyright © 2013. F.A. Davis Company  Unstable Angina  Symptomatic heart failure  Uncontrolled arrythmias  Moderate to severe aortic stenosis  Uncontrolled diabetes  Acute systemic illness/fever  Uncontrolled tachycarida (HR >100 bpm)  Resting SBP > 200 mmHG; DBP >110 mmHg  Thromophlebitis Contraindications to Aerobic Exercise

20. Copyright © 2013. F.A. Davis Company  Chest pressure  Dyspnea  Fatigue  Syncope  Palpitations  Edema – pulmonary/Peripheral – CHF  Fluid weight gain – CHF  S3 Heart Sound – CHF  Renal dysfunction - CHF Clinical Signs & Symptoms CAD/CHF

21. Copyright © 2013. F.A. Davis Company  Improve physiological reponse to increased O2 demand  Improvement of self management of symptoms  Increased ability to perform physical tasks  Acquire behaviors that foster healthy habits, wellness & prevention  Reduction of disability associated with acute or chronic illness  Reduction of secondary impairments  Improved awareness & use of community resources  Increased performance of & independence with ADL’s PT Intervention for CHF - Goals

22. Copyright © 2013. F.A. Davis Company  Activity Guidelines  Self Monitoring – pulse; RPE  Symptom recognition & response  Nutrition  Medications – prescription & OTC  Lifestyle issues  Psychological/Social Issues  Other Pt Education for Pts with CHD