Programming for Cardiovascular Fitness. Cardiovascular Fitness The ability of the body to utilize...

Programming for Cardiovascular Fitness

Cardiovascular Fitness

• The ability of the body to utilize oxygen efficiently.

Cardiovascular Fitness

People engage in aerobic exercise to:

• improve their health status or reduce their disease risk – basic health and fitness benefits

• while others are primarily interested in enhancing their physical fitness levels– optimal health and fitness benefits

Cardiovascular Fitness

• The quantity of exercise needed to promote health is less than that needed to develop and maintain higher levels of physical fitness.

• You must adjust your exercise prescription according to your client’s primary goal.

Cardiovascular Fitness

• Improvement is CV fitness is measured by assessing changes in VO2MAX

Cardiovascular Fitness

• Increases in VO2MAX may range from 5 to 30%.

• Individuals with low initial levels of fitness, cardiac patients, and those exhibiting large losses of body weight will demonstrate the greatest percent increase in VO2MAX.

Cardiovascular Fitness

• Similarly, more modest increases may be expected from healthy individuals with high initial levels of fitness and those who exhibit little change in body weight.

Improved Health

• When the primary goal for the exercise program is improved health, the following guidelines are recommended:

Basic Health and Fitness

Mode:

• Select endurance-type physical activities, including formal aerobic exercise training, house and yard work, and physically active, recreational pursuits.

Basic Health and Fitness

Intensity

• Program at least moderate intensity physical activities

• (> 40 - 49% of VO2R or HRR, and 55-64% of HRMAX).

Basic Health and Fitness

Frequency

• Schedule physical activity for most, preferably all days of the week.

Basic Health and Fitness

Duration

• Accumulate at least 30 minutes of activity each day.

• Duration varies depending on type of activity.

Physical ActivityRecommendations

• How much physical activity is required?

• For health benefits?– 30 minutes/day

• To prevent weight gain?– 60 minutes/day

• To prevent weight regain in the formerly obese?– 60-90 minutes/day

• Source—U.S. Dietary Guidelines 2005• S. Blair, 2005.

Incidental Physical Activity

• Physical activity as part of daily living

• Not exercise

Lifestyle and Energy Expenditure

• Sedentary Way kcal Active Way kcal•• Using remote to <1 Getting up and 3• change channel changing channel•• 30 min of phone 4 Standing for 3 X 10 20• calls—reclining minute calls•• Using garage door <1 Opening garage 2-3• opener door twice/day•• Hiring maid to 0 30 min of ironing 152• clean and iron 30 min vacuuming•• Kcal estimates for 150-160 pound person• Taken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

Lifestyle and Energy Expenditure

Sedentary Way kcal Active Way kcal

30 min waiting for 15 30 min of cooking 25pizza delivery

Buying pre-sliced 0 15 min washing, 10-13vegetables slicing & chopping

Using a leaf 100 30 min of raking 150blower for 30 min leaves

Using a lawn 0 30 min/week each 360service gardening, mowing

Kcal estimates for 150-160 pound personTaken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

Lifestyle and Energy Expenditure

Sedentary Way kcal Active Way kcal

Using car wash 18 Washing & waxing 300once/month car, 1 hr/month

Letting dog out the 2 Walking dog for 125back door 30 min

Drive 40 min, 5min 22 15 min walk to buswalk (parking) stop, 2 X day 60

Emailing colleague, 2-3 Walk 1 min, talk 34 min min (standing) 6

Kcal estimates for 150-160 pound personTaken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

Lifestyle and Energy Expenditure

Sedentary Way kcal Active Way kcal

Taking elevator 0.3 Walking up 3 15up 3 flights flights of stairs

Park close as poss, 0.3 Park 1st spot, 2 min 810 sec walk walk, 5 X week

Cashier unloads 2 Unload full 6shopping cart shopping cart

Ride escalator 2 1 flight of stairs, 3 153 times X week in mall

Kcal estimates for 150-160 pound personTaken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

Lifestyle and Energy Expenditure

Sedentary Way kcal Active Way kcal

1 hour internet 30 Shopping mall, 145-240shopping walking 1 hour

Sitting in car at 15 Parking & walking 70drive-in window, inside, 3 X week,30 min total of 30 min

Paying at the 0.6 Walking in to pay, 5pump 1 X week

Sitting & listening 30 Giving lecture 70to lecture, 60 min

Kcal estimates for 150-160 pound personTaken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

Lifestyle and Energy Expenditure

Assume a person’s caloric intake remains the same:

• Completing all of the tasks reviewed daily or as listed– Active way = 10,500 kcal/month– Sedentary way = 1,700 kcal/month

Difference of 8,800 kcal/month is energy equivalent of 2.5 pounds/month or 30 pounds/year

– Kcal estimates for 150-160 pound person– Taken from article by L. Beil, Dallas Morning News, 1999, S. Blair, 2005

The Exercise and Physical Activity Pyramid

From: Rauramaa, R. & Leon, A.S. (1996) Physical Activity and risk of cardiovascular disease in middle aged individuals. Sports Medicine; 22(2):65-69.

Optimal Health and Fitness

• When the primary goal for the exercise program is to attain optimal fitness, the following guidelines should be followed:

Optimal Health and Fitness

Mode

• The greatest improvement in VO2MAX occurs when exercise involves the use of large muscle groups and a large percentage of muscle groups over prolonged periods and is rhythmic and aerobic in nature.

Optimal Health and Fitness

Mode

• A wide range of activities provides for individual variability relative to skill and enjoyment, factors which influence compliance to the exercise program and thus desired outcomes.

Optimal Health and Fitness

Mode

• Resistive exercise such as weight training should not be considered as an activity for increasing VO2MAX

Optimal Health and Fitness

Mode

• Circuit weight training, which involves 10 to 15 repetitions with 15 to 30 seconds rest between weight stations, results in an average improvement in VO2MAX of about 5%, and thus is not generally recommended as an activity for improving CV endurance.

Optimal Health and Fitness

Mode

• It may be desirable to engage in several different activities to reduce repetitive orthopedic stresses and involve a greater number of muscle groups.– Cross train

Optimal Health and Fitness

Mode

• Because improvement in muscular endurance is largely specific to the muscles involved in exercise, it is important to consider unique vocational or recreational objectives of the exercise program when selecting activities.

Optimal Health and Fitness

Mode

• Finally, it is important to consider other barriers that might decrease the likelihood of compliance with, or adherence to, the exercise program (travel, cost, spousal or parent involvement, etc.).

Intensity

• Intensity and duration of exercise determine the total caloric expenditure during a training session, and are integrally related.

Intensity

• That is, similar increases in CV endurance may be achieved by a low intensity, long duration session as well as a higher intensity, shorter duration session.

Intensity

• The risk of orthopedic injury may be increased with the latter; however, programs emphasizing low-to moderate-intensity exercise with a longer training duration are recommended for most individuals.

Intensity

• Part of the art of exercise programming is being able to select an exercise intensity that is adequate to stress the cardiovascular system without overtaxing it.

Intensity

• As a general rule, the more fit the individual, the higher the exercise intensity needs to be to produce further improvement in CV fitness.

Optimal Health and Fitness

Intensity

• ACSM recommends that the intensity of exercise be programmed as 65 to 90% of maximum heart rate, or 50 to 85% of VO2R or heart rate reserve for optimal fitness improvement.

Intensity

• VO2R refers to maximum oxygen uptake reserve.

• It is calculated by subtracting resting VO2 from VO2MAX

Intensity

• However, individuals with a very low initial level of fitness respond to a low exercise intensity, for example 40 to 49% of VO2R

Intensity

• Several important factors to consider prior to determining the level of exercise intensity include:

Intensity

• Individual’s level of fitness.

• Presence of medications/supplements that may influence heart rate

Intensity

• Risk of cardiovascular or orthopedic injury.

• Individual preferences for exercise.

• Individual program objectives.

Intensity

• Altitude

• Humidity

• Temperature

• Terrain

Intensity

• Exercise surface

• Equipment

Intensity

• Several methods may be used to determine exercise intensity.

HR Methods

• Using HR as a guide to exercise intensity is useful, given the relatively linear relationship between HR and VO2, especially at low to moderate intensities.

HR Methods

• When programming exercise intensity based on HR, consideration must be given to potential influences:

• Anxiety• Medications• Fatigue• Stimulants• Altitude• Emotion• Temperature• Fitness

HR Methods

• Given exercise test data, there are several approaches to determining an exercise HR range for programming purposes:

HR Methods

• Using a straight percentage of HRmax

• Using the HR reserve method.

• Plotting HR vs VO2 or exercise intensity during the exercise test.

HR Methods

• Go over each method (p. 88):

• HRmax

• Karvonen (Reserve Method)

• Plotting

HRmax

• You may be familiar with:

• 220-age = Hrmax

• Don’t use this.

• Comes from one study on children and is not applicable to most people

HR Max

• Heart Rate max has been traditionally been calculated by 220 minus age.

• There is some concern that this technique is not accurate.

• It has been recommend that 208 – 0.7(age) be used instead.

HR Methods

• It is important to note that the HR response to graded exercise is somewhat dependent on the mode of exercise testing.

HR Methods

• For example, compared to treadmill testing, exercising on an electronic step ergometer elicits higher HRs, and stationary cycling typically results in somewhat lower HRs at the same relative exercise intensities.

HR Methods

• When using the plotting method to obtain HRs for an exercise program, be sure to match the exercise testing and training modes by selecting a testing mode that elicits HR responses that are similar to those obtained for the training mode.

HR Methods

• Using HR exclusively to develop intensity recommendations for your clients’ exercise prescriptions may lead to large errors in estimating relative exercise intensities for some individuals.

METS

• Programming by METs is most logically applicable to the apparently healthy and those with high VO2MAX values

METS

• It is less applicable for individuals with cardiac or pulmonary disease, or for individuals with low functional capacities.

METS

• First, assess the client’s functional aerobic capacity using a graded exercise test.

METS

• Use this value to determine the minimum, average, and maximum conditioning intensities.

METS

• For example, if the VO2MAX is 35 ml . kg-1 .

min-1 , the functional capacity is 10 METs.– 1 MET = 3.5 ml . kg-1 . min-1

METS

• The minimum training intensity is 50% of this value or 5 METs; the average intensity is 60 to 70% or 6 to 7 METs; the maximum exercise intensity is 85% or 8.5 METs.

METS

• Thus, the exercise program for an apparently healthy, active individual should include activities that produce an average intensity of 6 to 7 METs.

METS

• When programming exercise intensity based on METS for men and women, different formulae are used.

METS

• Women– 14.7 minus (0.13 x age)

• Ex. 50 yr old = 8.2 METS

• Men– 14.7 minus (0.11 x age)

• Ex. 50 yr old = 9.2 METS

(Gulati, NEJM, 2005)

METS

• Women’s fitness levels seem to be lower regardless of age than for men.

• Women lose 1% of exercise capacity per year – faster than men.

(Gulati, NEJM, 2005)

METS

• The exercise intensities (METs) for walking, jogging, running, cycling, and bench stepping are directly related to the speed of movement, resistance, or mass lifted.

METS

• Use the ACSM equations to calculate the speed or work rates corresponding to a specific MET intensity.

METS

• You can calculate target intensity for METS based on the reserve method by using:

(Ex. Int.)X(Max METS-1MET)+1MET

Ex: (.60) X (10-1) +1 = 6.4 METS

Rating of Perceived Exertion

• The RPE scales are valid and reliable tools for assessing the level of physical exertion during aerobic exercise.

RPE

• You can use the intensities (METs) corresponding to ratings of 12 (somewhat hard) and 16 (hard) to set the minimum and maximum training intensities for the exercise program.

RPE

• Compared with the %HRR method, RPEs between 11 and 16 closely approximate 50 and 85% HRR, respectively.

RPE

• With practice an individual can learn to associate RPE with a specific target exercise heart rate, especially at higher exercise intensities.

RPE

• Thus, the RPE can be used instead of HR, or in combination with HR, to monitor training intensity and to adjust the exercise program for conditioning effects.

RPE

• One advantage of RPE as a method of monitoring exercise intensity is that your clients do not need to stop exercising in order to check their heart rates.

Duration

• The time constraints imposed on the individual influence both the frequency and duration of exercise sessions.

Duration

• Increases in exercise duration should be instituted as the individual adapts to training without evidence of undue fatigue or injury.

Duration

• Duration may be determined by the total time expended exercising or by the caloric cost of the activity.

Optimal Health and Fitness

• The ACSM recommends 20-60 minutes of continuous physical activity to develop optimal fitness.

Duration

• It is now known that this period of time can be split into smaller segments and result in similar benefits.

Duration

• A minimum of 10 minute bouts accumulated throughout the day are recommended if an intermittent approach is selected.

Basic Health and Fitness

• To achieve health benefits, minimum caloric thresholds of 150 to 300 kcals per exercise session or 800 to 900 kcals per week are recommended.

Duration

• Throughout the improvement stage, the goal is to increase your client’s caloric expenditure from 800 to 2000 kcals per week by gradually increasing the frequency, intensity, and duration of the exercise.

Duration

• You can estimate the caloric cost of exercise (kcal per min) if you know exercise intensity (METs) and the relationship between METs and caloric cost:

• 1 MET = 1 kcal per kg per hr

Frequency

• Frequency is interrelated with both intensity and duration of exercise and therefore depends on those two variables.

Frequency

• However, functional capacity is of great importance.

Frequency

• Patients with functional capacities of < 3 METS benefit from multiple short daily exercise sessions; one to two sessions/day are most appropriate for three to five MET capacities; and 3 to 5 sessions/week are recommended for individuals with functional capacities > 5 METS.

Frequency

• Clearly the number of exercise sessions per week will vary given caloric goals, participant preferences, and limitations imposed by the participant’s lifestyle.

Caloric Thresholds for Adaptation

• The interaction of intensity, duration, and frequency determines caloric expenditure.

Caloric Thresholds for Adaptation

• ACSM recommends minimal thresholds of 300 kcal per exercise session performed 3 days per week, or 200 kcal per session done 4 days per week.

Caloric Thresholds for Adaptation

• It would appear that a reasonable approach in exercise programs is to target a weekly exercise caloric expenditure of approximately 1000 kcal.

Caloric Thresholds for Adaptation

• To achieve optimal physical activity levels the goal is to bring the weekly expenditure closer to 2000 kcal as health and fitness permits.

Caloric Thresholds for Adaptation

• One useful method to approximate the caloric cost of exercise is by using the following equation based on the MET level of the activity:– METS x 3.5 x body wt in kg / 200 = kcal/min