Cardiovascular Fitness	Flexibility
Muscular Fitness	Body Composition

Guidelines for Implementing Cardiovascular Fitness (Aerobic Fitness)

Screening

Purpose

• To determine the "exercise readiness" of a person who wants to begin an exercise program.
• To determine the necessity of an exercise test before beginning and exercise program.

Exercise screening will involve obtaining a health history, and possibly a medical exam. The purpose of screening is to identify those individuals who may be at "risk" when beginning and exercise program and/or exercise testing. An exercise test may be recommended for those individuals who are deemed at a "higher risk" for exercise. Many of these types of exercise tests are medically supervised. Focus is on cardiovascular risk.

 Methods:

• Medical Examination - performed by physician to determine whether there are any "resting" conditions to be addressed before beginning an exercise program or undergoing an exercise test.
• Health History - contains information of a person's health history. Many of the risk factors for Coronary Heart Disease (CHD) and special concerns for exercise may be identified on the health history.
• PAR-Q (link) - is a brief seven question form which will identify those persons who are: 1) at risk for beginning a moderate exercise program, 2) at risk for undergoing an exercise test without prior medical examination. The PAR-Q is a very practical screening tool because many persons are healthy enough to begin exercise without the expense of a medical examination or clinical exercise test.

   

  Assessment

   Purpose

Assessment is the evaluation of any component of fitness. Results of exercise assessment are used to prescribe the factors of frequency, intensity, time, type, and precautions of exercise. Exercise assessment is also called exercise testing.

Clinical Testing (testing done in a medical setting)

• Treadmill test (most common)
• Measure VO2 -(volume of oxygen consumed for work per minute).

Clinical testing is performed in a laboratory setting under medical or paramedical supervision. The most common from of testing is the treadmill test. Exercise intensity / performance is measured by VO2 .Clinical testing is warranted for those individuals who are at higher risk or are diseased.

Field Testing

• Run, Walk, Step test, Sub maximal bike test
• Measure heart rate

 Field testing often occurs in a " Fitness Setting" and is a practical choice for the apparently healthy person person. Field testing is preceded by the PAR-Q. Common forms of field tests are walking, running, biking, and step-tests. Exercise intensity / performance is predicted by measuring heart rate.

Goal Setting

 Purpose :

Goals may be established to address the deficits noted in exercise testing (ie. low level of aerobic fitness). Goals may also promote positive behavior change by building a structured plan to reinforce a positive behavior change. Goals also address target behaviors by identifying behaviors which are not conducive to exercise adherence. Thus goals should builds an objective plan to address target behaviors.

Methods : Personal Contract:

• Personal Plan - includes short and long term goals
• Remember goals are S. M. A. R. T. (link)

 The personal contract will contain a personal plan. The personal plan will contain personal goals to address target behaviors and the means of acquiring positive exercise behaviors. Goals in the personal plan must be S.M.A.R.T. .

Exercise Prescription

 Exercise prescription must answer the following questions:

How often?, How hard?, How long?, What type?

How often = FREQUENCY

How hard = INTENSITY

How long = TIME

What type =TYPE

(F.I.T.T.)

Precautions : Exercise prescription should also address precautions. Remember exercise precautions may be either modifications to the exercise program or contraindicated activities.

 To say it another way........

Frequency = days per week

Intensity = % of working heart rate

Time = workout session in minutes (at assigned intensity)

Type = aerobic activity (aerobic activity = large muscle groups, rhythmical, continuous, prolonged activity)

Precautions = special considerations

Generic Prescription for Cardiovascular Fitness

• Frequency: 3-6 days/week
• Intensity: Percent of working heart rate (heart rate reserve [HRR])

Heart rate reserve is the number of beats your heart has from the resting number (in beats per minute) to the number of beats your heart would produce if you were working as hard as you could. Thus the number of beats above rest is a "reserve" of beats needed to perform work.

 How to calculate target heart rates

 First, determine your Age Predicted Maximum Heart Rate:

Age Predicted Maximum Heart Rate [ MHR] = 220-your age. You can determine your age predicted maximum heart rate by subtracting your current age from 220.

Next, Use the Karvonnen Formula:

MHR - Resting heart rate [RHR] = HRR. Determine your heart rate reserve by subtracting your resting heart rate (beats per minute) from your age predicted max heart rate. Heart rate reserve is the total number of heart beats you have on reserve from rest to your maximum exercise effort.

(HRR * Intensity )+ RHR = Training heart rate [THR] Next you will multiply your heart rate reserve by the percent intensity you want to work. You should choose an intensity between 50-85% of your maximal effort. You don't want to go higher than 85% because you will probably become exhausted before you complete your work out. Likewise, you would not want to choose below 50% because you may not get the benefits that you want from aerobic exercise.

The decimal equivalents to 50-85% are .50 and .85 respectfully. Thus you could multiply your HRR by any intensity between 50 and 85%. For example, you may choose 70%.

Once you have obtained the value for HRR * Intensity you should add your resting heart rate (RHR) to the value to obtain your training heart rate (THR). Your THR is the rate you will use to guide how hard you are going to exercise. Thus you will measure your pulse to determine how hard you are exercising. Because it will be extremely difficult for you to exercise at only one intensity, you should calculate your THR for two different intensities (ex. 60 % and 70% of HRR)

Finally, you should determine your THR for either a 15 second or 10 second pulse count. THR divided by 4 = 15 second pulse count or THR divided 6 = 10 second pulse count. Thus, you may quickly access how hard you are working while you are exercising. This method allows you to guide the intensity of your exercise program. If your THR is too high you can slow down, if too low, speed up.

Example problem for class: Age = 23 yrs, Resting heart rate = 64 beats per minute. Calculate the ten second training heart rate range for an exercise intensity range of 50 to 85 percent of Heart Rate Reserve. Show work below.

220 - 23 = 197

(197 - 64) = 133

133 * 0.50 = 67; 133 * 0.85 = 113; so..

THR @ 50 % = 67 + 64 or 131 beats per minute

THR @ 85% = 113 + 64 or 177 beats per minute

10 second pulse count = ( 131 / 6 ) or 22 beats to ( 177 / 6 ) 30 beats per 10 seconds.

Thus, we guide the intensity of aerobic exercise by pulse assessment : measures heart rate. Note the importance of the 10 or 15 second measurement because heart rate declines rapidly, (faster in fit persons), when exercise stops. Another means of determining how hard you are working is by a Rating of Perceived Exertion. Another simple means of determining how hard you are working is by the Talk test. The talk test implies that if you cannot carry on a conversation, you are probably working too hard. If you can sing, you are not working hard enough.

• Time: 20 - 60 minutes

• Type: Running, Walking, etc..., ("-ing" activities)

** Precautions

• Contraindications
• Modifications

 Precautions are special considerations which may address: exercise contraindications and / or modifications to the exercise program. Contraindications are those activities which should be avoided. Exercise precautions should promote the maximum benefit or exercise while significantly decreasing the risk.

In conclusion, remember that one may choose to exercise for either Health or Fitness. Even though this unit has addressed Cardiovascular exercise for Fitness, you will again see the prescription for exercise for health included in the charts below. Charts are a very easy method of summarizing the exercise prescription.

Exercise Prescription for Health (review)

Prescription Components defined:

• Frequency: Most days of the week
• Intensity: Moderate
• Time: 30 minutes total
• Type: "ing" activities

Charting

	Sub
ACTIVITY	COMPONENT	FREQUENCY	INTENSITY	TIME	TYPE
				(minutes)
CV exercise	for fitness	3-6 days	50-85 % HRR	20-60	*"ing" activities
	for health	most days	moderate	accum 30	"ing" activities

* ing activities include activities such as running, walking, aerobic dancing, etc.., .

How does it work?

Interaction of components = exercise volume

 Exercise volume is really the number of calories expended per week. Because caloric expenditure is directly related to the amount of work performed, those factors which influence the amount of work performance will determine exercise volume. Increasing one factor (F.I.T.T.) or using a more strenuous component (ie cross country skiing vs. walking)or a combination of these will increase the volume of exercise. Thus, exercise volume should begin low and gradually increase. Remember the Principles of Exercise : Overload and Progression.

The arrangement and modification of the items which control exercise volume is the "art" of exercise prescription.

Guidelines for Implementing Muscular Fitness (Muscle endurance and muscle strength)

Screening

Purpose: To determine if there are muscle imbalances or skeletal abnormalities which would increase risk of injury or further insult preexisting musculoskeletal conditions. As in cardiovascular screening, the purpose of the musculoskeletal screening is to reduce risk associated with muscular fitness exercises. If the individual has a history of any preexisting conditions, these conditions should be considered when developing the assessment test and when developing the exercise prescription. A screening may also provide insight on conditions not previously documented.

 Methods:

PAR-Q

The PAR-Q contains a question related to the orthopaedic considerations for exercise programming and participation: "Has your physician ever told you that you have a bone or joint problem, such as arthritis that has been or could be aggravated by exercise?"

Health History

Health history questionnaires will contain a set of questions over the history of muscle and bone injuries.

Orthopaedic Examination

Persons with congenital bone and muscle disorders / deformities will have extensive amounts of information over exercise contraindications and modifications via findings of orthopaedic examinations. Those individuals who have experienced significant orthopaedic trauma may also have exercise restrictions, dependent upon the injury type and the phase of rehabilitation.

Assessment

Purpose: The evaluation of the endurance and / or strength of a muscle or muscle group. Results of the assessment are used to design the exercise prescription for muscle fitness.

Methods:

Repetition Maximum (RM)

The maximum amount of weight that can be moved through a full range of motion with the correct body posture required for the safety of the weight lift technique. Repetition is considered one full lift sequence. The RM may be a 1 RM assessment or multiple RM's, (i.e.. 10 RM = the maximum amount of weight that can be lifted, according to the criteria above, in a sequence of 10 lifts.)

Static and dynamic endurance field tests

 Static tests determine the length of time a particular position can be held against the resistance of gravity (ex. flexed arm hang)

Dynamic endurance tests determine:

1) the maximal number of repetitions which can be performed correctly in a set amount of time.

2) the maximum number of repetitions which may be performed until exhaustion.

Setting Goals

Purpose and Method is the same for all components of fitness. (S.M.A.R.T)

Generic Exercise Prescription for Muscular Fitness

F = 2-3 days per week

I = Strength = 60-90% RM

Endurance = < 40% RM

Combined = 40-70% RM

T = Repetitions and Sets

Muscle Strength:

• For Power = 1-3 reps
• For Size = 4-7 reps
• For Strength = 7-12 reps

Endurance:

> 15 reps

Sets = group of repetitions): for both Strength and Endurance > 2-3 sets

T = (type or mode)

Free Weights

Stacked Weights

Weight Machines

Styles of movements with weight training

Isometric : Iso = same; Metric = length . Muscle conditioning activity where the muscle contracts but no movement occurs in the joint line.

Isotonic: tonic = tone. Muscle conditioning exercise where the muscle contracts and move the joint through a full range of motion. This movement has two distinct phases:

Concentric Phase - movement through the range of motion where the muscle belly shortens. Eccentric Phase - movement through the range of motion where the muscle belly lengthens.

Isokinetic: kinetic = movement. Muscle conditioning activity where the speed of movement through the range of motion is held at a constant requires specialized weight equipment, also, contains a concentric and eccentric phase.

Precautions:

Muscle / skeletal disorders, disease, or injury:

Those individuals who do not possess the normal joint integrity or have diseases and disorders which alter the normal distribution of force across a joint, may require modifications to the exercise prescription.

Hypertension

Hypertensive persons should not engage in lifting heavy weights. Heavy resistance activities will further elevate blood pressure.

Proper technique and breathing

One should exhale on exertion when lifting to avoid the valsalva maneuver. Also, proper form should be followed to reduce the risk of injury and from becoming muscle bound.

CHARTING THE PRESCRIPTION :

Muscle Fitness

 

Activity	Frequency	Intensity	Time	Type
Sub-component	( Days/wk )	( %RM )	( Reps/sets )
Muscle Strength	2 to 3 +	60 to 90	Power =1-3 / 2-3 Size = 4-7 / 2-3 + Strength = 7-12 / 2-3 +	Iso - metric tonic kinetic
Muscle Endurance	2 to 3 +	< 40	> 15 / 2-3 +	(same as strength)
Mix	2 to 3 +	40-70	7-15 / 2-3 +	(same as strength)

Guidelines for Implementing Flexibility

Screening

 Purpose = To determine if there is any significant compromise in a joint or body region which would increase risk of injury with exercise or if certain types of exercise would further insult preexisting conditions .

As in cardiovascular screening, the purpose of the flexibility screening is to reduce risk associated with exercise. If the individual has a history of any preexisting conditions, these conditions should be considered when developing the assessment test and when developing the exercise prescription. A screening may also provide insight on conditions not previously documented.

 Methods

PAR-Q : The PAR-Q contains a question related to the orthopaedic considerations for exercise programming and participation: "Has your physician ever told you that you have a bone or joint problem, such as arthritis that has been or could be aggravated by exercise?"

Health History : Health history questionnaires will contain a set of questions over the history of muscle and bone injuries.

Orthopaedic Examinations: Persons with congenital bone and muscle disorders / deformities will have extensive amounts of information over exercise contraindications and modifications via findings of orthopaedic examinations. Those individuals who have experienced significant orthopaedic trauma may also have exercise restrictions, dependent upon the injury type and the phase of rehabilitation.

 Assessment

Purpose = The evaluation of ROM. Results of the assessment are used to design the exercise prescription for flexibility

 Methods

ROM : ROM assessment is the criteria for evaluation. There are normative standards for each joint which may be measured. Most flexibility tests used in fitness are for body regions (i.e.. low back and trunk flexibility). These tests still address ROM, but do so by considering multiple joint ROM. Thus, measurement criteria for these tests will not be in degrees of movement, but distance achieved in the motion measured. Instruments which are used in the field to measure ROM include goniometer and the Leighton flexometer.

Setting Goals

Purpose and Method is the same for all components of fitness.

Generic Exercise Prescription for Flexibility

F : 3-5 days / wk

I : "Feel the stretch, but not painful"

T : Hold stretch for 15-30 seconds

T : Static (active and passive) / Proprioceptive Neuromuscular Facilitation [ PNF ]

Static: Static stretching is recommended. Static stretching will allow the Golgi tendon organs to respond so the stretch can be maximized.

active - person stretching executes the stretch.

passive - someone else executes the stretch

PNF : Type of stretching that facilitates the proprioceptors (muscle spindles) thus allowing the muscles to be stretched further.

Precautions :

Hyper flexible joints: Those individuals who have hyper flexible joints should be careful not to "over stretch". For these individuals flexibility exercises can be counter productive.

Ballistic Stretching: Ballistic or bouncing stretches should be avoided. Bouncing stretches will cause the muscle spindle to respond with a greater counter contraction which may cause micro trauma (injury at the level of the individual muscle fibers) to the muscle. This micro trauma is the soreness felt the following day after performing ballistic stretching

Proper technique and breathing : Breathing out on exertion (i.e.. when engaging the stretch) may ease the difficulty of the stretch and also prevent the Valsalva maneuver (holding breath while performing strenuous work). Performing this maneuver will elevate your blood pressure.

CHARTING THE PRESCRIPTION :

Flexibility

Activity	Sub Component	Frequency (Days/wk)	Intensity	Time (seconds)	Type
Flexibility	Stretching	3-5	Feel the stretch, no pain	15-30	Static / PNF active and passive

Guidelines for Implementing Exercise for Body Composition (see CV and Muscular Fitness)

Body Fat Standards

 Classification Percent Fat 

Category	Men	Women
Essential Body Fat	3-5%	8-10%
Healthy Range	3-25%	8-32%
Obese	>25%	>32%

Generic Exercise Prescription for Obesity (more info with weight control later in semester)

Frequency	4-6 days
Intensity	40-50%
Time	40-60 min
Type	Walking