Designing Physical Activity Intervention Dr. Nayanjeet Chaudhury, M.D., M.P.H. Certified Personal Trainer (ACSM) Certified Aerobics Trainer (Reebok) Director for M&E and Health Services Delivery, Population Services International, New Delhi Feb’ 2014
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Designing Physical Activity
Intervention
Dr. Nayanjeet Chaudhury, M.D., M.P.H.
Certified Personal Trainer (ACSM)
Certified Aerobics Trainer (Reebok)
Director for M&E and Health Services Delivery,
Population Services International, New Delhi
Feb’ 2014
Flow of the presentation
• Basic Exercise Physiology
• Risk Stratification
• Physical Activity Guidelines
• Physical Activity Design
• Special populations
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Total energy expenditure(TEE)
or total metabolic rate
= (1) the basal metabolic rate (BMR)
+ (2) the activity energy costs,
+ (3) diet-induced thermogenesis
TEE = BMR when measured
(a) in the morning
(b) 20 h after the last meal,
(c) resting, reclining,
(d) at normal body temp., and
(e) at a comfortable ambient temperature
The BMR varies according to sex, age, body size and weight.
Basic Exercise Physiology: Principles
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• ATP is produced in the cells (except the RBCs). Usually the
mitochondria of the cell does so by burning fat and
carbohydrate into carbon dioxide and water
(metabolism)
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Sites of Energy generation/ATP
production during muscular activity
Anaerobic
Aerobic Occurs in Mitochondria. Burns fats, carbs and amino
acids in presence of Oxygen to produce large no. of ATPs
Occurs in Cytoplasm. Breaks only glucose or glycogen
without Oxygen to produce small number of ATPs
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Basic Exercise Physiology: Principles
Muscle fibre types
• In humans, 3 myosin isomorph fiber types I, IIA & IIB
• Type I – Slow twitch, high oxidative capacity.
• Type IIB – Fast twitch, low oxidative
• Type IIA – Intermediate
Long-term effects of training
• Resistance or endurance training, IIB IIA
• Prolonged resistance training - Hypertrophy
Source: American College of Sports Medicine
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Cardiovascular adaptations to chronic exercise
• No change on Max Heart Rate(H.R.) and Resting Cardiac
Output (C.O.). Rather, Resting H.R. may lower.
• Max C.O. increases due to Increased Stroke Volume (S.V.) in
trained people
• Remember, S.V. in supine posture (swimming) is higher than in
upright position (running)
Prolonged Endurance Training - reduced systolic, diastolic, and
mean arterial pressures (therapeutically effective on mild
hypertensives only)
Basic Exercise Physiology: Principles
Source: American College of Sports Medicine
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• Endurance training
• - Capacity of the oxidative
system to produce ATP by
increasing mitochondrial density
in muscle
• - Amplify the storage of energy
substrates(glycogen, lipids)
• - lipid depots more pronounced
• Resistance Training
• - Increased capacity of muscle
to produce ATP anaerobically by
increasing glycolytic enzymes &
glycogen stored in muscle
Basic Exercise Physiology: Principles
Source: American College of Sports Medicine
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Major Energy Systems in the Body
• Phosphagen system
– ATP and phosphocreatine
(PCr) stored in muscle
• Non-Oxidative system
– "anaerobic“ only Carb
pathway.
– End product = lactate
• Oxidative system
– "aerobic“- lipid/carb
pathway,
– End product= CO2 + H20
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Energy systems used in various sports Phosphagen system, almost
entirely (4 m ATP/min for 8-10 sec)
100 meter dash
Jumping
Weight lifting
Diving
Football dashes
Phosphagen and Glycogen
lactic acid system
200 m dash
Basketball
Base ball home run
Glycogen lactic acid system, mainly (2.5 m ATP/min for 1.3 to 1.6 min)
400 m dash
100 m swim
Tennis
Soccer Glycogen-lactic A & Aerobic
system
800 m dash/ 1500 m run
200/400 m swim
2000 m rowing
Boxing Aerobic system (1 m ATP/min
for unlimited time (nutrient limited)
10000 m skating
Cross country skiing
Marathon
jogging
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Age and Exercise • Resting B.P. and exercise B.P. are lower in children
• Both resting H.R. and exercise H.R. are higher in children
• C.O. at a submax oxygen consumption (V02) is lower in adults.
• Children have poor thermoregulation– high sweating threshold
• Men start losing bone mass in 50-55 yrs, women start in 30-35
yrs with increase after menopause
• Muscle strength declines by 15% per decade from 50-80yrs
and by 30% thereafter.
• Joint stiffness and loss of flexibility are common in elderly.
• Healthy older adults walk at a preferred speed that is 20%
slower than that of younger adults.
• Old age = Decreased visual acuity, hearing loss, deterioration
of short-term memory, slow processing of multiple information
(5.50 mmol·L-1) but <126 mg·dL-1 (6.93 mmol·L-1) or impaired glucose tolerance (IGT) =
2-hour values in oral glucose tolerance test (OGTT) ≥140 mg·dL-1 (7.70 mmol· L-1) but
<200 mg·dL-1 (11.00 mmol·L-1) confirmed by measurements on at least two separate
occasions
Negative Risk factor: HDL Cholesterol ≥60 mg·dL-1 (1.55 mmol·L-1). If HDL is high,
subtract one risk factor from the sum of positive risk factors.
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ACSM Risk Stratification Low Risk Moderate Risk High Risk
(Asymptomatic
<2 risk Factors)
Asymptomatic ≥ 2 Risk
Factors
Symptomatic/ known
cardiac, pulmonary or
metabolic ds
Med Exam & Graded Ex
test
(not necessary)
Med Exam & Graded Ex
test
(necessary for Vigorous
Ex)
Med Exam & Graded Ex
test
(Necessary for both
moderate and Vigorous
Ex)
Medical Supervision
necessary for Maximum
stress test
Medical Supervision
necessary for both submax
and max test
Moderate exercise - 40-60% of V02max; 3-6 METs; "an intensity well within the
individual's capacity, one which can be comfortably sustained for a prolonged
period of time (-45 minutes)"
Vigorous exercise - > 60% of V02max; > 6 METs; "exercise intense enough to
represent a substantial cardiorespiratory challenge"
Source: American College of Sports Medicine
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Pre-exercise Evaluation
• Detailed personal and medical history
• Pre-exercise Test Physical Examination
• Recommended Laboratory Tests
• Low/Moderate risk individuals
• Lipid profile, fasting glucose, thyroid profile
• High risk individuals
• Appropriate lab tests (refer to ACSM)
Source: American College of Sports Medicine
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Health-Related Physical Fitness Testing • Body composition assessment:
– Anthropometry – BMI, circumferences,
– skin fold measurements
– Bio-electrical impedence analysis
– Platysmography, DXA etc
• Cardiorespiratory fitness assessment
– Maximal or Submaximal exercise testing (clinic based or field tests)
• Muscular Fitness: Muscular Strength (the ability of the muscle to exert force) and Muscular Endurance (muscle's ability to continue to perform for successive exertions or many repetitions)
• Flexibility or Range of Movement Tests
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Available Guidelines for Indians
Age group WHO Guidelines Physical activity guidelines for