Dr Nahar Azmi - Specifically prescribed exercise for individual

Specifically Prescribed Exercise For Individuals

Dr Mohd Nahar Azmi Mohamed

Head

Sports Medicine Department

Consultant Sports Physician / Senior

Lecturer

University Malaya Medical Center /

Faculty Of Medicine, University Malaya

Introduction

“All parts of the body if used in

moderation and exercised in labour to

which each is accustomed, become

thereby healthy and well developed, and

age slowly; but if unused and left idle,

they become liable to disease, defective in

growth, and age quickly.”

Hippocrates

Introduction

‘‘The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults”

American College of Sports Medicine, 2011

The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults.

The ACSM recommendation

• moderate-intensity cardiorespiratory exercise training for > 30 min/d on > 5 d/wk for a total of . > 150 min/wk,

• vigorous-intensity cardiorespiratory exercise training for > 20 min/d on >3 d/wk ( >75 min/wk), or a

The ACSM recommendation

• Resistance exercises for each of the major muscle groups, and

• Neuromotor exercise involving balance, agility, and coordination.

• Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle–tendon groups (a total of 60 s per exercise) on > 2 d/wk

modified according to an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals.

• There are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults

• Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs.

Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise.

• Program of regular exercise that includes

• cardiorespiratory,

• resistance,

• flexibility,

• and neuromotor exercise training

• beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults

Exercise Prescription

Exercise prescription

The Principal of F.I.T.T.E

Exercise prescription

• F – Frequency

• I – Intensity

• T – Type

• T – time

• E - Enjoyment

F = Frequency

FREQUENCY

• Number of training sessions or activity sessions for a given time frame.

• The time frame usually consists of a week.

• For general health requirements the recommended frequency of activity is preferably every day of the week, for small quantities of time.

• For improved fitness levels, the frequency is three to five days a week.

Frequency

• Every day

• 3x/week

• 5x/week

I = Intensity

INTENSITY

• Level of demand the activity places on the body.

• This is usually measured by heart rate or maximal oxygen consumption.

• For general health requirements moderate intensity is preferred. This would be perceived as enough demand to increase heart and respiratory rates, but not cause exhaustion or breathlessness.

• For improved fitness levels, the intensity recommended is 40 to 85% of heart rate reserve (HRR) or 60 to 90% of maximal heart rate (HR max).

Intensity (I)

• Pulse

• Rate Perceive Exertion Scale

INTENSITY

• MHR

• HRR

Pulse

• Pulse

– Resting heart rate 60 -100 pulse/minute

– Maximum heart rate

• 220 – age = MHR

• E g. 220 – 40 = 180 seminit

• Exercise

– Targer heart rate 55 – 65%

– Umur 40 tahun

• 100 – 118 denyut seminit

Heart Rate Reserve (HRR)

• HRmax = highest HR recorded during the incremental exercise test

• Predicted HRmax = 220 – ageHRR = HRmax– resting HR

• Predicted HRR = predicted HRmax – resting HR.

Intensiti (I)

Level Weeks THR

Beginners 1 – 2 50 – 60%

Intermediate 2 – 4 55 – 65%

4 – 8 65 – 75%

Maintenance > 8 75 – 85

Intensity

VO2 max

Rating of perceived exertion (RPE) Borg Scale

Rating of perceived exertion (RPE) Modified Borg scale

Endurance training

Borg et. al.

T = Type

T - Type of Activity

• A variety of exercises to improve the components of physical fitness is recommended for all adults. The health-related components of physical fitness include cardiovascular (aerobic) fitness, muscular strength and endurance, flexibility, and body composition.

American College of Sports Medicine. Position Stand. Exercise and physical activity for older adults.

Med Sci Sports Exerc. 1998;30(6):992–1008.

Aerobic Exercise

T - Type of Activity

Components of the Exercise Training Session

A single exercise session should include the following phases:

– Warm-up

– Stretching

– Conditioning or sports-related exercise

– Cool-down

T - Type of Activity

• Muscle strength Activity

– 2 X / week

T- Type of Activity

• Flexibility

T - Type of Activity

Exercises that improve neuromuscular fitness, such as balance and agility, are also recommended, particularly for older adults and very deconditioned persons.

Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from

the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–45.

T- Type of Activity • Neuromotor Exercise Training

Agility Balancing

TYPE

• Mode or activity used. This can be virtually any activity.

• For general health requirements, this may consist of: – Using stairs (versus elevators)

– Parking farther from the desired location and walking a longer distance

– Mowing the yard with a push mower

– Raking leaves by hand

– Gardening

Time

TIME

• For general health requirements, approximately 30 total minutes a day is recommended.

• This could be six 5-minute bouts, three 10-minute bouts, or two 15-minute bouts (or any other combination equalling 30 minutes).

• For improved fitness levels, the time recommended is approximately 20 to 60 minutes.

PA to prevent weight gain.

• PA of 150 to 250 min/wk will prevent weight gain greater than 3% in most adults.

PA for weight loss.

• PA < 150 min/wk promotes minimal weight loss, PA >150 min/wk results in 5- to 7.5-kg weight loss, and a dose–response exists.

PA for weight maintenance after weight loss.

• 200- to 300-min/wk

T - Time

• Each Session – 10 ? 20 ? 30 min?

• Per Week – 75 min?

– 150 min?

– 300 min ?

E - Enjoyment

E - Enjoyment

• One of the most important components of a properly designed training program is that it must be

Enjoyable.

ENJOYMENT

• The amount of pleasure derived from the activity by the client.

• Often overlooked component of program

• The program and its activities must coincide with the personality, likes, and dislikes of the person.

• This ultimately translates into compliance.

Screening

Pre exercise program

1. Pre-Exercise

2. Exercise Prescription

Pre exercise

Screening

Safe to exercise !!

• Medical and Physical Examination

• Diseases

The purposes of the pre-participation health screening

• Identification of individuals with medical contraindications for exclusion from exercise programs until those conditions have been abated or are under control

• Recognition of persons with clinically significant disease(s) or conditions who should participate in a medically supervised exercise program

• Recognition of special needs of individuals that may affect exercise testing and programming

• Detection of individuals at increased risk for disease because of age, symptoms, and/or risk factor who should undergo a medical evaluation and exercise testing before initiating an exercise program increasing the frequency, intensity, or duration of their current program

Physical Activity Readiness Questionnaire (PAR-Q) (Suitable for 15 – 59 y.o) Name of participant ________________ Signature_____________________ Date___________ PAR-Q & You PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, 1. Has your doctor ever said you have heart trouble? 2. Do you frequently have pains in your heart and chest? 3. Do you often feel faint or have spells of severe dizziness? 4. Has a doctor ever said your blood pressure was too high? 5. Has your doctor ever told you that you have a bone or joint problem? 6. Is there a good physical reason not mentioned here why you should not follow

an activity program even if you wanted to? 7. Are you over age 65 and not accustomed to vigorous exercise?

Screening

• PAR – Q

– Answer for all questions – no

– At lease one yes

• Seek doctor advice and clearence

• Exercise Test Required

Risk Stratification

Low risk: • Individuals classified as low risk are those who do

not have signs/symptoms of or have diagnosed cardiovascular, pulmonary, and/or metabolic disease and have no more than one (i.e., ≤ 1) CVD risk factor.

• The risk of an acute cardiovascular event in this population is low, and a physical activity/exercise program may be pursued safely without the necessity for medical examination and clearance.

• Moderate risk: Individuals classified as moderate risk do not have signs/ symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease, but have two or more (i.e., ≥ 2) CVD risk factors.

• The risk of an acute cardiovascular event in this population is increased, although in most cases, individuals at moderate risk may safely engage in low- to moderate-intensity physical activities without the necessity for medical examination and clearance.

• However, it is advisable to have a medical examination and an exercise test before participation in vigorous intensity exercise (i.e., >60% ).

High risk:

• Individuals classified as high risk are those who have one or more signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease.

• The risk of an acute cardiovascular event in this population is increased to the degree that a thorough medical examination should take place and clearance given before initiating physical activity or exercise at any intensity.

Fitness Assessment

Purposes of Health-Related Fitness Testing

• Educating participants about their present health-related fitness status relative to health-related standards and age- and sex-matched norms

• Providing data that are helpful in development of exercise prescriptions to address all fitness components

• Collecting baseline and follow-up data that allow evaluation of progress by exercise program participants

• Motivating participants by establishing reasonable and attainable fitness goals

• Stratifying cardiovascular risk

VO2max Assessment

My VO2 My Fitness

• Treadmill

– Naughton Protocol

– Balke ware Protocol

– Modified Bruce Protocol

– Bruce Protocol

Astrand Cycle Fitness Test

VO2max Assessment

My VO2 My Fitness

VO2 Indirect/Predictive measurements Step Test

Step Test

• Patricia J. Ohtake (2005) – Field Tests of Aerobic Capacity for Children and Older Adults

• Based on ACSM O2 cost calculation to estimate VO2 max based on the formula

VO2 = (0.2 x stepping rate) + (2.4 x step height x stepping rate) + 3.5

* VO2 is in mL/kg/min, stepping rate is in steps per minute, and step height is in meters

CAN STEPS PER DAY BE USED TO PRESCRIBE EXERCISE?

• Better start than never

• 10,000 steps perday!!

Need to start physically active

NUMBER OF STEPS ACTIVITY LEVEL

• 0-5,000 Sedentary

• 5,000-7,499 Low Active

• 7,500-9,999 Somewhat Active

• 10,000-12,500 Active

• 12,500 or more Highly Active

• A daily goal for most healthy adults is 10,000 steps per day, or approximately five miles.

• If your baseline is under this level, try to increase your steps by 1,000 per day every two weeks until you reach your10,000 steps per day

NUMBER OF STEPS ACTIVITY LEVEL

• 0-5,000 Sedentary

• 5,000-7,499 Low Active

• 7,500-9,999 Somewhat Active

• 10,000-12,500 Active

• 12,500 or more Highly Active

• A daily goal for most healthy adults is 10,000 steps per day, or approximately five miles.

• If your baseline is under this level, try to increase your steps by 1,000 per day every two weeks until you reach your10,000 steps per day

Take Home Message

• Each session

– Warm up ( 10 – 15 min) • Light activity

• Stretching

• End of exercise session

– cooling down 5 – 10 minit

Safety PORPER FOOTWEAR

• Exercise prescription must reflect individual differences

• Remember that anything is better than nothing!

• If you’re not used to doing much activity, start by working towards 30 minutes of moderate activity each day

• Build up slowly until you reach your target.

Good effects of exercise

• Basal pulse rate

– Decrease resting heart rate

– Energetic

Sports Medicine Center, UMMC

• Diabetes Exercise Program

• Child Obesity Clinic

• Adult Obesity Clinic

• Cardiac Rehab Phase III

• Osteoarthritis Exercise Program

• Slim and Healthy Program

Performance Laboratory

Sports Medicine Gymnasium

The Candy Girls

Thank You