A MET is the caloric consumption of an individual while at complete rest.

A useful way to describe the intensity of a variety of physical activities; Light activity 6 METS

• Cardiovascular Endurance
• Body Composition
• Muscular Strength
• Muscular Endurance
• Flexibility

• Agility
• Coordination
• Balance
• Power
• Reaction Time
• Speed

• Improvement in Cardiovascular and Respiratory Function
• Reduction in Coronary Artery Disease Risk Factors
• Decreased Morbidity and Mortality
• Enhanced Physical Function
• Reduced Risk of Falls in older persons
• Decreased anxiety and depression

• To optimize saftey during exercise & exercise testing
• To aid in the development of safe and effective exercise prescription

• Identification of individuals with medical contraindications to exercise
• Recognition of persons with clinically significant diseases or conditions in which they need to be medically supervised
• Detection of individuals at increased risk for disease due to age, sypmtoms, and/or risk factors
• Recognition of special needs of individuals that may affect exercise testing and programming

Information on...

• Individuals health history
• Current medical conditions
• risk factors
• signs/symptoms
• current physical activity/exercise habits
• medications

• The presence or absence of known cardiovascular, pulmonary, and/or metabolic disease
• The presence or absence of signs or symptoms suggestive of cardiovascular, pulmonary and/or metabolic disease
• The presence or absence of CVD risk factors

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 1 (i.e., < or = to 1) CVD risk factor.

Medical exam before exercise?

Mod ex - No

Vig Ex - No

Medical Supervision of Ex Test?

Submax - No

Max- No

Individuals classifed as moderate risk do not have sign/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease, but have two or more (> or = to 2) CVD risk factors. May participate without necessity for medical examination for low-moderate activity. Suggested Examination for Vigorous activity.

Medical exam before exercise?

Mod ex - No

Vig Ex - Yes

Medical Supervision of Ex Test?

Submax - No

Max- Yes

Individuals classified as high risk are those who have one or more signs/symptoms of or diagnosed cardiovascular, pulmonary, and/or metabolic disease. A thorough medical examination should be performed and clearance should be given before initiating any physical activity or exercise at any intensity.

Medical exam before exercise?

Mod ex - Yes

Vig Ex - Yes

Medical Supervision of Ex Test?

Submax - Yes

Max- Yes

Cardiovascular: Cardiac, Peripheral Vascular, or cerebrovascular disease

Pulmonary: COPD, Asthma, Interstitial Lung disease, cystic fibrosis

Metabolic: Diabetes mellitus (1&2), thyroid disorders, renal or liver disease

• Pain or discomfort in the chest, neck jaw, arms, or other areases that may result from ischemia
• Shortness of breath at rest or with mild exertion
• Dizziness or syncope
• Orthopnea or paroxysmal nocturnal dyspnea
• ankle edema
• Palpations or tachycardia
• Intermittent claudication
• Heart Murmur
• Unusual Fatigue or shortness of breath with usual activities

• Age
• Family History
• Current Cigarette Smoker
• Sedentary Lifestyle
• Obesity
• Hypertension
• Dyslipidemia
• Pre-Diabetes

• Known CV, Pulmonary and/or Metabolic disease?
• Major Signs/Symptoms?
• CVD Risk Factors: Age? Family History? Smoker? Sedentary? Obesity? Hypertension? Hypercholesterolemia? Diabetes?

• Inflate cuff to 20mm about 1st korotkoff sound
• Release pressure equal to 2-5mm hg per second
• Systolic is 1st sound (Phase 1)
• Diastolic is Last sound (Phase 5)

• Normal
• Prehypertension
• Stage 1 Hypertension
• Stage 2 Hypertension

SBP <120

AND

DBP <80

SBP 120-139

OR

DBP 80-89

SBP 140-159

OR

DBP 90-99

SBP > or = to 160

OR

DBP > or = to 100

Lifestyle modefication including...

• Starting physical activity
• weight reduction
• DASH eating plan
• dietary sodium reduction
• moderation of alcohol consumption

< 100 = optimal

100-129 = Near optimal/Above optimal

130-159 = Borderline High

160-189 = High

> or = to 190 = Very high

<200 = Desirable

200-239 = Borderline high

> or = to 240 = High

<40 = Low

> or = to 60 = High

<150 = Normal

150-199 = Borderline High

200-499 = High

> or = to 500 = high

• Height
• Weight
• Circumference
• Skin folds

• A recent significant change in the resting ECG suggesting significant ischemia, recent myocardial infarction (within two days), or other acute cardiac event
• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled systematic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Actue myo carditis
• Suspected or known dissecting aneurysm
• Acute systematic infection, accompanied by fever, body aches, or swollen lymph glands

• Left main coronary stenosis
• moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Severe atrial hypertension at rest
• Tachydysrhythmia or bradydysrhythmia
• hypertrophic cardiomyopathy and other forms of outflow tract obstructions
• Nueromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
• high-degree atrioventricular block
• Ventricular aneurysm
• Uncontrolled metabolic disease
• Chronic infectious disease
• Mental or physical impairment leading to an inability to exercise adequately

Underweight: <18.5

Normal: 18.5-24.5

Overweight: 25.0-29.9

Obese Class 1: 30.0-34.9

Obese Class 2: 35.0-39.9

Obese Class 3: > or = to 40

• Abdomen: horizontal measurment across umbilicus
• Arm: Horizontal measurment across belly of bicep (midway between acromion and olecranon process)
• Buttocks/hips: horizontal measurment across maximal circumference level of buttocks
• Calf: Horizontal Measurment at maximum circumference between knee and ankle (Over belly of gastroc)
• Forearm: measure perpendicular to long axis at the maximal circumference
• Hips/thighs: horizontal measure is taken at the max cir. of the hip/proximal thigh, just below gluteal fold
• Mid thigh: Knee flexed at 90 degrees, meausre is taken between inguinal crease and proximal border of patella, perpendicular to long axis
• Waist: Horizontal measure at narrowest part of torso

• All measurements should be made with a flexible yet inelastic tape measure
• Tape should be placed on the skin sufrance without compromising the subcutaneous adipose tissue
• Take duplicate measurements at each site
• re-test if duplicates are not within 5mm
• Rotate through measurement sites or allow enough time for skin to regain normal texture.

• Enhancement of physical fitness for activities of daily life, recreation, or competetive athletic endeavors
• Primary or Secondary disease prevention
• Enjoyment, hobby, stress management, and psychological well-being.

• 150-400 kcals burned per day
• For some individuals with health problems or poor physical fitness <1000 kcals per week may result in enhanced health
• Weekly caloric expenditure in excess of 2,000 per week has been shown to be successful for short and long term weight control
• 10,000 steps per day has been shown to significantly reduce the risk for developing Coronary Heart Disease

• warm up
• caridovascular endurance (aerobic exercise) stimulus
• Resistance exercise
• cool down
• flexibility training

• Mode
• Frequency
• Intensity
• Duration
• Progression

• Limitations
• Needs
• Goals

• Heart Rate
• Blood Pressure
• RPE
• Ventilatory Values
• Blood Lactic Acid Values

• Involve movements where both feet leave the floor
• Requires significant energy expenditure
• Increases the risk for musculoskeletal injuries
• appropriate for highly fit individuals
• Not for overweight individuals

• One foot remains in contact with floor
• produce low impact forces
• Low incidence of injury
• Appropriate for beginners & overweight
• Can be increase in intensity by creating greater horizontal displacement

• Choreographed movements
• ranges from 6-11 METS
• should be reduced in cadence for individuals who are less fit

• Allows buoyancy properties of water to reduce weight bearing load
• May allows with injuries to exercise
• Combines buoyancy and the resistive properties of water which enhances muscular strength and endurance
• Benefits the: Obese, Pregnant, Arthritic (or fibromyalgia), and the Elderly

• Non weight-bearing activity with low incidence of injury
• Limiting factors to cycling would include localized muscle fatigue of the upper leg and expense of good equipment

• Current level of fitness
• Age and current cardiovascular risk factors
• Medical conditions and Medications
• Current or increase risk of orthopedic injury
• Individual preference
• Program objectives or performance goals

• 55%-90% of HRmax
• 40%-85% of VO2reserve or Heart Rate Reserve (HRR)

• 60%-80% HRR
• 77%-90% HR max

220 - AGE = #1

#1 - Resting HR = HRR

HRR x Desired Target HR (60% = .6) = #2

#2 + Resting HR = Target Heart Rate

• Exercise-induced angina
• Inappropriate BP changes
• Musculoskeletal discomfort
• Leg pain
• Any sign or symptom that causes premature termination of the exercise test

• The ACSM recommends 20-60 minutes of continuous or intermittent aerobic activity
• Excessive duration is associated with decreased compliance
• Deconditions individuals may benefit from multiple short duration exercise sessions with multiple rest periods
• Intermittent exercise programmed for health or fitness purposes should be aerobic in nature and not exceed and intensity of 85% of HRR.

is the number if exercise sessions per day and per week.

• ACSM recommends physical activity on all or most days of the week
• Frequency is affected by individuals goals, preferences, limitations, and time contraints.
• Deconditions people might benefit from lower intensity, shorter duration exercise sessions at higher frequencies.
• Exercise frequency on 5 or more days of the week is generally for athletic performance or weight loss

is the systematic changes in exercise prescription (intensity, duration, frequency) necessary to increase fitness.

• Rate of progression depends on health or fitness status, age, goals, and compliance
• Increase frequency and duration before intensity
• Adaptation occurs when and individual can adequately respond to the demands of a particular exercise stressor.
• Most participants adapt easily to smaller increases in intensity, duration and frequency.
• The rate of adaptation is affected by compliance with the exercise program
• Increase the duration by 10-20% per week until the relecant goal is attained.
• Increase intensity every 6th training session

• Initial
• Improvement
• Maintenance

Warm up: 10-15min

Moderate Intensity: 40-60% HRR

Interval: 15 minutes, progressing to 30min

Frequency: 3-4 Days per week

50-85% HRR

Progress duration by 10-20% per week or as tolerated

Progress intensity by 5-10% every 2 weeks

lasts 4-8 months

Goals have been attained

Attainment of average fitness is a reasonable goal

Maintain fitness with a variety of activities

Involves low intensity, large muscle group activity specific to the exercise to be performed.

Physiological Changes induced by warm up:

• Increased Muscle temperature
• Increased Blood Flow
• Increased ease of dissociation of oxygen from hemogloben
• increased muscle enzyme activity
• increased elasticity of muscle and connective tissue
• decreased muscle viscosity

• Improved performance of activities of daily living with less physiological stress.
• Maintenance of functional independence
• Decreased risk of bone mineral loss
• Maintenance of lean body mass
• Decreased risk of low back pain