Precising exercise prescription to

improve aerobic capacity for sport

(workshop)

Anitta FS Paulus
What differentiates between athlete and non
athlete

• Athlete : competition, prestige

• Non athlete : leisure, fitness, challenges
(recreational athlete meets at least 150 mins of
moderate intensity training weekly)

Athlete &
Recreational athlete
How high aerobic capacity (endurance level)
required?
1. Depends on kind of sport,
2. Duration,
3. intensity,
4. goals
Quiz 2 (quick pooling)
• Exercise testing (most likely) for :
1. Determine intensity
2. Exercise tolerance
Why exercise testing
• VO2Max
• Exercise economy
• Lactate threshold
• O2 uptake kinetics

This is exercise tolerance

Challenges in choosing exercise testing
• Population ; athlete, non athlete, non trained individual, with comorbid
• Goals : fitness level, outcome of treatment, outcome of training, cause of
dyspnea, prognosis, exercise tolerance
• Sources : human resources, device
Exercise Testing (ET)

• Does every athlete need maximal exercise test?

Maximal cardiopulmonary exercise testing
• Need for high intensity or long duration sport or both
• Detrained athlete (deconditioning athlete)
What is CPET
• Golden standard cardiopulmonary exercise testing with element of
cardiovascular evaluation, respiratory function, peripheral muscle function
• Describes exercise limitation’s factors
• Prescribe exercise precisely
 Fitness level

Causes of limitations
CARDIOPULMONARY
Exercise prescription
EXERCISE TESTING (CPX)
BENFITS

Readiness to play

Prognosis

Surgery tolerance

Cause of dyspnea

Outcome of program
CPX Other max ET Submax ET
• Heart rate • Heart rate
• Electrocardiogram • Heart rate
• Blood pressure • Electrocardiogram • Blood pressure
• Oxygen saturation
• Blood pressure • Oxygen saturation
• Respiratory rate
• Minute ventilation • Oxygen saturation • Respiratory rate
(amount of air that the • Borg scale
patient breathes in a • Respiratory rate
minute)
• Exhaled CO2
concentration
• Inhaled and exhaled
O2 concentration
 Cause of Variables
Termination

HR max Peak VO2

achieved

CV
Abnormality
VAT

Dyspnea RER

Fatigue VE/VO2 -
VE/VCO2

Pain MVV/VO2 -
MVV/VCO2

VE/VCO2
at VAT
 CPET VARIABLES
• Highest O2 uptake
Peak VO2 • Cardiac output xO2 extraction (by muscles)

Ventilatory • Point at which O2 demand exceeds supply and aerobic

metabolism is reached
Anaerobic Threshold • Anaerobic processes supplement aerobic metabolism with
(VAT) production of lactic acid

• Should increase linearly at >85% predicted (220-

HRmax age)
• Depends on age, fitness level/PAL

• Normally not increase more than 220/90

Blood Pressure • SBP not decrease than baseline point

• Oxygen delivered per heart beat

• Linear increase by exercising
O2 pulse (VO2/HR) • Based on predicted Peak O2 and HRMax ( > 85%
predicted value)
 CPET VARIABLES
Ventilatory Reserve (VR) • Peak ventilatory reserve/ max voluntary ventilation VE/MVV,
represents the ratio between maximal ventilation during
VE/MVV exercise (VE) and maximum voluntary ventilation (MVV) at rest

• Maximal RR reached by exercise could be double than resting

Respiratory Rate RR

• CO2 elimination / O2 uptake .

Respiratory Exchange • at steady state, RER is equal Respiratory quotient (determined by
Ratio (RER) source of energy for metabolic process.

Minute ventilation/CO2
• Ventilatory efficiency : increased ventilation in
output ratio (VE/VCO2) response of CO2 production at anaerobic threshold
at VAT
 Resting HR : measure at wake
up time (2-5 mins after awake,
in lying position)
Heart Rate ;
how Maximal HR (220- age)
important it
is in exercise Hear rate reserve : Heart rate
that (consider) differs max HR
and resting HR
SIMULATION
Quiz 3 (quick pooling)
• Resting Heart rate (take 1 minute to measure resting HR, or using Pulse or
smart phone) :
1. <40 bpm
2. 40-60 bpm
3. 61-90 bpm
4. 91-100 bpm
5. >100 bpm
A 50 yo female,
resting HR : 70 bpm
• Standard : 220- age
• HRR : (percentage in decimal)
0,.. (Max HR-Resting HR)+(resting HR)
Quiz 4 (quick count) give link of Karvonen
Calculator
For intensity 50% (0,5) Measure your HRR (using Karvonen calculator or
formula) take 90 seconds :
1. <120bpm
2. 120-140 bpm
3. 141- 160 bpm
4. >160 bpm
 SEMINAR FOR CLINICIANS
Example of VO2 max prediction & HR prediction
A B C
Healthy, untrained Athlete Right heart failure
HF 200 HF HF
200 predicted heart rate predicted heart rate 200 predicted heart rate
3
150
150 150

predicted peak VO2

predicted peak VO2

predicted peak VO2

2
100
100 100

1 50
50 50

0 0 0 0
0 1 2 3 0 1 2 3 4 0 0.5 1 1.5 2
VO2 [l/min] VO2 [l/min] VO2 [l/min]

Figure 6. Heart rate (HF; y-axis) plotted over V_ O2 (x-axis). X (red) marks the intersection of predicted heart rate (horizontal dashed line) and predicted pea
V_ O2 (vertical dashed line). (A and B) Physiological pattern in an athlete and in an untrained subject (linear increase of heart rate vs. V_ O2 with a shallow slope
(C) Pathological pattern in a patient with severe right-heart failure (resting tachycardia, steep increase of the heart rate vs. V_ O2 slope).
Normal VAT >40%
VO2
Increasing Exercise Capacity
• Know baseline fitness level (VO2max)
• Improving exercise economy, training to reach lower HR at higher intensity
• Training above LT, correcting muscle performance,
• Improving O2 uptake kinetic (improving pulmonary ventilation, improving
breathing pattern, respiratory muscle strength)
• Nutrition support ; pre- exercise, in exercise and post exercise fueling (carbo
loading, fat loading, hydration, electrolyte)
Designing exercise mode • INTERVAL
• High –vigorous intensity
• CONTINUOUS • Training above lactate
• Low-moderate intensity threshold
• Longer duration • Shorter duration

• Interval set
• 30s - 30s (high-recovery)
• CONTINUOUS • 3 min -1min/ 2min – 2min/ 5 min-
• Low-moderate intensity 1min à see anaerobic threshold
• Longer duration • Training above lactate threshold
• Shorter duration
 Recreational
Athlete Non Athlete
Athlete
• Competition • Fitness, challenge • Healthy
• Vigorous intensity • Vigorous intensity • 150mins/week at
moderate HRR
Increasing Exercise Capacity
• Temperature and humidity ; consideration to hydration, evaporation,
electrolyte lost and energy expenditure
• Biomechanical aspect in exercise training : energy reservation, injury
prevention
• Sport gear ; biomechanical basis, energy return, sport prevention
• Recovery muscles; strenuous exercise in long duration injure muscle, nutrition
and cooling down and resting fasten recovery
• Resting day
• Injury (pain management)
Quiz 5 (last simulation)
• Measure your single breath count test after self-air stack repeatedly (set your
metronome at 120bpm)
1. <10
2. 10-20
3. 21-30
4. 31-40
5. >40
Thank You
Quiz 1
• Measure your single breath counting test : After 3 cycles of deep breath, count
number in audible voice (no scream out/too loud, the rhythm according to
metronome -120bpm)
1. <10
2. 10-20
3. 21-30
4. 31-40
5. >40
Quiz 2 (quick pooling)
• Exercise testing (most likely) for :
1. Determine intensity
2. Exercise tolerance
Quiz 3 (quick pooling)
• Resting Heart rate (take 1 minute to measure resting HR, or using Pulse or
smart phone) :
1. <40 bpm
2. 40-60 bpm
3. 61-90 bpm
4. 91-100 bpm
5. >100 bpm
Quiz 4 (quick count) give link of Karvonen
Calculator
For intensity 50% (0,5) Measure your HRR (using Karvonen calculator or
formula) take 90 seconds :
1. <120bpm
2. 120-140 bpm
3. 141- 160 bpm
4. >160 bpm
Quiz 5 (last simulation)
• Measure your single breath count test after self-air stack repeatedly (set your
metronome at 120bpm)
1. <10
2. 10-20
3. 21-30
4. 31-40
5. >40
• Soundbrenner (metronome)

• Heart rate (heartRateFree)

• Link Karvonen calculator