CHAPTER 7: Principles of Aerobic Exercise
KEY TERMS and CONCEPTS
Physical Activity - any bodily movement produced by the
contraction of skeletal muscles that result in a substantial
increase over resting energy expenditure
Exercise - any planned and structured physical activity
designed to improve or maintain physical fitness
Physical Fitness - a general term used to describe the ability
to perform physical work
Maximum Oxygen Consumption - is a measure of the body’s
capacity to use oxygen
Endurance - is the ability to work for prolonged periods of
time and the ability to resist fatigue
Aerobic Exercise Training (Cardiorespiratory Endurance) -
augmentation of the energy utilization of the muscle by
means of an exercise program
Adaptation - results in increased efficiency of the
cardiovascular system and the active muscles
➢ represents a variety of neurological, physical, and
biochemical changes in the cardiovascular and
muscular systems
Myocardial Oxygen Consumption - measure of the oxygen
consumed by the myocardial muscle
Deconditioning - occurs with prolonged bed rest, and its
effects are frequently seen in the patient who has had an
extended, acute illness or long-term chronic condition
Energy Expenditure - Energy is expended by individuals
engaging in physical activity and is often expressed in
kilocalories
ENERGY SYSTEMS, ENERGY EXPENDITURE, and EFFICIENCY
Energy Systems - metabolic systems involving a series of
biochemical reactions resulting in the formation of adenosine
triphosphate (ATP), carbon dioxide, and water
• Phosphagen, or ATP-PC, System – characteristics:
o PC and ATP are stored in the muscle cell
o PC is the chemical fuel force
o No oxygen is required (anaerobic)
o When muscle is rested, the supple of ATP PC
is replenished
o The maximum capacity of the system is small
(0.7 mol ATP)
o The maximum power of the system is great
(3.7 mol ATP/min)
o The system provide energy for short, quick
bursts of activity
o Major source of energy during the first 30
seconds of intense exercise
• Anaerobic Glycolytic System – characteristics:
o Glycogen (glucose) is the fuel source
(glycolysis)
o No oxygen is required
o ATP is resynthesized in the muscle cell
o Lactic acid is produced
o The maximum capacity is intermediate (1.2
mol ATP)
o The maximum power of the system is
intermediate (1.6 mol ATP/min)
o The system provide energy for activity of
moderate intensity and short duration
o The major source of energy from the 30th to
90th second of exercise
• Aerobic System – characteristics:
o Glycogen, fats, and proteins are fuel sources
and are utilized relative to their availability
and the intensity of the exercise
o Oxygen is required
o ATP is resynthesized in the mitochondria of
the muscle cell.
o maximum capacity of the system is great
(90.0 mol ATP)
o maximum power of the system is small (1.0
mol ATP/min)
o system predominates over the other energy
systems after the second minute of exercise
• Recruitment of Motor Units
o Slow-twitch fibers (type I)
o Fast-twitch fibers (type IIB)
o Fast-twitch fibers (type IIA)
• Functional implications
o Bursts of intense activity lasting only seconds
develop muscle strength and stronger
tendons and ligaments
o Intense activity lasting 1 to 2 minutes
repeated after 4 minutes of rest or mild
exercise enhances anaerobic power
o Activity with large muscles, which is less than
maximum intensity for 3 to 5 minutes
o Activity of submaximum intensity lasting 20
to 30 minutes or more taxes a high
percentage of the aerobic system and
develops endurance.
➢ can be categorized as light, moderate, or heavy by
determining the energy cost.
• Quantification of Energy Expenditure
o Energy expended is computed from the
amount of oxygen consumed
o Units used to quantify energy expenditure: o
MET’s o Kilocalories
o MET is defined as the oxygen consumed
(milliliters) per kilogram of body weight per
minute (mL/kg
o kilocalorie is a measure expressing the
energy value of food o amount of heat
necessary to raise 1 kilogram (kg) of water
1°C. o can be expressed in oxygen equivalent
o To convert METs to kcal per minute, use the
following formula: [(METs x 3.5 mL/kg per
minute x body weight × in kg) ÷ 1000)] 5.2
• Classification of Activities
o Light Activity
▪ 2.0 - 2.9 METs / 3.5 - 10.15 mL/kg per
minute
o Moderate Activity
▪ 3.0 - 5.9 METs / 10.5 - 10.65 mL/kg per
minute
o Vigorous Activity
▪ 6 - 8.8 METs / 21 - 30.8 mL/kg per
minute

Efficiency - Usually expressed as a percentage
➢ Percent efficiency = useful work output/ energy
expended or work input x 100
PHYSIOLOGICAL RESPONSE TO AEROBIC EXERCISE
Cardiovascular Response to Exercise
Exercise Pressor Response - The SNS response includes
generalized peripheral vasoconstriction in nonexercising
muscles and increased myocardial contractility, an increased
HR, and an increased systolic blood pressure = marked
increase and redistribution of the cardiac output
Cardiac Effects - The frequency of sinoatrial node
depolarization and HR increases
➢ There is a decrease in vagal stimuli as well as an
increase in SNS stimulation
➢ There is an increase in the force development of the
cardiac myofiber
Peripheral Effects - Net reduction in total peripheral
resistance
➢ Increased cardiac output
➢ Increase in systolic blood pressure
Respiratory Response to Exercise
➢ Respiratory changes occur rapidly, even before the
initiation of exercise
➢ Minute ventilation increases as respiratory frequency
and tidal volume increase
➢ Alveolar ventilation
Responses Providing Additional Oxygen to Muscle
Increased Blood Flow
Increased Oxygen Extraction
Oxygen Consumption
TESTING AS A BASIS FOREXERCISE PROGRAMS
➢ distinct from graded exercise testing of convalescing
patients, individuals with symptoms of coronary heart
disease, or individuals who are 35 years or older but
asymptomatic
Fitness Testing of Healthy Subjects - Field tests for
determining cardiovascular fitness include the time to run 1.5
miles or the distance run in 12 minutes
➢ Multistage testing can provide a direct measurement
of VO2 by analyzing samples of expired air max
➢ Electrocardiographic (ECG) monitoring is performed
during the testing.
Stress Testing for Convalescing Individuals and Individuals at
Risk - Individuals undergoing stress testing should have a
physical examination; be monitored by the ECG; and be
closely observed at rest, during exercise, and during recovery
Principles of Stress Testing - Changing the workload
➢ An initial workload that is low in terms of the
individual’s anticipated aerobic threshold
➢ Maintaining each workload for 1 minute or longer
➢ Terminating the test
➢ When available, measuring the individual’s VO2 max
Purpose of Stress Testing
➢ Helps establish a diagnosis of overt or latent heart
disease
➢ Evaluates cardiovascular functional capacity
➢ Determines the physical work capacity in kilogram-
meters per minute (kg-m/min) or the functional
capacity in METs
➢ Evaluates responses to exercise training
➢ Assists in the selection and evaluation of appropriate
modes of treatment for heart disease
➢ Increases individual motivation
➢ Is used clinically to evaluate patients with chest
sensations or a history of chest pain
Preparation for Stress Testing
➢ Have had a physical examination
➢ Be monitored by ECG and closely observed at rest,
during exercise, and during recovery
➢ Sign a consent form
DETERMINANTS OF AN EXERCISE PROGRAM
Frequency - optimal frequency of training is generally three to
four times a week
Intensity - based on the overload principle and the specificity
principle and is the most important component for successful
changes to aerobic fitness
Overload Principle - stress on an organism that is greater than
that regularly encountered during everyday life
Time (duration) - dependent on the total work performed,
exercise intensity and frequency, and fitness level
➢ A 20- to 30-minute session is generally optimal at 70%
HRmax.
➢ When the intensity is below the HR threshold, a 45-
minute continuous exercise period may provide the
appropriate over load.
➢ With high-intensity exercise, 10- to 15- minute
exercise periods are adequate; three 5-minute daily
periods are effective in some deconditioned patients
Type (Mode) - For specific aerobic activities, such as cycling
and running, the overload must use the muscles required by
the activity and stress the cardiorespiratory system
(specificity principle)
Volume - The volume or quantity of exercise completed
weekly is the product of frequency, intensity, and time
Progression - volume or quantity of exercise completed
weekly is the product of frequency, intensity, and time
PHYSIOLOGICAL CHANGES THAT OCCUR WITH TRAINING
Cardiovascular Changes
Respiratory Changes
Metabolic Changes
APPLICATION OF PRINCIPLES OF AN AEROBIC TRAINING
PROGRAM FOR THE PATIENT WITH CORONARY DISEASE
Inpatient Cardiac Rehabilitation - occurs in the hospital
following stabilization of the patient’s cardiovascular status,
such as MI, valve replacement, or coronary bypass surgery,
and generally lasts 3 to 5 days
Outpatient Cardiac Rehabilitation: Early Exercise Program -
The early outpatient exercise program is initiated within 1 to 3
weeks of discharge from the hospital and lasts up to 36
sessions
➢ are monitored via telemetry to determine HR and
rhythm responses; blood pressure is recorded at rest
and during exercise
Maintenance Programs - Participants are reminded to monitor
their own pulse rate, and a supervisory person is available to
monitor blood pressure.
Special Considerations
➢ Mechanical efficiency
➢ Oxygen uptake
➢ Myocardial efficiency is lower
➢ Myocardial oxygen consumption
Adaptive Changes
➢ Increased myocardial aerobic work capacity.
➢ Increased maximum aerobic or functional capacity
➢ Increased stroke volume
➢ Decreased myocardial demand for oxygen
➢ Increased myocardial supple
➢ Increased tolerance to a given physical workload
➢ Significantly lower HR at each submaximum workload
➢ Improved psychological orientation
APPLICATIONS OF AEROBIC TRAINING FOR THE
DECONDITIONED INDIVIDUAL AND THE PATIENT WITH
CHRONIC ILLNESS
Deconditioning
Reversal of Deconditioning
Adaptations for those with Activity Limitations and
Participation Restrictions
Impairments, Goals, and Plan of Care
AGE DIFFERENCES
Children
• Heart rate:
o HRrest is on the average above 125 (126 in
girls and 135 in boys) at infancy.
o HRrest drops to adult levels at puberty.
o HRmax is age related (220 minus age).
• Stroke Volume:
o Stroke volume is closely related to size.
o Children 5 to 16 years of age have a stroke
volume of 30 to 40 mL
• Cardiac Output - Cardiac output is related to size.
o Cardiac output increases with increasing
stroke volume
• Arteriovenous oxygen difference
o Children tolerate a larger arteriovenous
oxygen difference (a VO2) than adults.
o The larger a-VO2 difference makes up for the
smaller stroke volume.
• Maximum oxygen uptake
o The VO2max increases with age up to 20
years
• Blood Pressure
o Systolic blood pressure increases from 40 mm
Hg at birth to 80 mm Hg at age 1 month to
100 mm Hg several years before puberty.
Adult
o Diastolic blood pressure increases from 55 to
70 mm Hg from 4 to 14 years of age, with
little change during adolescence.
• Respiration
o Respiratory rate decreases from 30 breaths
per minute at infancy to 16 breaths per
minute at 17 to 18 years of age
• Muscle mass and strength
o Muscle mass increases through adolescence,
primarily owing to muscle fiber hypertrophy
and the development of sarcomeres
• Anaerobic ability
o Children generally demonstrate a limited
anaerobic capacity. They produce less lactic
acid which may be due to a limited glycolytic
capacity.
Young Adults
• Heart rate
o HRrest reaches 60 to 65 beats per minute at
17 to 18 years of age (75 beats per minute in a
sitting, sedentary young man).
o HRmax is age related (190 beats per minute
in the same sedentary young man).
• Stroke Volume
o The adult values for stroke volume are 60 to
80 mL (75 mL in a sitting, sedentary young
man).
o With maximum exercise, stroke volume is 100
mL in that same sedentary young man.
• Cardiac output for the sedentary young man at rest
o Cardiac output at rest is 75 beats per minute
x 75 mL, or 5.6 liters per minute
o With maximum exercise, cardiac output is 190
beats per minute x 100 mL, or 19 liters per
minute.
• Arteriovenous oxygen difference
o Approximately 25% to 30% of the oxygen is
extracted from blood as it runs through the
muscles or other tissues at rest o In a normal,
sedentary young man, it increases three-fold
(5.2 to 15.8 mL/dL blood) with exercise.
• Maximum oxygen uptake
o Differences in VO2 between the sexes is
minimal when VO2 is expressed relative to
lean body weight
o In the sedentary young man, maximum
oxygen uptake equals 3,000 mL/min (oxygen
uptake at rest equals 300 mL/min).
• Blood pressure
o Systolic blood pressure is 120 mm Hg
(average)
o At peak effort during exercise, values may
range from as low as 190 mm Hg to as high as
240 mm Hg
o Diastolic blood pressure is 80 mm Hg
(average).
▪ Diastolic pressure does not change
markedly with exercise.
• Respiration
o Respiratory rate is 12 to 15 breaths per
minute
 o Vital capacity is 4,800 mL in a man 20 to 30
years of age.
• Muscle Mass and strength
o Muscle mass increases with training as a
result of hypertrophy
• Anaerobic ability
o Anaerobic training increases the activity of
several controlling enzymes in the glycolytic
pathway and enhances stored quantities of
ATP and PC.

Older Adults

• Heart rate
o HRrest is not influenced by age.
o HRmax is age related and decreases with age
(in very general terms, 220 minus age).
o The average HRmax for men 20 to 29 years of
age is 190 beats/ min.
o For men 60 to 69 years of age, it is 164
beats/min
• Stroke Volume
o Stroke volume decreases in the aged and
results in decreased cardiac output.
• Cardiac output
o Cardiac output decreases with age as the
result of a decrease in stroke volume and
other age-related health changes which
affect preload and afterload.
• Arteriovenous difference
o Arteriovenous oxygen difference decreases
as a result of decreased lean body mass and
low oxygen carrying capacity
• Maximum oxygen uptake
o According to cardiorespiratory fitness
classification, if men 60 to 69 years of age of
average fitness level are compared with men
20 to 29 years of age of the same fitness
level, the maximum oxygen uptake for the
older man is lower (20 to 29 years is 31 to 37
mL/kg per minute; 60 to 69 years is 18 to 23
mL/kg per minute).