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Individuals undergoing stress testing should have a physical examination, be monitored by the ECG, and the closely observed at rest, during exercise, and during recovery.

measuring the individual’s maximum oxygen consumption  .Changing the workload by increasing the speed and/or grade of the treadmill or the resistance on the bicycle ergometer  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 at the onset of symptoms or a definable abnormality of the ECG  When available.

 Assists in the selection and evaluation of appropriate modes of treatment for heart disease.  Evaluates cardiovascular functional capacity as a means of clearing individuals for strenuous work or exercise programs.  Determines the physical work capacity in kilogram-meters per minute (kg-m/min) or the functional capacity in METs.  Evaluates responses to exercise training and/or preventive programs.  .Helps establish a diagnosis of overt or latent heart disease.

 It can also evaluate the functional capacity of pt.  .  It used clinically to evaluate pt. have a coronary disease. with chest sensations or a history of chest pain to establish the probability that such pt. with chronic disease.Increases individual motivation for entering and adhering to exercise programs.

and during recovery. during exercise.  Be monitored by ECG and closely observed at rest.Have had a physical examination.  .  Sign a consent form.

 Excessive rise in blood pressure. or peripheral circulatory insufficiency. pallor. confusion.  Lightheadedness.  Subject wishes to stop.Progressive angina  A significant drop in systolic pressure in response to an increasing workload. nausea.  Abnormal ECG response including ST segment depression greater than 4 mm.  .

 Diastolic pressure should not exceed 120 mm Hg  Rate and Depth of respiration increase with exercise  .Monitor the pulse to assess abnormal increases in heart rate  Blood pressure increases with exercise approximately 7 to 10 mm of mercury per MET of physical activity  Systolic pressure should not exceed 220 to 240 mm Hg.

moist and warm to touch. and earlobes. and meets the demands of working muscles. results in changes in the skin of the cheeks.Respiration should not be labored  The individual should have no perception of SOB  The increase in blood flow while exercising.  . which regulates core temp. nose. They become pink.

Treadmill speed and grade are changed every 3 minutes. and the initial grade of 10% increases up to 18% during five stages. equipment to be used.     Can provide a direct measurement of VO2 max by analyzing samples of expired air. position of the body. The most popular treadmill protocol is the BRUCE PROTOCOL. Differences in protocols involve the number of stages.7 mph up to 5. . endpoints.0 mph. Speed increases from 1. magnitude of the exercise. and types of effort. duration of stages. Protocols have been developed for multistage testing. muscle groups exercised.

 Optimal frequency of training is generally 3 to 4 times a week.  Frequency may be less important factor than intensity of duration training.  Frequency varies.There is no clear-cut information provided on the most effective frequency of exercise for adaptation to occur.  . dependent on the health and age of the individual.

 A frequency of 2 times a week does not generally evoke cardiovascular changes. may benefit from a program of that frequency.  .Low intensity. greater frequency may be beneficial. although older individuals and convalescing pt.

 Overload principle  Specificity principle  Reversibility principle .

 is stress on an organism that is greater than that regularly encountered during daily life.  The higher the initial level of fitness. age. the greater the intensity of exercise needed to elicit a change. level of activity. the training intensity must be increase for the individual to achieve further improvement.  Once adaptation to a given load has taken place. .  Level of health.  Exercise load  Must be above the training stimulus threshold for adaptation to occur. gender.

 Methods to determine Maximum heart rate and Exercise rate. A conditioning response occurs at 60% to 90% maximum heart rate (50% to 85% VO 2 max ) Depending on the individual and the initial level of fitness. › Determine Maximum heart rate (HR)  From multistage test  HR achieved in predetermined submaximum test  220 minus age › Determine Exercise heart rate  Percentage of maximum heart rate  Karvonen’s formula  Exercise heart rate= HR rest + 60-70% (HR max .HR rest ) .

When training for swimming events.  Workload and work.Adaptation in metabolic and physiological systems depending on the demand imposed. › Aerobic training specific to the type of activity. the individual may not demonstrate an improvement in VO2max . › Anaerobic training without training the anaerobic systems. › Aerobic or Endurance training without training the anaerobic periods are selected so training result in:  › Muscle strength without a significant increase in total oxygen consumption.

Dependent on  Total work performed  Intensity  Frequency  Fitness level Greater Intensity Duration Lower Intensity Duration Shorter Longer .

20 – 30 minute of session is generally optimal to 60% to 70% maximum of heart rate. o 45 minute continuous exercise period may provide the appropriate overload. o 10 – 15 minute exercise period o 3 – 5 minute daily period o .

System (Specific principle)  .Large muscles  Rhythmic  Aerobic such as Cycling and running the overload msut use the muscles required by the activity and stress the cardiorespi.

and improvements can be lost within several months. significant reductions in work capacity can be measured. With loss of the ability to carry out normal daily activities as a result of  . the individual becomes severely deconditioned.The beneficial effects of exercise training are transient and reversible.  Detraining exercise occurs rapidly when a person stop exercising. After 2 weeks of detraining.  A similar phenomenon occurs with individuals who are confined to bed with illness or disability.

 The frequency or duration of physical activity required to maintain a certain level of aerobic fitness is less than that required to improve it. .

Warm up period  Aerobic exercise period  Cool down period  .

Muscle temperature  Need for oxygen to meet the energy demands for the muscle  Vasodilation  Adaptation of respiratory centers  Venous return  .

 Risk for ECG changes (arrythmias) › Guidelines  Should nbe Gradual and Sufficient to Increase muscle and core temperature without causing fatigue or reducing energy stores. .  Characteristic of period include:  10 minute period of total body movement exercise such as calisthenics and walking slowly.  Attaining heart rate that is within 20 beats/min of the target heart rate. Purpose › Prevent or Decreases  Musculoskeletal system to injury.

 Emphasized  Continuous  Interval  Circuit  Circuit interval  .Is the conditioning part of the exercise program.

20 – 60 minutes  Most effective in increasing endurance for healthy individuals  Work rate us Increased progressively as training improvements are achieved.Submaximal and sustained  Achievement of the steady state  Duration.  Increase exercise duration  .

5 work interval allows the succeeding exercise interval to begin before recovery is complete .  Exercise period is followed by rest interval  › Rest relief (Passive recovery) › Work relief (Active recovery)  Work recovery ratio › 1:1 to 1:5  1 : 1.Is perceived to be less demanding than continuous training.  Improve strength and power more than endurance.

Circuit Training Series of exercise activities  Several exercise modes  Improves both strength and endurance  .

Combining Circuit and Interval Training effective  Stresses both aerobic and anerobic systems  Delays the need for glycolysis and lactic acid production  .

Is similar to the warm up period in that it should last 5 – 10 minutes and consist of the total body movements and static stretching. . arrhythmias or other cardiovascular complications.  Prevents  › Pooling of blood › Fainting › Enhance recovery period With the oxidation of metabolic waste and replacement of the energy stores. › Myocardial ischemia.

 Cardiovascular Changes  Respirator Changes  Metabolic Changes .

. Changes at Rest › Reduction in the resting pulse rate occurs in some individual › Decrease in blood pressure › Increase in blood volume and hemoglobin  Changes During Exercise › Reduction in the resting pulse rate occurs in some › › › › individual Increased stroke volume Increased cardiac output Increased extraction of oxygen by the working muscle Decreased blood flow per kilogram of the working muscle.

 Changes at Rest › Large lung volumes › Larger diffusion capacities  Changes during Exercise › Larger diffusion capacities › Maximum diffusion capacity is unchanged › Maximal Ventilation is Increased › Ventilatory efficiency increased .

› Increased fat mobilizing and Fat metabolizing enzymes. Number and size of mitochondria are increased Increase capacity to generate ATP aerobically. Changes at Rest › Muscle Atrophy and Increased Capillary density › › › › occurs. .  Changes during Exercise › Decreased rate of depletion in muscle glycogen at submaximum work level. Increase Muscle myoglobin Concentration Increase the rate of oxygen transport and diffusion to the mitochondria.

. Changes during Exercise › Lower blood lactate level at submaximal work › Mechanism is unclear › Less reliance on phosphocreatine (PC) and ATP in skeletal muscle › Increased Capability to oxidize carbohydrate › Increased Oxidative potential of the mitochondria › Increased Glycogen storage in the muscle.

Decrease in body fat  Decrease on blood cholesterol and triglyceride levels.  .  Increase in the breaking strength of the bones and ligaments and the tensile strength in tendons.  Increased Heat acclimatization.

END  .