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Scott K. Powers Edward T.

Howley

Theory and Application to Fitness and Performance


SEVENTH EDITION

Chapter

Exercise Prescriptions
for Health and Fitness

Presentation prepared by:

Brian B. Parr, Ph.D.


University of South Carolina Aiken
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Chapter 16

Objectives
1. Characterize physical inactivity as a coronary
heart disease risk factor comparable to smoking,
hypertension, and high serum cholesterol.
2. Contrast exercise with physical activity; explain
how both relate to a lower risk of CHD and
improvement in cardiorespiratory fitness (CRF).
3. Describe the physical activity recommendation by
the American College of Sports Medicine and the
Centers for Disease Control and Prevention to
improve health status of sedentary U.S. adults.
4. Explain what screening and progression mean for
a person wishing to initiate an exercise program.
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Chapter 16

Objectives
5. Identify the optimal range of frequency, intensity, and
duration of activity associated with improvements in
CRF; why is more not necessarily better than less?
6. Calculate a target heart rate range by either the heart
range reserve or percent of maximal HR methods.
7. Explain why the appropriate sequence of physical
activity for sedentary persons is
walkwalk/jogjoggames.
8. Explain how the target heart rate (THR) helps adjust
exercise intensity in times of high heat, humidity, or
while at altitude.

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Chapter 16

Outline
Prescription of
Exercise
Dose-Response
Physical Activity and
Health

Exercise Prescription
for CRF
Frequency
Duration
Intensity

Strength and
Flexibility Training
Environmental
Concerns

General Guidelines for Sequence of Physical


Activity
Improving Fitness
Screening
Progression
Warm-Up, Stretch, and
Cool-Down, Stretch

Walking
Jogging
Games and Sports

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Introduction

Chapter 16

Introduction
Physical activity
Any form of muscular activity
Can reduce the risk of death from all causes
Physical inactivity is a primary risk factor for
coronary heart disease
Physical fitness
Set of attributes that relate to ability to perform
physical activity
Exercise
A subset of physical activity that is planned, with a
goal of improving or maintain fitness
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Introduction

Chapter 16

In Summary
Physical inactivity has been classified as a primary risk
factor for coronary artery disease.
Regular participation in physical activity can reduce the
overall risk for those who smoke or who are
hypertensive.
Those who increase their physical activity and/or
cardiorespiratory fitness have a lower death rate from all
causes compared to those who remain sedentary.

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Prescription of Exercise

Chapter 16

Dose-Response Relationships
The effect (response) of the amount of a drug
(dose)
Potency
Relatively unimportant characteristic

Slope
How much change in effect comes from a change in dose

Maximal effect
Efficacy

Variability
Effect varies between and within individuals

Side effect
Adverse effect
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Chapter 16

Prescription of Exercise

The Relationship Between Dose of a


Drug and Effect

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Figure 16.1

Prescription of Exercise

Chapter 16

Dose-Response
Dose
Intensity

%VO2 max
% maximal heart rate
Rating of perceived exertion
Lactate threshold

Frequency
Number of days per week
Number of times per day

Duration
Number of minutes of exercise
Total kcals expended
Total kcals expended per kilogram body weight
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Prescription of Exercise

Chapter 16

Dose-Response
Response
Specific changes

VO2 max
Resting blood pressure
Insulin sensitivity
Body weight (% fat)
Depression

Health and Fitness changes

Improving fitness, leading to improved health


Improving fitness and health simultaneously or separately
Improving fitness, but not health
Improving health, but not fitness
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Chapter 16

Prescription of Exercise

In Summary
An exercise dose reflects the interaction of the intensity,
frequency, and duration of exercise.
The cause of the health-related response may be related
to an improvement in VO2 max or may act through some
other mechanism, making health-related outcomes and
gains in VO2 max independent of each other.

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Prescription of Exercise

Chapter 16

Physical Activity and Health


The ACSM/CDC recommendation (1995):
Every U.S. adult should accumulate thirty minutes
or more of moderate-intensity (36 METs) physical
activity on most, preferably all, days of the week.
The ACSM/AHA recommendation (2007):
To promote and maintain health, all healthy adults
aged 18 to 65 years need moderate-intensity
aerobic (endurance) physical activity for a minimum
of 30 min on five days each week or vigorousintensity aerobic physical activity for a minimum of
20 min on three days each week.
Included resistance training
810 exercises, 812 reps, two or more non-consecutive
days per week
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Chapter 16

Prescription of Exercise

Pattern of Responses to Exercise


Acute response
Occur with one or several exercise bouts but do not
improve further
Rapid responses
Benefits occur early and plateau
Linear
Gains are made continuously over time
Delayed
Occur only after weeks of training

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Prescription of Exercise

Chapter 16

Dose-Response Relationship
for Exercise

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Figure 16.2

Chapter 16

Prescription of Exercise

Dose-Response Relationship for


Physical Activity and Health Benefit

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Figure 16.3

Chapter 16

Prescription of Exercise

Clinical Applications 16.1

Dose-Response: Physical Activity


and Health

Higher levels of physical activity associated with:


Lower rates of all-cause mortality, total CVD, and
CHD incidence and mortality
Lower risk of obesity and type 2 diabetes, lower risk
of mortality in those with type 2 diabetes
Lower risk of colon cancer and osteoporosis
Improved ability to complete activities of daily living
Reduction in depression and anxiety
Favorable changes in cardiovascular disease risk
factors
Clear dose-response relationship not established
between physical activity and other health
outcomes hasCopyright
not2009
been
established
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Prescription of Exercise

Chapter 16

Clinical Applications 16.2

Is Vigorous Exercise Better than


Moderate Activity?
Vigorous-intensity PA was associated with reduced
risk of CHD compared to lower intensities
CHD risk factors also lower
Vigorous-intensity PA was more beneficial for
altering CHD risk factors
In some cases, equal to moderate-intensity PA
Higher intensity PA associated with:
Greater impact on CHD risk factors
Less sick leave
Moderate intensity PA
36 METs
May be vigorous for deconditioned subjects
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Chapter 16

Prescription of Exercise

In Summary
In 2007 the ACSM and AHA updated the public health PA
recommendation: To promote and maintain health, all
healthy adults aged 18 to 65 years need moderateintensity aerobic (endurance) physical activity for a
minimum of 30 min on five days each week or vigorousintensity aerobic physical activity for a minimum of 20
min on three days each week.
Resistance training (810 exercises, 812 reps, two or
more non-consecutive days per week) was added as a
formal part of the recommendation.

Copyright 2009 The McGraw-Hill Companies, Inc. All Rights Reserved.

Chapter 16

General Guidelines for Improving Fitness

General Guidelines for Improving Fitness


Moderate physical activity results in reducing
health-related problems
Risk associated with PA is low
Risk of cardiac arrest in vigorously active men
Higher during exercise
Lower overall (exercise + rest) risk

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Chapter 16

General Guidelines for Improving Fitness

In Summary
In previously sedentary subjects, small changes in
physical activity result in large health benefits with only
minimal risk.
Strenuous exercise increases the risk of a heart attack
during the activity, but reduces the overall (rest +
exercise) risk of such an event.
Moderate to high levels of cardiorespiratory fitness
reduce the risk of death from all causes.

Copyright 2009 The McGraw-Hill Companies, Inc. All Rights Reserved.

General Guidelines for Improving Fitness

Chapter 16

General Guidelines for Improving Fitness


Screening
Risk of cardiovascular complications is related to
degree of pre-existing cardiac disease
Progression
Start with moderate-intensity activity
Walking 34 mph

Then increase duration and/or intensity


Walkwalk/jogjog

Warm-up, stretch and cool-down, stretch


Light exercise and stretching performed at beginning
and end of exercise session
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Chapter 16

Exercise Prescription for CRF

Exercise Prescription for CRF


Frequency
24 sessions per week minimum
2 sessions with higher-intensity exercise
Gains level off after 3 to 4 sessions/week
Duration
Total work per session should be 200300 kcal
Must be considered with intensity
Intensity:
Describes the overload needed to bring about a
training effect
60%80% of VO2 max
Lower in those with low initial fitness level

Target heartCopyright
rate2009range
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Chapter 16

Exercise Prescription for CRF

Exercise Prescription for CRF


Dynamic, large muscle activities
Walking, jogging, running, swimming, cycling,
rowing, dancing
ACSM recommendation
35 sessions per week
2060 min per session
Intensity of 40/5085% HRR or VO2R
Should result in expenditure of 200300 kcal per
session
Consistent with weight loss and reducing CHD risk
factors
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Chapter 16

Exercise Prescription for CRF

Intensity, Duration, and Frequency of


Exercise and VO2 Max

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Figure 16.4

Exercise Prescription for CRF

Chapter 16

Determining Target Heart Rate Range


Direct method
THR range determined from maximal GXT
HR at 6080% VO2 max
Indirect method
Heart rate reserve (Karvonen) method
Subtract resting HR from maximal HR to obtain HRR
Take 60% and 80% of HRR
Add each HRR to resting HRR to obtain THR range

Percentage of maximal HR
Take 70% and 85% of maximal HR as THR range

Use RPE scale in addition to HR


RPE of 1216 is about 40/5085% HRR
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Chapter 16

Exercise Prescription for CRF

Target Heart Rate Range Determined


From GXT

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Figure 16.5

Exercise Prescription for CRF

Chapter 16

Clinical Applications 16.3

Prescribing Exercise Intensity by the


VO2 Reserve (VO2R) Method

VO2 Reserve
Difference between VO2 max and resting VO2

% HRR more closely linked to % VO2R than % VO2 max

When measured maximal HR is known


Error is 6%

Most useful at low fitness levels


Large discrepancies between % HRR and % VO2R

60% HRR = 606% VO2R

When maximal HR is estimated


Error in estimating maximal HR (11 beatsmin1) is added to
error in estimating % VO2 max or % VO2R
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Chapter 16

Exercise Prescription for CRF

Percent VO2 Max at Different HRR and


VO2 Max Values

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Chapter 16

Exercise Prescription for CRF

In Summary
A sedentary person needs to go through a health status
screening before participating in exercise.
Exercise programs for previously sedentary persons
should start with low-intensity activities (walking), and the
person should not progress until he or she can walk
about four miles comfortably.
The optimal characteristics of an exercise program are:
intensity = 6080% VO2 max; frequency = 34 times per
week; duration = minutes needed to expend about 200
300 kcal.
The THR range, taken as 6080% HRR, or 7085% of
maximal HR, is a reasonable estimate of the proper
exercise intensity.
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Chapter 16

Sequence of Physical Activity

Sequence of Physical Activity


Walking
Recommended activity for sedentary
Start at a comfortable speed for 15 minutes
Gradually increase duration and speed
Jogging
Start by adding some running when walking
Gradually increase speed/duration of running
Games and sports
Intermittent higher-intensity activities within
THR range
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Chapter 16

Sequence of Physical Activity

An Example of a Walking Program

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Chapter 16

Sequence of Physical Activity

An Example of a Jogging Program

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Chapter 16

Strength and Flexibility Training

Strength and Flexibility Training


Muscular strength and flexibility are important
components of a complete fitness program
Weight control
Complete activities of daily living safely
ACSM Recommendation
Dynamic exercises
Done on routine basis

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Strength and Flexibility Training

Chapter 16

Clinical Applications 16.4

Strength Training: Single Versus


Multiple Sets
ACSM recommendation
One set of 810 exercises (major muscle groups)
812 reps per set
23 sessions per week
Multiple sets more effective for improving strength
Single set sufficient when maximal strength gain is
not the primary goal
For maximal gains in strength
Untrained: four sets at 60% 1-RM, three days/week
Trained: four sets at 80% 1-RM, two days/week
Athletes: eight sets at 85% 1-RM, two days/week
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Chapter 16

Strength and Flexibility Training

Physical
Activity
Pyramid

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Figure 16.6

Chapter 16

Strength and Flexibility Training

In Summary
A logical progression of physical activities is from walking
to jogging to games. The progression addresses issues
of intensity, as well as the risk of injury. For many,
walking may be their only aerobic activity.
Strength and flexibility activities should be included as a
regular part of an exercise program.

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Environmental Concerns

Chapter 16

Environmental Concerns
Environmental conditions can elevate exercise
heart rate
Heat and humidity
Increases blood circulation to skin

Altitude
Decreases oxygen bound to hemoglobin

Adjust exercise intensity in adverse environments


Use THR range as a guide for intensity
Exercise in cold is typically safe
Dress appropriately
Avoid dangerous cold/wind conditions
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Chapter 16

Environmental Concerns

In Summary
The THR acts as a guide to adjust exercise intensity in
adverse environments such as high temperature and
humidity, or altitude.
A decrease in exercise intensity will counter the effects of
high environmental temperature and humidity to allow
one to stay in the target HR zone.

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Chapter 16

Study Questions
1.

What are the practical implications of classifying physical


inactivity as a primary risk factor?

2.

From a public health standpoint, why is there so much


attention paid to increasing a sedentary persons physical
activity by a small amount rather than recommending
strenuous exercise?

3.

What is the risk of cardiac arrest for someone who


participates in a regular physical activity program?

4.

What is the difference between exercise and physical


activity?

5.

List the optimal frequency, intensity, and duration of


exercise needed to achieve an increase in cardiorespiratory
function.
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Chapter 16

Study Questions
6.

For a person with a maximal heart rate of 180 bmin1 and a


resting heart rate of 70 bmin1, calculate a target heart rate
range by the Karvonen method and the percent of maximal
HR method.

7.

Recommend an appropriate progression of activities for a


sedentary person wishing to become fit.

8.

Why is it important to monitor heart rate frequently during


exercise in heat, humidity, and at altitude?

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