Exercise Prescription
運動處方
Stanley Sai-chuen HUIAssociate Professor, Dept. of SSPE, CUHK
Fellow, ACSM
Vice-chairman, HKPFA
許世全教授許世全教授香港中文大學 體育運動科學系香港中文大學 體育運動科學系香港體適能總會 副主席香港體適能總會 副主席
Changes of Physical FitnessChanges of Physical Fitness
Changes of Physical FitnessChanges of Physical Fitness
Effect of 12-week Strength TrainingEffect of 12-week Strength Training
Effect Aerobic Ex on VO2maxEffect Aerobic Ex on VO2max
Foss 1998, Fox Ex Physiology, p. 329
Benefits of Regular Exercise
Improvements in Cardiovascular and Respiratory Function Increased maximal oxygen uptake due to both central
and peripheral adaptations
Lower minute ventilation at a given submaximal intensity
Lower myocardial oxygen cost for a given absolute submaximal intensity
Lower heart rate and blood pressure at a given submaximal intensity
Increased capillary density in skeletal muscle
Increased exercise threshold for the accumulation of lactate in the blood
Increased exercise threshold for the onset of disease signs or symptoms (e.g., angina pectoris, ischemic ST-segment depression, claudication)
Improvements in Cardiovascular and Respiratory Function (cont’)
Reduction in Coronary Artery Disease Risk Factors
Reduced resting systolic/diastolic pressures
Increased serum high-density lipoprotein cholesterol and decreased serum triglycerides
Reduced total body fat, reduced intra-abdominal fat
Reduced insulin needs, improved glucose tolerance
Benefits of Regular Exercise
Decreased Mortality and Morbidity
Primary prevention (I.e.,intervention to prevent an acute cardiac event)
1. Higher activity and/or fitness levels are associated with lower death rates from coronary artery disease
2. Higher activity and/or fitness levels are associated with lower incidence rates for combined cardiovascular diseases, coronary artery disease, cancer of the colon, and type 2 diabetes
Secondary prevention (i.e. interventions after a cardiac event [to prevent another])
1. Based on meta-analyses (pooled data across studies), cardiovascular and all-cause mortality are reduced in post-myocardial infarction patients who participate in cardiac rehabilitation exercise training, especially as a component of multifactorial risk factor reduction
2. Randomized controlled trials of cardiac rehabilitation exercise training involving post-myocardial infarction patients do not support a reduction in the rate of nonfatal reinfarction
Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases
* Few studies, probably less than 5; ** Approximately 5 to 10 studies;*** More than 10 studies.
No apparent difference in disease rates across activity or fitness categories;
Some evidence of reduced disease rates across activity or fitness categories;
Good evidence of reduced disease rates across activity or fitness categories;
Excellent evidence of reduced disease rates across activity or fitness categories, good control of potential confounders, excellent methods, extensive evidence of biological mechanisms, relationship is considered causal.
Disease or Condition
Number of Studies
Trends Across Activity or Fitness Categories and Strength of Evidence
All-cause mortality *** Coronary Artery Disease *** Hypertension ** Obesity *** Stroke *** Peripheral vascular disease
*
Type II diabetes mellitus ** Osteoarthritis * Osteoporosis **
Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases
Disease orCondition
Number ofStudies
Trends Across Activity orFitness Categories andStrength of Evidence
Cancer Colon *** Rectal *** Stomach * Breast ** Prostate *** Lung * Pancreatic *
Results of Studies Investigating the Relationship Between Physical Activity and Incidences of Selected Chronic Diseases
Other Health Benefits
Decreased anxiety and depression Enhanced feelings of well-being Enhanced performance of work,
recreational, and sport activities Increased ability to perform daily living
tasks Reduced muscle and joint injury risk
Improved work performance Enhanced self-concept and esteem Improved socialization Increased energy Greater resistance to fatigue
Other Health Benefits
Agility 敏捷
Balance 平衡
Coordination 協調
Power 肌爆炸力
Reaction time 反應時間
Speed 速度
Motor skill-relatedCardiovascular endurance
心肺耐力Muscular strength and endurance
肌肉力量與耐力Muscular flexibility肌關節柔軟度Body composition身體脂肪百分比
[Neuromuscular Relaxation肌神經鬆馳程度 ]
Health-related
Physical Fitness
Positive Risk Factors for CHD ACSM (2000) Family History Myocardial infarction, coronary revascularization (bypass
surgery) or sudden death before :• the age of 55 years in father or other male first degree relative
(i.e. brother or son)• the age of 65 years in mother or other female first degree relat
ive (i.e. sister or daughter)
Cigarette smoking Current cigarette smoker or those who have quit in the la
st six months
Hypertension Client on Hypertensive medications Resting SBP > 140 mmHg and/ or DBP > 90 mm Hg
Fasting Glucose Fasting blood glucose of 110mg/dL (6.1mmol/L)
Hypercholesterolemia Total serum cholesterol > 200mg/dL (5.2 mmol/L) or High density lipoprotein (HDL) < 35mg/dL (0.9 mmol/L) Low density lipoprotein (LDL) > 130mg/dL (3.4mmol/L) Client is on lipid lowering medications
Obesity Body Mass Index (BMI) > 25 kg/m2 Waist girth >= 90 cm (M); >= 80 cm (F)
Sedentary Lifestyle Accumulating less than 30 minutes moderate intensity exercis
e 3-5 days weekly
Positive Risk Factors for CHD ACSM (2000)
High level of HDL HDL cholesterol > 1.6 mmol/L (60 mg/dl)
Negative Risk Factors for CHD ACSM (2000)
Initial Risk Stratification
Low risk Younger individuals who are asymptomatic and meet
no more than one risk factor threshold
Moderate risk Older individuals (men 45 years of age; women 55
years of age) or those who meet the threshold for two or more risk factors
High Risk Individuals with one or more signs/symptoms or
known cardiovascular, pulmonary, or metabolic disease
ACSM Recommendations for:(A) Medical Examination and Exercise Testing Prior to Participation, and (B) Physician Supervision of Exercise Tests
Low Risk Moderate Risk High Risk
A.
Moderate exercise NN NN R
Vigorous exercise NN R R
B.
Submaximal test NN NN R
Maximal test NN R R
NN - Not Necessary R - Recommended
What to DO next ?
An individual program of exercise based on an individual’s level of fitness and health status; should consider exercise intensity, frequency per week , duration, and mode.
What is Ex. Prescription ?
Unfit Fit
Diseased Healthy & Well
3 – 5 days per week (F) 60 – 90% of HRmax (I) 15 – 60 min per session (T) Rhythmical & aerobic, large muscle acti
vities (running, jogging, cycling …etc.) (T)
1st Exercise Prescription (ACSM, 1978)
FeaturesCV training
Sufficient Intensity & T
Fitness improvement
A Quick Review
1990, the 1st Ex Prescription was revised
Muscular Fitness & Flexibility were added
Recognized moderate ex may have health benefits in addition to CV fitness
1995, Joint ACSM & CDC statements on revised Ex. Prescription
A Quick Review
3 – 5 days per week (F) 55/65% – 90% of HRmax (I) , or 40/50% - 85% VO2R / HRR, or 12-14 RPE 20 – 60 min per session (T) Rhythmical & aerobic, large muscle activities (ru
nning, jogging, cycling …etc.) (T)
Revised Exercise Prescription (ACSM, 1998)
A Quick Review
CV Fitness and Body Composition
Rate of Perceived Exertion Scale. (RPE)
Strength-Training Guidelines.Mode: 8 to 10 dynamic strength-training exercises
involving the body’s major muscle groups.
Resistance: Enough resistance to perform 8 to 12repetitions to near fatigue. (10 to 15repetitions for older and more frail
individuals)
Sets A minimum of 1 set.
Frequency: At least 2 times per week.
Revised Exercise Prescription (ACSM, 1998)
Guidelines for Various Strength-Training Programs.StrengthTrainingProgram
Healthfitness
Maximalstrength
Muscularendurance
Bodybuilding
* Recovery between sets can be decreased by alternating exercises that use different muscle groups.** Weekly training sessions can be increased by using a split body routine.
Resistance
8-12reps max
1-6reps max
10-30Reps
8-20 repsnear max
Sets
3x
3-6
3-6x
3-8x
RestBetween
Sets*
2 minx
3 minx
2 minx
0-1 minx
Frequency(workouts per
week)**
2-3x
2-3x
3-6x
4-12x
Revised Exercise Prescription (ACSM, 1998)
Frequency of Exercise:5 to 6 times a week
Intensity of Exercise:To a point of mild discomfort
Repetitions:Each exercise be done four or five times, holding the final position each time about 10-30 seconds
Types of stretching Static: Holding at the point of tension PNF: Contract / Relax - Using reflexes to your advantage
Flexibility Training Guidelines.
Revised Exercise Prescription (ACSM, 1998)
High relationship among exercise amount (KCal/wk), mortality rates and CHD
Those who expended at least 2,000KCal/wk, CHD mortality rate dropped significantly
Harvard Alumni Study(Paffenbarger et al., 1978, 1984)
Current RecommendationCurrent RecommendationPA vs FitnessPA vs Fitness
Death Rates and RR for Selected Mortality Predictors, Men, ACLS All-Cause Mortality Mortality Predictors
Deaths/10,000 MY
Relative Risk
Low Fit 45.5 2.03 Smoking 42.7 1.89 SBP>140 43.6 1.67 Chol>240 37.0 1.46 BMI>27 34.3 1.33
Death rates and relative risks are adjusted for age and examination yearRelative risks are for risk categories shown here compared with those notat risk on that predictor
Blair SN et al. JAMA 1996; 276:205-10
(Cooper Clinic Study)
Current Recommendation: PA vs FitnessCurrent Recommendation: PA vs Fitness
1996 U.S. Surgeons’ General Report: 1996 U.S. Surgeons’ General Report: Physical Physical Activity and Health (USDHHS / CDC / ACSM)Activity and Health (USDHHS / CDC / ACSM)
AccumulatingAccumulating at least at least 30 minutes30 minutes of of any any kindkind of of moderate intensity physical moderate intensity physical activityactivity on on most daysmost days of the week of the week
would effectively reduce the risk of would effectively reduce the risk of coronary heart disease, type 2 diabetes, coronary heart disease, type 2 diabetes, hypertension, stroke and some kinds of hypertension, stroke and some kinds of cancercancer
Current RecommendationCurrent Recommendation
A ComparisonPreviousRecommendation Emphasize on fitness Continuous 20 min /
session Emphasize on structured
exercise (esp. aerobic ex, strength training, stretching)
Emphasize sufficient intensity
Current Recommendation Emphasize on PA Any kind of PA At least 30 min Accumulated 30 min Moderate intensity
(150 Kcal) Most days of week
Ex Activity
Advantages of New Guidelines
Easier for inactive individuals More effective for PA promotion Health first then fitness Good for “BUSY” people More effective to low overall health
cost
Problems of New Guidelines Still a bit vague to many people What is “accumulate” means? 10+10+10 ? 5 x 6 ? 1+1+1+…etc? What is most days? How many days
exactly ? Give me a simple answer ? What is “moderate” means ? What is “any kind” of PA? How about home
activities or labor intensive activities during work
A 2nd Revision of New Guidelines An expert panel has been formed by CDC /
USDHHS 2005, consensus conf 2006 Atlanta. Revision were suggested: Accumulate at least 10 min / interval most days? 5 days Moderate? heavy breathing yet can talk Any kind? as long as you don’t sit Reinstate the advantages of vigorous ex
A 2nd Revision of New Guidelines (Aug 2007)
To promote and maintain health, all healthy adults aged 18 to 65 yr need
moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min (accumulated) on five days each week; or
vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week.
A 2nd Revision of New Guidelines (Aug 2007)
Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. For example:
walking briskly for 30 min twice during the week and then jogging for 20 min on two other days.
A 2nd Revision of New Guidelines (Aug 2007)
Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can beaccumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes.
A 2nd Revision of New Guidelines (Aug 2007)
Vigorous-intensity activity isexemplified by jogging, and causes rapid breathing and a substantial increase in heart rate.
A 2nd Revision of New Guidelines (Aug 2007)
Every adult should perform activitiesthat maintain or increase muscular strength and endurance a minimum of two days each week
A 2nd Revision of New Guidelines (Aug 2007)
Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseasesand disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity.
Still there is a problems !! Exercise / PA is not only a personal
factor Many external factors interact to
affect one’s PA For example: environment, public
policy, school systems… Future trends: We need guidelines for
external factors …
More Work to Do !! PA Guidelines for environment PA Guidelines for school PA Guidelines for parents PA Guidelines for Policy makers …..
New Technology: GPSGlobal Position SystemTracking Space of PA (i.e. environment)
What Is the Best Exercise (Activity)?
The one you will do regularlyNo matter how excellent the exercise is
or how effective the program might be, it will not produce any benefits for you if you do not do it
The End