Exercise Programming:From Initial Screening(s) and Baseline Assessments to the Exercise Prescription

Fitness/Wellness Specialist Responsibilities

• Educate clients

• Conduct pretest health evaluationsConduct pretest health evaluations

• Select, administer, interpret tests to assess Select, administer, interpret tests to assess components of physical fitnesscomponents of physical fitness

• Design exercise prescriptionsDesign exercise prescriptions

• Lead classes/Give presentations

• Analyze client exercise performance and correct errors

• Motivate clients

• Reassess clients/athletes – be dynamic!

The Exercise “Science Artist”“….exercise prescription is the successful integration of exercise science with behavioral techniques that result in long term program compliance and attainment of the individual’s goals.”

ACSM Guidelines for Exercise Testing andPrescription, 2000, pg 140

Exercise Programming and Prescription

Definition:

Elements of Exercise Prescription

FITT-P

Exercise Prescription vs. Health Related Fitness

Factors To Consider When Designing An Exercise Prescription

• Health status

• Risk factor profile

• Medical evaluation

• Individual’s goals

• Baseline values

• Exercise preferences

• Program design principles

• Adherence factors

Why do we care about health screening and risk stratification?

Health Screenings• Par – Q

• Medical History Questionnaire

• Coronary Risk factor analysis

• Disease Risk Classification

• Informed Consent

• Physical Exam

• Lipid Panel and Glucose Levels

• Blood Pressure

• 12-Lead ECG

• Graded Exercise Test

Clinical Tests

Self-Guided Screening

•PAR-Q and You▫Physical Activity Readiness Form

Figure 2.1, p. 24 (ACSM) For pregnancy, p. 196 (ACSM)

•AHA/ACSM Health/Fitness Facility Pre-participation Screening Questionnaire ▫Figure 2.2, p. 25 (ACSM)

Professionally Guided Screening •Health fitness/clinical assessment and activity

programming conducted and supervised by appropriately trained personnel

•Professionally guided screening includes:▫Coronary Risk factor analysis▫Review more detailed health/medical hx info

and risk stratification▫Detailed recommendations for PA/exercise,

medical exam, exercise testing, physician supervision

CVD Risk Factor Thresholds for Use with ACSM Risk Stratification

•Positive and Negative Risk Factors

(Table 2.2, p. 27, ACSM)

CVD Risk Factor Thresholds for Use with ACSM Risk Stratification

Positive Risk Factors (Table 2.2, p. 27, ACSM)

CVD Risk Factor Thresholds for Use with ACSM Risk Stratification

Positive Risk Factors (Table 2.2, p. 27, ACSM)

Calculating BMI• BMI = weight in kg. / height in meters2

Weight: 180 lbs Height 5 ft. 8 in.

What is the client’s BMI classification?

Weight: 257 lbHeight 5 ft. 9 in.What is the client’s BMI classification?

BMI Classification

Hypertension

Cholesterol Classifications

ClassificationClassification TCTC LDL-CLDL-C TGTG

Optimal

Near/above optimal

100-129

Borderline High

High >240 160-189 200-499

Very High >190 >500

HDL–C Classification

Classification HDL-C

Low

Normal

High (this is good!)

Fasting Blood Glucose

From 70 to 99 mg/dL

From 100 to 125 mg/dL

>126 mg/dL on more than one test

CVD Risk Factor Thresholds for Use with ACSM Risk Stratification

Negative Risk Factors (Table 2.2, p. 27, ACSM)

How do I remember all of those risk factors?

Case Study #1•Bob Marley

▫54 year old male▫Cigarette smoker▫Brother died of MI age 55▫BP: 130/82▫HDL-C: 44 mg/dL▫TC: 188 mg/dl▫Fasting glucose: 112 mg/dl (verified 2x)▫Height: 5’7.5”; Weight: 160 lbs▫Light activity 3 days/week, 30 min (last 3

years)▫Medications: ACE-inhibitor, diuretic

• Jane is a 46 year old female. She has a family history of breast cancer (mom was diagnosed at 47 and sister at 36). She quit smoking when she was 21. She has been walking briskly (mod) for 45 minutes, 3 days per week, for the last 6 months. Her height is 5’2” and she is 130 lbs and her waist circumference is 33”. Her cholesterol and glucose levels are all within normal range, though her HDLs are 62mg/dl. Her blood pressure is 126/88.

Medications

• Blood pressure control **▫ Diuretics ▫ Beta-blockers ▫ ACE Inhibitors▫ Angiotensin II receptor

blockers ▫ Calcium channel blockers▫ Vasodilators▫ Nitrates

• Asthma **▫ Oral or inhaled bronchodilators

• Glycemic control▫ Biguanides (Metformin,

Glucophage)▫ Alpha-glucosidase inhibitors

(Precose, Glyset)▫ Sulfonylureas (Glucotrol,

Amaryl)

• Cholesterol lowering▫ Statins (Lipitor, Zocor,

Provachol)▫ Nicotinic acid (Niacin)▫ Fibrates

• Thyroid **▫ Thyroid hormone medici

ne, levothyroxine sodium (Synthroid, Levoxyl, or Levothroid)

Medications• Beta blocker (BP)

▫ Decrease force of contraction▫ Decrease cardiac workload▫ Decrease demand for O2 in

myocardium• Nitrates (BP)

▫ Vasodilator▫ Decrease preload and cardiac

workload• Ca2+ channel blockers (BP)

▫ Prevent vasoconstriction▫ Prevent coronary artery spasm▫ Increase O2 supply to

myocardium

• Diuretic (BP)▫ Increase H2O

excretion▫ Decrease blood

volume• Ace inhibitor (BP)

▫ Prevent vasoconstriction

▫ Prevent H20 retention▫ Decrease blood

volume

MedicationsMeds HR BP

Beta Blocker

Nitrate

Calcium Channel Blocker

Diuretics

Ace Inhibitors

Bronchodilators

Thyroid meds

Nicotine

Table 2.1 ACSM Risk Stratification Categories for Atherosclerotic CVD (Figure 2.4 ACSM p. 28)

•CVD, pulmonary, or metabolic disease

▫CVD: Coronary, peripheral vascular, or cerebrovascular disease

▫Pulmonary: COPD, asthma, interstitial lung disease, cystic fibrosis

▫Metabolic: diabetes (I or II), thyroid disorders, renal, or liver disease

Cardiovascular, Pulmonary, and Metabolic Disease - - HIGH RISK!

Major symptoms or signs suggestive of cardiopulmonary or metabolic disease.* ___________________________________________________ 1. Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw,

arms, or other areas that may be ischemic in nature 2. Shortness of breath at rest or with mild exertion 3. Dizziness or syncope (fainting) 4. Orthopnea/paroxysmal nocturnal dyspnea (labored breathing;

discomfort in breathing in any but erect position) 5. Ankle edema 6. Palpitations or tachycardia 7. Intermittent claudication 8. Known heart murmur 9. Unusual fatigue or shortness of breath with usual activities ___________________________________________________ *These symptoms must be interpreted in the clinical context in which they appear, since they are not all specific for cardiopulmonary or metabolic disease. See description of each in ACSM Guidelines. ___________________________________________________

Figure 2.3 ACSM p. 26

ACSM Figure 2.3

Case Study•Lolo Jones

▫26 years old, non-smoker▫BMI: 24.6 kg/m2▫Asthmatic, normal cholesterol and BP▫Fasting glucose: 85 mg/dl▫Sprint athlete – works out 6 days/week 2+

hours per day (vigorous activity) for last 2 years

▫No family history of heart disease▫Sister, 22, has Type 2 diabetes

Exercise Testing and Participation Recommendation Based on Risk

•Once risk classification established, appropriate recommendations may be made regarding:

Maximal Graded Exercise Test (GXT),

Reasons for Max. Testing in the Clinical Setting:

To find the true max. HR for exercise prescription

To measure or estimate VO2 max. To determine baseline aerobic fitness level

To help plan a safe and effective exercise program

To aid in the diagnosis of CVD in the mod. risk or in those who are symptomatic (*with ECG*)

To follow the progress of known disease (*with ECG)

Submaximal Exercise Tests

•Sheri is a low risk client. She was told by her previous trainer that she should not have a GXT done because according to ACSM GXTs are only for moderate to high risk clients.

•Do you agree or disagree with her previous trainer? Why?

Metabolic Syndrome

>100

Factors To Consider When Designing An Exercise Prescription

• Health status

• Risk factor profile

• Medical Evaluation

• Individual’s goals

• Baseline Values

• Exercise preferences

• Program Design Principles

• Adherence factors

Purpose of Health Related Fitness Testing•Educate participants about present

health-related fitness status relative to standards and age and gender norms

•Provide data helpful in development of exercise prescriptions▫Address all fitness components▫Baseline data and follow – up▫Motivate participants▫Stratify risk

Components of Health Related Fitness1. Body weight and body composition

2. Cardiorespiratory Endurance (Fitness)

3. Muscular Endurance

4. Muscular Strength

5. Flexibility

Measures of Weight or Body Comp.

Anthropometric measures:

Cardiorespiratory Endurance (CRE) / Cardiorespiratory Fitness (CRF)

•Ability of heart, lungs, and circulatory system to supply O2 and nutrients effectively to working muscles

•Typically expressed as VO2max

•Clinical submaximal and maximal tests

▫Field tests

Musculoskeletal Fitness• Ability of skeletal muscle systems to perform

work

• Muscle strength

• Muscle endurance

Muscular Strength Testing

Grip Strength One Repetition

Max. 4, 5, or 6 Rep Max

•Muscular Endurance Testing

Curl Up Push Up

Flexibility• “Sit and Reach”

test

Components of Health Related Fitness1. Body weight and body composition

2. Cardiorespiratory Endurance (Fitness)

3. Muscular Endurance

4. Muscular Strength

5. Flexibility

Test Validity, Reliability, and Objectivity•Validity

•Reliability

•Objectivity

Prediction equations

•To whom is equation applicable?▫Population specific vs. general

•How were variables measured by the researchers who developed equation?

Feasibility

Efficacy

Health history

Goals

Things to keep in Things to keep in mind:mind:

Preparing to Test Your Client/Athlete

What should be the proper order of testing?

• Flexibility

• Body composition

• Muscular fitness

• HHQ/Risk stratification

• CRE / CRF

• Resting BP and HR

Give client specific instructions as to what to wear, what to bring, and what to expect on testing day!

Always have your supplies and equipment ready before the client arrives!

Make the client as comfortable as possible!

Be professional, be confident, be yourself!

Test Interpretation

•Calculate necessary values

•Classify client results by comparing to established norms or percentile rank

•Discuss results with clients▫Provide hard copy of results to client▫Keep a copy for your records!

Factors To Consider When Designing An Exercise Prescription

• Health status

• Risk factor profile

• Medical Evaluation

• Individual’s goals

• Baseline Values

• Program Design Principles

• Exercise preferences

• Adherence factors

Characteristics of Exercise Program Dropouts & Factors Related to “Dropping Out”

Reinforcing Factors for Exercising (Promoting Adherence)

Exercise Program Design Principles

Exercise Program Design Principles•Specificity of Training•Overload training•Progression•Initial values•Inter-individual variability•Diminishing returns•Reversibility

Principle of Specificity

The training effects from any exercise are specific to the activity and the muscles involved.

Overload Training

Progression

Inter-individual variability

•Responses to a training stimulus vary amongst individuals

•What are some factors that vary amongst individuals?

Initial Values

Diminishing Returns

Reversibility

Genetic Ceiling

Clinical Tests• Physical Exam

• Lipid Panel and Glucose Levels

• Blood Pressure

• 12-Lead ECG

• Graded Exercise Test

Case Study

•Height: 5’5”•Weight: 138lbs

Case Study

•Sonia Sotomayor ▫ 44 year old female with BMI of 23 kg/m2; ▫ WC = 35inches▫ BP: 134/82; does not smoke▫ HDL-C: 42 mg/dl▫ Father had MI age 42, Sister MI age 50▫ Brother has T2DM, diagnosed age 35▫ Fasting glucose: 95 mg/dl ▫ Mod exercises 5 days per week, 30 min (last 2

months)▫ Meds: aspirin for knee pain from a sporting

injury

Case Study• Mike Magiske

▫62 year old, sedentary male▫Quit smoking 5 months ago▫Impaired fasting glucose

(Pre-diabetes/insulin resistance)▫Obese --Low HDLs▫Normal Triglycerides▫Mother died of CVD age 57

•You have determined that Spencer is a high risk client. Spencer wants to begin a moderate walking program.