Regie A.

Layug, MD
Department of Family and Community Medicine
San Beda College of Medicine
A patient of yours consulted you because of
shortness of breath doing moderately
heavy activity like climbing up the stairs or
walking distances. She also has been
steadily gaining weight and her blood
pressure has been a little high. She wants
you to help her develop a cardiovascular
exercise program so she may be able to
improve her fitness status.
 How are you
going to help
your patient?
 What are the
things that you
have to consider
in formulating
an exercise
regimen?
At the end of the session, the student-learners
are expected to:
1. Review certain principles and definitions related
to exercise and fitness
2. Discuss the benefits of cardio respiratory
activities and fitness
3. Enumerate and discuss the components of an
exercise aerobic program
4. Discuss the FITTE factors for increasing fitness
5. Formulate a personal fitness plan catering to
their individual needs and assessment
 Any bodily
movement
produced by
skeletal muscles
that results in
energy
expenditure
 Planned,
structured, and
repetitive bodily
movement done to
improve or
maintain one or
more components
of physical fitness
 Those that cause
an increase in the
transport and
uptake of oxygen
by skeletal muscle
 Principle of Adaptation
 If a specific physiological capacity is
taxed by a physical training stimulus
within a certain range and on a regular
basis, this physiological capacity usually
expands
 Dependent on two correlated principles:
▪ Threshold
▪ Overload
 Training threshold
 Minimal level to which a physiologic
capacity must be challenged to in order
to elicit adaptation

 Overload
 Once training stimulus exceed the
threshold level, and the process of
physiological adaptation occurs
 Progression
 Workload must increase in order to
maintain overload
 Regression
 Refers to the transience of physiological
enhancement from training that occurs
when training ceases and the
physiological capacities regress toward
pretraining levels
 Retrogression
 Excessive taxing of
physiological
capacities leading
to their diminution
 Optimum Load
Retrogressi
ADAPTATION

on
Progressi
ve
Threshold Overload
Low High Very High
DEADAPTATIO

OVERLOAD

Disuse
N

Adam WC. Foundations of Physical

Education, Exercise and Sports
Sciences. Philadelphia: Lea & Febiger,
1991.
HEALTH-
RELATED
ASPECTS Body
OF Composition
FITNESS
Muscular
Strength Flexibility

Muscula Cardio
r respiratory
Enduran Endurance
ce
 Refers to the constellation of improvements
that enhance VO2max and/or aerobic work
capacity
 Ability to persist or sustain activity for
prolonged periods
 Describes the capacity of the lungs to
exchange oxygen and carbon dioxide with
the blood, and the circulatory system’s
ability to transport blood and nutrients to
metabolically active tissues for sustained
periods without undue fatigue
 Reduction in blood pressure
 Increased HDL-cholesterol
 Decreased total cholesterol
 Decreased body fat stores
 Increased aerobic work capacity
 Decreased clinical symptoms of
anxiety, tension and depression
 Reduction in glucose-stimulated insulin
secretion
 Increased heart function
 Reduction in mortality in post
myocardial infarction patients
 Increased lactate
threshold
 Decreased resting heart
rate
 Increased heart volume
 Increased resting and
maximum stroke volume
 Increased maximum
cardiac output
 Increased maximum
oxygen consumption
 Increased capillary
density and blood flow to
active muscles
 Increased total blood
volume
 Increased maximal
ventilation
 Increased lung
diffusion capacity
 Increased mobilization
and utilization of fat
 Reduced all-cause
mortality
 Decreased anxiety and
depression
 Decreased incidence of
some cancers
 Warm-up and cool down
 Primary cardio
respiratory activity
criteria (FITTE)
 Mode of exercise
 Frequency of exercise
session
 Duration of exercise session
 Intensity of exercise session
 Supportive conditioning
exercise
 Progression plan
 Safety and cautions
 Heart rate
 Blood pressure
 Oxygen
consumption
 Dilation of the
blood vessels
 Elasticity of the
active muscles
 Heat produced by
the active muscle
groups
1. Permits a gradual metabolic adaptation, which enhances
cardiorespiratory performance
2. Prevents the premature onset of blood lactic acid accumulation and
fatigue during higher level aerobic exercise
3. Causes a gradual increase in muscle temperature which decreases the
work of contraction and reduces the likelihood of muscle injury
4. Facilitates neural transmission for motor unit recruitment
5. Improves coronary blood flow in early stages of the conditioning
exercise, lessening the potential for myocardial ischemia
6. Allows a gradual redistribution of blood flow to active muscles
7. Increases the elasticity of connective tissue and other muscle
components
8. Provides a screening mechanism for potential musculoskeletal or
metabolic problems that may increase at higher intensities
9. Provides a psychological warm-up to higher levels of work

McArdle, et. Al. Exercise Physiology: Energy,

Nutrition and Human Performance, 5th edition
1. Graduated aerobic warm-up activity
 Walking
 Slow tempo rhythmic callisthenic
movements
 5-8 minutes low level aerobic activity
1. Flexibility exercise specific to the
biomechanical nature of the primary
conditioning activity
 Calf, quadriceps and Achilles stretching –
prior to running or hiking
 Purpose is to slowly decrease the heart rate and
overall metabolism
 Low-level aerobic exercise, similar to that of the
conditioning exercise, is recommended
 Length of cool-down is proportional to the
intensity and length of the conditioning phase
▪ Example: A typical 30-40 minute conditioning phase at 70%
MHR would warrant a 5-10 minutes of cool down
▪ The aerobic component of the cool down phase should be
followed by several minutes of stretching those muscle groups
active in the conditioning phase
1. Prevents post-exercise venous blood pooling and
too rapid a drop in blood pressure  reducing the
likelihood of post exercise lightheadedness or
fainting
2. Reduces the immediate post exercise tendency for
muscle spasm or cramping
3. Reduces the concentration of exercise hormones
(NE) that are at relatively high levels immediately
after vigorous aerobic exercise  lowers the
probability of post exercise disturbances in cardiac
rhythm
McArdle, et. Al. Exercise Physiology: Energy,
Nutrition and Human Performance, 5th edition
Primary Warm-up/Cool-down Activity
Conditioning
Exercise
Aerobics (Group Graduated low-level aerobic activity utilizing same
exercise) muscle groups
Circuit weight training Low-level aerobic activity (e.g. walking or cycling, and/or
beginning the circuit training session with a set of
relatively high-repetition, low-resistance exercises)
Jogging and running Walking, walk-jogging, or jogging at a slower pace
Outdoor cycling Begin with relatively flat terrain in lower gears;
gradually shift to higher gears and steeper terrain
Stationary cycling Start with cycling against little or no resistance
Stair-climber/elliptical Low-level aerobic activity (e.g. walking or cycling and/or
cross-trainer relatively low-tempo step exercise)
Swimming Begin with slow crawl and gradually increase arm stroke
and pace, and/or begin with short one- or two-lap slow
intervals
 Exercise Frequency
 Number of exercise sessions per week
 Depends on the duration and intensity of
the exercise session
▪ Lower-intensity exercise performed for
shorter periods  more sessions per week

To improve both cardio respiratory fitness and maintain body fat at

near optimum level:
•A client should exercise at least 3 days a week with no more than 2
days between sessions (ACE)
•3-5 days per week for most aerobic programs (ACSM)
 Exercise Frequency
(ACE)
 For otherwise healthy
individuals  start
aerobic programs every
other day for at least
eight weeks
 For those with poor
functional capacity 
1-2 daily sessions per
week
 Those with average
capacities  exercise
at least 3/week on
alternate days
 Exercise Intensity
 Refers to the speed or exercise workload
 55-90% of maximal heart rate (ACSM)
▪ Approximates 40-85% of heart rate reserve
and maximal oxygen uptake
▪ Lower intensities are advised for beginners  40-
50% O2 max
▪ Apparently healthy individuals  75-85% O2 max
 Intensity RELATIVE INTENSITY
O2 max, % Maximum Heart RPE
Rate, %
Very light <20 <35 <10
Light 20-39 35-54 10-11
Moderate 40-59 55-69 12-13
Hard 60-84 70-89 14-16
Very hard ≥85 ≥90 17-19
Maximum 100 100 20

American Heart Association’s Exercise

Standards for Testing and Training (2001).
Circulation, 104, 1694.
 Moderate
intensities in exercise (40-60%
maximum oxygen uptake) can lead to:
 Increased HDL cholesterol
 Decreased blood pressure
 Improved glucose tolerance
 Reduced blood clotting tendency
 Reduced anxiety
 Decreased cardiovascular disease risk
 Decreased potential for the development of
diabetes and all-cause mortality
 Heart rate
 Percentage of maximal heart rate
▪ May be determined by a maximal functional
capacity test using a bicycle or treadmill
ergometer
▪ Age-predicted maximal heart-rate tables
▪ Maximum heart rate = 220 – Age (years)

TRAINING 220 – Desired

HEART
RATE
= AGE X percent of MHR
(years)
A 40-year old man for whom an intensity of
70% of maximum heart rate is desired:

TRAINING 220 – Desired

HEART = AGE X percent of MHR
RATE (years)

= 220 – 40 X 0.70

126 ± 10 -12 beats per

= beats/mi minute
nute
 Heart rate
 Percentage of heart-rate reserve
(Karvonen formula)
▪ The difference between the resting and
maximal heart rates for a given client
represents the reserve of the heart for
increasing its cardiac output

TRAINING 220 – Resting Desired Resting

HEART = AGE - HR X % of + HR
RATE (years) MHR
 Rating of Perceived
Exertion (RPE)
 Takes into account all the
exercising client is
perceiving in terms of
exercise fatigue, including
psychological,
musculoskeletal, and
environmental factors
▪ RPE 12-13 corresponds to
approximately 55-69% MHR
 Talk-test method
 Subjective
 Useful in determining a
“comfort zone” of aerobic
intensity
 Clients should be able to
breathe comfortably and
rhythmically throughout
all phases of a workout to
ensure a safe and
comfortable level of
exercise
 Intensity measured
by METS
 Assessed by a graded
exercise test (bicycle
or treadmill)
▪ Based on time the client
stays on the machine,
the maximal oxygen
consumption can be
estimated and then
converted into MET
▪ 3.5 mL/kg/min
 Exercise Duration (or Time)
 Refers to the number of minutes of exercise
during the conditioning period
▪ Exclusive of warm-up and cool-down
▪ May vary from as little as 5-60 or more minutes
▪ 20-60 or more minutes per session, continuous or
intermittent activity (ACSM)
▪ Dependent upon the exercise intensity

Beginners  10-20 minutes aerobic conditioning

Very deconditioned individuals  5-10 minutes
Average classification  15-45 minutes
High fitness classification  30-60 minutes
 Exercise Mode (or Type)
 Criteria:
▪ Activity that uses large
muscle groups
▪ Rhythmic and repetitive in
execution
▪ Cardio respiratory in nature
 Selection is made on the
basis of the client’s
functional capacity,
interests, time availability,
equipment and facilities,
and personal goals
 All cardio respiratory
exercise programs
must be supported by:
 Flexibility exercises
▪ Add several separate
sessions of stretching per
week that improve the
strength of the back, legs
and abdomen
 Strength exercise
▪ Weight-bearing types
 Neuromuscular fitness
exercises
▪ Relaxation techniques,
yoga  especially in the
cool down periods
 Static stretching
 Slow, gradual, and controlled elongation
through a full range of motion
 Low intensity, long duration stretch
technique
▪ Position is maintained for 15-30 seconds
UPPER TRAPEZIUS ANTERIOR SHOULDER
POSTERIOR SHOULDER TRICEPS
LOW BACK OUTER HIP
ADDUCTOR QUADRICEPS
HAMSTRINGS GASTROCNEMIUS
 2 sets of exercise sessions per week
 At least 10 exercises
 At least one exercise to target all of the
major muscle groups
 Atleast one set of 8-12 repetitions
completed to fatigue
 Active recovery between sets
LOWER BODY HIP ABDUCTORS
LOWER BACK PECTORALIS MAJOR
SHOULDERS LATISSIMUS DORSI
TRICEPS BICEPS
NECK ABDOMINALS
 Provides details for a
graduated
progression in the
frequency, duration,
and intensity of the
exercise
 Written plan
recommended
 Should be
periodically
evaluated
 Depends on several factors:
 Individual level of fitness (aerobic capacity)
 Age
 Health status
 Cardio respiratory response to exercise
 Individual preferences and goals
 Social and family support
 Level of exercise initiative and motivation
 Access to appropriate facilities and equipment
 Initial conditioning stage
 Usually lasts 4-6 weeks or longer
 Includes low-level aerobic activities, stretching, and
light calisthenics
 Exercise frequency should begin every other day
 Duration may start with 10-20 minutes and
gradually increase according to the client’s response
▪ For those with low-level functional capacity  low-level
aerobic interval exercise of 2-5 minutes at a time
 Intensity: start with 40-60% of functional capacity
(approximately 40-60% of MHR)
 Improvement Conditioning Stage
 The primary conditioning stage for most
aerobic-training programs
 May last from 8-20 weeks
 Exercise intensity: 50-85% functional
capacity (60-90% of MHR)
 Duration should be increased every 2-3
weeks according to client’s response and
goals
 Review progress at 2-4 week intervals
 Maintenance Stage
 Usually reached after the first 6 months of
training
▪ May be delayed as long as 12 months, depending
upon goals
 Clients should have reached their target
functional capacity or primary goals
(reassess goals)
 Engage client in a variety of endurance-
related activities that are fun and enjoyable
to maintain cardio respiratory fitness
 Identify and list
any personal and
environmental
information that
reduces the risk of
exercise injury or
that may
compromise
exercise safety
 Do not exercise for at least 90 minutes
after a meal
 Avoid continuing exercise with chest
discomfort, lightheadedness, or
dizziness
 Reduce exercise intensity in response
to very hot or humid environments
 Avoid exercise with tenderness in a
joint that tends to worsen with activity
 Avoid strenuous aerobic exercise
during viral infections
 Make a personal cardio respiratory
fitness activity for yourself.
 What
are your goals in exercising? How
much time do you have?
 A fitness goal should be:
▪ Specific – “What exactly do you want to
accomplish?”
▪ Measurable – “How much body fat, or pounds do
you want to shed?” or “How far do you want to go
in a run without getting tired?”
▪ Attainable – goals should be not TOO difficult or
not TOO easy
▪ Relevant – look into your personal interests, needs
and abilities
▪ Time-bound – identify a “deadline” for each goal
 Writedown your goal and post in
areas which you often look into.

“I want to be able to walk three miles in

45 minutes by March 20, 2010..”

“I want to lose 25 pounds by the end of

the year..”
 What
are your resources at the
moment? Take into consideration:
 How much time are you willing to spend
for the activity?
 What activities do you enjoy the most
that may count as exercise? Remember
the general criteria.
 What equipment or facilities are readily
available for you?
 Financial resources
 Be specific in formulating the
following parameters. Bear in mind
the ACSM recommendations that you
have just learned:
 Warm-up and cool down
 Primary conditioning exercise:
▪ Frequency
▪ Intensity (in terms of %MHR)
▪ Type or mode
▪ Time or duration
 What supportive exercise would you
add in order to address other health-
related fitness areas? Be specific in
writing each activities and the
frequency of each exercise within
the week:
 Flexibility
 Muscular strength
 Neuromuscular exercise
 Identify
dates and the criteria that
would enable you to progress
throughout each stage. Encircle
them in your personal calendar.
What would you have attain in your
goals before you “upgrade” a stage?
 Initial conditioning stage
 Improvement conditioning stage
 Maintenance stage
 Identify
what cautions should you
take before you start exercising
“…Look to your
health; and if you
have it, praise God
and value it next to
conscience; for
health is the
second blessing
that we mortals are
Izaac Walton
capable of, a
blessing money
can’t buy…”
 ACSM Resource Manual for
Guidelines for Exercise Testing and
Prescription, 5th edition
 ACSM Guidelines for Exercise Testing
and Prescription
 American Council on Exercise
Personal Trainer Manual