Health fitness and promotion

D.A. Asir John Samuel, BSc (Psy), MPT (Neuro Paed), MAc, DYScEd, C/BLS, FAGE

Lecturer, Alva’s college of Physiotherapy, Moodbidri

Health fitness and promotion

• Fitness evaluation

• Analysis of body composition

• Evaluation and prescription of exercise

• Factors affecting exercise performance

• Exercise prescription for specific groups

- Elderly

- Women

- children

Fitness evaluation

• History

- Work history

- Exercise history (FITS)

Pre Exercise Evaluation

• Medical History

• Physical Evaluation

• Laboratory Tests

• Informed Consent

Evaluation

• Resting measurements are taken first

- HR

- BP

- Height

- Weight

- Body composition

Evaluation

• Resting measurements are followed by,

- Cardiac endurance

- Muscular fitness

- Flexibility

• Test environment

Analysis of body composition

• Anthropometric methods

- BMI

- WHR

- SFT

• Densitometry

- Hydrodensitometry

- plethysmography

BMI

BMI

Interpret axis of heart

Interpret position of heart

WHR

• Waist – horizontal measure taken directly

above the iliac crest/narrowest of torso

• Hip – legs slightly apart, a horizontal measure

taken at maximal circumference of hip or

proximal thigh, just above the gluteal fold

• Male < 0.75

• Female < 0.85

SFT

• Seven sites (common for both male and female)

- Chest

- Midaxillary

- Triceps

- Subscapular

- Abdomen

- Suprailiac

- Thigh

SFT - men

• Chest, abdomen and thigh

• Chest, triceps and subscapular

• Body density = 1.10938-0.0008267 (sum of 3

SF)+0.0000016(sum of 3 SF)2 -0.0002574(age)

• % fat = (495/Body density)-450

SFT - women

• Triceps, surpailiac, thigh

• Triceps, suprailiac, abdominal

• Body density = 1.099421-0.0009929 (sum of 3

SF)+0.0000023(sum of 3 SF)2 -0.0001392(age)

• % fat = (495/Body density)-450

Cardiorespiratory Fitness

• Ability to perform large muscle, dynamic,

moderate-to-high intensity exercise for

prolonged periods

• Depends on functional state of respiratory,

cardiovascular and skeletal muscle systems

Maximal oxygen uptake (VO2max)

• VO2max is accepted as criterion measure of CR

fitness

• VO2max = max cardiac output x arterial-venous

oxygen difference

• Open-circuit spirometry is used to measure

VO2max

• Direct measurement of VO2max is not feasible

Maximal Vs submaximal exercise testing

• Maximal exercise tests have the disadvantage

of maximal volitional fatigue and might

require medical emergencies

• Commonly rely on submaximal exercise tests

• Aim is to determine HR response and predict?

Exercise

Tolerance

Testing

Prognostic Testing

Indications for Exercise Testing

VO2max Ex- Duration,

Max Workload,

BP response

Symptoms, ST-T

changes, Arrhythmia

Submaximal exercise testing

• Practitioner uses various submaximal measures

- HR

- BP

- Workload

- Rating of perceived exertion (RPE)

- Functional response

Modes of testing

• Field tests

• Treadmill tests

• Cycle ergometry

• Step tests

Field tests

• Walking or running a certain distance in a

given time

• Easy to administer to large number of

individuals at one time and little equipment

• Cooper 12-minute test

• Rockport One-Mile fitness walking test

Rockport One-Mile fitness walking test

• Peak VO2 = (0.02 x distance) - (0.191 x age)-

(0.07 X weight) + (0.09 X height) + (0.26 X RPP

X10-3) + 2.45

Treadmill and ergometer

1. Exercise Equipment

– Treadmill

– Cycle Ergometer • Mechanically braked cycle

• Electrically braked cycle

– Arm Crank Ergometers

2. Airflow or Volume Transducers

3. Gas Analysers

4. Electrocardiograph

5. Non invasive Blood Pressure

6. Pulse Oximetry

7. Intraarterial Blood Pressure

Protocols

1. Single stage (constant work rate) Protocol

2. Multistage Protocol

Multistage Exercise Protocols • Bruce Protocol

• Balke – Ware Protocol

• Naughton Protocol

• USAFSAM Protocol

• Dukes Protocol

Constant Work Rate Protocol

• Treadmill or cycle ergometry exercise maybe used at levels

approximate to subject’s functional activity i.e. 3.0 mph on

treadmill or upto 50 W on a cycle ergometer.

• 6 minutes of continuous exercise.

• Constant work rate test for 5 -10 minutes achieves about 70

– 90% of VO2max achieved during incremental exercise

testing.

Arm Ergometry

• Work rate increments of 10 W every 2 -3 minutes with a cranking rate of 50 – 60rpm

correlation

• Used for Testing patients with vascular, orthopaedic or neurologic conditions that prevent them from doing leg exercise.

• Correlation between arm exercise and leg exercise

r = 0.37

Subjective Ratings & Symptoms

• Rate of percieved exertion (RPE)

• Angina 1. Mild, barely noticeable

2. Moderate, bothersome

3. Moderately Severe, Very uncomfortable

4. Most Severe or Intense pain ever experienced

Step test

• Step height

- 30.5 cm (12 inch)

- Rate of 24 steps/min

- After test, immediately sit down and HR is

counted for 1 min.

- Counting must start within 5 seconds

Test sequence

• Obtain resting HR & BP before exercise in

exercise posture

• Familiarized with ergometer or treadmill. If

using cycle ergometer 5° knee bend in max Ext

• 2-3 min. warm-up

• Monitor HR at least 2 times during each stage

• BP monitored in last minute of each stage

Test sequence

• PRE and additional rating scales

• Client appearance and symptoms

• Terminate when subject reaches 70% HRR or

85% of HRmax

• Cool-down/recovery period (passive/cont.ex)

• Continue physiologic observations for 5 min

Test termination criteria

• Onset of angina or angina like symptoms

• Drop in systolic BP > 10 mm Hg from baseline

BP despite an increase in workload

• Excessive rise in BP: SBP > 250 mm Hg or DBP

> 115 mm Hg

• Shortness of breath, wheezing, leg cramps or

claudication

Test termination criteria

• Signs of poor perfusion

• Failure of heart rate to increase with increased

exercise intensity

• Noticeable change in heart rhythm

• Subjects requests to stop

• Manifestations of severe fatigue

• Failure of testing equipment

Interpretation

• HR

• Heart rate recovery

• Systolic BP

• Diastolic BP

• ST-segment depression

• ST-segment elevation

• Aerobic fitness

Heart rate

• Progressive linear increase with exercise

• Each MET increase 10 ± 2 beats

Heart rate recovery

• An abnormal slowed HRR is associated with a

poor prognosis

• Decrease ≤ 12 beats/min at 1 min (walking)

• Decrease ≤ 22 beats/min at 2 min (supine)

Systolic BP

• Progressive increase in SBP at 10 ± 2 mm

Hg/MET

• Discontinue with SBP values of > 250 mm Hg

• Exertional hypotension (> 10 mm Hg) may

signify myocardial ischemia or LV dysfunction

• Maximal exercise SBP of < 140 mm Hg

suggests a poor prognosis

Diastolic BP

• Normal response is no change or decrease in

DBP

• DBP of > 115 mm Hg is considered an

endpoint for exercise testing

ST-segment depression

• Common manifestation of exercise induced

myocardial ischemia (Mi)

• Horizontal or downsloping ST-segment

depression is more indicative of Mi

• ≥1 mm of horizontal or downsloping ST

segment at J point extending 60-80 msec

• In recovery true positive

ST-segment elevation

• Early repolarization

• Indicate wall-motion abnormalities

• Significant myocardial ischemia and localizes

ischemia to specific area of myocardium

Aerobic fitness

• Average values of VO2max is expressed as METs

Men = (57.8-0.445[age])/3.5

Women = (41.2-0.343[age])/3.5

• RPE > 17 (abnormal)

Muscular fitness

• Muscular strength

- Ability of muscle to exert force

• Muscular endurance

- Ability to continue to perform for successive

exertions or many repetitions

Muscular strength

• Maximum voluntary contraction (MVC)

• Bench press or leg press

• 1-RM, the greatest resistance that can be

moved through full ROM in controlled manner

with good posture

• Find 1-RM within 4 trials of 3-5 min rest b/w

trials

Muscular endurance

• Curl-up (Crunch test)

• Push-up

• Females in modified “knee push-up”

• Maximum number of repetitions performed

without rest

Flexibility

• Depends on several specific variables

- Distensibility of joint capsule

- Adequate warm-up

- Muscle viscosity

Sit-and-reach test

Exercise prescription

Exercise training session

• Warm-up - (5-10 min) < 40% VO2R

• Stretching (10 min)

• Conditioning or sports related exercise (20-60

min)

• Cool-down (5 min)

Conditioning

• FITT principle

• Frequency

• Intensity

• Time (duration)

• Type (Mode)

Cardiovascular endurance

• Frequency

- 3-5 days/week

- > 5 days/week reaches plateau

• Intensity

- 40-60% VO2R – moderate

- ≥ 60% VO2R – vigorous

Cardiovascular endurance

• Time duration

- At least 20-30 min

- 50-60 min – vigorous

• Mode

- Jogging

- Cycling

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Selection Of Sports

Shoe

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Selection Of Sports Shoe

• Time of purchase

• Based on Midsole

• 5 pound pressure principle

• Thumb rule

• Shoe Life span

• For female

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TIME OF PURCHASE

• End of the day

• Soon after running or exercise

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BASED ON MIDSOLE

• Inert gas encapsulated in a ployurethane shell

(air pads) – NIKE

• Communicating air chambers (suspension

fibres) – REEBOK

• LD ethylene vinyl acetate pads – ADIDAS

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5 POUND PRESSURE PRINCIPLE

• When the shoe is held vertically & 2.27 kg wt is

applied only 40º to 60º bend

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THUMB’S RULE

• Thumb’s width of space between the end of the

longest toe and the front end of the shoe.

• Narrow shoe leads to blisters and to forefoot

and toe pain

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SHOE LIFE SPAN

• 300 to 500 miles ¹

• 6 months ²

• Whichever comes first ²

• Sensing small rocks

• Slapping sensation

1.Clin J Sports Med 1985;4(4):619-626

2.Clin J Sports Med 2005;15(3):172-176

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LADY’S SPECIAL

• Narrow heel

• Vertical ground reaction force

• Peak tibial acceleration

• Maximal pronation

• Peak pronation velocity

• Peak pressures 65 8/24/2012

Volume of resistance training

• Each muscle group should be trained for total

of 2-4 sets

• 8-12 repetitions per set

• Resistance is 60-80% of 1RM

• Each set should be performed to the point of

muscle fatigue not failure

• 2-3 min rest between sets

For muscular endurance

• Higher number of repetitions of 15-20 reps.

• Shorter rest intervals (< 2min)

• Fewer sets (Preferably 1-2 sets per muscle

group)

• RPE of 5-6 on 10-point scale

Resistance exercise technique

• Proper technique

• Minimizes chances of injury

• Proper body positioning and breathing

• Full ROM in controlled manner

• Emphasis on lifting and lowering phase

Progression

• Overload or greater stimuli to continue to

increase muscular strength and mass

• Perform more sets per muscle group

• Increasing number of days per week

Progressive overload

Progressive overload

Muscle fatigue

catabolism

Body responds

With aid of nutrition & rest

Builds up affected muscle

Anabolism

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Maintenance

• Muscular strength may be maintained by

training muscle groups as little as 1 day/week

Flexibility exercise

• Injury prevention

• At least 10 min. duration involving major

muscle groups of body

• > 4 repetitions per muscle group

• Static stretch should be held for 15-60 seconds

• Minimum 2-3 days/week

Exercise prescription for elderly

• Initial workload should be low and work

increments should be small

• Preferable to cycle ergometer

• Consider prescribed medications

Exercise prescription for elderly

• Aerobic activity

- Aquatic exercise and stationary-cycle exercise

- 20-30 min/day to 75-100 min/day walk

- Minimum 5 days/week

- 5-6 on RPE

Exercise prescription for elderly

• Muscle-strengthening

- At least 2 days/week

- 10-15 repetitions of low resistance

• Flexibility

- 2 days/week

- < 30 seconds hold for 3 repetitions

Exercise prescription for children

• Aerobic activity

- At least 3-4 days/week, preferably daily

- Moderate (5-6 RPE)

- 30 min/day to 60 min/day

- Dance, sporting

Exercise prescription FITT Diabetes HT Renal

failure Obesity

Frequency A- 3-7 d/wk; R-2-3 d/wk

A- all days; R- 2-3d/wk

A- 3-5d/wk; R-2-3d/wk

≥ 5d/wk

Intensity A-50%-80% VO2R; R-60%-80% 1RM

A-40%-<60% VO2R; R-60%-80% 1RM

A-40%-<60% VO2R; R-60%-75% 1RM

A-40%-<60% VO2R or HRR

Time 20-60 min to 150 min/wk; 2-3 sets 8-12 rp

30-60 min/d; 1set 8-12 rp

20-60 min/d; 1set 10-15 rp

30-60 min to 150 min/wk

Type Aeroic ex.; proper handling

Walking, jogging; 8-10 major ms

Walking and cycling

Walking, jogging, cycling,swim