Aerobic Exercises 2

aerobic aerobic exercisesexercises

aerobic aerobic exercisesexercises

Key terms & Key terms & conceptsconcepts

• 1. Fitness1. Fitness• 2.Maximum 2.Maximum

oxygen oxygen consumptionconsumption

• 3.Aerobic exercise 3.Aerobic exercise training ( training ( conditioning)conditioning)

• 4.Adaptation4.Adaptation• 5.Myocardial 5.Myocardial

oxygen oxygen consumptionconsumption

• 6.Deconditioning6.Deconditioning

• 7.Energy systems7.Energy systems• 8.Energy 8.Energy

expenditureexpenditure• 9.Efficiency9.Efficiency• 10.Functional 10.Functional

implicationsimplications• 11.Energy 11.Energy

expenditureexpenditure• 12.Efficiency12.Efficiency

1.fitness

• Ability to perform physical work • Physical work requires

> cardio respiratory functioning> muscular strength and endurance> musculoskeletal flexibility

2.maximum oxygen consumption ( VO2

max)• A measure of body’s capacity to use

oxygen ( milliliters of O2 per kg of BW per minute) mL/kg per minute

• Maximum amount of oxygen consumed per minute when the individual has reached maximum effort.

• Measured when performing an exercise that uses many large muscle groups like swimming, walking, and running

Factors affecting VO2 max

• Transport of oxygen• Oxygen-binding capacity of the

blood• Cardiac function• Oxygen extraction capabilities• Muscular oxidative potential

Endurance ( a measure of fitness)

• Ability to work for prolonged periods of time and the ability to resists fatigue.

• Includes muscular and cardiovascular endurance

• Muscular endurance vs. Cardiovascular endurance

Muscular & Cardiovascular

Endurance• ME refers to the ability of an

isolated muscle group to perform repeated contractions over a period of time.

• CE refers to the ability to perform large muscle dynamic exercise, such as walking, swimming, and/or biking for long periods of time.

3.aerobic exercise training( conditioning)

• Augmentation of the energy utilization of the muscle by the means of an exercise program.

Factors affecting the aerobic exercise

training• Increased levels of oxidative

enzymes• Increased mitochondrial density

and size• Increased muscle fiber capillary

supply

Training• Dependent on exercise of sufficient

intensity, duration and frequency• Produces cardiovascular and/or

muscular adaptation and is reflected in an individual’s endurance.

• Sports training depends on the specificity principle “ individual improves in the exercise task used for training and may not improve in other tasks”.

4.Adaptation • Ability to change• Can results in• > increased efficiency of the

cardiovascular system and active muscles.

• Dependent on the ability of the organism to change and the training stimulus threshold

5.Myocardial oxygen consumption (MVO2)

• A measure of the oxygen consumed by the myocardial muscle

• The need or demand for oxygen is determined by> heart rate(HR)> systemic blood pressure> myocardial contractility> afterload

MVO2 afterload

• The ventricular force required to open the aortic valve at the beginning of systole

• Determined by the left ventricular tension and central aortic pressure

6.Deconditioning• Occurs with prolonged bed rest• Can results in

> decrease VO2max> cardiac output> muscular strength

7.Energy systems• Metabolic systems involving a

series of biochemical reactions resulting in the formation of ATP, CO2, H2O.

• ATP ADP and Phosphate

• Phosphagen, or ATP-PC System• Anaerobic Glycolytic System• Aerobic System

Phosphagen, or ATP-PC, System

• Phosphocreatine and ATP are stored in the muscle cell

• Phosphocreatine is the chemical fuel source

• No oxygen is required (anaerobic)• When muscle is rested, the

supply of ATP-PC is replenished

Phosphagen, or ATP-PC, System

• The maximum capacity of the system is small (0.7 mol ATP)

• The maximum power of the system is great ( 3.7 mol ATP)

• The system provides energy, quick bursts of activity

• It is the major source of energy during the first 30 seconds of intense exercise

Anaerobic Glycolytic System

• Glycogen (glucose) is the fuel source ( glycolysis)

• No oxygen is required (anaerobic)• ATP is resynthesized in the muscle

cell• Lactic acid is produced ( by-

product of anaerobic glycolysis)

Anaerobic Glycolytic System

• The maximum capacity of the system is intermediate( 1.6 mol ATP/min)

• For activity of moderate intensity and short duration

• Major source of energy from 30th to 90th second of exercise

Aerobic System• Glycogen, fats, proteins are fuel

sources• Oxygen is required• ATP is resynthesized in the

mitochondria of the muscle cell• Maximal capacity of the system is great

(9.0 mol ATP)• Maximal power is small (1.0 mol/ATP)• Predominates on the second minute

of the exercise

Comparison of the Energy Systems

ATP-PC Anaerobic Glycolytic

Aerobic

Main source of energy

Phosphocreatine and ATP

Glycogen Glycogen, fats, proteins

Requiring oxygen

No No Yes

Capacity Small (0.7 mol ATP)

Intermediate ( 1.2 mol ATP)

Great ( 90.0 mol ATP)

Power Great ( 3.7 mol ATP/ min)

Intermediate ( 1.6 mol ATP/ min)

Small ( 1.0 mol ATP / min)

Usage Short,quick burst of activity

Moderate intensity and short duration

Long duration

First 30 secs of intense exercise

Major source of energy from the 30th to 90th second of exercise

Predominates on the 2nd minute of exercise

Recruitment of Motor Units

Slow-twitch fibers (Type I)

Fast-twitch fibers( Type IIa)

Fast-twitch fibers ( Type IIb)

Slow contractile response

Slow and fast Fast contractile response

Rich in myoglobin and mitochondria

Intermediate Low myoglobin content, few mitochondria

Used in low intensity exercise

Intermediate Used in activities requiring power

Energy Expenditure• Open-circuit portable spirometry• Telemetry• Kilocalorie(kcal) – a measure

expressing the energy value of food. Amount of heat necessary to raise 1 kg of water 1C

• 5kcal = 1 liter O2• MET – oxygen consumed(mL) per kg of

body weight per minute• 3.5mL/kg per minute

Activities• Light work for the average male

(65kg)• 2.0 to 4.9 kcal/min ( almost 1 liter of oxygen)• 6.1 to 15.2mL O2/kg per minute ( 15.2mL/kg per minute x

65 kg = 988mL O2 per minute)

• Heavy work for the average male ( 65kg)

• 7.5 to 9.9 kcal/min ( almost 2 liters of oxygen)• 23.0 to 30.6 mL O2/kg per minute ( 30.6mL/kg per minute x

65 kg = 1,989mL O2 per minute

Efficiency• Percent efficiency = useful work output x 100

energy expended or work input

(Treadmill) WORK = weight of the subject x vertical distance the subject is raised walking up the incline of the treadmill)

(Ergometer bike) WORK = distance( circumference of the flywheel times the number of revolutions) x the bicycle resistance

PHYSIOLOGIC RESPONSE TO AEROBIC EXERCISE

• Cardiovascular response to exercise

• Respiratory response to exercise• Responses providing additional

oxygen to muscle

CARDIOVASCULAR RESPONSE TO EXERCISE

• SNS• Peripheral vasoconstriction• Increased myocardial contractility• Increased heart rate• Hypertension• Cardiac Output• Increase in myocardial contractility• Increase in heart rate• Increase in blood flow through the working muscle• Increase in constriction of the vessels• Net reduction in the total peripheral resistance

RESPIRATORY RESPONSE TO

EXERCISE• Decrease in venous O2 saturation• Increase in Pco2 and H+• Increase in Body Temp• Increase in epinephrine• Increase stimulation of receptors

of the joints and muscles

RESPONSES PROVIDING ADDITIONAL OXYGEN TO

MUSCLE• Increase in blood flow• Production of more carbon dioxide

( cell acidosis)• Increase of red blood cell

TESTING AS A BASIS FOR EXERCISE PROGRAM

• FITNESS TESTING OF HEALTHY SUBJECTS

• FIELD TEST RUNNING (1.5 MILES) OR DISTANCE RUN FOR 12 MINUTES

• MULTISTAGE TEST MEASURE OF VO2 MAX ( Treadmill with 6 stages with 3-6 mins per stage)

TESTING AS A BASIS FOR EXERCISE PROGRAM

• STRESS TESTING• Should have PE first, monitored by ECG,

be observed at rest, during exercise, during recovery

• PRINCIPLES OF STRESS TESTING• Changing the workload by increasing the speed

(treadmill) resistance( ergometer)• An initial workload that is low in terms of the

individual’s anticipated aerobic threshold• Maintenance of each workload • Termination of the test at the onset of symptoms or

abnormality in the ECG• When available, measurement of the individual’s

maximal oxygen consumption

PURPOSE OF STRESS TESTING

• Helps establish a diagnosis of overt or latent heart disease

• Evaluates cardiovascular functional capacity as a means of clearing individuals with strenuous work

• Determines the physical work capacity (METS)• Evaluates responses to exercise training

and/or preventive programs• Assists in the selection and evaluation of

appropriate modes of treatment programs• Increases the pt’s motivation for entering and

adhering to exercise programs• Used clinically to evaluate pt with chest

sensations or hx of chest pain

PREPARATION FOR STRESS TESTING

• Have had a physical exam• Be monitored by ECG, closely

observed at rest, during , and during recovery

• Sign a consent form

Precautions for Stress Testing

• Monitor the pulse• BP increases with exercise 7-

10mm of mercury per MET of physical activity (Systolic pressure not exceed 220 to 240mmHg; Diastolic >120mmHg)

• Rate and depth and respiration ( respiration should not be labored and no SOB)

• Increase in blood flow while exercising

Termination of Stress Testing

• Progressive angina• Significant drop in systolic pressure in

response to an increasing load• Lightheadedness, confusion, pallor,

cyanosis, nausea, or peripheral circulatory insufficiency

• Abnormal ECG responses including ST segment depression greater than 4mm

• Excessive rise in BP• Subject wishes to stop

MULTISTAGE TESTING• Stage 1 to 4 last 1-6 minutes• Bruce protocol – most popular• Treadmill speed and grade

changed every 3 minutes• Speed increases from 1.7 mph to

5.0• ( 10% increases up to 18% during

the five stages)

DETERMINANTS OF AN EXERCISE PROGRAM

1. INTENSITY- determined by

A. Overload PrincipleB. Specificity Principle

2.DURATION3. FREQUENCY4. MODE

INTENSITY>>>Maximum Heart Rate and Exercise

Heart Rate

• Maximum Heart Rate• 220- age( less accurate)

• Exercise Heart Rate• Karvonen’s formula ( Heart rate

reserved)• HR rest + 60-70%(HR max-HR rest)

INTENSITY>>>Overload Principle

• Is a stress on an organism that is greater than that regularly encountered during everyday life to improve cardiovascular and muscular endurance.

• 60-90% conditioning maximum heart rate response or 50-85% VO2max ( Healthy)

• 40-50% VO2max ( deconditioned)

• The HIGH intensity, SHORT duration• MODERATE intensity, LONGER duration

INTENSITY>>Overload Principle

• Maximum oxygen consumption (VO2 max) is the best measure of exercise intensity

• Higher intensity, higher VO2max

INTENSITY>>>Specificity Principle

• No overlapping for a specific exercise

• Strength-power only• Endurance only

DURATION>>• 20-30 mins (60-70% maximum

heart rate)• 45 mins continuous exercise

(overload)• 10-15 mins high intensity • 5 mins x 3 reps ( deconditioned

pts)

FREQUENCY>>>AHA & Centers for Disease Control30 MINS OF moderate intensity 5-7x a

weekAmerican College of Sports Medicine3-5 days a week at 60-90% maximum

heart rate for 20-60 continuous or intermittent minutes

Longer duration exercise ( 10 mins or more)

MODE>>>>

• Cycling, running (overload principle)

• Cardiorespiratory system & endurance (specificity principle)

REVERSIBILITY PRINCIPLE

• 2 weeks of detraining, decrease work capacity, improvements can be lost within several months

EXERCISE PROGRAM• WARM-UP PERIOD• AEROBIC EXERCISE PERIOD• COOL-DOWN PERIOD

EXERCISE PROGRAM>> WARM-

UP PERIOD• enhances the numerous adjustments that must take place

before physical activity• RESPONSESa. Increase in muscle Tempb. Increase in oxygen supply to meet the energy demands of

musclec. Dilatation of the previously constricted capillariesd. Adaptation in sensitivity of the neural respiratory centere. Increase in venous return

PURPOSESa. Susceptibility of the musculoskeletal system to injuryb. Occurrence of ischemic ECG changes and arrhythmias

EXERCISE PROGRAM>> WARM-

UP PERIOD• Warm-ups should be:GradualPreferably 10 minutes of total

body movementHR within 20beats/min

EXERCISE PROGRAM>> AEROBIC EXERCISE PERIOD

The conditioning part of the exercise program

Focuses on:Intensity that will stimulate an

increase in SV and CO but within the person’s tolerance, above the threshold level and below the level that evokes clinical sx


• 4 methods of training1. Continuous training2. Interval training3. Circuit training4. Circuit-interval training


• CONTINUOUS TRAINING>Submaximum energy requirement that is

sustained>Stress is placed primarily on the slow-twitch

fibers>Activity can be 20-60mins without exhausting

O2 the transport system>Work rate is increased progressively>Increasing the exercise duration>Best for healthy individual to improve

endurance


• INTERVAL TRAINING With relief interval ( few secs to several minutes) +

Increase in VO2max

a. Rest relief (passive recovery)b. Work relief (active recovery) Longer work interval, more aerobic system

is stressed ( 1:5 rest:work)

Intermittent work should be greater than continuous training


• CIRCUIT TRAININGEmploys a series of exercise

activities( at last activity, starts again from the beginning and move through the series) parang cycle(bilog)

Mainly to improve the STRENGTH and ENDURANCE by stressing both aero and anaero


• CIRCUIT-INTERVAL TRAININGCombining circuit and interval

trainingWith relief interval there is a delay

in the need for glycolysis and production of lactic acid

EXERCISE PROGRAM>> COOL-DOWN PERIOD

• PURPOSEa. Prevent pooling of the blood in the

extremitiesb. Prevent fainting by increasing the

return of blood to the heart and brainc. Enhances the recovery periodd. Prevents Myocardial ischemia,

arrhythmias or other cardiovascular complications

EXERCISE PROGRAM>> COOL-DOWN PERIOD

• GUIDELINESTotal body exercisesShould last 5 to 10 minutes

GENERAL GUIDELINES FOR AN AEROBIC TRINING

PROGRAM• Establish the target heart rate• Warm-up for 5 to 10 minutes gradually

increasing( speed & effort)• Increase the pace of activity• Cool down for 5 to 10 minutes• Aerobic activity (3-5x/week)• Use appropriate equipment, correct footwear.• To avoid overuse syndromes, proper warm-up

and stretching• Individualize the program of exercise

PHYSIOLOGICAL CHANGES THAT OCCUR WITH

TRAINING• CARDIOVASCULARReduce resting PR ( increase

para:decrease sympha)Decrease in BP ( systolic >

diastolic)Increase in blood volume and

hemoglobin


TRAINING(CARDIOVASCULAR)• CHANGES AT REST> Reduce resting PR

( increase para :decrease sympha)

Decrease in BP ( systolic > diastolic)

Increase in blood volume and hemoglobin

• CHANGES DURING EXERCISE

Reduction in PR Increase SV Increase CO Greater VO2max Decrease blood flow Decrease myocardial

o2 consumption


TRAINING(RESPIRATORY)• CHANGES AT REST Larger lung volume Larger diffusion

capacities


Larger diffusion capacities

Smaller amt of air ventilated at same oxygen consumption occurs

Maximal minute ventilation increased

Increase ventilatory efficiency


TRAINING(METABOLIC)• CHANGES AT REST Muscle hypertrophy,

increased capillary density

Number and size of mitochondria increased

Increase muscle myoglobin


Decreased rate of depletion of muscle glycogen”glycogen sparing”

Lower blood lactate Less reliance on

phosphocreatine and ATP

PHYSIOLOGICAL CHANGES THAT OCCUR WITH TRAINING(OTHER

SYSTEM)

Decrease in body fatDecrease in blood cholesterol and

triglycerideIncrease heat acclimatizationIncrease in the breaking strength

of bones and ligaments

AEROBIC CONDITIONING FOR THE PATIENT WITH CORONARY

DISEASE>> INPATIENT PHASE(PHASE I)

> 3-5 DAYS OR COULD LAST UP TO 7-14 DAYSOccurs in the hospital ff stabilization of the pt’s

cardiovascular status after MI or CABGPURPOSE: Initiate risk factor education & behavior modifications Initiate self-care activities and progress from sitting to

standing Provide an orthostatic challenge to the cardiovascular

system(3 to 5days postevent) Prepare patients and family for continued rehabilitation

and for life at home after a cardiac event

AEROBIC CONDITIONING FOR THE PATIENT WITH CORONARY DISEASE>> OUTPATIENT

PHASE(PHASE II)

6-8 WEEKS LATERPURPOSE Increase the person’s exercise capacity in a safe,

progressive manner “ low level exercise training” Enhance cardiac function and reduce cardiac cost of

work Produce favorable metabolic changes Determine the effect of medications Relieve anxiety and depression Progress the patient to an independent exercise

program

AEROBIC CONDITIONING FOR THE PATIENT WITH CORONARY DISEASE>> OUTPATIENT PHASE(PHASE

II)

• GUIDELINES Symptom –limited exercise stress test is performed 6-12weeks after

discharge( mainly aerobic)INTENSITYInitial: 40-60% maximum heart rateDURATION 10-15 minutes at start then progress to 30-60 minutes ( with 8-10 mins warm-

up and cool-down)FREQUENCY 3x a weekMODE Continuous using large muscle groups( walking or biking)METHOD circuit-interval – most commonWEIGHT TRAINING Low level weight training Resistance exercises are allowed but with precautionsPROGRESSION> Progress after 3 consecutive sessions


PROGRAM(PHASE III)

Supervised exercise conditioning program in a hospital or community

HR and rhythm are no longer monitored via telemetry

PURPOSE:> Continue improving or maintaining

fitness levels achieved during phase II


PROGRAM(PHASE III)• GuidelinesSwimming (incorporates both arms and

legs)Outdoor hikingACTIVITIES at 8 METS Jogging approximately 5miles per hourCycling approximately 12miles per hourVigorous down-hill skiing


PROGRAM(PHASE III)• Special considerations O2 uptake is higher for arm than legs Myocardial efficiency is lower with leg

exercises with arm exercises Myocardial O2 consumption(heart rate x

systolic pressure) is higher with arm exercises than with leg exercises

PATIENTS WITH CAD COMPLETE 35% LESS WORK WITH ARM EXERCISES THAN WITH LEG EXERCISES BEFORE SYMPTOMS OCCUR

Fluid BalanceFluid Balance

Distribution of Body Fluids

Fluid BalanceFluid Balance

Aerobic Exercises 2

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