Applied Exercise Prescription: Why planning and ...
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Applied Exercise Prescription: Why planning and programming of the exercise dose is so important to improve health outcomes in inactive populations? From Linear to Undulating Periodization Models Prof. Alfonso Jimenez PhD, CSCS, NSCA-CPT, FLF
Transcript of Applied Exercise Prescription: Why planning and ...
Applied Exercise Prescription: Why planning and programming of the exercise dose
is so important to improve health outcomes in inactive populations?
From Linear to Undulating Periodization Models
Prof. Alfonso Jimenez PhD, CSCS, NSCA-CPT, FLF
A “natural” Evolution in Sport & Exercise Science
Frustrated athlete
Interested student
Motivated professional
Overwhelmed academic
Luis J. Gonzalez-Fanega 1992 European Indoor Champion 800m Genoa (1´46”80)
Personal best: 1’44″84
London 2012 David Rudisha WR 1'40"91!!
Workshop plan…
Background and fundamental knowledge linked to exercise prescription (20min).
Models for planning and programming of the exercise dose (20min). Moving into practice: Case studies and the “3-Questions Law” (20 min). 10min Break Group exercise, solving case studies by applying methodology (45 min). Sharing the outcomes and open discussion (30 to 45 min).
http://www.who.int/nutrition/topics/obesity/en/index.html
• Globally, there are more than 1 billion overweight adults, at least 300 million of them obese. • The key causes are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.
WHO’s Childhood Obesity Surveillance Initiative (COSI), around 1 in 3 children in the EU aged 6-9 years old were overweight or obese in 2010. This is a worrying increase on 2008, when estimates were 1 in 4…
What if there was one prescription
that could prevent and treat dozens of diseases,
such as diabetes, hypertension and obesity?
Robert E. Sallis, M.D., M.P.H., FACSM, Exercise is Medicine™ Task Force Chairman
Physical Inactivity and Health
(Risk high if Activity low)
Activity
Prevention of Weight Gain
Type 2 Diabetes
Musculoskeletal Injury
Functional Health Status
CHD
Stroke
Osteoporosis
Public Health Transitions
1900 2000 1960
Decisions about the Environment and Public Policies !!!
Ainsworth, 2006
Cancer
1900 1960 1990 2000
Obesity
1970 1980
Infectious
Diabetes
CVD
Chronic Diseases Impact
The introduction of the IBM PC marked a major milestone in 1980's computing, and led to the growth of the PC compatible market ...
IBM PC / XT / AT
To change the behaviour of anyone we have to ... Provide evidences,
Create opportunities,
And Facilitate positive experiences, specially at the beginning.
Delivering CHANGE!!!
The main role of an Exercise Professional is to serve as a FACILITATOR on this behavioural change,
by providing a customized optimal exercise dose to
improve health in a safe and healthy environment.
Prof. J.N. Morris Prof. R. Paffenbarger Jr.
Physical Activity at Work and Coronary Artery Disease, 31,000 London Transport Workers
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Coronary Occlusion Early Mortality*
DriversConductors
Morris JN et al. Lancet 1953
Rate/1000
*Within 3 days of MI
< 500 500 1000 1500 2000 2500 > 3000
40
%
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%
20
%
10
%
K/cal burned weekly (walking)
Ris
k re
duct
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There is a relation between regular physical activity and death risk reduction. From Paffenbarger et al. modified
RES
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Main Limitation: Measurement of physical activity level was based on questionnaires
Aerobic Center Longitudinal Study (ACLS)
• Cohort of 21,199 men examined at the Cooper Clinic in Dallas, Texas, since 1970 • Complete preventive medical exam, including a maximal exercise treadmill test • Identified 832 all-cause deaths from baseline through 1994 during 180,293 man-years of follow-up among men from 45-94 years of attained age
Blair SN et al. JAMA 1996; 276:205-10
Age-Adjusted All-Cause Mortality (10.000/PY) by Fitness Groups, Men
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Low 2 3 4 High
ACLS
RES
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Fitness Groups
Early investigations examining the relative risks of allEarly investigations examining the relative risks of all--cause cause mortality as a function of physical activity/fitness level. mortality as a function of physical activity/fitness level.
A: Harvard Alumni Study (A: Harvard Alumni Study (PaffenbargerPaffenbarger et al. 1986). et al. 1986). B: Aerobic Center Longitudinal Study (Blair et al. 1989).B: Aerobic Center Longitudinal Study (Blair et al. 1989).
Energy Expenditure (kcal/week)
<500 500-900 1000-1499 1500-1999 2000-2499 2500-2999 3000-3499 >3500
Rel
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e R
isk
of A
ll-C
ause
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talit
y
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Physical Fitness Quintile
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isk
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talit
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SED LOW MOD HIGH
Leon et al (1987) Morris et al (1990) Shaper et al (1991)
Ekelund et al (1988) Lie et al (1993) Sandvik et al (1993)
Activity/Fitness level
Adapted from Sallis & Owen, 1998
Reduction in coronary mortality with activity/fitness
Reduction in coronary
mortality (%)
Thirds of Muscle Strength and Mortality, 8.762 Men, ACLS
05
10152025303540
Age adj death rate/10,000
MY
All-Cause CVD
LowMiddleHigh
503 deaths (145 CVD) during average follow-up of 18.9 years
Ruiz J et al. BMJ 2008
40.842 males & 12.943 females, ACLS
But, LET’s talk about EXERCISE.... Physical Activity: Bodily movement produced by the contraction of skeletal muscles that requires energy expenditure in excess of resting energy expenditure. Exercise: a subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness.
Moore SC, et al. (2012) Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. PLoS Med 9(11): e1001335.
N: 650.000 personas!!!
PA vs Exercise PA is good, but…
Exercise is BETTER!!
Black: CG; Blue: PA (walk); Red: AER; Green: AER+RT
Lab research: • Large number of published
studies • Conclusive: Exercise IS Medicine
Real world research:
• Low number of published studies
• Reliance on weak metrics (body weight, adherence, self report)
• Lack of control group (was it the exercise or something else that drove the positive effects……..?)
Evidence
Reports
Application!!
The Research Challenge**
… and Health improvement???
Hass, C.J. (2001). Sports Medicine 31 (14), 953 - 964
“Despite innovations in clothing and equipment design, modern trends in
nutrition and suplementation for athletes, and the genesis of drug taking in
sports,
the major factor influencing athletic performance is still TRAINING!!!”
(Rowbottom 2000, in Garret WE, Kirkendall DT. Exercise and Sport Science, LWW)
“The Power of Training”… 1) It can produce great changes!!!
2) It really cares HOW do you train…
General Adaptation Syndrome
Alarm reaction - the body detects and prepares to mount a response to an external stimuli or training stress; last days to weeks; athlete may experience short term soreness, stiffness and a drop in performance Adaptation - the body protectively responds and adapts to the training stress; neurological, structural and biochemical adaptations occur; supercompensation occurs in this stage
Exhaustion - Failure of the body to fully adapt to the stress; can occur as a result of sub-optimal training variety or when training stress is too great; monotony, overtraining and other training maladaptations may occur; non-training stresses may also contribute to exhaustion
Supercompensation
• Supercompensation refers to the desired, beneficial training effect that occurs in direct response to the applied training stress, and following a recovery period.
• Supercompensation is the return of the performance level from a point of reduced capacity that follows a training episode, beyond the pre-training level and to a new, higher performance baseline.
Supercompensation & Adaptation
Positive Adaptation Negative Adaptation
Figure 1 Figure 2
Figure 1 - note that the training effect brings the performance capacity back to a higher level
Figure 2 - note the inadequate recovery stage and its’ effect on adaptation
Planned variation in program variables.
Periodization: prevent overtraining and optimize peak performance through training cycles.
Periodization
Periodization
• Periodization – systematic variation of training specificity, intensity, and volume organized into planned periods or cycles within an overall program
• Training programs need to be varied in order to continually presenting the athlete with new demands and challenges
• Training variation helps to avoid plateauing of physical adaptations and psychological adjustments
• The positive outcome gained through a successful training program cannot continue indefinitely unless the training stimulus is constantly changed
“Traditional“ Periodization Model Matveyev’s Model (optimal for novice athletes)
Example of annual plan
Traditional Periodization model
Phase How long? Frequency Duration Intensity Volume
Prep 4-8 weeks High Short-Medium Very little Low
Base 12-24 weeks High Medium- High Moderate Moderate to
High
Build 4-8 weeks Moderate-High High Heavy Moderate
Peak/Race 3-5 weeks Moderate Short Heavy Low
Periodization Cycles
A Periodized training
program is divided into a number of different specific time periods;
Each with specific training goals and training emphasis
Macrocycle
Mesocycle Mesocycle Mesocycle Mesocycle
Micro Micro Micro Micro Micro Micro Micro Micro
Macrocycle – entire training period; typically one year but may last from months to 4 years
Mesocycle – lasts several weeks to months, depending on the goals of training and/or number of competitions within period
Microcycle – typically 1 week long, possibly up to 4 weeks; focuses on daily and weekly training variations
Example of Mesocycle
Periodization Periods
The planned implementation of the meso- and microcycles within an overall macrocycle is the basis for varying the training program design
Training Intensity & Volume are the most often manipulated variables
To avoid overtraining and to optimize performance, the concept of periodization involves shifting training priorities:
Conventional Periodization models include four distinct periods:
Non-sport-specific
High Volume
Low Intensity
Sport-specific
Low Volume
High Intensity
Preparatory 1st Transition Competition 2nd Transition
Linear Periodization
• Set 2 to 4 week phases of a given intensity and a given volume within a small range
8-12 cycle
6-8 cycle
3-5 cycle
1-3 cycle
Competition
Or Active Rest Cycle
Non-Linear (Undulating) Periodization
Non-Linear Periodized Program ___________________________________________________________ This protocol uses a 4 day rotation. Monday Wednesday 2 sets 12-15 RM (light day) 3 sets of 8-10 RM (Moderate Day) Friday Monday 3 sets of 4-6 RM (Heavy Day) Power day- 10 sets of 1-2 reps at 30% 1RM ____________________________________________________________
This systematic review identified 21 research studies that tested the impact of periodized exercise programs on health outcomes in sedentary adults.
The majority of studies assessed overweight and obese adults
Traditional periodization being the most prevalent method.
Health status/function
PA/Exercise
Health & Fitness
Cardiorrespiratory disorders
Metabolic disorders
Musculoskeletal disorders
Mental disorders
Active lifestyle Exercise!!
AER RT COMB
Epidemiology/prevalence Effects of PA/Exercise Evidence-based dose/response
Contraindications Assessment Exercise prescription!!
Public Health & Clinical Exercise Framework
Drugs effects
PA is good, Exercise is BETTER, but ...
We NEED more and better research and more clear evidences.
In the meantime, we have to be able to offer a customized exercise solution for any individual, evidence-based, safe and effective.
So, we will need to make us the proper questions...
Exercise Programme design Decision-making process Flow-chart (Jimenez, Esteve, 2008)
Sedentary individual needs
Needs related to Optimal dose
Personal, espatial and temporal
conditional factors
Optimal dose Identification??
Exercise specific priority goals Exercise content definition
Evidence-based Knowledge
Applying effective exercise to inactive population ... The “3 key Questions Law”!!!
#1
#2
#3
Initial tailored exercise intervention
Planning and Programming the Exercise load
Exercise Mode
Variable M1 RM1 M2 RM2 M3 RM3 M4 RM4 M5 RM5 M6 RM6
AT Int %
Vol RT Int RM
Vol. Flex Int PT
Vol TOTAL Time
0102030405060708090
m1 m2 m3 m4 m5 m6
Microciclos
Sum
ator
io d
el ti
empo
/mic
roci
clo
(min
) cardiofuerzaflex
Example of Training Log for Hypertensive individual (combination of PA + Exercise)
Date HR SH Walking (PA)
BP1 AER RT Other BP2 T.T. BP/hour V.Sub. (0-10)
Drug Dose/time Observations
Time Distance Comments PA AER RT Total
Weekly Summary Report
METs Kcal/hour Kcal/week
Let’s put everything in practice….
Case study: Inactive male 54 years old (bank employee).. 106kg BW. 1,72m high. SBP 142 mm Hg / DBP 96 mm Hg. Tcol: 225 mg/dl DHL: 35mg/dl; LDL: 138 mg/dl Glucose (fasting): 126 mg/dl Refers chronic pain in right knee. Medication: Ommeprazol for local inflammation of stomach
entry…
Initial 12 weeks of exercise
3 sessions/week 75min/session
Factor #1: Attitude
Factor #2: Ambition/+Stress
(positive activation threshold)
Factor #3: Training!!!
(learning-by-doing)
