Exercise Prescription

for Cardiovascular
Fitness

The Art of Exercise

Prescription
The art of exercise prescription is the
successful integration of exercise
science with behavioral techniques that
result in long-term program compliance
and attainment of the individuals goals.
P 136 (ACSMs Guidelines)

Components of Fitness
Cardiorespiratory
Resistance Exercise
z
z

Muscular Strength
Muscular Endurance

Flexibility
Body Composition

MSSE
Vol 30, number 6
1998
The Recommended Quantity and
Quality of Exercise for Developing and
Maintaining Cardiorespiratory and
Muscular Fitness and Flexibility in
Healthy Adults
ACSM Position Stands

Definitions
Specificity training effects derived from an
exercise program are specific to the exercise
performed, muscle groups involved, ROM
and energy system utilized
Overload principle for a tissue or organ to
improve its function, it must be exposed to a
stimulus greater than it is normally
accustomed to

Components of the
Training Session
Warm-up (5-20 minutes)
z

Purpose
z
z
z
z
z
z
z

Facilitates transition from rest to exercise

Stretches postural muscles
Increases blood flow to working muscle
Elevates body temperature
Increase joint ROM
May decrease susceptibility to musculoskeletal injury
May decrease occurrence of ischemia and lifethreatening arrhythmias

Warm-up
Protocol
5-10 min of low-intensity exercise (10-30%
HRR) gradually increasing in intensity to
the lower limit of the exercise prescription
z 5-10 min of static, dynamic, or PNF
stretching
z

Stimulus or Conditioning
Phase
Purpose
z
z

Improve VO2max
Reduce risk of CAD, diabetes, etc.

Protocol
20-60 min of continuous or intermittent
activity (multiple bouts of 10 minutes)
z Lower intensity 30 min or more
z

Cool-down
Purpose
Gradually decrease heart rate
Prevent pooling of blood (muscle pump)
z Prevent post exercise hypotension antihypertensives
z Combats post exercise increase in plasma
catecholamines reducing risk of serious
arrhythmias
z
z

Cool-down
Protocol
Gradually decrease in intensity for 5-10
min (muscle pump) - large muscle groups
z Stretching
z

Length of W-U and C-D?

Depends.
Time of day
Temperature
z Medications
z Risk stratification
z Intensity of work out
z
z

Checking Heart
Rate/RPE
When?
End of warm-up
Reach steady state, not too late to adjust
z End of cool down
z
z

z
z

Heart rate still elevated

Hot shower

Where monitor?
Carotid problems at rest
Brachial
Radial
Hand over chest (exercise only)

How many seconds?

Rest 30 60 seconds
Exercise
15 X 4 = 60 seconds
10 X 6 = 60 seconds
z 6 X 10 = 60 seconds
z
z

Issues
Accuracy 15 second count
Decrease Intensity heart rate drops
within 15 seconds
Time to locate pulse
10 second count for exercise

Start from 0 or 1?
0 - if timing is initiated simultaneously
with a pulsation
1 - if a second person is keeping time or
a lag between the initiation of timing and
first pulsation

Variables That Interact

to Form Exercise
Prescription
Frequency
Intensity
Time
Type of Activity

Type of Activity
Variety
Exercise all major muscle groups
Reduce risk (high-impact vs nonweight
bearing) of injury
Increase likelihood that training effect
will transfer to vocational and
recreational activities

Aerobic Activity
Extended time
Rhythmic/repetitive
Large muscle groups*
CWT ~ 6% increase in VO2max vs 2025% for aerobic exercise program

If target heart rates are

equivalent during
cardiorespiratory
endurance exercise and
circuit weight training,
why arent the training
effects the same
(increase in VO2max)?

Pressor Response
Increase in SBP and DBP
Q = HR X SV
z
z

HR increases with CDV and WT

SV NC or decrease with WT
Decreased preload (venous return due to
compression of vena cava)
z Increased afterload (due to mechanical
constriction of vessels) - increased TPR
decreases EF or SV)
z

Box 7-1. Grouping of

Cardiorespiratory Endurance
Activities (p 144 G)
Group 1 Activities that can be readily maintained at
a constant intensity and interindividual
variation in energy expenditure is relatively
low. Desirable for more precise control of
exercise intensity, as in the early stages of
a rehabilitation program. Examples of
these activities are walking and cycling,
especially treadmill and cycle ergometry

Box 7-1. Grouping of

Cardiorespiratory Endurance
Activities Continued
Group 2 Activities in which the rate of energy
expenditure is highly related to skill,
but for a given individual can
provide a constant intensity. Such
activities may also be useful in early
stages of conditioning, but individual skill
levels must be considered. Examples
include swimming and cross-country
skiing

Box 7-1. Grouping of

Cardiorespiratory Endurance
Activities Continued
Group 3 Activities where both skill and
intensity of exercise are highly
variable. Such activities can be very
useful to provide group interaction and
variety in exercise, but must be cautiously
employed for high-risk, low-fit, and/or
symptomatic individuals. Competitive
factors must also be considered and
minimized. Examples of these activities
are racquet sports and basketball

Determining Exercise Intensity

p 145 G
Individuals level of fitness: low fit, very sedentary and
clinical populations can improve fitness with lowerintensity, longer- duration exercise sessions. Higher
fit individuals need to work at the higher end of the
intensity continuum to improve and maintain their
fitness
Medications (see Appendix A) that may influence HR
require special attention when defining the initial
target HR range and when the dose or timing is
changed

Exercise Intensity Continued

Risk of cardiovascular and orthopedic injuries is
higher and adherence is lower with higher-intensity
exercise programs
Individual preferences for exercise must be
considered to improve the likelihood that the
individual will adhere to the exercise program
Individual program objectives (lower BP; lower body
fatness; increased VO2max) help define the
characteristics of the exercise prescription

Time
20-60 min of continuous or intermittent
exercise
Minimum of 10 min bouts
Most train 20-30 min 70-85% HRmax or
60-80% HRR, not counting WU and CD
Related to caloric expenditure goals

Incidence of Injury
and Time
15 min - 22%
30 min 24%
45 min 54%****

10

Frequency
Deconditioned can improve with 2
d/wk
Optimal 3-5 d/wk
>3 d/wk magnitude of change is
smaller

Exercise at Lower
Intensities
> 3 d/wk required to achieve adequate caloric
expenditure in novice population
150-400 kcal/day in PA or Exercise
~ 1,000 kcal/wk as initial goal for sedentary
Goal = 300-400 kcal/d of PA
If < 5MET functional capacity
1-2 short daily sessions

Incidence of Injury
(Pollock et al.)
1 d/wk 0%
3 d/wk 12%
5 d/wk 39%*********
If 60-80% HRR or 70-85% HRmax 3
days adequate to improve or maintain
VO2max

11

Bottom Line
> 30 min, 3 d/wk significantly increases
risk of injury

Transfer of Training
Benefits (ACSM G p 157)

Mode of Activity
Specificity little transfer between arm
and leg work with regard to submaximal
or maximal exercise
Also applies to lactate threshold and
pulmonary ventilation
Central vs peripheral changes

12

Fick Equation
VO2 = HR X SV X a-v O2dif
Central
z Increase in SV
z Increase in Q at max
Peripheral
z Increase a-v O2dif
z Increase number of capillaries
z Increase mitochondrial enzymes
z Increase number of mitochondria
z Increased myoglobin

Mode of Activity
Maximal heart rates will be different with
different modes of activity
RPE values will be specific to mode of
exercise
Cross training
Muscle balance
Risk of injury
z Variety
z
z

Supervision?

13

Exercise for Weight

Loss
Rest 1.2 kcal/min
65% fat/35% CHO
Energy system - aerobic

Intensity and Substrate

Utilization with Exercise
Intensity
CHO Utilization
Fat Utilization

Training Status
Cardiorespiratory fitness burn more

fat and less CHO for a given workload

Why????
More mitochondria

14

Diet and Substrate

Utilization
Eat CHO within 8 hr of exercise
Fat utilization
CHO utilization
Fasting burn greater %age of fats vs
CHO

Questions
Is it better to exercise at a low intensity
which burns more fats or a higher
intensity which burns more CHO if
weight loss is my primary goal?

The facts about fat

(Stanforth, UTA)
50% VO2max
50% fat/50% CHO
4.86 kcal/min
146 total kcal for 30
min
Fat 73 kcal
CHO 73 kcal

70% VO2max
40% fat/60% CHO
6.86 kcal/min
206 total kcal for 30
min
Fat 82 kcal
CHO 124 kcal

15

Answer
If client can safely exercise for full exercise
period at the higher intensity better for
weight loss
Why?
Burns more total kcal
Burns more fat (even though %age fat higher
due to more total kcal burned)
Total kcal burned more important than kcal as
fat or CHO
Greater EPOC (>70% VO2max )

Which is better for

weight loss if only 30-60
minutes?
Both cardio and weight training
Studies show that cardiovascular
exercise is not adequate to maintain
FFM
Equally important
Resistance training burn more kcal
post exercise for equivalent VO2 and
more fat

Comparison of Weight
Loss Options
Goal: 5 pounds
Exercise only
Diet only
Diet + Exercise
Diet + Exercise + Resistance Training

16

Exercise Only
3 miles, 3 days/week
3 mi X 100 kcal/mile X 3 day/wk = 900 kcal/wk
3500 kcal/lb X 5 lb = 17,500 kcal
17,500 kcal/900 kcal/wk = 19.4 wk

Diet Only
Decrease caloric intake 250 kcal/day
250 kcal/day X 7 day/wk = 1,750 kcal/wk
17,500 kcal/1750 kcal/wk = 10 weeks

Diet + Exercise
Diet 1,750 kcal/wk
Exercise 900 kcal/wk
Total = 2,650 kcal/wk
17,500 kcal/2,650 kcal/wk = 6.6 weeks

17

Add Resistance Training

Add 2 pounds of muscle mass
Burn additional 35 kcal/day per lb of muscle
35 kcal/day X 2 = 70 kcal/day
70 kcal/d X 7 d/wk = 490 kcal/wk
490 + 2,650 (diet+exercise) = 3,140 kcal/wk
17,500 kcal/3,140 kcal/wk = 5.3 weeks

What type of exercise is

best for weight loss?
Aerobic Exercise
Improve health
Improve VO2max
z Burns more kcal (10-13 kcal/min)
z
z

What type of exercise is

best for weight loss?
Resistance Training
z Increase/preserve muscle mass
z Increase bone density
z Muscle is more metabolically active than
fat (burns more kcal)
z Increase muscular strength and endurance
z Hormonal response favors higher post
exercise oxygen consumption than
endurance aerobic conditioning and fat
burning

18

Bottom Line
Both are important!

Research on role of weight

training and weight loss
Not shown a definitive benefit alone or
in combination with endurance exercise
Reductions in FFM = Decrease in REE
No scientific evidence

Criteria for Overweight/Obesity

55-60% Adults Overweight (BMI > 25kg/m2)
Of this group 20-25% Adults Obese (BMI > 30
kg/m2)
Pattern of body fat distribution android (apple)
vs gynoid (pear)
Intra-abdominal fatness positively associated
with hypertension, hypercholesterolemia and
hyperinsulinemia

19

Energy Deficit
500-1,000 kcal/day
Goal 1-2 pounds/week
Reduce fat and kcal both for best
results
Maintenance of low fat intake important
for maintenance of long-term weight
loss

Summary
BMI >25 should reduce weight
Reduce weight by minimum of 5-10%
Long-term weight maintenance goal
Maintenance body weight within 5
pounds of current weight
Change eating and exercise behaviors
Reduce intake 500-1,000 kcal/d

Summary
Fat <30% of energy intake
Minimum of 150 min/wk of moderate intensity
activity goal
Long-term weight loss - 200-300 min/wk or >
2,000 kcal/wk of activity
Resistance training
Pharmacotherapy only for BMI > 30 or > 27
with comorbidities
Behavioral intervention

20

Intensity and Heart Rate

Intensity/type
High intensity
high impact
High intensity
low impact
Low intensity
high impact
Low intensity
low impact

Heart Rate
(bpm)
175

% Max HR

% VO2max

88

78

163

83

61

164

82

67

130

65

37

Ways to Increase Intensity (VO2)

Intensity/Type

VO2
(ml/kgmin)

Heart Rate
(bpm)

Low Impact
Aerobics

39.5

173

High Impact
Aerobics

39.4

Kcal/min

10.7

170

10.6

How do you increase HR

and VO2?
Propulsion (change center of gravity)
Jump
Bench
z As move
z
z

Locomotion
Change directions
Lengthen lever arm
Arms???????

21

Bench Height vs Step Rate

(VO2 ml/kgmin)
Bench Height (inches)

Step Rate
(bpm)

10

12

120

21.3

25.9

29.8

34.1

128

22.6

27.1

31.6

36.0

Body Position and Energy Cost on

Stairmaster (METs)
Workload
Level

11

No support

7.3

9.1

10.8

12.4

Arm
Support

6.4

7.8

9.1

10.3

Lean

6.2

7.4

8.9

10.1

22