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Aerobic Exercises

Aerobic Exercises. Mark David S. Basco, PTRP Department of Physical Therapy College of Allied Medical Professions University of the Philippines Manila. Objectives. At the end of the session, students should be able to Determine the components of an exercise program

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Aerobic Exercises

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  1. Aerobic Exercises Mark David S. Basco, PTRP Department of Physical Therapy College of Allied Medical Professions University of the Philippines Manila

  2. Objectives At the end of the session, students should be able to • Determine the components of an exercise program • Apply principles of a conditioning program for patients with • Coronary Artery Disease • Stroke and/or history of Hypertension • Peripheral Vascular Disease • COPD • Diabetes Mellitus • Well population

  3. Objectives • Determine criteria for initiating an exercise session for different clients / patients. • Decide when to terminate an exercise session based on established protocols and guidelines

  4. What do we need for this topic? Background knowledge of: • Cardiovascular physiology • Exercise physiology • Muscle physiology • Knowledge of different conditions presenting with impaired aerobic capacity Most importantly: • An open and inquisitive mind

  5. Endurance • Ability to work for prolonged periods of time and resist fatigue • Types • Cardiovascular • Muscular

  6. Determinants of an aerobic exercise program INTENSITY DURATION FREQUENCY MODE

  7. Intensity • Overload principle • Specificity principle • Quantifying intensity • Heart Rate • VO2 Max • Rating of Perceived Exertion

  8. Intensity Heart Rate • Maximum Heart Rate • 220-age • Karvonens Formula • THR= RHR + (MHR - RHR) (60-80%) • Deconditioned – 40-50% • Cardiopulmonary disease – 40 – 60% • Healthy individuals – 60 – 80% • For UE work • MHR = 220 – age - 11

  9. Intensity Rating of Perceived Exertion • Useful for patients with heart rate suppressors e.g. Beta blockers • Original • Revised

  10. Intensity Rating of Perceived Exertion • Original version ( 6-20 ) • Remember only the ODD numbers 7 – VERY VERY 9 - VERY 11 - LIGHT 13 – SOMEWHAT HARD 15 - HARD 17 - VERY 19 – VERY VERY 12- 60% HR range 13- 65 – 70% HR range 16- 85% HR range

  11. Intensity Rating of Perceived Exertion • Revised version ( 0-10 ) 0.5 – VERY VERY 1- VERY 2 - WEAK 3 – MODERATE 4 - SOME - WHAT 5 - STRONG 7 – VERY 10 VERY VERY

  12. Intensity • Exercising at a high intensity elicits a greater improvement of the VO2 max • The higher the intensity, the longer the exercise intervals, the faster the training effect • Exercising at high intensities increases the risk for CV complications and musculoskeletal injury

  13. Intensity Goal • Achievement of intensity 60-90% MHR OR 50-85% VO2 Max • Beginners: 50-60% VO2 Max • Average: 60-70% VO2 Max • Fit: 75-85% VO2 Max

  14. Duration Dependent on • Total work performed • Intensity • Frequency • Fitness level • HIGH intensity SHORT duration • LOW intensity LONG duration

  15. Duration • Poor functional capacity • 5 - 10 minutes • Beginners • 10 - 20 minutes • Average • 15 - 45 minutes • Fit • 30 – 60 minutes

  16. Duration Moderate to Minimal intensity • 20 – 30 minutes High intensity • 10 – 15 minutes Exercise longer than 45 minutes increases the risk for musculoskeletal complications

  17. Frequency • Dependent on the health and age of the individual • LOW intensity HIGH frequency • HIGH intensity LOW frequency

  18. Frequency • POOR • Daily • Beginner • Every other day • Optimal frequency • 3-4 times a week • 2 times a week does not generally evoke CV changes for well population • Increase in frequency beyond optimal range, increases risk for musculoskeletal complications • 30-45 mins 3x a week protects against CV disorders

  19. Frequency 3 – 5 sessions / week • Greater than 5 METS Daily or multiple daily sessions • Less than 5 METS

  20. Mode • Large muscles • Rhythmic • Long duration • Lower extremity versus Upper extremity exercise

  21. Mode Lower extremity Upper extremity • Larger muscle mass • Higher VO2 max • HR increases linearly as a function of increased workload / VO2 max • HR plateaus just before maximal VO2 max • Systolic BP increases • Diastolic BP remains the same • Smaller muscle mass • Lower VO2 max than LE exercise • HR higher • Stroke volume lower • Systolic AND Diastolic BP higher

  22. Exercise program Warm-up Aerobic exercise period Cool-down

  23. Warm-up • Muscle temperature • NCV • Vasodilation • Adaptation of respiratory centers • Venous return

  24. Warm-up • 2 components • Graduated low intensity warm-up (5-10 minutes) of total body movement • HR increase 20bpm • Flexibility exercises

  25. Warm-up • Should NOT cause fatigue • Decreases • Risk for ECG changes (arrythmias) • Musculoskeletal disorder

  26. Aerobic exercise • Continuous • Interval • Circuit • Circuit-interval

  27. Continuous • Submaximal and sustained • Achievement of the steady state • Duration; 20 – 60 minutes • Intensity: 60 – 85% VO2 Max • Most effective in increasing endurance for healthy individuals

  28. Continuous Two types: • Intermediate Slow Distance • 20-60 minutes continuous exercise • Most commonly used for managing weight • Long Slow Distance • Longer than 60 minutes for athletic training • Provided after 6months of successful ISD

  29. Interval • Designed to improve strength and power more than endurance • Incorporates recovery after continual exercise • Useful for beginners • Work – rest - work

  30. Interval • Exercise period is followed by rest interval • Rest relief (Passive recovery) • Work relief (Active recovery) • Work recovery ratio • 1:1 to 1:5 • 1 : 1.5 work interval allows the succeeding exercise interval to begin before recovery is complete

  31. Interval Aerobic Interval Training • For patients with poor CV fitness • 2-15 minutes at 50-80% functional capacity Anaerobic Interval Training • For patients with high CV fitness • 30 sec – 4 minutes at 85-100% functional capacity • Usually results in greater lactic acid concentrations

  32. Circuit • Series of exercise activities • Several exercise modes • Improves both strength and endurance

  33. Circuit interval • Stresses both aerobic and anerobic systems • Delays the need for glycolysis and lactic acid production

  34. Cool-down • Prevents • Pooling of blood • Post-exercise syncope • Ischemia, arrythmias, and other complications • Increases oxidation of metabolic waste

  35. Cool-down • Length of cool-down phase proportional to intensity and length of the conditioning phase • Typical 30-40 aerobic exercise period • Warrants a 5-10 minute cool-down phase

  36. Aerobic Conditioning program design Coronary Artery Disease Stroke and/or history of Hypertension Peripheral Vascular Disease COPD Diabetes Mellitus Well population

  37. Coronary Artery Disease • In-patient phase • Out-patient phase • Maintenance phase

  38. In – patient phase • 3 - 5 days • Objectives • Initiate early return to independence • Prevent deleterious effect of bed rest • Help allay anxiety and depression • Promote risk factor modification

  39. In – patient phase • Role of PT • Sit- to- stand 1-3 days post-op • Orthostatic challenge to the CV system 3-5 days post-op • Low-level exercise program (1-3 METS)

  40. In – patient phase Exercise recommendations • Intensity • 2-3 METS progressing to 3-5 METS by d/c • RPE < 13 (6-20) • Post-MI: HR <120 bpm or RHR + 20 bpm • To tolerance, if asymptomatic

  41. In – patient phase Exercise recommendations • Duration • Begin with intermittent bouts lasting 3-5 minutes, as tolerated • Rest periods can be slow walk or complete rest • Attempt 2:1 exercise/rest ratio • Frequency • Early mobilization: 3-4 times / day (days 1-3) • Later mobilization: 2 times/day (beginning on day 4) with increased duration

  42. In – patient phase Exercise recommendations • Mode • ADLs • Selected arm and leg exercises • Early supervised ambulation

  43. Out-patient phase • Initiated 6-8 weeks upon discharge • Objectives • Improve functional capacity • Promote early return to normal activity • Promote positive lifestyle changes • 9 METS functional capacity: suggested exit point • Weaned from continuous monitoring to self-monitoring

  44. Out-patient phase Exercise recommendations • Intensity: 40-60% MHR • Duration: Initial 10-15 minutes, Target 30-60 minutes • Frequency: 3 – 4 times / week • Mode: Continuous / Circuit interval • Walking, treadmill, cycle ergometer

  45. Maintenance phase • 3 - 6 months post-cardiac patient • Objectives • Maintenance of function • Compliance with exercise program • Risk factor modification • Entry-level criteria • Functional capacity of 5 METS • Clinically stable angina • Medically controlled arrhythmias during exercise

  46. Maintenance phase Exercise recommendations • Intensity • 40-75% MHR • Duration • 45 minutes to tolerance / session • Frequency • 3 – 5 days / week • Mode: • Continuous / Interval

  47. Coronary artery disease Mode of exercise • Patient preference • Skill required for proper performance • Potential for carryover at home • Availability of exercise equipment

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