Physical Training Lec 20 PDF

PHYSICAL ACTIVITY PT 704 Applied Physiology 1  Overview Inactivity and Obesity Related Epidemic Understanding Exercise Terminology How to Write an Exercise Prescription Muscular Strength and Endurance Flexibility Provide you...

PHYSICAL ACTIVITY PT 704 Applied Physiology 1  Overview Inactivity and Obesity Related Epidemic Understanding Exercise Terminology How to Write an Exercise Prescription Muscular Strength and Endurance Flexibility Provide you facts and tools to use in your PT practice 2  Inactivity & obesity related-disease epidemic obesehasbeen since Understanding the 80 Exercise Terminology s How to Write an Exercise Prescription Considerations for adults, youth and seniors Overview 3  4 Ogden C. L., Carroll, M. D., Kit, B.K., & Flegal K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814 2011 1992 1978 1972 1962 10% 20% 30% 34.9% Obese 40% 50% or Obese 60% 68.5% Overwt 70% 80% more womenobesethanmen NHANES Adult Obesity moremen OWthanwomen Obesity Epidemic  Obesity Epidemic Modifiable Risk Factors “Actual Causes of Death” Mokdad, JAMA, 2004 5  Overview Physicians, their Patients & Exercise 47% of primary care physicians include an exercise history as part of their initial examination (Self Report) Only 13% of patients report physicians giving advice about exercise Physically active physicians are more likely to discuss exercise with their patients Eakin, Am J Prev Med 6 Abramson, Clin J Sport Med Walsh, Am J Prev Med BMI’s of US FM Docs: OWtoo Physicians are 19 – 24: 43% 25 – 30: 40% >31: 17% (Females more likely to have normal BMI than males) Prelim AIM Physician BMI project – AAFP 2005 7  Overview Shifting the Paradigm: Exercise Activity Exercise = Training Activity = Play, Fun, 8 Stephens, USUHS Functional Fitness  Overview Why Exercise? “Be Active” To Lose Weight Penance for Bad Food Choices Because I Have To Treat Disease X Osteoporosis HBPdiabetesetc “I exercise because I want to and I like to enjoy life” 9  Overview Inactivity & obesity related-disease epidemic Understanding Exercise Terminology How to Write an Exercise Prescription Considerations for adults, youth and seniors 10  Definitions of Exercise Intensity Physical Activity: Body movement by contraction of skeletal muscle which substantially increases energy expenditure equivalence Low metabolic Moderate Heart Rate, VO2max, METs, RPE High Hattedexertion Exercise: Physical activity that can provide health benefits and improve fitness 11  Definitions Max Heart Rate (MHR) – 220- age = MHR (+/- 12 bpm) Heart Rate Reserve (HRR) Howmuchyou can goabove resting – HRR= MHR - Resting HR(RHR) naiHin Target Heart Rate (THR) Whatyou are whenyouwake up – THR = HRR X TI + RHR TI - Training Intensity, usually 40-60% for moderate exercise 12  What is VO2max? 13  Definition of VO2max Functional aerobic capacity: Maximal ability of the body to take in, transport and use oxygen Howwellyoutake it in transport use Fick Equation: VO2max = (HRmax x SVmax) x (a-v)02max Q Ca v a diff 14  FICK EQUATION Diffusion (220 - Age) Ventilation Whateffects PaO2 Perfusion Sinus Node Dysfunction Hgb [ ] Drugs (e.g., B - blockers) SaO2 VO2max = (HRmax X SVmax) X (CaO2max - CvO2max) biggerheartbiggeroutput Genetic Factors (Heart Size) Skeletal Muscles Conditioning Factors Aerobic Enzymes Contractility/Afterload/Preload Fiber Type Disease Factors Muscle Disease Wall Motion/Ventricular Fxn Valve Stenosis or Regurgitation Capillary Density 15 Metabolic equivalents METS The MET 16  Metabolic Equivalents One MET is equivalent to the amount of oxygen used while resting in the sitting position (3.5 ml O2/kg/min) Wide individual range of variation Higher the skill level, wider the variation Based on 70 kg person Widely used in cardiac rehabilitation 17  RPE Relative Perceived Exertion “God gives us our relatives--thank God we can choose our friends.” - Michel de Montaigne 18  Relative Perceived Exertion Scale (Borg) Category RPE Scale Category-Ratio Scale 6 0 Nothing at all 7 Very, very light 0.3 8 0.5 Extremely weak 9 Very light 0.7 10 1 Very weak 11 Fairly Light 1.5 12 60% VO2 Max Subjective 2 Weak 13 Somewhat hard measurement 2.5 14 3 Moderate 15 Hard 4 16 85% V02 Max 5 Strong 17 Very Hard 6 goodspot 18 7 Very strong 19 Very, very hard 8 20 9 10 Extremely strong * Add zero to RPE = HR * Add zero to C-RS = % MHR RPE Scales. Original (6-20) on left, and Revised Scale (1- Borg GA: Medical Science in Sports and19Exercise 10) on right—correlates with HR and VO2 143:377-389  Putting It All Together Exercise Intensity HRmax VO2max METS RPE women (47.9%) 3. Younger (59.6% vs 39%) 4. White (51.1% vs other groups) 5. Educated (53.2%) 35  BENEFITS – Dose Response Relationship College Alumni Health Study Health Professionals’ Follow-up Study Nurses’ Health Study Women’s Health Initiative Women’s Health study 36  BENEFITS w exercise 1. Cardiorespiratory Fitness improved 2. Lipid/lipoprotein profiles improved 3. Blood pressure 4. Fasting plasma insulin worksbetter to removesugar 5. Lipidemia increases HDL 6. Weight control Helis 7. ↓ CVD risk (25-50%) stroke as well 8. ↓ premature mortality prevents 37  Exercise (Activity) Prescription in Adults Orthopedic Injury vs. VO2max Gain In Vigorous Exercise Difference in V02maxgainisnegligible Exercise Duration Exercise Frequency 60 50 Orthopedic Injury VO2max Gain 40 % Injury 30 20 10 0 15 30 45 1 3 5 Minutes per Session Sessions per Week Over 30 min injuryincreases 38 Gettman, Med Sci Sports Exerc  Overview Inactivity & obesity related-disease epidemic Underst Muscular Strength and Endurancending Exercise Terminology Considerations for adults, youth and seniors 39  Physiological Effects of Strength Training – ↑muscle mass and size of muscle fibers – ↑utilization and coordination of motor units arehealth– ↑strength of tendons, hypertrophy ligaments, and bones in – ↑storage of fuel in and blood supply to muscles – Improvements in blood fat levels and biochemical processes metabolism moreefficient 40  Benefits of Muscular Strength and Endurance Improved performance of physical activities Injury prevention Improved body composition lose bodyfat Enhanced self-image and quality of life Improved muscle and bone health with aging Prevention and management of chronic disease 41  Assessing Muscular Strength and Endurance Muscular strength assessed by determining repetition maximum (1 RM), the maximum resistance that can be lifted once Muscular endurance assessed by counting the maximum number of repetitions of a muscular contraction beforefatigue 42 FUNDAMENTAL CONCEPTS OF PROGRESSION 43  Progressive Overload How it canbe done Weight/Resistance Adding Sets/Repetitions Addingreps in a set or sets – Set = a group of repetitions followed by a rest period Frequency Speed or Rate of Movement Duration of vonnat Rest Interval decrease Volume – total work=reps X resistance – 2.5-5% to avoid overtraining Isolation of Muscle ROM 44  Fundamental Concepts usingspecific movements themusclethat is workedistheonethatwillimprove Specificity Variation – Volume and intensity Periodization – Selye 45 Classic (linear) Model of Periodization – High initial volume and low intensity – As training progresses, volume decreases and intensity increases Preight reps – Superior to nonperiodized models 46 Undulating (nonlinear) Periodization heavy – Nonlinear Monday: 3-5RM Rotate heavy, moderate and light resistance Wednesday: 8-10 RM moderate Favorable results as Friday: 12-15 RMlight nonperiodized and classic periodization (Baker, 1994); superior to nonperiodized in women (Marx et al) 47  Impact of Initial Training Status on Strength Gain Untrained ↑40% orhigherdependingonhow weakfrail Moderately trained ↑20%they are Trained ↑16% – ~ 6 mos of consistent training Advanced ↑10% – Years of resistance training Elite ↑2% – Competitive athletes A maximum willbereache 48  TRAINABLE CHARACTERISTICS Muscle Strength Muscle Hypertrophy Power Endurance Motor Performance perform task better Depends on trainingtechnique 49  Muscle Strength Muscle Action – Concentric – Eccentric lover a heavy weightmorethan you can 49 fin More hypertrophy More DOMS Causes more than cometraining Loading – Novice – 60-70% of 1RM X 8-12 reps – ↑ 2-10% (high end for large muscles, multiple joint exercises) if can perform 1-2 reps over desired # on 2 consecutive training sessions Havethemdo thesamethingtwicemonwed Onfriday can increaseweight 21000 50 Proposed Causes of Delayed Onset Muscle Soreness (DOMS) Cellular damage – ↑CK, myoglobin 1creatinekinase Spasm hypothesis – Static stretch ↓ EMG activity Tear theory – Minute ruptures of individual fibers Excess metabolite theory toomuchlacticacid Connective tissue damage To muscle tendons 51  Muscle Strength-Training Volume Novice so no study has shown difference between 3 set of1090Wh Setof 70 single-set and multiple-set programs with 3 Wth short-term training (3 months) Intermediate/Advanced Sooners changing Multiple sets with periodized training most effective for strength improvement 52 Muscle Strength-Exercise Selection Multiple joint exercises – Maximize muscle strength Sivesbest strength Closed Chain exercises 53 Creating a Successful Weight Training Program Choosing equipment: Weight machines versus free weights – Resistance is provided by both types – Exercise machines Only workin cardinalplanes Safer, convenient, and easy to use – Free weights Require more care, balance, and coordination Strength transfers to daily activities 54  Muscle Strength – Exercise Order ALL MAJOR GROUPS IN 1 DAY 1. Large muscles < small muscle 2. Multiple joints < single-joint 3. Or rotate upper and lower body exercises UPPER BODY ONE DAY & LOWER BODY 2ND DAY (1 & 2 above) 3. Rotation of agonist-antagonist INDIVIDUAL MUSCLE GROUPS (1&2 above) 3. Higher intensity < lower intensity Stranger musclesbeforeweakerones 55  Muscle Strength – Rest Periods Rest periods of 2-3 min for multiple-joint exercises with heavy loads on large muscle mass (squat, bench press) Rest periods of 1-2 min for machines 56  Muscle Strength-Velocity Isokineticsmachine – Moderate velocity (180-240 degrees/sec) greatest strength gain downside is wemovefasterin space Isotonics upsideispersoncanstoppushingmachineifpain occursNo moreresistance – Slow (novice) Moveslower – Moderate (novice/intermediate/Advanced) 1-2 sec concentric 1-2 sec eccentric – Fast (Advanced) canmovefastertoimprovespeed < 1 sec concentric 1 sec eccentric – Modetate/Fast more strength gain than slow movements gain 57  Muscle Strength - Frequency Novice/Intermediate – 2-3 days/week Intermediate – 3-4 days/week if upper/lower body split (each muscle group trained 1-2 days/week) Advanced – 4-6 days/week Elite – 2 workouts/day X 4-5 days/week 58  MUSCLE HYPERTROPHY- Loading/Volume Novice/intermediate – 70-85% 1 RM X 8-12 reps/set X 1-3 sets Advanced – 70-100% 1 RM X 1-12 reps/setl X 3-6 setsl l periodized (majority 6-12 RM and less 1-6 RM) 59 MUSCLE HYPERTROPHY-Frequency Novice/Intermediate – 2-3 days/week 60  MUSCULAR POWER Predominantly multiple-joint exercises 1-3 sets/exercise 30-60% 1 RM 3-6 reps Progress with periodization Force component – 85-100% 1 RM Fast Force Production – 30-60% 1 RM lower Advanced – 3-6 sets/exercise 1-6 reps 61  MUSCLE ENDURANCE Novice/intermediate – 10-15 reps with 1-2 minute rests Advanced – 10-25 reps with periodization with < 1 min rest 62  Applying the FITT Principle Frequency = days per week Intensity = amount of resistance Time = number of repetitions and sets Type = strength training exercises for all major muscle groups 63  Frequency of Exercise American College of Sports Medicine recommends 2-3 days per week – Allow 1 full day of rest between workouts 64  Intensity of Exercise: Amount of Resistance Choose resistance based on your current fitness level and goals To build strength – Lift heavy weights (80% of 1 RM) – Perform a low number of repetitions To build endurance – Lift lighter weights (40-60% of 1 RM) – Perform a high number of repetitions For a general fitness program – Lift moderate weights (70% of 1 RM) – Moderate number of repetitions 65 Time of Exercise: Repetitions and Sets To build strength and endurance, do enough repetitions to fatigue the muscles The heavier the weight, the fewer the repetitions (1-5) to fatigue = a program to build strength The lighter the weight, the higher the number of repetitions (15-20) to fatigue = a program to build endurance To build both strength and endurance, try to do 8-12 repetitions of most exercises 66 Training for Strength versus Training for Endurance 67  Type of Exercise For a general fitness program: – 8–10 different exercises – Work all major muscle groups – Balance between agonist and antagonist muscle groups half in front half inback – Do exercises for large-muscle groups and multiple joints before exercises for small-muscle groups or single joints 68  FITT Whatyou'll Principle ghter for Strength Training forolderpeopleusea morerepsto lift 69  Maintenance ↓fitness > 2 weeks detraining ↓ VO2max gain by 50% > 4-12 weeks detraining to to back easier get thatlevel – Slower loss if have trained X years (Coyle) Can maintain strength X 12 weeks if ↓ to 1 day/week if intensity maintained 70  Warm Up and Cool Down Warm up prior to each weight training session with a general warm-up and a warm-up for the exercises you will perform Cool down after weight training, relax for 5-10 minutes, lower your heart rate 71  ACTIVE-RESISTIVE TRAINING exampleofperiodization of 10 1 sets Set and Repetition System DeLorme Method 3 sets of 10 repetitions 50% of 10 RM 75% of 10 RM 100% of 10 RM EXAMPLE 10RMis IN Ibs 50# X 10 REPS – REST 75# X 10 REPS – REST 100# X 10 REPS 72  LIGHT TO HEAVY SYSTEM Lighter wt 100# X 10 RM Add more resistance – REST Add more resistance 120# X 8 RM – REST Wtf reps 140# X 6 RM 73  Heavy to Light System – Oxford oh Technique (Zinovieff) Reverses DeLorme’s 100# X 10 RM light to heavy pattern REST Less fatiguing than the lessriskofinfry DeLorme method 75# X 10 RM REST 50# X 10 RM 74  CIRCUIT TRAINING Circuit of > 8 exercise stations Alternate arm, leg, shoulder, and back to prevent fatigue candocircuit morethan1x Progress by ↓rest, ↑reps, ↑circuit If 15-30 sec rest between circuits - ↑VO2max 6% If run during 1-2 mins of rest - ↑VO2max 15% rest period CanimprovestrengthandOnutilization 75 OVERVIEW Flexibility 76  FLEXIBILITY Major muscle groups 2-3 days/week Static stretch 10-30 seconds X 4 reps/muscle group Ballistic Dancing is not a goodway 77 PHYSICAL ACTIVITY GUIDELINES 78  Physical Activity & Public Health - Recommendations for Generally Healthy Adults  To promote and maintain good health and help prevent chronic disease, adults should perform moderate-intensity (3.0 - 6.0 METS) aerobic (endurance) physical activity for a minimum of 30 minutes on five days each week.  Or, this recommendation can be met by performing vigorous- intensity activity for at least 20 minutes on 3 days each week.  Combinations of moderate- and vigorous-intensity endurance exercise can be performed to meet this recommendation.  This activity is in addition to the required activities of daily living that are of light intensity or short duration. Ian t justexercise then sit alldaytopreventchroni disease  s Physical Activity Guidelines for Americans - Adults and Older Adults  Mix moderate and vigorous intensity activity to meet the aerobic activity goal (500 - 1000 MET-minutes/week).  Aerobic activity can be accumulated in bouts of 10 minute or longer (e.g., 3 x 10 minutes/day)  Resistance exercise should be performed 2 x week: 1-2 sets (10-12 repetitions) of 8-10 exercises of major muscle groups.  Start low, build slowly - the major goal is long-term maintenance.  4 Key Adult Guidelines Avoid inactivity Substantial health benefits from medium amounts of aerobic activity More health benefits from high amounts of aerobic activity Muscle-strengthening activities provide additional health benefits  Inactivity “All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.” Physical Activity Guidelines for Americans Health Benefits of Physical Activity: Strong Evidence Lower risk of: – Early death – Coronary heart disease, stroke to h bring BP igh – High blood pressure, adverse lipid profile treatment cholesteroldown and – Type 2 diabetes figs – Cancers: Colon and Breast isncentorst Prevention of weight gain Weight loss (with reduction of caloric intake) Prevention of falls Depression, cognitive function (older adults) Dopamine released dementiaAlzheimer 83  Substantial Health Benefits Guideline “For substantial health benefits, adults should do: – at least 150 minutes (2.5 hours) a week of moderate-intensity aerobic activity OR – 75 minutes (1.25 hours) a week of vigorous-intensity aerobic physical activity OR – an equivalent combination of moderate- and vigorous-intensity aerobic activity.” “Aerobic activity should be performed – in episodes of at least 10 minutes, – And preferably, it should be spread throughout the week.” Notjust on weekends  Comments on 150 Minute Guideline (1) Minimum intensity = moderate – A person who does only light-intensity activity is regarded to be inactive – If do moderate intensity, need at least 150 minutes/week Minimum duration = 10 minutes – Episodes of 10 minutes or longer improve aerobic fitness and some biomarkers – Total PA in most observational studies is usually accumulated from activities of varying, but unknown, duration – Unknown (and difficult to study) if health benefits of one 30 minute bout are exactly the same as from three 10 minute bouts.  Comments on 150 Minute Guideline (2) Minimum Frequency – There is insufficient evidence to say that the health benefits are any different from moderate-intensity PA: 50 minutes/day on 3 days/week = 150 minutes 30 minutes/day on 5 days/week = 150 minutes The 30 minute/day x 5 days/week guideline is too specific, but still OK to follow Guidelines suggest 3 days/week as minimum frequency – Know that 3 days/week produces health benefits – Concern about injury risk with 150 minutes from only 1 or 2 days/week higher riskBetter to spreadthroughoutweek – In the observational studies reporting health benefits of medium (& high) amounts of activity, it appears most people spread the activity throughout the week.  Comments on 75 Minute Guideline (1) One minute of vigorous-intensity activity counts the same as two minutes of moderate-intensity activity. Why? – Explained in detail in appendix in guidelines In brief, adult guidelines based upon total amount of physical activity measured in MET-minutes – 500 to 1000 met-minutes/week = range of substantial health benefits – 1 MET = rate of energy expenditure at rest – Moderate-intensity = 3.0 to 5.9 METs (e.g. walking at 3.0 mph = 3.2 METs) – Vigorous-intensity = 6.0 and higher METs (e.g. running at 10 minutes/mile = 10 METs) 150 minutes x 3.0 METs = 75 minutes x 6.0 METs  Additional & More Extensive Health Benefits Guideline “For additional and more extensive health benefits, adults should increase their aerobic physical activity to: – 300 minutes (5 hours) a week of moderate-intensity, – OR – 150 minutes a week of vigorous-intensity aerobic physical activity – OR – an equivalent combination of moderate- and vigorous- intensity activity.” “Additional health benefits are gained by engaging in physical activity beyond this amount.” More exercise morehealthbenefits  Comments on Additional Health Benefits Guideline Some health benefits of PA occur with as little as 150 minutes/week of moderate-intensity PA e.g. – Lower risk of coronary heart disease As total activity increases from 150 to 300 minutes of moderate-intensity PA/week, two things happen: – Additional benefits accrue, e.g. lower risk of breast cancer – More extensive benefits accrue, e.g., risk of heart disease is significantly lower with 300 minutes/week compared to 150 minutes/week As total activity increases upward from 300 minutes/week, – Greater benefits accrue in a dose-response fashion, but decreasing marginal benefit for each additional minute – No known upper limit where benefits no longer increase – Risk of injury increases as volume increases Thnowswhatistoomuchexert.se