PRINCIPLES OF AEROBIC EXCERCISE

Myra LESLIES S. VILORIA

Physical Activity
As

defined y ACSM and the Centers !f "isease C!ntr!l and #reventi!n $C"C% is any !dy &!ve&ent #r!d'ced y the c!ntracti!n !f s(eletal &'scles that res'lt in a s' stantial increase !ver restin) ener)y e*#endit're.

FI+NESS

a ility t! #erf!r& #hysical ,!r( -!r( re.'ires / A. B. C cardi!res#irat!ry f'ncti!nin)0 &'sc'lar stren)th and end'rance0 and &'sc'l!s(eletal fle*i ility. 1!, d! ,e ec!&e #hysically fit 2 A. B. 'ses lar)e &'scle )r!'#s and challen)e the cardi!res#irat!ry syste&. Activities that can i&#r!ve )eneral fitness 2 ,al(in)0 i(in)0 r'nnin)0 s,i&&in)0 stair cli& in)0 cr!ss c!'ntry s(iin)0 and3!r trainin) ,ith ,ei)hts.

Ma*i&'& O*y)en C!ns'&#ti!n

a &eas're !f the !dy4s ca#acity t! 'se !*y)en It is the &a*i&'& a&!'nt !f !*y)en c!ns'&ed #er &in'te ,hen the individ'al has reached &a*i&'& eff!rt. 1!, it is 's'ally &eas're2 A. lar)e &'scles B. Activities s'ch as / #erf!r&in) an e*ercise that 'ses &any lar)e &'scles )r!'#s s'ch as s,i&&in)0 ,al(in) and r'nnin) "e#endent !n / the trans#!rt !f !*y)en0 !*y)en5 indin) ca#acity !f the l!!d0 cardiac f'ncti!n0 !*y)en e*tracti!n ca#a ilities0 and &'sc'lar !*idative #!tential.

End'rance
Is 6

the a ility t! ,!r( f!r #r!l!n)ed #eri!ds !f ti&e and the a ility t! resist fati)'e. ty#es /

A. M'sc'lar B. Cardi!vasc'lar

M'sc'lar End'rance
Refers

t! the a ility !f an is!lated &'scle )r!'# t! #erf!r& re#eated c!ntracti!ns !ver a #eri!d !f ti&e.

Cardi!vasc'lar End'rance
Refers

t! the a ility t! #erf!r& lar)e &'scle dyna&ic e*ercises s'ch as ,al(in)0 s,i&&in)0 and3!r i(in) f!r l!n) #eri!ds !f ti&e.

Aer! ic E*ercise +rainin)

Aer! ic e*ercise trainin) !r c!nditi!nin) is a')&entati!n !f the ener)y 'tili7ati!n !f the &'scle y &eans !f an e*ercise #r!)ra&. +he i&#r!ve&ent !f the &'scles a ility t! 'se ener)y is a direct res'lt !f/ increased levels !f !*idative en7y&es in the &'scles0 increased &it!ch!ndrial density and si7e0 and an increased &'scle fi er ca#illary s'##ly

+rainin)

+RAININ85Is de#endent !n e*ercise !f s'fficient / A.F B.I C.+ Pr!d'ces/ A. M'sc'lar B. Cardi!vasc'lar C. individ'al4s end'rance +RAININ85F!r a #artic'lar s#!rt !r event 9ses :::::::: #rinci#le that is0 the individ'al i&#r!ves in the e*ercise tas( 'sed f!r trainin) and &ay n!t i&#r!ve in !ther tas(.

Ada#tati!n

Ada#tati!n5 efficiency !f the cardi!vasc'lar syste& and the active &'scles.

Re#resents a variety !f chan)es in the cardi!vasc'lar and &'sc'lar syste& / $PNB% A. Physical B. Ne'r!l!)ical C. Bi!che&ical Is de#endent !n the a ility !f the !r)anis& t! chan)e the trainin) sti&'l's thresh!ld $the sti&'l's that elicits a trainin) res#!nse%.

Is the #ers!n ,ith a l!, level !f fitness has &!re #!tential t! i&#r!ve that the !ne ,h! has a hi)h level !f fitness2 ;es !r N!2 +he hi)her the initial level !f fitness0 the )reater the intensity !f e*ercise needed t! elicit a si)nificant chan)e.

My!cardial O*y)en C!ns'&#ti!n

is a &eas're !f the !*y)en c!ns'&ed y &y!cardial &'scle. +he need !r de&and f!r !*y)en is deter&ined / A. B. C. ". the heart rate $1R%0 syste&ic l!!d #ress're0 &y!cardial c!ntractility0 and afterl!ad. "e#endent !n / A. arterial !*y)en c!ntent $ l!!d s' strate%0 B. he&!)l! in !*y)en diss!ciati!n0 C. and c!r!nary l!!d fl!,0 ,hich is deter&ined y a!rtic diast!lic #ress're0 d'rati!n !f diast!le0 ". c!r!nary artery resistance0 and E. c!llateral circ'lati!n.

In a healthy individ'al0 the alance et,een &y!cardial !*y)en s'##ly and de&and is &aintained d'rin) &a*i&'& e*ercise. -hen the de&and f!r !*y)en is )reater than the s'##ly0 &y!cardial ische&ia res'lts. Beca'se the &y!cardial &'scle e*tracts <=> t! <?> !*y)en fr!& the l!!d d'rin) rest0 its &ain s!'rce !f s'##ly d'rin) e*ercise is thr!')h an increase in c!r!nary l!!d fl!,.

"ec!nditi!nin)
"ec!nditi!nin)5 !cc'rs ,ith #r!l!n)ed ed rest0 and its

effects are fre.'ently seen in a #atient ,h! has had an e*tended0 ac'te illness !r l!n) ter& chr!nic c!nditi!n.

Refer t! B!* <.6

Ener)y Syste&s0 Ener)y E*#endit're0 and Efficiency

Ener)y Syste&s
Ener)y

Syste&s5 Are &eta !lic syste&s inv!lvin) a series !f i!che&ical reacti!ns res'ltin) in the f!r&ati!n !f aden!sine tri#h!s#hate $A+P%0 car !n di!*ide and ,ater. !f A+P t! #erf!r& &eta !lic activities /

C!nversi!n A. B.

Aden!sine di#h!s#hate $A"P% and #h!s#hate $P% cells 'se this ener)y f!r :::::::: cr!ss5 rid)e f!r&ati!n ,hen::::::::::::::::::. actin0 &y!sin0 c!ntractin)

M'scle

@ MAAOR ENER8; S;S+EM $ PAA%

A. Ph!s#ha)en B. Aer! ic C. Anaer! ic

Ph!s#ha)en0 !r A+P5PC0 Syste&

Ph!s#h!creatine the N! It

and A+P are st!red in the 2

che&ical f'el s!'rce2 !*y)en is re.'ired $anaer! ic% syste& #r!vides ener)y f!r/ 2

+he

is the &aB!r s!'rce !f ener)y d'rin) the::::: sec!nds !f ::::::::::::: e*ercise

Ph!s#ha)en0 !r A+P5PC0 Syste&

Ph!s#h!creatine M'scle the N!

and A+P are st!red in the 2

cell

che&ical f'el s!'rce2 !*y)en is re.'ired $anaer! ic% syste& #r!vides ener)y f!r/ 2

Ph!s#ha)en

+he It

Sh!rt0 .'ic(0 'rst !f activity is the &aB!r s!'rce !f ener)y d'rin) the::::: sec!nds !f ::::::::::::: e*ercise sec!nds0 intensity

@=

ANAEROBIC 8L;COL;+IC S;S+EM

8lyc!)n C f'el s!'rce !f ener)y N! !*y)en is re.'ires A+P is resynthesi7ed in &'scle cell By5#r!d'ct !f anaer! ic )lyc!lysis / lactic acid Pr!vides ener)y f!r activity !f &!derate intensity and sh!rt5d'rati!n MaB!r s!'rce !f ener)y fr!& the @= D E=th sec!nd

Aer! ic Syste&

f'el s!'rces/ $FP8 % A. Fats B. 8lyc!)en C. Pr!teins are 'tili7ed relative t! their / $AI% A. availa ility B. intensity !f the e*ercise O*y)en is re.'ired $aer! ic% A+P is resynthesi7ed in the / &it!ch!ndria !f the cell +he a ility t! &eta !li7e !*y)en and !ther s' strates is related t! A. n'& er B. +he syste& #red!&inates !ver the !ther ener)y syste&s after the :::::::::: !f e*ercise. @= t! E=th sec!nd

Aer! ic Syste&

f'el s!'rces/ A. B. C. are 'tili7ed relative t! their / A. B.. O*y)en is re.'ired $aer! ic% A+P is resynthesi7ed in the / +he a ility t! &eta !li7e !*y)en and !ther s' strates is related t! A. B. +he syste& #red!&inates !ver the !ther ener)y syste&s after the :::::::::: !f e*ercise.

"e#endent !n the rate !f ,!r( recr'ited seltectively !r n!t d'rin) e*ercise

SLOW TWITCH

FAST TWITCH ( TYPE II B )

FAST TWITCH ( TYPE II A )

a sl!, c!ntractile res#!nse0 are rich in &y!)l! in &it!ch!ndria0 have a hi)h !*idative ca#acity and a l!, anaer! ic ca#acity0 and are recr'ited f!r activities de&andin) end'rance. +hese fi ers are s'##lied y s&all ne'r!ns ,ith a l!, thresh!ld !f activati!n fast c!ntractile res#!nse0 have a l!, have a l!, &y!)l! in c!ntent fe, &it!ch!ndria0 have a hi)h )lyc!lytic ca#acity0 and are recr'ited f!r activities re.'irin) #!,er. have characteristics !f !th ty#e I and ty#e IIB fi ers and are recr'ited f!r !th anaer! ic and aer! ic activities.

Recr'it&ent !f M!t!r 9nits

Sl!, t,itch fi ers $ty#e I%5 are characteri7ed y a sl!, c!ntractile res#!nse0 are rich in &y!)l! in and &it!ch!ndria0 have a hi)h !*idative ca#acity and a l!, anaer! ic ca#acity0 and are recr'ited f!r activities de&andin) end'rance. +hese fi ers are s'##lied y s&all ne'r!ns ,ith a l!, thresh!ld !f activati!n Fast5+,itch fi ers $ty#e IIB% are characteri7ed y a fast c!ntractile res#!nse0 have a l!, have a l!, &y!)l! in c!ntent and fe, &it!ch!ndria0 have a hi)h )lyc!lytic ca#acity0 and are recr'ited f!r activities re.'irin) #!,er. Fast5+,itch fi ers $ty#e IIA% have characteristics !f !th ty#e I and ty#e IIB fi ers and are recr'ited f!r !th anaer! ic and aer! ic activities.

F'ncti!nal I&#licati!ns

B'rst !f intense activity5 lastin) !nly sec!nds devel!#s/ $M9SS+EL% A. &'scle stren)th B. str!n)er tend!ns C. str!n)er li)a&ents A+P is s'##lied y the :::::::::::: syste&. $P% Intense Activity5 lastin) F56 &in'tes re#eated after G &in'tes !f rest !r &ild e*ercise enhances ::::::::: #!,er. Anaer! ic A+P is s'##lied y the ::::::::::::::::: and ::::::::::: syste&. $AP% Activity ,ith lar)e &'scles5 ,hich is less than &a*i&'& intensity f!r @5? &in'tes re#eated after rest !r &ild e*ercise !f si&ilar d'rati!n0 &ay devel!# aer! ic #!,er and end'rance ca#a ilities. A+P is s'##lied y the #h!s#ha)en0 aer! ic 0 aner! ic . S' &a*i&'& intensity5 lastin) 6=5@= &in'tes !r &!re ta*es a hi)h #ercenta)e !f the aer! ic syste& and devel!# end'rance.

1!, d!es !'r !dy res#!nse t! e*ercise 2 $ #hysi!l!)ically %

Ra#id ener)y re.'ire&ents C circ'lat!ry adB'st&ents

+! &eet the increase need !f !*y)en and n'trients

+! a le t! re&!ve end #r!d'cts &eta !lis& s'ch as 2 $ a:::::::::: . ::::::::% $CO.LA% H Pr!d'cti!n !f &!re Car !n "i!*ide ,ill &a(e the tiss'e $ Al(aline !r Acidic% -hy 2 Acid!tic +iss'e 0 eca'se !f increase !ndin) !f 1ydr!)en I!ns If end #r!d'cts are n!t re&!ve ,hat ,ill ha##en 2 "OMS

+he shift in !dy &eta !lis& !cc'rs thr!')h a c!!rdinated activity !f all the syste&s !f the !dy/ A. ne'r!&'sc'lar0 B. res#irat!ry C. cardi!vasc'lar0 ". &eta !lic0 E. h!r&!nal

Cardi!vasc'lar Res#!nse t! E*ercise

Sti&'lati!n

!f &yelinated and 'n&yelinated fi ers in the s(eletal &'scle inv!lves a sy&#athetic nerv!'s syste& $SNS% res#!nse. -hat ha##ens d'rin) +he SNS 2 Peri#heral Vas!c!nstrict !r vas!dilate2 vas!c!nstricti!n ,hat area 2 rati!nale f!r this is increase in ,hat2 1R H syst!lic l!!d #ress're

Peri#heral In

n!n e*ercisin) &'scle increase &y!cardial c!ntracti!n

+he A0

B0I C.

Cardiac Effects
+he

fre.'ency !f sin!atrial n!de de#!lari7ati!n increases as d!es the heart rate. is a decrease in va)al sti&'li as ,ell as an increase in SNS sti&'lati!n is an increase in the f!rce devel!#&ent !f the cardiac &y!fi ers. A direct in!tr!#ic res#!nse !f the SNS increases &y!cardial c!ntractility.

+here +here

Peri#heral Effects
Net

red'cti!n in t!tal #eri#heral resistance5 8enerali7ed vas!c!nstricti!n !cc'rs that all!,s l!!d t! e sh'nted fr!& the / A. net,!r(in) &'scles0 (idney liver0 s#leen0 and s#lanchnic area t! the ,!r(in) &'scles.

B. C. ". E.

A l!cally

&ediated red'cti!n in resistance in the ,!r(in) &'scle arterial vasc'lar ed0 inde#endent !f the a't!n!&ic nerv!'s syste&0 is #r!d'ced y &eta !lites s'ch as M)6 0 Ca6 0 A"P and PCO.

-hat &a(es the #eri#heral ven!'s #ress're increase2

Increased

in &y!cardial c!ntractility0

,ith a res'ltant increase in str!(e v!l'&e0 heart rate0 l!!d fl!, thr!')h the ,!r(in) &'scle0 and increase in the c!nstricti!n !f the ca#acitance vessels !n the ven!'s side !f the circ'lati!n in !th the ,!r(in) and n!n ,!r(in) &'scles0

an

-hat are the Res#irat!ry Res#!nse t! E*ercise

8as e*chan)e $O60 CO6% increases acr!ss the alve!lar5ca#illary &e& rane y the first !r sec!nd reath. Increased &'scle &eta !lis& d'rin) e*ercise res'lt in &!re O6 e*tracted fr!& arterial l!!d0 res'ltin) in an increase in ven!'s PCO6 and 1J 0 an increase in !dy te&#erat're0 increased e#ine#hrine0 and increase sti&'lati!n !f rece#t!rs !f the B!ints and &'scles.

Other fact!rs that can increase t! res#irat!ry res#!nses

A. B. C. ". E Bar!rece#t!r refle*es0 #r!tective refle*es0 #ain0 e&!ti!n and v!l'ntary c!ntr!l !f res#irati!n &ay als! c!ntri 'te t! the increase in res#irati!n -hat ha##ens d'rin) diff'si!n !f )ases acr!ss ca#illary alve!lar &e& rane2 Alve!lar ventilati!n -hat is rati!nale !f increase alve!lar ventilati!n 2 increase F=56= f!ld d'rin) heavy e*ercise t! s'##ly the additi!nal !*y)en needed and e*crete the e*cess CO6 #r!d'ced

Res#!nses Pr!vidin) Additi!nal O*y)en t! M'scle

A decrease !f the l!cal tiss'e PO6 !cc'rs eca'se !f 'se !f &!re !*y)en y the ,!r(in) &'scle As the #artial #ress're !f !*y)en decreases0 the 'nl!adin) !f !*y)en fr!& he&!)l! in is facilitated. +he #r!d'cti!n !f &!re CO6 ca'ses the tiss'e t! ec!&e acid!tic $the hydr!)en i!n increases% and the te&#erat're !f the tiss'e t! increase. +he increase !f red l!!d cells 60@5di#h!s#!)lycerate $"P8% #r!d'ce the )lyc!sis d'rin) e*ercise als! c!ntri 'tes t! the enhanced release !f !*y)en

Fact!rs in O*y)en C!ns'&#ti!n

Vasc'larity !f the &'scle Fi er distri 'ti!n N'& er !f &it!ch!ndria O*idative &it!ch!ndrial en7y&es #resent in the fi er

is the difference et,een the !*y)en c!ntent !f arterial and ven!'s l!!d2 Atri!ven!'s !*y)en difference

+estin) as a Basis f!r E*ercise Pr!)ra&s

Re)ardless

!f the ty#e !f testin)0 the level !f #erf!r&ance is ased !n the s' &a*i&'& !r &a*i&'& !*y)en '#ta(e $VO6 &a*% !r the sy&#t!&5li&ited !*y)en '#ta(e. ca#acity !f the individ'al t! trans#!rt and 'tili7e !*y)en is reflected in the !*y)en '#ta(e.

+he

Fitness +estin) !f 1ealthy S' Bects

Field test f!r deter&inin) the cardi!vasc'lar fitness5 include the time to run 1. mile! or di!t"nce r"n in 1# minute!. +his &eas'res c!rrelate ,ell ,ith the VO6 &a*0 't their 'se is limited to $oun% &er!on! or middle "%ed indi'idu"l! (ho h"'e )een c"re*ull$ !creened or h"'e )een +o%%in% or runnin% *or !ome time M'ltista)e testin) can #r!vide can #r!vide a direct &eas're&ent !f VO6 &a* y analy7in) sa&#les !f e*#ired air +estin) is 's'ally c!&#leted in *our to !i, tre"dmill !t"%e!0 ,hich #r!)ressively increase in s#eed and !r )rade Each sta)e i! -./ minute! lon% Electroc"rdio%r"&hic (EC0) monitorin% is #erf!r&ed d'rin) the testin) Ma*i&'& !*y)en '#ta(e can e determined (hen the o,$%en utili1"tion &l"te"u! de!&ite "n incre"!e in (or2lo"d

Princi#les !f Stress +estin)

Chan)in)

the ,!r(l!ad y increasin) the s#eed and3!r )rade !f the tread&ill !r the resistance !f the icycle er)!&eter initial ,!r(l!ad that is l!, in ter&s !f the individ'al4s antici#ated aer! ic thresh!ld the ,!r(l!ad f!r a &in'te !r l!n)er the test at the !nset !f sy&#t!&s !r a defina le a n!r&ality !f the EC8.

An

Maintainin) +er&inatin)

P'r#!se !f Stress +estin)

1el# esta lish dia)n!sis !f !vert !r latent heart disease Eval'ates cardi!vasc'lar f'ncti!nal ca#acity "eter&ines the #hysical ,!r( ca#acity in (il!)ra&5&eters #er &in'te $()5&3&in% !r the f'ncti!nal ca#acity in ME+s Eval'ate res#!nses t! e*ercise trainin) and3!r #reventive #r!)ra&s Assist in the selecti!n and eval'ati!n !f a##r!#riate &!des !f treat&ent f!r heart disease Increase individ'al &!tivati!n f!r adherin) !r enterin) t! e*ercise #r!)ra&s Is 'sed clinically t! eval'ate ,ith #atients ,ith chest sensati!n !r ,ith a hist!ry !f chest #ain It can als! eval'ate the f'ncti!nal ca#acity !f #atients ,ith chr!nic disease

-hat are the Pre#arati!n f!r Stress +estin)2

1ave Be

had a #hysical e*a&inati!n

&!nit!r y EC8 and cl!sely ! served at rest0 d'rin) e*ercise and d'rin) rec!very a c!nsent f!r&

Si)n

-hen d! ,e need t! +er&inate stress +estin)2

Pr!)ressive An)ina A si)nificant dr!# in syst!lic #ress're in res#!nse t! an increase ,!r(l!ad Li)htheadedness0 c!nf'si!n0 #all!r0 cyan!sis0 na'sea !r #eri#heral circ'lat!ry ins'fficiency A n!r&al EC8 res#!nse incl'din) S+ se)&ent de#ressi!n )reater than G&& E*cessive rise in l!!d #ress're S' Bect ,ishes t! st!#

"eter&inants !f an E*ercise Pr!)ra&

Effective

end'rance trainin) f!r any #!#'lati!n &'st #r!d'ce a c!nditi!nin) !r cardi!vasc'lar res#!nse. !f the cardi!vasc'lar res#!nse is de#endent !n several critical ele&ents !f e*ercise. y ASCAM and !thers is t! 'se the FI++ &eth!d

Elicitati!n

A rec!&&endati!n F I + +.

Intensity
"eter&inati!n

!f the a##r!#riate intensity !f e*ercise is ased !n the $S=% A. B. S#ecificity 0 Overl!ad

Overl!ad Princi#le

Overl!ad is a stress !n an !r)anis& that is )reater than re)'larly enc!'ntered d'rin) everyday life. +! i&#r!ve cardi!vasc'lar and &'sc'lar end'rance0 an !verl!ad &'st e a##lied t! these syste& +rainin) sti&'l's thresh!lds are varia le0 de#endin) !n the / A.individ'al4s level !f health0 B. level !f activity0 C. a)e0 and ". )ender +he l!,er the initial level !f fitness0 the lesser the intensity !f the e*ercise needed t! elicit a chan)e.2 Or hi)her3lesser2 L!,er3)reater2 1i)her 3 )reater2 18

-h! is the ideal candidate f!r &a*i&'& and e*ercise heart rate #rescri#ti!n 2
A. B. C. ".

-h! is the ideal candidate f!r &a*i&'& and e*ercise heart rate #rescri#ti!n 2
individ'als 0

at ris( f!r c!r!nary artery disease

individ'als ,ith c!r!nary heart disease0 and individ'als ,h! are elderly and identified ased !n their #erf!r&ance !n stress

ideally

test.

S#ecificity Princi#le

S#ecificity #rinci#le is related t! the s#ecificity !f trainin) t! ada#tati!n in &eta !lic and #hysi!l!)ical syste&s de#endin) !n the de&and i&#!sed. +here is n! !verla# ,hen trainin) f!r stren)th5#!,er activities and trainin) f!r end'rance activities. M'scle stren)th ,ith!'t a si)nificant increase in t!tal !*y)en c!ns'&#ti!n Aer! ic !r end'rance trainin) ,ith!'t trainin) the anaer! ic syste&s Anaer! ic trainin) ,ith!'t trainin) the aer! ic syste& Aer! ic trainin) s#ecific t! the ty#e !f activity. -hen trainin) f!r s,i&&in) events0 the individ'al &ay n!t de&!nstrate an i&#r!ve&ent in VO6&a* ,hen r'nnin)

+i&e $"'rati!n%

+he !#ti&al d'rati!n !f e*ercise f!r cardi!vasc'lar c!nditi!nin) is de#endent !n the/ A. t!tal ,!r( #erf!r&ed0 B. e*ercise fre.'ency and C. intensity and fitness level. +he )reater the intensity !f the e*ercise0 the sh!rter the d'rati!n needed f!r ada#tati!nK and the l!,er the intensity !f the e*ercise0 the l!n)er the d'rati!n needed. A 6=5@= &in'te sessi!n is )enerally !#ti&al at L=> t! <=> &a*i&'& heart rate. -hen hi)h intensity e*ercise0 F=5F? &in'te e*ercise #eri!ds are ade.'ateK three ? &in'te daily #eri!ds are effective in s!&e dec!nditi!ned #atients

+y#e $M!de%

+he i&#!rtant fact!r that the e*ercise inv!lves lar)e &'scle )r!'#s that are activated in a rhyth&ic0 aer! ic nat're. F!r s#ecific aer! ic activity s'ch as cyclin) and r'nnin)0 the !verl!ad &'st 'se the &'scles re.'ired y the activity and stress the cardi!res#irat!ry syste& $s#ecific #rinci#le%. If end'rance !f '##er e*tre&ities is needed t! #erf!r& activities !n the B! 0 the '##er e*tre&ity &'scle &'st e tar)eted in e*ercise #r!)ra&. +rainin) enefits are !#ti&i7ed ,hen #r!)ra&s are #lanned t! &eet the individ'als needs and ca#acities !f the #artici#ants. +he s(ill !f the individ'al0 variati!ns a&!n) individ'als in c!&#etitiveness and a))ressiveness and variati!n in envir!n&ental c!nditi!n &'st e c!nsidered.

Reversi ility Princi#le

::::::

!cc'rs ra#idly ,hen the #ers!n ::::::::::::: st!#s trainin) !nly ::::,ee(s !f detrainin)0 si)nificant red'cti!ns in ,!r( ca#acity can e &eas'red0 and i&#r!ve&ents can e l!st ,ithin several &!nths. ,ee(s

"etrainin)0 After

Clinical +i#

Children a)es L t! F</ L= &in'tes !f &!derate vi)!r!'s aer! ic #hysical activity #er day Ad'lts a)es FM t! L?/ @= &in'tes !f &!derate intensity activity $@5L ME+ level% ? days3,ee( !r 6= &in'tes !f vi)!r!'s intensity activity $NL ME+s% @ days3,ee(0 !r a c!& inati!n !f &!derate and vi)!r!'s intensity. +he @= &in'te t!tal !f &!derate intensity can e acc'&'lated in s&all !'ts !f c!ntin'!'s activity !f at least F= &in'tes

E*ercise #r!)ra&
Caref'lly

#lanned e*ercise can res'lt in hi)her level !f fitness f!r healthy individ'al0 sl!, the decrease in f'ncti!nal ca#acity !f the elderly0 and rec!nditi!n th!se ,h! have een ill !r have chr!nic disease. are three c!&#!nents !f the e*ercise #r!)ra&/ $F% ,ar& '# #eri!d $6% the aer! ic e*ercise #eri!dK and $@% a c!!l d!,n #eri!d

+here

-ar&5 '# Peri!d

+he

#'r#!se !f the ,ar& '# #eri!d is t! enhance the n'&er!'s adB'st&ent that4s that &'st ta(e #lace ef!re #hysical activity.

Physi!l!)ical Res#!nse

An increase in &'scle te&#erat're. +he hi)her te&#erat're increases the efficiency !f &'sc'lar c!ntracti!n y red'cin) &'scle visc!sity and increasin) the rate !f nerve c!nd'cti!n. An increase need !f !*y)en t! &eet the ener)y de&and f!r the &'scle. E*tracti!n fr!& he&!)l! in is )reater at hi)her &'scle te&#erat'res0 facilitatin) the !*idative #r!cess at ,!r(. "ilati!n !f the #revi!'sly c!nstricted ca#illaries ,ith increase in the circ'lati!n0 a')&entin) !*y)en delivery t! the active &'scles and &ini&i7in) the !*y)en deficit and the f!r&ati!n !f lactic acid. Ada#tati!n in the sensitivity !f the ne'ral res#irat!ry center t! the vari!'s e*ercise sti&'lants. An increase in ven!'s ret'rn. +his !cc'rs as l!!d fl!, is shifted centrally fr!& the #eri#hery.

P'r#!ses
In

additi!n t! the #hysi!l!)ical res#!nse0 the ,ar& '# als! #revents !r decreases the s'sce#ti ility !f the &'sc'l!s(eletal syste& t! inB'ry and the !cc'rrence !f ische&ic electr!cardi!)ra#hic $EC8% chan)e and arrhyth&ias.

8'idelines
+he

,ar&5'# sh!'ld e )rad'al and s'fficient t! increase &'scle and c!re te&#erat're ,ith!'t ca'sin) fati)'e !r red'cin) ener)y st!res. &in'te #eri!d !f t!tal !dy &!ve&ent e*ercises0 s'ch as calisthenics and ,al(in) sl!,ly a heart rate that is ,ithin 6= eats3&in !f the tar)et heart rate.

A F=

Attainin)

Aer! ic E*ercise Peri!d

Attenti!n t! the deter&inants0 fre.'ency intensity0 ti&e and ty#e !f #r!)ra& as #revi!'sly disc'ssed has an i&#act !n the effectiveness !f the #r!)ra&. +he &ain c!nsiderati!n ,hen ch!!sin) a s#ecific &eth!d !f trainin) i! the inten!it$ )e %re"t enou%h to !timul"te "n incre"!e in !tro2e 'olume "nd c"rdi"c out&ut "nd to enh"nce loc"l circul"tion "nd "ero)ic met")oli!m in the "&&ro&ri"te mu!cle %rou&!. +here are f!'r &eth!d that challen)e the aer! ic syste&K c!ntin'!'s0 interval $,!r( relief%0 circ'it and circ'it interval.

Fe&ale B!dy +y#e

Male B!dy +y#e

C!ntin'!'s +rainin)
Once

the steady sta)e is achieved0 the &'scle ! tains ener)y y &eans !f aer! ic &eta !lis&. Stress is #laced #ri&arily !n the sl!,5t,itch fi ers. activity can e #r!l!n)ed fr!& 6=5L= &in'tes ,ith!'t e*ha'stin) the !*y)en trans#!rt syste&. ,!r( rate is increased #r!)ressively as trainin) i&#r!ve&ents are achieved. Overl!ad can e acc!&#lished y increasin) the e*ercise d'rati!n.

+he +he

Interval +rainin)
+he

,!r( !r e*ercise is f!ll!,ed y a #r!#erly #rescri ed relief !r rest interval trainin) is #erceived t! e less de&andin) than c!ntin'!'s trainin). relief interval is either a rest relief $#assive rec!very% !r a ,!r( relief $active rec!very%0 and its d'rati!n ran)es fr!& a fe, sec!nds t! several &in'tes. !f the &'sc'lar st!res !f A+P and !*y)en ass!ciated ,ith &y!)l! in that ,ere de#leted d'rin) the ,!r( #eri!d are re#lenished y the aer! ic syste&K an increase in VO6&a* !cc'rs.

Interval +he

A #!rti!n

Circ'it +rainin)
Circ'it

trainin) e&#l!ys a series !f activities. At the end !f the last activity0 the individ'al starts fr!& the e)innin) and a)ain &!ves thr!')h the series. e*ercise &!des can e 'sed inv!lvin) lar)e and s&all &'scle )r!'#s and a &i* !f static and dyna&ic eff!rt. !f circ'it trainin) can i&#r!ve stren)th and end'rance y stressin) !th the aer! ic and anaer! ic syste&.

Several

9se

Circ'it5 Interval +rainin)

C!&

inin) circ'it and interval trainin) is effective eca'se !f the interacti!n !f the aer! ic and anaer! ic #r!d'cti!n !f A+P. additi!n t! the aer! ic and anaer! ic syste& ein) stressed y the vari!'s activities0 ,ith the relief interval0 there is a delay f!r the need !f )lyc!lysis and the #r!d'cti!n !f lactic acid #ri!r t! the availa ility !f !*y)en s'##lyin) the A+P.

In

C!!l5"!,n Peri!d
Is

si&ilar t! the ,ar&5'# #eri!d in that it sh!'ld last ? t! F= &in'tes and c!nsist !f t!tal !dy &!ve&ents and static stretchin). #!!lin) !f l!!d fr!& the e*tre&ities y c!ntin'in) t! 'se the &'scles t! &aintain ven!'s ret'rn faintin) y increasin) the ret'rn !f l!!d t! the heart and rain as cardiac !'t#'t and ven!'s ret'rn decreases.

Prevents

Prevents

P1;SIOLO8ICAL C1AN8ES +1A+ OCC9R -I+1 +RAININ8

CAR"IOVASC9LAR C1AN8ES RESPIRA+OR; C1AN8ES ME+ABOLIC C1AN8ES O+1ER S;S+EM C1AN8ES

Cardi!vasc'lar Chan)es

Chan)es at Rest

A red'cti!n in the restin) #'lse rate !cc'rs in s!&e individ'als eca'se !f a decrease in sy&#athetic drive0 ,ith decreasin) levels in n!re#ine#hrine and e#ine#hrineK A decrease in in l!!d #ress're !cc'rs in s!&e individ'als ,ith a decrease in #eri#heral vasc'lar resistance. An increase in l!!d v!l'&e and he&!)l! in.

Chan)es "'rin) E*ercise

A red'cti!n in #'lse rate !cc'rs in s!&e individ'als eca'se !f the &echanis& listed earlier in this secti!n Increase str!(e v!l'&e Increase cardiac !'t#'t Increase e*tracti!n !f !*y)en y ,!r(in) &'scle "ecrease l!!d fl!, #er (il!)ra& !f the ,!r(in) &'scle "ecreased &y!cardial !*y)en c!ns'&#ti!n $ #'lse rate ti&es syst!lic l!!d #ress're%

Res#irat!ry Chan)es

Chan)es at Rest
Lar)er

l'n) v!l'&es devel!# eca'se !f i&#r!ved #'l&!nary f'ncti!n0 ,ith n! chan)e in vital v!l'&e. diff'si!n ca#acities devel!# eca'se !f lar)e l'n) v!l'&es and )reater alve!lar5 ca#illary s'rface area.

Lar)er

Chan)es "'rin) E*ercise

Lar)er

diff'si!n ca#acities !cc'rs f!r the sa&e reas!ns. a&!'nt !f air is ventilated at the sa&e !*y)en c!ns'&#ti!n rateK &a*i&'& diff'si!n ca#acity is 'nchan)ed. &a*i&al &in'te ventilati!n is increased. efficiency is increased.

A s&aller

+he

Ventilat!ry

Meta !lic Chan)es

Chan)es at Rest
M'scle

hy#ertr!#hy and increased ca#illary density

!cc'rs.
+he +he

n'& er and si7e !f &it!ch!ndria are increased0 increasin) the ca#acity t! )enerate A+P aer! ically. &'scle &y!)l! in c!ncentrati!n increases0 increasin) the rate !f !*y)en trans#!rt and #!ssi le the rate !f !*y)en diff'si!n t! &it!ch!ndria

Chan)es "'rin) E*ercise

A decreased rate !f de#leti!n !f &'scle )lyc!)en at s' &a*i&'& ,!r( levels &ay !cc'r. An!ther ter& f!r this is )lyc!)en s#arrin). It is d'e t! an increase in ca#acity t! &! ili7e and !*idi7e fat and increase fat &! ili7in) and fat &eta !li7in) en7y&es L!,er l!!d lactate levels at s' &a*i&al ,!r( &ay !cc'r. Less reliance !n #h!s#h!creatine $PC% and A+P in s(eletal &'scle and an increase ca#a ility t! !*idi7e car !hydrate &ay res'lt eca'se !f an increased !*idative #!tential !f the &it!ch!ndria and an increase )lyc!)en st!ra)e in the &'scle.

Other Syste& Chan)es

"ecrease "ecrease

in !dy fat in l!!d ch!lester!l and tri)lyceride heat accli&ati7ati!n

levels
Increases Increase

in the rea(in) stren)th !f !nes and li)a&ents and the tensile stren)th !f tend!ns.

A##licati!n !f Princi#les !f an Aer! ic C!nditi!nin) Pr!)ra& f!r the Patient ,ith C!r!nary "isease

"'rin) +he

the #ast 6= t! 6? years0 there have een &aB!r chan)es in the &edical &ana)e&ent !f these #atients chan)es have incl'ded sh!rtened h!s#ital stays0 &!re a))ressive #r!)ressi!n !f activity f!r the #atient f!ll!,in) MI !r cardiac s'r)ery0 and earlier initiati!n !f an e*ercise #r!)ra& ased !n l!, level stress test #ri!r t! dischar)e fr!& the h!s#ital.

In#atient Phase $Phase F%

+he

in#atient #hase !f the #r!)ra& !cc'rs in h!s#ital f!ll!,in) sta ili7ati!n !f the #atients cardi!vasc'lar stat's after MI !r c!r!nary y#ass s'r)ery0 and )enerally last @ t! ? days.

P'r#!se

Inta(e ris( fact!r ed'cati!n $ s'ch eatin) ha its0 s&!(in)% Initiate self care activities and #r!)ress fr!& sittin) t! standin) t! &ini&i7e dec!nditi!nin) $F t! @ days #!stevent%. Pr!vide an !rth!static challen)e t! the cardi!vasc'lar syste& $@ t! ? days #!stevent%. +his is 's'ally acc!&#lished y s'#ervised a& 'lati!n. Pre#are #atients and fa&ily f!r c!ntin'ed reha ilitati!n and f!r life at h!&e after cardiac event.

O't#atient #hase $Phase 6%

+he !'t#atient #hase !f the #r!)ra& is initiated either '#!n dischar)e fr!& the h!s#ital !r0 de#endin) !n the severity !f the dia)n!sis0 L t! M ,ee(s later. +his delay all!,s the &y!cardi'& t! heal as ,ell as ti&e t! &!nit!r the #atient4s res#!nse t! ne, &edical re)i&en. Partici#ants are &!nit!red via tele&etry t! deter&ine heart rate and rhyth& res#!nsesK l!!d #ress're is rec!rded at rest d'rin) e*erciseK and ventilati!n res#!nses are n!ted. +hese #r!)ra&s 's'ally last L t! M ,ee(s

P'r#!se

Increase the #ers!n4s e*ercise ca#acity in a safe #r!)ressive &anner0 s! ada#tive cardi!vasc'lar and &'sc'lar chan)es !cc'r. +he early #art !f the #r!)ra& is referred t! s!&e as Hl!,5levelI e*ercise trainin). Enhanced cardiac f'ncti!n and red'ce cardiac c!st !f ,!r(. Pr!d'ce fav!ra le &eta !lic chan)es. "eter&ine the effect !f &edicati!ns !n increasin) levels !f activity Relieve an*iety and de#ressi!n Pr!)ress the #atient t! an inde#endent e*ercise #r!)ra&.

8'idelines

A sy&#t!&5 li&ited e*ercise stress test is #erf!r&ed L t! F6 ,ee(s after h!s#ital dischar)e $!r as early as 6 t! G ,ee(s f!ll!,in) dischar)e%. +he e*ercise #r!)ra& is #red!&inantly aer! ic Fre.'ency5 #artici#ants !ften attend sessi!ns !ffered three ti&es #er ,ee(. Intensity5 +he initial level !f activity !r trainin) intensity &ay e as l!, as G=> t! L=> !f the &a*i&'& heart rate !r G=> t! <=> !f the f'ncti!nal ca#acity defined y ME+s.

+i&e5 +he d'rati!n !f the e*ercise sessi!n &ay e li&ited t! F= t! F? &in'tes at the start #r!)ressin) t! @= t! L= &in'tes as the #atients stat's i&#r!ves. Each sessi!n 's'ally incl'des M5F= &in'te ,ar& '# and c!!l d!,n #eri!ds. +y#e5 +he &eth!d !f e*ercise is 's'ally c!ntin'!'s0 'sin) lar)e &'scle )r!'#s0 s'ch as stati!nary i(in) !r ,al(in). Meth!d5 Circ'it5interval e*ercise is c!&&!n &eth!d 'sed ,it the #atient d'rin) #hase 6. +he #atient can e*ercise !n each &!dality at defined ,!r(l!ad0 c!&#ared ,ith e*ercisin) c!ntin'!'sly !n a icycle !r tread&ill.

As a res'lt the #atient can/

Perf!r& &!re #hysical ,!r( E*ercise at hi)her intensity5 fitness &ay i&#r!ve ,ithin a sh!rter #eri!d !f ti&e Maintain lactic acid and !*y)en deficit at &ini&'& levels E*ercise at a l!,er rate !f #erceived e*erti!n

-ei)ht +rainin)5 resistive e*ercises sh!'ld n!t #r!d'ce ische&ic sy&#t!&s ass!ciated ,ith an increase in heart rate and syst!lic l!!d #ress're. Pr!)ressi!n5 Pr!)ressi!n !f the ,!r(l!ad !cc'rs ,hen there have een three c!nsec'tive sessi!ns $every5!ther5day sessi!ns% d'rin) ,hich the #ea( heart rate is el!, the tar)et heart rate.

O't#atient Pr!)ra& $Phase @%

1eart

rate and rhyth& are n! l!n)er &!nit!red via tele&etry.

8'idelines
Recreati!nal Activities5 S,i&&in)5

activities t! &aintain levels )ained d'rin) #hase 6 &ay incl'de ,hich inc!r#!rate !th ar&s and le)s. 1!,ever0 there is a decreased a,areness !f ische&ic sy&#t!&s ,hile s,i&&in)0 es#ecially ,hen the s(ill level is #!!r. hi(in)5 ,hich is e*cellent if !n level terrain

O'td!!r

Activities at M ME+s
A!))in)

a##r!*i&ately ? &iles #er h!'r Cyclin) a##r!*i&ately F6 &iles #er h!'r Vi)!r!'s d!,nhill s(iin)

S#ecial C!nsiderati!n

Ar& e*ercise elicit different res#!nses than le) e*ercises. Mechanical efficiency ased !n the rati! et,een !'t#'t !f e*ternal ,!r( and cal!ric e*#endit're is l!,er than ,ith le) e*ercises. O*y)en '#ta(e is at a )iven e*ternal ,!r(l!ad is si)nificantly hi)her f!r ar& e*ercises than f!r le) e*ercises. My!cardial efficiency is l!,er ,ith le) e*ercise than ,ith ar& e*ercise. My!cardial !*y)en c!ns'&#ti!n $heart rate * syst!lic l!!d #ress're% is hi)her ,ith ar& e*ercise than ,ith le) e*ercise.

Ada#tive Chan)es

Increased &y!cardial aer! ic ,!r( ca#acity Increased &a*i&'& aer! ic !r f'ncti!n ca#acity y #red!&inantly ,idenin) the a5V!6 difference Increased str!(e v!l'&e f!ll!,in) hi)h intensity trainin) L5F6 &!nths int! the trainin) #r!)ra&. "ecreased &y!cardial de&and f!r !*y)en Increased &y!cardial s'##ly y the decreased heart rate and #r!l!n)ati!n !f diast!le. Increased t!lerance t! a )iven #hysical ,!r(l!ad ef!re an)ina !cc'rs Si)nificantly l!,er heart rate at each s' &a*i&'& ,!r(l!ad and0 theref!re0 a )reater heart rate reserve.

A##licati!n !f Aer! ic +rainin) f!r the "ec!nditi!ned Individ'al and the Patient ,ith Chr!nic Illness

"ec!nditi!ned

individ'als 0 incl'din) th!se ,ith chr!nic illness and the elderly0 &ay have &aB!r li&itati!n in #'l&!nary and cardi!vasc'lar reserves that severely c'rtail their daily activities.

"ec!nditi!nin)

+here is decrease ,!r( ca#acity0 ,hich is a res'lt !f decreased &a*i&'& !*y)en '#ta(e and decreased a ility t! 'se !*y)en and #erf!r& ,!r( F!r s!&e individ'als0 this res'lts in tachycardia al!n) ,ith !rth!static hy#ertensi!n0 di77iness and e#is!des !f sync!#e ,hen initially atte&#tin) t! stand. +here is a decrease in #las&a and l!!d cells0 ,hich increase the li(elih!!d !f life5 threatenin) e& !thr!& !lic e#is!des and #r!l!n)ati!n !f the c!nvalescent #eri!d. +here is a decrease in !dy &ass0 ,hich res'lt in decrease &'scle si7e and decreased &'scle stren)th and a ility t! #erf!r& activities re.'irin) lar)e &'scle )r!'#s. +here is increased e*creti!n !f 'rinary calci'&0 ,hich res'lts fr!& a decrease in ,ei)ht earin) sti&'l's critical in &aintainin) !ne inte)rity0 in !ne l!ss !r !ste!#!r!sis0 and in an increased li(elih!!d !f fract're '#!n fallin) eca'se !f !ste!#!r!sis.