chapter 05 designing cardiovascular exercise programs

Chapter 05Chapter 05

Designing Cardiovascular Exercise ProgramsDesigning Cardiovascular Exercise Programs


Client Centered ApproachClient Centered Approach

• What are your client’s needs and interests What are your client’s needs and interests in an exercise program?in an exercise program?

• What are the desired outcomes of the What are the desired outcomes of the exercise prescriptions?exercise prescriptions?

• What are the agreed upon exercise long What are the agreed upon exercise long and short term goals? and short term goals? (see online handout - writing (see online handout - writing goals)goals)


Elements of the Exercise WorkoutElements of the Exercise Workout

• Each exercise workout of the aerobic Each exercise workout of the aerobic exercise prescription and program should exercise prescription and program should include the following phases: include the following phases: – Warm-up (5-10 min) Warm-up (5-10 min) – Stretching (≥10 min)Stretching (≥10 min)– Endurance conditioning (20-60 min) Endurance conditioning (20-60 min) – Cool-down (5-10 min) Cool-down (5-10 min) – Stretching (≥10 min)Stretching (≥10 min)


• Guidelines for HealthGuidelines for Health– Mode Mode (Type)(Type)

– Intensity Intensity (How Hard)(How Hard)

– Frequency Frequency (How (How Often)Often)

– Duration Duration (Time)(Time)

• Guidelines for Guidelines for FitnessFitness– Mode Mode – IntensityIntensity– FrequencyFrequency– DurationDuration

These components may also be expressed as F.I.T.T.

Components of Exercise PrescriptionComponents of Exercise Prescription


• Guidelines for Improved Health Guidelines for Improved Health (p. 104, text)(p. 104, text)

– ModeMode• Various Endurance-Type Activities, preferably weight Various Endurance-Type Activities, preferably weight

bearingbearing

– IntensityIntensity• 3-6 METS (moderate intensity)3-6 METS (moderate intensity)

– Frequency and DurationFrequency and Duration• Frequency and duration: Schedule at least 150 to 300 Frequency and duration: Schedule at least 150 to 300

min per week (e.g., 30 min, 5 days per week or 60 min, min per week (e.g., 30 min, 5 days per week or 60 min, 3 days per week). Duration varies according to the 3 days per week). Duration varies according to the mode and intensity of activity.mode and intensity of activity.

Designing Cardiovascular Exercise ProgramsDesigning Cardiovascular Exercise Programs• ACSM Guidelines for Fitness ACSM Guidelines for Fitness (2010), p.105, text.(2010), p.105, text.

– ModeMode• Rhythmical, continuous, large muscle groups, require little skillRhythmical, continuous, large muscle groups, require little skill

– IntensityIntensity• Prescribe moderate-intensity (3.0 to 6.0 METs or 40% to <60% Prescribe moderate-intensity (3.0 to 6.0 METs or 40% to <60%

VOVO22 R) or vigorous intensity (> 6.0 METs or ≥60% VO R) or vigorous intensity (> 6.0 METs or ≥60% VO22R) or a R) or a combination of moderate-and vigorous-intensity exercise. combination of moderate-and vigorous-intensity exercise. Intensity varies depending on client’s cardiorespiratory fitness Intensity varies depending on client’s cardiorespiratory fitness classification.classification.

– FrequencyFrequency• 3-5 Days / Week moderate intensity; 3 Days / Week vigorous 3-5 Days / Week moderate intensity; 3 Days / Week vigorous

intensity; or a combination of moderate –and vigorous-intensity intensity; or a combination of moderate –and vigorous-intensity exercise 3 to 5 days/week.exercise 3 to 5 days/week.

– DurationDuration• 20 – 60 minutes continuous or intermittent activity, depending 20 – 60 minutes continuous or intermittent activity, depending

on intensity. Intermittent exercise bouts of at least 10 min may on intensity. Intermittent exercise bouts of at least 10 min may be accumulated throughout the day to reach the target duration be accumulated throughout the day to reach the target duration of 20 to 60 min.of 20 to 60 min.

•Progression (see next slide)Progression (see next slide)

Designing Cardiovascular Exercise ProgramsDesigning Cardiovascular Exercise Programs• ACSM Guidelines for Fitness ACSM Guidelines for Fitness (2010), p.105, text.(2010), p.105, text.

Progression – Progression – –For apparently healthy adults, the aerobic For apparently healthy adults, the aerobic exercise prescription consists of three stages: exercise prescription consists of three stages: initial conditioning, improvement, and initial conditioning, improvement, and maintenance.maintenance.–Adjust the exercise prescription for each client Adjust the exercise prescription for each client in accordance with the conditioning effect, in accordance with the conditioning effect, participant characteristics, new exercise test participant characteristics, new exercise test results, or performance duresults, or performance du–Adjust the exercise prescription for each client Adjust the exercise prescription for each client in accordance with the conditioning effect, in accordance with the conditioning effect, participant characteristics, new exercise test participant characteristics, new exercise test results, or performance during the exercise results, or performance during the exercise sessions. ring the exercise sessions.sessions. ring the exercise sessions.


• MODE MODE (see also next slide)(see also next slide)

– Initial stage or low fitness, use Initial stage or low fitness, use Type A Type A ActivitiesActivities– You may prescribe You may prescribe Type B Type B activities in the initial and activities in the initial and

improvement stages for individuals who exercise improvement stages for individuals who exercise regularly. regularly.

– Type C Type C activities include endurance activities that activities include endurance activities that require both skill and average physical fitness levelsrequire both skill and average physical fitness levels

– Type D Type D activities are recreational sports that may activities are recreational sports that may improve physical fitness and should be performed in improve physical fitness and should be performed in addition to the person’s regular aerobic exercise addition to the person’s regular aerobic exercise program. You should consider using type C and D program. You should consider using type C and D activities to add variety in the later stages activities to add variety in the later stages (maintenance stage) of your client’s exercise program.(maintenance stage) of your client’s exercise program.

Designing Cardiovascular Exercise Programs Designing Cardiovascular Exercise Programs

Classification of Aerobic Exercise ModalitiesClassification of Aerobic Exercise Modalities


• MODEMODE– Important considerations for ExRImportant considerations for ExRxx::

•What types of activities appeal to the client?What types of activities appeal to the client?

•What types of activities require additional What types of activities require additional expense or time preparing for (or travel to) expense or time preparing for (or travel to) the activity?the activity?

•Does a particular activity pose a higher risk Does a particular activity pose a higher risk for injury, and does the client have sufficient for injury, and does the client have sufficient training and skills to safely participate in the training and skills to safely participate in the activity?activity?

• Is the activity concordant with the goal of the Is the activity concordant with the goal of the exercise program? exercise program? ( if the major goal of the ( if the major goal of the program is to lose body fat, then an activity choice that program is to lose body fat, then an activity choice that is LSD [long slow distance] may be preferable)is LSD [long slow distance] may be preferable)


• MODEMODE– Important considerations for ExRImportant considerations for ExRxx::

•How easily can the mode be adjusted for How easily can the mode be adjusted for changes in exercise intensity as the client changes in exercise intensity as the client progresses in the exercise program?progresses in the exercise program?

•How difficult (RPE) is a particular mode of How difficult (RPE) is a particular mode of exercise for a given improvement in VOexercise for a given improvement in VO22??


• INTENSITYINTENSITY– Defined as “Defined as “How HardHow Hard” one is exercising.” one is exercising.

– A percentage of VOA percentage of VO22 reserve reserve (VO(VO22 max – VO max – VO22

rest) rest) may be used to guide the intensity of may be used to guide the intensity of the exercise session, and approximates the exercise session, and approximates %HRR, and vice versa.%HRR, and vice versa.

– Intensity and duration are interdependent. Intensity and duration are interdependent. The lower the initial fitness level, the more The lower the initial fitness level, the more emphasis that should be placed on lower emphasis that should be placed on lower intensity and longer duration. More fit intensity and longer duration. More fit individuals may prefer higher intensity individuals may prefer higher intensity and lower duration.and lower duration.


• INTENSITYINTENSITY– For most individuals lower intensity and longer For most individuals lower intensity and longer

duration exercise is recommended. This duration exercise is recommended. This increases the probability of adherence and increases the probability of adherence and decreases the risk of injury.decreases the risk of injury.

– The “Art” of prescribing an appropriate exercise The “Art” of prescribing an appropriate exercise intensity is to engage the principle of overload intensity is to engage the principle of overload without overuse. Again, this is dependent upon without overuse. Again, this is dependent upon the client’s initial level of fitness and skill ability the client’s initial level of fitness and skill ability ((hence, the purpose of exercise testing)hence, the purpose of exercise testing)..

– Exercise Intensity can be prescribed by VOExercise Intensity can be prescribed by VO22 Reserve, Heart Rate methods, and RPE.Reserve, Heart Rate methods, and RPE.


• INTENSITY : VOINTENSITY : VO22 Reserve Reserve– First determine VOFirst determine VO22 max or VO max or VO2 2 peak from GXT.peak from GXT.

– Calculate VOCalculate VO2 2 reserve in relative terms and in reserve in relative terms and in METS. This is called the target VOMETS. This is called the target VO22 , and you will , and you will need a range (ex. 50-85% of VOneed a range (ex. 50-85% of VO2 2 reserve).reserve).

– Formula :Formula :

• Target VOTarget VO2 2 = [relative exercise intensity (%) ] X VO= [relative exercise intensity (%) ] X VO2 2

reserve + reserve + VOVO2 2 rest rest

• Remember exercise intensity is rest plus the activity Remember exercise intensity is rest plus the activity above rest above rest (ex. 1 MET = resting VO(ex. 1 MET = resting VO22, whereas 3 METS = , whereas 3 METS = 3x Rest)3x Rest)


• INTENSITY – VOINTENSITY – VO22 Reserve ReservePractice Formula

– Client has VOClient has VO22 max of 45.5 ml/kg/min max of 45.5 ml/kg/min

– Resting VOResting VO2 2 = 3.5 ml/kg/min = 3.5 ml/kg/min

– Reserve = 42.0 ml/kg/minReserve = 42.0 ml/kg/min– Target range = 50-65% Target range = 50-65%

• TargetTarget11 VO VO2 2 = [0.5] X 42 ml/kg/min+ 3.5 ml/kg/min = = [0.5] X 42 ml/kg/min+ 3.5 ml/kg/min = 24.5 ml/kg/min.24.5 ml/kg/min.

• TargetTarget22 VO VO2 2 = [0.65] X 42 ml/kg/min+ 3.5 ml/kg/min = [0.65] X 42 ml/kg/min+ 3.5 ml/kg/min = 30.8 ml/kg/min.= 30.8 ml/kg/min.

• ExRExRxx range = 24.5 - 30.8 ml/kg/min range = 24.5 - 30.8 ml/kg/min



• ExRExRxx range = 24.5 - 30.8 ml/kg/min range = 24.5 - 30.8 ml/kg/min

– METSMETS = 24.5 / 3.5 = 7 METS (lower end of range) = 24.5 / 3.5 = 7 METS (lower end of range)– METSMETS = 30.8 / 3.5 = 8.8 METS (upper end of range) = 30.8 / 3.5 = 8.8 METS (upper end of range)

– VO and MET values can be used to guide VO and MET values can be used to guide the intensity of exercise using the ACSM the intensity of exercise using the ACSM equations equations (see pg. 73, text).(see pg. 73, text).

•Example using walking equation Example using walking equation (chose 3 mph – (chose 3 mph –

comfortable for client, solve for grade)comfortable for client, solve for grade)::•24.5 ml/kg/min = (24.5 ml/kg/min = (80.4 m/min * .01 ml/kg/min80.4 m/min * .01 ml/kg/min) + ) +

( ( 80.4 m/min * grade *1.8 ml/kg/min) + 3.5 ml/kg/min80.4 m/min * grade *1.8 ml/kg/min) + 3.5 ml/kg/min



•24.5 ml/kg/min = (24.5 ml/kg/min = (80.4 m/min * 0.1 ml/kg/min80.4 m/min * 0.1 ml/kg/min) + ) + ( ( 80.4 m/min * grade *1.8 ml/kg/min80.4 m/min * grade *1.8 ml/kg/min) ) + 3.5 ml/kg/min+ 3.5 ml/kg/min

•24.5 ml/kg/min = 24.5 ml/kg/min = (8.04 ml/kg/min) + ( 144.72 (8.04 ml/kg/min) + ( 144.72 m/min * grade) + 3.5 ml/kg/minm/min * grade) + 3.5 ml/kg/min

•24.5 ml/kg/min = 24.5 ml/kg/min = 11.54 ml/kg/min 11.54 ml/kg/min * * ( 144.72 ( 144.72 m/min * grade) m/min * grade)

•24.5 -11.54 ml/kg/min = 24.5 -11.54 ml/kg/min = ( 144.72 m/min * grade) ( 144.72 m/min * grade)

•12.96 = 144.72 * grade12.96 = 144.72 * grade

•..08955 or 9 % = grade08955 or 9 % = grade



– Check formula:Check formula:• X = (80.4 m/min * 0.1 ml/kg/min) + ( 80.4 X = (80.4 m/min * 0.1 ml/kg/min) + ( 80.4

m/min * 0.09) *1.8 ml/kg/min + 3.5 m/min * 0.09) *1.8 ml/kg/min + 3.5 ml/kg/minml/kg/min

•X = 8.04 + 13.0248 + 3.5X = 8.04 + 13.0248 + 3.5

•X = 24.5X = 24.5Thus, if your client needed to exercise at a 7 Thus, if your client needed to exercise at a 7

MET equivalent on the treadmill with the MET equivalent on the treadmill with the speed set at 3.0 mph the grade should be speed set at 3.0 mph the grade should be adjusted to 9%adjusted to 9% ( see also example on p.109, text)( see also example on p.109, text)


• INTENSITY – Heart Rate MethodsINTENSITY – Heart Rate Methods– Assumption: HR is a linear function of exercise Assumption: HR is a linear function of exercise

intensity.intensity.– Heart rate may be measured during exercise by Heart rate may be measured during exercise by

palpation (10 or 15 sec count), or by HR monitorpalpation (10 or 15 sec count), or by HR monitor– Again, HR is used to guide the intensity of Again, HR is used to guide the intensity of

exercise.exercise.– Different modes may evoke higher heart rate Different modes may evoke higher heart rate

responses for a given percentage of oxygen responses for a given percentage of oxygen consumption and RPE consumption and RPE (see figure 5.1 and 5.2 (see figure 5.1 and 5.2

respectively, p. 107, text), respectively, p. 107, text), thus you should consider thus you should consider matching the testing and training modes on a matching the testing and training modes on a relative relative (VO2 –HR – RPE ) (VO2 –HR – RPE ) for exercise.for exercise.


• INTENSITY – Heart Rate MethodsINTENSITY – Heart Rate Methods– If HR data is available from the exercise test, If HR data is available from the exercise test,

you can match the heart rates to the desired % you can match the heart rates to the desired % max VOmax VO22 from the exercise test. Thus, if you from the exercise test. Thus, if you want the client to exercise at 60% of VOwant the client to exercise at 60% of VO2 2 max max then find the corresponding HR on the then find the corresponding HR on the treadmill test, and prescribe the HR to guide treadmill test, and prescribe the HR to guide the intensity of the exercise session.the intensity of the exercise session.

– If there is no HR data from a GXT, us can use If there is no HR data from a GXT, us can use Heart Rate Reserve (Heart Rate Reserve (HRRHRR). ). See online handout See online handout for prescribing exercise by HRRfor prescribing exercise by HRR..


• INTENSITY – Heart Rate MethodsINTENSITY – Heart Rate Methods– If there is no HR data from a GXT, us can use If there is no HR data from a GXT, us can use

percent Heart Rate Maximumpercent Heart Rate Maximum ( (%HRmax%HRmax, p 111, text), p 111, text)

– When comparing HRR and %HRmax, the latter When comparing HRR and %HRmax, the latter tends to give a lower HR value for the same tends to give a lower HR value for the same prescribed exercise intensity. Thus, %HRmax is prescribed exercise intensity. Thus, %HRmax is probably a safer method of prescribing exercise probably a safer method of prescribing exercise intensity for older clients. intensity for older clients. HoweverHowever, one should , one should directly measure HR response and provide GXT’s directly measure HR response and provide GXT’s to older individuals, because of the increased to older individuals, because of the increased variability in HRmax of older individuals, and variability in HRmax of older individuals, and many are on meds that limit HR.many are on meds that limit HR.


• INTENSITY – Heart Rate MethodsINTENSITY – Heart Rate Methods– There is a large variability in actual exercise There is a large variability in actual exercise

intensity and prescribed exercise intensity intensity and prescribed exercise intensity when using HR formulas for guiding the when using HR formulas for guiding the exercise intensity. exercise intensity.

– Age-predicted HR formulas are not precise, Age-predicted HR formulas are not precise, especially if max HR is not known, but especially if max HR is not known, but predicted.predicted.

– Because HR can vary based on mode of Because HR can vary based on mode of exercise, emotional state, medications, etc., exercise, emotional state, medications, etc., you can advise your client to also use RPE as a you can advise your client to also use RPE as a guide to exercise intensity in conjunction with guide to exercise intensity in conjunction with the training HR range.the training HR range.


• INTENSITY – Rating of Perceived INTENSITY – Rating of Perceived Exertion. (Exertion. (RPERPE) ) (Table 4.2, p. 69, text, also see Lab (Table 4.2, p. 69, text, also see Lab One)One)

– Is based upon an “overall body feeling”Is based upon an “overall body feeling”– Is a valid and reliable toolIs a valid and reliable tool

– Again, one can locate the desired VOAgain, one can locate the desired VO22 from the from the exercise test and match these data with the RPE exercise test and match these data with the RPE collected. The corresponding RPE can then be collected. The corresponding RPE can then be used for the upper and lower limits to guide the used for the upper and lower limits to guide the exercise session.exercise session.

– If these data are not available, then typically an If these data are not available, then typically an RPE or 12-16 is used RPE or 12-16 is used (Omni Scale = 6). (Omni Scale = 6). RPE is RPE is especially useful when the HR response is especially useful when the HR response is questionable / invalid.questionable / invalid.


• INTENSITY – MonitoringINTENSITY – Monitoring

– The The best case scenario best case scenario is to undergo a GXT, is to undergo a GXT, determine the pace / exercise load to elicit the determine the pace / exercise load to elicit the predetermined exercise training intensity, predetermined exercise training intensity, correlate the predetermined exercise intensity correlate the predetermined exercise intensity with a training HR range, and match with the with a training HR range, and match with the corresponding RPE values. Thus all prescription corresponding RPE values. Thus all prescription values are directly linked to the values obtained values are directly linked to the values obtained to the exercise test. This is the best case scenario to the exercise test. This is the best case scenario for test-retest model.for test-retest model.

– When training in the field each client should When training in the field each client should monitor their own exercise intensity, unless they monitor their own exercise intensity, unless they are high risk clients and must be supervised for are high risk clients and must be supervised for medical purposes. medical purposes.


• INTENSITY – MonitoringINTENSITY – Monitoring

– Clients may guide the intensity of exercise by Clients may guide the intensity of exercise by monitoring their pulse, and utilizing RPE.monitoring their pulse, and utilizing RPE.

– Another good method of maintaining a desired Another good method of maintaining a desired exercise intensity is to used the “Talk Test” exercise intensity is to used the “Talk Test” (see (see the explanation on ventilatory mechanics on p 112, text). the explanation on ventilatory mechanics on p 112, text).

Thus, if you cannot talk, you need to not Thus, if you cannot talk, you need to not exercise so hard, if you can sing, you need to exercise so hard, if you can sing, you need to exercise harderexercise harder


FrequencyFrequency•Frequency Frequency of exercise depends on the goals of the of exercise depends on the goals of the

exercise prescription, and is interrelated with exercise exercise prescription, and is interrelated with exercise intensity. For example, if the client is focused on fat intensity. For example, if the client is focused on fat loss, exercise at a higher frequency and lower loss, exercise at a higher frequency and lower intensity. If the client is focused on rapidly increasing intensity. If the client is focused on rapidly increasing aerobic capacity, less frequency may be used with aerobic capacity, less frequency may be used with higher intensity and longer duration sessionshigher intensity and longer duration sessions..

• For health benefits, individuals should exercise at a For health benefits, individuals should exercise at a moderate intensity on at least 5 days per week. More moderate intensity on at least 5 days per week. More frequent sessions may follow increases in fitness frequent sessions may follow increases in fitness levels. levels.

• Individuals with fair to excellent cardiorespiratory Individuals with fair to excellent cardiorespiratory fitness levels should exercise at a moderate to fitness levels should exercise at a moderate to vigorous intensity a minimum of three to five times vigorous intensity a minimum of three to five times per week to produce significant changes in aerobic per week to produce significant changes in aerobic enduranceendurance


FrequencyFrequency•Frequency Frequency • Individuals with poor cardiorespiratory fitness levels Individuals with poor cardiorespiratory fitness levels

should exercise at light to moderate intensities a should exercise at light to moderate intensities a minimum of 5 days a week. Multiple daily exercise minimum of 5 days a week. Multiple daily exercise bouts of at least 10 min duration each may be bouts of at least 10 min duration each may be prescribed for sedentary clients having poor aerobic prescribed for sedentary clients having poor aerobic fitness.fitness.

• The ACSM (2010) recommends exercising on The ACSM (2010) recommends exercising on alternate days during the initial stages of training to alternate days during the initial stages of training to lessen the chance of bone or joint injury. Also, older lessen the chance of bone or joint injury. Also, older adults who can tolerate vigorous exercise should adults who can tolerate vigorous exercise should work out at least 3 days/wk with a day of rest work out at least 3 days/wk with a day of rest between each exercise session.between each exercise session.


DurationDuration•Duration Duration of exercise depends on the goals of the of exercise depends on the goals of the

exercise prescription, and is inversely related with exercise prescription, and is inversely related with exercise intensity.exercise intensity.

• The ACSM (2010) recommends 20 to 60 min of The ACSM (2010) recommends 20 to 60 min of continuous or intermittent activity. Apparently continuous or intermittent activity. Apparently healthy individuals usually can sustain exercise healthy individuals usually can sustain exercise intensities of 60% to 85% VOintensities of 60% to 85% VO22R for 20 to 30 min. R for 20 to 30 min.

• During the improvement stage, duration can be During the improvement stage, duration can be increased every 2 to 3 week until participants can increased every 2 to 3 week until participants can exercise continuously for 30 min at a modeexercise continuously for 30 min at a mode

• Poorly conditioned and older individuals may be able Poorly conditioned and older individuals may be able to exercise continuously at a low intensity (<40% to exercise continuously at a low intensity (<40% VOVO22R) for only 5 to 10 min. They may need to R) for only 5 to 10 min. They may need to perform multiple sessions (e.g., two to three 10 min perform multiple sessions (e.g., two to three 10 min exercise bouts) in a given day to accumulate 20 to 30 exercise bouts) in a given day to accumulate 20 to 30 min of aerobic exercise. min of aerobic exercise.


DurationDuration•An alternate method of measuring duration An alternate method of measuring duration

is via caloric threshold.is via caloric threshold.

•Caloric threshold is the predetermined Caloric threshold is the predetermined caloric expenditure required to meet the caloric expenditure required to meet the health and fitness goals of the exercise health and fitness goals of the exercise prescriptionprescription

•An alternative way of estimating the An alternative way of estimating the duration of exercise is to use the caloric cost duration of exercise is to use the caloric cost of the exercise. To achieve health benefits, of the exercise. To achieve health benefits, ACSM (2010) recommends target caloric ACSM (2010) recommends target caloric thresholds of 150 to 400 kcal·daythresholds of 150 to 400 kcal·day−1−1, and a , and a minimal weekly caloric threshold of 1000 minimal weekly caloric threshold of 1000 kcal from physical activity or exercise.kcal from physical activity or exercise.


ProgressionProgression• In the untrained individual, the greatest In the untrained individual, the greatest

rates of progression occur in the initial rates of progression occur in the initial stages of the program.stages of the program.

•The degree and rate of progression depend The degree and rate of progression depend on the initial level of fitness, age, and health on the initial level of fitness, age, and health status.status.

•For the ordinary person, progression in For the ordinary person, progression in fitness may be anywhere from 5-20 % fitness may be anywhere from 5-20 % increase in aerobic capacity, for the very increase in aerobic capacity, for the very unfit, perhaps up to 40%.unfit, perhaps up to 40%.

•There are three stages of progression: 1) There are three stages of progression: 1) Initial Conditioning, 2) Improvement, and 3) Initial Conditioning, 2) Improvement, and 3) Maintenance.Maintenance.


ProgressionProgression•During the initial stage of the exercise During the initial stage of the exercise

program, however, weekly exercise caloric program, however, weekly exercise caloric expenditure may be considerably lower (200 expenditure may be considerably lower (200 to 600 kcal·wkto 600 kcal·wk−1−1). Throughout the ). Throughout the improvement stage, the goal is to increase improvement stage, the goal is to increase your client’s caloric expenditure from 1000 to your client’s caloric expenditure from 1000 to 2000 kcal·wk2000 kcal·wk −1 −1 by gradually increasing the by gradually increasing the frequency, intensity, and duration of the frequency, intensity, and duration of the exercise.exercise.

• Calculate Calories from METS Calculate Calories from METS ( 4 METS = 3.5 X 4 = 14 ( 4 METS = 3.5 X 4 = 14 ml/kg/min. ; 14 ml/kg/min mass in kg = Absolute Gross ml/kg/min. ; 14 ml/kg/min mass in kg = Absolute Gross VOVO22 in ml/min; Absolute Gross VO in ml/min; Absolute Gross VO22 ml/min / 1000 ml/L = ml/min / 1000 ml/L = Absolute VOAbsolute VO22 Gross in L/min; Gross VO Gross in L/min; Gross VO22 in L/min * 5 in L/min * 5 kcals / L = Kcals/min; Total Kcal expenditure required / kcals / L = Kcals/min; Total Kcal expenditure required / Kcal min = Total exercise time for caloric expenditure.Kcal min = Total exercise time for caloric expenditure.


MaintenanceMaintenance•The goal of this stage is to maintain the The goal of this stage is to maintain the

cardiorespiratory fitness level and the cardiorespiratory fitness level and the weekly exercise caloric expenditure weekly exercise caloric expenditure achieved during the improvement stage. achieved during the improvement stage.

•Have your client accomplish this goal by Have your client accomplish this goal by engaging in aerobic activities 3 to 5 engaging in aerobic activities 3 to 5 days/week at the intensity and duration that days/week at the intensity and duration that were were

•Reducing the training frequency from 5 to 3 Reducing the training frequency from 5 to 3 days/week does not adversely affect days/week does not adversely affect VOVO22max as long as the training intensity max as long as the training intensity remains the same.remains the same.


Continuous and Discontinuous Continuous and Discontinuous MethodsMethods

•Either may be used to improve fitnessEither may be used to improve fitness

•Discontinuous is easier for those with low fitness Discontinuous is easier for those with low fitness

•Discontinuous with high intensity (interval work) Discontinuous with high intensity (interval work) is effective in rapidly increasing aerobic fitness, is effective in rapidly increasing aerobic fitness, but is has a higher attrition rate for those but is has a higher attrition rate for those beginning an exercise program with lower levels beginning an exercise program with lower levels of fitness.of fitness.

•See p.106– All exercise modes in Type A and B See p.106– All exercise modes in Type A and B are generally considered continuous types of are generally considered continuous types of exercise modes.exercise modes.

•Generally, continuous exercise at lower Generally, continuous exercise at lower intensities is safer, and more time efficient (less intensities is safer, and more time efficient (less total workout time)total workout time)


Exercise Volume Exercise Volume Exercise Volume is the caloric expenditure Exercise Volume is the caloric expenditure associated with exercise. Energy expenditure is associated with exercise. Energy expenditure is measured in Kcals.measured in Kcals.

– Determine VODetermine VO22 of specific activity of specific activity• ACSM EquationsACSM Equations

– Determine caloric costDetermine caloric cost• Determine VODetermine VO22 in Liters ( ml /kg/min X kg X1000) in Liters ( ml /kg/min X kg X1000)

• ( ml /kg/min X kg X1000) = L/min( ml /kg/min X kg X1000) = L/min

• 5 kcals expended per L of O5 kcals expended per L of O22

– Determine caloric goal for weekDetermine caloric goal for week– Divide by number of sessions / weekDivide by number of sessions / week– Arrive at number of calories per session Arrive at number of calories per session

• Variable = Frequency, Intensity, Duration and Mode.Variable = Frequency, Intensity, Duration and Mode.


• Putting it all together Putting it all together (PEP – personalized (PEP – personalized exercise program)exercise program)

– Case Study Review (see pg. 119)Case Study Review (see pg. 119)•Observe the steps required through Observe the steps required through

screening, testing, exercise prescription, and screening, testing, exercise prescription, and programming.programming.

•See handout on writing exercise goalsSee handout on writing exercise goals– You should help the client formulate both short You should help the client formulate both short

term, and long term goals.term, and long term goals.


End of PresentationEnd of Presentation

chapter 05 designing cardiovascular exercise programs

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