Health fitness and    promotionD.A. Asir John Samuel, BSc (Psy), MPT (Neuro Paed),             MAc, DYScEd, C/BLS, FAGE   ...
Health fitness and promotion• Fitness evaluation• Analysis of body composition• Evaluation and prescription of exercise• F...
Fitness evaluation• History- Work history- Exercise history (FITS)
Pre Exercise Evaluation• Medical History• Physical Evaluation• Laboratory Tests• Informed Consent
Evaluation• Resting measurements are taken first- HR- BP- Height- Weight- Body composition
Evaluation• Resting measurements are followed by,- Cardiac endurance- Muscular fitness- Flexibility• Test environment
Analysis of body composition• Anthropometric methods- BMI- WHR- SFT• Densitometry- Hydrodensitometry- plethysmography
BMI
BMI
Interpret axis of heart
Interpret position of heart
WHR• Waist – horizontal measure taken directly  above the iliac crest/narrowest of torso• Hip – legs slightly apart, a hor...
SFT•   Seven sites (common for both male and female)-   Chest-   Midaxillary-   Triceps-   Subscapular-   Abdomen-   Supra...
SFT - men• Chest, abdomen and thigh• Chest, triceps and subscapular• Body density = 1.10938-0.0008267 (sum of 3  SF)+0.000...
SFT - women• Triceps, surpailiac, thigh• Triceps, suprailiac, abdominal• Body density = 1.099421-0.0009929 (sum of 3  SF)+...
Cardiorespiratory Fitness• Ability to perform large muscle, dynamic, moderate-to-high    intensity   exercise     for prol...
Maximal oxygen uptake (VO2max)• VO2max is accepted as criterion measure of CR  fitness• VO2max = max cardiac output x arte...
Maximal Vs submaximal exercise testing• Maximal exercise tests have the disadvantage  of maximal volitional fatigue and mi...
Indications for Exercise TestingVO2max Ex-Duration,  Max                             Symptoms,Workload,                   ...
Submaximal exercise testing• Practitioner uses various submaximal measures- HR- BP- Workload- Rating of perceived exertion...
Modes of testing• Field tests• Treadmill tests• Cycle ergometry• Step tests
Field tests• Walking or running a certain distance in a  given time• Easy to administer to large number of  individuals at...
Rockport One-Mile fitness walking test• Peak VO2 = (0.02 x distance) - (0.191 x age)-  (0.07 X weight) + (0.09 X height) +...
Treadmill and ergometer1. Exercise Equipment  – Treadmill  – Cycle Ergometer     • Mechanically braked cycle     • Electri...
2. Airflow or Volume Transducers3. Gas Analysers4. Electrocardiograph5. Non invasive Blood Pressure6. Pulse Oximetry7. Int...
Protocols1. Single stage (constant work rate) Protocol2. Multistage Protocol
Multistage Exercise Protocols• Bruce Protocol• Balke – Ware Protocol• Naughton Protocol• USAFSAM Protocol• Dukes Protocol
Constant Work Rate Protocol• Treadmill or cycle ergometry exercise maybe used at levels  approximate to subject’s function...
Arm Ergometry• Work rate increments of 10 W every 2 -3  minutes with a cranking rate of 50 – 60rpm
correlation• Used for Testing patients with vascular,  orthopaedic or neurologic conditions that  prevent them from doing ...
Subjective Ratings & Symptoms• Rate of percieved exertion (RPE)• Angina 1.   Mild, barely noticeable 2.   Moderate, bother...
Step test• Step height- 30.5 cm (12 inch)- Rate of 24 steps/min- After test, immediately sit down and HR is  counted for 1...
Test sequence• Obtain resting HR & BP before exercise in  exercise posture• Familiarized with ergometer or treadmill. If  ...
Test sequence• PRE and additional rating scales• Client appearance and symptoms• Terminate when subject reaches 70% HRR or...
Test termination criteria• Onset of angina or angina like symptoms• Drop in systolic BP > 10 mm Hg from baseline BP despit...
Test termination criteria• Signs of poor perfusion• Failure of heart rate to increase with increased  exercise intensity• ...
Interpretation• HR• Heart rate recovery• Systolic BP• Diastolic BP• ST-segment depression• ST-segment elevation• Aerobic f...
Heart rate• Progressive linear increase with exercise• Each MET increase 10 ± 2 beats
Heart rate recovery• An abnormal slowed HRR is associated with a  poor prognosis• Decrease ≤ 12 beats/min at 1 min (walkin...
Systolic BP• Progressive increase in SBP at 10 ± 2 mm Hg/MET• Discontinue with SBP values of > 250 mm Hg• Exertional hypot...
Diastolic BP• Normal response is no change or decrease in DBP• DBP of > 115 mm Hg is considered an endpoint for exercise t...
ST-segment depression• Common manifestation of exercise induced  myocardial ischemia (Mi)• Horizontal   or    downsloping ...
ST-segment elevation• Early repolarization• Indicate wall-motion abnormalities• Significant myocardial ischemia and locali...
Aerobic fitness• Average values of VO2max is expressed as METs         Men = (57.8-0.445[age])/3.5        Women = (41.2-0....
Muscular fitness• Muscular strength- Ability of muscle to exert force• Muscular endurance- Ability to continue to perform ...
Muscular strength• Maximum voluntary contraction (MVC)• Bench press or leg press• 1-RM, the greatest resistance that can b...
Muscular endurance• Curl-up (Crunch test)• Push-up• Females in modified “knee push-up”• Maximum number of repetitions perf...
Flexibility• Depends on several specific variables- Distensibility of joint capsule- Adequate warm-up- Muscle viscosity   ...
Exerciseprescription
Exercise training session• Warm-up - (5-10 min) < 40% VO2R• Stretching (10 min)• Conditioning or sports related exercise (...
Conditioning• FITT principle• Frequency• Intensity• Time (duration)• Type (Mode)
Cardiovascular endurance• Frequency- 3-5 days/week- > 5 days/week reaches plateau• Intensity- 40-60% VO2R – moderate- ≥ 60...
Cardiovascular endurance• Time duration- At least 20-30 min- 50-60 min – vigorous• Mode- Jogging- Cycling
8/24/2012   57
Selection Of Sports       Shoe8/24/2012         58
Selection Of Sports Shoe• Time of purchase• Based on Midsole• 5 pound pressure principle• Thumb rule• Shoe Life span• For ...
TIME OF PURCHASE• End of the day• Soon after running or exercise8/24/2012                          60
BASED ON MIDSOLE• Inert gas encapsulated in a ployurethane shell    (air pads) – NIKE• Communicating air chambers (suspens...
5 POUND PRESSURE PRINCIPLE• When the shoe is held vertically & 2.27 kg wt is    applied only 40º to 60º bend8/24/2012     ...
THUMB’S RULE• Thumb’s width of space between the end of the    longest toe and the front end of the shoe.• Narrow shoe lea...
SHOE LIFE SPAN• 300 to 500 miles ¹• 6 months ²• Whichever comes first ²• Sensing small rocks• Slapping sensation          ...
LADY’S SPECIAL• Narrow heel• Vertical ground reaction force• Peak tibial acceleration• Maximal pronation• Peak pronation v...
Volume of resistance training• Each muscle group should be trained for total  of 2-4 sets• 8-12 repetitions per set• Resis...
For muscular endurance• Higher number of repetitions of 15-20 reps.• Shorter rest intervals (< 2min)• Fewer sets (Preferab...
Resistance exercise technique• Proper technique• Minimizes chances of injury• Proper body positioning and breathing• Full ...
Progression• Overload or greater stimuli to continue to increase muscular strength and mass• Perform more sets per muscle ...
Progressive overload        Progressive                                             Anabolism         overload            ...
Maintenance• Muscular strength may be maintained by training muscle groups as little as 1 day/week
Flexibility exercise• Injury prevention• At least 10 min. duration involving major  muscle groups of body• > 4 repetitions...
Exercise prescription for elderly• Initial workload should be low and work  increments should be small• Preferable to cycl...
Exercise prescription for elderly• Aerobic activity- Aquatic exercise and stationary-cycle exercise- 20-30 min/day to 75-1...
Exercise prescription for elderly• Muscle-strengthening- At least 2 days/week- 10-15 repetitions of low resistance• Flexib...
Exercise prescription for children• Aerobic activity- At least 3-4 days/week, preferably daily- Moderate (5-6 RPE)- 30 min...
Exercise prescriptionFITT        Diabetes HT                    Renal          Obesity                                    ...
Health fitness and promotion
Health fitness and promotion
Health fitness and promotion
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Health fitness and promotion

  1. 1. Health fitness and promotionD.A. Asir John Samuel, BSc (Psy), MPT (Neuro Paed), MAc, DYScEd, C/BLS, FAGE Lecturer, Alva’s college of Physiotherapy, Moodbidri
  2. 2. Health fitness and promotion• Fitness evaluation• Analysis of body composition• Evaluation and prescription of exercise• Factors affecting exercise performance• Exercise prescription for specific groups- Elderly- Women- children
  3. 3. Fitness evaluation• History- Work history- Exercise history (FITS)
  4. 4. Pre Exercise Evaluation• Medical History• Physical Evaluation• Laboratory Tests• Informed Consent
  5. 5. Evaluation• Resting measurements are taken first- HR- BP- Height- Weight- Body composition
  6. 6. Evaluation• Resting measurements are followed by,- Cardiac endurance- Muscular fitness- Flexibility• Test environment
  7. 7. Analysis of body composition• Anthropometric methods- BMI- WHR- SFT• Densitometry- Hydrodensitometry- plethysmography
  8. 8. BMI
  9. 9. BMI
  10. 10. Interpret axis of heart
  11. 11. Interpret position of heart
  12. 12. WHR• Waist – horizontal measure taken directly above the iliac crest/narrowest of torso• Hip – legs slightly apart, a horizontal measure taken at maximal circumference of hip or proximal thigh, just above the gluteal fold• Male < 0.75• Female < 0.85
  13. 13. SFT• Seven sites (common for both male and female)- Chest- Midaxillary- Triceps- Subscapular- Abdomen- Suprailiac- Thigh
  14. 14. SFT - men• Chest, abdomen and thigh• Chest, triceps and subscapular• Body density = 1.10938-0.0008267 (sum of 3 SF)+0.0000016(sum of 3 SF)2 -0.0002574(age)• % fat = (495/Body density)-450
  15. 15. SFT - women• Triceps, surpailiac, thigh• Triceps, suprailiac, abdominal• Body density = 1.099421-0.0009929 (sum of 3 SF)+0.0000023(sum of 3 SF)2 -0.0001392(age)• % fat = (495/Body density)-450
  16. 16. Cardiorespiratory Fitness• Ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged periods• Depends on functional state of respiratory, cardiovascular and skeletal muscle systems
  17. 17. Maximal oxygen uptake (VO2max)• VO2max is accepted as criterion measure of CR fitness• VO2max = max cardiac output x arterial-venous oxygen difference• Open-circuit spirometry is used to measure VO2max• Direct measurement of VO2max is not feasible
  18. 18. Maximal Vs submaximal exercise testing• Maximal exercise tests have the disadvantage of maximal volitional fatigue and might require medical emergencies• Commonly rely on submaximal exercise tests• Aim is to determine HR response and predict?
  19. 19. Indications for Exercise TestingVO2max Ex-Duration, Max Symptoms,Workload, ST-T BP changes,response Arrhythmia Exercise Tolerance Testing Prognostic Testing
  20. 20. Submaximal exercise testing• Practitioner uses various submaximal measures- HR- BP- Workload- Rating of perceived exertion (RPE)- Functional response
  21. 21. Modes of testing• Field tests• Treadmill tests• Cycle ergometry• Step tests
  22. 22. Field tests• Walking or running a certain distance in a given time• Easy to administer to large number of individuals at one time and little equipment• Cooper 12-minute test• Rockport One-Mile fitness walking test
  23. 23. Rockport One-Mile fitness walking test• Peak VO2 = (0.02 x distance) - (0.191 x age)- (0.07 X weight) + (0.09 X height) + (0.26 X RPP X10-3) + 2.45
  24. 24. Treadmill and ergometer1. Exercise Equipment – Treadmill – Cycle Ergometer • Mechanically braked cycle • Electrically braked cycle – Arm Crank Ergometers
  25. 25. 2. Airflow or Volume Transducers3. Gas Analysers4. Electrocardiograph5. Non invasive Blood Pressure6. Pulse Oximetry7. Intraarterial Blood Pressure
  26. 26. Protocols1. Single stage (constant work rate) Protocol2. Multistage Protocol
  27. 27. Multistage Exercise Protocols• Bruce Protocol• Balke – Ware Protocol• Naughton Protocol• USAFSAM Protocol• Dukes Protocol
  28. 28. Constant Work Rate Protocol• Treadmill or cycle ergometry exercise maybe used at levels approximate to subject’s functional activity i.e. 3.0 mph on treadmill or upto 50 W on a cycle ergometer.• 6 minutes of continuous exercise.• Constant work rate test for 5 -10 minutes achieves about 70 – 90% of VO2max achieved during incremental exercise testing.
  29. 29. Arm Ergometry• Work rate increments of 10 W every 2 -3 minutes with a cranking rate of 50 – 60rpm
  30. 30. correlation• Used for Testing patients with vascular, orthopaedic or neurologic conditions that prevent them from doing leg exercise.• Correlation between arm exercise and leg exercise r = 0.37
  31. 31. Subjective Ratings & Symptoms• Rate of percieved exertion (RPE)• Angina 1. Mild, barely noticeable 2. Moderate, bothersome 3. Moderately Severe, Very uncomfortable 4. Most Severe or Intense pain ever experienced
  32. 32. Step test• Step height- 30.5 cm (12 inch)- Rate of 24 steps/min- After test, immediately sit down and HR is counted for 1 min.- Counting must start within 5 seconds
  33. 33. Test sequence• Obtain resting HR & BP before exercise in exercise posture• Familiarized with ergometer or treadmill. If using cycle ergometer 5° knee bend in max Ext• 2-3 min. warm-up• Monitor HR at least 2 times during each stage• BP monitored in last minute of each stage
  34. 34. Test sequence• PRE and additional rating scales• Client appearance and symptoms• Terminate when subject reaches 70% HRR or 85% of HRmax• Cool-down/recovery period (passive/cont.ex)• Continue physiologic observations for 5 min
  35. 35. Test termination criteria• Onset of angina or angina like symptoms• Drop in systolic BP > 10 mm Hg from baseline BP despite an increase in workload• Excessive rise in BP: SBP > 250 mm Hg or DBP > 115 mm Hg• Shortness of breath, wheezing, leg cramps or claudication
  36. 36. Test termination criteria• Signs of poor perfusion• Failure of heart rate to increase with increased exercise intensity• Noticeable change in heart rhythm• Subjects requests to stop• Manifestations of severe fatigue• Failure of testing equipment
  37. 37. Interpretation• HR• Heart rate recovery• Systolic BP• Diastolic BP• ST-segment depression• ST-segment elevation• Aerobic fitness
  38. 38. Heart rate• Progressive linear increase with exercise• Each MET increase 10 ± 2 beats
  39. 39. Heart rate recovery• An abnormal slowed HRR is associated with a poor prognosis• Decrease ≤ 12 beats/min at 1 min (walking)• Decrease ≤ 22 beats/min at 2 min (supine)
  40. 40. Systolic BP• Progressive increase in SBP at 10 ± 2 mm Hg/MET• Discontinue with SBP values of > 250 mm Hg• Exertional hypotension (> 10 mm Hg) may signify myocardial ischemia or LV dysfunction• Maximal exercise SBP of < 140 mm Hg suggests a poor prognosis
  41. 41. Diastolic BP• Normal response is no change or decrease in DBP• DBP of > 115 mm Hg is considered an endpoint for exercise testing
  42. 42. ST-segment depression• Common manifestation of exercise induced myocardial ischemia (Mi)• Horizontal or downsloping ST-segment depression is more indicative of Mi• ≥1 mm of horizontal or downsloping ST segment at J point extending 60-80 msec• In recovery true positive
  43. 43. ST-segment elevation• Early repolarization• Indicate wall-motion abnormalities• Significant myocardial ischemia and localizes ischemia to specific area of myocardium
  44. 44. Aerobic fitness• Average values of VO2max is expressed as METs Men = (57.8-0.445[age])/3.5 Women = (41.2-0.343[age])/3.5• RPE > 17 (abnormal)
  45. 45. Muscular fitness• Muscular strength- Ability of muscle to exert force• Muscular endurance- Ability to continue to perform for successive exertions or many repetitions
  46. 46. Muscular strength• Maximum voluntary contraction (MVC)• Bench press or leg press• 1-RM, the greatest resistance that can be moved through full ROM in controlled manner with good posture• Find 1-RM within 4 trials of 3-5 min rest b/w trials
  47. 47. Muscular endurance• Curl-up (Crunch test)• Push-up• Females in modified “knee push-up”• Maximum number of repetitions performed without rest
  48. 48. Flexibility• Depends on several specific variables- Distensibility of joint capsule- Adequate warm-up- Muscle viscosity Sit-and-reach test
  49. 49. Exerciseprescription
  50. 50. Exercise training session• Warm-up - (5-10 min) < 40% VO2R• Stretching (10 min)• Conditioning or sports related exercise (20-60 min)• Cool-down (5 min)
  51. 51. Conditioning• FITT principle• Frequency• Intensity• Time (duration)• Type (Mode)
  52. 52. Cardiovascular endurance• Frequency- 3-5 days/week- > 5 days/week reaches plateau• Intensity- 40-60% VO2R – moderate- ≥ 60% VO2R – vigorous
  53. 53. Cardiovascular endurance• Time duration- At least 20-30 min- 50-60 min – vigorous• Mode- Jogging- Cycling
  54. 54. 8/24/2012 57
  55. 55. Selection Of Sports Shoe8/24/2012 58
  56. 56. Selection Of Sports Shoe• Time of purchase• Based on Midsole• 5 pound pressure principle• Thumb rule• Shoe Life span• For female8/24/2012 59
  57. 57. TIME OF PURCHASE• End of the day• Soon after running or exercise8/24/2012 60
  58. 58. BASED ON MIDSOLE• Inert gas encapsulated in a ployurethane shell (air pads) – NIKE• Communicating air chambers (suspension fibres) – REEBOK• LD ethylene vinyl acetate pads – ADIDAS8/24/2012 61
  59. 59. 5 POUND PRESSURE PRINCIPLE• When the shoe is held vertically & 2.27 kg wt is applied only 40º to 60º bend8/24/2012 62
  60. 60. THUMB’S RULE• Thumb’s width of space between the end of the longest toe and the front end of the shoe.• Narrow shoe leads to blisters and to forefoot and toe pain8/24/2012 63
  61. 61. SHOE LIFE SPAN• 300 to 500 miles ¹• 6 months ²• Whichever comes first ²• Sensing small rocks• Slapping sensation 1.Clin J Sports Med 1985;4(4):619-626 2.Clin J Sports Med 2005;15(3):172-1768/24/2012 64
  62. 62. LADY’S SPECIAL• Narrow heel• Vertical ground reaction force• Peak tibial acceleration• Maximal pronation• Peak pronation velocity• Peak pressures8/24/2012 65
  63. 63. Volume of resistance training• Each muscle group should be trained for total of 2-4 sets• 8-12 repetitions per set• Resistance is 60-80% of 1RM• Each set should be performed to the point of muscle fatigue not failure• 2-3 min rest between sets
  64. 64. For muscular endurance• Higher number of repetitions of 15-20 reps.• Shorter rest intervals (< 2min)• Fewer sets (Preferably 1-2 sets per muscle group)• RPE of 5-6 on 10-point scale
  65. 65. Resistance exercise technique• Proper technique• Minimizes chances of injury• Proper body positioning and breathing• Full ROM in controlled manner• Emphasis on lifting and lowering phase
  66. 66. Progression• Overload or greater stimuli to continue to increase muscular strength and mass• Perform more sets per muscle group• Increasing number of days per week
  67. 67. Progressive overload Progressive Anabolism overload Muscle Builds up affected fatigue muscle catabolism With aid of nutrition & rest Body responds8/24/2012 70
  68. 68. Maintenance• Muscular strength may be maintained by training muscle groups as little as 1 day/week
  69. 69. Flexibility exercise• Injury prevention• At least 10 min. duration involving major muscle groups of body• > 4 repetitions per muscle group• Static stretch should be held for 15-60 seconds• Minimum 2-3 days/week
  70. 70. Exercise prescription for elderly• Initial workload should be low and work increments should be small• Preferable to cycle ergometer• Consider prescribed medications
  71. 71. Exercise prescription for elderly• Aerobic activity- Aquatic exercise and stationary-cycle exercise- 20-30 min/day to 75-100 min/day walk- Minimum 5 days/week- 5-6 on RPE
  72. 72. Exercise prescription for elderly• Muscle-strengthening- At least 2 days/week- 10-15 repetitions of low resistance• Flexibility- 2 days/week- < 30 seconds hold for 3 repetitions
  73. 73. Exercise prescription for children• Aerobic activity- At least 3-4 days/week, preferably daily- Moderate (5-6 RPE)- 30 min/day to 60 min/day- Dance, sporting
  74. 74. Exercise prescriptionFITT Diabetes HT Renal Obesity failureFrequency A- 3-7 d/wk; A- all days; A- 3-5d/wk; ≥ 5d/wk R-2-3 d/wk R- 2-3d/wk R-2-3d/wkIntensity A-50%-80% A-40%-<60% A-40%-<60% A-40%-<60% VO2R; R- VO2R; R- VO2R; R- VO2R or HRR 60%-80% 60%-80% 60%-75% 1RM 1RM 1RMTime 20-60 min to 30-60 min/d; 20-60 min/d; 30-60 min to 150 min/wk; 1set 8-12 rp 1set 10-15 150 min/wk 2-3 sets 8-12 rp rpType Aeroic ex.; Walking, Walking and Walking, proper jogging; 8-10 cycling jogging, handling major ms cycling,swim
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