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Health fitness and promotion

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Contains Physical evaluation and exercise Prescription for normal

Contains Physical evaluation and exercise Prescription for normal


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  • 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. 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. Fitness evaluation• History- Work history- Exercise history (FITS)
  • 4. Pre Exercise Evaluation• Medical History• Physical Evaluation• Laboratory Tests• Informed Consent
  • 5. Evaluation• Resting measurements are taken first- HR- BP- Height- Weight- Body composition
  • 6. Evaluation• Resting measurements are followed by,- Cardiac endurance- Muscular fitness- Flexibility• Test environment
  • 7. Analysis of body composition• Anthropometric methods- BMI- WHR- SFT• Densitometry- Hydrodensitometry- plethysmography
  • 8. BMI
  • 9. BMI
  • 10. Interpret axis of heart
  • 11. Interpret position of heart
  • 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. SFT• Seven sites (common for both male and female)- Chest- Midaxillary- Triceps- Subscapular- Abdomen- Suprailiac- Thigh
  • 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. 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. 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. 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. 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. Indications for Exercise TestingVO2max Ex-Duration, Max Symptoms,Workload, ST-T BP changes,response Arrhythmia Exercise Tolerance Testing Prognostic Testing
  • 20. Submaximal exercise testing• Practitioner uses various submaximal measures- HR- BP- Workload- Rating of perceived exertion (RPE)- Functional response
  • 21. Modes of testing• Field tests• Treadmill tests• Cycle ergometry• Step tests
  • 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. 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. Treadmill and ergometer1. Exercise Equipment – Treadmill – Cycle Ergometer • Mechanically braked cycle • Electrically braked cycle – Arm Crank Ergometers
  • 25. 2. Airflow or Volume Transducers3. Gas Analysers4. Electrocardiograph5. Non invasive Blood Pressure6. Pulse Oximetry7. Intraarterial Blood Pressure
  • 26. Protocols1. Single stage (constant work rate) Protocol2. Multistage Protocol
  • 27. Multistage Exercise Protocols• Bruce Protocol• Balke – Ware Protocol• Naughton Protocol• USAFSAM Protocol• Dukes Protocol
  • 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. Arm Ergometry• Work rate increments of 10 W every 2 -3 minutes with a cranking rate of 50 – 60rpm
  • 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. 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. 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. 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. 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. 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. 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. Interpretation• HR• Heart rate recovery• Systolic BP• Diastolic BP• ST-segment depression• ST-segment elevation• Aerobic fitness
  • 38. Heart rate• Progressive linear increase with exercise• Each MET increase 10 ± 2 beats
  • 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. 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. Diastolic BP• Normal response is no change or decrease in DBP• DBP of > 115 mm Hg is considered an endpoint for exercise testing
  • 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. ST-segment elevation• Early repolarization• Indicate wall-motion abnormalities• Significant myocardial ischemia and localizes ischemia to specific area of myocardium
  • 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. Muscular fitness• Muscular strength- Ability of muscle to exert force• Muscular endurance- Ability to continue to perform for successive exertions or many repetitions
  • 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. Muscular endurance• Curl-up (Crunch test)• Push-up• Females in modified “knee push-up”• Maximum number of repetitions performed without rest
  • 48. Flexibility• Depends on several specific variables- Distensibility of joint capsule- Adequate warm-up- Muscle viscosity Sit-and-reach test
  • 49. Exerciseprescription
  • 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. Conditioning• FITT principle• Frequency• Intensity• Time (duration)• Type (Mode)
  • 52. Cardiovascular endurance• Frequency- 3-5 days/week- > 5 days/week reaches plateau• Intensity- 40-60% VO2R – moderate- ≥ 60% VO2R – vigorous
  • 53. Cardiovascular endurance• Time duration- At least 20-30 min- 50-60 min – vigorous• Mode- Jogging- Cycling
  • 54. 8/24/2012 57
  • 55. Selection Of Sports Shoe8/24/2012 58
  • 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. TIME OF PURCHASE• End of the day• Soon after running or exercise8/24/2012 60
  • 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. 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. 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. 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. LADY’S SPECIAL• Narrow heel• Vertical ground reaction force• Peak tibial acceleration• Maximal pronation• Peak pronation velocity• Peak pressures8/24/2012 65
  • 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. 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. 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. 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. Progressive overload Progressive Anabolism overload Muscle Builds up affected fatigue muscle catabolism With aid of nutrition & rest Body responds8/24/2012 70
  • 68. Maintenance• Muscular strength may be maintained by training muscle groups as little as 1 day/week
  • 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. Exercise prescription for elderly• Initial workload should be low and work increments should be small• Preferable to cycle ergometer• Consider prescribed medications
  • 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. 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. 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. 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