Contains Physical evaluation and exercise prescription for normal adult and diseased population. Courtesy: ACSM

1. Health fitness and
promotion
D.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

6. Evaluation
• Resting measurements are taken first
- HR
- BP
- Height
- Weight
- Body composition

7. Evaluation
• Resting measurements are followed by,
- Cardiac endurance
- Muscular fitness
- Flexibility
• Test environment

8. Analysis of body composition
• Anthropometric methods
- BMI
- WHR
- SFT
• Densitometry
- Hydrodensitometry
- plethysmography

9. BMI

10. BMI

12. Interpret axis of heart

13. Interpret position of heart

14. 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

15. SFT
• Seven sites (common for both male and female)
- Chest
- Midaxillary
- Triceps
- Subscapular
- Abdomen
- Suprailiac
- Thigh

16. 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

17. 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

18. 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

19. 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

20. 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?

21. Indications for Exercise Testing
VO2max Ex-
Duration,
Max Symptoms,
Workload, ST-T
BP changes,
response Arrhythmia
Exercise
Tolerance
Testing
Prognostic Testing

22. Submaximal exercise testing
• Practitioner uses various submaximal measures
- HR
- BP
- Workload
- Rating of perceived exertion (RPE)
- Functional response

23. Modes of testing
• Field tests
• Treadmill tests
• Cycle ergometry
• Step tests

24. 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

25. 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

26. Treadmill and ergometer
1. Exercise Equipment
– Treadmill
– Cycle Ergometer
• Mechanically braked cycle
• Electrically braked cycle
– Arm Crank Ergometers

27. 2. Airflow or Volume Transducers
3. Gas Analysers
4. Electrocardiograph
5. Non invasive Blood Pressure
6. Pulse Oximetry
7. Intraarterial Blood Pressure

28. Protocols
1. Single stage (constant work rate) Protocol
2. Multistage Protocol

29. Multistage Exercise Protocols
• Bruce Protocol
• Balke – Ware Protocol
• Naughton Protocol
• USAFSAM Protocol
• Dukes Protocol

30. 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.

32. Arm Ergometry
• Work rate increments of 10 W every 2 -3
minutes with a cranking rate of 50 – 60rpm

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. Interpretation
• HR
• Heart rate recovery
• Systolic BP
• Diastolic BP
• ST-segment depression
• ST-segment elevation
• Aerobic fitness

41. Heart rate
• Progressive linear increase with exercise
• Each MET increase 10 ± 2 beats

42. 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)

43. 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

44. Diastolic BP
• Normal response is no change or decrease in
DBP
• DBP of > 115 mm Hg is considered an
endpoint for exercise testing

45. 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

46. ST-segment elevation
• Early repolarization
• Indicate wall-motion abnormalities
• Significant myocardial ischemia and localizes
ischemia to specific area of myocardium

47. 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)

48. Muscular fitness
• Muscular strength
- Ability of muscle to exert force
• Muscular endurance
- Ability to continue to perform for successive
exertions or many repetitions

49. 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

50. Muscular endurance
• Curl-up (Crunch test)
• Push-up
• Females in modified “knee push-up”
• Maximum number of repetitions performed
without rest

51. Flexibility
• Depends on several specific variables
- Distensibility of joint capsule
- Adequate warm-up
- Muscle viscosity
Sit-and-reach test

52. Exercise
prescription

53. 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)

54. Conditioning
• FITT principle
• Frequency
• Intensity
• Time (duration)
• Type (Mode)

55. Cardiovascular endurance
• Frequency
- 3-5 days/week
- > 5 days/week reaches plateau
• Intensity
- 40-60% VO2R – moderate
- ≥ 60% VO2R – vigorous

56. Cardiovascular endurance
• Time duration
- At least 20-30 min
- 50-60 min – vigorous
• Mode
- Jogging
- Cycling

57. 8/24/2012 57

58. Selection Of Sports
Shoe
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59. Selection Of Sports Shoe
• Time of purchase
• Based on Midsole
• 5 pound pressure principle
• Thumb rule
• Shoe Life span
• For female
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60. TIME OF PURCHASE
• End of the day
• Soon after running or exercise
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61. BASED ON MIDSOLE
• Inert gas encapsulated in a ployurethane shell
(air pads) – NIKE
• Communicating air chambers (suspension
fibres) – REEBOK
• LD ethylene vinyl acetate pads – ADIDAS
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62. 5 POUND PRESSURE PRINCIPLE
• When the shoe is held vertically & 2.27 kg wt is
applied only 40º to 60º bend
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63. 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 pain
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64. 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):172-176
8/24/2012 64

65. LADY’S SPECIAL
• Narrow heel
• Vertical ground reaction force
• Peak tibial acceleration
• Maximal pronation
• Peak pronation velocity
• Peak pressures
8/24/2012 65

66. 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

67. 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

68. 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

69. 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

70. Progressive overload
Progressive
Anabolism
overload
Muscle Builds up affected
fatigue muscle
catabolism With aid of
nutrition & rest
Body
responds
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71. Maintenance
• Muscular strength may be maintained by
training muscle groups as little as 1 day/week

72. 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

73. Exercise prescription for elderly
• Initial workload should be low and work
increments should be small
• Preferable to cycle ergometer
• Consider prescribed medications

74. 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

75. 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

76. 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

77. Exercise prescription
FITT Diabetes HT Renal Obesity
failure
Frequency 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/wk
Intensity 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 1RM
Time 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
rp
Type Aeroic ex.; Walking, Walking and Walking,
proper jogging; 8-10 cycling jogging,
handling major ms cycling,swim