effective exercise and physical activity programming

Effective Exercise and Physical Activity Programming

Population

• Know your clients

Population

• Key factors to consider?

– Age

– Height

– Weight

– Health status

– Physical activity status

– Lifestyle issues

Case Study

• Analysis of one individual’s (case) background and history

Programming Basics

• First step

– meet with the client to determine

• interests,

• goals,

• objectives.

Basic Steps

Purpose• Open lines of

communication• Build trust• Establish credibility• Determine what will

be done next

Goals and Objectives

• Determine preliminary goals and objectives

– Know where you are going

– Select appropriate assessments

– Revisit after prescreening

– Modify frequently


• Goals and objectives help to:

– establish the parameters of any exercise program,

– determine the degree and type of prescreening that needs to occur,

– and establish realistic expectations in term of expectable outcomes.


• Short and long term goals should be determined between the client and the exercise programmer.


• Remember that you are assisting a client in developing a program to meet their goals and objectives – not yours!


• Realism is crucial in the establishment of goals to ensure success and to maintain credibility.


• Goal – major outcome

• Objective – subordinate to goal.

• Each goal will have several objectives.


• What does your client want to accomplish?

Basic Health vs Optimal Fitness

• Most people who exercise do so to attain either

– Basic health benefits

– Optimal fitness benefits

Basic Health Benefits

• Willing to do enough to improve health and reduce disease risk

– Largest segment of exercise population

– Moving from sedentary to moderately active will accomplish this goal

Optimal Fitness

• Willing to work harder

– More competitive and motivated

– Willing to risk pain and injury

– Dose-response

Basic Health Benefits

• Vast majority of physically active adults are not involved in structured, formal exercise programs, nor do they need to be.

Lessons from Spiderman

• Peter Parker’s (Spiderman) Uncle Ben says to him in Spiderman 2

• “With great power comes great responsibility”

Lessons from Spiderman

• The extension of this concept also can mean:

• “If we wish people to take responsibility, we must empower them”

Empowerment

• What does this mean and how does it apply to exercise programming?

• Get them involved in the programming process

• It’s their program!!!!!

Programming Basics

• There is an inverse relationship between activity and mortality risk across activity categories,

– some exercise is better than none, and more exercise - up to a point - is better than less.

Programming Basics

• Public health efforts should be directed toward “getting more people more active more of the time” rather than elevating everyone to an arbitrary fitness or activity level.

Risks Associated with Physical Activity

• While regular physical activity increases the risk of both musculoskeletal injury and life-threatening cardiovascular events such as cardiac arrest, the incidence is low.

– The risk is even lower in those who are habitually active.


• In general, the risk is lowest among healthy young adults and non-smoking women, greater for those with CAD risk factors, and highest for those with established cardiac disease.


• The overall absolute risk in the general population is low especially when weighed against the health benefits of exercise.


• To further reduce the risks of physical activity, proper prescreening must occur.

Prescreening

Prescreening

• A necessity prior to any fitness assessment or participation in any activity program

– Identifies those at risk

– Defines goals and objectives

– Provides starting FITS

– Provides a baseline for measuring progression

Prescreening

Objectives:

• Optimize safety during exercise testing and participation.

• Permit the development of a sound and effective exercise prescription.

Prescreening

The purpose of the pre-participation health screening include:

• Identification and exclusion of individuals with medical contraindications to exercise.

Prescreening

• Identification of individuals with disease symptoms and risk factors for disease development who should receive medical evaluation before starting an exercise program.

Prescreening

• Identification of persons with clinically significant disease considerations who should participate in a medically supervised exercise program.

Prescreening

• Use information from the initial health and lifestyle evaluations to screen clients for physical fitness testing and for program development.

Prescreening

• Identification of individuals with other special needs.

Prescreening

• It is essential that health screening procedures be valid, cost effective, and time efficient.

Prescreening

Prescreening may be composed of:

• Informed consent

• Medical clearance

• Risk stratification

Prescreening

• Medical history

• Lifestyle evaluation

• Exercise testing

Informed Consent

• Prior to conducting any physical fitness tests or developing any exercise program, you should see that each participant signs an informed consent.

Informed Consent

• This form explains the purpose and nature of each physical fitness test and/or program, any inherent risks in the testing and/or program, and the expected benefits of the tests and/or program.

Informed Consent

• It also ensures your clients’ results will remain confidential and their participation is voluntary.

Informed Consent

• If your client is underage (<18 years), a parent or guardian must also sign the informed consent.

– Minor gives assent

– Legal guardian gives consent

Informed Consent

• All consent forms should be approved by your institutional review board or legal counsel.

Case Studies

Demographic Factors:

• age

• gender

• ethnicity

Case Studies

Demographic Factors:

• occupation

• height

• weight

• family history

Prescreening

• Before assessing your client’s physical fitness profile, you should classify the individual’s health status and lifestyle.

Health Status

• Illness or disease?

• Injury?

• Medications and supplements?

Activity Status

• Currently active or inactive?

• Likes and dislikes?

• Obstacles?

Health Status

• PAR-Q

– Physical Activity Readiness Questionnaire

• The PAR-Q has been recommended as a minimal standard for entry into low-to-moderate intensity exercise programs.

Health Status

• The PAR-Q was designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the most suitable types of activity.

Medical History

• Your clients should complete a comprehensive medical history questionnaire, including personal and family health history.

Medical History

Use the questionnaire to:

• Examine the client’s record of personal illnesses, surgeries, and operations.

Medical History

• Assess previous medical diagnoses and signs and symptoms of disease that have occurred within the past year or are currently present.

Medical History

• Analyze your client’s family history of

– diabetes,

– heart disease,

– stroke

– and hypertension.

Medical History

• Focus on conditions that require medical referral.

Medical History

• If any of these conditions are noted, refer your client to a physician for a physical examination and medical clearance prior to exercise testing or starting an exercise program.

Medical History

Present Symptoms:

• Dyspnea or shortness of breath

• Angina or chest pain

• Leg cramps or claudication

• Musculoskeletal problems or limitations

• Medications

Medical History

Past History:

• Diseases

• Injuries

• Surgeries

• Lab tests

Medical History

• It is important to note the types of medication being used by the client.

Medical History

• Drugs such as digitalis, beta-blockers, diuretics, vasodilators, bronchodilators, and insulin may alter the individual’s heart rate blood pressure, ECG, and exercise capacity.

Medical History

• If your client reports a medical condition or drug that is unfamiliar to you, be certain to consult a physician to obtain more information before conducting any exercise tests or allowing the client to participate in an exercise program.

Medical Clearance

• Your prospective exercise program participants should obtain a physical examination and a signed medical clearance from a physician.

Risk Stratification

• Low Risk

– Asymptomatic < 1 Risk Factor

• Moderate Risk

– Asymptomatic > 2 Risk Factor

• High Risk

– Sypmtomatic, or known cardiac, pulmonary, or metabolic diseases

Prior Medical Exam

Current Medical Exam

Risk

Low Moderate High

• Moderate Ex. NN NN Rec

• Vigorous Ex. NN Rec Rec

NN = not necessary Rec = Recommended

Exercise Testing

Physician Supervision

Risk

Low Moderate High

• Submax test NN NN Rec

• Max test NN Rec Rec

NN = not necessary Rec = Recommended

Risk Stratification

• See ACSM’s Guidelines for risk factors - p. 28.

• See ACSM’s Guideline for signs and symptoms - p. 26-27.

• See ACSM’s Guidelines for risk stratification - p. 24.

Lifestyle Evaluation

• A well-rounded physical fitness program requires that you obtain information about the client’s living habits.


• The lifestyle assessment provides useful information regarding the individual’s risk factor profile.

Lifestyle Assessment

• Alcohol and caffeine intake

• Smoking

• Nutritional intake - eating patterns

• Physical activity patterns and interests

• Sleeping habits

Lifestyle Assessment

• Occupational stress level

• Mental status - family lifestyle


• These factors can be used to pinpoint patterns and habits that need modification and to assess the likelihood of the client’s adherence to the exercise program.


• Factors such as

• smoking,

• lack of physical activity,

• and diets high in saturated fats or cholesterol

• increase the risk of CAD atherosclerosis, and hypertension.

Physical Examination

• Blood pressure

• Heart or lung sounds

• Orthopedic problems

Laboratory Tests (Ideal #s)

• Triglycerides (<200 mg per dl)

• Total cholesterol (<200 mg per dl)

• LDL-C (<130 mg per dl)

• HDL-C (>35 mg per dl)


• TC/HDL-C ratio (<3.5)

• Blood glucose (60-114 mg per dl)

• Hemoglobin (13.5-17.5 mg per dl for men; 11.5-15.5 mg per dl for women)

• Potassium (3.5-5.5 meq per dl)


• Blood urea nitrogen (4-24 mg per dl)

• Creatinine (0.3-1.4 mg per dl)

• Iron (40-190 g per dl for men; 35-180 g for women)

• Calcium (8.5-10.5 mg per dl)

Physical Fitness Evaluation

• CV fitness (HR, BP, VO2MAX)

• Body composition (%BF)

• Musculoskeletal fitness (muscle and bone strength)

• Flexibility

• Neuromuscular tension/stress

Fitness Assessment

• Fitness assessment is discussed elsewhere (HPR 309)

• Very important in

program design

Risks of Exercise Testing.

• Clinical exercise testing is a relatively safe procedure, although complications may arise.


• The risk of death during or immediately after an exercise test is < 0.01%.

– 1 out of 10,000

• The risk of MI during or immediately after an exercise tests is < 0.04%.

– 4 out of 10,000


• The risk of a complication requiring hospitalization (including MIs) is approximately 0.1%.

– 1 out of 1,000


• The data suggest that the rate of complications during exercise testing is higher in populations undergoing diagnostic testing, compared with persons being tested as part of a preventive medical examination.


• The risks associated with submaximal physical fitness testing appear to be even lower.


• Submaximal physical fitness testing appears to have an extremely low risk when accompanied by appropriate pretest screening such as the PAR-Q and can be administered safely by qualified personnel in non-medical settings.


• No set of guidelines for exercise testing and participation can cover all situations.