Step 4: Applied Application to Exercise Programming

• Important considerations - pre-screening:

  • risk stratification
  • stage of change/interests/barriers
  • health beliefs
  • ethnicity
  • age, sex
  • functional capacity
  • comorbidities
  • level of supervision required
  • contraindications to exercise
• Contraindications to exercise:

  • unstable angina
  • active pericarditis or myocarditis
  • systolic blood pressure more than or equal to 200 mmHg or diastolic blood pressure more than or equal to 110 mmHg
  • blood pressure drop more than or equal to 20 mmHg during incremental exercise
  • resting/uncontrolled tachycardia
  • critical aortic stenosis
  • uncontrolled atrial or ventricular arrhythmias
  • unstable or acute heart failure
  • recent embolism
  • thrombophlebitis
  • unstable diabetes
  • AV block (without pacemaker)
  • febrile illness
• Exercise prescription: an overview

  • aim for at least 3 times per week:
  • warm up:
  • 15 minutes
  • within 20 beats of training HR
  • conditioning phase:
  • 20 to 30 minutes
  • cardiovascular endurance (interval progressing to continuous as able)
  • 40 to 70% HRR max
  • cool down:
  • 10 minutes
  • within 10 beats of pre-exercise HR
• Conditioning component:

  • the main objective is to improve cardiorespiratory fitness and therefore the main component is the cardiovascular conditioning component as aerobic training is known to confer the greatest benefits
• Cardiovascular conditioning - Continuous vs Intermittent training:

  
• Circuit Approach:

  
• Muscle balance, progression and more

  • feet moving
  • recumbent position
  • overall class management
  • accommodating individuals at varying risk and ability and in some cases with dual pathology
  • monitoring o intensity
• Cooling Down:

  • duration: minimum of 10 minutes
  • content:
  • dynamic movements of diminishing intensity
  • passive stretches of
  • major muscle groups used in the class
  • those subject to adaptive shortening
  • rationale:
  • in the absence of an adequate cool down there is an increase risk of:
  • hypotension
  • arrhythmias
  • in addition older adults heart rates take longer to return to pre-exercise levels
  • 15 to 20 minutes post exercise observation
• Circuit example