Prescribing exercise for fitness

• Warm up:

  • an essential component of the exercise session
  • An effective warm up prepares the body and mind for more strenuous activities to follow
  • It prepares the body by raising the heart rate within 20 beats of training heart rate in a graduated and safe way, therefore avoiding abrupt increases in myocardial workload, redistributing blood to active tissues increasing muscle temperature and thus facilitating nerve transmission and muscle metabolism
  • It also aids the release of synovial fluid facilitating joint movement
  • The warm up should last at least 15 minutes in duration
  • An effective warm up extends the angina/ ischemic threshold and reduces the incidence of ST depression during exercise
• Warm up consists of 4 key components:

  • Mobility exercises - Gradual progression of range of motion exercises to stimulate the release of synovial fluid
  • Pulse raising exercises using large muscle movements - These exercises should raise the heart rate to 20 bpm below the training heart rate and RPE no higher than 11 on the 6 - 20 scale
  • Preparation stretches interspersed with pulse raising exercises
  • Re-warm to elevate the heart rate before the conditioning component
• Conditioning Component pt1:

  • use cardiovascular (or aerobic) exercises
  • However, when people are not fit or unaccustomed to exercise a continuous cardiovascular exercise programme at moderate or vigorous intensity is not tolerated for 30 minutes non-stop
  • Hence in preventive cardiology settings, we typically use an interval approach
  • This is where there is a cardiovascular exercise followed by what is known as an “active recovery”
  • The cardiovascular exercise raises the heart rate to the upper end of the training heart rate range and the active recovery allows the heart rate to drop slightly; but keeping the heart rate at or slightly above the lower training heart rate
• Conditioning Component pt2:

  • By doing this it allows a relative rest and the individual can achieve a greater overall workload
  • Active recovery exercises can be either a cardiovascular exercise performed at a lower intensity or as seen in most supervised sessions using a circuit approach, it is the ideal opportunity to include muscle strength and endurance exercises of 10 – 15 reps
  • As the individual becomes fitter and they adapt in response to the exercise, the cardiovascular duration should be progressed
  • Ultimately the aim is to progress the individual towards 20 to 30 minutes of continuous uninterrupted cardiovascular exercises
• Cool Down:

  • aim of the cool down is to lower the heart rate to within 10 beats of the pre-exercise heart rates
  • The cool down should be gradual with a minimum period of 10 minutes recommended with a post class observation ideally of 15 - 20 minutes
  • The rationale behind an extended cool down is there a an increased risk of hypotension, increased risk of arrhythmias and in older adults it takes longer for the heart rate to return to pre exercise rates
  • Passive stretches of the major muscle groups or those subject to adaptive shortening may also be incorporate