Module 3 – Part 2 Preparation/Planning Stage

Outcomes: Upon completion of this module, the student shall have:

1. Been cleared medically to engage in physical activity particularly, exercise.
2. Designed for himself an exercise program for strengthening and cardiovascular
conditioning.

Estimated Duration: one week

STUDENT’S PLATFORM:
Teaching-Learning Activities:
ACTIVITY 1
1. Record your baseline anthropometric measurements that include:
a. Weight in kilogram
b. Height in meter
c. Body mass index = weight in kg divided by the square of the height in
meter
d. Waist circumference in centimeter
ACTIVITY 2
3. Make an exercise prescription using the FITT format for both cardiovascular
conditioning and strengthening. The format is found at the end of this module

ANNEX A
EXERCISE PRESCRIPTION
 Cardiovascular Conditioning Prescription
Name:_______________________________________ Age:__________________
Date of 1st Day of Training: _________ Initial Prescription/No. of Progression:_______

Components Target
Frequency
Intensity
Resting Heart Rate
Heart Rate Reserve
Target Heart Rate
HR @ High Interval
HR @ Low Interval
Borg Rate of Perceived Exertion
Time
Warm – up
Stimulus
Cool down
Number of cycles
Type

Example: A 25 year-old male medically cleared to engage in high intensity interval training.

Components Target
Frequency 5 x a week
Intensity
Resting Heart Rate 88 beats/min
Heart Rate Reserve 76%
Target Heart Rate (220-25-88)0.76 + 88 = 169
HR @ High Interval 169 beats/min
HR @ Low Interval (220-25-88)0.38 + 88 = 128 beats/min
Borg Rate of Perceived Exertion 10
Time
Warm up 5 min @ low interval
Stimulus 25 min
Cool down 3 min @ low interval
Number of cycles 4
Type HIIT on Motorized Treadmill

Muscular Resistance Training Prescription

Name: _______________________________________ Age: __________________
Date of 1st Day of Training: _________ Initial Prescription/No. of Progression: _______

Training Age
Goal
Volume
Frequency
Session/Duration
Warm up Stretch Duration Sets Reps

Exercise Sets Reps Rest Load RPE

Cool Down Stretch Duration Sets Reps

Example:

Training Age 28
Goal Increase strength
Volume Moderate
Frequency 2x week
Session/Duration 80 min including warm up and cool down
Warm up Stretch Duration Sets Reps
Arms across chest 30 sec 2 1
Prone quad stretch 30 sec 2 1
Hams stretch 30 sec 2 1
Exercise Sets Reps Rest Load RPE
Squat 5 4 2-3 min 85% 1RM 17
Bench press 3 5 2-3 min 80% 1 RM 17
Power clean 3 4 2-3 min 70% 1 RM 15
Deadlift 5 4 2-3 min 85% 1RM 17
Bench pull 3 8 1-2 min 75% 1RM 14
DB Split squat 3 8 1-2 min 75% 1RM 14
Military Press 3 8 1-2 min 75% 1RM 14
Cool down Stretch Duration Sets Reps
Arms across chest 30 sec 2 1
Prone quad stretch 30 sec 2 1
Hams stretch 30 sec 2 1

Basic Concept: Read the notes below before accomplishing the second and third
activities above.
Every exercise prescription should be tailored to meet individual health and
physical fitness goals. The principles of exercise prescription are based on the
psychological, physiological and health benefits of exercise training, and are generally
intended for a healthy adult. Modifications are however, necessary to accommodate the
individual characteristics such as health status, physical ability, age or athletic and
performance goals.
Components of Exercise Training Sessions
• Warm up

➢ Transitional phase that allows the body to adjust to the changing physiological,
biomechanical and bioenergetic demands during the conditioning phase of the exercise
session.

➢ Minimum of 5-10 minutes of low to moderate intensity cardiovascular and muscular

endurance activities.

➢ Increases body temperature.

➢ Decreases the potential for post-exercise muscle soreness.

• Conditioning

➢ 20-60 minutes of aerobic, resistance, neuromuscular and/or sports activities

(exercise bouts of 10 minutes are acceptable if the individual accumulates at least 20-
60 minutes each day of daily exercise).
• Cool down

➢ Allows gradual recovery of heart rate and blood pressure, and removal of metabolic
end-products from the muscles used during the more intense conditioning phase.

➢ Minimum of 5-10 minutes of low to moderate intensity cardiovascular and muscular

endurance activities.
• Stretching

➢ Minimum of 10 minutes of stretching performed after the warm up or cool down

phases.

Components of an Exercise Prescription

The components of a prescription for medication include the name of the medication,
strength or dose, frequency of administration, route, refills, and precautions. The
components of an exercise prescription follow a similar format, using the FITT principle:
Frequency, Intensity, Time (or duration) and Type. An important element to consider in
exercise prescription is exercise progression.
Frequency refers to the number of times the activity is performed each week. There is a
positive dose-response relationship between the amounts of exercise performed -- as
the amount (frequency and time or duration) of exercise performed increases, so do the
benefits received.
Intensity of the physical activity is the level of vigour at which the activity is performed.
There are a number of ways in which intensity can be measured. Some methods are
easier to use but are generally less objective, while others are more objective but may
require additional equipment or simple calculations. The Table 2.1 provides an overview
of some ways to measure exercise intensity.
In general, we recommend using a simple, though less objective, measure of intensity,
such as the talk test or the Rating of Perceived Exertion (RPE). Objective measures of
intensity are more accurate and often used in formal exercise testing.
• Subjective Measures of Intensity
The least objective but easiest measure of intensity is the ‘‘talk test.’’ When performing
physical activity at a low intensity, an individual should be able to talk or sing while
exercising. At a moderate intensity, talking is comfortable, but singing, which requires a
longer breath, becomes more difficult. At vigorous intensity, neither singing nor
prolonged talking is possible. A similarly easy but more robust measure of intensity is
‘perceived exertion.’
The original perceived exertion scale, the Borg Rate of Perceived Exertion (RPE) Scale
ran from a minimum of 6 to a maximum of 20. This scale has been simplified to a10-
point scale in which intensity increases from a minimum (level 0) to a maximum (level
10). Both are shown below. The talk test and RPE Scale are practical measures for
sedentary patients without significant cardiovascular risk factors.
Physiological/ Relative Physiological/Relative Measures of Intensity
Other more objective measures include percentages of maximal oxygen consumption
(VO2 max), oxygen consumption reserve (VO2 R), heart rate reserve (HRR) and
maximal heart rate (HRmax). Some of these more objective measures are used in
formal exercise testing. Perhaps the easiest but not the most accurate measure is
calculated using a percentage of the patient’s HRmax.
For example, exercising at a moderate intensity would be quantified as 64%-76% of
HRmax. You estimate your student’s HRmax using the formula 220 minus the student’s
age (220 - age).
Although this method is simple, it has a high degree of variability and tends to
underestimate HRmax in persons under the age of 40 and overestimate it in individuals
over the age of 40. This is generally true for both genders. A more accurate but more
complicated formula is 206.9 - (0.67 ◊ age). Depending on the situation, the clinician will
need to decide whether ease or accuracy is more important.
• Absolute Measures of Intensity Metabolic Equivalents
METs represent the absolute expenditure of energy needed to accomplish a given task
such as walking up two flights of stairs. One MET is defined as 1 kcal/kg/hour and is
roughly equivalent to the energy cost of sitting quietly. A MET is also defined as oxygen
uptake in ml/kg/min with one MET equal to the oxygen cost of sitting quietly, equivalent
to 3.5 ml/kg/min. METs are a useful and convenient way to describe the intensity of a
variety of physical activities and are helpful in describing the work of different tasks;
however, the intensity of the exercise needed to achieve that task is relative to the
individual’s reserve. A simple way of converting METs to calorie cost of physical activity
makes use of the following equation:
Calories expended/hr = *METs Rating X BW (kg)
* 2000 Compendium:?Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM,
Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr,
Leon AS. Compendium of Physical Activities: An update of activity codes and MET
intensities. Medicine and Science in Sports and Exercise, 2000;32 (Suppl):S498-
S516.1993 Compendium:?Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye
HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: Classification of
energy costs of human physical activities. Medicine and Science in Sports and
Exercise, 1993; 25:71-80.
For example, a healthy, active person may report that climbing the two flights of stairs
as light-intensity, while an inactive, chronically ill person may report that the same task
requires vigorous effort. Light physical activity is defined as requiring less than 3 METs,
moderate activities 3-6 METs, and vigorous activities greater than 6 METs. Table 2.2
illustrates common physical activities with the associated intensity in METs.
As with other aspects of this module, you and the student are offered choices. Here,
again, the choice of measure for intensity is used is up to the student and you. For
persons at risk for cardiac events, more objective measures may be necessary; while
for otherwise healthy, sedentary individuals, the easier, more subjective measures will
likely suffice.

Table 2.2. Common physical activities with the associated intensity in METs
Time, or duration of the activity, refers to the length of time that the activity is
performed. Generally, bouts of exercise that last for at least 10 minutes are added
together to give a total time or duration for a given day. For example, a student who
brisk walks 10 minutes in the morning, and 10 minutes in the evening, can count a total
time or duration of 20 minutes for the day. Note that the exercise recommendations are
dosed in terms of minutes of activity.
Type of physical activity: Walking is the most common form of physical activity that
sedentary individuals can begin. Walking is a very familiar activity, and one that can
easily be incorporated into daily life. The main types of exercise are:
• Cardiovascular / Aerobic exercise
• Resistance Exercise Aerobic (Cardiovascular) Exercise
• Aerobic (cardiovascular) exercise: Continuous rhythmic exercise that uses a large
amount of muscle mass; require aerobic metabolic pathways to sustain activity.
• Use of large amount of muscle? Sufficient? In total body oxygen consumption? Central
cardiopulmonary adaptations
e.g.: Walking, jogging, cycling, swimming, rowing, dancing, in-line skating
The quantity or volume of exercise is a function of the frequency (F), intensity (I) and the
duration/time (T) as well as the type of the exercise performed (T). The exact
composition of FITT varies depending on the characteristics and goals of the individual.
The FITT exercise prescription will need to be revised according to the individual’s
response, need, limitation and adaptation to exercise as well as the evolution of goals
and objectives of the exercise program.
Frequency

➢ 3-5 days a week of a combination of moderate and vigorous aerobic exercise.

Intensity

➢ Relative (physiologic) difficulty of the exercise (how hard the exertion feels).

➢ Exercise of at least moderate intensity that noticeably increases heart rate and
breathing is recommended as the minimum exercise intensity for adults to achieve
health benefits.

➢ A combination of moderate and vigorous intensity exercises that substantially

increases heart rate and breathing is recommended and ideal for attainment of health
improvements in most adults.

➢ The risk of exercise, which includes cardiac and musculoskeletal complications,

increases with higher intensity.

➢ Higher intensity interval training is time-efficient, especially for individuals who have
less time available for physical activity.

➢ Intensity and duration interact and are inversely related.

➢ Improvements in aerobic fitness from low intensity, longer duration exercise (easy run
for 90 min) are similar to those with higher intensity interval training (various quantities
of intervals between 30 sec and 4 min)

➢ Exercise intensity may be estimated by various methods, the easiest objective

measure being Peak HR method:
Target HR = HRmax x % intensity desired
where predicted maximal heart rate (HRmax): 220 - age

➢ Less objective but practical methods for sedentary subjects like the talk test and RPE
have been discussed above.
Other methods are:

➢ HR reserve (HRR) method:

Target HR = [(HRmax - HRrest) x % intensity desired] + HRrest
(HRmax is calculated by prediction equation).

➢ VO2 reserve method:

Target VO2 R = [(VO2 max - VO2 rest) x % intensity desired] + VO2 rest (VO2 max is
estimated by maximal or submaximal testing).
➢ Peak VO2 method:
Target VO2 = VO2 max x % intensity desired.

➢ Peak METs x (% METs) method:

Target METs = [(VO2 max)/3.5ml/kg/min] x % intensity desired. (Activities at the target
VO2 and METs can be determined using a compendium of physical activity or metabolic
equations).
HR reserve and VO2 reserve reflect the rate of energy expenditure during physical
activity more accurately than other exercise intensity prescription methods but require
more complex calculations and exercise testing.
Exercise quantity and duration (Time)

➢ Measure of amount of time physical activity is performed i.e. per session, day or
week, or by the total caloric expenditure.

➢ The quantity of physical activity may be performed continuously or intermittently and

accumulated over the course of a day through one or more sessions of physical activity
of at least 10 minutes in duration.

➢ A total of 150 minutes of moderate intensity aerobic exercise or vigorous intensity

aerobic exercise done for a total of 75 minutes is recommended for most adults.
Both moderate and vigorous intensity exercises can be accumulated over a week with 1
minute of vigorous intensity aerobic exercise equivalent to 2 minutes of moderate
intensity aerobic exercise.

➢ To promote or maintain weight loss, 50-60 minutes a day (to total 300 minutes per
week of moderate exercise), or 150 minutes per week of vigorous exercise (or an
equivalent combination of daily exercise) is recommended.

➢ Performing intermittent sessions of 10 minutes of exercise to accumulate the

minimum duration recommendations is an effective alternative to continuous exercise.

➢ Total caloric expenditure and step counts may be used as surrogate measures of
exercise duration.

➢ A minimum caloric expenditure of 1000 kcal a week through physical activity and
exercise, as well as 3000-4000 steps per day of walking at moderate to vigorous
intensity is recommended.
Aerobic (Cardiovascular) exercise mode (Type)

➢ Rhythmic, aerobic type exercises of at least moderate intensity involving large

muscle groups and requiring little skill to perform are recommended for improving
cardiovascular fitness.

➢ Other exercise and sports requiring skill to perform or higher levels of fitness are
recommended only for individuals with adequate skill and fitness to perform the activity.

➢ Exercise can be classified into different groups according to exercise intensity and
energy expenditure (see Table 2.3)
Table 2.3 Exercise Based Intensity and Energy Expenditure
Group A Group B Group C Group D
Ease of Ease of Ease of Energy
maintaining maintaining maintaining expenditure
constant constant constant variable
intensity intensity intensity Skill highly
Low inter Low inter Energy variable
Definition individual individual expenditure
variation in variation in related to skill
energy energy
expenditure expenditure
Low Vigorous
Treadmill Treadmill Swimming Racket sports
Walking Walking Cross – Outdoor
Examples Cycle Cycle country Bicycling
Ergometry Ergomentry Skiing Basketball
Running Soccer

➢ Group A & B - useful to regulate and maintain intensity of effort

➢ Provide predictable levels of energy expenditure - not affected by sex, age, skill

➢ As individuals progress to higher fitness levels, group C & D exercises provide more
variation. Rely on heart rate response or subjective RPE

➢ Cardiovascular exercises can also be classified by body-weight dependency

Southwestern University will follow the FITT format using the training design of the
European Association of Preventive Cardiology, European Society of Cardiology as
shown below. In the absence of the results of the cardiopulmonary exercise test, the
intensity discussed above will be used: <64% for light intensity, 64 – 76% for moderate
intensity, and >74% for high intensity. The Karvonen’s formula will be used to determine
the target heart rate: [(HRmax - HRrest) x % intensity desired] + HRrest; HRmax is 220
– age.

Muscular Fitness and Resistance Training

Resistance training is an essential component of any exercise training program. It
improves all components of muscular fitness including strength, endurance and power.
The aims of resistance training include reducing the physiological stress during activities
of daily living, preventing muscular deconditioning, and for effective management and
prevention of chronic diseases.
• Frequency

➢ For general muscular fitness, and for adults who are untrained or recreationally
trained, resistance training of each major muscle group is recommended for 2 or more
days a week with at least 48 hours separating the exercise training sessions for the
same muscle group.

➢ All muscle groups to be trained may be done so in the same session, or each session
may focus on selected muscle groups so that only a few of them are trained in any one
session. (split routine)
• Type
➢ Multi joint or compound exercises affecting more than one muscle group and
focusing on agonist and antagonist muscle groups are recommended for all adults, to
avoid creating muscle imbalances that may lead to injury.

➢ Single joint exercises targeting major muscle groups may also be included in a
resistance training program.
• Volume of resistance exercise (Repetitions and sets)

➢ Adults are encouraged to train each muscle group for a total of 2-4 sets, derived from
the same exercise or from a combination of exercises affecting the same muscle group,
with 8-12 repetitions per set i.e. 60-80% of one-repetition maximum (1-RM), with a rest
interval of 2-3 minutes between sets to improve muscular fitness. 1-RM is the maximum
amount of weight one can lift in a single repetition for a given exercise.

➢ Having different exercises training the same muscle group adds variety and improves
adherence to the training program.

➢ Resistance training intensity and number of repetitions performed each set are
inversely related.

➢ A higher number of repetitions with lower intensity not exceeding 50% 1-RM should
be performed per set along with shorter rest intervals and fewer sets if the objective of
the resistance training program is mainly to improve muscular endurance.

➢ For older adults and deconditioned individuals who are more susceptible to
musculotendinous injuries, 1 or more sets of 10-15 repetitions of moderate intensity i.e.
60-70% 1-RM resistance exercises are recommended.
• Technique

➢ Each exercise should be performed with proper technique and include both lifting
(concentric contractions) and lowering (eccentric contractions) phases of the repetition.
Each repetition should be completed in a controlled deliberate fashion throughout the
full range of motion.

➢ Maintain a regular breathing pattern i.e. exhaling during lifting phase and inhaling
during the lowering phase.
Flexibility Exercises (Stretching)

➢ Stretching exercise is recommended in any exercise training program for all adults.

➢ Stretching exercise is most effective when the muscles are warm and should be
performed before and/or after the conditioning phase.

➢ Stretching should be performed to the limits of discomfort within the range of motion,
perceived as the point of mild tightness without discomfort.

➢ Stretching following exercise may be more preferable for sport activities where
muscular strength, power and endurance are important for performance, rather than
during the warm up period.

➢ Stretching following warm up is still recommended for adults exercising for overall
physical fitness or athletes performing activities in which flexibility is important.
➢ There is minimal scientific evidence to demonstrate the efficacy of stretching for
injury prevention though limited evidence seems to suggest that it may be beneficial in
sports in which flexibility is an important part of performance.

➢ Stretching exercises improve the joint range of motion and physical function,
especially in the elderly.

➢ Stretching should be performed at least 2-3 times a week, for at least 10 minutes in
duration.

➢ Stretching exercises should involve the major muscle tendon groups of the body.

➢ Four or more repetitions per group are recommended.

➢ Static stretches should be held for 20-30 seconds.

Neuromuscular Exercise

➢ Neuromuscular exercise is recommended for the elderly population who are frequent
fallers or with mobility impairment, and suggested for all adults.

➢ Frequency: 2-3 days a week.

➢ Examples include core conditioning, balance & gait exercises, and taijiquan.