Aerobic Exercise

What is the best type of aerobic exercise? To promote adherence, the type of exercise depends on patient goals and physical conditioning. It should be convenient, comfortable and the individual should enjoy participation.

Although regular physical activity has profound benefits, it is important that the incidence of complications is considered during exercise:

• Ensure medical clearance/follow up
•  Questionnaires
  • “PAR-Q & You”
    • if patient’s can answer ‘no’ to each 7 questions, they are identified as generally safe to be able to undertake exercise of any intensity without supervision (ACSM, 2009)
    • If there is AT LEAST one yes, the screening process continues to assess risk level which will determine safety and supervision.

(ASCM, 2009)

• Ensure appropriate equipment
• ‘Too much, too soon’
• Previous injury/co-morbidities
• Provide education on the signs and symptoms of cardiovascular disease during exercise
• Promote a gradual increase in activity over time
• Encourage appropriate warm-up and cool-down

• Guidelines are for sedentary, healthy individuals
  • Frequency
    • At least 5 days per week of moderate intensity
    • At least 3 days per week of vigorous intensity
    • Combination
    • “weekend warrior” – will provide benefits (Cardiorespiratory function – increased Vo2 max, decreased mortality) however, the risk of MSK injury increases and CV events increase
  • Intensity
    • Moderate
      • 40-60%HRR or %V02R
      • BORG – 12 to 13
    • Vigorous
      • 60-90% HRR or %V02R
      • BORG – 14 to 17

To calculate intensity using HRR

1. Calcular heart rate reserve (HRR) = (MaximumHR (220-age in years) – restingHR))
2. Convert desired intensity into a decimal i.e. if you want 80% intensity; 0.8
3. Multiply the decimal by HRR i.e. 120×0.8 = 96bpm and 120×0.9 =108bpm
4. Determine the target heart rate range by adding in the HR
   1. Lower limit (96bpm + 60bpm (Resting HR)) = 156bpm
   2. Upper limit (108bpm + 60bpm (Resting HR)) = 168bpm

• Time (Duration)
  • 30-60 min (≥150 min/week) moderate intensity
  • 20-60 min (≥ 75 min/week) vigorous intensity
  • Combination
  • ANY IS BETTER THAN NONE
• Type
  • Apply principle of specificity! How will this type of exercise get patients closer to their goals?
  • Ensure it’s enjoyable for the individual
  • Ensure it’s taxing to the cardiorespiratory system
  • Consider patient limitations
• Volume
  • volume = frequency x intensity x time of exercise
  • Targets:
    • >500-1000 MET-min/week
      • METs = The amount of oxygen consumed while sitting at rest. 1 MET =3.5mL/kg/min
      • MET-min = the number of METs of an activity and the time spent performing that activity
    • ~150minutes/week moderate intensity exercise
    • >5400-7900 steps/day
• Progression
  • GRADUAL!!
  • Increase time/duration first

Assessment:

• 6MWT, shuttle walk, beep test, V02 testing

Progressing aerobic exercise:

• Manipulate one of frequency, intensity or time
• Aim to achieve >150minutes per week

Physical activity and exercise can be performed at different intensities. This should be considered when making recommendations to patients or prescribing exercise for therapeutic purposes.

ESSA use the following definitions in their position statement on physical activity and exercise terminology:

METs = The amount of oxygen consumed while sitting at rest. 1 MET =3.5mL/kg/min

American College of Sports Medicine, ed. Guidelines for exercise testing and prescription. Lippincott Williams & Wilkins, 2010.

Examples of aerobic activities: