Chapter 3

Exercise
Prescription

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Objectives
Determine your readiness to start an exercise
program
Learn the factors that govern cardiorespiratory
exercise prescription: intensity, mode, duration,
and frequency
Understand the variables that govern
development of muscular fitness (muscular
strength and muscular endurance): mode,
resistance, sets, and frequency
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Objectives (contd.)
Understand the factors that contribute to the
development of muscular flexibility: mode,
intensity, repetitions, and frequency
Learn to write personalized cardiorespiratory,
strength, and flexibility exercise programs
Be introduced to a program for the prevention
and rehabilitation of low back pain
Learn some ways to enhance compliance with
exercise
Be able to write fitness goals
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Introduction
Being physically active and participating in a
lifetime exercise program contribute greatly to:
Good health
Physical fitness
Wellness

To obtain optimal results, all programs must be

individualized
Our bodies are not all alike
Fitness levels and needs vary among individuals
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Monitoring Daily Physical Activity

The first step toward becoming more active is to
carefully monitor daily physical activity
Methods of monitoring
Stopwatch and daily log
Activity tracker
Smartphone
Pedometer

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Monitoring Daily Physical Activity (contd.)

Accelerometer measures gravity and changes in
movement
Found in an activity tracker and smart phone

Other activity tracker features

Vibrator alerts when one is sedentary for too long
Sleep tracker
Heart rate monitor

Smartphone apps provide feedback on

progress, help set goals, and allow for social
support

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Monitoring Daily Physical Activity (contd.)

Pedometers count footsteps
Activity trackers and pedometers tend to lose
accuracy at very slow walking speeds
General recommendation: 10,000 steps per day

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Readiness for Exercise

Benefits of being active do not apply unless
people carry out a physical activity program
List advantages and disadvantages of exercising
Easier if advantages outweigh disadvantages

Complete Activity 3.2

Evaluates mastery (self-control), attitude, health,
and commitment

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Physical Activity Pyramid

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Cardiorespiratory Endurance
For most people, cardiorespiratory (CR)
endurance is the single most important healthrelated physical fitness component
Percentage of adults in the U.S. who meet
federal guidelines for aerobic physical activity
50.4 percent of men
42.1 percent of women

34 percent do not engage in any leisure-time

physical activities
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Cardiorespiratory Exercise Prescription

Lack of activity destroys the good condition of
every human being, while movement and
methodical physical exercise save it and
preserve it ~ Plato, 380 BC
Aerobic exercise improves CR system capacity
Four factors involved in aerobic exercise:
Intensity, mode, duration, and frequency

With two-plus cardiovascular disease risk

factors, get a medical exam prior to vigorous
activity
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Intensity of Exercise
Cardiorespiratory stimulation: make heart pump
faster for a specified time period
CR development at 30 to 90 percent of heart
rate reserve (HRR)
Health benefits at 30 to 60 percent of HRR
Greater benefits through vigorous-intensity
60 to 90 percent of HRR

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Intensity of Exercise (contd.)

Determine exercise intensity (cardiorespiratory
training zone)
Maximal heart rate (MHR) = 207 (.7 age)
HRR = MHR resting heart rate (RHR)
Calculate training intensities (TIs) at 30, 40, 50,
60, 70, and 90 percent
% TI = [HRR (%)] + RHR

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Moderate- vs. Vigorous-Intensity Exercise

Emphasis switched from vigorous-intensity to
moderate-intensity training in the 1990s
Moderate-intensity training provides many health
benefits, including decreased risk for
cardiovascular mortality

Vigorous-intensity programs yield higher

improvements in VO2max
Better improvements in coronary heart disease
risk factors

Pendulum is swinging back to vigorous-intensity

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Monitoring Exercise Heart Rate

Monitor regularly in beginning of program
Make sure you are in the proper zone

Count your pulse for 10 seconds, then multiply

by six to get the per minute pulse rate
First measurement about five minutes into
aerobic phase

For unconditioned people and older adults, CR

training should be at the 50 percent rate

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Mode of Exercise
The mode of exercise that develops the CR
system must be aerobic in nature
Involves major muscle groups
Choose activities based on personal
preferences
Substantial health benefits
Lower end of CR zone

Greater VO2max improvements

Higher end of CR zone
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Duration of Exercise
Exercise between 20 to 60 minutes per session
Vigorous-intensity: minimum of 75 min/week
Moderate-Intensity: minimum of 150 min/week

Duration of exercise based on training intensity

At 90 percent intensity, 20 to 30 min. sufficient
At 50 percent intensity, 60 min. recommended

Even accumulation of 30 min. moderateintensity activity, conducted for at least 10

minutes three times per day, benefits the CR
system

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Duration of Exercise (contd.)

Five hours of moderate activity, or 2.5 hours of
vigorous activity per week, provide additional
benefits
Novice and overweight exercisers need proper
conditioning prior to vigorous exercise to avoid
injuries or cardiovascular-related problems

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Duration of Exercise (contd.)

Exercise sessions should be preceded by a 5- to
10-minute warm-up and followed by a 10-minute
cool-down period
Warm-up consists of general exercises at a lower
intensity than the actual target zone
In the cool-down, the intensity of exercise is
decreased gradually to help the body return to
near resting levels
Stretching and relaxation activities should follow
the cool-down
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Frequency of Exercise
Recommended aerobic exercise frequency
Three to five days per week

Vigorous-intensity recommendation
Three 20- to 30-minute exercise sessions per
week, on nonconsecutive days

Moderate-intensity recommendation
30-60 minutes more than three days per week

Light-to-moderate intensity for weight loss

60-90 minutes most days of the week
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Daily Active Lifestyle

People who spend most of the day sitting cancel
out the health benefits obtained through physical
activity and exercise
Death rates are high for those who spend most of
their day sitting

Incorporate as many physical activities

throughout the day
At least 10 minutes every waking hour of the day

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Daily Active Lifestyle (contd.)

Activities to enhance daily nonexercise activity
thermogenesis (NEAT)
Walk rather than drive short distances
Park farther away from the campus or office
Take a short walk after each meal or snack
Walk faster than usual
Move about whenever you take a break
Take the stairs
Stretch or work out during television-watching
time

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Activities to Enhance NEAT (contd.)

Perform housecleaning chores
Stand more while working/studying
Stand or pace while talking on the phone
Get up and move every 6-10 pages while
reading a book
Use a stability ball for a chair
Walk while conversing or holding meetings
Walk to coworkers offices to meet in place of
email or phone call
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Exercise Volume
Product of frequency, intensity, and duration
Recommended minimum volume
Energy expenditure of 1,000 calories per week
10,000 or more steps per day

For substantial fitness benefits:

75 minutes of vigorous-intensity aerobic activity
for three nonconsecutive days
30 minutes of moderate-intensity activity for two
additional days
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Rate of Progression
Depends on health and fitness status, exercise
tolerance, and program goals
Initially, only three weekly training sessions of 15
to 20 minutes are recommended to avoid
musculoskeletal injuries
Increase duration by 5-10 minutes per week and
frequency up to 5 times per week by the fourth or
fifth week
Progressively increase frequency, duration, and
intensity of exercise until you reach your fitness
maintenance goal
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Muscular Fitness (Muscular Strength and

Muscular Endurance)
Capacity to exert force varies with demands
placed on the muscles
Increases with strength training
Muscles atrophy and lose strength with sedentary
living or with required rest due to injury

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Muscular Fitness (Muscular Strength and

Muscular Endurance) (contd.)
Types of muscle hypertrophy
Myofibrillar hypertrophy
Increased synthesis of myosin and actin filaments
Results from training with heavy resistances and
low repetitions (1 to 6)

Sarcoplasmic hypertrophy
Increase in sarcoplasm (similar to cytoplasm)
Results from training with lower resistances and
higher number of repetitions (8 to 15)
Greater muscle size, but lower strength increases
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Muscular Fitness (Muscular Strength and

Muscular Endurance) (contd.)
Muscular strength is primarily dependent on the
amount and the density of the muscle fibers
Muscular fitness is needed for good health,
improved functional capacity, and better quality
of life
74 percent of American adults do not participate
in any type of muscular fitness activity

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Muscular Fitness (Muscular Strength and

Muscular Endurance) (contd.)
Overload principle
Demands must be increased systematically and
progressively over time, and the resistance must
be enough to produce development

Specificity of training
Training program must be specific to obtain the
desired effects of muscle strength or endurance
Sport-specific training to improve a specific
movement or skill
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Muscular Fitness (Muscular Strength and

Muscular Endurance) (contd.)
Periodization
Systematically altering training variables over
time to keep program challenging and lead to
greater strength development
Variables altered: resistance, number of
repetitions, number of sets, and number of
exercises
Types: classical, reverse, and undulating

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Muscular Strength-Training Prescription

Mode of training
Isometric: muscle contractions produce little or no
movement
Critical part of programs for the lower back

Dynamic: muscle contractions produce

movement; most common mode
Without weights; with free weights, fixed- or
variable-resistance machines; isokinetic machines
Two action phases: concentric (positive resistance)
and eccentric (negative resistance)
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Muscular Strength-Training Prescription (contd.)

Which training modality is better: free weights or
machines?
The quality of the program and the individuals
effort determine the level of strength development
not the equipment

Additional modes of training in recent years

Stability ball exercises
Elastic-band resistive exercises

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Muscular Strength-Training Prescription (contd.)

Resistance (intensity)
Recommended: 80 percent of maximum capacity
Commonly prescribed: 8 to 12 repetitions
Progressive resistance training: gradual increase
of resistance over a period of time

Sets
For general fitness, one to three sets per exercise
with rest intervals between sets

Frequency of training
Two to three times per week

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Guidelines for Various Strength-Training

Programs

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Strength-Training Exercises
Two strength-training programs presented in
Appendix A
Strength-Training Exercises without Weights
Strength-Training Exercises with Weights

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Strength-Training Exercise Guidelines

Select exercises that will involve all major
muscle groups
Select exercises that will strengthen the core
Never lift weights alone
Prior to lifting weights, warm up properly
Use proper lifting technique for each exercise
Maintain proper body balance while lifting
Exercise larger muscle groups before smaller
muscle groups
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Strength-Training Exercise Guidelines (contd.)

Exercise opposing muscle groups for a balanced
workout
Breathe naturally
Avoid holding your breath while lifting a weight
Allow adequate recovery time between sets
Discontinue training with unusual pain
Use common sense on days when you feel
fatigued
Stretch out for a few minutes after each workout
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Core Strength Training

Core strength training
Core: abdominal, hip, and spinal muscles
Benefits of a strong core
Perform activities of daily living with greater ease
Improve sports performance
Decrease incidence of low back pain

Benefits of core strength training

Enhances stability
Improves dynamic balance
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Designing Your Own Strength-Training

Program
Pre-exercise guidelines for cardiorespiratory
endurance apply to strength training
Base the resistance, number of repetitions, and
sets on your current strength-fitness level and
amount of time you have for your workout

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Dietary Recommendations for Strength

Development
Increase protein to 1.2 to 2.0 grams per kilogram
of body weight per day during periods of intense
training
Timing, dose, and type of protein are all
important
Pre-exercise snack: carbohydrates and protein
Similar snack post-training
Meal or second snack an hour after training

Whey protein is the most effective type

Adequate daily protein intake important
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Flexibility
Improving and maintaining good joint range of
motion enhances health and quality of life
Most significant detriments to flexibility are
sedentary living and lack of physical activity
Flexibility exercises to improve range of motion
around the joints are conducted following an
aerobic workout

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Muscular Flexibility Prescription

Comprehensive stretching program
Include all body parts
Follow guidelines for development of flexibility

Increasing the total range of motion of a joint

Requires specific muscles surrounding that joint
to be stretched progressively beyond their
accustomed length

Mode, intensity, repetitions, and frequency of

exercise are applicable to flexibility programs
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Flexibility Development Guidelines

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When to Stretch
For some activities, gentle stretching is
recommended in conjunction with warm-up
3-5 min warm-up for walking, jogging, cycling
10 min warm-up before stop-and-go activities

For injury prevention, evidence is unclear

regarding best time to stretch (before or after
exercise)
After aerobic exercise is a good time to stretch

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Designing a Flexibility Program

Subject each major muscle group to at least one
stretching exercise (refer to Appendix B)
Perform each exercise through the joints full
range of motion
A complete workout lasts 15-30 minutes

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Preventing and Rehabilitating Low-Back Pain

60 to 80 percent of the population experiences
back pain or injury
Prevention and treatment through physical
exercise is by far the best medicine
Causes of back pain
Physical inactivity
Poor postural habits and body mechanics
Excessive body weight
Psychological stress
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Preventing and Rehabilitating Low-Back Pain

(contd.)
Most common reason for low-back pain is
physical inactivity (excessive sitting)
Back muscles shorten, stiffen, and weaken

Low-back pain frequently associated with faulty

posture and improper body mechanics
Prolonged static postures
Repetitive bending and pushing; twisting a loaded
spine
Prolonged sitting with little movement
Refer to Figure 3.6: Proper Back Care
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Incorrect and Correct Pelvic Alignment

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Preventing and Rehabilitating Low-Back Pain

(contd.)
Back pain can result from bacterial infection
causing swelling and tissue damage in spine
Consult a physician with any of these symptoms:
Numbness in the legs
Trouble urinating
Leg weakness
Fever
Unintentional weight loss
Persistent, severe pain even at rest
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Preventing and Rehabilitating Low-Back Pain

(contd.)
If there is no indication of disease or injury,
spinal manipulation may provide pain relief
Reducing back pain
Aerobic exercise; muscular flexibility exercise,
and muscular fitness targeting the core
Exercise as medicine needs to be the right type
of exercise

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Preventing and Rehabilitating Low-Back Pain

(contd.)
Effects of posture
Poor posture is a risk factor for musculoskeletal
problems of the neck, shoulders, and lower back
Incorrect posture strains hips and knees
Faulty posture and weak and inelastic muscles
are a leading cause of chronic low back problems
Improve posture by:
Engaging in recommended exercises
Striving to maintain good posture
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Preventing and Rehabilitating Low-Back Pain

(contd.)
Effects of stress
Psychological stress may lead to back pain
Frequent tightening of back muscles can result in
misalignment; constricted blood vessels
Chronic stress increases release of hormones
linked to muscle and tendon injuries
As part of a comprehensive back-care program,
include proper stress management

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Contraindicated Exercises
Exercises that are not recommended because
they pose potentially high risk for injury
Refer to Appendix D

Safe alternative exercises

Appendix A (strength exercises)
Appendix B (flexibility exercises)

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Getting Started
Adding exercise to a persons lifestyle may
require behavior modification
Different things serve as motivation
If you enjoy an activity, you will continue to do it

First few weeks will likely be the most difficult

Refer to the suggestions on page 88
Behavior Modification Planning: Tips to Enhance
Compliance with Your Fitness Program

Keep a detailed record of all of your activities

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Setting Fitness Goals

Fitness takes time and dedication
Requires commitment and persistence to reap
the rewards

Set realistic fitness goals

Complete Activity 3.4 (goal-setting form)
Create measurable and time-specific goals
Monitor progress
Reevaluate actions and make adjustments as
needed
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