Sports Medicine: Just the Facts

CHAPTER 15 • EXERCISE PRESCRIPTION 93

Preparation/Action
•Patients in this stage should have an individualized
exercise prescription. Encouragement and support
should be offered with specific follow-up to assess
progress.

Maintenance

• Individuals in this stage have incorporated physical
  activity into their regular routine. The exercise pre-
  scription should be revised and updated periodically
  to ensure patients do not extinguish their behaviors.
  Most individuals incorporating an exercise prescrip-
  tion into their routine lifestyle will progress through
  predictable phases of acclimation, improvement,and
  maintenance.


• Acclimation: Acclimation typically lasts several
  weeks and is often the most psychologically challeng-
  ing phase. Dropout rates are highest during the accli-
  mation phase. Patients should be encouraged to
  commit to the frequency of activity first, then to dura-
  tion, and finally to intensity.


• Improvement: Improvement occurs after patients
  have acclimated to regular activity. Patients experi-
  ence predictable improvements in self-efficacy, phys-
  ical fitness, and mood. The exercise prescription can
  be modified during the improvement phase as well to
  target patient goals.


• Maintenance:In addition to the psychologic charac-
  teristics described with the stages-of-change model,
  maintenance also has physical characteristics as well
  including heart rate adaptations, and exercise toler-
  ance. The exercise prescription should be modified to
  account for changes in cardiovascular condition and
  enhanced muscular performance.

THE EXERCISE PRESCRIPTION:
BEYOND CARDIOVASCULAR
ENDURANCE

• An exercise prescription should also include specific
  advice regarding muscular strength and endurance.
  •Muscular strengthening exercises should be per-
  formed twice weekly (General Principles of Exercise
  Prescription, 2000). The same FITT principle can be
  applied to muscular conditioning as well.


• Frequency:Activities focused on improving muscu-
  lar strength should be performed two to three times
  per week (General Principles of Exercise Prescription,
  2000).


• Intensity:To develop muscular strength, individuals
  should perform several sets of exercises using three to
  five repetition maximum(RM) resistance (one RM is
  the maximum amount of weight that an individual can

lift one time using proper technique). To develop mus-

cular endurance, an individual should perform several

sets using lower resistance-—typically 8–20 RM.

• Type:Muscular strength and endurance can be devel-
  oped using either free weights or dedicated resistance
  machines. Household items such as rubber tubing can
  also serve as creative forms of resistantce.


• Duration (Time):For muscular strength and condi-
  tioning, time refers to the number of sets of a particu-
  lar exercise that an individual performs. Typically,
  two sets are performed for each muscular group.

EXERCISE PRESCRIPTIONS FOR

SPECIAL POPULATIONS

ELDERLY

•Regular physical activity helps prevent many common

chronic medical conditions associated with aging

including obesity, hypertension, diabetes, osteoporo-

sis, stroke, depression, colorectal cancer, and prema-

ture death (Stephens, O’Connor, and Deuster, 2002).

•Regular physical activity improves an elderly individ-

ual’s ability to carry out functional activities of daily

living (Nied and Franklin, 2002). Strength training,

balance training, and flexibility training are particu-

larly important for elderly patients.

• Elderly patients should accumulate at least 30 min of
  moderate aerobic activity on most, preferably all days
  of the week. Elderly patients should also perform
  strength training activities with single sets of 10–15
  repetitions using at least eight different activities two
  to three times per week. While many elderly patients
  are fearful that increased levels of physical activity
  increases their risk of falling and bone fracture, evi-
  dence indicates that patients who are physically active
  have a reducedrisk of falling and lower rates of frac-
  ture (Mazzeo and Tanaka, 2001).


• Elderly patients should also stretch major muscle
  groups after exercising on a daily basis. Balance train-
  ing also helps elderly patients reduce the risk of falling.

DIABETES

•Patients with diabetes are four to six times more likely

to have a heart attack and are 80% more likely to die

from cardiovascular complications than individuals

without diabetes (US Dept HHS, 1996). Exercise and

proper nutrition are essential components of diabetic

disease management.

•To avoid rapid fluctuations in serum glucose levels, dia-

betic patients should exercise only when feeling well.