What is Cardiovascular Fitness?

Change in levels of lipoproteins

● Elevated levels of HDL cholesterol
The ability of the heart, lungs and ● Reduction in triglyceride levels
circulatory system to efficiently deliver
oxygen and nutrients to the muscles during Improved insulin sensitivity
physical activity. ● Improved blood glucose levels
● Reduced risk for or reduce the
Aerobic exercise is robustly associated with effects of diabetes
a decrease in cardiovascular mortality as ● Insulin resistance leads to release of
well as the risk of developing cardiovascular free fatty acids, triglycerides,
disease. reduced HDL, promotes
atherosclerosis
Cardiovascular Disease
LDL - bad
HDL - good

Blood Pressure
● Short term increase, long term
decrease in BP
● Reduced systemic vascular
● CVD is the leading cause of resistance
morbidity and mortality worldwide ● Greater vasodilatory capacity
● Improved coronary vasculature
PH Incidence (2022) ● Improved NO production
● 33% of deaths
● 17.9% heart disease Others
● Reversal of arterial stiffening
Predisposing factors: ● Suppression of inflammation
● Sedentary lifestyle - Rubor, pallor, warm
● Exercise found to reduce the risk -
even with other factors such as Heart
obesity and smoking ● Undergoes morphological adaptation
during exercise to meet the demand
Effects of Exercise ● Remodeling during exercises
improves ⑩
contractile function,
Advantages and Benefits: whereas remodeling due to overload
-
- >

● Increased Insulin Sensitivity -reduces performance

● Decreased Blood Pressure ● Cardiac muscle hypertrophy
● Suppression of atherogenesis - not good, Decrease blood
(creation of atherosclerosis)
● ↑ Vasodilatory mediators (nitric Decreased HR in athle
oxide)
● Improved plasma lipoprotein profile
● Increased insulin sensitivity
 Physically Inactive
- Healthy and asymptomatic - begin
light to moderate exercise and
progress gradually without clearance
- If have known condition, must get
clearance first

Patient Education
● Dyspnea
● Chest discomfort
● Dizziness
● Syncope
● Orthopnea - difficulty breathing while
laying down
● Ankle edema
● Palpitations
● Intermittent claudication
● Unusual fatigue

Assessment

What is Cardiovascular Fitness? ● Gold Standard - Maximal Oxygen

● Pre-participation health screening Consumption Vo2 Max
before you begin ● Exercise Stress Test
● Some may require a medical ● Treadmill or Stationary Bike
clearance ● Submaximal vs Maximal Stress Test
● Exercise is safe for most, but may
come with some risk for patients with Submaximal - you have a goal (ex. 70% of
certain conditions 200)
Highest risk: sedentary who suddenly Maximal - as far as the patient can handle
perform vigorous intensity exercise ● Can be performed in the rehab
● Expensive
Pre-Screening Can obtain the true maximum heart
rate
Physically Active
- If asymptomatic with CVD, metabolic HR = 220 - age
or renal disease can exercise with
moderate intensity without clearance Criteria for Termination
(American College of Sports ● Worsening arrhythmias
Medicine) ● Increasing angina
- If symptoms present, should ● Mental confusion
terminate exercise and consult ● Hypotension
physician ● Extreme shortness of breath
● Dizziness
 ● Coordination problems ● Duration
● Leg fatigue, cramps - 20-30 minutes per day
● Patient’s request - Longer if less vigorous

● Type
- Aerobic exercise
- Has to be long

Rockport Walk Test

● For less physically fit patients
- -

● Less equipment needed and low

cost
● Ask the patient to walk 1 mile (4
laps) as fast as possible
● Start to record the heart rate at the
start of the final minute
● Record the time
Barriers to Exercise

● 87% of older adults have at least

one barrier
Run Test: 1.5 mile
➔ Low self-efficacy
● More rigorous, for physically fit
➔ Fear of injury
patients
➔ Lack of social support
● Multiple patients can be assessed at
➔ Social isolation
once
➔ Pain
● Ask the patient to run 1.5 miles (6
laps) at a steady pace but fast as
● Group based exercise has been
possible
shown to be more effective for long
● Record the time
term adherence
Run Test: 12 minute
● Found to be as valid as treadmill
tests
● Developed for the military
● Ask the patient to run for 12 minutes
at a steady pace but fast as possible
● Record the distance

General Prescription FITT

● Frequency and Intensity

- 5 days/week if moderate intensity
- 3 days a week if vigorous
 Body Classification: William Sheldon
(1900s)
- acceptable but not measurable
1. Ectomorph thin -

2. Endomorph thick -

3. Mesomorph muscular ·

Body Types

Physical Wellness and Body

Composition

What is body composition?

● Refers to the quality of body weight
● FAT weight versus MUSCLE weight
- muscle is denser than fat = less
A. GYNOID
space consumed
● Females: > adipose tissue
- Fat percentage necessary for
deposition in the hip and thigh region
insulation, energy, cushion
● Greater percentage of total body fat
on the extremities (lower extremities)
What is body composition wellness
● “Pear” shape pattern

BODY COMPOSITION WELLNESS

B. ANDROID
● Refers to the habits and practices
● Males: > adipose tissue deposition
related to body composition,
(abdominal region)
including:
● Greater percentage of total body fat
○ Nutritional wellness
on the trunk
○ Aerobic capacity wellness
● Greater cardiovascular disease
○ Muscular fitness wellness
● “Apple” shape pattern
○ Mental wellness beer
belly
Hyperplasia - when cells replicate
- occurs normally in 3 phases of life:
growth spurt
1. Before birth (last trimester)
2. First year of life
3. Adolescence

Lose weight > decrease in size of

adipocytes

Hypertrophy - cells enlarge

Relevance in PT Practice
Research tells us that other adverse health
consequences of obesity include:
● Cardiovascular disease
● Stroke; diabetes mellitus type 2
● Hypertension, dyslipidemia cancers
of the breast, colon, endometrium,
and prostate
● Gallbladder disease; osteoarthritis
● Respiratory problems, including
sleep apnea
● Asthma (in women)
● Depression
● Psychological distress

★ Obesity is a worldwide epidemic

and contributes to early mortality
★ Obesity may hinder aerobic
capacity and the ability to perform
physical activities
 ● Physical activity is important function
● Exercise - duration, intensity

Basic Terms and Concepts

Basal metabolic rate

- amount needed after digestion
- 60% to 75% of total caloric input
- The energy needed to sustain the
body in the postabsorptive stage

Influence:
- age, height, growth
- Current health status (pregnancy or
illness)
- Nutrition
- Environment
- Total body mass
- -Lean body mass (best predictor of
BMR)
- lean mass = higher metabolic rate
Fat mass/Fat weight
LEAN BODY MASS (vs total body mass): Mass - every molecule in the body
- Precise predictor of BMR Weight - influenced by pull of gravity
- more active metabolically than fat It
mass

Generally speaking the larger the lean body

mass, the higher the BMR

Body Mass Index

● BMI is a numerical value derived
from an individual’s height and
weight
● Does not assess body composition
or percent of body fat
● BMI = BW (kg) / height (m)²

The Problem:
W: 63.6 kg
H: 5’5 (1.6764) m
 ●
Basic Terms and Concepts
Ways of Assessing: Body Composition
● Fat mass/Fat weight (FM /FW) 1. Densitometry
FW = TBW x % body fat ● Measurement of body density by
I underwater weighing
% of body fat: ● Density = body mass (kg) / body
(waist + hip) - neck circumference volume
● % of body fat computed using the
FW = 140 lbs x 30% formula
FW = 42 lbs ● % of fat = 495/density - 450
● Disadvantage is that being
Waist - umbilicus submerged under water may be
Hip - widest part difficult and produce some anxiety

● Lean body mass/lean body weight 2. Air Densitometry (Plethysmography)

(LBM/LBW)
LBM = TBW/FW 3. Dual energy X-Ray
● Dual x-ray absorptiometry has
LBM = 140 lbs - 42 lbs replaced underwater densitometry
LBM = 98 lbs as the gold standard for body
composition

gold standard
 4. Fatfold/Skinfold technique Male:
● Tool: CALIPER
● Principle: Axilla
- Amount of subcutaneous body fat is - Measure axilla to nipple
proportional to the total amount of - Mark midway
body fat
- In the “reference” man, Umbilicus
approximately 50% of total body fat - 1 inch away to the right
is subcutaneous on nature - Mark midway
- Measure
Research tells us:
● Research suggests that the validity Anterior thigh
of the fatfold technique to estimate - Mark Iliac crest
body fat is high (r=0.85) - from Iliac crest to base of patella
- mark midway
● Always get the measurement on
the R side PHYSICAL WELLNESS AND FITNESS
● Take measurements 3 times, get ● Fitness - consist of aerobic capacity,
average muscular fitness and flexibility
● Fitness wellness - habits and
Female: practices related to aerobic capacity,
1. R triceps muscular fitness and flexibility
habits
2. 1 in above iliac crest -

3. Anterior thigh (from iliac crest to TERMS AND CONCEPTS

base of patella
● Anabolic steroids
Triceps ○ Therapeutically used to
- From tip of SH to elbow - mark stimulate bone growth,
midway (e.g. 12 in so 6 in) reduce muscle loss and treat
- Pinch slightly the skin fold above the AIDS
mark ○ Body builders use it to gain
- measure below the mark muscle mass
● Risks
Iliac crest ○ Multi-organ abnormal
- From iliac crest then 1 inch above it functioning and damage
○ Kidney failure, liver disease,
Anterior thigh heart disease
- Mark Iliac crest ○ "Roid Rage" - severe
- from Iliac crest to base of patella aggressive behavior
- mark midway
● Caloric Input
○ The amount of calories you
bring in to the body through
eating/drinking
 ● Caloric Output
○ The amount of calories you
burn. Composed of basal
metabolic rate, dietary
thermogenesis, and physical
activity
● Dehydration
○ Prolonged time without
consuming an adequate
amount of fluid
● Hydration
○ The replenishment of water
through consumption of
water or water-based
beverages

● Isometric exercises - no joint

movement, does not change length
● Isokinetic exercises - same velocity EXAMINATION
● Isotonic exercises - constant ● Direct examination of fitness
resistance wellness
○ Possible but inefficient and
● Plyometric exercises impractical
○ Targets and enhances elastic ○ It is about habits
strength ○ Need to monitor the client
○ Involves a forcible and rapid throughout the day for
stretch in the eccentric phase multiple days
immediately before the ○ Patients must also have
concentric phase sufficient knowledge about
○ Primary goal is to enhance the wellness task
athletic performance ○ Use the Fitness Wellness
● Warm-Up Exercises - movement Survey
becomes efficient
● Cool-Down Exercises

- you will have acute muscle soreness if

you don't cool-down
 ● Goals
● Demonstrate optimal fitness
-

● To enhance their ability to

-

function at home, leisure,

- >

occupation and more

● Variables
○ Intensity
○ Duration
○ Frequency

● Within 3 months, patient will be

exercising at moderate intensity
5x/wk at 30 minutes each

PLAN: Aerobic Capacity

● Modes of Exercise
○ Cardiovascular aerobic
exercise
○ Recreational sporting
activities
○ Calisthenics
○ Jogging

● Intensity Determination
○ Karvonen's Formula
○ Precautions
○ Smoking
○ Medications
● Borg RPE
Q

● Not appropriate to use MMT for

athletes

PLAN OF CARE
● Components of a①
-
broader physical
therapy plan of care
-
 ● Emotional support
● Injury

FLEXIBILITY
● The ability to move a joint or series
of joints through their full range of
motion, pain free and unrestricted"
● Affected by the joint surfaces,
capsule, ligaments, muscle length
and soft tissue

How do we measure FLEXIBILITY

- ROM
- Sit and Reach
Principle of training - SORI
● Specificity - Specific training yields Variables
specific results ● Mode - type of activity or exercise
● Overload - For improvement to ● Frequency - number of sessions in a
occur, there must be an week
ever-increasing amount of stress ● Duration - number of minutes or sets
● Reversibility - The effects of ● Intensity - degree to which we hold
exercise are transient the position; number of seconds and
● Individual Differences - Baseline degree
levels of fitness for individuals and
their response are different ● Stretching
● PNF
Stages of Conditioning ● Yoga
● Pilates - incorporates core
Initial Stage engagement
● Gradually increase exercise stimulus ● Gymnastics
-

● Length varies per individual ● Strength training

● Calisthenics
ProgressionProgression Stage ● Jogging/Cardiovascular activities
● More assertive ● ADLs - gardening
- >

● Enhance fitness
-
FLEXIBILITY WELLNESS GOALS
MaintenanceMaintenance Stage
● Fitness goals achieve 1. Cognitive goals
-
● Focus on patient's⑳level of
Exercise Adherence oknowledge about flexibility wellness
● Inconvenient location ○ LTG: Patient/client, within 1
month. will verbalize the
-

● Inconvenient time
● Safety contraindications and
● Cost
 precautions for flexibility stretch a cold muscle, it should be
exercise properly warmed up
○ STG: Patient/client, within 1 ● Some commonly employed
week, will verbalize the stretching exercises may not be
contraindications and one appropriate for some participants
precaution for flexibility who may be at greater risk for
exercise musculoskeletal injuries
● Activities requiring substantial
● Patients/ clients must be educated (KULANG)
that daily activities can "count as
exercise GENERAL GUIDELINES
○ LTG: Patient/client, within 1 (For healthy individuals only)
month, will verbalize 10 of ● Type
the daily activities she or he ○ A general stretching routine
performs and estimate their that exercises the major
respective effects on his her muscle and/or tendon groups
flexibility: using static or PNF
● STG: Patient/client, within 1 techniques
week, will verbalize 5 of the ● Frequency
daily activities she or he ○ Minimum 2-3 days per week
performs and estimate their ○ The best is everyday
respective effects on his /her ● Intensity
flexibility ○ To a position of mild
discomfort
2. Psychomotor goals ● Duration
○ 15-30 seconds (static);
Consider: 6-second contraction
● Patient’s/client’s baseline flexibility followed by 10-30 second
● Medical status and history - age, assisted stretch (PNF)
gender, etc ● Repetitions
● Patient's/client's input about factors ○ 2-4 for each stretch
related to her or his flexibility-
environment, resources 3. Affective goals
● Patient's/client's motivation to ● Focuses on the patient's/client's
engage in activities promoting level of commitment to flexibility
flexibility wellness
○ LTG: patient/client, in 3
STRETCHING GUIDELINES months, indicates via a
● can be effectively included in the self-report survey that her or
warm-up and/or cool-down periods his commitment to aerobic
that precede and follow the exef ise capacity wellness is at least
session an 8 on a scale of 1-10.
● An active warm-up must precede ○ STG: patient/client, within 2
static, vigorous stretching - do not months, indicate via a
 self-report survey that her or
his commitment to flexibility
is at least 6 on a scale of
1-10

FLEXIBILITY GOALS/OBJECTIVES
● Address the mode, frequency,
duration, and intensity
● May be more general or more
specific
● Consider: patient’s baseline
flexibility/ROM; medical status and
history; patient’s knout about factors
related to flexibility activity; level of
motivation; reasonable expectations
● PNF isometric contraction
stretching > static stretching >
ballistic stretching
● Static - neuromuscular
● PNF - incorporates all