aerobic

exercises
Key terms & concepts
• 1. Fitness • 7.Energy systems
• 2.Maximum oxygen • 8.Energy expenditure
consumption
• 9.Efficiency
• 3.Aerobic exercise
• 10.Functional
training
implications
( conditioning)
• 11.Energy
• 4.Adaptation
expenditure
• 5.Myocardial oxygen
• 12.Efficiency
consumption
• 6.Deconditioning
 1.fitness

• Ability to perform physical work

• Physical work requires
> cardio respiratory functioning
> muscular strength and endurance
> musculoskeletal flexibility
 2.maximum oxygen
consumption ( VO2 max)
• A measure of body’s capacity to use
oxygen ( milliliters of O2 per kg of BW per
minute) mL/kg per minute
• Maximum amount of oxygen consumed per
minute when the individual has reached
maximum effort.
• Measured when performing an exercise
that uses many large muscle groups like
swimming, walking, and running
 Factors affecting
VO2 max
• Transport of oxygen
• Oxygen-binding capacity of the blood
• Cardiac function
• Oxygen extraction capabilities
• Muscular oxidative potential
 Endurance ( a measure
of fitness)
• Ability to work for prolonged periods
of time and the ability to resists
fatigue.
• Includes muscular and cardiovascular
endurance
• Muscular endurance vs. Cardiovascular endurance
Muscular & Cardiovascular
Endurance
• ME refers to the ability of an
isolated muscle group to perform
repeated contractions over a period
of time.
• CE refers to the ability to perform
large muscle dynamic exercise, such
as walking, swimming, and/or biking
for long periods of time.
 3.aerobic exercise
training( conditioning)
• Augmentation of the energy
utilization of the muscle by the
means of an exercise program.
 Factors affecting the
aerobic exercise training
• Increased levels of oxidative
enzymes
• Increased mitochondrial density and
size
• Increased muscle fiber capillary
supply
 Training
• Dependent on exercise of sufficient
intensity, duration and frequency
• Produces cardiovascular and/or muscular
adaptation and is reflected in an
individual’s endurance.
• Sports training depends on the specificity
principle “ individual improves in the exercise
task used for training and may not improve in
other tasks”.
 4.Adaptation
• Ability to change
• Can results in
• > increased efficiency of the
cardiovascular system and active muscles.
• Dependent on the ability of the organism
to change and the training stimulus
threshold
 5.Myocardial oxygen
consumption (MVO2)
• A measure of the oxygen consumed by the
myocardial muscle
• The need or demand for oxygen is
determined by
> heart rate(HR)
> systemic blood pressure
> myocardial contractility
> afterload
 MVO2 afterload
• The ventricular force required to
open the aortic valve at the beginning
of systole
• Determined by the left ventricular
tension and central aortic pressure
 6.Deconditioning
• Occurs with prolonged bed rest
• Can results in
> decrease VO2max
> cardiac output
> muscular strength
 7.Energy systems
• Metabolic systems involving a series
of biochemical reactions resulting in
the formation of ATP, CO2, H2O.
• ATP ADP and Phosphate

• Phosphagen, or ATP-PC System

• Anaerobic Glycolytic System
• Aerobic System
 Phosphagen, or ATP-PC,
System
• Phosphocreatine and ATP are stored
in the muscle cell
• Phosphocreatine is the chemical fuel
source
• No oxygen is required (anaerobic)
• When muscle is rested, the supply of
ATP-PC is replenished
 Phosphagen, or ATP-PC,
System
• The maximum capacity of the system
is small (0.7 mol ATP)
• The maximum power of the system is
great ( 3.7 mol ATP)
• The system provides energy, quick
bursts of activity
• It is the major source of energy
during the first 30 seconds of
intense exercise
 Anaerobic Glycolytic
System
• Glycogen (glucose) is the fuel source
( glycolysis)
• No oxygen is required (anaerobic)
• ATP is resynthesized in the muscle
cell
• Lactic acid is produced ( by-product
of anaerobic glycolysis)
 Anaerobic Glycolytic
System
• The maximum capacity of the system
is intermediate( 1.6 mol ATP/min)
• For activity of moderate intensity
and short duration
• Major source of energy from 30th to
90th second of exercise
 Aerobic System
• Glycogen, fats, proteins are fuel sources
• Oxygen is required
• ATP is resynthesized in the mitochondria
of the muscle cell
• Maximal capacity of the system is great
(9.0 mol ATP)
• Maximal power is small (1.0 mol/ATP)
• Predominates on the second minute of the
exercise
 Comparison of the
Energy Systems
ATP-PC Anaerobic Aerobic
Glycolytic
Main source of Phosphocreatine Glycogen Glycogen, fats,
energy and ATP proteins
Requiring oxygen No No Yes

Capacity Small (0.7 mol Intermediate ( 1.2 Great ( 90.0 mol

ATP) mol ATP) ATP)
Power Great ( 3.7 mol Intermediate ( 1.6 Small ( 1.0 mol
ATP/ min) mol ATP/ min) ATP / min)
Usage Short,quick burst Moderate intensity Long duration
of activity and short duration
First 30 secs of Major source of Predominates on
intense exercise energy from the the 2nd minute of
30th to 90th second exercise
of exercise
 Recruitment of Motor
Units
Slow-twitch fibers Fast-twitch fibers( Fast-twitch fibers
(Type I) Type IIa) ( Type IIb)
Slow contractile Slow and fast Fast contractile
response response

Rich in myoglobin and Intermediate Low myoglobin content,

mitochondria few mitochondria

Used in low intensity Intermediate Used in activities

exercise requiring power
 Energy Expenditure
• Open-circuit portable spirometry
• Telemetry
• Kilocalorie(kcal) – a measure expressing
the energy value of food. Amount of heat
necessary to raise 1 kg of water 1C
• 5kcal = 1 liter O2
• MET – oxygen consumed(mL) per kg of
body weight per minute
• 3.5mL/kg per minute
 Activities
• Light work for the average male
(65kg)
• 2.0 to 4.9 kcal/min ( almost 1 liter of oxygen)
• 6.1 to 15.2mL O2/kg per minute ( 15.2mL/kg per minute x 65 kg
= 988mL O2 per minute)

• Heavy work for the average male

( 65kg)
• 7.5 to 9.9 kcal/min ( almost 2 liters of oxygen)
• 23.0 to 30.6 mL O2/kg per minute ( 30.6mL/kg per minute x 65 kg
= 1,989mL O2 per minute
 Efficiency
• Percent efficiency = useful work output x 100
energy expended or work input

(Treadmill) WORK = weight of the subject x vertical distance

the subject is raised walking up the incline of the treadmill)

(Ergometer bike) WORK = distance( circumference of the

flywheel times the number of revolutions) x the bicycle
resistance
 PHYSIOLOGIC RESPONSE
TO AEROBIC EXERCISE
• Cardiovascular response to exercise
• Respiratory response to exercise
• Responses providing additional
oxygen to muscle
 CARDIOVASCULAR
RESPONSE TO EXERCISE
• SNS
• Peripheral vasoconstriction
• Increased myocardial contractility
• Increased heart rate
• Hypertension
• Cardiac Output
• Increase in myocardial contractility
• Increase in heart rate
• Increase in blood flow through the working muscle
• Increase in constriction of the vessels
• Net reduction in the total peripheral resistance
RESPIRATORY RESPONSE
TO EXERCISE
• Decrease in venous O2 saturation
• Increase in Pco2 and H+
• Increase in Body Temp
• Increase in epinephrine
• Increase stimulation of receptors of
the joints and muscles
 RESPONSES PROVIDING
ADDITIONAL OXYGEN TO
MUSCLE
• Increase in blood flow
• Production of more carbon dioxide (
cell acidosis)
• Increase of red blood cell
 TESTING AS A BASIS
FOR EXERCISE PROGRAM
• FITNESS TESTING OF HEALTHY
SUBJECTS
• FIELD TEST RUNNING (1.5 MILES)
OR DISTANCE RUN FOR 12
MINUTES
• MULTISTAGE TEST MEASURE OF
VO2 MAX ( Treadmill with 6 stages
with 3-6 mins per stage)
 TESTING AS A BASIS
FOR EXERCISE PROGRAM
• STRESS TESTING
• Should have PE first, monitored by ECG,
be observed at rest, during exercise,
during recovery
• PRINCIPLES OF STRESS TESTING
• Changing the workload by increasing the speed (treadmill)
resistance( ergometer)
• An initial workload that is low in terms of the individual’s
anticipated aerobic threshold
• Maintenance of each workload
• Termination of the test at the onset of symptoms or
abnormality in the ECG
• When available, measurement of the individual’s maximal
oxygen consumption
 PURPOSE OF STRESS
TESTING
• Helps establish a diagnosis of overt or latent
heart disease
• Evaluates cardiovascular functional capacity as a
means of clearing individuals with strenuous work
• Determines the physical work capacity (METS)
• Evaluates responses to exercise training and/or
preventive programs
• Assists in the selection and evaluation of
appropriate modes of treatment programs
• Increases the pt’s motivation for entering and
adhering to exercise programs
• Used clinically to evaluate pt with chest
sensations or hx of chest pain
 PREPARATION FOR
STRESS TESTING
• Have had a physical exam
• Be monitored by ECG, closely
observed at rest, during , and during
recovery
• Sign a consent form
 Precautions for Stress
Testing
• Monitor the pulse
• BP increases with exercise 7-10mm
of mercury per MET of physical
activity (Systolic pressure not exceed 220 to 240mmHg;
Diastolic >120mmHg)

• Rate and depth and respiration

( respiration should not be labored and no SOB)

• Increase in blood flow while

exercising
 Termination of Stress
Testing
• Progressive angina
• Significant drop in systolic pressure in
response to an increasing load
• Lightheadedness, confusion, pallor,
cyanosis, nausea, or peripheral circulatory
insufficiency
• Abnormal ECG responses including ST
segment depression greater than 4mm
• Excessive rise in BP
• Subject wishes to stop
MULTISTAGE TESTING
• Stage 1 to 4 last 1-6 minutes
• Bruce protocol – most popular
• Treadmill speed and grade changed
every 3 minutes
• Speed increases from 1.7 mph to 5.0
• ( 10% increases up to 18% during the
five stages)
 DETERMINANTS OF AN
EXERCISE PROGRAM
1. INTENSITY
- determined by
A. Overload Principle
B. Specificity Principle
2.DURATION
3. FREQUENCY
4. MODE
INTENSITY>>>Maximum Heart
Rate and Exercise Heart Rate
• Maximum Heart Rate
• 220- age( less accurate)

• Exercise Heart Rate

• Karvonen’s formula ( Heart rate
reserved)
• HR rest + 60-70%(HR max-HR rest)
 INTENSITY>>>Overload
Principle
• Is a stress on an organism that is greater
than that regularly encountered during
everyday life to improve cardiovascular
and muscular endurance.
• 60-90% conditioning maximum heart rate
response or 50-85% VO2max ( Healthy)
• 40-50% VO2max ( deconditioned)

• The HIGH intensity, SHORT duration

• MODERATE intensity, LONGER duration
INTENSITY>>Overload
Principle
• Maximum oxygen consumption (VO2
max) is the best measure of exercise
intensity
• Higher intensity, higher VO2max
INTENSITY>>>Specific
ity Principle
• No overlapping for a specific
exercise
• Strength-power only
• Endurance only
 DURATION>>
• 20-30 mins (60-70% maximum heart
rate)
• 45 mins continuous exercise
(overload)
• 10-15 mins high intensity
• 5 mins x 3 reps ( deconditioned pts)
 FREQUENCY>>>
AHA & Centers for Disease Control
 30 MINS OF moderate intensity 5-7x a
week
American College of Sports Medicine
 3-5 days a week at 60-90% maximum heart
rate for 20-60 continuous or intermittent
minutes
 Longer duration exercise ( 10 mins or
more)
 MODE>>>>
• Cycling, running (overload principle)
• Cardiorespiratory system &
endurance (specificity principle)
 REVERSIBILITY
PRINCIPLE
• 2 weeks of detraining, decrease work
capacity, improvements can be lost
within several months
 EXERCISE PROGRAM
• WARM-UP PERIOD
• AEROBIC EXERCISE PERIOD
• COOL-DOWN PERIOD
 EXERCISE PROGRAM>>
WARM-UP PERIOD
• enhances the numerous adjustments that must take place
before physical activity
• RESPONSES
c. Increase in muscle Temp
d. Increase in oxygen supply to meet the energy demands of
muscle
e. Dilatation of the previously constricted capillaries
f. Adaptation in sensitivity of the neural respiratory center
g. Increase in venous return

PURPOSES
j. Susceptibility of the musculoskeletal system to injury
k. Occurrence of ischemic ECG changes and arrhythmias
 EXERCISE PROGRAM>>
WARM-UP PERIOD
• Warm-ups should be:
 Gradual
 Preferably 10 minutes of total body
movement
 HR within 20beats/min
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
 The conditioning part of the exercise
program
 Focuses on:
 Intensity that will stimulate an
increase in SV and CO but within the
person’s tolerance, above the
threshold level and below the level
that evokes clinical sx
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
• 4 methods of training
2. Continuous training
3. Interval training
4. Circuit training
5. Circuit-interval training
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
• CONTINUOUS TRAINING
>Submaximum energy requirement that is sustained
>Stress is placed primarily on the slow-twitch fibers
>Activity can be 20-60mins without exhausting O2
the transport system
>Work rate is increased progressively
>Increasing the exercise duration
>Best for healthy individual to improve endurance
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
• INTERVAL TRAINING
 With relief interval ( few secs to several minutes) +
Increase in VO2max
c. Rest relief (passive recovery)
d. Work relief (active recovery)
 Longer work interval, more aerobic system is
stressed ( 1:5 rest:work)

Intermittent work should be greater than

continuous training
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
• CIRCUIT TRAINING
 Employs a series of exercise activities( at
last activity, starts again from the
beginning and move through the series)
parang cycle(bilog)
 Mainly to improve the STRENGTH and
ENDURANCE by stressing both aero and
anaero
 EXERCISE PROGRAM>>
AEROBIC EXERCISE PERIOD
• CIRCUIT-INTERVAL TRAINING
 Combining circuit and interval
training
 With relief interval there is a delay
in the need for glycolysis and
production of lactic acid
 EXERCISE PROGRAM>>
COOL-DOWN PERIOD
• PURPOSE
b. Prevent pooling of the blood in the
extremities
c. Prevent fainting by increasing the return
of blood to the heart and brain
d. Enhances the recovery period
e. Prevents Myocardial ischemia,
arrhythmias or other cardiovascular
complications
 EXERCISE PROGRAM>>
COOL-DOWN PERIOD
• GUIDELINES
 Total body exercises
 Should last 5 to 10 minutes
 GENERAL GUIDELINES FOR
AN AEROBIC TRINING
PROGRAM
• Establish the target heart rate
• Warm-up for 5 to 10 minutes gradually increasing(
speed & effort)
• Increase the pace of activity
• Cool down for 5 to 10 minutes
• Aerobic activity (3-5x/week)
• Use appropriate equipment, correct footwear.
• To avoid overuse syndromes, proper warm-up and
stretching
• Individualize the program of exercise
 PHYSIOLOGICAL CHANGES
THAT OCCUR WITH
TRAINING
• CARDIOVASCULAR
 Reduce resting PR ( increase
para:decrease sympha)
 Decrease in BP ( systolic > diastolic)
 Increase in blood volume and
hemoglobin
 PHYSIOLOGICAL CHANGES
THAT OCCUR WITH
TRAINING(CARDIOVASCULAR)
• CHANGES AT REST • CHANGES DURING
> Reduce resting PR EXERCISE
( increase para  Reduction in PR
:decrease sympha)  Increase SV
 Decrease in BP  Increase CO
( systolic > diastolic)  Greater VO2max
 Increase in blood  Decrease blood flow
volume and hemoglobin
 Decrease myocardial
o2 consumption
 PHYSIOLOGICAL CHANGES
THAT OCCUR WITH
TRAINING(RESPIRATORY)
• CHANGES AT REST
 Larger lung volume
 Larger diffusion capacities
• CHANGES DURING
EXERCISE
 Larger diffusion capacities
 Smaller amt of air
ventilated at same oxygen
consumption occurs
 Maximal minute ventilation
increased
 Increase ventilatory
efficiency
 PHYSIOLOGICAL CHANGES
THAT OCCUR WITH
TRAINING(METABOLIC)
• CHANGES AT REST • CHANGES DURING
 Muscle hypertrophy, EXERCISE
increased capillary  Decreased rate of
density depletion of muscle
 Number and size of glycogen”glycogen
mitochondria sparing”
increased  Lower blood lactate
 Increase muscle  Less reliance on
myoglobin phosphocreatine and
ATP
 PHYSIOLOGICAL CHANGES
THAT OCCUR WITH
TRAINING(OTHER SYSTEM)
 Decrease in body fat
 Decrease in blood cholesterol and
triglyceride
 Increase heat acclimatization
 Increase in the breaking strength of
bones and ligaments
 AEROBIC CONDITIONING FOR THE
PATIENT WITH CORONARY
DISEASE>> INPATIENT
PHASE(PHASE I)
> 3-5 DAYS OR COULD LAST UP TO 7-14 DAYS
Occurs in the hospital ff stabilization of the pt’s
cardiovascular status after MI or CABG
PURPOSE:
 Initiate risk factor education & behavior modifications
 Initiate self-care activities and progress from sitting to
standing
 Provide an orthostatic challenge to the cardiovascular
system(3 to 5days postevent)
 Prepare patients and family for continued rehabilitation and
for life at home after a cardiac event
 AEROBIC CONDITIONING FOR THE
PATIENT WITH CORONARY
DISEASE>> OUTPATIENT
PHASE(PHASE II)

 6-8 WEEKS LATER

PURPOSE
 Increase the person’s exercise capacity in a safe,
progressive manner “ low level exercise training”
 Enhance cardiac function and reduce cardiac cost of work
 Produce favorable metabolic changes
 Determine the effect of medications
 Relieve anxiety and depression
 Progress the patient to an independent exercise program
AEROBIC CONDITIONING FOR THE PATIENT WITH
CORONARY DISEASE>> OUTPATIENT PHASE(PHASE
II)

• GUIDELINES
 Symptom –limited exercise stress test is performed 6-12weeks after discharge(
mainly aerobic)
INTENSITY
Initial: 40-60% maximum heart rate
DURATION
 10-15 minutes at start then progress to 30-60 minutes ( with 8-10 mins warm-up and
cool-down)
FREQUENCY
 3x a week
MODE
 Continuous using large muscle groups( walking or biking)
METHOD
 circuit-interval – most common
WEIGHT TRAINING
 Low level weight training
 Resistance exercises are allowed but with precautions
PROGRESSION
> Progress after 3 consecutive sessions
AEROBIC CONDITIONING FOR THE
PATIENT WITH CORONARY
DISEASE>> OUTPATIENT
PROGRAM(PHASE III)
 Supervised exercise conditioning program
in a hospital or community
 HR and rhythm are no longer monitored via
telemetry
PURPOSE:
> Continue improving or maintaining fitness
levels achieved during phase II
 AEROBIC CONDITIONING FOR THE
PATIENT WITH CORONARY
DISEASE>> OUTPATIENT
PROGRAM(PHASE III)
• Guidelines
 Swimming (incorporates both arms and
legs)
 Outdoor hiking
ACTIVITIES at 8 METS
 Jogging approximately 5miles per hour
 Cycling approximately 12miles per hour
 Vigorous down-hill skiing
 AEROBIC CONDITIONING FOR THE
PATIENT WITH CORONARY
DISEASE>> OUTPATIENT
PROGRAM(PHASE III)
• Special considerations
 O2 uptake is higher for arm than legs
 Myocardial efficiency is lower with leg exercises
with arm exercises
 Myocardial O2 consumption(heart rate x systolic
pressure) is higher with arm exercises than with
leg exercises
PATIENTS WITH CAD COMPLETE 35% LESS
WORK WITH ARM EXERCISES THAN WITH
LEG EXERCISES BEFORE SYMPTOMS OCCUR
Fluid Balance
Distribution of Body Fluids
Fluid Balance