PHYS ED 1 GENERAL CONDITIONING TONI MARTONI MAR isolated fashion, e.g., abdominal curls, but also in...

PHYS ED 1 GENERAL CONDITIONING TONI MAR

PHYS ED 1 - GENERAL CONDITIONING (0.05 units)

Instructor: Toni Mar http://pe.berkeley.edu/instructors_toni_mar.html https://www.yogatrail.com/teacher/toni-mar-1384324 http://www.ratemyprofessors.com/ShowRatings.jsp?tid=312615 https://berkeley.uloop.com/professors/view.php/56459/Toni-MarContact: e: [email protected] p: 1.510.642.2375Office: 225 Hearst Memorial GymnasiumOffice Hours: Tuesday 9:15-10:00 with advance reservation or congruent availabilityRequired Material: Syllabus contents, videos, links and Discussions via bCourse

I. Course Description: Periodized training (progressive organized cycling of various aspects of training during various time periods) that addresses the Five Components of Fitness: cardiovascular endurance, muscle strength, muscle endurance, flexibility, and body composition. General Conditioning is a modality of training that provides the foundation for Sports Specific Training and Tactical Training, the latter two of which focus on the specific demands of the sport, e.g., tennis, football, rugby, etc. or tactical demands of the job, e.g., firefighter, paramedic, police, military, special ops, etc. Regardless of the modality and emphasis, training and conditioning result in developing fitness including exercise and sport nutrition, rest and recovery. The preparatory training is called General Physical Preparation (GPP) which is the emphasis of the General Conditioning physical education course. In the sporting world, General Physical Preparation is the training that leads to Sport Specific Training (SST) where athletic attributes required for the specific activity are developed for high-level performance. The General Conditioning course initially focuses on (1) core development and core conditioning to provide proper spinal alignment and spinal stabilization with muscle strength and muscle endurance as a foundation and preparation for (2) the introduction of aerobic exercise activity to promote aerobic fitness and cardiovascular endurance, and (3) the reduction of risk of injury.

http://pe.berkeley.edu/instructors_toni_mar.htmlhttps://www.yogatrail.com/teacher/toni-mar-1384324http://www.ratemyprofessors.com/ShowRatings.jsp?tid=312615https://berkeley.uloop.com/professors/view.php/56459/Toni-Marmailto:[email protected]


II. Statement of Course Goals and Learning Objectives: Instruction and training are planned, progressive and sequential in skill development and apply the multi-disciplinary parameters of exercise and sport science and allied health disciplines to develop the skill set, mindset, and goal attainment for success. Be mentally prepared to work hard physically. The physicality of training is unique from the mental challenges of analytical or logical reasoning. Physical training is not as easy as the GRE, MCAT or LSAT. You will initially feel like stopping, giving up or taking numerous rest breaks---but you will appreciate the discipline and mental toughness that you develop to break negative habits, take your training to the next level, and value the positive changes in your fitness level, physique, energy levels, dietary habits, mindset, stress management and lifestyle. The course goals and learning outcomes for General Conditioning include the instruction, training, mindset, physical performance demands, course description, skill set, and the Fundamentals of General Condition- ning (listed below) for both components of the course: core development and core conditioning, and aerobic exercise and cardiovascular endurance. Jointly this information provides a clear understanding of and appreciation for the importance and physiological justification of planned sequen-


tial instruction (periodization) for core development as a preliminary foundation for activities that promote aerobic fitness and cardiovascular endurance. The variety of their respective training modalities and methodologies of instruction also provide understanding and indisputable recognition of the metrics for assessing performance throughout the semester. In addition to the physicality of General Conditioning is the application of mental skills to become comfortable with uncomfortable during moments when you are pushed beyond your threshold level and training reaches intensities you may not have experienced before (and you want to quit) but realize that these are absolutely necessary for getting results, attaining goals, improving physical performance, and optimizing athletic attributes. Goals - Core development & core conditioning: Recognition of the alignment of the neutral spine position; identification, location, and activation verification of the musculature of the primary core muscle groups (abdominal wall, spinal muscles and gluteal muscles) required for core strength and stability; initial training of the core muscle groups with fundamental static (stationary) exercises and drills and progressing to dynamic (“constantly changing”) functional

fitness exercises; prevention of muscle imbalances (where agonist muscles become short and dominant and antagonists become weak and inhibited); development of balance and the somato- sensory system and motor control to increase efficiency of movement; practical application of basic muscle physiology principles to enhance flexibility, joint mobility and proper joint function;; and sequential development of muscle endurance and aerobic endurance. Ancillary attributes include static and dynamic balance, proprioception, static and dynamic stretching/flexibility, and postural alignment; training methods and modalities in calisthenics (compound bodyweight exercises for strength, flexibility and balance); resistance training (use of medicine balls, dumbbells, weighted bars, kettlebells resistance bands; and balance training (use of balance pads, yoga blocks). Strong emphasis on the fundamentals of exercise and sport science (the multi-disciplinary study of human movement and performance encompassing biomechanics, neuromuscular physiology, exercise physiology, pathology, sport psychology, sport medicine, and sport nutrition) to provide a thorough understanding of the underlying principles of the training performed in class and to reinforce consistency; reinforce the process of skill acquisition including mental discipline; the effect of diet, nutrition, recovery, and mental mindset/stress management on goal attainment; exercise and sports injury prevention; and the development of positive lifestyle behaviors. Fundamentals of training are also incorporated as listed below with specific emphasis on the components of fitness, benefits of exercise and a strong core, exercise design, exercise and sports nutrition, recovery/rest/sleep, warm up and cool down; General Adaptation Syndrome; troubleshooting skills, the tonimar Lifestyle Rx.

Core development & core conditioning skill set: Elementary-level core-activating exercises and calisthenics in the supine, prone, seated and vertical body positions including but not limited to shoulder and wrist stability and upper body strength: plank, pushups, resistance training exercises using dumbbells and medicine ball; lower extremity strength training: front and rear squats, Bulgarian Split Squat, front, side and rear lunges, single-leg exercises; torso/functional strengthening: Russian Twist, Burpees, Turkish Getup; flexibility and mobility: stretching exercises, yoga; kinesthetic awareness/balance/proprioception exercises; sports relaxation techniques: breath control and visualization.


Outcomes: Students shall successfully demonstrate (1) knowledge and understanding of all contents within the Syllabus and Course Objectives through the testing of knowledge and comprehension (Knowledge Festival) of the the parameters of exercise science as provided in the instruction in each training session and in the supplemental material presented in bCourse, and (2) skill set proficiency (physical performance assessment of proper form and alignment, technique, and biomechanics) during the execution of exercises and drills practiced in class.

Goals - Aerobic exercise and cardiovascular endurance: Progressive development of aerobic fitness and cardiovascular endurance, and improvement in heart rate recovery; calculation of The Karvonen Method to determine target heart rate training zone; identification of pulse sites and accuracy in monitoring of pulse; understand and define the different types of heart rates; demonstrated ability to reach and sustain target heart rate continuously over an extended period of time, i.e., ≥ 20-30 minutes in indoor and outdoor aerobic activities; ability to explain the relationship of exercise and sport nutrition, diet, meal timing, and rest/recovery on physical performance. Aerobic exercise and cardiovascular endurance skill set: Demonstrated ability to perform indoor and outdoor aerobic activities maintaining target heart rate continuously for ≥ 20-30 minutes with proper form, alignment, technique and spinal stabilization. Outcomes: Students shall successfully demonstrate (1) knowledge and understanding of all contents within the Syllabus and Course Objectives through the testing of knowledge and comprehension (Knowledge Festival) of the the parameters of exercise science as provided in the instruction in each training session and in the supplemental material presented in bCourse; calculation of target heart rate zone using the Karvonen Method and the definition of each type of heart rate; location and accuracy in monitoring pulse; understanding the relationship between exercise and sports nutrition, rest, and recovery on aerobic performance; knowledge and application of aerobic training modalities to develop and improve aerobic and cardiovascular fitness; and (2) skill set practical demonstrating the ability to perform indoor and outdoor aerobic activities maintaining target heart heart rate continuously for ≥ 20-30 minutes with proper form, alignment, technique and spinal stabilization; demonstrated knowledge and understanding of pre-post stretching, warm-up and cool- down. stabilization; knowledge and application of training modalities to develop and improve aerobic and cardiovascular fitness including exercise and sports science and nutrition.

Required reading - Fundamentals of training in General Conditioning course

What is the core? Your core acts as a spinal stabilizer and force transfer center. It has three-dimensional depth and functional movement in all three planes of motion. There are twenty-nine muscles of the core but for purposes of our activity lab course, the primary muscle groups we focus on are the abdominal muscle group, spinal muscle group, and gluteal muscle group, all three of which must be balanced in strength in order to withstand large loads (resistance) during training without risk of injury.

What is core strength? Core strength refers to lumbar stabilization and allows for motion to occur through the lumbar spine using the work of the abdominal musculature and primarily the superficial muscles, often in an


isolated fashion, e.g., abdominal curls, but also in functional movement, e.g., deadlift. Core muscles consist of superficial and deep muscles for a total of twenty-nine muscles.

Core abdominal hollowing vs abdominal bracing Abdominal hollowing is basically “drawing your navel to the spine”, a technique used for spinal stabilization and engages the deeper core muscles, specifically the Transverse abdominis (TA) without allowing the contraction of the superficial abdominals, the internal (OI) and external obliques (OE) and rectus abdominis (RA), which become inactive in order for hollowing to occur. The problem with this is that it focuses on single muscles, opposing the fact that muscles work together in functional movement and activities of daily living (ADL’s). There is greater transverse abdominis activation in abdominal hollowing but it causes a weakening of the external oblique muscles and rectus abdominis muscles, which can result in spinal dysfunction and a less stable spine. Abdominal bracing simultaneously co-activates all core layers of the abdominal muscles (versus abdominal hollowing) therefore stimulating muscle fibers from all of the angles and directions of each skeletal muscle and creates a binding effect. This further strengthens the stiffness of the core and provides 360 degrees of spinal stability and eliminates joint micro movements that could contribute to spine and tissue degeneration.


What is core stability? (spinal stiffness) The performance of the deep muscles to control and stabilize the spine, maintain optimal alignment and movement relationships between the spine and the pelvic girdle, and prevent excessive stress and compensatory motions of the pelvis during movement of the arms and legs. All three work towards maintaining stability, versus core strength and force production. Training involves both muscle strength and sensory input, the latter of which communicates the interaction of the body and the environment with the nervous system, thus allowing constant feedback and therefore refinement of a movement or drill.


Lumbar spine characteristics and function The functionality of the lumbar spine allows for movement in all three planes of motion but not without limitations. It is relatively mobile through flexion and extension but caution should taken to avoid overuse or overtraining. Lumbar rotation contributes to approximately thirteen percent of total spinal rotation and therefore this motion should also be limited. Finally, lateral flexion should also be limited because there is a degree of rotation involved that the lumbar spine is not really designed for. Though some degree of rotation occurs, and movements in these specific areas should therefore be limited, the lumbar spine was designed more for stability than for mobility. It makes sense that movement should be focused at the thoracic spine and hip region and not at the lumbar area. Engaging in simple movements is one approach to determining lumbar stabilization. The more simple the task, skill, or movement, the easier it is to assess level of stabilization. For example, can the individual perform the following movements without exhibiting lumbar extension? If not, intervention is necessary to develop a neutral lumbar spine.


• Lifting one leg while standing • Abduct the leg without compensation • Internally or externally rotating one leg from the hip joint • Perform shoulder extension • Contract the gluteal muscles and the abdominal muscles without flexion?

Training for balance of core musculature and physique The three major muscle groups emphasized in Core Conditioning are the spinal muscle group, gluteal muscle group (both groups located posterior to the spine), and the opposing muscle group, the abdominals (primarily the rectus abdominis, external and internal oblique abdominals, and the tranverse abdominis). Verification of core activation of the spinal muscle group activation is demonstrated by the retraction and depression of the scapulae. Drawing the navel and rib cage towards the spine verify activation of all three of the major abdominal muscles. Activation of the gluteals, per tonimar instruction, is when a 100 mph fastball rebounds off of the buttocks. However, the current trend for gluteal activation is the use of a resistance band worn around the thighs during hip abduct- tion exercises, e.g., clamshell, squats. etc. Training the core involves the monitoring of appropriate strength gains in each of the three primary core muscle groups to ensure the integrity of proper postural alignment and spinal stabilization. The anatomical landmarks that determine postural alignment from the side view are the ankle, knee, hip, shoulder, and ear. Domination of any one of the three core muscle groups results in overdeveloped and under-developed muscles and therefore compromises posture and may lead to abnormal spinal curvatures and spine disorders.

Kinesthetic awareness Kinesthetic awareness refers to internal awareness of muscular and skeletal movement, position, direction, effort in and/or movement through space via sensory receptors in the muscles, joints, tendons and skin.

Functional movement Purposeful exercise that trains compound multi-joint movement as opposed to training isolated muscle groups, and intentionally incorporates balance and body awareness (proprioception).

Proprioception and relationship to motor control Proprioceptors are sensors in our joints, muscles, and fascia, providing information needed to produce coordinated movement. Movement in exercise, sports and activities of daily living (“ADL’s)” should be smooth, precise and controlled for successful and risk-free task completion. The somato- sensory system provides multiple inputs to the central nervous system (CNS) from three common components: visual, vestibular, and somatic, contributing to balance and proprioception, and the governing of efficient and effective movement and stability which is essential for motor control.


Balance (postural control, stability and equilibrium) The ability to maintain proper posture over the body's base of support (BOS) including stabilization of the body moving away from the base of support in various movement patterns and returning to the starting position efficiently, the latter of which is beneficial for dynamic joint stabilization and injury prevention. Our course incorporates instability and asymmetrical movements to force the muscles required for balance to activate and stabilize during compromising movements and sur- faces thus addressing aspects of the muscle(s) that are not necessarily activated during traditional strength exercises. Asymmetrical training also prepares the individual or the athlete to react quickly with a greater sense of control in unpredictable moments or situations, and hence reduce the risk of injury with an increased chance of successfully completing the task. Core strength and balance


are mutually inclusive. When one component improves, the other also improves. From a troubleshooting perspective, altered balance results from not only weak core and joint stabilization but other factors such as kinetic chain imbalances.

Static balance Static balance occurs when the center of gravity is positioned and maintained at the base of support (BOS), e.g., plank.

Dynamic balance Dynamic balance occurs when the body is in movement, with or without changing directions, while maintaining equilibrium.

Flexibility Flexibility is the ability of a muscle to lengthen during movement of a joint’s available range of motion.

Static stretching Static stretching holds a stretch position for a specific amount of time without movement.

Dynamic stretching Dynamic stretching utilizes force and momentum moving through the available range of motion of a joint.

Mobility Flexibility and mobility are often used interchangeably but they are in fact different. Mobility is the ability of a joint to move actively through its intended range of motion. Flexibility precedes mobility but is not the only factor affecting mobility. Joint structure, tendons, and ligaments, integrity of the stabilizing muscles (generally single joint muscles) and mover muscles (muscles that generally cross multiple joints), and the particular form and technique of the stretch, of lack thereof, also af- fect mobility. When there is dysfunction of the stabilizer such as weakness, poor posture and/or biomechanics, the “movers” compensate by becoming the stabilizer. Since the movers cross multiple joints they result is limited mobility. For example, the hamstrings (eccentric stabilizers for the knee and sacroiliac joint and concentric synergists for hip extension) may become hypertonic (“tight”; overactive) due to compensation for a lack of stability in other areas such as the pelvic girdle (where the hamstring muscles attach at the ischial tuberosities) even though the hamstrings may indeed have good flexibility. An anterior tilt of the pelvic girdle occurs if stabilizers responsible for maintaining proper alignment for the spine and pelvic girdle are weak and/or the individual has poor posture; the hamstrings are therefore stretched and being pulled upward becomes hypertonic. Hence, during a standing forward bend or toe touch the hamstring is unable to continue stretching and the individual is under the impression that the hamstrings are tight when in fact they are not. The intervention of a sound stretching program is important but strengthening the core muscles holds precedence.


Kinetic chain The kinetic chain is an engineering concept applied to human movement involving the nerves, muscles, joints, and spine and the interrelationship of these systems when performing movements. A closed chain refers to a position where the most distal aspects of a given extremity are fixed to the earth or another solid object which directly affects/influences the movement of the joints and musculature upward along the chain. For example, in a squat the feet are planted on the floor and the ankles, knees, and hips move towards the fixed end, the feet, during the descent phase of the squat movement. Closed-chain movements promote joint stabilization and have the potential to recruit more muscles and their associated joints. These movements may be transferred to activities of daily living (ADL’s) that also utilize compound multi-joints, which may reciprocate neuromuscular coordination and joint stability. Thus, many closed-chain exercises, such as the squat, are considered functional movement exercises. The squat teaches proper mechanics for the preparation of lifting heavy objects from the floor, while muscle strength, coordination, balance and joint stability are enhanced. Open-chain movements, in contrast, refer to movement of the distal end of an extremity, as


in biceps curl. They also create more shearing forces at the involved joint than closed-chain movements, and tend to recruit muscle fibers associated only with the single working joint, as in the biceps curl. When performing the biceps curl, the elbow joint is isolated and the biceps muscle performs the work.

Importance of the warmup Warmup is important for gradually increasing various biological temperatures, gradually increasing heart rate and the respiratory system and circulatory system, the delivery of oxygen and nutrients to muscle cells, lubrication of the joints with synovial fluid, and mental preparation. Blood temperature rises which increases blood flow to the muscles and subsequently the binding of oxygen to hemoglobin which makes oxygen more readily available to the working muscles, and may enhance endurance. Additionally, blood vessels dilate which also increases blood flow and puts less stress on the heart.An increase in muscle temperature allows muscles to contract with more force and also be able to relax more quickly which can reduce the risk of injury by preventing over stretching. Muscle elasticity, joint flexibility (range of motion) and mobility are enhanced and can maximize movement potential important for athletic attributes like strength and speed. The warmup also triggers the hormonal system, specifically cortisol and epinephrine, which are responsible for increasing carbohydrate and fatty acid metabolism and regulating energy production. Heat-dissipation mechanisms activate to prevent overheating by allowing the body to cool efficiently early on during the warmup and into and through the duration of an exercise activity. The hypothalamus responds to the changes in body temperature and makes physiological adjustments for thermoregulation—-which is always challenged during exercise. All of these factors are involved in the warm up ultimately to enhance physical performance and reduce the risk of injury.

Importance of the cool down The cool down provides a gradual transition from exercise activity levels to a normal resting level, promotes cardiovascular recovery and restores physiological systems to their baseline. There is a gradual decrease in heart rate, breathing rate, and body temperature. Cool down prevents venous pooling of blood in the the lower extremities which can cause dizziness and fainting. It transitions hypertonic muscles to their optimal length-tension relationships to prevent muscle strain, prevent the reduction in joint range of motion and mobility, and prevent the reduction of muscle efficiency in force generation and power. Mental recovery is also important in the cool down. Relaxation, breathing techniques and meditation calm the mind.

Periodization Periodization is an organized approach to training that involves progressive cycling of various aspects of a training program during a specific period of time. Training variables are manipulated to provide variation in volume and intensity. The fundamentals of periodization come from Hans Selye’s General Adaptation Syndrome and has been utilized by athletes, coaches, and trainers since the late 1950s. Optimization of training, performance, and muscular fitness, e.g., muscle strength, strength-speed, and strength-endurance, requires the ability to systematically alternate high loads of training with decreased loading phases, provide with full recovery and prevent overtraining. There


are three periodized cycles: (1) microcycle (generally up to 7 days); (2) mesocycle (approximately 2 weeks to a few months, and includes preparation, competition, peaking and transition phases); and (3) the macrocycle (referring to the overall training period and usually covers a year of time).

Repetition Maximum Continuum (aka Strength-Endurance Continuum) A weight training concept based on the belief that muscle strength and muscle endurance exist on a continuum with strength represented by the 1RM (the 1 repetition maximum; the maximum load that can be overcome by a single effort) and muscle endurance represented by the ability to exert a lower force repeatedly over time. Low numbers of repetitions with relatively high loads are associated with increases in strength, whereas high numbers of repetitions with low loads (20–100 RM) are associated with increases in endurance. According to the concept, as repetitions increase there is a gradual transition from strength to endurance. — The Oxford Dictionary of Sports Science & Medicine The Strength Continuum A traditional strength and conditioning categorization of different kinds of strength (sub-sections) during the concentric (shortening) phase of muscle contraction and the position along the force-velocity curve. This results in specificity of training for maximum expression of the different subsections or categories. The Strength Continuum goes beyond the scope of the UC Physical Edu- cation Core Conditioning courses but it is important to be aware and informed of its principles for future training plans. Subsections along the strength continuum include but are not limited to:

• Absolute Strength • Maximum Strength • Accelerative Strength • Strength-Speed • Speed-Strength • Absolute Speed • Max Strength • Basic Power Development • Elastic and Reactive Strength The Principle of Adaptation Adaptation is the body's ability to adjust and alter to increased or decreased biomechanical and neurological stress and demands. The effect of mechanical stress from external loads results in muscle hypertrophy; tendon hypertrophy and hyperplasia; and ligament hypertrophy. Neurological plasticity occurs as physical skills are learned and reinforced through repeated training. These mechanisms enhance coordination of muscle movement and allow the body to withstand the specific demand(s) in the future. The appropriate amount of overload is essential to ensure adaptation and the individual must therefore have a goal, a plan, a program, and proper training overloads to elicit the desired metabolic and hypertrophic responses. Occasional workouts will never provide improvements in performance. Repeated training makes a movement easier to perform, becomes


instinctive (“second nature”), optimizes performance, proficiency, and energy efficiency. The Principle of Adaptation reinforces the need to vary a workout routine if you want to see continued improvement. This is why a strategic training program is valuable and why we adopt the planned organized system of periodization in our training in class.

Principles underlying muscle hypertrophy The Principle of Specificity states that adaptations are specific to the stimuli provided. This is

known as the SAID Principle: Specific Adaptations to Imposed Demands. The Principle of Overload states that adaptation occurs when tissue is progressively overloaded.

The Principle of Adaptation is that the human body will adapt physiologically to the demands we place on it. This is further explained below. The Principle of Reversibility is that any gains are progressively lost when training ceases.

Muscle hypertrophy Hypertrophy is defined as the the growth and increase in the size of existing skeletal muscle fibers in response to an overload of high volumes of resistance (body weight, gravity, equipment), and occurs as a result of muscle cell regeneration from the overload of resistance during training. It is dependent upon a variety of factors such as baseline fitness, periodization, exercise prescription, individual activity threshold, frequency/intensity/duration, recruitment of muscle fibers, sufficient muscle stimulus, overload of resistance, metabolic stress, strength adaptations, rest intervals, recovery, nutrition, and form/technique. Most studies indicate that a muscle should be trained twice a week with a 48-hour rest period to promote muscle hypertrophy including consistency in training.


DOMS Delayed Onset Muscle Soreness is an inflammatory response to muscle that develops 12-24 hours after unaccustomed exercise activity, or when training intensity is increased rapidly or during post- injury rehabilitation. It is caused by the disruption of myofibrils causing muscle microtrauma par- ticularly at the myotendinous junction (the primary site of force transmission where the muscle and tendon interface), damage to connective tissue of the muscle, and associated with excessive eccentric muscle contractions, e.g., plyometrics, landing drills, downhill running, slow elbow extension during the return phase of a biceps curl. The pain itself is caused from inflammatory enzymes and chemical by-products that sensitize pain receptors and cause cellular swelling. The degree of muscle soreness correlates with the intensity and duration of the exercise or activity. The peak of muscle soreness occurs 24-72 hours post-exercise and begins to subside within a week. The repair of muscle fibers generally begins at three days and is complete by seven days. During this period the muscles involved become better prepared for future workouts of the same activity. It should be noted that DOMS is not the same as acute muscle soreness which is pain that develops during the activity. Additionally, muscle soreness is not caused by lactate:

“For much of the 20th century, lactate was largely considered a dead-end waste product of glycoly- sis due to hypoxia, the primary cause of the O2 debt following exercise, a major cause of muscle fatigue, and a key factor in acidosis-induced tissue damage. Since the 1970s, a 'lactate revolution' has occurred…… It now appears that increased lactate production and concentration as a result of anoxia or dysoxia (hypoxia) are often the exception rather than the rule. Lactic acidosis is being re- evaluated as a factor in muscle fatigue….Lactate can no longer be considered the usual suspect for metabolic 'crimes', but is instead a central player in cellular, regional and whole body metabolism..” — Dr. George Brooks, UC Berkeley, Integrative Biology The Recovery Principle Adequate rest and recovery are essential to be successful in attaining fitness goals, optimizing performance, and increasing workload and training intensity. Rest is literally the cessation of activity which is the period of time between workouts when the body adapts to the stress of of exercise, muscle glycogen is replenished, hydration is restored, and damaged muscle tissue is repaired. The greater the effort and intensity of training, the greater the need for planned recovery. Continuous training without adequate rest effects diminishing returns. Recovery refers to modalities that maximize the repair, restoration, and recuperation of the body, the calming and clearing of the mind, mental reflection, chemical and hormonal balance, and structural and neurological factors. These include hydration, nutrition, heat, ice, stretching, myo- fascial release (MFR), stress management, and compression. Immediate Recovery or Short-Term Recovery or Active Recovery Immediate or short-term recovery may be the time between sets of an exercise, between a bout of exercise in interval training, the cool down, or the hours immediately following a training session that involve low-intensity exercise. Of the latter, immediate recovery replenishes energy stores depleted from exercise and optimizes protein synthesis (the process of increasing the protein content of muscle cells, preventing muscle breakdown, and promoting muscle hypertrophy) through post-


exercise recovery nutrition, and also rehydrates the body from fluid loss during exercise. Refuel, rehydrate, rest, recover. Quality sleep is also an important factor in short-term recovery. A decline in performance and changes in hormonal levels may result from sleep deprivation. There may be an increase in cortisol levels, a decrease in human growth hormone (HGH) which is active during tissue repair and regeneration, and a decrease in glycogen synthesis.

Long-term Recovery or Training Recovery Long-term recovery includes days and/or weeks for recovery that are built into the entire training program or season. This is a period where training modalities may be changed or modified, cross- training activities may be integrated, as well as changes in training variables. Tracking workouts in a training log is helpful in determining recovery needs and recovery changes or modifications based on how the body feels after each training session.

The Law of Diminishing Returns Success in exercise and sport conditioning for optimal performance requires a balance between training load, intensity and rest/recovery. Intensity is manipulated by a variety of factors including but not limited to changes in sets; repetitions; resistance; rest intervals; rate of execution; tempo; training technique, e.g., supersets, drop sets, giant sets; lever length, range of motion, angle of execution, etc. An individual starting off in an exercise program requires relatively small training loads while making significant gains. As improvements progress, heavier workloads are required for continued progress and yet at that point they are the smallest incremental gains. Increased loads are tolerable only through the planned cycling of periodization for rest/recovery. However, limits do exist to the body’s ability to adapt and endure intense exercise before it breaks down and risks injury especially in the absence of rest and recovery. Once this adaptation threshold is exceeded, the body fails to improve appropriately, there is a decline in physical and mental performance, and the individual has reached a performance plateau. When the individual attempts to adjust training variables to override the plateau and continues to train yet without success the Law of Diminishing Returns becomes evident. The magnitude of adaptation diminishes with greater manipulated variables (volume, duration, intensity, etc.) and there is no further improvement. The individual experiences frustration and is not able to train at his/her prescribed level, performance is compromised and degraded. Overreaching Overreaching is a temporary short-term decline in performance in response to an accumulation of heavy or intense training loads and exhibits feelings of malaise, disrupted sleep, and fluctuations in mood. The intervention of appropriate rest allows the body to regenerate and the individual is able to return to normal, resume training within a few days, and may ultimately lead to an increase in performance. In fact, various phases of overreaching are actually utilized in many training programs as a vehicle for training stimuli. However, if overreaching is extreme and the individual does not completely recover and continues to train hard, coupled with another stressor, overtraining may result.


Overtraining Syndrome (OTS) or Burnout Overtraining syndrome is a complex clinical disorder identified as a maladaptive response to an imbalance between training, recovery, and emotional and psychological stress, and results in performance decline and impairment; the individual simply fails to recover from training. It is ideo- opathic—-there is no underlying medical reason nor explanation for the decline in performance and no overt illness to diagnose. Symptoms include but are not limited to altered hormonal imbalances, i.e.,overproduction of stress hormones such as cortisol and epinephrine; suppression of the immune system, i.e., inability to fight infection; fatigue resulting from physical, emotional, and psychological overloads; depression; unrestful sleep which can compound chronic fatigue and mood swings; decrease in strength, endurance, agility, and reaction time; nutrition, i.e., appetite suppression and nutrient deficiencies that can often lead to iron deficiency/anemia; metabolic imbalances, i.e., long- term low energy levels); distorted perceived exertion, i.e., effortless workouts are unusually difficult with abnormally high heart rate during exercise and longer than normal return to resting heart rate; waking resting heart rate 10-15 BPM higher than the individual’s normal resting heart rate; asymp- tomatic muscle and joint aches and pains in areas of the body that have not been directly trained; and medical complications, e.g., bone mineral density, testosterone, menstrual cycle disturbances.

General Adaptation Syndrome (GAS) Terminology The following terms provide and preface an understanding of the General Adaptation Syndrome and are adopted from Hans Selye’s scientific explanation of biological stress. • Stress A condition in which the human body responds to changes in its normal balanced state. • Stressor Events that are perceived as challenging, threatening or demanding and threaten the organism’s well being. These events may be acute or chronic, real or imagined, passive o reactive, good or bad. • Eustress Is also known as positive stress. Characteristics: it is manageable stress, motivating, exciting, can improve performance, and it is short-term. According to Hans Selye, “positive, manageable stress that can lead to growth and enhanced competence.”• Distress Is also known as negative stress. It is uncontrollable, overwhelming, unpleasant and causes anxiety. It is perceived as beyond one’s coping abilities, decreases performance, and can lead to mental and physical problems. According to Hans Selye, ““uncontrollable, prolonged, or overwhelming stress that is destructive.” • Adaptation The changes that occur as a result of the response to a stressor. • Coping The biological, psychological, and social process of responding effectively to the challenges of a stressor or change. There are three kinds of coping: - Adaptive Coping: contributing to the resolution of the stress response. - Maladaptive Coping: Strategies that exacerbate problems. - Active Coping: Actively seeking resolution to the stress.


• Homeostasis Homeostasis is a state of active equilibrium of various interdependent physiologic systems within the body. • Resilience Resilience is the capacity to experience difficult and sometimes severe experiences without being subsumed by them and without conceding to the automatic responses dictated by fight, flight or freeze. It is a resistant quality that allows one to recovery quickly and thrive in spite of adversity.

The General Adaptation Syndrome (GAS) The General Adaptation Syndrome is the body’s response to perceived stressful events in the environment and the demands placed upon it, as a survival mechanism to preserve life. It is a stress model developed by Hans Selye, a Hungarian endocrinologist who was the first to provide a scientific explanation for biological stress based on physiology and psychobiology and became known as “the father of stress research.” Selye explained that stress plays a role in disease and that the hypo- thalamic-pituitary-adrenal axis (HPA axis) system prepares the body to cope with stress. He detailed how stress induces hormonal autonomic responses and, over time, failure to cope or adapt to a stressor can lead to disease such as ulcers, high blood pressure, arteriosclerosis, arthritis, kidney disease, and allergic reactions. According to Selye the body uses a predictable three-stage body response to stressors:

Alarm Stage The Alarm Stage is the initial reaction to stress identified as the fight or flight response. A distress signal is sent to the hypothalamus which triggers an immediate release of glucocorticoids (steroid hormones) including cortisol, and adrenaline, and noradrenaline to provide instant energy. Adrenaline immediately increases blood pressure, heart rate and glucose levels. These physiologic alterations are governed by the autonomic nervous system (ANS) and specifically the sympathetic branch. The stressor upsets homeostasis or cellular balance. When the stress is removed, the body returns to normal state of homeostasis. The Resistance Stage The Resistance Stage is also known as the adaptation stage when stress continues or recurs for a period of time and the body tries to counteract the physiological changes that happened during the Alarm Stage. The body adjusts in structure and enzyme levels for added protection against the stress. The Resistance Stage is governed by the parasympathetic nervous system (PSNS), a branch of the autonomic nervous system (ANS) and tries to return the body to normal by reducing the amount of cortisol produced. Rest must occur in order for recovery and rebuilding to take place. However, if the stressor remains, the body will stay in a state of alert, and stress hormones continue production. The individual struggles to concentrate and becomes irritable. However, if the stressful situation ceases during this stage, the body will return to normal.


Exhaustion Stage This is the final stage of the General Adaptation Syndrome. Rest permits enhanced adaptation. If there is no rest, there is injury, overtraining, and no adaptation. The body has been continually try ing to recover from the initial Alarm Stage, but has failed to do so. Reserve energy sources become depleted and the body is no longer equipped to fight stress. At this point without stress management there is a risk of developing stress-related health conditions. With reference to The Recovery Prin- ciple, the inability to recover during the Exhaustion Stage completely compromises an individual’s training and mental, physical and emotional abilities. The individual becomes fatigued and irritable. Application of the General Adaptation Syndrome to a training program 1. Specific exercise and fitness training or sport-specific stressors cause the body to adapt: it strengthens the physiological systems, activates the specific energy systems, and repairs damaged cells. 2. The stressors, i.e., the training program, need to be systematically planned to produce a recoverable level of fatigue to the cells and organs within a reasonable amount of time. The individual should train to fatigue and exhaustion within the parameters and governance of the Recovery Principle and not compromise homeostasis which could lead to overtraining. 3. Structural and enzyme protein adaptations occur during the recovery phase and include super- compensation of the internal body structures and energy stores. The individual can now perform at a higher level of physiological functioning. 4. However, recovery time should not extend to a point of detraining or deconditioning which is The Principle of Reversibility.

Aerobic exercise Aerobic = “with oxygen”; activities using the large muscle groups of the body especially the lower body (legs), are rhythmic and continuous over time, and challenges the heart and lungs. Aerobic


exercise develops aerobic fitness: an increase in heart rate and an increase in oxygen uptake (VO2 max). The targeted training heart rate is developed and trained to sustain activity over an extended period of time, e.g., ≥ 20-30 minutes. These activities include jogging, running, swimming, cross- country skiing, bicycling, aerobic dance, stationary aerobic equipment, e.g., treadmill, elliptical, ergometer, stair climbers.

Benefits of aerobic exercise• Helps decrease the risk of developing coronary artery disease, hypertension, cancer and diabetes • Increases the efficiency of respiration • Improves blood volume, distribution, and delivery to muscles • Improves cardiovascular efficiency • Increases the stroke volume, or the amount of blood pumped from the ventricle during each

contraction of the heart • Increases cardiac output, or the volume of blood pumped by the heart each minute • Decreases resting heart rate • Lowers blood pressure • Improves the condition and efficiency of breathing muscles • Improves the efficiency of movement • Improves the body’s ability to use fat as an energy source • Improves body composition by decreasing body fat • Helps with weight control/management; obesity • Strengthens muscles; improves muscle endurance • Strengthens ligaments, tendons and bones • Improves flexibility, usable range of joint motion and mobility • Increases bone density or reduce the rate of decline in osteoporosis • Improves balance and reduce the risk for falling • Improves mood; helps to decrease anxiety and stress • May improve memory and other mental functions

Aerobic fitness Aerobic fitness represents the body’s ability to transport, deliver and utilize oxygen measured by the maximal amount of oxygen consumed (VO2 max) during aerobic exercise via aerobic metabolism which, with consistent training, sustains the production of energy for exercise over an extended period of time.

Aerobic metabolism Aerobic metabolism is the oxidative process of the generation of adenosine triphosphate (ATP), an immediate source of energy that provides fuel during both resting and exercise states.

Aerobic energy Aerobic energy is produced in the mitochondria of muscle cells using carbohydrates and fats for fuel. Mitochondria function as energy “powerhouses” for aerobic metabolism. When aerobic exercise is performed repeatedly and consistently the number and density of mitochondria increase. The


higher the level of intensity of the aerobic activity, i.e., the aerobic threshold is challenged, the more powerful the effect on mitochondrial adaptations and extraction of oxygen, compared to aerobic activity of a low-to-moderate intensity level. When the body is challenged at a higher intensity level that exceeds the ability to produce aerobic energy, it will begin to tap into anaerobic energy pathways. Aerobic power The ability to sustain a challenging exercise pace over an extended period of time.

Cardiovascular Fitness Cardio fitness reflects the ability of the heart and pulmonary system to continuously supply oxygen- rich blood to the working muscles during continuous aerobic activity. It is the measure of the amount of oxygen transported in the blood to the working muscles. Cardiovascular fitness increases energy, stamina, controls blood pressure, and improves blood lipid profiles (cholesterol).

Cardiovascular endurance The increase in heart rate during intense aerobic exercise therefore increasing VO2 max. The body continues to transport, deliver, utilize oxygen (VO2 max) and remove wastes via aerobic metabolism which sustains the production of energy required to sustain exercise over an extended period of time. Aerobic fitness and cardiovascular endurance When heart rate is increased oxygen intake is increased. When oxygen intake is increased, heart rate is increased. Both occur simultaneously and are not separate. When engaged in cardiovascular activity the individually is training aerobically. American College of Sports Medicine (ACSM) Quantity and Quality of Exercise

https://www.acsm.org/acsm-positions-policy/official-positions/ACSM-position-stands

https://journals.lww.com/acsm-msse/Fulltext/2011/07000/ Quantity_and_Quality_of_Exercise_for_Developing.26.aspx

The ACSM defines cardiovascular exercises as those that are rhythmic, continuous and performed with large muscles of the body. These exercises include such activities as walking, jogging, cycling, swimming, hiking, stair climbing, rope jumping, cross-country skiing, skating, rowing and dancing. The goal is to exercise for at least 10 consecutive minutes at a moderate to vigorous intensity level. The talk test is one way to monitor your workout intensity. You should exercise at a level that leaves you slightly breathless, but able to maintain a conversation.

The ACSM continues the definition of cardio exercise by recommending an exercise frequency. Cardio exercise should be performed three to five days a week. If you are new to exercise, aim for three days a week with a day of rest in between. As your endurance improves, increase your workout frequency to continue to see and feel fitness benefits.

https://www.acsm.org/acsm-positions-policy/official-positions/ACSM-position-standshttps://journals.lww.com/acsm-msse/Fulltext/2011/07000/


Your cardiovascular workout may fall into the required definition, but if you do not exercise at the proper workout intensity, you will not receive the benefits. The ACSM recommends exercise at a l level that raises your pulse between 60 and 90 percent of your maximum heart rate, or MHR. Calcu late your MHR by subtracting your age from 220. Then multiply the MHR by 60 and 90 percent to determine your exercise target heart rate. One other factor determines whether your exercise is con sidered cardiovascular. Ten minutes is the minimum duration for your continuous exercise session. The ACSM suggests between 20 and 60 continuous minutes of exercise. You can begin with 10 to 15 minutes at a time and then increase your duration as your fitness level improves.

The Physical Activity Guidelines for Americans recommends you get 150 to 300 minutes of moderately-intense cardio exercise a week; or 75 to 150 minutes of vigorous cardio. https://health.gov/paguidelines/second-edition/pdf/ Physical_Activity_Guidelines_2nd_edi tion.pdf#page=55

Aerobic Exercise, Medical Author: Richard Weil, MEd, CDE https://www.medicinenet.com/aerobic_exercise/article.htm The heart The heart has four chambers that fill with blood and pump blood (two atria and two ventricles) and some very active coronary arteries. Because of all this action, the heart needs a fresh supply of oxygen, and as you just learned, the lungs provide it. Once the heart uses what it needs, it pumps the blood, the oxygen, and other nutrients out through the large left ventricle and through the circulatory system (cardiovascular system) to all the organs, muscles, and tissues that need it. A whole lot of pumping going on Your heart beats approximately 60-80 times per minute at rest, 100,000 times a day, more than 30 million times per year, and about 2.5 billion times in a 70-year lifetime! Every beat of your heart sends a volume of blood (called stroke volume -- more about that later), along with oxygen and many other life-sustaining nutrients, circulating through your body. The average healthy adult heart pumps about 5 liters of blood per minute. Oxygen consumption and muscles All that oxygen being pumped by the blood is important. You may be familiar with the term “oxygen consumption." In science, it's labeled VO2, or volume of oxygen consumed. It's the amount of oxygen the muscles extract, or consume from the blood, and it's expressed as ml/kg/minute (milli liters per kilogram of body weight). Muscles are like engines that run on fuel (just like an automo bile that runs on fuel); only our muscles use fat and carbohydrates instead of gasoline. Oxygen is a key player because, once inside the muscle, it's used to burn fat and carbohydrate for fuel to keep our engines running. The more efficient our muscles are at consuming oxygen, the more fuel we can burn, the more fit we are, and the longer we can exercise. How aerobically fit can we be? The average sedentary adult will reach a level of oxygen consumption close to 35 ml/kg/minute during a maximal treadmill test (where you're asked to walk as hard as you can). Translated, that means the person is consuming 35 milliliters of oxygen for every kilogram of body weight per

https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf#page=55https://health.gov/paguidelines/second-edition/pdf/https://www.medicinenet.com/script/main/art.asp?articlekey=57174https://www.medicinenet.com/aerobic_exercise/article.htmhttps://www.medicinenet.com/image-collection/heart_detail_picture/picture.htmhttps://www.medicinenet.com/heart_disease_pictures_slideshow_visual_guide/article.htmhttps://www.medicinenet.com/stroke_pictures_slideshow/article.htm


minute. That'll get you through the day, but elite athletes can reach values as high as 90 ml/kg/ minute! How do they do it? They may have good genes for one, but they also train hard. And when they do, their bodies adapt. The good news is that the bodies of mere mortals like the rest of us adapt to training too. Here's how. What are the fitness benefits of aerobic exercise? How our bodies adapt Here's what happens inside your body when you do aerobic exercise regularly: 1. Your heart gets stronger and pumps more blood with each beat (larger stroke volume). Elite athletes, as I just mentioned, can have stroke volumes more than twice as high as average individuals. But it's not just that. Conditioned hearts also have greater diameter and mass (the heart's a muscle too and gets bigger when you train it), and they pump efficiently enough to allow for greater filling time, which is a good thing because it means that more blood fills the chambers of the heart before they pump so that more blood gets pumped with each beat. 2. Greater stroke volume means the heart doesn't have to pump as fast to meet the demands of exercise. Fewer beats and more stroke volume mean greater efficiency. Think about a pump emp- tying water out of a flooded basement. The pump works better and lasts longer if it can pump larger volumes of water with each cycle than if it has to pump faster and strain to get rid of the water. High stroke volume is why athletes' hearts don't pump as fast during exercise and why they have such low resting heart rates; sometimes as low as 40 beats per minute, whereas the average is 60-80 beats per minutes.

3. Downstream from the heart are your muscles, which get more efficient at consuming oxygen when you do regular aerobic exercise (remember, "consuming" oxygen means that the muscles are taking the oxygen out of the blood). This happens because of an increase in the activity and number of enzymes that transport oxygen out of the bloodstream and into the muscle. Imagine 100 oxygen molecules circulating past a muscle. You're twice as fit if the muscle can consume all 100 molecules than if it can only consume 50. Another way of saying it is that you're twice as fit as someone if your VO2 max is 60ml/kg/min. and theirs is 30ml/kg/min. In terms of per formance in this scenario, you'll have more endurance because your muscles won't run out of oxygen as quickly. 4. Mitochondria inside the muscle increase in number and activity. Mitochondria are the power houses of your cells. They do all the heavy-duty work to keep you moving. They use the oxygen to burn the fat and carbohydrate that makes you go. The good news is that they increase in number and activity, by as much as 50%, in just a matter of days to weeks in response to regular aerobic exercise in adults of all ages.

Cardiovascular fitness is expressed as your VO2 max — the maximum volume of oxygen you can take in through your lungs, pump around your body using your heart and blood vessels and then make use of in your muscles. Other factors, such as aerobic muscular endurance, are part of cardio vascular fitness. Factors of Cardiovascular Fitness As you get fitter — for example after an extended period of performing regular aerobic exercise your body makes numerous adaptations that result in improved cardiovascular fitness. The mus-

https://www.medicinenet.com/stroke_symptoms_and_treatment/article.htmhttps://www.medicinenet.com/stroke_pictures_slideshow/article.htmhttps://www.medicinenet.com/stroke_quiz/quiz.htmhttps://www.medicinenet.com/11_signs_and_symptoms_of_stroke/article.htm


cles involved in respiration — your intercostals and diaphragm — get stronger and more efficient. The capillaries in your alveoli — the tiny blood vessels that supply the air sacs deep in your lungs increase in number. In short, you become better able to take in oxygen and exhale carbon dioxide. Your heart gets stronger and more efficient as you get fitter, reports the American Heart Associa- tion. A fit, strong heart can pump more blood per beat than a smaller, less fit heart. Your muscles also get fitter and stronger as a result of exercise. The number and size of the capillaries that deliver oxygen to and take carbon dioxide from your muscles increase. The number and size of mitochondria — the energy-producing cells — also increase. As a result of the respiratory adaptations, the term "cardiorespiratory" is sometimes used. Cardiovascular fitness is linked to a reduction in blood pressure, reduced risk of developing coronary heart disease, lowered incidence of diabetes, decreased risk of stroke and heart attack, lower resting heart rate, lower fat mass, increased bone mass (for weight bearing body parts — usually the legs in cardio exercise; resistance training more no tably increases bone density), improved energy levels and greater resistance to illness and fatigue.

Monitoring heart rate Heart rate is measured in beats per minute (BPM). Locate the pulse and start the count with zero for a duration of 10 seconds. Multiply the recorded pulse by 6 to determine your heart rate in beats per minute. 1. Radial Pulse - Place the 2nd and 3rd fingers between the bone and the tendon right below and perpendicular to the wrist, on the thumb side the wrist. 2. Carotid Pulse - Place the 2nd and 3rd fingers or 3rd and 4th fingers on your neck below the jaw.

What's a normal resting heart rate? A normal resting heart rate for adults ranges from 60 to 100 beats per minute. Generally, a lower heart rate at rest implies more efficient heart function and better cardiovascular fitness. For example, a well-trained athlete might have a normal resting heart rate closer to 40 beats per minute. Keep in mind that many factors can influence heart rate, including:

• Age • Fitness and activity levels • Being a smoker • Having cardiovascular disease, high cholesterol or diabetes • Air temperature • Body position (standing up or lying down, for example) • Emotions • Body size • Medications

Although there's a wide range of normal, an unusually high or low heart rate may indicate an under lying problem. Consult your doctor if your resting heart rate is consistently above 100 beats a minute (tachycardia) or if you're not a trained athlete and your resting heart rate is below 60 beats a minute (bradycardia) — especially if you have other signs or symptoms, such as fainting, dizziness or shortness of breath. — Edward R. Laskowski, M.D., Web MD

https://www.mayoclinic.org/expert-biographies/edward-r-laskowski-m-d/bio-20025114


The Karvonen Method: Determining target heart rate Formula: target training HR = resting HR + (0.6 [maximum HR -resting HR]) Video: https://www.youtube.com/watch?time_continue=114&v=UzRZDDMoD_M This formula is based on the Heart Rate Reserve: the difference between maximal heart rate and rest ing pulse. The correlation is more directly linear: 60% to 80% of your Heart Rate Reserve, HRR, equals 60% to 80% of your functional capacity. Resting Heart Rate, Maximum Heart Rate, and Heart Rate Reserve are first determined before using the Karvonen Method:

1. Maximum Heart Rate (MHR) = 220- your age. 2. Resting Heart Rate (RHR) = The pulse at rest - the best time to get a true resting heart rate is first thing in the morning before you get out of bed; monitor it for a week to get the average. 3. Heart Rate Reserve (HRR)= Maximum Heart Rate - Resting Heart Rate

Abstract: Martti Karvonen was born in Finland in 1918. He received a medical degree from the University of Helsinki in 1945 and a PhD degree from the University of Cambridge in 1950. His contribution to cardiovascular epidemiology began in the mid-1950s, when he observed that serum cholesterol levels were higher in men living in eastern Finland than those living in western Finland. He brought these observations to the attention of Ancel Keys, and the two collaborated on the first epidemiological studies of risk factors for coronary heart disease. This collaboration ultimately led to the inclusion of Finland in the hallmark 1958 Seven Countries study that established a relation ship between lifestyle and the prevalence of atherosclerosis. Karvonen also developed a formula that can be used to determine a target heart rate for aerobic activity. Although the Karvonen formula can overestimate or underestimate the exercise intensity in certain patients, it provides general rule-of-thumb target heart rates, with light-intensity exercise being defined as activity using 30% to 40% of the heart rate reserve, moderate-intensity exercise using 40% to 60%, and vigorous- intensity activity using 60% to 90%. Ideally, physicians should provide patients with an exercise prescription that outlines the frequency, intensity, time (duration), and type of exercise. Exercise prescriptions should include both aerobic activity and resistance training. Patients with underlying cardiac conditions can benefit from a cardiac rehabilitation program with pre-participation cardiac assessment and development of a specialized exercise routine. https://www.bcmj.org/articles/science-exercise-prescription-martti-karvonen-and-his-contributions: Issue: BCMJ, vol. 59 , No. 1 , January February 2017 , Pages 38-41 Clinical Articles By: Maya Ignaszewski, MD Benny Lau, MD, FRCPC Shannon Wong, BSc Saul Isserow, MBBCh The Karvonen formula, exercise intensity and exercise prescription Exercise physiologist Martti Karvonen is remembered today as a founding father of cardiovascular disease epidemiology and prevention in Finland. He was born in 1918 and received his medical degree from the University of Helsinki in 1945 and his PhD degree from the University of Cam bridge in 1950. He then became the director of the Department of Physiology at the Institute of Occupational Health in Helsinki, and eventually went on to become the director general of that institute. Karvonen served as chief physician for both the Finnish air force (1956 to 1966) and the Finnish

https://www.youtube.com/watch?time_continue=114&v=UzRZDDMoD_Mhttps://www.bcmj.org/articles/science-exercise-prescription-martti-karvonen-and-his-contributionshttps://www.bcmj.org/node/726https://www.bcmj.org/author/maya-ignaszewski-mdhttps://www.bcmj.org/author/benny-lau-md-frcpchttps://www.bcmj.org/author/shannon-wong-bschttps://www.bcmj.org/author/saul-isserow-mbbch


army (1974 to 1978). Even after his retirement he remained active in the medical community and continued to act as a consultant for the WHO Division of Cardiovascular Diseases.[1] Karvonen’s upbringing in North Karelia, a rugged part of eastern Finland, defined his approach to cardiovascular medicine. It became apparent to him that many men in the area were dying of heart disease after returning from service in the Second World War. He noticed that the local diet was rich in calories and fat, and observed that serum cholesterol levels in men from eastern Finland were higher than those of men in western Finland. Karvonen became interested in understanding the reason for cultural differences in cardiovascular event rates and the role of diet in the develop ment of atherosclerosis.[1] Karvonen’s pioneering work in cardiovascular epidemiology began in the mid-1950s when he brought his observations about Finnish males to the attention of Ancel Keys, and the two scientists undertook the first epidemiological studies of risk factors on coronary heart disease in eastern and western Finland. Their collaboration eventually led to the inclusion of Finland in the hallmark 1958 Seven Countries study that established a relationship between lifestyle and the prevalence of atherosclerosis in various parts of the world. In 1972 Karvonen’s advice resulted in the creation of the North Karelia Project, a community- based program to address the high burden of coronary heart disease affecting the area. This pro gram was credited with triggering major lifestyle changes across Finland, which in turn led to reductions in mean serum cholesterol and blood pressure levels, lower smoking rates, and, most important, a reduction in cardiovascular disease mortality rates and stroke-related risk factors.[2] In 1979 Karvonen’s 12-year Finnish Mental Hospital study proved that a diet low in cholesterol was associated with reductions in coronary heart disease, and the field of preventive cardiology was born.[3] The Karvonen formula and exercise intensity While Karvonen played a major role in establishing a link between lifestyle factors and cardiovascular events, he is also known for developing a formula to determine a target heart rate (HR) for aerobic activity. In the Karvonen formula, peak HR is the maximum heart rate achieved during ex ercise stress testing and K is a coefficient: target HR = resting HR + (peak HR – resting HR) x K. In a study published in 1957, Karvonen examined the effect of different training intensities on resting, working, and maximum heart rates.[4] He found that training at an intense level will cause a de crease in working heart rate, which is a direct indication of increased peak oxygen consumption and cardiorespiratory fitness. He identified the threshold at which improvements are seen as 60% of the heart rate reserve (HRR), which is expressed as the difference between the peak heart rate and rest ing heart rate. Although the benefits of exercise were well documented, this finding was monumen- tal in defining the parameters for exercise intensity that produced tangible results. We know now that the intensity range to improve and maintain cardiorespiratory fitness is broad and depends on a number of factors, including age, underlying health, individual physical activity habits, and baseline functional status. Davis and Convertino found the Karvonen formula to be a reasonably accurate method for estimating exercise intensity.[5] Despite occasionally overestimat- ing or underestimating exercise intensity in certain patients, the formula provided general rule-of- thumb training heart rates, with light-intensity exercise defined as activity using 30% to 40% of the heart rate reserve, moderate-intensity activity as using 40% to 60% of HRR, and vigorous-intensity


activity as using 60% to 90% of HRR. There are several methods for determining exercise intensity that differ from the Karvonen formula. When cardiopulmonary exercise testing is available, a percentage of either the oxygen uptake re serve or the maximal oxygen uptake can be calculated. Measures of absolute intensity include metabolic equivalent tasks (METs), absolute oxygen uptake, and caloric expenditure. Unfortunately, these methods do not account for individual differences and commonly misclassify exercise intensity. Several subjective tools of determining exercise intensity have also been developed and can be used as adjuncts to the objective methods. These include the Borg Rating of Perceived Exertion (RPE) scale, the talk test, and the OMNI scale. Exercise prescription Although the benefits of regular physical activity are well known, physicians are often uncertain how to provide appropriate recommendations when patients ask for advice. Ideally, physicians should provide patients with an exercise prescription based on the FITT-VP6 principle: Frequency: How often to exercise. Intensity: How hard to exercise, as determined by methods described above. Time: Duration of each exercise session. Type: Kind of exercise. Volume: Product of frequency, intensity, and time to give an overall estimate of energy expended when following the exercise prescription. Progression: Rate of progression for frequency, intensity, and time. Exercise prescriptions should include both aerobic activity and resistance training. Aerobic activity involves the repetitive, rhythmic motion of large muscle groups, and can be seen in activities such as running and cycling. For those unaccustomed to regular exercise, aerobic activity should begin at a lower intensity and shorter duration, with gradual progression over time until target volume is achieved. In general, exercise time should be increased before intensity is increased. An example of a reasonable progression would be an increase of 5 to 10 minutes per session every 1 to 2 weeks. [6] The benefits of aerobic activity can also be obtained from interval training, which involves high- intensity exercise interspersed with light-intensity activity or rest. Aerobic interval training can result in a larger increase in peak oxygen consumption than continuous training,[7] and may be most useful for those at the extremes of exercise capacity. For adults, the American Heart Association (AHA) currently recommends 30 minutes of moderate- intensity aerobic activity at least 5 days a week for a total of 150 minutes, or 25 minutes of vigor ous-intensity aerobic activity at least 3 days a week for a total of 75 minutes, or a combination of moderate-intensity and vigorous-intensity aerobic activity and moderate- to high-intensity muscle strengthening activity at least 2 days a week for additional health benefits. If the goal is to lower blood pressure or cholesterol levels, an average of 40 minutes of moderate- to vigorous-intensity aerobic activity 3 to 4 days a week is recommended.[8] With the recent increase in childhood obesity, physical activity is becoming increasingly important for children. Currently, the AHA recommends that all children older than 2 years participate in at least 60 minutes a day of enjoyable, moderate-intensity physical activities that are developmentally appropriate and varied. If scheduling a full 60-minute break for daily activity is impossible, children should have at least two 30-minute periods or four 15-minute periods to engage in vigorous-intensi-


ty physical activities appropriate for their age, gender, and stage of physical and emotional development.[9] It is known that the increased muscular strength resulting from resistance training is associated with decreased risk of all-cause mortality.[10] Other benefits of this type of exercise include reductions in functional limitations, improvements in self-efficacy and quality of life, and increases in bone mass and strength. The current recommendation is to train each major muscle group against resistance 2 to 3 days a week, with two to four sets during each session and eight to twelve repetitions per set.[6] The intensity of resistance should be approximately 60% to 80% of the one-repetition maximum for each individual, which can be achieved using resistance bands, free weights, ma- chines with stacked weights, or pneumatic resistance. It is also important to note that physical inactivity is associated with inferior health outcomes. Therefore, in addition to providing exercise recommendations, physicians should advise patients to reduce time spent being physically inactive. Lastly, special attention should be paid to patients with underlying cardiac conditions who are ready to start an exercise program. These individuals would benefit most from enrolling in a cardiac rehabilitation program with pre-participation cardiac assessment and development of a specialized exercise routine. Conclusion Before writing a prescription for an antihypertensive or antihyperglycemic agent, physicians might consider writing a prescription for exercise. The benefits of physical exercise on overall health have been known for centuries, with exercise prescriptions dating as far back as 600 BC.[11] Finland’s Martti Karvonen played a pivotal role in the science of exercise prescription by helping to establish the link between lifestyle and risk factor development, and by determining the role of exercise intensity in improving cardiorespiratory fitness. The formula he developed remains one of the most widely used methods for determining a target heart rate for aerobic activity. Physicians are often approached by patients for advice on exercise and are in an ideal position to promote this invaluable behavior by providing safe, useful, and objective exercise recommendations. Competing interests None declared. This article has been peer reviewed. References 1. Pincock S. Martti Karvonen. Lancet 2009;374(9694):972. 2. Puska P. Successful prevention of non-communicable diseases: 25 year experiences with North Karelia project in Finland. Pub Health Med 2002;4:5-7. 3. Turpeinen O, Karvonen MJ, Pekkarinen M, et al. Dietary prevention of coronary heart disease: The Finnish Mental Hospital Study. Int J Epidemiol 1979;8:99-118. 4. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Bil Fenn 1957;35:307-315. 5. Davis A, Convertino V. A comparison of heart rate methods for predicting endurance training intensity. Med Sci Sports 1975;7:295-298. 6. Pescatello LS, American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Phil-adephia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014.


7. Pattyn N, Coeckelberghs E, Buys R, et al. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: A systematic review and meta-analysis. Sports Med 2014;44:687-700. 8. American Heart Association recommendations for adults. Updated 27 July 2016. Accessed 7 November 2016. 9. The AHA’s recommendations for physical activity in children. Updated 18 October 2016. Ac- cessed 7 November 2016. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs- for-physical-activity-in-children#.V2LqyigjmL0.%C2%A0 10. Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: Prospective cohort study. BMJ 2008;337:a439. 11. Tipton CM. The history of “exercise is medicine” in ancient civilizations. Adv Physiol Educ. 2014;38:109-117.

https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-

PHYS ED 1 GENERAL CONDITIONING

PHYS ED 1 GENERAL CONDITIONING TONI MARTONI MAR isolated fashion, e.g., abdominal curls, but also in...

Documents

Transcript of PHYS ED 1 GENERAL CONDITIONING TONI MARTONI MAR isolated fashion, e.g., abdominal curls, but also in...