Principles of Exercise

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The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. For most adults, an exercise program including aerobic, resistance, flexibility, and neuromotor exercise training is indispensable to improve and maintain physical fitness and health. An exercise training program ideally is designed to meet individual  health and physical fitness goals within the context of individual health status, function, and the respective physical and social environment.. Conclusive scientific evidence, based on a wide range of well-conducted studies, shows that physically active people have higher levels of healthrelated fitness, a lower risk profile for developing a number of disabling medical conditions, and lower rates of various chronic noncommunicable diseases than do people who are inactive. The dose of exercise can be described using the so-called FITT factors, where FITT stands for Frequency, Intensity, Time, and Type of activity. In addition, the duration of a programme (week/months) is an important factor.

It should be noted that some individuals may not respond as expected because there is appreciable individual variability in the magnitude of response to a particular exercise regimen. Furthermore, the FITT principle of exercise may not apply in certain cases because of individual characteristics (e.g., health status, physical ability, age) or athletic and performance goals. Accommodations to the exercise should be made for individuals with clinical conditions and healthy individuals with special considerations.

ACSM recommends to use the FITT method:

• Frequency (how often)

Exercise should be carried out 3-5 days a week. Training three times a week produces significant training effects; however training 5 days a week at a lower-intensity exercise may be more manageable for some people. Little additional benefit is seen with more than five training sessions a week, and the risk of injury is increased. Training twice a week does not produce increases in YO2max; however it may produce some functional changes and it is probably better than no exercise at all.

• Intensity (how hard)

Intensity can be monitored by heart rate in most patients, although some patients may have pathology or be on drug treatment that affects their HR response to exercise in which case HR cannot be used to monitor exercise intensity. The recommended training HR zone is from 55-65% to 90% of maximum heart rate. Maximum HR can be estimated by 220 age. The Karvonen method, which takes into account resting can also be used to calculate an individual's training HR band using the following calculation. Maximum heart rate (MHR) is estimated by 220 -age in years, and resting heat rate (RHR) measured. Heart rate reserve (HRR) is calculated as: MHR-RHR = HRR 60% and 80% of HRR are calculated and added onto RHR to give the parameters of the 60-80% training band. Exercise is categorized into three different intensity levels. These levels include low, moderate, and vigorous and are measured by the metabolic equivalent of task (aka metabolic equivalent or METs).

• Time (duration or how long)

A total of 20-60 minutes of continuous or intermittent aerobic activity a day should be performed. The activity can be divided into a minimum of lO-minute bouts throughout the day. The duration of training is dependent on the intensity. llnfit iI1dividuals starting at the lower end of the training band need to sustain exercise longer (30-60 minutes) to achieve training effects.

• Type(mode or what kind)
• Volume (amount)
• Progression (advancement)

DESIGNING A THERAPEUTIC EXERCISE PROGRAMME A programme may include a range of different types of exercise such as those for improving or preventing deterioration in aerobic capacity, muscle strength, power and endurance, flexibility or range of movement, balance, coordination and agility. Although there are many different professionals involved in delivering advice on physical activity and exercise to various population groups, physiotherapists are equipped with special skills to provide therapeutic exercise programmes. To be able to do this, a physiotherapist requires an understanding of the underlying disease process or pathology, exercise physiology, biomechanics, physical principles and the evidence base supporting the area as well as an awareness of psychological o and safety issues. The physiotherapist must also be able to identify appropriate treatment goals in conjunction with the patient.

In general, all exercise training and sport sessions should start with a 10–15-min dynamic warm-up period followed by 20–60 min of exercise training. Finally, a 10-min cool-down period with less intensive activities and stretching should end the exercise training session. Between the training sessions there must be enough time to recover.

Common training principles: Overload A system must be exercised at a level beyond which it is presently accustomed for a training effect to occur. The system being exercised will gradually adapt to the overload or training stimulus being applied, and this will go on happening as long as the training stimulus continues to be increased until the tissue can no longer adapt. The training stimulus applied consists of ditTerent variables such as intensity, duration and frequency of exercise. It is important to give the system being exercised enough time to recover and only apply a training stimulus again when the system is no longer fatigued.

Specificity Any exercise will train a system for the panicular task being carried out as the training stimulus. This means that, for example, a training programme including muscle strengthening will train the muscle in the range that it is working and the way that the muscle is being used, i.e. isometrically, concentrically or eccentrically. It is important that any exercise to strengthen muscle targets the muscle range and type of muscle work specific to the task required. For example, riding a bicycle requires concentric knee extension from mid-to inner r,1I1ge, as the pedal is pushed down to propel the bicycle along. cyclist wishing to increase the strength of his quadriceps will need to tr.lin concentrically in mid-to inner range. Depending on the presenting problem, the required task should become part of the training progrilmme at an appropriate stage.

Reversibility The beneficial effects of training begin to be lost as soon as training stops. This happens in a similar time frame as it takes to train the system.

Individuality Variation in response to a training programme will occur in a population as people respond differently to the same training programme. This response can be explained by the initial fitness level of the individual, their health status and their genetic make up. Training programmes should be designed to take this into account.Some individuills will have a predisposition to endurance training and some to strength training. Some will respond well to a training programme and others much more slowly. Those individuals with a lower fitness level before starting an exercise programme show improvement in fitness more quickly than those who are relatively fit before training begins. Some individuals with health conditions may not be able to work at the same kind of intensity as a healthy individual and so will take longer to achieve a training goal.

Motor learning To be able to teach and supervise an exercise programme effectively, the physiotherapist needs an understanding of how people learn motor skills. Motor learning is not just concerned with the acquisition of motor skills but also with how the individual interacts with the task to be learnt and the environment. This uses perception or sensing, cognition and motor processes. Learning a skill is a reliltively permanent change in an individual and there are several stages that the person will go through before the skill is retained.Initially a person may be unable to perform a task. With practice, o they will achieve the task but it will not be carried out efficiently. With further practice and feedback the person will be able to carry out the task to a reasonable standard but they may forget how to do it if they do not do the task regularly. In the final stage the person I will carry out the task efficiently, in a skilled manner and will not U forget how to do the task. When teaching a patient an exercise, the physiotherapist should explain or demonstrate how to carry out the exercise, doing this as a whole if the exercise is simple or breaking a complex exercise into parts. When the patient is able to carry out the component parts, the exercise should be practised as a whole. The patient needs to think about and practise the exercise. Both the physiotherapist and the patient should evaluate how well the exercise was performed and if the exercise task was completed. The physiotherapist should allow the patient a short time to evaluate their own performance, before providing feedback prior to subsequent practice. Practising a skill (or exercise) in a varied manner, for example at different speeds or in different environments, will help with learning.

Safety Whenever an individual exercises there is a risk that they may injure themselves. Safety factors are considered here in relation to the physiotherapist. the environment and the patient or person carrying alit the exercise.

Healthy subjects must train for at least 30 min per day, 3 to 5 days per week for 4 to 8 weeks to achieve a physiologic training effect

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The main principles of exercise training are well established in the exercise field; these are specificity, overload, progression, initial values, reversibility and diminishing returns.Sub Heading 3 ==

References

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