1. Pamela O’Mara PT, MS, CWS
November 27, 2012
CHRISTUS St. Catherine Sports Medicine

5.  Hypertension  Family history
 Diabetes  Age
 SMOKING  Gender
 Stress  Race
 Elevated lipids  Obesity
 Stress  Sedentary lifestyle

6.  DO NOT SMOKE
 Vasoconstriction, increase BP, increase HR, 1:5 deaths
 GET ACTIVE
 Stress reduction, increase oxygenation, increase HDL, decrease
BP, reduced insulin needs, reduced platelet aggregation
 EAT RIGHT
 Heart healthy diet low in fat, cholesterol, salt; focus on lean
protein, fruits/veggies, grains
 AVOID OBESITY
 Decrease risk of HTN, high cholesterol, and diabetes, reduced
body fat

7.  AVOID STRESS
 Cortisol is a hormone released in response to stress. It
functions to increase blood sugar, suppress the immune
system, and decrease bone formation.
 SLEEP
 Adequate sleep is necessary for health, fitness, and stress
reduction
 REGULAR MEDICAL CHECK-UPS
 See your physician to monitor your risk factors

8. Increased use of alcohol Nausea or stomach pain
or drugs Shallow or rapid breathing
Increased smoking Not sleeping or sleeping
Muscle tension too much
Heart palpitations Need to urinate
Fear / panic Pacing
Diarrhea or constipation Headaches
Cold or sweaty hands/feet Grinding teeth
Is it surprising that stress is a risk factor for obesity, cardiac arrhythmia,
diabetes, depression, hypertension, etc.

9. EXERCISE OR ANY PHYSICAL ACTIVITY !!!
GET PLENTY OF SLEEP !!! (but not too much)
Eat regular, well balanced meals
Take time every day to do something you enjoy
Listen to your body. Stop and rest when you feel tired
Avoid stimulants if possible. Smoking, caffeine, alcohol
Take a mini vacation in your mind
Relax and do mental imagery of a favorite place or event
Practice slow deep breathing
Listen to slow, calming music or sounds
Do stretching exercises daily to relieve that muscle tension
Intimate relationships
If you feel depressed, fearful, or hopeless for an extended period of
time, talk to your doctor.

10. Face – Squinch up your face. Clench your teeth. Purse your lips. Push
tongue to the roof of your mouth. Lift eyebrows with your eyes still
closed. Hold. Release.
Shoulders – Hunch up your shoulders to your ears. Pinch shoulder blades
together. Hold. Release.
Chest – Tense your chest by taking a deep breath and hold for 5 sec.
Back – Arch your back. Hold. Release.
Abdomen – Tense your stomach muscles by bearing down.
Thigh/Buttocks – Tense up thighs/buttocks by pressing feet into the floor
and pinching buttocks together.
Toes – Curl your toes up. Hold. Release.
Hands – Clench your fists. Feel the tension. Release.
RECOGNIZE THE DIFFERENCE IN TENSION AND RELAXION.

11.  All cause mortality YES
 Coronary heart disease YES
 Cardiovascular disease YES
 Hypertension YES
 Stroke YES
 Obesity YES
 Osteoporosis/Osteoporotic Fx YES
 Type 2 Diabetes YES
 Colon cancer YES
 Breast cancer YES
 Gallbladder disease YES
 Anxiety / Depression YES
 Independent living (Geriatric) YES
 AND…….drum roll please…….

12. CARDIOVASCULAR AND
OVERALL ALL CAUSE
MORTALITY ARE REDUCED IN
POST HEART ATTACK PATIENTS
WHO PARTICIPATE IN REGULAR
PHYSICAL ACTIVITY

14.  Cardiovascular Endurance
 Ability to supply oxygen during sustained activity
 Body Composition
 Relative amounts of muscle, fat, bone, etc.
 Muscular Strength
 Ability of muscle to exert force
 Muscular Endurance
 Ability of a muscle to continue to perform without fatigue
 Flexibility
 Range of motion available at the joint

15.  Agility
 Ability to move with speed and accuracy
 Coordination
 Ability to move the body parts smoothly and accurately
 Balance
 Maintaining equilibrium while stationary or moving
 Power
 Ability or rate one can perform work
 Reaction Time
 Time elapsed between stimulation and reaction
 Speed
 Ability to perform a movement within a period of time

16. MODIFIED BORG RATE OF PERCEIVED EXERTION SCALE
LEVEL DESCRIPTION
0 NOTHING
0.5 EXTREMELY EASY
1 VERY EASY
2 EASY
3 MODERATE
4 SOMEWHAT HARD
5 HARD

17. MODIFIED BORG RATE OF PERCEIVED EXERTION SCALE
LEVEL DESCRIPTION
5 HARD
6
7 VERY HARD
8
9 VERY VERY HARD
10 MAXIMALLY DIFFICULT

18.  AHA Recommendation
 Pacing yourself is paramount when beginning a new
exercise program
 Target heart rates allow you to monitor your fitness
progression over time.
 Requires you to measure your pulse (radial or
carotid) periodically as you exercise to ensure you
remain within 50-85 % of your maximum heart rate.
 This range is called your Target Heart Rate.
 How do I calculate this ????

19. Maximum Heart Rate
 Men: 220 - Age = Max Heart Rate
 Women: 226 – Age = Max Heart Rate
Target Heart Rate (50-85%)
 Maximum Heart Rate x 0.5
 50% is best when starting a new exercise program
 Maximum Heart Rate x 0.85
 Progress, as you can tolerate, to 85% over a period of
at least 6 months.

20. Average Maximum
Target HR Zone Heart Rate
Age 50–85 % 100 %
20 years 100–170 beats per minute 200 beats per minute
25 years 98–166 beats per minute 195 beats per minute
30 years 95–162 beats per minute 190 beats per minute
35 years 93–157 beats per minute 185 beats per minute
40 years 90–153 beats per minute 180 beats per minute
45 years 88–149 beats per minute 175 beats per minute
50 years 85–145 beats per minute 170 beats per minute
55 years 83–140 beats per minute 165 beats per minute
60 years 80–136 beats per minute 160 beats per minute
65 years 78–132 beats per minute 155 beats per minute
70 years 75–128 beats per minute 150 beats per minute

22. What if I can’t stop to take my pulse during my
exercise program ??
Try using a conversational pace to monitor your
efforts during moderate activities.
If you can talk and walk at the same time, you
aren’t working too hard.
If you can sing and maintain your level of effort,
you’re not working hard enough.
If you get out of breath quickly, you’re probably
working too hard, especially if you have to
stop to catch your breath.

23.  Warm up
 5-10 minutes, low to moderate intensity, RPE 2-3
 Stretching
 10 minutes, can be done after warm up or cool down
 Conditioning
 20-60 minutes, aerobic/resistance/neuromuscular/sport
 Moderate to vigorous intensity for health/fitness
benefits, RPE 5-6
 Cool down
 5-10 minutes, low to moderate intensity, RPE 2-3

24.  Low Intensity  Moderate Intensity
 Minimal skill  Minimal skill
 Minimal fitness  Average fitness
 Walking  Jogging/running
 Leisurely cycling  Pilates **
 Aquatic aerobics  Aerobic class
 Slow dancing  Spinning
 Tai chi **  Elliptical exercise
 Yoga **  Stepping exercise
 Gardening  Fast dancing
 Housework
**Neuromuscular exercise

25.  Resistance training should focus on the major muscle
groups of the chest, shoulders, back, abdomen, hips, and legs.
 Average fitness individual
 2-4 sets for each muscle group
 8-12 repetitions for each set
 2-3 minute rest between each set
 Deconditioned individual
 1-2 sets for each muscle group
 10-15 repetitions for each set
 To avoid muscle imbalances that could lead to injury, train
the opposing muscle groups…..
 Low back and abdomen (back extension and abdominal crunches)
 Biceps and triceps (bicep curls and triceps dips)
 Quadriceps and hamstrings (leg press and leg curls)
 And, perform the exercise with the proper technique.
 Controlled movement, regular breathing pattern (exhale with exertion)

26.  Types of resistance training equipment
 Weight stack
 Cable pulleys
 Free weights
 Elastic bands
 Grocery bags
 Lawn mower
 Toddlers
 Pets

27.  Improves range of motion, physical function
 Insufficient data to prove that stretching prevents
injury, but it does warm the muscle group in
preparation for the activity for optimal performance.
 Stretch should involve the major muscle tendon
groups of the body (i.e. neck, shoulders, back, hips
and legs)
 Stretch should be performed to the limits of
discomfort (mild tightness) for 4 or more repetitions
per muscle group and held for a minimum of 20
seconds each.

35.  Hot environments
 Dehydration
 Heat illness – disorientation, headache, dizziness, wet and pale skin,
muscle cramps, vomiting
 Tools: gradual acclimatization, hydrate, cooler hours, loose
clothing, caution with low salt diet
 Cold environments
 Frostbite
 Numbness (miss angina symptoms)
 High Altitude
 Altitude illness – altered mental status, headache, nausea, fatigue,
bronchitis, coughing spasms
 Expect a significant decrease in physical performance due to
decreased ATM pressure.

36.  Unstable angina
 Resting systolic BP >200 and/or
 Resting diastolic BP > 110
 Acute systemic illness or fever
 Uncontrolled tachycardia > 120 bpm
 Uncompensated CHF
 30 AV block w/o pacemaker
 Peri or myocarditis
 Recent embolism
 ST segment elevation
 Uncontrolled diabetes
 Severe orthopedic conditions that would prevent exercise
 Other acute systemic metabolic conditions (thyroiditis,
hypokalemia, hyperkalemia, hypovolemia)
 Symptoms of exercise intolance

37. STOP ALL EXERCISE AT THE FIRST
SIGN OF
 ANGINA
 SEVERE FATIGUE
 SHORTNESS OF BREATH