The State of Qatar
National Physical Activity
Guidelines
First Edition
The State of Qatar
National Physical Activity Guidelines
First Edition
“And your body has a right over you.”
Prophet Muhammad
PBUH
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Qatar National Physical Activity
Guidelines - 2014
Senior Editor
Dr. Khalid Walid Al-Bibi, CETT, CHFS, CNS
Director, Sport Science
Professor, Health and Human Performance
College of Arts and Sciences
Qatar University
Doha, Qatar
Qatar National Physical Activity
Guidelines - 2014
5
PREFACE
This book was written as a practical guideline reference and not as a scientific resource.
Distilled from the latest scientific evidence and driven by local realities, the intention of
this book is to be an immediate and easy source of information for practitioners, physicians,
educators, and individuals who wish to prescribe or engage in regular physical activity. We
limited the number of beneficiary populations in the first edition of the National Physical
Activity Guidelines for Qatar (NPAG-Q) to the most prevalent epidemiologies currently facing
the nation. Subsequent or special e-addendums will include special populations, such as
people with disabilities, cerebral palsy, Down syndrome, restrictive and obstructive pulmonary
disease, spinal cord injuries, asthma, multiple sclerosis, cancer patients, etc.
Behavior modification cannot be considered independently from cultural norms, local
sensibilities, and environmental factors. Hence, we were careful to address social and
environmental factors that are unique to Qatar. Sport scientists, epidemiologists, public
health experts, health promotion specialists, health care professionals, and physicians from
Qatar and the world contributed to the development of these guidelines.
It is our hope that Qatari citizens and residents alike will use NPAG-Q as a guiding reference
as they prepare to lead more physically active lives. It is also our hope that this text becomes
ever-present in the office of every health care practitioner in Qatar and shared with patients
at every appropriate opportunity. Given the strong scientific body of evidence, it is our belief
that the practice of state-of-the-art health care is incomplete without the careful consideration
of the physical fitness of its population.
To make the guidelines as useful and as up-to-date as possible, a dedicated companion
webpage (www.namat.qa/NPAG-Q) was developed to provide practitioners, educators, and
citizens with an extensive array of resources, including data sheets, scientific references,
screening tools, health questionnaires, warm-up and flexibility exercises, basal metabolic
rate calculators, body mass index calculators, nutrition guidance, and much more. We also
added two “ask the expert” blogs, one for health care practitioners (HCPs) and another for the
general public.
Prof. Dr. Khalid Walid Al-Bibi
Professor, Health and Human Performance
Director, Sport Science
Qatar University
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Guidelines - 2014
ACKNOWLEDGMENTS
Aspire Zone Foundation (AZF) would like to acknowledge the contributions made by various
partners in the development of the first National Physical Activity Guidelines for Qatar. Among
the notable ones are the Aspetar, Aspire Academy, Qatar University, the Supreme Council of
Health, Primary Health Care Corporation, and Hamad Medical Corporation for providing the
experts to support the development of these guidelines.
Our sincere gratitude goes to our colleagues; members of the Advisory Group and the
subgroups, for their valuable input in ensuring that the guidelines are matched with the latest
scientific evidence and tailored towards meeting the various needs of the population of Qatar.
Lastly, our appreciation is extended to Aspetar’s management for their financial support to
this project as a part of their contribution to promote physical activity as a healthy lifestyle
in the community.
Dr. Mohamed Ghaith Al-Kuwari
Preventive Medicine Consultant
Director of Healthy Lifestyle Programme
Aspetar Hospital
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Guidelines - 2014
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ADVISORY GROUP
Dr. Mohamed Ghaith Al-Kuwari
Dr. Izzeldin Ibrahim
Preventive Medicine Consultant
Director of Healthy Lifestyle Program
Aspetar Hospital
E-mail: [email protected]
Preventive Medicine Consultant
Coordinator of Healthy Lifestyle Programme
Aspetar Hospital
E-mail: [email protected]
Dr. Dennis Hatcher
Dr. Stephen Targett
Manager, Exercise & Sport Science Department
Aspetar Hospital
E-mail: [email protected]
Sports Medicine Physician - Athlete Screening
Coordination, Sports Medicine
Aspetar Hospital
E-mail: [email protected]
Dr. Paul Dijkstra
Dr. Farrukh Hamid
Sport Medicine Physician, Sports Medicine
Aspetar Hospital
E-mail: [email protected]
Musculoskeletal Pain Specialist, Sports Medicine
Aspetar Hospital
E-mail: [email protected]
Dr. Robbart Vanlinschoten
Dr. Floor Groot
Sport Medicine Physician, Sports Medicine
Aspetar Hospital
E-mail: [email protected]
Sports Medicine Fellow, Sports Medicine
Aspetar Hospital
E-mail: [email protected]
Mr. Fuad Al-Mudahka
Mr. Abdulla Saeed Al-Mohannadi
Exercise Physiologist, Healthy Lifestyle
Programme
Aspetar Hospital
E-mail: [email protected]
Researcher in Health Promotion, Healthy
Lifestyle Programme
Aspetar Hospital
E-mail: [email protected]
Ms. Ivana Matic
Dr. Khalid W. Al-Bibi
Senior Health Promotion Researcher, Healthy
Lifestyle Programme
Aspetar Hospital
E-mail: [email protected]
Professor and Director, Sport Science
College of Arts and Sciences
Qatar University
E-mail: [email protected]
Dr. Walaa Fattah Al-Chetachi
Supervisor Chronic Disease Unit
Public Health Department
Supreme Council of Health
E-mail: [email protected]
Dr. Leonieke Richardson
Aspire Active Manager
Aspire Active
Email: [email protected]
Ms. Vasiliki Topalidou
Dr. Veronica Bachiller
Head, Events & Partnerships
Aspire Academy
Email: [email protected]
Lifestyle Programme Leader
Aspire Academy
Email: [email protected]
Mr. Trevor Smith
Dr. Hamad Rashid Al-Madhaki
Aspire MSSD Manager
Aspire Academy
Email: [email protected]
Head of Healthy Lifestyle Programme
Primary Health Care Corporation
E-mail: [email protected]
Dr. Madeeha Kamal
Consultant Paediatrician
Hamad Medical Corporation
Email: [email protected]
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Guidelines - 2014
EXTERNAL EXPERT
READERS
We wish to thank the following experts for lending their valuable
expertise in the finalisation of the guidelines:
Dr. Dennis W. Koch, CHFS
Associate Professor of Professional Studies
Director of Health and Human Performance
Canisius College
Buffalo, New York
United States
Prof. Dr. Yahya Al-Nakeeb, FLFHE
Associate Dean for Academic Affairs
College of Education
Qatar University
Doha, Qatar
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Guidelines - 2014
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TABLE OF CONTENTS
Evidence, Rationale, and Need
10
First Do No Harm
12
Goal Setting and Relapse Prevention
15
Goal Setting
15
Relapse Prevention
17
The General Principles of Exercise Prescription
18
Components of an ExRx for Enhancing Aerobic Fitness 19
Components of an ExRx for Enhancing Muscular Fitness
24
Healthy Adults: Asymptomatic, apparently healthy 18-64 years
27
Apparently Healthy Older Adults: Asymptomatic, 65+ Years
28
Adults with Hypertension
30
Coronary Artery Disease
31
Adults with Heart Failure
32
Diabetes Mellitus
33
Type I Diabetes
35
Type 2 Diabetes
35
Adults with Osteoarthritis
36
Adults with Metabolic Syndrome
38
Youth (12-17 years)
39
Children (5-11 years)
41
Early Years (0-4 years)
44
Recommendations for asthmatic children and children with chronic pulmonary disease:
48
Preconception, Pregnancy and Post-Partum 49
Environmental Considerations
52
Pregnancy and Heat
53
Fasting Ramadan
54
Tips for the General Public
55
Fasting and Pregnancy
56
Aspetar’s Guidelines for Exercise and Sport in Hot Weather
56
Glossary59
Appendixes63
Contraindications to Exercise
63
PAR-Q and You
64
Perceived Exertion for Physical Exertion (Borg’s Scale)
65
PARmed-X for Pregnancy
66
Blank ExRx Sheet
70
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Evidence, Rationale,
and Need
Lack of regular physical activity is a significant contributing factor for many of the most
prevalent acute and chronic diseases that have become alarmingly common in the State of
Qatar. Evidence to support the inverse relationship between a physically active lifestyle and
the incidence of cardiovascular disease, hypertension, stroke, osteoporosis, type 2 diabetes,
obesity, colon cancer, breast cancer, anxiety and depression is indisputable.
Over the past two decades, numerous epidemiologic studies, enrolling tens of thousands of
individuals from around the world, have documented a dose-response relationship between
physical activity and risk of cardiovascular disease and premature mortality. The evidence
supporting the effect of exercise on the quality of life as well as affective disorders is
very strong. A meta-analysis of 23 cohorts, representing over 1.2 million person-years of
follow-up, showed a dose-response relationship between physical activity and the risks of
cardiovascular disease. It is clear that additional amounts of physical activity or increased
physical fitness levels provide added health benefits.
In Qatar, deaths attributable to chronic non-communicable diseases (NCD) collectively
ranked as the number one cause of death in the last 10 years. The National STEPS Survey
(NSS) recently examined the health and behavior of 2,496 adults in Qatar. The results were
alarming, revealing:
41.4% of the respondents were obese
21.9% of the respondents had high blood cholesterol level
16.7% of the respondents had diabetes mellitus (vs. 11.3% in the United States,
4.9% in the United Kingdom, and 2.5% in Yemen) According to International Diabetes
Foundation (2012), Qatar ranks as the world’s 8th highest nation in the prevalence of
diabetes
To slow down or reverse these trends, health care practitioners (HCP), government
institutions, and citizens must work together to increase the levels of physical activity
in the nation. The NSS study revealed that between the ages of 18-64 years old, 63.3%
of the population reported no participation in recreational physical activity, and
86.2% of the women between 45-65 years old reported no participation in any form
of vigorous physical activity. The 2011 Global School-Based Student Health Survey
(GSHS), conducted in 32 schools and on 2,021 students in Qatar in grades 7, 8, and 9, showed
that only 15% of the students reported being physically active for a total of 60 minutes or
more on 5 or more days per week.
Although Qatar is a sports-loving nation, we fall short of meeting our minimal physical activity
needs. The dual purposes of the NPAG-Q are: 1) to encourage and help Qataris lead more
physically active lifestyles, and 2) to enlist the support of HCPs in monitoring and prescribing
more daily physical activity for their patients. Research evidence suggests that patients
counselled by their physicians to participate in physical activity are more likely to exercise.
Unfortunately, only 13% of patients in this study reported that their physician gives them
advice concerning the benefits of regular physical activity
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Economic Benefits
The logical assumption has always been that employees who are more physically active
in their place of employment incur lower medical costs, exhibit less absenteeism, reduced
disability expense, and are generally more productive. This assumption is supported by
research that reports benefit/cost ratio ranging from 0.76 to 3.43, meaning that the return
rate can be as high as three times the investment in the physical fitness of the employees.
Inactivity greatly contributes to medical costs. As an example, in the United States of America
and Canada, the total economic costs of physical inactivity and obesity represented 2.6%
and 2.2%, of the total health care costs, respectively. Therefore, investing in the health of
employees does not only make common sense, it makes economical sense as well.
The Challenge: Changing The Ethos
Changing the nation’s attitude and behaviour towards physical activity will require a
multipronged, long-term approach that involves every sector of our society. In Qatar, this is
a national priority. Building athletic and recreational facilities is a good start, but this alone
will not result in a physically active populace. Nor will dis-articulated efforts by the various
health entities lead to a new culture where physical activity is an accepted, expected, and
practiced way of life. Lessons learned from nations with a successful record in preventive
health management clearly show that all the players must come together to create a strong
and sustained effort to change the ethos towards our health and fitness as a nation. This
effort will involve the health sector, educators, sport and exercise experts, policy makers,
the Supreme Council on Education, the food industry, the health insurance industry, urban
planners and real-estate developers, and employers. When these players work in tandem and
in a sustained fashion, we will create a permanent cultural ethos towards physical activity
that will sustain itself for generations to come.
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First Do No Harm
Generally, exercise does not cause untoward events in apparently healthy individuals. When
exercise is performed according to established exercise guidelines, the risk of sudden cardiac
complications or heart attack is very low in healthy individuals performing low to moderateintensity activities. There is an increased risk of sudden cardiac death and/or heart attack
in individuals performing vigorous exercise with either diagnosed or undetected underlying
cardiovascular disease. It is therefore incumbent on the person who wishes to engage in
moderate to high intensity physical activity to rule-out such conditions if exercise is to be
conducted in clinically unsupervised settings. In clinically diagnosed individuals, carefully
prescribed exercise must be conducted under the supervision of trained specialists until
medical clearance for unsupervised exercise is given.
The risk of sudden cardiac death in individuals less than 35 years of age is small due to the
low prevalence of cardiovascular disease in this population, with the most common causes of
death in young individuals being congenital and hereditary abnormalities. The absolute risk
of non-traumatic exercise related death among high school and college athletes is one per
133,000 men and one per 769,000 women.
Studies on injuries from exercise show that the most significant factors in determining the
risk of injuries are physical condition, age, training intensity, and impact of the activity.
Exercise duration can also increase the risk of musculoskeletal and heat-related injuries. For
example, the incidence of orthopedic injuries more than doubles when comparing 45 minute
exercise sessions versus 30 minute sessions. Table 1 lists common exercises and their impact
classification. With appropriate conditioning and gradual increases in duration and intensity,
most injuries can be avoided.
For some individuals the risks associated with a high intensity physical activity programme
outweigh its potential benefits (Appendix A). In such cases, it is important to seek medical
consultation before engaging in high intensity exercise. A pre-exercise test evaluation in
the clinical setting generally includes a medical history, physical examination, laboratory
tests, and a possible submaximal or maximal graded exercise test. These evaluations provide
valuable information that help in individualising the exercise prescription (ExRx), and also
assessing the efficacy of the training programme.
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Table 1. Impact Classification of Common Exercises
Weight-Bearing/High Impact/ Resistance Activities:
Stair-climbing
Hiking
Dancing
Jogging
Downhill and cross-country skiing
Aerobic dancing
Volleyball
Basketball
Gymnastics
Weight lifting or resistance
Football
Jumping rope
Weight-Bearing/Low Impact Activities:
Walking
Treadmill walking
Cross-country ski machines
Stair-step machines
Rowing machines
Water aerobics
Deep-water walking
Low impact aerobics
Weight-Bearing/Low Impact Activities:
Lap swimming
Indoor cycling
Stretching or flexibility exercises(avoid forward-bending exercises)
Yoga
Pilates
The evidence on the effect of regular exercise on the human body is no longer anecdotal.
Over the past two decades, much research has been conducted on the effects of regular
physical activity on the physiology, psychology and health of human beings. The body of
evidence collected over the past two decades has proven unequivocally that regular physical
activity can:
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Improve general well-being and quality of life
Improve insulin sensitivity and blood sugar control (patients on oral medication or
insulin may be able to reduce the dose)
Improve blood pressure, regulate blood lipids and reduce the risk of heart attack and
stroke
Reduce joint pain and improve joint function
Improve muscle strength
Improve posture and walking, reducing the risk of falling
Promote weight management/control
Improve mental health better and lower stress levels
Improve sleep, in duration and quality
Are you ready for exercise? Your first step is
to self-screen.
There are a number of self-administered instruments that screen physical readiness for
engaging in physical activity. The NPAGQ recommends the use of the PAR-Q (Appendix B)
for its ease of use and high sensitivity. The PAR-Q is a simple one-page pre physical activity
screening tool. It should be completed before starting a moderate to vigorous physical activity
programme. If you answer ‘yes’ to one or more questions on the form, you should seek
clearance from a physician before starting a physical activity program.
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Goal Setting and
Relapse Prevention
An individual’s state of health is not a dichotomous condition where they are either healthy
or unhealthy. Rather, it exists somewhere on a hypothetical continuum where it is always in
flux, edging to one side or another based on the events of the moment. By and large, your
daily decisions and actions determine the direction your health takes on this continuum. Our
health improves when we make good decisions, and it lapses (deteriorates) when we make
the wrong decisions.
We are all at some level of health at any moment. Our goal should be to make and act on
correct decisions in an effort aimed at becoming healthier. To succeed in improving your
health, it is important to understand that becoming healthier is a process. It takes time, it
happens progressively, and there are bound to be lapses along the way. Excluding infectious
diseases and acute illnesses, we do not become “healthy” or “unhealthy” overnight, and
shortcuts to health (e.g. very fast weight loss) are almost always bound to fail.
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Goal Setting
No matter how many times you lapse, you can still reach your
goal as long as you do not give up
(collapse).
Realistic goal setting is a critical part of behaviour modification. Unrealistic goal setting (e.g.
to lose 10 Kg of fat weight in three weeks) ultimately leads to failure. This negative experience
reinforces one’s aversion to the healthy behavior making it tougher to face the same attempt
in the future. The NPAG-Q is designed around scientific evidence, which maximises the
chances of success by setting realistic goals and minimising the risk of injury and discomfort.
It is important to remember that everyone struggles to reach his or her health goals (e.g.
smoking cessation, better eating habits, weight loss, exercising regularly). We all experience
numerous lapses on our way to reaching our goals. The primary mistake committed by
individuals who embark on behaviour modification is that they consider lapses as failure
by telling themselves that they cannot control their behaviour or that they do not deserve
to succeed. This is far from the truth, as we all are subject to lapses in any behaviour
modification endeavour we may embark on.
In the context of becoming healthier by becoming more physically active, the goal is to
increase the amount of physical activity in your daily life. The NPAG-Q will provide you with
an optimal but regimented way to do that. However, whenever complying with the exercise
prescription becomes impossible (travel, visitors, family matters, weather, work) there are
numerous creative ways to continue to supplement physical activity into your daily schedule
(Table 2).
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Table 2. Simple ways to add more activity into your daily routine
Take the stairs instead of the elevator
Power-walk the mall hallways before the shops open
Park your car further away from your destination and walk the rest of the way
Get off the couch and walk around the house during TV commercial breaks
When the weather and distance permit it, walk to your friend’s house instead of
driving there
Utilise the facilities at Aspire Park and the Corniche whenever the weather allows it.
Even better, walk and talk with a friend or take your family members and make it a
regular family habit
If you have children, be their role model. Your children are very impressionable at
any age. Children will mimic their parents’ behaviours well into their old age. One
of the best gifts you can give loved ones is the gift of a good health behaviours.
Do some work in and around your house: wash your car by hand, do some gardening
and house cleaning yourself
Relapse Prevention
1.Accept responsibility
2.Examine the context
3.Rehearse new actions
Relapse prevention (RP) is a self-management technique to improve behaviour modification
by predicting future lapses (slips) and developing coping strategies to better manage high-risk
situations. RP is based on the understanding that lapses are natural and are to be expected.
If you are willing to learn from your mistakes, lapses become useful because they can help
you develop tools to avoid bad behaviour in the future.
RP encompasses identifying situations in which you are more likely to lapse and developing
coping skills that will help you overcome these situations when encountered again. RP
consists of: 1) accepting responsibility for your actions and decisions that led to the lapse,
2) examining the context in which the lapse took place, and 3) examining alternative actions
you could use should you find yourself in the same situation again. You can improve your
chances at success dramatically by learning more about RP. You can get more information
about RP on www.namat.qa.
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The General
Principles of Exercise
Prescription
The scientific principles for a safe and effective exercise programme presented in the NPAG-Q
are intended to assist in the development of an individually tailored exercise prescription.
These principles are based on the application of scientific evidence and include all healthrelated components of physical fitness. For more information about indicated (safe) and
contraindicated (unsafe) exercises please visit www.namat.qa for a more comprehensive
list. In this chapter the general components of an ExRx are presented. Chapter V will cover
population and condition-specific modifications to the general ExRx. The NPAG-Q provides
recommendations for basic activity (i.e. minimal or maintenance) as well as aerobic activity
(optimal).
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Components of an ExRx for Enhancing
Aerobic Fitness
1. Warm-up: This phase consists of
a minimum of 5-10 minutes of low-toExercise most days of the
moderate intensity cardiovascular (aerobic)
week
and muscular endurance activity designed to
increase body temperature. The purpose of
a good warm-up is to slowly increase your
Minimal 3 days per week
heart rate to the prescribed exercise intensity.
The warm-up phase improves the mechanical
efficiency of the circulatory system by
decreasing the viscosity of joint fluids and
inducing vasodilation of muscle vessels, making it easier for the heart to pump the blood
throughout the body.
2. Pre-Exercise Stretching: This phase should focus on range of motion exercises that targets
the joints most used in the conditioning phase of the ExRx. For example, if swimming is
the exercise mode, one should perform range of motion exercises for the shoulder, neck,
and hip.
3. Conditioning (stimulus phase): This is the phase that stimulates the cardiovascular
system to adapt and become stronger and more efficient with time. The components
of the conditioning phase can best be described and memorised using the FITT principle,
an acronym that stands for Frequency, Intensity, Time, and Type of exercise. It is also
important to consider the progression, or when and by how much the frequency, intensity,
time, or type of exercise is adjusted.
Frequency (how often should I exercise?): Moderate intensity aerobic exercise done
at least 5 days per week, vigorous intensity aerobic exercise done at least 3 days
per week, or a weekly combination of moderate and vigorous intensity exercise is
recommended for the majority of healthy/asymptomatic adults to achieve and maintain
health/fitness benefits.
Intensity (how hard should I exercise?):
Exercise intensity is the toughest component
of the ExRx to quantify.
There are many
12-13 on RPE scale for most
techniques that can be used to measure
adults
exercise intensity. The two most practical
ways are heart rate reserve (HRR) and ratings
Deconditioned individuals can
of perceived exertion (RPE). RPE is a simple
benefit from intensities as low
but highly valid method for measuring
exercise intensity. Moreover, unlike heart
as 9-11 on RPE scale
rate (HR), RPE is not affected by the most
commonly prescribed cardiac medications
(e.g. beta-blockers) and is considered more
robust because it is affected to a much lesser
extent by medication. RPE correlates highly
with HR and oxygen consumption (VO2) and can therefore be used as a good measure
of exercise intensity1.
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Figure 1. Ratings of Perceived Exertion (RPE) Scale
Rating of Perceived Exertion Borg RPE Scale
6
7
8
9
10
Very, very light
Very light
How you feel when lying in bed or sitting in a chair
relaxed.
Fairly light
Little or no effort
Somewhat hard
Target range: How you should feel with exercise or
activity.
11
12
13
14
15
Hard
16
17
18
19
20
Very hard
Very, very hard
Hoow you felt with the hardest work you have ever
done.
Maximum exertion
Don’t work this hard!
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How to Use the Ratings of Perceived Exertion (RPE) Scale
While doing physical activity, rate your perception of exertion (Appendix C). This feeling
should reflect how heavy and strenuous the exercise feels to you, combining all sensations
and feelings of physical stress, effort, and fatigue. Do not concern yourself with any one
factor such as leg pain or shortness of breath, but try to focus on your total feeling of
exertion.
Look at the RPE Scale while you are engaging in an activity. The scale ranges from 6 to
20, where 6 means “no exertion at all” and 20 means “maximal exertion.” Choose the
number that best describes your level of exertion. This will give you a good idea of the
intensity level of your activity, and you can use this information to decrease or increase
the exercise intensity to reach your desired range. Examples of common physical activities
by intensity of effort can be found in Table 3.
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Table 3. Examples of Common Physical Activities by Intensity of Effort
Light
Moderate/Somewhat Hard
Hard
Walking, slowly
Horseback riding (slow
gait)
Horseback riding (fast gait)
Cycling, stationary
Swimming, slow treading
Calisthenics, stretching
Golf, power cart
Fishing, sitting
Boating, power
Home care, sweeping/
vacuuming
Mowing lawn, riding
mower
Walking, briskly
Cycling, pleasure
Swimming, moderate
Calisthenics, general
Racket sports (leisure)
Golf, pulling/carrying clubs
Fishing, standing/casting
Canoeing, leisure
Home care, general
cleaning
Walking, briskly uphill
Cycling, fast or uphill
Swimming, fast treading
Calisthenics, aerobic dance
Racket sports (competitive)
Fishing, heavy and
sustained pulling
Canoeing, rapid
Moving furniture
Mowing, hand mower
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There is a positive continuum of health and fitness benefits with increasing exercise
intensity. A minimum intensity threshold - an intensity level below which the body is not
challenged sufficiently to adapt - exists for most people, with the possible exception of very
deconditioned persons. Exercise of at least moderate intensity that increases heart rate and
breathing is recommended as the minimum exercise intensity for adults to achieve health/
fitness benefits. However, a combination of moderate and vigorous intensity exercise is
ideal for the attainment of improvements in health/fitness in most adults. It is important to
take into consideration that in moderate to low fit individuals, high exercise intensity is the
primary reason for failing to comply with an ExRx.
Moderate: 30 minutes, 5
days per week
Vigorous: 20 minutes, 3 days
per week
Avoid vigorous intensity
exercise performed more
than 5 days per week
For weight loss, lower
intensity and extend
duration
Expend 1,000-2,000
Calories per week
Time (how long should I exercise?): Moderate
intensity exercise performed for at least
30 minutes ≥5 days per week, or vigorous
intensity aerobic exercise done for at least 20
minutes ≥3 days per week is recommended
for maintaining health and preventing
disease.
To promote or maintain weight
loss, 50-60 minutes per day or more of daily
exercise is recommended. Performance of
intermittent exercise of at least 10 minutes
in duration to accumulate the minimum
duration recommendations above is an
effective alternative to continuous exercise.
Total caloric expenditure and step counts may
be used as surrogate measures of exercise
duration.
For an exercise training programme that
emphasises fat loss, time must be adjusted
to allow for the expenditure of 1,000-2,000
Calories per week. In addition, irrespective
of the exercise intensity, expending 2,000
Calories per week has been shown to offer
protective health benefits and is the level at
which optimal weight loss occurs.
Type (what mode of exercise is best?): The
“best” type of exercise is inevitably the one
that you are more likely to perform again
and again.
However, rhythmic, aerobic
(cardiovascular endurance) exercise of at least
moderate intensity that involves large muscle
groups and requires little skill to perform
Use large muscles in rhythmic,
is recommended for all adults to improve
repetitive and continuous
health/fitness and offers the best results. The
motion that can be sustained
simplest exercise that meets this criterion for
most people is walking. Other exercise and
throughout the duration of
sports requiring skill to perform or higher
the session
levels of fitness are recommended only for
individuals possessing adequate skill and
fitness to perform the activity continuously
and without frequent interruptions. When
choosing the exercise type, the individual’s
goals, current physical ability, health status,
and available equipment should be considered. Table 4 provides general recommendations
for the types of exercises to be included in a health/fitness exercise training programme for
apparently healthy adults.
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Table 4. Modes of Exercise to Improve Aerobic Fitness
Exercise
Group
Exercise Descripition
A
Endurance activities
requiring minimal skill
All adults
or physical fitness to
perform
Walking leisurely
cycling ,aqua –
aerobics slow
dancing
B
Adults (as per the preparVigorous intensity
ticipation screening guideendurance activities
lines in chapter 2) who are
requiring minimal skill habitually at least average
physical fitness
Jogging,running
Rowing,aerobics
Spinning,elliptical
Exercise,stepping
Exercise,fast dancing
C
Endurance activities
requiring skills to
perform
Adults with acquired skill and/
or at least average physical
fitness levels
Swimming crosscountry skiing,
skating
D
Recreational sports
Adults with a regular exercise
programme and at least
average physical fitness
Racquet sports,
basketball, football
down skiing, hiking
Recommended for
Examples
Rate of Progression: The recommended rate
of progression in an exercise programme
depends on the individual’s health status,
exercise tolerance, and exercise programme
goals. Progression may consist of increasing
any of the components of the FITT
Changes should be made in
framework. During the initial phase of the
small increments.
exercise programme, increasing exercise
duration is recommended. An increase in
exercise duration per session of 5-10 minutes
every 1-2 weeks over the first 4-6 weeks of
an exercise training programme is reasonable
for the average adult. After the individual has been exercising regularly for one month
or more, the frequency, intensity and/or time of exercise is gradually adjusted upward
over the next 4-8 months or longer for older adults and very deconditioned persons. Any
progression in any of the FITT exercise prescription components should be made gradually.
Avoid large increases in any of the FITT components.
Increase duration first, by
5 -10 minutes every 1-2
weeks.
Components of an ExRx for Enhancing
Muscular Fitness
Further health/fitness benefits can be added by supplementing an aerobic training programme
with resistance training. In addition to the many benefits gained from increasing muscular
fitness, a well-developed resistance-training programme makes everyday activities less
stressful. A resistance-training programme usually takes the form of weight lifting using freeweights or machines, but may also include exercises that utilise body weight, such as pushups and pull-ups. When performed correctly, resistance training improves all components of
muscular fitness including strength, endurance, and power. Resistive exercise also improves
bone density and coordination, minimising the incidence of injury consequent to falling,
which is common in the elderly population. For these reasons, resistance training in the
elderly population should play a significant role in their training.
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1. Warm-up: This phase consists of a minimum of 5-10 minutes of low intensity cardiovascular
(aerobic) and muscular endurance activity designed to increase body temperature. Knee
lifts, walking in place or around a track while doing shoulder circles, or light stationary
cycling are all good forms of a gentle and proper warm-up.
2. Pre-Exercise Stretching: This phase should focus on range of motion exercises that targets
the joint(s) most used in the conditioning phase of the ExRx. For example, if you plan
to focus on strengthening your shoulder or chest muscles, one should perform range of
motion exercises for the shoulder.
3. Conditioning Phase:
Frequency:
For general muscular fitness, particularly
among those who are untrained or
recreationally trained, an individual should
Allow for 48 hours recovery
resistance train each major muscle group
2-3 days per week with at least 48 hours
separating the exercise training sessions for
the same muscle group. Depending on the
individual’s daily schedule, all muscle groups
to be trained may be done so in the same session (whole body) or each session may “split” the
body into selected muscle groups so that only a few of them are trained in any one session.
For example, muscles of the lower body may be trained on Mondays and Thursdays, while
upper body muscles may be trained on Tuesdays and Fridays. This “split” weight training
routine entails 4 days per week to train each muscle group twice weekly; however, each
session is of shorter duration than a whole body session used to train all muscle groups
of the body. Both methods are effective as long as each muscle group is trained 2-3 days
per week. Having these different resistance training options provides the individual with
more flexibility in scheduling, which may help to improve the likelihood of incorporating a
resistance-training regimen into his/her daily schedule.
Exercise 2-3 days per week
Intensity and Volume:
To focus on muscle toning,
use lightweights or none.
Perform three sets, but
increase the repetitions to
12.
Rest for at least 60 seconds
in between sets. However, to
focus on muscle endurance,
lower rest time to less than
30 seconds.
Intensity in resistive training is the weight
that is used to train relative to the maximal
force that each muscle group can perform
maximally (i.e. % of the resistance that the
muscle can perform once only). The process
of finding any given muscle’s maximal force
production, called one-repetition maximal
(1RM), is derived via trial and error and
involves the progressive increased loading
of a muscle until the exercise can only be
performed once. The resistance is noted for
each muscle group and the intensity for the
ExRx is calculated as a percentage of the 1RM.
Training volume is the product of sets and
repetitions (reps). A rep is the number of times
an exercise is repeated. A set is the number
of times the exercise is repeated for the set
number of repetitions. For example, if you do
10 pushups and then relax, and then you repeat this sequence 2 more times, then that means
that you performed 3 sets of 10 reps of pushups. The number of sets and reps and be varied
to modify the volume of training for each specific muscle group.
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Adults:
Should train each muscle group for a total of 2 - 4 sets with 8 -12 repetitions per set with a
rest interval of 2 - 3 minutes between sets to improve muscular fitness.
For older adults and very deconditioned individuals:
≥ 1 set of 10 - 15 repetitions of moderate intensity (i.e., 60%– 70% 1-RM), resistance exercise
is recommended.
Type:
Resistance training regimens should include
multi-joint or compound exercises, i.e.
Use multi-joint exercises
exercises that affect more than one muscle
group. These exercises should focus on the
Training opposing muscles
major muscle groups of the chest, shoulders,
equally
upper and lower back, abdomen, hips, and
legs.
Examples of multi-joint exercises
include the chest press, shoulder press, pulldown, dips, lower-back extension, abdominal
crunch/curl-up, and leg press. Single joint
exercises targeting major muscle groups, such as biceps curls, triceps extensions, quadriceps
extensions, leg curls, and calf raises, can be included in a resistance-training programme.
In order to avoid creating muscle imbalances that may lead to injury, train opposing muscle
groups. Examples of these types of complementary resistance exercises are lower back
extensions (to target for the lower back muscles) and abdominal crunches (to target the
abdominal muscles). For a more complete listing of exercises please visit www.NPAGQ.com.
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Population-Specific
ExRx Guidelines
Healthy Adults: Asymptomatic, apparently
healthy 18-64 years
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
3 days per week
v
5 days per week or more of
moderate exercise or 3 days
per week or more of vigorous
exercise or a combination
of moderate and vigorous
exercise 3 to 5 days per week
Light to moderate
intensity
Moderate: RPE = 11-13 or
RPE = 10-13
Vigorous: RPE = 13-15
TIME
15 to 30 minutes
per day
30 to 60 minutes per day of
moderate exercise or 20 to 60
minutes per day of vigorous
exercise
TYPE
Low to moderate
impact continuous
physical activity
utilising
large
muscle
groups
such as walking or
leisurely cycling
Low to high impact physical
activity utilising large muscle
groups such as power walking,
jogging, cycling, swimming or
combination of such exercises
(cross training)
STRENGTH
At least two days a week. Physical
activities that strengthen muscles
involve using body weight or
working against a resistance.
This should involve using all the
major muscle groups. Examples
include:
carrying or moving
heavy loads such as groceries,
activities that involve stepping
and jumping, aerobics.
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Frequency
Do These Types of Exercises
At least 5 days per
week
Moderate intensity (RPE = 11-13) aerobic (cardiovascular
endurance) activities, weight bearing exercise, flexibility exercise
At least 3 days per
week
Vigorous intensity (RPE= 13-15) aerobic activities, weight
bearing exercise, flexibility exercise
3-5 days per week
A combination of moderate and vigorous intensity aerobic
activities, weight bearing exercise, flexibility exercise
2-3 days per week
Muscular strength and endurance, resistance exercise,
calisthenics, balance and agility exercise
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Apparently Healthy Older Adults:
Asymptomatic, 65+ Years
Basic Activity
Aerobic Fitness
FREQUENCY
3 days per week
5 days per week or more of moderate
exercise. For those who are already
moderately active 5 days per week
or more, 3 days per week or more of
vigorous exercise or a combination of
moderate and vigorous exercise 3 to
5 days per week is appropriate
INTENSITY
Initial
workload
should be light.
Additional increase
in intensity should
be
incremental
and small
RPE = 10-13
RPE = 13-15
At least 50-60 minutes per day of
moderate intensity activity.
TIME
Up to 50 minutes
per day
TYPE
Stationary
equipment is
preferred initially,
particularly for
those with poor
balance (e.g. cycle
ergometers).
Leisurely walking
STRENGTH
At least two days a week. Physical
activities that strengthen muscles
involve using body weight or
working against a resistance.
This should involve using all the
major muscle groups. Examples
include:
carrying or moving
heavy loads such as groceries,
and activities that involve
stepping.
This can be done in bouts of 10
minutes or more – one way to
approach this is to do 30 minutes on
at least 5 days a week.
For those who are already regularly
active
at
moderate
intensity,
comparable benefits can be achieved
through 75 minutes of vigorous
intensity activity spread across the
week or a combination of moderate
and vigorous activity
Brisk walking, jogging, water
activities
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Adults with Hypertension
Hypertension (high blood pressure) is a medical condition where the blood pressure (measured
on more than one occasion under standardised conditions) is too high (systolic blood pressure
of 140 mm Hg or more or diastolic blood pressure of 90 mmHg or more). Untreated high
blood pressure leads to many complications affecting blood vessels, the heart, kidneys, eyes
and the brain.
The basis of treatment is a combination of interventions to lower the blood pressure, such
as an increase in physical activity, diet modification, smoking cessation, and reducing stress.
Medication might be prescribed when blood pressure is very high or when it does not respond
to lifestyle changes alone.
Basic Activity
Aerobic Fitness
FREQUENCY
Most days of the
week
3-5 sessions per week
INTENSITY
Light: RPE= 10-12
Moderate: RPE = 11-13
TIME
>30 minutes every
day
30-60 minutes, which can be accumulated
over the day
Walking, jogging, cycling, swimming, ball
sports, skating, fitness class, rowing
TYPE
Walking, climbing
stairs, gardening
Avoid upper body-only exercises, such as arm
ergometers, and avoid Valsalva maneuvre
(holding breath while exerting) during any
exercise
STRENGTH
It is important to include a warm-up and cool-down activity of a lower exercise
intensity.
Resistance training should be done 2-3 times per week. The focus should be on more
repetitions and low resistance
1-3 sets of 8-10 different exercises, each 20-30 repetitions
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Coronary Artery Disease
Coronary Artery Disease (CAD) is hardening of the blood vessels that feed the working
muscles of the heart. A significant block in these arteries may lead to angina (chest pain) or
a myocardial infarction (heart attack).
The basis of CAD treatment is a combination of short and long-term interventions to improve
the blood supply to the heart muscle, such as medication or invasive widening of the artery
using a stent or bypass graft surgery. Physical activity, exercise, and accompanying life-style
behaviour modification are essential components for treating and preventing coronary artery
disease.
Patients with coronary artery disease should perform regular aerobic, strength and flexibility
type exercises as well as maintaining a good baseline physical activity. Limit low activity
pastimes (watching television, computer work, playing electronic games) to no more than 2
hours per day.
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Every day
3-5 sessions per week
Talking is still possible
but heart rate and
breathing will be
increased
Until out of breath
RPE = 12-13
RPE = 10-12
TIME
>30 minutes every day
Walking, climbing stairs,
gardening
TYPE
STRENGTH
2-3 sessions per week
8-10 different exercises, each
8-12 repetitions or until near
muscle exhaustion
Movements using body weight
as resistance, resistance bands,
weights, resistance equipment
NOTE: increase standing
and walking at work and
at home
20-60 minutes total over
24 hours
Brisk walking, jogging,
cycling, swimming, ball
sports, skiing, skating,
fitness class
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Adults with Heart Failure
Heart Failure is a medical condition where the heart (muscle) is unable to pump enough blood
(to provide oxygen) to the body. The most important causes of this is hardening of the blood
vessels of the heart muscle and high blood pressure. There might be other reasons why the
heart muscle is not strong enough like diabetes, heart valve disease, abnormal heart rhythm,
and other diseases.
The basis of treatment is a combination of interventions to improve the function of the
heart muscle. This includes medication, dietary adjustments, and the strengthening of the
myocardium as well as skeletal muscles through exercise.
Limit pastimes where you are sitting (watching television, computer work, playing electronic
games) to no more than 2 hours per day.
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
3-5 sessions per week
INTENSITY
Talking is still possible but
heart rate and breathing will be
increased
Until out of breath
RPE = 10-12
>30 minutes every day
TIME
TYPE
Walking, climbing stairs,
gardening
NOTE: increase standing and
walking at work and at home
RPE = 12-13
20-60 minutes total over 24 hours
Walking, jogging, cycling,
swimming, ball sports, skating,
fitness class, rowing
STRENGTH
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
Please refer to the general precautions and exercise tips earlier in this chapter. In addition
you need to consider the following:
Water exercises (hydrotherapy) are a good form of exercise for patients with heart
failure
Training of respiratory muscle 3-7 times per week for 30-60 minutes will help to
improve the symptoms of heart failure
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Diabetes Mellitus
Type 1 diabetes is a chronic disease characterised by high blood sugar levels due to the body
not being able to make enough insulin. Regular physical activity and a low carbohydrate diet
help to reduce insulin requirements and will lower the risk of heart disease and stroke.
Special Considerations for Diabetics:
Blood Glucose Levels
Physical activity greatly affects blood glucose levels. Hence, patients must consult
with their physician about medication adjustments (time of day, dosage).
Diabetics need to consult with a dietician about pre- and post exercise meals in relation
to the intensity and the exercise session.
If ketones are present in urine, exercise will be contraindicated until blood level is
below 13mol/l
If blood glucose < 6.0 mmol/L, take 20-30g carbohydrate before exercising
Do not exercise if blood glucose > 15.0 or ketotic
Exercise 1-2 hours after food and more than one hour after your last dose of insulin
Reduce the last insulin dose by 30-50% if the exercise bout will be long or intense
Do not inject the insulin in the muscle that will be used extensively in the exercise
Carry a carbohydrate snack with you in case of a hypoglycemic episode and try to
exercise with a partner who is able to help in an emergency
Wear a medic alert bracelet
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Footwear and Clothing
Footwear should be comfortable and breathable to help avoid injury during exercise.
Diabetics are predisposed to neuropathy, which can decrease sensation in the feet.
Avoiding bruises and blisters is important because these injuries will take longer to
heal, thus preventing the patient from exercising for an extended period of time
Clothing needs to allow breathability and be appropriate for the exercising environment.
Clothing that retains heat and moisture is not appropriate for patients during exercise,
especially in hot or humid environments. An increase in core temperature can lead to
a rapid onset of dehydration Hydration:
Proper hydration should be easily accessible during exercise
Hydration should not be with sodas or sugary beverages, which will alter blood glucose
levels
Hydration with water should occur before the onset of thirst Sugar Snack
A sugary snack can be given to increase the blood glucose concentration before
exercise if it is below 6 mmol/L
A sugary snack should also be available during exercise, and not only in vending
machines. The risk of hypoglycemia is decreased with the intake of a sugary snack
A carbohydrate snack should be eaten for every 30 minute session of exercise
Aerobic Exercise versus Resistive Training
Aerobic exercise is the best form of exercise for Type 1 or 2 diabetic patients because
it does not require quick bursts of energy
Resistance training may also be appropriate, depending on overall health status
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Type I Diabetes
Basic Activity
(diabetes well controlled)
Aerobic Fitness
(diabetes well controlled)
FREQUENCY
Every day
3-5 sessions per week
INTENSITY
Talking is still possible but heart
Moderate: RPE = 11-13
rate and breathing will be increased or Vigorous: RPE = 13-15
TIME
>30 minutes every day
20-60 minutes total over 24 hours
Walking, climbing stairs, gardening
Brisk walking, jogging, cycling,
swimming, ball sports, skating,
fitness class, rowing
TYPE
NOTE: increase standing and
walking at work and at home
STRENGTH
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
Type 2 Diabetes
Type 2 diabetes is a chronic disease characterised by high blood sugar, which can lead to heart
attack, stroke, and abnormal blood lipids. Regular physical activity, a weight loss programme,
and a low carbohydrate diet help to reduce insulin or oral medication need and will lower the
risk of heart disease and stroke.
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
3-5 sessions per week
INTENSITY
Talking is still possible but
heart rate and breathing will be
increased
Until out of breath
TIME
>30 minutes every day
20-60 minutes total over 24 hours
TYPE
Walking, climbing stairs,
gardening
NOTE: increase standing and
walking at work and at home
Brisk walking, jogging, running, cycling,
swimming, ball sports, skating, fitness
class, rowing
Strength
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
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Adults with Osteoarthritis
Osteoarthritis (OA) is a very common chronic disease characterised by the deterioration of the
articular cartilage in a joint. Most people complain of joint pain and a loss of joint function,
and some patients report associated stiffness.
The basis of treatment is exercise to improve joint function and lose weight where appropriate.
Medication is sometimes prescribed to reduce pain and stiffness. For some individuals with
advanced OA, joint replacement surgery might be recommended.
Patients with osteoarthritis should do regular aerobic, strength, and flexibility exercises and
also maintain a good baseline physical activity to improve posture, gait and increase strength
and joint flexibility. This will lower the risk of falling and reduce joint pain.
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
3-5 sessions per week
INTENSITY
Normal talking is still possible
during the exercise but heart
rate and breathing will be
increased
RPE = 12-13
TIME
>30 minutes every day
20-60 minutes total over 24 hours
Brisk walking, cycling, swimming,
skating, fitness class, rowing.
TYPE
Weight bearing exercises such
as walking, climbing stairs,
and resistive exercise.
NOTE: increase standing and
walking at work and at home
Jogging and ball sports might
aggravate osteoarthritis – seek advice
first
STRENGTH
2-3 sessions per week. The focus should be on more repetitions and low resistance
Low to moderate muscle contractions
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
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Special Considerations for Osteoarthritis:
People with osteoarthritis should match the type and amount of physical activity to
their abilities and the severity of their condition. A physician should do this as part of
the pre-exercise medical assessment
Extra care much be considered when participating in contact sports e.g. football,
basketball, handball and rugby, especially if cases of advanced OA or increased
symptoms of pain and swelling
Patients with generalised osteoarthritis should keep the intensity of the exercise at a
low level for a prolonged period of time
Strenuous exercise should be avoided when joints are very painful or stiff
Pain may increase in the first 4 weeks after beginning exercise. This can be treated
with normal painkillers or anti-inflammatory medication
Proper seat height is important to ensure knee flexion is not less than 90 degrees
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Adults with Metabolic Syndrome
Metabolic Syndrome is a disease consisting of a number of factors such as abdominal obesity,
insulin resistance, abnormal blood lipids, and high blood pressure. Patients with metabolic
syndrome have an increased risk of cardiovascular disease, type 2 diabetes, dementia,
Alzheimer’s disease and some common forms of cancer (prostate, colon and breast).
The basis of treatment is changing lifestyle behaviours. The two key elements are increasing
physical activity and weight loss.
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Most days of the week
At least 3-5 sessions per week
Talking is still possible
Until out of breath but not
hyperventilating
RPE = 11-13
RPE = 13-15
20-60 minutes total over 24 hours
TIME
TYPE
>30 minutes every day
Walking, climbing stairs,
gardening
NOTE: increase standing and
walking at work and at home
Increased duration will be more
beneficial for obesity
Brisk walking, jogging, cycling,
swimming, ball sports, skating,
fitness class, rowing
STRENGTH
2-3 sessions per week. The focus should be on more repetitions and low resistance
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
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Youth (12-17 years)
For healthy adolescents, we recommend 60 minutes of daily physical activity and reducing
sedentary activities. This can be accomplished by the following:
Adults should act as role models
Youth should participate in a variety of enjoyable and safe physical activities that
support their natural development. Expose children to a variety of activities and let
them select what they enjoy to participate in regularly
Daily activity can be accumulated in various settings: at home, in school and in the
community
Remove TV and computers from bedrooms and limit screen time (TV, computer, iPad,
mobile phones, video games, etc.) to less than 2 hours a day
Take an activity break after every hour of sitting time
Register children in extracurricular activities, such as youth leagues in football, skating,
etc. Parents should encourage their children by taking them to the training sessions
and providing support from the sidelines. Verbally reward them for their effort
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FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Everyday
At least 3 times per week
Moderate: Heart is
beating faster and
breathing is harder
than normal. It is still
possible to talk during
the activity
Vigorous: Heart is beating much faster and
breathing is much harder than normal. It is
very hard to talk during the activity
RPE = 13-15
RPE = 10-12
TIME
60 minutes per day
60 minutes per day
TYPE
Brisk walking, bike
riding, skate boarding,
leisurely skating
Running, football, basketball, swimming,
jumping, basketball, volleyball, and most
forms of competitive sports
STRENGTH
At least 3 times per week
Calisthenics: Push-ups, Sit-ups, Pull-ups, etc.
High intensity weight training is permissible if physical maturity is reached.
Safety tips
Base activities on physical maturity rather than chronological age to reduce the risk
of injury
Use of appropriate protective equipment (bicycle helmets, shin guards, etc.)
Use appropriate footwear
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Children (5-11 years)
For healthy children, we recommend 60 minutes of daily physical activities, along with
reducing sedentary activities. This can be accomplished by the following:
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Less active children can start with smaller amounts of physical activity and gradually
increase duration, intensity and frequency
Children should participate in Physical Education classes
Enroll children in scheduled age specific sporting activities
Daily activity can be accumulated in various settings (including outdoor activities
whenever possible): at home, in school and in the community
Encourage children to progressively reduce amount of time spent sitting and in front
of electronic devices
Remove TV and computers from bedrooms
Take an energy break after every one hour of sitting
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Basic Activity
FREQUENCY
Every day of the week
INTENSITY
Moderate to vigorous physical activity. Children should not be forced
to overexert
TIME
At least 60 minutes per day
TYPE
Bike riding, tricycle, scooter, playground activities (races, tag, etc.), sport
games (football, basketball tennis), swimming, gymnastics, jumping,
running, folk dancing
Exercise should not be over-structured for this age group. Children
want to make their own gameplay rules. Excessive over-structuring of
gameplay reduces the fun and discourages the children from the game
STRENGTH
Children should not be discouraged from participating in strengthening exercise, but they
should not be pushed to overexert. Children generally know their physical limitations and
are prone to get injured more readily when subjected to external pressure
Safety tips
Base activities on physical maturity rather than chronological age to reduce the risk
of injury
Use of appropriate protective equipment (bicycle helmets, flotation devices, sun screen
lotion, shin guards, etc.)
Use appropriate footwear
Exercise in the Heat
Avoid participation in physical activity during the hottest parts of the day
Use shaded areas whenever possible and especially between 10 am and 3 pm, when the sun
is at its hottest
In cases of extreme heat and humidity, restrict excessive physical activities outdoors
Remind children to drink enough water before, during and after physical activity
Drinking milk after physical activity in the heat can be good for replacing the fluids because
it contains salt
Children should wear loose-fitting white or light-coloured clothes and clothes that expose the
skin to the air in order to help sweat evaporate and cool the body
Use sunscreen (sunblock) 20 minutes before going outdoors to protect your child’s entire skin
exposed to the sun (SPF of at least 30)
Physical activities in hot weather should only be at moderate level
Splash your child’s body with water to cool down before physical activity and during breaks
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Any child or adolescent should avoid or limit exercise, sport participation, or other physical
activity in the heat if he or she is currently ill or is recovering from an illness especially those
involving gastrointestinal distress (e.g., vomiting, diarrhoea) and/or fever
Warning signs: dizziness, headache, nausea (desire to vomit), shivering, hot dry skin,
exhaustion, or collapse. In these cases get professional medical help without delay.
Vitamin D deficiency
Vitamin D deficiency continues to be prevalent in this group and supplementation may be
needed. The amount of sun exposure needed to meet the body’s vitamin D requirements
varies from one person to another and is also dependent on location, skin colour, time of year,
time of day, and atmospheric conditions. However, as a general guide, exposure to the sun
with the appropriate exercise attire, for 15 minutes per day will help reduce or eliminate the
need for vitamin D supplementation.
Early Years (0-4 years)
Caregivers should minimise time children spend being sedentary during waking hours,
including prolonged sitting or being restrained in a stroller or a high chair for more than an
hour at a time.
Infants:
< 1 Year Old
Toddlers:
1-2 years old
Preschoolers:
3 – 4 years old
At own but
encourage more
active play
FREQUENCY
Several times per day
INTENSITY
At own
At own
TIME
Kids should not be confined for
any extended duration of time
180 minutes of play per day
progressing to include more energetic
play by the age of 5
Unstructured Play
Interaction with caregiver
TYPE
“Tummy time” and “floor time”time spent on the stomach
or back during waking hours
including rolling and playing on
the floor
Reaching out and grasping
objects (e.g. rough, soft), pulling
and pushing
Include a greater variety of physical
activity options, including:
Climbing stairs and moving around the
house
Playing outside and safely exploring
their environment
Crawling, running and walking, hopping,
sliding, galloping, leaping
Bouncing, catching, kicking, throwing
Crawling
Rhythmic activity
Body awareness
Any activity that gets children moving,
including playing with water
Introduce to music
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How to reduce the sedentary behaviour?
Provide equipment to encourage movement (balls of different sizes and textures,
beanbags, scarves, ropes, push scooter etc.).
Older children should be encouraged to engage in more energetic play.
Create safe spaces for play. Restrict access to swimming pools without adult
supervision. Make sure there are no small or sharp objects accessible.
Provide opportunities for children to interact with other same age children.
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Exercise in the Heat- Children and Young Adults
Keep your children away from direct sun and try to avoid hottest parts of the day
Use shaded areas whenever possible especially between 10 am and 2 pm when the
sun is hottest
In cases of extreme heat and humidity, restrict excessive physical activities outdoors
Remind children to drink enough water before, during and after physical activity
Drinking milk after physical activity in the heat can be good for replacing the fluids
because it contains salt
Children should wear loose-fitting white or light-coloured clothes and clothes that
expose the skin to the air in order to help sweat evaporate and cool the body
Use sunscreen (sunblock) 20 minutes before going outdoors to protect your child’s
entire skin exposed to the sun (SPF of at least 30).
Physical activities in hot weather should only be at moderate level
Splash your child’s body with water to cool down before physical activity and during
breaks
Any child or adolescent should avoid or limit exercise, sport participation, or other
physical activity in the heat if he or she is currently ill or is recovering from an illness
especially those involving gastrointestinal distress (e.g., vomiting, diarrhoea) and/or
fever.
Warning signs: dizziness, headache, nausea (desire to vomit), shivering, hot dry skin,
exhaustion, or collapse. In these cases get professional medical help without delay.
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Vitamin D deficiency
In infants and children, requires a supplementation of vitamin D of 400 IU. Vitamin D deficiency
continues to be prevalent in this group and doses may need to be increased, especially in light
of the evidence that the amount of vitamin D needed for sufficiency can vary with weight
or BMI. Overweight and obese children are at higher risk for vitamin D deficiency and may
need a higher intake.
Sun exposure
The amount of sun a person needs to meet their vitamin D requirements varies hugely,
depending on location, skin type, the time of year, the time of day, and even the atmospheric
conditions. However, it is safe to state that 5 to 30 minutes of exposure to the face, arms,
back or legs (without sunscreen) two times every week is sufficient. Individual factors that
influence how much Vitamin D a person needs include: 1) how much time they spend outdoors
2) the colour of their skin, 4) age, 5) diet, and 6) body weight.
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Recommendations and ExRx Adjustments for
children with asthma and diabetes
Children with well-controlled diabetes or asthma should be able to be physically active and
reduce sedentary life style.
Type 1 Diabetes Management:
Parents should inform the school nurse and physical trainer that their child is a Type I
diabetic prior to starting physical activity
The child should also have a medic alert ID
The school should have a diabetes management plan. Parents should check with the
school for the existence of such a plan before they allow their children to engage in
vigorous physical activity at the school
Type I diabetic children, their teachers and parents should always have the required
medication and sugars required for treatment of hypoglycemia available when they
exercise
Keep child well hydrated. Water should be consumed ad-libitum (at will) and
encouraged throughout the day. Water fountains should be available throughout the
training/exercise area
In the summer, children should be called in regularly to consume water
Monitor blood glucose before and after physical activity
If blood sugar is below target range before exercise, the suggested intake is 15g of
carbohydrate (may need to be less in younger children)
For prolonged vigorous exercise, monitor blood glucose hourly during exercise and
after completion of exercise to gauge carbohydrate intake and insulin dose adjustment
Recommendations for asthmatic children and children with
chronic pulmonary disease:
Physical activity/exercise should be conducted indoors if the outdoor environment is
dusty and polluted
Asthmatic children should use their prescribed medications (b2 agonists, inhalers, etc.)
15 to 30 minutes prior to beginning exercise, or as indicated by their peadiatrician
The school must have an emergency plan to manage asthma attacks. Parents should
check with the school for the existence of such a plan before they allow their children
to engage in vigorous physical activity at the school
Children who had experienced asthma symptoms during the previous 24 hours should
consult with their physicians before allowing their children to participate in vigorous
physical activity
The child should be free of asthma symptoms immediately prior to physical activity
No coughing or wheezing
No difficulty breathing or chest tightness
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Preconception, Pregnancy and Post-Partum
Women of childbearing age should be physically active. For many women, pregnancy is an
appropriate time to modify behaviours and adopt a healthier lifestyle. These habits can
affect the future health of both mothers and their babies. Exercise improves overall health and
maternal cardiovascular fitness, prevents and controls hypertension and gestational diabetes
mellitus, improves self-esteem and decrease risk of depression, makes postpartum weight
loss easier, decreases fetal stress during delivery and increased neurological development,
and decreases the risk of infant obesity.
Current research suggests that moderate levels of regular exercise performed over the course
of a low risk pregnancy bear minimal risk to the fetus while delivering numerous metabolic
and cardiorespiratory health benefits to the mother. Therefore, initiating or continuing
exercise is recommended in most pregnancies to achieve the associated health benefits. In
a recent study, 42% of women of childbearing age reported exercising during pregnancy and
having a strong desire to continue exercising post-delivery.
The PARmed-X for pregnancy document (Appendix D) is a complimentary form to consider
utilising during medical prescreening, monitoring, and exercise prescription for pregnant
women.
Inactive or Unfit
(high risk)
Active and Fit
(low risk)
Seek medical direction
3-4 days per week
Low intensity
Moderate Intensity
RPE = 9-11
RPE = 12-15
TIME
10-minute bouts performed 5-6
times daily or 15-minute bouts
performed 3-4 times daily
40-50 minutes per day accumulated
in 15 – 30 minute exercise bouts
TYPE
Walking, cycling, light swimming
Prenatal Yoga, swimming, jogging,
power walking, cycling
FREQUENCY
INTENSITY
STRENGTH
2-3 times per week.
40-60% 1RM, Pilates, Yoga, Kegel exercises
Pregnancy is not a time to lose weight, diet, nor train to compete. Intense or vigorous exercise
is discouraged. Exercise intensity should not exceed pre-pregnancy levels.
Additional Precautions:
Avoid hot and humid places.
Pool temperature should be 28-31°C.
The following conditions should be considered contraindications to exercise during
pregnancy. Women with these conditions should not exercise:
Pregnancy-induced hypertension
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Pre-term rupture of membranes
Pre-term labor during the prior or current pregnancy or both
Incompetent cervix/cerclage
Persistent second or third trimester bleeding
Intrauterine growth retardation
Exercise Guidelines for Pregnancy and the Postpartum Period
There are no data in humans to indicate that pregnant women should limit exercise intensity
because of potential adverse effects. For women who do not have any additional risk factors
for adverse maternal or perinatal outcomes, the following recommendations may be made:
During pregnancy, women can continue to exercise and derive health benefits even
from mild to moderate exercise routines. Regular exercise (at least 3 times per week)
is preferable to intermittent activity
Women should avoid exercise in the supine position after the first trimester. Such a
position is associated with decreased cardiac output in most pregnant women; because
the remaining cardiac output is preferentially distributed away from the uterus during
vigorous exercise, such regimens are best avoided during pregnancy. Prolonged
periods of motionless standing should also be avoided
Women should be aware of the decreased oxygen available for aerobic exercise during
pregnancy. They should be encouraged to modify the intensity of their exercise
according to maternal symptoms. Pregnant women should stop exercising when
fatigued and not exercise to exhaustion. Weight-bearing exercises may under some
circumstances be continued at intensities similar to those before pregnancy throughout
pregnancy. Non-weight-bearing exercises, such as cycling or swimming, minimise the
risk of injury and facilitate the continuation of exercise during pregnancy
Morphologic changes in pregnancy should serve as a relative contraindication to types
of exercise in which loss of balance could be detrimental to maternal or fetal wellbeing, especially in the third trimester. Further, any type of exercise involving the
potential for even mild abdominal trauma should be avoided
Pregnancy requires an additional 300 kcal/day to maintain metabolic homeostasis.
Thus, women who exercise during pregnancy should be particularly careful to ensure
an adequate diet.
Pregnant women who exercise in the first trimester should facilitate for heat dissipation
by ensuring adequate hydration, appropriate clothing, and optimal environmental
surroundings during exercise. Avoid body temperatures above 38°C (hot tubs, saunas,
prolonged exercise in heat and humidity)
Many of the physiologic and morphologic changes of pregnancy persist 4 to 6 weeks
postpartum. Thus, pre-pregnancy exercise routines should be resumed gradually
based on a woman’s physical capability. Acceptable guidelines are to resume activity
1 week after vaginal delivery and 6 to 10 weeks following a cesarean section
Strenuous exercise should not exceed 15 minutes and may require adjusting as the
pregnancy advances
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Environmental
Considerations
In Qatar, the weather, traditions, culture, and faith play a very important role in how we
schedule our daily work and school routines, our social life, and our physical activities
throughout the day. Although winters are very pleasant and conducive to outdoor activities,
summers tend to be hot with strong and dominant sunshine. When considering partaking
in physical activity in the summer, precautions must be considered to safeguard our health
from untoward consequences of overexposure to the elements. This chapter will discuss
precautions that must be considered for healthy individuals, individuals with known disease,
during pregnancy, as well as for fasting the holy month of Ramadan.
Heat illness and all its variants (Table 5) are preventable illnesses, and can also include
dehydration (loss of body fluid), heat cramps (cramping of skeletal muscle), that result from
exposure to environmental temperature (classic or non-exertional) or from strenuous exercise
(exertional) and can progress to severe and life-threatening illnesses characterised by a core
body temperature that rises above 40°C that is accompanied by hot, dry skin and central
nervous system alterations (delirium, convulsions or coma). These illnesses are often fatal
and under diagnosed.
Sequence of Events in the Progression of Heat Illness.
CONDITION
DEFINITION
Heat wave
Three or more consecutive days during which the air temperature
is >32.2oC
Perceived discomfort and physiological strain associated with
exposure to a hot environ ment especially during physical work
Serve illness characterised by a core temperature >40oC and central
nervous system. Abnormalities such as delirium, convulsions or
come resulting from exposure to environmental heat (classic heat
stroke) or strenuous physical exercise (exertional heat stroke)
Mild-to-moderate illness due to water or salt depletion that results
from exposure to high environmental heat or strenuous physical
exercise sign and symptoms include intense thirst, weakness,
discomfort, anxiety , dizziness, fainting, and headache,core
temperature may be normal, below normal,or slightly elevated
(>32.2oC but >40oC)
A rise in body temperature above the hypothalamic set point
when hear-dissipating mechanisms are impaired (by drug or
disease) or overwhelmed by external (environmental or induced)
nor internal (metabolic) heat
Continuum of changes that occure in more than one organ system
after an insult such as trauma, sepsis or heat stroke
Heat stress
Heat strock
Heat exhaustion
Hyperthermia
Multiorgandysfunction
syndrome
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In Saudi Arabia, for example, incidence varies seasonally, from 22 to 250 cases per 100,000
population and the mortality rate associated to these conditions is 50 percent. It is important
to highlight that there are genetic factors that determine the susceptibility to develop these
illnesses.
The balance between heat production and heat loss determines the body temperature. Normal
body function depends upon a relatively constant core temperature because biochemical
reactions function optimally at narrow temperature ranges. In response to the rise of heat,
the mechanisms of cutaneous vasodilation, sweating, and increased respiration come into
effect to increase heat loss. Once blood temperature increases, thermal sweating is initiated.
This will also cause heart rate to go faster (tachycardia), increasing the work from the heart
as well as the volume of blood ejected (Cardiac Output) and the respiratory frequency (minute
ventilation). Nonetheless, most people might be able to adapt to hot environments.
Some physiologic conditions like pregnancy, cardiovascular diseases and some medications
may interfere with the cardiac function and impair heat tolerance increasing the susceptibility
to develop any heat illness. If heat production exceeds heat dissipation capacity, for example
during exercise in hot, humid conditions or during very high intensity exercise, the core
temperature will continue to rise. During prolonged exercise, loss of fluid as sweat may
compromise heat dissipation. Maintenance of euhydration (good or appropriate hydration) is
critical to heat balance.
Pregnancy and Heat
Pregnant women and their fetuses are not excluded from the harmful effects of extreme
heat exposure. Therefore, thermoregulation is especially important for the physically active
pregnant women and even more in hot weathers like in Qatar. Exercise in hot and humid
environments is a great challenge to temperature regulation because if sweating is excessive
and fluids are not replaced, blood volume falls and core temperature may rise to lethal levels.
During pregnancy, basal metabolic rate, and therefore heat production, is increased above
non-pregnant levels. The increase in body temperature during exercise is directly related to
the intensity of the exercise. During moderate intensity, aerobic exercise in thermoneutral
conditions, the core temperature of non-pregnant women rises an average of 1.5°C during
the first 30 minutes of exercise and then reaches a plateau if exercise is continued for an
additional 30 minutes.
Fetal body core temperatures are about 1°C higher than maternal temperatures. In animal
studies, an increase in maternal core temperature of more than 1.5°C during embryogenesis
has been observed to cause major congenital malformations. These data coupled with the
results of human studies suggest that hyperthermia in excess of 39°C during the first 45–60
days of gestation may also be teratogenic in humans. However, there have been no reports
that hyperthermia associated with exercise is teratogenic in humans. There is no evidence
on the impact of heat associated with exercise and the adding effect of environmental
heat. Recent studies that have led to the conclusions that the fetus is granted some thermal
protection when the mother experiences thermal stress. This is referred to as “fetal thermal
inertia,” which appears to protect the fetus and prevents the rise or fall of fetal temperature
to the extent of the maternal responses.
During swimming, a relatively smaller rise in temperature is obtained due to better heat
dissipation. Maternal exercise in the water may be more beneficial than exercise on land
because heat loss can be facilitated through the water. However, care must be taken if the
water temperature is hot as the body is more apt to experience heat illness.
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The best ways to prevent heat illnesses are acclimatise to heat, schedule outdoor activities
in the coolest time of the day (early morning and late at night), reduce the level of physical
activity, increase the amount of water drank daily, ensure electrolytes such as sodium and
potassium, and try to be in air conditioned areas as much as possible.
Exercise recommendations for preventing hyperthermia suggest that the pregnant woman
should:
Acclimatise gradually to ambient conditions
Exercise during the cooler times of the day or in well-ventilated and air-conditioned
environments
Wear comfortable clothing that will permit free evaporation of sweat. Clothing should
be lightweight, loose fitting, and light in colour
Drink plenty of fluids before, during, and after exercise
Be aware of the early symptoms of heat illness: nausea, dizziness, headache, poor
coordination, and apathy
Train with a partner who is aware of the symptoms of heat disorders (heat cramps,
heat syncope, heat exhaustion, and heat stroke)
Exercise at her own pace, and at a length of personal comfort
Avoid swimming in warm or hot water and avoid immersion in hot tubs
Fasting Ramadan
The holy month of Ramadan incorporates refraining from food or fluids during the daylight
hours of the holy month. This can last from12-16 per day and is dependent on the season
the holy month of Ramadan coincides with. There have been many concerns regarding the
engagement of exercise and physical activity during Ramadan, especially during the summer
months. Research has shown that fasting for 30 consecutive days without any form of
exercise or physical activity results in decrease of strength and fitness. Therefore, Muslims
should maintain their physical activities level during the month of fasting in comprehensive
ideal way to avoid any health complications.
Physical Activity should be undertaken in non-competitive settings in dark hours (post
fasting). If the activity is in competitive settings, it should be performed on non-consecutive
days. Efforts to optimise sleep and to stay hydrated before and after the activity are of
paramount importance to avoid any possible deleterious effects of intense physical activity
during Ramadan. Also, an individual can perform the activities in very early morning after
the last meal of the post-fast (Suhor), but as this activity will not be followed by any food and
liquid replenishment, it has to be light in intensity, and short in duration. Also, avoid direct
exposition to the sun and/or heat for this early day exercise.
During cold/temperate seasons:
Ninety minutes before sunset would be a good time to perform in non-competitive activities
(e.g. walking).
During hot season:
When Ramadan coincides with the summer months any pre-Iftar (pre-fast-break) moderate or
vigorous activities are not recommended in open-sky settings unless it is of short duration.
If the individual cannot perform any form of activity at night, it would be recommended that
she/he should find an air-conditioned space to practice.
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Modifications to the ExRx During Fasting
Component
Intensity
Duration
Warm-up
(Light) RPE = 10
7-10 minutes
Stretching
(Light) and Stop stretching
when muscles start to cause
pain
5 minutes: ~20 seconds per limb/
muscle group
Aerobic
Training
(Light) RPE = 10-11
~20 minutes
Strength
training
(Light) 50-60% of 1-Repetition
Maximum (1-RM)
~20 minutes: 2 sets of 8-12 reps (1.5
to 2 minutes rest in-between sets)
Cool-down
(Light) RPE = 9
5 minutes
Table 6 shows the structure of a proposed session with either (1) cardiovascular training, or
(2) strength training as a core of the session. Warm-up, light stretching, and Cool-down being
constant parts of any session.
Frequency: 3 to 6 days/week
Example: 3 times a week: One can have Cardiovascular sessions on days 1 and 5 of the week
with a Strength training session for day 3. Days 2, 4, 6, and 7 being resting days.
Example: 5 times a week: One can have Cardiovascular sessions for days 1, 4, and 6 of the
week, and Strength training for days 2 and 5. Resting for days 3 and 7.
Tips for the General Public
Do not use Ramadan as an excuse to not perform the physical activity. Rather, try to
take opportunity of Ramadan enjoyment of physical activity (e.g. at least mall walking
if not structured activity) to keep active throughout the year
For sick persons, you must consult your physician before any physical activity. When
engaged in the activity, if possible use a pedometer to count your steps and try to
reach the goal of 10,000 steps a day as set by the “step into health” Aspire programme
Terminate any physical activity immediately if ever feeling dizzy or nauseous. For
daylight activity, one should only break their fast if they really feel extremely weak
and fatigued. In this case you should consult your Physician
Plan when to sleep and when to wake up and try to sleep in an appropriate environment:
dark, cool, and quiet
Consider naps and schedule times to rest, as your body might feel more fatigued
during Ramadan. This will allow you to get in rested state for performing physical
activity before you break your fast or after Iftar
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Irregular non-competitive activities (e.g. playing football, volleyball, tennis) after
sunset and evening pray, is a good way to maintain physical activity and fitness in
addition to general well-being
Any intense sessions of these forms of exercise: Endurance, plyometric (power and
explosive training), speed and agility training, should be avoided as these activities
utilise more energy and can place one’s body in greater strain
During post-fasting (dark hours) you should focus on the hydration and consuming
sufficient fluids to prevent dehydration during exercise and the next fasting day.
Hydrate a lot during the night (after sunset and evening prayer; keeping a water bottle
when going for evening prayers). Nevertheless, the rule is to drink small amounts
of liquids (preferably water), very often and avoid taking too much liquid at a time,
because this will have negative impact on body hydration status
Fasting and Pregnancy
Fasting during pregnancy is not encouraged. This is especially true during the 1st trimester,
as the fetus is undergoing critical development and this can affect their normal formation. A
reduction in energy or fluid intake by the pregnant mother may produce detrimental effects
on fetal growth. Women in late pregnancy showed the phenomenon of ‘accelerated starvation’
during Ramadan, characterised by low serum levels of glucose and alanine, and especially
high levels of free fatty acids and beta-hydroxybutyrate. The additional metabolic stress of
Ramadan fasting in pregnancy and during lactation has the potential to cause retardation of
fetal and neonatal growth and development, respectively. In Saudi Arabia, the ratio of lowbirth weight babies born during the festival months of Ramadan and Hajj was significantly
higher than in the non-festival months.
The volume of breast milk produced was reduced during the Ramadan fast and mothers
increased the amount of solid supplements they gave their children during Ramadan.
However, fasting caused changes in milk osmolality, and lactose and potassium concentrations
indicative of a marked disturbance of milk synthesis.
A 2008 study conducted in the United States, based on census data from the US, Iraq and
Uganda, found that pregnant women who fast are likely to have smaller babies who are more
prone to learning disabilities in adulthood. The researchers from Columbia University found
that this trend was most marked if mothers-to-be fasted early on in their pregnancy and
during the summer when longer days meant they went more hours without food.
Aspetar’s Guidelines for Exercise and Sport
in Hot Weather
During exercise or sport in hot weather, it is easy to become too hot. Taking precautions
before and during exercise is a good way to avoid the negative effects of exercising in the
heat. However, in case of dizziness, headache, nausea (desire to vomit), shivering, hot dry
skin, exhaustion, or collapse, one should cool down immediately (using shade, fan or A/C) and
sip liquids such as water or a rehydration mixture.
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Guidelines for organiSations:
Always provide thermoneutral (21-23oC, low %RH) and safe facilities: air-conditioned
meeting rooms and locker rooms; shady areas outside; and emergency plans, including
on-site trained staff and cooling stations
Use the Wet Bulb Globe Temperature to estimate the risk of exercising in hot conditions.
This temperature is calculated from a combination of the heat and humidity of the air,
the wind speed and the heat of the sun in the sporting environment
Guidelines for participants:
Stay well hydrated:
Drink at least two litres per day in normal conditions, and drink up to six litres per day
in hot conditions, of water or isotonic sports drinks
Weigh yourself before and after exercise, and also check urine colour and quantity, to
know how much water you have lost
Consume enough salt, potassium and other electrolytes to balance sweat loss
Warm up carefully:
Keep warm-up periods short, and allow some recovery time before the main event
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If possible, cool down (especially if the exercise is long or repeated): bathe in cold
water, drink ice-water or wear a cooling vest during warm-up or in between exercise
sessions
Wear sensible clothing:
Wear clothes that expose your skin to the air, to help sweat evaporate and cool the
body
Wear white or light-coloured clothes, to help reflect heat
Wear loose-fitting clothes made of natural fibres or special absorptive sports fibres
In general:
Stay out of the sun, and go into the shade, as often as possible, for as long as possible
Use sunscreen (sunblock) to protect all exposed skin
Sleep and rest well, because properly rested athletes may tolerate heat for longer
Splash the body with water to cool down before exercise and during breaks
Tell coaches or team leaders about conditions such as asthma which make heat illness
worse
Get medical help immediately for shivering, muscle cramps, headache, fatigue or
collapse
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Glossary
Glossary Of Terms
TERM
DEFINITION
Abnormal Heart Rhythm
Sometimes called arrhythmia or dysrhythmia, this is
an irregular beating of the heart.
Acute/Chronic Diseases
Acute often also refers to an illness that is of short
duration, rapidly progressive, and often in need
of urgent care. Chronic refers to a disease that
progresses over an extended period of time, sometime
throughout one’s lifetime.
Aerobic Fitness
(see physical fitness)
A health-related component of physical fitness that
relates to ability of the circulatory and respiratory
systems to supply oxygen during sustained physical
activity. (From Surgeon General’s Report on Physical
Activity and Health, USDHHS, 1996 as adapted from
Corbin and Lindsey, 1994).
Comment: Aerobic fitness is also referred to as
cardiovascular fitness, cardiovascular endurance, and
cardiorespiratory fitness.
Agility
(see skill-related physical fitness)
Balance
(see skill-related physical fitness)
A skill-related component of physical fitness that
relates to the ability to rapidly change the position
of the entire body in space with speed and accuracy.
(From Surgeon General’s Report on Physical Activity
and Health, USDHHS, 1996 as adapted from Corbin
and Lindsey, 1994).
A skill-related component of physical fitness that
relates to the maintenance of equilibrium while
stationary or moving. (From Surgeon General’s Report
on Physical Activity and Health, USDHHS, 1996 as
adapted from Corbin and Lindsey, 1994).
Behaviour Modification
A set of learning techniques to alter negative human
behaviour.
Cardiovascular Disease
Diseases of the cardiovascular system, which includes
the vessels of the body as well as the heart.
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Clinically Supervised Settings
Exercise setting conducted under the observation of
qualified clinicians.
Congenital
A condition as a result of heredity or present at birth.
Contraindicated Exercise
Exercise that is inadvisable, as it constitutes risk that
outweighs benefits.
Coordination
The ability to use the senses, such as sight and hearing,
together with body parts in performing motor tasks
smoothly and accurately. (From Surgeon General’s
Report on Physical Activity and Health, USDHHS,
1996 as adapted from Corbin and Lindsey, 1994).
Dose-Response Relationship
The relationship between the amount of exercise and
the benefits gained from it.
Exercise
A specific form of physical activity dedicated to
improving physical fitness.
Exercise Prescription (ExRx)
The quantification of physical activity.
Fat Loss/Weight Loss
Fat loss is the amount of fat weight – usually expressed
as percentage of body fat content – lost. Weight loss
is the overall body weight reduction, which may be
due to fat loss, lean mass loss, fluid loss, etc.
Flexibility/Stretching
A health-related component of physical fitness that
relates to the range of motion available at a joint.
(From Surgeon General’s Report on Physical Activity
and Health, USDHHS, 1996 as adapted from Wilmore
and Costill, 1994).
Graded Exercise Test (GXT)
Sometimes called a stress-test, a GXT is a clinical
procedure to evaluate the functional ability and
health of the cardiovascular system and the heart.
Health
Health is a state of being associated with freedom
from disease and illness that also includes a positive
component (wellness) that is associated with a quality
of life and positive well-being. (Adapted from Corbin,
Lindsey, & Welk, 2000; Bouchard, et al., 1990).
Health-Related Attributes
Cardiorespiratory fitness, muscular strength and
endurance, flexibility, body composition, and
neuromotor fitness.
High/Low Impact Exercise
Low impact exercise is any type of aerobic exercise
that does not stress musculoskeletal tissues, and
joints.
High impact exercise is any type of aerobic exercise
that promotes physical fitness, at the risk of stress to
musculoskeletal tissues, and joints.
Hyperglycemia
High blood glucose content, measure with fasting
glucose levels at or above 6.99 mmol/L.
Hypertension
Scientific term for high blood pressure, where systolic
and diastolic resting and/or exercise blood pressure
is higher than normal.
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Hypoglycemia
Low blood glucose content, measured at or below
3.89 mmol/L.
Incidence/ Prevalence
Incidence is the number of instances of a particular
illness during a given period in a specified
population. This term gives an indication of the
increase or decrease of a disease over a period of
time. Prevalence is a figure for a disease at a single
point in time.
Insulin Sensitivity
Describes how sensitive the body is to the effects
of insulin. An individual who is insulin sensitive will
require smaller amounts of insulin to lower his/her
blood glucose levels than an individual who has low
sensitivity.
Intermittent Exercise
A total dose of exercise that is accumulated over the
duration of the day in shorter bouts. For example, a
total of 30 minutes of exercise on a given day can be
accumulated in three separate sessions of 10 minutes
each performed at different times of the day.
Interval Training
A physical training programme that involves a series
of exercises interspersed with rest periods.
Lapse
A slip in one behaviour modification goal.
Leisure Activities
Physical activity undertaken during discretionary
time.
Meta-Analysis
A thorough examination of all the literature regarding
a particular problem.
Metabolic End-Products
These are the chemical by-products of metabolism
that must be cleared by the body for the body to
resume normal function.
Multi-Joint/Compound Exercises
An exercise that involves more than one joint.
Muscular Endurance
A health-related component of physical fitness that
relates to the muscle’s ability to continue to perform
without fatigue. (From Surgeon General’s Report
on Physical Activity and Health, USDHHS, 1996 as
adapted from Wilmore and Costill, 1994).
Muscular Fitness
This term includes muscular strength, endurance, and
power.
Non-Communicable Diseases
A disease that is not infection and is not passed on.
Obesity/Overweight
The terms “overweight” and “obesity” refers to body
fat content that is greater than what is considered
healthy.
Osteoporosis
A progressive bone disease that is characterised by a
decrease in bone mass and density.
Physical Activity
Bodily movement that is produced by the contraction
of skeletal muscle and that substantially increases
energy expenditure. (Adapted from USDHHS, 1996;
Bouchard, et al., 1990). Hence, the terms exercise,
sport, leisure activities, and dance can be can be
considered as dimensions under the term physical
activity.
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Physical Activity
Physical Fitness
Any body movement that requires muscular
contraction resulting in an increase in metabolic rate
beyond resting.
A state of well-being with low risk of premature health
problems and energy to participate in a variety of
physical activities (Howley & Franks, 1997)
A set of attributes that people have or achieve
relating to their ability to perform physical activity
(U.S. Department of Health & Human Services, 1996).
Power
A skill-related component of physical fitness that
relates to the ability to the rate at which one can
perform work. (From Surgeon General’s Report on
Physical Activity and Health, USDHHS, 1996).
Quality of Life
A term that connotes an overall sense of well-being.
(USDHHS, 2000).
Range of Motion
The extent of a movement of a joint measures in
degrees.
Relapse
To return to a former state.
Resistance Training/Resistive
Exercise
Training achieved by working dynamically against
weights or statically against fixed resistances.
Skill-Related Attributes
Agility, balance, coordination, power, speed, and
reaction time.
Stationary Equipment
Immobile training equipment like a fixed cycle or
rowing machine.
Stroke
A sudden death of brain cells due to inadequate blood
flow.
Sudden Cardiac Death
An unexpected death due to heart failure.
Valsalva Manoeuvre
Forcibly exhaling while keeping mouth and nose
closed.
Vigorous Exercise
An intensity of exercise that is 6 times or more
greater than resting oxygen consumption.
Weight Bearing Exercise
Exercise in which body weight is used against gravity,
such as walking. Non-weight bearing exercises include
activities such as stationary (machine) cycling.
Well-Being (Wellness)
A state of positive health in the individual and
comprising biological and psychological well-being
as exemplified by quality of life and a sense of wellbeing. (Adapted from Corbin, Lindsey, & Welk, 2000;
Bouchard, et al., 1990; USDHHS, 2000).
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Appendixes
Contraindications to Exercise
You should NOT exercise:
If you have
chest pain,
unusual shortness of breath,
sudden or new irregular heartbeats,
dizziness or lightheadedness.
If you experience any of the above symptoms at rest or during exercise you should
seek immediate medical attention
If you have low or very high blood sugar levels
If you have very high blood pressure (>200/115)
If you have any infection with fever
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PAR-Q and You
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Perceived Exertion for Physical Exertion
(Borg’s Scale)
Brog Relative Perceived Exertion Scale
6
7
Very, Very Light
8
9Very LightLow Intensity
10
11
Fairly Light
12
13
Somewhat Hard
14Moderate Intensity
15
Hard
16
17
Very Hard
18Vigorous Intensity
19
20
Very, Very Hard
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PARmed-X for Pregnancy
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PARmed-X for Pregnancy
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Physical Activity Readiness
Medical Examination for
Pregnancy (2002)
PHYSICAL ACTIVITY READINESS
MEDICAL EXAMINATION
PARmed-X for PREGNANCY
Prescription for Muscular Conditioning
It is important to condition all
major muscle groups during
both prenatal and postnatal
periods.
WARM-UPS & COOL DOWN:
Range of Motion: neck, shoulder girdle, back, arms, hips,
knees, ankles, etc.
Static Stretching: all major
muscle groups
(DO NOT OVER STRETCH!)
EXAMPLES OF MUSCULAR STRENGTHENING EXERCISES
CATEGORY
PURPOSE
EXAMPLE
Upper back
Promotion of good posture
Shoulder shrugs, shoulder blade pinch
Lower back
Promotion of good posture
Modified standing opposite leg & arm lifts
Abdomen
Promotion of good posture,
prevent low-back pain, prevent
diastasis recti, strengthen muscles of labour
Abdominal tightening, abdominal
curl-ups, head raises lying on side or standing position
Pelvic floor
(“Kegels”)
Promotion of good bladder control,
prevention of urinary incontinence
“Wave”, “elevator”
Upper body
Improve muscular support for breasts
Shoulder rotations, modified push-ups against a wall
Buttocks,
lower limbs
Facilitation of weight-bearing, prevention
of varicose veins
Buttocks squeeze,standing leg lifts, heel raises
PRECAUTIONS FOR MUSCULAR CONDITIONING DURING PREGNANCY
VARIABLE
EFFECTS OF PREGNANCY
Body Position
Joint Laxity
Abdominal Muscles
Posture
Precautions
for
Resistance Exercise
EXERCISE MODIFICATIONS
• in the supine position (lying on the back), the enlarged uterus
may either decrease the flow of blood returning from the lower
half of the body as it presses on a major vein (inferior vena cava)
or it may decrease flow to a major artery (abdominal aorta)
• past 4 months of gestation, exercises normally done in the
supine position should be altered
• such exercises should be done side lying or standing
• ligaments become relaxed due to increasing hormone levels
• joints may be prone to injury
• avoid rapid changes in direction and bouncing during exercises
• stretching should be performed with controlled movements
• presence of a rippling (bulging) of connective tissue along the
midline of the pregnant abdomen (diastasis recti) may be seen
during abdominal exercise
• abdominal exercises are not recommended if diastasis recti
develops
• increasing weight of enlarged breasts and uterus may cause a
forward shift in the centre of gravity and may increase the arch in
the lower back
• this may also cause shoulders to slump forward
• emphasis on correct posture and neutral pelvic alignment.
Neutral pelvic alignment is found by bending the knees,
feet shoulder width apart, and aligning the pelvis between
accentuated lordosis and the posterior pelvic tilt position.
• emphasis must be placed on continuous breathing throughout exercise
• exhale on exertion, inhale on relaxation using high repetitions and low weights
• Valsalva Manoevre (holding breath while working against a resistance) causes a change in blood pressure and therefore
should be avoided
• avoid exercise in supine position past 4 months gestation
PARmed-X for Pregnancy - Health Evaluation Form
(to be completed by patient and given to the prenatal fitness professional
after obtaining medical clearance to exercise)
I, _____________________________________ PLEASE PRINT (patientʼs name), have discussed my plans to participate in physical
activity during my current pregnancy with my health care provider and I have obtained his/her approval to begin participation.
Signed: ___________________________________________
(patientʼs signature)
Date:____________________________________________
HEALTH CARE PROVIDERʼS COMMENTS:
Name of health care provider: _________________________________
Address: __________________________________________________
__________________________________________________________
Telephone: _________________________________________________
2
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
(health care providerʼs signature)
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Blank ExRx Sheet
Exercise Prescription
Name: _________________________________
Date: _______________________
Weight: _______________________ Height: __________________ BMI/% Body Fat: ___________________________
Medications: _________________________________________________________________________________________
BASIC ACTIVITY
AEROBIC FITNESS
FREQUENCY
INTENSITY
TIME
TYPE
Strength
Additional Remarks: ________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
“Lack of activity destroys the good condition of every human being, while movement and
methodical physical exercise save it and preserve it” ~Plato