Copyright © 2011 American College of Sports Medicine Clinical Exercise Physiology Chapter 4

Copyright © 2011 American College of Sports Medicine

Clinical Exercise PhysiologyClinical Exercise Physiology

Chapter 4


What is Clinical Exercise Physiology?What is Clinical Exercise Physiology?

• Uses physical activity and exercise to prevent or delay the onset of chronic disease in healthy individuals

• Provides therapeutic or functional benefits to individuals with disease conditions or physical disabilities

• Requires an understanding of how the body responds to acute and chronic physical activity and exercise in both a healthy and diseased condition


Development of Clinical Exercise PhysiologyDevelopment of Clinical Exercise Physiology

• First use of physical activity and exercise in disease recovery can be traced to the 18th and 19th centuries

• Morris and colleagues studied coronary heart disease in London bus drivers and conductors

– Demonstrated the relationship between physical activity and the risk of developing heart disease

– Initiated interest in disease risk reduction and public health epidemiology



• Cardiac rehabilitation programs first developed in the 1950s

• AHA and ACSM developed testing and training procedures for healthy and diseased individuals

• Late 1950s pulmonary rehabilitation programs began to use exercise



• Additional landmark events

– Publication of the Journal of Cardiopulmonary Rehabilitation

– Founding of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)




Clinical Exercise PhysiologyClinical Exercise Physiology

• Duties and responsibilities:

– Conducting pre-exercise screening

– Performing exercise testing and evaluation

– Developing exercise prescriptions

– Instructing individuals in proper training techniques

– Supervising exercise programs in various settings


Exercise Testing and EvaluationExercise Testing and Evaluation

• Used to clear individuals for safe participation in physical activity and exercise

• Serves as a basis for developing exercise prescriptions

• Diagnostic testing helps assess the presence of cardiovascular or pulmonary disease

• Functional capacity helps assess an individual’s capacity to participate in physical activity and exercise


Exercise Testing and EvaluationExercise Testing and Evaluation• A diagnostic exercise test



• Pretesting Procedures

– Pretest Screening for Health Risk

– Physical Examination

– Health History

– Informed Consent



• Performing the Test

– Heart Rate

– Blood Pressure

– Rating of Perceived Exertion

– Electrocardiogram

– Echocardiography

– Oxygen Consumption and Functional Capacity


Exercise Testing and EvaluationExercise Testing and Evaluation• Assessments made during a GXT



• Performing the Test

– Submaximal Graded Exercise Tests

– Maximal Graded Exercise Testing


Health-Related Physical Fitness Testing and InterpretationHealth-Related Physical Fitness Testing and Interpretation


Exercise PrescriptionExercise Prescription

• Plan for physical activity and exercise

• Achieve specific outcomes – improvement in fitness, reduction in disease risk, or weight loss

• Meets the interests, goals, health needs, and clinical condition of an individual

• Based on sound principles and innovative programming


Specific Disease ConditionsSpecific Disease Conditions• Cardiovascular Disease

– Myocardial Infarction

– Coronary Artery Disease

– Angina Pectoris

– Cardiac Arrhythmia

– Valvular Heart Disease

– Chronic Heart Failure

– Peripheral Vascular Disease

– Hypertension


Specific Disease ConditionsSpecific Disease Conditions• Prevalence of cardiovascular diseases in 2005 in the

United States


Specific Disease ConditionsSpecific Disease Conditions• Progression of peripheral artery disease


Specific Disease ConditionsSpecific Disease Conditions

• Respiratory Disease

– Obstructive Pulmonary Disease

– Restrictive Pulmonary Disease

– Asthma

– Cystic Fibrosis


Specific Disease ConditionsSpecific Disease Conditions• Chronic obstructive pulmonary disease as a result of

emphysema



• Metabolic Disease

– Diabetes Mellitus

– Hyperlipidemia

– Obesity

– Metabolic Syndrome


Specific Disease ConditionsSpecific Disease Conditions• Prevalence of the three most common metabolic disease

conditions: high blood cholesterol, diabetes mellitus, and overweight and obesity



• Orthopedic and Neuromuscular Disease

– Arthritis

– Osteoporosis

– Muscular Dystrophy

– Multiple Sclerosis

– Cerebral Palsy


Specific Disease ConditionsSpecific Disease Conditions• Prevalence of the two most common orthopedic and

neuromuscular diseases: arthritis and osteoporosis


SummarySummary

• Clinical exercise physiology is used to help promote health and reduce disease risk in both healthy and diseased individuals.

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Copyright © 2011 American College of Sports Medicine Clinical Exercise Physiology Chapter 4