PTY1009

Exercise Physiology
STUDENT PRACTICAL AND TUTORIAL MANUAL

Year 1 | Trimester 3
 Disclaimer

The materials used in this manual were put together for students taking the module
PTY1009 Exercise Physiology. This manual is intended for in-class use only and no
part of it is to be reproduced for any other purposes. All original references and
credits are given to the relevant authors, publishers and websites whenever possible
for the use of any illustrations found in this manual (e.g. texts, pictures and tables).
We do not own any of the illustration used in this manual.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 2 of 73

 EXERCISE PHYSIOLOGY
PTY1009
YEAR 1, TRIMESTER 3

This module profile may be subject to change during the trimester – the online version
is the authoritative version.

1. General Module Information

1.1 General Information

Credit Value: 5 credits

Prerequisite(s): Nil

Co-requisite(s): Nil

Result type: Grade

Module Coordinator: Name: Asst Prof Cindy Ng

Email: [email protected]

Module Co-Coordinator: Name: Dr. Tan Xiang Ren

Email: [email protected]

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 3 of 73

 1.2 Module Descriptor

This module aims to introduce the role and purpose of exercise physiology.
Applied physiology and the impact of exercise or activity on our physiological
system provide the basic principles of physiotherapy management in managing
chronic diseases. Exercise Physiology is a module to empower physiotherapists
with the delivery and modification of exercise, lifestyle, and behavioural
modification programs. This module will explore the concepts underpinning
current approaches to the assessment of cardiovascular fitness, strength and
flexibility; a deeper understanding of healthy and untrained individuals’
physiological responses to acute and chronic exercise; and prescription of
specific and effective exercise programs. There will be analysis of the supporting
theory and available evidence alongside with practical application of assessment
and management techniques. Significant emphasis will be placed on the
development of clinical reasoning in the evaluation and management of patients
with various chronic diseases in addition to other co-morbidities. Students will be
encouraged to critically appraise and evaluate the theory, evidence-base and
practical application of current delivery and modification of exercise, lifestyle and
behavioural modifications for prevention and effective management of chronic
diseases and co-morbidities.

1.3 Contact hours:

Lecture: 22 hours
Tutorial: 6 hours
Lab: 8 hours

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 4 of 73

 2. Learning Outcomes

After successfully completing this module, you should be able to:

1. Explain the physiological adaptations as a consequence of acute versus chronic

exercise training
2. Evaluate the effects of exercise on pain and psychosocial affects
3. Identify precautions and contraindications to exercise testing and training
4. Evaluate and interpret exercise test results
5. Design an appropriate exercise training program for persons with and without
pathological conditions
6. Demonstrate competency of conducting an exercise training session

3. Learning Activities

Tentative content is listed below and it is subject to change.

Lectures Tutorials Labs
Week Topics/Content
(hours) (hours) (hours)
1. Cellular energetics
2
2. Systems coupling
2
3. Acute responses to exercise
2
(aerobic and resistance)
3
4. Exercise assessment (aerobic
2
and resistance)
2
5. ECG reading and interpretation
6. Exercise Training Principles and
2
Prescription
7. Load prescription and coaching
2
8. ‘Diabesity’ and exercise 2
4 2
9. Exercise prescription for differing
2
populations
10. Physiological adaptations (long-
5 term; aerobic and resistance) 2 2 2
11. Exercise as a preventive strategy

6 Practical 2 and tutorial 3 2 2

7 Recess Week (no classes)

8 Practical 3 2

9 Practical 4 2

Total (hours) 22 6 8

4. Learning Resources

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 4.1 Required Resources

• McArdle WD, Katch FI, Katch VL. (2014). Exercise Physiology: Energy, Nutrition,
and Human Performance. 8th edition. Wolters Kluwer Lippincott Williams and
Wilkins.
• Kisner C, Colby LA. (2012) Therapeutic Exercise: Foundations and Techniques.
6th edition. F.A. Davis Company.

4.2 Recommended Resources

• American College of Sports Medicine (2017). ACSM’s Guidelines for exercise

testing and prescription. Wolters Kluwer Lippincott Williams and Wilkins. 10th ed.
• Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE, Sun XG and
Whipp BJ (2011). Principles of Exercise Testing and Interpretation, including
Pathophysiology and Clinical Applications. 5th edition. Wolters Kluwer Lippincott
Williams and Wilkins.
• Hampton, JR (2013). The ECG Made Easy. Elsevier Health Sciences.

4.3 Any Other Learning Resources

• Moore GE, Durstine JL, Painter PL (2016). ACSM’s Exercise Management for
Persons with Chronic Diseases and Disabilities. 4th ed. Human Kinetics

• Relevant journals

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 6 of 73

 Lectures
TOPIC Match to Learning Objectives

System coupling Explain the physiological adaptations as a

consequence of acute versus chronic exercise
training

Cellular energetics Explain the physiological adaptations as a

consequence of acute versus chronic exercise
training

Exercise assessment (aerobic Identify precautions and contraindications to

and resistance) exercise testing and training

Acute responses to exercise Explain the physiological adaptations as a

(aerobic and resistance) consequence of acute versus chronic exercise
training

Exercise Training Principles Evaluate and interpret exercise test results

and Prescription
ECG reading and interpretation Evaluate and interpret exercise test results

Strength, loading and injuries Demonstrate competency of conducting an

exercise training session

Physiological adaptations (long- Explain the physiological adaptations as a

term; aerobic and resistance) consequence of acute versus chronic exercise
training
Exercise prescription for Design, evaluate and justify the effects of exercise
differing populations in different special populations

Diabesity and Exercise Design and justify an appropriate exercise training

program for persons with and without pathological
conditions (primarily diabetes)

Exercise as a preventive Design an appropriate exercise training program

strategy for persons with and without pathological
conditions

5 Assessment

5.1 Assessment Summary

This is a summary of the assessment in the module. For detailed information on
each assessment, refer to link to details on learning management system for details
of assessment. Dates for assessments are subjected to minor amendment, and
early notification will be made should changes be required.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 7 of 73

 WEEK ASSESSMENT WEIGHTAGE Learning
(%) Outcomes

Week 11 Practical Examination 40% 1,3,4,5,6

(OSCE)

Week 12 Final Examination (Written 60% 1,2,3,4,5

or online – MCQ)

TOTAL 100%

5.2 Pass Requirements

In order to pass the module, students are required to

a) achieve a minimum grade of E, and
b) attend a minimum of 70% of practical and tutorial classes (if applicable)

A “C” grade or above is considered as ‘Pass’ and an “F” grade is considered as

“Fail”. Students with grades “D” or “E” will be given the option to repeat module
but the maximum grade for repeated attempt will be capped at 2.0. Successful
completion of the academic module is also based on fulfilment of any other
requirement(s) set by the module coordinator and programme director.

Do note that the criteria for acceptable standing in any given trimester is
maintaining a minimum Cumulative Grade Point Average (CGPA) of 2.0.

Refer to the SIT Academic Guide for further details.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 8 of 73

 Faculty members
Dr. Muhammad Rahizan Zainudin, Assistant Professor
Dr. Cindy Ng Li Whye, Assistant Professor
Dr. Anthony James Goff, Lecturer
Dr. Tan Xiang Ren, Lecturer
Mr Haja Mydin S/O Yah Kathier, Associate Faculty
Mr Aaron Yeo Sulun, Associate Faculty
Ms Katherin Huang Shilin, Associate Faculty

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 9 of 73

 PRACTICAL
IMPORTANT NOTE:
1. For every practical session, students must wear
appropriate exercise attire; loose clothes,
shorts/track pants, sports/running shoes, and for
ladies, sports undergarment
2. There are different stations in some of the practical
session. We may split the class into pairs / groups
and to take turns completing a station.
3. ALL students must fill up the PAR-Q+ and consent
form on Page 16 to 18 (to be downloaded into
LMS by 12th June 2020 7pm).

Due to SARS-CoV2, there may be some changes in

the delivery of the content to meet the learning
objectives.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 10 of 73

 Practical Session 1

Familiarisation/Competencies
Lesson objectives

At the end of the session, you will be able to:

1. Perform/Outline capillary blood glucose test.

2. Perform vitals monitoring accurately and at appropriate times with exercise
3. Conduct a safe exercise session on the cycle ergometer and on treadmill

Outcomes:
1. Able to perform/outline capillary blood glucose monitoring with the glucometer
2. Competency using the cycle ergometer safely
3. Competency using the treadmill safely
4. Competency on using the manual and automated sphygmomanometer measuring
blood pressure

Preparatory materials (available on LMS): (please refer to videos link under

Annex E)

1. Video on the technique of capillary pricking to measure blood glucose.

2. Video on the safe use of the cycle ergometer and treadmill

3. Video on the technique of taking manual blood pressure measurement

Activity:
Prior to the class, we will familiarize ourselves with the PAR-Q+, Screening checklist,
Contraindications to and Termination of exercise, and RPE. (Refer to Annex A, B, C
and D respectively)

Station 1 - Competency checklist for Capillary Blood Glucose Monitoring

Station 2 - Competency checklist for using the Monark cycle ergometer
Station 3 - Competency checklist for using the treadmill
Station 4 - Using the sphygmomanometer (manual and automatic)

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 STATION 1: Competency check for Capillary Blood Glucose Monitoring

PERFORMANCE STANDARDS COMPETENCY ASSESSMENT

Met Not Met Comments
Knowledge
Store Accu-Chek test strips (green symbol-no interference from
maltose) in an environment of 2 to 30 degrees Celsius.
Keep strips and meter away from extreme heat, cold and
humidity
Store test strips in their original container
Ensure that the test strip to be used is not expired
Check that the code number on glucometer’s display panel
matches with that on the bottle
Check that the date and time displayed on the meter is current
Use test strips within 3 minutes after removal from container
Do not allow any blood or liquid to get into the test strips slot as
it can damage the meter
Use 70% isopropyl alcohol swabs or hospital-approved
disinfectant for cleaning and disinfecting or wash your hands
Skills
(A) Preparation Met Not Met Comments
Identify the correct person using two identifiers
Explain the purpose and procedure to patient
Adhere to infection control protocol throughout procedure.
Perform hand hygiene according to WHO Five moments.
Replace cap tightly and immediately after removal of strips
(B) Measuring Met Not Met Comments
Inserts test strip in machine through the test strip slot
Selects and prepares puncture site.
Cleans site with alcohol swab. Allows site to dry before lancing.
Places lancet over site and presses the trigger. Blood should be
visible at puncture site.
Place meter above the level of the finger to avoid blood from
getting into the test strip slot
Allow the test strip to draw the patient’s blood sample into the
strip window until the window is completely filled
Applies dry swab onto punctured site.

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 STATION 2: Competency checklist for using the Monark cycle ergometer
Instructions: Conduct a cycle ergometer exercise session. The subject pedals at 5-10W for 2
minutes warm up before pedaling at 50W for next 4 minutes. Create your own table for
recording vitals [hint: heart rate, blood pressure, oxygen saturation etc].

Task Tick, if
performed
safely
Describes the exercise session and its aim/s

Obtains consent from subject

Adjusts seat height so that knee flexion is about 5-10o when the pedal
is at the most bottom
Explains and demonstrates the safe and correct technique on
mounting and dismounting the bike and on pedaling
Describe to the subject what one normally feels during exercise, when
one needs to terminate and what needs to be done
Sets up the workload (Watts) on the Monark bike
Ensures subject cycles within 50-60 rpm

Monitors subject’s vitals; HR, BP &/or SpO2 at appropriate times

Monitors symptoms before, during and after exercise

Demonstrates correct recording of vitals

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 13 of 73

 STATION 3: Competency checklist for using the treadmill
Instructions: Conduct a treadmill walking exercise session. The subject walks on the
treadmill at 2.7km/h for 2 minutes before increasing the speed to 5.0 km/h at incline 0% for 4
minutes. Create your own table for recording vitals [hint: heart rate, blood pressure, oxygen
saturation etc].

Task Tick, if
performed
Describes the exercise session and its aim/s

Obtains consent from subject

Explains and demonstrates the safe and correct technique on getting
on and off the treadmill
Explains and demonstrates the correct walking technique on the
treadmill (including the incorrect technique if unable to keep up with
the pace of the belt)
Puts the safety clip onto subject’s clothes
Describes to the subject what one normally feels during exercise,
when one needs to terminate and what needs to be done
Corrects subject’s walking technique on the treadmill

Monitors subject’s vitals; HR, BP &/or SPO2 at appropriate times

Monitors symptoms before, during and after exercise
Demonstrates correct recording of vitals

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 STATION 4: Competency checklist for using the sphygmomanometer
(manual and automatic)

Task Tick, if
performed
Select the right cuff size

Place the cuff correctly on the subject’s arm

Demonstrates correct technique in measuring BP using the manual
sphygmomanometer when the subject is at rest seated
(Use Teaching Stethoscope if possible)
Demonstrates correct technique in measuring BP using the automatic
machine when the subject is at rest seated
Demonstrates technique to read the heart rate and oxygen saturation
from the pulse oximeter

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 15 of 73

 Practical Session 2

Exercise Testing with CPET

(Submaximal test)
Lesson objectives:
At the end of the session, you will be able to:
1. Explain & demonstrate the operations of conducting a maximal exercise test and a
submaximal exercise test
2. Identify the precautions and contraindications to exercise testing and training
3. Interpret findings from a maximal exercise test and from a submaximal exercise test
4. Explain and summarise the acute physiological changes expected from an exercise test
5. Apply exercise training principles to prescribe an exercise training session based on the
test results

Preparatory materials (available on LMS):

1. Videos on the conduct of the CPET (please refer to videos under ANNEX E).
2. Revise lecture notes

Activity:

Station 1 - Treadmill submaximal test using Bruce protocol

Station 2 - Ramp incremental test on an upright bike
Station 3 - Modified Astrand Rhyming Cycle Ergometer test
Station 4 - Interpretation of exercise test results

Answer the questions at the end of each station.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 16 of 73

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 17 of 73
 What is a Cardiopulmonary Treadmill Exercise Test?

Cardiopulmonary Exercise Test (CPET) is a noninvasive method used to assess the

performance of the heart and lungs at rest and during exercise.

How is the test done?

During the CPET, you will be required to perform exercise on a treadmill or cycle ergometer
whilst breathing through a mask attached to a gas analyzer. Your electrocardiogram (ECG)
will be recorded prior to, during and post exercise. The CPET procedure will lasts
approximately 30 minutes; however you will only be required to exercise for approximately 10
to 15 minutes. During the test your blood pressure, capillary oxygen saturation, heart rate,
ECG and general condition will be monitored continuously.

You will be required to exercise to your maximum effort. However, you may tell the staff to
stop the test at any time if you feel tired, unwell or unable to continue. You will be taught the
Rate of Perceived Exertion (RPE) Borg scale. You will be asked to give a scoring for the RPE
Borg scale every minute.

When the exercise test has ended, you will be asked to rest on the bed for 5 minutes while
your ECG, heart rate, capillary oxygen saturation and blood pressure are monitored.

Is the test safe?

The risk for CPET is the same as for mild-moderate exercise. The number of patients who
develop symptom is low (1:10,000). Other possible adverse side effects include:
1. Life-threatening heart rhythm (<0.2%)
2. Death (<0.01 %)
3. Fall
You will be closely monitored during the test, with continuous ECG, blood pressure and
oxygen measurements. If you develop significant symptoms, the trained staff will stop the test.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 18 of 73

 ACKNOWLEDGEMENT SECTION

I have read and understood the potential complication(s) that can occur from the procedure.

I acknowledge that the complication(s) listed are not intended to be exhaustive. I have had an
opportunity to ask for more information about the above-mentioned complications, as well as risks in
general, or any specific condition of concern to me.

*Signature/Thumbprint (*Right/ Left) of Name & NRIC of *Parent/ Guardian/ Next of

*Parent/Guardian/Next of Kin Kin

(if student is below the age of 18) (if student is below the age of 18)

____________________________________ ___________________________________

Signature/Thumbprint (*Right/ Left) of Name & NRIC of Student

Student

Date of Acknowledgement

*Please delete accordingly.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 19 of 73

 STATION 1: Treadmill Bruce protocol (CPET) station
Instructions to students
Introduction
This is the Cardiopulmonary Exercise Test (CPET) station, where the subject performs the
Bruce Protocol on the treadmill until volition. You are required to conduct, record, and
measure the relevant parameters on your classmate. You are also required to use the test
results to measure/calculate your classmate’s VO2peak.
Aims
1. To set up and conduct the CPET safely and independently
2. To record parameters of the test
3. Answer the station questions.
4. To understand the precautions and challenges of conducting a maximal test

Tasks and Roles

Watch the videos and discuss

Answer the questions.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 20 of 73

 CPET (Bruce Protocol) station
Instructions on conduct of test
1. Before the test :
a. Weigh the test subject and document the value.
b. Ensure the ECG electrodes remain on the chest at correct anatomical landmarks.
c. Measure resting Heart Rate and Blood Pressure in sitting position. The subject
may sit on the couch.
d. Explain the RPE scale to the subject. (refer to ANNEX C)
e. Put on the COSMED mask for expired gas analysis.
f. Put on the safety harness.
g. Participant gets on the treadmill. Secure the participant with the hook onto the
safety harness.

Instructions to participant
You will be performing a maximal treadmill test, which will increase speed and incline after
every 3 minutes. At any time, should you feel dizzy, giddy, too fatigue or breathless, such
that you cannot continue anymore, you could lift your right arm up to indicate to us to stop
the test. During the test, we will also ask for your rating of perceived exertion from 0-10 or 6
to 20. Give us a thumbs-up when we reach the number on the scale that reflects your
perception of fatigue. Do you have any questions?

2. Test procotol :
a. Record parameters at the final 30 seconds of each stage.
b. Cool Down Phase :
i. Upon test completion, the subject will cool down for 3-5 minutes at 2.7km/h
with no incline.
ii. The recovery should take about 3-5 minutes for the HR and BP to return to
near resting levels.

3. Test termination criteria :

a. Students to answer faculty

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 21 of 73

 CPET (Bruce Protocol) station: Recording Log
Subject Name : ___________________________________________________
Age : __________________ Body Weight (kg)_______________
Age Predicted Maximum Heart Rate (217 – 0.85 x age) = __________________
60 to 85% of age predicted maximum heart rate = _________________________

HRrest: bpm Resting BP: ___/ __mmHg

Time Speed % HR BP
Stage RPE METs VO2 Remarks
(min) Km/h Grad (bpm) (mmHg)
(ml/kg/min)
NA
Standing 0 0 0 /

I 3 2.7 10 / 4.6 16.1

II 6 4 12 / 7.0 24.5

III 9 5.5 14 / 10.2 35.7

IV 12 6.8 16 / 12.1 42.35

V 15 8.0 18 / 14.9 52.15

Cool
1 2.7 0 - -
down
Cool
2 2.7 0 - -
down
Cool
3 2.7 0 / - -
down
* Stage I is optional

At Test Termination: Time: min .

HRrest: bpm Resting BP: ___/ __mmHg

Reasons for termination of test:

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 22 of 73

 Treadmill Bruce Protocol (CPET)
Questions
1. List the CONTRAINDICATIONS of conducting a CPET.

2. What are conditions for the termination of the treadmill test?

3. Using the raw data of the test subject, plot a graph showing :
(i) HR against VO2,

4. How do the VO2 & HR respond with increasing intensity at every stage of the Bruce
protocol?

5. What is the subject’s VO2max? Calculate the predicted VO2max using the ACSM
formula. Appraise the similarity and/or difference between the actual VO2max obtained
from the CPET program and that of the predicted VO2max.
Explain if there is a difference observed.

(i) Select a moderate intensity treadmill exercise based on VO2max. (state YOUR
moderate intensity range)
(ii) Find the speed and inclination of the treadmill exercise that will elicit the above
moderate intensity.
(iii) Find the HR range that the subject should be exercising at.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 23 of 73

 Plot the VO2 against HR

220

215

210

205

200

195

190

185

180

175

170

165

160

155

150
Heart Rate (bpm)

145

140

135

130

125

120

115

110

105

100

95

90

85

80

75

70

65

60

58

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58
Oxygen Consumption (VO2peak) ml/kg/min

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 24 of 73

 STATION 2: Ramp Incremental Cycle Test (CPET) station
Instructions to students
Introduction
This is the Cardiopulmonary Exercise Test (CPET) station, where the subject performs the
ramped Incremental Cycle Test on the Monark bicycle ergometer until volition. You are
required to conduct, record, and measure the relevant parameters on your classmate. You
are also required to use the test results to measure/calculate your classmate’s VO2peak.
Aims
1. To set up and conduct the CPET safely and independently
2. To record parameters of the test
3. Answer the station questions.
4. To understand the precautions and challenges of conducting a maximal test

Tasks and Roles

Watch the video and discuss.
Answer the questions.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 25 of 73

 Ramp incremental cycle ergometer test (CPET) station
Instructions on conduct of test
1. Before the test :
a. Weigh the test subject and document the value.
b. Ensure the ECG electrodes remain on the chest at correct anatomical landmarks.
c. Measure resting Heart Rate and Blood Pressure in sitting position. The subject
may sit on the couch.
d. Explain the RPE scale to the subject.
e. Put on the COSMED mask for expired gas analysis.
f. Adjust seat height accordingly. Participant gets on the Monark stationary bicycle.

Instructions to participant
You will be performing a maximal test called ramp incremental cycle test. You will start
pedaling at 0W for the first 2 minutes. Then, the load will increase by 20 W every minute. At
all times, keep the cadence between 50-60 rpm. You will cycle until you are not able to or
the tester wants you to stop. At any time, should you feel dizzy, giddy, too fatigue or
breathless, such that you cannot continue anymore, you could lift your right arm up to
indicate to us to stop the test. During the test, we will also ask for your rating of perceived
exertion (RPE). Give us a thumbs-up when we reach the number on the scale that reflects
your perception of fatigue. Do you have any questions?

2. Test procotol :
a. First 2 minutes, the subject pedals at 0 W.
b. Increase to 20W in the next minute. This is considered the first minute of the test.
c. Increase by 20W at every minute, until termination at subject’s volition. The test
duration should be between 8-12 minutes, excluding the 2 minutes at 0W.
d. Record parameters at the final 15 seconds of each minute.
e. Cool Down Phase :
i. Upon test completion, the subject will cool down for 3 mins at 0W.
3. Test termination criteria : Students to answer faculty.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 26 of 73

 Ramp Incremental Cycle Test station: Recording Log

Subject Name : ___________________________________________________

Age : __________________ Body Weight (kg) : _____________
Age Predicted Maximum Heart Rate (217 – 0.85 x age) = __________________
60 to 85% of age predicted maximum heart rate = _________________________
Stage Time(min) Intensity HR BP RPE Remarks
(Watts)
Rest 0 seated /

Warm Up 0-1 0

Warm Up 1–2 0
1 2–3 20
2 3–4 40
3 4–5 60 /
4 5–6 80
5 6–7 100
6 7–8 120 /
7 8–9 140
8 9 – 10 160
9 10 – 11 180 /
10 11 – 12 200
11 12 – 13 220
12 13 – 14 240 /

Recovery 1 0 - 10
Recovery 2 0 - 10
Recovery 3 0 - 10 /

At Test Termination: Time: min .

HRrest: bpm Resting BP: ___/ __mmHg

Reasons for termination of test:

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 27 of 73

 Ramp Incremental Cycle Ergometer Test (CPET)
Questions
1. List the CONTRAINDICATIONS of conducting a CPET.

2. What are conditions for the termination of the cycle test?

3. Using the raw data of the test subject, plot a graph showing :
(i) HR against VO2,

4. How do the VO2, and HR respond with increasing intensity at every stage of the cycle
protocol? (Clue: Plot a graph of the parameter against time)

5. What is the subject’s VO2max? Calculate the predicted VO2max using the ACSM
formula. Appraise the similarity and/or difference between the actual VO2max obtained
from the CPET program and that of the predicted VO2max.
Explain if there is a difference observed.

6. You are going to plan an exercise program training session for the subject in the
practical session 4 class.
(i) Select a moderate intensity treadmill exercise based on VO2max. (state YOUR
moderate intensity range)
(ii) Find the work rate of the cycle exercise that will elicit the above moderate intensity.
(iii) Find the HR range that the subject should be exercising at.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 28 of 73

 Plot the VO2 against HR

220

215

210

205

200

195

190

185

180

175

170

165

160

155

150
Heart Rate (bpm)

145

140

135

130

125

120

115

110

105

100

95

90

85

80

75

70

65

60

58

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58
Oxygen Consumption (VO2peak) ml/kg/min

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 29 of 73

 STATION 3: Modified Astrand-Rhyming Cycle Test
Instructions to students
Introduction
This is the Modified Astrand-Rhyming Cycle Test station, where the subject cycles at
submaximal intensity between heart rates of 120- 170 bpm. You are required to conduct,
record, and measure the cycle ergometer test on your classmate. You are also required to
use the test results to estimate your classmate’s VO2peak.
Aims
1. To conduct the Modified Astrand Rhyming Cycle test safely and independently
2. To record parameters of the test
3. Answer the station questions.

Tasks and Roles

Watch the videos and discuss
Answer the questions.

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 30 of 73

 Modified Astrand-Rhyming Cycle Test
Instructions on conduct of test

This test estimates VO2max using a single-stage, six-minute submaximal cycling protocol. It is
a single-stage test and relatively simple to perform.
1. Before the test :
a. Weigh the test subject and document the value.
b. Measure resting Heart Rate and Blood Pressure in sitting position. The subject
may sit on the couch.
c. To ensure safety limits of the test, calculate 85% of the subject’s maximum Age
Predicted Maximum Heart Rate (APMHR) using the formula :
85% APMHR = (217 - 0.85 x age) * 85%
d. Adjust the height of the cycle seat using the greater trochanter as a landmark.
i. The subject’s knee should be in slight flexion of 5-10 degrees when during the
bottom of the pedalling cycle.

Instructions to participant
You will be performing a submaximal test called Modified Astrand Rhyming Cycle Test. You
will start pedaling at a low intensity (2-3 / 10 RPE) for the first 2 minutes as a warm-up.
Then, the load will increase so that you are working with a heart rate of 120-170 bpm. You
are required to exercise at this level constantly for 6 minutes while maintaining the heart
rate range. At all times, keep the cadence between 50-60 rpm. You will cycle until you are
not able to or the tester wants you to stop. At any time, should you feel dizzy, giddy, too
fatigue or breathless, such that you cannot continue anymore, you could lift your right arm up
to indicate to us to stop the test. During the test, we will also ask for your rating of perceived
exertion (RPE). Give us a thumbs-up when we reach the number on the scale that reflects
your perception of fatigue. Do you have any questions?

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2. Test procotol :
a. Warm Up Phase :
i. The subject will warm up for 2 mins at a low intensity (2-3 / 10 or 7-8 / 20
RPE or HR slightly > 120 bpm, if possible).
b. Test Phase :
i. The total test duration is 6 mins.
ii. Subject is to maintain a cycling cadence of 50-60 rpm.
iii. The workload should be determined by the subject’s gender and physical
condition. The following workloads are used throughout the entire six minutes
(see table below).

Male Unconditioned 50 – 100 W

Conditioned 100 – 150 W
Female Unconditioned 50 – 75 W
Conditioned 75 – 100 W

iv. After the first and second minutes, measure HR and adjust intensity
accordingly:
- Increase cycle resistance (Watts) if the HR is below 120 bpm.
- Decrease cycle resistance (Watts) if the HR is near 170 bpm.
v. Instruct the subject to maintain a steady pace throughout the test. Record
RPE and HR at each minute to ensure the subject is staying within the
recommended target heart-rate range (THRR). Blood pressure should be
assessed and recorded at the four-minute mark. Record the subject’s HR at
the 5th minute and 6th minute of the test.
vi. If there is a difference of more than 5 bpm, extend the time to 1-2 minutes
until the difference between each minute is less than 5 bpm.
vii. The mean value of the final 2 minutes will be used for determining VO2max.
c. Cool Down Phase :
i. Upon test completion, the subject will cool down for 3 mins at a workload of 0-
10 W until HR and BP return to near resting levels.

3. Test termination criteria :

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 Modified Astrand-Rhyming Cycle Test
Recording Log
Subject Name : ___________________________________________________
Age : __________________ Body Weight (kg) : _____________
Age Predicted Maximum Heart Rate (217 – 0.85 x age) = __________________
85% APMHR (this is the test end point) = _____________________________

Stage Time(min) Intensity HR BP RPE Remarks

(Watts)
Rest 0 seated /

Warm Up 0-1

Warm Up 1–2
1 2–3
2 3–4
3 4–5
4 5–6 /
5 6–7
6 (End) 7–8

Recovery 1
Recovery 2
Recovery 3 /
(the empty boxes are meant for further extension of the test when the difference of HR at minutes 5 and 6
exceeds 5bpm)

HRrest: bpm Resting BP: ___/ __mmHg

Reason for test termination:

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 SUBMAX station: Modified Astrand-Rhyming Cycle Test
Formulae and Questions
Determining Maximal Oxygen Consumption
1. Using the Astrand-Ryhming nomogram (see Figure1 or 2), draw a line from the mean
HR through the VO2max and to the workload used for the test, either male or female.
The place where the line intersects the VO2max is used to determine the client’s
maximum oxygen uptake.
VO2 (from nomogram): __________________ L/min

2. VO2max value must then be age-adjusted using the correction factors listed in the table
below. To calculate the estimated VO2max, the age correction factor is multiplied by the
VO2max value from the nomogram.

Age 15 20 25 30 35 40 45 50 55 60 65

Factor 1.10 1.05 1.0 0.94 0.87 0.83 0.78 0.75 0.71 0.68 0.65

VO2 (corrected for age) = _________________ L/min

3. Convert the age corrected VO2 to VO2 per kilogram of body weight:

VO2 = ____________________________ ml/kg/min

Questions

1. State the differences between the submaximal Astrand Cycle Test and a ramped
Incremental Cycle Test.

2. What are the advantages and disadvantages of performing a submaximal test?

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Figure 1. Modified Astrand-Rhyming nomogram for predicting VO2max

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Figure 2. Modified Astrand-Rhyming nomogram for predicting VO2max

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 STATION 4: Interpretation of exercise test results

Mdm Z is 43 years old. Height 1.55m, weight 65kg, waist circumference 114cm.

Her CPET results are plotted out the graph below.

Questions

1. Calculate Mdm Z’s age predicted maximum heart rate.

2. Convert VO2 of 10ml/kg/min to METs (metabolic equivalents).

3. Calculate the estimated VO2 peak for Mdm Z.

4. Reflect how having these results aid in your prescription of exercise. Prescribe an
aerobic exercise program based on these results.

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 Practical Session 3
Resistance exercise selection, coaching,
assessment, and modification

Lesson objectives

At the end of the session, you will be able to:

1. Demonstrate clinical reasoning skills to select appropriate resistance and/or
plyometric exercise for an individual suitable to a case scenario
2. Demonstrate effective coaching and communication skills for the successful
completion of desired movement pattern/exercise suitable for your case scenario
3. Demonstrate ability to perform a submaximal or progressive test to predict one rep
max or identify appropriate level of plyometrics, including the use of RPE for your
case scenario
4. Demonstrate ability to prescribe a comprehensive exercise programme based upon
sub maximal testing, taking into account principles of training and acute programme
variables for your case scenario
5. Demonstrate ability to evaluate exercise response and utilize a number of different
strategies to appropriately pro and regress exercises for your case scenario
6. Demonstrate awareness of essential safety and infection control issues throughout
the practical session

Preparatory materials:
Knowledge: Revise lecture notes from:
- PTY 1009 – Anthony’s sessions
- PTY 1007 – Anthony’s sessions

Materials:
- Bring along a fully charged camera or mobile device for which to film activities
- Please bring along water bottles of varying sizes and a rucksack to use as resistance
items if needed.

Activity:
This activity is intended to get you to practice key skills in the assessment, prescription and
coaching of resistance exercises as well as to practice presentation and discussion of a case
scenario in a similar manner to your oral viva. You will be working in a pair, however you will
be assigned 3 other pairs to form a larger group (no contact in classes beyond your pair) to

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share resources and knowledge with after the practical session. Each pair will be given a
case scenario for which they have to plan, prepare, demonstrate and rationalize. You are
encouraged to record and/or present based upon the following powerpoint guide:

Practical
presentation slides.pptx

Additionally, you will be encouraged to view and critique the powerpoint presentations from
the other 3 pairs in your group after the class using a standardized format. Please use the
following file (also available on the LMS) when peer reviewing the other pairs in your
grouping:

Peer review
form.docx

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 Practical Session 4
Practical Assignment
Objectives

Take this opportunity to revise and prepare for viva

Preparatory materials (available on LMS): Revise lecture notes & videos

Activity:

1. A case scenario for oral viva will be provided.

2. Answer all the questions.
3. Create your own monitoring sheet

Please review your answers and upload to LMS with:

OralViva_FULL NAME_Matriculation No.

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Figure 3. Table showing various methods of prescribing exercise at different intensity
level

Source: Garber et al (2011). ACSM Position Stand. Quantity and quality of exercise for
developing and maintaining cardiorespiratory, musculoskeletal and neuromotor fitness in
apparent healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports
and Exercise, 43(7), 1334-1359.

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 TUTORIAL

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 Tutorial 1
ECG Study and Discussion

ECG Electrode Placement

Step 1 : Skin preparation

Skin preparation is a key factor in minimizing noise and artifact on the stress test recording.
a. Shave to remove all hair on the electrode sites.
b. Scrub all electrode sites with alcohol wipes.
c. Abrade the skin with an abrasive pad.
• Skin should be red, with visible abrasion marks, when the skin preparation
is complete.
Step 2 : Electrode Placement
Palpate and attach electrodes at the following landmarks
a. V1 : Right side of sternum at Fourth intercostal space.
b. V2 : Left side of sternum at Fourth intercostal space.
• Where the sternum stops and the intercostal space begins, this is where
the CENTER of each electrode is placed.
c. Finding the Fourth intercostal space
• Palpate the suprasternal notch at the top of the sternum (base of the
throat).
• Gently move the finger down the sternum until you feel a horizontal ridge
(about 1 ½ inches down). This is called the Angle of Louis.
• The Angle of Louis is an important anatomic landmark. The second rib is
at the level of the Angle of Louis.
• Below the second rib is the second intercostal space. Distal to this space is
the third rib and space and so on.
d. V4 : Fifth Intercostal Space in the Mid-Clavicular Line
e. V3 : placed in between V2 and V4
f. V5 : placed in a direct line with V4 at the Anterior Axillary Line (front of the
armpit).
g. V6 : placed in alignment with V4 & V5 at the Mid-Axillary Line (middle of the
armpit).

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Placement of Limb Leads
a. RA and LA electrodes should be placed just below the right and left clavicle.
b. RL and LL electrodes should be placed
• on the lower edge of the rib cage, or at the level of the umbilicus at the mid-
clavicular line.

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 ECG READING STATION

Steps to Systematic ECG Reading

• Rate
• Rhythm
• P Wave
• PR Interval
• QRS Complex
• ST Segment
• T Wave

Wave P PR Interval QRS ST segment T

Deflection Positive No Electrical Q = negative No Electrical Positive

Deflection Inactivity deflection Inactivity Deflection

R = positive
deflection

S = negative
deflection

Amplitude 0.5 - 2.5 Zero 5 small Zero < 3 boxes

small boxes (isoelectric boxes - 25 (isoelectric
(< 2.5 mV)
Line) small boxes line)
(< 0.25mV)

Duration 1.5 - 3 small 3 -5 small 2 – 3 boxes 2 – 3 boxes ~ 6 boxes

boxes boxes
0.08 – 0.12 s 0.08 = 0.12 s 0.10 to 0.25 s
0.06 - 0.12 s 0.12 – 0.20 s

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 ECG Case 1

1. Identify the Precordial Leads.

2. Identify the rhythm in the ECG shown. Give your reasons

3. Calculate the Heart Rate.

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 ECG Case 2

1. The rhythm of the ECG above shows

a. Irregularly irregular pattern
b. Regular Sinus pattern
c. No predictable pattern

2. Which method is best to calculate the heart rate?

a. number of QRS complexes over 6 seconds
b. number of small boxes between 2 R waves
c. number of squares between 2 R waves

3. Name this ECG rhythm.

4. During a Bruce test on the treadmill, the rhythm changes from Sinus to the above
rhythm. The subject complains of giddiness and breathlessness. Do you continue or
terminate the test? Give reasons for your decision.

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 ECG Case 3

The above is the ECG rhythm strip of a patient who complained of chest pain.

1. Name the component marked with the arrows.

2. State or explain the indications behind the component marked with the arrows.
3. Is this a sinus rhythm or an arrhythmia?
4. If this ECG is presented during a CPET test, what will you do?
a. Pause the test because electrodes V2 and V3 have fallen off; reposition the
electrodes and restart the test.
b. Terminate the test because the saturation has dropped.
c. Continue the test untill completion and ask the subject to go home and rest.
d. Terminate the test and contact the doctor immediately.

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 Tutorial 2
Case Study Discussion
(Flipped Learning)

Lesson objectives

At the end of the session, you will be able to:

1. Discuss the acute physiological responses during the exercise tests

2. Evaluate and interpret exercise test results
3. Design an appropriate exercise training program for persons with and without pathological
conditions.

Preparatory materials
Lectures from Weeks 1 to 4

Activity:
Students are expected to have attempted the questions related to the case studies, using
reading materials from Weeks 1-3 and the core text. In this tutorial, students will discuss the
answers within their small group/pair and present their answers to the class.

Students may divide into pairs/small groups. Each pair/group will present a case study,
therefore there will be 2 presentations of the same case study.

The intent of the flipped classroom is to identify and address students’ gaps, direct self-
directed learning and encourage peer teaching-and-learning.

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Instructions: Answer the questions to each case to the best of your abilities using the
knowledge you have gained in the past weeks. Please come prepared with your answers for
this tutorial in a Flipped Classroom format.

Case 1
Mr A, 28 y/o male, 70kg. He is active, runs 5km 3 times a week and plays football every
Sunday. No clinical condition. A cardiopulmonary test using the incremental cycle test was
conducted.
Protocol: 2 minutes of unloaded cycling, then load of 20 Watts (W) at every minute until
exhaustion or VO2 plateau despite increase of workload or > 85% of HRmax.
Results of his incremental cycle test:

Workload Time VO2 VCO2 Rf VT VE HR SpO2 Dysp RPE

W min ml/min ml/min b/min l l/min b/min %
rest 277.76 304.16 13.19 0.92 11.30 74 0 0
0 Unloaded 563.29 468.94 16.11 0.97 14.51 0 0
1
0 Unloaded 493.86 448.11 17.47 0.84 14.25 86 0 0
2
20 1 501.19 473.98 15.75 1.05 14.59 88 0 0.5
40 2 678.95 575.84 18.23 0.96 17.03 91 0 0.5
60 3 904.46 741.99 19.75 1.03 20.15 97 0 0.5
80 4 1125.22 1008.42 17.17 1.51 24.69 105 0 1
100 5 1314.87 1243.62 19.66 1.54 29.55 112 0.5 1
120 6 1542.13 1501.76 19.06 1.77 33.08 121 0.5 2
140 7 1900.31 1953.77 23.55 1.90 43.48 131 1 3
160 8 2116.60 2246.41 24.94 2.03 49.96 142 1 3
180 9 2406.55 2625.61 26.45 2.18 57.32 152 2 4
200 10 2601.20 2930.05 29.31 2.27 66.22 163 3 5
220 11 2570.96 3170.36 37.35 2.41 90.38 173 5 7
end 9 9
recovery 1147.20 1820.65 26.25 1.99 51.98

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 3000.00

2500.00
VO2, ml/min

2000.00

1500.00

1000.00
VO2 ml/min
500.00

0.00

9
3
4
5
6
7
8
rest
unloaded1
unloaded2
1
2

10
11
Time

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Questions:

1. Describe the VO2 kinetics of Mr A during the incremental cycle test.

2. What is his VO2max? What is his maximum workload?

3. What is his predicted HR max? Compare that to his true HR max.

4. How would the kinetics for HR and VE appear in this test for Mr A?

5. How do you prescribe a cycle exercise intensity for Mr A? Show using 3

methods.

6. How do you prescribe a treadmill exercise intensity at 0% incline for Mr A?

(Hint: ACSM equation)

7. Calculate his R value at the 3rd minute and at the end of the test. Explain the
difference in R values at both time points.

8.How would you prescribe his resistance strength exercise training?

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Case 2
Ms B, 33 year old female technician, Height 1.6m, weight 100kg. Recently had some chest
discomfort while at work.

Medical history:
Asthma
Total hysterectomy with lymph nodes removal (Stage 1 endometrial cancer)
Vitamin D deficiency
Right knee pain

Medications:
Colecalciferol
Phentermine 15mg
Topiramate 25mg
Symbicort 160/4.5 Turbuhaler

Blood results:
Total cholesterol 4.61
HDL 1.15
TG 0.92
LDL 3.10
ALT/AST/GGT 22/19/46
Glucose 5.8
TSH 1.60

Cardiopulmonary exercise test (BRUCE protocol):

HR BP RPE
Standing 81 160/82 0
Stage 1 101 159/80 1
Stage 2 105 150/72 4
Stage 3 131 178/75 7
Cool down (4 min) 98 148/78 2

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Questions:

1. Which information would warrant some caution during an exercise test for
Ms B?

2. From her Treadmill Bruce Protocol results, what is her VO2max?

3. How would her VO2 kinetics look during the Treadmill Bruce Protocol Test
by every minute?

4. What is her rate pressure product at rest and at the end of Stage 3?

5. How do you prescribe a walking exercise for Ms B?

6. Using her medical history and test results, what needs to be monitored
during her walking exercise?

7. What other aerobic exercises would be suitable for her? Prescribe this
exercise.

8. How would you prescribe her resistance strength exercise training?

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 Tutorial 3
Assessment and Treatment
(Exercise Prescription) in clinical
conditions
(Problem-Based Learning)

Lesson objectives

At the end of the session, you will be able to:

1. Apply Subjective Objective Assessment Plan Intervention Evaluation (SOAPIE) format

2. Evaluate the effectiveness of exercise in persons with diabetes, persons with chronic pain
and persons with osteoporosis with considerations to pathophysiology
3. Select appropriate exercise tests for these groups
4. Appraise the risks of exercise in these groups and justify risk-mitigating strategies.

Preparatory materials
Lectures from Weeks 1 to 8

Activity:
Students will break into pairs/groups, with each pair/group managing a case. Students are
required to define the problem, activate prior knowledge, brainstorm on strategies, identify
learning resources, design an exercise program and present their management strategy to
the class.

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 CASE 1: Mrs Ng
Mrs Ng is a 70 year old retired teacher. She has diabetes mellitus, hypertension and
hyperlipidemia. She also has neck and back ache for many years. She was an ex-smoker
(50 years ago).
Six months ago Mrs Ng was told by her doctor that her kidney function is worsening and was
advised lifestyle changes as her weight has been gradually increasing over the last 2 years
(3kg weight gain). She was also given new medications to manage her blood pressure and
diabetes. Her present medications include Aspirin, Empagflozin, Losartan Potassium,
Metformin HCL, Repaglinide, Rosuvastatin, and Aspirin.
Mdm Ng enjoys watching Korean drama late into the night, and thus finds it challenging to
get up early to join her friends for morning walks. Further her back pain makes her reluctant
to walk too much.

1. Define the problem(s) that you can address

2. What knowledge can you draw upon to help you with dealing with Mrs Ng’s
problems? (across the programme to date)

3. Brainstorm ideas as a team as to how you would address these problems

4. Generate a suitable exercise programme that you would prescribe to Mrs Ng

5. Identify issues surrounding the successful implementation and adherence to

your programme
6. Identify further learning resources for your peers

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 CASE 2: Bernard
Bernard is a 45 year old chemistry teacher at a local polytechnic. He has suffered with
stiffness and spinal pains for many years, however he always put this down to getting older
and gradually doing less exercise.
Six months ago Bernard was diagnosed with ankylosing spondylitis and he has noticed an
increase in his pain and decrease in his function since this time. On his latest visit to his
rheumatologist they advised him to keep active and go for physiotherapy, however he is
unsure how this will help.
Bernard has previously been very active and enjoyed playing sports and going to the gym,
however the past 5 years he felt exercise was making him worse, therefore stopped. He now
just enjoys watching sports on T.V.

1. Define the problem(s) that you can address

2. What knowledge can you draw upon to help you with dealing with Bernard’s
problems? (across the programme to date)

3. Brainstorm ideas as a team as to how you would address these problems

4. Generate a suitable exercise programme that you would prescribe to Bernard

5. Identify issues surrounding the successful implementation and adherence to

your programme

6. Identify further learning resources for your peers

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 CASE 3: Gwen
Gwen is a 65 year old post menopausal housewife. Last year whilst on a hiking trip to
Switzerland she fell and broke her arm. Upon further testing it was found that she had low
bone mineral density. She has been advised by the geriatrician to do exercises to improve
her function and BMD, however she is cautious as she has never been very into gym
exercises as she finds them intimidating. Additionally – she doesn’t understand why she
needs this as she describes herself as ‘very fit’ as she enjoys hiking ++.
She has come to see you today for your expert advice and opinions to help her improve her
function and BMD.

1. Define the problem(s) that you can address

2. What knowledge can you draw upon to help you with dealing with Gwen’s
problems? (across the programme to date)

3. Brainstorm ideas as a team as to how you would address these problems

4. Generate a suitable exercise programme that you would prescribe to Gwen

5. Identify issues surrounding the successful implementation and adherence to your

programme

6. Identify further learning resources for your peers

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 Annex
Annex A: PAR-Q+ & PAR-Q
Annex B: Contraindications to Exercise and Termination Criteria
Annex C: Ratings of Perceived Exertion (RPE) Scale
Annex D: Formulae
Annex E: Useful links to videos

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 ANNEX A

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 60 of 73

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 61 of 73
PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 62 of 73
 Physical Activity Readiness Questionnaire (PAR-Q)

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Regular physical activity is fun and healthy, and increasingly more people are starting to
become more active every day. Being more active is very safe for most people. However,
some people should check with their doctor before they start becoming much more
physically active.

If you are planning to become much more physically active than you are now, start by
answering the seven questions in the box below. If you are between the ages of 15 and 69,
the PAR-Q will tell you if you should check with your doctor before you start. If you are over
69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read
the questions carefully.
YES NO
□ □ 1. Has your doctor ever said that you<End>
have a heart condition and that you should only do
physical activity recommended by a doctor?
□ □ 2. Do you feel pain in your chest when you do physical activity?
□ □ 3. In the past month, have you had chest pain when you were not doing physical activity?
□ □ 4. Do you lose your balance because of dizziness or do you ever lose consciousness?
□ □ 5. Do you have a bone or joint problem that could be made worse by a change in your
physical activity?
□ □ 6. Is your doctor currently prescribing drugs (for example, water pills) for your blood
pressure or heart condition?
□ □ 7. Do you know of any other reason why you should not do physical activity?

If you answered YES to any of the above, please provide details:

___________________________________________________________________
___________________________________________________________________

Delay becoming much more active:

• If you are not feeling well because of a temporary illness such as a cold or a fever – wait until
you feel better; or
• If you are or may be pregnant – talk to your doctor before you start becoming more active.

DECLARATION AND AUTHORISATION

I confirm that the information given is a true and accurate statement. I understand
that if I have declared any of the conditions listed, further information may be
requested.
Please be aware that it is your responsibility to inform us if there is a change to any
of your answers on the PAR-Q.

Participant Name, Signature and Date:

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 ANNEX B
Contraindications to Exercise and Termination Criteria

Reference: ACSM

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PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 66 of 73
PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 67 of 73
 ANNEX C
Ratings of Perceived Exertion (RPE)
Instructions for Borg Rating of Perceived Exertion (RPE)
6 to 20 Scale

While doing physical activity, we want you to rate your perception of exertion. 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 rating scale below while you are engaging in an activity; it ranges from 6
to 20, where 6 means "no exertion at all" and 20 means "maximal exertion." Choose
the number from below 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
speed up or slow down your movements to reach your desired range.

Try to appraise your feeling of exertion as honestly as possible, without thinking

about what the actual physical load is. Your own feeling of effort and exertion is
important, not how it compares to other people's. Look at the scales and the
expressions and then give a number.

Note:

9 corresponds to "very light" exercise. For a healthy person, it is like walking slowly
at his or her own pace for some minutes
13 on the scale is "somewhat hard" exercise, but it still feels OK to continue.
17 "very hard" is very strenuous. A healthy person can still go on, but he or she
really has to push him- or herself. It feels very heavy, and the person is very tired.
19 on the scale is an extremely strenuous exercise level. For most people this is the
most strenuous exercise they have ever experienced.

Borg RPE scale

© Gunnar Borg, 1970, 1985, 1994, 1998

Instructions for Borg Rating of Perceived Exertion (RPE)

1 to 10 Scale

The RPE scale is used to measure the intensity of your exercise. The RPE scale
runs from 0 – 10. The numbers below relate to phrases used to rate how easy or
difficult you find an activity. For example, 0 (nothing at all) would be how you feel
when sitting in a chair; 10 (very, very heavy) is how you feel at the end of an
exercise stress test or after a very difficult activity.
https://my.clevelandclinic.org/health/articles/17450-rated-perceived-exertion-rpe-
scale

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PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 69 of 73
 Breathlessness / Leg Fatigue Scale

0 Nothing at all

0.5 Very, very slight

1 Very slight

2 Slight

3 Moderate

4 Somewhat severe

5 Severe

7 Very Severe

9 Very, very severe

10 Maximal

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 ANNEX D
Formulae

ACSM Formula

Age-Predicted Maximum Heart Rate = 217 – 0.85 x age

Calories (kcal/min) = [METs x 3.5 x weight (kg)] / 200

Predicted VO2 formula from different modes of exercise:

Treadmill (walking) exercise:

VO2 (mL/kg/min) =
[0.1 (mL/kg/min) x Speed (m/min)] + [1.8 (mL/kg/min) x Speed (m/min) x
Gradient (% in decimal)] + 3.5 (mL/kg/min)

Leg cycle exercise:

VO2 (mL/kg/min) =
[1.8 x Work Rate (W) x 6/ Body Mass (kg)] + 3.5 (mL/kg/min) + 3.5
(mL/kg/min)

Please note:
W to kg.m/min = W X 6.12 ( 6)
kg.m/min to W = kg.m/min x 0.1634

Step exercise:

VO2 (mL/kg/min) =
[0.2 x Stepping Rate (steps/min)] + 1.33 x 1.8 x Step Height (m) x
Stepping Rate (steps/min) + 3.5 (mL/kg/min)

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 71 of 73

 ANNEX E
Links to relevant videos

Video on the technique of capillary pricking to measure blood

glucose
https://www.youtube.com/watch?v=AyDHP9puCag
https://www.youtube.com/watch?v=PADmEPMtr2s

Video on the technique of taking manual blood pressure

measurement
https://www.youtube.com/watch?v=bHXvhOQ0hYc

https://www.youtube.com/watch?v=5TahRMklod8

https://youtu.be/-LqKmrmaHsk

CardioPulmonary Exercise Testing (CPET) by ERS: Purpose and

procedures
https://www.youtube.com/watch?v=YDZxVtRJtMo

Treadmill Stress or Tolerance test

https://www.youtube.com/watch?v=4-jS6BKaVSY
https://www.youtube.com/watch?v=l9Q34UAbjTs

https://youtu.be/y3Zq4n3WSyc

Recognising ST segments on stress ECG

https://www.youtube.com/watch?v=r8Kwmutod34

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 72 of 73

Astrand Bike test
https://www.youtube.com/watch?v=6KOoejoYP8A

https://youtu.be/JKfHGzyjqVg

Others
Refer to videos loaded on LMS

PTY1009 Exercise Physiology Practical and Tutorial Manual 2019 Page 73 of 73