SPS 290 CHAPTER 6 :
Exercise for Chronic Diseases
SubtMinimal Effective Strain
(MES)opic
Water exercise is appropriate when 
multiple vertebral fractures are present or 
back pain precludes participation in weight 
bearing exercise
Force must meet or exceed the MES to 
initiate new bone formation
OSTEPOROSIS
Osteoclasts promote bone resorption. 
Osteoblasts are responsible for bone 
deposition
Post menopausal women experience a 
rapid acceleration of bone loss due to 
estrogen deficiency
Key Risk Factors
- smoking
- family history
- low calcium intake
- low vitamin D intake
- anorexia
- prolonged amenorrhea
- hyperthyroidism
- sedentary lifestyle
CANCER
Increased muscular strength
cancer rehabilitation through exercise 
prescription
strong inverse relationship between activity & 
all cancer
NO MAJOR ADVERSE EFFECTS OF 
EXERCISE IN CASE REPORTS 
INVOLVING SEVERAL HUNDRED 
CANCER PATIENTS
DIABETES
May use RPE for neuropathy
Intensity: 50-85% VO2 max
Duration: 20-60 min
Frequency: 4-6 day per week or daily low intensity
HYPERTENSION
Resistance training is recommended as a 
component of a well rounded fitness 
program
Resistance training is not recommended 
as the primary form of exercise
Avoid valsalva maneuver
Exercise mode, frequency, duration, and 
intensity of exercise similar to low risk 
individuals
6.1 General Principles of 
Exercise Prescription
6.0 Neuro-motor Exercise
Methods for optimal progression are not known
The optimal volume
Involving motor skills
More	than	20 to 30 mins per day is needed
An effective intensity of neuromotor exercise has not been determined
More	than	2 to 3 days per week is recommended
5.0 Flexibility Exercise
Methods	for	optimal	progression	are	unknown
A reasonable target is to perform 60 s of total stretching time for each flexibility exercise
1. Ballistic	stretching	
2. Dynamic	stretching	
3. Static	stretching	
4. Active static stretching	
5. Passive static stretching	
6. PNF
1. Hold	a static stretch for 10 to 30 second for adults	
2. For older populations hold for 30 to 60 seconds	
3. For PNF, 3 to 6 seconds of max voluntary	contraction followed by 10 to 30 seconds assisted stretching
Stretch from the discomfort point
More than 2-3 days per week
4.0 Resistance Exercise
increasing	
frequency	is recommended
Set and repetitions
Involve a lot of body muscle
No specific time
From low to high intensity
Resistance	training of each	muscle group 2-3days per week	with at least 48	hours separating the exercise training sessions for same muscle groups
3.0 Aerobic Exercise (Cardiorespiratory Endurance)
Progression
The progress of the exercise is depends on the individual goals
Volume
The volume is the product from the frequency, intensity and the time of exercise
Type
The type of the exercise need to suitable for the age category
Time
Adults should accumulate 30-60mins per day
Intensity
1. Moderate(40% to 60% of HRR or Vo2 Reserve)for healthy adults	
2. Vigorous (60% to 90% of HRR and	Vo2	Reserve)	for healthy adults	
3. Light(30%	to 40% of	HRR	and	Vo2	Reserve)
Frequency
1. Moderate intensity,	aerobic exercise	done	at least 5 days per week	
2. Vigorous intensity,	aerobic exercise	done	at least 3 days per week
2.0 Components of Exercise Training Session
Stretching
Cool Down
Conditioning
Warm Up
1.0 Introduction on Principle of Exercise  Prescription
a) Beginning a new program of exercise at light-tomoderate intensity 
b) Employing a gradual progression of the quantity 
and quality of exercise 
c) Following the pre-participation health screening 
and evaluation procedures
Principles of Exercise Prescription includes: 
i. F – Frequency (how often) 
ii. I – Intensity (how hard) 
iii. T – Time (how long) 
iv. T – Type (mode or what type of exercise) 
v. V – Volume (amount) 
vi. P – Progression (advancement)
An exercise training program ideally is designed to 
meet individual health and physical fitness goals.