Clinical Exercise Physiology (KIN 460)
Exercise Prescription for High Risk
Populations (KIN 639)
Eric P. Plaisance, PhD, FACSM, ACSM-CEP, CSCS
Associate Professor and Department Chair of Human Studies
Scientist, Nutrition Obesity Research Center and Center for Exercise Medicine
Jennifer M. Ponder, PhD
Associate Professor and Department Chair of Curriculum & Instruction
Co-Director UAB Teach
Welcome
Introduction
Syllabus Overview
Approach to Exercise and Disease
Management
Problem-Oriented Exercise Management
(POEM)
• POEM was developed in the late 1960s to provide a
systematic way of organizing extremely complex
problems into simpler parts that make them easier to
evaluate and solve
• POEM consists of 5 steps commonly collected in the
SOAP format
1. Collection of Subjective data (Empathize)
2. Collection of Objective data (Define)
3. Assessment and generation of a problem list (Ideate)
4. Formulation of a Plan that is diagnostic or therapeutic (or both)
(Prototype)
5. Periodic reassessment (follow-up) (Test/Refine/Re-test)
Collection of Subjective Data (Empathize)
• Consider barriers to lifestyle change, identifying and describing risk
factors, medical concerns, chronic disease and disability is crucial
for patient safety and efficacy of your exercise prescription
• Medical history:
• Identify all chronic disease and medical issues
• Identify all signs and symptoms and risk factors for CVD, pulmonary
disease and metabolic disease (+orthopedic)
• Obtain a list of all current medications and results of any recent medical
and exercise tests
• Perform a comprehensive review of past and current physical activity and
exercise habits and identify any prior symptoms or signs of adverse events
• Identify the reason the person was referred for exercise testing or training
Collection of Objective Data (Define)
• Data collected during a physical examination and from
clinical laboratory studies
• Once an individual’s medical history is obtained, the
most appropriate exercise tests can be selected
• Aerobic Power (maximal or submaximal graded exercise test
(GXT, HRmax, VO2max, lactate threshold, ventilatory
threshold)
• Anaerobic Power (Wingate, vertical jump)
• Endurance (push-ups, sit-ups, pull-ups)
• Strength (1-RM, Multiple-RM)
• Flexibility (sit and reach)
• Neuromuscular (coordination and skill)
• Functional (6 minute walk test, activity of daily living tasks)
Assessment (Ideate)
• Use of the subjective and objective information gathering steps
should make it possible to generate a list of specific problems
• Case Study Example: A patient presents with cardiovascular disease,
takes beta blockers, has an internal defibrillator with low aerobic
capacity and weak hip and knee extensors (what ideas do you have to
solve the problem)
• The assessment may explain the individual’s problems or lead
to further assessment of problems
• Health-related problems should then be prioritized by impact
and potential for adverse events during the intervention
Steps in Formulating an Exercise-Treatment
Plan (Prototype)
• First, the exercise prescription must include both short-
and long-term individualized goals based on the
subjective and objective findings of the assessment.
Goal setting strategies (SMART).
• Specific: Goals need to be defined precisely
• Measurable: How will you quantify?
• Actionable: The goal should be something that the
Examples
individual believes in and truly desires
• Realistic: Goals should actually be achievable
• Weight Loss
• Time oriented: Setting deadlines • Type 2 Diabetes
Steps in Formulating an Exercise-Treatment
Plan (Cont’d Prototype)
• Second, consider any unique circumstances an
individual might have, such as prosthetics,
medications, exercise facilities available, and other
conditions that may require modification of a more
typical program
• It is also important to evaluate the risks, benefits, and
costs of the program and discuss any concerns the person
might have
• Finally, develop a reassessment schedule
(test/refine/re-test)
Things to Consider when Prototyping
• Similar to medication, exercise is prescribed by
action (families of specific exercises performed to
achieve success with a treatment plan)
• Aerobic exercise increases aerobic fitness; resistance
exercise increases skeletal muscle strength, endurance
and/or mass
• Exercise dose is a function of intensity and
duration
• Frequency is determined by the desired fitness
level
• Exercise has a half-life and recovery is crucial
Test/Refine/Re-test
• Periodic reassessment should be scheduled with
your client to provide objective information about
the safety and efficacy of the exercise prescription.
This process provides feedback to the participant
about their progress, permits active learning, and
is proven to reduce rates of dropout
• Case: A patient wishing to lose and maintain
weight-loss will have to periodically be required to
reassess frequency, intensity and duration of
exercise, dietary consumption, and other lifestyle
behavioral challenges
