SPORT

NUTRİTİON
FATMA ÖZSEL ÖZCAN
ARAÇ
PHYSICAL ACTIVITY IN HEALTH
PROTECTION

The evolution of humans is based on

an active life.

Sedentary: Sedentary/inactive
lifestyle

According to WHO reports, physical

inactivity, one of the common risks
of chronic diseases, ranks 4th.
 According to the Turkish Nutrition
and Health Survey, children aged
6-11 years do not exercise
regularly for more than 30 minutes.
Tv internet computer use...
Regular exercise either reduces
the risk of chronic disease and
stimulates the release of
endorphins.
 What is endorphins ? ( appetite,
pain and mood swings)
Guessing Game? The
Body fat/weight and abdominal fat :
Increase in systolic and diastolic blood
Health
pressure and hypertension Affectin
Stroke risk
Resting heart rate
g
Blood lipid profile Benefits
of
Blood glucose
 Cancer risk

Regular
Exercise
Immunity

Resting metabolic rate and 24-hour energy

expenditure

Risk of mortality

Muscle Loss
 Bone and joint diseases
The lowest level of physical activity recommended by
WHO is 600 MET minutes per week. 150 minutes of
moderate-intensity or 75 minutes of high-intensity
physical activity per week
 300 minutes of moderate intensity or 150 minutes
of high intensity activity per week is very good
 Activity Period
Physical Activity Levels Moderate Intensity/week
Still Only basic daily activities
Low level of physical Basic daily activities+150 min
activity physical activity

Moderate physical 150-300 min of physical

activity activity
High level of physical >300 min physical activity
activity
10,000 names per day at the 2015
Athens Obesity congress

Pedometer (pedometer)

Increase the average start by 10%

 Like 5000 steps +500 steps?
Physical activiy has two key features;

It increases the rate of energy expenditure,

and it increases the rate of fluid lost via
sweat.

Importantly, fluids and foods are related

issues, because consumption of the right
fluids can also provide energy, vitamin, and
minerals.
Low-calorie chronic diets lower the basal
metabolic rate.
There is a positive relationship between
muscle mass and basal metabolism.
Exercise increases the basal metabolic
rate.
If BMR is high, calorie burning is
accelerated.
◾Rapid BMR contributes to
the recovery of metabolic
diseases such as insulin
resistance and diabetes.

(Kurian, Thopson and Davidson

2008).
Objectives of pre-exercise health
screening:
Medical contraindications?
What should be done with a medical
evaluation and exercise test because
they have a high risk in terms of age,
symptoms, risk factors?
Identify those with clinically significant
disease who should participate in a
medically assisted exercise program.
 Identify individuals with other special
needs
Risk Factors
Before starting exercise programs, people should be
evaluated for risk factors (Table 1) and signs and
symptoms of cardiovascular, pulmonary, or endocrine
diseases (Table 2).
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source/files-for-resource-library/
acsmprescreening101.pdf?
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Talking Test: It is an auxiliary method
used to determine the intensity of
exercise. The person is able to talk
during exercise (e.g., brisk walking) but
cannot sing
Intensity is considered moderate
intensity. At high intensity, the person
can take several times without being out
of breath.
 he can't speak more than words.
DETERMINING THE SYMPTONES
During electrocardiography (ECG)
and blood pressure arterial controlled
exercise tests, the degree of fatigue,
chest pain, dyspnea, dizziness,
syncope, pallor, cyanosis, severe
arrhythmia, leg cramps are
monitored along with the heart rate.
The exercise test is finished
according to precise and relative
termination criteria.
IN RISKY OCCASIONS
Maximal exercise testing with
increased load (eg; Bruce
protocol) may pose a risk in
those with chronic diseases. In
this case, submaximal exercise
tests (Modified Bruce,
Naughton, etc.) are preferred,
which generate less stress and
have smaller workload
increases, but at the same time
adequately stimulate the
cardiorespiratory system.
When the person's heart rate reserve
(HRR) reaches 70% or the age-related
maximum heart rate (MSCs) reaches
85%, or depending on a symptom that
develops, the person may continue
If it reaches a point where it cannot
(peak VO2), the test is terminated.
Medical Treatment
Medical Nutrition
Medical Exercise
the dose of drugs, the mode of daily use, the duration of use,
Food, type, quantity,
contents, frequency of eating
Exercise, duration, frequency,
Its density and type are very important.
Exercise should be done regularly.
 The exercise should be planned, implemented, observed,
evaluated and changed when necessary.
 Frequency; Frequency of Exercise
(Everyday, every other day, 3
times a week, etc.)
Intensity; Intensity/Intensity of
Exercise (Max. 50% of heart rate,
moderate intensity, etc.)
FITT Type: (aerobics, resistance,
combined, running
swimming, etc.)
 Time; Duration of the exercise
(15 min, half hour, 1 hour
etc.)
 Determination of
exercise intensity
(intensity)

The most accurate and reliable method

for determining aerobic capacity is the
measurement of VO2max.
With bicycle, treadmill or arm ergometer
submaximal or maximal that can be
made
During the exercise test, VO2max is
measured directly with oxygen
consumption analyzers or indirectly from
its close correlation with heart rate.
VO2max is estimated by leveraging it.
Instead of measuring physical
work capacity with exercise
testing, it takes into account
Maximum Heart Rate (MSCs)
and resting heart rate
heart rate reserve,
FLOW
 Indirect methods of
determining exercise
intensity, such as
perceived difficulty, can
also be used.
The formula often used to
calculate the maximum heart rate;
MHR=220-year-old.
The resulting number is multiplied
by the lower and upper limits of
the desired percentage of intensity
during exercise
there is a "target
heart rate range"
to maintain.
Example: If the age is 40 and the
desired exercise intensity is 70-
80%, what is the target heart rate
range?
MKH=220-40=180
Heart rates according to the
desired exercise intensity 70-
80%; 180x0.7=126 hits/min and
180x0.80=144 hits/min. Target
heart rate range = 126-144
beats/min.
 Reserve by subtracting the resting
heart rate from the maximum
heart rate
heart rate is calculated. The value
found and the desired exercise
HEART RATE RESERVE METHOD
The percentages of functional
(HRR), CARVONEN FORMULATION
capacity are multiplied. By adding
the resting heart rate to the
obtained values, the desired target
heart rate range is found in the
exercise.
Target heart rate range=[(Max heart rate-
Resting heart rate) x %
Intensity] + Resting heart rate
Example: Age 40, resting heart rate 60/min,
desired exercise intensity
If it's 60-80%, what is the target heart rate
range?
MKH: 220-40=180 beats/min
180 (max)-60 (ist)=120 (Heart rate reserve)
120x0,6=72+60=132 beats/min and
120x0,8=96+60=156 beats/min Target pulse
range: 132-156 beats/min.
In addition, according to the degree of
difficulty of the person, the intensity of the
exercise can be determined
EXERCİSE
TIME
Exercising for 20-30 minutes
(excluding warm-up and cool-down
periods) in the range of 70-85% of
the maximum heart rate or 60-80%
of the heart rate reserve is
sufficient to achieve the benefits
(e.g. cardiopulmonary benefits,
physical capacity increase, weight
loss).
 The duration of the exercise
can be increased gradually
until you reach the goal.
Increases in exercise times
should be made after the
physical adaptation of the
individual has taken place.
 EXERCISE
FREQUENCY
 Although exercise twice a week by
unconditioned individuals has been
shown to increase cardiopulmonary
function, it is generally
recommended to exercise 3-5 times
a week. While the contribution of
more frequent repetitions to fitness
is minimal, the likelihood of injuries
increases.
Those who exercise 3 times a
week with 60-80% of the heart
rate reserve or 70-85% of the
maximum heart rate
experience adequate
cardiopulmonary development
and increased VO2 max levels.
The frequency of exercise of the person is
determined according to the MET (metabolic
equivalent = metabolic equality) value. MET in
calculating the energy consumed in exercise
is the value used;
A value of 1 MET is the value spent for basal
metabolic rate. For those with MET values
between 3-5, exercise in 1-2 short sessions each
day is recommended, and for those with MET
values higher than 5 MET, exercise in 3-5 sessions
each week is recommended.
 The number of weekly exercises
depends on the person's calorie goal,
preference, and the changes they can
make in their daily life
 Egzersizde tüketilen enerjinin matematiksel
olarak hesaplanması için MET(metabolic
equivalent=metabolik eşitlik) değeri kullanılır.
 1 MET=3.5 ml/kg/dk oksijen tüketimi
 METx3.5xağırlık (kg)/200 (yakılması istenen
kalori)= … kcal/dk.
This formula is used to determine how much
exercise to do to reach the targeted calories
when preparing an exercise prescription.
is useful.
Let's assume that a 70 kg individual with a
weekly calorie target of 1000 kcal will do 6
MET of activity (6 MET = threshold for
moderate-intensity exercise).
This person's net calorie consumption would
be 5 MET, because 1 MET is the value spent
on basal metabolic rate. (6-1 MET= 5 MET net
residual value). 5x3.5x70/200=6 kcal/min
1000/6=167 min
33 minutes of exercise 5 days a week or 42
minutes of exercise 4 days a week may be
recommended.
 Overview of
Physical Activities
 Group 1.
Activities that
can continue
with low
intensity.
Individual
differences in
energy use are
low.
 Example:
walking, cycling,
treadmill.
Group 2 :It is the group in which energy use
varies according to individual abilities. Can be
used in the early stages of conditioning
studies
should be kept in front of you.
Example: swimming, skiing, etc.
Group 3: They are group
activities that vary greatly in
ability and intensity.
Examples: basketball, carpet
football, racquet sports.
  Aerobic exercise list
 Type of exercise; Swimming, Walking, Zumba
 Frequency of exercise: 5 to 6 days a week,
 intensity of exercise; moderate intensity (40-
60% heart rate reserve)
 Duration of exercise ;
 It is recommended that it is gradually
increasing (single session or ≥divided into 10
minutes) starting with a duration of at least 20
minutes.
 Initially reaching 150 minutes per week
 While it is intended, the long-term goal is 300
minutes per week.
Fox, K. R., & Hillsdon, M. (2007). Physical activity
and obesity. Obesity reviews, 8(s1), 115-121.
 PEDOMETRE
 It is a physical activity
monitoring tool that shows the
number of steps taken during
the day and the walking
distance.
 (<5,000 steps/day=sedentary,
 ≥10,000 steps/day = active)
(Tudor 2011).
 Although the pedometer is used
in physical activity monitoring,
it is insufficient to show the
intensity of physical activity.
 Recent studies recommend
taking at least 3,000 steps in 30
minutes to reach adequate
exercise intensity (Marshall
2009).
Aerobic exercise
progresion
Gradual loading should be
ensured with the parameters
of severity, duration and
frequency.
First, the duration and
frequency of exercise should
be increased,
then to the desired level
according to the patient's
degree of strain or heart rate
reserve.
The intensity of the exercise
should be increased.
Resistance exercises have a very limited effect on
VO2 max.
Facilitates the daily activities of the person,
Increases muscle strength,
Lowers body fat.
 Exercise practices that involve 10-15
repetitions and resting for 15-30
seconds between weight stations can
cause an increase in VO2 max of about
6%.
 However, resistance exercises alone
are not recommended for
cardiovascular health and regular
exercise and should be supplemented
with aerobics.
RESISTANCE EXERCISE COMPONENTS
Exercise type: free weights, weights
machines, elastic bands
Frequency of exercise: at least 2 times
a week.
Exercise intensity:Once for each
exercise
defined as the maximum weight it can
lift
a maximum repetition (1 RM)
So he will be able to do 10-12
repetitions in each set
the appropriate resistance (65-70% of 1
RM) can be determined.
Repeat/set: 8-10 exercises targeting
the main muscle groups are
determined.
 For each exercise, 10-12
repetitions (1 Set) are
performed.
Free Weights;
Dumbbell, kettlebell, bar, plate
Isotonic Machines, leg press, leg
curl..
Elastic band
◾ Equipment
With your own
body weight
◾ (sit-ups, push-
ups, planks)
Equilibrium
Small and deep
muscles Whole
body
In resistance exercises, the
principle of increasing load applies.
◾ In other words, as muscle
strength increases, the
number of repetitions, the
number of sets or resistance
should be increased.
 Increasing the number of sets after 3–4
weeks
1-2 exercises to large muscle groups
(quadriceps, gluteals,
hamstrings, chest, back, shoulders,
biceps, triceps, gastrocnemius/soleus
complex, abdominals, and back
extensors)
It should maintain its frequency as 2-3
per week.
There should be a 48-hour break
between workouts.
 Rest between exercises should be 1-2
minutes

Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., &
Smith, B. K. (2009). American College of Sports Medicine Position
Stand. Appropriate physical activity intervention strategies for weight
loss and prevention of weight regain for adults.
Warm-up phase, low-to-
moderate cardiovascular
endurance activities.
Increase body temperature,
to prepare the muscles for
exercise and
aims to prevent muscle
fatigue after exercise. Warm-
up exercises are necessary to
prevent injury and
cardiovascular complications.
Usually walking at a low
speed or cycling without
resistance is sufficient.
The cool-down phase is the gradual lowering of
heart rate and blood pressure following the
main exercise program and the waste produced
in the muscles
5-10 minutes low-medium for the purpose of
removal of metabolic products
includes cardiovascular endurance activities in
severity.
Stretching exercises separately from and after
the warm-up and cool-down phases
workable.
Stretching and stretching
exercises
Stretching exercises to the main
muscle-tendon groups
4 or more repetitions to each
muscle group
for at least 10 minutes,
It should be done at least 2-3
times a week.
 Static tensions
should be kept for
15-60 seconds.
Combined workout
program
aerobics, consisting of a
combination of
resistance and flexibility
exercises
It should focus on
maintaining a balanced
exercise program.
Combined exercise..
Aerobics + exercises (15+15
min), aerobic only (30 min at
60% HR) or weight lifting
exercises only (4 sets of 8-12
repetitions,
with 75% of the maximum
liftable weight) provides more
weight and fat loss
Observed.

In a study comparing aerobics, resistance, combined
groups and sedentary groups, waist in all three
groups
While the decrease in HbA1c values was significant
compared to the control group, the decrease in
HbA1c values was observed most in the combined
group.
It is aimed to use 60-90% of the body performance with
high intensity, low loading time and long rest time.
WHY INTERVAL

Intensive interval training,

Low-tempo interval training
By increasing the oxidative capacity of skeletal muscles,
oxygen to the muscles is more efficient
and improve exercise performance.
Accelerates basal metabolism
Simple, engaging, motivating

HITT DEĞİLDİR ----high-intensity continuous training

A "time-saving" alternative to long-term
low-tempo aerobic exercise.
The same effect in a short time ?
As opposed to boring aerobic exercise,
you're more likely to stick to HIIT routines
Because adults love packaged programs.
 Scientists say that HIIT is suitable
for people of all ages and fitness
levels.
 Liverpool John Moores University ve
University of Birmingham
15 minutes 3 days a week
Beginning; Walk as fast as you can for 1
minute, rest for 2 minutes
Intermediate; Run for 1 minute, walk for
2 minutes
Advanced; Intermittent rope shooting,
in the fitness room;
 Intermediate Rest Rowing, Cycling
In order to get the most out of your workout,
it is useful to mix less intense cardio
exercises with intense interval exercises in
the right ratio.
The important thing is to create an exercise
program that is suitable, enjoyable and
sustainable.
Sample graded Combined HITT / Beginner
level
20 minutes elliptical three days a week
Add resistance exercises when you reach the
tolerable level
Exercise prescription in patients with
hypertension
Type of exercise?
Walking, cycling, swimming.
Weight training; 10-15 repetitions
with light load (should not perform
valsalva maneuver)
Exercise intensity? RPE de 11-13.
The drug he uses is the heart
Prescription should be made without
losing sight of the fact that it will
reduce the speed by an average of
about 20-30 beats per minute
Duration: 30-60 minutes
Exercise frequency? 3-7 days/week
PRESCRIPTION FOR EXERCISE IN DIABETES
Type of exercise?
Walking, running slowly, cycling, stairs
get out, lift weights.
Weight training; 8-12/10-15 repetitions
with light load
Exercise intensity? 60-90% of maximum
heart rate
/ RPE 12-14
Duration: 20-60 minutes
Exercise frequency? Type I Diabetes Daily/
Type II Diabetes 3-5 days/week
⮚ To sum up;

Obesity is a disease and the individual

must undergo a doctor's control and the
tests should be evaluated by the doctor.
The harmony of the doctor, dietitian and
exercise specialist is important.
The individual's past exercise experiences
should be assessed
Appropriate exercises should be selected
Develop an exercise plan
Besides;
Changes that will increase the level of
daily physical activity. (new lifestyle).
⮚ Teaching the patient to monitor and
evaluate himself/herself.
Initiation, progress, maintenance
phases should be followed
Duration of aerobic exercise, intensity,
Constructs
Changes should be made in the
number of sets and repetitions of
resistance exercises, rest periods
Fun new goals should be set
Its gains must be protected
 Exercise motivation should
be maintained
Within 2 weeks of cessation
of intensive exercise, there is
a significant decrease in
cardiorespiratory endurance,
After 10 weeks, it returns to
the baseline level, after 8
months an individual who has
not exercised at all
level.
6 months of regular exercise
for exercise addiction.