Part 4: Cardiovascular Programming
Ready to program your own cardiovascular training?
You know how the heart works. You know that heart rate is not an indicator of true cardiovascular training. And you know that having big, strong, sexy heart is actually the key to unlocking optimal body composition, lifelong health, and peak physical performance in nearly all domains of life!
If you don't feel confident with those statements above, feel free to read back through Part 1, Part 2, and/or Part 3. These articles are all designed to serve as the foundation upon which these recommendations are written.
If you could care less about the science behind the training and just want to "trust the process," then read on, my friend!
Let's breakdown the ACSM Cardiovascular Fitness Guidelines.
The American College of Sports Medicine (ACSM) guidelines are the most internationally accepted and respected guidelines in health, fitness, and even medicine. The guidelines are both research-driven and practical. Dr. Kenneth Jay, author of The Cardio Code, even references them in his text.
The ACSM utilizes the FITT Principle (also called the FITT formula) to flesh out their guidelines. FITT is an acronym for: Frequency, Intensity, Time, and Type.
The Punchline:
Here are the guidelines in all their glory. We discuss them deeper throughout the article.
Frequency: Perform cardiovascular exercise 3-5 days per week with a mix of moderate and vigorous-intensity exercise.
Intensity: Light Intensity = 30-39% HRR or VO2R. Moderate Intensity = 40-59% HRR or VO2R. Vigorous Intensity = 60-89% HRR or VO2R
Time (and Volume): At least 10min per bout of cardiovascular exercise. Perform 150min of moderate-intensity and/or 75min of vigorous intensity activity each week. Ultimately, achieve >500-1,000 MET/min per week (e.g. 1,000 kcal/wk of moderate intensity physical activity; 150min per week moderate intensity exercise; pedometer counts of >5,400-7,900).
Type: Rhythmic, simple activity (running, biking, rowing). The ACSM recommends that recreational sports that include cardiovascular components should be considered ancillary to the guidelines. We extensively reviewed what defined an exercise as "cardiovascular" in Part 3.
Progression: Start low and go slow. Increase time 5-10min every 1-2 weeks.
Let's talk frequency.
Cardiorespiratory fitness (CRF) starts to decline with training less than 3 days per week, and starts to plateau with training more than 5 days per week. It should be noted that, especially in poorly trained individuals, more than 5 days per week of vigorous-intensity training can lead to greater risk of musculoskeletal injury.
So anything less than 3 days per week is not worth much. And anything more than 5 days doesn't give us any special powers.
This gives us the sweet-spot recommendation of 3-5 days per week that everyone is used to hearing and recommending.
When we look at the frequency recommendation based on intensity, we get:
5 days per week of moderate-intensity cardiovascular exercise or
3 days per week of vigorous-intensity cardiovascular exercise or
3-5 days per week of combined moderate/vigorous-intensity exercise
Combining moderate and vigorous intensity cardiovascular training is appropriate for most people. Again, if you're a health professional, be smart and assess prior to prescription.
Let's talk intensity.
Michael Phelps winning his 20th Gold Medal… Not a big deal.
Based on the overload principle, we know (and occasionally assume) that there is a positive dose response of benefits from increasing exercise intensity. The problem is that a minimal intensity to elicit a benefit is hard to predict from person to person.
Though hard to predict, we generally can assume that an exercise does not reach cardiovascular potential until 50% of VO2max (or roughly 65% of HRmax). If you remember from Part 3, at 50% VO2max is when we start to stimulate changes in stroke volume.
The ACSM distinguishes between intensities using Heart Rate Reserve (HRR) and/or VO2 Reserve (VO2R) for most people. The ACSM states that HRR and VO2R have less potential for over/underestimation than %HRmax or %VO2max. That said, Dr. Kenneth Jay recommends breaking intensities down utilizing VO2 and %HRmax. He actually goes much deeper than we will go specifically in this article, but you will get a teaser below.
We can generally calculate intensity utilizing the following equations. These are the most accessible for trainers and the general public alike.
Estimated HRmax = 220 - Age (years)
%HR Max = Estimated HRmax * [% Intensity]
%HRR = [Max HR - Resting HR]*[% Intensity] + Resting HR
Once you have these numbers you have your intensity ranges.
Below, I added the intensity ranges from the National Academy of Sports Medicine (NASM) to confuse you… just kidding. I put them in there to show that these ranges are exactly that - ranges. Only through more specific testing of VO2max, Lactate Threshold/OBLA, power, power-endurance, etc.. (usually reserved for elite athletes or individuals suffering serious cardiorespiratory conditions) can we truly get specific and nit-picky with our training.
For general health and performance purposes, these intensity ranges serve us quite well.
Tying this together with frequency, you can see that we want our clients and/or patients working at 40-59% HRR (moderate) 5 days per week, or 60-89% HRR (vigorous) 3 days per week, or a combination between 40-89% HRR 3-5 days per week.
We use the light intensity (30-39% HRR) for deconditioned and/or untrained individuals. It is important to tailor programs safely for people.
It should be noted that, in the short-term (<3mo), interval training appears to be equivalent to or superior to steady-state moderate-to-vigorous intensity exercise in individuals with metabolic, cardiovascular, or pulmonary disease. (And if you think "that's not me," but you're taking medications for blood pressure or blood sugar - then, yes, that is you. Talk to your ND about how you can integrate exercise into your health plan.)
If you would like to see how Dr. Kenneth Jay breaks up training intensity recommendations, check out the ranges below.
[La] Tolerance Training is top 90% of range between vVO2max and Wmax
[La] Production Training is top 50% of range between vVO2max and Wmax
Upper Limit for Aerobic High Intensity Training is low 20% range between vVO2max and Wmax
Lower Limit for Aerobic High Intensity Training is 80% Hrmax
Low-Moderate Intensity Training is 65-80% HRmax
Absolute Minimum Intensity (Recovery Sessions/Rest Periods): 50% of VO2max (roughly 65% HRmax)
If you have further questions about how to apply this to your health or performance please feel free to schedule an appointment with me.
Let's talk time (and volume).
We're actually going to breakdown volume first. The way the ACSM did this is in terms of total energy expenditure (EE) measured in metabolic equivalents (METs).
METs are actually a ratio of the rate of energy expenditure during an activity compared to the rate of energy expenditure at rest. One MET (1 MET) is the equivalent to sitting at rest and is measured as 1 MET = 3.5 mL O2/kg/min. A [MET/min] is a standardized index for measuring total physical activity performed across various individuals and activities. Calculated as (Total METs * minutes), these get standardized as "per day" or "per week" measurements for exercise volume.
The ASCM recommends that we ultimately achieve greater than 500-1,000 MET/min per week (or roughly 10 MET/hour per week). This is the volume at which we see consistently lower rates of cardiovascular disease and premature mortality. Pretty cool, huh?
So what does METs/min translate to in the real world?
It translates to roughly 1,000 cal/week of moderate-intensity activity, which further translates to roughly 150min per week (333 cal/week intensities can be beneficial in deconditioned individuals).
Some cardio machines in the gym (e.g. treadmills, ellipticals, bikes) will show actual MET activity. For someone 150-200lbs, the above recommendation translates to an exercise intensity of 3-5.9 METs.
Quick Detour: Step Counting (this ties into time and volume, I promise)
So the goal of 10,000 steps per day is popular as hell lately, but is not actually all that specific to anything.
In terms of meeting exercise recommendations, achieving 5,400 to 7,900 steps per day can meet the target (staying on the higher end is obviously better). Because most pedometers (step counters) are not all that accurate and vary in accuracy from product to product, it is generally recommended to hit at least 7,000 steps per day.
So where does 10,000 step come from? Likely from the data around weight management (i.e. weight loss). Individuals who are looking to lose weight need to go beyond the generic exercise recommendation of 7,000 steps… closer to 10,000.
Men looking to lose weight need roughly 11,000 to 12,000 steps per day.
Women looking to lose weight need roughly 8,000 to 12,000 steps per day.
Getting even more specific with our steps:
Moving at a rate of 100 steps per minute is roughly moderate-intensity for most individuals.
Walking at a moderate-intensity (100 steps/min) for 30 minutes a day will yield around 3,000 to 4,000 steps.
Also noteworthy, walking 1 mile per day translates to roughly 2,000 steps.
With an understanding of volume, time makes more sense.
The ACSM recommends that most adults perform 30-60min per day (or at least 150min per week) of moderate-intensity activity. Additionally, most adults should performed 20-60min per day (or at least 75min per week) of vigorous-intensity activity. Combining moderate and vigorous-intensity activity is encouraged so long as recommended volume of exercise is achieved.
As little as 10 minute bouts of cardiovascular exercise can still help achieve the beneficial outcomes, so long as total time still meets the recommendations. For example, taking a 10min brisk walk in morning, after lunch, and after dinner will meet the 30min per day moderate-intensity recommendation. An exception is within HIT training. High intensity intervals (e.g. 4 minute Tabata Intervals) can be beneficial without meeting the 10 minute mark.
Do you see how the volume recommendations shaped the intensity and time recommendations? Specific times and intensities help us to achieve the heart-healthy and life-improving volumes of >500-1,000 MET/min per week.
These recommendations don't work for everybody. In individuals who are deconditioned or dealing with a health condition it can still be beneficial to start with a bout of less than 10min.
Let's talk type.
Now that we know how often and how hard we should be exercising our hearts, what types of exercise should we be doing?
The ACSM recommends rhythmic aerobic exercise that involves large muscle groups and requires relatively little skill. More skilled activities are, conservatively, reserved for more fit and skilled individuals.
They note that recreational activities (e.g. basketball, soccer, tennis, etc..) should be considered ancillary to other cardiovascular training modalities.
Want more on exercise type, check out Part 3 of this series.
The big review.
The ACSM, using the FITT Formula, ultimately recommends:
Frequency: Perform cardiovascular exercise 3-5 days per week with a mix of moderate and vigorous-intensity exercise.
Intensity: Light Intensity = 30-39% HRR or VO2R. Moderate Intensity = 40-59% HRR or VO2R. Vigorous Intensity = 60-89% HRR or VO2R
Time (and Volume): At least 10min per bout of cardiovascular exercise. Perform 150min of moderate-intensity and/or 75min of vigorous intensity activity each week. Ultimately, achieve >500-1,000 MET/min per week (e.g. 1,000 kcal/wk of moderate intensity physical activity; 150min per week moderate intensity exercise; pedometer counts of >5,400-7,900).
Type: Rhythmic, simple activity (running, biking, rowing). The ACSM recommends that recreational sports that include cardiovascular components should be considered ancillary to other cardiovascular training. We extensively reviewed what defined an exercise as "cardiovascular" in Part 3.
Progression: Start low and go slow. Increase time 5-10min every 1-2 weeks.
Here is how they summarize it.
These are great guidelines that make things pretty clear-cut.
You are either doing true cardiovascular exercises at the proper intensity for the appropriate amount of time 3-5 days per week OR you’re not.
When designing your program look at these guidelines…
How many days are you training your heart per week?
Are you getting 150min per week total?
If less than 150min, are you including vigorous intensity and/or HIT cardiovascular training?
Are your exercises truly cardiovascular?
You made it!
The man. The myth. The legend. Usain Bolt. (Image source: https://time.com/4895004/usain-bolt/)
This is the final piece in the core cardiovascular series! At this point in the series you should feel confident in:
Benefits to training the heart
Basics of cardiovascular structure and function
How to define true cardiovascular exercise (and why weight training doesn't cut it for cardiovascular health)
How to piece all the knowledge above into training recommendations that you can explain with confidence to your clients and/or patients.
To steal words from Dr. Kenneth Jay and put them in a different order…
May you all grow and develop big, sexy hearts made of elastic steel!
Resources
American College of Sports Medicine. (2018). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.
Jay, Kenneth. The Cardio Code - Limitless Cardio-Vascular Health and Performance 1st Ed. Slangerup, Velocity ApS. 2014.
Robbins, P. (2008) Cardiorespiratory Training for Fitness. National Academy of Sports Medicine.