The building muscle mass and strength, and increasing cardiovascular endurance improves functional status in sports and in everyday activities and protects against injury. Specific training is often given for rehabilitation after heart attack, major surgery and musculoskeletal injuries. Preoperative training plans are drawn up many elective surgical procedure to improve the postoperative recovery (2). Regardless of the indication, the training recommendations should be based mainly on two principles:

Training stimulates the change and adaptation of tissue (eg. B. increase of muscle mass and strength, and endurance), while rest and relaxation, enable the implementation of these changes and adjustments (1,2). The recovery after exercise is as important as the training stimulus itself. Regular physical activity reduces the likelihood of disease, reduces the incidence of the major causes of death and improve the overall health and quality of life for most patients. The building muscle mass and strength, and increasing cardiovascular endurance improves functional status in sports and in everyday activities and protects against injury. Specific training is often given for rehabilitation after heart attack, major surgery and musculoskeletal injuries. Preoperative training plans are drawn up many elective surgical procedure to improve the postoperative recovery (2). Regardless of the indication, the training recommendations should be based mainly on two principles: The goal of the activity should be tailored to the patient and his motivation, his physical abilities and his mental state into account to maximize its readiness for training and the training result. The activity should be carried out in a suitable amount to achieve the desired effect. The exercises should be sufficient to achieve a higher level of fitness, but not be so extensive that there is injury or demolition. Too little or too much can prevent the desired goal is reached. According to the principle of diminishing returns more activity is not always better. Regulation of training should be the intensity specify (level of exertion), the volume (the amount of activity per session), the frequency (the number of exercises per unit), and the load increase (progressive overload, either the degree of the increase in one or more of these elements over time, or the current load). The balance between these elements depends on the individual tolerance and the physiological principles from (if, for. Example, increases the intensity, may need to decrease volume and frequency, whereas with increased volume may need to decrease the intensity). Intensity, volume and frequency can be increased at the same time, but only up to a certain point, because the performance of the body is finite. The aim is to create an individually correct training program for an optimum result for the objectives, the health status and current training level of the patient. Festivals and traditional generic recommendations (z. B. 3 sets of 10 to 12 repetitions, running 30 minutes 3 times a week) are not always right because they do not ask for the personal performance or possible disabilities. So do people who have been driven some sports, another program, as well-trained people. Variation in therapy help overfitting (Verbrauchtheit) to avoid to the same stimulus, as well as minor injuries through repetitive actions. It is important that the training is langsfristig successful and does not cause that it is aborted. People vary greatly in their motivation and ability to withstand strain and endure. In order to improve compliance with the training plan, the training usually starts at a lower load and increases gradually. Some people need individually supervised Traininseinheiten (eg., By a personal trainer), others by supporting a group (eg. As an exercise group or a running group) motivated, while others are able langsfristig all alone and of itself To do sport. So that people maintain their motivation over the long term, the training requirements should their needs into account (eg. As strengthening exercises of the legs for someone who is wheelchair dependent), what is really needed for them to achieve a specific goal (ie how realistic the goal is) and preferences (the kind of the fitness program). Training programs should include more dimensions of health, including stretching and flexibility Aerobic capacity (cardiovascular endurance) force (including endurance and muscle mass or structural) balance training information at a glance Selye H. The Stress of Life, revised ed. New York, McGraw Hill Companies, Inc., 1984. Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation128 (8): 873-934, 2013. Medical evaluation before training Before the start of a sporting or strengthening exercise program, should children and adults are reviewed by a screening (eg history and physical examination), focusing on the detection of cardiovascular risks. Testing is done only when diseases are clinically suspected. Stretching and mobility Mobility is important for a safe and enjoyable performance of the physical activities. Stretching can be advantageous to improve the range of motion and to relax muscles during strength training. These exercises should be performed before or after other forms of training or as a standalone training such. As in yoga and Pilates. Although stretching promotes mental readiness before training, there is no evidence that it lowers the risk of injury. However, there is no reason to talk to someone stretching before exercise, if it is good for him. For a safe workout general warm-up is apparently (z. B. simulation exercises with low intensity, running on the spot, gymnastics or other light activities to increase core body temperature) more effective than stretching. Stretching after exercise is usually preferred because the fabric better expands when it is heated. Special mobility exercises involve a slow and steady stretching of muscle groups without jerking or bouncing. In order to improve mobility, an elongation should be at least 10 to 30 seconds and no longer than 60 s are held (there are no disadvantages when an elongation> 60 s is maintained, but no benefits). Each exercise is repeated 2 to 3 times, and each time, the stretch is held a little longer. A slight pull is to be expected, but severe pain should be avoided because pain can be a signal of unintended small tissue tears. Many muscles mobility increases automatically by a balanced weight training program because muscles with every movement stretch as well as tense. Aerobic exercise aerobic (cardiovascular) – Training is a continuous, rhythmic, physical activity. The load is at a level that can be handled by the aerobic metabolism (although short periods of greater stress to trigger the anaerobic metabolism can be inserted), is held for at least 5 minutes at the beginning and gradually increases. However caused too much activity, excessive fatigue of the body and increases cellular oxidation. Aerobic exercise increases the maximum oxygen uptake and cardiac output (mainly through an increase in stroke volume), reduces the quiescent frequency of the heart and reduces cardiac and all-cause mortality. Examples of aerobic exercise are walking, jogging, brisk walking, swimming, cycling, rowing, kayaking, skating, cross-country skiing and the training of special equipment for aerobic exercises (eg. As treadmill, stepper or elliptical machine). Certain team sports such as basketball and football can provide vigorous aerobic exercise, but however weigh on knees and other joints. Recommendations should be based on patient preferences and abilities. The aerobic metabolism occurs in 2 minutes after the start of training one, but prolonged efforts are needed to achieve a health effect. The usual recommendation is at least 30 minutes at least three days a week, each with a five-minute warm-up and run-down phase, but the advantage of this recommendation is not occupied. An optimal aerobic conditioning can adjust in the week, also at the interval driving with the wheel after 10-15 minutes in 2-3 days. When interval driving, short-term moderate activity alternate with intense effort. In a training plan moderate activity after about 90 seconds (60-80% of maximum heart rate [HR max]) with intensive Sprint-type activity made further (85-95% HRmax or as hard as possible for about 20-30 s at the right posture and technology). This program, known as high-intensity interval training (HIIT) is more harmful to joints and tissues and should therefore only be used sporadically or alternating with more conventional, mildly to moderately intensive training methods. Devices with resistors or free weights can be used for aerobic exercise, as long as the number of repetitions is large enough. The rest period between exercises is only 20 to 60 seconds, and the intensity level is relatively high. When circuit training the large muscles (legs, hips, back and chest) before the smaller muscles (shoulders, arms, abdomen, neck) are trained. the cardiovascular system of a 15-20 minute long circuit training benefits more than from jogging or aerobic exercise equipment over the same period because the intense training to a greater increase in heart rate and oxygen intake leads .. This combined aerobic and strength training improves muscular endurance all the muscles involved (ie not just the heart). Aerobic exercise volume simply depends on the duration. The intensity is determined by the heart rate. The target value of an appropriate intensity is (heart rate at the maximum O2 consumption, [VO2peak] or the value beyond which the aerobic metabolism can not be maintained because of lack of O2 and anaerobic metabolism begins) at 60-85% of HR max , HRmax can be adjusted by direct measurement (1, 2), or can be calculated using the following formula: Alternatively, the Karvonen formula used to calculate the target value of the heart rate (2): These formulas are based on the general population and are not exact targets for people exercising at extreme performance limits (ie well-trained athletes or physically dekonditionierte patients). These people metabolic or VO2 tests can provide more accurate information. Chronological age must be distinguished from the biological. People of all ages who are less accustomed to aerobic exercise are (lower condition) reach their target frequency much earlier and at a lower load, which at least initially requires shorter training times. Obese patients may have a lower condition and need to move more weight, which increases much faster with greater expansion of the heart and lower vital force their heart rate than thin people. In patients who are sick or have to take certain medications (eg. As beta blockers), however, the formula for age and heart rate should be modified. A safe starting point for these patients may be 50-60% of based on age, heart rate. These objectives can be increased on the basis of achievements and progress of the patient. Notes on aerobic exercises Robergs RA, Landwehr R. The surprising history of the “HRmax = 220-age” equation. Am J Physiol Soc Exercise 5 (2), 2002. Karvonen J, Vuorimaa T. The heart rate and exercise intensity during sporting activities. Practical use. Sports Med 5 (5): 303-311, 1988. strength training force (resistance) training involves powerful muscle contractions against a resistance in the form of free weights or exercise machines special (eg dumbbells.). This training increases muscle strength, muscle endurance and muscle mass. Strength training also improves operability and, depending on the pace of the program, the aerobic power. Cardiovascular endurance and agility are increased simultaneously. The volume is usually determined by the amount of the upper weights and the number of repetitions. The voltage-time, so the total time raising and weaning weights in one pass, is an equally important factor. To moderate conditioning (development of both muscle mass and strength) to achieve a suitable voltage may be about 60 seconds. A voltage of 90 to 120 seconds is important for the rehabilitation of injuries and improving endurance. To increase power, the voltage time is more important than the number of repetitions, which takes place the passage of time and as slowly every repetition period within the voltage by the technique, may vary. a person holding a voltage time of at least 60 seconds at good technique, the resistance (the weight) can be increased, so that a voltage is tolerated for at least 60 seconds on the next higher level weight. The number of sets is determined by the intensity of the workout; intense workout requires fewer sets. The intensity is basically a subjective value for the perceived stress and how close someone in a particular passage on the muscular fatigue (or exhaustion during training) approach comes. So if a person can lift more than 100 kg deadlift once, correspond 75 kg 75% RM. The intensity can be objectively specified by the set of weights akimbo, in percent of personal maximum power for repeating a particular exercise (1 RM). A general guideline is to train with a load at 70-85% RM. Heavier loads increase the risk of injury and are only suitable for athletes who participate in competitions in general. In general lifting brings only a minimal increase in strength of less than 30-40% RM, although there can be an aerobic conditioning with sufficient voltage and time burden. During strength training, the incentive for a change of the tissue is mainly determined by the quality and effort of exercise. For example, a person who once raises 85% RM would (if 6 repetitions with maximum effort would be possible) cause less incentive for tissue variation than the lifting of 75-80% RM in several sequence (always on the verge of muscle fatigue). The intensity is limited by motivation and tolerance. In many patients who are in a Rehabilitionsprogramm cause discomfort, pain, inexperience and / or restriction of movement (because of discomfort or pain) to less motivation and commitment. As a result, more weights are required to achieve the desired benefits (although it must be taken into account when adding more weights that may increase too much activity irritation and pain of an injury). The intensity of exercise should vary regularly to give yourself a mental and physical break. An exercise in a training session should be run at no more than half the rates in the highest intensity. Breaks within high-intensity training sessions are important (eg. As one week every 3 months, perhaps associated with holidays or vacations) and should be integrated into the health plan to allow adequate recovery. Continuous, high performance training is counterproductive, even for trained athletes. Symptoms such as fatigue or muscle pain and muscle severity outside the training, reduced exercise performance and motivation, joint and tendon pain (caused by inflammation) and increased heart rate show that the exercises were too intense. Variations are helpful by different stimuli; repeated use of the same stimulus ultimately does not lead to the desired effect, because the muscles adapt to the stimulus. Change helps avoid even minor injuries caused by repetitive actions. Proper technique is important for personal safety and an effective strength training. The point is to strive for a smooth technique that requires no jerky or sudden movements, otherwise small tissue damage can be caused. It is also important to strive for a controlled breathing, prevents dizziness (and in extreme cases, loss of consciousness), which may occur with the Valsalva maneuver. When lifting a weight is exhaled and inhaled at weaning. In a slow motion such as weaning weight of more than 5 seconds, the exercisers may need to repeatedly inhale and exhale. However, the breathing should still be coordinated so that the last breath occurs directly before lifting and exhale during lifting. Blood pressure increases during weight training (is not associated with atherosclerosis) s and tends then to be highest when excessively added packs (this is common in the leg press, the case in which the large lower muscles be├╝bt while the handles of the machine are greatly comprises). With correct breathing technique the rise in blood pressure is minimal, regardless of the effort. Blood pressure rises during resistance training, but returns to normal levels shortly after the workout back. The balance training Balance training demands the center of balance through exercises in unstable conditions, such as when standing on one leg or with a balance board or rocker board. Basic weight training improves the balance because it increases muscle mass and strength around the joints and thus improves the stability indirectly. This training can help people with impaired proprioception, but it is also prescribed often elderly, so as to prevent falls (Training for seniors). Hydration Adequate hydration is important, especially when it comes to a longer or taking place in extreme heat stress. Even before the activity is a good hydration should be done and even during a long exposure should be consumed regularly. An existing deficit at the end of the activity must be balanced. During loading a supply of 120-240 ml (one-half to one cup) liquid is useful every 15-20 minutes, depending on the load and temperature. However, overhydration must be avoided, which can lead to hyponatremia and subsequent seizures. Tips and risks During the Trainins should be avoided excessive fluid intake, because this can lead to hyponatremia, which can be so severe at times, causing seizures. A lack of fluid after exercise can be calculated by comparing the body weight before and after exercise. Liquid is on a one-to-one basis replaced (i. E. 1 l for any lost kg) In most normal water is right. Staggered electrolyte sports drinks are also possible. However, reduce liquids having a carbohydrate content of> 8% (8 g / 100 ml or 20 g in a typical 250-ml portion) gastric emptying and lead to a slower liquid absorption. Often it is best to mix the sports drinks with water in half, allowing rapid absorption of glucose and electrolytes. In cases of suspected heat stroke or dehydration immediate administration of fluids and electrolytes may be oral or iv be displayed. For more information Bandy WD, Irion JM, Briggler M. The effect of time and frequency on static stretching on flexibility of the hamstring muscles. Phys Ther 77 (10): 1090-1096, 1997. Borms J, Van Roy P, Santens JP, Haentjens A. Optimal duration of static stretching exercises for improvement of coxo-femoral flexibility. J Sports Sci 5 (1): 39-47., 1987

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