Developing the P (for Progression) in a FITT-VP Exercise Prescription

Abstract

Q: For an exercise prescription to be effective, advancement or progression is recommended. What factors should be considered when addressing progression of an exercise program? A: Progression is an important part of an effective exercise program. To highlight the various aspects to consider when developing an exercise training plan, the American College of Sports Medicine (ACSM) uses the FITT-VP principle of exercise prescription (1,2). The FITT-VP principle includes the following: Frequency (how often is exercise done each week), Intensity (how hard is the exercise), Time (how long is the exercise duration), Type (what is the mode of exercise), Volume (what is the total amount of exercise), and Progression (how is the program advanced).FITT-VP is applied to each component of a complete exercise program, including aerobic, resistance, flexibility, and neuromotor exercise training. Within this frame of reference, an exercise prescription should be individualized with consideration for health status (including clinical conditions), physical ability, age, training responses, and individual goals (1). For example, a training program for a 25-year-old competitive marathoner obviously will differ from a 65-year-old patient participating in a cardiac rehabilitation program. Even in an apparent homogeneous group, progression should be individualized to match personal goals as well as differing responses to the exercise stimulus. Thus, ACSM recommendations are presented in a way that supports customization to match the individual participant with ranges and options for frequency, intensity, time, and type of activity. See Box 1 for a brief summary of recommendations for adults (for more complete information on the FITT-VP for each exercise component, see the ACSM Position Stand at http://journals.lww.com/acsm-msse/Abstract/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx (2)). BOX 1. Exercise recommendations for adults Recommendations for the components of a complete exercise program include the following (note – deconditioned or sedentary individuals may benefit from activity levels below those listed; additional recommendations are available for youth as well as older adults (1)): AEROBIC EXECISE: At least 5 days/week of moderate intensity activity or at least 3 days/week of vigorous activity, or a combination of moderate and vigorous on at least 3 to 5 days/week; 30 to 60 minutes/day for moderate activity and 20 to 60 minutes/day for vigorous activity; includes exercises using major muscle groups in a continuous, rhythmic manner. RESISTANCE EXERCISE: Train each major muscle group 2 to 3 days per week; for strength development 60% to 70% of one repetition max (1-RM) for novice to intermediate exercisers and higher levels (80% or greater) for more experienced strength exercisers, for muscular endurance development 50% 1-RM or lower; includes exercises for each major muscle group. FLEXIBILITY EXERCISE: At least 2 to 3 days/week (daily is most effective); stretch to point of feeling tightness or slight discomfort; includes exercises (static, dynamic, ballistic, or proprioception neuromuscular facilitation) for each of the major muscle-tendon units. NEUROMOTOR EXERCISE: At least 2 to 3 days/week; consider at least 20 to 30 minutes; activities depend on the individual with recommendations for fall reduction including exercises involving balance, agility, coordination, gait, proprioception, and other multifaceted activities such as Tai Chi and yoga. RECOMMENDATIONS FOR PROGRESSION Progression takes into account the exercise volume (which reflects FITT factors) over time. General progression recommendations by ACSM for each of these areas are described in Box 2 (1). Given the current lack of research on optimal progression for flexibility and neuromotor exercise training, the focus of this article is on aerobic and resistance exercise for general health and fitness. Box 2. Exercise prescription progression ACSM’s Guidelines for Exercise Testing and Prescription, 10th edition, includes information on the principle of progression as follows: AEROBIC EXERCISE: Program advancement can occur by adjusting frequency, intensity, and/or time, thus progressing the overall exercise volume. Care should be taken to enhance adherence also while reducing risks of injury or cardiac events; the recommendation of “start low and go slow” reflects this objective. RESISTANCE EXERCISE: Program advancement can occur by adjusting resistance, repetitions, and/or frequency. FLEXIBLITY EXERCISE: Methods to achieve optimal progression are not known. NEUROMOTOR EXERCISE: Methods to achieve optimal progression are not known. The ACSM Position Stand “Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise” includes evidence-based recommendations related to exercise prescription (for information on the ev