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FITT Principles
GENERAL POPULATION: FITT Principle
Aerobic
FModerate: 5 days/week; Vigorous: 3 days/week
IModerate: 40-59% VO2R or HRR; Vigorous: 60-89% VO2R or HRR
TModerate: 30-60 minutes/day; Vigorous: 20-60 minutes/day
TLarge muscle groups, continuous activity
V500-1000 MET-min/week
P10-20% per week until goal is attained
increase by 5-10 min 1-2 weeks for 1st 4-6 weeks
Every 6th session: increase intensity by 5-10%
Resistance
Flexibility
F2-3 nonconsecutive days per week
I2-4 sets per muscle group
TNo time frames
TSelect exercises that are comfortable and provides full ROM. Include
opposing muscle groups
V2-4 sets at 8-12 reps, 2-3 min rest between sets
PIncrease number of sets and resistance by 2.5-5 lbs. Good technique is
mandatory
FMinimum: 2-3 days/week; preferable: 5-7 days/week
ITo limit of mild discomfort
T10 minutes; static stretched hold for 15-60 seconds; 4 reps/muscle group
TAll major muscle tendon groups; ballistic and PNF not recommended
Children/Adolescents
CHILDREN/ADOLESCENT POPULATION: FITT Principle
Aerobic
FDaily
IModerate – vigorous at least 3 days a week
T60 minutes a day
TVariety of activities
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Resistance
Special Considerations
-Exercise in thermoneutral environments
-Hydrated
-Overweight children may not be able to complete 60 mins a day
-Gradual progression
-Children with disease or disabilities should have their exercise tailored
F3 or more day per week
IPoint of fatigue
TApart of 60 mins a day
TExercises to strengthen bones
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ELDERLY POPULATION: FITT Principle
Aerobic
F 5 days/week moderate; 3 days/ week vigorous
I0-10 scale for physical exertion; 5-6 moderate; 7-8 vigorous
TModerate: 30-60 min in bouts that last at least 10 min, Vigorous: 20-30 min
TAny exercise that doesn't impose excessive orthopedic stress
Resistance
F2 times a week
I60-70% 1 RM, 40-50% beginners
TProgressive weight training program or weight bearing calisthenics involving
the major muscle groups of 10-15 reps each
F 5 days/week moderate; 3 days/ week vigorous
I0-10 scale for physical exertion; 5-6 moderate; 7-8 vigorous
TModerate: 30-60 min in bouts that last at least 10 min, Vigorous: 20-30 min
TAny exercise that doesn't impose excessive orthopedic stress
Flexibility
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PREGNANCY: FITT Principle
AEROBIC
F3-4 days/week
IModerate (40-60% VO2R) BMI <25; Light BMI>25
T15 min, gradually increase to 30 min/day; 10-15 min warm up/cool down
TDynamic, rhythmic, physical activities that use large muscle groups
PProgress after 1st Trimester (13 weeks)
Special considerations:
- Avoid exercising in supine position after 1st trimester
- Avoid valsalva maneuver and isometric contractions
- Exercise in thermoneutral environment
- Increase caloric intake to meet caloric needs of pregnancy and exercise metabolic
demand increase by about 300 kcals/day
- Exercise may begin 4-6 weeks after vaginal delivery; 8-10 weeks after C-section
- Light-moderate intensity is okay with breastfeeding
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DEPRESSION: FITT Principle
F5x/week
I60-70% HRR
T40-60 min
TGross motor activities, walking or biking
Special considerations:
- Symptoms of depression may interfere with participation in exercise
- Recognize that significant comorbidities exist with depression
- Depression can affect the course of chronic disease
- Depression is associated with unhealthy lifestyle behaviors
DIABETES: FITT Principle
Aerobic
F3-7 days/week
I40-59% VO2R; 11-13 RPE
TType II: 150 min/week (minimum); goal: >299 min/week
TLarge muscle groups in a rhythmic and continuous fashion
Resistance
F2-3 days/week
I60-80% 1 RM
T2-3 sets of 8-12 reps
TTailor to comorbidities; emphasize technique
Special considerations
- Monitor blood glucose before/after exercise
- Avoid injecting insulin into exercising limbs
- Exercise under supervision
- Avoid activities that dramatically elevate B
OVERWEIGHT/OBESITY: FITT Principle
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AEROBIC
F5 days/week
IModerate: 40-<60% VO2R or HRR, Progress vigorous: >59% VO2R or HRR
T30-60 minutes; total 150 minutes/week; progressing to 300 minutes/week of
moderate adding vigorous as able
TAerobic activities that involve large muscle group
Special considerations
- The amount of physical activity required to sustain weight loss and prevent
- weight regain may be more; progression to 60-90 minutes/day may be necessary
- Adequate amounts of physical activity should be performed on 5-7 days/week
- Physical activity can be accumulated through 10-minute bouts of exercise or lifestyle
activities
- Addition of resistance exercise to energy restriction does not appear to prevent the loss of
fat-free mass or the observed reduction in resting energy expenditure, however, it may
enhance muscular strength and physical function as well as provide additional health
benefit
DYSLIPIDEMIA: FITT Principle
AEROBIC
F5 days/week
I40-75% VO2R or HRR
T30-60 min or 50-60 min to promote/maintain weight loss
TAerobic activities involving large muscle groups
Special considerations
- Exercise prescription may need to be modified if they have comorbidities
- Individuals taking lipid-lowering medications that have to potential to cause muscle
damage may experience muscle myalgia. Physicians should be consulted if patient
experiences unusual muscle soreness
- Improvement in blood lipids and lipoproteins may take several weeks to months
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PAD: FITT Principle
AEROBIC/RESISTANCE
F3-5 days/week Resistance: 2-days/week
IModerate (40-<60%)
T30-60 min/day (start with 10 min bouts)
TWeight bearing such as walking and non-weight bearing such arm and leg
ergometry
HYPERTENSION: FITT Principle
AEROBIC
FAerobic daily
IModerate (40-<60%)
T30-60 min/day (start with 10 min bouts)
TWeight bearing such as walking and non-weight bearing such arm and leg
ergometry
RESISTANCE
FAerobic daily
IModerate (40-<60%)
T30-60 min/day (start with 10 min bouts)
TWeight bearing such as walking and non-weight bearing such arm and leg
ergometry
Special considerations
- If uncontrolled [grr than 180 sys or 110 dia at rest] see MD
- Folks with ischemic heart disease, CHF, or stroke --- exercise training is best
- started in a rehab center under medical supervision
- Resting SBP > 200 and/or DBP > 110 are relative contraindications to exercise
- testing.
- when exercising, it is best to keep SBP < 221 and/or DBP < 106
- Beta-blockers may increase chance of hypoglycemia [esp in those on insulin or
- secretagogues] --- may also mask some of the signs of hypoglycemia
- [tachycardia]
- Beta-bl's and diuretics may affect thermoregulatory function
- BP meds may cause excess decrease in BP's post-exercise [post-exercise
- hypotension]
- Those with known ischemia during exercise should keep intensity at least 10 beats
- per minute below the ischemic threshold
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OUTPATIENT REHAB: FITT Principle
AEROBIC
FAt least 3 days/week
IRPE: 11-16; 40-8-% VO2R or HRR, HR below ischemic threshold
T20-60 min, warm up/cool down and stretches, ROM, and light intensity 5-10
min
TRhythmic, large muscle groups, emphasis on increased caloric expenditure;
promote whole body fitness using multiple forms of exercise/equipment
PStart with 5-10 min and progress 1-5 min/session or 10-20%/week time
increase
RESISTANCE
F
IRPE: 11-16; 40-8-% VO2R or HRR, HR below ischemic threshold
T20-60 min, warm up/cool down and stretches, ROM, and light intensity 5-10
min
TRhythmic, large muscle groups, emphasis on increased caloric expenditure;
promote whole body fitness using multiple forms of exercise/equipment
PIncrease slowly as patient adapts
CARDIOVASCULAR DISEASE: FITT Principle
RESISTANCE
F2-3 days/week with at least 48 hours separating session
I30-40% 1 RM upper; 50-60% 1 RM lower increase 5%
T10-15 reps progress 8-12 reps at 60-80%
TBands, light weights, pulleys, machine
PIncrease slowly as patient adapts
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COPD: FITT Principle
AEROBIC
F3-5x/wk
I Vigorous (60-80% WR), light (30-39% WR), dyspnea rating 4-6 on borg
scale)
TIntermittent
TWalking strongly recommended, stationary cycling as alternative
PIncrease slowly as patient adapts
Special Considerations
- Resistance training should be incorporated because COPD also affects the skeletal
muscles
- Exercises should focus on muscles of the shoulder girdles
- Inspiratory muscle training should be incorporated as weakness contributes to exercise
intolerance and dyspnea
o4-5x/week; 30% maximal inspiratory pressure; 30 min/day
oMethods: inspiratory resistance training, threshold loading, &normocapnic
hyperpnea
- Symptoms supersede objective measures of exercise prescription
- Exhibit desaturation so oxygen saturation should be measured during exercise
- Supplemental oxygen is indicated for patients with an %SaO2 ≤88% while breathing
room air
- Patients with asthma should use inhaled bronchodilator therapy 15 minutes prior to
exercise and should warm up gradually
-
ASTHMA: FITT Principle
AEROBIC
F2-3 d/wk
I 60% VO2peak or 80% of max walking speed per results of 6 min walk test
T20-30 min/D
Twalk/run/cycle/swim (non-chlorinated pool)
PAfter 1st month, 70% VO2peak, 40 min/d, 5d/wk
RESISTANCE
F2-3 days/week with at least 48 hours separating session
I30-40% 1 RM upper; 50-60% 1 RM lower increase 5%
T10-15 reps progress 8-12 reps at 60-80%
TBands, light weights, pulleys, machine
PIncrease slowly as patient adapts
Special Considerations
- Hold off exercise until flare-up sx's & airway function have improved.
- May need to use short-acting bronchodilators before or after exercise.
- Avoid cold and allergenic environments.
- Inspiratory muscle training has not been proven to help with asthma
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ONCOLOGY: FITT Principle
AEROBIC
F3-5 d/wk
I Mod. 40-<60% VO2R, vigorous 60-85% VO2R
TMultiple short bouts, 75 min/wk of vig or 150 min/wk
TProlonged, rhythmic, large muscle groups
RESISTANCE
F2-3 d/wk
I Mod. 60-70% 1RM
T1 set 8-12 reps
TWeights, machines, or functional tasks
FLEXIBILTY
F7 d/wk
I Hold until discomfort
T20-30 mins hold 10-30 sec
Tall major muscle groups, especially targeting areas of joint or muscle
restriction resulting from treatment
Special Considerations
- Cancer-related fatigue is prevalent and may prevent or restrict ability to exercise
- one is a common site for metastases, high impact activities and contact sports
- should be avoided
- Cachexia is prevalent and may limit exercise
- Swimming should not be prescribed for patients with indwelling catheters or central lines
and feeding tubes, or those receiving radiation
- Patients receiving chemo may experience periods of sickness and fatigue that may require
frequent modifications to exercise prescriptions
- Be aware of health fluctuations during chemotherapy
HIV: FITT Principle
AEROBIC
F3-5 d/wk
I40-59% VO2R or HRR
Tbegin at 10 min and progress to 30-60 min/day
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TDifferent modality’s
RESISTANCE
F2-3 d/wk
Iselect a weight that can be lifted 8-10repetitions at about 60% 1RM
T30 min length, 2-3 sets of 10-12 exercises of major muscle groups
TDifferent weight bearing activities
special considerations
- There are no currently established guidelines regarding contraindications, so general
guidelines should apply
- Supervised exercise is recommended; Asymptomatic individuals may participate in more
vigorous intensity exercise than patients with lower cell counts and impairments
- Day-to-day variations in health may affect participation; general fatigue should not
preclude participation, but dizziness, swollen joints, or vomiting should
- Monitoring progress of health-related components of physical fitness and CVD risk
factors is critical for clinical management and continued exercise participation
ARTHRITIS: FITT Principle
AEROBIC
F3-5 d/wk
Imay be limited by pain -40-<60% VO2R or HRR for most and 30-<40% for
the deconditioned
Tshort bouts of 10 minutes with a goal of progressing to 150 minutes or more
per week
Tlow joint stress such as walking, cycling, and swimming
RESISTANCE
F2-3 d/wk
Istart with low weight (40-60%1RM) using 10-15 reps
T1 or more sets of 10-15
Tsignificant pain may benefit from beginning with maximal voluntary
isometric contractions then progressing to dynamic training], should include
all major muscle
FLEXIBILTY
F7 d/wk
I Hold until discomfort
T20-30 mins hold 10-30 sec
Tall major muscle groups, especially targeting areas of joint or muscle
restriction resulting from treatment
Special Considerations
- Avoid strenuous exercises during acute flares and periods of inflammation
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- Progression of duration should be emphasized over increased intensity
- Adequate warm up and cool down periods are critical, Discomfort during or immediately
following exercise can be expected, however, if pain persists for more than 2 hours the
duration and/or intensity of exercise should be reduced
- Encourage exercise during the time of day when pain is typically least severe
- Appropriate shoes are particularly important
- Incorporate functional exercises
- For water exercises temperature should be between 83- and 88-degrees F
- Use functional exercises such as the sit-to-stand and step-ups as tolerated to
- improve neuromotor control, balance and maintenance of ADL's
AT RISK OSTEOPOROSIS: FITT Principle
AEROBIC
F3-5 d/wk
IMod: [40-60% VO2R or HRR] to vigorous at 60% or more
T30-60 minutes of combines A and R
TWeight-bearing aerobic [tennis, stair climbing/descending, walking with
intermittent jogging], jumping activities [volleyball, basketball]
RESISTANCE
F2-3 d/wk
IMod: 60-80% of 1RM and 8-12 reps to vigorous 80-90% of 1RM at5-6 reps
of each major muscle group
T30-60 minutes of combines A and R
Tweightlifting
OSTEOPOROSIS: FITT Principle
AEROBIC
F3-5 d/wk
IMod: [40-60% VO2R or HRR] to vigorous at 60% or more
T30-60 minutes of combines A and R
Tweightlifting
RESISTANCE
F2-3 d/wk
IMod: 60-80% of 1RM and 8-12 reps to vigorous 80-90% of 1RM at5-6 reps
of each major muscle group
T30-60 minutes of combines A and R
TWeight-bearing aerobic [tennis, stair climbing/descending , walking with
intermittent jogging], jumping activities [volleyball, basketball]
Special Considerations: Osteoporosis
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- There are currently no established guidelines regarding contraindications for exercise for
people with osteoporosis; general recommendation is moderate intensity exercise that
does not cause or exacerbate pain
- Exercises that should be avoided: explosive movements, high-impact loading, twisting,
bending, or compression of the spine
- Hip BMD is a more reliable indicator of risk for osteoporosis than spine BMD
- For older women and men at increased risk for falls, exercise prescription should include
activities that improve balance
- Even the frailest elderly should remain as physically active as their health permits to
preserve skeletal integrity
NON-SPECIFIC LBP: FITT Principle
Stay physically active and avoid bed rest
May need to avoid exercise if acute, severe pain --- however, those with subacute and
chronic LBP as well as recurrent LBP should participate
Use recommendations for the healthy, general populations using aerobic, resistance, and
flexion
Special considerations
- Patient should obtain medical clearance Patients experience a fear-avoidance behavior
- Deconditioning may be greater in these patients than in sedentary healthy individual
MULTPILE SCEOROSIS: FITT Principle
AEROBIC
F3-5 d/wk
I40-70% of VO2R or HRR; RPE 11-14
Tincrease to at least 10 min duration before increasing intensity, progress to 20-
60 min; slower in those with excessive fatigue
Tlow joint stress such as walking, cycling, and swimming
RESISTANCE
F2 days/week
I60-80% 1RM
T1-2 sets of 8-15 reps, may need to use increased rest time between sets to
allow for full muscle recovery, focus on large anti-gravity muscle groups
Tmachine weights, elastic bands, aquatic training
Pcareful progression based on individual's abilities
FLEXIBILTY
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F5-7 d/wk
I Hold until discomfort
THold each stretch 10-30 sec, 2-4 reps
Special Considerations
- Due to problems with thermoregulation, cooling with a fan and controlling room
temperature is important
- Pre-cooling by body immersion in cool water has been successful in improving exercise
tolerance
- Fluid should be replaced during and after exercise at the rate it is lost○
- MS patients need to be educated about the potential problem of hyperthermia
- Address issues related to sigh
CEREBRAL PALSY: FITT Principle
Special considerations
Cardiovascular
- Non-weight bearing activities
- Modify interval training
-arm ergometer training should include directional changes
- Maintain a cadence that doesn't increase spasticity
-Intermittent exercise may be necessary as there is easy fatigue which
has a disastrous effect on hypertonic muscles
-Use caution during prolonged sitting
-Proper positioning is important
Resistance
- Should use elastic bands, Swiss balls, exercise machines, and hydrotherapy, NOT free
weights
- If athetosis is present, elastic bands may be inappropriate
- Active-assistive exercise may be needed to perform motion smoothly
- Aquatic therapy is extremely useful in decreasing the effect of musculoskeletal pain
- Unilateral training may be necessary
- Greater emphasis may need to be placed on strengthening the hip abductors
- Static and dynamic balance should be measured to determine whether standing exercises
are safe
