Aerobic Exercise Program Design Guidelines

Introduction

In line with the universal algorithm explained in Chapter 2 (screen, assess, initiate, progress), it is critical to perform a screen and initial consultation prior to designing an individualized aerobic training program. As explained in this chapter, the assessment and initial program design are essentially the same. Once the program has been initiated and it has been determined that the exerciser is adapting well, the program should be progressed in small, tolerable increments.

This chapter will provide the guidelines necessary to assess, initiate, and safely progress an aerobic training program. Practical application will also be provided for more clarity. The assessment, initiation, and progression strategies outlined in this chapter integrate seamlessly into the universal algorithm, providing a structured approach to enhancing aerobic capacity.

Section 1: Field Test (Assessment) and Initial Aerobic Program Design

The latest physical activity guidelines suggest, "Adults should perform at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Pregnant and postpartum women should perform at least 150 minutes of moderate-intensity aerobic activity a week. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity."

Everyone will benefit from being physically active. Importantly, benefits begin accruing with any amount of physical activity and are most dramatic when an individual's fitness capacity is low. Physical activity encompasses leisure-time activity, cardiovascular, resistance, and neuromotor training. This chapter will focus exclusively on cardiovascular exercise guidelines and considerations for the initial assessment, program design, and progression (Piercy, 2018).

Step 1 - Determine the Aerobic Training Zone

If the initial screening process has determined that the individual is physically capable and not at increased risk, the first step to designing an aerobic training program is to determine the heart rate training zone.

A recent (within the past 6 months) cardiovascular stress test or a VO2max test is the most accurate way to determine the training zone. If this information is available, the aerobic training zone can be found by multiplying their maximum (or predicted maximal heart rate) by 50% and 85%. Fifty percent corresponds with the low end of the aerobic training zone and eighty-five percent corresponds with the upper end of the aerobic training zone. These two numbers provide the aerobic training zone heart rate range.

If a recent maximal cardiovascular test has not been performed, the individual may perform a submaximal field test to determine their heart rate training zone.

The purpose of the maximal cardiovascular stress test or submaximal field tests is to determine a person's baseline fitness level by assessing their heart rate or VO2max. Although these are objective tests, they are all still estimates and have a window of error associated with each of them. Two recent critical evaluations concluded that these gold standard methods for determining aerobic training zones and exercise prescription based on fixed percentages of maximum values conform poorly to exercise intensity domains, do not adequately control the metabolic stimulus, and may not be appropriate to determine exercise intensity at the individual level (Marini, 2020; Iannetta, 2019).

An alternative to performing a field test is to use formulas such as 220 - age or 208 - (0.7 x age) to predict maximum heart rate. Once the maximum heart rate is calculated, it can be multiplied by 50% to 85% to determine aerobic training zone (Hirofumi, 2001).

Fitness professionals and exercisers should keep in mind that for general fitness the primary goal is to increase overall aerobic capacity. This increased aerobic capacity is evidenced by a person being able to accomplish the same workload (i.e., running on a treadmill at 6 mph) with a lower heart rate than before. In other words, when the intensity of exercise becomes easier, fitness level has improved (Riebe D., 2018).

Separately, RPE scales and the Talk Test are valid and reliable methods to determine intensity (Foster, 2008). Combined, these two methods (heart rate, RPE/Talk Test) provide a more objective point of reference. Since the goal of performing aerobic exercise is to maintain or improve levels of aerobic fitness preferably to average or above average (compared to established norms), the use of RPE scales combined with the Talk Test (Table 4.1) can provide an accurate determination of the initial baseline aerobic capacity and can be used to monitor and guide progression over time.

Additional Information

• For most individuals an RPE of 4 to 7 corresponds with exercising within the aerobic training zone. An RPE below 4 is not high enough to cause a training effect.
• The work portion of high-intensity interval training occurs at an RPE of 8 to 9.
• The work portion of sprint interval training occurs at an RPE of 10.

Recommended Universal Field Test

While any of the previously mentioned maximal or submaximal tests can be utilized to calculate the aerobic training zone, the following field test protocol may be the simplest, most specific, and reliable test in most settings. It is safe, valid, and can determine the initial baseline aerobic intensity for individuals interested in general fitness. Table 4.2 below shows the steps involved in conducting the test.

Table 4.3 below provides an example of a completed universal aerobic field test. This field test, or assessment, performed during the initial familiarization phase, also serves as data to design the aerobic program. It is the start point for the individual. As mentioned in the introduction to this chapter, this is why the assessment and initial program design are essentially the same.

Section 2: Aerobic Program Design

The FITT-VP Principle

As discussed in Chapter 4, Exercise Prescription Variables, the FITT-VP principle is fundamental to designing aerobic exercise programs for individuals across all fitness levels. Each component of the acronym - Frequency, Intensity, Time, Type, weekly Volume, and Progression - provides the framework needed to design safe, effective, and individualized programs. Below, each variable in the acronym is described in detail.

Frequency

Frequency refers to how often an individual performs aerobic exercise, typically measured in days per week. This variable is highly adaptable and depends on factors such as the individual's goals, time availability, and desire to perform this type of exercise. For example, while the general recommendation may suggest training five days a week for 30 minutes per session, not everyone has the time or desire to start at that frequency. Meeting individuals where they are is critical; even starting with just two days a week is acceptable. By doing so, a safe entry point into the exercise program is executed, and a safe, trusting environment is initiated. From there, frequency can gradually increase as part of a progression plan.

For weight loss goals, higher frequencies, such as 5 to 6 days per week, are often more effective, as they increase caloric expenditure. On the other hand, maintaining general aerobic fitness may only require 2 to 4 sessions per week. The key is to personalize the approach to the individual's circumstances and long-term goals.

Intensity

Intensity describes the level of effort an individual exerts during aerobic activity. This variable can be measured in two primary ways.

It is essential to remember these calculations are approximations, include a window of error, and should be combined with observation of breathing patterns via the Talk Test to provide a fuller and more accurate picture of intensity.

At RPE 8 to 10, intensity is so demanding that it cannot be sustained for more than a few minutes. At an RPE of 9.5 to 10, the individual is performing an all-out sprint, capable of maintaining the effort for only 10 to 15 seconds. Breathing becomes extremely labored, making speech nearly impossible beyond a few fragmented words. This form of exercise is characterized by short bursts of maximum intensity followed by longer recovery periods to restore the ability to repeat the effort effectively. Recovery is essential at this intensity to prevent overexertion and ensure safety.

Intensity Distribution and Domains of Cardiovascular Training

Balancing intensity distribution across an aerobic exercise program is essential for optimizing cardiovascular fitness, performance, and long-term adherence. Intensity levels are best distributed as follows.

Long Slow Duration Training (Zone 2)

• Purpose: Builds aerobic capacity, promotes recovery, and supports endurance.
• Intensity: Low to moderate, corresponding to approximately 50% to 70% of maximal heart rate or an RPE of 4 to 5. This intensity allows sustained efforts of 30 minutes or more, where breathing remains light to moderate and a conversation can be held comfortably.
• Training Volume: 70% of total training time should focus here, ensuring a strong aerobic base and sustainable progression over time.

Tempo Training

• Purpose: Improves lactate threshold and enhances endurance performance.
• Intensity: The high end of the aerobic zone, around 75% to 90% of HRmax or RPE 6 to 7. Breathing becomes heavier, conversations are more challenging, and efforts are sustainable for 10 to 20 minutes. This is near the second lactate threshold (LT2), where blood lactate levels stabilize but remain below 4 mmol/L.
• Training Volume: Approximately 10% of total training time.

High-Intensity Interval Training (HIIT)

• Purpose: Increases anaerobic capacity, power, and overall cardiovascular efficiency.
• Intensity: Ranges from 85% to 95% of HRmax or RPE 8 to 9. This intensity is above the second lactate threshold (LT2), where lactate accumulates exponentially, causing a burn from hydrogen ion buildup. Efforts last 30 seconds to 3 minutes with corresponding recovery periods.
• Training Volume: Around 20% of total training time, ensuring recovery to prevent overtraining and fatigue.

Sprint Interval Training (SIT)

• Purpose: Maximizes power output and anaerobic performance.
• Intensity: The high end of the anaerobic zone, above 95% HRmax or RPE 9 to 10. Breathing is extremely heavy, and speaking is limited to a few words. Efforts last 10 to 15 seconds and are accompanied by full recovery periods.
• Prerequisites: Clients should progress to SIT only after demonstrating tolerance to both long slow duration and HIIT sessions.

Practical Application for Fitness Professionals

Combining these training domains - long slow duration, tempo, HIIT, and SIT - provides the variety of stimuli necessary for physiological adaptation and performance improvement. Most training (70%) should focus on long slow duration to promote recovery and adherence, while tempo (10%) and high-intensity efforts (20%) should be strategically incorporated to enhance thresholds, capacity, and cardiovascular efficiency.

Time (Duration)

Time refers to the length of each aerobic exercise session. Duration varies widely depending on the individual's goals, fitness level, and type of training. Deconditioned individuals may start with just a few minutes, gradually increasing over time. More advanced individuals or those with performance goals may perform sessions lasting 60 minutes or more.

For high-intensity interval training (HIIT) or sprint interval training (SIT), durations are typically much shorter, lasting between 6 to 15 minutes. The session's duration should reflect its purpose: building endurance, improving cardiovascular health, or integrating higher-intensity work.

Type

Type refers to the mode of aerobic exercise and falls into two categories.

For most people aiming to improve general fitness and health, alternating between impact and non-impact exercises is recommended. This approach balances the benefits of placing stress on the joints, which can strengthen bones and connective tissues, with the need to give those same joints a break. The ratio of impact to non-impact exercise does not need to be 1:1; it can be adjusted based on individual preferences. For example, some may prefer a balanced 1:1 ratio, while others might choose to engage in more impact or non-impact activities, such as a 3:1 ratio of running to swimming or vice versa.

Selecting an enjoyable and accessible exercise type is crucial for adherence and long-term success. Ensuring the activity aligns with the individual's goals, preferences, and physical limitations enhances sustainability while maintaining variety and minimizing injury risk.

Volume

Volume is the total amount of aerobic exercise performed, typically calculated over a week. This variable integrates frequency and time into a single measure. Weekly volume recommendations often range from 150 to 300 minutes of moderate-intensity exercise, but the total can also be expressed as caloric expenditure for those tracking energy balance.

Volume provides a cumulative perspective on the exercise dose, helping to track progress and adjust programs as needed. It is particularly helpful in ensuring alignment with the individual's capacity and goals.

Important to note: These recommendations do not account for the role of progressive resistance training in improving aerobic capacity, cardiovascular function, and overall fitness. For individuals who are meeting or preferably exceeding the strength training guidelines, it may be possible to reduce the recommended weekly volume of aerobic exercise while still realizing its full benefits. This adjustment can be particularly advantageous for those who have limited time or who prefer resistance training over traditional aerobic activities.

Progression

Progression ensures that an aerobic exercise program evolves as fitness improves. This can involve incremental changes in frequency, intensity, duration, volume, and variety.

Using Objective Benchmarks to Guide Aerobic Fitness Progression

Progressing an aerobic program should be purposeful and grounded in meaningful, objective benchmarks rather than increasing frequency or duration arbitrarily. The principles outlined in this chapter demonstrate how a structured progression approach, guided by the FITT-VP framework, can help individuals achieve meaningful improvements in aerobic capacity while aligning with their goals and preferences.

Understanding Aerobic Fitness Stratifications

Maximal oxygen uptake (VO2max) remains a gold standard for assessing aerobic fitness. Stratified norms, categorized by age and biological sex, provide a clear understanding of what constitutes average, above average, or excellent fitness.

• A man aged 36 to 45 with an average VO2max has a range of 35 to 38 ml/kg/min.
• A woman in the same age group with an average VO2max falls between 31 to 33 ml/kg/min.

These metrics provide critical insights into health and longevity. Research consistently links higher aerobic fitness with reduced risk of chronic disease, enhanced metabolic health, and increased lifespan.

To make these benchmarks more accessible, the practical tables included in this section translate VO2max norms into real-world activities such as jogging and cycling (Tables 4.4 and 4.5). For instance, men with an average VO2max for the 36 to 45 age range may see that category translated into a practical jogging pace and cycling speed, while women in the same age group can compare against the corresponding female norms.

Setting Realistic and Motivating Goals

The benchmarks provided here serve dual purposes: they offer a starting point for program design and a motivator for progression. A well-structured program begins with an assessment, such as the universal field test described earlier in this chapter, and establishes an appropriate baseline. Progression then occurs through gradual adjustments in intensity, duration, and volume, ensuring the individual consistently challenges their aerobic capacity.

For most individuals, achieving average fitness levels represents a realistic and impactful goal. For those with higher aspirations, moving toward the above average category offers additional health benefits and motivation. These goals are achievable with the progression strategies outlined in this chapter.

Practical Application and Avoiding Stagnation

A key tenet of this chapter is the iterative process of assessment, implementation, and adjustment. By periodically re-evaluating fitness levels, individuals can track their progress toward benchmarks and refine their programs. For those balancing aerobic and resistance training, the interference effect should be considered. Strategic scheduling, such as alternating high-intensity aerobic sessions with resistance training days, ensures both modalities complement rather than hinder each other.

Summary

Objective benchmarks provide clarity and motivation in aerobic fitness progression. By setting realistic goals rooted in VO2max norms and practical translations into everyday activities, individuals can work toward improved health and longevity. The principles of progressive overload, balanced intensity distribution, and regular re-assessment ensure these goals are attainable within a structured and engaging program.

Recognizing that The Medical Fitness Bible is part of a larger ecosystem which includes instructional videos developed to bring the book to life, the reader is directed to www.MRFInstitute.org. It would be beneficial to view the videos, as they provide greater clarity to the information presented in this chapter.