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How to create a BH-EPAP

This is an excerpt from Brain Health and Exercise by Ryan Glatt,Aimee Nicotera.

This section will give you a brief overview of the exercise counseling decision tree, a framework to assist in assessing a client’s current exercise program and making stepwise recommendations with sound behavior change strategies. We will identify how to manipulate acute variables based on a client’s current plan and goals and introduce a similar process with different exercise modalities. You will also be able to identify strategies for modifying a brain health exercise and physical activity plan (BH-EPAP). By the end of this section, you will be able to analyze a client’s current exercise and physical activity plan (EPAP), make a systematic and stepwise modification to the acute variables and exercise modalities within that program, and modify their BH-EPAP overtime to ensure variability, enjoyment, and progressive overload.

Let’s first review the Physical Activity Guidelines for Americans, Second Edition, to better understand the minimum recommendations for exercise and general guidelines for specific exercise modalities. For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous aerobic physical activity, or an equivalent combination of moderate to vigorous aerobic activity. Aerobic activity should be spread throughout the week. Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week. Adults should also do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on two or more days a week, because these activities provide additional health benefits (Beaulac et al. 2011; Piercy et al. 2018).

The exercise counseling decision tree (figure 4.4) is a flowchart that will help you to analyze a client’s current exercise routine and activity habits based on the acute variables of exercise. This appraisal, analysis, and recommendation process is called exercise counseling. It is important to remember that a BH-EPAP should be updated roughly every three months, and you can use the exercise counseling decision tree each time you assess a new client or an existing plan. This resource is intended to provide easy-to-follow logic to ensure that any exercise program’s duration, intensity, frequency, and variability meet the minimum exercise recommendations to support brain health.

The exercise counseling decision tree breaks down as follows:

1. Frequency: This lists the number of days per week.
2. Intensity: This refers to the metabolic, neuromuscular, and cognitive load of the exercise or physical activity. All intensities have been found to benefit brain health in various ways.
3. Duration: This is the number of minutes per session; 60 minutes is often recommended, but there is value in shorter bouts of exercise, such as those found in 7- to 30-minute sessions.
4. Modality: Resistance, aerobic, and neuromotor modalities should all be included.
5. Aerobic: There should be 150 minutes of aerobic exercise present in a client’s EPAP. Aerobic exercise includes various activities that are open or closed skills and involve increased cardiovascular demands.
6. Resistance: Participation in resistance training should occur at least two days per week. Increasing to three days per week may be better for cognitive improvements if deemed safe and preferable.
7. Neuromotor: Neuromotor, motor, coordinative, or skill-based exercise should be recommended at least two days per week. Three days per week may yield additional benefits but may require a trade-off with other exercise modalities.
8. Modify: Modifying BH-EPAPs over time requires consideration of progress, preferences, problem-solving and enjoyment.

Let’s take a closer look at each variable and how to determine the most effective course of action for each client.

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