Ch. 10 - Inclusive Instruction For Special Populations Flashcards
Multi-level fitness classes
—inclusive instruction
Most classes will have varying degrees of ability
—participant-centered approach - provides options for intensity and complexity of movements - empower them with opp. To make decisions about personal movement selection
Fitness professionals are NOT qualified to diagnose or treat any medical condition and must remain w/in their scope of practice when working w/ special populations
—indiv. Should openly discuss their exercise habits, training regimen, and goals with their physician and instructors should be prepared to share detailed info. About class design with both parties
Basic considerations for special populations video
A large # of your participants may have chronic health conditions who require modifications
—pregnant or illnesses
—those with osteoporosis should avoid plyometric movements and instead choose low impact classes like cycling, aquatics, or low intensity yoga to reduce stress on the bones
Another population you will undoubtedly interact with are those struggling with obesity
—first thing to remember is obesity boosts the likelihood of other chronic diseases
—those with other chronic conditions who need weight loss, it’s imp. To simply help them feel comfortable
—moving from prone or supine positions can be diff. For obese participants, so keep exercises seated or standing and recommend any class format they feel comfortably with and have fun in it
Class participants will occasionally be in various stages of pregnancy
—most exercise is relatively safe during first semester
—but prone, supine and plyometric exercises should be avoided during 2nd and 3rd for the safety of both mother and baby
—light to moderate exercise for 20 to 30 min. Per day is recommended through the entire pregnancy
It is imp. To monitor the group and identity indiv. Who may be struggling and offer appropriate modifications as needed - not everyone will vocalize their conditions
Chronic health conditions
The likelihood of encountering individuals with a variety of chronic health conditions is high
—instructors must be well-informed about the associated risks and know how to adapt class design, exercises, instruction and class programming
Obesity
Individuals with a BMI of 30 or above
Hypertension
Chronically high blood pressure as defined by a systolic pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg
Coronary heart disease
Coronary arteries of the heart become narrowed due to fatty build-up along the walls of the arteries
Congestive heart failure
A complex condition defined by impairment of the heart
Atherosclerosis
Narrowing of the arteries due to a build-up of plaque alone their walls
Peripheral artery disease
Condition in which blood flow to the extremities is reduced due to the narrowing of arteries
Stroke
An acute condition in which blood supply to the brain or areas of the brain is greatly reduced or interrupted
—individuals who have suffered a stroke may be left with chronic paralysis or physical dysfunction
Cancer
Abnormal, invasive growth of cells within the body
Osteoporosis
Bones become thin, fragile and prone to fracture
Hypertension part 2
Also known as high blood pressure
—common chronic condition for which exercise is recommended for prevention and reduction
—cardiorespiratory exercise reduces blood pressure and risk of hypertension as it increases stroke volume and HR - although be cautious to avoid excessive increases in blood pressure
Resistance training was once considered something hypertensive patients should avoid, but is now considered a helpful supplement to cardio in order to improve functional capacity - as it does not exacerbate high blood pressure
Basic exercise guidelines for participants with hypertension
Mode: classes such as indoor cycling, low-impact cardiorespiratory activities, dance, group rowing
Frequency: 3-7 days per week
Intensity: 50-85% of maximum heart rate
Duration: 30-60 minutes per day
Special conditions
—avoid heavy lifting and valsalva maneuvers; make sure the participants are breathing normally
—modify tempo to avoid extended isometric and concentric muscle action
—avoid lying down
—allow participants to stand up slowly to avoid possible dizziness
Obesity part 2
—overweight and obese participants may need alterations to general exercise, especially those with medical conditions that often coexist with overweight and obesity (hypertension, hyperlipidemia, type 2 diabetes, and osteoarthritis)
—most affected indiv. Recognize their limitations and will use the modifications provided
Cardio is an imp. Component of fitness programs for obese participants, bc it can decrease the risk of cardiorespiratory disease and increase caloric expenditure
Basic exercise guidelines for participants who are obese
Mode: classes such as indoor cycling, dance, resistance or aquatics
Frequency: at least 5 days per week
Intensity: 60-80% of maximum heart rate; if needed the ranges for training can be adjusted to 40-70% of maximum HR
Duration: 40-60 min. Per day or 20-30 min. Sessions twice each day of cardio training
Special considerations
—make sure the participant is comfortable
—exercise should be performed in a standing or seated position when possible
—the participant may have other chronic diseases. In these cases a medical release should be obtained from the individual’s physician
Cardiovascular disease
Coronary heart disease, congestive heart failure, atherosclerosis and peripheral artery disease - conditions that impair physical function, increase risk of mortality and are a leading cause of disability for both men and women
—exercise in proper doses can improve cardiorespiratory and muscular fitness, decrease morbidity and mortality, positively influence risk factors such as obesity and hypertension, and enhance overall quality of life
Cardiovascular disease 2
—Dyspnea
—heart palpitations
Light to moderate cardio exercise can provide indiv. With cardiovascular disease an appropriate level of stress to the cardiovascular system, resulting in improved function
—resistance training complements cardio training bc improved muscular fitness contributes to the ability to perform and sustain exercise
Dyspnea
—difficulty or troubled breathing
—participants with this should take longer breaks and train with reduced loads
Exercise must be ceased immediately if chest pain, nausea, dizziness or HEART PALPITATIONS (heart flutters or rapid beating of the heart) result
Basic exercise guidelines for participants with cardiovascular disease
Mode: classes such as indoor cycling (carefully monitored), low-impact cardio activities and dance formats
Frequency: 3-5 days per week
Intensity: 40-60% of peak work capacity
Duration: work up to 20-45 minutes
Special considerations
—upper body exercises cause increased Dyspnea and must be monitored
—allow for sufficient rest btwn sets
Stroke part 2
—stroke often leads to a sedentary lifestyle, physical inactivity, low fitness levels and post-stroke functional limitations
—muscle weakness after a stroke also affects ability to perform daily activities
—special attention should be given to stability, which may be compromised until balance and coordination improve
Basic exercise guidelines for participants recovering from stroke
Mode: large muscle group activities
Frequency: 3-7 days per week
Intensity: 50-80% of max HR
Duration: 20-60 min. Per session
Special considerations
—be sure that the participant can balance for the appropriate exercise
—standing or seated exercises are advised
—movement patterns should be progressed before weight
Cancer part 2
Cancer-related fatigue commonly interferes with normal functioning and contributes to muscle wasting, declines in cardio fitness, negative changes in body composition and depression
—research has shown that cardio and resistance training may counteract many of the side effects of cancer treatments
Exercise should be avoided during periods of increased infection, ATAXIA (the loss of control of body movements), dizziness, or during wound recovery from surgery
Basic exercise guidelines for participants with cancer
Mode: classes such as low-impact cardio activities, circuit-style classes with plenty of options provided, balance, and core training classes
Frequency: 3-5 days per week
Intensity: 50-70% of max HR
Duration: 15-30 min. Per session
Special considerations
—avoid heavy lifting in initial stages of training
—allow for adequate rest intervals and progress the participant slowly
—only use SMR if tolerated by the participant
—avoid SMR for participants undergoing chemotherapy or radiation treatments
—there may be a need to start with only 5 minutes of exercise and progressively increase, depending on the severity of conditions and fatigue
Osteoporosis part 2
A skeletal condition of decreased bone mass and increased risk of fracture
—exercise has shown to reduce bone mass loss and increase bone mineral density
—for those with osteoporosis, exercise can be a valuable tool for improving physical function, decreasing risk of falls and fractures and improving quality of life
—the greatest exercise risk for those suffering from osteoporosis is bone fracture, either caused by excessive weight or falls during exercise
—instructors should do all they can to help prevent a fracture from occurring
Basic exercise guidelines for participants with osteoporosis
Mode: stationary or recumbent cycling, aquatic exercise, or low-intensity yoga
Frequency: 2-5 days per week of moderate activities or 3 days per week of vigorous activities
Intensity: 40-85% of V02 peak
Duration: 20-60 min. Per day or 8-10 minute bouts
Special considerations
—progression should be slow and well monitored
—exercises should be progressed toward free sitting (no support) or standing
—participants should breathe in a normal manner and avoid holding their breath as in a valsalva maneuver
—if a participant cannot tolerate SMR or static stretches due to other conditions, perform slow rhythmic active or dynamic stretches
—twisting motions should be performed slowly, if at all
Special populations
A group of people who have similar conditions or characteristics that require alterations to the general exercise plan to ensure health, safety and effectiveness
Youth - children btwn 8-18 years
Older adults - 65+
Prenatal - pregnant
Postnatal - recently given birth
Age
Most general exercise guidelines are designed specifically for healthy indiv. Btwn 18-65 years
—benefits for youths or older adults, but participants may req. some adaptations
Youth
Many studies on youth resistance training have found that resistance training results in improved muscular fitness, body composition, power, and motor coordination among children and adolescents with relatively low risk of injury if resistance training is age-appropriate and supervised
Mode: circuit style classes w/ lots of variety and opp. For individualization and interaction work well for youth
—most classes are deemed safe by motor control
Freq.: 5-7 days per week
Intensity: moderate to vigorous activities
Duration: 60 min. Per day
Special considerations
—progression for youth pop. Should be based on postural control and not on the amt. of weight that can be used
—make exercising fun!
Older adults
65+ can achieve life-altering improvements in muscular fitness if working out correctly and safely
—research supports the use of resistance training among older adults for inc. muscle mass, strength, function, balance, enhancing power, and either improving bone density or preventing bone mass decline
—resistance training is a valuable tool for improving the health, fitness and independence of older adults
—resistance training among older adults is highly productive, and the incidence of injury is extremely low
Basic exercise guidelines for older adults
Mode: classes such as aquatics, chair-based resistance training formats, cycle, and basic or beg. Yoga
Freq. - 3-5 days per week of moderate activity or 3 days per week of vigorous activity
Intensity: 40-85% of VO2 peak
Duration: 30-60 min. Per day or 8-10 min. Bouts
Special considerations:
—progression should be slow and well-monitored
—exercises should be progressed toward free sitting (no support) or standing
—participants should breathe in a normal manner and avoid holding their breath such as with the valsalva maneuver
—if participant cannot tolerate SMR or static stretches due to other conditions, perform slow rhythmic active or dynamic stretches
Pregnancy
Their participation should be encouraged (with physical consultation) as regular exercise before, during and after pregnancy has a wide range of benefits for both mother and baby including
—improved weight mgmt.
—reduced incidence of gestational diabetes
—decreased hypertension
—enhanced body image
—improved psychological well-being
—decreased risk of premature labor
—shorter delivery and hospitalization
—improved fetal development
—decreased risk of obesity in both mother and child
Pregnancy 2
GFI should offer modifications to exercise routine to account for increased secretion of the hormone relaxing: which relaxes joints during pregnancy
—as joints become less stable, loads must be controlled and proper exercise tech. Strictly adhered to
—high impact, reactive exercises should be replaced with exercises that present less stress on the joints
—participants should be advised to avoid excessive range of motion in flexibility exercises
Special attention should be paid to controlling body temp. During exercise
—hot and humid env. Should be limited
—resistance exercises selected should promote total-body fitness, with special emphasis on core musculature to reduce low back pain and maintain posture
Basic exercise guidelines for pregnancy
Mode: low-impact classes that avoid jarring motions such as indoor cycling, low-impact cardio, light resistance and aquatics
—all activities should be cleared by the participant’s physician
Freq.: 5-7 days per week
Intensity: light to moderate intensity; 13-14 on the Borg scale
Duration: 20-30 min. Per day
Special considerations:
—avoid exercises in a prone or supine position after 12 weeks of pregnancy
—avoid SMR on varicose veins and areas of swelling
—plyometric movement is not advised in 2nd and 3rd trimesters
Postpartum exercise guidelines
—pregnant women should get clearance from their physician before beg. Any exercise program or participating in classes - will vary based on prev. Fitness levels or specific conditions of her unique pregnancy
Postpartum exercise has garnered a great deal of attention in the research literature as well
—body fat loss
—improved cardio and muscular fitness
—improved bone health
—enhanced mood
The timing of return to exercise
Should be at the discretion of the indiv. In consultation w/ her primary care physician - but typically ranges from 6-12 weeks after delivery
Low-intensity resistance training can be added to focus on core and total-body muscular endurance within the following guidelines
—frequency: 2-3 days per week
—volume: 1-3 sets per exercise (no more than 8-10 exercises per session)
—repetitions: 10-15 per set
—intensity: less than 50% of 1RM
Bodyweight exercises, combined with exercises performed while holding the baby, can be excellent choices to produce improvements in muscular fitness, stability, and muscle coordination immediately following pregnancy
The Americans with disabilities act (ADA)
—according to U.S. census bureau, as of 1010, nearly 1 in 5 people int he U.S. had a disability
—of the over 56MM ppl (~19% of the pop.) affected, more than 50% of people w/ disabilities indicated they get no physical activity whatsoever
The ADA (Americans with disabilities act) prohibits discrimination against people with disabilities in employment, transportation, public accommodations, comm., access to state and local gov. Programs and services
Regardless of exp. Level with disability issues, opp. Exist to “remove the obstacles that traditionally get in the way of gym participation”
—to be complaint with the law, fitness and rec facilities must provide general access and reasonable accommodations for people w/ disabilities
How fitness prof. Can adopt practices of inclusion
—in line with ADA
- Show enthusiasm
—creative opp. For inclusion should be offered with positivity and energy w/o being condescending - Make accommodations
—even w/o special modifications, some programs and equipment can be adapted - Keep activities age-appropriate
—avoid perpetuating the myth that persons with disabilities are “different” by using child-like games, toys or rewards
—whenever possible, participants w/ disabilities should learn by the same rules as a person w/o disabilities
Other tips
—introduce yourself and make eye contact as you would with any other participant
—connect and acknowledge the individuals presence
—respond to all communicative attempts by observing body lang.
—do not refer to an indiv. As “handicapped” or “disabled” - he or she is a person w/ a disability or medical diagnosis
—understand that a person’s wheelchair or other mobility device is an extension of his or her body - respect personal space and never move a wheelchair out of it’s user’s reach
—use clear and concise instructions and demonstrate whenever possible
—encourage participants to keep working on tasks rather than rewarding “false wins”
There was an Appendix D: chronic conditions and expanded emergencies in fitness
There was more info in the appendix D here!!
To come back to
Which of the following is an appropriate exercise for a participant who has had a stroke?
—step-up to balance
NOT
—squat to press
—hammer curl
—reverse plank
What effect does the hormone relaxin have on women who are pregnant?
Decreases joint stability
A participant in your class exhibits dyspnea. What is the best recommendation for this participant?
Take a prolonged break
Which of the following chronic conditions would benefit most from cardiorespiratory exercise?
Obesity
When is an individual considered obese?
With a BMI of 30
During your class, you notice an obese participant struggling with the exercises. Which of the following would be the most appropriate course of action?
Show options for body weight exercises
Which condition often coexists with hypertension, hyperlipidemia, Type II diabetes, and osteoarthritis?
Obesity
Which of the following populations should avoid hot and humid environments?
Prenatal
When dealing with chronic conditions in the group fitness setting, which of the following is most important for the Group Fitness Instructor to do?
Facilitate a non-intimate intimidating, inclusive environment
Which special population may experience significant decreased joint stability due to an increase in relaxin?
Pre-natal
How can the Group Fitness Instructor teach with a participant-centered approach that is inclusive of special populations and those with chronic conditions?
By providing options for intensity and complexity of movements for a variety of fitness levels
Which of the following physiological characteristics should an instructor be aware of when working with senior participants?
Decreased lean body mass
Which of the following is an appropriate exercise guideline for a participant who has had a stroke?
Ensure the participant can balance well enough for each exercise
A participant comes up to you before class and lets you know she just found out she is pregnant. Which of the following is the most appropriate recommendation?
Recommend she get clearance from her doctor before starting an exercise program
Which of the following is an appropriate lifting intensity range for a participant who has just had a baby?
45-50% of 1RM
Which of the following is a method of inclusion for participants with disabilities?
Maintain age-appropriate activities and allow all participants to learn in the same way
Which of the following strength exercises is inappropriate for a person with hypertension?
Floor bridge
What is the greatest exercise risk for those suffering from osteoporosis?
Bone fracture
Which of the following training methods should be avoided for a participant with hypertension?
High-intensity maximal resistance training
Which of the following special populations would benefit most from speed, agility, and quickness training?
Youth
A person affected by the hormone relaxin should avoid what type exercise?
Plyometric
While preparing to teach a strength training class, a new participant approaches you and says they are undergoing cardiac rehabilitation due to a recent heart attack. What should you do to ensure the safety of this participant?
Tell the participant they will need a medical clearance before attending class and that you hope to see them as much as possible when they move into a post-rehabilitative state
