Ch. 10 - Inclusive Instruction For Special Populations

Question 1

Multi-level fitness classes
—inclusive instruction

Answer 1

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

Question 2

Basic considerations for special populations video

Answer 2

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

Question 3

Chronic health conditions

Answer 3

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

Question 4

Obesity

Answer 4

Individuals with a BMI of 30 or above

Question 5

Hypertension

Answer 5

Chronically high blood pressure as defined by a systolic pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg

Question 6

Coronary heart disease

Answer 6

Coronary arteries of the heart become narrowed due to fatty build-up along the walls of the arteries

Question 7

Congestive heart failure

Answer 7

A complex condition defined by impairment of the heart

Question 8

Atherosclerosis

Answer 8

Narrowing of the arteries due to a build-up of plaque alone their walls

Question 9

Peripheral artery disease

Answer 9

Condition in which blood flow to the extremities is reduced due to the narrowing of arteries

Question 10

Stroke

Answer 10

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

Question 11

Cancer

Answer 11

Abnormal, invasive growth of cells within the body

Question 12

Osteoporosis

Answer 12

Bones become thin, fragile and prone to fracture

Question 13

Hypertension part 2

Answer 13

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

Question 14

Basic exercise guidelines for participants with hypertension

Answer 14

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

Question 15

Obesity part 2

Answer 15

—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

Question 16

Basic exercise guidelines for participants who are obese

Answer 16

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

Question 17

Cardiovascular disease

Answer 17

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

Question 18

Cardiovascular disease 2
—Dyspnea
—heart palpitations

Answer 18

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

Question 19

Basic exercise guidelines for participants with cardiovascular disease

Answer 19

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

Question 20

Stroke part 2

Answer 20

—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

Question 21

Basic exercise guidelines for participants recovering from stroke

Answer 21

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

Question 22

Cancer part 2

Answer 22

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

Question 23

Basic exercise guidelines for participants with cancer

Answer 23

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

Question 24

Osteoporosis part 2

Answer 24

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

Question 25

Basic exercise guidelines for participants with osteoporosis

Answer 25

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

Question 26

Special populations

Answer 26

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

Question 27

Age

Answer 27

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

Question 28

Youth

Answer 28

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!

Question 29

Older adults

Answer 29

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

Question 30

Basic exercise guidelines for older adults

Answer 30

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

Question 31

Pregnancy

Answer 31

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

Question 32

Pregnancy 2

Answer 32

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

Question 33

Basic exercise guidelines for pregnancy

Answer 33

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

Question 34

Postpartum exercise guidelines

Answer 34

—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

Question 35

The timing of return to exercise

Answer 35

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

Question 36

The Americans with disabilities act (ADA)

Answer 36

—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

Question 37

How fitness prof. Can adopt practices of inclusion
—in line with ADA

Answer 37

1. Show enthusiasm
   —creative opp. For inclusion should be offered with positivity and energy w/o being condescending
2. Make accommodations
   —even w/o special modifications, some programs and equipment can be adapted
3. 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

Question 38

There was more info in the appendix D here!!

Answer 38

To come back to

Question 39

Which of the following is an appropriate exercise for a participant who has had a stroke?

Answer 39

—step-up to balance

NOT
—squat to press
—hammer curl
—reverse plank

Question 40

What effect does the hormone relaxin have on women who are pregnant?

Answer 40

Decreases joint stability

Question 41

A participant in your class exhibits dyspnea. What is the best recommendation for this participant?

Answer 41

Take a prolonged break

Question 42

Which of the following chronic conditions would benefit most from cardiorespiratory exercise?

Answer 42

Obesity

Question 43

When is an individual considered obese?

Answer 43

With a BMI of 30

Question 44

During your class, you notice an obese participant struggling with the exercises. Which of the following would be the most appropriate course of action?

Answer 44

Show options for body weight exercises

Question 45

Which condition often coexists with hypertension, hyperlipidemia, Type II diabetes, and osteoarthritis?

Answer 45

Obesity

Question 46

Which of the following populations should avoid hot and humid environments?

Answer 46

Prenatal

Question 47

When dealing with chronic conditions in the group fitness setting, which of the following is most important for the Group Fitness Instructor to do?

Answer 47

Facilitate a non-intimate intimidating, inclusive environment

Question 48

Which special population may experience significant decreased joint stability due to an increase in relaxin?

Answer 48

Pre-natal

Question 49

How can the Group Fitness Instructor teach with a participant-centered approach that is inclusive of special populations and those with chronic conditions?

Answer 49

By providing options for intensity and complexity of movements for a variety of fitness levels

Question 50

Which of the following physiological characteristics should an instructor be aware of when working with senior participants?

Answer 50

Decreased lean body mass

Question 51

Which of the following is an appropriate exercise guideline for a participant who has had a stroke?

Answer 51

Ensure the participant can balance well enough for each exercise

Question 52

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?

Answer 52

Recommend she get clearance from her doctor before starting an exercise program

Question 53

Which of the following is an appropriate lifting intensity range for a participant who has just had a baby?

Answer 53

45-50% of 1RM

Question 54

Which of the following is a method of inclusion for participants with disabilities?

Answer 54

Maintain age-appropriate activities and allow all participants to learn in the same way

Question 55

Which of the following strength exercises is inappropriate for a person with hypertension?

Answer 55

Floor bridge

Question 56

What is the greatest exercise risk for those suffering from osteoporosis?

Answer 56

Bone fracture

Question 57

Which of the following training methods should be avoided for a participant with hypertension?

Answer 57

High-intensity maximal resistance training

Question 58

Which of the following special populations would benefit most from speed, agility, and quickness training?

Answer 58

Youth

Question 59

A person affected by the hormone relaxin should avoid what type exercise?

Answer 59

Plyometric

Question 60

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?

Answer 60

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