Ch 9: Fostering Inclusive Experiences

Question 1

It is the responsibility of the _____ to determine if medical evaluation by a physician is warranted prior to an individual participating in physical activity.

Answer 1

facility/business operator

Question 2

It is prudent from a professional and legal perspective to obtain a _______ for all participants with an identified chronic disease, disability, or injury.

Answer 2

medical clearance

Question 3

__________ refers to any disease that affects the cardiovascular system, principally, cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease.

Answer 3

Cardiovascular disease (CVD). Risk factors include hypertension and blood lipid disorders.

Question 4

A common subset of CVD, ______ results from the development of artherosclerosis in the coronary arteries, which involves the hardening and accumulation of lipid-rich plaques within the walls of the arteries that supply the myocardium (muscles of the heart).

Answer 4

Coronary heart disease. Left untreated, it can lead to myocardial infarction, stroke, or peripheral heart disease. This is the most common cause of sudden death.

Question 5

When ________ is chronically too high, the constant force of blood against the arterial walls can be damaging to the arteries and organs.

Answer 5

blood pressure

Question 6

What are some general guidelines when participants with known CVD or risk factors for CVD are exercising?

Answer 6

Emphasize the importance of self-monitoring intensity. Avoid abruptly changing from lying or seated to standing. Avoid performing Valsalva manuever. Avoid isometric exercises, which elevate BP.

Question 7

______ can be debilitating for some exercises because they can affect the ability to progress exercise intensity and sometimes physical activity can instigate symptoms.

Answer 7

Pulmonary diseases and disorders (asthma, COPD). Exercise is strongly recommended for pulmonary rehab because it helps people overcome the psychological and cognitive comorbidities that may accompany these conditions

Question 8

_____ is a chronic inflammatory disorder of the airways that causes airflow obstruction, characterized by varying degrees of difficulty breathing, wheezing, coughing, and chest tightness.

Answer 8

Asthma. Low-moderate intensity aerobic conditioning improvces one’s tolerance to exercise.

Question 9

_____ is when physical activity induces an asthmatic response.

Answer 9

Exercise-induced asthma

Question 10

Steps to manage an asthma attack

Answer 10

Rest/relax at least 10 minutes. Take prescribed medication if available. Drink warm liquid (slowly). NO COLD LIQUIDS. Get medical help if you have any doubt about the severity of the attack.

Question 11

Exercise considerations (6) for participants with asthma

Answer 11

1. If exacerbated during exercise, limit movement until symptoms subside
2. Longer warm ups and cool downs
3. Emphasize hydration before, during, and after exercise
4. Diaphragmatic or pursed-lip breathing may help
5. Use RPE and dyspnea scale to monitor exercise intensity
6. Limit exposure to cold, polluted or high-allergen environments

Question 12

_____ is a degenerative joint disease and leading cause of disability.

Answer 12

Arthritis

Question 13

_____ accounts for 85% of arthritis cases. It’s characterized by a degeneration of synovial fluid, which over time progresses into loss of articular cartilage and underlying subchondral bone.

Answer 13

Osteoarthritis. Primary symptoms include localized joint pain, stiffness, reduced ROM, atrophy of surrounding muscles

Question 14

Exercise considerations for participations with osteoarthritis

Answer 14

1. Avoid vigorous exercise during flare-ups, but gentle ROM exercises are appropriate.
2. Stop exercise if joint pain is too severe
3. Explain that small amount of joint/muscle discomfort during exercise is normal.
4. Perform 5-10 minute warm up to lubricate joints, and an adequate cool-down
5. Start with light aerobic exercise to increase blood flow and body temperature
6. Perform dynamic flexibility exercises to enhance tissue elasticity and increase joint lubrication
7. Water temp for aquatics should be 83-88 F
8. Start with bilateral exercises and progress to unilateral
9. Perform activation exercises to target specific areas

Question 15

_____ is an autoimmune disease caused by the destruction of pancreatic cells that produce the body’s insulin.

Answer 15

Type I diabetes. Must take regular amounts of insulin to sustain safe levels of glucose in blood.

Question 16

_____ results from insulin resistance combined with defective insulin secretion.

Answer 16

Type II diabetes. Typically occurs when adults are overweight. Results in increased glucose in blood; not always treated with insulin.

Question 17

Exercise considerations for people with diabetes

Answer 17

1. Exercise can have significant impact on lowering blood glucose
2. Measure blood glucose before and after exercise. If below 100 mg/dl, consume small carb snack prior to activity.

Question 18

What are the symptoms of an insulin reaction (hypoglycemia)?

Answer 18

EARLY SX: Anxiety, uneasiness, irritability, extreme hunger, confusion, headaches, insomnia
LATE SX: double vision, sweating, palpitations, nausea, loss of motor coordination, pale/moist skin, strong/rapid pulse, convulsions, loss of consciousness, coma

Question 19

How can you help someone who is having an insulin reaction?

Answer 19

Stop physical activity. Have them sit, check blood glucose. Drink OJ or other rapidly absorbing carb. Check blood glucose again; if more than 100 mg/dl, can resume activity. Check again in 15-30 mins to ensure levels are sufficient to continue activity. Seek medical attention if they don’t improve.

Question 20

Exercise considerations for participants with low back pain

Answer 20

1. Consult physician before exercising
2. Adequate warm up and cool down
3. Be aware of adequate form
4. Avoid working through pain
5. Always maintain neutral posture and erect torso
6. Avoid forward-head positions when chin is tilted up
7. Hinge at hips and bend knees to lift
8. Avoid hyperextending the spine
9. Avoid extreme ROM, abrupt twisting, excessive spinal flexion under load

Question 21

Exercise programs for older adults should include the same components as those for younger people, with an emphasis on: (5)

Answer 21

Functional capacity
Mobility
Balance
Strength and power development
Bone health

Question 22

Strength and power training are relevant for older adults to reduce the rate of age-related _____, which is associated with falls and diminished functional capacity.

Answer 22

sarcopenia

Question 23

Exercise considerations for older adults

Answer 23

1. Ask about limitations
2. 10 minute warm up and cool down
3. Incorporate movements they can replicate at home
4. Be mindful of their inability to move quickly from the floor to seated/standing
5. Barefoot balance training is helpful (but if existing diabetic or podiatric conditions, shouldn’t train barefoot without physician approval)
6. Monitor intensity using RPE or dyspnea
7. Use music appealing to this generation
8. Instead of running, offer stationary options like jumping jacks, toe taps
9. For agility exercises, dedicate a lane in the area for less complex coordination and agility exercises
10. If using resistance bands, coach to control eccentric phase (don’t snap back)
11. Include cognitive exercises (catching ball with one hand)

Question 24

Exercise considerations for youth

Answer 24

1. They sweat less, so take caution in hot/humid environments
2. Max HR is much higher (200-205)
3. BP responses are similar in adults
4. RPE may be good for children over 8 but younger kids might just have “easy” and “hard”
5. Muscle-mass increases occurring during growth lead to increased muscular strength
6. Use games in exercise sessions (scavenger hunts, dance competitions, relay races) to increase adherence
7. Supervise and use lightweight equipment

Question 25

Benefits to exercising during pregnancy

Answer 25

Better cardio and muscular fitness
Reduced fatigue
Lower resting HR
Higher VO2 max
Reduced urinary incontinence, low back pain, deep vein thrombosis, hypertension, diastasis recti, nausea, anxiety, heartburn, C-section, insomnia, leg cramps, and depression

Question 26

Factors such as _____ and _____ during exercise can potentially harm the fetus.

Answer 26

Ambient temperature and nutrient availability. Exercise in temperature-controlled areas and eating a snack before exercise will promote a safe, healthy exercise experience for mother and baby.

Question 27

What are some physical changes that will impact a pregnant woman during exercise?

Answer 27

Weight gain puts stress on back, pelvis, hips, legs
Belly up and out, displacing center of gravity and resulting in low back discomfort and changes in balance and coordination
Increase in relaxin makes them more flexible
Increased risk of falls/injuries due to altered balance and joint laxity

Question 28

Exercise considerations for pregnant women

Answer 28

Reduce intensity, duration, frequency over the course of pregnancy if activity is not well tolerated
Use RP scale
Incorporate exercises for postural muscles (thighs, hips, trunk, shoulders)
No repetitive jumping, deep knee bends, full sit ups, double leg raises and straight leg toe touches
After 1st trimester, avoid supine and prone exercises
Avoid long periods of standing, don’t lock out knees
Avoid hot/humid environments
Extended warm up/col down
Walking and running should occur on flat surfaces
Adequate hydration
Some women may need a snack to avoid hypoglycemia

Question 29

Exercise considerations for postpartum participants

Answer 29

Start slowly, gradually increase intensity and duration
Avoid excessive fatigue and dehydration
Wear a supportive bra
Cease activity if unusual pain
Cease activity and seek medical attention if bright red vaginal bleeding occurs that’s heavier than a period
Women with C-sections will need extra time before ab exercises

Question 30

How do beta blockers impact heart rate response?

Answer 30

Decreased resting HR and exercise HR. They may not allow participants to reach target heart rates so use RPE to monitor intensity.

Question 31

How to angiotension II receptor blockers and calcium channel blockers impact heart rate response?

Answer 31

It may decrease resting HR and exercise HR. No change to exercise capacity.

Question 32

How do other hypertensives impact heart rate response?

Answer 32

Resting HR and exercise HR may increase, decrease, or stay same. Exercise capacity usually stays same.

Question 33

How do antihistamines impact heart rate response?

Answer 33

Increased resting HR. Exercise HR stays same, no change in exercise capacity

Question 34

How to antidepressants and antianxiety medications impact heart rate response?

Answer 34

Resting and exercise HR may increase or stay same

Question 35

How do stimulants impact heart rate response?

Answer 35

Increase resting HR and exercise HR. Exercise capacity may increase or stay same

Question 36

How does caffeine impact heart rate response?

Answer 36

Increased resting HR. Exercise HR may increase or stay same. Increased endurance.

Question 37

How do bronchodilators impact heart rate response?

Answer 37

Resting HR, exercise HR, and exercise capacity are not likely to change. Exercise capacity can increase in people with COPD

Question 38

How does alcohol impact heart rate response?

Answer 38

Resting and exercise HR will stay same, but decreased exercise capacity

Question 39

How does nicotine-replacement therapy impact heart rate response?

Answer 39

Increased resting and exercise HR. Exercise capacity will stay same or decrease

Question 40

How do NSAIDS impact heart rate response?

Answer 40

No impact on heart rate. Exercise capacity may increase.