Chapter 14 Special Populations

Question 1

Special populations

Answer 1

 Personal trainers frequently encounter clients with special needs and health concerns.

 Documentation of client encounters, health status, and progress is especially important.

 SOAP notes

 In general, clients with chronic conditions should follow a low- to moderate-intensity exercise program that progresses gradually.

 Communication with healthcare professionals is critical when
working with special populations.

Question 2

Cardiovascular Disorders

Answer 2

 Coronary artery disease (CAD)

 Also called atherosclerotic heart disease

 A narrowing of the coronary arteries that supply the heart muscle with blood and oxygen

 Caused by an inflammatory response within the arterial walls
resulting from an initial injury and the deposition of plaque and
cholesterol

 Manifestations of atherosclerosis include:

 Angina

 Heart attack

 Stroke

 Intermittent claudication

Question 3

Exercise and Coronary Artery
Disease

Answer 3

 Physical inactivity is a major independent risk
factor for CAD.

 Exercise is a critical part of treatment for people with CAD.

 Clients with a history of CAD should be evaluated by their physicians.

 The physician should then provide the personal trainer with basic exercise program parameters.

 It is most appropriate for personal trainers to work with low-risk CAD clients.

Question 4

Hypertension

Answer 4

 High blood pressure

 Having systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg or taking antihypertensive medication

 Prehypertension

 Untreated SBP of 120 to 139 mmHg or an untreated DBP of 80 to 89 mmHg

 Prehypertensive individuals have twice the risk of developing high blood pressure compared to those with normal values.

 Each 20 mmHg rise in SBP or 10 mmHg rise in DBP doubles
the risk of developing cardiovascular disease.

 Exercise, weight loss, sodium reduction, and reduced fat and
alcohol intake are lifestyle therapies for hypertension.

 Post-exercise hypotension (PEH)

Question 5

Stroke

Answer 5

 Ischemic stroke

 Occurs when the blood supply to the brain is cut off

 Hemorrhagic stroke

 Occurs when a blood vessel in the brain bursts

 Warning signs of a stroke:

 Sudden numbness or weakness of the face, arms, or legs

 Sudden confusion or trouble speaking or understanding others

 Sudden trouble seeing in one or both eyes

 Sudden walking problems, dizziness, or loss of balance and coordination

 Sudden severe headache with no known cause

 Transient ischemic attacks (TIA)

 Exercise can increase functional capacity and improve CVD risk factors in stroke patients.

 Exercise has been shown to improve fibrinolytic activity.

Question 6

Peripheral Vascular Disease

Answer 6

 Peripheral vascular disease (PVD) is caused by atherosclerotic lesions in one or more peripheral arterial and/or venous
blood vessels.

 Peripheral artery occlusive disease (PAOD)

 Peripheral vascular occlusive disease (PVOD)

 A subjective rating of pain can be made with the four-point scale presented here.

 Regular exercise improves ambulation distances in individuals with PVD.

Question 7

Dyslipidemia

Answer 7

 Correlates of CVD

 Elevated levels of total cholesterol and LDL cholesterol

 Suboptimal levels of HDL cholesterol

 Elevated levels of triglycerides

 Cholesterol travels through the body attached to a lipoprotein.

 Low-density lipoprotein (LDL)
 Very low-density lipoprotein (VLDL)
 High-density lipoprotein (HDL)
 Non-HDL cholesterol (non-HDL)

 Treatment generally encompasses diet, exercise, and medications.

 Exercise and diet are particularly effective at increasing low
HDL levels.

Question 8

Diabetes

Answer 8

 Hyperglycemia

 Type 1 diabetes

 Body’s immune system destroys pancreatic beta cells
that are responsible for producing insulin

 Regular insulin delivered by injections or a pump to
regulate blood glucose levels is required

 5 to 10% of all adult diagnosed cases of diabetes

Question 9

Diabetes

Answer 9

 Type 2 diabetes

 Initially presents as insulin resistance

 As the demand for insulin rises, the pancreas gradually loses
its ability to produce it

 Accounts for 90 to 95% of all diagnosed cases

 Approximately 75% of people with type 2 diabetes are obese
or have a history of obesity

 Gestational diabetes

 Occurs during approximately 7% of all pregnancies

 Women who have experienced gestational diabetes have a 40
to 60% chance of developing diabetes over the subsequent
five to 10 years.

Question 10

Diabetes Control

Answer 10

 The primary treatment goal is twofold:

 Normalize glucose metabolism

 Prevent diabetes-associated complications and disease
progression

 Proper management of diabetes requires a team approach:

 Physicians
 Diabetes educators
 Dietitians
 Exercise specialists

 The diabetic person’s self-management skills

Question 11

Benefits of Exercise for Diabetes

Answer 11

 Type 1 diabetes

 Improved functional capacity, reduced risk for CAD,
and improved insulin-receptor sensitivity

 Type 2 diabetes

 Prevention of CAD, stroke, peripheral vascular
disease, and other diabetes-related complications

 The combination of weight loss and exercise can
positively affect lipid levels, thereby lowering a type 2
diabetic’s risk for heart disease.

Question 12

Metabolic Syndrome

Answer 12

 The metabolic syndrome (MetS) is a cluster of conditions that puts a person at an increased risk for developing heart disease, type 2 diabetes, and stroke.

 MetS be identified as the presence of three or more of the following components:

 Elevated waist circumference

 Men ≥40 inches (102 cm)

 Women ≥35 inches (88 cm)

 Elevated triglycerides: ≥150 mg/dL

 Reduced HDL cholesterol

 Men <40 mg/dL

 Women <50 mg/dL

 Elevated blood pressure: ≥130/85 mmHg

 Elevated fasting blood glucose: ≥100 mg/dL

Question 13

Asthma

Answer 13

 Asthma is a chronic inflammatory disorder characterized by:

 Shortness of breath

 Wheezing

 Coughing

 Chest tightness

 The inflammatory response is typically set off by
environmental triggers.

 Approximately 80% of people with asthma experience asthma
attacks during and/or after physical activity [exercise-induced
asthma (EIA)].

Question 14

Precautions/Recommendations for Asthma and
Exercise

Answer 14

 Clients with asthma should have rescue medication with them at all times and be instructed on how to use it.

 Clients should drink plenty of fluids before, during, and after exercise.

 Clients should avoid asthma triggers during exercise.

 Asthmatic clients should utilize gradual and prolonged warm-up and cool-down periods.

 Peak exercise intensity should be determined by the client’s state of conditioning and asthma severity.

 Reduce intensity and terminate the exercise session should symptoms worsen.

 If an asthma attack is not relieved by medication, activate the
emergency medical system.

 People with asthma often respond best to exercise in mid-to-late morning.

Question 15

Cancer

Answer 15

 Cancer is a group of diseases in which abnormal cells divide without control.

 Cancer rates may dramatically increase over the next decade due to:

 The aging population

 Continued population growth

 Rapidly improving detection technology

 Metastasis

 Malignant versus benign cells

Question 16

Benefits of exercise

Answer 16

 Physical activity can help protect active people from acquiring
some cancers

 The goal of exercise in the treatment of cancer is to:

 Maintain and improve cardiovascular conditioning

 Prevent musculoskeletal deterioration

 Reduce symptoms such as nausea and fatigue

 Improve the client’s mental health outlook and overall quality
of life

Question 17

Precautions for Exercise and Cancer

Answer 17

 Clients who are anemic should not exercise without physician
clearance.

 Clients with neutropenia should consider avoiding public gyms.

 Clients who have experienced frequent vomiting and/or diarrhea should check with their physicians before resuming exercise.

 Swollen ankles, unexplained weight gain, and/or shortness of breath at rest or with limited exertion should be reported to the client’s physician.

 Clients with thrombocytopenia and those taking blood thinners
should avoid activities that raise the risk of falls and physical contact.

 Cancer clients that have a catheter should avoid aquatic exercise.

 People should not exercise within two hours of chemotherapy or radiation therapy.

Question 18

Osteoporosis

Answer 18

 Osteoporosis is characterized by low bone mass and disrupted
microarchitecture.

 Defined as a bone mineral density (BMD) that is 2.5 standard
deviations (s.d.) or more below the mean for young adults

 Results in structural weakness and increased risk for fracture

 Osteopenia

 BMD between 1.0 and 2.5 s.d. below the mean

 Bone remodeling

 Formation versus resorption

 The goals of treatment are to retain bone mineral and decrease the risk of falls and fractures.

 Exercise is an important part of the prevention and treatment plan for osteoporosis.

Question 19

Contraindications for Exercise and
Osteoporosis

Answer 19

 To prevent further injury and falls, some clients
(e.g., those with spinal and other fractures) may
need to avoid:

 Spinal flexion, crunches, and rowing machines

 Jumping and high-impact aerobics

 Trampolines and step aerobics

 Abducting or adducting the legs against resistance

 Pulling on the neck with hands behind the head

Question 20

Arthritis

Answer 20

 Arthritis is a chronic condition characterized by inflammation and associated joint pain.

 Osteoarthritis

 Rheumatoid arthritis

 Prevalence

 Higher in women, and obese and overweight individuals

 Higher in physically inactive people

 Increases with age in both genders

Question 21

Arthritis and Exercise

Answer 21

 Consistent exercise benefits clients with arthritis by:

 Improving cardiovascular fitness, muscular strength and endurance, and joint mobility

 Improving daily function and enhancing quality of life

Question 22

Precautions

Answer 22

 Clients with hip and/or knee arthritis should avoid jarring
exercises.

 All joints should be moved through their full range of
motion at least once a day to maintain mobility.

 Emphasize proper body alignment and proper exercise technique at all times.

 Special precautions must be taken when working
with clients who have undergone a hip replacement.

 Individuals with rheumatoid arthritis should not exercise during periods of inflammation.

 Clients with arthritis may be more limited by joint pain than by cardiovascular function.

Question 23

Fibromyalgia

Answer 23

 Fibromyalgia is a syndrome characterized by long-lasting
widespread pain and tenderness at specific points on the body.

 Diagnosis is based on generalized symptoms such as pain, fatigue, and sleep disturbances.

 Criteria for diagnosis is based on pain on palpation of 11 of 18
tender point sites (as listed in the table on the following slide).

 Exercise is beneficial, easing symptoms and preventing the
development of other chronic conditions.

 Clients with fibromyalgia are typically deconditioned and tend to shy away from exercise.

Question 24

Chronic Fatigue Syndrome

Answer 24

 Chronic fatigue syndrome (CFS) is characterized by incapacitating fatigue lasting at least six months.

 Diagnosis can be challenging, as many of the signs and symptoms of CFS also occur with other diseases and health conditions (as listed in the table on the following slide).

 The treatment regimen may include:

 Moderating daily activity

 Gradually progressing exercise

 Cognitive behavior therapy

 Treatment of depression

 Treatment of existing pain

 Treatment of allergy-like symptoms

Question 25

Low-back Pain

Answer 25

 Chronic back pain is pain that persists for more than three months.

 A number of lifestyle-related factors are associated with low-back pain (LBP):

 Physical inactivity

 Being overweight or obese

 Poor posture and sleeping position

 Stress

 Smoking

 Exercise is one of the cornerstones of both the prevention and treatment of LBP.

Question 26

Contraindications for Clients With LBP

Answer 26

 Clients with LBP should avoid:

 Unsupported forward flexion

 Twisting at the waist with turned feet, especially when carrying a load

 Lifting both legs simultaneously when in a prone or supine position

 Rapid movements, such as twisting, forward flexion, or
hyperextension

 Clients should not be encouraged to “work through the pain.”

Question 27

Recommendations for Exercise for LBP

Answer 27

 Clients with LBP should consult with a physician and get specific recommendations for exercise.

 Always maintain neutral pelvic alignment and an erect torso during any exercise movements.

 Avoid head-forward positions in which the chin is tilted up.

 When leaning forward or lifting or lowering an object, always bend the knees.

 Avoid hyperextending the spine in an unsupported position.

 Low-back exercises have the most beneficial effect when performed daily.
 Diurnal variation stresses are highest in the intervertebral discs following bed rest and diminish over the subsequent few hours.

 Strength gains should not be overemphasized at the expense of endurance.

 There is no such thing as an ideal set of exercises for all individuals.

 Increased function and pain reduction may not occur for three months.

Question 28

Daily routine for enhancing low-back
health

Answer 28

 The following exercises will:

 Spare the spine

 Enhance the muscle challenge

 Enhance the motor control system

 This ensures that spine stability is maintained in all
other activities

 These are examples of exercises that challenge the
muscles of the torso

Question 29

Cat-camel pose

Answer 29

Spine flexion- extension cycles

Intended as a motion exercise not a stretch

5-8 cycles have shown to bes ufficient to reducemost viscous-
frictional stresses

Question 30

Modified curl-up

Answer 30

 Hands or a rolled towel are placed under the lumbar spine to
preserve a neutral spine posture.

 One knee is flexed but the other leg is straight to lock the pelvis- lumbar spine and minimize loss of neutral lumbar posture

Question 31

Birddog pose

Answer 31

Consists of leg extensions and the “birddog”

The isometric holds should last only 7-8 seconds

Question 32

Side bridge

Answer 32

 Targets the lateral muscles of the torso

 Beginner level of this involves keeping knees on ground

 Keep a neutral neck and spine position when performing exercise

Question 33

Weight Management

Answer 33

 Lifestyle habits and cultural changes contribute to weight gain and obesity, including:

 Overeating through increased caloric intake

 The proliferation of microwaveable and ready-to-eat high-fat
foods

 Less in-home cooking and eating out and on-the-go more often

 Marketing that entices people to choose foods that are higher in calories and fat

 Low levels of physical activity

 Excessive amounts of time spent doing sedentary activities

Question 34

Obesity

Answer 34

 Obesity is defined as an excessive amount of adipose tissue in
relation to lean body mass.

 Most common way to measure BMI

 BMI=weight (kg)/height2(m)

 BMI of 25.0 to 29.9 kg/m2 are considered overweight

 BMI of >30.0 kg/m2 are considered obese

 *Slight controversy with BMI*

Question 35

Overweight or obese clients seeking
weight loss

Answer 35

should accumulate more
than 150 minutes of moderate-intensity
exercise each week.

Question 36

Exercise and Older Adults

Answer 36

 Regular physical activity is essential for older adults who wish
to maintain independence and quality of life.

 The following areas are affected by aging and should be
considered when programming for this population:

 Cardiovascular system

 Musculoskeletal system

 Sensory systems

 Mental health

 At least twice each week, older adults should perform muscle-
strengthening and flexibility activities.

 Older adults at risk for falling should perform exercises that
maintain or improve balance.

Question 37

Exercise and Youth

Answer 37

 Regular physical activity in children and adolescents is essential to promote health and fitness.

 The primary exercise activities for youth are aerobic conditioning, muscle strengthening, and bone strengthening.

Question 38

Guidelines for youth exercise

Answer 38

 The following guidelines help decrease the risk of injury from exercise training in youth:

 Obtain medical clearance or instructions regarding physical needs.

 Children should be properly supervised and use proper exercise technique at all times.

 Do not allow children to exercise unless the weight-training facility is safe for them.

 Never have children perform single maximal lifts.

 Teach children how to breathe properly during exercise movements.

 Never allow children to use any equipment that is broken or damaged, or that they do not fit on properly.

 Children should rest for approximately one to two minutes between each exercise.

 Children should have scheduled rest days between each training day.

 Tell children that they need to communicate when they feel tired or fatigued, or when they have been injured.

Question 39

Heat-related Precautions for Exercise in Youth

Answer 39

 Reduce the intensity of exercise when it is very hot, humid, or
sunny.

 Cancel activity or move indoors to an air conditioned
environment during periods of very hot and especially humid
conditions.

 Maintain hydration

 To prevent hyponatremia, replace both lost water and salt.

 Encourage frequent breaks/rest periods in the shade, and
have children drink fluids during these breaks.

 Encourage lightweight, light-colored, loose-fitting clothing, as
well as the use of sunscreen.

Question 40

Pre- and Postnatal Exercise

Answer 40

 Exercise during pregnancy and the postpartum period:
 Reduces the risk of preeclampsia
 Treats or prevents gestational diabetes
 Helps manage or alleviate pregnancy-related musculoskeletal
issues
 Positively affects mood and mental health
 Is safe and does not harm offspring health or development
 Pregnant women with the following health conditions should not exercise:
 Risk factors for pre-term labor
 Vaginal bleeding
 Premature rupture of membranes

Question 41

Exercise Recommendations for Pregnancy

Answer 41

 Do not begin a vigorous exercise program shortly before or during pregnancy.

 Women who have been previously active may continue their
exercise programs, as tolerated.

 Women who have not previously been active may need to begin slowly and perform intermittent exercise.

 Gradually reduce the volume of exercise during the second and third trimesters.

 Use the RPE scale rather than heart rate to monitor exercise
intensity.

 Avoid prolonged exercise in the supine position after the first
trimester.

Question 42

Exercise Recommendations for
Pregnancy

Answer 42

 Avoid long periods of standing and instead keep moving or sit and rest.

 Exercise should be avoided when the temperature and/or humidity is high.

 Body temperature should not exceed 100° F (38° C).

 Focus on proper fluid intake.

 Utilize extended warm-up and cool-down periods and incorporate some stretching.

 Wear supportive shoes and undergarments.

 Eat a small snack prior to exercise.

Question 43

Contraindicated Activities for Pregnant
Exercisers

Answer 43

 Activities that require extensive jumping, hopping, skipping,
bouncing, or running

 Deep knee bends, full sit-ups, double-leg raises, and straight-leg toe touches

 Contact sports such as softball, football, basketball, and volleyball

 Bouncing while stretching

 Activities where falling is likely

Question 44

Postnatal Exercise Guidelines

Answer 44

 After delivery, women should adhere to the following general guidelines:

 Obtain physician clearance and guidelines prior to resuming or starting an exercise program.

 Begin slowly, and gradually increase duration and then intensity.

 Start with walking several times per week.

 Avoid excessive fatigue and dehydration.

 Wear a supportive bra.

 Stop the exercise session if unusual pain is experienced.

 Stop the exercise session and seek medical evaluation if bright red vaginal bleeding occurs that is heavier than a normal menstrual period.

 Drink plenty of water and eat appropriately