Chapter 16 Flashcards
Physiologic & Training Considerations for Youth
- Peak oxygen uptake
- Submaximal oxygen demand is higher compared with adults for walking & running
- Glycolytic enzymes are lower than adult
- Sweating rate
Basic Guidelines for Youth Training
Mode - walking, jogging, running, games, activities, sports, water activity, resistance training
Frequency - 5 to 7 days of the week
Intensity - Moderate to vigorous cardiorespiratory exercise training
Duration - 60 minutes per day (but not if outside!)
Movement assessment - Overhead squats; 10 push up (or as many as can be tolerated); Single leg stance (if tolerated, 3-5 per leg)
Flexibility - Follow the flexibility continuum for each phase of training
Resistance training - 1 to 2 sets of 8 to 12 reps at 40 to 70% on 2 to 3 days per week; Phase 1 of OPT model should be mastered before moving on ; Phases 2-5 should be reserved for mature adolescents on the basis of dynamic postural control and licensed physicians recommendation
Special considerations - Progression for the youth should be based on postural control and not on the amount of weight that can be used; make it fun
Arteriosclerosis
A general term that refers to hardening (and loss of elasticity) of arteries
Atherosclerosis
Buildup of fatty plaques in arteries that leads to narrowing and reduced blood flow
Peripheral vascular disease
A group of diseased in which blood vessels become restricted or blocked, typically as a result of atherosclerosis
Normal physiologic & functional changes associated with aging
- Reductions in maximal attainable heart rate
- Reductions in cardiac output
- Reductions in muscle mass
- Reductions in balance
- Reductions in coordination (neuromuscular efficiency)
- Reductions in connective tissue elasticity
- Reductions in bone mineral density
Physiologic & Training Considerations for Seniors
- Max oxygen uptake, max heart rate and measures of pulmonary function decrease with age
- % of body fat will increase & bone mass & lean body mass will decrease with age
- Balance, gait, and neuromuscular coordination may be impaired
- Higher rate of both diagnosed & undetected heart disease
- Pulse irregularity is more frequent
Basic Guidelines for Seniors
Mode - stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support
Frequency - 3 to 5 days for moderate-intensity; 3 days for vigorous intensity
Intensity - 40% to 80% of VO2peak
Duration - 30 to 60 min per day or 8 t 10 minute bouts
Movement assessment - Push, pull, OH squat or sitting and standing into a chair; single leg balance
Flexibility - Self myofascial elease and static stretching
Resistance training - 1 to 3 sets of 8 to 20 reps at 40 to 80% on 3 to 5 days per week; Phase 1 of OPT model should be mastered before moving on ; Phases 2-5 should be based on dynamic postural control and licensed physicians recommendation
Special considerations - Progression should be slow, well monitored & based on postural control; Exercises should be progressed if possible toward free sitting (no support) or standing; Making sure client is breathing in normal manner & avoid holding breath as in a Valsalva maneuver; If client cannot tolerate SMR or static stretches because of other conditions, perform slow rythmic or dynamic stretches
Obesity
The condition of subcutaneous fat exceeding the amount of lean body mass
Physiologic & Training Considerations for Overweight or Obese individuals
- May have other comorbidities (diagnosed or undiagnosed) including hypertension, cardiovascular disease, or diabetes
- Maximal oxygen uptake and ventilatory (anaerobic) threshold is typically reduced
- Coexisting diets may hamper exercise ability and result in significant loss of lean body mass
- Measures of body composition (hydrostatic weighing, skin-fold calipers) may not accurately reflect degree of overweight or obesity.
Basic Guidelines for Obesity
Mode - Low impact or step aerobics (such as treadmill walking, rowing, stationary cycling, and water activity)
Frequency - At least 5 days per week
Intensity - 60% to 80% of max heart rate. Use the “talk test” to determine exertion; Stage 1 cardiorespiratory training progressing to stage 2 (intensities may be altered to 40%-70% of max heart rate if needed).
Duration - 40 to 60 min per day or 20-30 minute sessions twice per day
Movement assessment - Push, pull, single leg balance (if tolerated)
Flexibility - SMR (only if client is comfortable); Flexibility continuum
Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 will be appropriate performed in a circuit-training manner (higher reps such as 20 may be used)
Special considerations - Make sure client is comfortable; exercises should be performed in a standing or seated position; May have other chronic diseases
Diabetes
Chronic metabolic disorder, caused by insulin deficiency, which impairs carbohydrate usage and enhances usage of fat and protein
Type 1 Diabetes
Typically diagnosed in children, teens, or young adults; specialized cells in the pancreas called beta cells stop producing insulin, causing blood sugar levels to rise, resulting in hyperglycemia - to control this the individual must inject insulin to compensate for what the pancreas cannot produce
Type 2 Diabetes
Associated with obesity, particularly abdominal obesity; produce adequate amounts of insulin, but their cells are resistant to the insulin (the insulin present cannot transfer adequate mounts of blood sugar to the cell).
Physiologic & Training Considerations for Individuals with Diabetes
- Frequently associated with comorbidities (including cardiovascular disease, obesity, and hypertension)
- Exercise exerts an effect similar to that of insulin
- Hypoglycemia may occur several hours after exercise, as well as during exercise
- Clients taking Beta blocking medications may be unable to recognize signs and symptoms of hypoglycemia
- Exercise in excessive heat may mask signs of hypoglycemia
- Increased risk for retinopathy
- Peripheral neuropathy may increase risk for gait abnormalities and infection from foot blisters that may go unnoticed
Basic Guidelines for Diabetes
Mode - Low impact activities (such as cycling, treadmill walking, low-impact or step aerobics)
Frequency - 4 to 7 days per week
Intensity - 50% to 90% of max heart rate. Use the “talk test” to determine exertion; Stage 1 cardiorespiratory training (may be adjusted to 40%-70% of max heart rate if needed) progressing to stage 2 and 3 based on a physician’s approval
Duration - 20 to 60 minutes
Movement assessment - Push, pull, OH squat, single leg balance or single leg squat
Flexibility - Flexibility continuum
Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model (higher reps such as 20 may be used)
Special considerations - Make sure client has appropriate footwear and have client or physician check feet for blisters or abnormal wear patterns; Advise client or class participant to keep a snack (quick source of carbohydrate) available during exercise, to avoid sudden hypoglycemia; Use SMR with special care and licensed physician’s advise; Avoid excessive plyometric training, and higher-intensity training is not recommended for typical client
Hypertension
Consistently elevated arterial blood pressure, which, if sustained at a high enough level, is likely to induce cardiovascular or end-organ damage
Normal blood pressure - <120/80 mm HG.
Hypertension blood pressure - >140/90 mm HG
Prehypertensive blood pressure - 120/80 to 135/85
Valsalva maneuver
A maneuver in which a person tries to exhale forcibly with a closed glottis (wind pipe) so that no air exits through the mouth or nose as, for example, in lifting a heavy weight. The Valsalva maneuver impedes the return of venous blood to the heart.
Physiologic & Training Considerations for Individuals with Hypertension
- Blood pressure response to exercise may be variable and exaggerated, depending on the mode and level of intensity
- Despite medication, clients may arrive with preexercise hypertension
- Hypertension frequently is associated with other comorbidities, including obesity, cardiovascular disease, and diabetes
- Some medications, such as beta blockers, for hypertension will attenuate the heart rate at rest and its response to exercise
Basic Guidelines for Hypertension
Mode - Stationary cycling, treadmill walking, rowers
Frequency - 3 to 7 days per week
Intensity - 50% to 85% of max heart rate. Stage 1 cardiorespiratory training progressing to stage 2 (intensities may be altered to 40%-70% of max heart rate if needed)
Duration - 30 to 60 minutes
Movement assessment - Push, pull, OH squat, single leg balance (squat if tolerated)
Flexibility - Static and active in a standing or seated position
Resistance training - 1 to 3 sets of 10 to 20 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model; Tempo should not exceed 1 second for isometric and concentric portions (e.g. 4/1/1 instead of 4/2/1); Use circuit or PHA weight training as an option, with appropriate rest intervals
Special considerations - Avoid heavy lifting and Valsalva maneuvers - make sure client breathes normally; Do not let client overgrip weights or clench fists when training; Modify tempo to avoid isometric & concentric muscle action; Perform exercises in a standing or seated position; Allow client to stand up slowly to avoid possible dizziness; Progress client slowly
Physiologic & Training Considerations for Individuals with Coronary Heart Disease (CHD)
- The nature of heart disease may result in a specific level of exercise, above which it is dangerous to perform
- Clients with heart disease may not have angina (chest pain equivalent) or other warning signs
- Between the underlying disease & medication use, the heart rate response to exercise will nearly always vary considerably from age-predicted formulas, and will almost always be lower
- Clients may have other comorbidities (such as diabetes, hypertension, peripheral vascular disease, or obesity)
- Peak oxygen uptake (as well as ventilatory threshold) is often reduced because of the compromised cardiac pump and peripheral muscle deconditioning
Basic Guidelines for CHD
Mode - Large muscle group activities, such as stationary cycling, treadmill walking or rowing
Frequency - 3 to 5 days per week
Intensity - 40% to 85% of max heart rate reserve. Talk test. Stage 1 cardiorespiratory training.
Duration - 5 to 10 minutes warm-up, 20 to 40 minutes of exercise, followed by a 5 to 10 minute cool down
Movement assessment - Push, pull, OH squat, single leg balance (squat if tolerated)
Flexibility - Static and active in a standing or seated position
Resistance training - 1 to 3 sets of 10 to 20 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model; Tempo should not exceed 1 second for isometric and concentric portions (e.g. 4/1/1 instead of 4/2/1); Use circuit or PHA weight training as an option, with appropriate rest intervals
Special considerations - Be aware that the clients may have other diseases to consider as well; Modify tempo to avoid isometric & concentric muscle action; Avoid heavy lifting and Valsalva maneuvers - make sure client breaths normally; Do not let client overgrip weights or clench fist; Perform exercises standing or sitting; Progress exercise slowly
Osteopenia
A decrease in the calcification or density of bone as well as reduced bone mass
Osteoporosis
Condition in which there is a decrease in bone mass and density as well as an increase in the space between bones, resulting in porosity and fragility
Type 1 (primary) - associated with normal aging and is attributable to a lower production of estrogen & progesterone, both of which are involved with regulating the rate at which bone is lost
Type 2 (secondary) - caused by certain medical conditions or medications that can disrupt normal bone reformation, including alcohol abuse, smoking, certain diseases or certain medications
Physiologic & Training Considerations for Individuals with Osteoporosis
- Maximal oxygen uptake and ventilatory threshold is frequently lower, as a result of chronic deconditioning
- Gait and balance may be negatively affected
- Chronic vertebral fractures may result in significant lower-back pain
- Age, disease, physical stature, and deconditioning may place the client at risk for falls
Basic Guidelines for Osteoporosis
Mode - Treadmill with handrail support
Frequency - 2 to 5 days per week
Intensity - 50% to 90% of max heart rate. Stage 1 cardiorespiratory training progressing to Stage 2.
Duration - 20 to 60 minutes per day or 8 to 10 minute bouts
Movement assessment - Push, pull, OH squat, sitting & standing in front of a chair
Flexibility - Static and active stretching
Resistance training - 1 to 3 sets of 8 to 20 reps up to 85% on 2 to 3 days per week; Phase 1 and 2 of the OPT model should be mastered before moving on
Special considerations - Progression should be slow, well monitored, and based on postural control; Exercises should be progressed if possible toward free sitting (no support) or standing; Focus exercises on hips thighs, back and arms; Avoid excessive spinal loading on squat & leg press exercises; Make sure client is breathing in normal manner and avoid holding breath as in a Valsalva maneuver
Arthritis
Chronic inflammation of the joints
Oseoarthritis
Arthritis in which cartilage becomes soft, frayed, or thins out as a result of trauma or other conditions
Rheumatoid arthritis
Arthritis primarily affecting connective tissues, in which there is a thickening of articular soft tissue, and extension of synovial tissue over articular cartilages that have become eroded
Physiologic & Training Considerations for Individuals with Arthritis
- Maximal oxygen uptake and ventilatory threshold are frequently lower as a result of decreased exercise associated with pain and joint inflammation
- Medications may significantly influence bone and muscle health
- Medications may significantly influence bone and muscle health
- Tolerance to exercise may be influence by acute arthritic flare-ups
- Rheumatoid arthritis results, in particular, in early morning stiffness
- Evaluate for presence of comorbidities, particularly osteoporosis
Basic Guidelines for Osteoporosis
Mode - Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics
Frequency - 3 to 5 days per week
Intensity - 60% to 80% of max heart rate. Stage 1 cardiorespiratory training progressing to Stage 2 (may be reduced to 40%-70% of max heart rate if needed).
Duration - 30 minutes
Movement assessment - Push, pull, OH squat, single-leg balance or squat (if tolerated)
Flexibility - SMR and static and active stretching
Resistance training - 1 to 3 sets of 10 to 12 reps on 2 to 3 days per week; Phase 1 of OPT model with reduced repetitions; May use a circuit or PHA training system
Special considerations- Avoid heavy lifting and high repetitions; Stay in pain-free ranges of motion; Only use SMR if tolerated by the client; There may be a need to start out with only 5 minutes of exercise and progressively increase, depending on the severity of conditions
Cancer
Any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to recur after attempted removal and to cause death of the patient unless adequately treated
Physiologic & Training Considerations for Individuals with Cancer
- Fatigue and weakness is common
- Excessive fatigue may result in overall diminished activity
- Diminished immune function
- Decreased lean muscle mass
Basic Guidelines for Cancer
Mode - Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics
Frequency - 3 to 5 days per week
Intensity - 50% to 70% of max heart rate reserve. Stage 1 cardiorespiratory training progressing to Stage 2 (may be reduced to 40%-70% of max heart rate if needed).
Duration - 15 to 30 minutes (may only start with 5 minutes)
Movement assessment - Push, pull, OH squat, single-leg balance (if tolerated)
Flexibility - SMR and static and active stretching
Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 of OPT model; May use a circuit or PHA training system
Special considerations - Avoid heavy lifting in initial stages of training; Allow for adequate rest intervals and progress client slowly; Only use SMR if tolerated by the client - avoid SMR for clients 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
Physiologic & Training Considerations for Women and Pregnancy
- Contraindications include persistent bleeding 2nd to 3rd trimester, medical documentation of incompetent cervix or intrauterine growth retardation, pregnancy-induced hypertension, preterm rupture of membrane, or preterm labor during current or prior pregnancy
- Decreased oxygen available for aerobic exercise
- Posture can affect blood flow to uterus during vigorous exercise
- Even in the absence of exercise, pregnancy may increase metabolic demand by 300 kcal per day to maintain energy balance
- High-risk pregnancy considerations include individuals older than the age of 35, history of miscarriage, diabetes, thyroid disorder, anemia, obesity, and a sedentary lifestyle
Basic Guidelines for Women and Pregnancy
Mode - Low-impact or step aerobics that avoid jarring motions, treadmill walking, stationary cycling, and water activity
Frequency - 3 to 5 days per week
Intensity - Stage 1 and only enter stage 2 on a physician’s advice
Duration - 15 to 30 minutes; There may be a need to start out with only 5 minutes of exercise and progressively increase to 30 minutes, depending on the severity of conditions
Movement assessment - Push, pull, OH squat, single-leg squat or balance
Flexibility - Static and active stretching, SMR
Resistance training - 2 to 3 days per week, using light loads at 12-15 repetitions; Phase 1 and 2 of the OPT model are advised (use only phase 1 after first trimester)
Special considerations - Avoid exercise in a prone (on stomach) or supine (on back) position after 12 weeks of pregnancy; Avoid SMR on varicose veins and areas of swelling; Plyometric training is not advised in the second and third trimesters
Restrictive lung disease
The condition of a fibrous lung tissue, which results in a decreased ability to expand the lungs
Chronic obstructive lung disease
The condition of altered airflow through the lungs, generally caused by the airway obstruction as a results of mucus production
Physiologic & Training Considerations for Individuals with Lung Disease
- Lung disease frequently is associated with other comorbidties, including cardiovascular disease
- A decrease in the ability to exchange gas in the lungs may result in oxygen desaturation and marked dyspnea at low workloads
- Chronic deconditioning results in low aerobic fitness and decreased muscular performance
- Upper extremity exercise may result in earlier onset of dyspnea and fatigue than expected, when compared with lower extremity exercise
- Clients may have significant muscle wasting and be of low body weight
- Clients may be using supplemental oxygen
Basic Guidelines for Individuals with Lung Disease
Mode - Treadmill walking, stationary cycling, steppers, and elliptical trainers
Frequency - 3 to 5 days per week
Intensity - 40%-60% of peak work capacity; Stage 1
Duration - Work up to 2- 45 minutes
Movement assessment - Push, pull, OH squat, single-leg squat or balance
Flexibility - Static and active stretching, SMR
Resistance training - 1 set of 8-15 repetitions 2-3 days per week; Phase 1 of the OPT model is advised; PHA training system is recommended
Special considerations - Upper body exercises cause increased dyspnea and must be monitored; Allow for sufficient rest between exercises
Intermittent claudication
The manifestation of the symptoms caused by peripheral arterial disease
Peripheral arterial disease
A condition characterized by narrow of the major arteries that are responsible for supplying blood to the lower extremities
Physiologic & Training Considerations for Individuals with Intermittent Claudication or PAD
- PAD patients frequently have coexisting coronary artery disease or diabetes
- Smoking significantly worsens PAD and exercise tolerance
- PAD frequently results in decreased aerobic capacity and endurance
- Resistance training may improve overall physical function, but may not address limitations of PAD
Basic Guidelines for Individuals with Intermittent Claudication/PAD
Mode - Treadmill walking is preferred, also stationary cycling, steppers, and elliptical trainers
Frequency - 3 to 5 days per week
Intensity - 50%-85% of maximal heart rate
Duration - Work up to 20-30 minutes
Movement assessment - Push, pull, OH squat, single-leg squat or balance
Flexibility - Static and active stretching
Resistance training - 1 to 3 sets of 8 to 12 repetitions 2 to 3 days per week, and slowly increasing up to 12 to 20 reps; Phase 1 of the OPT model is advised
Special considerations - Allow for sufficient rest between exercises; Workout may start with 5-10 minutes of activity; Slowly progress client
