Chapter 23 - Chronic Health Conditions and Special Populations

Question 1

Ben has been diagnosed with Coronary Heart Disease. After getting approval from his doctor regarding exercise, you perform an assessment. During the overhead squat, you notice Ben has knees that fall inward. What would be an appropriate way to stretch the overactive muscles?

Answer 1

• Standing adductor static stretch
• Standing hamstring static stretch stretch
• Standing TFL static stretch

Clients with CHD should not perform SMR and all stretches must be completed in a seated or standing manner. When knees cave in, probable overactive muscles include the adductors, TFL, and Bicep femoris (a muscle of the hamstrings).

Question 2

According to NASM, youth clients are considered between the ages of ____ and _____.

Answer 2

6 - 20

Question 3

What is the major consideration to take into account with obese clients?

Answer 3

Prevalence of other chronic and more serious conditions such as hypertension.

Question 4

What is believed to be the leading cause of obesity?

Answer 4

Energy balance

Energy balance refers to the amount of energy taken in vs the amount of energy used. In humans, we measure this energy in calories. The leading cause of obesity is usually a result of eating more calories than what the body uses.

Question 5

Your client is currently in Phase 2 of the OPT model and based on her macrocycle is scheduled to advance to Phase 3 in the next 2 weeks. This client just disclosed to you that she is pregnant. Should you still progress to phase 3?

Answer 5

No.

During pregnancy, the goal is to progress the pregnancy, not the workouts. Pregnant clients should remain in the phase they are currently in and, if needed, regress to a lower phase as the pregnancy progresses.

Question 6

When training children, what mode of activity should be included?

Answer 6

Anything that the child thinks is fun.

Children are very competitive in nature. When planning exercise, try to make exercises into games or competitions such as playing tag, having a push-up contest with perfect form, etc.

Question 7

True or False

When working with obese clients, you should only use machines.

Answer 7

False.

Machines, while often thought of as superior for beginning weight lifting, usually cause more harm than help with obese clients due to their strict range of motion and size of the machines. Some obese clients may not be able to fit into a machine to use it which will cause more emotional pain. For obese clients, using free weights and resistance bands may work better.

Question 8

Your client is hypertensive. During an assessment, you observe the client has an excessive forward lean. What are some appropriate exercises to strengthen the underactive muscles?

Answer 8

• Wall ball Squat performed at a 4/1/1/1 tempo
• Seated Hamstring Curls at a 4/1/1/1 tempo
• Standing Cobra

An excessive forward lean usually indicates underactive glutes, hamstrings, and core stabilizers. Because your client is hypertensive, all exercises need to be performed in a seated or standing manner. Standing core exercises, such as a standing cobra, can be used to strengthen the core. Since hypertensive clients cannot perform isometric holds, a modified plank would not be appropriate. For resistance, and stabilization exercises in a seated or standing position can be implemented with a 4/1/1/1 tempo to lower the time in the isometric hold.

Question 9

What are the two most common forms of arthritis?

Answer 9

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis refers to the general wear and tear on joints. Rheumatoid Arthritis is an autoimmune condition in which the immune system starts to break down joints.

Question 10

When should you progress a child out of phase 1?

Answer 10

• Maturity level
• Postural control
• Past response to training

Question 11

Define

Arteriosclerosis

Answer 11

Hardening of arteries making them less efficient at transporting blood.

Question 12

Mary is 8 weeks pregnant and is still comfortable doing plyometric exercises. Is she still allowed to do plyometrics?

Answer 12

Yes. As long as she is comfortable with them and has been completing them before she was pregnant.

Plyometrics should stop after the first trimester. Aside from plyometrics, women are encouraged to keep working at their current intensity. For more information on exercising while pregnant, click here!

Question 13

True or False

Exercising as a diabetic will elicit a similar response to what insulin does in the body, which may cause hypoglycemia.

Answer 13

True.

When training a diabetic client, always make sure the client has a fast-digesting carbohydrate to help bring blood sugars back up such as fruit or sports drink. For more information on training diabetics, click here.

Question 14

True or False

Personal trainers are allowed to tell a client they have hypertension.

Answer 14

False.

Hypertension can only be diagnosed by a medical doctor. Personal trainers can only warn clients that their blood pressure is elevated and should advise their client to go meet with their primary care doctor before exercise sessions should continue.

Question 15

What kind of program system is recommended for those with PAD?

Answer 15

Circuit

Question 16

Jacky is 14 weeks pregnant. Jacky should no longer do exercises in what position(s)?

Answer 16

Prone or supine.

After the first trimester, pregnant women should no longer complete exercises in which the client is laying on their belly or laying on their backs because these positions can decrease blood flow to the placenta.

Question 17

Define

Arthritis

Answer 17

Inflammation of the joints

Question 18

When working with diabetic clients, why would you want to take precautions with what footwear they have?

Answer 18

• Abnormal wear patterns
• Diabetics commonly have peripheral neuropathy which will cause damage to the nerves in the feet

Question 19

Why is resistance training important in working with obese clients?

Answer 19

Resistance training will maintain or increase lean body mass which will increase metabolic rate.

Question 20

What should the tempo be in Phase 1 for clients with hypertension or CHD?

Answer 20

4/1/1/1

Clients with hypertension or CHD should limit the amount of time in an isometric hold.

Question 21

What assessments are acceptable for obese clients?

Answer 21

• Push
• Pull
• OHSA (if tolerated)

Question 22

Is SMR safe to use on an obese client?

Answer 22

Yes, however, SMR is not necessary if the client does not feel comfortable doing it.

Question 23

True or False

Clients with arthritis are encouraged to lift heavy weight as putting more demand on the joints will strengthen the connective tissue of the joint, creating a stronger and less painful joint capsule.

Answer 23

False.

Clients with arthritis should never lift heavy weight or max out on weights as this could cause more damage and pain to the joint

Question 24

What kind of flexibility training is appropriate for clients with osteoporosis?

Answer 24

Static and Active stretching.

Question 25

True or False

Personal trainers can claim to treat hypertension with exercise.

Answer 25

False.

Personal trainers, unlike medical doctors and Exercise Physiologists, cannot treat any condition. While personal trainers can work with hypertensive clients to lower blood pressure, personal trainers cannot guarantee to treat or lower blood pressure.

Question 26

What training system should be utilized with hypertensive clients and those with other vascular or cardiac conditions because it circulates the blood from the upper to the lower body?

Answer 26

Peripheral Heart Action (PHA)

PHA training is a form of resistance training in which exercises are performed in an order of one upper body, one lower body, one upper body, one lower body, etc. in order to keep the blood moving throughout the entire body. For more information on PHA, click here!

Question 27

Would skinfolds be an accurate way to test the body composition of an obese client?

Answer 27

No.

With noticeably obese clients, skinfold measurements will often not give you an accurate reading because of the amount of extra skin and subdermal fat. Instead, tracking body composition by weight on a scale may be more useful until the client has lost enough weight.

Question 28

What is considered healthy blood pressure?

Answer 28

Below 120/80

Question 29

As the human body ages, there is a decrease in?

Answer 29

• Maximum heart rate
• Cardiac output
• Muscle mass
• Balance and coordination
• Connective tissue elasticity
• Bone mineral density

Question 30

On average, clients with cancer should perform cardiovascular exercise how often?

Answer 30

15 to 30 minutes, 3 to 5 days per week

Question 31

When working with a client with rheumatoid arthritis, what time would be an optimal time to schedule a workout?

Answer 31

Afternoon or evening

Clients with rheumatoid arthritis will experience a decreased range of motion and more pain in the mornings.

Question 32

True or False

Resistance training for children is contraindicated as it causes severe injury and damages growth patterns.

Answer 32

False.

Resistance training for youth, if done correctly, is both safe and effective. Injuries while resistance training are usually due to improper supervision, improper technique, and too fast of a progression.

Question 33

When determining intensity for an obese client, which would be more effective - Heart rate reserve or the talk test?

Answer 33

Talk test.

Usually, clients with obesity will be on medications for other conditions they may have such as diabetes or hypertension. These medications may alter their resting and max heart rates making the talk test a more effective way of determining how hard a client is working.

Question 34

What kind of flexibility should be followed for an elderly population, regardless of the phase of training?

Answer 34

SMR and static stretching

Question 35

What is the main goal of an exercise program for a client with cancer?

Answer 35

Lessen the side effects of cancer and maintain fitness levels.

For more on training those with cancer and those in recovery, click here!

Question 36

With arthritis, clients in phase 1 should perform how many reps of a given exercise?

Answer 36

10-12

Question 37

What assessments are acceptable for clients with hypertension?

Answer 37

• Push
• Pull
• OHSA
• Single leg squat

Question 38

Define

Osteoporosis

Answer 38

A decrease in bone mineral density causing bones to become fragile.

For more information on bone density and training clients with osteoporosis, click here!

Question 39

When training clients with hypertension, you should avoid exercises that put the body in what position?

Answer 39

Any position where the head is not above the rest of the body such as bending over to touch your toes when standing. All exercises should be done in a seated or standing manner.

Being in a position where the head is below other parts of the body usually means the heart is also below the rest of the body. This position increases blood pressure.

Question 40

Which kind of arthritis is formed as a result of trauma or injury to the joint?

Answer 40

Osteoarthritis

Question 41

For obese clients with the goal of weight loss, it is recommended to burn how many calories per exercise session?

Answer 41

200-300

Question 42

On average, incorporating an exercise program with a hypertensive client will lower blood pressure by how much?

Answer 42

10 mm Hg for both diastolic and systolic.

Question 43

Your client Earnie has a BMI of 40 and is under the supervision of his doctor for his high blood pressure. When training this client, what condition would be most important to program for?

Answer 43

Hypertension.

The training recommendations are more specified for hypertension than they are for obesity. For this reason, hypertension protocol should be taken with this client.

Question 44

When training seniors, what is most important to consider?

Answer 44

Progressing slow and that most seniors have other chronic conditions that require more considerations such as hypertension, diabetes, and osteoporosis.

Question 45

Maxine has osteoporosis and is in Phase 3. Instead of doing a back squat, you have her perform squats with kettlebells at her side. Why?

Answer 45

Clients with osteoporosis should not have weight loaded onto their spine.

By changing where the weight was held, you are achieving the same goal but putting the client in a safe position.

Question 46

What are some physiological differences between children and adults that need to be considered while training youth clients?

Answer 46

• Children have a peak oxygen uptake instead of a VO2 max because children do not plateau in the amount of oxygen they are using
• Children are less efficient and exercise at a higher percentage of oxygen uptake
• Children produce less glycolytic enzymes so they cannot exercise at high intensities for the same duration as adults
• Children have immature thermoregulatory systems

For more on training considerations for different ages, click here.

Question 47

What population is at higher risk for osteoporosis, men or women?

Answer 47

Women

Postmenopausal women are at the highest risk for developing osteoporosis due to a deficiency in estrogen.

Question 48

How many sets and reps are acceptable for youth clients?

Answer 48

• 1-2 sets
• 8-12 reps

Question 49

Ideally, a child should get how much physical activity?

Answer 49

At least 60 minutes, most or all days during the week.

Question 50

Define

Peripheral Vascular Disease

Answer 50

A group of diseases in which arteries and veins become restricted or blocked.