Chapter 23 - Chronic Health Conditions and Special Populations Flashcards
Define “Youth” in age-range terms.
- Youth: children and adolescents between ages 6-20
What are the current exercise recommendations for children and adolescents?
- 60 minutes or more of physical activity daily
- Should engage in aerobic, muscle-strengthening, and bone strengthening activities daily to improve health and reduce risk of developing chronic disease
True or False:
Children do not produce sufficient levels of glycolytic enzymes to be able to sustain bouts of high-intensity exercise.
True
How do children differ from adults when it comes to exercise?
Children tend to have lower peak oxygen uptake levels, lower sweating rates, and lower tolerance for temperature extremes (compared to adults)
Children and adolescents have lower glycolytic enzymes than adults resulting in a decreased ability to perform longer-duration (10-90sec) high-intensity tasks.
What types of health considerations should a personal trainer take into consideration in order to accommodate for this?
- Lower reps and sets with an emphasis on proprioception, skills, and controlled movement.
Resistance exercise for muscular fitness:
- 1-2 sets of 8-10 exercises
- 8-12 reps per exercise
- Resistance exercise should emphasize proprioception, skill, and controlled movements
- Repetitions should not exceed 6-8 per set for strength development or 20 for enhanced muscular endurance
When working with children and adolescents, their submaximal oxygen demand is high compared with adults for walking and running.
What types of health considerations should a personal trainer take into consideration in order to accommodate for high submaximal oxygen?
- Moderate to vigorous - 60 mins 3+ days/week or 3 days/wk if more vigorous
- Intensive anaerobic exercise exceeding 10 seconds is not well tolerated (if using stage II or III training, provide sufficient rest and recovery intervals between intense bouts of training)
Children and adolescents have lower absolute sweating rates compared with adults. What types of health considerations should a personal trainer take into consideration in order to accommodate for lower sweating rates?
Restrict vigorous exercise in hot, humid environments to less than 30 minutes and include frequent rest periods.
Untrained children can improve their strength by an average of __-__% after 8 weeks of progressive resistance training.
30-40%
Basic exercise guidelines for youth training:
What modes of exercise are safe for youth training?
Walking, jogging, running, games, activities, sports, water activity, resistance training
Basic exercise guidelines for youth training: What frequency (how many times per week) is safe for youth training?
5-7 days/week
Basic exercise guidelines for youth training: What intensity (for CRE) is safe for youth training?
Moderate-to-vigorous cardiorespiratory exercise training
Basic exercise guidelines for youth training: What duration (how long per day/session) is safe for youth training?
60 minutes per day
Basic exercise guidelines for youth training:
What types of movement assessments would a personal trainer conduct for youth?
- Overhead squats
- 10 push-ups (if 10 cannot be performed, do as many as can be tolerated)
- SL stance (if can tolerate, perform 3-5 SL squats per leg)
What are the basic steps/guidelines when developing an Exercise program for youth:
- Assess for any movement deficiencies using a variety of movement assessments
- Assessments will help individualize phase 1 stabilization endurance training
- Progression to phases 2-5 should be decided on
- Maturity level
- Dynamic postural control (flexibility and stability)
- How they have responded to training up until this point
- Make it safe and fun!
Basic exercise guidelines for youth training:
What resistance training guidelines are safe for youth training?
Reps: 8-12
Sets: 1-2
Intensity: 40-70%
Frequency: 2-3 days/week
Phases:
- Phase 1 of OPT should be mastered before moving on
- Phases 2-5 should be reserved for mature adolescents on the basis of dynamic postural control and a license physician’s recommendation
What are some typical forms of degeneration associated with aging?
- Osteoporosis
- Arthritis (osteoarthritis)
- Low-back pain (LBP)
- Obesity
List a normal physiologic change that occurs with age and what may cause it.
- Blood pressure tends to be higher at rest and during exercise (could be natural causes, could be disease, could be both)
- Arteriosclerosis may cause blood pressure to be higher
What is arteriosclerosis?
Arteriosclerosis: a general terms that refers to the hardening (and loss of elasticity) of arteries
- Arteries are less elastic and pliable
- Result: greater resistance to blood flow = higher blood pressure
(normal with age)
List 2 abnormal physiologic changes that occur with aging
- Atherosclerosis
- Peripheral vascular disease
What is atherosclerosis? What is it typically caused by?
- Atherosclerosis: buildup of fatty plaques in arteries that lead to narrowing and reduced blood flow
- Caused largely by poor lifestyle choices (smoking, obesity, sedentary lifestyle etc)
- Restricts blood flow due to plaque buildup = increased resistance and higher blood pressure
(Abnormal with Age)
What is peripheral vascular disease?
- Peripheral vascular disease: a group of diseases in which blood vessels become constricted or blocked, typically as a result of atherosclerosis
- Diseases caused by hypertension
- Refers to plaques that form in any peripheral artery, typically those in the lower leg
What modes of exercise are safe for senior training?
- Stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support
What frequency (how many times per week) is safe for senior training?
- 3-5 days/wk of moderate-intensity activities or
- 3 days/wk of vigorous-intensity activities
What intensity (for CRE) is safe for senior training?
- 40-85% of VO2 Peak
What duration (how long per day/session) is safe for senior training?
- 30-60 minutes / day or 8-10 minute bouts
What types of movement assessments would a personal trainer conduct for seniors?
- Push, pull, OH squat or
- Sitting and standing into a chair
- Single-leg balance
What resistance training guidelines are safe for senior training?
- 1-3 sets of 8-20 reps at 40-80% on 3-5 days/wk
- Phase 1 of OPT model should be mastered before moving on
- Phases 2-5 should be based on dynamic postural control and a licensed physician’s recommendation
Basic exercise guidelines for senior training:
What flexibility training guidelines are safe for senior training?
- Self-myofascial release and static stretching
What are some special considerations to keep in mind when developing an exercise program and training seniors.
- Progression should be slow, well monitored, and based on postural control
- Exercises should be progressed if possible toward free sitting (no support) or standing
- Make sure client is breathing normal manner and avoid holding breath as in a Valsalva maneuver
- If client cannot tolerate SMR or static stretching b/c of other conditions, perform slow rhythmic active or dynamic stretches
What is obesity? Give BMI ranges for the 3 categories of obesity.
- Obesity: The condition of subcutaneous fat exceeding the amount of lean body mass
- 30 - 34.99 = Obese - high risk of disease
- 35 - 39.99 = Obesity II - very high risk of disease
- ≥ 40 = Obesity III - extremely high risk of disease
What are some main causes of obesity?
Primary:
- Energy balance (too many calories consumed and too few expended)
Other causes:
- Complex medical issues
Adults who remain sedentary throughout their lifespan will lose approx. _lbs of muscle per decade and gain __lbs of fat per decade
- 5lbs
- 15lbs
Average adults will experience __% reduction in fat-free mass (FFM) between the ages of 30 and 80
- 15% reduction
What is the main focus of obesity exercise training? How is it achieved?
Focus:
- Primarily on energy expenditure, balance, and proprioceptive training to help them expend calories and improve balance and gait mechanics
- By performing in a proprioceptively enriched environment (controlled, unstable) the body is forced to recruit more muscles to stabilize itself resulting in more calories potentially expended
What are the main goals for obesity exercise training?
Goals:
- Should expend 200-300 kcal/exercise session
- Minimum weekly goal: 1,250 kcal of energy expenditure from combined physical activity and exercise (progressively increase to 2,000 kcal/week)
Basic exercise guidelines for obese individuals:
What modes of exercise are safe for obese clients?
- Low-impact or step aerobics (treadmill walking, rowing, stationary cycling and water activity)
- Dumbbells
- Cables
- Exercise tubing
- Swimming
- Cycle ergometer
- SMR with extreme caution in case client is not comfortable rolling or lying on floor
Basic exercise guidelines for obese individuals: What frequency (how many times per week) is safe for obese clients?
- At least 5 days per week
Basic exercise guidelines for obese individuals: What intensity (for CRE) is safe for obese clients?
- 60-80% of max heart rate. Use talk test to determine exertion
- Stage I cardiorespiratory training progression to stage II (intensities may be altered to 40-70% of max heart rate if needed)
Basic exercise guidelines for obese individuals: What duration (how long per day/session) is safe for obese clients?
- 40-60 minutes per day or
- 20-30 minutes sessions twice each day
Basic exercise guidelines for obese individuals:
What types of movement assessments would a personal trainer conduct for obese clients?
- Push, pull, squat
- Single-leg balance (if tolerated)
Basic exercise guidelines for obese individuals:
What resistance training guidelines are safe for obese clients?
- 1-3 sets of 10-15 reps on 2-3 days per week
- Phases 1 and 2 will be appropriate performed in a circuit-training manner (higher reps such as 20 may be used)
Basic exercise guidelines for obese individuals:
What flexibility training guidelines are safe for obese clients?
- SMR (only if comfortable with client)
- Flexibility continuum
What are some special considerations to keep in mind when developing an exercise program and training obese clients.
- Make sure client is comfortable! Be aware of positions and locations in the facility your client is in
- Exercises should be performed in a standing or seated position
- May have other chronic diseases; in such cases a medical release should be obtained from the individual’s physician
What is diabetes?
- A chronic metabolic disorder caused by insulin deficiency, which impairs carbohydrate usage and enhances usage of fate and protein.
What is Type I diabetes? How/When does it develop?
- Type I: body does not produce enough insulin (insulin dependent)
- Specialized cells in the pancreas (beta cells) stop producing insulin, causing blood sugar levels to rise, resulting in hyperglycemia (high levels of blood sugar)
- Usually develops in childhood, teenagers and young adults
What happens if a person with Type I diabetes does not control blood glucose levels (via insulin injections or dietary carbs) before, during and after exercise?
- Blood sugar levels can drop rapidly causing hypoglycemia (low blood sugar) leading to weakness, dizziness, and fainting
- Insulin levels may need to be adjusted with exercise
because exercise increases the rate at which cells utilize glucose
How does an individual with diabetes control hyperglycemia (high levels of blood sugar)?
- To control hyperglycemia, individual must inject insulin to compensate for what the pancreas cannot produce.
What is Type II diabetes? How does it develop?
- Type II: cells become insulin resistant and body cannot respond normally to the insulin that is made (non-insulin dependent)
- Because cells are resistant to insulin (the insulin present in system cannot transfer adequate amounts of blood sugar into the cell) individual may be hyperglycemic (high blood sugar)
- Associated with obesity, specifically abdominal
Chronic hyperglycemia is associated with a number of diseases:
- Damage to kidneys
- Damage to heart
- Nerves
- Eyes
- Circulatory system
What are the goals of exercise training with Type I and Type II diabetes clients?
- Glucose control (type I and II)
- Lose weight (type II)
Why is exercise effective to achieving glucose control (and potential weight loss) specific to diabetic clients?
- Exercise training is effective to achieve these goals (glucose control and weight loss) because of its similar action to insulin by enhancing the uptake of circulating glucose by exercising the skeletal muscle.
What are the benefits of exercise for diabetic clients?
Improves a variety of glucose measures:
- Tissue sensitivity
- Improved glucose tolerance
- Decrease in insulin requirements
List some physiologic considerations with diabetic clients in regard to exercise?
- 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 𝛃-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 (loss of protective sensation in feet and legs) may increase risk for gait abnormalities and infection from foot blisters that may go unnoticed
Basic exercise guidelines for individuals with diabetes:
What modes of exercise are safe for diabetic clients?
- Low-impact activities (cycling, treadmill walking, low-impact or step aerobics)
Basic exercise guidelines for Individuals with diabetes: What frequency (how many times per week) is safe for diabetic clients?
- 4-7 days per week
Basic exercise guidelines for individuals with diabetes: What intensity (for CRE) is safe for diabetic clients?
- 50-90% of maximum heart rate
- Stage I cardiorespiratory training (may be adjusted to 40-70% of max heart rate if needed) progressing to stages II and III based on a physician’s approval
Basic exercise guidelines for individuals with diabetes: What duration (how long per day/session) is safe for diabetic clients?
- 20-60 minutes
Basic exercise guidelines for individuals with diabetes:
What types of movement assessments would a personal trainer conduct for diabetic clients?
- Push, pull, squat
- Single-leg balance or single-leg squat
Basic exercise guidelines for individuals with diabetes:
What resistance training guidelines are safe for diabetic clients?
- 1-3 sets of 10-15 reps 2-3 days/week
- Phases I and 2 of OPT model (higher reps such as 20 may be used)
Basic exercise guidelines for individuals with diabetes:
What flexibility training guidelines are safe for diabetic clients?
- Flexibility continuum
What are some special considerations to keep in mind when developing an exercise program and training diabetic clients?
- Make sure the client has appropriate footwear and have the client or physician check feet for blisters or abnormal wear patterns
- Advise client to keep a snack (quick source of carbs) available during exercise, to avoid sudden hypoglycemia
- Use SMR with special care and licensed physician’s advice
- Avoid excessive plyometric training, and higher-intensity training is not recommended for typical client
What is hypertension?
- Consistently elevated arterial blood pressure, which, if sustained at high enough level, is likely to induce cardiovascular or organ damage
- Aka. high blood pressure
What are the BP ranges for hypertensive and prehypertensive people.
Hypertensive:
- Resting systolic: ≥ 140 mm Hg;
- Resting diastolic: ≥ 90 mm Hg
Prehypertensive:
- Resting systolic: between 120 and 135 mm Hg;
- Resting diastolic: between 80 and 85 mm Hg
What are the causes of hypertension?
- Smoking
- Diet high in fat (particularly saturated fat)
- Excess weight