Exercise and Special Populations Flashcards
documentation provided by fitness professionals and commonly used by healthcare providers to document patient progress
SOAP note
SOAP note components
Subjective
Objective
Assessment
Plan
client’s own observations, description of symptoms, challenges with the program, and progress made (SOAP content)
subjective content of the SOAP note
measurements such as vital signs, height, weight, age, posture, and exercise and other test results, as well as exercise and nutrition log information (SOAP content)
objective content of the SOAP note
a brief summary of the client’s current status based on the subjective and objective observations and measures (SOAP content)
assessment content of the SOAP note
a description of the next steps in the program based on the assessment (SOAP content)
plan content of the SOAP note
T/F: During the initial interview and throughout the program, it is important to ask the client an open-ended question on how they are feeling.
True
3 things that are important for a client to recall that help the client have a positive image of fitness activity and with program progression
1) a functional gain
2) a limitation
3) a moment when they felt good with the circumstances
the single most influential factor in the incidence of major diseases such as cardiovascular disease and musculoskeletal disorders
lifestyle
how to approach clients with multiple health challenges
1) offer understanding
2) encourage transparency into their habits
3) establish accountability for their choices
clients with multiple health challenges should follow this type of exercise program
low- to moderate-intensity that progresses gradually
the leading cause of death in the developed world and for more than 100 years has caused more deaths in Americans than any other major cause
cardiovascular disease (CVD)
types of CVD
1) dyslipidemia
2) CAD
3) congestive heart failure (CHF)
4) hypertension
5) stroke
6) peripheral vascular disease
risk factors that contribute to CVD
1) family history
2) hypertension
3) smoking
4) diabetes
5) age
6) dyslipidemia
7) lifestyle (i.e., poor diet and physical inactivity)
another term for CAD
atherosclerotic heart disease
disease that is characterized by a narrowing of the coronary arteries that supply the heart muscle with blood and oxygen
CAD / atherosclerotic heart disease
underlying cause of cerebral and peripheral vascular diseases
atherosclerosis
manifestations of atherosclerosis
1) angina
2) heart attack
3) stroke
4) intermittent claudication
percentage decrease in risk of developing CAD in people who participate in:
1) moderate amounts of physical activity
2) higher amounts of physical activity
1) 20%
2) 30%
T/F: It is imperative that a client with 2+ risk factors and/or active CAD is evaluated by his or her physician and obtains a release prior to starting an exercise program.
True
T/F: All clients with documented CAD should have a physician-supervised maximal graded exercise test to determine their functional capacity and cardiovascular status to establish a safe exercise level.
True
low-risk cardiac clients have these characteristics
1) an uncomplicated clinical course in the hospital
2) no evidence of resting or exercise-induced ischemia
3) functional capacity greater than 7 METs three weeks following any medical event or treatment that required hospitalization
4) normal ventricular function with an ejection fraction > 50%
5) no significant resting or exercise-induced arrhythmias (abnormal heart rhythms)
typical resistance training guideline for low-risk, stable CAD clients
1 set, 12-15 reps, 8-10 exercises targeting major muscle groups, twice a week
T/F: Low-risk CAD clients’ heart rates should not exceed training targets and/or RPE of 11-14 (6-20 scale).
True
T/F: Isometric exercises should be utilized for low-risk CAD clients.
False
Should be avoided since they can dramatically raise BP and the associated work of the heart
frequency of aerobic and resistance training for low-risk CAD clients
- aerobic: 3-5 days/week
- resistance: 2 days/week
markers for hypertension
1) SBP at or above 140 mmHg,
2) DBP at or above 90 mmHg, or
3) taking antihypertensive medication
markers for prehypertension
1) SBP from 120-139 mmHg or
2) DBP from 80-89 mmHg
percentage of US population over age of 20 diagnosed with prehypertension
37%
rises in SBP and DBP that doubles the risk of developing CAD
1) SBP: 20 mmHg
2) DBP: 10 mmHg
150 minutes of exercise per week has shown to reduce SBP by this much
2-6 mmHg
the acute post-exercise decrease in SBP and DBP can last for this long
22 hours
term to describe acute post-exercise reduction in both SBP and DBP
post-exercise hypotension (PEH)
magnitude of post-exercise hypotension for SBP and DBP
SBP: 15 mmHg
DBP: 4 mmHg
amount of exercise prehypertensive and hypertensive individuals should participate in each week
30 min, 5 days/week
forms of appropriate exercise for prehypertensive and hypertensive individuals
1) aerobic: walking, cycling, swimming, and ergometers
2) resistance: circuit training using low to moderate weight
certain medications that can alter HR response and cause orthostatic hypotension and PEH
1) beta blockers
2) calcium channel blockers
the exercise session should be terminated for these SBP and DBP reasons
1) SBP rises to 250 mmHg
2) DBP rises to 115 mmHg
3) SBP fails to increase with increasing workload
4) SBP drops at least 20 mmHg
two types of strokes
1) ischemic stroke
2) hemorrhagic stroke
occurs when the blood vessel in the brain bursts
hemorrhagic stroke
occurs when the blood supply to the brain is cut off
ischemic stroke
percentage of strokes that are ischemic
80%
the warning signs of a stroke
1) sudden numbness or weakness of the face, arms, or legs
2) sudden confusion or trouble speaking or understanding others
3) sudden trouble seeing in one or both eyes
4) sudden walking problems, dizziness, or loss of balance and coordination
5) sudden severe headache with no known cause
the leading cause of chronic disability
stroke
risk factors for stroke
1) high BP
2) smoking
3) heart disease
4) previous stroke
5) physical inactivity
6) transient ischemic attacks (TIA)
momentary reductions in oxygen delivery to the brain, possibly resulting in sudden headache, dizziness, blackout, and/or temporary neurological dysfunction
transient ischemic attacks (TIA)
T/F: Clients at risk for, or have experienced, a stroke, should follow the same guidelines and recommendations used for CAD and hypertension.
True
duration of exercise activity for clients recovering from a stroke
begin with 3-5 min bouts, then gradually build to 30 minutes over time
risk factors for peripheral vascular disease (PVD) - similar to CAD
1) hyperlipidemia
2) smoking (most prominent)
3) hypertension
4) diabetes (most prominent)
5) family predisposition
6) physical inactivity
7) obesity
8) stress
one of the most common forms of PVD
peripheral artery occlusive disease (PAOD)
atherosclerosis of the arteries of the lower extremities
peripheral artery occlusive disease (PAOD)
characterized by muscular pain caused by ischemia, or lack of blood flow to the muscle
peripheral vascular occlusive disease (PVOD)
subjective grading scale for peripheral vascular disease (PVD)
- Grade 1: definite discomfort or pain, but only of initial or modest levels
- Grade 2: moderate discomfort or pain from which the client’s attention can be diverted (e.g., conversation)
- Grade 3: intense pain from which the client’s attention cannot be diverted
- Grade 4: excruciating and unbearable pain
exercise-related improvements for PVD
1) decreased blood viscosity (increased blood flow and perfusion)
2) increased capillary and mitochondrial density
3) increased oxidative and glycolytic enzymes
4) improvement in walking mechanics and pain perception
goals of an exercise program with a PVD client
1) improve arterial flow
2) increase oxygen extraction
3) improve walking mechanics (that will ultimately serve to decrease oxygen demand at a given workload)
typical exercise of choice for PVD clients
walking - uses the lower-leg muscles, effectively producing ischemia in the affected limbs
how to improve exercise capacity for PVD clients through walking
1) encourage clients to walk to the point of intense pain (b/w Grades 2 and 3) before stopping
2) client should rest until the pain subsides then repeat
3) this process should be repeated for 20-30 min with gradual progression to 30 to 60 min sessions
4) initial workload intensity should stimulate claudication pain within 2-6 min
5) when 8-12 min of continuous walking can be tolerated, consider increasing walking pace or progressing total activity time
6) RPE should stay within moderate intensities (9-13 on 6-20 scale)
T/F: Clients with PVD should avoid exercising in cold air or water to reduce the risk of vasoconstriction.
True
the major carrier of cholesterol, containing 60-70% of the body’s total serum cholesterol; referred to as the “bad” cholesterol
low-density lipoprotein (LDL)
major carrier of triglyceride, containing 10-15% of the body’s total serum cholesterol
very low-density lipoprotein (VLDL)
produced in the intestine and liver, normally containing 20-30% the body’s total cholesterol; inversely related to CAD; often referred to as the “good” cholesterol
high-density lipoprotein (HDL)
defined as total cholesterol minus HDL, or the sum of LDL, VLDL, and intermediate-density lipoprotein (IDL); strongly associated with the development of CVD and are equal or better than LDL levels at identifying atherogenic particles
non-HDL cholesterol (non-HDL)
aerobic exercise benefits for dyslipidemia
1) may reduce LDL levels by 3-6 mg/dL on average
2) may reduce non-HDL levels by 6 mg/dL on average
* has no consistent effect on triglyceride or HDL levels
Triglyceride classifications and ranges - normal, borderline, high, very high
Normal: < 150 mg/dL
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 or more
LDL classifications and ranges - optimal, near optimal, borderline high, high, very high
Optimal: < 100 mg/dL Near Optimal: 100-129 Borderline High: 130-159 High: 160-189 Very High 190 or more
Total Cholesterol classifications and ranges - desirable, borderline high, high
Desirable: < 200 mg/dL
Borderline High: 200-239
High: 240 or more
HDL classifications and ranges - low, high
Low: < 40 mg/dL
High: 60 or more
duration of exercise for clients with dyslipidemia
begin at 15 min, progressively build to 30-60 min/day; goal is 150-200 min/week (frequency can be across 5 days)
indication of diabetes when using a fasting plasma glucose (FPG) test
blood glucose > 125 mg/dL
indication of prediabetes when using a fasting plasma glucose (FPG) test
blood glucose is between 100-125 mg/dL
number of Americans with prediabetes and diabetes
Prediabetes: 79 million
Diabetes: 23.6 million
former name of type 1 diabetes
insulin-dependent diabetes mellitus (IDDM)
develops when the body’s immune system destroys pancreatic beta cells that are responsible for producing insulin
type 1 diabetes
T/F: Type 1 diabetes can occur at any age, but is most prominent in children and young adults.
True
percentage of all diagnosed cases of diabetes that type 1 accounts for
5-10%
typical symptoms of type 1 diabetes
1) thirst and hunger
2) frequent urination
3) weight loss
4) blurred vision
5) recurrent infections
symptoms that occur when excess glucose (as a result of reduced glucose uptake and storage by the cells) is excreted in the urine
1) increased thirst
2) decreased appetite
3) weight loss
former name for type 2 diabetes
non-insulin dependent diabetes mellitus (NIDDM)
most common form of diabetes, accounting for 90-95% of all diagnosed cases
type 2 diabetes
initial treatment protocols for people with type 2 diabetes
1) weight loss
2) diet modification
3) exercise
amount of adults aged 20 or older that are affected by insulin resistance (and can lead to type 2 diabetes)
one-third
a form of glucose intolerance that occurs during pregnancy
gestational diabetes (GDM)
risk factors for gestational diabetes (GDM)
1) obesity/overweight
2) family history of type 2 diabetes
3) belong to an ethnic group at increased risk for the condition (e.g., Hispanic, Native American, South or East Asian, African American, or Pacific Islands)
the twofold primary treatment goal for diabetes control
1) normalize glucose metabolism
2) prevent diabetes-associated complications and disease progression
reason for exercise for clients with type 1 diabetes
establishment of an important positive life behavior with multiple benefits - this is a shift from glucose control as evidence does not support the assertion that exercise controls glucose levels
T/F: In type 2 diabetes, with blood glucose elevation, blood fats rise to become the primary energy source for the body, creating an increased risk for heart disease.
True
For clients with diabetes, what must blood glucose levels be at before exercise (otherwise postponing the session)?
between 100 and 300 mg/dL (upper limit is 250 with the presence of ketosis)
exercise intensity for clients with type 1 diabetes
55-75% functional capacity or RPE 11-14 (6-20 scale)
T/F: RPE is the preferred measurement of exercise intensity for clients with type 1 diabetes due to potential inaccuracies in HR measurement as a result of complications such as autonomic and peripheral neuropathy.
True
For clients with type 1 diabetes, long-duration exercise can increase the risk of…
hypoglycemia
For clients with type 1 diabetes, high-intensity exercise can increase the risk of…
hyperglycemia
primary goals of exercise for clients with type 2 diabetes
1) better glucose regulation
2) weight loss (80% of people with type 2 diabetes are overweight)
exercise intensity for clients with type 2 diabetes
50-80% of HRR or RPE 11-16 (6-20 scale)
T/F: Avoid injecting insulin into the primary muscle groups that will be used during exercise, as it will be absorbed more quickly, potentially resulting in hypoglycemia.
True
T/F: For clients with diabetes, exercise should be performed during periods of peak insulin activity.
False
Should be avoided
Metabolic syndrome (MetS) is a cluster of conditions that increases risk for…
1) heart disease
2) type 2 diabetes
3) stroke
percentage of the population affected by MetS
over 25%
characterizations of MetS
1) abdominal obesity
2) atherogenic dyslipidemia
3) increased blood pressure
4) insulin resistance
5) prothrombotic state
6) proinflammatory state
MetS is identified when at least 3 of these components are observed
1) elevated waist circumference: men >40 in; women >35 in
2) . elevated triglycerides: ≥150 mg/dL
3) reduced HDL: men <40 mg/dL; women <50 mg/dL
4) increased BP: ≥130/85 mmHg
5) elevated fasted blood glucose: ≥100 mg/dL
primary treatment objective for MetS
reduce the risk for developing CVD and type 2 diabetes
T/F: Removal of abdominal adipose tissue with liposuction does not appear to improve insulin resistance or risk factors for CAD.
True
exercise intensity for clients with MetS
30-75% VO2 reserve or RPE 9-13 (6-20 scale)
duration of exercise of clients with MetS
target of 200-300 min of weekly exercise using gradual progression
number of children and adults in the US that are affected by asthma
25 million
a chronic inflammatory disorder that is characterized by variable and recurring symptoms, such as shortness of breath, wheezing, coughing, and chest tightness
asthma
typically occurs after ventilation of large quantities of air, especially dry, cold air that contains environmental allergens and/or pollutants
exercise-induced asthma (EIA)
When does exercise-induced asthma (EIA) typically occur?
during or shortly after vigorous activity
T/F: Asthma is a contraindication to exercise.
False
general activity guidelines for clients with asthma
1) have rescue medication at the ready
2) drink plenty of fluids in the peri-workout window
3) avoid asthma triggers and move inside if weather is extremely hot or cold; may also benefit from wearing a mask to keep inhaled air warm and moist
4) utilize gradual and prolonged warm-up and cool-down periods
5) keep initial intensity low and gradually increase it over time
6) keep a lookout for signs of asthma attack and either terminate or reduce intensity should symptoms worsen
7) activate emergency medical system if asthma attack is not relieved by medication
8) mid-to-late morning may be best for exercise time
goals of exercise in the treatment of cancer
1) maintain and improve cardiovascular conditioning
2) prevent musculoskeletal deterioration
3) reduce symptoms like nausea and fatigue
4) improve mental health outlook and overall quality of life
training protocol for clients with cancer
aerobic, light strength training, and stretching
low bone mass and microarchitecture where bone mineral density is at least 2.5 standard deviations below the mean
osteoporosis
T/F: Osteoporosis is more prevalent in women than men.
True
primary goal of exercise for clients with osteoporosis or osteopenia
retain or prevent loss of bone mineral and decrease the risk of falls and fractures
recommended type of exercise for clients with osteoporosis
weight-bearing exercises
T/F: Shorter, frequent loading cycles have been shown to be more effective in increasing bone strength than longer single sessions.
True
Certain resistance training exercises that may need to be avoided for some clients with osteoporosis
1) spinal flexion, crunches, and rowing machines
2) jumping and high-impact aerobics
3) trampolines and step aerobics
4) abducting or adducting the legs against resistance
5) pulling the neck with hands behind the head
two most common types of arthritis
1) osteoarthritis
2) rheumatoid arthritis
the leading cause of disability in the US
arthritis
T/F: Arthritis is more prevalent in men than women.
False
4 categories/classifications of functional capacity in rheumatoid arthritis
- Class 1: can perform all usual ADL (self-care, vocational, and avocational)
- Class 2: can perform usual ADL but limited in avocational activities
- Class 3: can perform usual ADL but limited in vocational and avocational activities
- Class 4: limited in ability to perform all ADL
exercise intensity for those with arthritis
RPE 9-13 (6-20 scale), gradually progressing to 11-15
guidelines for exercise for clients with arthritis
1) full ROM
2) isometric exercises may provide benefit in strengthening joint structures and surrounding muscle while placing less stress on the joint itself
3) individuals with rheumatoid arthritis should not exercise during periods of inflammation
4) proper body alignment and exercise technique
exercise guidelines for individuals with a hip replacement
1) lift knee no higher than hip level or 90 degrees of flexion
2) keep toes straight ahead; no pigeon or duck toes
3) no adduction past the midline
4) focus on hip/leg abduction, lateral movements, and strengthening
diffuse pain in the muscles and surrounding connective tissues, usually accompanied by malaise
fibromyalgia
most common symptoms of fibromyalgia
1) aches and pains similar to flu-like exhaustion
2) multiple tender points
3) stiffness
4) decreased exercise endurance
5) fatigue
6) muscle spasms
7) paresthesis
T/F: Criteria for diagnosing fibromyalgia is characterized by a history of widespread pain occurring for longer than 3 months, in combination with pain on palpation in 11 of 18 tender point sites.
True
When diagnosing fibromyalgia, widespread pain is when all 5 of these are present.
1) pain in the left side of the body
2) pain in the right side of the above
3) pain above the waist
4) pain below the waist
5) axial skeletal pain (in the cervical spine or anterior chest, or thoracic spine or low back)
T/F: Aerobic exercise has an analgesic and antidepressant effect that can significantly reduce pain, depression, and anxiety frequently associated with fibromyalgia.
True
duration and frequency of exercise for clients with fibromyalgia
gradually progress to a goal of 150 min/week of aerobic activity, spread across 3-5 days
a debilitating and complex illness characterized by profound, incapacitating fatigue lasting at least 6 months that results in a substantial reduction in occupational, recreational, social, and educational activities
chronic fatigue syndrome (CFS)
T/F: Full recovery from CFS may be rare with only 5-10% sustaining total remission.
True
a major indicator that must be present in order to diagnose CFS
unexplained, persistent fatigue that isn’t due to ongoing exertion, is not substantially relieved by rest, is of new onset (not lifelong), and results in a significant reduction in previous levels of activity
general treatment regiment for an individual with CFS
1) moderating daily activity
2) gradually progressing exercise
3) cognitive behavior therapy
4) treatment of depression
5) treatment of existing pain
6) treatment of allergy-like symptoms
primary objective of exercise for people with CFS
create a balance that allows the client to avoid post-activity malaise, while also preventing deconditioning so they can achieve better function and improved quality of life; key is to avoid extremes of exercise (i.e., no exercise or vigorous exertion)
exercise guidelines for clients with CFS
1) work-to-rest ratio should be 1:3
2) deconditioned clients limited to ADL until symptoms are stabilized
3) return to a reasonable level of activity if symptoms worsen
4) start with simple stretching and strengthening exercise
5) can add resistance as strength improves (bands or light weights)
6) may benefit from swimming or using a recumbent bike if can’t tolerate an upright position
duration and frequency of exercise for clients with CFS
2-5 min exercise periods followed by 6-15 min rest periods, gradually building to 30 min of total activity and performed 3-5 days/week
clients with low-back pain (LBP) should avoid these exercises/techniques
1) unsupported forward flexion
2) twisting at the waist with turned feet, especially when carrying a load
3) lifting both legs simultaneously when in a prone or supine position
4) rapid movements, such as twisting, forward flexion, or hyperextension
T/F: Muscular endurance, not muscular strength, has been shown to have the strongest positive association with low-back health.
True
daily routine for enhancing low-back health
1) cat-camel motion exercise (5-8 cycles)
2) modified curl-up
3) birddog (isometric holds last no longer than 7-8 secs)
4) side bridge
5 key facts about obesity
1) worldwide obesity has more than doubled since 1980
2) in 2008, 1.5 billion adults 20 years old and over were overweight- of this amount, 200 million men and 300 million women were obese
3) more than 1 in 10 of the world’s adult population is obese
4) 65% of the world’s population lives in countries where overweight and obesity kill more people than underweight
5) nearly 43 million children under the age of 5 were overweight in 2010
T/F: When implementing weight-loss programs for obese clients, the primary prevention of obesity starts with maintenance of current weight, not weight reduction.
True
pregnant women with these health conditions should not exercise
1) risk factors for pre-term labor
2) vaginal bleeding
3) premature rupture of membranes
general exercise guidelines for pregnant women
1) do not begin a vigorous exercise program shortly before or during pregnancy
2) previously active women can continue their exercise programs for the first trimester to a max of 30-40 min/day for 3-4 days/week
3) previously non-active women should start with 15 min of low-intensity exercise and gradually increase to 30 min
4) gradually reduce intensity, duration, and frequency during the second and third trimesters
5) use RPE scale rather than HR
6) avoid plyometrics, contact sports, deep knee bends, full sit-ups, double leg raises, activities where falling is likely
7) avoid long periods of standing (either move or sit and rest)
8) body temp should not exceed 100 F / 38 C
recommended rep range for clients with osteopenia and/or osteoporosis
6-8 (8RM)
T/F: Low-back exercises have the most beneficial effect when performed on a daily basis.
True
