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ACE Lesson 19: Exercise Programming for Special Populations > Exercise and Special Populations > Flashcards

Exercise and Special Populations Flashcards

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1
Q

documentation provided by fitness professionals and commonly used by healthcare providers to document patient progress

A

SOAP note

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2
Q

SOAP note components

A

Subjective
Objective
Assessment
Plan

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3
Q

client’s own observations, description of symptoms, challenges with the program, and progress made (SOAP content)

A

subjective content of the SOAP note

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4
Q

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)

A

objective content of the SOAP note

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5
Q

a brief summary of the client’s current status based on the subjective and objective observations and measures (SOAP content)

A

assessment content of the SOAP note

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6
Q

a description of the next steps in the program based on the assessment (SOAP content)

A

plan content of the SOAP note

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7
Q

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.

A

True

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8
Q

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

A

1) a functional gain
2) a limitation
3) a moment when they felt good with the circumstances

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9
Q

the single most influential factor in the incidence of major diseases such as cardiovascular disease and musculoskeletal disorders

A

lifestyle

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10
Q

how to approach clients with multiple health challenges

A

1) offer understanding
2) encourage transparency into their habits
3) establish accountability for their choices

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11
Q

clients with multiple health challenges should follow this type of exercise program

A

low- to moderate-intensity that progresses gradually

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12
Q

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

A

cardiovascular disease (CVD)

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13
Q

types of CVD

A

1) dyslipidemia
2) CAD
3) congestive heart failure (CHF)
4) hypertension
5) stroke
6) peripheral vascular disease

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14
Q

risk factors that contribute to CVD

A

1) family history
2) hypertension
3) smoking
4) diabetes
5) age
6) dyslipidemia
7) lifestyle (i.e., poor diet and physical inactivity)

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15
Q

another term for CAD

A

atherosclerotic heart disease

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16
Q

disease that is characterized by a narrowing of the coronary arteries that supply the heart muscle with blood and oxygen

A

CAD / atherosclerotic heart disease

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17
Q

underlying cause of cerebral and peripheral vascular diseases

A

atherosclerosis

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18
Q

manifestations of atherosclerosis

A

1) angina
2) heart attack
3) stroke
4) intermittent claudication

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19
Q

percentage decrease in risk of developing CAD in people who participate in:

1) moderate amounts of physical activity
2) higher amounts of physical activity

A

1) 20%

2) 30%

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20
Q

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.

A

True

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21
Q

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.

A

True

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22
Q

low-risk cardiac clients have these characteristics

A

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)

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23
Q

typical resistance training guideline for low-risk, stable CAD clients

A

1 set, 12-15 reps, 8-10 exercises targeting major muscle groups, twice a week

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24
Q

T/F: Low-risk CAD clients’ heart rates should not exceed training targets and/or RPE of 11-14 (6-20 scale).

A

True

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25
Q

T/F: Isometric exercises should be utilized for low-risk CAD clients.

A

False

Should be avoided since they can dramatically raise BP and the associated work of the heart

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26
Q

frequency of aerobic and resistance training for low-risk CAD clients

A
  • aerobic: 3-5 days/week

- resistance: 2 days/week

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27
Q

markers for hypertension

A

1) SBP at or above 140 mmHg,
2) DBP at or above 90 mmHg, or
3) taking antihypertensive medication

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28
Q

markers for prehypertension

A

1) SBP from 120-139 mmHg or

2) DBP from 80-89 mmHg

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29
Q

percentage of US population over age of 20 diagnosed with prehypertension

A

37%

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30
Q

rises in SBP and DBP that doubles the risk of developing CAD

A

1) SBP: 20 mmHg

2) DBP: 10 mmHg

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31
Q

150 minutes of exercise per week has shown to reduce SBP by this much

A

2-6 mmHg

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32
Q

the acute post-exercise decrease in SBP and DBP can last for this long

A

22 hours

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33
Q

term to describe acute post-exercise reduction in both SBP and DBP

A

post-exercise hypotension (PEH)

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34
Q

magnitude of post-exercise hypotension for SBP and DBP

A

SBP: 15 mmHg
DBP: 4 mmHg

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35
Q

amount of exercise prehypertensive and hypertensive individuals should participate in each week

A

30 min, 5 days/week

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36
Q

forms of appropriate exercise for prehypertensive and hypertensive individuals

A

1) aerobic: walking, cycling, swimming, and ergometers

2) resistance: circuit training using low to moderate weight

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37
Q

certain medications that can alter HR response and cause orthostatic hypotension and PEH

A

1) beta blockers

2) calcium channel blockers

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38
Q

the exercise session should be terminated for these SBP and DBP reasons

A

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

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39
Q

two types of strokes

A

1) ischemic stroke

2) hemorrhagic stroke

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40
Q

occurs when the blood vessel in the brain bursts

A

hemorrhagic stroke

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41
Q

occurs when the blood supply to the brain is cut off

A

ischemic stroke

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42
Q

percentage of strokes that are ischemic

A

80%

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43
Q

the warning signs of a stroke

A

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

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44
Q

the leading cause of chronic disability

A

stroke

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45
Q

risk factors for stroke

A

1) high BP
2) smoking
3) heart disease
4) previous stroke
5) physical inactivity
6) transient ischemic attacks (TIA)

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46
Q

momentary reductions in oxygen delivery to the brain, possibly resulting in sudden headache, dizziness, blackout, and/or temporary neurological dysfunction

A

transient ischemic attacks (TIA)

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47
Q

T/F: Clients at risk for, or have experienced, a stroke, should follow the same guidelines and recommendations used for CAD and hypertension.

A

True

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48
Q

duration of exercise activity for clients recovering from a stroke

A

begin with 3-5 min bouts, then gradually build to 30 minutes over time

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49
Q

risk factors for peripheral vascular disease (PVD) - similar to CAD

A

1) hyperlipidemia
2) smoking (most prominent)
3) hypertension
4) diabetes (most prominent)
5) family predisposition
6) physical inactivity
7) obesity
8) stress

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50
Q

one of the most common forms of PVD

A

peripheral artery occlusive disease (PAOD)

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51
Q

atherosclerosis of the arteries of the lower extremities

A

peripheral artery occlusive disease (PAOD)

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52
Q

characterized by muscular pain caused by ischemia, or lack of blood flow to the muscle

A

peripheral vascular occlusive disease (PVOD)

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53
Q

subjective grading scale for peripheral vascular disease (PVD)

A
  • 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
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54
Q

exercise-related improvements for PVD

A

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

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55
Q

goals of an exercise program with a PVD client

A

1) improve arterial flow
2) increase oxygen extraction
3) improve walking mechanics (that will ultimately serve to decrease oxygen demand at a given workload)

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56
Q

typical exercise of choice for PVD clients

A

walking - uses the lower-leg muscles, effectively producing ischemia in the affected limbs

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57
Q

how to improve exercise capacity for PVD clients through walking

A

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)

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58
Q

T/F: Clients with PVD should avoid exercising in cold air or water to reduce the risk of vasoconstriction.

A

True

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59
Q

the major carrier of cholesterol, containing 60-70% of the body’s total serum cholesterol; referred to as the “bad” cholesterol

A

low-density lipoprotein (LDL)

60
Q

major carrier of triglyceride, containing 10-15% of the body’s total serum cholesterol

A

very low-density lipoprotein (VLDL)

61
Q

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

A

high-density lipoprotein (HDL)

62
Q

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

A

non-HDL cholesterol (non-HDL)

63
Q

aerobic exercise benefits for dyslipidemia

A

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

64
Q

Triglyceride classifications and ranges - normal, borderline, high, very high

A

Normal: < 150 mg/dL
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 or more

65
Q

LDL classifications and ranges - optimal, near optimal, borderline high, high, very high

A 
Optimal: < 100 mg/dL
Near Optimal: 100-129
Borderline High: 130-159
High: 160-189
Very High 190 or more
66
Q

Total Cholesterol classifications and ranges - desirable, borderline high, high

A

Desirable: < 200 mg/dL
Borderline High: 200-239
High: 240 or more

67
Q

HDL classifications and ranges - low, high

A

Low: < 40 mg/dL
High: 60 or more

68
Q

duration of exercise for clients with dyslipidemia

A

begin at 15 min, progressively build to 30-60 min/day; goal is 150-200 min/week (frequency can be across 5 days)

69
Q

indication of diabetes when using a fasting plasma glucose (FPG) test

A

blood glucose > 125 mg/dL

70
Q

indication of prediabetes when using a fasting plasma glucose (FPG) test

A

blood glucose is between 100-125 mg/dL

71
Q

number of Americans with prediabetes and diabetes

A

Prediabetes: 79 million
Diabetes: 23.6 million

72
Q

former name of type 1 diabetes

A

insulin-dependent diabetes mellitus (IDDM)

73
Q

develops when the body’s immune system destroys pancreatic beta cells that are responsible for producing insulin

A

type 1 diabetes

74
Q

T/F: Type 1 diabetes can occur at any age, but is most prominent in children and young adults.

A

True

75
Q

percentage of all diagnosed cases of diabetes that type 1 accounts for

A

5-10%

76
Q

typical symptoms of type 1 diabetes

A

1) thirst and hunger
2) frequent urination
3) weight loss
4) blurred vision
5) recurrent infections

77
Q

symptoms that occur when excess glucose (as a result of reduced glucose uptake and storage by the cells) is excreted in the urine

A

1) increased thirst
2) decreased appetite
3) weight loss

78
Q

former name for type 2 diabetes

A

non-insulin dependent diabetes mellitus (NIDDM)

79
Q

most common form of diabetes, accounting for 90-95% of all diagnosed cases

A

type 2 diabetes

80
Q

initial treatment protocols for people with type 2 diabetes

A

1) weight loss
2) diet modification
3) exercise

81
Q

amount of adults aged 20 or older that are affected by insulin resistance (and can lead to type 2 diabetes)

A

one-third

82
Q

a form of glucose intolerance that occurs during pregnancy

A

gestational diabetes (GDM)

83
Q

risk factors for gestational diabetes (GDM)

A

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)

84
Q

the twofold primary treatment goal for diabetes control

A

1) normalize glucose metabolism

2) prevent diabetes-associated complications and disease progression

85
Q

reason for exercise for clients with type 1 diabetes

A

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

86
Q

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.

A

True

87
Q

For clients with diabetes, what must blood glucose levels be at before exercise (otherwise postponing the session)?

A

between 100 and 300 mg/dL (upper limit is 250 with the presence of ketosis)

88
Q

exercise intensity for clients with type 1 diabetes

A

55-75% functional capacity or RPE 11-14 (6-20 scale)

89
Q

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.

A

True

90
Q

For clients with type 1 diabetes, long-duration exercise can increase the risk of…

A

hypoglycemia

91
Q

For clients with type 1 diabetes, high-intensity exercise can increase the risk of…

A

hyperglycemia

92
Q

primary goals of exercise for clients with type 2 diabetes

A

1) better glucose regulation

2) weight loss (80% of people with type 2 diabetes are overweight)

93
Q

exercise intensity for clients with type 2 diabetes

A

50-80% of HRR or RPE 11-16 (6-20 scale)

94
Q

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.

A

True

95
Q

T/F: For clients with diabetes, exercise should be performed during periods of peak insulin activity.

A

False

Should be avoided

96
Q

Metabolic syndrome (MetS) is a cluster of conditions that increases risk for…

A

1) heart disease
2) type 2 diabetes
3) stroke

97
Q

percentage of the population affected by MetS

A

over 25%

98
Q

characterizations of MetS

A

1) abdominal obesity
2) atherogenic dyslipidemia
3) increased blood pressure
4) insulin resistance
5) prothrombotic state
6) proinflammatory state

99
Q

MetS is identified when at least 3 of these components are observed

A

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

100
Q

primary treatment objective for MetS

A

reduce the risk for developing CVD and type 2 diabetes

101
Q

T/F: Removal of abdominal adipose tissue with liposuction does not appear to improve insulin resistance or risk factors for CAD.

A

True

102
Q

exercise intensity for clients with MetS

A

30-75% VO2 reserve or RPE 9-13 (6-20 scale)

103
Q

duration of exercise of clients with MetS

A

target of 200-300 min of weekly exercise using gradual progression

104
Q

number of children and adults in the US that are affected by asthma

A

25 million

105
Q

a chronic inflammatory disorder that is characterized by variable and recurring symptoms, such as shortness of breath, wheezing, coughing, and chest tightness

A

asthma

106
Q

typically occurs after ventilation of large quantities of air, especially dry, cold air that contains environmental allergens and/or pollutants

A

exercise-induced asthma (EIA)

107
Q

When does exercise-induced asthma (EIA) typically occur?

A

during or shortly after vigorous activity

108
Q

T/F: Asthma is a contraindication to exercise.

A

False

109
Q

general activity guidelines for clients with asthma

A

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

110
Q

goals of exercise in the treatment of cancer

A

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

111
Q

training protocol for clients with cancer

A

aerobic, light strength training, and stretching

112
Q

low bone mass and microarchitecture where bone mineral density is at least 2.5 standard deviations below the mean

A

osteoporosis

113
Q

T/F: Osteoporosis is more prevalent in women than men.

A

True

114
Q

primary goal of exercise for clients with osteoporosis or osteopenia

A

retain or prevent loss of bone mineral and decrease the risk of falls and fractures

115
Q

recommended type of exercise for clients with osteoporosis

A

weight-bearing exercises

116
Q

T/F: Shorter, frequent loading cycles have been shown to be more effective in increasing bone strength than longer single sessions.

A

True

117
Q

Certain resistance training exercises that may need to be avoided for some clients with osteoporosis

A

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

118
Q

two most common types of arthritis

A

1) osteoarthritis

2) rheumatoid arthritis

119
Q

the leading cause of disability in the US

A

arthritis

120
Q

T/F: Arthritis is more prevalent in men than women.

A

False

121
Q

4 categories/classifications of functional capacity in rheumatoid arthritis

A
  • 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
122
Q

exercise intensity for those with arthritis

A

RPE 9-13 (6-20 scale), gradually progressing to 11-15

123
Q

guidelines for exercise for clients with arthritis

A

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

124
Q

exercise guidelines for individuals with a hip replacement

A

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

125
Q

diffuse pain in the muscles and surrounding connective tissues, usually accompanied by malaise

A

fibromyalgia

126
Q

most common symptoms of fibromyalgia

A

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

127
Q

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.

A

True

128
Q

When diagnosing fibromyalgia, widespread pain is when all 5 of these are present.

A

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)

129
Q

T/F: Aerobic exercise has an analgesic and antidepressant effect that can significantly reduce pain, depression, and anxiety frequently associated with fibromyalgia.

A

True

130
Q

duration and frequency of exercise for clients with fibromyalgia

A

gradually progress to a goal of 150 min/week of aerobic activity, spread across 3-5 days

131
Q

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

A

chronic fatigue syndrome (CFS)

132
Q

T/F: Full recovery from CFS may be rare with only 5-10% sustaining total remission.

A

True

133
Q

a major indicator that must be present in order to diagnose CFS

A

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

134
Q

general treatment regiment for an individual with CFS

A

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

135
Q

primary objective of exercise for people with CFS

A

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)

136
Q

exercise guidelines for clients with CFS

A

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

137
Q

duration and frequency of exercise for clients with CFS

A

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

138
Q

clients with low-back pain (LBP) should avoid these exercises/techniques

A

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

139
Q

T/F: Muscular endurance, not muscular strength, has been shown to have the strongest positive association with low-back health.

A

True

140
Q

daily routine for enhancing low-back health

A

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

141
Q

5 key facts about obesity

A

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

142
Q

T/F: When implementing weight-loss programs for obese clients, the primary prevention of obesity starts with maintenance of current weight, not weight reduction.

A

True

143
Q

pregnant women with these health conditions should not exercise

A

1) risk factors for pre-term labor
2) vaginal bleeding
3) premature rupture of membranes

144
Q

general exercise guidelines for pregnant women

A

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

145
Q

recommended rep range for clients with osteopenia and/or osteoporosis

A

6-8 (8RM)

146
Q

T/F: Low-back exercises have the most beneficial effect when performed on a daily basis.

A

True

ACE Lesson 19: Exercise Programming for Special Populations (2 decks)

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