Exercise Prescription for Healthy Populations with Special Considerations Flashcards
Children and adolescents (defined as individuals 6–17 yr) are more physically active than…
Their adult counterparts.
What age range are as physically active as recommended by experts?
Only the youngest children (6-7 yr), and most young individuals older than the age of 10 yr do not meet prevailing physical activity guidelines.
The 2008 Physical Activity Guidelines for Americans call for children and adolescents to engage in…
At least 60 min ∙ day−1 of moderate-to-vigorous intensity PA; To include vigorous intensity PA, resistance exercise, and bone loading activity on at least 3 d ∙ wk−1
In addition to the PA guidelines, recommendations include children limit total entertainment screen time to…
<2 hours per day
Children and adolescents are physiologically adaptive to…
Endurance exercise training, resistance training, and bone loading exercise.
Exercise training in children and adolescent produces improvements in…
Cardiometabolic risk factors, weight control, bone strength, and psychosocial well-being, and may help prevent sports-related injuries; thus, the benefits of exercise are much greater than the risks
Do children and adolescents need medical screening before beginning exercise?
Most young individuals are healthy and able to start moderate intensity exercise training without medical screening; Vigorous exercise can be initiated after safely participating in moderate exercise. (Because prepubescent children have immature skeletons, younger children should not participate in “excessive” amounts of vigorous intensity exercise)
Physiologic responses of children to acute, graded exercise are qualitatively similar to…
those seen in adults; There are important quantitative differences, many of which are related to the effects of body mass, muscle mass, and height; Children have a much lower anaerobic capacity than adults limiting their ability to perform sustained vigorous intensity exercise
What physiological responses to acute exercise are higher in children than adults?
Relative oxygen uptake, Heart rate, Respiratory rate
Children and Adolescents Exercise Testing
Exercise testing for clinical purposes is generally not indicated for children or adolescents unless there is a health concern; The exercise testing protocol should be based on the reason the test is being performed and the functional capability of the child or adolescents; Children and adolescents should be familiarized with the test protocol and procedure before testing to minimize stress and maximize the potential for a successful test.
Exercise testing for clinical purposes is generally not indicated for children or adolescents unless there is a…
Health Concern
The exercise testing protocol for children and adolescents should be based on…
The reason the test is being performed and the functional capability of the child or adolescents
Children and adolescents should be familiarized with the…
Test protocol and procedure before testing to minimize stress and maximize the potential for a successful test.
What test protocols are best for children and adolescents?
Treadmill and cycle ergometers should be available for testing. Treadmills tend to elicit a higher peak oxygen uptake (VO2peak) and maximum HR (HRmax); Cycle ergometers provide less risk for injury but need to be correctly sized for the child or adolescent; Children and adolescents may require extra motivation and support during the exercise test compared to adults.
Health/fitness testing for children and adolescent may be performed…
outside of the clinical setting
The components of the Fitnessgram test battery for children and adolescents include…
Body composition (BMI or skinfold thicknesses), Cardiorespiratory fitness (1-min walk/run, PACER), Muscular fitness (curl-up test, pull-up/push-up tests), and Flexibility (sit-and-reach test).
Children and adolescents should be encouraged to participate in…
Various physical activities that are enjoyable and age appropriate.
PA in young children should include…
Unstructured active play, which typically consists of sporadic bursts of moderate- and vigorous-intensity PA alternating with brief periods of rest; These small bouts of PA, however brief, count toward FITT recommendations.
Aerobic: Frequency (FITT recommendations for children and adolescents)
Daily
Resistance: Frequency(FITT recommendations for children and adolescents)
> /= 3 days/wk
Bone Strengthening: Frequency (FITT recommendations for children and adolescents)
> /= 3 days/wk
Aerobic: Intensity(FITT recommendations for children and adolescents)
Most should be moderately (noticeable increase in HR and breathing) to vigorous intensity (substantial increases in HR and breathing). Include vigorous intensity at least 3 days/wk
Resistance: Intensity (FITT recommendations for children and adolescents)
Use of body weight as resistance or 8-15 sub maximal repetitions of an exercise to the point of moderate fatigue with good mechanical form
Bone Strengthening: Intensity (FITT recommendations for children and adolescents)
N/A
Aerobic: Time (FITT recommendations for children and adolescents)
As part of >/=60 min/day of exercise
Resistance: Time (FITT recommendations for children and adolescents)
As part of >/=60 min/day of exercise
Bone Strengthening: Time (FITT recommendations for children and adolescents)
As part of >/=60 min/day of exercise
Aerobic: Type (FITT recommendations for children and adolescents)
Enjoyable and developmentally appropriate activities including running, brisk walking, swimming, dancing, bicycling, and sports such as soccer, basketball, or tennis
Resistance: Type(FITT recommendations for children and adolescents)
Muscle strengthening physical activities can be unstructured (ex. playing on playground equipment, climbing trees, tug of war) or structured (ex. lifting weights, working with resistance bands)
Bone Strengthening: Type (FITT recommendations for children and adolescents)
Bone strengthening activities include running, jump rope, basketball, tennis, resistance training, and hopscotch
Children and adolescents may safely participate in strength training activities provided they receive…
Proper instruction and supervision.
Generally, adult guidelines for resistance training may be applied.
Because of immature thermoregulatory systems, youth should avoid exercise in
Hot humid environments, be properly hydrated, and appropriately modify activities
Efforts should be made to decrease sedentary activities in children and adolescents such as…
Television watching, Surfing the Internet, and Playing video games) and increase activities that promote lifelong activity and fitness (i.e., walking and cycling).
Low back pain (LBP) is defined as…
Pain, Muscle tension, or Stiffness localized below the rib margin and above the inferior gluteal folds, with or without leg pain.
What percent of the adult population experience LBP at any given point in time
Between 4% and 33%;
Recurrent episodes of LBP can occur in what percent of cases?
over 70% of cases.
What percent of LBP cases become chronic and what percent progress to a disability?
Approximately 20% of cases become chronic and about 10% of the cases progress to a disability
Individuals with LBP can be classified into one of three broad categories:
- LBP associated with another specific spinal cause (e.g., cancer or fracture)
- LBP associated with radiculopathy or spinal stenosis
- Nonspecific LBP, which encompass over 85% of cases
For prognosis and outcome purposes, LBP can be described as:
Acute (< 6 wk)
Subacute (6-12 wk)
Chronic (> 12 wk)
What percent of acute low back episodes resolve within 6 weeks, regardless of treatment
Approximately 90% of acute low back episodes resolve within 6 weeks, regardless of treatment; Individuals with LBP should stay active, continue ordinary activity within pain limits, avoid bed rest, and return to work as soon as possible
Psychosocial Factors for Long-Term Disability and Work Loss Associated with Low Back Pain
- A negative attitude that back pain is harmful or potentially severely disabling
- Fear avoidance behavior and reduced activity levels
- An expectation that passive rather than active, treatment will be beneficial
- A tendency to depression, low morale, and social withdrawal
- Social or financial problems
Current literature does not support a definitive cause for initial bouts of LBP
Previous LBP is one of the strongest predictors for future back pain episodes.
What do current guidelines place a heavy emphasis on to minimize the risk of an acute LBP episode from becoming chronic and/or disabling?
Preventive measures and early interventions
Current best evidence guidelines for treating LBP indicate PA as a
Key component in managing the condition
When LBP is a symptom of another serious pathology (e.g., cancer), exercise testing and Ex Rx should be guided by…
Considerations related to the primary condition.
If LBP is not a symptom of another serious pathology (e.g., cancer), for all other causes, and in the absence of a comorbid condition (e.g., CVD with its associated risk factors), recommendations for exercise testing and Ex Rx are…
Similar as for healthy individuals.
Cardiorespiratory Fitness (Low Back Pain – Exercise Testing)
- Few studies have subjected individuals with LBP to exercise tests to exhaustion.
- Submaximal exercise tests are considered reliable and valid for individuals with LBP.
- Actual or anticipated pain may limit submaximal testing as often as maximal testing. Therefore, the choice of maximal versus submaximal testing in individuals with LBP should be guided by the same considerations as for the general population
Individuals with LBP frequently have deficits in…
Trunk muscle strength and endurance and neuromuscular imbalance; The role these play in the development and progression of LBP remains unclear; Decreases in muscular strength and endurance may be independent of the period and intensity of LBP
Muscular Strength and Endurance (Low Back Pain– Exercise Testing)
- General testing of muscular strength and endurance in individuals with LBP should be guided by the same considerations as for the general population.
- Tests of the strength and endurance of the trunk musculature (e.g., isokinetic dynamometers with back attachments, selectorized machines, and back hyperextension benches) are commonly assessed in individuals with LBP.
- Performance of muscular strength and endurance assessments is often limited by actual or anticipated fear of reinjury in individuals with LBP.
Flexibility (Low Back Pain– Exercise Testing)
There is no clear relationship between gross spinal flexibility and LBP; Flexibility testing in individuals with LBP should be guided by the same considerations as for the general population. (It is essential to identify whether the assessment is limited by stretch tolerance of the target structures or exacerbation of LBP symptoms.)
Clinical practice guidelines for the management of LBP consistently recommend… (Low Back Pain – Exercise Rx)
Staying physically active and avoiding bed rest.
Individuals with subacute and chronic LBP as well as recurrent LBP are encouraged to be… (Low Back Pain – Exercise Rx)
Physically active.
When recommendations are provided, those with LBP should follow very closely the… (Low Back Pain – Exercise Rx)
Recommendations for the general population combining resistance, aerobic, and flexibility exercise.
In chronic LBP, exercise programs that incorporate… are associated with the best outcomes? (Low Back Pain – Exercise Rx)
Individual tailoring, supervision, stretching, and strengthening
For the most favorable outcomes in those with LBP, use an individualized approach that addresses… (Low Back Pain – Exercise Rx)
psychological distress, fear avoidance beliefs, self-efficacy in controlling pain, and coping strategies.
Trunk coordination, strengthening, and endurance exercises can be used to reduce LBP and disability in individuals with… (LBP Special Considerations)
Subacute and chronic LBP with movement coordination impairments; However, there is insufficient evidence for any benefit of emphasizing single-dimension therapies such as abdominal strengthening.
LBP Special Considerations
There is a lack of agreement on the definition, components, and assessment techniques related to core stability.
The majority of tests used to assess core stability have not demonstrated validity
Pregnancy
- Healthy, pregnant women without exercise contraindications are encouraged to exercise throughout pregnancy.
- Regular exercise during pregnancy provides health benefits and reduces the risks associates with sedentary behavior.
- ACOG and USDHH guidelines provide evidence-based guidance on exercise prescription for the minimization of risk and promotion of health benefits.
Benefits of Exercise During Pregnancy
Prevention of excessive gestational weight gain, Prevention of gestational diagnosis mellitus, Decreased risk of preeclampsia, Decreased incidence/symptoms of LBP, Decreased risk of urinary incontinence, Prevention/improvement of depressive symptoms, Maintenance of fitness, Prevention of postpartum weight retention
Pregnancy - Exercise Testing
Maximal exercise testing should not be performed on women who are pregnant unless medically necessary; If a maximal exercise test is warranted, the test should be performed with physician supervision after the woman has been medically evaluated for contraindications to exercise.
Relative Contradictions for Exercising During Pregnancy
Severe anemia, Unevaluated maternal cardiac dysrhythmia, Chronic bronchitis, Poorly controlled Type I diabetes mellitus, Extreme morbid obesity, Extreme underweight, History of extreme sedentary lifestyle, Intrauterine growth restriction in current pregnancy, Poorly controlled seizure disorder, Poorly controlled hyperthyroidism, Heavy smoker
Absolute Contradictions for Exercising During Pregnancy
Hemodynamically significant heart disease, Restrictive lung disease, Incompetent cervix/cerclage, Multiple gestation at risk for premature labor. Persistent second or third trimester bleeding, Placenta prevue after 26 week of gestation, premature labor during the current pregnancy, Ruptured membranes, Preclampsia/pregnancy-induced hypertension
The acute physiologic responses to exercise are generally increased during… (Pregnancy - Exercise Testing)
Pregnancy compared with nonpregnancy
Because of the physiological changes that accompany pregnancy, assumptions of submaximal protocols in predicting maximal aerobic capacity may be… (Pregnancy - Exercise Testing)
Compromised and are therefore most appropriately used in determining the effectiveness of training rather than accurately estimating maximal aerobic power.
Increased Physiologic Responses to Acute Exercise during Pregnancy Compared to Nonpregnancy
Oxygen uptake (during weight dependent exercise), Heart rate, Stroke volume, Cardiac output, Tidal volume, Minute ventilation, Ventilatory equivalent for oxygen (VE/VO2), Ventilatory equivalent for carbon dioxide (Ve/VCO2)
No change/ decreased Physiologic Responses to Acute Exercise during Pregnancy Compared to Nonpregnancy
Systolic blood pressure, Diastolic blood pressure
In the absence of obstetric or medical complications, the exercise recommendations during pregnancy are… (Pregnancy - Exercise Testing)
consistent with recommendations for healthy adults
The recommended Ex Rx for women who are pregnant should be… (Pregnancy - Exercise Testing)
Modified according to the woman’s symptoms, discomforts, and abilities during pregnancy.
The Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy) or the electronic Physical Activity Readiness Medical Examination (ePARmed-X+) should be used for… (Pregnancy - Exercise Testing)
The health screening of pregnant women before their participation in exercise programs
Research on the effects of resistance exercise during pregnancy is limited, but show that compared to sedentary controls, resistance training either: (Pregnancy - Exercise Testing)
Has no effect (e.g., no difference in gestational age, preterm labor, or caesarian delivery; delivery of normal birth weight infants at term); Or produces better outcomes (e.g., lower incidence of low back pain; shorter labor duration; shorter recovery time/faster return to activity in postpartum)
Aerobic: Frequency (FITT Recommendations for Pregnant Women)
> /= 3-5 d/wk
Resistance: Frequency (FITT Recommendations for Pregnant Women)
2-3 nonconsecutive d/wk
Flexibility: Frequency (FITT Recommendations for Pregnant Women)
> /= 2-3 d/wk with daily being most effective
Aerobic: Intensity (FITT Recommendations for Pregnant Women)
Moderate intensity (3-5.9 METS, RPE of 12-13 on the 6-20 scale); Vigorous intensity exercise (>/= 6 METS, RPE of 14-17 on the 6-20 scale) for women who were highly active prior to pregnancy or for women who progress to higher fitness levels during pregnancy
Resistance: Intensity (FITT Recommendations for Pregnant Women)
Intensity that permits multiple sub maximal repetitions (8-10 or 12-15 repetitions) to be performed to a point of moderate fatigue
Flexibility: Intensity (FITT Recommendations for Pregnant Women)
Stretch to the point of feeling tightness or slight discomfort
Aerobic: Time (FITT Recommendations for Pregnant Women)
about 30 min/d of accumulated moderate intensity exercise to total at least 150 min/wk or 75 min/wk of vigorous intensity aerobic exercise
Resistance: Time (FITT Recommendations for Pregnant Women)
One set for beginners; Two to three sets for intermediate and advanced; Target major muscle groups
Flexibility: Time (FITT Recommendations for Pregnant Women)
Hold static stretch for 10-30s
Aerobic: Type (FITT Recommendations for Pregnant Women)
A variety of weight and non weight bearing activities are well tolerated during pregnancy (ex. Hiking, Group ex, Swimming)
Resistance: Type (FITT Recommendations for Pregnant Women)
A variety of machines, free weights, and body weight exercises are well tolerated during pregnancy (ex. Upright chest press, Dumbbells, Lunges)
Flexibility: Type (FITT Recommendations for Pregnant Women)
A series of static (ex. Active or Passive) and dynamic flexibility exercises for each muscle tendon unit
While there is no ideal number of days, exercise frequency during pregnancy should be… (Pregnancy - Exercise Testing)
Regular, occurring throughout the week, and adjusted based on total exercise.
What should be used to monitor exercise intensity during pregnancy? (Pregnancy - Exercise Testing)
Heart rate ranges corresponding to moderate intensity exercise have been developed, however due to heart rate variability, RPE may also be used to monitor exercise intensity during pregnancy.
For pregnancy women, how can exercise be accumulated and how long should they warm up or cool down? (Pregnancy - Exercise Testing)
in shorter bouts (e.g., 15 minutes) or performed continuously. A 10–15 min warm-up and a 10–15 min cool-down of light-intensity PA are suggested before and after each exercise session.
Pregnancy BMI <25, Age: <20, Fitness Level: – (Heart Rate Ranges for Women who are Pregnant)
140-155 b*min
Pregnancy BMI <25, Age: 20-29, Fitness Level: Unfit (Heart Rate Ranges for Women who are Pregnant)
129-144 b*min
Pregnancy BMI <25, Age: 20-29, Fitness Level: Active (Heart Rate Ranges for Women who are Pregnant)
135-150 b*min
Pregnancy BMI <25, Age: 20-29, Fitness Level: Fit (Heart Rate Ranges for Women who are Pregnant)
145-160 b*min
Pregnancy BMI <25, Age: 30-39, Fitness Level: Unfit (Heart Rate Ranges for Women who are Pregnant)
128-144 b*min
Pregnancy BMI <25, Age: 30-39, Fitness Level: Active (Heart Rate Ranges for Women who are Pregnant)
130-145b*min
Pregnancy BMI <25, Age: 30-39, Fitness Level: Fit (Heart Rate Ranges for Women who are Pregnant)
140-156 b*min
Pregnancy BMI >/=25, Age: 20-29, (Heart Rate Ranges for Women who are Pregnant)
102-124 b*min
Pregnancy BMI >/=25, Age: 30-39, (Heart Rate Ranges for Women who are Pregnant)
101-120 b*min
Previously inactive women should progress from… (Pregnancy - Exercise Testing)
15 min∙d−1 (~3 d∙wk−1) at the appropriate RPE or target HR to approximately 30 min∙d−1 on most days of the week
Women who habitually participate in resistance training should… (Pregnancy - Exercise Testing)
Continue during pregnancy and should discuss how to adjust their routine with their health care provider.
Kegel exercises and those that strengthen the pelvic floor are recommended to… (Pregnancy - Exercise Testing)
Decrease the risk of incontinence during and after pregnancy.
PA in the supine position should be… (Pregnancy - Special Considerations)
Avoided or modified after 16 wk of pregnancy.
Women who are pregnant should avoid exercising in what kind of environment? (Pregnancy - Special Considerations)
A hot humid environment, be well hydrated, and dressed appropriately to avoid heat stress.
During pregnancy, the metabolic demand increases by…(Pregnancy - Special Considerations)
~300 kcal∙d−1. Women should increase caloric intake to meet the caloric costs of pregnancy and exercise.
PA may help regulate weight gain during pregnancy
Women who are pregnant and severely obese and/or have gestational diabetes mellitus or hypertension should… (Pregnancy - Special Considerations)
Consult their physician before beginning an exercise program and have their Ex Rx adjusted to their medical condition, symptoms, and physical fitness level.
In any activity, pregnant women should avoid using… (Pregnancy - Special Considerations)
the Valsalva maneuver, prolonged isometric contraction, and motionless standing.
PA can be resumed after pregnancy, but should be done so gradually because of normal deconditioning in the initial postpartum period. (Pregnancy - Special Considerations)
- Generally, gradual exercise may begin ~4–6 wk after a normal vaginal delivery or about 8–10 wk (with medical clearance) after a cesarean section delivery
- Women with higher CRF levels and more rigorous exercise routines prior to and during pregnancy may be able to resume exercise sooner.
- Light to moderate intensity exercise in the postpartum period is important for return to prepregnancy body mass index and does not interfere with breastfeeding.
