[L2 Principles of Exercise] Section 6: Contraindications to exercise

Question 1

What is Pre-Exercise Screening

Answer 1

A comprehensive pre-screening process that needs to be completed prior to participation to check for any medical considerations that need to be signposted to and cleared by a GP.

Question 2

List the Specialist populations

Answer 2

• Older adults (50+).
• Pre- and post-natal women.
• Young people (14-16).
• Disabled people.

Question 3

Define the ageing process.

Answer 3

The ageing process is characterized by progressive loss and decline in the functioning of the skeletal/cardiovascular and neuromuscular systems

Question 4

What ages do the effects of ageing begin to take place and become noticeable?

Answer 4

50, with the effects being noticeable at 65.

Question 5

Decline in functional ability may lead to what?

Answer 5

Reduced mobility, loss of independence, increased frailty and increased risk of falls for some older adults.

Question 6

What are some contraindications to exercise in older adults?

Answer 6

Unstable or controlled medical conditions (diabetes, asthma, angina).
• Resting blood pressure greater than 180/90.
• Resting heart rate over 100 bpm.
• Joint condition made worse by exercise.
• Unexplained dizziness.
• The effects of the ageing process.

Question 7

What are the effects of aging on the muscles?

Answer 7

Fewer fast twitch muscle fibres.
• Weaker and smaller muscle fibres.
• Reduced motor neurons.
• Reduced neuromuscular transmission (fewer nerves
sending messages).
• Reduced capillaries in the muscle.
• Increased connective tissue.
• Sensory decline (loss of hearing and vision).
• Cognitive decline.

Question 8

What are the fitness potential considerations for muscles due to the effects of aging?

Answer 8

• Reduced muscular strength.
• Reduced muscle power.
• Reduced coordination.
• Reduced movement speed.
• Reduced muscular endurance.
• Reduced flexibility and range of motion.
• Reduced balance and coordination.
• Reduced postural stability.
• Reduced short-term memory.

Question 9

What are the effects of aging on bones?

Answer 9

• Loss of bone mass and reduced bone density.
• Increased risk of osteoporosis.
• Reduced availability of synovial fluid.
• Calcification of the joints (calcium laid down in the
cartilage).

Question 10

What are the fitness potential considerations for bones due to the effects of aging?

Answer 10

• Bones less resilient to stress and more susceptible
to fracture.
• Stiffer, less mobile joints.
• Reduced shock absorption in the joints.

Question 11

What are the effects of aging on the Respiratory system?

Answer 11

• Reduced stroke volume and cardiac output.
• Less efficient heart and circulatory system.
• Increased blood pressure.
• Fewer capillaries.
• Less elastic vessels.
• Reduced intake, uptake and utilisation of oxygen.

Question 12

What are the fitness potential considerations for respiratory system due to the effects of aging?

Answer 12

• Lower maximal heart rate.
• Lower training heart rate.
• Slower recovery rate.
• Decreased tolerance to fatigue.
• Tire quicker.
• Lower anaerobic threshold.
• Less tolerant of high-intensity exercise.

Question 13

What’s the name of the screening tool used for pregnant women?

Answer 13

PARmedX

Question 14

What are some RELATIVE contraindications to exercise for pregnant women?

Answer 14

• Very sedentary lifestyle.
• Severe anaemia.
• Morbid obesity.
• Extreme underweight.
• Heavy smoker.

Question 15

What are some ABSOLUTE contraindications to exercise for pregnant women?

Answer 15

Heart or lung disease.
• Persistent second or third trimester bleeding.
• Preeclampsia/pregnancy induced hypertension.
• Premature labour.

Question 16

What are some general effects on the Cardiovasualur system of pregnancy on pre.post-natal women?

Answer 16

• Increased heart rate.
• Increased stroke volume.
• Increased cardiac output.
• Increased oxygen uptake.

Question 17

What changes in the body that makes pre-natal women more vulnerable to injuryy, joint misalignment, muscle imbalance and motor skills decline?

Answer 17

Hormonal and postural changes

Question 18

Pregnant women should avoid what when exercising?

Answer 18

• Exercising in the supine position after 16 weeks.
• Exercising to the point of exhaustion (the goal is to maintain activity, rather than improve fitness).
• Prone lying exercise.
• Prolonged motionless standing.
• Heavy, uncontrolled, isometric or prolonged resistance work above the head.
• Leg adduction and abduction against a resistance.
• Isometric exercises.
• Loaded forward flexion.
• Rapid changes of direction or position.
• Uncontrolled twisting.
• Exercise with a risk of falling or abdominal trauma.
• Excessive and uncontrolled de-stabilisation (balance)
techniques.
• Abdominal exercises (focus instead on posture, mobility and pelvic floor).

Question 19

When can post-natal women begin exercising?

Answer 19

When they have received the permission of their healthcare professional, usually at the post-partum six-to-eight-week check.

Question 20

What should the main focus of the training done by post-natal women before progressing to more vigorous exercise?

Answer 20

Posture and joint alignment, address muscle imbalances, improve stability and motor skills, and encourage transversus abdominis (TA) recruitment and pelvic floor function.

Question 21

A woman should be referred to a health professional if she is experiencing what symptoms
post birth?

Answer 21

Stress incontinence or pelvic floor muscle weakness.
• ‘Dragging’ pain or a feeling of heaviness in the lower abdominal or pelvic floor area.
• Groin, low back pain or difficulty walking; even if mild and intermittent.
• Abdominal muscle weakness, excessive abdominal doming, abdominal muscle separation or softness/
sinking at the umbilical mid-line, umbilical hernia.

Question 22

What is the Equality Act (2010)

Answer 22

Service providers must anticipate the needs of disabled clients and make reasonable changes to
accommodate these.

Question 23

What is The Inclusive Fitness Initiative (IFI)

Answer 23

The IFI provides guidance and support to operators interested in welcoming disabled people into their facilities and to disabled people interested in getting active.

Question 24

What is a progressive disorder?

Answer 24

These conditions worsen over time, e.g. multiple sclerosis. Careful monitoring is required to ensure that the exercise programme does not cause the condition
to worsen (exacerbation).

Question 25

What is asymmentrical weakness?

Answer 25

These conditions result in a difference in strength between the left and right sides of the body, e.g. stroke and cerebral palsy. The aim should be to improve the affected side as much as possible without neglecting the unaffected side.

Question 26

What is a Neurological condition?

Answer 26

These affect the central nervous system (CNS), e.g. muscular dystrophy. Muscles can become progressively weaker as a result of the decline in CNS
functioning; this can be offset in the programme by working on general fitness levels.

Question 27

What is Sensory damage?

Answer 27

Damage to sensory nerves occurs with many types of physical disability. An inability to detect pressure against the skin can result in a pressure sore.

Question 28

What is Depression?

Answer 28

Depression reduces motivation and energy levels and can contribute to drop-out from the programme. Medications used to treat depression have many negative side effects, including weight gain and suicide risk.

Question 29

What is Spasticity?

Answer 29

Many physical disabilities present with spastic muscles that are very tight or rigid. Flexibility training is important. Seek advice from a suitably trained
medical authority on how to stretch a spastic muscle without causing injury before incorporating any flexibility into a programme.

Question 30

What percentage of childhood fractures are growth plate fractures?

Answer 30

15% (with the greatest incidence among 14-16-year-old boys and 11-13-year-old girls)

Question 31

A serious injury to a joint is more likely to damage the growth plate than the what?

Answer 31

Than the ligaments around the joint.

Question 32

Preventative measures to avoid growth-related injuries include:

Answer 32

• Avoid excessive training; this includes playing too much of one sport, playing the wrong sport for the
young person’s body type or using a resistance that is too heavy.
• Consider gender differences and the differing stages of development.
• Avoid inappropriate size matching in pairs activities.
• Avoid too much static, high-impact activity, e.g. jogging on the spot.
• Warm up and cool down thoroughly.
• Use appropriate equipment for the activity, e.g. correct size and weight.

Question 33

What are the safey considerations for young people?

Answer 33

Growth plate fractures
Flexibility
Temperature
Self-esteem & confidence
Medical condiditions
Obesity
Immaturity
Reduced coordination

Question 34

What safety measures for Growth plate fractures in young people

Answer 34

Lower impact and lower intensity (fewer repetitions, less resistance) and avoid overtraining.

Question 35

What safety measures for Flexibility in young people

Answer 35

Modify stretch positions, stretch to the point of mild tension (without overstretching), modify range of motion and focus on correct technique, avoid ballistic stretching.

Question 36

What safety measures for Temperature in young people

Answer 36

Maintain hydration, lower intensity and avoid exercise in humid conditions.

Question 37

What safety measures for Self-esteem & confidence in young people

Answer 37

Be mindful of any lack of confidence and low self-esteem and how this may affect behaviour and motivation. Body image issues may be apparent (eating disorders would present a contraindication for exercise).

Question 38

What safety measures for Medical condiditions in young people

Answer 38

The presence of any medical conditions need to be signposted to a GP prior to participation.

Question 39

What safety measures for Obesity in young people

Answer 39

This may present with other CVD risk factors (inactivity, hypertension, high cholesterol, diabetes) that negatively affect health. These need to be signposted to a GP prior to participation.

Question 40

What safety measures for Immaturity in young people

Answer 40

This may affect behaviour and regard for safety.

Question 41

What safety measures for Reduced coordination in young people

Answer 41

Simpler and non-complex activities with less technical demand.