Special Populations Flashcards
OBESITY - respiratory function
lower tidal volumes with higher RR
reduced lung and chest wall compliance causes and increased WOB
reduced expiratory reserve volume
reduced FRC
profound obesity can cause a reduced FEV1, FVC and TLC
increased airway resistance
OBESITY - Clinical Implications
reduced lung volumes impaired gas exchange airflow limitation - reversible with weight loss reduced exercise tolerance dyspnoea
OBESITY - Hypoventilation Syndrome
combination of obesity, daytime hypercapnia and sleep disordered breathing
Implications
- reduced gas exchange
- dyspnoea
- reduced exercise tolerance
- daytime somnolence (strong desire to sleep)
- fatigue
- depression headaches
Treatment
- weight loss
- nocturnal CPAP/NIV to maintain ventilation whilst sleeping
OBESITY - Exercise
need CV and strength training
need volume significant enough to expend 1000 calories in a week, then progress to 2000 calories
AEROBIC F - at least 5 days a week I - moderate-intense T - 150 mins- 300 mins a week T - prolonged rhythmical activities
RESISTANCE F - 2-3 days a week I - 60-70% 1RM T - 2-4 sets, 8-12 reps for major muscle groups T - resistance machines/free weight
OBESITY - Special Considerations
need to consider diet and general lifestyle changes also
need to make these changes sustainable and meaningful
consider potential harmful consequences of high impact activity
help to facilitate exercise adherence
DIABETES - Potential long term complications
Neuropathy Retinopathy - eye disease Nephropathy - increased BGLs damage the kidneys CVD - atherosclerosis and HTN Diabetic Ketoacidosis
T1D Benefits of Exercise
Aerobic lowered overall mortality levels improved fitness improved insulin sensitivity improved endothelial function
Resistance increased muscle mass improved overall physical function improved bone/mineral density reduced risk of exercise induced hyperglycaemia
T2D Benefits of Exercise
Aerobic
lowered mortality levels
reduced triglycerides
lowered BP andinsuline resistance
Resistance improve muscle mass improved overall physical function improved bone mineral density improved glycaemic control reduced insuline resistance improved lean body mass improved BP
DIABETES - Exercise Prescription
AEROBIC F - 3-7 days a week I - moderate - vigorous T - 150mins a week T - prolonged, rhythmical activity
RESISTANCE F - 2-3 days a week, non-consecutive I - moderate to vigorous (60-80% 1RM) T - 8-10 exercises, 1-3 sets, 10-15 reps T - resistance machines and free weights
DIABETES - Special Considerations
need to make appropriate insulin and carbohydrate intake changes prior to, during and after exercise
be aware of potential nocturnal hypoglycaemia post exercise
don’t exercise if BGLs are elevated or have ketones
consider the implications of vascular disease
consider the implications of peripheral neuropathy
regularly test BGLs
have plan in place to deal with hypoglycaemia or hyperglycaemia
BGL AIM PRIOR TO EXERCISE 6-13mmol/L
CHRONIC KIDNEY DISEASE - Risk Factors
Modifiable overweight obese physical inactivity poor diet tobacco smoking increased BP low birth weight
Non-Modifiable advanced age genetic predisposition previous kidney disease male gender family history
CHRONIC KIDNEY DISEASE - Clinical Implications
dyspnoea reduced exercise tolerance impaired gas exchange musculoskeletal dysfunction abnormal haemodynamics fatigue electrolyte derangement loss of bone mineral density
CHRONIC KIDNEY DISEASE - Exercise Prescription
AEROBIC F - 3-5 days a week I - moderate T - 20-60 mins of continuous activity T - prolonged rhythmical activity
RESISTANCE F - 2-3 days a week I - 65-75% 1RM T - 1 set, 10-15 reps, 8-10 different exercises T - machines and free weights
CHRONIC KIDNEY DISEASE - special considerations
exercise performed on non-dialysis days
consider intermittent exercise to start with
risk of hypotension if exercise post - dialysis
take care with dialysis access points
monitor for rejection if post transplant
monitor any other co-morbidities
