Special Populations

Question 1

Youth

Answer 1

Key considerations
Children are different from adults in that they have:
Less blood volume
Smaller airways and more soft tissue
Faster respiratory rates and heart rates
More skin surface area in relation to weight
Less muscle mass and fat mass
A child’s vision doesn’t fully develop until the age of eight
Children going through puberty have poor coordination and balance
Resistance and strength training are acceptable and, in most cases, desirable

Question 2

Benefits of exercise for youth

Answer 2

Higher self-concepts than those who are inactive
Has the potential to increase their self-efficacy, creativity, self-esteem, internal locus of control (a belief that the individual is responsible for their own success), test scores for cognitive functioning, and classroom behavior
20–35% reduced risk of premature mortality
15–65% less likely to have psychiatric (mental health) problems
Reduced risk of suicide
Increased muscle endurance and strength
Improved bone density
Reduced risk of physical injury
Improved self-esteem
Improved athletic performance
Improved heart and lung capacity and function
Reduced excess body fat
Reduced risk of depression
Reduced risk of general diseases (heart disease, cancer, type 2 diabetes, etc.)
Promotes healthy blood pressure

Question 3

Injury prevention

Answer 3

Always ensure proper instruction and form
Use proper training progression
Adjust exercise intensity to meet the child’s physical capabilities
Always include a warm-up and cooldown
Always supervise children during the entirety of a training session
Use appropriate equipment and make sure the client knows how to use each piece correctly
Require proper attire and shoes for training
Ensure adequate rest during exercise sessions and promote rest on off days
Use cross-training to prevent injury and keep children engaged
Encourage optimal hydration and nutrition before, during, and after exercise

Question 4

Childhood development

Answer 4

Under 6
Growth slows after age 2
Sensitive period for motor skills development
Responsive to what they see, hear, and touch and will learn skills and movement patterns easily
Enjoys parallel play

6–10 years
Slow steady growth until adolescence
Ideal stage for both gross and fine motor skill development
Can successfully join and work in a group, manage conflict, take turns, find new friends, and manage relationships
High self-esteem and eager to learn new skills
Emphasize personal development and process goals over outcome goals
Ideal activities: bodyweight exercises, running and jogging, dancing, push-ups and pull-ups, sports activities, gymnastics, stretching, climbing, and wrestling

11–19 years
Growth spurt
Girls: 10 to 13
Boys: 12 to 15

Dramatic hormonal changes
Often think and behave in their own best interest
Tend to think everyone is watching them
Can begin learning specialized motor skills, such as those pertaining to sports
Refine movement patterns

Question 5

Youth fitness assessments

Answer 5

Aerobic capacity: PACER test, one-mile run, or walk test
Body composition: Skinfold, bioelectrical impedance (BIA), or body mass index (BMI)
Flexibility: Back-saver sit and reach, shoulder stretch
Muscular strength and endurance: Curl-up, trunk lift, 90-degree push-up, modified pull-up, flexed arm hang

Question 6

Older adults

Answer 6

Key terms

Senescence: the process or state of growing old
Chronological age: the number of years a person has lived
Functional capacity: the capability of performing tasks and activities that people find necessary or desirable in their lives

Question 7

Sarcopenia

Answer 7

the degenerative loss of skeletal muscle mass

Question 8

Dynapenia

Answer 8

the age-associated loss of muscle strength that is not caused by neurologic or muscular disease

Question 9

Metabolic syndrome

Answer 9

a cluster of at least three biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes

Question 10

Frailty

Answer 10

an increased vulnerability resulting from age-associated decline in reserve and function across multiple physiologic systems

Question 11

Sleep apnea

Answer 11

a disorder of breathing during sleep

Question 12

Comorbidities

Answer 12

the simultaneous presence of two chronic diseases or conditions in a person

People with chronic health conditions often have more than one condition

Question 13

Parkinson’s disease

Answer 13

a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement

Question 14

Osteoporosis

Answer 14

a skeletal condition that results in weak or brittle bones

Question 15

Aging affects

Answer 15

Aging affects the function of all body systems

Decreases in hormone production
Decreased elasticity
Diminishment in muscles, skin, and blood vessels
Recovery time is important with this age group

Question 16

Fitness professionals should consider the following when designing programs:

Answer 16

Between the ages of 20 and 80:
Maximal oxygen uptake declines by approximately 50 percent
Maximal cardiac output declines by approximately 25 percent
Maximal heart rate declines by approximately 25 percent
Maximal stroke volume declines by approximately 15 percent

The average rate of decline (per decade) for adults over the age of 50 is as follows:
Loss of muscle mass declines by approximately 6 percent
Muscle strength declines by approximately 12 to 14 percent
Bone mass declines by approximately 10 to 15 percent

Question 17

Senior fitness tests

Answer 17

30-second chair stand:

Evaluate: Lower-body strength for activities of daily living (ADL) such as getting out of a chair, gardening, or navigating stairs.
How to perform: With arms folded across chest, count the number of stands that can be fully completed within 30 seconds.
At risk: Less than 8 unassisted stands for men and women.
Arm curl:

Evaluate: Upper-body strength that measures ADL such as carrying groceries, lifting grandchildren, or putting dishes away.
How to perform: Count the number of biceps curls that can be completed within 30 seconds while holding a hand weight (5 lb. or 2.27 kg for women; 8 lb. or 3.63 kg for men).
At risk: Less than 11 curls for men and women.
Two-minute step test:

Evaluate: Stamina for activities such as shopping, traveling, or yard work.
How to perform: Count the number of full steps completed within two minutes. Each knee must be raised to point midway between the kneecap and hip bone. Only the number of times the right knee reaches required height is scored.
At risk: Less than 65 steps for men and women.
Chair sit and reach:

Evaluate: Lower-body flexibility for preventing lower-back pain, balance, posture, and falls.
How to perform: While seated at the front of a chair and with one leg extended, reach toward the toes with the hands. Count the number of inches between fingers and tip of toe.
At risk: Minus four inches or more for men; minus two inches for women.
Eight-foot up and go:

Evaluate: Speed, agility, and balance to help in activities such as walking through crowds or playing at the playground with grandkids.
How to perform: Count the number of seconds needed to get up from a seated position, walk eight feet (2.44 m), turn, and return to a seated position.
At risk: Greater than 9 seconds for men and women.
Back scratch test:

Evaluate: Flexibility in the upper body, which may affect the ability to reach up high, change a light bulb, or open the refrigerator.
How to perform: Begin standing. Place one hand behind the back and slowly move it up the spine toward the head. The opposite hand is placed behind the neck and is slowly moved down the spine with the goal of bringing both hands as close together as possible. Repeat with the opposite hands.
At risk: N/A.

Question 18

Seniors Cardiovascular guidelines:

Answer 18

150 minutes per week of moderate-intensity aerobic exercise (30-minute workouts five times per week)

75 minutes per week of vigorous-intensity aerobic exercise (30-minute workouts three times per week)

Or any combination of the two

Question 19

Seniors Resistance training

Answer 19

Start with closed kinetic chain exercises to support the joints.
Safety and form are critical.
Common modalities: bands, machines, free weights, and calisthenics.
Guidelines:
One set of 8–10 repetitions for exercises working the major muscle groups on two to three nonconsecutive days of the week.
Ask the client to rate their exertion on a scale of 0 to 10, with 0 equating to no movement and 10 to an all-out effort.
Moderate-intensity exercise (a perceived effort of 5 or 6) should allow the client to perform 12–15 repetitions, and high-intensity exercise (a 7 or 8 on the scale) should permit between 8 and 10 repetitions.

Question 20

Seniors Flexibility training:

Answer 20

Flexibility of the shoulder and hip joints decreases by approximately six degrees per decade between 55 and 86 years of age.
Promotes optimal biomechanics and posture.
Light static stretching of the major muscle groups at least twice per week can elicit improvements.
Is best done after a thorough warm-up, after walking, or directly after a hot shower to improve muscle pliability.

Question 21

Seniors Balance training:

Answer 21

Essential for seniors.
Three days per week for about 10 to 15 minutes per session.
Safety is of utmost importance.

Question 22

Mental training:

Answer 22

Reducing sedentary behavior may improve brain health for those at risk for progressive mental degeneration conditions such as Alzheimer’s disease.
Both cognitive and physical training have positive effects on the brain.
Moderate-intensity exercise can improve brain structure and function and may reverse neural decay.

Question 23

Pregnancy

Key terms:

Answer 23

Prenatal: occurring or existing before birth.
Postpartum: the period of time following childbirth.

Question 24

Pregnancy Key physiological changes:

Answer 24

Relaxin: a sex hormone that facilitates birth by causing relaxation of the pelvic ligaments.
Progesterone: a female hormone that regulates the menstrual cycle and is crucial for pregnancy.
Hypermobility: the condition of having an excessive range of motion in a joint or joints.
Diastasis: the separation of the large abdominal muscles during pregnancy.
Gestational diabetes mellitus (GDM): a condition characterized by an elevated level of glucose in the blood during pregnancy, typically resolving after birth.

Question 24

Body system changes during pregnancy:

Answer 24

Cardiovascular system:

Resting heart rate increases.
There is a 45 percent increase in blood volume.
Stroke volume and cardiac output increase.
Respiratory rate may increase up to 50 percent.
Lung capacity decreases.
Decreased oxygen availability.
Risk for orthostatic hypotension.
Musculoskeletal system:

Bodyweight increases, placing more stress on joints.
Elasticity of muscles, tendons, and ligaments increases.
The center of gravity changes, causing issues with balance.
Postural changes contribute to compensations.
Endocrine system:

Levels of relaxin and progesterone increase.
Thyroid-stimulating hormones are released more often.
Insulin resistance increases.
More lipid (fat) use leads to ketogenesis.
Contraindications:

Incompetent cervix.
Persistent vaginal bleeding.
Placenta previa after 26 weeks gestation.
Premature labor.
Preeclampsia.
Uncontrolled diabetes or other systemic disorder.

Question 24

Adaptive fitness
Key terms:

Answer 24

Disability: a physical or mental condition that limits a person’s movements, senses, or activities.
Impairment: the state of being diminished, weakened, or damaged—especially mentally or physically.
Activity limitation: difficulty experienced by an individual in executing a task or action.
Participation restrictions: a problem experienced by an individual in involvement in life situations.
Inclusion: the act of including into a group; encourages involvement and empowerment, where the inherent worth and dignity of all people are recognized.
Adaptive physical fitness: the art and science of developing, implementing, and monitoring a carefully designed physical fitness program for a person with a disability.

Question 25

Disability type statistics:

Answer 25

Mobility Dysfunction: 57 percent of the population doesn’t get exercise (34,770,000 people).
Cognitive Disability: 40 percent of the population doesn’t get exercise (24,400,000 people).
Vision Disability: 36 percent of the population doesn’t get exercise (21,960,000 people).
Hearing Impairment: 33 percent of the population doesn’t get exercise (20,130,000 people).
No disability: 26 percent of the population doesn’t get exercise (84,682,000 people).

Question 25

Fitness is for everyone and helps to:

Answer 25

Reduce the risk of heart disease, stroke, diabetes, and some cancers.
Improve self-confidence and autonomy.
Reduce feelings of depression.
Increase quality of life and life satisfaction scores.
Increase longevity.
Reduce some symptoms of chronic medical conditions.

Question 26

Exercise program design:

Answer 26

Fitness programming is fundamentally similar for clients with disabilities and those without.
Some clients’ disabilities may require alterations or subtractions in different components of fitness.