Working with Participants with Health Considerations Flashcards
What is CHD?
Coronary heart disease
What is CVD?
Cardiovascular disease
What is Cardiovascular disease?
Any disease that affects, the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease.
What is peripheral arterial disease?
Any disease caused by the obstruction of large peripheral arteries, which can result from atherosclerosis, inflammatory processes leading to stenosis, and embolism, or thrombus formation.
What is another name for Coronary heart disease (CHD)
Coronary artery disease
What is the myocardium?
The muscle of the heart.
What is myocardial infarction?
An episode in which some of the heart’s blood supply is severely cut off or restricted, causing the heart muscle to suffer and die from lack of oxygen. Commonly known as a heart attack.
What is ischemia?
A decrease in the blood supply to a bodily organ, tissue or part caused by constriction or obstruction of the blood vessels.
What is Coronary heart disease?
The major form of cardiovascular disease, results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue, also called coronary artery disease (CAD)
What is atherosclerosis?
A specific form of arteriosclerosis characterized by the accumulation of fatty material on the inner walls of the arteries, causing them to harden thicken and lose elasticity.
What are baroreceptors?
A sensory nerve ending that is stimulated by changes in pressure, as those in the walls of blood vessels.
What percentage of Americans over the age of 75 have hypertension?
70%
What are some risk factors for CVD?
Hypertension
Blood lipid disorders
What is the most common cause of sudden death?
CHD
What is the most common cause of death in people over 65 years of age?
CHD
Who is more likely to develop CHD, men or women?
Men - 10 times more likely.
What is considered hypertension (high blood pressure)
Systolic blood pressure over 130 mmHg
and/or
Diastolic blood pressure over 80 mmHg
What is SBP?
Systolic blood pressure
What is DBP?
Diastolic blood pressure
What is systolic blood pressure?
The pressure exerted by the blood on the vessel walls during ventricular contraction.
What is diastolic blood pressure?
The pressure in the arteries during the relaxation phase (diastole) of the cardiac cycle, indicative of total peripheral resistance.
What percentage of Americans over the age of 75 have hypertension?
70%
What is considered normal blood pressure for adults?
SBP <120 mmHg
and
DBP < 80 mmHg
What is considered elevated blood pressure for adults?
SBP 120-129 mmHg
and
DBP < 80 mmHg
What is considered Stage 1 Hypertension for adults?
SBP 130-139 mmHg
and/or
DBP 80-89 mmHg
What is considered Stage 2 Hypertension for adults?
SBP > 140 mmHg
and/or
DBP > 90mmHg
What are some general points of emphasis when working with participants with CVD?
Encourage self-monitoring
Do not exceed target HR and/or somewhat hard exertion (12-13 on 6-20 scale or 4-5 on 0-10 scale)
Focus on proper breathing patterns
What are some modifications when working with participants with CVD?
Change exercise order to complete all standing, seated, or floor work together, to avoid orthostatic hypotension.
Extend the cool-down.
What is orthostatic hypotension?
A drop in blood pressure associated with rising to an upright position.
Why is it helpful to extend the cool-down when working with participants with CVD?
Antihypertensive medication may lead to post-exercise hypotension.
What are some things to avoid when working with participants that have CVD?
Avoid the Valsalva maneuver
Avoid exercises with significant isometric activation hold times.
What is the Valsalva maneuver?
Forced expiration against a closed glottis to compress the contents of the thoracic and abdominal cavity causing an increased intrabdominal and intrathoracic pressure.
What is isometric activation?
Muscle engagement/tension without changing length or causing a joint to move. May increase blood pressure.
What are some additional precautions that should be taken when working with individuals with CVD?
Exercise should not continue if abnormal signs observed.
Understand the effects of medication on the HR response to exercise.
What are some signs to watch for that indicate exercise should not continue for individuals with CVD?
Angina
Dyspnea
Lightheadedness/Dizziness
Pallor
Rapid HR above established targets.
What are the most common pulmonary conditions?
Asthma
Chronic obstructive pulmonary disease (COPD)
What is the third leading cause of death worldwide?
COPD
What is the most common chronic disease among children?
Asthma
What are the goals of physical activity for people with pulmonary conditions?
Improved exercise tolerance and performance
Alleviation of the magnitude of dyspnea
Improved state of mind, emotional state, and quality of life
Enhanced ability to perform activities of daily living
Improved gas exchange in the lungs and circulatory system
Improved mechanical efficiency of the anatomical structures involved in breathing.
What does ADL stand for?
Activities of daily living.
What are the 4 main steps for managing an asthma attack?
Rest and relax
Take medication
Drink warm liquid
Emergency care
What is the first step in managing an asthma attack?
At the first sign of breathing difficulties, the person should STOP and rest for at least 10 minutes.
Make the person feel comfortable and relaxed.
What is the second step in managing an asthma attack?
Take medication. Make sure the prescribed medicine is available and that the person knows how to use it correctly.
What is the third step of managing an asthma attack?
Have the person slowly drink warm liquid. Do not allow the person to drink cold beverages.
What is the last step of managing an asthma attack?
If you have any doubts about the severity of the attack, get medical help immediately.
If the person’s lips or fingernails turn blue or If the person exhibits shallow breathing and is focusing all attention on breathing, get medical help immediately.
What are some points of emphasis for working with people with asthma?
Encourage hydration before, during and after exercise.
Have participants use the RPE scale and dyspnea scale to monitor exercise intensity.
What are some exercise modifications for participants with asthma?
Encourage use of extended warm-up/cool-down
If pulmonary exacerbations arise before or during exercise, physical activity should be limited until symptoms subside.
Encourage frequent rest periods
Encourage individuals to use diaphragmatic breathing or pused-lip breathing.
What are some things to avoid when working with people with asthma?
Avoid or limit exposure to cold, dry, polluted, or high-allergen environments.
Avoid chlorinated pools, which can trigger an asthmatic event in some individuals.
What are some additional precautions that should be taken when working with people with asthma?
Remind participants to have medication nearby for use in the event of an asthma episode.
Understand the effects of medication on the HR response to exercise.
What is pursed-lip breathing?
Breathing in for two seconds through the nose, out for four seconds through pursed lips.
What are some benefits of pursed-lip breathing?
It helps improve expiratory flow rates and oxygenation in the lungs.
Helps to optimize lung function and tidal volume.
Helps reduce respiratory rate in individuals with asthma.
What is tidal volume?
The volume of air inspired per breath, moves in and out of lungs.
What is a benefit of diaphragmatic breathing for asthma sufferers?
It can help improve breathing capacity.
What are the most common types of arthritis?
Osteoarthritis (OA)
Rheumatoid arthritis (RA)
What are some co-morbidities of arthritis?
Diabetes
Obesity
Heart disease.
What is Osteoarthritis?
A degeneration of synovial fluid that progresses into a loss of articular cartilage and the underlying subchondral bone, causing bone on bone interactions.
How many adults suffer from Osteoarthritis?
One in seven.
What are the primary symptoms of Osteoarthritis?
Localized joint pain, stiffness, swelling, a reduction of range of motion (ROM), atrophy of the surrounding muscles, and a feeling that the joint is unstable or loose.
What are some reasons exercise is important for people with osteoarthritis?
It helps preserve muscle tissue
Improves ROM
Improves cardio-respiratory fitness
Helps maintain healthy body weight.
What are seven points of emphasis for working with participants with osteoarthritis?
Perform adequate warm-up to ensure joint lubrication and increased elasticity of tissues.
Start with light aerobic exercise to increase systemic blood flow and body temperature.
Dynamic flexibility exercises to enhance elasticity and increase joint lubrication.
Target specific areas during warm-up and conditioning.
Incorporate exercises that relate to activities of daily living.
Pay attention to posture/joint mechanics.
Perform adequate cool-down.
Teach participants to distinguish between soreness and pain.
What are some possible modifications for individuals with osteoarthritis?
Reduce volume and intensity if pain is present at higher levels two hours after session than before.
Start with bilateral and advance to unilateral exercises.
Replace isotonic with isometric strengthening.
If pain or swelling appears reduce load.
Change body position to avoid pain.
If specific exercises exacerbate joint pain, alternative for same muscle group should be considered.
What should be avoided when working with individuals with osteoarthritis?
Vigorous exercise during flare-up. Gentle ROM exercises are appropriate during these periods.
No high-impact activities during acute inflammation.
What are some additional precautions for working with individuals with osteoarthritis?
Stop exercise if joint pain is too severe.
Water temperatures for aquatic Exercise should be between 83-90° F.
Participants should wear appropriate shoes with good shock absorption and stability.
Understand the effects of medication on the HR response to exercise.
What percentage of Americans had diabetes as of 2018?
10% - 34 million
What percentage of adults with diabetes were not aware that they had the condition, as of 2020?
21%
How many American adults had pre-diabetes as of 2018?
88 million
What percentage of American with pre-diabetes were aware that they had it as of 2020?
15%
Which type of diabetes is a result of the body not being able to produce insulin?
Type 1
What type of diabetes is a result of insulin resistance?
Type 2
What is hyperglycemia?
Abnormally high content of glucose in the blood.
What is hypoglycemia?
A deficiency of glucose in the blood commonly caused by too much insulin, too little glucose, or too much exercise where glycogen stores become depleted. Most commonly found in those with insulin-dependent diabetes.
What are fatty acids?
A long hydrocarbon chain with an even number of carbons and varying degrees of saturation with hydrogen. The building blocks of fat in our food and bodies.
What is the glycemic index?
A ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar levels.
What effect does exercise have on blood glucose?
It can significantly lower blood glucose levels.
What are some things that can cause hyperglycemia during exercise?
Too many calories and/or not enough insulin.
What can cause hypoglycemia during exercise?
Low pre-exercise blood glucose levels
Too much pre-exercise insulin
Not enough glucose consumption during long-duration physical activity.
When should people with diabetes avoid high-intensity activity?
When blood glucose levels are trending to low levels.
What should people with low glucose levels do prior to activity?
Consume a small fast-absorbing carbohydrate snack (eg juice or a banana)
Avoid high-intensity activity.
Keep hydrated.
What are some early signs/symptom of Hypoglycemia?
Shakiness
Nervousness/anxiety
Sweating, chills, clamminess
Irritability or impatience
Fast heartbeat
Light-headedness or dizziness
Nausea
Hunger
Loss of skin color
Weakness or lack of energy
Headache
Clumsiness/coordination problems
Nightmares/crying out during sleep.
What are some late (severe) signs and symptoms of hypoglycemia?
Blurred or impaired vision
Confusion
Slurred speech
Tingling or numbness (lips/tongue/cheek)
Drowsiness
Seizures
Coma
Death
What are the instructions for an individual who is experiencing hypoglycemia?
- Check blood sugar before exercise.
- If 100 mg/dL or lower, consume 15-20 grams of carbohydrates (eg 4 glucose tablets, 1 gel tube, 1/2 cup juice or regular soda, 1 Tbs sugar/honey)
- After 15 minutes, check blood sugar again. If still under 100 mg/dL, ingest another 15 grams of carbohydrates.
- Repeat these steps every 15 minutes until your blood sugar is at least 100 mg/dL
- Do not start or resume exercise until blood sugar is above 100 mg/dL.
What are some high Glycemic Index (GI) foods?
White Bread
Corn Flakes
Graham Crackers
Dried fruit
Instant white rice.
What are some medium GI (Glycemic index) foods?
Rye bread
Shredded wheat
Ice cream
Blueberries
Refined pasta
What are some low GI (Glycemic index) foods?
Pumpernickel bread
All Bran
Plain Yogurt
Strawberries
Oatmeal
What are the definitions of high, medium and low GI (Glycemic index) foods?
Low GI ≤ 55
Medium GI 56-69
High GI ≥ 70
What are some points of emphasis for working with participants with Diabetes?
Emphasize frequency and duration over intensity.
Ensure that participants understand their own glucose medication management as it relates to exercise.
Timing of exercise related to insulin/carbohydrate intake.
Optimal pre-exercise blood glucose levels that are between 90-250 mg/dL.
What are some modifications for people with diabetes?
Allow time for them to monitor blood glucose before, during, and after exercise.
What are some things to avoid when working with individuals with diabetes?
Do not exercise if blood glucose levels lower than 70 mg/dL
Avoid vigorous physical activity if blood glucose levels are above 250 mg/dL
What are some additional precautions to take when working with participants with diabetes?
Know the signs and symptoms of hypoglycemia.
Encourage self-care of the feet.
Be aware of the participant’s medications and their potential effects on the hear-rate response to exercise.
What are some points of emphasis when working with participants with obesity?
Majority of time exercising should be at a low-to-moderate intensity level to avoid joint stress, injury, heat intolerance.
To reduce risk of injury, include cross training, gradual progression, low-impact/non weight-bearing exercises.
Start with shorter bouts of exercise.
What are some modifications for people with obesity?
Seated exercise is a good option.
Aquatic Exercise places less stress on joints.
Recumbent cycling may be more comfortable.
What are some things to avoid when working with people with obesity?
Running, jumping and high-impact exercises.
Supine exercises may cause breathing difficulty.
Prudence should be taken in doing too much lunge/squat work due to possible knee/back discomfort/injury.
Avoid body-weight exercises on unstable surface due to balance difficulties for some.
What are some additional precautions to take when working with participants with obesity?
Participants need high-quality fitness shoes.
Skin chafing may occur
Water for aquatic Exercise should be between 80-86° F.
Be respectful of the physical challenges and emotional struggles faced by participants.
What does LBP stand for?
Low-back pain.
What is Low-back pain (LBP)?
A non-specific symptom that effects people for a variety of reasons, including mechanical problems, excess body weight, injuries, and chronic diseases.
What is the leading cause of years lived with disability?
Low-back pain (LBP).
What are some points of emphasis when working with participants with LBP?
Adequate warm up and cool down
Use of proper form.
Maintain neutral posture and erect torso during any movements.
Perform low or non-impact activities.
Focus on core function and fundamental movement patterns.
More repetitions of less demanding low-back strength and stability exercises to enhance postural endurance and strength.
What are some modifications when working with individuals with LBP?
When leaning forward to lift or lower an object, always hinge at the hips and bend the knees.
What are some things to avoid when working with individuals with LBP?
Do not work through pain.
Avoid forward head positions in which the chin is tilted up.
Avoid hyper-extending the spine in an unsupported position.
Avoid extreme ranges of motion, excessive spinal flexion under load, and abrupt twisting movements.
What are some additional precautions to take when working with people with low back pain?
Individuals with LBP should consult a physician to get specific recommendations for exercise.
What are some exercises recommended for enhancing low-back health?
Cat-cow
Modified curl-up
Bird dog
Side bridge
What is sarcopenia?
Decreased muscle mass, often used to refer specifically to an age-related decline in muscle mass or lean-body tissue that may result in diminished muscle strength and functional performance.
What are some points of emphasis for working with older adults?
Include extended warm-up and cool-down.
Monitor intensity using the Dyspnea or RPE Scale.
Teach exercises and movement patterns that can be replicated when at home.
Cognitive exercises, such as catching a ball, boxing, Simon says may improve reaction time and cognitive function.
If using resistance tubes or band, coach participants to control the eccentric phase, as rapidly snapping can impose shearing forces.
Use music that is appealing to the generation.
What are some modifications for working with older adults?
Be mindful moving from floor to seated/standing positions.
Provide chair-based exercise options.
Barefoot balance training can be helpful.
For outdoor formats, offer shorter distances or stationary options.
For agility exercises, dedicate section for less complex exercises.
What are some things to avoid when working with older adults?
Avoid the use of excessive equipment (trip hazard).
Avoid dim lighting.
What are some additional precautions to take when working with older adults?
Ask participants if they have any limitations they would like to share with the instructor.
Water temperature should be between 83-86° F for high intensity and 86-88° for low-intensity exercises.
What is bone mineral density?
A measure of the amount of minerals (mainly calcium) contained in a certain volume of bone.
What are good ways to build bone mineral density?
Weight-bearing cardio-respiratory exercise
Muscular training
What is osteoporosis?
A disorder, primarily affecting postmenopausal women, in which bone mineral density decreases and susceptibility to fractures increases.
What are some points of emphasis when working with individuals with osteoporosis?
Choose resistance exercises that strengthen the muscles of the hips and spine.
Choose ROM exercises that improve posture, such as flexibility exercises for the chest, shoulders, hip flexors, calves and ankles.
Aerobic activity should be weight bearing.
Balance activities should be added to help reduce risk of falls.
What are some modifications to consider when working with participants with osteoporosis?
Short bouts of activity interspersed with recovery are preferable to long-duration loading.
Multiplanar activity should be encouraged.
Higher loads with fewer repetitions are recommended for bone formation.
What are some things to avoid when working with individuals with osteoporosis?
Explosive movements/high-impact loading if high risk for fractures.
If participant has very low spinal BMD, avoid excessive twisting, bending or compression of the spine.
What are some additional precautions when working with individuals with osteoporosis?
The intensity of each exercise modality that can be tolerated will vary depending on bone status, risk factors for fall, previous fractures, and contraindications to exercise.
What is dry heat dissipation?
The loss of energy such as occurs during the cooling of the body in the open air, without sweating.
What are some points of emphasis when working with youth?
Supervise appropriately and use light weight equipment for safety.
Help children develop motor skills.
Focus on physical literacy.
Incorporate bone-strengthening activities because the greatest gains occur just before and during puberty.
Teach proper breathing techniques.
Encourage frequent fluid consumption.
Encourage communication when feeling tired, fatigued, pain or discomfort.
What are some modifications when working with youth?
RPE may not work well with children younger than eight, use easy and hard instead.
To increase adherence, gamify exercise sessions.
What is something to avoid when working with youth?
Use caution because heat exhaustion can occur quickly in children, if their core temperature rises faster than their dissipation rate.
What are some additional precautions when working with youth?
Provide proper supervision, focus on technique.
Free weight and body-weight exercises preferred over machines.
Never encourage children to perform single maximal lifts or sudden explosive movements, or to compete with other children while performing muscular training.
Water temperatures for aquatic Exercise should be between 83-86° F.
What are some benefits of exercise during pregnancy?
Better cardio-respiratory and muscular fitness.
Reduced fatigue threshold.
Lower resting heart rate.
Higher VO₂ max.
Reduced rates of urinary incontinence, low-back pain, deep vein thrombosis, pregnancy-induced hypertension, diastasis recti, nausea, Cesarean birth, anxiety, heartburn, insomnia, leg cramps, and depression.
What is relaxin?
A hormone that relaxes ligaments and soft tissues in preparation for childbirth.
Why is there an increased risk for falls with pregnant women?
Change in center of gravity/balance issues
Joint laxity - more flexible joints.
What amount of exercise is recommended for women with uncomplicated pregnancies?
30-60 minutes on at least three to four days per week (up to daily). At least 150 minutes per week of moderate intensity aerobic exercise.
What are some points of emphasis when working with pregnant women?
Include an extended warm-up and cool-down.
Use the RPE and talk test to monitor exercise intensity (9-13 on 6-20 scale and can talk comfortably) or maintain an intensity less than 60-80% age-predicted maximal HR.
Incorporate exercises for postural muscles (thighs, hips, trunk and shoulders)
Adequate hydration and appropriate clothing are essential, as heat dissipation is important throughout pregnancy.
What are some modifications for pregnant women?
Reduce intensity, duration, and frequency if not well tolerated.
Walking and running should occur on a flat surface to reduce the risk of falling.
Modify jumping or quick change in direction activities due to increased laxity of joints and ligaments.
What are some things to avoid when working with pregnant women?
After 20 weeks of gestation, avoid lying in a supine position for long periods.
Avoid hot and humid environments.
Avoid contact or collision activities that may cause loss of balance, trauma, or increase risk of falling.
What are some additional precautions when working with pregnant women?
Some women may need a snack prior to exercise to help avoid Hypoglycemia.
Be aware of warning signs to discontinue exercise, such as bleeding, amniotic fluid leakage, chest or abdominal pain, calf pain or swelling, or painful contractions.
Low-back pain during pregnancy is common, so exercise to support back health and proper posture are important.
Water temperatures should be between 83-85°F.
What are some points of emphasis when working with postpartum women?
Start slowly and gradually increase intensity/duration.
Wear a supportive bra and express milk before exercise.
Select exercises that strengthen major muscle groups
Drink plenty of water.
What are some modifications when working with postpartum participants?
Women who have had Cesarean deliveries need extra time before performing abdominal exercises.
What are some things to avoid when working with postpartum women?
Avoid excessive fatigue
Avoid dehydration.
What are some additional precautions when working with postpartum women?
Cease activity if unusual pain is experienced
Cease activity and seek medical attention if bright red vaginal bleeding occurs that is heavier than a normal period.
What is the effect on heart rate response of Beta blockers?
Lowers resting and exercise heart rate, lowers exercise capacity (VO₂ max) with chronic administration. The response is dose-related.
What is the effect on heart rate response of Angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs)?
Lowers or has no significant effect on resting and exercise heart rates. Has no effect exercise capacity.
What is the effect on heart rate response of Other hypertensives?
Raises, lowers, or has no significant effect on resting and exercise heart rates. Usually has no effect exercise capacity. Many antihypertensive medications are used, with different effects. Some have dose-related responses.
What is the effect on heart rate response of antihistamines?
Raises resting heart rate, has no effect on exercise heart rate or exercise capacity (performance and endurance).
What is the effect on heart rate response of antidepressants and anti-anxiety medications?
Raises or has no significant effect on resting and exercise heart rates.
What is the effect on heart rate response of Stimulants?
Raises resting and exercise heart rate, increases or has no effect on exercise capacity (endurance and performance).
What is the effect on heart rate response of Caffeine?
Raises resting heart rate, raises or has no effect on exercise heart rate, increases exercise capacity (endurance).
What is the effect on heart rate response of bronchodilators?
Has no effect on resting or exercise heart rate, has no effect on Exercise capacity (VO₂ max) except for individuals with COPD (increases or has no effect).
What is the effect on heart rate response of alcohol?
Has no effect on resting or exercise heart rate. Decreases performance and VO₂ max. Exercise is prohibited while under the influence. Effects of alcohol on coordination increase possibility of injuries.
What is the effect on heart rate response of Nicotine-replacement therapy?
Raises resting and exercise heart rate, decreases or has no effect on exercise capacity.
What is the effect on heart rate response of Nonsteroidal anti-inflamatory drugs (NSAIDs)?
Have no effect or increase exercise capacity (performance).
What are beta blockers, and what effect do they have on an individuals ability to reach their target heart rate?
Medicines that lower blood pressure. Since it lowers resting, exercise, and maximal heart rate, exercisers will not reach target heart rates based on age-predicted MHR. RPE should be used to monitor intensity.
