I did this detailed summary (isn't that an oxymoron?) of the Special Populations chapter. There is probably a way to consolidate all of the programs that are similar but I haven't gotten around to doing that. I may not ever since it would be a tedious job and I'm kind of burned out typing plus I'm having that issue w/ my neck so I can't type for long or it irritates it :)
Anyway, I think everything is accurate, it's possible there's a typo here or there even though I did double check it.
I'm going to post it as a reply to this one. It won't fit as one post because it's too long so I'll break it up into sections.
I actually did this several weeks ago but hadn't posted it yet, I thought it might be helpful, especially to folks who are close to testing so I wanted to get it posted.
Its important to identify health conditions that will influence exercise program development in the initial screening portion of the client-trainer interaction. Regularly update your client screening records to identify and effectively address changes in health status as they occur.
Obtain physician approval for client identified w/ medical and/or health condition before proceeding w/ exercise program development, testing, or training. Also request guidelines and limitations from clients physician (or other recommended health professional). Maintain close contact w/ appropriate health professional to have questions answered and provide status reports at predetermined intervals.
Rule of thumb :In general, clients w/ one or more of above characteristics should follow a low- or non-impact, low-intensity exercise program that progresses gradually. In many cases there are specific exercises or modifications to exercises that will enhance safety and effectiveness of the program.
CARDIOVASCULAR DISEASE: CAD results from atherosclerosis (narrowing of coronary arteries that supply heart w/ blood and O2)
Exercise Guidelines for CAD
Its best if clients w/ CAD first complete a supervised cardiac rehab program before starting a program w/ a personal trainer (inform clients of these programs, they should ask their physicians if participations is recommended).
A cardiologist (or other health professional) would provide an upper-limit heart rate, as well as guidelines and limitations to physical activity.
1. Low-risk cardiac clients should have stable cardiovascular/physiological responses to exercise. 2. Clients w/ two or more cardiac risk factors or history of cardiac disease must have physician release and referral to exercise. 3. All clients w/ documented CAD should have maximal graded exercise test (GXT) to determine functional capacity and cardiovascular status to establish safe exercise level. 4. Design clients exercise programs according to guidelines given by physicians (usually based on exercise test results, medical history, clinical status, and symptoms). 5. Exercise should not continue if any abnormal signs or symptoms are observed before, during, or immediately following exercise. If symptoms persist, activate the EMS.
Sample Exercise Recommendation:
Mode: Low-intensity endurance exercise (low-impact aerobics, walking, swimming, or stationary cycle as primary exercise mode). Avoid isometric exercises (the dramatically raise blood pressure and the work of the heart).
Weight training program: low resistance/high reps.
Client who has had cardiovascular event within the last month, follow these guidelines:
Intensity: RPE of 9-14 (6-20 scale), HR as low as 20 to 30 beats over resting heart rate and up to 40-75% of maximal HRR (Karvonen).
Duration: Total duration gradually increased to 20-30 minutes of continuous or interval training, plus additional warm-up/cool-down.
Frequency: 3-5 days per week.
Client who has been stable for at least 6 months follow guidelines for sedentary healthy adult:
HYPERTENSION: Related to development of CAD, increased severity of atherosclerosis, stroke, congestive heart failure, left ventricular hypertrophy, aortic aneurysms, and peripheral vascular disease. Hypertensive clients are 3-4 Xs at risk for developing CAD, up to 7 Xs risk for stroke. Exercise reduces SBP/DBP by average 10 mmHG. Reduces cardiac output and total peripheral resistance at rest and sympathetic activity.
Exercise guidelines: Consider these factors re: exercise for hypertensive: 1. Medical/clinical status; 2. Current medications; 3. Frequency, durations, intensity and mode of exercise individual is currently participating in; 4. How well the individual manages their hypertension.
1. Dont allow hypertensive clients to hold their breath or strain during exercise (Valsalva maneuver), exhale on exertion.
2. Weight training should supplement endurance training. Utilize circuit training rather than heavy weight lifting, and keep low resistance/high reps.
3. Use RPE scale to monitor intensity (because meds can alter accuracy of training heart rate).
4. Be aware of changes in medications, which should have written guidelines from clients physician (not all new meds require change in program).
5. Stop exercise if any abnormal signs or symptoms are observed before, during, or immediately following exercises. If they persist, activate EMS. If they stop, discontinue exercise until clients physician gives clearance.
6. Physicians may instruct patients to record blood pressure before/after exercise.
7. Instruct hypertensive clients to move slowly when getting up from floor (susceptibility to orthostatic hypotension-a drop in B.P. associated w/ rising to an upright position-due to medication).
8. Both hypertensive/hypotensive responses possible during/after exercise w/ hypertensive clients. Report either response to physician and get additional exercise guidelines
9. Monitor clients BP during exercise initially and possibly long term. Best measured during lower-body aerobic activity (stationary cycling) and resistance training (ex. Leg extension). Clients w/ more severe hypertension may be on meds that affect response to exercise.
10. Individuals w/ hypertension may have multiple CAD risk factors which should be considered when developing exercise program.
Sample Exercise Recommendations:
Mode: for mild-moderate hypertension is basically same for apparently healthy individuals. Endurance exercise: low-impact aerobics, walking, swimming as primary exercise mode. Avoided isometric exercise. Weight training with low resistance/high reps (12-20 initially)
Intensity: near lower end of HR range (40-65%).
Frequency: at least 4 times weekly. Elderly clients or those w/ low functional capacity may exercise daily for shorter durations.
Duration: Gradual warm-ups/cool-downs lasting longer than 5 minutes recommended. Gradually increase total duration to as much as 30-60 minutes per session, depending on medical history and clinical status of the individual.
Stroke affects arteries of the nervous system. Nerve cells are deprived of O2 because of blockage or rupture of blood vessel supplying blood to the brain, cells die within minutes. Risk factors for stroke include: high BP, heart disease, smoking ,high red blood cell count, and transient ischemic attacks (TIAs-momentary reductions in O2 delivery to the brain, causing possible sudden headache, dizziness, or blackout).
Note: risk factors for stroke are the same as CAD. Exercise may lesson the risk for stroke by reducing overall CAD risk. Hypertension is a primary risk factor for strokes, so exercise is primary lifestyle modification used for preventing them as well as being used for those recovering from a stroke. 70-80% of strokes are caused by a thrombosis (blood clot within intact blood vessel). Exercise may help enhance fibrinolytic activity (system responsible for dissolving blood clots).
For clients at risk for, or who have experienced, a stroke, follow same guidelines and recommendations for CAD and hypertension. Guidelines should ideally come from health care team w/ approval from clients personal physician.
PERIPHERAL VASCULAR DISEASE(PVD):
caused by atherosclerotic lesions in one or more peripheral arterial and/or venous blood vessels (usually in the legs). Common sites for these lesions include the iliac, femoral and popliteal arteries.
Most people w/ PVD are older w/ long established CAD risk factors.
Exercise is used to improve blood flow and functional capacity ( this is in addition to medications/medical procedures and surgery which are also used to treat PVD patients in various ways).
Note: PVD is 20 times more common in diabetics.
Its characterized by muscular pain caused by ischemia to the working muscles, usually the result of spasms or blockages (claudicating).
Pain may be experienced at rest. For others walking, cycling, or stair climbing can cause painful, intermittent claudication usually relieved by immediate rest. Use claudicating pain scale to help regulate exercise intensity, duration, and frequency.
Grade 1: Moderate discomfort/pain Grade 2: Moderate discomfort/pain from which clients attention can be diverted (by conversation). Grade 3: Intense pain to which the clients attention can not be diverted Grade 4: excruciating/unbearable pain.
Note: Exercise can improve peak work capacity for people w/ PVD.
Exercise guidelines for PVD: Complete medical evaluation necessary before starting an exercise program.
Focus on low-intensity, non-weight bearing activities. Use gradual progression and eventually additional activities may be added to program.
Other lifestyle modifications, such as diet and weight management, should be encouraged to lower overall CAD risk.
1. Encourage daily exercise w/ frequent rest periods to allow maximal exercise tolerance. 2. Initially, low-impact, non-weight bearing activities (swimming, rowing, cycling). Add weight bearing activities as exercise tolerance improves. 3. Avoid exercise in cold air/water to reduce risk of vasoconstriction. 4. Interval training (5-10 minute exercise bouts), 1-3 times per day, may initially be appropriate for some PVD clients. 5. Because many PVD clients are diabetic, foot care is essential to avoid infection (from blisters, other injuries). 6. PVD clients should ideally be closely supervised (ex. Cardiac rehab program). 7. Gradually increase time, duration, intensity. Degree of progress (absence or reduction of pain) will dictate how often and how much to increase these variables. As functional capacity improves, increase these factors accordingly. 8. Encourage PVD clients to walk as much and as often as they can tolerate.
Sample Exercise Recommendation:
Mode: Non-impact endurance exercise (swimming/cycling) may allow longer-duration/higher intensity exercise. Recommend weight bearing activities shorter in duration/lower in intensity w/ more frequent rest periods.
Intensity: Low intensity rather than high-intensity/high-impact exercises. PVD clients should go to point of moderate to intense pain (Grade 2-3 on claudication pain scale). As functional capacity improves, gradually increase the intensity.
Frequency: Daily exercise recommend initially. As functional capacity improves, reduce to 4-6 days per week.
Duration: Longer more gradual warm-up/cool-down (longer than 10 minutes) recommended. Gradually increase total exercise duration to 30-40 minutes.
DIABETES: Characterized by reduced insulin secretion by pancreatic beta cells and/or reduced sensitivity to insulin. Diabetes causes abnormalities in metabolism of carbohydrates, protein, and fat, if left untreated, can be deadly. Symptoms not always evident in early stages. Diabetics at greater risk for numerous health problems, including kidney failure, nerve disorders, eye problems, and heart disease, 2-4 times more likely to develop cardiovascular disease. Prolonged/frequent blood sugar elevation can damage capillaries (microangiopathy) that leads to poor circulation. Also diabetics at greater risk for permanent nerve damage.
Two types: Type 1 diabetes: destruction of insulin-producing beta cells in pancreas (little or no insulin secretion). Usually occurs in childhood, regular insulin injections required to regulate blood glucose levels.
Typical symptoms: excessive thirst/hunger, frequent urination, weight loss, blurred vision, and recurrent infections. During periods of insulin deficiency, higher than normal level of glucose remains in blood due to reduced uptake/storage. A portion of the excess glucose is excreted in urine (which leads to increased thirst, appetite and weight loss). Chronically elevated blood glucose levels is called hyperglycemia.
Type 2 diabetes: most common form (90% of diabetics). Usually in overweight adults. Characterized by reduced sensitivity of insulin target cells to available insulin (insulin resistance), where body is unable to use its own insulin efficiently.
Treatment usually includes diet modification, medication, and exercise therapy.
Type 2 diabetes is characterized by frequent states of hyperglycemia but w/o the increased catabolism of fats and protein. This condition is often reversible w/ permanent weight loss.
Type 1: glucose regulation thru regular glucose assessment, proper diet, exercise, and appropriate insulin medication. Type 2: glucose regulation thru lifestyle changes via proper diet, weight management, exercise, and insulin or oral agents if needed. Combined diet/exercise results in weight loss/weight control, improved circulation/Cardiorespiratory fitness, reduced need for insulin, improved self-image, better stress management.
Exercise and Type 1 Diabetes: exercise can improve functional capacity, reduce CAD risk, improve insulin receptor sensitivity and number.
Exercise and Type 2 Diabetes: reduces both cholesterol levels and weight. W/ excessive blood glucose elevation, blood fats rise to become primary energy source for the body. These higher than normal blood-fat levels put diabetics at greater risk for heart disease.
Exercise Guidelines for Diabetes: before beginning, clients should speak w/ physician or diabetes educator to develop program of diet, exercise and medication.
Type 1 primary goal of exercise: better glucose regulation/reduced heart disease risk. Timing of exercise, insulin amount injected, injection site important considerations before exercising.
Exercise should be performed consistently, so regular pattern of diet/insulin dosage maintained.
Ideally perform similar exercise routine every day within one hour of meal or snack.
Type 2 primary goal of exercise is weight loss and control. primary objective is calorie expenditure, best achieved by long duration-lower intensity exercise.
1. Check blood glucose levels often. Work w/ physician for correct dosage. 2. Always have rapid-acting carbohydrate in case of hypoglycemia. 3. Dont inject insulin into primary muscle groups used during exercise (absorbed to fast, therefore hypoglycemia). 4 .Exercise same time each day. 5. Avoid exercise during periods of peak insulin activity. 6. Consume carbohydrate snack before and during prolonged exercise. 7. Foot care critical (check for cuts, blisters, signs of infection). Also good quality exercise shoes are very important. 8. Check blood glucose level before/after exercise. Curtail exercise if preexercise levels below 100 mg/dL. W/ additional carbohydrate consumption, exercise may take place. Also curtail if preexercise blood glucose is greater than 300 mg/dL or greater than 240 mg/dL w/ urinary ketone bodies. Postpone in latter case until blood sugars under control. Clients should have specific guidelines in these situations based on clinical status and medical history w/ respect to blood glucose control. Sample Exercise Recommendation (Diabetes):
Mode: Endurance activities (walking, swimming, cycling) Intensity: 50-60% of cardiac reserve, gradually progress to 60-70%. Frequency: 4-7 days/week. Some may need to start w/ several shorter daily sessions. Duration: Type 1 diabetics should gradually work up to 20-30 minutes per session. Type 2 diabetics, 40-60 minutes best.
Special precautions for type 1 diabetics: Two potential problems during or following exercise: 1. Lack of insulin, which may cause hyperglycemic effect 2. Rapid mobilization of insulin, which dangerously lower blood glucose levels (hypoglycemia)
w/ Type 1 diabetic: either reduce insulin intake or increase carbohydrate intake before exercise. If pre-exercise blood glucose is below 100 mg/dL in clients taking insulin, they should consume 20-30 gms of additional carbs before exercise.
Clients w/ either type of diabetes should exercise 1-2 hours after a meal and before peak insulin activity. Because exercise has an insulin-like effect, insulin dosages generally should be lowered prior to exercise. Check blood glucose levels frequently when starting exercise program and be aware of any unusual symptoms prior to, during or after exercise.
Exercise and diabetes can cause autonomic neuropathy which may blunt HR response to exercise. Peripheral neuropathy may cause numbness in extremities, microvascular complication which may cause vision or kidney problems, and peripheral vascular disease (which may cause claudication)
ASTHMA: Reactive airway disease characterized by shortness of breath, coughing and wheezing.
Its due to: 1. Constriction of the smooth muscle around the airways, 2. Swelling of mucosal cells, and/or 3. Increased secretion of mucous.
It can be caused by an allergic reaction, exercise, infections, stress, or other environmental irritants (pollens, inhalants, cigarette smoke, air pollution).
80% of people w/ asthma have attacks during (and related to the intensity of and ventilatory requirement of) exercise (exercise-induced asthma (EIA) as well as the environmental conditions. These are not life threatening. Cold dry air vrs warm moist air causes greater airway obstruction.
People with asthma should work w/ their physicians to develop appropriate exercise programs.
Exercise guidelines: 1. Have medication/treatment plan to prevent EIA attacks. 2. Have bronchodilating inhaler at all times, use at first sign of wheezing. 3. Keep intensity low at first, gradually increase over time (intensity is directly linked to severity/frequency of EIA). 4. Reduce intensity if symptoms occur. 5. Using inhaler several minutes before exercise may reduce possibility of EIA attacks. 6. Use results of pulmonary exercise testing to design program. 7. Drink plenty of fluids before/during exercise. 8. Extend warm-up/cool-down periods. 9. Extreme environmental conditions(high/low temp, high pollen count, air heavy air pollution) cause more symptoms of respiratory distress. 10. Face mask during exercise may minimize asthmatic responses during exercise. 11. Clients w/ respiratory disorders need to be carefully followed by their physician. 12. Only clients w/ stable asthma should exercise. 13. If asthma attack not relieved by medication, activate EMS. 14. Mid to late morning is usually the best time for exercise for people w/ asthma. 15. Avoid extremes in temps and humidity.
Mode: Walking, cycling/swimming. Avoid upper body exercises w/ arm cranking, rowing, cross-country skiing (due to higher ventilatory demands) Intensity: low-intensity dynamic exercise based on fitness status and limitations. Frequency: at least 3-4 times per week. If low functional capacity or shortness of breath, use two 10 minute sessions. Duration: longer more gradual warm-up/cool-down (longer than 10 minutes). Gradually increase total exercise duration to 20-45 minutes.
BRONCHITIS AND EMPHYSEMA
Bronchitis: inflammation of bronchial tubes. Acute bronchitis is inflammation of mucous membranes as well. Emphysema: over-inflation of alveoli (from breakdown of walls of alveoli). Chronic breathlessness and coughing.
Both are referred to as chronic obstructive pulmonary diseases (COPD).
Exercise and COPD: Primary goals 1. Increase functional capacity. 2. Increase functional status. 3. Decrease severity of dyspnea 4. Improve quality of life.
Exercise Guidelines of COPD: 1. Complete extensive pulmonary test before starting. 2. Medical supervision necessary for unstable COPD. 3. Carefully choose exercise intensity and type to avoid developing shortness of breath. 4. Use exercise guidelines for asthma for COPD clients. 5. Dont exercise unless fully recovered from acute bout of bronchitis. 6. Have bronchodilating inhaler at all times, use at first sign of wheezing. 7. Individuals w/ COPD should Perform breathing exercises. 8. Initially avoid upper-body exercises (arm cranking/owing). Upper body resistance training gradually added . 9. Some clients may need supplemental oxygen during exercise as well as continuous ECG and BP monitoring. 10. Clients w/ COPD mustnt smoke. 11. Based on clients response to exercise, review type and dose of medications w/ their physicians. 12. If COPD clients performance worsens, encourage participation in pulmonary rehab program until signs and symptoms improve.
Sample Exercise Recommendation:
Mode: walking/stationary cycling. Avoid arm cranking, rowing, cross country skiing. Gradually add upper body resistance exercises. Intensity: low-intensity dynamic exercise (avoid high intensity, high impact exercise). Adjust intensity according to clients breathing responses to exercise. Keep intensity below point where any difficulty in breathing may occur. Frequency: at least 4-5 times per week. They may benefit from shorter, intermittent sessions. Duration: Long gradual warm-up/cool-down (more than 10 minutes). Gradually increase total duration to 20-30 minutes.
CANCER: Cancer mortality is higher in those who exercise the least even after age and smoking are considered. Exercise safe/beneficial as long as patient is able and has physician approval. They can improve overall aerobic capacity, neuromuscular function and quality of life via exercise.
5 Questions to ask before designing exercise program for clients w/ cancer.
Are there: 1. Limitations in activity based on preexisting conditions or medical procedures? 2. Limitations due to nutritional/fluid deficits? 3. Limitation in mobility due to disease or treatment? 4. Limitation in O2 delivery due to disease or treatment? 5. Limitations based on risk for anemia, bleeding and infections?
If any of above, get guidelines from clients healthcare professionals.
OSTEOPOROSIS: Premenopausal women should consume 1,000 to 1,5000 mg calcium per day. Weight bearing exercise either retards or increases bone mass.
Exercise guidelines: Greater physical stress and compression on a bone equals great rate of bone deposition. Use exercise guidelines and recommendations for older adults. Resistance training is an important component in the prevention of osteoporosis.
Avoid: jumping, high impact aerobics, jogging and running. Spinal flexion, crunches, rowing machines. Trampolines and step aerobics. Wood gym floors (slipper from sweat). Abducting/adducting legs against resistance (esp. machines), Moving legs sideways or across the body. Pulling on neck w/ hands behind the head.
LOW-BACK PAIN (LBP): Number 1 disability for people under age 45. Back pain/sprain is the most common workers compensation claim.
Four common causes: 1. Herniated disc,(rupture of outer layers of fibers surrounding gelatinous portion of disc), spondylolisthesis (forward sliding of body of one vertebra on vertebra below it), trauma to back (accident), degenerative disc disease .
Lower-back problems are often associated w/ an imbalance of strength and flexibility of the lower back and abdominal muscle groups. Poor flexibility in hamstrings and hip flexors also linked to LBP.
Major cause of LBP is physical reconditioning. More specifically low endurance in large muscle groups, esp the back extensor. Aerobic training and exercises for low-back should be performed on a regular basis as part of treatment and prevention of LBP.
Exercise guidelines for LBP: Client should be screen for LBP risk factors. If recent LBP strain or injury, physician clearance needed before exercise.
In addition to aerobic and resistance training, basic core back exercise should be performed. (table 12.2).
Avoid: Unsupported forward flexion, twisting at the waist with turned feet (esp. when carrying a load), lifting both legs simultaneously when in prone or supine position, and rapid movements such as twisting, forward flexion, or hyper extending.
Keep in mind the following:
1. Proper form and alignment. 2. Always maintain neutral pelvic alignment/erect torso during any exercise movements. 3. Avoid head-forward position (chin tilted up). 4. Always bend at the knees when leaning forward, lifting or lowering an object. 5. Avoid hyper extending spine in unsupported position. 6. Adequately warm-up/cool-down. 7. Most LBP caused by muscle weakness and imbalance in hamstrings, hip flexors, lower-back muscle groups and abs. Routinely use exercises to improve muscle strength and/or flexibility (table 12.2). 8. Advise clients w/ LBP or chronic back pain to consult w/ physician for specific exercise recommendations 9. If client has LBP after exercise have them sit or lie down in comfortable position and apply ice to affected area. Take a few days off from exercise if mild back strain.
ARTHRITIS: Two types: Rheumatoid arthritis (inflammation of membrane surrounding joint, often pain/swelling in one or more joints). Osteoarthritis (aka degenerative joint disease), cartilage wears away, leaving two surfaces of bone in contact w/ each other.
Avoid exercise during inflammatory periods.
There are 4 categories of functional capacity (see table 12.3): Individuals in Functional class 1: perform most activities a typical healthy person can. Class 2: non-weight bearing (cycling, warm water exercise, walking), Class 3: cycling or warm water aquatic program.
Fatigue and some discomfort may follow exercise. Achieve proper balance between rest, immobilization of affected joints, and appropriate exercise to reduce severity of the inflammatory joint disease.
Exercise Guidelines for Arthritis: 1. Low impact activities (stationary cycling, rowing, water fitness classes). 2. Begin w/ low intensity frequent session. 3. Reduce intensity/duration during inflammation or pain periods. 4. Extend warm-up/cool-down 5. Modify intensity/duration according to client response, changes in medications and level of pain. 6. Put all joints thru full ROM at least daily. 7. Take a day or two of rest if continued pain during or following exercise. If pain or discomfort more than 2 hours after workout, reduce intensity of future exercise. 8. Emphasize proper body alignment at all times. Use special precautions for those w/ hip replacement (lift knee no higher than hip level or 90 degrees flexion/toes straight ahead/no adduction past midline/need leg/hip abduction and lateral movements and strengthening). 9. Work just up to pint of pain but not past it. 10. Use isometric exercises. 11. If there is severe pain following exercise see physician. 12. Clients w/ rheumatoid arthritis shouldnt exercise during periods of inflammation, use regular rest periods during session. 13. Joint pain may limit clients more than cardiovascular function.
Sample Exercise Recommendation:
Mode: Non-weight bearing (cycling, warm water aquatic programs, swimming. Water temp 83 degrees to 88 degrees F.
Intensity: low-intensity, dynamic exercise (no high intensity/impact). Base it on clients comfort level before, during and after exercise.
Frequency: at least 4-5 times per week.
Duration: long, gradual warm-up/cool-down (more than 10 minutes). Initial exercise sessions no longer than 10-15 minutes).
OLDER ADULT: Someone may be 65 years old chronologically but may have a biological age of 45 based on fitness/health status.
Heart Rate: Maximal HR declines w/ age which diminishes accuracy of estimating training intensity based on HR. RPE more effective. Stroke volume can increase or be maintained which overcomes effect of lowered HR.
Blood Pressure: Usually high BP reading during Submaximal and maximal exercise. Endurance training can reduce mean BP and systemic vascular resistance in older individuals.
Cardiac Output and Stroke Volume: usually lower in older individuals. This effect may be countered w/ exercise.
Maximal Oxygen Uptake: w/ normal aging declines 8-10% per decade after age 30. Aerobic capacity can be improved at any age.
Bones: Weight bearing/resistance training help maintain bone mass.
Skeletal Muscle: significant strength gains in previously sedentary older adults can follow regular exercise program.
Body Composition: Changes are mostly due to decrease in muscle mass, BMR and lack of physical activity. Regular physical activity preserves lean body mass, decreases fat stores and stimulates protein synthesis, may reverse adverse changes in body composition due to aging.
Exercise Guidelines: See physician first. Principles of exercise design are similar to those for any group, w/ older participants a preexercise evaluation may need to include a complete medical history, a physical exam, and treadmill test. Combine endurance, flexibility, and balance training plus muscle strength and joint mobilization. Low impact advisable. Also, become more active in all daily activities and bend, move and stretch to keep joints flexible.
Older Adult: Sample Exercise Recommendation:
Mode: Endurance exercise: low impact aerobics, walking, cardio equipment, swimming should be primary mode. Weight training w/ low resistance and high reps.
Intensity: Lower end of HR range (40-65%)
Frequency: at least 4-5 times per week. Daily exercise w/ shorter duration for those w/ initial low functional capacity.
Duration: longer more gradual warm-up/cool down(more than 5 minutes) recommended. Gradually increase total duration to 30-60 minutes per session, depending on medical history and clinical status of client.
Special Precautions for Older Adults: Clients w/ high BP, heart disease or arthritis use particular care w/ weight-training exercises. Extended warm-up/cool-down (about 10-15 minutes). Extreme environmental conditions should be avoided. Elderly clients w/ arthritis or poor joint mobility should participate in non-weight bearing activities (cycling, swimming, and chair and floor exercises).
WEIGHT MANAGEMENT: Exercise w/ sensible eating plan equals best long-term weight-loss. Exercise can contribute up to 300-400 kcal deficit per session. Exercise helps maintain RMR and fat-free mass. Both strength training and aerobic exercise make greatest contribution when caloric intake doesnt go below 1,200 kcal per day. Exercise may help control appetite and improve psychological outlook.
Sample Exercise Recommendation:
Mode: Walking is highly effective for weight loss and control Walking, cycling and aerobic dance have better results than swimming, though key is to find safe ,effective and enjoyable activity to do regularly. Variety in aerobic modes has benefits in safety, effectiveness, and compliance.
Intensity: start low at first (as low as 40-50% of maximal HR). Increase intensity as fitness improves. RPE may be more useful than monitoring HR for determining intensity. Look for signs of too high intensity: excessive sweating, higher than normal breathing rate, joint pain, excessive fatigue, inability to complete session and flushed color.
Frequency: 5-6 days per week is ideal. Obese clients may need to start w/ as few as 2-3 days per week.
Duration: since most overweight clients wont be able to use high intensity, duration is essential exercise program variable, esp. at start. Longer duration equals greater caloric expenditure.
Resistance Training: helps overweight client maintain lean body mass w/ caloric restricted diet. Start beginners w/ one set of 8-12 reps of 6-10 exercises.
Some clients can progress to higher-intensity programs, others will benefit from a consistent and more moderate program. Variety in exercises should be incorporated for all clients regardless of intensity.
Keep weight loss goals reasonable. Body weight reductions of only 10% yield significant health benefits. 1-2 lbs weight loss per week is best w/ a sensible diet/exercise approach..
Try not to over-focus on weight loss, instead, support clients w/ making. healthy lifestyle changes.
EXERCISE AND CHILDREN: Children respond to exercise much as adults do.
Exercise Guidelines: Current recommendations are children and youth obtain 20-30 minutes of vigorous exercise daily. (table 12.5).
Sample Exercise Recommendation:
Mode: Sustained activities using large muscle groups (swimming, jogging, aerobic dance). Also recreational sports/fun activities that develop speed, power, flexibility, muscular endurance, agility and coordination).
Intensity: Start low and progress gradually. Use RPE.
Frequency: 2-3 days of endurance training allows time for other activities and will cause a training effect.
Duration: since children involved in a variety of activities during/after school, dedicate specific amount of time to endurance training. Gradually increase to 30-40 minutes per session. W/ younger children start w/ less time.
In order to minimize injury risk with resistance training: 1. Get medical clearance or instructions regarding physical needs. 2. Proper supervision 3. Make sure facility is safe for them. 4. Never perform single maximal lifts, sudden explosive movements or compete w/ other children. 5. Teach proper breathing. 6. Avoid broken/damaged or ill-fitting equipment. 7. Rest for about 1-2 minutes between each exercise (or more). Have scheduled rest days between each training day. 8. Drink plenty of fluids before, during and after exercising. 9. Tell them to communicate w/ coach, parent or teacher if tired, fatigued or injured.
EXERCISE AND PREGNANCY: Cardiac reserve is reduced in pregnant women. As pregnancy progresses, heart seems less able to adapt to increased demand, especially in supine position. Discourage high levels of exercise or activities that require sudden bursts of movement. Also, joint laxity due to hormone relaxin increases risk for injury. Be aware of ambient temperature prior to each workout. Increased body temp can harm fetus, esp. if core temp exceeds 100 degrees F (38 degrees C). Be conservative in hot humid environments since body temp regulation is more difficult.
Exercise Guidelines for Pregnant Women: During first trimester exercise should be without much difficulty and normal exercise program should be okay. Exercise in supine position performed w/ caution and possibly avoided after first trimester. Some forms of exercise (running) may be difficult during second and third trimesters due to increased body weight, edema, varicose veins, and increased joint mobility. Make decision to exercise in conjunction w/ physician and be carefully monitored by them.
Guidelines:
1. Discuss exercise goals w/ physician. 2. Dont begin vigorous program shortly before or during pregnancy. 3. Gradually reduce intensity, duration, and frequency of exercise during 2nd and 3rd trimesters. 4. Avoid exercise when temp and/or humidity is high. 5. Run or walk on flat, even surfaces. 6. Wear supportive shoes while walking or running. 7. If running becomes uncomfortable during 2nd and 3rd trimesters, try other aerobic exercise (swimming, running in water, bicycling). 8. Extend warm-up/coo-down periods. 9. Body temp not to exceed 100 degrees F. Take temp immediately after exercise. If it exceeds 100 degrees F, modify intensity and duration and exercise during cooler part of day. 10. Use RPE rather than HR. Intensity should be comfortable. Pounding HR, breathlessness, or dizziness are indicators to reduce intensity. 11. Eat small snack before to help avoid hypoglycemia. 12. Drink plenty of water before, during and after exercise. 13. Avoid overstretching or going beyond normal ROM. 14. Any unusual physical changes (vaginal bleeding, severe fatigue, joint pain, or irregular heart beats, call physician immediately!
Hi Scott, Great summary as usual- I was just going to study this chapter today- timing is perfect! I was so excited yesterday, I was scoring mostly 80% & 85% on the Ex, Etc tests !!! Yes! I'm getting there and feeling way more confident now.
I hope your neck is doing better, and you're taking it easy. Years ago I had a bulging disk in my lumbar spine that pressed on the nerve. It took a long time and I had to change my workouts, but it did heal up completely. Happy Independence Day everyone! Thanks again Nora for having setting-up this board- I honestly don't know where I would be without it!! You're ACEs girl (pun intended).
Hi Scott, Great summary as usual- I was just going to study this chapter today- timing is perfect! I was so excited yesterday, I was scoring mostly 80% & 85% on the Ex, Etc tests !!! Yes! I'm getting there and feeling way more confident now.
I hope your neck is doing better, and you're taking it easy. Years ago I had a bulging disk in my lumbar spine that pressed on the nerve. It took a long time and I had to change my workouts, but it did heal up completely. Happy Independence Day everyone! Thanks again Nora for having setting-up this board- I honestly don't know where I would be without it!! You're ACEs girl (pun intended).
Hi Vonni,
I'm glad this will be helpful, please let me know if you happen to notice any mistakes. It could probably be summarized into a more cliff notes format but I ran out of gas :)
Thanks for the well wishes on my neck, I appreciate it!
I have been thru this exact same thing before and I'm hoping my chiropractor can help me thru it again w/o me having to go thru more drastic measures. Either way, it would be great not to have to deal with this for the exam. I still have over a month so I feel optimistic about being good by then!
I'm sorry that you had to deal w/ that issue with your back, I'm sure that was pretty bad to deal with. In some ways I think lower back issues can be worse because they can really be debilitating. I'm glad you are okay from that!
I'm so happy to hear you're scoring so well on the exercise etc test, it definitely gets easier the more you do it and I can only imagine it'll help us on the exam (how could it not help right? :)).
I do something similar with the flash cards and the Home Study Course questions. It takes a LOT of time writing but I find it's a great tool for imbedding info into my brain. I write the information into an Excel spreadsheet. This way the questions can be organized in one column and the answers in the coresponding adjacent column. You can print out the sheets for studying anywhere in a format much more convenient than the bulky manual, etc. You can also self-test by hiding the answer column and writing your own answers from memory in the newly adjacent blank column, then unhide the original answer column and compare your results. I'd be pleased to send the file to you or anyone else interested. Best though to send it as an email attachment. As mentioned, it's a slow process, so I'm only up to Chapter 4 (Nutrition).
Thanks again. I know how much time it takes to do what you've done and it's great that you share.
Best of luck with resolving the neck problem. Keep us posted.
I do something similar with the flash cards and the Home Study Course questions. It takes a LOT of time writing but I find it's a great tool for imbedding info into my brain. I write the information into an Excel spreadsheet. This way the questions can be organized in one column and the answers in the coresponding adjacent column. You can print out the sheets for studying anywhere in a format much more convenient than the bulky manual, etc. You can also self-test by hiding the answer column and writing your own answers from memory in the newly adjacent blank column, then unhide the original answer column and compare your results. I'd be pleased to send the file to you or anyone else interested. Best though to send it as an email attachment. As mentioned, it's a slow process, so I'm only up to Chapter 4 (Nutrition).
Thanks again. I know how much time it takes to do what you've done and it's great that you share.
Best of luck with resolving the neck problem. Keep us posted.
Barry
Hi Barry,
That sounds like an intense process to compile the material that way, I appreciate you offering to share them.
I think I'll be okay because at this point I feel I pretty much have the material down. Based on what I've read about the test it seems like there's a lot of stuff that isn't based on mastery of the text so I don't know what to expect.
If you want, I have a LOT of summaries already done that might help you speed up your process (copying and pasting). I'd be happy to email them to you.
Yes! I'm getting there and feeling way more confident now. 
