NASM CPT 7th Edition Chapter 23: Chronic Health Conditions and Special Populations

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Chapter Goals:

• Find the exercise need and limitations for different populations.
• Be able to summarize the effects of chronic disease and the limitations and challenges of health, and how a client responds and adapts to exercise.
• Find the differences in exercise considerations for clients that have chronic disease risk factors for chronic disease, and other physical or health challenges. 
• Find the considerations that are taken to accommodate special populations when doing exercise.

Age Considerations

Youth are becoming less active than they were in the past, and this is likely due to the cost and demand on parents, the travel needed, and the concerns about getting injured when they are still young.

Youth applies for the ages of 6 and 20 years old. 

The current recommendations are that adolescents need 60 minutes or more of vigorous activity daily. 

Only around 25 percent of the youth actually get these recommended guidelines met.

Physiologic Differences Between Children and Adults

Peak oxygen uptake is seen as a major difference to take into account.

Submax oxygen demand is quite different as children are less efficient and often exercise at their peak oxygen uptake during Submax exercise compared to adults.

Children don’t produce sufficient glycolytic enzymes to sustain bouts of high-intensity exercise.

Children do not have good thermoregulatory systems, and there is a delayed response and limited ability to sweat in response to hot environments. 

Resistance Training for Youth

Resistance training is safe and effective for both children and adolescents. This form of training for youth and adolescents is proven to reduce the risk of injury compared to sports.

Untrained youth can improve their strength by around 30 – 40 percent in a mere 8 weeks. 

Basic Exercise Guidelines for Youth Training:

Mode – walking, jogging, games, resistance training, and water activity.

Frequency – 5 – 7 days each week

Intensity – moderate to vigorous cardio

Duration – 60 minutes each day

Fitness assessments – overhead squat, push up, cardiorespiratory.

Flexibility – all stretching modalities.

Resistance training – 1–2 sets of 8–12 repetitions at 40–70% intensity, 2–3 days per week. Progression of exercise programs should be reserved for mature adolescents based on dynamic postural control and physical capabilities.

Older Adults

Aging sees a lot of degeneration and loss of functional abilities of older adults. 

There are many things to look out for in older age, like blood pressure problems and osteoporosis.

Basic Guidelines for Older Adults

Mode – stationary and recumbent bikes, aquatic exercise, or treadmill with handrail support.

Frequency – 3 – 5 days per week of moderate intensity activities or 3 days each week of vigorous activity.

Intensity – 40 – 85% of Vo2 Peak

Duration – 30 – 60 minutes daily or 8 – 10 minute bouts.

Movement Assessments – Pushing, Pulling, Overhead squat

Flexibility – all, but some might not be tolerated

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Resistance Training – 1–3 sets of 8–20 repetitions at 40–80% intensity, 3–5 days per week. Exercise training should be progressed slowly, emphasizing executing ideal movement patterns and enhancing stabilization using appropriate core, balance, and resistance exercises before moving on to more advanced forms of exercise.

Special Considerations – Progression should be slow, well monitored, and based on postural control. Exercises should progress toward free sitting (no support) or standing if possible.

Obesity

This is the fastest growing health problem throughout the US and in most other industrialized countries in the world.

Body Mass Index

BMI is used to estimate the healthy weight ranges of individuals easily, but it comes at a risk of being inaccurate when considering people with excessive lean body mass. 

The BMI classifications are as follows:

• Underweight is a BMI of less than 18.5
• Healthy is a BMI of 18.5 – 24.9
• Overweight is a BMI of 25 – 29.9 
• Obese is a BMI of 30 – 34.9
• Obesity 2 is a BMI of 35 – 39.9
• Obesity 3 is a BMI of 40 or greater

Causes of Obesity

There are a variety of possible causes, but it is pretty much agreed that the root cause is a positive energy balance for a long amount of time. So, essentially this means the obese person consumes far too many calories than they expend. 

Obesity and Exercise Training

Regular activity is one of the more important factors that relate to long term success in losing weight. Many problems may arise in obese and overweight individuals, which should be addressed. 

Basic Guidelines for Individuals who are Overweight or Obese

Mode – Low impact cardio

Frequency – around 5 times per week

Intensity – 60–80% of maximum heart rate. Intensities may be altered to 40–70% of maximal heart rate if needed. Using the *talk test can help determine exercise intensity.

Duration  – 40 – 60 minutes daily, or 20 – 30 minute sessions twice daily.

Assessments – pushing, pulling, overhead squat

Flexibility – self-myofascial release and static, dynamic, and active stretching

Resistance Training – 1–3 sets of 10–15 repetitions on 2–3 days per week. Exercises performed in a circuit-training manner, with higher repetitions, such as 20, may be used if tolerated by the individual.

Diabetes

This is a metabolic disorder where the body does not produce insulin sufficient for the body to survive in the case of type one diabetes, and the body cannot respond to the insulin that is being made in the case of type two diabetes.

This is the seventh leading cause of death in the world now. 

Type one diabetes is one considered to be with the person from birth. 

Exercise and Diabetes

The focus for either of these types of diabetes is on the control of glucose in the body. For those with type two, the focus is also on losing weight and spending energy. 

Basic Guidelines for Individuals with Diabetes

Mode – low impact activity

Frequency – 4 – 7 days each week

Intensity – 50 – 90 percent of max heart rate

Duration – 20 – 60 minutes

Assessment – pushing, pulling, overhead squat

Flexibility – all forms of stretching are good 

Resistance Training – 1–3 sets of 10–15 repetitions, 2–3 days per week. Higher repetitions, such as 20, may be used.

Hypertension

Hypertension is a blood pressure that is greater than 120/80. 

The top number is the systolic blood pressure. This is the pressure in the arteries and other blood vessels when the heart is contracting.

The bottom number is the diastolic blood pressure. This is the pressure in the arteries and blood vessels when the heart rests or between the beats.

Normal blood pressure is one below 120/80

Elevated blood pressure is between 120 – 129, and diastolic under 80.

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Stage one hypertension is between 130 – 139 over 80 – 89.

Stage two hypertension is systolic of 140 or more and/or a diastolic of 90 or higher.

Basic Exercise Guidelines for People with Hypertension

Mode – stationary cycling, treadmill walking, rowers.

Frequency – 3 – 7 days each week

Intensity – 50–85% of maximal heart rate. Cardiorespiratory training can start as low as 40% of HR_max, if needed, and be progressed as tolerated.

Duration – 30 – 60 minutes

Assessment – pushing, pulling, overhead squat, and single-leg squat

Flexibility – static and active

Resistance Training – 1–3 sets of 10–20 repetitions, 2–3 days per week. Tempo should not exceed 1 second for isometric and concentric portions of the lift. Use circuit or peripheral heart action system (PHA) weight training as an option, with appropriate rest intervals.

Coronary Artery Disease

This is the leading cause of death and disability in both women and men, despite a reduction in the past years.

It is caused by plaque formation in the heart, leading to heart attack, angina, and other problems. 

The ratings of perceived exertion are quite useful for clients with this condition.

Basic Exercise Guidelines for People with Coronary Heart Disease

Mode – large muscle group activities

Frequency – 3 – 5 days each week

Intensity – Moderate-intensity exercise, 40% to 75% HR_max, and only progress with the physician’s advice. The talk test may also be more appropriate as medications may affect heart rate.

Duration – 5–10 minutes warm-up, followed by 20–40 minutes of exercise, followed by a 5- to 10-minute cool-down

Assessment – pushing, pulling, and overhead squat assessments

Flexibility – static and active stretching in seated or standing position

Resistance Training – 1–3 sets of 10–20 repetitions, 2–3 days per week. Tempo should not exceed 1 second for isometric and concentric portions. Use circuit or PHA weight training as an option, with appropriate rest intervals.

Osteoporosis

This is when the bones become porous and will break more easily. Exercise is an important part of trying to fight this occurring. 

Basic Exercise Guidelines for Individuals with Osteoporosis

Mode – treadmill with handrail support

Frequency- 2 – 5 days each week

Intensity – cardio starting at 40 – 65% of HR_max and progressing as tolerated

Duration – 20 – 60 minutes each day or 8 – 10 minute bouts

Flexibility – static and active

Resistance Training – 1 – 3 sets of 8 – 20 reps, 2 – 3 days each week

Arthritis 

This is an inflammatory condition that mainly affects the joints within the body. It is a chronic condition that is hard to avoid.

Basic Exercise Guidelines for Individuals with Arthritis 

Mode – treadmill, stationary cycling, rowers, step aerobics

Frequency – 3 – 5 days each week

Intensity – 40 – 65% HR_max and progressing as the client can

Duration – 30 minutes

Flexibility – all types

Resistance Training –  1 – 3 sets of 10 – 12 repetitions, 2 – 3 days per week

Cancer

This is one of the leading causes of death in the US and the World. Around 39% of people get diagnosed with it at some point in their life. 

Basic Exercise Guidelines for Individuals with Cancer

Mode – treadmill, stationary cycling, rowers, step aerobics

Frequency – 3 – 5 days each week

Intensity – 40 – 70% HR_max and progressing as the client can

Duration – 15 – 30 minutes

Flexibility – static and active

Resistance Training – 1 – 3 sets of 10 – 15 repetitions, 2 – 3 days per week

Exercise and Pregnancy

Pregnancy does not require as much halting of working out as people think it does. Especially when you have been active before pregnancy, you can typically continue with your program as it was.

Basic Exercise Guidelines for Women and Pregnancy

Mode – low impact step aerobics

Frequency – 3 – 5 days each week

Intensity – 40 – 70 percent of HR_max with an increase as tolerated 

Duration – 15–30 minutes per day. There may be a need to start out with only 5 minutes of exercise and progressively increase to 30 minutes, depending on the severity of the conditions.

Flexibility – self-myofascial, active, and static

Resistance training – 2–3 days per week, using light loads at 12–15 repetitions

Chronic Lung disease

Basic Exercise Guidelines for Individuals with Lung Disease

Mode – treadmill, stationary bike, steppers, and elliptical trainers

Frequency – 3 – 5 days each week

Intensity – 40 – 60 % peak work capacity

Duration – work up to around 20 – 45 minutes

Flexibility – static and active

Resistance – 1 set of 8–15 repetitions, 2–3 days per week. A PHA training system is recommended.

Intermittent Claudication and Peripheral Arterial Disease

Basic Exercise Guidelines for Individuals with Intermittent Claudication or PAD

Mode – treadmill walking, stationary bike, steppers, elliptical

Frequency – 3 – 5 days per week and eventually every day

Intensity – 50 – 85%  of HR_max

Duration – work to 30 or 30 minutes

Flexibility – static and active

Resistance Training – A circuit-training format is recommended