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- Know the guidelines and recommendations for each population group and condition throughout the chapter.
Working with Special Populations
Special populations are defined subgroups of the general population with some acute or chronic conditions that may or may not be pathological.
An easy example is comparing a child in adolescence and a pregnant woman. These two groups need entirely different guidelines for what would be healthy for them regarding physical activity.
Some individuals have a disease status that places them in more specific physical activity guidelines due to the constraints of their status.
Exercise professionals are entirely responsible for maintaining competency that is relative to the individuals they work with.
Oftentimes all of these conditions will have to have some form of medical clearance for training with a personal trainer.
Exercise and Asthma
Asthma is a chronic inflammatory pulmonary disorder that can cause recurrent spasmodic episodes and is characterized by hyperirritability or a reversible obstruction of the airways.
The disease is a COPD disorder that happens due to smooth muscle contractions and reactivity of the airways. These lead to bronchospasms.
The narrowing of the airways further worsens the swelling of the windpipe lining and increases mucus in the tract, which causes known difficulty with breathing.
Around 3,500 Americans die every year from asthma.
Symptoms of asthma include things such as shortness of breath, coughing, wheezing, and labored breathing.
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Exercise-induced asthma is a narrowing of the airways in the lungs as a response to strenuous physical activity. This could also be called exercise-induced bronchoconstriction.
Asthma is induced by several mechanisms, like allergens, chemical irritants, smoke, pollutants, and cold air.
Asthma can be managed effectively through preventative strategies, medication, and regular exercise.
Exercise needs to be introduced to asthmatics early on so they can have the psychosocial impacts lowered.
Hypercapnia is the excessive carbon dioxide levels in the blood, usually resulting from inadequate respiration.
Exercise effectively prevents many asthma problems; therefore, exploring the options for kids early on is a good idea.
Obesity carries a higher risk for asthma in adults, and it is a good thing to note that adults can see many of the improvements that kids see with exercise being introduced along with the presence of asthma.
Routine exercise participation is the key to reducing the occurrence and severity of exercise-induced asthma.
Some of the general recommendations for asthmatics are:
- Evaluate the training environment for common triggers of asthma
- Using a longer warm-up period can cool down to prevent quick-changing physiological conditions
- Swimming, cycling, and walking are less likely to trigger events than running
- Participation in sports that have stop-and-go activities is less likely to trigger EIA compared to long endurance activity
- 60 – 80% HRR is recommended for aerobics
- Steady-state endurance training is less likely to trigger responses than intervals.
- Encourage the use of controlled nasal breathing
- Keep the right medications on-site and have a plan for any emergencies
Diabetes and Exercise
Diabetes is a major health problem in America, and it has a rather bleak outlook seeing as the rate of diabetes has doubled in the last 20 years, and up to 14% of all Americans have the disease.
A high blood glucose level shows diabetes due to impaired sugar regulation of the body.
We have type 1 diabetes, which is genetic and must be controlled the whole life with insulin.
Type 2 diabetes is more common and is shown with insulin sensitivity and beta-cell dysfunction later in life. This is a form of diabetes that is caused by obesity, sedentary habits, and poor diet.
The main one that will be discussed is type 2 diabetes, the biggest problem resulting from entirely changeable lifestyle habits.
Physical activity plays a big role in improving the symptoms of diabetes.
The benefits of exercise for people with diabetes include:
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- Improved quality of life
- Improved glucose regulation
- Improved insulin sensitivity
- Improved muscular fitness
- Reduced loss of muscle mass
- Reduced risk for cardiovascular disease
- Reduced risk for peripheral vascular disease
- Reduced risk for heart attack and stroke
- Improved blood lipid profile
- Reduced visceral fat storage
- Improved cardiovascular fitness
A powerful predictor of mortality rate due to diabetes is the presence of low cardiorespiratory fitness.
Resistance training will also yield some great effects, and sometimes even more profound than aerobic training.
Glycosylated hemoglobin measures the amount of hemoglobin that glucose is bound to and shows long-term glucose control.
Type 1 diabetics can compete at elite levels with proper disease management.
Some general recommendations for type 2 diabetics are:
- Keep proper identification of the disease
- Avoid exercising when fasting glucose is over 200 mg/dL and ketosis is present
- Beware, fasting glucose is over 300 mg/dL without the presence of ketones
- Watch the blood glucose before and after exercise and know when changes to food and insulin are needed
- Track your glycemic response to exercise conditions for future reference
- Keep fast-acting carbs available during exercise
- Avoid high intensities when doing new exercises
Some general recommendations for those with type 2 diabetes:
- Keep the proper pre-exercise metabolic control
- Consume a good amount of fluids
- Perform regular activities every day of the week that you can
- Include activities appropriate for clients in terms of aerobic and anaerobic
- Focus on caloric expenditure and weight loss
- Start the exercise with the right acclimation periods
- Work up to intensities of 60 – 80% HRR
- Modify exercise for microvascular problems
Exercise and Cardiovascular Disease
Exercise is universally accepted as a component of cardiac rehabilitation and therapy for CVD.
It is proven to reduce the risks of comorbidities, which are the presence of additional diseases and disorders that happens along with the main disease.
Participation levels and recommended guidelines depend on specific disease-related factors like the progressive stage of the disease, degree of damage or symptoms, current physical status, and presence of other factors limiting health.
Hypertension is the presence of high blood pressure in the circulating arteries, and it is an epidemic in today’s world.
The general guidelines for individuals with hypertension are as follows:
- Aerobic exercise should happen for 40 – 60 minutes at an intensity of 50 – 75% Vo2 max for 3 – 5 days each week.
- The aerobic workouts do not have to be done in a single bout and can be split up throughout the day in intervals such as 10 minutes.
- Resistance training uses sets of 12 – 15 reps, preferably in a circuit style, while avoiding heavy training over 70% of one-rep max and holding one’s breath.
- Some other guidelines of importance are to remind clients to lower their salt intake, get enough potassium, reduce body weight when needed, and limit alcohol.
Coronary artery disease is one of the more common forms of heart disease and accounts for the most disease-related deaths in the US.
CAD is shown with narrowing, hardening, and blockage of the coronary vessels from plaque build-up.
Aerobic training is highly recommended as a form of therapy and prevention of furthering CAD.
Resistance training can help those with CAD by improving their muscle strength and endurance, increasing metabolism and overall function of the cardiovascular system, enhancing psychosocial well-being, and reducing cardiovascular disease risk factors.
The levels of resistance training that are best for clients will depend on the client’s status, cardiac stress tolerance, and comorbidities.
Heart rate, blood pressure, rate pressure product, and RPE scales should be utilized with these individuals.
General recommendations for Coronary Arter Disease:
- Aerobic exercise is a must
- People should accumulate 40 – 60 minutes of low-intensity aerobics as many days a week as possible.
- Use 10-minute warm-up and cool-down protocols
- Resistance training is highly recommended
- The resistance training should use closed-chain, bodyweight movements with just one set and 15 – 20 reps.
- Circuits are a good idea for training
- It is important to measure the cardiovascular measures and RPE scales
- Flexibility requires a focus on breathing properly
- Heavy resistance training needs to be avoided
Congestive heart failure is due to the enlargement of the left ventricle and central portion of the heart as a response to CAD and strain against peripheral vascular resistance.
Both aerobic and resistance training is going to be recommended for these clients as well.
Some general recommendations for CHF:
- Short bouts of aerobics at the peak of 40 – 50% O2 capacity should be done several times daily for 3 – 5 minutes per session.
- Appropriate aerobic exercise programs can improve circulation throughout the body, increase the capacity of the heart to pump blood and enlarge the heart.
- Resistance training at intensities of just 50 – 60% of one-rep max is recommended., with longer rest intervals than normal clients.
- The RPE scale is helpful and counters the common medicines seen.
- Excessive stress should be avoided
Exercise During Pregnancy
Physical activity is very beneficial for expectant mothers.
Some of the main benefits seen with moderate exercise during pregnancy are:
- Improvements in cardiorespiratory fitness
- Reduction in weight gain
- Reductions in the discomfort of the musculoskeletal system
- Reductions in compromised posture
- Decreases in incidence and severity of varicose veins and thrombosis
- Reductions in preterm birth
- Less complication in delivery and potentially shorter length of delivery
- Improved glucose tolerance
Reductions in the risk for complications during pregnancy are a major reason to participate in physical activity.
Aerobic physical activity in pregnancy can be beneficial in keeping the baby’s birth weight in the normal range.
The level of training that is defined as correct for a pregnant woman is specific to the individual and based on many physiological and genetic factors.
General recommendations during pregnancy:
- Consult the primary healthcare provider before starting an exercise program.
- Always keep an adequate hydration level and ensure correct caloric intake during pregnancy and lactation.
- Stop the exercise when excessive fatigue is experienced.
- Adjust intensities according to the decreases in the O2 reserve
- Beware of laxity in the joints during the selection of activity
- Report any vaginal spotting, bleeding, and other major symptoms to your healthcare provider.
- Avoid all dangerous activities and high-risk training in general during high-risk pregnancies.
Children and Exercise
The prevalence of overweight and obesity has increased dramatically in adults, and a similar result has occurred in children and adolescents.
The number of children that are overweight has doubled since the 70s.
Overweight children and adolescents are at a higher risk for many health problems and are put into a category of risk later in life due to poor habits in childhood.
Some overweight children and adolescents are at risk for health problems like cardiovascular disease, high blood pressure, high cholesterol, type 2 diabetes, hepatic steatosis, and sleep apnea.
It is important to participate in physical activity at a young age routinely.
General guidelines for aerobic training for adolescents:
- Children can train at steady-state levels like adults
- Avoid extended periods of activity
- Children can perform short bouts of intense aerobics intermittently
- Emphasize the enjoyable activities that stimulate play
- Be aware of overheating and make sure children remain well-hydrated
General recommendations for anaerobic training for children:
- These activities can start when children enter organized sports
- Higher rep schemes are more effective for children before puberty
- Encourage proper technique and motor learning
- Two sets are sufficient for strength and endurance
- Multi-joint activities for motor skill development are preferred over isolated training
- Children should preferably not live greater than their 8-rep max.
- Progressive overload should involve increasing reps instead of load
Exercise and the Elderly
Age causes some loss in physiological ability, which has something to do with the decline in physical function.
Elderly people are more susceptible to hypertension, CAD, diabetes, obesity, osteoporosis, depression, and limitations related to structural changes in connective tissues.
Resistance training is seen to have the greatest ability to slow the age-related declines in function.
Some movements with a range of motion limitations are seen in trunk extension, trunk rotation, shoulder flexion, and external humeral rotation.
Some general recommendations for resistance training are:
- 2 – 3 sessions per week done with 8 – 10 exercises with 10 – 15 reps
- Encourage the use of functional activities with a full range of motion
- Healthy older adults can perform heavy resistance training but need to avoid holding their breath and using isometrics
Some general recommendations for aerobic training are:
- Deconditioned elderly people should accumulate 30 – 40 minutes in 10-minute sessions on as many days of the week as possible. This should be at 50 – 60% HRR
- For healthy older adults, 60 – 80% HRR for 30 – 60 minutes is good
Some general recommendations for flexibility training are:
- Static stretching through pain-free ranges of motion should be done 2 – 3 times per week with 2 – 3 sets of 10 – 15 sec holds
- Proper breathing is to be encouraged
- The dynamic range of motion activities should be used for 2 – 3 sets of 10 – 15 reps
- Use spinal extension and outward rotation activities