NASM CPT 7 Chapter 23

BMI chart

<18.5 Increased Underweight 18.5-24.9 Low Healthy weight 25.0-29.9 Increased Overweight 30-34.9 High Obese 35.0-39.9 Very high Obesity II ≥40 Extremely high Obesity III

valsava manuever

A process that involves expiring against a closed windpipe, creating additional intra-abdominal pressure and spinal stability

Considerations for Health and Fitness, Sport, and Athletic Training

A program of continuous, lower-intensity (50-85% of work capacity) aerobic exercise is initially recommended. Frequency and duration parameters should be at a minimum 3-5 days per week, 20-45 minutes per day, with additional increases in overall volume of exercise if weight loss is also desired. Resistance exercise should consist of a peripheral heart action or circuit-training style. Avoid Valsalva maneuvers (holding breath), emphasize rhythmic breathing and a program design for muscular fitness (e.g., 1-3 sets of 8-10 exercises, 10-20 reps, 2-3 days per week). Screening for comorbidities is important. Exercise should target a weekly caloric goal of 1,500-2,000 kcal, progressing as tolerable, to maximize weight loss and cardio protection.

fact

Aging is synonymous with degeneration and loss of functional ability in older adults. Typical forms of degeneration associated with aging include osteoporosis, arthritis, degenerative low-back pain, and obesity (Demontiero et al., 2012). Special considerations for those chronic conditions associated with aging will be addressed later;

need to know

Although medications have been shown to be highly effective, comprehensive lifestyle changes, including regular physical activity, healthy eating, and smoking cessation, have also been shown to reduce blood pressure, potentially eliminating the need for medications or lending to reduced dosing

need to know

Another disease-related cause of hypertension is peripheral vascular disease, which refers to plaques that form in any peripheral artery, typically those of the lower leg. Individuals with diagnosed hypertension should be carefully monitored and referred to a physician if their blood pressure continues to rise or if they have other risk factors for heart disease.

need to know

BMI is defined as total body weight in kilograms divided by the height in meters squared. For example, a client with a body weight of 200 lb (91 kg) and height of 70 in. (178 cm, or 3.16 m2) would have a BMI of 28.79 (91 kg/3.16 m2). Because BMI does not actually measure body fat percentage, other techniques, such as bioelectrical impedance or circumference measurements, may be performed to assist in developing realistic weight-loss goals and to help provide feedback to clients.

fact

Approximately 40% of Americans aged 20 years and older are obese (Hruby & Hu, 2015). Obesity is a complex disease and can be associated with a variety of chronic health conditions as well as emotional and social problems.

need to know

As populations age, dealing with issues such as mortality, longevity, and quality of life becomes a greater focus. The upward drift in average age has significant implications for fitness professionals as well. As the role of exercise to help improve and maintain functional independence becomes more widely known and accepted, opportunities for Certified Personal Trainers will continue to increase.

fact

Because of their relatively high peak oxygen uptake levels, children can perform endurance activities fairly well. However, children do not tolerate exercise in hot, humid environments because they have higher submaximal oxygen demands and a lower absolute sweating rate when compared with adults. Vigorous exercise in hot, humid environments should be restricted to less than 30 minutes for children, including frequent rest periods.

Physiologic Considerations

Blood pressure response to exercise may be variable and exaggerated, depending on the mode and level of intensity. Despite medication, clients may arrive with pre-exercise hypertension. Hypertension frequently is associated with other comorbidities, including obesity, cardiovascular disease, and diabetes.

physical activity readiness questionnarie plus

Certified Personal Trainers can make a dramatic impact on the overall health and well-being of older adults. Before initiating any exercise training, older adults must complete a

fact

Chronic hyperglycemia is linked with a number of diseases associated with damage to the kidneys, heart, nerves, eyes, and circulatory system. Although individuals with type 2 diabetes do not experience the same fluctuations in blood sugar as those with type 1, it is still important to be aware of the symptoms, particularly for individuals with type 2 diabetes who use insulin medications.

fact

Current recommendations state that children and adolescents should get 60 minutes (1 hour) or more of moderate to vigorous physical activity daily. Unfortunately, there is a youth physical inactivity crisis, especially in many Western countries. For example, in the United States, only 25% of youth participate in the minimum guidelines necessary for improving and maintaining overall health and well-being

fact

Degenerative processes associated with aging can lead to a decrease in the functional capacity of older adults, including potentially significant reductions in muscular strength and endurance, range of motion or mobility, cardiorespiratory fitness, and proprioception (

fact

For effective weight loss, obese clients should expend 200-300 kcal (calories) per exercise session, with a minimum weekly goal of 1,200 kcal of energy expenditure from combined physical activity and exercise. The initial exercise energy expenditure goal should be progressively increased to 2,000 kcal per week

exercise progressions for kids

Exercise progressions should be determined based on the youth client's maturity level, dynamic postural control (flexibility and stability), and response to training up to this point. One of the most important aspects to consider when designing and implementing exercise training programs for youth is to make it safe and fun.

obesity training

Exercise training for obese clients should focus primarily on energy expenditure, through a combination of core, balance, cardiorespiratory, and resistance training, to help them expend calories and improve their balance and gait mechanics. In doing so, more calories are potentially expended

signs of hypoglacemia

Fatigue Pale clammy skin Irregular heart rate Sweating Shaky, unstable feeling Extreme hunger

need to know

Fitness professionals should always ensure that clients with hypertension try to breathe normally and avoid the Valsalva maneuver or overgripping (squeezing too tightly) when using exercise equipment, as this can dramatically increase blood pressure. Fitness professionals should also monitor clients with hypertension carefully when rising from a seated or lying position, as they may experience dizziness.

important

Fitness professionals should ensure that the client is breathing correctly during resistance training exercises and avoids straining during exercise or squeezing exercise bars too tightly, which can cause an increase in blood pressure

Physiologic Considerations for people with diabetes

Frequently associated with comorbidities (including cardiovascular disease, obesity, and hypertension) Clients taking beta-blocking medications may be unable to recognize signs and symptoms of hypoglycemia. Exercise in excessive heat may mask signs of hypoglycemia.

need to know

Hypoglycemia is a condition that occurs when blood glucose becomes too low to support normal physiological functioning. Symptoms of hypoglycemia generally occur when blood glucose levels fall below 70 mg/dL. Identifying signs and symptoms of hypoglycemia is the first step to help correct a hypoglycemic event

fact

In addition, it is recommended that obese clients engage in weight-supported exercise (such as cycling or swimming) to decrease orthopedic (joint) stress. However, walking is often both a preferred activity for many obese clients and one that is easily engaged in and adhered to. Thus, if the benefits of walking, particularly adherence, exceed the observed or perceived risk of an orthopedic injury, walking may be a primary exercise recommendation

implicatications of health and fitness training for older adults

Initial exercise workloads should be low and progressed more gradually to 3-5 days per week. Duration = 20-45 minutes Intensity = 45-80% of VO2 peak Resistance exercise is recommended, with lower initial weights and slower progression (e.g., 1-3 sets of 8-10 exercises, 8-20 reps, session length equals 20-30 minutes). Exercise modalities should be chosen and progressed to safeguard against falls. Cardio options include stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support. Resistance options include seated machines, progressing to standing exercises.

consideration for health and fitness when training an obese person

Initial screening should clarify the presence of potential undiagnosed comorbidities Consider testing and training modalities that are weight supported (such as cycle ergometer, swimming, water aerobics). If a client does not have these limitations, consider a walking program to improve compliance nitial programming should emphasize low intensity, with a progression in exercise duration (up to 60 minutes as tolerable) and frequency (5-7 days per week), before increases are made in intensity of exercise

important to know as a trainer

It is important to monitor the body position of clients with hypertension at all times throughout an exercise training session. As with obese and diabetic clients, body position can have a dramatic effect on blood pressure response before, during, and after exercise in clients with hypertension. Supine or prone positions (especially when the head is lower in elevation than the heart) can often increase blood pressure, and as such, these positions may be contraindicated.

physiological considerations for older adults

Maximal oxygen uptake, maximal exercise heart rate, and measures of pulmonary (lung) function will all decrease with increasing age. Percentage of body fat will increase, and both bone and lean body mass will decrease with increasing age.Balance, walking mechanics, and neuromuscular coordination may be impaired.

what will be affected when youre older

Maximum attainable heart rate Cardiac output Muscle mass Balance Coordination (neuromuscular efficiency) Connective tissue elasticity Bone mineral density Anabolic hormones

physiological considerations when training an obese person

May have other comorbidities (diagnosed or undiagnosed), including hypertension, cardiovascular disease, or diabetes.Maximal oxygen uptake and ventilatory (anaerobic) threshold is typically reduced Coexisting diets may hamper exercise ability and result in significant loss of lean body mass.

basic guideline for training someone is who overweight or obese

Mode Low-impact (such as treadmill walking, rowing, stationary cycling, and water activity) Frequency At least 5 days 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 be helpful to determine exercise intensity. Duration 40-60 minutes per day, or 20- to 30-minute sessions twice each day Assessment Pushing assessment Pulling assessment Overhead squat assessment (if tolerated) Flexibility Self-myofascial techniques (only if comfortable to client) Static, active, and dynamic stretches

basic guidelines for training someone with diabetes

Mode Low-impact activities (such as cycling, treadmill walking, swimming) Frequency 4-7 days per week Intensity 50-90% of maximum heart rate Cardiorespiratory training (may be adjusted to 40-70% of maximal heart rate if needed) Duration 20-60 minutes Assessment Pushing assessment Pulling assessment Overhead squat (if tolerated) Flexibility Static, active, or dynamic stretches Resistance Training 1-3 sets of 10-15 repetitions, 2-3 days per week

basic guidelines for people with hypertension

Mode Stationary cycling, treadmill walking, rowers Frequency 3-7 days per week Intensity 50-85% of maximal heart rate Cardiorespiratory training can start as low as 40% of HRmax, if needed, and be progressed as tolerated. Duration 30-60 minutes Assessment Pushing assessment Pulling assessment Overhead squat assessment Single-leg squat assessment (if tolerated) Flexibility Static and active in a standing or seated 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 of the lift.

basic guidelines for youth training

Mode Walking, jogging, running, games, activities, sports, water activity, resistance training Frequency 5-7 days per week Intensity Moderate to vigorous cardiorespiratory exercise training Duration 60 minutes per day Fitness Assignments Overhead squat assessment Push-up assessment Cardiorespiratory assessments Flexibility Self-myofascial techniques; static, active, and dynamic stretching 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 Special Considerations Progression for the youth population should be based on postural control and not on the amount of weight that can be used

fact

Normal blood pressure is less than 120/80 mm Hg. Elevated blood pressure is 120-129 mm Hg (systolic) and less than 80 mm Hg (diastolic). Stage 1 hypertension is 130-139 mm Hg (systolic) or 80-89 mm Hg (diastolic). Stage 2 hypertension is 140 mm Hg or higher (systolic) or 90 mm Hg or higher (diastolic). A hypertensive crisis is greater than 180 mm Hg (systolic) and/or 120 mm Hg or higher (diastolic).

physchosical aspects of working with obese clients

Obesity can alter the emotional and social aspects of a person's life as much as it does the physical aspects. Fitness professionals must be very aware of the psychosocial aspects of obesity when training obese clients to ensure that the client feels socially and emotionally safe. Such attention to their emotional and physical well-being will help create trust between the client and fitness professional and assist the client in adhering to a weight-loss and exercise program.

need to know

One of the most important and fundamental functional activities affected by degenerative aging is walking. The decreased ability to move freely in one's own environment not only reduces the physical and emotional independence of an individual but also can lead to an increase in the degenerative cycle

age considerations

Participation in organized youth sports is declining in certain areas, and youths as a whole are becoming more sedentary. Some of the possible reasons for a decline in sport participation may include high costs and demands on parents, lots of travel, and concerns over injury (Merkel, 2013). Consequently, there is a significant need for increased awareness and access to fitness training for youth year-round, not just during one or more sport seasons.

physiological difference between adults an kids

Peak oxygen uptake: Because children do not typically exhibit a plateau in oxygen uptake at maximal exercise, the term peak oxygen uptake is a more appropriate term than VO2max or maximal oxygen uptake. Adjusted for body weight, peak oxygen consumption is similar for young and adult males and slightly higher for young females (compared with adult females). A similar relationship also exists for force production or strength. Submaximal oxygen demand (or economy of movement): Children are less efficient and tend to exercise at a higher percentage of their peak oxygen uptake during submaximal exercise compared with adults. Children do not produce sufficient levels of glycolytic enzymes to be able to sustain bouts of high-intensity exercise. Children have immature thermoregulatory systems, including both a delayed response and limited ability to sweat in response to hot, humid environments.

special considerations

Progression should be slow, well monitored, and based on postural control. Exercises should be progressed if possible, toward free sitting (no support) or standing. Make sure the client is breathing in a normal manner and avoids holding their breath, as in a Valsalva maneuver. If the client cannot tolerate self-myofascial techniques or static stretches, they can opt for slow and controlled active and dynamic stretches.

need to know

Published guidelines on youth fitness and exercise have previously focused on sport-specific training. However, given the increase in childhood obesity and diabetes, current youth fitness guidelines now focus on promoting healthy lifestyles and health-related physical fitness

resistance training for youth

Research has demonstrated that resistance training is both safe and effective in children and adolescents (Lloyd et al., 2014). Resistance training for health and fitness conditioning in youth also results in a lower risk of injury when compared with many popular sports, including soccer, football, and basketball

fact

Research has shown that exercise improves a variety of glucose measures, including tissue sensitivity, glucose tolerance, and insulin requirements (Moore et al., 2016; Thent et al., 2013). Thus, exercise has been shown to have a substantial positive effect on the treatment and prevention of type 2 diabe

Considerations in Sport and Athletic Training for people with diabetes

Screening for comorbidities (presence of two chronic diseases) is important. Substantial insulin dose reduction may be necessary before exercise. Carbohydrate intake before and during exercise may be necessary. Initial exercise programming should emphasize low intensity, with a progression in exercise duration (up to 60 minutes as tolerable) and frequency (5-7 days per week). for consistent glucose control. Intensity should be no greater than 50-90% of work capacity to start with.

hyperglacemia (high blood sugar)

Type 1 diabetes is typically diagnosed in children, teenagers, or young adults. With type 1 diabetes, specialized cells in the pancreas called beta cells stop producing insulin, causing blood sugar levels to rise, resulting in

basic exercise guideline for older adults

Stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support Frequency 3-5 days per week of moderate-intensity activities or 3 days per week of vigorous-intensity activities Intensity 40-85% of VO2 peak Duration 30-60 minutes per day or 8- to 10-minute bouts MovementAssessment Pushing assessment Pulling assessment Overhead squat (if tolerated) Flexibility Self-myofascial techniques using a handheld roller (if tolerated), static stretching, slow and controlled active or dynamic movement Resistance Training 1-3 sets of 8-20 repetitions at 40-80% intensity, 3-5 days per week

need to know, important

The American College of Cardiology and the American Heart Association have updated blood pressure guidelines to state normal blood pressure to be less than 120/80 mm Hg. Elevated blood pressure is 120-129 mm Hg systolic and less than 80 mm Hg diastolic. Stage 1 hypertension is now 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic, whereas stage 2 hypertension is now 140 mm Hg or higher (systolic) or 90 mmHg or higher (diastolic). A hypertensive crisis involves a systolic reading greater than 180 mm Hg and/or a diastolic reading greater than 120 mm Hg.

need to know

The World Health Organization (2010) recommends that children ages 5 to 17 years get 60 minutes of moderate to vigorous physical activity and exercise daily.

injuries can occur regardless

The most common injuries associated with resistance training in youth are injury to ligaments (sprains) and injury to tendons or muscles (strains), which are usually attributable to a lack of qualified supervision, poor technique, and improper progression (Lloyd et al., 2014). Injuries can and do occur in youth participating in any activity or sport, including resistance training

need to know

The most important goal of exercise for individuals with either type of diabetes is glucose control, and for those with type 2 diabetes, weight loss and energy expenditure.

Physiologic Considerations for people with chd

The nature of heart disease may result in a specific level of exercise that would be dangerous to go beyond.Clients with heart disease may not have angina or other warning signs.

important info

The primary cause of CHD is poor lifestyle choices—primarily cigarette smoking, poor diet, and physical inactivity (Esselstyn, 2017). From a medical standpoint, the emphasis on treating CHD is centered on improving the health of the internal lining of the coronary artery, called plaque stabilization. The other primary focus on the treatment of CHD is through medical management, including pharmaceuticals, as well as aggressive lifestyle intervention, including healthier food choices, more exercise, smoking cessation,

Considerations for Health and Fitness, Sport, and Athletic Training for chd

The safe upper limit of exercise, preferably by heart rate, must be obtained. Heart rate should never be estimated from existing prediction formulas for clients with heart disease; consult their physician. Clients must be able to monitor pulse rate or use an accurate monitor to stay below the safe upper limit of exercise.Although symptoms should always supersede anything else as a sign to decrease or stop exercising, some clients may not have this warning system, so monitoring heart rate becomes increasingly important.

fact

The term youth refers to children and adolescents between the ages of 6 and 20 years. Although a group of children or adolescents may be the same age, their response to exercise can vary considerably as a result of individual differences in growth, development, and physical maturation.

physiological difference between adults and kids

There are fundamental physiological differences between children and adults. Although youth may experience similar effects of exercise training as adults, they do not respond, adapt, or progress the same. Youth exercise training programs should progress specific to their physiologic capabilities. Fitness professionals should be aware of important physiologic differences between youth and adults that impact their response and adaptation to exercise.

need to know

There are two primary forms of diabetes: type 1 (insulin-dependent diabetes) and type 2 (noninsulin-dependent diabetes). Although type 2 is referred to as noninsulin-dependent diabetes, some individuals with type 2 diabetes cannot manage their blood glucose levels and do require additional insulin. Type 2 diabetes is strongly associated with an increase in childhood and adult-onset obesity.

Considerations for Health and Fitness for people with diabetes

Type 2 diabetes exercise program should target a weekly caloric goal of expending 1,000-2,000 kcal, progressing as tolerable, to maximize weight loss and cardio protection.Some reduction in insulin and increase in carbohydrate intake may be necessary and proportionate to exercise intensity and durationPostexercise carbohydrate consumption is advisable.

fact and need to know

Untrained children can improve their strength by an average of 30% to 40% or more after 8 weeks of progressive resistance training (Lloyd et al., 2014). Resistance training in youth has also been shown to improve motor skills, such as sprinting and jumping, body composition, and bone mineral density

atherosclerosis

caused largely by poor lifestyle choices—restricts blood flow as a result of plaque buildup within the walls of arteries thus leading to increased resistance and blood pressure.

fact

Worldwide, the occurrence of diabetes has risen from 108 million in 1980 to 422 million in 2014 (World Health Organization, 2018a). It has been shown that people who develop diabetes before the age of 30 years are 20 times more likely to die by the age of 40 years than those who do not have diabetes

core and balance training

are also important for this population because they tend to lack balance and walking speed, both of which are important for exercise. Fitness professionals must use caution when placing an obese client in a prone (on stomach) or supine (on back) position because they are susceptible to both hypotensive (low blood pressure) and hypertensive (high blood pressure) responses to exercise

flexibility

assessment and training are also important considerations with older adults because they tend to lose the elasticity of their connective tissue, which reduces movement and increases the risk of injury. Self-myofascial techniques

type 2 diabetes

associated with obesity, particularly abdominal obesity (Caspard et al., 2017). The incidence and prevalence of adult type 2 diabetes across the globe has increased sharply in recent years. There is a significant public health concern about the rising incidence of type 2 diabetes in children, associated with both the increase in abdominal obesity and decrease in voluntary physical activity. I

low to moderate intensity

cardiorespiratory training is recommended for this population. However, older adults taking certain prescribed medications and those with other chronic health conditions must be carefully monitored. Exercise training should be progressed slowly—with an emphasis on executing ideal movement patterns and enhancing stabilization using appropriate core, balance, and resistance exercises—before moving on to more advanced forms of exercise.

Coronary Heart Disease (CHD)

emains the leading cause of death and disability for both men and women despite a significant reduction in death rates from CHD in recent years (Mensah et al., 2017). CHD is caused by atherosclerosis (plaque formation), which leads to narrowing of the coronary arteries and ultimately angina pectoris (chest pain), myocardial infarction (

hypoglacemia(low blood sugar)

f the individual with type 1 diabetes does not control their blood glucose levels before, during, and after exercise, blood sugar levels can drop rapidly and cause a condition called

need to know

hildren are at a disadvantage when participating in short-duration (10 to 90 seconds), high-intensity anaerobic activities because they produce less glycolytic enzymes that are required to support sustained anaerobic power

arteriosclerosis

is a normal physiologic process of aging that results in arteries that are less elastic and pliable, which in turn leads to greater resistance to blood flow and thus higher blood pressure (hypertension), which will be discussed later in this chapter.

obesity

is the fastest growing health problem in America and in most all other industrialized countries. In fact, obesity has nearly tripled worldwide since 1975 (World Health Organization, 2018b). At present, 72% of Americans older than the age of 20 years are either overweight or obese.

Body Mass Index (BMI)

is used to estimate healthy body-weight ranges based on a person's height. Because it is simple to measure and calculate, it is the most widely used assessment tool to identify individuals who are underweight, overweight, and obese.

need to know

machines are often not designed for obese individuals and may require a significant amount of mobility to get in and out of. Dumbbells, cables, or exercise tubing exercises work quite well instead of machines. The use of self-myofascial techniques performed on the floor should be done with caution, or avoided altogether, as some obese clients may not feel comfortable performing these flexibility techniques.

important

n contrast to walking being a highly preferred form of exercise for obese clients, care must be taken when recommending walking to clients with diabetes to prevent blisters and foot microtrauma that could result in foot infection

fact

o control this hyperglycemia, the individual with type 1 diabetes must inject insulin to compensate for what the pancreas cannot produce. Exercise increases the rate at which cells use glucose, which may mean that insulin levels may need to be adjusted with exercise.

causes of hypertension

ome of the most common causes of hypertension include smoking, sedentary living, alcohol abuse, and excess weight. The health risks of hypertension are well known and include increased risk for stroke, cardiovascular disease, heart failure, and kidney failure.

hypertension

or high blood pressure, is a common medical disorder in which arterial blood pressure is above 120 mm Hg for systolic and 80 mm Hg for diastolic. A client is considered to have

fact

research has shown that musculoskeletal degeneration may not be entirely age-related and that certain measures can be taken to prevent loss of muscle strength and functional immobility with aging

diabetes

s a metabolic disorder in which the body does not produce enough insulin (type 1) or the body cannot respond normally to the insulin that is made (type 2). An estimated 23.6 million children and adults in the United States (9.4% of the population) have diabetes

fact

t has been suggested that adults who remain sedentary throughout their life span will lose approximately 5 lb of muscle per decade, while simultaneously adding 15 lb of fat per decade (Mozaffarian et al., 2011). In addition, the average adult will experience a 15% reduction in fat-free mass between the ages of 30 and 80 years. When age-related fat gain was investigated, it was determined that body fat is not an age-related problem but instead relates to the number of hours individuals spend exercising per week

important

t is also important to emphasize the importance of an overall plan to reduce blood pressure that includes exercise, diet, weight loss (if appropriate), and most important, compliance with any medical treatment plans if clients are under the care of a physician. Fitness professionals are encouraged to stress to all of their clients the importance of taking any prescribed medications.

after the parq+

t is also recommended that older adults complete a health history questionnaire and appropriate fitness and movement assessments (discussed in Chapters 11 and 12). Assessments such as those included in the senior fitness test (e.g., sit to stand test, back scratch test, stand up and go) help provide information about an individual's quality of movement as well as the ability to perform activities of daily living

important

t is vital to note that various physiologic changes are considered normal with aging, and some are considered pathologic, meaning related to disease. For example, blood pressure tends to be higher at rest and during exercise, which can be the result of either natural causes, as a result of disease, or a combination of both.