Ch. 31 Children

ex testing protocols - (T/F) protocols for adults can be usually used for children - common protocols for children include (4)

(T/F) protocols for adults can be usually used for children - T - May need to accommodate the earlier onset of fatigue in children common protocols for children include (4) - Aerobic testing (treadmill or cycle): Bruce, Balke, James, Godfrey - Anaerobic testing (cycle): Wingate - Strength: handgrip or isokinetic dynamometers - Flexibility: flexometer, goniometer

ex test referral - Children have many conditions that may elicit a referral for exercise testing, including but not limited to (4)

- Asthma - Diabetes - Obesity - Various forms of heart disease

ROM rx - dependent on training goals - flexibility does decline as children age

- Basic health-related fitness (get them moving) Focus on "play", active games, dancing, recreational activities - Intermediate health-related fitness (introduce fitness principles) Fitness-based games, higher intensity activity, league sports - Athletic performance (structured training) Sport/activity-specific

ex testing considerations - why is clinical testing difficult for children? (4)

- Children's body size in relation to testing equipment may be problematic (equipment designed for adults) - Their peak performance may be poor - Their attention span tends to be short, and they may have poor motivation during exercise testing, most often with longer exercise protocols - Very young children or those with chronic conditions may present additional and unique challenges to testing

acsm testing guidelines (5)

- Exercise testing for children is not indicated unless there is a health concern. - The testing protocol should be based on the reason the test was requested and the capabilities of the child. - Children should always be familiarized with the test modality and protocol before the actual test; this will help to reduce test anxiety as well as increase the chances for success of the exercise test. - A treadmill and a cycle ergometer should each be available for exercise testing. - Children are psychologically and emotionally immature and may require more motivation and support than older people to complete the exercise test.

pediatric concern - obesity, therefore whats happening?

- Increasing numbers of children are obese or overweight THEREFORE many children being diagnosed with associated conditions that we often see in adult clinical populations - Type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome

history and physical examination of children (3)

- Medical history, physical exam, and any pertinent laboratory findings - Determine contraindications to exercise testing and participation - The goal is to ensure that the benefit of testing outweighs the risk associated with the tests

ex testing considerations - what should clinical professionals do when testing children? (5)

- Safe environment - Two testers to ensure constant visual and verbal contact with child (also to have two spotters during test) - Explanation of test to child and parent - Modified testing equipment (if appropriate) to properly fit size of child - Motivational factors/encouragement to keep child interested

common reasons for pediatric stress testing (6)

- To evaluate specific signs that are induced or aggravated by exercise - To assess or identify abnormal responses to exercise in children with cardiac, pulmonary, or other organ disorders, including the presence of myocardial ischemia and arrhythmias - To assess efficacy of specific medical or surgical treatments -To assess functional capacity for recreational, athletic, and vocational activities - To evaluate prognosis, including both baseline and serial testing measurements - To establish baseline data for institution of cardiac, pulmonary, or musculoskeletal rehabilitation

exercise testing mode - name 3 and what is the most preferred?

- Treadmill (76% preference by clinical centers) - Cycle ergometer (24% preference) - Arm ergometer (population specific)

ex rx overall

- tailor it to child's goals - safety is key - exercise everyday - make it fun

ex responses of children (2)

Intensity: - use OMNI RPE vs Borg RPE Poor temperature regulation - Greater risk of heat-related illness due to lower sweat rate - Longer acclimatization required - Greater risk of dehydration - Faster body cooling in water

ex rx aerobic training - dependent on training goals, name 3 examples

dependent on training goals, name 3 examples - Basic health-related fitness (get them moving) Focus on "play", active games, dancing, recreational activities - Intermediate health-related fitness (introduce fitness principles) Fitness-based games, higher intensity activity, league sports - Athletic performance (structured training) Sport/activity-specific - Allow for accommodation of differences in abilities, interests, and fitness objectives of children

Contraindications & Termination of Exercise Testing - general reasons for terminating a clinical test in children

general reasons for terminating a clinical test in children - In cases in which diagnostic findings have been established (i.e. continuing the test would not produce any further information) - Appearance of signs or symptoms indicating that continuation of the test would put the patient at potential risk for an adverse event

definition pediatrics children

pediatrics - branch of medicine concerned with children and their diseases children - population between infancy (birth) and adolescence (from puberty until growth stops) - Not typically considered a "clinical" population

ex rx resistance training - historically thought that resistance training may not be safe for prepubescent children (potential damage to growth plates) - what evidence proves that the statement was false? (4) - dependent on training goals - what is key to ensuring proper technique

what evidence proves that the statement was false? - Improvements in muscle strength and endurance - Enhanced motor skills - Protection against injury - Psychological benefits dependent on training goals - Basic health-related fitness (get them moving) Focus on "play", active games, dancing, recreational activities - Intermediate health-related fitness (introduce fitness principles) Fitness-based games, higher intensity activity, league sports - Athletic performance (structured training) Sport/activity-specific what is key to ensuring proper technique - Supervision is key to ensuring proper technique

signs and symptoms - when are ex evaluations used in children? - ex evaluation in children is dependent on what? - signs and symptoms that are typical of adults?

when are ex evaluations used in children? - Exercise evaluations are not used in children unless absolutely necessary ex evaluation in children is dependent on what? - signs and symptoms - Evaluations may aid in diagnosis or in development of a treatment plan signs and symptoms that are typical of adults? - Shortness of breath, chest pain, dizziness, syncope, unusual fatigue, and exercise intolerance

aerobic fitness in children why is it difficult to measure in children? (4) - pa - HR - perceiving intensity - VO2

why is it difficult to measure in children? (4) - Increased physical activity does NOT result in increased aerobic capacity - HR responses can vary more widely in children -Children perceive intensity differently than adults -Usually perceive intensity as less difficult than adults -VO2 max is lower in children compared to adults

special considerations: pharmacology - why is it important to review important issues in regard to pharmacology and pediatrics? (3)

why is it important to review important issues in regard to pharmacology and pediatrics? - Many drugs that are prescribed for children were not initially developed for children. - Physiologic differences in children result in alterations in the pharmacokinetics and pharmacodynamics of medications. - The CEP needs to be cognizant of these issues so as to be aware of possible adverse drug reactions.