SECTION IV: Program modifications for clients with special considerations

bariatric surgery

A variety of surgical procedures (e.g., gastric bypass, sleeve gastrectomy, and adjustable gastric band) to induce weight loss. - recommended for patients with a BMI.40 or.35 with at leas gt one obesity related comorbidity.

Consider following steps when selecting exercises to improve neck function

- First, observe the relationship of neck position to that of the thoracic spine and shoulder. forward-rounded shoulders and exaggerated kyphosis will be especially common. If faulty posture is observes, address the spine and should position first. - next introduce dentelemovement and stretching that can be executed by the client at any time of day when discomfort occurs. - finally, refer to a physician if pain Is severe or persistent.

Program design for the foot, ankle, and lower leg

- considerations depend on the client barefoot position (flat feet or high arch). - increase mobility and stability. - stretch twice daily for most effective results. - use a tennis ball for self myofascial release - incorporate balance work. Steps to follow when selecting exercises: - first address mobility and stability in his foot and ankle. - next improve strength in the muscles that control movement in the sagittal plane. - then improve strength in the muscles that control movement in the transverse plane and frontal plane. - lastly improve strength in the muscles of the posterior chain.

Program Design for the Shoulder

- emphasize strength and posture that opens the subacromial space while regaining stability of the joint. - stretch anterior shoulder and chest during warm up for proper scapular positioning. - focus on muscles that stabilize the scapulae (exercises that target lower trapezius, rhomboids, and serrates anterior) - activate rotator cuff through bird dog (closed chain) and farmer carry (open chain). Steps to follow when selecting exercises: - first dress postural. imbalances that may cause a decrease in space between the acromion process and humeral head (e.g. forward rounded shoulders or exaggerated kyphosis) - strengthen the scapular stabilizing muscles including the rotator cuff. - improved strength of the anterior shoulder muscles and pectorals major though pushing motions. - begin to introduce overhead activities as it is approproate and instruct clients to perform exercises in the scapular plan (30 degrees anterior of the frontal plane) to prevent impingement.

coronary artery disease (CAD) EXERCISE overview

- exercises essential part of treatment plan. - clients need medical clearance for exercise and guidance as far as HR limits, exercise limitations, and other program recommendations. - Pts should work with low risk CAD clients. - improving muscular strength and endurance is also very beneficial but must emphasize proper breathing techniques and full ROM. - general program guidelines is 1-3 sets of 10-15reps using 8-10 exercises targeting all major muscle groups 2-3 times a week. - stop exercise sessions if s/ssuch as angina, dyspnea, lightheadedness, dizziness, pallor, or rapid HR above established targets occur.

conversation about pain management with a client

- explain to the client before starting an exercise that the affected area may be challenged. - explain the perceived pain scale. - explain that the exercise will discontinue if pain exceeds a 3 on the scale or if the client feels uncomfortable continuing. - encourage the client to communicate any amount of paint. -ask the client to assess pain prior to exercise and throughout the session to ensure that pain has not surpassed a 3.

Program Design for the elbow, wrist, and hand

- focus on commonly compromised mobility and stability related to all upper-extremity function. - use a splint if recommended by doctor or refer to a doctor if client thinks it might be helpful. steps to follow when selecting exercises: - first limit overuse by introducing various grips for comfort and/or wearing gloves to increase friction between the hand and handle or device when doing pulling exercises, which will lessen the workload on injured tissues. - Next increase ROM through gentle stretches in all planes of motion. - then, improve strength of the wrist and hadn't through exercises such as a wall push-up and wrist flexion and extension. - finally remove grips or gloves and slowly introduce volume to pulling exercises as tolerated.

Muscular training: obesity

- focus on muscular strength and endurance to maintain functional tasks. - FITT is relatively the seem focusing on muscular strength and timing being 20-30 minutes a session.

important questions for clients with an injury

ch. 15 pg 695

chief components of. behavioral weight loss program

study this

tendinitis

inflammation of the tendons caused by excessive or unusual use of the joint

Modifications to training programs for chronic diseases should be based on:

- characteristics of the disease. - any restrictions that the disease places on clients and how they will respond to exercise. - disease severity. - safety concerns. - activities to emphasize. - activities to avoid.

Arthritis overview

Chronic degenerative condition of joints. - Prevalence: 27 million Americans. - pain is associated with and leads to depression, anxiety, and feelings of helplessness. - Results form overuse, trauma, obesity, or the degeneration of the joint cartilage that takes place with age. - symptoms include joint pain, swelling, stiffness, and in some cases contracture. - no established nutritional guidelines but Mediterranean style eating plan can be beneficial as well as a diet rich in anti-inflammatory nutrients such as omega 3 fatty acids, antioxidants, and phytochemical. - weight loss can preen onset of OA, relieve symptoms, improve function, and increase quality of life.

questions to ask clients when evaluating diets

How does the diet cut calories? What is the nutrient density of the diet? Does the diet recommend exercise? Does it make sense? Where is the evidence? Does it meet your individual needs? How much does it cost? What kind of social support does it provide? How easy is it to adhere to the diet?

Exercise Guidelines Summary for clients recovering from a stroke

Same/similar to recommendations used for CAD and hypertension but differ depending on client's neurologic deficit profile, current functional capacity, and at risk status.

Nutritional guidelines

- 46 - 56 g/day pr 10-35% of total caloric intake. - spread food. and protein intake to ensure adequate p protein to build, repair, and maintain lean tissue. - low energy density food help create feelings of satiety and hunger. - typical low energy density diet is high in fruits, vegetables, whole grains, legumes, and water, and low in fat, sweetened beverages, and alcohol. - exercise perfumed at greater that 60% of VO2 max suppresses appetite bu altering gut appetite-regulating hormones for 2-10 hours.

Low-risk CAD clients characteristics:

- An uncomplicated clinical course in the hospital. - No evidence of resting exercise-induced ischemia. - functional capacity ≥7METS three weeks following any medical event or treatment that required hospitalization (e.g., angina, heart attack, or cardiac surgery). - normal ventricular function with an ejection fraction greater than 50%. - no significant resting or exercise induced arrhythmias (abnormal heart rhythms).

exercise guidelines for youth

- Bone strengthening activities are especially important. - find pleasurable activities to help create a healthy relationship with movement. - muscle strengthening activities don't have to be programmed (resistance training) but can be incorporated into play and games (e.g., climbing trees, tug of war, jumping). To minimize injury: - children should be properly supervised, use proper exrcise technique, use appropriate equipment with free weights and body weight exercises being preferred and most suiting. - Never encourage children to perform single maximal lifts, sudden explosive movements, or compete with other children while performing muscular thinning. - teach children to breath properly during exercise movements. - encourage children to drink plenty of fluids. - tell them to communicate when feeling fatigued, discomfort, or pain. - create dynamic, fun, and age appropriate muscular training program.

Possible Causes of Obesity: Genetic Factors

- Rate of heritability of body BMI ranges from 40-70%. - specific genes for associated with BMI and body fat account for only 5% of the variation. -genes are a factor but not as important as lifestyle. - the more obesogenic genes = higher the body weight with the average increase of weight being higher in physically inactive people. -genetic predisposition an be reduced by 40% by being physically active. - genetics can affect how much weight is gained or lost. - more specific genetic disorders that affect appetite, metabolism, energy balance, and fat distribution require specific therapeutic strategies by a physician along with healthful exercise and nutrition.

Exercise Guidelines for women during pregnancy

- Warning signs: vaginal bleeding, regular painful contractions, amniotic fluid leakage, dyspnea before exertion, dizziness or feeling faint, headache, chest pain, muscle weakness affecgingbalance, calf pain or swelling. - screen with PARmed-X to assess pregnancy physical activity readiness. - women who were previously active can continue their exercise program and if they have no complications they can maintain their previous level of exercise intensity as tolerated. - women who were previously inactive should begin slowly and progress to a moderate level of exercise. - avoid exercises with high risk of abdominal trauma from contact or fall as well as exercise performed in extreme heat. - focus on hydration and balancing caloric intake with the metabolic demands of exercise and pregnancy,. - some pregnant women may benefit from a small snack prior to exercise to help avoid hypoglycemia especially when exercising at moderate intensity for longer than 45 min. -

Lifestyle Modifications for hypertension

- Weight reduction: maintain normal body weight (BMI 18.6 -24.9) to reduce SBP by 5-20 mmHg/kg weight loss. - Adopt DASH eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat to reduce SBP by 8-14 mmHg. - Dietary sodium reduction: reduce dietary sodium intake to no more than 100 mol per day (2.4 g sodium or 6 g sodium chloride) to reduce SBP by. 2-8 mmHg. - Physical Activity: Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week) to reduce SBP by 4-9 mmHg. - Moderation of Alcohol: Limit consumption to no more than two drinks per day for most men and to no more than one drink a day for women and lighter-weight persons to reduce SBP. by 2-4 mmHg. - Stop the use of tobacco. - maintain adequate levels of dietary potassium, magnesium, and calcium.

pharmacological interventions

- accessory when client undergoes intensive lifestyle interventions but c cannot meet or maintain weight loss goals and still have a BMI ≥30 or ≥27 with at least one obesity related comorbidity. - short term: phentermine. - long term: orlisttat, lorcaserein, phentermine-topiramate, naltrexone-buipropion, and liraglutide. - best when combined with lifestyle interventions. -weight loss achieves with pharmacotherapy is generally associated with improvements in risk factors and chronic diseases. -

Exercise guidelines/considerations for clients with osteoporosis

- avoid excessive flexion, twisting, and compression movements of the spine to avoid spine fractures. - engage in muscular training, weight bearing, and impact exercise to stimulate bone mass and strength. - incorporate activities promoting balance. - avoid movements or environments that could lead to falling.

Exercise guidelines summary for clients with Asthma.

- clients should have rescue medication at all times/ - drink plenty of fluids. - avoid asthma triggers during exercise. - prolonged warm up and cool downs. - intensity should be gradually increased. - observe carefully for s/s of EIB. - activate EMS if needed. -

Considerations when Programming for pregnant women

- consider recommending shorter sessions (e.g., 30 min vs. 60 minutes) for new clients who have not exercised before pregnancy and then slowly increase duration and intensity over the course of the program. - choose exercises to support the changing COG, such as squats, stiff-legged deadlifts, side lunges, lat pull-downs, seated rows, and bird dog exercises. - encourage clients to discuss their energy, aches and pains, and exercise warning signs in real time so the program can be modified accordingly. - individualize intensity level and rest time as need. These requirements may change daily.

initial cardiorespiratory training programming considerations: obesity

- gradually increase frequency, duration, and/or intensity of exercise over a long period to promote tolerance and exercise adherence. Frequency and duration should be increased first and then eventually intensity to reduce musculoskeletal injuries. - injury is especially a risk in first few months so it is important to minis exercise injury risk when programming and deciding if client should initially be supervised by an exercise professional for all workouts. - other ways to reduce injuries: inclusion of cross training, gradual progression of exercise intensity and duration, and use of low-impact. or non-weight bearing exercises, consideration of a person's injury hx, selection of appropriate exercise environments, apparel to avoid heat related complications, and incorporation of muscular and flexibility training into the exercise program.

Possible Causes of Obesity: Sleep

- inadequate sleep and poor sleep quality is associated with hunger, appetite, the immune system, stress, and inflammatory mediators, as well as fatigue and reduced physical activity. - 58% of sleep apnea is due to obesity and sleep apnea triggers the release of stress hormones. - (OSA) sleep apnea can also lead to rapid weight gain which leads to a vicious cycle.

Postpartum exercise guidelines

- largely depends on women delivery experience. General guidelines for programming: - obtain physician clearance. - being slowly and gradually increase durations, frequency, and then intensity. - ACOG recommend at least 20-30 m in of activity daily. - stop exercising if unusual pain is experienced. - stop exercise if client experiences bright red vaginal bleeding aside from normal menstrual period and seek medical evaluation asap. - drink plenty of water and eat healthfully taking into account every needs for physical activity and lactation. - Remind women to stay realistic and expect to return to pre-pregnancy exercise intensity level over the subsequent 9-12 months.

Nutritional components of recommended weight loss program

- portion control: providing information on serving sizes and the number of calories in various foods. - eating frequently: eating throughout the day, including breakfast, rather than mainly in the evening. - consuming foods high in nutrient density (nutrients per calorie of foods) and low in energy density (calories per weight or volume of food).

biomechanical considérations for cardiorespiratory exercise: obesity

- preferred type is a combination of weight bearing modes and non-weight berating modes. - find modes with a perceived comfort level and few barriers. - majority of time exercising should. be at low-to moderate intensity to avoid joint stress and injury - running, jumping, high-impact is not recommended. - emphasis should be performing longer and/or m ore frequent bouts of exercise. - monitor muscle soreness and orthopedic problems or discomfort. - walking a stationary cycling indoors is recommended. - high quality fitness shoes to minimize chance of exacerbating orthopedic and joint problems. -

Physical and physiological changes during pregnancy

- recommended to gain 25-35 lbs. - Center of gravity moves upward and forward and results in low- back discomfort that affects balance and coordination - focus on posterior leg and trunk strength (swats, lunges, deadlifts) early on in pregnancy to prepare. - increase in nausea and fatigue due to change in hormone levels so adjust intensity and rest periods accordingly. - train for strength and stability to combat increased relaxin hormone which increases joint laxity. -motionless postures and supine lying positions should be avoided they may result in decreased venous return and hypotension. - cardiac reserve is decreased, and HR, blood volume, and stroke volume is increased so intensity should be adjusted accordingly. -

Program design for the knee

- requires ROM and movement assessment to identify areas that need improved mobility, stability, and/or strength. - in general open-chain extension exercises (seated knee extension) exacerbate pain. - stationary and recumbent bikes are recommended to increase ROM and strength. Steps to follow when selecting exercises: - first, address any imbalance between the right and left side (particularly in the hip, ankle, and foot). - next, address any tightness and instability the hip, ankle, and foot. that may be contributing to femoral internal rotation. -then, improve hip-hinge mobility and stability. - lastly, improve he strength of the muscles of he posterior chain. Include satin stretches early (after a brief warm-up) to allow for increased ROM o maximize effects of exercise.

Biomechanical considerations for muscular training: obesity

- seated exercises can be a good alternative for those with mobility or balance challenges. - some gym seats such as weight benches or those on machine stay not be suitable for clients with obesity. - certain supine exercises may cause breathing difficulties. - minimize squat and lunge work. to prevent knee and back discomfort and injury.

Possible Causes of Obesity: Stress Factors

- stress contributes to obesity + other eating disorders and chronic diseases. - stressful events causes food suppression. - chronic psychological stress stimulates hunger and particularly the intake of high calorie foods . - pt should promote power of exercise to reduce stress.

Possible Causes of Obesity: Environmental Factors

- the availability, quantity, and energy density of foods consumed (energy intake). - availability of labor-saving devices. - more time spent sitting. - less availability o facilities where one can be active in the built environment (energy expenditure)

Possible Causes of Obesity: energy balance

- the number of kilocalories required for 1 lb of weight loss depends on how long the dieting period lasts, the type of diet, and whether participants engage in physical activity. - adding exercise to dietary changes also can change the composition of weight lost, the relative amounts of fat and carbs used, and how fast the weight is lost. - resting metabolic rate is also effected by body weight, composition of the diet., type of exercise performed, and level of daily physical activity.

exercise guidelines: obesity

- total distance is what matters - the client does not have to walk thirty minutes in a row but can walk for 10 minutes 3 different times in the day. - walking faster increases intensity which also bring improved to total fitness. - people with obesity have relative heat intolerance (require longer time to acclimate and experience skin chaffing) so they should train at lower intensities the heat. - water exercise is a good alternative when its hot but does have some drawbacks. - many obesity clients have mobility and balance problems so exercising with certain equipment that challenges that is not safe. - promote NEAT (non-exercise activity its thermogenesis) to clients. - exercise tolerance is low so lifestyle physical activities accumulated at home and at work can be an effective option to increase EE.

Iliotibial Band Friction Syndrome

A repetitive overuse condition that occurs when he distal portion of the IT band rubs again the lateral femoral epicondyle, causing a burning or pain at the lateral aspect of the knee, which may be described as sharp or stabbing. - common among active individuals 15-50 yro. - caused by poor training form, lack of recovery, or poor technique in runners cyclist, volleyball players, and weightlifters. - risk factors: overuse, improper footwear or equipment use, changes in running surface, muscle imbalance, or structural abnormalities like pes planus (flat feet), knee valgus, and leg-length discrepancy. - posture assessment can be useful. - self-myofascial release and static stretching can be useful

Hip Replacement

A surgical procedure in which the hip joint is replaced by a prosthetic implant - necessary when medication and physical therapy don't have positive effects. - client must work with a physical therapist post-surgery until released. - equal mobility in both hips is ideal when working with your client but not necessary - expectations must remain realistic. - recumbent bike is excellent to improve cardiorespiratory fitness, ROM, and quadriceps strength. - stationary bike more appropriate for this struggling to regain full ROM

Program Design for the Spine

Address faulty posture and range of motion. - General exercise to improve low back strength: cat-cow, modified curl-up, bird-dog, side bridge. Steps to follow when selecting exercises: - first dress any imbalance between the right and left sides. - next address any anterior/posterior postural imbalance (e.g. anterior or posterior pelvic tilt) - then increase functional internal and external rotation of the hip(e.g. wood chop exercises promote internal rotation of the hip in the downward movement and external rotation of the same hip in the upward movement) - finally strengthen the posterior chain, especially the hamstrings and gluteal muscles to provide powerful support.

plantar fasciitis

An inflammation of the connective tissue (plantar fascia) on the bottom, or plantar surface of the foot. - create a program that challenges a client but does not excessively load the foot. - stretch out the gastrocnemius, soleus, and planter fascia and roll the foot over a tennis ball to increase ROM in dorsiflexion and relieve pain.

Cancer overview

Approx 200 related diseases characterized by the uncontrolled spread and growth of abnormal cells. prevalence: second leading cause of morbidity and mortality worldwide. - linked to factors such as environmental exposures, p physically inactive lifestyle, and poor diet. - Nutrition used to prevent or resolve nutrient deficiencies, achieve or maintain healthy weight, preserve lean body mass, minimize nutrition related side effects, and maximize quality of life.

Bone fractures

Caused by impact or stress to the bone - may experience an audible snap, are may appear deformed and/or swollen, discolored, painful/tender to the touch. - provide first aid for shock if necessary, and activate EMS and control surroundings so client can rest easy until Ems arrives.

examples of lower body modifications (squats)

Chair Sit: - good when client is not ready for unsupported movement. - teaches clients to hinge at the hip and maintain a neutral spine while functionally challenging the posterior chain. - Cue client to push feet firmly into the ground. - encourage clients to progressively pull less with he arm. Body Weight Squat: - good when clients study less with suability, strength, and/or ROM. - focus on the form and cue client to keep the spine long and press he feet firmly into the ground to return to standing. - cue client to push harder into the floor to activate more stabilizing musculature if knees are drifting forward. Cable Squat: - good for clients who are ready o improve posterior chain strength, but no ready for weighted barbell or dumbbell squats. - gives more support in pushing the hips back similarly to other two.

coronary artery disease (CAD) overview

Characterized by a narrowing the coronary arteries that supply the heart muscle with blood and oxygen. - can be triggered from high BP, elevated levels of LDL cholesterol, elevated blood glucose levels, brother chemical agents like carcinogens. Underlying cause is atherosclerosis. - can result in heart attack. -Estimated 121.5 million Americans have one or more types of CAD audits the leading cause of death in the developed world. - Nutrition has an important influence on incidence and severity. - Physical inactivity is a major independent risk factor; people participating in moderate amounts physical activity have a 20% lower risk, people participating in higher amounts exercise have a 30%+lower risk of developing CAD.

Osteoporosis Overview

Characterized by low bone mass and disrupted microarchitecture. - prevalence: 54+ million Americans have or are at risk and it has become the most prevalent public health issue. - controllable risk factors: reproductive hormone levels, adequate levels of calcium and vitamin D, and physical activity. - uncontrollable risk factors: genetics, being female, being caucasian or asian, and being postmenopausal. - nutrition: focus on meeting daily values of vitamin D and calcium. - Exercise increases bone mass density and decreasing risk of falls and fractures.

Asthma overview

Chronic inflammatory disorder of the airways in which many cell and cellular elements play a role - inflammation causes recurrent episodes of wheezing, breathlessness, and chest tightness. - can be triggered by exercise (exercise-induced bronchoconstriction), allergens. irritants, viruses, stress, and cold air. - prevalence: 25 mil+ American children and adults. - exercise can be done with minimal restriction and is necessary to better symptoms.

Metabolic Syndrome Overview

Cluster of conditions that increases a person's risk for developing heart disease. Identified by the presence of 3 or more the following: - elevated waist circumference: ≥40 in. for men & ≥35 in. for women. - Elevated Triglycerides: ≥150 mg/dl or on drug treatment. - Reduced HDL cholesterol: <40 mg/dl for men <50 mg/dl for women or on drugs treatment. - Increased BP: ≥130/85 mmHg or drug treatment. - Elevated fasting blood glucose: ≥100 mg/dl or on drug treatment. Prevalence: likely as high or higher. than obesity and insulin resistance since it is present in these cases. - Associated with physical inactivity, excessive caloric intake, obesity, genetics, *excess visceral fat*, and aging. - Lifestyle interventions important for treatment.

Hip Arthritis

Condition characterized by joint pain and inflammation, which, especially in advanced stages, may lead to decrease ROM, stability, and strength. - inactivity worsens condition. -program should focus on improving mobility and function and avoid exercises that exacerbate symptoms by putting under stress on he joints structure.

Program Design for the Hip

Conduct Rom and movement assessment to identify ares that require improved ROM, stability, and/or strength. Conduct standing postural assessment to identify any differences in the right or left side - pay attention to the pelvis. Steps to follow when selecting exercises. -first, address any imbalances between the right and leg side. - next, improve ROM in hip internal and external rotation as well as single leg stance stability. - then, improve hip-hinge mobility and stability. - lastly, improve he strength of the muscles of he posterior chain.

Exercise guidelines summary for clients with arthritis

Consistent exercise program that promotes cardiorespiratory fitness, improved muscular strength and endurance, and joint mobility will decrease fatigue and significantly improve daily function and associated quality of life.

Diabetes Overview

Group of metabolic disorders involving an absolute or relative insufficiency of insulin secretion Type 1: - prevalence: 5-10% of Americans - insulin deficiency due to the destruction of beta cells. - must be mindful of when food is eaten, when exercise is performed, and when insulin is injected. - reduce insulin dose and consume absorbable carbohydrate before exercise. Type 2: - 8.6% of Americans and 90% of people with diabetes. - insulin resistance caused by lifestyle habits. - risk factor: family hx, physical inactivity, overweight, and obesity, high BP, abnormal lips, high percentage of abdominal fat, and smoking. - healthy nutrition (following U.S) guidelines is essential part of treatment. - regular cardiorespiratory training is also an essential part of treatment.

Muscle Strains

Injuries in which the muscle works beyond its capacity, resulting in microscopic tears of the muscle fibers. Grade I: strains are mild and their will likely be an acute episode of mild pain or intense local sorenesss or cramping of the muscle. Grade II: stains are moderate and characterized by more severe pain and swelling that causes weakness and decreased ROM. Grade III: strains are severe injuries and indicate a complete tear of the muscle. some people report a tear or pop and then immediate pain and loss of function. pain, swelling, and discoloration may occur and it is more common in older adults.

Possible Causes of Obesity: Hormones

Leptin: - key hormone in energy metabolism. - mainly instructs body to eat free when when fat cells decrease in size but also can do the opposite. Adiponectin: - key hormones in energy metabolism. - helps insulin by seeing blood glucose into the body's cells for storage or use as fuel which increases cells insulin sensitivity or glucose metabolism. - low in overweight people or people with insulin resistance. Immune Hormones: -tumor necrosis factor-alpha, interleukin-6, plasminogen activator inhibitor 1, angiotensin II, and other cytokines (hormone like proteins) - cytokines are inflammatory proteins and inflammation is a large part of obesity a a major risk factor for heart disease Appetite-regulating hormones: - "gut hormones" - includes ghrelin which is related to obesity as a hunger hormone. - peptide YY helps reduce hunger as its a satiety hormone and there is ongoing research on how It can be be used to regulate food intake and energy homeostasis.

chronic injuries and conditions considerations

Make sure you are constant communication with client about pain and treatment and that your program aligns with physicians recommendations. Warm up should be very mindful and possible longer/more extensive to address specific movement patterns when necessary. Joints surrounding injured are should be especially warmed up to precent from any injuries and provide sufficient ROM and stability. honor the clients goals and possibly address conditions in the warm up or during active rest periods of the program design and/or recommend targeting stretching routines for recovery days. Static stretching can be included in both the warm up and cool down. Programming self-myofascial relates and stretching after light arctic on recovery days may promote healthy tissue recovery.

Exercise Guidelines for Older Adults

Muscle mass declines, body fat typically increases, balance and coordination tend to decline. - Muscular training recommended at least twice a week to maintain and increase muscular strengthen and endurance. - Balance training should be incorporated to improve proprioception and decrease risk of falls. - programs accordingly depending on different medical conditions.

Stroke Overview

Occur when blood supply to the brain is compromised (ischemic stroke) or when a blood vessel in the brain bursts (hemorrhagic stroke). - most important modifiable risk factor is hypertension. - other risk factors: smoking, heart disease, previous stroke, physical inactivity, transient ischemic attack (TIA). - prevalence: 790,000 Americans have it and second leading cause of death globally and number on cause of disability. - lifestyle changes to reduce risk include incorporating a diety high in fruits and vegetables or in minerals such as potassium, reducing salt intake, no smoking, regular physical activity, and maintenance of normal body weight. - rehabilitation focuses on optimizing basic ADLS; regaining balance, coordination, functional independence, and preventing complications and stroke reoccurrence.

Acute and chronic injuries: the physiology of healing

Phase I: inflammaiton - 3-4 days after injury. - redness, swelling, pain, and localized increased temperature. - Implement RICE (rest or restricted activity, ice, compression, and elevation) Phase II: Repair. - may overlap with inflammation phase and last about 6 weeks. - formation of scar tissue which may cause movement restriction. - challenging area with pain free, non weight bearing movement can lead to less adhesive scarring and stronger tissues preventing re-injury. Phase III: Remodeling. - overlaps with phase II and occurs 3-6 weeks post-injury. -can last up to 2 years. - scare tissue continues to strengthen. - movement can help prevent adhesive scar.

Peripheral Arterial Disease Overview

Results from atherosclerosis of the arteries of the lower extremities. - Prevalence: 3-10% of adults; 70+ 15-20%. Rates increase if diabetes is also present. - Risk Factors: dyslipidemia, *smoking*, hypertension, *diabetes*, family history, physical inactivity, obesity, and stress. - Nutrition is important as this is common in people with CAD so same recommendations apply. - Exercise can help improve walking distance, blood flow, and change blood viscosity and capilarry and mitochondria density which all improves oxygen utilization. - exercise clearance and guidelines needed.

concussion

a brain injury that causes a change in mental status. -s/s: temporary loss of consciousness, confusion, disorientation, irregular speech, impaired balance or be dizzy, seizure, numbness in limbs. - remove individuals immediately from activity.

pirformis syndrome

a condition here the piriform muscle becomes tight, taut, or inflamed causing compression of the sciatic nerve that runs between its and the gemelli. - estimated that 60%. of people with low back pain actually have this. - the pelvis will likely be uneven with one hip higher than the other. - proper progression of exercises consists of static stretching to the tight side while working on active ROM for both sides with a concerted effort towards improved strength and stability on the chronically stretched side's hip abductors and external rotators. ***program should focus on balancing the position of the right and left pelvis via static static stretching of the tight muscle and conditioning and strenghting of the trait muscle. - program should also include closed-chain internal and external hip rotation exercises improving both mobility and stability of the hip.

importance of flexibility and elasticity

a decrease in elasticity and flexibility may be the case or consequence of injury - can cause muscle imbalances and result in misuse or overuse injury elsewhere.

Achilles tendinitis

a painful inflammation of the Achilles tendon caused by excessive stress being placed on that tendon. -often results in Grade II or III muscle strains. - prevent with programming that improves elasticity. - risk factors: high arches, flat feet, leg-length discrepancies, lateral ankle instability, poor training mechanics, poor footwear, muscle weakness, and poor flexibility. -simple dynamic stretching in the warm up can help.

Ligament Sprains

a result of an external force that applies sufficient pressure to stretch the ligament to the point of injury. - non-contact injuries: caused by ground reaction force when individual has insufficient strength, coordination, or stability to maintain control of joint during movement.

Hypertension overview

abnormally high blood pressure; can be designated as essential or primary hypertension and the other 5-10% is the result of some identifiable cause. prevalence: 46% of population which is approximately 103 million - can be treated with lifestyle changes which is good and bad for those who do and do not have the support needed. Major factors are nutrition, exercise, and reduced body weight. - is a key modifiable risk factor for CVD. - risk factors include; stress (mental illnesses), body weight (esp excess body fat/correlation with obesity), sleep, age, excessive sodium intake, increased alcohol intake, family history, and physical inactivity. - medication can also be used to treat this but individuals need to monitor exercise intensity, change positions slowly, and conclude each session with a gradual and prolonged cool down.

shin splints

general term used to describe exertion, lower-leg pain. classified as two specific conditions: - medial tibial stress syndrome (posterior shin splints) and anterior shin splints. -caused by the inflammation of the periosteum (connective tissue concerning the bone) - do not require complete rest and clinicians recommend a modified program.

Exercise Guidelines for Clients

goal is to maintain and improve cardiovascular conditioning, achieve and/or maintain a healthy weight, prevent musculoskeletal deterioration, reduce. symptoms such as nausea and fatigue, and improve mental health. outlook and overall quality of life. specific should be tailored to clients needs, type of cancer, and treatment plan.

Tendinitis

inflammation of h tendon hat may be progressing through the stages of haling or can be categorized as chronic. - patellar tendon, pees anserine, and quadriceps common places. - critical o stay in communication with client when pain is present and have them stop that exercise in that case.

Bursitis

inflammation of the bursa sac. sometime due to acute trauma but more frequently form repetitive stress, muscle imbalance, or muscle tightness surrounding the bursa.

fasciitis

inflammation of the fascia. - 2 common types are plantar fasciitis and iliotibial band (IT band) friction syndrome.

cartilage damage

mechanism of injury for cartilage damages compression of the joint couples with a shearing motion. - s/s: joint stiffness, clicking or popping with weight bearing activities, giving way, catching, and/or locking, joint pain, swelling and muscle weakness.

Stress fracture

occurs when there is an imbalance in bone formation and bone resorption and a result of compression forces tat put repetitive stress on a bone that it not strong enough. to withstand these forces. s/s: point tenderness in a single spot on the bone, pain is focal and progressive and will worsen with weight bearing activities, can. experience acing pain at rest or during sleep.

acute neck and back injuries

often muscle strains sustained during exercise and should be treated as such. sometimes a client may suffer from a disc injury which are most often a consequence of combined compression and shearing forces. - ice may be bale to alleviate pain but immediate referral to doctor is needed and if client is unable to walk, contact EMS.

Ankle sprains

range from muscle strains and ligament strains to dislocations and fractures. - 70% of lateral ankle sprains lead to repetitive sprains and chronic symptoms - lateral ankle sprains are very common and medial or eversion ankle sprains are rare. - follow same guidelines as any other sprains and remember the upper body can still be worked while resting ankle sprain as long as it is thoroughly protected. - once released from physical therapy, focus on restoring proper proprioception, flexibility, and strength is an important first step.

Resting energy expenditure (REE)

the amount of energy expended at rest; represents 60 to. 75% of. the body;s total energy expenditure. - can be measured through indirect calorimetry in a clinical setting or using the. Mifflin-St Jeor equation: Males: REE (kcal/dau) = (10 x Weight in kg) + (6.25 x Height in cm) - (5 x Age in yr) + 5. Females: REE (kcal/dau) = (10 x Weight in kg) + (6.25 x Height in cm) - (5 x Age in yr) - 161. conversions: lbs to kg: divide by 2.2 (e.g., 140/2.2 = 63.6 kg) inch to cm: multiply 2.54 (e.g., 66 inches x 2.54 = 167.6 cm)

Dyslipidemia Overview

undesirable levels of lipids . - elevated levels of total cholesterol and LDL cholesterol are correlated with CAD, along with low levels of HDL and leveled levels of Triglycerides. Primary risk factors: genetics, sex, age. Secondary risk factors:body-fat distribution, cigarete smoking, some medications, dietary habits, and physical inactivity. - Nutrition is used as a treatment recommendation: diets emphasizing vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical cegatebqle oils, nuts, limited intake of sweets and sugar sweetened beverages and red meets, very low intake of saturated fat, and eliminate consumption of trans fat.

Patellofemoral pain syndrome

A degenerative condition of the posterior surface of the patella, which may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee. - Can be caused by various factors including overuse, altered biomechanics, and muscle dysfunction. -can. be caused by excessive loading which puts the body ou too balance and leads to tissue trauma, injury, and pain.