ET Test 6

Describe increased energy demands during pregnancy

- Add 150 kcal/day in 1st two trimesters and 300 kcal/day in 3rd trimester

Describe loss of balance during pregnancy

- Change in center of gravity, lumbar lordosis - Avoid activities with sudden change in body position

Describe the 6 minute pegboard ring test

- The patient moves as many rings as possible in 6 minutes on to a pegboard -Each ring weighs 50 g or 0.5 ounce - This test has been shown to be a reliable and valid method to assess unsupported arm exercise endurance in patients with COPD1 and to be a predictive test to help maintain and improve upper body ADL's in pulmonary rehab patients2

Describe the three prognosis categories of lower back pain

-Acute (< 6 weeks) -Subacute (6-12 weeks) -Chronic (> 12 weeks)

Describe maternal hypoglycemia during pregnancy

-Associated w/ strenuous exercise in 3rd trimester - increased glucose uptake by mother & fetus ( increase CHO 30-50 g/d)

List some other cautions to consider during pregnancy

-Avoid abdominal trauma (e.g., exercises) -Avoid excessive joint stress (increased joint laxity due to increased production of Relaxin, a pregnancy hormone that produces joint laxity ) -Proper hydration critical! -Avoid sauna and hot whirlpool baths -Prevent overheating (appropriate clothing for heat dissipation; proper exercise environment)

Describe the required equipment for 8 foot up and go test

-Chair with a straight back (17" or 43 cm) -Chair legs should be placed against wall to stop the chair from sliding backwards -Cone placed so the rear of the marker is 2.44 meters (8 feet) from the front of the chair -Stopwatch and tape measure

If a patient has lower back pain, what is best for their cardiorespiratory exercise testing?

-Few studies have subjected individuals with LBP to exercise tests to exhaustion. -Submaximal exercise tests are considered reliable and valid for individuals with LBP. -Actual or anticipated pain may limit submaximal testing as often as maximal testing. Therefore, the choice of maximal versus submaximal testing in individuals with LBP should be guided by the same considerations as for the general population.

Describe flexibility testing for patients with LBP?

-Flexibility testing in individuals with LBP should be guided by the same considerations as for the general population. •It is essential to identify whether the assessment is limited by stretch tolerance of the target structures or exacerbation of LBP symptoms.

What should exercise testing for LBP be guided by?

-General testing of muscular strength and endurance in individuals with LBP should be guided by the same considerations as for the general population.

What are 3 considerations to consider when looking to resume physical activity during exercise

-Generally, gradual exercise may begin ~ 4-6 weeks after a normal vaginal delivery, or about 8-10 weeks (with medical clearance) after a cesarean section delivery. -Women with higher CRF levels and more rigorous exercise routines prior to and during pregnancy may be able to resume exercise sooner. -Light to moderate intensity exercise in the postpartum period is important for return to pre-pregnancy BMI and does not interfere with breastfeeding.

According to ACSM, what are 3 indications for test termination

-In cases in which diagnostic findings have been established and continuing the test would not provide any further information -Failure of the monitoring equipment -Appearance of signs or symptoms indicating that continuing the test would put the patient at potential risk for an adverse event

What are the primary factors in the fat mass with age?

-Inactivity -Decreased BMR -Loss of muscle mass -decreased Bone density w/aging -Role of sex hormones: increased estrogen & testosterone and increased bone resorption

How should older adults perform power training?

-Increasing muscle power in healthy older adults should include both single- and multiple-joint exercises (1-3 sets) using light to moderate loading (30-60% of 1RM) for 6-10 repetitions with high velocity.

Describe results you will see for strength and endurence if a patient has LBP

-Individuals with LBP frequently have deficits in trunk muscle strength and endurance and neuromuscular imbalance. •The role these play in the development and progression of LBP remains unclear •Decreases in muscular strength and endurance may be independent of the period and intensity of LBP

Describe the 3 categories of lower back pain

-LBP associated with another specific spinal cause (e.g., cancer or fracture) -LBP associated with radiculopathy or spinal stenosis -Nonspecific LBP, which encompass over 85% of cases

Are patients with LBP afraid of injury during testing?

-Performance of muscular strength and endurance assessments is often limited by actual or anticipated fear of reinjury in individuals with LBP.

Describe recommendations for nueromotor training in older adults

-Progressively difficult postures that gradually reduce the base of support (two-legged stand, semi-tandem stand, tandem stand, and one-legged stand) -Dynamic movements that perturb the center of gravity (tandem walk and circle turns) -Stressing postural muscle groups (heel and toe stands) -Reducing sensory input (standing with eyes closed) -Tai chi

Describe the SEMI-TANDEM STANCE BALANCE EXERCISE TECHNIQUE

-Stand next to a chair for safety and stability reasons. -Place one foot in front of the other foot, with the big toe of the back foot in the groove of the front foot. -Hold this position for as long as directed and if able keep track of your time.

What are common tests of strength and endurance for patients with LBP?

-Tests of the strength and endurance of the trunk musculature (e.g., isokinetic dynamometers with back attachments, selectorized machines, and back hyperextension benches) are commonly assessed in individuals with LBP.

Is there a clear relationship between LBP and flexibility?

-There is no clear relationship between gross spinal flexibility and LBP or associated disability. A range of studies have shown associations between measures of spine flexibility, hip flexibility, and LBP but further study is needed.

Describe what research says on the effects of resistance exercise on pregnant women

-has no effect (e.g., no difference in gestational age, preterm labor, or caesarian delivery; delivery of normal birth weight infants at term) -or produces better outcomes (e.g., lower incidence of low back pain; shorter labor duration; shorter recovery time/faster return to activity in postpartum)

For older adults, describe some health benefits

-slowing physiologic changes of aging that impair exercise capacity, -optimizing age-related changes in body composition, -promoting psychological and cognitive well-being, -managing chronic diseases, -reducing the risks of physical disability, and -increasing longevity.

one out of how many children are obese?

1-5 children

Describe the Jonas Case study (can get extra credit) if you do it

1.Is Jonas at risk with respect to his BMI? At what level of risk? 2.Is he at risk with respect to his aerobic capacity? (HINT: Check ACSM norms) 3.Is he at risk with regard to his BP, lipids or BG? How many risk factors does Jonas have altogether? 4. What would be an appropriate exercise test for Jonas (mode, protocol) and why? 5.As you sit down with Jonas and his mother following testing, how would you approach this patient regarding his results? 6.What suggestions would you give Jonas to improve his health? 7.If you suggest increasing physical activity, how would you justify this to him? Explain why or why not PA would be beneficial for Jonas. 8.Write an exercise Rx for Jonas to improve his aerobic fitness level, his muscular strength and endurance, and his flexibility.

How do we Measure Resistive Exercise Testing Outcomes?

1.Properly screen the patient! 2. Test with the appropriate testing modality. 3. Record entry strength testing measurements. 4. Test again at 12-16 weeks (or whatever follow- up interval your institution utilizes) and throughout program participation. 5. Subtract the entry test value from the post-test value and divide by the entry-test value for the % improvement. (Post-test - Pre-test/ Pre-test)

What are adolescents classified as?

13-18 years old

How many trials should be done for 8 foot up and go test

2

What are children classified as

< 13 years old

Where should you start to look when developing testing and prescription for elderly populations

A good place to start is the "Senior Fitness Test Manual, 2nd edition" (Rikli & Jones, 2013, Human Kinetics)

Describe the setup of the Gallon Jug Set up

Align the lower shelf with the participant's patella. Align the upper shelf with the top of the patient's shoulder (acromion process). Place the 5 one-gallon jugs on the bottom shelf. Provide detailed instructions prior to testing. Demonstrate the test protocol.

Describe hypoxemia during pregnancy

Blood is diverted from abdomen and uterus to exercising muscles - Avoid supine exercise after the 1st trimester (16 weeks) - Added compression of uterus on inferior vena cava can ⇣ venous return

What are some common test on older adults?

CHAIR STAND (# of stands) ARM CURL (# of reps) 6-MINUTE WALK (# of yards) 2-MINUTE STEP TEST (# of steps) CHAIR SIT-AND-REACH (inches +/-) BACK SCRATCH (inches +/-) 8-FOOT UP AND GO (seconds)

Describe cardiovascular changes related to aging

Cardiovascular Stiffening of arteries Ventricular thickening

What is the conclusion of the Pollock study for 1RM test for older adults?

Conclusion: 1 RM testing likely inappropriate for older men and women with joint problems specific to the muscle being tested.

What is the conclusion of the Kaelin study for 1RM max test on older adults?

Conclusion: No altered ADLs, muscle soreness, or muscle injury in patients with moderate to severe COPD

What is the conclusion of the Shaw 1RM study during ET?

Conclusion: With proper prep, 1 RM testing safe in older, apparently healthy subjects. Use caution with older, inexperienced patients.

-You are pregnant and get altitude sickness at 6000 feet or above—what would you do?

Descend slowly

Describe guidelines for resistance training for children and adolescents

Ensure appropriate training for individual providing training instruction and supervision Provide a safe exercise environment Start training session with a 5- to 10-min. dynamic warm-up Initiate training program two to three times per week on nonconsecutive days, with light resistance, and ensure exercise technique is correct General training session guidelines: one to three sets of 8-15 repetitions with combination of upper and lower body exercise Incorporate exercises specifically focusing on trunk Training program should induce symmetrical and balanced muscular development

Describe the cycle ergometer protocol for children

Examples Adams Submax Progressive Continuous Cycling Protocol McMaster (50 rpm) James (60-70 rpm)

WHY IS RESISTIVE EXERCISE TESTING UNDERUTILIZED?

Few (if any) evidenced-based guidelines and lack of research Fear of the patient becoming injured Lack of testing protocols and knowledge of existing protocols Each special population has their own unique and specific characteristics Time factor—do you perform different tests for different patients for their individualized ITP?

Describe the Signorile Gallon Jug Shelf Test

Fill five (5) one gallon jugs with water. Set bottom and top shelves of a bookcase level with top of patella and tip of the acromion process respectively Time (in seconds) how long it takes to pick all five jugs (one at a time) with one arm (dominant arm) up from the bottom shelf and place them each on the top shelf This is a measure of power and strength

Describe the equipment needed for the Gallon jug shelf test

Five (5) one gallon jugs filled with water. Bookshelf (84" H x 42" W x 12" D) Stopwatch

Describe weight gain during pregnancy

Gestational weight gain (10-16 kg) in breasts and abdomen Anterior translation of center of gravity = increased risk for balance complications (2nd, 3rd trimesters)

Describe the Kaelin study for 1RM test for older adults

Kaelin et al. 1999, JCR (Pulmonary Patients) • 9 men / 11 women (43-75 yrs.) • 1 RM testing with gradual increase of weight • Light warm-up of 5-10 reps at 40-60% 1 RM • HR, BP, SOB, O2sat, muscle soreness (1-4) monit. • No sig. difference in muscle soreness after 1 week; no cardiopulmonary complications

Describe the benefits of the Gallon jug test

Measure of upper/lower body power Measure of upper/lower body strength Measure of upper/lower body dynamic ROM Measure of ability to lift and place objects on shelves Safe Inexpensive Easily administered Probably a better assessment of ADL's than the other tests presented

Describe metabolism changes related to aging

Metabolism Insulin insensitivity Risk for Type II diabetes

What is the key to getting kids to exercise?

Must be fun!

When older populations are doing ET, what is essential?

Must be supervised

Look at these practice questions for exercise during pregnancy

Name 5 benefits of exercise during pregnancy Why does Q increase during exercise? Name 3 cautions during exercise and pregnancy. Is being a heavy smoker a relative or absolute contraindication to exercise if pregnant? Who needs medical clearance? Name 1 exercise termination criteria.

Describe Neuromotor exercise training for preventing falls in the elderly

Neuromotor exercise training, which combines balance, agility, and proprioceptive training, is effective in reducing and preventing falls if performed 2-3 d ∙ wk−1.

Describe the accuracy of the timing that should be taken during the 8 foot up and go test

Once the patient stops, record time to closest 1/10 of a second

Describe resuming physical activity after pregnancy

PA can be resumed after pregnancy, but should be done so gradually because of normal deconditioning in the initial postpartum period.

Describe the test procedure of the gallon jug test

Patient sits comfortably in front of bookcase. Instruct the patient to keep back straight, head up, not lean forward, use legs as primary source of power for lift, and abort if any feelings of discomfort. Provide a test trial and evaluate/correct form. Remind patient to move 1 jug at a time, not alternate hands, and begin test standing up. Begin trial with "Ready" followed by "Go!" Stop test when 5th jug placed on the top shelf.

Describe the Pollock Study for safety of 1RM test in older adults

Pollock et al. 1991, MSSE (Healthy Older Adults) • Older men (70-79 yrs.) • 11 of 57 incurred injuries during 1 RM testing • 5 injuries knee, 5 shoulder, 1 back (19%) • 4 of 5 knee related to prior knee problems • 6 other injuries unrelated to previous problems

What is the best "treatment" of LBP?

Prevention!! •Current guidelines place a heavy emphasis on preventive measures and early interventions to minimize the risk of an acute LBP episode from becoming chronic and/or disabling.

Describe renal changes related to aging

Renal Associated w/ risks for CV disease & glucose tolerance

Describe respiratory changes related to aging

Respiratory Chest wall stiffening and loss of elastic recoil Reduced pulmonary function

Describe the Shaw test for 1RM safety for older adults

Shaw et al. 1995, JCR (Healthy Older Adults) • 40 men / 43 women (60-72 yrs.) • Divided into 3 groups by lifting experience • Light warm-up of 9 min; tests on 5 machines • Many c/o muscle soreness (none by day 7) • 2 older subjects in the inexperienced group had injuries to the back and ribs

Describe Skeletal muscle changes related to aging

Skeletal muscle Sarcopenia

Describe the fitness gram, know the components

Subjects are either... Considered fit: IN HEALTHY FITNESS ZONE Needs Improvement: NOT IN HEALTHY FITNESS ZONE

Describe thermoregulation changes related to aging

Thermoregulation decreased ability to sweat decreased thirst sensation Attenuated skin blood flow

Why is exercise declining in young children?

Total entertainment screen time is associated with adiposity, decreased fitness, HTN, and other health ailments. Screen time is increasing in EPIC proportions

Describe possible premature labor

increased norepinephrine may lead to increased uterine contractions

Is there research that provides definitive causes for present LBP?

• Current literature does not support a definitive cause for initial bouts of LBP, however, previous LBP is one of the strongest predictors for future back pain episodes.

Describe the scale for chronic pain

• For those with chronic pain, if > 5 on a 0-10 scale best to delay testing until the pain level is lower

What should be be done for those with visual or auditory limitation patients

• For those with visual or auditory limitation, make the appropriate testing adjustments (e.g., have cleared area, ask if you can help, large cones)

Why do we Need to Perform Strength Testing for Our Special Population Patients?

• Must have pre- & post-rehab strength measurements for strength improvement outcomes documentation for program certification and Medicare. • Need to test after 3, 6, 12, 18 and 24 months (or whatever outcome follow-up intervals your program uses) • To let the patient know how they stand up compared to those in their age and gender groups strength-wise • To let the patient know how much they are improving (or regressing) throughout their rehabilitation program

Describe when ET is should be stopped for elderly populations

• Stop testing immediately if the patient is using improper technique or form • Stop testing if any clinically abnormal signs or symptoms

HOW DO YOU SELECT THE PROPER RESISTIVE TESTING PROTOCOL FOR YOUR PATIENTS WITH VARYING TYPES OF DISEASES?

• The CEP should look for established protocols with normative data in the literature. • The test need not necessarily be designed specifically for that type of patient. • There is a significant lack of testing research for special populations in the literature—thus, the CEP must often use their own best judgment on which test to use for which type of patient.

Describe maternal body temp and how it effects fetal heat dissipation during pregnancy

• increased maternal body core temp could decrease fetal heat dissipation—wear proper clothing, choose correct environment, and drink plenty of water

Describe metabolic rate during pregnancy

• increased metabolic rate during pregnancy & exercise -~ 300 kcal/day, therefore increased caloric need to meet caloric loss during exercise

Describe the cycle ergometer and when it may be preffered

•A cycle ergometer may be preferable to a treadmill for those with poor balance, poor neuromotor coordination, impaired vision, impaired gait patterns, weight-bearing limitations, and/or foot problems. However, local muscle fatigue may be a factor for premature test termination when using a cycle ergometer.

Describe why the cycle may be preferred on older populations

•A cycle ergometer may be preferable to a treadmill for those with poor balance, poor neuromotor coordination, impaired vision, impaired gait patterns, weight-bearing limitations, and/or foot problems. However, local muscle fatigue may be a factor for premature test termination when using a cycle ergometer.

When is medical clearance recommended for exercise in pregnant women

•A pregnant woman who is sedentary •A pregnant woman who is severely obese and/or have gestational diabetes mellitus or hypertension

Do older adults require exercise testing?

•ACSM: Most older adults do not require an exercise test prior to initiating a moderate intensity PA program (I personally disagree!)

Describe special considerations for patients with LBP during ET

•Abdominal bracing should be used with extreme caution, as the increases in spinal compression that occur with abdominal bracing may cause further harm to the individual. •Certain exercises or positions may aggravate symptoms of LBP. Walking, especially downhill, may aggravate symptoms in individuals with spinal stenosis. •Limit any activity that causes a peripheralization of symptoms (spread of pain into lower limbs).

Describe the adaptive pelvic posture results during pregnancy

•Adaptive pelvic posture results in imbalance between hip flexors and extensors--pseudo-hamstring tightness

Is a haldrail required for elderly on treadmill?

•Adding a treadmill handrail support may be required because of reduced balance, decreased muscular strength, poor neuromotor coordination, and fear. However, handrail support for gait abnormalities will reduce the accuracy of estimating peak MET capacity based on the exercise duration or peak workload achieved.

Which race groups in students exercise the most?

•African-American and Hispanic students exercise more than white students.

Describe MET exertions in older vs younger adults

•An important distinction between older and younger adults should be made relative to intensity. -Apparently healthy younger adults - moderate and vigorous intensity PA defined relative to METs (moderate intensity, 3-5.9 METs; vigorous intensity ≥6 METs) -For older adults, activities should be defined relative to an individual's physical fitness within the context of a perceived 10-point physical exertion scale which ranges from 0 (an effort equivalent to sitting) to 10 (an all out effort), with moderate intensity defined as 5 or 6, and vigorous intensity as ≥7.

Describe the percentages of the adult population that has lower back pain, and how many of those cases are chronic

•Anywhere between 4% to 33% of the adult population experience LBP at any given point in time, and recurrent episodes of LBP can occur in over 70% of cases. -Approximately 20% of cases become chronic and about 10% of the cases progress to a disability

How fast does lower back pain usually cease?

•Approximately 90% of acute low back episodes resolve within 6 weeks, regardless of treatment.

Describe why women should avoid the valsalva maneuver during pregnancy

•As in any activity, avoid using the Valsalva maneuver, prolonged isometric contraction, and motionless standing.

What happens to Q, SV, HR and o2 uptake during pregnancy?

•At rest Q, SV, HR, and resting O2 uptake increase, while systemic vascular resistance decreases.

What types of patients are at higher risk for osgood schlatter disease?

•Because physical activity puts additional stress on bones and muscles, children who participate in athletics — especially running and jumping sports - are at an increased risk for this condition.

Describe bone density during pregnancy

•Bone density loss

What types of populations are treated during cardiac/pulmonary rehab?

•Cardiac (MI, CABG, Valvular, Stent, CHF, Transplant) • Cardiovascular (PAD, Stroke, HTN, TIA) • Metabolic (Diabetes, Obesity, Hyperlipidemia, Renal) • Geriatric (Frail, Elderly, Higher Risk Older Populations) • Immunologic (Cancer, AIDS, Fibromyalgia, CFS) • Neuromuscular (MS, ALS, Cerebral Palsy, Parkinson's) • Musculoskeletal (Osteoporosis, Arthritis, Low back pain)

Describe how benefits of exercise in children outweight the cons

•Children and adolescents are physiologically adaptive to endurance exercise training, resistance training, and bone loading exercise. •Exercise training produces improvements in cardiometabolic risk factors, weight control, bone strength, and psychosocial well-being, and may help prevent sports-related injuries. • The benefits of exercise are much greater than the risks!

Describe special considerations for children

•Children and adolescents may safely participate in strength training activities provided they receive proper instruction and supervision. Generally, adult guidelines for resistance training may be applied. •Because of immature thermoregulatory systems, youth should avoid exercise in hot humid environments, be properly hydrated, and appropriately modify activities. •Efforts should be made to decrease sedentary activities (i.e., television watching, surfing the Internet, and playing video games) and increase activities that promote lifelong activity and fitness (i.e., walking and cycling).

Describe exercise prescription in children

•Children and adolescents should be encouraged to participate in various physical activities that are enjoyable and age appropriate. •PA in young children should include unstructured active play, which typically consists of sporadic bursts of moderate- and vigorous-intensity PA alternating with brief periods of rest. -These small bouts of PA, however brief, count toward FITT recommendations.

Describe exercise prescription for patients with LBP (5 points) (may want to break it up)

•Clinical practice guidelines for the management of LBP consistently recommend staying physically active and avoiding bed rest. •Individuals with subacute and chronic LBP as well as recurrent LBP are encouraged to be physically active. •When recommendations are provided, they should follow very closely the recommendations for the general population combining resistance, aerobic, and flexibility exercise. •In chronic LBP, exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening are associated with the best outcomes. •For the most favorable outcomes, use an individualized approach that addresses psychological distress, fear avoidance beliefs, self-efficacy in controlling pain, and coping strategies.

What is a key of managing LBP?

•Current best evidence guidelines for treating LBP indicate PA as a key component in managing the condition

Describe what must be demonstrated to subject before machine weight testing

•Demonstrate proper position of the seat and other attachments on the machine weights. •Demonstrate proper pin placement in the weight stack. •Demonstrate proper placement of additional weight on the weight stack.

What is essential in ET subject prep

•Demonstrate the testing protocol

What is a 4, 6, 8 RM test

•Determine the maximal amount of weight that can be lifted 4-8 times with proper technique and prescribe a %

What happens to average HR during submax exercise?

•During exercise, heart rate is higher at lower intensities and HRmax is lower when pregnant.

What are CONTRAINDICATIONS FOR CLINICAL EXERCISE TESTING IN CHILDREN

•Dyspnea at rest or FEV1 less than 60% of age-predicted •Acute renal disease or hepatitis •Insulin dependent diabetes •Severe pulmonary vascular disease •Heart failure

Describe main idea surrounding exercise duration during pregnancy

•Exercise may be accumulated in shorter bouts (e.g., 15 minutes) or performed continuously. A 10-15 min warm-up and a 10-15 min cool-down of light-intensity PA are suggested before and after each exercise session.

When does exercise testing generally occur on children?

•Exercise testing for clinical purposes is generally not indicated for children or adolescents unless there is a health concern.

What are 7 exercise testing considerations for children

•Extra motivation and support may be required during GXT. •Have a "Kid-Friendly" environment (e.g., pictures, games, nice nurses/CEPs). •Consider benefits/risks of a treadmill versus a cycle ergometer. •You want them to go to exhaustion. •Adult exercise testing guidelines generally apply (e.g., ACSM test termination criteria and contraindications.) •You normally do not usually perform a GXT for health/fitness unless indicated that there is a health concern. •Children and adolescents might need a longer time for familiarization.

Describe administering a ET to special populations

•Have the patient perform at least 5-8 minutes of warm-up and stretching activities (typical rehab warm-up activities) • OK to test the patient after group warm-up • Typically no additional physiologic monitoring needed (telemetry ECG or SaO2 OK) • Include dynamic stretching that exercises the muscle groups being tested

What is another useful tool to monitor exercising pregnant women during ET

•Heart rate ranges corresponding to moderate intensity exercise have been developed, however due to heart rate variability, RPE may also be used to monitor exercise intensity during pregnancy.

If exercise testing is required for an older adult, describe it

•If exercise testing is recommended, the associated ECG has higher sensitivity (i.e., ~84%) and lower specificity (i.e., ~70%) than in younger age groups (i.e., <50% sensitivity and >80% specificity), producing a higher rate of false positive outcomes.

What happens to HR during pregnancy?

•Increased HR is due to increased levels of gestational hormones in the first trimester. •During subsequent trimesters, the HR is elevated to maintain BP.

Describe the glomerular filtration rate during pregnancy

•Increased glomerular filtration rate accompanied by increased diuresis = renal adaptations (kidneys enlarge)

Describe guidelines for resistance training for children and adolescents continued

•Individualized exercise progression based on goals and skill •Gradual increase (~5%-10%) in training resistance as gains are made •Use calisthenics and/or stretching post-resistance training session •Be aware of individual needs/concerns during each session •Consider use of an individualized exercise log •Continually alter training program to maintain interest and avoid training plateaus •Ensure proper nutrition, hydration, and sleep •Instructor and parents should be supportive and encouraging to help maintain interest

Describe the progression in training technique for older adults with sacropenia (loss of skeletal muscle mass)

•Individuals with sarcopenia, a marker of frailty, need to increase muscular strength before they are physiologically capable of engaging in aerobic training.

What is the main take away for RPE in children?

•It is difficult for children to interpret the traditional RPE scales.

Describe joint laxity during pregnancy

•Joint laxity and laxity of ligamentous structures due to increased levels of estrogen, progesterone, and relaxin (primarily in pubic symphysis)

What type of exercise is recommended to pregnant women?

•Kegel exercises and those that strengthen the pelvic floor are recommended to decrease the risk of incontinence during and after pregnancy.

Describe what happens to kidneys during pregnancy

•Kidneys get bigger and hormones increase filtration rate - therefore more potty breaks needed!

Define lower back pain

•Low back pain (LBP) is defined as pain, muscle tension, or stiffness localized below the rib margin and above the inferior gluteal folds, with or without leg pain.

Describe lumbar-pelvic alterations during pregnancy

•Lumbar-pelvic alterations result in compensatory shoulder girdle postural accommodations, altering glenohumeral joint and cervical spine mechanics

What is common to a patient with LBP psyche?

•Many individuals with LBP have fear, anxiety, or misinformation regarding their LBP, exacerbating a persistent pain state. A combination of therapeutic and aerobic exercise, and pain education, improves individual attitudes, outcomes, perceptions, and pain thresholds.

Describe APMHR for elderly patients

•Many older adults exceed the age-predicted HRmax during a maximal exercise test, which should be taken into account when considering test termination.

What are some ways/equipment to make exercise fun for kids

•Medicine balls •Jump ropes •Cones •Hoops •Parachutes

Describe the treadmill protocol for children

•Modified Bruce protocols - (e.g., 2 min stages) •Modified Balke protocol Healthy: 3-5mph, increased grade 2% every 2' until volitional fatigue

Are most children healthy/ready for exercise without testing?

•Most young individuals are healthy and able to start moderate intensity exercise training without medical screening.

Is power training beneficial in older adults?

•Older adults may particularly benefit from power training because this element of muscle fitness declines most rapidly with aging, and insufficient power has been associated with a greater risk of accidental falls.

Are all adolescents physically active?

•Only 8% of adolescents aged 12-19 years meet PA guidelines.

Are all children physically active?

•Only the youngest children (6-7 years) are as physically active as recommended by experts, and most young individuals older than the age of 10 years do not meet prevailing physical activity (PA) guidelines. •Only ~ 27% of children in U.S. exercise for 30 minutes/ day, 5 days/week. •Currently 42% of children aged 6-11 years and 8% of adolescents 12-19 years meet the recommended PA guidelines of 60 minutes/day of exercise.

Describe the adolescent bone growth disease "osgood=schlatter disease

•Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the patellar tendon attaches to the tibia. •Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly.

What happens to o2 consumption during exercise?

•Oxygen consumption during submaximal exercise is higher when pregnant, more so than would be expected from just the increase in body weight.

Describe physiologic responses to exercise in young individuals

•Physiologic responses to acute, graded exercise are qualitatively similar to those seen in adults. -There are important quantitative differences, many of which are related to the effects of body mass, muscle mass, and height. -Children have a much lower anaerobic capacity than adults, limiting their ability to perform sustained vigorous intensity exercise.

Is hypotension more likely during pregnancy?

•Pregnant women are more prone to episodes of hypotension with changes in body position.

What intensity and duration should previously inactive women use during exercise while pregnant

•Previously inactive women should progress from 15 min∙d−1 (~3 d∙wk−1) at the appropriate RPE or target HR to approximately 30 min∙d−1 on most days of the week

What do you tell a patient in a special population before exercise test

•Prior to the test tell the patient to "Do the best they can, but not to the point of overexertion or beyond what they think is safe for them"

What helps dilate the capillaries during pregnancy

•Progesterone also helps to increase capillary dilation.

What is a a modified 1RM test?

•Progressively increase weight to determine the maximal amount lifted twice, but not 3 times, with proper technique

Describe RBC count during pregnancy

•RBC increases 33% (increased iron needs) so total blood volume increases 30-50% to accommodate needs of both mother and child (may result in heart murmurs in 90%).

How do you make resistance exercise on children?

•RESISTANCE EXERCISE -Free weights, elastic bands, machine weightlifting, handgrips, fun resistive devices

List some benefits of exercise during labor

•Rapid weight loss after pregnancy •Improved mood & mental health •Improved sleep patterns •Feel better during 1st & 3rd trimesters •decreased Perceived exertion during labor!! •Improvement in strength and circulation •↓ Edema •Shorter labor!! •Fewer obstetric interventions •↓risk of developing pregnancy-induced hypertension and gestational diabetes •↓Less risk for cesarean delivery •Benefits to the fetus (possibly transferred to the fetus)

What should be described in terms of subject breathing during resistance testing

•Reinforce proper breathing techniques and posture on the machine (i.e., exhale with the muscle contraction, pursed-lip breathing).

Describe SBP, DBP, and Total peripheral resistance during exercise

•SBP remains unchanged b/c ↓ total peripheral resistance (TPR) offsets the increase in blood volume that typically causes BP to increase during pregnancy. •DBP decreases by ~ 15 mmHg.

Is scuba diving allowed during pregnancy?

•Scuba should be avoided • increased risk of fetal decompression sickness •Exercise at high altitude? Need to be aware and cautious.

Describe edema during pregnancy

•Soft-tissue edema in lower legs and ankles (primarily during 3rd trimester)

What is a good alternative to VO2 max testing during pregnancy

•Submax testing can be performed •Used to determine effectiveness of training •Cycle ergometer best—changes in posture and center of gravity •Lower RER in pregnant vs. non-pregnant may be a mechanism to protect glucose metabolism of the fetus

Describe the ACSM physical activity guidelines

•The 2018 Physical Activity Guidelines for Americans call for children and adolescents to engage in at least 60 min ∙ day−1 of moderate-to-vigorous intensity PA and to include vigorous intensity PA, resistance exercise, and bone loading activity on at least 3 d ∙ wk.−1 •In addition to the PA guidelines, an expert panel from the National Heart, Lung, and Blood Institute and the American Academy of Pediatrics also recommend that children limit total entertainment screen time to < 2 hours per day.

What happens to HRR during pregnancy

•The HRR, or the range of HR response, declines

How do you health screen pregnant women?

•The Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy) or the electronic Physical Activity Readiness Medical Examination (ePARmed-X+) should be used for the health screening of pregnant women before their participation in exercise programs.

Describe the administration of the exercise protocol for children

•The exercise testing protocol should be based on the reason the test is being performed and the functional capability of the child or adolescent. •Children and adolescents should be familiarized with the test protocol and procedure before testing to minimize stress and maximize the potential for a successful test.

What happens to the heart during pregnancy

•The heart is displaced laterally - you may see ECG changes.

What are indications to terminate a test for older adults?

•The increased prevalence of cardiovascular, metabolic, and orthopedic problems among older adults increases the overall likelihood of an early test termination.

Describe the elderly and their medications during ET

•The influence of prescribed medications on the electrocardiographic (ECG) and hemodynamic responses to exercise may differ from usual expectations.

Describe the workload and protocol for ET in older adults

•The initial workload should be light (<3 metabolic equivalents [METs]) and workload increments should be small (i.e., 0.5-1.0 MET) for those with low work capacities. The Naughton treadmill protocol is a good example of such a protocol.

What is a 1 RM test?

•The maximal amount lifted once, but not twice, with proper technique (no straining, full extension)

What happens during Osgood-Schlatters disease?

•This disease is caused by repeated stress on the top of epiphysis plate of tibia, just below the patella, where the quads are inserted into tibia.

Describe blood volume during pregnancy

•This increase in blood volume also increases SV and Q (Q may increase 40%--average ~ 1500 mL).

Why else do you Need to Perform Strength Testing for Our Special Population Patients?

•To help determine the patient's ability to perform basic ADL's (walking, dressing, picking things up, housework, squatting) • To measure individual success in resistive exercises with validated norms • To boost confidence and self-efficacy • To help assess posture and balance issues and to prescribe posture and balance exercises • To assess and determine the individual needs of the patient with respect to their unique overall muscular weaknesses and develop their exercise Rx

If you have LBP, what should you do?

•To reduce the probability of disability, individuals with LBP should stay active, continue ordinary activity within pain limits, avoid bed rest, and return to work as soon as possible.

Should the speed be modified for elderly ET?

•Treadmill workload may need to be adapted according to walking ability by increasing grade rather than speed.

Describe exercise testing on children

•Treadmills and cycle ergometers should be available for testing. •Treadmills tend to elicit a higher peak oxygen uptake (VO2peak) and maximum HR (HRmax). •Cycle ergometers provide less risk for injury and are more stable, but need to be correctly sized for the child or adolescent. •Children and adolescents may require extra motivation and support during the exercise test compared to adults.

What is a good way to know if children get enough daily activity?

•Using pedometers + accelerometers may be helpful •60 minutes/day = ~ 9,000-12,000 steps/day

Should you VO2 max test during pregnancy?

•VO2max testing not recommended (unless medically necessary) •Not used to estimate maximal aerobic power due to pregnancy-induced changes •Physician present

What are some signs to terminate exercise during pregnancy

•Vaginal bleeding •Dyspnea prior to exertion •Dizziness, syncope, or headache •Chest pain •Muscle weakness •Calf pain/swelling •Preterm labor •decrease Fetal movement •Amniotic fluid leakage

Describe ventilation during exercise

•Ventilation increases due to elevated progesterone, which decreases CO2 via hyperventilation and increases MV (up to 50%).

Is it safe to administer vigorous exercise to young individuals?

•Vigorous exercise can be initiated after safely participating in moderate exercise. -Because prepubescent children have immature skeletons, younger children should not participate in excessive amounts of vigorous intensity exercise. -Obese children are definitely at higher risk of multiple diseases over time!

Look at these practice questions for material of children and testing

•Which metabolic pathway is less efficient in children than adults? •Why do children need heat acclimatization longer than adults? •Is cardiac output and stroke volume higher or lower in children than adults? Why? •Name a TM protocol for children. •Is the traditional RPE scale good for children? •Name one special exercise testing consideration for children. •Name 2 contraindications to exercise for children.

Is there a optimal frequency of exercise during pregnancy?

•While there is no ideal number of days, exercise frequency during pregnancy should be regular, occurring throughout the week, and adjusted based on total exercise.

Should a physician be consulted before resuming exercise after pregnancy

•Women who are pregnant and severely obese and/or have gestational diabetes mellitus or hypertension should consult their physician before beginning an exercise program and have their Ex Rx adjusted to their medical condition, symptoms, & physical fitness level.

Are contact sports allowed during pregnancy?

•Women who are pregnant should avoid contact sports and sports/activities that may cause loss of balance or trauma to the mother or fetus.

If you resistance train before pregnancy, should you continue while pregnant?

•Women who habitually participate in resistance training should continue during pregnancy and should discuss how to adjust their routine with their health care provider.