Programming for Special Populations

Balance Exercises and Training Progression for Older Adults: Training progression

-Arm progressions: use surface for support, hands on thigh, hands folded across chest -Surface progressions: chair, balance discs, foam pad, physioball -Visual progressions: open eyes, sunglasses or dim room lighting, closed eyes -Tasking progressions: single tasking, multitasking (i.e., balance exercise + pass/catch ball)

Resistance-Training Guidelines for Clients with Cardiac Disease: Exercise Intensity

-Begin program with a low weight for each exercise. -10-15 repetitions per exercise to "moderate" fatigue, which approximately corresponds to an RPE range of 11-13 (light to somewhat hard) on the Borg 6-20 scale -The rate-pressure product (heart rate × systolic blood pressure) should not be greater than that prescribed during aerobic exercise

Balance Exercises and Training Progression for Older Adults: Standing

-Clock" — balance on one leg (other leg at 45° or 90° angle), Personal Trainer calls out time, client moves nonsupport leg to the time called out (i.e., 5 o'clock, 9 o'clock), alternate legs -Perform leg activities (heel, toe, or single-leg raises — 45° or 90° angle, marching). -"Spelling" — balance on one leg, Personal Trainer asks the client to spell word working with nonsupport leg (i.e., client's name, day of week, favorite food), alternate legs

Resistance-Training Guidelines for Clients with Cardiac Disease: Exercise Session Duration

-Complete one set of each exercise initially; multiple sets can be introduced later as tolerated. -Allow adequate rest between exercises to prevent carry-over fatigue.

Additional Recommendations for Weight-Loss Programs

-Gradual weight loss of 1 kg ∙ wk−1 or less -Daily, negative caloric balance should not exceed 500-1,000 kcal -Goal for long-term weight loss of at least 5%-10% of total weight -Employ behavioral modification strategies to enhance adherence -Dietary intake should not be <1,200 kcal ∙ d−1 -Balanced diet with fat intake <30% of total calories consumed

Balance Exercises and Training Progression for Older Adults: In motion

-Heel-to-toe walking along 15-ft line on floor (first with and then without partner) -"Excursion" — alternating legs, lunge over a space separated by two lines of tape. Progress to hopping or jumping (using single-leg or double-leg) back and forth across the space. -Dribble basketball around cones that require the client to change direction multiple times.

Resistance-Training Guidelines for Clients with Cardiac Disease: Exercise mode

-Perform 8-10 exercises using the major muscle groups. -Dynamic muscle strengthening exercises include machine and free weights, weight-bearing calisthenics, resistance bands, and similar resistance exercises that use major muscle groups. -Isometric exercise is not recommended for clients with CVD.

Aerobic Exercise Program Modifications for Pregnant Women: Exercise Intensity

-Target heart rate (e.g., %HRmax or %HRR) should not be employed as a method to monitor exercise intensity due to the variability in maternal resting and maximal heart rate throughout pregnancy. Likewise, target O2 (e.g., %O2R) is not a valid tool to monitor intensity due to the progressive decrease in cardiorespiratory fitness over the course of the pregnancy. -RPE values of 12-13 (light to somewhat hard) on the 6-20 scale can be used to accurately and safely monitor exercise intensity. -Talk test should be used, intensity should be lowered if not able to talk

Aerobic Exercise Program Modifications for Pregnant Women: Exercise Mode

-Walking and cycling may be easier to monitor for exercise intensity. -Activities that increase the risk of falls (e.g., skiing and skating), abdominal trauma (e.g., basketball and softball), and rapid changes in movement that impact balance (e.g., tennis) should be avoided and generally are not recommended. -Activities at elevations >6,000 ft and scuba diving are contraindicated.

Mode

-aerobic activity: running, hopping, swimming, dancing, bicycling -resistance: can be unstructured - playground equipment, climbing, tug of war or structured with weights and resistance bands -bone loading: running, jumping rope, basketball, tennis, hopscotch

Intensity

-aerobic: moderate intensity most days, corresponds to noticeable increase HR and breathing; vigorous intensity min of 3 days/week, gives increase HR and quick breathing -resistance: body weight as resistance of 8-15 submax reps to moderate fatigue all performed wit h good technique -bone loading: no specific rec. but avoid extreme intensity

Exercise Intensity Considerations for Clients with Cardiac Disease

-deconditioned and low functional capacity clients start at low intensities like 20-30% HRR or VO2R -target exercise intensity fall 10-15 bpm below HR that previously elicited abnormal clinical symptoms -beta blockers and other HR lowering meds decrease accuracy of exercise intensity prescription methods based on age predicted max HR -RPE levels of 11 to 13 typically correspond to target HR for clients w/CVD first initiating an exercise program. RPE can be progressed 14-16 after several months of training when conditioned has improved and no complications are present

Other Considerations for Clients with Diabetes: Minimizing risk for hypoglycemia

1. Know the warning signs of hypoglycemia and hyperglycemia (Table 20.11). 2. Avoid exercise during the time when hypoglycemic medication is working at its peak. 3. Client should eat 1-2 hours before exercise (perhaps, eat a snack during exercise if duration is prolonged). 4. Check blood glucose before exercise and if blood glucose is less than 100 mg ∙ dL−1 and then the client should eat a snack. 5. Client should exercise with a partner for safety reasons. 6. Have fruit juice or candy available if blood glucose gets too low.

Programming Goals: Hypertension

1. Lower systolic and diastolic blood pressures at rest and during exercise 2. Lower the risk of mortality from CVD (myocardial infarction, stroke, heart failure, etc.) 3. Lower the risk of other comorbidities (kidney disease, eye problems, diabetes, etc.) 4. Incorporate opportunities for clients to pursue other lifestyle changes (stress management, diet, smoking cessation, weight management, etc.)

Programming Goals: Comorbidities

1. Lower the overall risk of mortality by identifying the condition with the highest mortality risk; prioritize exercise program design around this condition. 2. Recognize that the presence of comorbidities may serve as competing demands on client's self-management resources, thus reducing time and energy an individual has remaining to devote to each and every condition (30); these individuals will require additional guidance and resources provided by the personal trainer to ensure that all conditions are managed effectively. 3. Have realistic expectations for the expected improvement for all comorbidities; improvement is not always feasible (80), and there will be instances where maintaining functional capacity or stabilizing the disease process can, and should, be viewed as a successful outcome.

Selected Signs and Symptoms of Hypoglycemia

<70 mg ∙ dL−1 or rapid drop in glucose dizziness or headache, weakness or fatigue, shaking, tachycardia (high HR), irritable, confusion, sweating, slurred speech, anxious, hunger

Aerobic Training for Clients with Diabetes

A hallmark training adaptation to be expected from increased levels of aerobic activity is improved cardiorespiratory fitness. Individuals with higher levels of cardiorespiratory fitness are at decreased risk of mortality from CVD regardless of BMI. Pos effects of aerobic exercise on glucose metabolism and insulin insensitivity in clients w/ diabetes known to be subacute, meaning they are lost w/in few days following cessation of training. This means need consistent almost daily training. Goal is to control blood glucose, enhance insulin sensitivity, decrease and manage body weight+BP, improve lipid profiles, increase cardiorespiratory fitness+exercise capacity, manage related conditions like coronary heart disease

Aerobic Exercise Program Modifications for Pregnant Women: Exercise session duration

Accumulating 30 min of exercise in 20-30 min intermittent bouts and adjusted as needed to a total of 150 min ∙ wk−1 of vigorous aerobic exercise.

Programming for Obese Clients

BMI greater than 30 kg ∙ m−2. Rising obesity levels may be from increased caloric consumption (overconsumption), decreased levels of physical activity, genetic predisposition, disease, and cultural/environmental (home, school, work, and community) influences. Obesity closely associated with type 2 diabetes, CVD, hypertension, certain types of cancers.

Other Considerations for Clients with Diabetes

Clients w/ diabetes need check blood glucose before exercise. Blood sugar levels should be betw.100 and 250 mg ∙ dL−1, if lower client should eat carb rich snack, if higher 250-300 mg ∙ dL−1 will need to check urine for ketones, and if present exercise should be delayed. Exercise has insulin like effect on circulating blood glucose, even when no blood insulin, therefore hypoglycemia very serious.

Aerobic Training for Clients with Hypertension: Type

Clients with hypertension should primarily engage in aerobic endurance activities that involve large muscle groups and are rhythmic in nature. Avoid activities that emphasize isometric muscle contractions or that may elicit large blood pressure responses in your clients.

Resistance-Training Guidelines for Older Adults: Exercise session duration

Complete at least one set of each exercise, Allow adequate rest between exercises to prevent carry-over fatigue

Programming for Clients with Diabetes

Diabetes mellitus is a metabolic disorder stemming from abnormal pancreatic insulin production and/or diminished peripheral action of insulin. Positively associated with other diseases, and seriously compromises heart and vascular system. CVD mortality rates 4 times higher in those with diabetes

Programming for Clients with Hypertension

Elevated resting systolic blood pressure of ≥130 mm Hg and diastolic blood pressure of ≥80 mm Hg. However, SBP betw. 120 and 129 and DBP less than 80 has equally important diagnosis. Almost half of adult population has hypertension, it is most prevalent risk factor for CVD in US. Major contributor to risk of stroke and related to development of CAD (can lead to myocardial infarction). Sometimes called silent killer. People with blood pressure >115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg.

Aerobic Training for Obese Clients

Even though rec. is 150min/week, greater weight loss likely requires more approximately 250-300 min ∙ wk−1 or approximately 2,000 kcal ∙ wk−1 of mod. intensity. Exercise alone is ineffective, must be coupled with dietary restriction. Extreme exercise or physical activity that results in a large negative energy balance will clearly result in weight loss. Regular aerobic exercise should be used in concert with a low-calorie, low-fat, and high-fiber diet plan,

Successful Aging

Exercise not only improves quality of life but also increases the length of life. Regular physical activity at a mild to moderate intensity was strongly associated with a reduction in all-cause mortality in active compared with sedentary individuals. No exercise has effect of limiting participation in life and reducing independence. Regular involvement in aerobic, anaerobic, resistance, flexibility, and functional training is a key element of successful aging.

Aerobic Exercise Prescription during Pregnancy

General cardiorespiratory principles apply to pregnant women and those in post partum, though special adaptations must be made. 30 min of moderate intensity is good goal

Other Considerations for Clients with Comorbidities

Greatest challenge is designing exercise programs for clients with comorbidities is the amount of planning required. Needs preparticipation screening, which helps recognize limitations. Personal Trainers must be prepared to accommodate an ever-changing chronic condition landscape with these types of clients and constantly adjust the session to best serve the client on any given day.

Exercise testing older adults

Health screening and assessment should be done as likelihood is high clinically sig. or underlying chronic disease. Exercise testing determine functional capacity, establish safe exercise prescription, and monitor progress in program. Design programs with 3 things in mind: 1. Prevent or delay the progression of chronic diseases (and/or possibly "reverse" symptoms as in normalizing blood glucose). 2. Maintain or enhance cardiorespiratory fitness levels (i.e., functional capacity). 3. Prevent functional limitations and disabilities.

Selected Signs and Symptoms of Hyperglycemia

Hyperglycemia: >300 mg ∙ dL−1 dry skin, hunger, nausea/vomiting, blurred vision, frequent urination, extreme thirst, drowsiness, acetone breath (fruit breath)

Programming for Clients with Diabetes: Type 2

In general, the critical risk factors for Type 2 diabetes are associated with a sedentary lifestyle. Primary risk factors are age, family history, ethnicity, obesity, alcohol intake, high fat diet, high blood truglycerides, high BP, and gestational diabetes or birthing baby w/ weight more than 9 pounds. approximately 81.5 million adult Americans have prediabetes (36.8% of the U.S. adult population) - blood glucose values are elevated beyond normal levels.

Resistance-Training Guidelines for Clients with Cardiac Disease: Progression

Increase slowly as patient adapts (~2-5 lb ∙ wk−1 [1-2.3 kg] for upper body and 5-10 lb ∙ wk−1 [2.3-4.5 kg] for lower body).

Aerobic Training for Clients with Diabetes: Progression

Maximizing caloric expenditure is the highest priority in clients with Type 2 diabetes. Thus, the Personal Trainer should progressively increase exercise duration (either continuous or accumulated) and develop a program that promotes beneficial adaptations while combating boredom.

Aerobic Training for Obese Clients: Intensity

Moderate- to vigorous-intensity aerobic activity is encouraged. Initial intensities should be determined based on current fitness level (e.g., 40%-59% O2R or HRR). Later progression into more vigorous intensities (>60% O2R or HRR) may be appropriate for some obese clients but should be individualized on the basis of the client's goals and history.

Aerobic Exercise Program Modifications for Pregnant Women: Exercise Frequency

Moderate-intensity exercise should be regular rather than sporadic in nature. Exercise should be performed 3-5 d ∙ wk−1

Weight Loss Expectations

Most people do not understand that exercise alone is not very effective for reducing weight. PTR explain exercise beneficial even if weight loss goals are not met. Recommends obese reduce body weight by 5-10%, but 150min/week only reduce 3%. A lot of ptrs think they can prescribe the right amount of energy expenditure for losing weight, but most of the time obese clients are dissatisfied. Need to understand obesity is a heterogeneous condition, requiring multifocal treatment plan, and wide variability in weight loss outcomes in obese people, regardless of program design - no single appropriate weight loss treatment plan for all obese people.

Pathophysiology of Diabetes: Type 1 and 2

Normally, insulin released in pancreas response to high blood glucose following food. Type 1 pancreatic beta cells that produce insulin destroyed by autoimmune disorder, creating absolute insulin deficiency; Type 2 insulin produced but ineffective at controlling blood glucose bc of insulin resistance in tissues. Then pancreas increases insulin to overcome resistance, giving excess blood insulin - hyperinsulinemia over time can contribute to hose of problems like hypertension, hypercholesterolemia, excessive blood clotting, atherosclerosis, and kidney stones.

General Exercise Considerations during Pregnancy and Postpartum

Not much exercise in first trimester due to morning sickness and fatigue, PTR also know increased nuritional requirements of pregnant clients - utilize mtabolic calculations to estimate total energy expenditure (additional intake of 300 kcal per day). Pregnant woman have decreased thermoreg. so stay hydrated, weak appropriate clothing avoid hot humid conditions, encouraged to choose environmentally controlled indoor settings, and let them know normal for numerous fitness parameters to decline. Physiological changes associated with preganancy persist 4-6 weeks postpartum

Programming for Children

PTR should identify a variety of age-appropriate activities for children that will safely and effectively develop aerobic, muscular, and bone strength. PTRs should design physical activity programs for children with two primary goals in mind: 1. program should fulfill minimal amount of physical activity needed to achieve health benefits associated with reg physical activity 2. Children should be encouraged participate variety of activities that are enjoyable and age appropriate.

Resistance-Training Guidelines for Older Adults: Exercise Mode

Perform 8-10 exercises using the major muscle groups, Dynamic muscle strengthening activities include machine and free weights, weight-bearing calisthenics, resistance bands, and similar resistance exercises that use major muscle groups

Resistance-Training Guidelines for Older Adults: Exercise intensity

Perform each lift or movement with a resistance that allows for 10-15 repetitions per exercise, Level of effort for muscle-strengthening activities should be light for beginners progressing to moderate to vigorous. On a 10-point scale, where no movement = 0, maximal effort = 10, moderate-intensity effort = 5 or 6, and high-intensity effort = 7 or 8

Balance Exercises and Training Progression for Older Adults: Sitting

Perform leg activities (heel, toe, or single-leg raises, marching). Can sit on chair, on physioball, crossed arms, one leg

Programming Goals for CVD

Positive risk factor modification is the primary goal of an aerobic exercise program. Risk of CVD highest those with low levels of cardiorespiratory fitness, and inverse relationshp between VO2 max and CVD and total mortality. Each MET can reduce risk of CVD by 8-17%. Dose response betw. exercise and health outcomes . health benefits closely associated with total weekly energy expenditure - programs with energy expenditure of 14-23kcal/kg/week lead to sig improvements in cardiorespiratory fitness and risk factors of CAD. Sometimes high intensity aerobic interval training potential improving VO2 peak. PTRs use FITT-VP for getting total weekly energy expenditure+pos. adaptations to CAD risk factors. Goal to modify process of atherosclerosis and reduce likelihood of future cardiac events

Other Considerations for Clients with Hypertension

Primary focus is safety during and after exercise. Clients likely to be taking some form of antihypertensive med. Drop in BP after exercise expected, but w/ meds there is greater risk in elicit abnormal drop in BP following exercise. This means need gradual and prolonged cool down activities. Beta blockers lower HR in response to exercise, and angiotensin converting enzyme (ACE) inhibitors lower BP by preventing vasocontriction w/out sig change in HR. Also, gain more skill in enhancing skills in BP monitoring, need BP measurements before, during, and after exercise. Avoid exercise is resting BP more than 200/110, and terminated if exceeds 220/105 or client has 10 drop in SBP during exercise.

Training for Clients with Comorbidities

Relatively safe with assessment +screening prior to program. Need physician clearance, and likelihood of adverse event can be reduced by baseline assessments, risk stratification, pt education, and client adherence. Clients need more monitoring, and PTRs should know potential signs that warrant termination of exercise. Generally can follow FITT-VP

Resistance Training for Clients with Hypertension

Resistance training is considered a supplement to aerobic exercise and should not be prescribed as the primary form of activity for clients with hypertension. intensity should be kept at 60%-80% 1-RM. the overall effect is not as great as the response to aerobic exercise training. Specific RT recommendations for these clients similar to healthy ones. Need to teach proper technique, breathing, and avoid larger amounts of isometric work during RT to minimize large increase in BP

Resistance-Training Guidelines for Clients with Cardiac Disease: Exercise Frequency

Resistance training should be performed on 2-3 nonconsecutive days per week

Resistance-Training Guidelines for Older Adults: Exercise frequency

Resistance training should be performed on two or more nonconsecutive days per week

Aerobic Training for Clients with Hypertension: Progression

Specific consideration should be given to blood pressure control, recent changes in blood pressure medications, and the other comorbidities that may be present. avoid large increases in any of the FITT components, especially intensity for most people with hypertension.

Programming Goals for Those with Diabetes

The main exercise programming goals for individuals with diabetes are: 1. Improve insulin sensitivity and blood glucose control and decrease insulin requirements 2. Improve cardiorespiratory fitness 3. Improve blood lipid profiles 4. Reduce blood pressure 5. Improve muscular strength and endurance through enhancing skeletal muscle mass 6. Improve flexibility and joint ROM 7. Reduce body weight (particularly reduce intra-abdominal fat) 8. Assist with decreasing the risk of diabetic complications PTR should maintain reg contact with physician

Aerobic Training for Obese Clients: Type

Thus, any type of physical activity that the client will do regularly is recommended. The primary mode of exercise for large clients should involve large muscle groups and be aerobic in nature to provide the greatest caloric expenditure during exercise. RT is added to exercise, but only in addition to overall increase in leisure time physical activity and decreased sitting time.

What PTRs need to know

Trainers should instruct their clients that exercise and increasing physical activity will improve health but may not cure obesity. The exercise threshold required to improve one's health may be far below the exercise threshold required for weight loss. Personal Trainers are advised to not generalize that obese individuals lack self-control (116) or rationalize that weight-loss failure is solely a consequence of poor client compliance.

Warning Signs to Terminate Exercise during Pregnancy

Vaginal bleeding, Regular painful, Amniotic fluid leakage, Dyspnea prior to exertion, Dizziness, Muscle weakness affecting balance, Calf pain or swelling, Headache, Chest pain

CVD

about 82.6 million AMerican adults, more than1 in 3 have one or more types of CVD, and 2200 Americans die from CVD everyday. Nutrient intake and physical inactivity lead to obesity, hypertension, dyslipidemia, and type 2 diabetes, which are risk factors for CAD. Main goal of the Personal Trainer is to help clients with the primary prevention of atherosclerotic risk factors. Exercise programs can effectively stabilize and even reverse process of atherosclerosis can be designed for individuals with known CAD

Duration

aerobic: at least 60min/day resistance: included with the at least 60min/day bone loading: included with the at least 60min/day

Frequency

aerobic: daily resistance: at least 3days/week bone loading: at least 3days/week

Older adults

age expectancy for women is 81.2 years and 76.4 years for men. Older adults are defined as men and women 65 years and older and/or adults age 50-64 years with clinically significant chronic conditions and/or functional limitations that impact movement ability, fitness, or physical activity. Each system in the body responds to aging differently. Thus, one's chronological age cannot be assumed equivalent to one's physiological or functional age.

Preparticipation Screening Exercise during Pregnancy and Postpartum

always have pregnant woman evaluated by obstetric provider determine whether exercise is contraindicated. Have client review PARmed-X for Pregnancy recommended, can be signed by OB to verify safety of exercise and provide recommendations for cardiorespiratory and RT activities.

Resistance Training for Clients with Diabetes

applicable for people with either prediabetes or Type 1 or Type 2 diabetes, but have to take into account contraindications like retinopathy and neuropathy. RT good for people w/ diabetes bc helps manage disease and maintain physiologic function thru improvement in strength+endurance. Diabetes might also be caused from increased fat and decrease muscle mass result of aging, which effects independence+ADLs. Advised to perform circuit weight training to regulate blood glucose and prevent age related muscle atrophy. Patients with Retinopathy can do circuit training with light loads bc blood pressure will not spike. RT to maintain skeletal muscle mass good for improving glycemic control+insulin sensitivity, decreasing HbA1C levels, reducing intra abdominal fat, improving overal metabolic profile+quality of life

Programming for Clients with Comorbidities

approx 80% individuals older than 65 or older living with at least one chronic health problem and 50% living with 2. Challenge is clients focus on only one of their chronic health issues and not taught to manage more than 1. Sedentary lifestyle as a controllable risk factor for many chronic health conditions

cardiorespiratory fitness older adults

arguably the most important goal of an exercise program. Low cardiorespiratory fitness contributes to premature mortality in middle-aged and older adults, every 10% improvement in CR fitness, expect 15% reduction in overall mortality. Decreased CR fitness contributes reduction in physiological functional capacity and loss of independence. If not change, then program was effective bc inevitable decline in physiological function, in this case cardiorespiratory fitness, has been delayed. General, physical activity programs should be designed to meet the 150 min/week or 75min/week. Physical exertion scale is 0-10, 0 being sitting and 10 max effort. Moderate intensity is 5 or 6 and vigorous is 7 or 8.

Physiological Aspects of Aging: Other

balance decreases, reaction time increases

Physiological Aspects of Aging: CNS

betw. 45-85 years, decline in brain blood flow, 20% decrease in brain weight, due to loss of fluid and nerve conduction velocity slows by 10-15% causing slower reaction times and vol. movements. Also decrements in nerve conduction velocity thought to contribute to losses in muscular strength as well

Other

by age 7 or 8, should be physically and mentally mature to initate RT program, critical PTR provide instruction for proper lifting technique+safety, if machines used, should be designed for children's body size to reduce injury. Children have underdeveloped thermoreg. systems and more prone to heat injuries than adults, so PTR ensure properly hydrated and activity in thermoneutral environments. Children may have asthma, type 1 diabetes, cerebral palsy - consult with medical team familiarize themselves with specific exercie recommendations and adapt exercise program according to condition, symptoms, and functional capacity

Developing Muscular Strength for Older Adults

can have reduced balance, mobility problems, and lack of independence if no muscle mass, and plays a role in glucose intolerance and type 2 diabetes, so increased muscle fiber size+performance, and rate of force dev. are higher if exposed to strength training. General RT applied and explosive heavy still safe and effective. Machines for beginners as safer, other modalities are good promote kinesthetic awareness and improve balance. Go through full ROM and avoid breath holding, intensity betw. moderate and vigorous, should be 60-70% 1-RM or 40-50% 1-RM for beginners. One set of 10-15 reps recommended, load increased when # of reps can be completed with proper form exceeds initially prescribed #

Other

cautioned against late night exercise as this could cause low blood glucose during sleep (nocturnal hypoglycemia) and inadvertently cause a potentially life-threatening situation, if this can't be avoided, need to eat after exercise. Warm up and cool down particularly important to avoid exercise induced cardiovascular complications. Proper footwear important, especially those at risk for peripheral neuropathy or peripheral vascular disease. Maintain hydration, avoid exercise in hot/humid environments, recommend light RT avoid high BP spikes especially those with retinopathy

Resistance Training for Obese Clients

commonly treated as an adjunct to a regular, aerobic exercise program and generally should not be used in lieu of an aerobic program. Still a critical component and should be added. RT associated with improvements in many chronic disease risk factors in the absence of significant weight loss, shown to improve blood cholesterol, insulin insensitivity, reduce glucose stimulated plasma insulin concentrations, and improve systolic+diastolic BP. resistance training may also improve the maintenance of lean body mass in clients following a calorically restricted diet

Aerobic Training for Clients with Hypertension

cornerstone activity in the total program for clients with hypertension. Average, decline of approximately 3-4 mm Hg for systolic blood pressure and approximately 2-3 mm Hg for diastolic blood pressure from aerobic exercise training. Several studies have shown that higher cardiorespiratory fitness provides a cardioprotective effect of lower mortality risk from all causes and CVD in individuals with hypertension

Physiological Aspects of Aging: Cardiovascular

decrease: Max HR and SV by 10% (amount of blood pumped per heart beat), max CO by 20% (blood flow out of heart per minute), max oxygen consumption, anaerobic capacity (reduced ability perform high intensity), max lactate production, tolderance, and clearance after exercise decline, increase: resting and exercise BP, prevalence of hypertension (blood vessels stiffen and less able to expand increasing resting and exercise BP, also total body water declines) same: resting HR *changes predispose older people to reduced exercise capacity, dehydration, and impaired exercise tolerance in hot+humid weather

Physiological Aspects of Aging: Environmental

decrease: cold tolerance (heat production/blood redistribution), and heat tolerance (sweat capacity/blood redistribution)

Physiological Aspects of Aging: Metabolic

decrease: glucose tolerance, insulin sensitivity,

Physiological Aspects of Aging: MS

decrease: lean body mass, muscle strength, bone mineral density, flexibility (main culprit in decreasing mus. strength is 30-50% decrease in muscle mass betw. 30 and 80 yo bc decrease in # of muscle fibers and greater atrophy of Type 2/fast twitch muscle fibers compared with type 1 fibers - power function of strength and speed, fiber changes mean power output declines at faster rate than strength alone), lower body muscles decline faster than upper, muscular endurance goes down not as quickly as power, connective tissue, ligaments, cartilage, tendons, bones also weaken, can give osteoporosis, degeneration elastic components of conn. tissue gives loss mobility and stability in joints, body weight increases bc of accumulation body fat, after 70 yo, body weight starts decline increase: fat mass

Developing Balance in Older Adults

decreased balance can be from, decreases in joint and muscle flexibility (ROM), muscular strength, reduced central processing of sensory info, and slow motor responses. Sometimes myelin sheaths exhibit degenerative change and loss of nerve fibers from white matter in brain - decline in sensory capability and cognitive function. Sight, hearing, taste, balance, vestibular function, and proprioception decline in old age, leading greater risk of falling. Balance critical for ADLS and leisure time activities. Balance + posture enhanced by flexibility and RT, both static and dynamic balance activities employed 2/week. Balance training can be done 3 days/week for 10-15 min each session, can be integrated into warm up, main component, or cool down.

Exercise training makes diff

even though aging is biological, only about 50% of the decrements noted earlier are due to actual aging, whereas the other 50% are due to sedentary living and can be altered with exercise, and older adults encouraged avoid physical inactivity. Active reg. minimizes normal age related changes and restores functional capacity previous sedentary adults. Anaerobic, aerobic, RT programs increase aerobic capacity and muscular strength by 20-30% in older adults. Aerobic training may actually improve exercise efficiency to a greater extent in the elderly as compared with the young.

Aerobic Training for Obese Clients: Frequency

frequency of 5 or more days per week to maximize energy expenditure in obese clients.

Resistance Training and Flexibility Prescription during Pregnancy

general resistance and flexibility training principles can apply. After first trimester, RT and flexibility training exercises in supine position be avoided bc of potential obstruction of venous return and risk of orthostatic hypotension. Isometric or heavy RT may elicit pressor response - sudden increase in HR or BP and not recommended. Joint ROM will be enhanced during pregnancy bc increased relaxin, so potential exists for ligament and joint capsule damage with over aggressive flexibility program. use slow static stretching throughout pregnancy

Children vs Adults

higher in children: relative oxygen uptake, heart rate, respiratory rate, lower in children: absolute oxygen uptake, cardiac output, stroke volume, minute ventilation, respiratory exchange ratio, systolic and diastolic BP

Designing Resistance-Training Programs for Clients with CVD

improves muscular strength and endurance, decreases cardiovascular demands of a given task, helps prevent/treat other chronic diseases, increases ability to perform daily activities, and improves self-confidence, among other benefits. Two primary goals of resistance training for those with CVD are as follows: 1. To maintain and improve muscular fitness levels for performing ADLs 2. To reduce the cardiovascular demands (e.g., lower heart rate and blood pressure) associated with performing these tasks PTR get physician approval before RT training, and ask medical team about limitations. Monitor for proper technique and breathing patterns, straining, tight gripping, and Valsalva maneuver should be avoided

Programming for Children + Adolescents

includes 6-17 yo, participate at least 60min/day of moderate to vigorous intensity physical activity, and include RT exercises and bone loading activity on at least 3 days per week

Aerobic Exercise Program Modifications for Older Adults: Exercise intensity

intensity start low and progress, initating program at <40% HRR or VO2 R not unusual, conservative approach to increasing intensity may be required as older individuals have underlying chronic diseases, measured peak HR better than age predicted peak HR bc of variability in peak HR in clients above 65 and greater risk for underlying CAD, Activities performed at a given MET level represent greater relative intensities in older adults than in younger clients, likely to be taking meds that influence HR, should be 5-6 for moderate intensity and 7-8 for vigorous.

Programming Goals

main goal for ptrs is providing exercise programs that focus on promoting adherence to an active lifestyle that matches closely w/appropriate dietary strategies. Most common goals are: 1. Maximize caloric expenditure 2. Maintain or increase lean body mass to maintain resting metabolic rate 3. Improve metabolic profile 4. Lower the risk of comorbidities (e.g., hypertension, diabetes, orthopedic problems) 5. Lower mortality risk 6. Promote appetite control 7. Improve mood state

Pathophysiology of Diabetes: Controlling blood glucose levels

main goal in the management of diabetes is adequately controlling blood glucose levels. Normal resting blood glucose level is less than 100 mg ∙ dL−1, and diabetes diagnosed when fasting blood glucose is 126 mg ∙ dL−1 or greater on two or more occasions. Important measurement of glucose control is glycolated hemoglobin or hemoglobin A1c (HbA1C) measurement. Although blood glucose numbers describe the blood sugar at a single point in time, the HbA1C provides a better measure of glucose control over the last 2-3 months. People w/out diabetes, have normal HbA1C betw. 3.5%-5.5%, while diabetes have higher values bc bodies consistently higher levels of blood glucose. Goal HbA1C for people w/ diabetes is less 7%

Aerobic Training for Obese Clients: Time

minimum of 30 minutes per day exercise duration progressing gradually to 60 minutes per day. If client to severly deconditioned or have condition that limits ability to exercise for this long, should do multiple bouts of exercise throughout the day. successful weight control may be more likely when obese clients are exercising 45-60 minutes per session (200-300 min ∙ wk−1), expending at least 300 kcal per session, and a total of 2,000 kcal or more per week.

Aerobic Training for Clients with Hypertension: Intensity

moderate-intensity exercise, 40%-59% of O2R or HRR, as the primary-intensity prescription for individuals with hypertension. Should apply the lower end of this range for hypertensive clients who are deconditioned, older, or have comorbid conditions that can affect their risk of experiencing cardiovascular complications during exercise (diabetes, CAD, etc.). RPE can be used to help determine intensity rather than HR bc of medication; RPE of 12-13 is good for moderate intensity.

3 target areas for children

most young people are health so safe to initate moderate-intensity without medical screening, medical exams and testing prior to participation generally unnecessary in this population unless clinically indicated. Children have lower anaerobic capacities, limiting potential for high intensity exercise performance. ACSM rec. three target areas: aerobic endurance, muscular strengthening, bone strengthening activities, giving favorable training adaptations in children, resulting in benefits to cardiovascular, metabolic, and skeletal health

Other: Obese Clients

obese clients do no reg. body temp as effectively as leaner clients. Clients should be advised to have proper exercise clothing, hydration, environmental issues, and look for signs of heat exhaustion/stroke. Obese clients more likely experiencing ortho injuries bc greater stress on joints due to overall weight. This should kept in mind when thinking of intensity of exercise program. Should include non wight bearing modalities when appropriate to minimize ortho stress. Prepared to modify exercise program. Some exercise machines may not be able to accomodate obese client.

Aerobic Exercise Program Modifications for Older Adults: Exercise session duration

older adults should increase exercise duration prior to intensity, Duration need not be continuous to produce benefits and can do bouts of 10min, A daily accumulation of 30 min moderate-intensity physical activity can provide health benefits, Even greater benefits are possible with up to 60 min ∙ d−1 of moderate-intensity physical activity,

Developing Flexibility in Older Adults

poor flexibility and decreased MS strength associated with diminished ability perform ADLs; conn tissue is sitiffer, joints more resistant to bending. Static stretching done right before exercise could decrease muscle strength+endurance, impair balance, diminished reaction time. Should stretch 2 days/week by dynamically, statically or both. Guidelines altered when working with those w/ functional limitations such as arthritis or osteoporosis.

Cardiorespiratory Training for Clients with CVD

pretty safe, need screening +assessment before. Clients w/CVD should have cardiovascular risk assessed by physician and get clearance prior to exercise. Most cardiorespiratory assessments in ACSM can be provided to clients w/ CVD after proper screening, clinical eval, and recent clinical exercise test. Determine proper intensity dependent on baseline cardiorespiratory fitness level. For most sedentary clients w/ CVD, threshold intensity for improving cardiorespiratory fitness approx. 40-80% of VOSR or HRR. Prescribing moderate intensity on 5-7 days/week for 20-60 min/session

Aerobic Training for Clients with Diabetes: Frequency

recommends 3-7 days/week w/ no more than 2 consecutive days betw. sessions of aerobic activity bc of relatively brief exercise induced improvements in insulin action. Greater frequencies of physical activity shown to more effective in improving glucose tolerance and insulin sensitivity; clients who are obese or take insulin benefit most by daily schedule allows for greater consistency and opportunity increase caloric expenditure for weight management

Aerobic Training for Clients with Diabetes: Time

recommends a range of 20-60 minutes for clients with diabetes, continuous or accumulated in bouts of at least 10 minutes to total of 150 minutes per week. (minimum to elicit pos. changes in glucose tolerance and insulin sensitivity). 10min bouts may be good progression if they want to increase their exercise (300 min/week). Because intensity may be relatively low in this population, frequency and duration are critical factors in determining caloric expenditure. If weight loss is the goal, recommends 2000 kcals/week or more and daily exercise.

Aerobic Training for Clients with Diabetes: Intensity

recommends a range of 40%-59% of O2R or HRR for clients with diabetes. Individuals who are reg. exercisers, better blood glucose control may be achieved at higher exer intensities (at least 60% VO2R). Clients who are overweight, sendentary, deconditioned, starting point at 40% VO2R or HRR, or slightly lower. Progress client through intensity range is to made after taking into account age, ability to tolerate exercise, and individual goals - general, frequency+duration goals should be realized before implementing a sig. progression in intensity. Clients w/long history of diabetes may incur condition that can effect HR and BP response to exercise, ptr encouraged to use RPE for determining intensity

Aerobic Training for Clients with Hypertension: Time

recommends an exercise time of 30-60 minutes of continuous or accumulated exercise per session. Exercise duration goals based on individual goals + history. A caloric expenditure goal of 2,000 kcal or more per week is indicated to help treat persons with hypertension especially if weight loss is also a goal.

Aerobic Training for Clients with Hypertension: Frequency

recommends exercise for clients with hypertension on most, if not all, days of the week. Encouraged to do daily reg. exercise as the subacute response of blood pressure following a bout of aerobic exercise is to remain below levels measured prior to exercise. This translates into more controlled and consistent blood pressure levels from day to day, which is ideal for clients with hypertension. Research studies find that more than 150min of exercise/week shows greater decrease in BP

Programming for Clients with Diabetes: Type 1

results from an autoimmune response whereby the body's own immune system mistakenly destroys the insulin-producing cells in the pancreas. Type 1 diabetes comprises approximately 5%-10% of all diagnosed cases of diabetes. This leaves 90%-95% of all diagnosed adults in the category of Type 2 diabetes.

Aerobic Training for Clients with Diabetes: Type

similar to those for an apparently healthy adult. program adherence is improved if the client chooses an exercise modality that he or she enjoys. Walking is the most common form of exercise for clients with diabetes. Considerations who are obese or experience diabetic complications like peripheral neuropathy, ptrs should minimize high impact, weight bearing activities or that require greater balance or coordination. So alternating weight bearing activities with non weight bearing activities such as cycling, upper body ergometry, and swimming may enhance the safety and appropriateness of the exercise program.

Aerobic Exercise Program Modifications for Older Adults: Mode

walking is good, modality should not impose excessive orthopedic stress, aquatic, stationary cycle, good for clients diminished ability to tolerate weight bearing exercises, group setting food, modality is accessible, convenient and enjoyable