Special Pops - Exam 1

Slide 9: Estimated energy requirements for boys and girls

understand the graph

Ballistic methods or "bouncing" stretches

use the momentum of the moving body segment to produce the stretch.

Goals for a health related resistance training program

for adults of all ages, the goals of this program should be to make ADLs easier and effectively manage/prevent chronic diseases

Slide 6 Homeostasis of body temperature

graph

Exercise testing: expect higher

-Relative oxygen uptake -Heart rate -Respiratory rate

Methods of estimating the relative intensity of exercise

-%HRR -%HRmax -%VO2R - %VO2 - %METs

General guidelines for cardiovascular training

-30 minutes of moderate activity and 30 minutes of vigorous activity on at least 3-4 days per week -Encourage running, swimming, bicycling, jumping, etc. -Exercise in a cool environment

Exercise testing: expect lower...

-Absolute oxygen uptake -Cardiac output -Stroke volume -Blood pressure -Tidal volume -Minute ventilation

Progesterone

-Acts as trigger of the primary respiratory center by increasing sensitivity of respiratory center to carbon dioxide (drive to breathe comes from CO2) -Alters smooth muscle tone of airways resulting in bronchodilator effect -side effects of too much progesterone headache,blurred vision, heartburn

Osteoarthritis

-Also known as degenerative arthritis -Long-term use wears down articular cartilage -Loss of cartilage can expose bone surfaces

Decrease in lean tissue

-Also known as sarcopenia -Accompanied by loss of strength

Loss of balance

-Balance issues arise from loss of muscle mass, weakened joints, and decreased flexibility -Balance problems often promote falling -Falling often results in broken bones

Interrupted blood flow to fetus

-Blood from the mother supplies the fetus -Working muscles demand increased blood flow -Blood might be diverted away from fetus and to mother's muscles during exercise -Fetus might be deprived of oxygen and nutrients -should not be a concern for mothers (biggest fears research has shown)

•Second trimester

-Body adjusts to hormone levels -Enlarging fetus promotes back pain -Center of balance changes -Joints become less stable -Reflux develops as uterus and fetus are displaced -Edema develops (if standing make sure they are moving)-risk of vericose veins -pressure on stomach-heart burn -risk of hemmeroids

Musculoskeletal changes

-Body weight increases -Center of balance changes (with relaxin - increased fall risk -Joints become less stable -avoid heavy weight and rapid change in direction

Cardiovascular system changes

-Changes in blood vessels •Blood vessels develop plaque (does not just start when you are old) •Elastic arteries lose elastic fibers (becomes stiff) •Venous valves weaken •Total number of blood vessels diminishes •Blood pressure tends to increase

General guidelines for resistance training

-Closely supervise if offered -Can be safe if using high repetitions, low resistance (perform 8-15 repetitions to moderate fatigue)

Respiratory system

-Coughing reflex slows -Macrophages in lungs become less active -Mucus thickens -Number of cilia drops -Other changes are directly proportional to exposure to environmental pollutants - severity a lot related to the environment (been chronic smokers when they didn't know it was bad for them or exposed to second hand smoke) -alveoli are still there but the walls thin so )2 and CO2 exchange will be impaired

Lymphatic system

-Decreased immune function Thymus shrinks -Cytotoxic T cells become less active -Macrophage activity slows -Wound healing is delayed (biggest takeaway) -Ability to develop fever diminishes -Inflammation occurs frequently

Increased risk fir low-birth-weight babies

-Developing fetus requires extra energy (.19 pounds lighter - so not a big difference) -Energy might be used to support activity rather than to support developing fetus (can help decrease risk of obesity later as they grow up)

Overweight and obesity among children- Excess weight increases risk for

-Diabetes -High blood pressure -Elevated cholesterol levels -Heart disease -Joint disorders -Only 33% have regular phys. Ed.

Increased core body temperature

-Elevated core temperature can denature proteins -Denatured proteins are unable to function normally -Exercise produces significant amounts of heat -Extreme and prolonged elevated temperature can result in neural tube defects in fetuses -102.6 deadly to the fetus -body learns to sweat at lower body temp to decrease the internal temp

Integumentary system changes

-Epidermis, dermis, and hypodermis thin -Langerhans cells suffer from UV exposure -Melanocytes diminish and become less active -Number of nerve receptors declines* (diminishes ability to feel things to the touch - cutaneous stimulation -Number of sweat glands drops* (risk for overheating is high and risk at cold for retaining warmth) -Number of blood vessels diminishes* (same as sweat glands)

Youth have an increased risk for musculoskeletal injuries

-Epiphyseal plate damage -Intervertebral disk rupture -Joint injuries -Less stable joints (bc muscle isn't fully developed) so need to be careful of what activities they are doing

Reduces overall discomfort and improves mood

-Exercise alleviates back pain, stiff joints, constipation, bloating, and insomnia, edema in legs -Exercise maintains joint range of motion -Exercise preserves muscle mass and strength -Exercise improves mood and decreases the incidences of depression in pregnant women

Eases pregnancy, labor, and delivery

-Exercise improves cardiorespiratory functioning •It increases blood volume and red blood cell count •It improves the oxygen-binding capacity of hemoglobin during and after activity -Exercise improves muscular functioning •It prepares muscles for childbirth -helps knowing when to breathe

Third trimester

-Fetus enlarges and crowds out maternal organs (diapghram displaced) -Urge to urinate increases -Constipation develops -Fatigue ensues -Braxton-Hicks contractions might develop (does not mean the baby is coming - practice contractions)

Endocrine system changes

-Gland size and activity change •Thymus gland •Pituitary gland •Parathyroid glands* (releases thyroid stimulated hormone- control metabolism, HR, BP, depression/anxiety, sleep at night) - usually experience hypothyroid •Pancreas* (not utilizing insulin and it making more (become resistant to it), blood glucose levels with this •Pineal gland

Loss of cardiorespiratory functioning

-Heart's functional ability declines -Maximal heart rate drops -Ejection fraction decreases -Blood pressure rises -VO2max decreases (3-8% per decade) and is primary contributor to decrease in lean muscle mass

Estrogen

-Helps maintain positive maternal nitrogen balance -Increases blood volume by causing the collecting ducts and kidney tubules to remain more sodium -As blood volume continues to increase (50% above normal) to meet needs of fetus,cardiac output increases -(blood flow increases by about 10x) -big reason for swelling -more rapid HR with rest and exercise

First trimester

-Hormone levels fluctuate dramatically and promote nausea (especially HCG) -Perspiration increases -Fetus enlarges and puts pressure on urinary bladder -Fetal organ systems develop

Urinary system

-Kidney size diminishes as nephrons are lost -Ability to remove wastes diminishes -Reabsorption of water, glucose, and other useful materials diminishes -Urinary bladder loses elasticity!! - cant hold enough-incontinence (scared to have accident) -Seniors become less sensitive to urge to void

Relaxin

-Limits the natural movements of the uterus to prevent contractions early in pregnancy -effects entire body -Makes joints in the body flexible (joint instability throughout the 9 nine months)

Inability to regulate body temperature

-Loss of blood vessels impairs radiative cooling -Loss of sweat glands impairs evaporative cooling -Loss of subcutaneous fat impairs heat retention in cold environments (cant retain the heat)

Reproductive system

-Male •Prostate gland enlarges •Risk for prostate cancer increases •Testosterone levels remain fairly stable -Protects bone tissue -Maintains secondary sex characteristics -Female •Ovary structure changes -Affects monthly cycle -Affects hormone levels •Estrogen levels drop significantly postmenopause -Increases risk for heart disease and osteoporosis -Might impair immune system functioning

Decreased oxygen delivery to fetus

-Maternal cells require more oxygen with exercise -Fetal cells might be deprived (but probs not gonna happen) -Growth and development might suffer -More hard and intense exercise- respiratory rate , o2 and tidal volume decrease (ur body will stop you from exercising to a point the fetus cant handle) -if you are being safe this wont be an issue

Muscular system changes

-Number of blood vessels, myoglobin, and mitochondria drops (carries oxygen-oxygen use affected) -Number of myofibrils decreases (so will the relative amount of CT) -Glycosomes disappear -Number of fast and intermediate fibers decreases -Type II affected first (fast twitch anaerobic), then Type IIa, then Type I if you live long enough -Sarcopenia is the loss of muscle mass with age -Dynapenia is the loss strength with age

Exercise Prescription - Resistance training

-Perform 1 set of 10-15 repetitions for 8-10 different exercises targeting major muscle groups -Intensity should be moderate (RPE = 5 or 6) to vigorous (RPE = 7 or 8) -Pay extra attention to body alignment -bands and machines are better bc free weights require stability

Decreases risk for preeclampsia

-Preeclampsia is characterized by high blood pressure and protein in the urine -It detrimentally affects mother and fetus -comes on very quickly it is hard to catch it. Can get out of control fast and can be detrimental to mother and fetus.

Human chorionic gonadotropin

-Produced by day 12 after fertilization -Detected by pregnancy tests -Associated with nausea, vomiting, and fatigue -makes sure estrogen and progesterone staying high

Loss of range of motion

-Spine loses flexibility and stiffens -Articular cartilage wears away, promoting inflammation -Synovial fluid production slows -risk for overuse injuries increases Use simple but challenging exercises (do not require a lot of change in motion)

Exercise Prescription- Flexibility training

-Stretch the hip, back, shoulders, knees, upper trunk, and neck -Hold static stretches at the point of tightness but not pain for 15-30 seconds each -Perform 2-4 repetitions per stretch -should be worked on every day

Digestive system

-Teeth are lost -Gums become inflamed -Medications can interfere with absorption -GI tract lining thins -Ability to produce secretions diminishes -Risk of lactose intolerance increases -vitamin A,D,K (impair blood clotting) aren't absorbed as well -tastebuds less sensitive

Some young athletes experience fatal heart failure

-These cases are very rare -They follow vigorous activity -They are associated with genetic heart problems

Youth have an increased risk for hypothermia

-They lose large amounts of heat when active in water -Encourage them to exit water periodically

Nervous system changes

-Total number of neurons drops -Neurotransmitter levels decrease -Brain size diminishes (10% over course of life) -Memory, hearing, balance, vision, smell, and taste acuity are impaired -Reflexes slow (diminished fight or flight) -Dendrites ability to receive signals from other neuron decrease

Improves circulation

-Weight gain, even during pregnancy, interferes with circulation and promotes edema -Exercise increases blood volume, cardiac output, and blood vessel number, thereby improving circulation -Exercise also improves functioning of lymphatic system, which minimizes edema

if previously sedentary... program should be....

-no resistance training -3 days a week of low impact cardio activity -if tolerated, allowed to do 30 mins

Preparticipation health screening before initiating PA or an exercise program is a two-stage process:

1.The need for medical clearance before initiating or progressing exercise programming is determined using the ACSM screening algorithm (see Figure 2.2) a)In the absence of professional assistance, interested individuals may use self-guided methods 2.If indicated during screening (see Figure 2.2), medical clearance should be sought from an appropriate health care provider a)The manner of clearance should be determined by the clinical judgment and discretion of the health care provider

Exercise for youth

12 and under children, 13-8 adolescents, all considered youth

Commonly used equations for estimating maximal heart rate

220 - age is not most accurate but it is easiest to do on the fly Astrand is the one that is recommended Measure directly if you can.

How many years ago was the dose-response relationship between physical activity and health outcome seen?

25 years ago need to know chart?

cardiac output

50% greater and puts extra strain on the heart

rec. target HR for preg women

<20 140-155 20-29 135-150 30-39 130-145 >40 125-140

Summary of contemporary exercise-based cardiac rehabilitation program complication rates chart

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FITT Box Aerobic Exercise Volume Recommendation

A target volume of ≥500-1,000 MET-min ∙ wk−1 is recommended for most adults. This volume is approximately equal to 1,000 kcal ∙ wk−1 of moderate intensity, physical activity, ~150 min ∙ wk−1 of moderate intensity exercise, or pedometer counts of ≥5,400-7,900 steps ∙ d−1. Because of the substantial errors in prediction when using pedometer step counts, use steps ∙ d−1 combined with currently recommended time/durations of exercise. Lower exercise volumes can have health/fitness benefits for deconditioned individuals, and greater volumes may be needed for weight management.

Recommendations in 1995

American College of Sports Medicine (ACSM) in conjunction with the Centers for Disease Control and Prevention (CDC) "30 minutes or more of moderate PA on most, preferably all, days of the week"

MET-min

An index of EE that quantifies the total amount of physical activity performed in a standardized manner across individuals and types of activities (38). Calculated as the product of the number of METs associated with one or more physical activities and the number of minutes the activities were performed (i.e., METs × min); usually standardized per week or per day as a measure of exercise volume.

Components of the Exercise Training Session

Box 6.1

Exercise prescription - Cardiovascular

Cardiovascular training RPE best way to measure intensity here (most likely on meds that alter HR or BP) -Begin each session with at least 5 minutes of low-intensity activity -Encourage 30-60 minutes of activity (RPE = 5 or 6 on a 0 to 10 scale) on at least 5 days per week -If high-intensity activity (RPE = 7 or 8), adjust frequency to 3 times per week -Avoid activities with rapid changes in direction -Avoid high-impact activities

Precautions during exercise

Children and adolescents have difficulty dissipating heat!!!!!!!!!!!!! -Avoid exercising in extreme heat and humidity -Encourage breaks from activity -Overheating can denature proteins and start to influence body processes

Changes in heart

Elasticity of heart wall decreases •Heart valves thicken •Heart can atrophy or hypertrophy (if hypertrophy its fat and cartilage - not good growth)

PAR-Q+

Explain

Factors contributing to excess weight

Genetic factors -Genes influence metabolic rate Environmental factors -Sedentary lifestyle lowers metabolic rate -Excess energy consumption promotes weight gain

Physical inactivity

Global pandemic that has been identified as one of the four leading contributors to premature mortality Globally, 31.1% of adults are physically inactive In the US: •51.6% of adults meet aerobic activity guidelines •29.3% meet muscle strengthening guidelines •20.6% meet both the aerobic and muscle strengthening guidelines

Relative hormone level

Human chorionic gonadotropin - big peak at 2 months the n goes back down at 3 and stays at plateau Estrogen and Progesterone - steady increase through preg. Estrogen a little higher

Table 3.3 on HDL+ LDL

LDL is the most powerful risk factor for cardiovascular disease Higher the HDL, the lower the risk

Sedentary Behavior and Health

Prolonged periods of sitting or sedentary behavior are associated with deleterious health consequences independent of PA levels (increase risk of type 2 diabetes, colon cancer, breast cancer, CVD disease) -50% of an average person's waking day involves activities associated with prolonged sitting such as television viewing and computer

FITT BoxFlexibility Exercise Recommendation

ROM is improved acutely and chronically following flexibility exercises. Flexibility exercises are most effective when the muscles are warm. Static stretching exercises may acutely reduce power and strength so it is recommended that flexibility exercises be performed after exercise and sports where strength and power are important for performance.

Respiratory changes during pregnancy

Respiratory rate increases slight (when baby crowds out diaphram) Expiratory reserve volume decrease Residuals volume slight decrease Functional residual capacity decreases Inspiratory capacity should not change too much

Exercise testing - seniors

Use standard testing procedures for generally healthy seniors -Initial workload should be 2-3 METs -Use a cycle ergometer for those with balance issues -Be flexible during testing -Be aware that exercise-induced dysrhythmias are common in seniors -Note that the ECG has higher sensitivity and lower specificity in seniors than in younger populations

Sample exercise program- preg

Warm up for 5-10 minutes -Use a treadmill or exercise bike -Add limbering arm movements -Perform mild stretching Upper body exercises •Seated chest press •Seated row •Seated shoulder press •Biceps curls •Seated triceps extension Lower body exercises •Seated pelvic tilt •Thigh abduction and adduction •Squat •Kegel exercises

Nutritional considerations

Water -Important for body temperature regulation -Often deficient because seniors lose sense of thirst -Inadequate because seniors deliberately restrict intake to avoid embarrassing incontinence -Minimum recommendation is 6 glasses of water/day

First 12-13 weeks

critical period.. when some major systems are developing (CNS, cardiovasular, eyes, ears, teeth, palate, genitalia) -also most vulnerable to harmful effects

Dynamic or slow movement stretching

involves a gradual transition from one body position to another, and a progressive increase in reach and range of motion as the movement is repeated several times

Passive static stretching

involves assuming a position while holding a limb or other part of the body with or without the assistance of a partner or device (such as elastic bands or a ballet barre).

Active static stretching

involves holding the stretched position using the strength of the agonist muscle as is common in many forms of yoga.

Static stretching

involves slowly stretching a muscle/tendon group and holding the position for a period of time (i.e., 10-30 s). Static stretches can be active or passive.

Proprioceptive neuromuscular facilitation (PNF)

methods take several forms but typically involve an isometric contraction of the selected muscle/tendon group followed by a static stretching of the same group (i.e., contract-relax).

To avoid creating muscle imbalances that may lead to injury...

opposing muscle groups (i.e., agonists and antagonists), such as the chest and upper back or the quadriceps and hamstring muscles, should be included in the resistance training routine.

Several large-scale epidemiology (large pop. over long period of time) studies have been performed that document...

the dose-response relationship between PA and cardiovascular disease (CVD) and premature mortality Dose response relationship- more physically active a person was throughout their lifetime ... meant lower instance of cardiovascular disease Even if the person was not 'physically fit' and just active, their risk was still lowered.

Skeletal system changes

women by 45 8% of bone mass every decade, men by age 60 3% every decade -Bone mass diminishes -Bone becomes brittle -Intervertebral disks compress -Articular cartilage wears away -Sprains, bursitis, and arthritis become more common -Osteoclast activity increases (harder to preserve the bone) -Become lactose intolerant around 60/65 (hard with the calcium) After age 30 you lose 1/16th of an inch every year

Eating disorders

•Anorexia nervosa •Bulimia nervosa •Binge eating disorder •Muscle dysmorphia

Additional tips for exercise

•Avoid strenuous exercise during hot, humid weather •Avoid exercise during flare-ups of arthritis or other chronic conditions •Encourage low-impact activities like walking, stationary cycling, water aerobics, and swimming •Limit high-impact activities like running, jumping, and bouncing

Precautions during exercise-seniors

•Inability to regulate body temperature •Loss of range of motion •Decrease in lean tissue •Loss of balance •Loss of cardiorespiratory functioning

Special considerations - preg

•Avoid strenuous exercise during hot, humid weather •Encourage plenty of water •Avoid exercise when severely fatigued •Avoid exercising at altitudes above 6,000 feet •Be aware that pregnancy increases energy needs only slightly, but exercise increases needs as well •Free weights can be hazardous owing to joint instability

Muscle dysmorphia

•Characterized by a preoccupation with developing muscle •Normally affects men •Sufferers feel compelled to constantly lift weights •Sufferers have a high risk of joint and muscle injury

Binge eating disorder

•Characterized by repeated binging not followed by purging •Sufferers are usually overweight or obese •Not recognized by the American Psychiatric Association as an actual eating disorder

Bulimia nervosa

•Characterized by repeated bouts of binging and purging •Purging can be in the form of -Vomiting -Misuse of laxatives or diuretics -Fasting -Excessive exercise •Weight is typically within 10 pounds of a healthy weight

Anorexia nervosa

•Characterized by self-starvation •Body weight <85% of ideal •Two subtypes -Restrictive anorexia -Binge eating/purging anorexia

Upper body strengthening exercise

•Chest flies using elastic tubing •Seated row using elastic tubing •Lateral shoulder raises •Biceps curls with 1-pound dumbbells •Triceps dips in a chair

Managing lactose intolerance

•Consume dairy products in moderation •Eat other food types along with dairy •Take enzyme tablets with meals •Consume enzyme-enriched foods •Consume fermented products like yogurt •Read food labels—many products contain lactose

Benefits of exercise

•Decreased risk for obesity •Increased muscular strength •Increased bone density •Improved cardiorespiratory performance •Improved psychological factors •Decreased risk for chronic disease

Barriers to exercise- seniors

•Fear of injury •Lack of knowledge •Lack of transportation to a facility •Lack of skills, abilities, and confidence •Physical limitations resulting from disease •Limited income

Aging

•Gerontology—the study of the aging process •Chronologic age—a person's age in years •Biologic age—a person's physiologic age based on level of performance of various body systems Chronologic age and biologic age are not necessarily the same

Fat cell growth

•Hypertrophy -Increase in cross-sectional area of a cell •Hyperplasia -Increase in number of cells

Lactose intolerance

•Inability to digest lactose found in dairy products •Lactose remains in GI tract lumen and attracts water -Results in cramping and bloating -GI tract bacteria ferment lactose and produce gas •Promotes bone loss if other sources of calcium and vitamin D are not consumed (bone strength impaired)

Precautions during exercise - pregnancy

•Increased core body temperature •Interrupted blood flow to fetus •Decreased oxygen delivery to fetus •Increased risk for low-birth-weight babies •Musculoskeletal changes

Barriers to exercise

•Lack of time (females) •Self-consciousness about attributes and competence •Dislike of physical exertion •Peer pressure •Inaccessibility

General guidelines

•Make activities fun and nonthreatening •"Closely supervised resistance training using...relatively high repetitions and low resistance...improves muscular strength with no adverse effect..."

Physical Performance Testing

•May replace exercise testing for functional status •Certain performance tests identified cutpoints indicative of functional limitations associated with poorer health status -Better for ADLs, mimic things we do in real life -can see risk of mortality based off results -Table 7.3 slide 31

Children and body mass index

•Measures weight in relation to height BMI = kg/m2 or BMI = (lb ´ 703)/in2 •Healthy BMI varies with each month of age and by sex •Use BMI-for-age growth charts (see Appendix C)

Neuromuscular (balance) Exercises

•No specific recommendations •Effective in reducing/preventing falls if done 2-3 days/wk •General recommendations -Progressively difficult postures •2-legged stand, semitandem stand, tandem stand, 1-legged stand -Dynamic movements (ie: circle turns) -Stressing postural muscle groups (heel, toe stands) -Reduced sensory input (eyes closed) -Tai Chi (balance and flexibility - can be done sitting standing and lying dowm)

Exercise testing

•Not usually necessary for healthy participants •If done, use the same basic tests available for adults

Cardiovascular training - preg

•Perform on at least 3 (preferably all) days of the week •Exercise for a duration of 15 to 30 minutes •Work at a moderate intensity (40% to 60% of VO2R or 12 to 14 on the 6 to 20 Borg RPE scale) •Avoid contact sports and high-impact sports -best way to test exertion is talk test- they should be able to hold conversation -not exercising until complete exertion

Exercise testing - preg

•Pregnant women without contraindications may continue exercise throughout pregnancy •Maximal exercise testing should be done only if medically necessary and only under physician supervision. •Submaximal testing to predict maximum oxygen uptake for better program design is fine for most women -<75% Heart rate reserve •Begin all exercise with at least a 5- to 10-minute warm-up -Include limbering movements -Perform mild stretching

Exercise prescription - pregnancy

•Previously sedentary women should seek medical clearance before exercise initiation •All pregnant women should be screened using the Physical Activity Readiness Medical Examination

Benefits of exercise - pregnancy

•Promotes a healthy weight gain •Improves circulation •Reduces overall discomfort and improves mood •Eases pregnancy, labor, and delivery •Decreases risk for preeclampsia

Consequences of aging on skin

•Prone to injury •Slow to repair •Susceptible to infection •Unable to regulate body temperature •Likely to wrinkle

Stop exercising and seek medical attention if experiencing any of the following

•Shortness of breath •Vaginal bleeding •Dizziness •Headache •Chest pain •Amniotic fluid leakage •Decreased fetal movement •Significant calf pain, swelling, or muscle weakness

Lower body strengthening exercise

•Sit-to-stand •Single-knee extension on chair •Seated single-leg curl •Seated heel raises •Seated toe raises

sprains, bursitis, arthritis

•Sprains (tendons never really heal) -Occur when connective tissues associated with joints are overstretched •Bursitis -Occurs when bursa sacs associated with joints become inflamed •Arthritis -Occurs when joints become inflamed(most common is osteoarthritis -Small joints affected first, then progresses to more weight bearing (obesity and diabetes make this worse)

Stop exercise testing if

•Systolic blood pressure drops by more than 10 mm Hg from baseline despite an increase in workload •Moderately severe angina develops •Dizziness, incoordination, or loss of consciousness occur •Cyanosis or pallor develop •Subject requests to stop •Ventricular tachycardia is sustained

Exercise for the frail senior (someone with mental or physical impairment - trouble with ADLs)

•Warm up for 3-5 minutes -Begin with seated marching, arms relaxed -Tap toes to front then side -Tap heels to front then side -Add arm movements and repeat •Strength training -Split the workout into two sessions, 15 minutes each (one in the morning, one in the evening) -Work upper body one day; lower body another -Participant's weight might be adequate resistance •If more intensity is needed, trainers can apply resistance with their own hands •Elastic bands or very light weights are also fine •Sometimes practicing everyday activities is sufficient

Promotes a healthy weight gain

•Weight gain should be about 25-35 pounds -35 to 40 pounds for more than one fetus at once •Birth weight is the greatest predictor of health -overweight increases risk of very high BP, preeclampsia (see persistent severe swelling), gestational diabetes •Exercise can prevent unwanted weight gain by increasing energy expended •Exercise preserves muscle and bone mass and minimizes fat mass

Resistance training - preg

•may not want to do if it they have never done it before -be careful with deep flexion and extension -Perform on at least 2 days per week •Complete 8-10 exercises targeting major muscle groups (esp. abs, back, pelvic floor) •Work at an intensity that permits 12-15 repetitions/set •Avoid isometric exercises and the Valsalva maneuver •Avoid full sit-ups throughout pregnancy •Avoid the supine position after the 3rd month

Child's response to exercise

-20-30% more O2 is required per unit of body mass when running (energy expenditure is greater because of this) -Respiratory cycle is shorter -Minute volume is greater (amount of O2 per minute is greater) -VO2max improves minimally with training -Stroke volume is lower at rest and exertion -Blood pressure is lower at rest and during exertion -Heart rate higher because needs to pump fast since heart is smaller -VO2 declines for girls once maturity

Frequency of exercise

-Aerobic exercise is recommended on 3-5 d ∙ wk−1 for most adults, with the frequency varying with the intensity of exercise. -Improvements in cardiorespiratory fitness (CRF) are attenuated with exercise frequencies more than 3 d ∙ wk−1 and a plateau in improvement with exercise done more than 5 d ∙ wk−1. -Vigorous intensity exercise performed more than5 d ∙ wk−1 might increase the incidence of musculoskeletal injury, so this amount of vigorous intensity, physical activity is not recommended for adults who are not well conditioned.

Progression/maintenance

-As muscles adapt to a resistance exercise training program, the participant should continue to subject them to overload or greater stimuli to continue to increase muscular strength and mass. -The most common approach is to increase the amount of resistance lifted during training. -Other ways to progressively overload muscles include performing more sets per muscle group and increasing the number of days per week the muscle groups are trained. -Do not change more than one thing at a time.. Need to see if they can tolerate.. Don't change weight and reps at same time ex. -Increasing the overload by adding resistance, sets, or training sessions per week is not required during a maintenance resistance training program. -Muscular strength may be maintained by training muscle groups as little as 1 d · wk−1 as long as the training intensity or the resistance lifted is held constant.

Methods of estimating the absolute intensity of exercise

-Caloric expenditure (kcal · min−1) -Absolute oxygen uptake (VO2; mL ∙ min−1 or L ∙ min−1) -Metabolic equivalents (METs)

Anatomic and physiologic differences between adults and youth - •Regulation of body temperature

-Children produce more heat/kg during activity -Children have more sweat glands, but their sweat glands are less active -The sweating mechanism is not activated until children reach a much higher core temperature -Children are more vulnerable to dehydration, which impairs their ability to dissipate heat -At risk for heat related illnesses

Algorithm components

-Classifying individuals who do or do not currently participate in regular exercise -Identifying individuals with known CV, metabolic, or renal diseases or those with signs or symptoms suggestive of cardiac, peripheral vascular, or cerebrovascular disease, Types 1 and 2 diabetes mellitus (DM), and renal disease -Identifying desired exercise intensity KNOW THIS CHART WELL

Pulmonary function testing with spirometry is recommended for all smokers >45 yr and in any individual presenting with:

-Dyspnea (shortness of breath) -Chronic cough -Wheezing -Excessive mucus production.

Volume of resistance exercise (sets and repetitions)

-Each muscle group should be trained for a total of two to four sets. -These sets may be derived from the same exercise or from a combination of exercises affecting the same muscle group. -A reasonable rest interval between sets is 2-3 min. -Using different exercises to train the same muscle group adds variety, may prevent long-term mental "staleness". -Four sets per muscle group is more effective than two sets; however, even a single set per exercise will significantly improve muscular strength, particularly among novices. -The resistance training intensity and number of repetitions performed with each set are inversely related. -To improve muscular strength, mass, and — to some extent — endurance, a resistance exercise that allows an individual to complete 8-12 repetitions per set should be selected. This repetition number translates to a resistance that is ~60%-80% of the individual's one repetition maximum (1-RM) -At the beginning, strength changes all neural, they wont see many changes

Frequency of resistance exercise

-For general muscular fitness, particularly among those who are untrained or recreationally trained (not engaged in a formal training program), an individual should resistance train each major muscle group (the muscle groups of the chest, shoulders, upper and lower back, abdomen, hips, legs) 2-3 d · wk−1 with at least 48 h separating the exercise training sessions for the same muscle group. -All muscle groups to be trained may be done so in the same session (i.e., whole body), or each session may "split" the body into selected muscle groups so that only a few of groups are trained in any one session. -This split weight training routine entails 4 d ∙ wk−1 to train each muscle group 2 times ∙ wk−1 -The split and whole body methods are effective as long as each muscle group is trained 2-3 d ∙ wk−1.

FITT-VP principle of exercise prescription

-Frequency (how often) -Intensity (how hard) -Time (duration or how long) -Type (mode or what kind) -Total Volume (amount) -Progression (advancement) •Based on application of existing scientific evidence •Intended as guidelines for apparently healthy adults

Types of resistance exercises

-Many types of resistance training equipment can effectively be used to improve muscular fitness including free weights, machines with stacked weights or pneumatic resistance, and even resistance bands. -Based on what you have available and client themselves -Form is most important -Resistance training regimens should focus on multijoint or compound exercises that affect more than one muscle group (e.g., chest press, shoulder press, pull-down, rows, push-ups, leg press, squats, deadlifts). -Single joint exercises targeting major muscle groups (e.g., biceps curls, triceps extensions, quadriceps extensions, leg curls, and calf raises) and exercises that affect core muscles should also be included in a resistance training program.

Methods of estimating the intensity of exercise

-Rating of perceived exertion (RPE) -Affective valence -OMNI Scale -Talk Test ( most valid and reliable measure besides using heart rate) -Feeling Scale

Volume of resistance exercise (sets and repetitions) continued

-Older and very deconditioned individuals who are more susceptible to musculotendinous injury should begin a resistance training program conducting more repetitions (i.e., 10-15) at a very light-to-light intensity of 40%-50% of 1-RM, or an RPE of 5-6 on a 10-point scale assuming the individual has the capacity to use this intensity while maintaining proper lifting technique. -Subsequent to a period of adaptation to resistance training and improved musculotendinous conditioning, older individuals may choose to follow guidelines for younger adults (higher intensity with 8-12 repetitions per set). -Follows dose response (beg can see improve w/even just 1 set// moderate can do 1-2x a week at 85% 1RM for at least 4 sets 8-10 reps -For muscular endurance, 15-25 reps (shouldn't be more than 50% 1RM)

Explicit instructions for participants before exercise testing increase test validity and data accuracy.

-Participants should refrain from ingesting food, alcohol, or caffeine or using tobacco products within 3 h of testing. -Participants should be rested for the assessment, avoiding significant exertion or exercise on the day of the assessment. -Clothing should permit freedom of movement and include walking or running shoes. Women should bring a loose fitting, short-sleeved blouse that buttons down the front and should avoid restrictive undergarments. -If the evaluation is on an outpatient basis, participants should be made aware that the exercise test may be fatiguing and that they may wish to have someone accompany them to the assessment to drive them home afterward. -If the exercise test is for diagnostic purposes, it may be helpful for patients to discontinue prescribed cardiovascular medications, but only with physician approval. Currently prescribed antianginal agents alter the hemodynamic response to exercise and significantly reduce the sensitivity of ECG changes for ischemia. Patients taking intermediate- or high-dose β-blocking agents may be asked to taper their medication over a 2- to 4-d period to minimize hyperadrenergic withdrawal responses (see Appendix A). -If the test is for functional or Ex Rx purposes, patients should continue their medication regimen on their usual schedule so that the exercise responses will be consistent with responses expected during exercise training. -Participants should bring a list of their medications including dosage and frequency of administration to the assessment and should report the last actual dose taken. As an alternative, participants may wish to bring their medications with them for the exercise testing staff to record. -Participants should drink ample fluids over the 24-h period preceding the test to ensure normal hydration before testing.

Exercise time (duration)

-Prescribed as a measure of the amount of time PA is performed. -It is recommended that most adults accumulate 30-60 min ∙ d−1 (≥150 min ∙ wk−1) of moderate intensity exercise, 20-60 min ∙ d−1 (≥75 min ∙ wk−1) of vigorous exercise, or a combination of moderate and vigorous exercise per day. -For weight management, longer durations of exercise (≥60-90 min ∙ d−1) may be needed, especially in individuals who spend large amounts of time in sedentary behaviors. -The recommended time/duration of physical activity may be performed continuously (i.e., one session) or intermittently and can be accumulated over the course of a day in one or more sessions of physical activity that total at least 10 min ∙ session−1. -Exercise bouts of less than 10 min may yield favorable adaptations in very deconditioned individuals or when done as part of a high intensity aerobic interval program.

Exercise volume (quantity)

-Product of Frequency, Intensity, and Time (duration) or FIT of exercise. -Exercise volume may be used to estimate the gross EE of an individual's Ex Rx. -MET-min ∙ wk−1 and kcal ∙ wk−1 can be used to estimate exercise volume in a standardized manner.

Type (mode)

-Rhythmic, aerobic type exercises involving large muscle groups are recommended for improving cardiorespiratory fitness. -The specificity principle states that the physiologic adaptations to exercise are specific to the type of exercise performed.

Rate of progression

-The recommended rate of progression in an exercise program depends on the individual's health status, physical fitness, training responses, and exercise program goals. -Progression may consist of increasing any of the components of the FITT principle of Ex Rx as tolerated by the individual. -Make sure they are tolerating it -During the initial phase of the exercise program, applying the principal of "Start Low and Go Slow" is prudent to reduce risks of adverse cardiovascular events and musculoskeletal injury as well as to enhance adoption and adherence to exercise -An increase in exercise time/duration per session of 5-10 min every 1-2 wk over the first 4-6 wk of an exercise training program is reasonable for the average adult. -After the individual has been exercising regularly for at least 1 month, the FIT of exercise is gradually adjusted upward over the next 4-8 months — or longer for older adults and very deconditioned individuals — to meet the recommended quantity and quality of exercise presented in the Guidelines.

Exercise volume (quantity) cont.

-There is a dose-response association between the volume of exercise and health/fitness outcomes (i.e., with greater amounts of physical activity, the health/fitness benefits also increase). -A total EE of ≥500-1,000 MET-min ∙ wk−1 is consistently associated with lower rates of CVD and premature mortality, this is a reasonable target volume for an exercise program for most adults. -Pedometers are effective tools for promoting physical activity and can be used to approximate exercise volume in steps per day. -The goal of 10,000 steps ∙ d−1 is often cited, but it appears that achieving a pedometer step count of at least 5,400-7,900 steps ∙ d−1 can meet recommended exercise targets.

The optimal Ex Rx should address the health-related physical fitness components of

-cardiorespiratory (aerobic) fitness -muscular strength and endurance -flexibility -body composition -neuromotor fitness

Exercise Pre-Participation Health Screening Questionnaire for Exercise Professionals

...

•Goals of new ACSM exercise pre-participation health screening process:

1. who should receive medical clearance before initiating exercise program or increasing frequency, intensity, volume of current program 2. with clinically significant disease(s) who may benefit from participating in a medically supervised exercise program 3. with medical conditions that may require exclusion from exercise programs until conditions are abated or better controlled

FITT BoxFlexibility Volume Recommendation

A total of 60 s of flexibility exercise per joint is recommended. Holding a single flexibility exercise for 10-30 s to the point of tightness or slight discomfort is effective. Older adults can benefit from holding the stretch for 30-60 s. A 20%-75% maximum voluntary contraction held for 3-6 s followed by a 10-30 s assisted stretch is recommended for PNF techniques. (Optimal technique for PNF stretching) Performing flexibility exercises ≥2-3 d ∙ wk−1 is recommended with daily flexibility exercise being most effective.

Sudden Cardiac Death among Young Individuals

Absolute annual risk of exercise-related death among high school and college athletes: -One per 133,000 men -One per 769,000 women •It should be noted that these rates, although low, include all sports-related nontraumatic deaths. Of the 136 total identifiable causes of death, 100 were caused by CVD.

FITT BoxVolume of Resistance Exercise (Sets and Repetitions) Recommendation

Adults should train each muscle group for a total of 2-4 sets with 8-12 repetitions per set with a rest interval of 2-3 min between sets to improve muscular fitness. For older adults and very deconditioned individuals, ≥1 set of 10-15 repetitions of moderate intensity (i.e., 60%-70% 1-RM), resistance exercise is recommended.

FITT BoxResistance Exercise Technique Recommendations

All individuals should perform resistance training using correct technique. Proper resistance exercise techniques employ controlled movements through the full ROM and involve concentric and eccentric muscle actions.

Risks Associated with Physical Activity and Exercise

Although the benefits of regular PA are well established, participation in exercise is associated with an increased risk for musculoskeletal injury (MSI) and cardiovascular complications such as sudden cardiac death (SCD) and acute myocardial infarction (AMI) -MSI is the most common exercise-related complication and is often associated with exercise intensity, the nature of the activity, preexisting conditions, and musculoskeletal anomalies -Youth at higher risk for injuries -Injury and fitness level is an inverse relationship

Metabolic Equivalents (METs):

An index of EE. "[A MET is the ratio of the rate of energy expended during an activity to the rate of energy expended at rest. . . . (One) MET is the rate of EE while sitting at rest . . . by convention, [1 MET is equal to] an oxygen uptake of 3.5 [mL ∙ kg−1 ∙ min−1]" (38).

Box 2.2. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Risk Stratification Criteria for Patients with Cardiovascular Disease

Characteristics of patients at lowest risk for exercise participation (all characteristics listed must be present for patients to remain at lowest risk): •Absence of complex ventricular dysrhythmias during exercise testing and recovery •Absence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness, during exercise testing and recovery) •Presence of normal hemodynamics during exercise testing and recovery (i.e., appropriate increases and decreases in heart rate and systolic blood pressure with increasing workloads and recovery) •Functional capacity ≥7 metabolic equivalents (METs)

Know table 3.1 slide 11 (chpt. 3)

Diabetes counts as its own risk factor and its own metabolic disease Positive risk factor means you are being put at a risk for something Negative risk is a good factor and takes away risk If you don't have info about something, count it as a risk factor

Health Benefits of Regular Physical Activity and Exercise

Evidence to support the inverse relationship between regular PA and/or exercise and premature mortality, CVD/CAD, hypertension, stroke, osteoporosis, T2DM, metabolic syndrome (Metsyn), obesity, 13 cancers, depression, functional health, falls and cognitive function

The Primary Physical Activity Recommendations from the 2008 Physical Activity Guidelines Advisory Committee Report

Finally made new recommendations in 2008- highlights different components of physical activity Guidelines: All Americans should participate in an amount of energy expenditure equivalent to 150 min/wk of mod intensity aerobic activity, 75 min/wk of vigorous intensity aerobic activity, or a combination of both that generates energy equivalency to either regimen for substantial health benefits These guidelines further specify a dose-response relationship, indicating additional benefits are obtained with 300 min/wk or more of moderate intensity aerobic activity, 150 min/wk of vigorous intensity aerobic activity, or an equivalent combination of moderate and vigorous intensity aerobic activity (no real benefits past 300 min/wk) Adults should do muscular strengthening activities that are moderate or high intensity and involve all major muscle groups in greater or equal to 2 days/wk because these activities provide additional health benefits.

Anatomic and physiologic differences between adults and youth

Growth and development -Bones, muscles, and joints of children and adolescents are still forming -Growth occurs in spurts -No two children alike Neuromuscular control -Communication between nervous system and muscular system develops over time •Neurons begin to branch more •Neurons synthesize neurotransmitters more efficiently •Myelin sheath develops

Two important conclusions from the Physical Activity Guidelines Advisory Committee Report that influenced the development of the PA recommendations are the following:

Important health benefits can be obtained by performing a moderate amount of PA on most, if not all, days of the week. Additional health benefits result from greater amounts of PA. Individuals who maintain a regular program of PA that is longer in duration, of greater intensity, or both are likely to derive greater benefit than those who engage in lesser amounts.

Benefits of Regular Physical Activity and/or Exercise

Improvement in cardiovascular and respiratory function Reduction in cardiovascular disease risk factors Decreased morbidity and mortality Many others as well

Exercise-Related Cardiac Events in Adults

In general, exercise does not provoke cardiovascular events in healthy individuals with normal cardiovascular systems. -Risk is related to the absence or presence of occult CVD, exercise intensity, age and PA. Onset study showed... Sedentary subjects had highest risk and risk decreases the more active they were

Risks of Cardiac Events during Cardiac Rehabilitation

In one survey, there was one nonfatal complication per 34,673 h and one fatal cardiovascular complication per 116,402 h of cardiac rehabilitation. More recent studies have found a lower rate, one cardiac arrest per 116,906 patient-hours, one MI per 219,970 patient-hours, one fatality per 752,365 patient-hours, and one major complication per 81,670 patient-hours. The mortality rate appears to be six times higher when patients exercised in facilities without the ability to successfully manage cardiac arrest.

FITT BOX Aerobic Exercise Intensity Recommendation

Moderate (e.g., 40%-59% heart rate reserve [HRR] or VO2R) to vigorous (e.g., 60%-89% HRR or VO2R) intensity aerobic exercise is recommended for most adults, and light (e.g., 30%-39% HRR or VO2R) to moderate intensity aerobic exercise can be beneficial in individuals who are deconditioned. Interval training may be an effective way to increase the total volume and/or average exercise intensity performed during an exercise session and may be beneficial for adults.

FITT Box Aerobic Exercise Frequency Recommendation

Moderate intensity, aerobic exercise done at least 5 d ∙ wk−1; or vigorous intensity, aerobic exercise done at least 3 d ∙ wk−1; or a weekly combination of 3-5 d ∙ wk−1 of moderate and vigorous intensity exercise is recommended for most adults to achieve and maintain health/fitness benefits.

FITT BOX Aerobic Exercise Time (Duration) Recommendation

Most adults should accumulate 30-60 min ∙ d−1 (≥150 min ∙ wk−1) of moderate intensity exercise, 20-60 min ∙ d−1 (≥75 min ∙ wk−1) of vigorous intensity exercise, or a combination of moderate and vigorous intensity exercise daily to attain the recommended targeted volumes of exercise. This recommended amount of exercise may be accumulated in one continuous exercise session or in bouts of ≥10 min over the course of a day. Durations of exercise less than recommended can be beneficial in some individuals.

FITT Box Neuromotor Exercise Recommendations

Neuromotor exercises involving balance, agility, coordination, and gait are recommended on ≥2-3 d ∙ wk−1 for older individuals and are likely beneficial for younger adults as well. The optimal duration or number of repetitions of these exercises is not known, but neuromotor exercise routines of ≥20-30 min in duration for a total of ≥60 min of neuromotor exercise per week are effective. Most highlighted aspect of program

FITT BoxResistance Training Frequency Recommendation!!

Resistance training of each major muscle group 2-3 d ∙ wk−1 with at least 48 h separating the exercise training sessions for the same muscle group is recommended for all adults.

FITT Box Aerobic Exercise Type Recommendation

Rhythmic, aerobic exercise of at least moderate intensity that involves large muscle groups and requires little skill to perform is recommended for all adults to improve health and CRF. Other exercise and sports requiring skill to perform or higher levels of fitness are recommended only for individuals possessing adequate skill and fitness to perform the activity.

General Considerations for Exercise Prescription

Separately, a reduction in the time spent in sedentary activities is important for the health of both physically active and inactive individuals and a plan to decrease periods of physical inactivity should be included in the Ex Rx.

American College of Sports Medicine Pre-participation Screening Algorithm

The ACSM pre-participation screening algorithm (Figure 2.2) is a new instrument designed to identify participants at risk for CV complications during or immediately after aerobic exercise Although resistance training is growing in popularity, current evidence is insufficient regarding CV complications during resistance training to warrant formal prescreening recommendations -CV complications during resistance training, this risk cannot currently be determined but appears to be low

FITT Box THE FITT-VP Principle of Ex Rx Summary

The FITT-VP principle of Ex Rx features an individually tailored exercise program that includes specification of the Frequency (F), Intensity (I), Time or duration (T), Type or mode (T), Volume (V), and Progression (P) of exercise to be performed. The exact composition of FITT-VP will vary depending on the characteristics and goals of the individual. The FITT-VP principle of Ex Rx will need to be revised according to the individual response, need, limitation, and adaptations to exercise as well as evolution of the goals and objectives of the exercise program.

Kilocalorie (kcal):

The energy needed to increase the temperature of 1 kg of water by 1° C. To convert METs to kcal ∙ min−1, it is necessary to know an individual's body weight, kcal · min−1 = [(METs × 3.5 mL ∙ kg−1 ∙ min−1 × body wt in kg) ÷ 1000)] × 5. Usually standardized as kilocalorie per week or per day as a measure of exercise volume.

Health Benefits of Improving Muscular Fitness

The health benefits of enhancing muscular fitness (i.e., the functional parameters of muscle strength, endurance, and power) are well established (Decreases of chronic back pain -> most reason for people missing work, improvement muscular strength, better metabolic and cardiac risk factor, better at using fat and glucose (substrates) as energy)

Aerobic Exercise Intensity of exercise

The minimum threshold of intensity for benefit seems to vary depending on an individual's CRF level and other factors such as age, health status, physiologic differences, genetics, habitual physical activity, and social and psychological factors.

This updated pre-participation process is based on the outcomes of a scientific roundtable sponsored by the American College of Sports Medicine (ACSM) in 2014

The relative risk of a CV event is transiently increased during vigorous intensity exercise as compared with rest but that the absolute risk of an exercise-related acute cardiac event is low in healthy asymptomatic individuals (Figure 1.2) Among adults, the risk for activity-associated SCD and AMI is known to be highest among those with underlying CVD who perform unaccustomed vigorous PA -Insufficient evidence is available to suggest that the presence of CVD risk factors without underlying disease confers substantial risk of adverse exercise-related CV events CVD risk factor-based exercise pre-participation health screening may be overly conservative due to the high prevalence of risk factors and may generate excessive physician referrals, particularly in older adults Exercise professionals are encouraged to complete a CVD risk factor assessment with their patients/clients as part of the preexercise evaluation (see Chapter 3)

Blood Pressure

•A classification scheme for hypertension in adults is detailed in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) (see Table 3.2). •The recently published 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults (JNC 8) specifically does not address the classification of prehypertension or hypertension in adults but rather recommends thresholds for pharmacologic treatment. -Patients > 60 yr and JNC 8 •BP and risk for cardiovascular events is continuous, consistent, and independent of other risk factors. •Main goal is trying to decrease the risk

Exercise Testing and the Risk of Cardiac Events

•As with vigorous intensity exercise, the risk of cardiac events during exercise testing varies directly with the prevalence of diagnosed or occult CVD in the study population. •These data indicate that in a mixed population the risk of exercise testing is low, with approximately six cardiac events per 10,000 symptom-limited maximum tests.

Appropriate components of the physical examination may include the following:

•Body weight; in many instances determination of body mass index, waist girth, and/or body composition (percent body fat) is desirable •Apical pulse rate and rhythm •Resting blood pressure: seated, supine, and standing •Auscultation of the lungs with specific attention to uniformity of breath sounds in all areas (absence of rales, wheezes, and other breathing sounds) •Auscultation of the heart with specific attention to murmurs, gallops, clicks, and rubs •Palpation and auscultation of carotid, abdominal, and femoral arteries •Evaluation of the abdomen for bowel sounds, masses, visceromegaly, and tenderness •Palpation and inspection of lower extremities for edema and presence of arterial pulses •Follow-up examination related to orthopedic or other medical conditions that would limit exercise testing •Tests of neurologic function including reflexes and cognition (as indicated) •Inspection of the skin, especially of the lower extremities in known patients with diabetes mellitus

Risk Stratification for Patients in cardiac Rehabilitation and Medical Fitness Facilities

•Exercise professionals working with patients with known CVD in exercise-based cardiac rehabilitation and medical fitness settings are advised to use more in-depth risk stratification procedures Risk stratification criteria from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) are presented in Box 2.2

Commonly used spirometry measurements:

•Forced vital capacity (FVC) •Forced expiratory volume in one second (FEV1.0) •FEV1.0/FVC ratio •Peak expiratory flow (PEF)

Prevention of Exercise-Related Cardiac Events

•Health care professionals should know the pathologic conditions associated with exercise-related events so that physically active children and adults can be appropriately evaluated. •High school and college athletes should undergo pre-participation screening by qualified professionals. •Athletes with known cardiac conditions or a family history should be evaluated prior to competition using established guidelines. •Health care facilities should ensure that their staffs are trained in managing cardiac emergencies, have a specified plan, and have appropriate resuscitation equipment •Physically active individuals should modify their exercise program in response to variations in their exercise capacity, habitual activity level, and the environment

Flexibility Exercise (Stretching)

•Joint ROM or flexibility can be improved across all age groups by engaging in flexibility exercises. •The ROM around a joint is improved immediately after performing flexibility exercise and shows chronic improvement after about 3-4 wk of regular stretching at a frequency of at least 2-3 times ∙ wk−1. •Postural stability and balance can also be improved by engaging in flexibility exercises, especially when combined with resistance exercise. •The goal of a flexibility program is to develop ROM in the major muscle/tendon groups in accordance with individualized goals. •Static stretching exercises may result in a short-term decrease in muscle strength, power, and sports performance when performed immediately prior to the muscle strength and power activityis important to performance, especially with longer duration (>45 s) stretching.

Components of the Medical History

•Medication use including supplements and drug allergies (even supplements and vitamins bc of interaction) •Other habits including caffeine, alcohol, tobacco, or drug use •Exercise history •Work history •Family history •Medical diagnosis •Previous physical examination findings •Laboratory findings •History of symptoms •Recent illness, hospitalization, new medical diagnoses, or surgical procedures •Orthopedic problems

Neuromotor Exercise

•Neuromotor exercise training involves motor skills, such as balance, coordination, gait, and agility, and proprioceptive training and is sometimes called functional fitness training. •Neuromotor exercise training results in improvements in balance, agility, and muscle strength and reduces the risk of falls and the fear of falling among older adults •The optimal effectiveness of the various types of neuromotor exercise, doses (i.e., FIT), and training regimens are not known for adults of any age. Studies that have resulted in neuromotor improvements have mostly employed training frequencies of ≥2-3 d wk−1 with exercise sessions of ≥20-30 min duration for a total of ≥60 min of neuromotor exercise per week

Informed Consent

•Obtaining adequate informed consent from participants before exercise testing and participation in an exercise program is an important ethical and legal consideration. •Although the content and extent of consent forms may vary, enough information must be present in the informed consent process to ensure that the participant knows and understands the purposes and risks associated with the test or exercise program in health/fitness or clinical settings. •The consent form should be verbally explained and include a statement indicating that the patient has been given an opportunity to ask questions about the procedure and has sufficient information to give informed consent. •Note specific questions from the participant on the form along with the responses provided.

Lifestyle modification is the cornerstone of antihypertensive therapy:

•PA •Weight reduction (if needed) •DASH eating plan (i.e., a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat), dietary sodium reduction (no more than 2 g sodium · d−1) •Moderation of alcohol consumption

Major Signs or Symptoms Suggestive of Cardiovascular, Metabolic and Renal Disease

•Pain; discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areas that may result from ischemia •Shortness of breath at rest or with mild exertion •Dizziness or syncope •Orthopnea or paroxysmal nocturnal dyspnea •Ankle edema •Palpitations or tachycardia •Intermittent claudication •Known heart murmur •Unusual fatigue or shortness of breath with usual activities

Self-Guided Methods

•Preparticipation health screening by self-reported medical history or health risk appraisal should be done for all individuals wishing to initiate a physical activity program. This self-guided method can be easily accomplished by using the PAR-Q+ (see Figure 2.1)

Characteristics of patients at moderate risk for exercise participation (any one or combination of these findings places a patient at moderate risk)

•Presence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness occurring only at high levels of exertion [≥7 METs]) •Mild to moderate level of silent ischemia during exercise testing or recovery (ST-segment depression <2 mm from baseline) •Functional capacity <5 METs Nonexercise Testing Findings •Rest ejection fraction 40% to 49%

Characteristics of patients at high risk for exercise participation (any one or combination of these findings places a patient at high risk)

•Presence of complex ventricular dysrhythmias during exercise testing or recovery •Presence of angina or other significant symptoms (e.g., unusual shortness of breath, light-headedness, or dizziness at low levels of exertion [<5 METs] or during recovery) •High level of silent ischemia (ST-segment depression ≥2 mm from baseline) during exercise testing or recovery •Presence of abnormal hemodynamics with exercise testing (i.e., chronotropic incompetence or flat or decreasing systolic BP with increasing workloads) or recovery (i.e., severe postexercise hypotension)

Highest risk continued... Non-exercise Testing Findings

•Rest ejection fraction <40% •History of cardiac arrest or sudden death •Complex dysrhythmias at rest •Complicated myocardial infarction or revascularization procedure •Presence of congestive heart failure •Presence of signs or symptoms of postevent/postprocedure ischemia •Presence of clinical depression

Lowest risk continued... Non-exercise Testing Findings

•Resting ejection fraction ≥50% •Uncomplicated myocardial infarction or revascularization procedure •Absence of complicated ventricular dysrhythmias at rest •Absence of congestive heart failure •Absence of signs or symptoms of postevent/postprocedure ischemia •Absence of clinical depression

Muscular Fitness

•The ACSM uses the phrase "muscular fitness" to refer collectively to muscular strength, endurance, and power. •Muscular strength and endurance are often the foundation of a general training regimen focusing on health/fitness outcomes for young and middle-aged adults, however, muscular power should be equally emphasized. •Older adults (≥65 yr) 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. Importantly, aged individuals can safely perform the fast-velocity muscular contractions, or repetitions, that optimally develop muscular power

Pulmonary function explained

•The FEV1.0/FVC is diminished with obstructive airway diseases (e.g., asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease [COPD]). •However, it remains normal with restrictive disorders (e.g., kyphoscoliosis, neuromuscular disease, pulmonary fibrosis, other interstitial lung diseases).

Informed consent cont.

•The consent form must indicate that the participant is free to withdraw from the procedure at any time. •If the participant is a minor, a legal guardian or parent must sign the consent form. •It is advisable to check with authoritative bodies (e.g., hospital risk management, institutional review boards, facility legal counsel) to determine what is appropriate for an acceptable informed consent process. •All reasonable efforts must be made to protect the privacy of the patient's health information (e.g., medical history, test results) as described in the Health Insurance Portability and Accountability Act (HIPAA) of 1996. •No sample form should be adopted for a specific test or program unless approved by local legal counsel and/or the appropriate institutional review board. •When the exercise test is for purposes other than diagnosis or Ex RX (i.e., for experimental purposes), this should be indicated during the consent process and reflected on the informed consent form, and applicable policies for the testing of human subjects must be implemented. •Because most consent forms include the statement "emergency procedures and equipment are available," the program must ensure available personnel are appropriately trained and authorized to carry out emergency procedures that use such equipment. •Written emergency policies and procedures should be in place, and emergency drills should be practiced at least once every 3 mo or more often when there is a change in staff.

Introduction to pre-exercise evaluation

•The healthier populations typically encountered in the health fitness setting generally warrant a less intensive approach to the preexercise evaluation. However, individuals with chronic disease and other health challenges may be encountered in these settings, so exercise professionals are urged to be prudent in identifying those who need medical clearance.

Interval training

•involves varying the exercise intensity at fixed intervals during a single exercise session, which can increase the total volume and/or average exercise intensity performed during that session. -Improvements in CRF and cardio-metabolic biomarkers with short-term (≤3 mo) interval training are similar or superior to steady state moderate to vigorous intensity exercise in healthy adults and individuals with metabolic, cardiovascular, or pulmonary disease training can increase the total volume and/or average exercise intensity performed during an exercise session •During interval training, aspects of the Ex Rx can be varied depending on the goals of the training session and physical fitness level of the client -(e.g., exercise mode, the number, duration, and intensity of the work and recovery intervals, the number of repetitions of the intervals, and the duration of the between-interval rest period) •Studies of high intensity interval training (HIIT) and sprint interval training (SIT) demonstrate improvements in CRF, cardiometabolic biomarkers and other fitness and health-related physiological variables when including repeated alternating short (<45-240 seconds) bouts of vigorous to near maximal intensity exercise followed by equal or longer bouts (60-360 seconds) of light to moderate intensity aerobic exercise