NASM: Chapter 23 - Chronic Health Conditions and Special Populations Part 1

• Youth: children and adolescents between ages 6-20

• 
  60 minutes or more of physical activity daily

• Should engage in aerobic, muscle-strengthening, and bone strengthening activities daily to improve health and reduce risk of developing chronic disease

True

Children tend to have lower peak oxygen uptake levels, lower sweating rates, and lower tolerance for temperature extremes (compared to adults)

• Lower reps and sets with an emphasis on proprioception, skills, and controlled movement.

Resistance exercise for muscular fitness:

• 1-2 sets of 8-10 exercises

• 8-12 reps per exercise

• Resistance exercise should emphasize proprioception, skill, and controlled movements

• Repetitions should not exceed 6-8 per set for strength development or 20 for enhanced muscular endurance

• Moderate to vigorous - 60 mins 3+ days/week or 3 days/wk if more vigorous

• Intensive anaerobic exercise exceeding 10 seconds is not well tolerated (if using stage II or III training, provide sufficient rest and recovery intervals between intense bouts of training)

Restrict vigorous exercise in hot, humid environments to less than 30 minutes and include frequent rest periods.

30-40%

Walking, jogging, running, games, activities, sports, water activity, resistance training

5-7 days/week

Moderate-to-vigorous cardiorespiratory exercise training

60 minutes per day

• Overhead squats

• 10 push-ups (if 10 cannot be performed, do as many as can be tolerated)

• SL stance (if can tolerate, perform 3-5 SL squats per leg)

• Assess for any movement deficiencies using a variety of movement assessments

• Assessments will help individualize phase 1 stabilization endurance training

• Progression to phases 2-5 should be decided on
  

  • Maturity level

  • Dynamic postural control (flexibility and stability)

  • How they have responded to training up until this point

• Make it safe and fun!

Reps: 8-12
Sets: 1-2
Intensity: 40-70%
Frequency: 2-3 days/week
Phases:
- Phase 1 of OPT should be mastered before moving on
- Phases 2-5 should be reserved for mature adolescents on the basis of dynamic postural control and a license physician’s recommendation

• Osteoporosis

• Arthritis (osteoarthritis)

• Low-back pain (LBP)

• Obesity

• Blood pressure tends to be higher at rest and during exercise (could be natural causes, could be disease, could be both)

• Arteriosclerosis may cause blood pressure to be higher

Arteriosclerosis: a general terms that refers to the hardening (and loss of elasticity) of arteries
- Arteries are less elastic and pliable
- Result: greater resistance to blood flow = higher blood pressure
(normal with age)

• 
  Atherosclerosis

- Peripheral vascular disease

• Atherosclerosis: buildup of fatty plaques in arteries that lead to narrowing and reduced blood flow
  

  • Caused largely by poor lifestyle choices (smoking, obesity, sedentary lifestyle etc)

  • Restricts blood flow due to plaque buildup = increased resistance and higher blood pressure
    (Abnormal with Age)

• Peripheral vascular disease: a group of diseases in which blood vessels become constricted or blocked, typically as a result of atherosclerosis
  

  • Diseases caused by hypertension

  • Refers to plaques that form in any peripheral artery, typically those in the lower leg

• Stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support

• 3-5 days/wk of moderate-intensity activities or

- 3 days/wk of vigorous-intensity activities

• 40-85% of VO2 Peak

• 30-60 minutes / day or 8-10 minute bouts

• Push, pull, OH squat or

• Sitting and standing into a chair

• Single-leg balance

• 1-3 sets of 8-20 reps at 40-80% on 3-5 days/wk

• Phase 1 of OPT model should be mastered before moving on

• Phases 2-5 should be based on dynamic postural control and a licensed physician’s recommendation

• Self-myofascial release and static stretching

• Progression should be slow, well monitored, and based on postural control

• Exercises should be progressed if possible toward free sitting (no support) or standing

• Make sure client is breathing normal manner and avoid holding breath as in a Valsalva maneuver

• If client cannot tolerate SMR or static stretching b/c of other conditions, perform slow rhythmic active or dynamic stretches

• Obesity: The condition of subcutaneous fat exceeding the amount of lean body mass

• 30 - 34.99 = Obese - high risk of disease

• 35 - 39.99 = Obesity II - very high risk of disease

• ≥ 40 = Obesity III - extremely high risk of disease

Primary:

• Energy balance (too many calories consumed and too few expended)
  Other causes:

• Complex medical issues

• 5lbs

| - 15lbs

• 15% reduction

Focus:

• Primarily on energy expenditure, balance, and proprioceptive training to help them expend calories and improve balance and gait mechanics

• By performing in a proprioceptively enriched environment (controlled, unstable) the body is forced to recruit more muscles to stabilize itself resulting in more calories potentially expended

Goals:

• Should expend 200-300 kcal/exercise session

• Minimum weekly goal: 1,250 kcal of energy expenditure from combined physical activity and exercise (progressively increase to 2,000 kcal/week)

• Low-impact or step aerobics (treadmill walking, rowing, stationary cycling and water activity)

• Dumbbells

• Cables

• Exercise tubing

• Swimming

• Cycle ergometer

• SMR with extreme caution in case client is not comfortable rolling or lying on floor

• At least 5 days per week

• 60-80% of max heart rate. Use talk test to determine exertion

• Stage I cardiorespiratory training progression to stage II (intensities may be altered to 40-70% of max heart rate if needed)

• 40-60 minutes per day or

| - 20-30 minutes sessions twice each day

• Push, pull, squat

| - Single-leg balance (if tolerated)

• 1-3 sets of 10-15 reps on 2-3 days per week

| - Phases 1 and 2 will be appropriate performed in a circuit-training manner (higher reps such as 20 may be used)

• SMR (only if comfortable with client)

| - Flexibility continuum

• Make sure client is comfortable! Be aware of positions and locations in the facility your client is in

• Exercises should be performed in a standing or seated position

• May have other chronic diseases; in such cases a medical release should be obtained from the individual’s physician

• A chronic metabolic disorder caused by insulin deficiency, which impairs carbohydrate usage and enhances usage of fate and protein.

• Type I: body does not produce enough insulin (insulin dependent)

• Specialized cells in the pancreas (beta cells) stop producing insulin, causing blood sugar levels to rise, resulting in hyperglycemia (high levels of blood sugar)

• Usually develops in childhood, teenagers and young adults

• Blood sugar levels can drop rapidly causing hypoglycemia (low blood sugar) leading to weakness, dizziness, and fainting

• Insulin levels may need to be adjusted with exercise
  because exercise increases the rate at which cells utilize glucose

• To control hyperglycemia, individual must inject insulin to compensate for what the pancreas cannot produce.

• Type II: cells become insulin resistant and body cannot respond normally to the insulin that is made (non-insulin dependent)

• Because cells are resistant to insulin (the insulin present in system cannot transfer adequate amounts of blood sugar into the cell) individual may be hyperglycemic (high blood sugar)

• Associated with obesity, specifically abdominal

• Damage to kidneys

• Damage to heart

• Nerves

• Eyes

• Circulatory system

• Glucose control (type I and II)

| - Lose weight (type II)

• Exercise training is effective to achieve these goals (glucose control and weight loss) because of its similar action to insulin by enhancing the uptake of circulating glucose by exercising the skeletal muscle.

Improves a variety of glucose measures:

• Tissue sensitivity

• Improved glucose tolerance

• Decrease in insulin requirements

• Frequently associated with comorbidities (including cardiovascular disease, obesity, and hypertension)

• Exercise exerts an effect similar to that of insulin

• Hypoglycemia may occur several hours after exercise as well as during exercise

• Clients taking 𝛃-blocking medications may be unable to recognize signs and symptoms of hypoglycemia

• Exercise in excessive heat may mask signs of hypoglycemia

• Increased risk for retinopathy

• Peripheral neuropathy (loss of protective sensation in feet and legs) may increase risk for gait abnormalities and infection from foot blisters that may go unnoticed

• Low-impact activities (cycling, treadmill walking, low-impact or step aerobics)

• 4-7 days per week

• 50-90% of maximum heart rate

• Stage I cardiorespiratory training (may be adjusted to 40-70% of max heart rate if needed) progressing to stages II and III based on a physician’s approval

• 20-60 minutes

• Push, pull, squat

| - Single-leg balance or single-leg squat

• 1-3 sets of 10-15 reps 2-3 days/week

| - Phases I and 2 of OPT model (higher reps such as 20 may be used)

• Flexibility continuum

• Make sure the client has appropriate footwear and have the client or physician check feet for blisters or abnormal wear patterns

• Advise client to keep a snack (quick source of carbs) available during exercise, to avoid sudden hypoglycemia

• Use SMR with special care and licensed physician’s advice

• Avoid excessive plyometric training, and higher-intensity training is not recommended for typical client

• Consistently elevated arterial blood pressure, which, if sustained at high enough level, is likely to induce cardiovascular or organ damage

• Aka. high blood pressure

Hypertensive:

• Resting systolic: ≥ 140 mm Hg;

• Resting diastolic: ≥ 90 mm Hg
  Prehypertensive:

• Resting systolic: between 120 and 135 mm Hg;

• Resting diastolic: between 80 and 85 mm Hg

• Smoking

• Diet high in fat (particularly saturated fat)

• Excess weight

• Stroke

• Cardiovascular disease

• Chronic heart failure

• Kidney failure

• Stationary cycling

• Treadmill walking

• Rowers

• 3-7 days per week

• 50-85% of maximal heart rate

| - Stage I cardiorespiratory training progressing to stage II (intensities may be altered to 40-70% of max HR if needed)

• 30-60 minutes

• Push, pull, OH squat

| - Single-leg balance (squat if tolerated)

• 1-3 sets of 10-20 repetitions 2-3 days per week

• Phases 1 and 2 of the OPT Model

• Tempo should not exceed 1 sec for isometric and concentric portions (ex 4/1/1 instead of 4/2/1)

• Use circuit or PHA weight training as an option, with appropriate rest intervals

• Static and active in a standing or seated position

• Avoid heavy lifting and Valsalva maneuvers - make sure client breathes normally

• Do not let client over-grip weights or clench fists when training

• Modify tempo to avoid extended isometric and concentric muscle action

• Perform exercises in a standing or seated position

• Allow client to stand up slow to avoid possible dizziness

• Progress client slowly

• A maneuver in which a person tries to exhale forcibly with a close glottis (windpipe) so that no air exits through the mouth or nose as, for example, in lifting a heavy weight.

• The Valsalva maneuver impedes the return of venous blood to the heart.

Primary Cause:

• Poor lifestyle choices (primarily cigarette smoking, poor diet, and physical inactivity)
  Other causes:

• Caused by atherosclerosis (plaque formation) which leads to narrowing of the coronary arteries and ultimately angina pectoris (chest pain), myocardial infarction (heart attack), or both

• Improving the health of the internal lining of the coronary artery called plaque “stabilization.”

• Lower risk of mortality

• Increased exercise tolerance, muscle strength

• Reduction of angina and heart failure symptoms

• Improved physiological status and social adjustment

• Heart disease may even be slowed (or even reversed) when a multi-factor intervention program of intensive education, exercise, counseling, and lipid-lowering medications are used (as appropriate)

Intensity:
Low intensity to start and based on recommendations provided by a certified exercise physiologist or physical therapist with specialty training.

Aerobic training guidelines:

• At minimum 20-30 minutes 3-5 days/wk at 40-85% of maximal capacity, but below upper safe limits prescribed by a physician

Weekly caloric goal:

| - 1,500-2,000 kcal is usually recommended, progressing as tolerable to maximize cardio protection

• May be started after the patient has been exercising asymptomatically comfortably for >3 months in the aerobic exercise program

• Circuit training format is recommended:

• 8-10 exercises, 1-3 sets of 10-20 reps/exercise

• emphasizing breathing control and rest as needed between sets