Chapter 16

Question 1

Physiologic & Training Considerations for Youth

Answer 1

1. Peak oxygen uptake
2. Submaximal oxygen demand is higher compared with adults for walking & running
3. Glycolytic enzymes are lower than adult
4. Sweating rate

Question 2

Basic Guidelines for Youth Training

Answer 2

Mode - walking, jogging, running, games, activities, sports, water activity, resistance training

Frequency - 5 to 7 days of the week

Intensity - Moderate to vigorous cardiorespiratory exercise training

Duration - 60 minutes per day (but not if outside!)

Movement assessment - Overhead squats; 10 push up (or as many as can be tolerated); Single leg stance (if tolerated, 3-5 per leg)

Flexibility - Follow the flexibility continuum for each phase of training

Resistance training - 1 to 2 sets of 8 to 12 reps at 40 to 70% on 2 to 3 days per week; Phase 1 of OPT model should be mastered before moving on ; Phases 2-5 should be reserved for mature adolescents on the basis of dynamic postural control and licensed physicians recommendation

Special considerations - Progression for the youth should be based on postural control and not on the amount of weight that can be used; make it fun

Question 3

Arteriosclerosis

Answer 3

A general term that refers to hardening (and loss of elasticity) of arteries

Question 4

Atherosclerosis

Answer 4

Buildup of fatty plaques in arteries that leads to narrowing and reduced blood flow

Question 5

Peripheral vascular disease

Answer 5

A group of diseased in which blood vessels become restricted or blocked, typically as a result of atherosclerosis

Question 6

Normal physiologic & functional changes associated with aging

Answer 6

1. Reductions in maximal attainable heart rate
2. Reductions in cardiac output
3. Reductions in muscle mass
4. Reductions in balance
5. Reductions in coordination (neuromuscular efficiency)
6. Reductions in connective tissue elasticity
7. Reductions in bone mineral density

Question 7

Physiologic & Training Considerations for Seniors

Answer 7

1. Max oxygen uptake, max heart rate and measures of pulmonary function decrease with age
2. % of body fat will increase & bone mass & lean body mass will decrease with age
3. Balance, gait, and neuromuscular coordination may be impaired
4. Higher rate of both diagnosed & undetected heart disease
5. Pulse irregularity is more frequent

Question 8

Basic Guidelines for Seniors

Answer 8

Mode - stationary or recumbent cycling, aquatic exercise, or treadmill with handrail support

Frequency - 3 to 5 days for moderate-intensity; 3 days for vigorous intensity

Intensity - 40% to 80% of VO2peak

Duration - 30 to 60 min per day or 8 t 10 minute bouts

Movement assessment - Push, pull, OH squat or sitting and standing into a chair; single leg balance

Flexibility - Self myofascial elease and static stretching

Resistance training - 1 to 3 sets of 8 to 20 reps at 40 to 80% on 3 to 5 days per week; Phase 1 of OPT model should be mastered before moving on ; Phases 2-5 should be based on dynamic postural control and licensed physicians recommendation

Special considerations - Progression should be slow, well monitored & based on postural control; Exercises should be progressed if possible toward free sitting (no support) or standing; Making sure client is breathing in normal manner & avoid holding breath as in a Valsalva maneuver; If client cannot tolerate SMR or static stretches because of other conditions, perform slow rythmic or dynamic stretches

Question 9

Obesity

Answer 9

The condition of subcutaneous fat exceeding the amount of lean body mass

Question 10

Physiologic & Training Considerations for Overweight or Obese individuals

Answer 10

1. May have other comorbidities (diagnosed or undiagnosed) including hypertension, cardiovascular disease, or diabetes
2. Maximal oxygen uptake and ventilatory (anaerobic) threshold is typically reduced
3. Coexisting diets may hamper exercise ability and result in significant loss of lean body mass
4. Measures of body composition (hydrostatic weighing, skin-fold calipers) may not accurately reflect degree of overweight or obesity.

Question 11

Basic Guidelines for Obesity

Answer 11

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

Frequency - At least 5 days per week

Intensity - 60% to 80% of max heart rate. Use the “talk test” to determine exertion; Stage 1 cardiorespiratory training progressing to stage 2 (intensities may be altered to 40%-70% of max heart rate if needed).

Duration - 40 to 60 min per day or 20-30 minute sessions twice per day

Movement assessment - Push, pull, single leg balance (if tolerated)

Flexibility - SMR (only if client is comfortable); Flexibility continuum

Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 will be appropriate performed in a circuit-training manner (higher reps such as 20 may be used)

Special considerations - Make sure client is comfortable; exercises should be performed in a standing or seated position; May have other chronic diseases

Question 12

Diabetes

Answer 12

Chronic metabolic disorder, caused by insulin deficiency, which impairs carbohydrate usage and enhances usage of fat and protein

Question 13

Type 1 Diabetes

Answer 13

Typically diagnosed in children, teens, or young adults; specialized cells in the pancreas called beta cells stop producing insulin, causing blood sugar levels to rise, resulting in hyperglycemia - to control this the individual must inject insulin to compensate for what the pancreas cannot produce

Question 14

Type 2 Diabetes

Answer 14

Associated with obesity, particularly abdominal obesity; produce adequate amounts of insulin, but their cells are resistant to the insulin (the insulin present cannot transfer adequate mounts of blood sugar to the cell).

Question 15

Physiologic & Training Considerations for Individuals with Diabetes

Answer 15

1. Frequently associated with comorbidities (including cardiovascular disease, obesity, and hypertension)
2. Exercise exerts an effect similar to that of insulin
3. Hypoglycemia may occur several hours after exercise, as well as during exercise
4. Clients taking Beta blocking medications may be unable to recognize signs and symptoms of hypoglycemia
5. Exercise in excessive heat may mask signs of hypoglycemia
6. Increased risk for retinopathy
7. Peripheral neuropathy may increase risk for gait abnormalities and infection from foot blisters that may go unnoticed

Question 16

Basic Guidelines for Diabetes

Answer 16

Mode - Low impact activities (such as cycling, treadmill walking, low-impact or step aerobics)

Frequency - 4 to 7 days per week

Intensity - 50% to 90% of max heart rate. Use the “talk test” to determine exertion; Stage 1 cardiorespiratory training (may be adjusted to 40%-70% of max heart rate if needed) progressing to stage 2 and 3 based on a physician’s approval

Duration - 20 to 60 minutes

Movement assessment - Push, pull, OH squat, single leg balance or single leg squat

Flexibility - Flexibility continuum

Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model (higher reps such as 20 may be used)

Special considerations - Make sure client has appropriate footwear and have client or physician check feet for blisters or abnormal wear patterns; Advise client or class participant to keep a snack (quick source of carbohydrate) available during exercise, to avoid sudden hypoglycemia; Use SMR with special care and licensed physician’s advise; Avoid excessive plyometric training, and higher-intensity training is not recommended for typical client

Question 17

Hypertension

Answer 17

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

Normal blood pressure - <120/80 mm HG.
Hypertension blood pressure - >140/90 mm HG
Prehypertensive blood pressure - 120/80 to 135/85

Question 18

Valsalva maneuver

Answer 18

A maneuver in which a person tries to exhale forcibly with a closed glottis (wind pipe) 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.

Question 19

Physiologic & Training Considerations for Individuals with Hypertension

Answer 19

1. Blood pressure response to exercise may be variable and exaggerated, depending on the mode and level of intensity
2. Despite medication, clients may arrive with preexercise hypertension
3. Hypertension frequently is associated with other comorbidities, including obesity, cardiovascular disease, and diabetes
4. Some medications, such as beta blockers, for hypertension will attenuate the heart rate at rest and its response to exercise

Question 20

Basic Guidelines for Hypertension

Answer 20

Mode - Stationary cycling, treadmill walking, rowers

Frequency - 3 to 7 days per week

Intensity - 50% to 85% of max heart rate. Stage 1 cardiorespiratory training progressing to stage 2 (intensities may be altered to 40%-70% of max heart rate if needed)

Duration - 30 to 60 minutes

Movement assessment - Push, pull, OH squat, single leg balance (squat if tolerated)

Flexibility - Static and active in a standing or seated position

Resistance training - 1 to 3 sets of 10 to 20 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model; Tempo should not exceed 1 second for isometric and concentric portions (e.g. 4/1/1 instead of 4/2/1); Use circuit or PHA weight training as an option, with appropriate rest intervals

Special considerations - Avoid heavy lifting and Valsalva maneuvers - make sure client breathes normally; Do not let client overgrip weights or clench fists when training; Modify tempo to avoid isometric & concentric muscle action; Perform exercises in a standing or seated position; Allow client to stand up slowly to avoid possible dizziness; Progress client slowly

Question 21

Physiologic & Training Considerations for Individuals with Coronary Heart Disease (CHD)

Answer 21

1. The nature of heart disease may result in a specific level of exercise, above which it is dangerous to perform
2. Clients with heart disease may not have angina (chest pain equivalent) or other warning signs
3. Between the underlying disease & medication use, the heart rate response to exercise will nearly always vary considerably from age-predicted formulas, and will almost always be lower
4. Clients may have other comorbidities (such as diabetes, hypertension, peripheral vascular disease, or obesity)
5. Peak oxygen uptake (as well as ventilatory threshold) is often reduced because of the compromised cardiac pump and peripheral muscle deconditioning

Question 22

Basic Guidelines for CHD

Answer 22

Mode - Large muscle group activities, such as stationary cycling, treadmill walking or rowing

Frequency - 3 to 5 days per week

Intensity - 40% to 85% of max heart rate reserve. Talk test. Stage 1 cardiorespiratory training.

Duration - 5 to 10 minutes warm-up, 20 to 40 minutes of exercise, followed by a 5 to 10 minute cool down

Movement assessment - Push, pull, OH squat, single leg balance (squat if tolerated)

Flexibility - Static and active in a standing or seated position

Resistance training - 1 to 3 sets of 10 to 20 reps on 2 to 3 days per week; Phase 1 and 2 of the OPT model; Tempo should not exceed 1 second for isometric and concentric portions (e.g. 4/1/1 instead of 4/2/1); Use circuit or PHA weight training as an option, with appropriate rest intervals

Special considerations - Be aware that the clients may have other diseases to consider as well; Modify tempo to avoid isometric & concentric muscle action; Avoid heavy lifting and Valsalva maneuvers - make sure client breaths normally; Do not let client overgrip weights or clench fist; Perform exercises standing or sitting; Progress exercise slowly

Question 23

Osteopenia

Answer 23

A decrease in the calcification or density of bone as well as reduced bone mass

Question 24

Osteoporosis

Answer 24

Condition in which there is a decrease in bone mass and density as well as an increase in the space between bones, resulting in porosity and fragility

Type 1 (primary) - associated with normal aging and is attributable to a lower production of estrogen & progesterone, both of which are involved with regulating the rate at which bone is lost

Type 2 (secondary) - caused by certain medical conditions or medications that can disrupt normal bone reformation, including alcohol abuse, smoking, certain diseases or certain medications

Question 25

Physiologic & Training Considerations for Individuals with Osteoporosis

Answer 25

1. Maximal oxygen uptake and ventilatory threshold is frequently lower, as a result of chronic deconditioning 2. Gait and balance may be negatively affected 3. Chronic vertebral fractures may result in significant lower-back pain 4. Age, disease, physical stature, and deconditioning may place the client at risk for falls

Question 26

Basic Guidelines for Osteoporosis

Answer 26

Mode - Treadmill with handrail support Frequency - 2 to 5 days per week Intensity - 50% to 90% of max heart rate. Stage 1 cardiorespiratory training progressing to Stage 2. Duration - 20 to 60 minutes per day or 8 to 10 minute bouts Movement assessment - Push, pull, OH squat, sitting & standing in front of a chair Flexibility - Static and active stretching Resistance training - 1 to 3 sets of 8 to 20 reps up to 85% on 2 to 3 days per week; Phase 1 and 2 of the OPT model should be mastered before moving on Special considerations - Progression should be slow, well monitored, and based on postural control; Exercises should be progressed if possible toward free sitting (no support) or standing; Focus exercises on hips thighs, back and arms; Avoid excessive spinal loading on squat & leg press exercises; Make sure client is breathing in normal manner and avoid holding breath as in a Valsalva maneuver

Question 27

Arthritis

Answer 27

Chronic inflammation of the joints

Question 28

Oseoarthritis

Answer 28

Arthritis in which cartilage becomes soft, frayed, or thins out as a result of trauma or other conditions

Question 29

Rheumatoid arthritis

Answer 29

Arthritis primarily affecting connective tissues, in which there is a thickening of articular soft tissue, and extension of synovial tissue over articular cartilages that have become eroded

Question 30

Physiologic & Training Considerations for Individuals with Arthritis

Answer 30

1. Maximal oxygen uptake and ventilatory threshold are frequently lower as a result of decreased exercise associated with pain and joint inflammation 2. Medications may significantly influence bone and muscle health 3. Medications may significantly influence bone and muscle health 4. Tolerance to exercise may be influence by acute arthritic flare-ups 5. Rheumatoid arthritis results, in particular, in early morning stiffness 6. Evaluate for presence of comorbidities, particularly osteoporosis

Question 31

Basic Guidelines for Osteoporosis

Answer 31

Mode - Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics Frequency - 3 to 5 days per week Intensity - 60% to 80% of max heart rate. Stage 1 cardiorespiratory training progressing to Stage 2 (may be reduced to 40%-70% of max heart rate if needed). Duration - 30 minutes Movement assessment - Push, pull, OH squat, single-leg balance or squat (if tolerated) Flexibility - SMR and static and active stretching Resistance training - 1 to 3 sets of 10 to 12 reps on 2 to 3 days per week; Phase 1 of OPT model with reduced repetitions; May use a circuit or PHA training system Special considerations- Avoid heavy lifting and high repetitions; Stay in pain-free ranges of motion; Only use SMR if tolerated by the client; There may be a need to start out with only 5 minutes of exercise and progressively increase, depending on the severity of conditions

Question 32

Cancer

Answer 32

Any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to recur after attempted removal and to cause death of the patient unless adequately treated

Question 33

Physiologic & Training Considerations for Individuals with Cancer

Answer 33

1. Fatigue and weakness is common 2. Excessive fatigue may result in overall diminished activity 3. Diminished immune function 4. Decreased lean muscle mass

Question 34

Basic Guidelines for Cancer

Answer 34

Mode - Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics Frequency - 3 to 5 days per week Intensity - 50% to 70% of max heart rate reserve. Stage 1 cardiorespiratory training progressing to Stage 2 (may be reduced to 40%-70% of max heart rate if needed). Duration - 15 to 30 minutes (may only start with 5 minutes) Movement assessment - Push, pull, OH squat, single-leg balance (if tolerated) Flexibility - SMR and static and active stretching Resistance training - 1 to 3 sets of 10 to 15 reps on 2 to 3 days per week; Phase 1 of OPT model; May use a circuit or PHA training system Special considerations - Avoid heavy lifting in initial stages of training; Allow for adequate rest intervals and progress client slowly; Only use SMR if tolerated by the client - avoid SMR for clients undergoing chemotherapy or radiation treatments; There may be a need to start with only 5 minutes of exercise and progressively increase, depending on the severity of conditions and fatigue

Question 35

Physiologic & Training Considerations for Women and Pregnancy

Answer 35

1. Contraindications include persistent bleeding 2nd to 3rd trimester, medical documentation of incompetent cervix or intrauterine growth retardation, pregnancy-induced hypertension, preterm rupture of membrane, or preterm labor during current or prior pregnancy 2. Decreased oxygen available for aerobic exercise 3. Posture can affect blood flow to uterus during vigorous exercise 4. Even in the absence of exercise, pregnancy may increase metabolic demand by 300 kcal per day to maintain energy balance 5. High-risk pregnancy considerations include individuals older than the age of 35, history of miscarriage, diabetes, thyroid disorder, anemia, obesity, and a sedentary lifestyle

Question 36

Basic Guidelines for Women and Pregnancy

Answer 36

Mode - Low-impact or step aerobics that avoid jarring motions, treadmill walking, stationary cycling, and water activity Frequency - 3 to 5 days per week Intensity - Stage 1 and only enter stage 2 on a physician's advice Duration - 15 to 30 minutes; There may be a need to start out with only 5 minutes of exercise and progressively increase to 30 minutes, depending on the severity of conditions Movement assessment - Push, pull, OH squat, single-leg squat or balance Flexibility - Static and active stretching, SMR Resistance training - 2 to 3 days per week, using light loads at 12-15 repetitions; Phase 1 and 2 of the OPT model are advised (use only phase 1 after first trimester) Special considerations - Avoid exercise in a prone (on stomach) or supine (on back) position after 12 weeks of pregnancy; Avoid SMR on varicose veins and areas of swelling; Plyometric training is not advised in the second and third trimesters

Question 37

Restrictive lung disease

Answer 37

The condition of a fibrous lung tissue, which results in a decreased ability to expand the lungs

Question 38

Chronic obstructive lung disease

Answer 38

The condition of altered airflow through the lungs, generally caused by the airway obstruction as a results of mucus production

Question 39

Physiologic & Training Considerations for Individuals with Lung Disease

Answer 39

1. Lung disease frequently is associated with other comorbidties, including cardiovascular disease 2. A decrease in the ability to exchange gas in the lungs may result in oxygen desaturation and marked dyspnea at low workloads 3. Chronic deconditioning results in low aerobic fitness and decreased muscular performance 4. Upper extremity exercise may result in earlier onset of dyspnea and fatigue than expected, when compared with lower extremity exercise 5. Clients may have significant muscle wasting and be of low body weight 6. Clients may be using supplemental oxygen

Question 40

Basic Guidelines for Individuals with Lung Disease

Answer 40

Mode - Treadmill walking, stationary cycling, steppers, and elliptical trainers Frequency - 3 to 5 days per week Intensity - 40%-60% of peak work capacity; Stage 1 Duration - Work up to 2- 45 minutes Movement assessment - Push, pull, OH squat, single-leg squat or balance Flexibility - Static and active stretching, SMR Resistance training - 1 set of 8-15 repetitions 2-3 days per week; Phase 1 of the OPT model is advised; PHA training system is recommended Special considerations - Upper body exercises cause increased dyspnea and must be monitored; Allow for sufficient rest between exercises

Question 41

Intermittent claudication

Answer 41

The manifestation of the symptoms caused by peripheral arterial disease

Question 42

Peripheral arterial disease

Answer 42

A condition characterized by narrow of the major arteries that are responsible for supplying blood to the lower extremities

Question 43

Physiologic & Training Considerations for Individuals with Intermittent Claudication or PAD

Answer 43

1. PAD patients frequently have coexisting coronary artery disease or diabetes 2. Smoking significantly worsens PAD and exercise tolerance 3. PAD frequently results in decreased aerobic capacity and endurance 4. Resistance training may improve overall physical function, but may not address limitations of PAD

Question 44

Basic Guidelines for Individuals with Intermittent Claudication/PAD

Answer 44

Mode - Treadmill walking is preferred, also stationary cycling, steppers, and elliptical trainers Frequency - 3 to 5 days per week Intensity - 50%-85% of maximal heart rate Duration - Work up to 20-30 minutes Movement assessment - Push, pull, OH squat, single-leg squat or balance Flexibility - Static and active stretching Resistance training - 1 to 3 sets of 8 to 12 repetitions 2 to 3 days per week, and slowly increasing up to 12 to 20 reps; Phase 1 of the OPT model is advised Special considerations - Allow for sufficient rest between exercises; Workout may start with 5-10 minutes of activity; Slowly progress client