Exercise Science

1. Exercise Science Training Special Populations

2. Training Special Populations Special Populations – individuals that have unique needs or concerns physically, due to disease, injury or lifestyle conditions. These individuals will NEEDaccommodations and/or adjustments made to the standard exercise guidelines and recommendations to challenge but not overwhelm. Key Words: Accommodate & Adjust

3. Training Special Populations Cardiovascular Disorders • Hyperlipidemia • Hypertension • Arteriosclerosis • Coronary (Heart) Disease • Cerebral Vascular Accident (Stroke) • Peripheral Vascular Disease (PVD)

4. Training Special Populations Hyperlipidemia (high cholesterol) • Lipid is the scientific term for fats in the blood. At proper levels, lipids perform important functions in your body, but can cause health problems if they are present in excess. • The term hyperlipidemia means high lipid levels. • Hyperlipidemia includes several conditions, but it usually means that you have high cholesterol and high triglyceride levels. • High lipid levels can speed up a process called atherosclerosis, and heart disease

5. Training Special Populations Hyperlipidemia Exercise Guidelines • Eat a diet low in total fat, saturated fat, and cholesterol. • Increase consumption of high-fiber foods such as fruits, vegetables, beans, and whole grains. • If you are overweight, lose weight. • Exercise regularly (cardiovascular training 1st) • Physician Release

6. Training Special Populations Hypertension • Systolic 160mmHg or greater, Diastolic 90 mmHg or greater • Over 50 million people have elevated blood pressure • Hypertensive individuals have a 3 to 4 times greater risk of developing heart disease and 7 time greater risk of having a stroke • Typically caused by narrowing of the arteries

7. Training Special Populations Hypertension Exercise Guidelines • Obtain a Physician Release • No Valsalva Maneuver • Aerobic Activities (1st) • May need to use alternate methods of assessing intensity • May appropriate of monitor and record BP during training

8. Training Special Populations Hypertension Exercise Guidelines • Stop training immediately if ANY abnormal symptoms arise • Muscular training if used should be muscular conditioning • Be aware of orthostatic Hypotension • No Isometric Activities • Frequency 4+ sessions/week • Duration of 30 to 60mins • Intensity – Low

9. Training Special Populations Cerebral Vascular Accident (stroke)

10. Training Special Populations Cerebral Vascular Accident (stroke)

11. Training Special Populations Cerebral Vascular Accident Exercise Guidelines • Same guidelines as Hypertension • Obtain Physician Release • Frequency – 4+ sessions/week • Intensity – Low • Time – 30 to 60 mins • Type – Aerobic Activities (1st) Muscular conditioning if at all

12. Training Special Populations Arteriosclerosis • A disease affecting the arterialblood vessel. It is commonly referred to as a "hardening" of the arteries. It is caused by the formation of multiple plaques within the arteries. • increases your risk of heart disease, stroke, and other vascular diseases.

13. Training Special Populations Coronary (heart) Disease • Plaque often narrows a coronary artery so that the heart does not get enough blood. • This slowing of blood flow causes chest pain, or angina.

14. Training Special Populations Coronary (heart) Disease • If plaque completely blocks blood flow, it may cause a heart attack (myocardial infarction) or a fatal rhythm disturbance (sudden cardiac arrest). • A major cause of death and disability, coronary heart disease claims more lives in the United States than the next 7 leading causes of death combined.

15. Training Special Populations Exercise Guidelines for CHD & Arteriosclerosis • Obtain a Physician Release • Network with the individuals Cardiologist • Frequency – 3 to 5 sessions/week • Intensity – Low as per tolerance • Time – 20 to 30 min continuous • Type – Aerobic Activities

16. Training Special Populations Peripheral Vascular Disease • The blood vessels outside the heart and brain begin to develop arteriosclerosis. • It's often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. • 20 times more common in Diabetics • Intermittent claudication(weakness, pain) • Painful!!!

17. Training Special Populations Peripheral Vascular Disease Exercise Guidlines • Avoid training in the cold (air or water) encourages vasoconscriction • Interval Training – frequent rests periods • Avoid Blistering to the feet • Initially non-weight bearing • Frequency – Daily to tolerance • Intensity – Low to High (claudication Scale) • Time 30 to 40 min working to continuous • Type – Aerobic (non-impact)

18. Training Special Populations Metabolic Disorders • Hypoglycemia • Insulin Dependant Diabetes Mellitus • Non-Insulin Dependant Diabetes Mellitus • Gestational Diabetes

19. Training Special Populations Hypoglycemia • The pancreas sends out too much insulin and the blood sugar plummets below the level necessary to maintain well-being.Since all the cells of the body, especially the brain cells, use glucose for fuel, a blood glucose level that is too low starves the cells of needed fuel, causing both physical and emotional symptoms Symptoms: fatigue heart palpitations insomnia dizziness faintness blurred vision headaches

20. Training Special Populations Hypoglycemia & Exercise Guidelines • Exercise is an important component in the management of hypoglycemia because it is a great metabolic booster. • Increases insulin sensitivity • Lowers insulin needs • Improves glucose tolerance. • Frequency – 3 to 5 sessions/week • Intensity – As per tolerance • Time – work towards 30+ mins continuous • Type – Aerobic initially

21. Training Special Populations Insulin Dependant Diabetes Mellitus • Juvenile or Type I Diabetes • The body (pancreas) does not produce insulin • Insulin must be introduces externally • Diabetics are at greater risk for kidney failure, nerve damage, eye problems & heart disease • Prolonged and frequent elevation of blood sugars can damage capillary beds, which lead to poor circulation • Prone to infections

22. Training Special Populations Non-Insulin Dependant Diabetes Mellitus • Adult onset or Type II Diabetes • Body Produces insulin, reduced sensitivity • Most Common 90% of all diabetics • Lifestyle – high sugar diets, overweight • Reversible – by lifestyle modification

23. Training Special Populations Gestational Diabetes Mellitus • A form of Type II diabetes • Manifests during pregnancy • Ceases post gestation • Prone to Type II diabetes in later life

24. Training Special Populations Diabetes Exercise Guidelines • Check glucose levels frequently • Always have a rapid acting carbo snack available • Avoid exercising during peak insulin periods • Do not inject insulin into muscles that will be trained • Take care of their feet

25. Training Special Populations Diabetes Exercise Guidelines • Frequency – IDDM: 5 to 7 sessions/week NIDDM: 4 to 5 sessions/week • Intensity – IDDM: 50% to 60% HRR NIDDM: 60% to 70% HRR • Time – IDDM: 20 to 30 min continuous NIDDM: 40 to 60 min continuous • Type – Aerobic Activities

26. Training Special Populations Pulmonary Disorders • Asthma • Bronchitis (COPD) • Emphysema (COPD)

27. Training Special Populations Asthma • Reactive Airway Disease Allergies, exercise, infections, stress, environmental irritants • Shortness of Breaths, coughing & Wheezing • Caused by: Constriction of Smooth muscle around airways Swelling of mucosal cells Increase in mucous • Approx 80% of asthmatics –exercise induced

28. Training Special Populations Asthma Exercise Guidelines • Pre-exercise medicine • Carry inhaler • Drink plenty of fluids • Extend Warm-up & Cool down • Avoid training in extreme environment conditions (cold, pollen, heat) • Freqency – 3 to 4 session/week • Intensity – Initially Low to tolerance • Time – 25 to 45 min continuous • Type – Aerobic (1st)

29. Training Special Populations Bronchitis (COPD) • Form of Chronic Obstruction Pulmonary Disorder • Inflammation of the bronchi, the main air passages to the lungs, it generally follows a viral respiratory infection. • Symptoms include; coughing, shortness of breath, wheezing and fatigue.

30. Training Special Populations Emphysema (COPD) • lung disease that involves damage to the air sacs (alveoli) in the lungs. • The air sacs are unable to completely deflate, and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body.

31. Training Special Populations Bronchitis & Emphysema (COPD) Exercise Guidelines • May not see improvements in pulmonary function • Benefits – decreased stress, weight, anxiety, increased functionality of daily duties • Unstable COPD physician release • Avoid upper body exercises • Frequency – 4 to 5 sessions/week • Intensity – low • Time – 20 to 30 mins (continuous) • Type – Aerobic/Dynamic activities

32. Training Special Populations Bone or Joint Disorders • Osteoarthritis • Rheumatoid Arthritis • Osteoporosis • Chronic Low Back Pain

33. Training Special Populations Osteoarthritis • most common joint disorder • The chronic disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. It can also cause new pieces of bone, called bone spurs, to grow around the joints. • Causes: primarily related to aging. However, metabolic, genetic, chemical, and mechanical factors play a role • The cartilage of the affected joint becomes rough and wears down (degenerates). As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually develop around the joint.

34. Training Special Populations Rheumatoid Arthritis • Chronic disease that causes inflammation of the joints and surrounding tissues. • Cause is unknown • It is considered autoimmune disease • RA can occur at any age. It usually occurs in people between 25 and 55. Women are affected more often than men.

35. Training Special Populations Arthritis Exercise Guidelines • Low impact activities • Extend Warm-up and Cool-downs • Be able to modify activity during session • Train full ROM • Emphasize correct Biomechanics • More limited due to ROM than CV • Frequency – 4 to 5 session/week • Intensity – Low to tolerance • Time – Initially 10 to 15 min bouts • Type – Aerobics, Calisthenics

36. Training Special Populations Osteoporosis • The thinning of bone tissue and loss of bone density over time. • Most common type of bone disease • The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. • Women, especially those over the age of 50, get osteoporosis more often than men. • Osteoporosis is the most common type of bone disease. • There are currently an estimated 10 million Americans suffering from osteoporosis, as well as another 18 million who have low bone mass.

37. Training Special Populations Osteoporosis Exercise Guidelines • Weight Bearing Activities, promotes greater bone deposition • Avoid Ballistic Activities , Jumping, Running, etc. • Avoid spinal flexion, wood floors, abducting & adducting hips • Frequency – 4 to 5 sessions/week • Intensity – Low (40% to 50% HRR) • Time – 30 to 60 mins continuous (long warm-up) • Type – Aerobic (weight bearing) training, muscular conditioning training

38. Training Special Populations Low Back Pain • Low back pain is the #2 leading reason that Americans see their doctor -- second only to colds and flus. • Most back injuries occur at work • 85% of chronic low back pain is a result of weak abdominal muscles and poor flexibility of low back and hamstrings.

39. Training Special Populations Low Back Exercise Guidelines • Always proper mechanical alignment • Neutral pelvic alignment • Avoid low back hyperextension • Proper warm-up & cool down • Frequency – 4 to 5 sessions/week • Intensity – Low (40% to 50% HRR) • Time – 30 to 60 mins continuous (long warm-up) • Type – Aerobic (weight bearing) training, muscular conditioning training

40. Training Special Populations Miscellaneous Disorders • Cancer • Aging • Obesity (Over Weight) • Children

41. Training Special Populations Cancer • Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells • Cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. • Cancer cells develop because of damage to DNA

42. Training Special Populations Cancer • Often, cancer cells travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis • Not all tumors are cancerous. • Cancer is the second leading cause of death in the United States. • Half of all men and one third of all women in the United States will develop cancer during their lifetimes. • The risk of developing most types of cancer can be reduced by changes in a person's lifestyle

43. Training Special Populations Cancer Exercise Guidelines • Adjust activity to individual’s capacity (physical, nutritional, treatment) • Exercise does not CURE cancer but it can help improve quality of life • Exercise can be a factor to assist in prevention of Cancer • Frequency – as per status • Intensity – as per status • Time – as per status • Type – as per status

44. Training Special Populations Aging • By 2030, the number of older Americans will have more than doubled to 70 million, or one in every five Americans. • Regular physical activity greatly reduces a person's risk from dying of heart disease, and decreases the risk for colon cancer, diabetes, and high blood pressure. Physical activity also helps to control weight; contributes to healthy bones, muscles, and joints; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and can decrease the need for hospitalizations, physician visits, and medications. • People tend to be less active as they age.

45. Training Special Populations • By age 75, about one in three men and one in two women do not engage in ANY physical activity. • The heart muscle becomes a less efficient pump, working harder to pump the same amount of blood through your body. • Also, your blood vessels become less elastic & possibly harden. • Bones shrink in size and density. • Gradual loss of density weakens your bones and makes them more susceptible to fracture. • Muscles, tendons and joints generally • lose some strength and flexibility. • Metabolism generally slows

46. Training Special Populations Aging Exercise Guidelines • Physical activity does not need to be strenuous to be beneficial; people of all ages benefit from moderate physical activity. • Obtain a Physician Release • Emphasize Full ROM • Frequency – 4 to 5 Sessions/week • Intensity – Moderate as per status • Time – 30 to 60 mins (include an extended warm-up and cool-down) • Type – Aerobic activities, muscular conditioning, flexibility exercises, calisthenics

47. Training Special Populations Obesity (Over Weight) • On any given day 1 out of every 4 Americans is on a diet • Among adults aged 20–74 years the prevalence of obesity increased from 15.0% (in the 1976–1980 survey) to 32.9% (in the 2003–2004 survey). • Weight Management Industry $40 billion • 95% of those who lose weight will be unsuccessful in keeping it off.

48. Training Special Populations Obesity (Over Weight) • May Lead to Hypokinetic disorders • Hypertension • Hyperlipidemia (for example, high total cholesterol or high levels of triglycerides) • Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Osteoarthritis • Sleep apnea and respiratory problems • Some cancers (endometrial, breast, and colon)

49. Training Special Populations Obesity (Over Weight) Exercise Guidelines • Moderation • 1 to 2 pounds /week • Lifestyle Change • Exercise – Appetite Suppressant • Emotional Concerns • Be sensitive to mobility, balance, coordination, & fitness levels • Frequency – 5 to 6 sessions/week • Intensity – Low (40% -50% HRR) progress slowly • Time – 30 to 60min continuous • Type – Aerobic Activities, Muscular Conditioning initially

50. Training Special Populations Children • Children are NOT “mini” adults • Child Definition Birth – 1 year 1 year -3 years 4 years – 5 years 6 years – 12 years 13 years – 18years • Childhood Obesity epidemic • Overweight children are more likely to be overweight adults.