Exercise for the Special Population

1. Exercise for the Special Population Exercise Science 2001

2. Objectives: Using examples, • To identify special populations • To identify physical activity / exercise needs of special populations • To integrate principles of exercise training in the implementation & the evaluation of exercise training programs

3. Special Populations • Target population • Group vs. Individual, age group, gender • Identify Needs • Goal Setting • Design Program • Record Keeping • Evaluation • Pre and post testing

4. So….Who are they?

5. Special Population • Special Population = Adapted State • Population at risk • population with sedentary lifestyle • low cardiorespiratory fitness • women: aged, osteoporosis • children with obesity • Population with chronic disabilities • e.g. ankylosing spondylitis, diabetes mellitus, chronic obstructive pulmonary disease, cystic fibrosis, rheumatoid arthritis, poliomyelitis, stroke, amputations, spinal cord injury…

6. Lifelong Fitness Lifestyle

7. Four phases of natural history of exercise Sedentary Adoption Maintenance Drop-out Resumption Time

8. Guidelines To implement an effective exercise programme: • An understanding of the body responses to exercise in diseases/conditions • Unique adaptations to exercise training in different age group with regard to strength, functional capacity, motor skills

9. Guidelines (Cont’d) • Identify risk factors / precautions / contraindications prior to participation in physical activity • Identify determinants of physical activity • Integrate the principles of exercise training • Define ways to monitor and evaluate the effectiveness of the program

10. Local Data 1 • Report on Healthy Living Survey 1999 • Department of Health • Cross-sectional telephone survey • n = 3,270 • Aged 18-64 years

11. Results of the Healthy Living Survey • 51% of men and 47% of women engaged in exercise (at least 30 minutes) within last one month • Participation in exercise drop markedly for both sexes from 70% (in age group 18-24) to less than 40% in age group (age 45-54)

12. Results of the Healthy Living Survey • 52% had done something to improve health or to prevent diseases in the past year • Exercise was the most common action • Major barrier: lack of time • On average spent 2.7 hours daily watching TV

13. Local Data 2 (1999) • Chinese University of Hong Kong • Interview survey • n = 26,111 • Aged 10 to 20 from 48 primary and secondary schools

14. Results of the CUHK Survey • Have you engaged in any leisure time exercise that make you sweat last week?NO percentage: • P4 to P6: 13.8% • F4 to F7: 25.8% • Have you watched TV for 3 hours or more last week? YES percentage: • P4 to P6: 54.3% • F4 to F7: 51.2%

15. So….What does it mean?

16. INACTIVITY - a major health problem • Association between sedentary lifestyle and morbidity / mortality from chronic disease - Evidence??

17. Evidence (Blair and Brodney, 1999) Association of physical activity or cardiorespiratory fitness to the outcomes of mortality: • Cardiovascular disease + • Coronary heart disease ++ • Hypertension + • Type 2 diabetes mellitus ++ • Cancer 

18. Effects of Physical Activity on Health Outcomes in Adolescents • Aerobic Fitness  • Body Fat  • Blood pressure  • HDL cholesterol  • LDL cholesterol 0 • BMD  • Musculoskeletal injuries 

19. Exercise Prescription Considerations

20. An Example

21. Adolescence • Defined as ages 11 - 21 • Pre-pubescent  preadolescent • Post-pubescent  adult

22. Physiologic Characteristics of Exercise in Preadolescents (ACSM Resource Manual, 1998) • Immature cardiovascular system • Higher O2 consumption per unit of body mass (i.e. higher metabolic rate) • Lower SV, compensated by higher HR • Higher RR • Poor sweating capacity • Large surface-to-mass ratio • RPE perceived as easier for a given workload

23. Physiologic Characteristics of Exercise in Preadolescents •  concentration and rate of utilization of glycogen •  ability to utilize muscle glycogen and produce lactate  lower anaerobic capacity than adults • Reach metabolic steady state faster, lower oxygen deficit, faster recovery • Rely more on aerobic metabolism

24. Implications • Can perform endurance task fairly well • Greater fatiguability in prolonged high-intensity task • Ability to perform intense anaerobic task lower than adults • Low tolerance to extreme heat / cold • Thermoregulation less efficient - less tolerance for exercising in the heat susceptible to heat exhausation

25. In planning exercise program: • Preparticipation examination • Avoid anaerobic training (concentrate on skill and movement in aerobic sports such as basketball and soccer) • Intermittent activities preferred • Intensity and duration should be lower initially  gradually increase

26. In planning exercise program: • Special attention to acclimatization (avoid high heat and humidity) • Fluid replacement • Be conservative / prescribe an easily tolerable program • Have a high index of suspicion for injury

27. Skeletal System • Active musculoskeletal development • Muscle-tendon units accommodate to the rapid growth of long bones  flexibility compromised • At puberty, relative over-growth of long bones to soft tissue  muscle imbalance • Repetitive microtrauma on vulnerable prestressed muscle-tendon units  tendinitis, bursitis, apophysitis, stress fractures

28. Implications • Gradual progression of exercise • Avoid extremes in exercise duration and intensity • Adequate period of warm-up, stretching and cool-down exercises

29. Determinants of Physical Activity • Demographic • Biological • Psychological / emotional • Social and cultural • Physical Environment

31. Facts • Boys more physically active than girls • Physical activity declines dramatically with age (from age 13 to 16) • Self-efficacy strong predictor • Perceived barriers: lack of time and lack of interest • Enjoyment a strong correlate

32. Facts • Social influence strong++ - peer and parents influence • Physical environmental strongly associated with physical activity (especially preschool children)

33. Local Data • Lindner and Sit, 1998 • n = 4,690 (P.5 to F.7) • Reasons for participation: • For Fun • For health and fitness • To be with friends • To become good at the activity

34. Local Data • Reasons for non-participation: • Prefer to do one’s ‘own thing’ (? Not attracted by the regularity, commitments and expectations being involved in sports) • Reasons for withdrawal: • Need time for studying • Wanting to spend more fun time on other leisure activities • Wanting time to be with friends

35. Implications • Target high risk group - female adolescents • Build perceptions of competence or self-efficacy • Fun enjoyable activities

36. Implications (Cont’d) • Reduce perceptions of barriers • Social support from friends • Stimulate parental assistance • Increase time to spend outdoors

37. Physical Activity Guidelines • International Consensus Conference on Physical Activity Guidelines for Adolescents (Sallis and Patrick, 1994) • Health Education Authority (Biddle et al, 1998)

38. International Consensus Conference on Physical Activity Guidelines for Adolescents • All adolescents should be physically active daily, or nearly every day • Engagement in 3 or more days/week of activities that last for 20 or more minutes that require moderate to vigorous levels of exertion

39. Health Education Authority (UK) • Participation in physical activity of moderate intensity for 1 hour/day • Young people who currently do little activity should participate in physical activity of moderate intensity for at least 30 minutes/day (note: consistent with adult guidelines) • At least 2 days a week, engage in exercise that enhance/maintain muscle strength, flexibility and bone health

40. Exercise for Obese Children

41. Exercise for Obese Children • Local Data: Report from Department of Health • Health services provided to schools review 13.2% primary school children as obese • Related to homework, watching TV, computer games, surfing on the net  all sedentary behaviours!!

42. Fitness or Fatness?? • Measures of adiposity and sedentary behaviours are consistently related • Children with high level of total body fat mass and visceral adipose tissue have increased factors for coronary artery disease and NIDDM • Obesity predicts poor adherence to exercise programs • Obesity in childhood  adulthood • Physical activity best predictor of weight loss maintenance

43. Think about: • Physical Activity Guidelines for Adolescents • Determinants of Physical Activity • Principles of exercise training • Components of physical fitness • Evaluation Tools • Follow up period

44. Evaluation Tools Measurements of: • Cardiovascular fitness • Body fat composition • Physical activity level

45. Components of the Program • Exercise • Nutrition • Social Support - parents involvement • Behaviour change • Relapse prevention

46. Characteristics of the Exercise Programs • Home based vs. site-based • Build activity into child / adolescent’s lifestyle • Negative energy balance • Think about the activity guidelines

47. Physical Activity Levels • Low intensity - 30-50% VO2 max; HR 120-149 beats/min; 2-4 METS • Moderate intensity - 50-70% VO2 max; HR 150--169 beats/min; 5-7.5 METS • High intensity - > 70% VO2 max; HR > 169 beats/min; > 7.5 METS • HR monitoring considered for assessing moderate to vigorous activity

48. Initiatives in Hong Kong

49. Exercise Program