1、Special Populations,Special Populations,Obese Cardiac Diabetes Hypertension Osteoporosis Chronic Obstructive Pulmonary Disease Asthma Bronchitis Emphysema Arthritis Pregnancy,The Obese Client,Effects on the Exercise Response,Low physical work capacity. Higher risk for coronary artery disease and may
2、 exhibit myocardial ischemia during exercise (testing). Hypertensive response may occur during exercise despite the absence of hypertension at rest. Must consider glucose intolerance as well.,Effects of Exercise Training,Exercise training is effective in decreasing the BW in moderately obese clients
3、. However, it may not be effective in the morbidly obese. When body weight is reduced through regular exercise, body fat is reduced and lean tissue is maintained or increased. Those with the least lean mass to begin with have the most lean mass to gain during training.,Effects of Exercise Training,O
4、bese individuals may already have a significant amount of lean mass (beneath the adipose) due to the overload from the excess fat increases in lean mass may not be as significant. Ultimately, resistance training can increase the lean mass of almost any population. Exercise affects body fat distribut
5、ion by promoting regional fat loss in the abdominal sites.,Effects of Exercise Training,Fat loss through exercise is more efficient for clients with upper body fat distribution (significantly decreases risk of diseases). Exercise may be one of the most important factors in the maintenance of weight
6、loss. Exercise has profound effects of glucose metabolism in the obese client: Decreased fasting glucose and insulin Decrease insulin resistance Increased glucose tolerance,The primary objective of obesity management is the reduction of fat weight with the preservation of lean body weight. The clien
7、t most likely to be successful is: Slightly or moderately obese Has upper body fat distribution Has no history of weight cycling Has a sincere desire to lose weight Became overweight as an adult,Management & Meds,Management & Meds,Behavioral change focuses on dietary and activity habits toward weigh
8、t reduction. Those who are morbidly obese (BMI 40) may need more invasive interventions: Starvation diets Gastric Bypass Jaw wiring Intragastric balloons Fat excision Anti-obesity meds,Recommendations for Exercise Testing,The primary reason to conduct exercise testing is to determine exercise prescr
9、iption to determine physical work capacity. Assessment should include: Medical & weight history Motivation and readiness for change Nutrition & eating habits Body composition Extent of the obesity Distribution of body fat Reasonable target weight Assessment for potential injury,Recommendations for P
10、rogramming,Goal is to optimize calorie burn yet minimize the potential for injury. Remember the E (enjoyment) in FITTE and exercise should fit the lifestyle. Consider the energy expenditure of the actual exercise and the recovery period Debate over exercising once or twice a day. The literature supp
11、orts total kcals expended rather than concerning oneself with whether the kcals are coming from fat or CHO stores.,Recommendations for Programming,Mode: Aerobic exercise Low-weight bearing exercise Walking Increase activities of daily living Resistance training Frequency: 5+ times/wk Duration: 40-60
12、/day or 20-30 2x/day Intensity: 40-70% or 70-85%,Special Considerations,Injury prevention is very important; also injury history. Thermoregulation, neutral temp pool? Adequate hydration Clothing should be loose fitting Equipment modification might be needed Frequent follow ups,The Cardiac Client Wit
13、h focus on the Post-myocardial infarction,Cardiovascular Diseases,Myocardial Infarction Coronary Artery Bypass Graft Surgery Angina & Silent Ischemia Atrial Fibrillation Pacemakers Valvular Heart Disease Chronic Heart Failure Cardiac Transplant Hypertension Peripheral Arterial Disease Aneurysms,Effe
14、cts of Exercise Training (ACSMs Exercise Management for Persons with Chronic Diseases & Disabilities, 2nd Ed),Increased max oxygen consumption Improved ventilatory response to exercise Relief of anginal symptoms Increased heart rate variability Modest decrease in body weight, fat stores, BP, blood p
15、rofile components Increase in high density lipoproteins Improved psychosocial well-being and self-efficacy Protection against the triggering of myocardial infarction by strenuous physical exertion ( 6 METs).,Recommendations for Programming,Use lower intensity due to higher risk Keep below threshold
16、of angina, significant arrhythmias or symptoms of exercise intolerance Interval training considerations for those with: Very low aerobic capacity,Recommendations for Programming (ACSMs Exercise Management for Persons with Chronic Diseases & Disabilities, 2nd Ed),Large muscle, rhythmic group exercise
17、, ie) walking, biking, rowing, stairclimbing) is appropriate for outpatient physical conditioning (phase II-IV). Training benefits do not transfer from the legs to the arms, and vice versa, both sets of limbs should be exercised. Mild to moderate resistance training can also provide a safe and effec
18、tive method for improving cardiovascular function and other fitness parameters.,Recommendations for Programming,Aerobic Exercise: Frequency: minimum 3 non-consecutive days/wk Duration: 20-40 continuous or accumulated activity Intensity: 40-80% max HRR (heart rate reserve; RPE (rated perceived exerti
19、on 11-15 (Borg) Need longer warm-up & cool-down periods Max benefit requires 5-6 hrs/wk of physical activity Circuit Weight Training: Frequency: 2-3 days/wk Duration: 20-40 Intensity: 40-50% max (no valsalva) 1-3 sets of 10-15 reps 8-12 different exercises,Special Considerations,Monitor for abnormal
20、 symptoms Avoid high intensity exercise in post-myocardial infarction clients. Supervision suggested for moderate- to high-risk clients. Be aware that many post-MI clients have peripheral arterial disease and/or diabetes If possible, select equipment that can be adjusted in 1-MET increments Increasi
21、ng muscular strength is an important component of a program for post myocardial infarction patient.,The Diabetic Client,Overview,A chronic metabolic disease characterized by an absolute or relative deficiency of insulin that results in hyperglycemia. Are at risk for developing microvascular & macrov
22、ascular complications. Silent ischemia is common for those who have had the disease a long time. Many classifications of the disease: Type I Type II Gestational Other,Overview Type I Diabetes,Of the 16 million people with diabetes in US, 5-10% have Type I. An absolute deficiency of insulin. Insulin
23、must be supplied by injection or pump. Usually occurs age 30 but can occur at any age.,Overview Type II Diabetes,Considered to have a relative insulin deficiency because while insulin levels are elevated, reduced or normal, they present with hyperglycemia. Pathophysiology is unclear but believed to
24、be multifactoral. Believed it is due to: Peripheral tissue insulin resistance Defective insulin secretion,Overview Type II Diabetes,Glucose does not readily enter the tissues and blood glucose causes the pancreas to secrete more insulin in an attempt to maintain normal blood glucose concentrations.
25、Obesity significantly contributes to the insulin resistance. 80% of the people with type-II are obese at onset.,Overview Type II Diabetes,Genetically influenced found in studies of twins. Onset occurs with few or no classic symptoms and many go undetected until organ damage has occurred. Usually occ
26、urs age 40. Some develop age 30 maturity onset-diabetes of youth.,Effects on the Exercise Response,Diabetics do not respond to exercise in a normal manner. The effect of diabetes on a single exercise session is dependent of several factors: Use & type of medication: insulin or oral agents Timing of
27、med administration Blood glucose level prior to exercise Timing, amount, and type of previous food intake Presence & severity of diabetic complications Use of other meds secondary to diabetic complications Intensity, time, and type of exercise,Effects of Exercise Training,Exercise is considered to b
28、e one of the cornerstones of diabetes care. Exercise benefits include: Improved blood glucose control (except for Type I) Improved insulin sensitivity & lower doses of meds Decrease body fat Decrease cardiovascular disease risk Stress Reduction Prevent Type-II diabetes in the first place,Management
29、& Meds,Careful monitoring of blood glucose and attention to balancing food intake and meds are needed for safe participation. Watch for hypoglycemia the effects of both insulin and oral agents may cause. If exercise sessions are due to exceed 60, test blood glucose during exercise. Should avoid exer
30、cise if blood glucose level is below 60.,Recommendations for Programming,Must be individualized Predictable and consistent in frequency, intensity, and time Type I daily exercise recommended for best sugar regulation Shorter duration (20-30) Type II 3-5x/wk Lower intensity, longer duration Be aware
31、of contraindications for exercise such as illness or infection. Be on guard for hypoglycemia.,Special Considerations,Insulin adjustments by physician only. Insulin dosage may be warranted 30-60 minutes ahead of session. Those with type I must consider food intake with exercise. In general, 1 hour of
32、 exercise requires an additional 15 g of carbohydrates before OR after exercise. If exercise is vigorous or of longer duration, an added 15-30 g of carbohydrates for every hour may be needed. Be aware of proper precautions such as glucose tabs, hydration, foot care, medical identification. Inject in
33、to the non-exercising limbs,The Hypertensive Client,Overview, 50 million individuals have an elevated blood pressure or are taking meds for it. In these people, the risk of heart disease increase progressively with higher levels of both systolic and diastolic blood pressure. Hypertension is based on
34、 the average of 2 or more readings taken at each of 2 or more visits after an initial screening.,Effects on the Exercise Response,Usually see a rise in the systolic blood pressure from baseline in those with hypertension who are not medicated. The response may be exaggerated or diminished in certain
35、 people. Those will hypertension will usually have a higher systolic blood pressure than those who dont have hypertenstion. The diastolic blood pressure may not change or may rise slightly probably due to impaired vasodilatory response. Studies show a decrease in systolic blood pressure during the i
36、nitial hours following 30-45 of moderately intense exercise.,Effects of Exercise Training,Endurance training may elicit an average reduction of 10 mmHg in both systolic and diastolic blood pressure in stage I & II hypertension. Physically active clients with hypertension who also have good cardiovas
37、cular fitness levels have a lower mortality rate than sedentary and less fit people. Heavy resistance exercise has been shown to increase systolic and diastolic blood pressure. Circuit weight training is the exception to this however. It is OK to do!,Management & Meds,Beta Blocker Ace Inhibitor Calc
38、ium Channel Blocker Diuretic Antihistamines/Cold meds Tranquilizers Antidepressants Alcohol Nicotine Caffeine,Management & Meds,The goal is to prevent sickness and death associated with high blood pressure and to control blood pressure by the least intrusive means possible. Blood pressure should be
39、lowered and maintained below 140/90 while controlling other modifiable cardiovascular risk factors at the same time. Must rely on the RPE (rated perceived exertion) scale vs. TTZ (target training zone) for monitoring exercise. Be aware of the possibility of hypotension as a result of antihypertensiv
40、e agents that reduce total peripheral resistance by vasodilation.,Recommendations for Programming,Mode: Aerobic exercise Frequency: 3-7 d/wk Duration: 30-60 Intensity: 40-70% Exercising at lower intensities appears to lower blood pressure as much as, if not more than, higher intensity exercise. This
41、 is very important in the elderly and those who also have chronic diseases w/hypertension.,Special Considerations,Do not exercise if systolic blood pressure 200 or diastolic blood pressure 115 700 kcal/wk should be the initial goal 2000 kcal/wk should be the long term goal,The COPD Client (Chronic O
42、bstructive Pulmonary Disease),Overview,Imposes multiple pathophysiological problems: Ventilatory Impairments Abnormalities of Gas Exchange CV Impairments Muscular Impairments Symptomatic Limitations Psychological Disturbances,Effects of Exercise Training,Regular participation in exercise can cause p
43、ositive changes in COPD client: Cardiovascular reconditioning Desensitization to dyspnea Improved ventilatory efficiency Increased muscle strength Improved flexibility Improved body comp Improved balance Enhanced body image,Recommendations for Programming (Asthmatics),Must be controlled Take meds an
44、d have meds with them Extended warm-up Lower intensity, increase duration Purse-lipped breathing Adequate hydration Avoid cold, pollution, high pollen,Recommendations for Programming (COPD),Mode: Aerobic exercise such as walking or biking Frequency: 3-7 d/wk Duration: 30 or shorter intermittent Inte
45、nsity: duration is more important than intensity. Rated perceived exertion 11-13/20 Resistance training should be low resistance, high reps, 2-3 d/wk,Special Considerations,Rated perceived exertion is preferred methods of monitoring intensity. Patients usually respond best to exercise in mid to late
46、 morning. Avoid extremes in temperature and humidity.,Osteoporosis,Peak Bone Mass,Depends upon: Your inherited ability to make bone The amount of Calcium you consume Your exercise level Peak bone mass is reached at about age 30. Beyond age 30, bone mass steadily decreases. Making the right lifestyle
47、 choices during peak bone-mass building years and afterward may contribute to a higher peak bone mass and decrease risk of osteoporosis.,Why Should You Care?,Osteoporosis is preventable! No cure for osteoporosisonly treatment. One out of every two women and one out of every eight men over age 50 wil
48、l have an osteoporosis-related fracture in their lifetime. Fractures of the hip and spine result in: Disability Decreased independence Decreased quality of life Increased risk of death Multi-billion dollar cost to our health-care system annually.,Osteoporosis in the Lumbar Spine,Osteoporosis makes t
49、he normal honeycomb matrix inside your bones (left) more porous. Under a microscope, osteoporotic bone (right) looks like a steel bridge with many girders missing., 1998-2002 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,“ “Mayo Clinic,“ “MayoC,“ “Mayo Clinic Health Information,“ “Sharing our Tradition of Trusted Answers“ and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.,
