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Exercise and Special Populations

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Exercise and Special Populations Powered By Docstoc
					Exercise and Special Populations




           Sue Baldwin
            HEW 225
      Exercise for every body
• Maintain health
• Prevent disease and disability
• Recover from accident, illness or disability
• Develop cardiovascular endurance
• Increase muscle strength, speed and
  endurance
• Improve balance and flexibility
    The role of the personal trainer
• Working with acute care professionals
• Working with physical therapists
• Post rehabilitation strategies
• ACSM Guidelines
• Modification of the exercise plan to fit the
  individual
• Consultation and multidisciplinary
  approaches
 The circle of life for exercisers
• Active
• Stress - accident, illness, injury or chronic
  condition(s)
• Diminished capacity
• Medical correction or resolution
• Acute phase rehabilitation
• Return & maintenance of functional status
• Training to enhance CV, strength, balance and
  endurance
     Organization of information
•   Theory                 •   Practical Application
•   Diagnosis/condition    •   Assessment
•   Anatomy/physiology     •   Medical clearance
•   Cause/risk factors     •   Limitations
•   Benefits of exercise   •   Precautions
•   Supervision protocol   •   Prescription
•   Training guidelines    •   Progression
•   Tips                   •   Evaluation
      Purpose of this course
• Safe delivery of post rehabilitation
  conditioning programs
• Describe current best practices
• Reinforce the need for continued study &
  collaboration with acute care professionals
• Emphasize the importance of tailoring the
  exercise prescription to each individual
     Chapter one - Pregnancy
• Physiological
  changes
• Risk status
• Fitness history
• Precautions
• FITT Prescription
• Supervision
         Physiological changes
•   Increased blood volume
•   Increased cardiac output
•   Lordosis
•   Relaxin - increases joint mobility
•   Change in center of gravity
•   Increased heart rate
•   Increased core temperature
               Risk status
Low risk
High risk
•    Previous miscarriage or fetal loss
•    Regular painful uterine contractions
•    Vaginal discharge (fluid or blood)
•    Pre-eclampsia or pregnancy induced HTN
•    Excessive fatigue, anemia
•    Overheating
              Risk Status

• Persistent contractions 6-8 hours post
  exercise
• Elevated HR or BP several hours after
  exercise
• Unexplained pain anywhere in the body
               Precautions
•   Listen to her body
•   Drink plenty of fluid
•   Don’t push through fatigue or pain
•   High reps low weight
•   No Valsalva Maneuver
•   Consult with coach and OB provider when
    working with athletes
                 F-I-T-T
•   Frequency - 3-5 days per week
•   Intensity - PRE 11-14
•   Time - 20 - 30 minutes goal
•   Type - CV - low impact
•   Strength - High reps, low weight, use
    machines or bands for safety
                 Asthma
• Exercise may cause airways to tighten,
  swell and fill with mucous
• Asthma attacks often occurs 5-15 minutes
  after initiating strenuous exercise
• No “cure.” Manage symptoms by taking
  medication before exercising
• Air pollution and certain medications (like
  beta blockers) can make attacks worse
                   Triggers
• Upper respiratory      •   Exercise
  infections             •   Cold air
• Pollen from flowers,   •   Dry air
  trees or grasses       •   Air pollution
• Molds or dust
• Smoking
• Emotional distress
              Medications
• Rescue - Theophyline (short acting),
  adrenaline -used in hospital ER, and Beta-
  antagonist inhalers (albuteral, ventolin or
  proventil) preventive
• Prophylactic - Theophyline (long acting),
  Cromolyn sodium, Leukotriene inhibitors,
  cortocosteriods
    Pre-exercise assessment
• Pulmonary function testing -
  FVC (forced vital capacity),
  FEV1 (forced expiratory volume in one
  sec), PEFR (peak expiratory flow rate)
• Exercise tolerance testing using Borg or
  Dyspnea scale rating
                 Helpful tips
• Begin with activities     • Prolong warm up to at
  least likely to trigger     least 15 minutes
  asthma (kayaking,         • Always have rescue
  swimming, walking)          medication available
• Progress as tolerated     • Maintain hydration
  to cycling, treadmill     • Use diaphragmatic
  running, outdoor            breathing
  running                   • Monitor for signs of
                              an asthma attack
                 F-I-T-T
• F - 3-5 days a week
• I - Based on pulmonary function and
 triggers, generally 50-60% MHR
• T - CV 20-30 min. goal
• T - Strength training high volume low
 intensity 2x15 min. or 1x30 min. 4-5 days
 per week
               Supervision
• Ensure adequate hydration
• Verify preventive meds are taken prior to
  exercise session & rescue meds ready
• Use dyspnea scale to measure potential for
  attack, avoid sudden intense exercise
• Have client use peak-flow meter readings
  regularly to monitor effectiveness
• Consult with HCP on monitoring, treatment plan
  and breathing exercises
    Hypertension - Chapter 3
• Cause of primary HTN is unknown in 90-
  95% of cases
• Two resting BP readings greater than
  140/90mm Hg on two different days
• Uncontrolled HTN can lead to blood vessel
  and organ failure - the silent killer
• Physical activity/aerobic fitness markedly
  reduce mortality for HTN patient
            Hypertension
• Medication & lifestyle modification are
  effective in improving outcome
• 52% of people with HTN are not taking
  medication
• 21% receive inadequate medical therapy
  to lower their elevated BP
• Smoking, obesity, poor diet, and sedentary
  lifestyle increase risk
    Assessment considerations
• Preferred test -          • Is BP well controlled?
  Physician supervised      • Which lifestyle
  12 lead exercise            modifications are
  stress test, with noted     being followed?
  BP response to            • Type of medications
  increasing workloads        regularly used &
  determining upper           effect on HR & BP?
  limits of intensity       • Affect of additional
                              clinical conditions?
                 F-I-T-T
•   F 5-6 days per week
•   I 40-70% MHR (40-70% Vo2)
•   T 30-60 min. per session
•   T Emphasize aerobic activities
•   ST Circuit weight training best to reduce
    blood pressure
             Precautions
• Avoid isometric exercises to lessen impact
  of sodium and potassium retention on
  kidneys
• For HTNs on diuretics, monitor hydration
  levels when exercising, especially on high
  heat index days
• Avoid high intensity exercise and highly
  competitive activities
                Supervision
• Know S/Sx of              • Is medication taken
  elevated BP                 as prescribed?
• Have BP equipment         • Is client well
  available                   hydrated?
                            • Monitor BP
• Inform clients of
  modifiable risk factors   • Exercise is unsafe
                              when BP is greater
• Check for new               than 200/100 - refer
  medical conditions          to HCP
           Reassessment
• Regularly assess for development of new
  conditions and changes in treatment plans
• Monthly reassess all physical parameters
• Measure weekly resting and exercise BP
  to assist in determining proper intensity
• Reinforce HCP dietary recommendations
  for sodium, fitness and pharmacological
  therapies
        Chapter 4 - Diabetes
• Insulin (hormone) is secreted by the
  pancreas and converts glucose so it can
  enter muscle cells and produce energy
• With limited or no insulin production, blood
  glucose rises, depriving the body of
  energy and causing serious complications
  for all organ systems
             Types of Diabetes
Type 1                         Type II
Insulin dependant              Non-insulin dependant
• Affects children and         • Primarily affects mostly >
  young adults                   40 yrs old & overweight
• Daily doses of insulin are   • Achieving optimal
  required to keep blood         glucose control (ideal
  glucose levels controlled      body weight, exercise,
                                 oral medications) can
                                 reduce complications
             Assessment
• Complete history and physical exam by
  HCP
• Exercise stress test for those over 35
• Standard fitness assessment
              Precautions
• Glucose levels over 250 mg/dl are a
  contraindication for exercise
• Neuropathy decreases ability to feel pain
  and increases risk for abnormal heart rate,
  abnormal BP and overheating
• Proliferative retinopathy increases risk for
  hemorrhages and retinal detachment
             Precautions
• Type 1 diabetics should avoid vigorous or
  prolonged exercise if hypoglycemic or
  fasting plasma glucose exceeds 250-350
  mg/dl.
• Avoid exercise in climatic extremes
• Check feet daily for cuts & blisters,
  especially after exercise
                   Tips
• Have diabetic keep a log of insulin dose,
  timing, activity, BS levels and symptoms.
  Record BS 30 minutes before and 1 hour
  after exercise.
• Know how meds affect HR and BP
• Review symptoms of hypoglycemia
• Insulin abdominally, 1 hour before
  exercising
       F -I-T-T IDDM/NIDDM
• F- 3-5 days per week / 5-6 days per week
• I - 55-75% VO2 Max or 3-5 RPE / 40-70%
  2-5 RPE
• T- 30 min. aerobic / 20-30 min for glucose
  control 40-60 min. per session
• T- Aerobic and aerobic interval, low impact
• ST- 2-3 days per week 40-60% 1RM, 2-3 sets
  per exercise. Warm up & cool down
  5-10 min.
                      Tips
• Wear good fitting       • Self monitor glucose level
  supporting shoes          < 100 = eat carbo
• Wear protective gear      100 - 250 = OK
                            > 250 postpone high
  during contact sports
                            intensity activity
• Petroleum jelly in
                          • NIDDM carbo snack 30
  friction areas            min. to avoid low BS
• Loose clothing          • Wear medical ID bracelet
• Exercise with a
  partner
Time for a break!

Review your notes, so far
  Stretch and breath
    Chapter 5 - Low back pain
• 80% of Americans will experience LBP
• Main causes: Disc wear, sprains, strains
  or degenerative conditions
• Prevention: Good posture, proper body
  mechanics, short periods of sitting and
  regular exercise
• Best treatment for acute LBP of
  < 3 months duration: physical activity
                   Assessment
         For new or sudden increase in pain
• Medical history and exam: may include
  X-rays, MRI, CT or EMG and/or neurological
  workup
• Consult with PT for spinal care, biomechanics
  and diagnosis specific exercises
• List dx specific & contraindicated exercises,
  meds & their effect on HR & BP
• TX: NSAIDs, Heat, Ice, Stretching
          Training guidelines
• Communicate A&P of       • Model good body
  back supports              mechanics for your
• Include diagnosis          client
  specific exercises       • Client should always
• Good body                  squat rather than
  mechanics are              bend at the waist to
  essential during ST to     pick up weight
  prevent further injury   • Avoid overhead press
                      F-I-T-T
•   F - 3-5 days per week
•   I - 60-80% VO2 Max
•   T - 20-60 minutes per session
•   T - Best aerobic activities - low impact CV.
    Avoid jumping, twisting and bending
• ST - Stretching: legs, hips, low back
    Resistance: abdominals, legs, glutes, back
                     Tips
• Stretch twice a day     • In the weight room lift
• Resistance work.          client’s feet onto
  Progress as tolerated     bench when lying
• Prolong warm ups to       down
  decrease back strain    • Practice perfect
                            technique, no back
                            hyperextensions
                          • Wear flat soled shoes
                            with good support
              Precautions
• Monitor for leg pain, numbness, tingling or
  weakness
• Monitor body mechanics and postural
  position during all activities
• Educate about body mechanics, postural
  stabilization and lumbar support
• Avoid prolonged sitting, standing or
  repetitive bending and twisting
    Chapter 6 - Osteoporosis
• 40% of Americans over 50 will experience
  a fracture due to bone loss
• 1 in 4 women over 40 have osteoporosis
• Prevention: Adequate calcium intake,
  exercise, decrease ETOH, smoking and
  caffeine
• Hip & spine fractures cause disability and
  death
             Assessment
• Medical history and physical exam
  including DEXA - often monitored yearly
• Medications and effect on HR & BP
• Functional fitness testing
• Balance, flexibility and walking skills
       Women at high risk for
          osteoporosis
• Menopause earlier than 45
• High volume aerobic athletes: Distance
  runners,swimmers, gymnasts, dancers
• Low calcium intake
• Smokers
• Competitive or high intensity activities that
  predispose individual to fractures
         Training guidelines
• Weight bearing activity is essential
• Becoming physically active helps prevent
  more bone loss
• Exercise and hormone therapy may be
  necessary to prevent further bone loss
• Goals: Improve strength, flexibility, and
  balance to reduce falls and fractures
                F-I-T-T
    For Clients with Osteoporosis
•   F - 3-7 days per week
•   I - Age appropriate, generally 60-80% MHR
•   T - 20-60 minutes per session
•   T - Weight bearing aerobics, strength training,
    functional exercises, balance
• ST - 75% 1RM, progress to 3 set/10 to 15 rep
    program
              Supervision
• Lower body exercises in sitting position
• Light dumb bell work standing
• Monitor overhead exercises carefully
• Avoid abdominal curls and sit and reach
• Provide stable, non-slippery floor and
  lifting surfaces
• Know medications and side effects
  especially those causing dizziness
Chapter 7 The most regular
   exercisers are over 50!

 • Body fat can double between 25 and 75
   > intra-muscular fat, < sub-q fat
 • Total body water decreases which
   increases dehydration risk
 • Decreased lean body mass
 • Liver loses 1/3 of it’s weight, kidney 1/4
 • Loss of 2 inches in height by 80
              Exercise can
• Decrease heart         • Increase feelings of
  disease                  well being
• Hypertension           • Self image
• Diabetes               • Energy level
• Osteoporosis           • Balance
• Body fat               • Flexibility
• Insomnia               • Mobility
• Joint aches and pain   • Bone strength
              Assessment
• Medical history and physical exam to
  identify contraindications or limitations
  (severe CV disease, severe COPD,
  uncontrolled DM, seizure disorder or
  severe motor limitations)
• Pulmonary function testing - FEV & FVC
• Medications used & effect on HR & BP
• Functional or exercise tolerance testing
          Training guidelines
• Custom fit to individual interests, medical
  concerns, fitness goals and limitations
• Utilize multiple joint exercises for full ROM
• Include activities that enhance flexibility and
  balance, increase strength and CV endurance
• Control speed, body alignment, and positioning
  to protect from injury & strain
                    F-I-T-T
• F - Daily stretching, aerobic 3 X per week
• I - 60-80% MHR or 40% of VO2 max if
  sedentary
• T - Stretching 10-20 min., aerobic 20-30 min.
• T - Any low impact aerobic activity
• ST - 2-3 X per week, 20-30 min. session, 75%
  1RM progress to 3-4 sets/8-12 reps of 8-10 total
  body exercises, light hand wts 1-6 #s
               Precautions
• Prevent falls: understand clients fall risk &
  history, measure BP before, during and
  after exercise, know the effects of meds
  on HR and BP
• Choose activities based on
  musculoskeletal limitations and
  cardiovascular conditions
• Focus on proper techniques for lifting and
  body mechanics
 Chapter 8 - Battle of the Bulge
• One third of adults and 26% of our
  children are overweight in America
• Risks: ASHD, DM, stroke, certain cancers,
  social, academic and career bias
• Reducing the risks:
  Increase: calories burned, muscle mass, fruits,
    vegetables, and frequency of smaller meals
  Decrease: fat and portion sizes
             Assessment
• If history reveals medical problems that
  could be contraindications, request HCP
  history and physical exam
• Obtain baseline values for BP, body
  composition and aerobic capacity (75%
  VO2 max) record body circumferences
• Reassure client that change is possible
         Training guidelines
• Set realistic goals for weight loss
• Adjust for limiting diseases or conditions
• Build self confidence and motivation
• Consider non-weight bearing activities to
  protect joints and ligaments
• The best exercise is one that you will do
  regularly; remember the “fun factor!”
                    F-I-T-T
•   F - 3-5 days per week
•   I - 50-75% MHR 10-14 RPE
•   T - Goal 40-60 min. per session
•   T - CV low impact, non weight bearing
•   ST - Total body routine emphasizing high
    rep lower intensity
              Precautions
• Excess weight may exacerbate skin
  irritation
• Loss of balance and flexibility requires
  area free of obstacles
• Encourage extra fluid intake to prevent
  dehydration
                 Tips
• Create comfortable •    Offer special theme
  non-intimidating        classes or events to
  environment             celebrate holidays,
                          birthdays, seasons
• Convenient times
                      •   Educate clients with
• Be a caring role
                          literature, BBs or
  model                   newsletters
• Emphasize enjoyment •   Provide incentives
  and variety
• Encourage client
  ownership of process
        Chapter 9 - Arthritis
• Rheumatoid and Osteoarthritis are the
  most common of 100 arthritic conditions
• OA is most common, affects hips, knees &
  spine, usually only one joint is affected
• RA is progressive, symmetrical, cartilage
  destroying, can fuse & scar joints < ROM
• Arthritis is the most common cause of
  disability in America
             Treatment goals
•   Reduce pain
•   Decrease inflammation
•   Improve function
•   Decrease joint damage
•   Manage through lifestyle changes, weight
    reduction, medication, heat/cold, and joint
    protection strategies
             Assessment
• Isokinetic machines for muscle strength &
  endurance - 60-90 E/second major muscle
• 6 min. or 1 mile walk test
• Gonimeter for ROM & symmetry
• Gait analysis and balance assessment
• Functional capacity - assess ability to
  walk, sit, stand several times
Training guidelines for clients
         with arthritis

• Preserve or restore motion and flexibility
  around affected joint
• Increase muscle strength and endurance
• Increase aerobic conditioning to enhance
  mood, maintain function & overall health
• Revise training as new symptoms present
                   F-I-T-T
•   F - Progress to 3-5 days per week
•   I - 50-75%
•   T - Slowly increase to 30 min. sessions
•   T - Light weight bearing, non-weight bearing, Tai
  Chi and aquatic exercise is best
• ST - Stretching, ROM, isometric then
  progressive resistance isotonic exercises –
  3 second contraction, 6 second hold
       Precautions/ Arthritis
• If pain increased after exercise for more
  than two hours reduce level of exercise
• Pain, stiffness and biomechanical
  inefficiency increase metabolic cost 50%
• Progress training gradually
• Ensure joint safety, adapt plan to joints
• Refer new or worsening joint pain to HCP
  and adjust training
    Chapter 10 - Peripheral vascular
                disease
• Atherosclerotic plaques narrow vessels limiting
  blood flow causing hypoxia, muscle pain in hips,
  legs & calves when walking
• Called intermittent claudication when relieved by
  rest. Often first appears after coronary bypass
  surgery
• Risk factors: DM, smoking, HTN, FHx, obesity,
  elevated lipids, inactivity and stress
              Assessment
• Medical history and physical exam
  including peripheral pulses, skin temp,
  exercise tolerance test with Doppler scan
• Monitoring BP before and during slow
  treadmill walking. Continue until ischemic
  threshold. This provides workload range
  Training guidelines for
peripheral vascular disease

• Short 8 week training programs can
  reduce CV risk and improve exercise
  tolerance, perhaps through
  development of collateral circulation
• Walking is the preferred exercise
                Precautions
• Refer to HCP: edema, weakness and fatigue,
  numbness, cold extremities, diminished or
  absent peripheral pulses, skin color changes,
  bruits, and atrophy of toes
• Smoking, infection, injury, trauma and cold
  temperatures can exacerbate symptoms
• Contraindications same as CA, avoid exercising
  if ulceration present or weight bearing activities
  cause pain at rest
                     F-I-T-T
• F – Initially, 2X per day, then once daily after 40-
  60 min. sessions reached
• I - Walk to point of severe pain before stopping,
  rest till pain stops, repeat
• T - Initially 2-6 min. intervals for 20-30 min., goal
  40-60 min. continuous/ discontinuous
• T - Walking or shallow water aquatic
• ST - Light upper extremity 11-12 RPE
Supervision for clients with
peripheral vascular disease

• Teach client to recognize warning signs
  and symptoms of heart problems and
  strokes and how to respond to them
• Stress proper foot care and daily
  inspections. Refer to HCP if injuries or
  wounds develop
  Chapter 11 - Cardiovascular
            disease
• Atherosclerosis causes 1.5 million AMIs every
  year, 1/3 will die from their AMI
• When coronary arteries are affected it is called
  coronary artery disease (CAD), devoid of
  symptoms it is a silent killer
• Risk factors: Smoking, HTN, high cholesterol
  and physical inactivity
• Prevention: Increase activity, decrease body
  weight, decrease HTN
               Assessment
• Obtain physician signed referral
• Document risk factors and changes
• Understand cardiac meds, actions and effect on
  HR and BP
• Consider age, sex, clinical status, related
  medical conditions, habitual practices and MS
  limitations
• 12 lead ECG is mandatory for functional
  capacity, diagnostic and prognostic value
   Training guidelines for CAD
• Uncomplicated hospital course
• No resting or exercise induced ischemia
• Functional capacity 6 METs, 3 wks post
  event
• Normal ventricular ejection fraction
  > 55%
• No significant resting or exercise induced
  ventricular arrhymias
                   F-I-T-T
•   F - 3-5 days per week
•   I - 60-85% MHR
•   T - 20-60 min. sessions
•   T - Any type aerobic activity, modify for medical
  limitations
• ST - 2-3 X / week, up to 60% 1RM, 10-15 reps /
  2-3 sets slow progression, limit lower intensity
  isometrics
     Precautions for CAD

• Client knows S & Sx of cardiac ischemia,
  alerts trainer if present during exercise
• Discuss and document risk factors
• Monitor exercise intensity carefully
• Client with history of angina has
  nitroglycerine, knows protocol for use
• Avoid valsalva, tight grips & > 1 minute rest
  between sets
• Emphasize full ROM
          Supervision

• Obtain physician signed referral noting
  exercise capacity, limitations, risk
  factors & medications
• Monitor exercise intensity carefully
• Understand cardiac medications,
  actions, treatment plans
• Maintain CPR certification
• Give feedback to physician, share
  concerns
 Chapter 12 Multiple Sclerosis
• Progressive demylinating neurological
  disease causing loss of physical function,
  muscle mass and some cognitive function
• Common symptoms - loss of muscle
  function, paralysis, poor balance &
  coordination, spasticity, tremors,
  numbness and tingling, visual
  disturbances, slurring of speech
          Multiple Sclerosis
• Highly individual course
• Triggers: viral infection, trauma, exposure
  to toxins or undue stress
• Progressively becomes weaker, less
  coordinated and eventually
  non-ambulatory
• Exercise can > CV fitness, >
  bladder/bowel function, < fatigue &
  depression
             Assessment
• Diagnosis requires eliminating other
  causes of symptoms, heat worsens sx
• Types: Chronic progressive or relapsing
• Note type of MS, limiting conditions,
  specific exercises requested by HCP
• Goal: maintain as much muscle mass,
  joint ROM, balance and proper posture as
  symptoms allow, decrease social isolation
          Training guidelines
• Avoid fatigue, excessive heat and climate
  extremes - aquatic exercise 80-84 degrees
• Modify based on symptoms and PT
  recommendations
• Priorities: coordination, balance, functional
  strength, endurance & ROM, improve static
  posture - balance flexion & trunk extension
• Friendly, small workout group may be helpful
                      F-I-T-T
•   F - Daily
•   I - 50-70% HR Max
•   T - Adjust to sx, short 30 sec. - 5 min. to start
•   T – Low impact: aquatics, walking, cycling ST -
    Swiss ball, rubber tubes or bands, light hand
    weights. Standard progression. No “failure” lifts.
    Minimize fatigue
             Precautions
• Avoid high intensity, exacerbates sx
• MS meds can increase overheating & sx
• Muscles above joints weak - no lockouts,
  high loads or high impacts, do not
  overload
• Prolonged low intensity warm ups best,
  30-40% VO2 Max
• Do not exercise to the point of fatigue
    Chapter 13 - Stroke (CVA)
• Decreased oxygen and blood flow to brain cells
  caused by atherosclerotic plaque, blood clot or
  hemorrhage
• Results in motor, sensory and/or communication
  skill impairment
• Can occur at any age and during exercise sx
  confusion, dizziness, severe HAs, slurred
  speech and transient ischemic attacks (TIAs)
               Stroke (CVA)
• Prompt recognition & treatment can prevent
  sharp declines in function
• Receiving clot busting drugs within the first three
  hours can rescue neurons
• 50% of brain cells die in the first hour;
  90% die by three hours
• Rehab goals: OT, PT, independent functioning,
  gain strength, coordination and balance,
  disability adaptations
              Assessment
• Obtain from HCP: movement, weight
  bearing & exercise restrictions, sensory or
  skin deficits, cognitive deficits, specific
  exercise recommendations
• Obtain from OT and PT: additional
  recommendations or exercise guidelines
          Training guidelines
• Perform ROM below pain threshold, some
  restriction is a protective limitation
• Low intensity resistance work
• Have therapist check proprioception, static and
  dynamic balance to reduce fall risk
• Utilize client feedback to monitor progress
• Apraxia - mind willing, body won’t respond. Be
  patient and assist when necessary
            Stroke (CVA)
• Dynamic balance compromised - place
  equipment on good side, give
  step-by-step directions
• New tasks may precipitate resistance.
  Offer support and encouragement.
  Repetition will make the task easier
                F-I-T-T

• F - Aerobically progress as tolerated to 3-5
  days per week. ROM daily, initially with
  assistance. Goal: volitional/unassisted
• I - 50-70% MHR
• T - Short intervals progress to 30 min
• T - Aquatic exercise preferred. Initially use a,
  stationary bike for balance deficits
• ST - Seated position initially, low intensity,
  keep HR & BP from rising too high
             Supervision
• Assist on/off equipment, spot correctly
• Participate in training
• Share feedback with HCP, PT, OT
• PNF facilitates full ROM
• Expect muscle flaccidity, spasticity and
  weakness. Accommodate limitations
• Resistance train only volitional movements
       Chapter 14 - Children
• TV viewing is up, weight is up, physical
  activity is down, signs of early CVD are
  increasingly evident in children and
  adolescents
• Children’s aerobic capacity increases
  before anaerobic capacity
• Due to high metabolic rate, children tire
  quickly
              Assessment
• HCP history and screening for illness,
  disease, injury & any contraindications for
  exercise
• At 12 years of age basic field tests safely
  establish training guidelines:
    Aerobic - 1.5 mile run/12 min. walk
    Anaerobic - 30-60 meter sprint (power)
    200 meter sprint ( capacity)
Precautions For Training Children
• Due to high metabolic rate children’s muscles
  fatigue quickly
• Body fat has significantly greater effect on
  endurance runs than body mass
• #1 priority: secure energy for healthy growth
  and development. Monitor load to rest ratio
• Be alert for overtraining: excessive fatigue,
  weakness or decreased attention span
Precautions For Training Children
• Sequence of load increases is critical
  development stimulus
    1st - increase frequency of workouts,
    2nd - increase the duration of workouts,
    3rd - increase the # of exercises without
    increasing duration
• Base workouts on child’s training and
  biological age NOT chronological age
                  F - I - T- T
• F - Hrs/wk
    6-10 yrs.     4 hrs.
    11-14 yrs.    4 – 6 hrs.
    15-19 yrs.    6 – 8 hrs.

• I&T
    6-10 yrs.     emphasize play & flexibility
    11-14 yrs.    team games, intro long easy intervals
    15-19 yrs.    moderate length & short intervals, regular
                  training at anaerobic threshold

• ST -3 days/wk
    6-10 yrs.     own body weight                     15 min.
    11-14 yrs.    12-20 reps strength
                  endurance                           30 min.
    15-19 yrs.    10-12 reps strength/power           45 min.
         Training guidelines
• Target heart rate restrictions unnecessary
• < 2 hours of TV or video games per day
• Create more opportunities for fun physical
  activity. Involve friends and peers.
  Encourage confidence in sports
• Encourage family, teachers and adults to
  model active lifestyle
   Strength training guidelines
• Obtain medical check-ups before training
• ST just one part of varied fitness program
• Use calisthenics to build muscle endurance and
  strength
• Use variety of training methods
• Proper technique first, low resistance
• Progress from low resistance/high reps to higher
  resistance/ fewer reps
   Strength training guidelines
• Limit ST to 3X/week, avoid negative or
  eccentric exercises, use full ROM
• Circuit system maximizes CV fitness
• Warm up before, flexibility after training
• Provide constant experienced adult
  supervision
• Heed pain as a warning, seek medical
  advice

				
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