Chapter 16 Chronic Health Conditions and Physical or Functional Limitations:
For this chapter, read through the text and highlight the training guidelines and have a general idea on how to design a program for the special populations mentioned in this particular chapter. Don’t worry too much about the acute variables (reps, sets, tempo, etc.) but rather on contraindications and more appropriate techniques for these populations.
Age Considerations
- Children and adolescents should get 1 hr or more of physical activity daily.
Physiologic Differences between Children and Adults
- Children do not exhibit plateau in oxygenuptake, peak oxygen uptake is more appropriate.
- Children less efficient, tend to exercise at higher percentage of peak oxygen uptake during submaximal exercise.
- Do not produce sufficient levels of glycolytic enzymes to sustain bouts of high-intensity exercise.
Resistance Training for Youth
- Resistance training is both safe and effective in children and adolescents.
- Untrained children can improve strength by 30 to 40% in 8 weeks.
Seniors
- Older adults with and without other chronic health conditions can and do respond to exercise much in the same manner as apparently healthy younger adults.
- Walking is one of most fundamental functional activities affected with degenerative aging.
- Musculoskeletal loss not entirely related to aging.
- Complete PAR-Q. Assessments.
- Progression should be slow, well monitored, based on postural control. Exercises should be progressed if possible toward free sitting or standing. If client cannot tolerate SMR perform slow rhythmic active or dynamic stretches.
Obesity
- Flexibility exercises should be performed from standing or seated position, using standing hip flexor stretch rather than kneeling hip flexor stretch, standing hamstring stretch, wall calf stretch.
- Core and balance training important for obese individuals.
- May find it difficult to use machines, dumbbells, cables, exercise tubing work quite well.
Diabetes
- Most important goal is glucose control. Exercise improves insulin sensitivity. Positive effect on prevention of type 2 diabetes.
- Take care to prevent blisters and foot microtrauma that could result in foot infection.
- Daily exercise recommended. Flexibility exercises recommended.
- Follow exercise guideline for obese adults. Lower impact exercise modalities.
Hypertension
- Low to moderately intense exercise just as effective as high intensity activity in reducing blood pressure.
- Important to monitor body position of clients with hypertension at all times. Body position can have dramatic effect on blood pressure response before, during, and after exercise in clients with hypertension.
- Avoid heavy lifting and valsalva maneuvers. Do not let client overgrip weights or clench fists. Modify tempo to avoid extended isometric and concentric muscle action. Perform exercises in standing or seated position. Allow client to stand up slowly to avoid possible dizziness. Progress client slowly.
Coronary Heart Disease
- Monitor pulse to stay below safe upper limit of exercise.
- Clients may have other diseases to consider as well, such as diabetes, hypertension, peripheral vascular disease, or obesity
- Modify tempo to avoid extended isometric and concentric muscle action
- Avoid heavy lifting and Valsalva maneuvers
- Do not let client overgrip weights
- Perform exercises in standing or seated position
- Progress slowly
Osteoperosis
- Progress should be slow, well monitored, 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 and leg press
- Make sure client is breathing in normal manner and avoid holding breath in Valsalva maneuver
Arthritis
- Avoid heavy lifting and high reps
- Stay in pain-free ranges of motion
- Only use SMR if tolerated by client
- May be need to start out only with 5 mins of exercise and progressively increase
Cancer
- Avoid heavy lifting in initial stages of training
- Allow for adequate rest intervals and progress client slowly
- Only use SMR if tolerated, avoid SMR for clients undergoing chemo or radiation
- May be need to start out with only 5 mins of exercise and progressively increase
Exercise and Pregnancy
- Avoid exercises in prone or supine position after 12 weeks
- Avoid SMR on varicose veins and areas of swelling
- Plyometric training not advised in second and third trimesters
Chronic Lung Disease
- Upper body exercises cause increased dyspnea and must be monitored
- Allow for sufficient rest between sets
Intermittent Claudication/Peripheral Arterial Disease
- Allow for sufficient rest
- Workout may start with 5-10 mins of activity
- Progress slowly
- Treadmill walking preferred.
- Primary limiting factor is leg pain.