Chapter 14: Exercise and Special Populations Flashcards
SOAP Notes
*Used by health care providers to log patient/client progress *
Subjective: These are the client’s personal symptoms, challenges, progress, and report
Objective: These are exercise, nutrition log, vital signs and anthropometrics
Assessment: This is the summary of all objective and subjective observations
Plan: This is the description of what needs to be done
Stop exercise when these signs/symptoms are noticed:
- lightheadedness
- Pallor (pale)
- angina (chest pain/pressure or squeezing sensation)
- dizziness
- dyspnea (short of breath)
- quick heart rate above target zones
Clients with CAD (coronary artery disease)
- Need a physician-supervised exercise test for maximal grade
- This helps determine the safe exercise levels in functional capacity of the client
Hypertension
- 150 minutes weekly may reduce SBP 2-6mmHg
- Acute post-exercise lowering of DBP and SBP
- Calcium channel blockers and beta blockers alter HR Response, so it is key that these clients use an RPE, transitions b/w exercises slowly, and carefully monitor intensity
Stroke
signs of/ how to PA
The signs of a stroke:
- Sudden weakness/numbness of arms, face, and legs
- Sudden confusion or difficulty speaking/understanding
- Difficulty seeing in both or one eye
- Sudden difficulty with balance, coordination, and walking
- Sudden extreme headache with no apparent cause
Exercise recomms. for people recovering from a stroke:
- Focus on maximizing function and performance of ADLs
- Light-moderate intensities only
Peripheral vascular disease (PVD)
**Muscular pain that is caused by a lack of blood flow or ischemia (low blood supply to that body part) **
- Ischemic pain is a result of spasms or blockages ad is referred to as claudication
- Need for medical clearance prior to exercise
- Goal = improving arterial flow and increasing oxygen extractions
- Walking is a great PA choice bc it activates lower leg muscles, effectively activating the ischemia in the affected limbs
- it is important fo clients to activate their ischemic pain to a point, and then rest
Dyslipidemia
- Elevated triglycerides
- Lowered HDL
- Elevated LDL
EFFECTS FROM EXERCISE
- Can reduce LDL cholesterol on average by 3 to 6 mg/dl
- Can reduce non-HDL cholesterol on average by 6 mg/dl
- No consistent change on TG
- No consistent change on HDL cholesterol
- Three times a week may reduce LDL, non-HDL, TG by 6 to 9 mg/dl on average
- *Note: no effect on HDL**
Diabetes
goals w/exercise, type 2?, guidelines
GOAL FOR DIABETIC CLIENTS
- normalize glucose metabolism, and prevent progression of diabetes, or complications.
Hyperglycemia – Chronic elevation of blood glucose
Type II diabetes: Also known as non-insulin dependent diabetes mellitus or NIDDM
- This is the most common form of diabetes
- Approximately 90% to 95% of diagnosed diabetes
- Cells cannot use insulin correctly (insulin resistance)
- Approximately 75% of patients with type II diabetes are obese
- must be screened and cleared prior to PA
EXERCISE GUIDELINES FOR TYPE 1 DIABETICS
- 3 to 5 sessions per week or every day
- Training at a 55% to 75% of functional capacity or 11 to 14 RPE
- Avoid high intensity or prolonged training
- Increased risk of hypoglycemia (low blood sugar) with higher intensity exercises
POTENTIAL COMPLICATIONS
- Do not exercise if fasting glucose levels are at 250 mg/dl or more
A- void exercise if blood glucose levels are higher than 300 mg/dl
- Do not exercise during peak insulin activity
- Keep client hydrated
Metabolic syndrome (METS)
Elevated blood pressure, abnormal obesity, atherogenic dyslipidemia, insulin resistance, pro-inflammatory state, pro-thrombotic state
(Affects more than 25 % of pop.)
Indicated as three or more of the following:
- Waist circumference (More than 40 inches or 102 cm for men// More than 35 inches or 88 cm for women)
- High triglyceride levels (more than or equal to 150 mg/dl)
- Low HDL cholesterol levels (Less than 40 mg/dl four men // Less than 50 mg/dl for women)
- Blood pressure readings of more than or equal to 130/85
- A fasting blood glucose level of 100 mg/dl or more
Primary objective: Reduce the risk of developing type II diabetes and CV
EXERCISE GUIDE
- Very low impact, non-weight bearing for obese clients
Borg scale between 11 and 13 RPE or 30% to 75% VO2R - Approximately 200 to 300 total minutes of exercise weekly
- Progress from short 10-15 minute bouts of exercise to longer ones
- The client should train at least 3 to 5 times per week
OSTEOPOROSIS
Defined by a bone mineral density that is 2.5 or more standard deviations below the mean for young adults.
Osteopenia – not as severe as osteoporosis, Bone mineral density between one and 1.5 deviations
INCREASING BONE MINERAL DENSITY
- Weightlifting exercises
- Plyometric training
Avoid the following exercises for clients that have spinal problems/fractures:
- Crunches, spinal flexion, and rowing machines
- High impact aerobics/jumping
- Step aerobics/trampolines
- Abducting and adducting legs against resistance
- Pulling on the neck while hands are cusped behind the head
ARTHRITIS
4 classes
Most common forms:
- Osteoarthritis
- Rheumatoid arthritis
CLASSIFICATIONS
Class 1: Can completely perform usual ADLs
Class 2: Can perform self-care as well as vocational activities but are limited with avocational activities
Class 3: Can do normal self-care but is limited with vocational/avocational activities
Class 4: Is limited in what they can do with their normal self-care as well as vocational/avocational activities
EXERCISE
- must create program collaboratively with PT and it should be based on client’s functional levels
PRE-AND POSTPARTUM
- Pregnant clients need clearance from a physician
AVOID THE FOLLOWING
- Hopping, bouncing, skipping, jumping and running
full sit-ups, knee bends (deep), double leg raise
- Stretching that involves bouncing (Ballistic)
- Any activity where falling is a possibility
- After the first trimester It’s discouraged to have client stay in supine position for more than five minutes
This is because it has a fetal hypoxia potential
