Chapter 14: Exercise and Special Populations Flashcards Preview

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Flashcards in Chapter 14: Exercise and Special Populations Deck (61)
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1
Q

General Characteristics of Coronary Artery Disease (CAD) and the contributions of Atheroscerosis, Dyslipidemia, and Physical inactivity

A
  • aka atherosclerotic heart disease
  • characterized by a narrowing of the coronary arteries that supply the heart muscle with blood and oxygen-the narrowing is an inflammatory response within the arterial walls resulting from an initial injury (due to high blood pressure, elevated levels of low-density lipoprotein -LDL-, cholesterol, elevated blood glucose, or other chemical agents such as those produced from cigarettes) and the deposition of lipid-rich plaque and calcified cholesterol
  • heart attacks (or myocardial infarctions) or the release of thrombin substances (blood clotting) can be the result
  • Atherosclerosis is the underlying cause and peripheral vascular diseases (manifestations of it include angina, heart attack, stroke, and intermittent claudication)
  • Dyslipidemia (blood lipid disorder) also greatly contributes to it. Estimated that about 15.4 million Americans have CAD
  • Inactivity is a big risk of getting this-people participating in moderate amounts of exercise have a 20% lower risk, while those undertaking higher amounts of exercise have a 30% or more reduction in the risk of developing it
2
Q

The role of exercise in treatment and prevention of CAD

A

-progressive physical activity reduces the mortality and morbidity among patients with CAD. It is essential. Being inactive to “recover” will increase the risk of more blood clots, muscle wasting etc.

3
Q

CAD Risk Factors

A

Clients with low risk:
-an uncomplicated clinical course in the hospital
-no evidence of resting or exercise induced ischemia
-functional capacity great than 7 METs (metabolic equivalents) three weeks following any medical event or treatment that required hospitalization
-normal ventricular function with an ejection fraction greater than 50%
-no significant resting or exercise induced arrhythmias (abnormal heart rhythms)
Abnormal signs/symptoms:
-angina
-dyspnea
-lightheadedness or dizziness
-pallor
-rapid heart rate above established targets

4
Q

General Characteristics of Hypertension and the contributions of Age, Prehypertension, Diet, Physical inactivity, Antihypertensive medications

A
  • one of the most chronic diseases in the US, aka “Silent Killer”
  • one in three US adults have high blood pressure, defined as having systolic blood pressure (SBP) greater or equal to 140 mmHg or diastolic blood pressure (DBP) greater than or equal to 90 mmHg or taking antihypertensive medication
  • just over 37% of US pop aged 20 years or older have prehypertension (untreated SBP of 120 to 139 mmHg or an untreated DBP of 80 to 89 mmHg
  • prehypertensive individuals have twice the risk of developing high blood pressure compared to those with normal values
  • Approx. 69% of people who have a first heart attack, 77% who have a first stroke, and 74% who have CHF have blood pressure higher than 140/90 mmHg (it’s estimated that each 20 mmHg rise in SBP or 10mmHg rise in DBP doubles the risk of developing cardiovascular disease
5
Q

The role of exercise in the treatment of hypertension

A
  • regularly performing 150min of exercise per week is shown to reduce SBP by an average of 2 tp 6 mmHg with the greatest reductions occurring in hypertensive adults
  • has an acute post-exercise on both SBP and DBP (related to peripheral vascular resistance that is not compensated for by an increase in cardiac output and can persist for up to 22 hours
  • both prehyper and hyper pees should participate in 30min or more of exersie at least 5 times a week(walking swimming, using ergometers and great and should be supplemented with resistance training-should avoid isometric exercise and tach/emphasize appropriate technique and breathing-circuit training utilizing low to moderate resistance and high reps are great as opposed to heavy lifting)
6
Q

Magnitude of post-exercise hypotension (PEH)

A

post-exercise hypotension (PEH) can be of magnitude of 15 and 4 mmHg for both BPs, and emphasizes the potential benefits of daily activity

7
Q

General Characteristics of Hypertension and the contributions of Diet, Physical inactivity, Antihypertensive medications

A
  • aka silent killer, one of the most prevalent chronic diseases in US, 1 in 3 adults have high blood pressure (systolic BP greater than or equal to 140 mmHg or a DBP over or equal to 90 mmHg or those who take antihypertensive meds), just over 37% of US 20 yo or older are prehypertensive (untreated SBP of 120-139 or untreated DBP of 80-89)
  • sodium reduction, reduced fat intake, and alcohol intake help
  • regularly performing 150min of exercise per week has been consistently shown to reduce SMP by average of 2-6 mmHg, exercise also has an cute post-exersie effect on both SBP and DBP
  • post exorcise hypotension can be of equal magnitude of 15 and 4 mmHg for SBP and DBP
  • both prehyper and hyper peeps should exercise 30 min five days a week at least (aerobic activities and supplemented with resistance-should avoid isometric exercise and should mostly focus on technique and breathing)
  • circuit training using low to moderate resistance and high reps, as opposed to heavy lifting, is a great choice
  • Medications: beta blockers and calcium channel blockers can alter HR response and cause orthostatic hypotension and PEH (clients should be taught about RPE, with gradual and prolonged cool-down period); those on diuretic meds need to be extra hydrated, especially in warmer environments
  • should always measure the pre and post workout BP; exercise should be stopped if SBP or DBP rise to 250 mmHg or 115 mmHg or if SBP fails to increase with increasing workload or drops greater than or equal to 20 mmHg; yoga and tai chi are great, as well (except avoid isometric muscle contractions and inverted positions (head below level of heart)
  • Examples of exercises: low impact endurance training (walking, cycling, swimming, ergometers should be primary-significant isometric components should be avoided), low resistance and high number of reps, as in circuit training, intensity should be lower (just as effective, if not more effective than high intensity), duration- gradual warmup and cool down lasting longer than 5min, gradually increase total duration to as much as 40-60min (can be continuous or intermittent-each section performed at a minimum of 10min and a total of 30-60min for each day), four to seven days a week, daily is advised
8
Q

Stroke:

  1. Types
  2. Risk factors
  3. Disability after stroke
  4. Warning signs of stroke
A
  1. Types
    - ischemic stroke: when blood supply to the brain is cut off
    - hemorrhagic stroke: when a blood vessel in the brain bursts (80% are ischemic, t-PA must be administered within the initial three hours of the stroke to prevent significant damage or reduce it)
  2. Risk Factors
    - high blood pressure
    - smoking
    - heart disease
    - previous stroke
    - physical inactivity
    - transient ischemic attacks (TIA)- momentary reductions in oxygen delivery to the brain, possibly resulting in sudden headache, dizziness, blackout, and/r temporary neurologic dysfunction
  3. Disability
    - can dramatically reduce quality of life
    - can rob the ability to speak and the movement of facial, arm, and leg muscles
    - can cause metabolic disorders (like impaired glucose tolerance and type 2 diabetes) and significantly increase risk of recurrent stroke and myocardial infarction- these are typically worsened with lack of physical activity
  4. Warning signs
    - sudden numbness or weakness of face, arms, or legs
    - sudden confusion or trouble speaking or understanding others
    - sudden trouble seeing in one eye or both
    - sudden walking problems, dizziness, or loss of balance and coordination
    - sudden severe headache with no known cause
9
Q

Stroke:

  1. Role in exercise in treatment and prevention
  2. Impact of exercise in cardiovascular disease risk for stroke patients
A

rehabilitation focus on optimizing basic basic activities of daily living skills (balance, coordination, and functional independence); improved functionality has come from results of various exercise modalities like bicycle ergometer, water exercise, and weigh-supported treadmill exercise as well as gait, balance, and coordination activities
; exercise has been shown to reduce overall risk of CAD (SBP, lipid profiles, insulin sensitivity, glucose metabolism, and body composition), recurrent stroke, and fibrinolytic activity (system responsible for dissolving blood clots)
-Exercise examples: guidelines must come from physical, occupational, and/or recreational therapist; activities vary depending on each condition (cycle ergometers, walking/treadmill training, water exercise, and other exercise classes can be modified); activities that include balance and coordination can also be helpful
1. Mode-walking, stationary bike, recumbent bicycling, upper extremity ergometers, and water exercise; balance exercises and light resistance should be implemented
2. Intensity: light to moderate depending
3. Duration: should begin with shorts bouts of exercise (3-5min) and gradually build to 30min over time (should consider using intermittent exercise with rest periods as needed
4. Frequency: preferably 5 days a week, however some should begin with three and work their way unto five
* (RPE 4 or 5)

10
Q

Peripheral Vascular Disease:

  1. Risk factors
  2. Peripheral artery occlusive disease (POAD)
  3. Peripheral Vascular occlusive disease (PVOD)
  4. Claudication pain and the use of subjective grading scale for PVD
A

*it’s caused by the atherosclerotic lesions in one or more peripheral arterial and/or venous blood vessels and is an important medical concern because of high risk of concomitant coronary and cerebral artery disease
1. Risk Factors
-hyperlipidemia
-smoking
-hypertension
-diabetes
- family predisposition
-physical inactivity
-obesity
-stress
(smoking and diabetes are most important)
2. PAOD: results from atherosclerosis of arteries in lower extremities (most common sites are in abdominal aorta and the iliac, femoral, popliteal, and tibial arteries); consequently, blood flow distal to lesion is reduced, significantly impacting ambulation
3. PVOD: characterized by muscle pain caused by ischemia, or lack of blood flow to the muscle
4. (this pain is usually the realist of spasms or blockages and is referred to as claudication-most claud is brought on by physical activity, but some with more severe cases can have it as rest); the pain associated with PVOD is described as a dull, aching, cramping pain, and is usually reproducible at a given exercise workload (many who have it can only walk a limited distance before needing to rest)

11
Q

Peripheral Vascular Disease:

  1. The role of exercise in the treatment and prevention
  2. Impact of exercise in CVD risk for PVD patients
A
  1. shown to improve ambulation distances in peeps with PVD (changes in blood viscosity and capillary and mitochondrial density, along with increases in oxidative and glycolytic enzymes, all of which improve oxygen utilization
  2. helps to lower overall risk for CVD patients in addition to improving blood flow and overall cardiovascular endurance
    *guidelines for exercise should come from physician
    Exercise examples: walking (to the point of intense pain -Grades II and III- before stopping; then the client rests until the pain subsides, then they repeat it), this should be repeated for a total of 20-30min with gradual progression to 30-60min sessions (initial workload intensity should stimulate claudication pain within 2-6min of walking, when 8-12min of continuous walking can be tolerated, consider increasing the walking pace or progressing the total activity time), other low intensity, non-weight bearing activities can also be helpful, light upper extremity resistance training is also good with moderate intensities (RPE 4 or 5) and are taught lifting technique
    -proper footwear is important, should not exercise in cold air or water to reduce the risk of vasoconstriction
    -Exercise examples:
  3. Mode: nono-impact endurance exercise such as swimming, cycling, and other ergometer use, may allow for longer and higher intensity exercise; can recommend weight bearing activities such as walking that are shorter in duration and lower in intensity with more frequent rest periods, to improve walking distance and delay pain onset
  4. Intensity: for aerobic, low to moderate intensities depending; walking is carried out until intense pain, can gradually increase intensity once there is improvement
  5. Duration: longer and more gradual warmup and cool downs (longer than 10min), gradually increase total duration to 30-60min depending
  6. Frequency: daily is recommend, as functional capacity improves, can be reduced to 4-5 days a week
12
Q

Dyslipidemia:

  • Primary lipoproteins
    1. Low-Density lipoprotein (LDL)
    2. Very low-density (VLDL)
    3. High-density (HDL)
    4. Non-HDL cholesterol (non-HDL)
A
  • elevated levels of total cholesterol and LDL cholesterol are well-recognized as lipid parameters with the highest correlation to CVD along with suboptimal levels of HDL cholesterol and elevated levels of triglycerides
  • cholesterol travels through the body attached to a protein, referred to as a lipoprotein
    1. major carrier of cholesterol in the circulation, containing 60-70% of the body’s total serum cholesterol. it’s frequently referred to as the “bad” cholesterol because of its role in atherogenesis, the early stages of atherosclerosis
    2. the major carrier of triglyceride, contains 10-15% of the body’s total serum cholesterol. Triglyceride is a major form of fat the tends to be associated with low levels of HDL and elevated levels of LDL
    3. often referred to as “good” cholesterol, produced in the intestine and liver and normally contains 20-30% of the body’s total cholesterol, HDL levels are inversely correlated to CAD, meaning that the higher the level of HDL, the lower the risk of developing CAD
    4. defined as total cholesterol minus HDL, or the sum of the LDL, VLDL, and intermediate density lipoprotein (IDL), its strongly associated with the development of CVD and its levels appear to be equal or better than LDL levels at identifying atherogenic particles
13
Q

Dyslipidemia:
2002 National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) Classification of LDL, total cholesterol, HDL cholesterol, and triglycerides

A
~ATP III Class of LDL, TC, and HDL~
-LDL Cholesterol-
Optimal: <100
Near optimal: 100-129
Borderline high: 130-159
High: 160-189
Very high: >_190

-Total Cholesterol-
Desirable: <200
Borderline high: 200-239
High: >_240

-HDL-
Low: <40
High: >_60

~Class of Tri~
Normal: <150
Borderline high: 150-199
High: 200-499
Very high: >_500
14
Q

Dyslipidemia: Diet and Exercise effect, sample exercise

A
  1. modifications of both help manage high serum cholesterol and triglyceride levels, and are particularly effective in elevating low HDL levels
  2. Aerobic exercise…
    - may reduce LDL cholesterol by 3.0 to 6.0 mg/dL on average
    - May reduce non HDL cholesterol by 6 mg/dL on average
    - Has no consistent effect on TG
    - Has no consistent effect on HDL cholesterol
  3. Moderate-intensity resistance training (70% 1-RM, three days a week, nine exercises performed for three sets and 11 reps) may reduce LDL cholesterol, TG, and on-HDL by 6mg/dL to 9mg/dL on average and has no effect on HDL cholesterol (biggest impact on lipid profiles is made when there is a decrease of body fat through nutrition)

~Exercise Sample~

  • Mode: aerobic (like walking, jogging, cycling, or swimming) are good unless other health conditions interfere; resistance training twice a week using light to moderate weights at 10-12 reps may provide additional benefit
  • Intensity: Clients should begin at a low to moderate intensity with a focus on duration, especially over weight clients. Some may be able to progress to short bouts of vigorous-intensity exercise, depending on medical history and overall condition
  • Duration: depending on client status, workouts should begin at 15min and build up to 30-60min per day (goal: total of 150-200min each week)
  • Frequency: five days a week is appropriate
15
Q

Diabetes:

  1. Definition
  2. Manifestations of diabetes (type 1, 2, and gestational)
A
  1. a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both
    • T1: aka-insulin-dependent diabetes mellitus (IDDM) develops when the body’s immune system destroys pancreatic beta cells that are responsible for producing insulin, can occur at any age, most frequent in children and young adults, require insulin through injections or a pump to regulate blood glucose levels, in adults T1 accounts for 5-10% of all diagnosed cases of diabetes
    • T2: non-insulin dependent diabetes mellitus (NIDDM), most common (90-95% of all diagnosed cases, initially presents as insulin resistance in which the cells do not use insulin properly, as demand for it rises, pancreas gradually loses its ability to produce it, combo of insulin resistance ad impaired insulin leads to frequent states of hyperglycemia, initial treatment usually includes weight loss, diet modification, and exercise, about 75% are obese or have a history of it , many are placed on oral and (sometimes) injectable medications
    • Gestational: a form of glucose intolerance that occurs during pregnancy, of the 4million women who give birth every year in the US, approx. 7% get this, its increasing as obesity and older age pregnancy is becoming more common, higher risk if there’s a family history of if you’re of a particular nationality (Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent), women who have this are at higher risk for gestational hypertension, preeclampsia, and C-section delivery, and have a sevenfold increased risk of developing diabetes later in life
16
Q

Diabetes: Signs/Symptoms

A

T1: excessive thirst and hunger, frequent urination, weight loss, blurred vision, and recurrent infections, elevated blood glucose level (hypoglycemia)

17
Q

Diabetes: Chronic health problems associated with it

A

higher risk at developing heart disease, stroke, kidney failure, nerve disorders, and eye problems

18
Q

Diabetes: Benefits of Exercise

A
  1. T1: role of exercise in controlling glucose levels in type 1 has not been well demonstrated, however-can improve their functional capacity, reduce their risk for CAD, and improve insulin-receptor sensitivity, more about having positive life behavior with multiple benefits rather than a cure
  2. T2: substantial benefits including prevention of CAD, stroke, peripheral vascular disease, and others, shown to improve lipid profiles and hypertension fibrinolysis and reduce elevated body weight
19
Q

Diabetes: Exercise Routine Sample

A
  1. Mode: can include walking, cycling, swimming, and recreational sports, depending on client’s age and condition, essential to gradually warmup and cool down, twice a week resistance training i good for those without complications using 8-10 exercises at 8-12 reps, clients should monitor blood glucose before and after exercise
  2. Intensity: should train at moderate intensity (RPE of 5-6), for type 1 and 5-7 for type 2
  3. Duration: T1- should gradually work up to 30min or more per session, while 40-60min is recommended for T2
  4. Frequency: 5-6 days a week is good for most, initial goal is to establish a regular pattern of exercise then gradually progress to higher levels of intensity
20
Q

Metabolic syndrome:

  1. cluster of conditions that constitute the criteria for MS
  2. lifestyle interventions recommended as initial strategies for the treatment of MS
A
  1. characterized by: abdominal obesity, atherogenic dyslipidemia, increased blood pressure, insulin resistance, prothrombotic state, and pro inflammatory state, identified as the presence of three or more of the following…
    - Elevated waist circumference (Men: >= 40in, Women: >=35inches)
    - Elevated triglycerides (>=150mg/dL)
    - Reduced HDL cholesterol (Men: <40 mg/dL, Women: <50mg/dL)
    - Increased blood pressure (>=130/85 mmHg)
    - Elevated fasting blood glucose (>=mg/dL)
  2. weight loss, increased physical activity, healthy eating, and tobacco cessation
21
Q

Metabolic syndrome:

  1. Role of exercise in treatment and prevention
  2. Impact of obesity on the performance of exercise for individuals with MS
A
  1. those who are inactive are much more likely to get it- not surprising because it has shown to help prevent hypertension, insulin resistance, obesity,, elevated lipids, and low HDL, level of cardio has been shown to independently influence the risk of premature mortality in people with increased body weight and/or the presence of MetS
  2. BMI of >=25 kg/m^2 and >=30kg/m^2, exercise must adhere to obesity guidelines, additional factors such as underlying CAD, hypertension, and dyslipidemia, and others should be evaluated before exercise
22
Q

Metabolic syndrome: Sample Exercise Routine

A
  1. Mode: should begin with low-impact actives (walking, elliptical, low-impact aerobics), consider using non-weight-bearing activities (like water exercise and cycling) for those who are obese or have musculoskeletal challenges, twice a week resistance is appropriate and beneficial for those who are without complications using 8-10 exercises at 8-12 repetitions, also important to incorporate an active lifestyle (stairs, gardening, housework, and other recreational activities)
  2. Intensity: RPE of fairly light to somewhat hard (5-6 or7), being at low intensity and gradually progress as conditioning improves and weight loss occurs, should initially work on increasing duration rather than intensity to optimize caloric expenditure
  3. Duration: should target 200-300min a week using gradual progression, intermittent short exercise bouts (10-15min) throughout the day may be easer and more beneficial for some in maximizing weight loss
  4. Frequency: at least 3-5 days a week, preferably daily
23
Q

Asthma:

  1. Characteristics (symptoms and triggers)
  2. Exercise induced asthma (EIA)
A
  1. its a chronic inflammatory disorder that is characterized by variable and recurring symptoms such as shortness of breath, wheezing, coughing, and chest tightness (typically set off by environmental factors like allergens, (animal dander, dust mites, cockroaches, and mold), irritants (cigarette smoke, air pollution, strong odors/sprays, and pollens), viruses, stress, cold air, and exercise)…these can activate an inflammatory response that leads to airway hyper-responsiveness and airway obstruction due to contraction of smooth muscle around the airways, swelling of mucosal cells, and/or increased secretion of mucus
  2. 80% experience asthma attacks from exercise… typically occurs after ventilation of large quantities of air, especially dry, cld air that contains environmental allergens and/or pollutants…severity of responses depends on the intensity of the exercise and environmental factors…typically occurs during or shortly after vigorous activity, and can easily be brought on by sudden intense exercise for some individuals…symptoms usually peak 5-10min after the person stops exercising and can last 20-30min…some will also develop a hacking cough 2-12 hours after exercise that can last for 1-2 days…approx. 50% incurring an EIA episode experience a relative refractory period, lasting up to 2 hours, during which another exercise bout will not produce and EIA attack or will result in a less intense reaction…late asthmatic responses 6-8 hours after the initial bronchospasm also occur in approx. half the EIA population…they are typically mild in nature
24
Q

Asthma:

  1. Role of exercise in treatment and prevention
  2. Medications used to treat and prevent asthma
  3. Hyperventilation
A
  1. need to see a physician beforehand, doc typically knows what the triggers are and what to do when they occur, they also provide meds to prevent/lessen EIA…most people will benefit from exercise…can hep to reduce the ventilatory requirement fr various tasks, making it easier for them to participate in more every day activities, recreational events, and competitive sports…can reduce the number and severity of EIA asthma attacks…should be encouraged to undertake gradual and prolonged warm-up and cool-down periods…this will allow some to use the refractory period to lessen the bronchospastic response during subsequent higher-intensity exercise
  2. bronchodilators, anti-inflammatory agents, prophylactic treatment
  3. EIA is brought on by this…need gradual and prolonged warm ups and cool downs
25
Q

Asthma: Sample Exercise Routine

A

*should have rescue medicine nearby and should know how to use it, client should drink plenty of fluid before, during, and after, should consider changing environment if necessary, often respond best to exercise in mid to late morning

  1. Mode: walking, cycling, and swimming/younger and more conditioned may be able to jog/run…for some clients, upper-body exercises such as arm cranking, rowing, and cross-country skiing may not be good because of higher ventilation demands
  2. Intensity: low-to-moderate intensity dynamic exercise based on client’s fitness status and limitations, should begin easy and increase intensity during the session
  3. Duration: gradually progress total exercise time to 30 min or more, more gradual/prolonged warmup/cooldown (10min or more)
  4. Frequency: at least 3-5 times a week, those with initially low functional capacities and those who experience symptoms during prolonged exercise may benefit from intermittent exercise (2-3 10 minute sessions or interval training)
26
Q

Arthritis:

Sample Exercise Routine

A
  1. Mode: non-weight bearing or non-impact actives such as elliptical training, cycling, warm-water aquatic exercise (83-88 degrees F), and swimming are preferred because they reduce joint stress, recreational activities such as golf, gardening, table tennis, or bowling to supplement the exercise program
  2. Intensity: should emphasize low-intensity, low-impact dynamic exercise rather than high-intensity, high impact activities…intensity is based on client’s comfort level before, during, and after the exercise (generally between a 5 or 6 RPE)
  3. Duration: can stress the importance of prolonged warm-up and cool down periods (greater than 10min) clients can begin initial exercise sessions at 10-15min and gradually progress to 30min…some may require intermittent exercise with shorter durations, at least initially
  4. Frequency: 3-5 times per week
27
Q

Cancer:

  1. Influence of Age, continued population growth, and detection in improvement technology on future cancer rates
  2. Malignant and benign tumors
  3. Metastasis
A
  1. cancer may dramatically increase over the next decade
  2. Malignant: typically metastasize Benign: stay locally at the site of the origin and do not spread…they can still pose a challenge when they grow too large and compress and/or interfere with vital organs, organ systems, and their important functions
  3. cancer is a group of more than 100 diseases that are characterized by uncontrolled growth and spread (meta) of cells within the body…it begins at the cellular level and develops when the DNA or normal cells is damaged, producing mutations that affect the orderly, controlled process..this results in uncontrolled cell growth, formation of tissue masses (tumors) and in some cases metastasize to other areas of the body…cancer tumors and metastasized cells can eventually interfere with organ and organ system function
28
Q

Cancer:

  1. Exercise and role of prevention in certain cancers
  2. The role of exercise in treatment
  3. The impact of chemotherapy and/or radiation on exercise performance
A
  1. can help protect active people from acquiring some cancers (colon, prostate, and breast) either by balancing caloric intake with energy expenditure or by other means, including changes that positively affect the hormonal environments…colon, prostate, endometrium, breast, and kidney have been linked to weight gain and obesity….it also improves risk factors associated with cancer development…some evidence that it improves immune function
  2. improves physical function, mental outlook, and quality of life…this includes preservation of muscle mass and increase of muscular strength and endurance, improve balance and overall physical function, reductions in fatigue, nausea, anxiety, and depression, and decreased risk for heart disease, osteoporosis, and diabetes…studies have shown that walking at a brisk pace for three to five hours a week will decrease breast cancer by 50%…cardiorespiratory fitness can be protective against the development of breast cancer and its progression after diagnosis
  3. those people may be anemic and require reduced exercise intensity, while others may have compromised skeletal integrity that may prevent weight bearing activites
29
Q

Cancer:

Sample Exercise Program

A

Mode: many patients are at risk for developing osteoporosis due to treatment combined with inactivity…thus weight-bearing exercise, particularly walking, is an appropriate first step in the cardioresp recovery phase for most clients…low impact or non weight bearing aerobic machines such as ellipticals, treadmills, and cycle are generally considered secondary options, although they may be good for some…Aquatic exercise may be good for some with treatment-related hand and foot numbness, if they aren’t undergoing radiation, does not have an indwelling catheter, and all surgical sites are healed
Intensity: light to moderate (RPE 5-6) is recommend for most…those in remission and with good conditioning may be able to increase their intensity…intenstiy may need to be adjusted from session to session depending on the client’s responses to treatment and exercise, and associated fatigue and symptoms (should focus more on duration and consistency than intensity)
Duration: low-functioning clients may be required to begin with multiple short bouts of activity, three to five minutes in duration with frequent rest breaks..they should progress to 10-minutes intermittent bouts and gradually build to 30-40min of accumulated exercise
Frequency: a cardiovascular, flexibility, and balance program can be performed on a daily basis…strength can be performed 2-3 times a week, with at least a full 24 hours of rest between sessions

30
Q

Osteoporosis:

  1. Common fracture sites and consequences of those fractures
  2. Osteopenia
  3. Bone remodeling
  4. Impact of Lifestyle choices related to bone density
A
  1. most common are: proximal femur (hip), vertebrae (spine), and vital forearm (wrist)…consequences of hip: could result in severe disability and increased mortality…chances increase with age due to bone density decline, loss of muscular strength, and poor balance (falls are responsible for more than 90% of all hip fractures) spine: also very significant
  2. bone density between 1.0 and 2.5 s.d. below the mean…similar to diabetes because its seen as a possible precursor to osteoporosis…those who have it are at greater risk for fracture and further bone deterioration to osteoporosis…
  3. during early growth, the rate of bone formation is typically greater than the rate of bone resorption, resulting in an overall gain in bone mineral (aka remodeling balance)…this balance is disrupted as people age and the formation is no longer able to keep up with the resorption
  4. physical inactivity, smoking, poor nutrition and others affect bone health…
31
Q

Osteoporosis:

  1. Role of exercise in treatment and prevention
  2. Importance of adequate nutrition in combo with exercise for treatment
A
  1. physical stress determines the strength of bone…mechanical stress applied to bone results in a small deformation, or bending, of bone, referred to as a string…this stimulates bone deposition and associated gains in bone mass and strength…forces that result in bone strain are easily induced via impact with the ground…for this reason, weight-bearing exercises (jogging, hopping, skipping, jumping, and other plyometrics) are recommended…of course, remember it depends on the client…shorter, frequent loading cycles have been shown to be more effective in increasing bone strength than longer single sessions…resistance training is important in prevention…higher intensity strength exercises (8 rep max: 8-RM) may derive the most benefit to bone…improved strength will also prevent falling…to prevent further injuries and falls, clients may need to avoid spinal flexion, crunches, and rowing machines, jumping and high impact aerobics, trampolines and step aerobics, abducting or adducting the legs against resistance, pulling on the neck with hands behind the head
  2. caloric intake, calcium, and vitamin D are especially important
32
Q

Osteoporosis:

Sample Exercise

A

Mode: should choose weight bearing exercises (like walking, group fitness, and resistance training) based on needs of client…walking would need to be accompanied by high intensity (8-RM) strength training…its important to supplement weight bearing actives with traditional aerobic exercises to stimulate cardiovascular conditioning…activiites that promote balance and coordination should also be included to reduce risk of falling and associate fractures
Intensity: weight bearing activities are best performed at higher intensity in order to promote high strain and stimulate bone adaptation (8-RM)…for cardio, clients can follow the general exercise guidelines for children, adults, and older adults
Duration: for prevention, the actual number fo strain impacts can be small (50-100) so the duration of loading activities can be short (5-10min) depending on the type pf activity…for cardio, clients with osteoporosis can follow general guidelines excluding any jarring, high-impact activities such as running
Frequency: multiple bouts of bone loading exercises are more efficient than a single longer-duration session…it is important to provide for adequate rest between exercise bouts, depending on the number of strain cycles and the intensity…for cardio, follow general guidelines except jarring activities

33
Q

Arthritis:

  1. The two primary forms of arthritis
  2. American College of Rheumatology Criteria for Classification of Function Status in Rheumatoid Arthritis
A
  1. osteoarthritis: degenerative joint disease that leads to deterioration of cartilage and development of bone growth (spurs) at the edges of joints…its the most common kind…results from overuse, trauma, obesity, or degeneration of the joint cartilage that takes place with age; rheumatoid: most gripping form…classified as an autoimmune disease…exact cause or etiology is unknown..its characterized by joint pain, swelling, stiffness, and in more severe cases, contractors
  2. Class I: completely able to perform usual activities of failing living (self-care, vocational, and avocational; Class II: able to perform usual self-care and ovational activities, but limited in avocational actives; Class III: able to perform usual self-care, limited in vocational and avocational; Class IV: limited in ability to perform self-care, vocational, and avocational activities
34
Q

Arthritis:

  1. Role of exercise in prevention and treatment
  2. The impact of physical inactivity for those with it
A
  1. a consistent program that promotes cardio, improved muscular strength and endurance, and joint mobility will help and will significantly improve daily function…will also include lower risk for Cardiovascular disease, improve psychosocial well-being, decreased pain and stiffness, and improved neuromuscular coordination
  2. causes significant deconditioning, which results in diminished endurance and muscular strength, as well as joint weakness, all of which accelerate the negative effect of arthritis and associated pain…increases the risk for CAD, diabetes, and other chronic health conditions, while decreased bone loading can result in osteoporosis
35
Q

Fibromyalgia:

  1. Common fib triggers and symptoms
  2. 1990 American College of Rheumatology criteria for the diagnosis of fib
  3. Typical treatment modalities
A
  1. sleep disturbances and fatigue are symptoms (not defining characteristics)…it contains a group of signs and symptoms that occur together and characterize an abnormality…symptoms include aches and pains similar to flu-like exhaustion, multiple tender points, stiffness, decreased exercise endurance, fatigue, muscle spasms, paresthesis, excessive fatigue, disruptive sleep patterns, bowel and bladder irritability, anxiety, depression, cognitive difficulties, temporomandibular joint disorders (TMJ), sensitivity to loud noises and allergic symptoms such as nasal congestion and rhinitis
  2. Widespread pain must be present in order to diagnose (pain in left side of body, in right side of body, above waist, below waist) in addition, axial skeleton pain (cervical spine and anterior chest or thoracic spine or low back) must be present…pain on digital palpitation in 11 of 18 tender-point sites (see table 14-7)
  3. treatment of any underlying sleep disorder, allergy testing and treatment, medications such as analgesics, nonsteroid anti-inflammatory drugs (NSAIDS) including ibuprofen, selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants, muscle relaxants, and other medications, exercise, relation techniques, other complementary therapies
36
Q

Fibromyalgia:

  1. Role of exercise in treatment
  2. Impact of physical inactivity in clients with fibromyalgia
A
  1. eases symptoms and prevents the development of other chronic conditions associated with inactivity
  2. causes downward spiral that produces further decreases in fitness and results in lower levels of exertion that bring fatigue and pain
37
Q

Fibromyalgia:

Sample Exercise Program

A
  1. Mode: walking and low-impact activities such as elliptical training, recumbent cycling, warm-water aquatic exercise, and swimming are excellent…should include light stretching as part of the daily routine, along with resistance exercise activities utilizing resistance bands…some can use light weights and/or perform other functional activities
  2. Intensity: generally perform at low-moderate intensity (RPE of 5 or 6) depending on age and condition
  3. Duration: gradually progress to goal of 150min or more per week of aerobic activity some may need to begin with short-duration sessions (10min) and gradually build over time
  4. Frequency: key is to establish a “regular” pattern of exercise 3-5 days a week
38
Q

Chronic Fatigue Syndrome:

  1. Common Symptoms
  2. CSF Criteria
  3. General treatment guidelines for CFS
A
  1. problems with memory and concentration, unrefreshing sleep, muscle and joint pain without inflammation and redness, headaches, tender cervical or axillary lymph nodes, recurrent sore throat, and extreme exhaustion lasting more than 24 hours following physical or mental exercise…also abdominal pain, bloating, chest pain, chills, chronic cough, diarrhea, dizziness, nausea, night sweats, pyschological probs (depression, irritability, anxiety, and panic attacks), and visual disturbances
  2. Unexplained, persistent fatigue that is not due to ongoing exertion, is not substantially relieved by rest, is of new onset (not lifelong), and results in a significant reduction in previous levels of activity…also four or more of the following present for 6 months: memory and concentration, unrefreshing sleep, muscle and joint pain without inflammation and redness, headaches of a new type or severity, tender cervical or axillary lymph nodes, recurrent or frequent sore throat
  3. moderating daily activity (slow down and avoid physical and psychological stress…still need some activity, but in moderation); gradually progressing exercise; cognitive behavior therapy (helps identify negative beliefs and behaviors that might adversely impact recovery and replace them with healthy, positive ones; treatment of depression; treatment of existing pain; treatment of allergy-like symptoms
39
Q

Chronic Fatigue Syndrome:

  1. The role of exercise in treatment
  2. Importance of appropriate rest following physical exertion
  3. Training approach if exercise worsens CSF symptoms
  4. Exercise recommendations
A
  1. it has been shown to decrease psychological stress and improve fatigue, functional capacity, and fitness
  2. avoid extremes of activity (no exercise or vigorous exercise), rest must occur…1:3 ratio (resting for three minutes after 1 minute of exercise…some deconditioned clients can start with daily activity and slowly begin to add low impact brief activity like stretching, walking, or cycling (increase by 1-5min a week as tolerance develops)
  3. if it worsens with exercise, client should be encouraged to return to the most recent manageable level of activity that did not result in increased symptoms…daily exercise may be divided into two or more sessions to avoid this
  4. Should start with simple stretching and strengthening exercise using only body weight for resistance…can gradually add activity (like wall pushups, modified chair dips, toe raises, etc.) reps should be increased gradually, beginning with 2-4 reps and building to a max of 8…can add resistance as strength improves by using bands or light weights…some may not tolerate an upright position, so may benefit by swimming or using a recumbent bike
40
Q

CFS: Sample Exercise Routine

A
  1. Mode: ADL, walking or low impact, light stretching and light resistance using bands…can slowing increase with some clients
  2. Intensity: low intensity…goal is to develop a regular pattern of activity that doesn’t kill them
  3. Duration: begin with 2-5min exercise periods followed by 6-15min rest breaks (1:3 ratio)…gradually build to 30min of activity
  4. Frequency: 3-5 days a week in general
41
Q

Low Back Pain:

  1. Prevalence
  2. Typical Causes
  3. The role of exercise in prevention and treatment
A
  1. its a major problem globally and it has been shown to have the highest prevalence (ranging from approx. 12-23%) among women age 40-80 years
  2. trauma (sports injury, lifting, bending, or reaching, sudden jolt like in a car accident), certain disorders such as arthritis, and aging…it persists for more than 3 months
  3. aerobic training and exercises for the lower back should be performed on a regular basis with proper technique…maintain and improving muscular balance across the joins is particularly important for people with skeletal irregularities…should be cleared by physician before exercise routine…cardiorespiratory training, resistance training, and basic core exercises should be the primary components of the program…avoid unsupported forward flexion, twisting at the waist with turned feet, especially when carrying a load, lifting both legs simultaneously when in a prone or supine position, rapid movements such as twisting, forward flexion, or hypertension…muscular endurance as opposed to muscular strength has been shown to have the best results for lower back health (higher reps and lower weight)
42
Q

LBP: Sample Exercise Routine

A
  1. Mode: walking, stationary biking and swimming…should avoid prolonged sitting while cycling..variety is good, core strengthening, light resistance training, and stretching…follow physician’s guidelines
  2. Intensity: light to moderate is recommended initially…as conditioning improves and symptoms dissipate, some will be able to progress to moderate to vigorous
  3. Duration: gradually build to 30-60 min per session…some may need to begin with short 10-minute bouts of activity
  4. Frequency:3-5 days a week with the goal to establish a regular routine
43
Q

Weight Management:
1. Health consequences of overweight and obesity
2. Lifestyle habits and cultural changes that contribute to weight gain and obesity
The role of exercise in prevention and treatment

A
  1. more than 20 chronic diseases (including type 2 diabetes, hypertension, CAD, some cancers, arthritis, Alzheimer’s disease, and dementia
  2. caloric intake increased by 300 per day from 1985 to 2002…overeating is often related to stress, portion size and value perceptions, and high caloric-density foods; the proliferation of microwaveable and read-to-eat high-fat foods has worsened the average diet; people do less cooking at home and eat out/on the go more often; marketing entices people to choose foods that are higher in calories and fat; 60% of Americans do not see the recommended amount of physical activity and 22% report no physical activity…this is compounded by the fact that many communities are not designed for safe and effective physical activity; people spend excessive amounts of time doing sedentary activities such as computer-based work and play, video games, and television watching; jobs more sedentary…they offer less or no opportunity for physical activity during the workday…also many worksite cafeterias and lunch options offer a variety of unhealthy food choices; most spend a significant amount of driving to work/school…this is especially problematic in areas of heavy traffic and long commutes
44
Q

Weight Management:

-The role of exercise in prevention and treatment

A

Studies have shown a strong dose-response relationship between the volume (frequency, intensity and duration) of endurance and/or resistance training, the training duration, and the amount of total and regional fat loss…overweight and obese adults should accumulate more than 150min of moderate-intensity exercise each week, and when possible, more than 225 min per week…weight maintenance (weight fluctuation <3%) is likely to be associated with ~60min of physical activity at a moderate intensity; one of the benefits of exercise is its impact on resting metabolic rate and fat-free mass

45
Q

Weight Management:

Sample Routine

A
  1. Mode: walking, cycling, group fitness such as aerobics, aquatic and swimming for some, just find safe, effective, and enjoyable activities…resistance may derive additional benefits at first
  2. Intensity: low to moderate, begin at low and gradually progress as conditioning improves, monitor with RPE, watch out for excessive sweating, shortness of breath, or fatigue, or inability to complete session
  3. critical component. should be encouraged to accumulate 150-200 or more minutes of exercise each week
  4. 5-6 days per week to maximize caloric expenditure…some may need to start off with 2-3 days a week
46
Q

Exercise and Older Adults:

Normal age-related changes of the cardiovascular and musculoskeletal systems

A
  • Cardio: maximal HR declines (in many cases is affected by medication thus diminishing the accuracy of estimating training intensity based on HR (RPE or talk test is more effective), cardiac output is typically lower, resting cardiac output declines by 1% per year upon reaching adulthood, resting stroke volume decline approx. 30% from age 25-85…combined with decrease in max HR, leads to a drop in cardiac output of 30-60%, stroke volume has shown to increase or be maintained in healthy older subjects who exercise…associated with the decrease in HR and stroke volume is a reduction i maximal oxygen uptake (VO2 max) (8-10% decline per decade after age 30 and is impacted by decreased O2 extraction by working muscles
  • Musculoskeletal: muscle mass declines, resulting in reduced muscular strength and endurance, 3-5% for each decade is out after age 25 (primarily associated with lifestyle changes- less physical activity, and decreased neuromuscular system), bones become more fragile and porous (greater risk of fractures), loss of calcium results in decreased bone mass (weight bearing and resistance helps to maintain bone mass), as lean body mass declines with age body fat increases usually…this is primarily due to decreased muscle mass, basal metabolic rate, and reduced or lack of physical activity…one average there is a 10% decline in basal metabolic rate between early adulthood and retirement age and a further 10% decline after that (regular physical activity helps to stimulate protein synthesis, preserve lean body mass and decrease fat stores)
47
Q

Exercise and Older Adults:

  1. Normal age-related changes of sensory system
  2. The impact of physical activity on the cognitive declines associated with aging
A
  1. Sensory: balance and coordination decline, increase risk of falls/fall injuries; visual, vestibular, and somatosensory systems are also affected…people rely on visual for balance (can cause people to hunch over as they walk)
  2. Physical activity has been show to prevent or delay cognitive impairment and disability and improve sleep (can prevent depression and anxiety disorders), it also gives them the opportunities to have regular social interaction
48
Q

Exercise and Older Adults:

  1. The role of exercise in delaying the physiological declines associated with aging
  2. The importance of exercises intended to maintain or improve balance
  3. The impact of physical activity on common chronic health problems experienced by older adults
A
  1. (according to Musculoskeletal info) regular physical activity helps to stimulate protein synthesis, preserve lean body mass, and decrease fat stores
  2. shown to improve balance and coordination in other adults as they age, especially activities that focus on the mind-body connection, such as yoga, pilates, or tai chi
  3. it helps prevent or lessen risks
49
Q

Exercise and Older Adults:

Exercise Routine Sample

A
  1. Mode: endurance exercise such as low-impact aerobics, walking, using cardiovascular equipment such as ellipticals and cycles, and swimming, should be primary exercise mode for most. low resistance weight training and high reps (at least initially), and include exercises that improve or maintain balance (backward walking, sideways walking, heel walking, toe walking, standing from a sitting position, and tai chi), use appropriate technique and monitor safety…it is important to encourage an active lifestyle and recreational activities (tennis, dance, etc.)
  2. Intensity: depending on conditioning level, current state of health, and age, it ranges from low to moderate with very few performing vigorous (RPE of 5 or 6)
  3. Duration: should perform longer and more gradual warmups and cool downs…can gradually increase duration to 30-60min per session, depending on medical history and clinical status
  4. Frequency: at least 5 days a week, daily exercise of shorter duration may be appropriate from some with an initially low functional capacity
50
Q

Exercise and Youth:

  1. Prevalence and health consequences of inactivity
  2. Health consequences related to poor nutrition habits
A
  1. and 2. at risk for developing diseases (hypertension, type 2 diabetes, osteoporosis, and development of atherosclerosis) in their adult years, increase in being overweight or obese (could cause premature death), these behaviors could continue if not established early on, which could also lead to premature death
51
Q

Exercise and Youth:

Health benefits associated with regular physical activity

A

can achieve these benefits by completing up to 60min or more each day of moderate to vigorous activity (but it appears that the total amount of physical activity accumulated each week is most important), bone strengthening activities are the most important because the greatest gains in bone mass occur during the period just before and during puberty, children should also have muscle strengthening activity at least three days a week

52
Q

Exercise and Youth:

Guidelines to minimize risk of injury during resistance training

A
  • Obtain medical clearance or instructions regarding physical needs
  • should be properly supervised and use proper technique
  • dont allow them to exercise unless the weight training facility is safe for them
  • never have children perform single maximal lifts or sudden explosive movements or try to compete with other children
  • tach children how to breath properly during exercise movements
  • children should rest for approx. 1-2min between each exercise and for longer if needed…there should also be rest days between each training day
  • encourage them to drink plenty of fluids before, during, and after workout
  • tell them that they need to communicate with their coach, parent, or teacher when they feel tired or fatigued or when they have been injured
53
Q

Exercise and Youth:

The impact of environmental temperature extremes in exercising youth

A
  • Extreme cold: increased risk of dehydration and hypothermia
  • extreme heat: at greater risk of heat-related illnesses than adults due to their higher ratio of body surface area to mass, lower exercise economy, diminished sweating capacity, lower cardiac output at a similar workload
54
Q

Exercise and Youth:

Guidelines for working with youth effectively at different stages of physical and psychological development

A
  1. Children and adolescents who do not currently meet the recommended physical activity guidelines for youth (60 or more minutes of daily physical activity) should slowly increase their activity levels in small steps ad in ways that they enjoy. A gradual increase in the number of days and time spent being active will help reduce risk of injury
  2. Children and adolescents who do meet the guidelines should continue being active on a daily basis and, if possible, become more active. (performing more than 60min of daily activity may provide additional health benefits)
  3. Children and adolescents who exceed the guidelines should maintain their activity levels and vary the kinds of activities they do to reduce the risk of overtraining or injury
55
Q

Exercise and Youth:

Exercise Routine Sample

A
  1. Mode: should encourage children and adolescents to participate in sustained activities that use large muscle groups (like swimming, running, jogging, and aerobics). Need to incorporate fun activities (like recreational sports) that develop other components of fitness (speed, power, flexibility, muscular endurance, agility, and coordination)…should encourage them to participate in muscle-training and bone-strengthening exercise at least 3 days a week and to live active lifestyles by walking to school and playing outdoors whenever possible
  2. Intensity: Children and adolescents who have not been active should start with low-intensity activity and gradually progress…as conditioning progresses, they should be encouraged to go to moderate-vigorous intensity…activities that encompass all three zones are an excellent choice
  3. Duration: 60min or more a day
  4. Frequency: ch and ad should be encouraged to exercise daily (don’t have to be heavily structured, but should include a variety of play and recreational activities)
56
Q

Pre and Post-Partum Exercise:

Evidence in support of exercise and physical activity during pregnancy and postpartum period

A
  • can exercise safely without harming fetus
  • helps reduce adverse heath risks
  • can maintain or improve cardiovascular and muscular fitness
  • reduced rates of preeclampsia, GDM, C-section, low-back pain, anxiety, nausea, heartburn, insomnia, leg cramps, and possibly control of excessive weight gain
57
Q

Pre and Post-Partum Exercise:

Common physiological changes during pregnancy that affect woman’s body to exercise

A
  • on average, pregnant women gain 25-40 pounds, placing additional stress on joints of the back, pelvis, hips, and legs
  • the COG (center of gravity) moves upward and out (can cause low back pain and affect balance and coordination
  • many are more flexible during pregnancy due to hormone-related joint laxity
  • cardiac reserve (the difference between resting and maximal cardiac function) is reduced
  • during early months of pregnancy, hormonal signals stimulate increases in HR, blood volume, stroke volume, and cardiac output
  • these cardio changes can make increased physical demand more difficult, especially in the supine position(should not exercise as high intensity or participate in activities that require sudden bursts of movement)
  • thermoregulatory system is also affected, resulting in a slight improvement in women’s ability to dissipate heat (may be due to increased blood flow to skin and increases in tidal volume)-they need to be aware of the ambient temperature prior to workout (really high body temperatures could result in hyperthermia and potentially harm the fetus-however, does not cause malformations)
58
Q

Pre and Post-Partum Exercise:

  • Published Guidelines for Exercise for Pregnant Women
  • Contraindicated exercises for women
A
  • don’t being vig exercise before or during preg
  • women who have been previously active can continue their program during the first trimester at 30-40min max at a frequency of 3-4 days a week as tolerated
  • women who were not active should begin slowly with 15min of low intensity and a gradual increase not 30min (some may need to being with shorter durations or do intermittent activity)
  • gradually reduce intensity, duration, and frequency of exercise during the second and third trimesters ( for example, a woman running at 40min per session can drop to 30min and then more after third trimester)
  • Use RPE scale rather than HR (choose intensity that is comfortable-4 to 5)- a pounding HR, breathlessness, and dizziness are indicators that intensity should be reduced
  • Avoid these exercises:
    1. anything that includes extensive jumping, hopping, skipping, bouncing, or running
    2. deep knee bends, full sit-ups, double-leg raises, and straight-leg toe touches
    3. contact sports such as softball, football, basketball, and volleyball
    4. Bouncing while stretching
    5. Activities where falling is likely (downhill skiing or cross country skiing and horseback riding)
  • after first trimester, prolonged exercise in supine position (greater than 5min) should be discouraged due to the potential for fetal hypoxia
  • avoid long periods of standing and keep moving or sit and rest
  • exercsie should be avoided when temperature and/orhumdity is high
  • body demo should be taken immediately after exercise (if it exceeds 100 degrees F, client should be encouraged to exercise during cooler parts of the day
  • focus on proper fluid intake to balance loss of fluids
  • use extended warm-up and cool down periods and incorporate some stretching
  • avoid skiing, contact sports, scuba diving, jumping/jarring motions, and quick changes in the environment
  • walking and running should occur on flat, even surfaces to reduce the likelihood of falls
  • wear supportive shoes while walking or running
  • wear a bra that fits well and gives lots of support
  • some women may benefit from having a small snack before exercise to help avoid hypoglycemia (they should consume the required extra daily calories needed during pregnancy)
59
Q

Pre and Post-Partum Exercise:

Abnormal signs or symptoms that necessitate delaying or termination the exercise session

A
  • vaginal bleeding
  • dizziness or feeling faint
  • increased shortness of breath
  • chest pain
  • headache
  • muscle weakness
  • calf pain or swelling
  • uterine contractions
  • decreased fetal movement
  • fluid leaking from vagina
60
Q

Pre and Post-Partum Exercise:

-Published Guidelines for Exercise for Postpartum Women

A
  • Obtain physician clearance and guidelines prior to resuming or starting an exercise program
  • begin slowly, and gradually increase duration and then intensity-goal is to develop consistency, not to see how hard one can work
  • start with walking several times a week
  • avoid excessive fatigue and dehydration
  • wear a supportive bra
  • stop the exercise if unusual pain is experienced
  • stop the exercise session and seek medical evaluation if bright red vaginal bleeding occurs that is heavier than a normal menstrual period
  • drink plenty of water and eat appropriately
61
Q

Pre and Post-Partum Exercise:

Exercise Routine Sample

A
  1. Mode: aerobic and strengthening conditioning exercises such as brisk walking, elliptical training, stationary biking, cross-country skiing (no downhill), and swimming are recommended. Should avoid jumping and jarring activities and contact sports
  2. Intensity: light to moderate is recommended. the talk test or RPE scale can be used (4-5)
  3. Duration: should begin with 15min of continuous exercise and gradually build to 30min sessions (women who are already active may be able to start ate 30-40min)
  4. Frequency: 3 times a week is the general rec, though some may be able to progress to 4-5 times per week