Exercise and Special Populations

1
Exercise and Special Populations

• Sue Baldwin
• HEW 225

2
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

3
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

4
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

5
Organization of information

• Theory
• Diagnosis/condition
• Anatomy/physiology
• Cause/risk factors
• Benefits of exercise
• Supervision protocol
• Training guidelines
• Tips

• Practical Application
• Assessment
• Medical clearance
• Limitations
• Precautions
• Prescription
• Progression
• Evaluation

6
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

7
Chapter one - Pregnancy

• Physiological changes
• Risk status
• Fitness history
• Precautions
• FITT Prescription
• Supervision

8
Physiological changes

• Increased blood volume
• Increased cardiac output
• Lordosis
• Relaxin - increases joint mobility
• Change in center of gravity
• Increased heart rate
• Increased core temperature

9
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

10
Risk Status

• Persistent contractions 6-8 hours post
  exercise
• Elevated HR or BP several hours after exercise
• Unexplained pain anywhere in the body

11
Precautions

• Listen to her body
• Drink plenty of fluid
• Dont push through fatigue or pain
• High reps low weight
• No Valsalva Maneuver
• Consult with coach and OB provider when working
  with athletes

12
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

13
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

14
Triggers

• Upper respiratory infections
• Pollen from flowers, trees or grasses
• Molds or dust
• Smoking
• Emotional distress

• Exercise
• Cold air
• Dry air
• Air pollution

15
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

16
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

17
Helpful tips

• Begin with activities least likely to trigger
  asthma (kayaking, swimming, walking)
• Progress as tolerated to cycling, treadmill
  running, outdoor running

• Prolong warm up to at least 15 minutes
• Always have rescue medication available
• Maintain hydration
• Use diaphragmatic breathing
• Monitor for signs of an asthma attack

18
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

19
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

20
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

21
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

22
Assessment considerations

• Preferred test - Physician supervised 12 lead
  exercise stress test, with noted BP response to
  increasing workloads determining upper limits of
  intensity

• Is BP well controlled?
• Which lifestyle modifications are being followed?
• Type of medications regularly used effect on
  HR BP?
• Affect of additional clinical conditions?

23
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

24
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

25
Supervision

• Know S/Sx of elevated BP
• Have BP equipment available
• Inform clients of modifiable risk factors
• Check for new medical conditions

• Is medication taken as prescribed?
• Is client well hydrated?
• Monitor BP
• Exercise is unsafe when BP is greater than
  200/100 - refer to HCP

26
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

27
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

28
Types of Diabetes

• Type 1
• Insulin dependant
• Affects children and young adults
• Daily doses of insulin are required to keep blood
  glucose levels controlled

• Type II
• Non-insulin dependant
• Primarily affects mostly 40 yrs old
  overweight
• Achieving optimal glucose control (ideal body
  weight, exercise, oral medications) can reduce
  complications

29
Assessment

• Complete history and physical exam by HCP
• Exercise stress test for those over 35
• Standard fitness assessment

30
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

31
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

32
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

33
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 / 40-702-5 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.

34
Tips

• Wear good fitting supporting shoes
• Wear protective gear during contact sports
• Petroleum jelly in friction areas
• Loose clothing
• Exercise with a partner

• Self monitor glucose level carbo100 - 250 OK 250 postpone high
  intensity activity
• NIDDM carbo snack 30 min. to avoid low BS
• Wear medical ID bracelet

35
Time for a break!

• Review your notes, so far
• Stretch and breath

36
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 duration physical activity

37
AssessmentFor 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

38
Training guidelines

• Communicate AP of back supports
• Include diagnosis specific exercises
• Good body mechanics are essential during ST to
  prevent further injury

• Model good body mechanics for your client
• Client should always squat rather than bend at
  the waist to pick up weight
• Avoid overhead press

39
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

40
Tips

• Stretch twice a day
• Resistance work. Progress as tolerated
• Prolong warm ups to decrease back strain

• In the weight room lift clients feet onto bench
  when lying down
• Practice perfect technique, no back
  hyperextensions
• Wear flat soled shoes with good support

41
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

42
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
  

43
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

44
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

45
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

46
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

47
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

48
Chapter 7 The most regular exercisers are
over 50!

• Body fat can double between 25 and 75
  intra-muscular fat,
• Total body water decreases which increases
  dehydration risk
• Decreased lean body mass
• Liver loses 1/3 of its weight, kidney 1/4
• Loss of 2 inches in height by 80

49
Exercise can

• Decrease heart disease
• Hypertension
• Diabetes
• Osteoporosis
• Body fat
• Insomnia
• Joint aches and pain

• Increase feelings of well being
• Self image
• Energy level
• Balance
• Flexibility
• Mobility
• Bone strength

50
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

51
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

52
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

53
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

54
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

55
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

56
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!

57
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

58
Precautions

• Excess weight may exacerbate skin irritation
• Loss of balance and flexibility requires area
  free of obstacles
• Encourage extra fluid intake to prevent
  dehydration

59
Tips

• Create comfortable non-intimidating environment
• Convenient times
• Be a caring role model
• Emphasize enjoyment and variety
• Encourage client ownership of process

• Offer special theme classes or events to
  celebrate holidays, birthdays, seasons
• Educate clients with literature, BBs or
  newsletters
• Provide incentives

60
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
• Arthritis is the most common cause of disability
  in America

61
Treatment goals

• Reduce pain
• Decrease inflammation
• Improve function
• Decrease joint damage
• Manage through lifestyle changes, weight
  reduction, medication, heat/cold, and joint
  protection strategies

62
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

63
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

64
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

65
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

66
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

67
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

68
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

69
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

70
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

71
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

72
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

73
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

74
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

75
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

76
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

77
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

78
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

79
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,

80
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

81
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

82
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

83
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

84
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)

85
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

86
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

87
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 wont respond. Be
  patient and assist when necessary

88
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

89
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

90
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

91
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
• Childrens aerobic capacity increases before
  anaerobic capacity
• Due to high metabolic rate, children tire quickly

92
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)

93
Precautions For Training Children

• Due to high metabolic rate childrens 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

94
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 childs training and biological
  age NOT chronological age

95
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 flexibility11-14
  yrs. team games, intro long easy intervals15-19
  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.

96
Training guidelines

• Target heart rate restrictions unnecessary
• Create more opportunities for fun physical
  activity. Involve friends and peers. Encourage
  confidence in sports
• Encourage family, teachers and adults to model
  active lifestyle

97
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

98
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