Special Populations

In Obese individuals, what pre-screening tool should we use?

PAR-Q

A BMI greater than ___ is considered obese

30

What is the main goal(s) of exercise for obese individuals?

-Weight loss
- Maintaining weight loss
- Preventing weight gain

In obese individuals, we should prescribe how much aerobic exercise?

30+ minutes daily
150+ minutes weekly

In obese individuals for weight maintenance, how much aerobic exercise weekly?

200-300 minutes

True or False: Weight loss requires greater exercise volume than fitness improvement alone

True

What type of exercise for 30+ minutes uses fat as primary fuel?

Longer, low-intensity aerobic exercise

For weight management, use an initial exercise intensity at ___ VO2 reserve or ____ HR max

40-60%; 55-70%

Combining what interventions benefits obesity prevention and management (greater benefits women > men)

Aerobic and resistance exercise

What increases segment intertia?

Higher body mass

____ intensity exercise programs are ineffective for weight loss

Low to moderate

What is the best recommended obesity management strategy

Multimodal treatment with counseling, diet, exercise and pharmacological intervention

What is the recommendation for obese children, adolescents, men <45, women <55 with NO cardiovascular issues

Moderate and vigorous intensity exercise without stress

What is the recommendation for obese men >45, women >45 with NO cardiovascular issues

Moderate intensity without stress test
Vigorous intensity with stress test

What is the recommendation for obese men >45, women >45 with 2 or more cardiovascular risk factors but no disease

Moderate intensity exercise without stress test
Vigorous intensity with stress test

What is the recommendation for obese individuals with cardiovascular disease

Medical exam and stress test before moderate or vigorous exercise

Why is attention to exercise environment important for obese individuals?

Hyperthermia risk

True or False: You should know what medications being taken and potential impact exercise may have

True

Why should we be cautious pursuing weight loss goals in individuals over 80?

Due to frailty and loss of muscle mass related to dietary changes

Why should we choose low-impact activities for cardiopulmonary fitness in obese patients?

Joint reaction forces and compressive loads will be higher

What is the main goal of exercise in individuals with Metabolic Syndrome?

Reduce the amount of abdnominal adipose tissue

For Metabolic Syndrome, why is targeting abdominal adipose tissue important?

Due to its link to systemic inflammation and insulin resistance

What is the recommended exercise frequency and intensity for individuals with Metabolic Syndromes?

150-250 minutes of moderate-intensity exercises weekly

What type of exercise effectively reduces waist circumference at any intensity?

Aerobic exercise or combined with resistance training

In Metabolic Syndromes, longer, more frequent aerobic sessions targets ____ while HITT targets ____

systemic inflammation; abdominal fat

For prevention, resistance exercise at what frequency lowers metabolic syndrome risk?

1-2 times weekly

In Metabolic Syndrome, programs lasting 1-59 minutes weekly reduces risk by ____; 4 days weekly reduces risk by ____

29%; 38%

Why is exercise beneficial for patients with Type 2 Diabetes?

-Improves insulin sensitivity
- Regulates weight
- Reduces cardiovascular risk
- Lowers hemoglobin A1c levels

What is a critical thing to do for patients with Type 2 DM?

Check their feet before, during and after exercise

The American Diabetes Association recommends what frequency and intensity of aerobic exercise?

30 minutes of moderate to vigorous aerobic exercise 3-7 days weekly at 65-90% HRmax

Type 2 DM patients should aim for ____ weekly of moderate aerobic and resistance exercise, with no more than ___ consecutive days off

150 minutes; 2

Resistance training at what frequency improves insulin sensitivity and lipid profiles?

2-3 times weekly

What intervention is the most effective for managing glucose and lipids in Type 2 DM?

Combining aerobic and resistance exercise

At what exercise intervals and time does HITT training reduce insulin resistance and regulates glucose

4-6 sets of 30 second vigorous intervals, alternating 30-60 second rest (total of 10 minutes)

True or False: Participation screening is recommended for adults in Type 2 DM before exercise

False

When starting or modifying exercise programs, what should we test before, during and after exercise to assess impact

blood glucose

What is the precaution for exercise when an individual experiences hypoglycemia?

Avoid exercise within 24 hours

What is Hypoglycemia?

When blood glucose levels are lower than 3.9 mmol/L

Blood glucose levels rise after meals for about _____

90 minutes

True or False: Exercise can increase blood glucose levels

False; decrease

What should we do if blood glucose >15 mmol/L during exercise

Monitor closely (Hyperglycemia)

What is the target glucose range for exercise in those on insulin

5.5-15.0 mmol/L

What is the thought of exercise for individuals with cancer?

Safe and beneficial for improving fatigue, anxiety, depression, QoL and physical function

True or False: Pre-Exercise Assessments are recommended for individuals with cancer

True

What is a precaution to note when working with cancer patients?

Exercise tolerance varies so do regular assessments and adjustments
(Also be aware of irradiated skin to avoid harm)

In cancer patients, a high platelet or WBC count is? Hemoglobin?

WBC = >50,0000-150,000
Hemoglobin = >10g/dL

In cancer patients, what could be a potential sign of steroid-induced myopathy?

Severe fatigue or muscle weakness

How is exercise beneficial for patients with chronic pain?

Aerobic exercise decreases pain and improves physical function and QoL

For pain improvement, what intensity and type of exercise should we do?

Low-moderate aerobic exercise that is 50-60% HRmax

For cardiovascular benefits, what intensity and type of exercise should we do?

Moderate-vigorous aerobic exercise that is 60-80% HRmax

Reducing systolic BP by 10mmHg reduces stroke risk by ____ and heart attack risk by ___

25-54%; 16-46%

True or False: Greater exercise volume directly correlates with greater resting blood pressure reductions

True

4 weeks of minimum aerobic training reduces systolic & diastolic BP by how much?

8.3 & 5.2

True or False: Resistance training is less beneficial except for those with higher baseline BP

True

What type of exercise reduces systolic BP by 5.3 and diastolic BP by 3.6 mmHg?

Combined aerobic and resistance training

For patients with COPD, what rehab program is the most recommended?

Pulmonary rehab with exercise components

What is the benefit of breathing exercises for patients with COPD?

-Diaphragmatic function
- Reduce accessory muscle dependence
- Decrease respiratory rate

What should we used to assess perceived respiratory effect during breathing exercises?

Borg CR-10

What is better tolerated when compared to continuous exercise in advanced COPD patients?

Interval training

For adults with SCI, what is the recommended type and frequency of exercise for cardiometabolic health benefits?

Moderate to vigorous aerobic exercise 3 times per week

What is the minimum recommendation frequency and type for adults with SCI?

20 minutes of moderate to vigorous at least twice weekly

For adults with SCI, what is the strength training exercise frequency recommendation?

3 sets twice weekly at moderate to vigorous intensity

For adults with SCI, what are common barriers to exercise?

-Lack of adaptive equipment
- Transportation issues
- Equipment costs

What is Primary Prevention for PD?

Strenuous exercise lowers risk of developing PD

What are core interventions to implement for PD patients?

-Aerobic exercise
- Resistance training
- Balance training
- External cueing
- Community based
- Gait training
- Task specific training

For patients with Fibromyalgia, what is a good intervention especially when they face “good” and “bad” days

Pacing activities

What is the education piece for patients with Fibromyalgia?

Central sensitization signs and effective management strategies

What is the exercise type recommendation for Fibromyalgia?

Aerobic exercise (reduces symptoms)

For Myofascial pain syndrome, what is the idea of correct chronic overload?

Address contributing factors like faulty posture, repetitive activity or poor lifting techniques through education and intermittent mini breaks

What are some ways we can eliminate trigger points in patients with Myofascial Pain Syndrome?

-Contract-relax-passive stretching
- Contract-relax-active stretching
- Trigger point release
- Dry needling
- Modalities

What are two things to strengthen for individuals with Myofascial Pain Syndrome for improving overall performance?

Core and scapular stabilizing muscles

In individuals with Osteoporosis, what does the NOF recommend for prevention?

Weight-bearing exercises

What frequency and intensity of Aerobic Exercise should patients with Osteoporosis do?

5+ days per week, 30 minutes of moderate or 20 minutes of vigorous
(Alternate three 10 minute bouts daily)

What frequency and intensity of Resistance Exercise should patients with Osteoporosis do?

2-3 days per week; 8-12 reps to muscle fatigue