SPHERE final

specific population

specific common grouping, influences the way an individual engages in PA or the way exercise is prescribed

goal for working with specific populations

safe, effective, inclusive (person first language)

general movement guidelines for specific populations

use recommendations for healthy adults; adapt to accommodate for risks, symptoms, and treatment protocol; exercise professional must be knowledgable on condition

4 principles of exercise prescription

safety, client-centred prescription, knowledge, coaching

safety principle

minimize risk of injury, monitor for correct technique, provide variations

client-centred prescription

history and fitness assessment, goals, motivation, barriers

knowledge principle

physiology and movement skills, health-related behaviour change, program designs principles, implementation

coaching principle

educate, communicate, demonstrate

fitness assessment components

screening and physician approval, meeting client, assess fitness, evaluate and prescribe

screening tools

Par-Q+, PARmed-X for pregnancy, Get Active Questionnaire

motivational interviewing

broad and open-ended questions instead of “yes/no”, what/where/why/when/how questions, probe and prompt for more information

fitness assessment

tests of aerobic capacity, musculoskeletal strength, endurance, power, balance, stability, flexibility

SOAP client history and assessment method

S - subjective data, O - objective data, A - assessment (interpret), P - plan a program

aging statistics in Canada

19% of population is 65+ years old, more 65+ year olds than 0-14 year olds

health decline with age

not unavoidable, trajectory impacted greatly by PA levels

chronological age

number of years since birth

biological age

proportion of an individual’s lifespan that has elapsed; accounts for lifestyle factors of lifespan; better predictor of disease and all-cause mortality

factors associated with age

health status, fitness levels, chronic disease, disability, functional limitations, community-dwelling vs. nursing or residential care

65+ y/o 24H movement guidelines - PA

150 mins/week MVPA, muscle strengthening 2x/week, several hours light PA, PA that challenges balance

65+ y/o 24H guidelines - sedentary time and sleep

<8 hours sedentary time, <3 hours screen time, break up long periods of sitting, 7-8 hours good sleep

CCAA functional fitness assessment (FFax)

standardized fitness assessment for baseline and progress measurement; aerobic fitness and muscular, flexibility, balance

FFax aerobic fitness protocols

mCAFT (15-69 y/o), treadmill walking test (20-59 y/o), one mile walk, cycle ergometer test

muscular, flexibility, and balance protocols

for 15-69 y/o: grip strength, push-ups, sit and reach, vertical jump, back extension, single leg stance

single leg stance results

fall risk increased if <10-15 seconds, risk decreased if >30 seconds, mortality risk increased if <10 seconds

frequency principle

strength training each muscle group 2-3x/week, aerobic training 3-5x/week

PA guidelines for adults with spinal cord injury

start: 20 mins MVPA, 2x/week, 3×10 2x/week train each muscle group. progress: 30 mins MVPA 3x/week, 3×10 2x/week train each muscle group

intensity principle

effort or difficulty; RPE (1-10) or talk test

time principle

aerobic guidelines - start slow, work to 20-60 mins sustained movements involving larger muscle groups

type principle

aerobic type, RT - compound vs. isolation, modality of exercise

primary movement patterns

hinge, squat, lunge, vertical push, vertical pull, horizontal push, horizontal pull

regression

make an exercise easier; promotes form, allows for necessary volume

progression

make and exercise harder; apply progress and overload principle, fatigue muscles at appropriate volume

substitution

alternate exercise entirely or different way of performing an exercise; works same or similar muscles

order of exercises

large to small muscles, complex to isolated movements, alternate muscle groups, pair agonists and antagonists, core last

RT goals and recommendations

muscular goals - endurance, hypertrophy, strength, power. volume for older adults - 10-15 reps, 1-2 sets

strength-based feedback process

identify specific strengths, encourage self-reflection (with open-ended questions), identify areas for improvement with questions or prompts

SBF benefits

promotes reflection, builds self-efficacy, improves motivation and performance

what is a fall

an event which results in a person coming to rest inadvertently on the ground or floor or other lower level, with or without injury

fall statistics

1/3 people 65+ fall each year (higher for 85+), leading cause of hospitalization in older adults, leading cause of injury and mortality among adults 75+, 1/3 of those who fall are admitted to long-term care

fall injuries stats

1/5 result in serious injury, 95% of hip fractures due to falls and 25% of older patients die in the first year of recovery, ~50% of older adults can’t get up from a fall (dehydration, sores, penumonia)

side-effects of falls

delayed functional recovery, increased medications, disability, reduced QoL, health-care costs

intrinsic risk factors for falls

demographic (increases with age, women>men), systems (gait, balance, strength, vision, cognition), symptoms/disease (dizziness, CVD, dementia, depression), medications

extrinsic risk factors for falls

environment (walking surfaces), footwear, weather (ice)

psychological factors associated with falls among older adults

1/4 report a fear of falling after 1 event, falling once doubles the chances of a second, loss of confidence affects daily living

fall prevention methods

functional training (specificity principle), balance training, gait training (technique, pace, etc.)

fall intervention outcome variables

rate of falls = # of falls per person, risk of falls = # of people experiencing falls

exercise type for fall prevention

strong evidence for balance and functional exercise; moderate evidence for combination with RT; strong evidence for Tai Chi and risk reduction, but low for rate reduction; unclear evidence for RT alone, dance, walking programs; no investigation on flexibility or endurance

FITT recommendations for exercise as fall prevention

type - significant challenge to balance (reduce base of support, shift COG, limited supports), frequency - 3+ hrs/week, preform regularly and long term (6+ months)

target audience for exercise as fall prevention

include community-dwelling individuals (increased risk), for exercise in a group or home setting, prevents falls in people with Parkinson’s or cognitive impairment, no evidence for stroke patients or recently discharged hospital patients

exercise prescription for fall prevention

balance with or without walking program (without for high risk), strength training may be added, providers must refer other risk factors to be addressed

4 main ways to manipulate balance

base of support, centre of gravity, supportive aid, sitting vs. standing vs. in motion

additional progressions for balance exercise

arm changes, surface changes, visual progressions, tasking addition

benefits of PA in childhood

healthy growth and development, promotes prolonged engagement, increased HRQoL, reduced incidence of injuries, combats non-communicable diseases, psychosocial benefits, academic improvement, fun

PA recommendations for infants (<1year)

30 mins tummy time/day, 14-17 (0-3 mo.) or 12-16 (4-11 mo.) hours of sleep, not restrained for >1 hour at a time

PA recommendations for toddlers (1-2 years)

180 mins PA/day (including energetic play)< 11-14 hours sleep, not restrained for >1 hour at a time, <1 hour screen time (0 for 1 year olds)

PA recommendations for preschoolers (3-4 years)

180 mins PA/day (60+ energetic), 10-13 hours sleep, not restrained for >1 hour at a time, <1 hour screen time; only 14% meet

physical literacy definition

the motivation, confidence, physical competence, knowledge, and understanding to value and take responsibility for engagement in PA for life - Margaret Whitehead, IPLA, CPL consensus statement

physical literacy process

individualized, builds confidence and competence; movement vocabulary (repetoire), fluency (execution), physical proficiency (selection and utilization), physical literacy (demonstration)

fundamental movement skills

exposure between 0-4, developed between 0-9 years old, must be mastered for children to be completely physically literate and participate in sport

locomotor skills

movement - crawling, walking, running, jumping, hopping, skipping

non-locomotor skills

stability - stretching, balancing

manipulative skills

object manipulation - throwing, catching, kicking, striking

ways to get infants active

supervised tummy time, indoor and outdoor movement; limit sitting to <15 minutes/session; roll, reach, scoot, stand, crawl, walk

ways to get toddlers and preschoolers active

positive experiences, diverse activities, challenge, small goal, basic motor skills, short bursts with breaks, integrate into daily routine

PA in childcare setting stats

lowest in centre-based, 1.5/mins.hour MVPA (12 mins in 8 hours day), 10x more active outdoors than indoors (5 min/hr vs. 0.5 min/hr), more intense PA outdoors (especially in first 10 mins)

active outdoor play definition

unstructured, in child’s free time; in 1 hour, 7+ mins MVPA, 762+ steps, 13 mins less sedentary time

safety of outdoor play

1 in 14 million odds of stranger abduction in Canada, most injuries are minor, risk of death 8x greater as a car passenger than being hit walking or biking

risks of indoor play

screen time - unhealthy eating, cyber-predators, violence; worse air quality indoors; sedentarism increases risk of health problems

SPACE study objective

to increase PA and decrease sedentary time of preschoolers in centre-based childcare

SPACE study intervention

childcare educator training, shorter and more frequent outdoor play (4×30 mins), new portable play equipment; 11 centres implemented, 11 as control, for 8 weeks

SPACE study measures

338 students and 83 educators, accelerometer tracks all levels of movement, baseline compared to week 8 and 6- and 12-month follow-up; participant measures - PA, SED, staff PA knowledge and seLf-efficacy, child HRQoL

SPACE study results

increase in energetic and all levels of PA, decrease in sedentary time, not sustained at follow-ups

SPACE secondary study

smaller sample, only 4×30 intervention component; successful, feedback changed recommendation to 3x/day (more feasible), perhaps integrate with numeracy and literacy

risky play definition

experimenting with uncertainty, exploration, and overcoming fears; important for development

6 categories of risky play

great speeds, great heights, harmful tools, near dangerous elements, rough-and-tumble play, play where child can “disappear”/get lost

living with a disability

WHO ICFSH - relationship between health condition and external factors, differences in function or participation

types of disability

congenital, acquired later in life, chronic or acute, detected later in life, visible, barely detectable or invisible

disability in Canada stats

5% of children <15 years, 13% of youth 15-24, 2.8 million/14% of those 15+, 42% of adults 75+ years

meeting the 24H movement guidelines with disability

16-62% less likely to meet, individual guidelines for certain populations (eg. SCI)

keys to inclusive PA service

disability label does not define functional ability, consider client unique function, consider contextual factors

principles of an abilities-based approach

person-centred (client interest and skills), inclusive (equal opportunity), individualization, environmental compatibility (positive and welcoming)

common biases to avoid

generalizations (assumptions), distressed identification (need for pity), patronization (treating as a dependent), expressed discomfort

inclusive communication attitudes

awareness of common biases, use person-first language, avoid negative terminology, use regular conversational terms for specific PA, ask client if unsure

barriers to PA faced by people with disabilities

cost, transportation, accessibility, self-consciousness/lack of self-efficacy, lack of knowledge (of individual and exercise professionals), need for support, lack of social support, social inclusion barriers and bias

prescribing PA for individuals with a disability - client intake

same procedure to obtain history, same needs/concerns, disability does not indicate health or vulnerabilities, not necessarily at greater risk; address extra barriers

foundational strategies for PA prescription for people with a disability

belonging, autonomy, mastery, challenge, engagement, meaning

factors to consider when prescribing PA for people with a disability

mobility, object manipulation, behavioural and social skills, cognitive function, communication and perception

stages of pregnancy

first trimester (week 1-13), second trimester (14-27), third trimester (28-40), up to 2 more week (late and post term)

musculoskeletal changes during pregnancy

hormone relaxin (mobility), COG shift anteroposterior, relaxed abdominal wall muscles, compensatory lumbar lordosis, increased force on bones/muscles/ligaments

weight gain during pregnancy

35% from placenta, fetus, amniotic fluid; additional weight from fluids, tissues, fat; most gained in 2nd and 3rd trimester

gestational diabetes

first diagnosed during pregnancy, affects sugar use by cell, increases blood sugar; risk factors - lack of PA, overweight, pre-diabetes, polycystic ovary syndrom

physiological complications during pregnancy

to mother - high BP, preeclampsia, type 2 diabetes, C-section; to baby - excessive weight, preterm or still birth, respiratory distress, hypoglycemia

types of high BP during pregnancy

chronic hypertension - before 20 weeks; gestational hypertension - after 20 weeks; preeclampsia - after 20 weeks AND organ system damage, very serious

benefits of PA during pregnancy

40% risk reduction for major complication; reduced risk of blood issues, diabetes, excessive weight gain, less depressive symptoms, lumbopelvic pain, baby size

2019 Canadian PA for pregnancy guidelines

all women without contraindication, 150+min/week moderate PA, over at least 3 days/week, various RT and aerobic activity, pelvic floor exercises daily, avoid supine positions (after 4 months)

2019 Get Active Questionnaire for Pregnancy

medical clearance removed by OBGYN Canada

Exercise prescription for pregnancy

start - 3x/week, 15 mins/session, non weight bearing, low impact, aerobic, endurance, large complex groups, avoid Valsalva Manoeuvre and supine. progress - 4-5x/week, 30 mins/session, same type

absolute contraindications for PA while pregnant

ruptured membranes, premature labour, vaginal bleeding, placenta previa after 28 weeks, preeclampsia, incompetent cervix growth, intrauterine growth restriction, high-order multiple pregnancy; uncontrolled type 1 diabetes, hypertension, thyroid disease, serious CV or R disorder

relative contraindications for PA while pregnant

recurrent pregnancy loss, gestational hypertension, history of spontaneous preterm birth, mild-moderate CV or R disease, symptomatic anemia, malnutrition/ED, twin pregnancy after 28 weeks

precautions for PA while pregnant

body position - no supine, joint laxity - avoid rapid changes, abdominal muscles - avoid (DR), posture - emphasize breathing