ACE_Chapter 12: Working with Participants with Health Considerations (Reading Notes) PART 1

Exercise Considerations for Older Adults

• General Assessment Roles of the Group Fitness Instructor (GFI):

  • The GFI must observe three primary factors in all participants, with a specific focus on older adults: fitness level, mobility limitations, and self-efficacy level.

  • Identifying these factors allows the GFI to maximize a participant's ability and willingness to stick to a regular exercise lifestyle.

• Physiological Challenges in Aging:

  • Older adults often experience losses across multiple senses.

  • These sensory losses directly impact balance, which in turn reduces movement efficiency and motor control.

• Foundational Programming Priorities:

  • Balance: This is the foundational skill for all programming for older adults. It enhances physical performance and contributes to the cognitive domain, affective domain, and the building of self-efficacy and self-confidence.

  • Core Conditioning: This is a critical component of balance training and is considered a prerequisite to effective training.

  • High-Velocity Power Training: Research indicates this can elicit meaningful changes in muscle force production, peak power, and muscle contraction speed. It is safe once an adequate fitness level is established and supervised. This training improves overall performance and quality of life.

• Scope of Practice Limitations:

  • Working with older adults who are considered frail or possess severe functional and mobility limitations is typically beyond the scope of practice for a GFI.

  • These individuals usually require specialized programs rather than those designed for the general population.

• General Exercise Guidelines for Older Adults:

  • Warm-up and Cool-down: Include extended periods for both; at least $10$ minutes each. Include activation exercises (e.g., routines for low back health).

  • Intensity Monitoring: Use the Dyspnea scale or the Relative Perceive Exertion (RPE) scale.

  • Functional Independence: Teach exercises and movement patterns that participants can replicate at home to remain active outside of class.

  • Cognitive Integration: Incorporate exercises like catching a tennis ball with one hand, "Simon Says," or boxing with targets/mitts to improve reaction time and cognitive function.

  • Equipment Safety: When using resistance tubes or bands, coach participants to control the eccentric phase. Rapidly snapping during the lowering phase can impose excessive shearing forces on the elbow joint (e.g., during bicep curls).

  • Environment and Music: Use music appealing to the specific generation (if the class is dedicated to older adults). Be mindful of volume (music and microphone) and tempo.

  • Mobility Transitions: Be mindful of the ability to move quickly from the floor to seated or standing positions (orthostatic blood pressure changes).

  • Balance Options: Provide chair-based exercise options for those with mobility issues.

  • Barefoot Training: Yoga or Pilates can improve proprioception and tactile response. However, those with diabetes, preexisting podiatric conditions, or orthopedic conditions must not train barefoot unless cleared by a healthcare provider.

  • Outdoor/Agility Modifications: For boot camps or relays, allow shorter distances or stationary options (e.g., toe taps on a curb, modified jumping jacks, step-ups on a bench). Use a dedicated lane for less complex agility tasks. Note: Even walking backwards can be a challenge.

  • Safety Hazards: Avoid excessive equipment to prevent trip and fall hazards. Avoid dim lighting due to age-related eye changes.

  • Communication: GFI should arrive early to allow private conversations regarding limitations.

  • Aquatic Temperatures: High-intensity exercise should be between $83$ and $86$ degrees Fahrenheit. Low-intensity exercise should be between $86$ and $88$ degrees Fahrenheit.

Exercise Considerations for Participants with Osteoporosis

• Definition and Diagnosis:

  • Osteoporosis is characterized by very low bone mass.

  • Diagnosis: Bone mineral density (BMD) of more than $2.5$ standard deviations below the average peak value for normal adults.

• Statistics and Impact:

  • Approximately $54$ million Americans are afflicted by osteoporosis and low BMD.

  • Clinical significance: Susceptibility to bone fractures from low-trauma injuries (occurring from a standing height or lower).

  • Risk: $1$ in $2$ women and $1$ in $4$ men over age $50$ will break a bone due to osteoporosis.

  • Consequences: Severe disability, immobility, decreased functional status, poor quality of life, negative self-esteem, and mortality.

• Beneficial Activities:

  • Weight-bearing cardiorespiratory exercise and muscular training are essential for building and maintaining BMD.

  • Examples: Group strength, dance-based fitness, step training, and treadmill classes.

• General Exercise Guidelines for Osteoporosis:

  • Muscle Targeting (Hips): Squats, leg press, hip extension, hip abduction, knee extension, and hamstring curls.

  • Muscle Targeting (Spine): Back extension, shoulder press, lat pull-down, and seated row.

  • Range of Motion (ROM): Exercises targeting posture improvement (chest, shoulders, hip flexors, calves, and ankles).

  • Aerobic Nature: Must be weight-bearing.

  • Modifications: Short bouts of activity with recovery are better than long-duration loading. Multiplanar activity is encouraged.

  • Loading: Higher loads with fewer repetitions are recommended specifically for bone formation.

  • Precautions: Avoid explosive movements or high impact if at high fracture risk. If spinal BMD is low, avoid excessive twisting, bending, or compression of the spine.

Exercise Considerations for Youth

• Health and Development:

  • Growth status is a primary indicator of health. Lack of exercise impacts skeletal and muscular development.

  • Inactive lifestyles have led to an obesity epidemic and an increase in Type 2 diabetes and hypertension among youth.

  • Over $80\%$ of the world's adolescent population is insufficiently active.

• Thermoregulation in Children:

  • Children have a higher body surface-to-mass ratio compared to adults.

  • They devote more cardiac output to the skin surface rather than the core in hot conditions.

  • Children cool via dry heat dissipation and sweat less than adults. Adults cool primarily via evaporation.

  • Risk: Heat exhaustion can occur rapidly in hot, humid environments if core temperature rises faster than dissipation.

• Strength Training Facts:

  • Muscular strength increases with muscle mass growth. Before puberty, males and females improve strength similarly. During puberty, testosterone increases muscle size/strength more in males.

  • Fact: There is no evidence that muscular training stunts growth.

• General Exercise Guidelines for Youth:

  • Supervision: Use lightweight equipment: medicine balls, athletic balls, resistance tubing, suspension straps, stability balls, light dumbbells, gliding discs, and sandbags.

  • Physical Literacy: Focus on the ability, confidence, and desire to be physically active. Develop skills like running, jumping, kicking, and throwing.

  • Bone Growth: Greatest gains from bone-strengthening activities occur just before and during puberty.

  • Intensity: RPE can be used for ages > 8. For younger children, use "easy" and "hard" descriptors.

  • Engagement: "Gamify" sessions with relay races, scavenger hunts, or dance challenges. Use imagination (e.g., animal-inspired yoga).

  • Prohibited Actions: Never encourage single maximal lifts (1-RM), sudden explosive movements, or competition during muscular training.

  • Aquatic Temperatures: Between $83$ and $86$ degrees Fahrenheit.

Prenatal and Postpartum Participants

• Benefits of Prenatal Exercise:

  • Better cardiorespiratory/muscular fitness, higher $VO_2\text{max}$, reduced fatigue, and lower resting heart rate.

  • Reduced rates of urinary incontinence, low back pain, deep vein thrombosis, pregnancy-induced hypertension, diabetes, nausea, cesarean birth, anxiety, heartburn, insomnia, and depression.

• Fetal and Mother Safety:

  • Exercise does not reduce birth weight or pre-term pregnancy risk.

  • Factors like ambient temperature and nutrient availability are key; eat a snack prior to exercise and work in temperature-controlled areas.

• Physical Changes During Pregnancy:

  • Weight gain: $11$ to $40$ pounds (depending on BMI).

  • Center of gravity shift: Belly moves upward and out, causing low back discomfort and balance changes.

  • Hormonal changes: Increase in Relaxin, which relaxes ligaments and soft tissues, increasing joint laxity and injury risk.

• Exercise Guidelines for Pregnancy:

  • ACOG Recommendations: Moderate intensity, $30$ to $60$ minutes, $3$ to $4$ days per week (up to daily).

  • WHO/US Dept Health: At least $150$ minutes of moderate-intensity aerobic exercise per week.

  • Intensity: Use RPE or the Talk Test. Maintain heart rate at less than $60-80\%$ of age-predicted maximal HR ($MHR$).

  • Positions: After $20$ weeks, avoid lying in a supine position for long periods.

  • Warning Signs to Stop: Vaginal bleeding, amniotic fluid leakage, chest/abdominal/calf pain, swelling, or regular painful uterine contractions.

  • Aquatic Temperature: $83$ to $85$ degrees Fahrenheit.

• Postpartum Guidelines:

  • Return to activity requires physician clearance (especially after C-sections or complications).

  • Prioritize restoring pre-pregnancy fitness, weight loss, and maternal sense of control.

  • Breast Care: Wear a supportive bra and express milk before exercise to avoid discomfort from engorgement.

  • Hydration: Essential for milk production if nursing.

  • Warning Signs: Stop and seek medical attention if bright red vaginal bleeding occurs (heavier than normal menstrual periods).

Effects of Medications and Substances on Heart Rate (HR) Response

• Beta Blockers:

  • Resting HR: Decreases.

  • Exercise HR: Decreases.

  • $VO_2\text{max}$: Decreases with acute use; increases with chronic use.

  • Intensity Monitoring: Participants MUST use RPE. HR measurements will not reflect actual work, as the drug prevents the heart from reaching age-predicted target heart rates ($THR$).

• Antihypertensives (ARBs and CCBs):

  • Resting HR: Decrease or no change.

  • Exercise HR: Decrease or no change.

  • Exercise Capacity: No significant change.

• Other Antihypertensives:

  • Variable response (increase, decrease, or no change depending on the specific drug and dose).

• Antihistamines:

  • Resting HR: Increases.

  • Exercise HR: No change.

• Antidepressants / Antianxiety Medications:

  • Resting HR: Increase or no change.

  • Exercise HR: Increase or no change.

• Stimulants and Caffeine:

  • Resting HR: Increases.

  • Exercise HR: Increases (Caffeine may be no change).

  • Performance: Generally increases endurance.

• Bronchodilators:

  • Generally no change in HR; may increase $VO_2\text{max}$ in individuals with COPD.

• Alcohol:

  • Resting/Exercise HR: No significant change.

  • Performance: Decreases $VO_2\text{max}$ and coordination; exercise is prohibited while under the influence.

• Nicotine Replacement Therapy:

  • Resting HR: Increases.

  • Exercise HR: Increases.

  • Capacity: No change or decrease.

• NSAIDs (Non-steroidal anti-inflammatory drugs):

  • No significant change or slight increase in exercise capacity/performance.