module 2 lifestyle, fitness and wellness aims:to heighten awareness of the importance of choosing a...

Module 2 Lifestyle, Fitness and Wellness

Aims: To heighten awareness of the importance of choosing a

healthy and active lifestyle, and to understand the

effects of stress and nutrition on lifestyle.

Objectives Module 2

Objectives:• To recognise the consequences of modern

society and identify the reasons for choosing a healthy lifestyle

• To describe techniques used to motivate individuals to participate in regular physical activity

• To prescribe exercise modification for people with special needs in a regular exercise class

Objectives

• To describe appropriate stress reduction techniques

• To describe the principles underlying healthy eating and the relationship between energy balance, physical activity and weight management

Continuous Assessment Procedures

Two written assessments 50% x 2

(6-7 questions per assessment, 40 mins for each

assessment)

3.1.a.iv OH

What is a healthy lifestyle?

Stress M anagem ent D iet

Physica l Activ ity Sm oking

Healthy Lifestyle

WHO/FAO (2003)

• “The burden of chronic diseases – which include cardiovascular diseases, cancers, diabetes and obesity – is rapidly increasing worldwide. In 2001, chronic diseases contributed approximately 59% of the 56.5 million total reported deaths in the world and 46% of the global burden of disease.”

• Global Strategy on Diet, Physical Activity and Health (WHO/FAO June 2003)

Risk Factors for Chronic diseases

• High blood pressure• High cholesterol levels• Obesity• Low levels of physical activity• All of these risk factors could be easily

prevented.

Cigarette Smoking

• Cigarette smoking affects the heart and the lungs

• Causes cancers and is a risk factor for osteoporosis

• Passive smoking is a significant factor in cardiovascular deaths each year (American Heart Association, American Lung Association, American Cancer Society)

Stress Management1. Continuous stress over time may

contribute to heart problems and other illnesses.

2. Exercise, listening to music, meeting friends are all ways to relax.

3. Everyone should find time to relax and do something enjoyable.

4. Adequate rest and sleep are necessary to avoid fatigue, a possible stressor.

Diet

• Eat a wide variety of foods – Food Pyramid

• Reduce fat intake• Increase intake of fruit and vegetables• Drink more water• Eat less sugary foods and drinks• Reduce salt intake• Alcohol in moderation – 14 units for

women, 21 units for men over one week

Physical Activity

• Undertake moderate-intensity physical activity for at least an hour a day (WHO/FAO, 2003).

• Choose activities you enjoy• Choose activities that are dynamic and

use the major muscle groups.• Examples – brisk walking, swimming,

cycling, dancing etc (AHA, 2002)

Physical Activity 2

• Simple rule – physical activity should elevate heart rate and breathing somewhat, but a person should still be able to carry on a conversation. (ACSM, 2001)

• Greater health benefits can be achieved by increasing the amount (duration, frequency or intensity) of physical activity (Surgeon General’s Report, 1996).

Health Benefits of Regular Exercise

Energy Levels improved

Strengthen muscles

Social benefits

Body fat reduced

CV Endurance improved

Stress management

Bone health

Lean body tissue increased

Improved BP

CHD risk reduced

Risk of diabetes reduced

Flexibility improved

Reaction time improved

Arthritis – Quality of life

Mental wellbeing

Risk of injury reduced

Benefits of Daily Physical Activity (AHA, 2002)

• Reduces risk of heart disease• Healthy body weight• Healthy cholesterol levels• Prevents and manages high blood

pressure• Prevents bone loss• Boosts energy levels

Benefits of Daily Physical Activity 2

• Stress management – releases tension, improves sleeping patterns

• Improves self-image• Counters anxiety and depression• Improves muscular strength• Accommodates socialisation• Establishes good lifetime habits in

children• Maintains independence and quality of life

in older adults

Precautions for a Healthy Start

• Suggestions?• Medical readiness• To avoid soreness and injury?• People with chronic health problems

should consult their physician (screening)• Any other advise? – Footwear, clothing,

hydration, timing of exercise etc

Exercise for Fitness(ACSM, 2000)

• Cardio-respiratory fitness and body composition

• Muscular endurance and strength• Flexibility• FITT

Category Frequency Intensity Time Type Cardiovascular 3-5 days per

week 60-85% MHR 20-60

minutes Large muscle mass, continuous, rhythmic

Muscular Strength/Endurance

2-3 days per week

8-12 RM range 60-70% 1RM (LME) 70-90% (MS)

1 set each of 8-10 exercises (less than 1hr)

Major muscle groups, full ROM, controlled speed

Flexibilty 2-3+ days per week

To mild discomfort/point of tension

15-30 secs Static or assisted (PNF)

ACSM’s Guidelines for Exercise Testing and Prescription (2000)

Wellness

• Integration of all parts of health and fitness that expands one’s potential to live and work effectively (Mind/body concept)

• Self-responsibility• How one feels as well as one’s ability

to function effectively

Domains of Wellness(Mind/Body Concept)

• Social domain: Personal relationships• Emotional domain:Positive self-concept• Physical domain:Exercise, Diet and safe

practices• Occupational domain: Productivity• Intellectual domain: Critical Thinking• Spiritual domain:Meaning and purpose

in life

How can adopting a healthy lifestyle benefit

the domains of wellness?

• Physical• Emotional• Social• Intellectual• Occupational• Spiritual

Hypokinetic

Risk Factors (What

diseases/illnesses may occur?) • Excessive weight• Low levels of physical activity• Poor dietary habits• High blood pressure• Excessive stress• Cigarette smoking• Excessive alcohol consumption

Revision

• Briefly define wellness and outline its components.

• Explain the term ‘hypokinetic’.• Name three hypokinetic diseases or

conditions.• Identify risk factors that cause these

diseases.

Cardiovascular Disease

• Irish men and women have the highest rate of death from CHD in the EU before age 65. (WHO)

• Almost as many women die each year from heart disease as men. (IHF, 2002)

• In 2001, just under 6,000 women died from diseases of the heart and circulatory system and just over 6,000 men. (IHF, 2002)

The Heart (M1 notes)

Coronary Heart Disease (CHD)

• Arteriosclerosis: hardening of the arteries due to conditions that cause the arterial walls to become thick, hard and non-elastic

• Atherosclerosis: progressive condition; deposits of cholesterol; other lipids and cellular waste products accumulate on the inner walls of the coronary arteries; plaque

Coronary Heart Disease (CHD)

• What Injures the Lining of Arteries?

High blood cholesterol levels, excessive dietary cholesterol and saturated fats, high blood pressure, nicotine, reaction to perceived stress

• Ischemia: decrease in blood supply to heart muscle

Heart Disease through the Life Cycle

Damage to the Heart

Damaged Artery

Questions (1)

• What Is Angina Pectoris?

Coronary artery is partially blocked leading to O2 debt. May be brought on by vigorous exercise or sudden exertion. Individual feels a sharp pain in the chest, jaw or along the inside of the arm indicative of a mild heart attack.

Questions (2)

• What Is Myocardial Infarction?

Results when one or more coronary arteries are blocked by atherosclerosis and a blood clot (thrombus) plugs the remaining opening. Portion of heart muscle beyond blockage is deprived of O2, resulting in injury or death of that portion.

Questions (3)

• What Is a Stroke?• Blood vessel bursts or artery is clogged

by clot or other matter. This causes nerve cells to die. Brain cells cannot heal.

• Risk Factors for Stroke: hypertension, heart disease, gender, diabetes, age, race, stress, smoking, high cholesterol levels

Risk Factors for CHD

• High blood pressure• Smoking • Obesity - android, high blood pressure,

high blood lipids, diabetes• Stress• Sedentary lifestyle

Risk Factors for CHD

• Family history• Gender: oestrogen effect may raise

levels of HDLs• Age: males after 45 years, Females

after 55 years• Race: in the U.S., blacks are 33% more

likely to suffer from hypertension

Modifiable and Non-Modifiable Risk Factors

for CHD

• High blood pressure• Cigarette smoking• Inactivity• High blood cholesterol

levels• Obesity• Stress

• Age • Positive

family history• Gender• Race• Diabetes

mellitus

Cholesterol

• Suggested “Healthy” levels of cholesterol – Total cholesterol no greater than 5 mmol/L. LDL cholesterol no greater than 4. HDL cholesterol greater than 1.15 (IHF, 2003)

• LDLs: more prone to oxidation by macrophages at an injured site on the arterial wall (plaque). Smoking, emotional stress, diets high in saturated fats increase LDLs.

• HDLs: protective against the development of atherosclerosis. Acts as a scavenger. Exercise may increase levels of HDLs.

Primary Risk Factors

• High blood pressure• High blood lipid levels• Cigarette smoking• Inactivity

Secondary Risk Factors

• Obesity• Stress• Age• Gender• Race• Positive family history• Diabetes mellitus

Exercise Programming for Clients with CHD

• Frequency = 3-4 times per week• Intensity = low intensity dynamic

exercise, gradually increasing to 60-85% MHR, 4-7 RPE(11-15 RPE)

• Time (duration) = total exercise duration should be gradually increased to 30-60 mins

• Type = aerobic exercise (long gradual warm-up and cool-down); resistance training: low weight, high reps; flexibility

Review

• Exercise for health – recommendation? Give examples

• Exercise for Fitness should include what components of fitness?

• Domains of wellness• Why is exercise recognised as a means

of reducing the incidence of CHD?

Risk Factors for Coronary Heart Disease

– Exam Question

• List 5 modifiable risk factors for CHD and identify what lifestyle changes can positively influence such risk factors. (15 marks)

• Answer may be given in table format• Key words?

• Read question twice• Underline key words• Decide - Give answers in bullet

points/ table format/ diagram• Read question again• Check if you are on the right track• Write answer• Leave 8-10 lines blank – in case of

Divine Inspiration!

Risk Factor + Lifestyle Modifications

High blood pressure

Reduction in dietary fat; aerobic exercise; stress management

Cigarette smoking

Quit

Sedentary lifestyle

Adopt CV exercise programme

High cholesterol levels

Reduction in dietary fat; aerobic exercise

Obesity Diet; exercise programme

Blood Pressure

• Is the force exerted against the blood vessel walls

• Arterial blood pressure is the one most commonly measured and most important to our health

Blood Pressure 2

• BP is given in two numbers – systolic/diastolic

• Systolic = that phase during which the heart is pumping blood through the arterial system

• Diastolic = that phase when the heart is resting between beats and blood is flowing back into it

Hypertension (high blood pressure)

• Stage 1 (mild) 140/90• Stage 2 (moderate)

160/100• Stage 3 (severe)

180/110• Stage 4 (very severe)

>210/>120

Factors That Influence BP

• Age• Body position• Time of day• Smoking

Alcohol intake Caffeine Exercise Stressful situation

Risk Factors for Hypertension

• Family history• Gender• Race• Obesity

Sedentary lifestyle Alcohol Salt intake Low potassium intake

(irregular heart beat)

Why is Hypertension Dangerous?

• Drastically increases workload on the heart

• Can damage the arterial walls (CHD)

Measures to Prevent Hypertension

• Drug therapy• Dietary reduction of fat• Dietary reduction of salt intake

Measures to Prevent Hypertension

• Alcohol in moderation• Aerobic exercise with large muscle

groups 3-5 times per week at an intensity of 50-85% of maximal O2 uptake for 20-60 minutes duration

• What exercises may be dangerous for someone suffering from hypertension?

Exercise Recommendations for Hypertensive Individuals

(ACSM 2000)

Frequency: 3-7 days per week to maximize the benefits of blood pressure reduction from exercise.

Intensity: lower end of heart rate range (40-65% MHR) / 11-13 RPE scale / client should be able to carry on conversation while exercising (talk test)

Exercise Recommendations for Hypertensive Individuals

(ACSM 2000)Time: Use a longer and more gradual warm-

up > 10 mins. Total exercise duration should increase gradually from 30 to 60 mins.

Type: Aerobic exercise – walking, swimming, cycling. Wts: low resistance, high reps, compound exercises. Avoid Valsalva manoeuver. Flexibility.

Revision of Hypertension

• Explain blood pressure.• List risk factors for Hypertension.• Identify exercise guidelines for

hypertensive individuals (FITT).

Session 4 Objectives

At the end of the session, students will be able to:

• identify psychological and social factors that inhibit individuals from participating in regular physical activity

• discuss how body image and self-concept could cause perceived barriers to exercise

• identify the different factors for internal and external motivation to exercise adherence

Session 4 Objectives

• outline strategies that will encourage individuals to (a) become involved and (b) stay involved in physical activity

• identify the role of the instructor in aiding adherence to exercise

Why Do People Exercise?

Why Do People Not Exercise?

Characteristics of Adherers

• Enjoy physical activity• High self-motivation• High exercise knowledge• Positive attitude toward exercise• Perceive benefits outweigh the

costs• Past participation in exercise• At high risk for heart disease

Characteristics of Adherers 2

• Perceived good health• Sufficient behavioural skills• Receive social reinforcement for

exercise• Perceived available time

Dishman et al, 1988

Characteristics of Dropouts

• Blue collar occupation

• Smoker

• Overweight

• Psychological mood disturbance

• Perceived poor health

• Low self-motivation

• Low exercise knowledge

• Negative attitude towards exercise

• Perceived disruptions in exercise routine

• Activity too intense, too much exertion

Reasons for Exercise

• Fun• Feeling good• Weight control

• Challenge• Stress Reduction• Doctor’s advice

• Social reasons

• Appearance• Achievement• Competition• Health• Skill Learning• Self-actualisation• Fitness

Perceived Barriers to Exercise

• Lack of time• Injuries

• Expense• Lack of support• Limiting health• Lack of interest

• Previous exercise experience

• Lack of choice• Lack of facilities• Boredom• Too much effort

Transtheoretical Model (Stages of Change)

P recon tem p lation Con tem p lation

P rep aration A ction

M ain ten an ce R elap se

S tag es o f Ch an g e

(Prochaska & Marcus, 1994)

The Stages of Change

Typical Behaviour

Pre-contemplation Not interested, ‘in one ear, out the other’

Contemplation “maybe I should”, “if I don’t lose weight ….”

Preparation “I’ve enquired about classes in my area and organised babysitter!”

Action The starter/novice exerciser

Maintenance The stayerRelapse The ‘stop/start’ client

TTM - Strategies

• Precontemplation (“never) – be non-judgemental; information leaflets etc

• Contemplation (“someday”) – Assure the client that change is worthwhile

• Recognition of source of motivation is important at this stage – e.g. successful weight loss by a friend

TTM - Strategies

• Use strategies such as free introductory visit/discounts/before and after pictures etc

• A contemplator weighs up the pros and cons of initiating behaviour

Preparation

• Preparation (“soon”) – encourage client to set date to commence exercise

• Guide the client into an exercise programme that suits their interests and personality type

Preparation

• Discuss potential barriers to starting an exercise programme and provide solutions for each. E.g. Effort of getting to the gym, physical discomforts etc

Action – Take Off!

• Encourage progression rather than perfection

• Attendance goals vs improvement goals• Increase exercise intensity gradually• Identify the client’s strengths • Praise their efforts and adherence• Help clients to recognise the intrinsic

rewards of exercise (e.g. increased energy).

Maintenance & Relapse

• Task now is to keep client motivated to prevent relapse to sedentary lifestyle

• Create new challenges (long-term goals – mini-marthon), use fitness assessments

• Encourage intrinsic and extrinsic motivation

• Ensure variety to avoid drop out• Acknowledge possible relapse situations

DISC System of Personality Type

Dominant (D) Driven, decisive, competitive, confident, assertive, goal-oriented

Interactive (I) Optimistic, enthusiastic, sensitive, disorganised, emotional, social

Steady (S) Reliable, easy-going, patient, loyal, agreeable, complacent, people-focused

Cautious (C) Analytical, systematic, diligent, accurate, thorough, task-oriented

Strategies to Encourage Exercise Adherence (Summary)

• Make exercise sessions easy, interesting and fun

• Acknowledge exercise discomforts • Use exercise reminders, cues and

prompts• Encourage an extensive social

support system

Strategies to Encourage Exercise Adherence

(Summary)

• Develop group camaraderie• Emphasise positive aspects of

exercise• Help develop intrinsic rewards• Set attainable goals (SMART),

action-oriented not outcome-oriented

• A lady client in your gym is very overweight and is keen to start an exercise programme to help her lose weight. She is shy and lacks confidence and is very reluctant to exercise in public.

• How would you deal with this client?• (Give evidence of relevant teaching

strategies/skills so as to promote exercise adherence.)

• Headings/Table – bullet points

Initial Meeting/ Screening

Tests

Goalsetting

Programme (FITT)

A.O.A

Session 5 Objectives

At the end of this session, students will be able to:

• define stress• give examples of stress-inducing factors• describe the positive and negative aspects

of stress• describe and demonstrate a range of stress

management techniques for a variety of situations

Stress Management

What Is Stress?

• Eustress – positive stress, motivates us to act

• Distress – negative stress• Stress response – • Acute (quite intense but disappears

quickly) • Chronic (lingers for prolonged periods

of time)

Stress Response/Alarm Reaction

• Muscles tense and tighten• Breathing becomes deep and

fast• HR rises and blood vessels

constrict• Blood pressure rises

Stress Response/Alarm Reaction

• The stomach and intestines halt digestion temporarily

• Thyroid gland is stimulated• Perspiration increases, secretion of

saliva slows down• Blood sugar and fats rise• Sensory perceptions become

sharper

Types of Stressors

• Environmental stressors: heat, noise, overcrowding, climate

• Physiological stressors: drugs, caffeine, tobacco, injury, infection or disease, physical effort

• Emotional stressors: life-changing events, family illnesses, death, problems with superiors, increased responsibilities

Ill Effects of High Stress

• Heart disease• Cancer• Infection• Suppressed immunity• Asthma attacks

• Back pain• Chronic fatigue• Gastrointestinal

distress• Headaches• insomnia

Stress Management

• Active exercise• Rest and sleep• Breathing• Meditation• Imagery• Autogenic training• Progressive relaxation

training

Stress Management 2

• Controlling stressors: Tackle it through modification, reduction in numbers, avoidance

• Managing stress reactions: Reframing/ the mind can choose a more positive response to any particular stressful event

• Seek the social support of others: sharing emotional, social, physical, financial support and assistance of others rather than social isolation

Stress Management 3

• Diet: prudent intake of alcohol, caffeine, fatty foods, sugary foods and salt

• Increase intake of fruit and vegetables• Time management: prioritise, make lists,

plan ahead, learn to say “no”, take one thing at a time, reward yourself for getting things done

• Take time out for you – laugh!!

Session 6 ObjectivesAt the end of this session, students will be able to:• identify the psychological, physiological and social

factors regarding back pain• identify the main causes of back pain, e.g. incorrect

exercise techniques, muscular imbalances, overuse, wear and tear and age

• discuss the importance of good posture in the prevention of back pain

• identify the necessary exercises to alleviate back pain, giving recommendations for client care in different situations

Session 6 Objectives

• describe the safety guidelines necessary when programming for back pain sufferers

• design a positive exercise programme for the back pain sufferer to include resistance exercises, flexibility and CV exercises

• identify and apply the necessary safety concerns for clients taking exercise with low back pain

Structure of the Spine

Examples of Causes of Lower Back Pain (lbp)

Prolapsed intevertebral disc

Causes of back pain 2

• Wear and Tear – Arthritis/degenerative disease

• Affects the joints between vertebrae and joints as the back of the spine

• Discs may become thinner – spikes of bone may press on nerve roots

• Causes pain/pins and needles/numbness

Causes of back pain 3

• Strained muscles due to a sudden of unexpected movement

• Muscles are more easily strained if fitness is poor/not warmed up before exercise/fatigued

• Strained ligaments – injured when joint is stretched to its limit and held there too long, or repeated too often

Causes of back pain 4

• Internal problems: kidneys, gallstones, gynaecological problems, shingles

• Emotional problems – chronic daily stress

Prevention of Back Pain

• Standing Posture – low-heeled shoes

• Use ledge to relieve stress on back

• Work surfaces at correct height

• Seated posture – sit with knees higher than hips

• Use foot rest

• Have a chair that supports lower back

• Adjust monitor height if necessary

• Have orthopaedic bed• Bend knees• Have supportive pillow• Lifting – (M8) 3Bs• Footwear while

exercising• Exercise technique• Exercise intensity

Why do the following people suffer from back

pain?

What lifestyle changes could they make to prevent back pain?

Exercise Programming

• CV exercise while maintaining spine in neutral (stomach tight, back straight, shoulders back, chest lifted)

• Suitable CV machines (stepper?)• Strengthen the abdominal muscles –

Core stability, use of mats and stability balls (M10)

• Stretch the hamstrings and erector spinae (M10)

Exercise Programming

• Strengthen erector spinae (M10)• Introduce clients to Pilates and Yoga• Abdominal ptosis should be

prevented through use of diet and exercise

• If in doubt, refer to a specialist!

Backache Risk Factors (Corbin and Lindsey, 1994)

• Overweight• Frequent bending over (forward flexion)• Lack of lumbar flexibility• Lack of hamstring flexibility• Weak trunk extensor muscles• Trunk muscle imbalance• Age• Osteoporosis

Backache Risk Factors• Previous back problems• Participation in certain sports where

there is a repetitive and large range or rapid acceleration or deceleration of the spine

• Poor posture or postural imbalances

• Incorrect exercise technique

Backache Risk Factors

• Improper lifting technique• Poor fitness levels• Overuse• Poor footwear and mechanics

Exercise Programme for Back Care - Question

• design a positive exercise programme for a back pain sufferer(lbp) to include resistance exercises, flexibility and CV exercises

• Chronic lbp sufferer – non-disc related• Doctor’s approval to exercise• FITT• Specific exercises to be included (stretch &

strengthen)• Modifications

In general, maintenance of regular physical activity during pregnancy helps keep the

mother fit and healthy, causes no harm to the growing foetus, and may improve the birthing

experience.

(Nieman, 1998)

Regular, moderate exercise is sufficient to derive health benefits. Pregnant women

should listen to their bodies, stop exercising when fatigued, and not exercise to

exhaustion.

ACOG (1994)

Screening – What Questions?

• Doctor’s clearance?• First baby?• Any complications in previous pregnancies?• Pregnancy induced hypertension?

Screening – What Questions?

• Pre-term rupture of membrane?• Any persistent bleeding,

dizziness, pain?• Sudden swelling of ankles?• Stage of pregnancy?• Regular exerciser/previously

sedentary?

Warning Signs to Stop Exercise

• Vaginal bleeding• Abdominal/chest pain• Leaking/gushing from

vagina• Swelling of hands, feet or

face• Severe headache• Dizziness• Reduction in fetal activity

• Painful, reddened area in the leg

• Severe pain in hip/pelvic area

• High temperature (>38 degrees C)

• Persistent nausea/vomiting

• Uterine contractions• Heart palpitations• Shortness of breath

Pre-class Advice

• Intensity – low to moderate• 4-6 RPE scale, <75% MHR, 140 bpm• Low impact• “easy” stretches• Floor exercise adjustments• No sudden changes in direction• Placement near exit• Hydration

Benefits of Exercise

• Increase energy• Maintain fitness level• Control weight• Improve posture – decrease backache• Promote circulation• Decrease constipation• Reduce stress – enhance sleep

Changes in the body

• Diaphragm• Internal organs (stomach & intestines)• Lumbar spine• Bladder• Uterus• Sciatic nerve

Breathing Changes

• Diaphragm pushes upwards

• Breathless, may hyperventilate - don’t over-exert

• O2 consumption increases

• Lift arms up and out to ease breathing

• Breathing rate increases by 45%

• Avoid exercising in humid weather

Heart and Circulatory Changes

• Heart wall thickens, heart enlarges• Blood volume increases• Resting heart rate increases• Cardiac output increases• Cardiac reserve diminishes• Blood vessels soften and stretch• Varicose veins• Blood vessels constrict in some cases

Heart and Circulatory Changes 2

• Supine Hypotensive Syndrome

Implications

• Tire sooner• Moderate intensity – RPE 4-6 • < 75% MHR• Change direction slowly• Rise slowly from the floor• No exercises in supine position after

12 weeks

Stomach and Intestinal Changes

• Heartburn and indigestion• Constipation• “Morning sickness”

Implications:• Exercise at the same time everyday• Drink plenty of fluids• Eat an hour before exercise

Kidney and Bladder Changes

• Need to urinate more frequently• Leaking urine• Swelling

Implications:• Pelvic floor exercises• Placement in class• Minipads

Muscular, Joint and Postural Changes

• Centre of gravity shifts• Lordosis• Kyphosis• Relaxin- joint looseness• Diastasis recti

Diastasis Recti

Muscular, Joint and Postural Changes

Implications:• Change direction slowly• Keep choreography simple• Strengthen back, buttocks

and abdominals• Don’t stretch to maximum

Pelvic Floor Changes

• Sag due to weight of uterus

Implications:• Pelvic floor exercises - 50 reps per

day

Potential Risk for the Foetus

• Decrease in blood flow to the uterus• Reduced glucose supply to the foetus• Overheating

Implications:• Do not exercise to exhaustion• Reduce exercise time

Energy Intake

• Extra energy is required during pregnancy (300 calories – ACOG)

• Extra demands on blood glucose during pregnancy

• Balanced diet (food pyramid)

First Trimester

• Fatigue• Nausea• Emotional changes• Frequent urination• Blood volume

increases• RHR increases• HRR decreases

• Shift to maintenance mode

• Watch for overheating

• Holding of breath• Overstretching• Monitor intensity –

RPE, HR, observation

Second Trimester

• Changes in posture• Weight gain• Joint laxity increases• COG changes• Lordosis increases• Risk of diastasis recti

• All low impact work• 4” or no step• No sudden changes

in direction • Care when getting

up from the floor• No supine work• Stationary

bike/treadmill walking/swimming

Third Trimester

• Posture and Gait changes

• Uterus is 1000 times its normal size

• Increased fatigue (insomnia)

• Decreased ROM• Increased shortness of

breath• Heartburn

• Avoid quick jerky movements

• Do not exercise to fatigue

• Opt for swimming and stationary cycling/treadmill walking

• Use stability ball/wall squats to relieve LBP

Benefits of Exercise Postpartum

• Opportunity for weight loss increases

• Urinary incontinence decreases

• Favourite activities can be resumed more quickly

• Back pain is reduced or eliminated

• Energy levels improve

• Anxiety, depression decrease significantly

(Clapp, 1998; Creager, 2001)

Post-partum

• 6-8 weeks normal delivery• 10-12 weeks for c-birth• Doctor’s written clearance• Gradually resume prepregnancy

exercise levels (ACOG, 1994)• A previously pregnant client should start

with short sessions and gradually build up to desired level of activity (US Dept of Health, 1996)

Postpartum 2

• Postural problems – backache, frequent bending forward over changing table

• Feel fat (extra adipose tissue)• Pelvic floor weak

Postpartum 3

• Fatigue – disrupted sleep patterns• Start with non-weight bearing exercises

and walking• Strength work – target abs, back, pelvic

floor (core stability)• Ensure adequate calorie intake and

hydration

Postpartum 4

• Beware of any signs of overexertion – dizziness, joint pain, bleeding

• Certain moves e.g. jumping jacks may cause stress incontinence

• Keep stretches “easy”

Exercise and Pregnancy

• Identify the benefits of exercise for a pregnant client.

• Outline 3 adaptations that should be made for the pregnant client in an exercise to music class. Give the physiological reasons for these adaptations.

“No one is too old to enjoy the benefits of regular physical

activity.” US Surgeon General, 1996

Exercise and the Older Adult

• 11% of the Irish population is aged over 65. By 2026, it is projected that 18% of the population will be over 65. (Codd et al., 1998)

• This has serious implications for resources in health care and for the HFI.

Exercise and Older Adults 2

• National Survey of Involvement in Sport and Physical Activity (1996) reported that 40% of the adult population were sedentary. This portion is disproportinately drawn from older adults – male and female.

• Sedentary = people who in the past 30 days have not sustained any activity for 20 minutes

Exercise and the Older Adult 3

• The age-related decline in activity is also shown by the Irish Universities Nutrition Alliance (1997, 1999)

• It showed that activity levels are low among Irish adults and that activity declines significantly with age – 51% of women aged 51-64 years reported no vigorous activity

Exercise and the Older Adult 4

• Comparing the results of the Institute of European Food Studies (1997) & a survey by Dept of Health and Children (1998)

• Participation in “everyday” activities such as walking and gardening was declining

Barriers to Participation

• Lack of money• Community halls were unavailable

(licencing/insurance problems)• Too few adequate paths and trails in

the country side• Lack of information about activities,

events and courses.• “Quality of Life” Survey, Limerick

County Development, 2001

Barriers to Participation 2

• Facility issues (lack of facilities, difficulty of access)

• Lack of facilities specific to the needs of older people

• Lack of transport• Concerns about health/fitness/age• (Ballymun Active Living Survey, 1999)

Overcoming Barriers

Realisation that• It is possible to become active without

great cost• Being active does not entail a large time

commitment• It is not necessary to be sporty, have lots

of free time, or be a member of a gym

Overcoming Barriers 2

For older people the social element of physical activity is very important

(Ballymun Active Living Survey (1999)

Reasons for Participation

• Enhance their daily functionality• Play with their grandchildren• Socialise• Shop, cook and maintain independent

lives• Enjoy recreational activities• (Pruitt, 2003)

Screening Older Adults

• Moderate risk classification (ACSM, 2000)• ≥45 years for men• ≥ 55 years for women• Doctor’s written clearance• Detailed questionnaire that investigates

existing and prior medical conditions

Medical Concerns for Older Adults

Heart disease, high blood pressure, diabetes, stroke, cancer, arthritis, orthopaedic impairments, hearing impairments, cataracts, visual impairments, osteoporosis, senile dementia, depression, overmedication

• As much as 50% of the functional decline seen in ageing is related to disuse and can be prevented with regular exercise.

Physiological Changes

• VO2 max is reduced (8-10% per decade ›25 years)

• Cardiac output is reduced (20-30% by 65 years)

• Blood vessels become inelastic• Max HR decreases

Physiological Changes

• Respiratory changes: vital lung capacity reduces, chest wall compliance, and alveolar size decreases

• Body Fat increases – metabolic rate is reduced

Physiological Changes

• Muscle mass and strength reduces (particularly in the lower body)

• Loss in bone mass• Connective tissue loses its elasticity,

muscle fibres shorten and joints produce less synovial fluid

Physiological Changes

• Reduction in nerve conduction, number of neurons and brain mass

• Reduction in haemoglobin• TC increases and HDLs reduce• Balance, taste, sight, hearing

Task

• What implications do these changes have for the design of physical activity programmes?

• (Intensity, length of warm up and cool down, selection of exercises, components of fitness etc)

Benefits of Physical Activity 1

• Primary and secondary prevention of chronic diseases (e.g. CHD, adult onset diabetes), disabling conditions (e.g. osteoporosis), and chronic disease risk factors (e.g. high blood pressure, obesity) (CDC, 2002)

Benefits of Physical Activity 2

• Greater life expectancy• Delays the onset of functional limitations

& loss of independence• Lowers risk of falls (balance work)• Manages arthritis – maintains ROM,

reduces pain & improves function

Benefits of Physical Activity 2

• Improves sleep patterns• Reduces symptoms of depression• May reduce the amount of cognitive

associated with ageing

Benefits of Exercise While Ageing (ACE, 2002)

– To increase bone density and prevent osteoporosis

– Increases muscle mass and metabolism– Create a sense of belonging through

social interaction– To improve pulmonary function

Benefits of Exercise While Ageing (ACE, 2002)

– To help prevent and regulate non-insulin dependent diabetes by regulating blood sugar levels

– To improve flexibility, joint ROM– To improve blood circulation– To improve cardiovascular endurance

Programming for the Older Adult

• Many may not have exercised for 10, 20, 30+ years

• Start at low intensity levels – teach RPE, use talk test, external observation

• Consider interest level, medical limitations, base progression on the client’s functional capacity, health status, age, preference and needs or goals

• Work on diaphragmatic breathing, making sure clients avoid shallow breathing

Programming for the Older Adult 2

• Work on enabling the client to get up and down off the floor, develop static and dynamic balance

• A minimum of 10 minutes should be given to flexibility training, where stretches are held for 10-15 seconds

• Ensure clients stay hydrated• Remember their thermoregulatory

capacity is reduced with age – therefore wear layers

Cardiovascular Training for Older Adults (ACSM, 2000)

Frequency

3 times per week on alternate days

Intensity 50-60% MHR initially Increase gradually to 75% MHR

Time 5-15 minutes 2/3 times per day until client can sustain exercise for 30 minutes

Type Work within client’s orthopaedic tolerance level. Walking/Aquatic exercise/recumbent cycling

CV Programming for Older Adults

• Frequency, intensity and duration should be changed individually

• Altering them at the same time may provide too much overload

Weight-training and Older Adults

• Studies show that is it never too late to improve muscular strength and size through weight training, and that elderly people who do so can greatly improve function and life quality. (Nieman, 1998)

LME/Strength Recommendations (Swain & Leutholtz, 2002)

• F: 3 times per week (alternate days)• I: 8-12RM. Once client can lift wt 12

times increase wt by 10% to bring client back to 8RM

• T: 20-30 minutes per session• T: Machine wts, multijoint, linear,

pulling/pushing movements initially e.g. leg press

LME

• Target legs, chest, back, shoulders, arms, abdominals and cervical region

• Client with knee and/or hip concerns should focus on multijoint linear movements such as leg press rather than single joint movements like leg extension which can produce sheer force.(Ensure proper technique). Avoid rotional movements like leg abduction and adduction.

LME/Strength

• Focus on proper lifting technique• ROM through painfree arc• Proper breathing • Controlled speed of movement• Do not exercise during an acute

arthritic flare up• Reduce the load by 50% or more

when returning after a layoff

Balance Work

• Balance training helps in the prevention of falls

• One legged standing near a bar, wall or chair

• Standing up and sitting down without using hands

• Walking heel to toe along a line• Use of step aerobics (118-122bpm)• Tai chi has been shown to improve

balance in older adults (Kessenich, 2002)

Goal

• “to die young as late in life as possible” (Ashley Montague)

Osteoporosis

Osteoporosis, porous bone, is a disease characterised by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist (NOF, 2003).

The Silent Disease

• Bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebrae to collapse

• Collapsed vertebrae cause loss of height, spinal deformities (kyphosis) and severe pain

Osteoporosis

• Type 1 occurs primarily in women aged 45-60 years (postmenopausal). This is associated with oestrogen depletion. The most common fractures are in the radius and the vertebrae.

• In the first 5-7 years following menopause, women can lose as much as 20% of their bone mass (Chopra, 2002)

Osteoporosis (Brittle Bones)

• The rate of bone loss slows after this. By age 65-70 men and women lose bone at the same rate (NIA, 2000)

• Type 2 occurs in males and females over 70 years - hip fractures not only associated with low bone mass but with the ageing process.

• An average of 24% of hip fracture patients 50 years and older die in the year following their fractures (NIH, 2002)

Bone Remodelling

• Osteoclasts breakdown old bone• Osteoblasts replace it with new tissue.

Which then mineralises.• With age more bone is broken down

than is replaced.• From the fourth decade onwards,

more bone is absorbed than is formed. The imbalance increases with age.

Microarchitecture of bone deteriorates.

Stages of Osteoporosis

1. Bone building – from childhood to early adulthood (diet rich in Ca and vitamin D; weight bearing exercise)

2. Osteopenia- evidence of reduced bone mass is detected (stooped posture)

3. Osteoporosis – bone loss is unmistakable (bone mineral density test)

Risk Factors

• Low level of peak bone mass• Low lifetime intake of Ca• Smoking• Sedentary lifestyle• Family history• Heavy drinking

Risk Factors 2

• Low body weight – small frame• Prolonged steroid use• Amerorrhea• Oestrogen deficiency due to

menopause• Anorexia nervosa• Advanced age

Nutrition

• Clients should ensure adequate intake of Calcium and Vitamin D

• Sources of Ca: Milk and diary products, broccoli, oranges, grapefruit, figs, fish with bones

• Vitamin D: egg yolks, cod liver oil, fortified milk and cereals.

• It is synthesized in the skin after exposure to sunlight (15 mins of outdoor exercise per day).

• Avoid heavy drinking and smoking

Oestrogen Deficiency

• Oestrogen deficiency is a stronger stimulus for bone loss than Ca deficiency (Raisz and Smith, 1989)

• Oestrogen influences bone three times as much as exercise (Larsson et al, 1979)

Exercise Programming for

Bone Health

• Mechanical stress must be applied to those areas where osteoporotic fractures occur

• Principle of specificity - bone only responds at the site where mechanical stress is placed (Lanyon, 1992)

Exercise Programming for

Bone Health

• Principle of overload• Principle of reversibility• Currently, further study is needed to

clearly outline the training variables that promote bone health

Exercise Programming 2

• Walking is ineffective as a bone-building stimulus

• However adding impact e.g. walking faster/jogging/skipping/Irish dancing will increase strain/stress on bones

Exercise Programming 3

• Radius: sponge ball squeezing, press ups (wall/floor)

• Hips: abduction/adduction with dynabands/ankle weights, squats, leg press

• Back: Focus on posture• Rhomboids/traps, lats, erector spinae and

abdominals (stability work)• Include flexibility for functional

independence

Contraindicated Exercises

• Forward spinal flexion and spinal rotation• Avoid side bending, abdominal work in

supine position• No pilates/yoga exercises in supine position

or with spinal rotation

Diabetes

• Glucose is the main source of energy for the body. It is the only source for brain cells.

• Insulin is a hormone secreted by the pancreas. It stimulates cells to absorb glucose.

Diabetes

• Metabolic disorder - the body cannot metabolise carbohydrates properly, which leads to high levels of glucose in the blood.

• The body then switches to fats and proteins as an energy source.

Long-term Complications of

Diabetes• Blindness• Kidney failure• Nerve damage• CHD• Stroke• High blood lipids• Amputation

Type 1 and Type 2

• Type 1 = <30 years, autoimmune disease

• Insufficieny insulin production keep body cells “locked” so glucose cannot be used as fuel source

• Type 2 = >40 years, adult onset

• Cells unresponsive to existing insulin

• Age, family history, obesity & sedentary lifestyle (risk factors)

• Smoking accelerates the disease

Hypoglycaemia – Insulin Shock

• Insulin reaction (too much circulating insulin) - always carry something sweet, if unconscious seek medical attention immediately

• Make sure the client monitors their blood sugar levels

• Signs = Uneasy, nauseated, confused, uncoordinated, moist pale skin

Hyperglycaemia – Diabetic Coma

• Too little insulin available, dehydration occurs, exercise exacerbates hyperglycaemia

• Signs = dry mouth, sweet smelling breath, weak rapid pulse, abdominal pain, nausea/vomiting

• Insulin injection required immediately and medical attention

Screening Diabetics (Dr’s clearance)

As normal screening plus:• Check for cardio-vascular complications,

i.e. high BP, HR abnormalities• Medical screening and advice on insulin

and dietary changes if needed• Have sugar or sweets at hand in case of a

hypoglycaemic reaction• Ensure the diabetic does not exercise

alone/ overtrain

Exercise Recommendations

• ACSM (2000) Guidelines • 3-5 times per week• 60-90% MHR (progress gradually)• 20-60 minutes• Aerobic: if client has foot or leg injuries

non-impact activity, cue participants to keep legs moving to avoid blood pooling (longer warm up & cool down)

• Include LME/strength work & flexibility

Benefits of Exercise

• Improved insulin sensitivity and blood glucose control

• Prevention or management of obesity

• Improved physical fitness• Improved blood lipid profile

Benefits of Exercise 2

• Reduced blood pressure• Reduced risk of thrombosis• Reduced risk of CHD• Psychosocial benefits

Asthma

• Can occur due to an allergy, anxiety or exercise

• It is an inflammation of the lungs that causes airways to narrow, making is difficult to breathe.

• Results in breathing and speaking difficulties, wheezing, coughing or phlegm; person can also turn a grey-blue colour

Exercise and Asthma

• Avoid exercise if the client has an obvious wheeze or breathing difficulty

• Warm-up period may need to be longer than usual; avoid stopping exercise abruptly

• Always warm down for 10 minutes• Exercise intensity should begin at low

levels and gradually increase as the client’s fitness level improves

Exercise and Asthma

• Avoid exercises that necessitate lying on dusty floors, carpets etc.

• Advise client to take oral medication before and, if needed, during session

• If possible, encourage client to take up swimming where the air is moist and warm

Nutrients

• Carbohydrates: complex and simple• Fats: monounsaturated, polyunsaturated,

saturated fats• Proteins• Minerals (Ca, Potassium, Iron)• Vitamins • Water – no calorific value, 6-8 glasses per

day

Carbohydrates (CHO)

• Simple: glucose, glycogen• Complex: stored in muscle/liver• Food containing complex

carbohydrates also contain fibre which is important for a healthy digestive tract

• Excess is stored as fat (adipose tissue)

CHO

• Provides four calories per gram

• Should contribute to 60% of daily caloric intake, 45-50% from complex CHO and less than 10% from simple CHO

• Recommendation of 20-35 grams of dietary fibre per day

Role of CHO

• Energy source • Four calories per gram • Protein sparing• Fuel for the central nervous system• A metabolic primer for fat metabolism

Fats/Lipids

• < 30% per day• Saturated fats• Monounsaturated fats• Polyunsaturated fats• Essential fatty acid - linoleic acid• Cholesterol is not a fat

Role of Fat

• Energy source and reserve: nine calories per gram

• Cushion for the protection of vital organs

• Insulation from the thermal stress of cold environments

• Vitamin carrier (A, D, E, K) and hunger depressor

Proteins (C, H, O, N)

• Amino acids (20)• Animal sources (turkey, fish, skim milk)• Plant sources (beans on toast)• Excess protein causes liver and kidney

disease• Four calories per gram

Functions of Proteins

• Growth and repair• Main structural component of all tissues of

the body• Formation of enzymes – all physiological

processes are dependent on this nutrient• Formation of hormones

Vitamins (Micronutrients)

• Fat soluble vitamins: A, D, E, K• Water soluble: C- & B-complex vitamins• Regulate metabolism, facilitate energy

release and are important in the process of bone and tissue synthesis

• Vitamin supplementation does not lead to improved exercise performance or potential for training – balanced diet is the key

Minerals

• Provide structure in the formation of bones, teeth and muscles (Ca)

• Deficiency in diet particularly in childhood and adolescence is a risk factor for osteoporosis

• Iron is essential for the formation of haemoglobin

• Deficiency causes fatigue, anaemia, illness

• Sodium is needed for metabolism and blood pressure

Dietary Fibre (Roughage)

• Fibre is found in plant foods like whole grains, fruits and vegetables

• A high dietary fibre intake has been associated with a lower risk of colon cancer and heart disease

• It is an important component of the diet used to help control blood glucose levels in diabetics.

Water (H2O)

• 40-60% of body weight • 65-75% of muscle weight and 25% of

fat weight • Main transportation mechanism in the

body• Regulates the acid-base balance in the

body• Regulates body temperature

Signs & Symptoms of

Dehydration

• Exhausted but restless• Headaches• Tired and dizzy• Muscular cramps in stomach and legs• Pale face and skin is cold and clammy• Individual may faint on sudden

movement

Water Balance: Intake versus Output

Intake• 2-3 litres per day• Liquids• Foods• During metabolism

Output• Loss in urine• Loss through skin• Loss through lungs • Loss in faeces

Hydration (2-3 litres)

• Drink fluids before, during and after exercise

• Dispel myths about sweating and weight loss

• Avoid exercise in extreme temperatures

• Ensure adequate ventilitation

General Dietary Guidelines

• Food Groups: Potatoes, breads and starches; Fruit and Vegetables; Dairy Products; Meat, fish and alternatives

• Fluids• Cooking and preparation of foods

Recommended Dietary Intake

• Fat: 30% or less• Water: 2-3 litres per day• Carbohydrates: 55-60%• Protein: 10-15%

Benefits of Healthy Eating

Benefits of Healthy Eating

• Less risk of coronary heart disease and certain cancers

• Improved appearance, less weight-related problems

• Less risk of nutrient deficiency-related problems

• Increased energy and zest for life

Food Labels

• Name• List of ingredients• Datemark: “use by” or “best before”

• Nutritional information: per 100g/100ml• Weight and Manufacturer• Big e

Major Body Components

• Minerals• Carbohydrates – muscles and liver• Protein• Fat – essential and storage• Visceral and subcutaneous• Water – 60%

Determining Body Composition

• Hydrostatic weighing (laboratory)• Height/weight charts• Body mass index (BMI) = Weight in

kgs/height in metres squared, 20-25 normal, > 30 = obese, > 40 = morbidly obese

• WHR: Males > 0.9-0.95, females > 0.8-0.85

• Body fat percentage - skinfolds

Body Fat Percentage Level

(18 to 30 years)Rating Males

Females

Athletic 6-10% 10-15%Good 11-14% 16-19%Acceptable 15-18% 20-25%Too fat 19-24% 26-29%Obese 25% or over 30% or

over

Source: Williams (1996)

Obesity

• Accumulation and storage of excess body fat

• > 25% body fat for men• > 30% body fat for women• BMI exceeds 30 • Be aware of client care, e.g.

measurement-taking, record-keeping

Hazards of Obesity

• Psychological burden

• Increased incidence of osteoarthritis

• Increased incidence of hypertension

• Increased TC, reduced HDLs

• Increased risk of Type 2 diabetes

• Increased risk of CHD

• Increased incidence of most cancers

• Increased risk of premature death

Terms

• Calorie • Kilocalorie• Metabolism• Basal metabolic rate

(BMR) / Resting Energy Expenditure (REE)

• Thermic effect of exercise

• Thermic effect of food

• Energy balance

Metabolism

• Staying alive - anabolism and catabolism

• BMR = calories per kg of body weight per hour. 70 kg male uses 70 calories per hour. 55 kg female uses 49.5 calories per hour (55 x 0.9)

• Resting energy expenditure (REE)• Thermic effect of food (TEF)• Thermic effect of exercise (TEE)

Daily Energy Expenditure

REE/BMR67%

TEF10%

TEE23%

Factors that affect BMR

• Gender• Age• Body Surface Area• Fitness level• Fasting• Climate

Energy Balance

Nutritional Guidelines for Fat Loss

Nutritional Guidelines for Fat Loss

• Combine decreased calorie intake with exercise

• Reduce body fat gradually• Eat a balanced diet – Food

Pyramid• Drink plenty of water• Food preparation

Weight Loss StepsWeight Loss Steps

• Determine body composition

• Establish reasonable weight loss goals (1-2lbs per week)

• Evaluate dietary habits – fruit and veg intake, water intake, cooking methods, time of eating, breakfast?

Weight Loss StepsWeight Loss Steps

• Avoid crash diets• Train systematically (ACSM

2000 Guidelines)• Utilise behaviour modification

techniques, e.g. set goals, food diary, rewards etc.

Why Dieting Alone Does Not Work

Why Dieting Alone Does Not Work

• Decrease in calorie intake = decrease in BMR: body adapts to conserve energy

• Body reduces energy-burning tissue (lean muscle broken down to supply energy)

• Every time weight is lost through excessive dieting, BMR decreases and food requirements drop even further

What’s the Best Type of Exercise?

What’s the Best Type of Exercise?

• An enjoyable activity that can be maintained for 20-30 mins (to begin with) three times per week (minimum)

• Low to moderate intensity with emphasis on duration rather than intensity

• Included CV, LME, and Flexibility in all sessions

Combine Diet with Exercise

Combine Diet with Exercise

• Exercise ensures BMR is kept high• Muscles burning fuel are less likely

to be used as fuel themselves• BMR remains elevated for 2-4 hours

after exercise (by 4-5% approx)

Myths and Fallacies Myths and Fallacies

• Spot reduction• Meal replacement powders and

pills• Sauna and fluid loss• Crash diets• Vibrating belts/pounding

Behaviour Modification Techniques

Behaviour Modification Techniques

• Use a food diary: record places and situations when fatty foods are eaten

• Rewards• Set goals: long- and short-term using the

SMARTER principle

Behaviour Modification

• Never shop while hungry• Eat slowly, leave down fork and knife

between mouthfuls• Never eat while reading or watching TV• Pre-plan meals/menus

Behaviour Modification

• Smaller plates – leave a little each time

• Keep extras away from the table• Get kids to make their own

snacks• Always keep the fruit bowel full

• “Like puppies, diets are not just for Christmas, they’re for life. And that’s where the problem lies, not on our hips but in our psyches.”

• “The Tribune Magazine”, Jan 1997

• What would be the most effective advice to give to a client to lose weight?/ Information for one page handout

• Exercise Advice• Dietary guidelines• Behaviour Modification

Exercising Programming for Weight Loss

Energy Balance

Negative Energy Balance

• ACSM (2000) recommends a balanced approach that results in gradual fat loss of no more than 1kg (2lbs)/week.

• Negative caloric balance of 500-1,000 kcal per day

• At least 300 kcal should come from exercise

• Initially emphasise duration and frequency

Exercise Programming

• Arthur is sedentary man who has been gradually gaining weight for 10 years. His weight is 18 stone. He is 42 years old. His doctor has referred him for exercise as his brother died of a heart attack at age 47. He has a resting heart rate of 90 bpm. Currently he has no signs or symptoms of heart disease.

Exercise Programming 2

• Include CV, LME, Flexibility in his programme• Use treadmill walking or stationary cycling

initially• Keep intensity low for CV, use

duration/frequency to achieve negative caloric balance

• Include gradual warm up and cooldown• LME exercises should be compound, balanced

(agonist/antagonist), UML• All muscles used in CV phase and LME should

be stretched

Cardiovascular Endurance

• 3 to 5 times per week• 60-85% MHR, may have to start at 50%

as client is deconditioned (always state why)

• 20-60 minutes, may have to start with intervals of 8-10 minutes (deconditioned)

• Aerobic – using major muscle groups

Local Muscular Endurance

• 3-5 times per week• 10 – 12 reps x 1 set (60% 1RM)• Increase reps to 15-20, increase

sets• As long as it takes to do required

number of reps

LME 2

• Circuits, weights (machine and free wts), body resistance

• Minimum of 6 exercises – U, M, L, agonist/antagonist, compound (Keep M exercises out of circuit)

• Circuit must be designed giving exercises, W:R, paying appropriate attention to U, M, L etc

Flexibility

• 3-5 times per week• To the point of tension• 15-30 secs per stretch• Passive, Active, Active Assisted, PNF• Name muscles – relate to CV and LME

Design one exercise session

• Warm up & pre-stretch• CV phase• LME phase• Flexibility – post-stretch• Include information on time, intensity,

type etc• Show balance in LME – have a

minimum of 6 exercises building up to 8/10/12

Group Exercise Session

• Warm up and pre-stretch• Main activity – Circuit (CV & LME), Step,

Exercise to music• Circuit – layout, exclude floor work, W:R,

intensity• Step/Exercise to Music – phases, intensity,

examples of moves for wave effect• Floorwork – exercises, sets, reps• Post-stretch – length of hold, muscles, type

Eating Disorders = Body Image Distortion

Eating Disorders

• Eating Disorders – Why are they so common in western society?

• What practices do they engage in?• What are the longterm effects?• Exercise Addiction – Telltale signs?• Longterm effects?• Positive/negative body image

Eating Disorders

• Term used to describe disturbances in eating habits

• Often observed in young females attempting to maintain or achieve an unrealistic weight

• May begin as simply calorie counting but can escalate to self-induced vomiting and laxative abuse

• Can lead to clinical eating disorders such as anorexia nervosa or bulimia nervosa

Diagnostic Criteria for Anorexia Nervosa American

Psychiatric Association (1994)

1. Refusal to maintain body weight at or above a minimal normal weight for age and height, e.g. weight loss leading to maintenance of body weight less than 85% of that expected.

2. Intensive fear of gaining weight or becoming fat, even though underweight.

Diagnostic Criteria for Anorexia Nervosa American

Psychiatric Association (1994)

3. Disturbance in the way in which body weight, size or shape is experienced, e.g.the person feels fat even when emaciated, and/or believes that one area of the body is ‘too fat’ even when obviously underweight. Will deny the seriousness of the current low body weight.

Diagnostic Criteria for Anorexia Nervosa American

Psychiatric Association (1994)

4. In females, absence of at least three consecutive menstrual cycles when otherwise expected to occur.

• NB. Physical illness that would account for weight loss needs to be excluded.

Diagnostic Criteria forBulimia Nervosa

(APA, 1994)

3. The binge eating and compensatory behaviour occur at least twice a week for three months.

4. Persistent over-concern with body shape and weight.

Diagnostic Criteria forBulimia Nervosa

(APA 1994)

1. Recurrent episodes of binge eating (rapid

consumption of a large amount of food in a discrete period of time, with a feeling of lack of control over eating behaviour during the episode)

Diagnostic Criteria for

Bulimia Nervosa (APA 1994)

2. The person regularly engages in either self-induced vomiting, the use of laxatives,

diuretics, strict dieting or vigorous exercise in order to prevent weight gain.

The Female Athlete Triad

• Eating disorders

• Amenorrhea

• Osteoporosis

Amenorrhea

• Primary amenorrhea – delayed menarche

• Secondary amenorrhea – absence of three or more menstrual cycles

Amenorrhea

Suggested General Causes• Acute effects of stress• Previous history of menstrual

dysfunction• Low body weight and fat• Inadequate nutrition and disordered

eating• Hormonal alterations

Athletes and Amenorrhea

The relationship between training distance and the incidence of amenorrhea

0

20

40

60

80

17 19 22 29 40

% incidence of amenorrhea

Wee

kly

trai

nin

g

dis

tan

ce (

mile

s)

• In athletes, amenorrhea is often related to training intensity

• Training intensity either directly or indirectly affects the incidence of amenorrhea

The Triad

• Poor nutrition from disordered eating and intensive training can lead to low body weight and fat

• Oestrogen is necessary for normal menstrual function

The Triad

• If body fat is very low, may lead to oestrogen levels being low - amenorrhea

• Osteoporosis is a consequence of amenorrhea

• Oestrogen has a protective effect on bone-enhancing calcium absorption and limits its withdrawal