chapter 17 exercise for special populations

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Chapter 17 Exercise for Special

Populations

EXERCISE PHYSIOLOGYTheory and Application to Fitness and Performance, 6th edition

Scott K. Powers & Edward T. Howley


Objectives

1. Describe the difference between Type 1 and Type 2 diabetes

2. Contrast how a diabetic responds to exercise when blood glucose is "in control, " compared to when it is not

3. Explain why exercise may complicate the life of a Type 1 diabetic, while being a recommended and primary part of a Type 2 diabetic undertaking an exercise program


Objectives

4. Describe the changes in diet and insulin that might be made prior to a diabetic undertaking an exercise program

5. Describe the sequence of events leading to an asthma attack, and how cromolyn sodium and β-adrenergic agonists act to prevent and/or relieve an attack

6. Describe the cause of exercise-induced asthma and how one may deal with this problem


Objectives

7. Contrast chronic obstructive pulmonary disease (COPD) with asthma in terms of causes, prognosis, and the role of rehabilitation programs in the return to "normal" function

8. Identify the types of patient populations that one might see in a cardiac rehabilitation program and the types of medications that these individuals may be taking


Objectives

9. Contrast the type of exercise test used for cardiac populations with the test used for the apparently healthy population

10. Describe the physiological changes in the elderly that result from an endurance-training program

11. Describe the guidelines for exercise programs for pregnant women


Diabetes

• Characterized by an absolute (type 1) or relative (type 2) insulin deficiency that results in hyperglycemia

• A major health problem and leading cause of death in the United States

• More than 17 million with diabetes, only 11.1 million are diagnosed


Diabetes

• Type 1– Lack of insulin– Develops early in life– 10% diabetic population

• Type 2– Resistance to insulin– Develops later in life– 90% diabetic population


Diabetes

CharacteristicsType 1Insulin-dependent

Type 2Non insulin-dependent

Another name Juvenile-onset Adult-onset

Proportion of all diabetics ~10% ~90%

Age at onset <20 >40

Development of disease Rapid Slow

Family history Uncommon Common

Insulin required Always Common, but not always

Pancreatic insulin None, or very little Normal or higher

Ketoacidosis Common Rare

Body fatness Normal/lean Generally obese


Exercise and the Diabetic

• Control of blood glucose is important• Adequate insulin is required• Ketosis

– Metabolic acidosis from accumulation of ketone bodies

– May result from a lack of insulin


Effect of Prolonged Exercise in Diabetics

Fig 17.1


Exercise and Type 1 Diabetes

• Pre-exercise blood glucose level– 80 to 250 mg•dl-1

• Timing with insulin– Should not exercise at time of peak insulin

action• Glucose monitoring

– During/after exercise• Carbohydrate intake

– During recovery


Effect of Plasma Insulin Levels in Type 1 Diabetics

During Exercise

Fig 17.2


Exercise and Type 2 Diabetes

• Blood glucose monitoring– In those taking oral hyperglycemic agents

• Exercise prescription– 4-7 times per week

• Promotes weight loss and sustained increase in insulin sensitivity

– Minimum of 1,000 kcal/wk • From all physical activity


American Diabetes AssociationGoals for Nutrition Therapy

• Attain & maintain optimum metabolic outcomes:– Blood glucose levels in normal range– A lipid and lipoprotein profile that reduces the

risk of macrovascular disease– Blood pressure level that reduces risk of

vascular disease• Improve health through food choice and activity• Address individual nutritional needs


Asthma

• A respiratory problem characterized by a shortness of breath accompanied by a wheezing sound

• Due to: – Contraction of smooth muscle of airways– Swelling of muscosal cells– Hypersecretion of mucus

• May be caused by allergic reaction, exercise, aspirin, dust, pollutants, and emotion


Asthma: Diagnosis & Causes

• Diagnosed using pulmonary-function testing• Agent causes influx of Ca++ into mast cells

– Release of chemical mediators• Triggers asthma attack

– Bronchoconstriction– Bronchoconstrictor reflex– Inflammation response


Proposed Mechanism by which an Asthma Attack Is Initiated

Fig 17.3


Prevention and Relief of Asthma

• Prevention– Avoidance of allergens– Immunotherapy

• Treatment– Cromolyn sodium 2-agonists– Theophylline


Mechanisms by which Common Medications Prevent/Treat Asthma

Fig 17.4


Exercise-Induced Asthma

• Caused by cooling/drying of respiratory tract– Increases osmolarity on surface of mast

cell• Reducing the chance of an attack

– Warm-up– Short-duration exercise

• Treatment -agonist


Chronic Obstructive Pulmonary Disease (COPD)

• Includes chronic bronchitis, emphysema, and bronchial asthma– Can create irreversible changes in the lung– Can severely limit normal activities

• Treatment includes:– Medication (including supplemental O2)– Breathing exercises– Dietary therapy– Exercise


Testing and Training COPD Patients

• Medical exam including exercise testing– FEV1

– VO2max

– Maximum exercise VE

– Blood gasses (PO2 and PCO2)• Training goals include

– Reduced reliance on O2 and medications– Improved ability to complete daily activities


Hypertension• Defined as >140 or >90• Increase risk of coronary heart disease• Exercise can be used as a non-drug treatment• Precautions

– Blood pressure should be monitored for those on medications


HypertensionACSM Guidelines, Gordon 1997

• Loss of weight if overweight• Limit alcohol intake• Reduce sodium intake• Maintain adequate dietary K+, Ca2+, Mg2+ • Stop smoking• Reduce dietary fat, saturated fat, and

cholesterol intake


Cardiac Rehabilitation: Patient Population• Those who have or have had:

– Myocardial infarction (MI)– Coronary artery bypass graft surgery (CABG)– Angioplasty (PTCA)– Angina pectoris

• Medications -blockers (reduce work of the heart)– Anti-arrhythmics (control dangerous heart rhythms)– Nitroglycerine (reduce angina symptoms)


Cardiac Rehabilitation Testing • Graded exercise testing

– ECG monitoring (12-lead)• Heart rate and rhythm• Signs of ischemia (ST segment depression)

– Blood pressure– Rating of perceived exertion (RPE)– Signs or symptoms (chest pain)– May include radionuclide imaging

• Determination of myocardial blood flow


Cardiac Rehabilitation:Exercise Programs

• Exercise prescription– Based on GXT results

• MET level, heart rate, signs/symptoms– Whole body, dynamic exercise– Intensity, duration, and frequency based on severity of

disease • Effects

– Increased functional capacity (VO2max)– Reduced signs/symptoms of ischemia– Improved risk factor profile


Exercise and the Elderly

• Benefits of participation– Improved risk factor profile– Increased strength and VO2max

– Increased bone mass• Recommendations

– Similar to younger subjects– Medical exam and risk factor screening are

essential


Exercise During Pregnancy

• Regular endurance exercise poses no risk to the fetus and is beneficial for the mother

• Pregnant women should consult their physician prior to beginning any exercise program

• Rating of perceived exertion may be the best method of setting intensity


Chapter 17 Exercise for Special Populations

chapter 17 exercise for special populations

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