Prescribing Exercise for Special Populations

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Prescribing Exercise for Special Populations
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Exercise Throughout Childhood

• Substantial variability in growth status and
  maturity level for any given chronological age
• Physiological Aspects (compared to adults)
• Lower stroke volume, higher heart rate, lower
  cardiac output (immature CV system)
• Compensate by using O2 more efficiently than
  adults
• Lack of metabolic specialization
• Low economy of locomotion

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Exercise Throughout Childhood

• Less able to facilitate anaerobic pathways
• Higher energy expenditure at any given submaximal
  intensity
• Less tolerance for exercising in heat
• Poor sweating capacity
• Produce excessive body heat
• greater susceptibility to heat stress
• Fluid replacement is essential

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Growth and Biological Maturation

• Physical activity and exercise (weight bearing)
  are necessary for attainment of maximal genetic
  bone density
• Excessive training may have adverse effects
  (reduce growth potential), but more concerned
  with lack of physical activity

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Exercise Prescription Aerobic training

• 30-60 minutes of accumulated physical
  activity/day
• Girls may require additional support
• Allow to be naturally active
• Encourage to play outside
• Involve with organized activities where emphasis
  is placed on gaining basic motor and sport skill
  competency

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Exercise PrescriptionStrength Training

• Benefits include
• Strength gains injury protection improved
  sports performance
• Risks include
• Low back and growth plate injury
• acute chronic musculoskeletal injuries
• Risk factors for overuse injury
• significant changes in frequency /or intensity
• imbalance of strength and flexibility
• incorrect biomechanics/footwear
• 50 of overuse injuries are preventable

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Strength Training Programs

• Trained supervision
• High repetitions ( 8 reps/set)
• Adequate recovery between sessions
• frequency 2-3 days/week
• Emphasis on proper form
• Inclusion of flexibility exercises
• Especially during growth spurts

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Diabetes Mellitus
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Diabetes Mellitus

• A chronic metabolic disease c.b an absolute or
  relative deficiency of insulin resulting in
  hyperglycemia ketoacidosis
• Major public health problem affecting an
  estimated 16 million of the US population
• Leading cause of adult blindness and amputation
• Secondary causes include renal failure, heart
  attacks and stroke

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Major Classifications

• Type 1 (Insulin-Dependent, IDDM, Juvenile Onset)
• Type 2 (Non-Insulin-Dependent, NIDDM, Adult
  Onset) - 80-90
• Gestational Diabetes
• Occurs during pregnancy and is resolved postpartum

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Exercise Diabetes

• Exercise is considered to be one of the
  cornerstones of care in T2D
• Exercise is not considered a component of
  treatment in Type 1 diabetes
• Exercise training leads to improved insulin
  sensitivity, which leads to a reduction in dose
  of insulin or oral hypoglycemic agents

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Effects on the exercise response

• The effect of diabetes on exercise is dependent
  upon several factors
• Type of medication and the timing of its
  administration
• blood glucose level and food intake prior to
  exercise
• Intensity and duration of exercise bout

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Exercise Precautions with Diabetes

• Hypoglycemia (transient and prolonged)
• Defined as blood glucose concentration of mg/dL
• Adrenergic symptoms - anxiety, palpitation
  (tachycardia), tremor, and sweating
• Neuroglycopenia symptoms - headache, slurred
  speech, confusion, seizures, coma

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Exercise Precautions with Diabetes

• Contraindication to exercise
• Blood glucose is 250-300 mg/dL
• Practice good foot care and wearing proper shoes
• Presence of foot sores? Engage in non-weight
  bearing activity
• One hour of exercise requires 15 gm of CHO
  either before or after exercise
• Keep source of rapidly acting CHO available