Chapter 17 Exercise for Special Populations

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Chapter 17Exercise for Special Populations

• EXERCISE PHYSIOLOGY
• Theory and Application to Fitness and
  Performance, 6th edition
• Scott K. Powers Edward T. Howley

Presentation revised and updated by Brian B.
Parr, Ph.D. University of South Carolina Aiken
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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 18.2 million have diabetes
• Only 11.1 million are diagnosed
• Warning signs
• Frequent urination/unusual thirst
• Extreme hunger
• Rapid weight loss, weakness, and fatigue
• Irritability, nausea, and vomiting

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Diabetes

• Type 1
• Lack of insulin
• Dependent on exogenous insulin
• Develops early in life
• Associated with viral infections
• 510 diabetic population
• Type 2
• Resistance to insulin
• Develops later in life
• Associated with upper-body obesity
• 9095 diabetic population

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Characteristics of Type 1 and Type 2 Diabetes
Table 17.1
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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

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Effect of Prolonged Exercise in Diabetics
Figure 17.1
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Exercise and Type 1 Diabetes

• Metabolic control before physical activity
• Avoid exercise if fasting glucose is gt300 mg/dl
  (or gt250 mg/dl with ketosis)
• Ingest carbohydrates if glucose is lt100 mg/dl
• Blood glucose monitoring before and after
  exercise
• Identify when changes in insulin or food intake
  is needed
• Learn how blood glucose responds to different
  types of exercise
• Food intake
• Consume carbohydrates to prevent hypoglycemia
• Carbohydrates should be readily available during
  and after exercise

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Effect of Plasma Insulin Levels in Type 1
Diabetics During Exercise
Figure 17.2
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Exercise Prescription for Type 1 Diabetes

• Exercise 2060 min, 34 days per week, 5085
  heart rate reserve
• May use non-weight bearing, low-impact activities
  
• If weight-bearing activities are contraindicated
• Use lighter weights (4060 1RM), 1520 reps
• Avoid the Valsalva maneuver
• Heavier weights for athletes
• Drink extra fluids and have carbohydrates
  available
• Exercise with someone in case of emergency

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Exercise and Type 2 Diabetes

• Exercise is a primary treatment
• Help treat obesity
• Help control blood glucose
• Combination of diet and exercise may eliminate
  need for drug treatment
• Exercise prescription
• Dynamic aerobic activity at 5090 HRmax
• 2060 min, 47 times/week
• Strength training is also recommended
• Goal to expend a minimum of 1,000 kcal/week
• May need to reduce dosage of medications to
  maintain blood glucose

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American Diabetes Association Goals for Nutrition
Therapy

• Attain and maintain optimum metabolic outcomes to
  reduce risk of complications
• Blood glucose in normal range
• Improved lipid and lipoprotein profile
• Lower blood pressure
• Prevent and treat chronic diabetes complications
• Improve health through healthy food choices and
  physical activity
• Address individual nutritional needs

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Prevention or Delay of Type 2 Diabetes

• Impaired fasting glucose (IFG)
• Fasting BG 100125 mg/dl
• Impaired glucose tolerance (IGT)
• Oral glucose tolerance test
• 2-hour blood glucose 140199 mg/dl
• Prediabetes
• Having IFG or IGT
• Likely to develop type 2 diabetes
• 150 min/week of physical activity and losing
  5-10 of body weight reduces risk
• Better approach than using drugs

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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 mucosal cells
• Hypersecretion of mucus
• 20 million are affected by asthma
• 1.9 million emergency room visits
• 4,000 deaths
• Direct and indirect costs of 16.1 billion

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Asthma Diagnosis and Causes

• Diagnosed using pulmonary-function testing
• Low maximal expiratory flow rate
• Triggers
• Dust, chemicals, antibodies, exercise
• Causes influx of Ca2 into mast cells
• Release of chemical mediators that cause
• Increased smooth muscle contraction leading to
  bronchoconstriction
• Bronchoconstrictor reflex via vagus nerve
• Inflammatory response

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Proposed Mechanism by Which an Asthma Attack Is
Initiated
Figure 17.3
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Prevention and Relief of Asthma

• Prevention
• Avoidance of allergens
• Immunotherapy
• Medications
• Cromolyn sodium
• ?2-agonists
• Theophylline
• Corticosteroids
• Leukotriene inhibitors

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Exercise-Induced Asthma

• More common in asthmatics
• Does not necessarily impair performance if
  controlled
• Caused by drying of respiratory tract
• Increases osmolarity on surface of mast cell
• Triggers Ca2 influx and airway narrowing
• Reducing the chance of an attack
• Warm-up
• Short-duration exercise
• Treatment
• ?-agonist in case of attack during exercise
• Other medications to prevent attack

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Chronic Obstructive Pulmonary Disease (COPD)

• Includes chronic bronchitis, emphysema, and
  bronchial asthma
• Can create irreversible changes in the lung
• Can severely limit normal activities
• Testing for COPD
• FEV1
• Graded exercise test
• VO2max
• Maximal exercise ventilation
• Changes in arterial PO2 and PCO2

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Treatment of COPD

• Goals
• Reduced reliance on O2 and medications
• Improved ability to complete daily activities
• Treatments
• Medications (including supplemental O2)
• Breathing exercises
• Dietary therapy
• Exercise
• Counseling
• Outcomes
• Increased exercise tolerance without dyspnea
• Increased sense of well-being

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Hypertension

• Classifications
• Normal lt120/lt80 mmHg
• Prehypertension 120139/8089 mmHg
• Hypertension (stage I) 140159/9099 mmHg
• Recommendations
• Lose 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

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Exercise for Hypertension

• Exercise can be used as a non-drug treatment
• Recommendations
• Moderate intensity exercise (4060 HR reserve)
• 30 minutes on most, preferably all, days
• Goal of expending 7002000 kcal/week
• ACSM recommendation for improving VO2max can also
  be followed
• Precautions
• Blood pressure should be monitored for those on
  medications

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Cardiac Rehabilitation Patient Population

• Those who have or have had
• Angina pectoris
• Chest pain due to ischemia
• Myocardial infarction (MI)
• Heart damage due to coronary artery occlusion
• Coronary artery bypass graft surgery (CABGS)
• Bypass one or more blocked coronary arteries
  saphenous vein or internal mammary artery
• Angioplasty (PTCA)
• Balloon tipped catheter used to open occluded
  arteries
• May insert a stent to keep artery open

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Cardiac Rehabilitation Medications

• b-blockers
• Reduce work of the heart
• Anti-arrhythmics
• Control dangerous heart rhythms
• Nitroglycerine
• Reduce angina symptoms

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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
• Evaluate perfusion (201Thallium)
• Evaluate ventricular ejection (99Technetium)

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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

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Exercise For Older Adults

• VO2max declines 1 per year
• Regular exercise may reduce rate of decline
• 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 is
  essential

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Exercise and Bone Health

• Osteoporosis results in reduced bone mineral
  density and increased fracture risk
• More common in women over fifty due to lack of
  estrogen
• Prevention and treatment
• Dietary calcium
• gt1000 mg/day through food and supplements
• Hormone replacement therapy (HRT)
• Prevents bone loss and reduces fracture risk
• May increase risk of cardiovascular disease and
  cancers
• Exercise
• Weight-bearing activities and resistance training
• 23 hours per week

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Exercise During Pregnancy

• Regular endurance exercise poses no risk to the
  fetus and is beneficial for the mother
• Recommendations
• Pregnant women should consult their physician
  prior to beginning any exercise program
• Absolute and relative contraindications
• Follow ACSM/CDC recommendation
• 30 min/day of moderate-intensity activity on
  most, preferably all, days
• Intensity determined by
• Heart rate, Rating of perceived exertion, or
  talk test
• No supine exercise after first trimester