Exercise for the Special Population I

1
Exercise for the Special Population
Exercise Science 2001
2
Objectives

• Using examples,
• To identify special populations
• To identify physical activity / exercise needs of
  special populations
• To integrate principles of exercise training in
  the implementation the evaluation of exercise
  training programs

3
Special Populations

• Target population
• Group vs. Individual, age group, gender
• Identify Needs
• Goal Setting
• Design Program
• Record Keeping
• Evaluation
• Pre and post testing

4
So.Who are they?
5
Special Population

• Special Population Adapted State
• Population at risk
• population with sedentary lifestyle
• low cardiorespiratory fitness
• women aged, osteoporosis
• children with obesity
• Population with chronic disabilities
• e.g. ankylosing spondylitis, diabetes mellitus,
  chronic obstructive pulmonary disease, cystic
  fibrosis, rheumatoid arthritis, poliomyelitis,
  stroke, amputations, spinal cord injury

6
Lifelong Fitness Lifestyle
7
Four phases of natural history of exercise
Sedentary
Adoption
Maintenance
Drop-out
Resumption
Time
8
Guidelines

• To implement an effective exercise programme
• An understanding of the body responses to
  exercise in diseases/conditions
• Unique adaptations to exercise training in
  different age group with regard to strength,
  functional capacity, motor skills

9
Guidelines (Contd)

• Identify risk factors / precautions /
  contraindications prior to participation in
  physical activity
• Identify determinants of physical activity
• Integrate the principles of exercise training
• Define ways to monitor and evaluate the
  effectiveness of the program

10
Local Data 1

• Report on Healthy Living Survey 1999
• Department of Health
• Cross-sectional telephone survey
• n 3,270
• Aged 18-64 years

11
Results of the Healthy Living Survey

• 51 of men and 47 of women engaged in exercise
  (at least 30 minutes) within last one month
• Participation in exercise drop markedly for both
  sexes from 70 (in age group 18-24) to less than
  40 in age group (age 45-54)

12
Results of the Healthy Living Survey

• 52 had done something to improve health or to
  prevent diseases in the past year
• Exercise was the most common action
• Major barrier lack of time
• On average spent 2.7 hours daily watching TV

13
Local Data 2 (1999)

• Chinese University of Hong Kong
• Interview survey
• n 26,111
• Aged 10 to 20 from 48 primary and secondary
  schools

14
Results of the CUHK Survey

• Have you engaged in any leisure time exercise
  that make you sweat last week? NO percentage
• P4 to P6 13.8
• F4 to F7 25.8
• Have you watched TV for 3 hours or more last
  week? YES percentage
• P4 to P6 54.3
• F4 to F7 51.2

15
So.What does it mean?
16

• INACTIVITY - a major health problem
• Association between sedentary lifestyle and
  morbidity / mortality from chronic disease -
  Evidence??

17
Evidence (Blair and Brodney, 1999)

• Association of physical activity or
  cardiorespiratory fitness to the outcomes of
  mortality

• Cardiovascular disease
• Coronary heart disease
• Hypertension
• Type 2 diabetes mellitus
• Cancer ?

18
Effects of Physical Activity on Health Outcomes
in Adolescents

• Aerobic Fitness ??
• Body Fat ?
• Blood pressure ?
• HDL cholesterol ?
• LDL cholesterol 0
• BMD ?
• Musculoskeletal injuries ?

19
Exercise Prescription Considerations
20
An Example
21
Adolescence

• Defined as ages 11 - 21
• Pre-pubescent ? preadolescent
• Post-pubescent ? adult

22
Physiologic Characteristics of Exercise in
Preadolescents (ACSM Resource Manual, 1998)

• Immature cardiovascular system
• Higher O2 consumption per unit of body mass (i.e.
  higher metabolic rate)
• Lower SV, compensated by higher HR
• Higher RR
• Poor sweating capacity
• Large surface-to-mass ratio
• RPE perceived as easier for a given workload

23
Physiologic Characteristics of Exercise in
Preadolescents

• ? concentration and rate of utilization of
  glycogen
• ? ability to utilize muscle glycogen and produce
  lactate ? lower anaerobic capacity than adults
• Reach metabolic steady state faster, lower oxygen
  deficit, faster recovery
• Rely more on aerobic metabolism

24
Implications

• Can perform endurance task fairly well
• Greater fatiguability in prolonged high-intensity
  task
• Ability to perform intense anaerobic task lower
  than adults
• Low tolerance to extreme heat / cold
• Thermoregulation less efficient - less tolerance
  for exercising in the heat?? susceptible to heat
  exhausation

25
In planning exercise program

• Preparticipation examination
• Avoid anaerobic training (concentrate on skill
  and movement in aerobic sports such as basketball
  and soccer)
• Intermittent activities preferred
• Intensity and duration should be lower initially
  ? gradually increase

26
In planning exercise program

• Special attention to acclimatization (avoid high
  heat and humidity)
• Fluid replacement
• Be conservative / prescribe an easily tolerable
  program
• Have a high index of suspicion for injury

27
Skeletal System

• Active musculoskeletal development
• Muscle-tendon units accommodate to the rapid
  growth of long bones ? flexibility compromised
• At puberty, relative over-growth of long bones to
  soft tissue ? muscle imbalance
• Repetitive microtrauma on vulnerable prestressed
  muscle-tendon units ? tendinitis, bursitis,
  apophysitis, stress fractures

28
Implications

• Gradual progression of exercise
• Avoid extremes in exercise duration and intensity
• Adequate period of warm-up, stretching and
  cool-down exercises

29
Determinants of Physical Activity

• Demographic
• Biological
• Psychological / emotional
• Social and cultural
• Physical Environment

30
(No Transcript)
31
Facts

• Boys more physically active than girls
• Physical activity declines dramatically with age
  (from age 13 to 16)
• Self-efficacy strong predictor
• Perceived barriers lack of time and lack of
  interest
• Enjoyment a strong correlate

32
Facts

• Social influence strong - peer and parents
  influence
• Physical environmental strongly associated with
  physical activity (especially preschool children)

33
Local Data

• Lindner and Sit, 1998
• n 4,690 (P.5 to F.7)
• Reasons for participation
• For Fun
• For health and fitness
• To be with friends
• To become good at the activity

34
Local Data

• Reasons for non-participation
• Prefer to do ones own thing (? Not attracted
  by the regularity, commitments and expectations
  being involved in sports)
• Reasons for withdrawal
• Need time for studying
• Wanting to spend more fun time on other leisure
  activities
• Wanting time to be with friends

35
Implications

• Target high risk group - female adolescents
• Build perceptions of competence or self-efficacy
• Fun enjoyable activities

36
Implications (Contd)

• Reduce perceptions of barriers
• Social support from friends
• Stimulate parental assistance
• Increase time to spend outdoors

37
Physical Activity Guidelines

• International Consensus Conference on Physical
  Activity Guidelines for Adolescents (Sallis and
  Patrick, 1994)
• Health Education Authority (Biddle et al, 1998)

38
International Consensus Conference on Physical
Activity Guidelines for Adolescents

• All adolescents should be physically active
  daily, or nearly every day
• Engagement in 3 or more days/week of activities
  that last for 20 or more minutes that require
  moderate to vigorous levels of exertion

39
Health Education Authority (UK)

• Participation in physical activity of moderate
  intensity for 1 hour/day
• Young people who currently do little activity
  should participate in physical activity of
  moderate intensity for at least 30 minutes/day
  (note consistent with adult guidelines)
• At least 2 days a week, engage in exercise that
  enhance/maintain muscle strength, flexibility and
  bone health

40
Exercise for Obese Children
41
Exercise for Obese Children

• Local Data Report from Department of Health
• Health services provided to schools review 13.2
  primary school children as obese
• Related to homework, watching TV, computer games,
  surfing on the net ? all sedentary behaviours!!

42
Fitness or Fatness??

• Measures of adiposity and sedentary behaviours
  are consistently related
• Children with high level of total body fat mass
  and visceral adipose tissue have increased
  factors for coronary artery disease and NIDDM
• Obesity predicts poor adherence to exercise
  programs
• Obesity in childhood ? adulthood
• Physical activity best predictor of weight loss
  maintenance

43
Think about

• Physical Activity Guidelines for Adolescents
• Determinants of Physical Activity
• Principles of exercise training
• Components of physical fitness
• Evaluation Tools
• Follow up period

44
Evaluation Tools

• Measurements of
• Cardiovascular fitness
• Body fat composition
• Physical activity level

45
Components of the Program

• Exercise
• Nutrition
• Social Support - parents involvement
• Behaviour change
• Relapse prevention

46
Characteristics of the Exercise Programs

• Home based vs. site-based
• Build activity into child / adolescents
  lifestyle
• Negative energy balance
• Think about the activity guidelines

47
Physical Activity Levels

• Low intensity - 30-50 VO2 max HR 120-149
  beats/min 2-4 METS
• Moderate intensity - 50-70 VO2 max HR 150--169
  beats/min 5-7.5 METS
• High intensity - gt 70 VO2 max HR gt 169
  beats/min gt 7.5 METS
• HR monitoring considered for assessing moderate
  to vigorous activity

48
Initiatives in Hong Kong
49
Exercise Program