Special Populations: Training Youth, Older Adults, & Pregnant Clients Based on NASM CPT Textbook & ACE CPT Textbook © 2017 NPTI Colorado  | Slide 1 | Revision 4 (4/8/17) JR

Lecture Objectives After this lecture, you will be able to: Define and describe the cause and symptoms of selected chronic health conditions. Describe the characteristics of selected health-related physical and functional limitations to exercise. Recognize how acute and chronic responses to exercise vary in clients with chronic health conditions or physical or functional limitations compared with apparently healthy clients. Describe how to modify program design for clients with chronic health and physical or functional limitations.

Exercise and Youth Youth fitness programs and services are one of the fastest growing segments of the health club industry. The term youth refers to children and adolescents between the ages of 6 and 20.

Exercise and Youth Regular physical activity in children and adolescents is essential. Unfortunately, millions of American youth do not get the recommended amount of physical activity Lack of physical activity and poor nutritional habits have resulted in an exponential increase in overweight and obese children ACE

Exercise and Youth The primary exercise activities for children and adolescents are: Aerobic conditioning Fun activities and recreational or competitive sports (e.g., rollerblading and canoeing) Muscle strengthening Structured (weight training) or unstructured (e.g., games such as tug-of-war or climbing a wall) Bone strengthening Activity to produce a force on the bones (e.g., hopscotch, jump rope, and tennis) ACE

Exercise and Youth Youth have been negatively impacted by the decline in physical activity requirements in schools and sedentary pursuits (internet, social media, gaming, TV) Behaviors established at a young age have a high probability of persisting into adulthood Youth can achieve substantial health benefits by doing moderate- and vigorous-intensity physical activity for periods of time that add up to 60 minutes or more each day ACE

Exercise and Youth Current recommendations for children and adolescents: 60-minutes or more of physical activity a day Aerobic, muscle-strengthening, and bone-strengthening activities are encouraged NASM

Exercise and Youth National Association for Sport and Physical Education (NASPE): Children should accumulate at least 60 minutes, and up to several hours, of age-appropriate physical activity on all, or most days of the week. Children should participate in several bouts of physical activity lasting 15 minutes or more each day.    Children should participate each day in a variety of age-appropriate physical activities designed to achieve optimal health, wellness, fitness, and performance benefits.   Extended periods (periods of two hours or more) of inactivity are discouraged for children, especially during the daytime hours. 1. More info concerning youth guidelines from NASPE can be found here: http://www.aahperd.org/naspe/standards/nationalGuidelines/PA-Children-5-12.cfm

Exercise and Youth The risk of injuries to children participating in resistance training is low However, injuries can occur in any sport To minimize the risk of injury during resistance training, personal trainers should adhere to the following guidelines ACE

Exercise and Youth Obtain medical clearance or instructions regarding physical needs Children should be properly supervised and use proper exercise technique at all times Do not allow children to exercise unless facility is safe for them Never have children perform single maximal lifts or sudden explosive movements or to compete with other children ACE

Exercise and Youth Teach children how to breathe properly during exercise movements Never allow children to use equipment that is broken or damaged, or that they don’t fit on correctly Children should rest for approximately 1-2 minutes between each exercise (longer if necessary) Encourage children to drink plenty of fluids before, during and after exercise Tell children that they need to communicate with their coach, parent or teacher when they feel tired or fatigued, or when they have been injured ACE

Exercise and Youth Children exercising in extremely cold temps are at increased risk for dehydration and hypothermia Layer clothing Ensure proper hydration Hot environments present a challenge as well, and concern has existed that children are at higher risk for heat-related illness than adults due to: Higher ratio of body surface area to mass Lower exercise economy Diminished exercising capacity Lower cardiac output at similar workload ACE

Exercise and Youth Despite these concerns, research suggests that children and adults are similar in terms of risk of heat illness The following guidelines apply to children and adults alike: Reduce intensity of exercise in very hot, humid, or sunny environments Cancel activity or move indoors to air conditioned environment during periods of very hot and especially humid conditions Maintain hydration Encourage frequent breaks Lightweight, light-colored, loose fitting clothing; use sunscreen To prevent hyponatremia, replace both fluids and electrolytes ACE

Exercise and Youth General Guidelines for Training Youth: Children / adolescents who DO NOT currently meet the recommended guidelines should slowly increase their activity levels in small steps Children who DO meet the guidelines should continue being active on a daily basis and, if appropriate, become even more active. (Evidence shows that MORE THAN 60 min/day can show more health benefits Children who EXCEED guidelines should maintain their activity levels and vary the activities to prevent overtraining and injury ACE

Exercise and Youth Physiologic Differences Between Children & Adults: Children do not respond, adapt, or progress the same as adults Youth progress is specific to their physiologic capabilities      Important physiologic differences between children and adults: (Next slide)

Exercise and Youth Although a group of children or adolescents may be the same age, their responses to exercise can vary considerably: Growth Development Physical maturation Psychological maturation

Exercise and Youth 1. Spend some good time reviewing this table

Exercise and Youth Research has clearly demonstrated that resistance training is both safe, and effective, in children and adolescents. The most common injuries associated with resistance training in youth: Sprains Strains Define “sprain” and “strain”.

Exercise and Youth Research suggests that untrained children can improve their strength by an average of 30% to 40% after 8 weeks of progressive resistance training. Additional benefits associated with resistance training: Improved motor skills Improved strength and performance Improved body composition Improved bone mineral density

Exercise and Youth Improvements in strength and performance after a resistance training program appear to be due to neuromuscular adaptations versus hypertrophy. When designing programs for youth clients: Assess client for movement deficiencies Typically need to start with Stabilization Endurance program Progression into Phases 2 through 5 should be based on youth’s past performance and current abilities FUN!

Exercise and Youth 1. Review the guidelines found in Table

Any questions?

Exercise and Older Adults Regular physical activity is essential for older adults (> or = 65 years) who wish to maintain independence and quality of life By 2030 an estimated 1 in 5 Americans (71 million) will be 65 years old or older Most rapidly growing age group in America: 85 and older (due in part to healthcare advances and health-promotion activities

Exercise and Older Adults Older adults are a varied group Many, but not all have one or more chronic conditions that vary in type and severity Typical signs of aging: Graying and loss of hair Loss of height Reduced lean body mass Loss of skin elasticity and associated wrinkles Thickening of nails Changes in eyesight Reduced coordination

Exercise and Older Adults There are also changes in cardiovascular, endocrine, respiratory and musculoskeletal systems So, what exactly happens to the human body as it ages?

Exercise and Older Adults Typical forms of degeneration associated with aging: Osteoporosis Arthritis Low back pain Obesity Arteriosclerosis Atherosclerosis Peripheral vascular disease (PVD) 1. Briefly discuss each of the listed forms of “degeneration”.

Exercise and Older Adults Older adults, with or without other chronic conditions respond to exercise much the same way as apparently healthy younger adults. Normal physiological and functional changes associated with aging: (Next Slide)

Exercise and Older Adults

Exercise and Older Adults Degenerative processes associated with aging can lead to a significant reduction in functional capacity: Strength Endurance Cardiorespiratory fitness Proprioceptive neural responses

Exercise and Older Adults One of the most import and and fundamental activities affected by degenerative ageing is walking. The ability or inability to perform ADLs can be measured: Bathing Eating Housekeeping Leisure activities

Exercise and Older Adults It has been demonstrated that the decreased functional capacity of older adults can be slowed or reversed. Before initiating an exercise program: Initial Consultation Forms Movement Assessments Senior Fitness Test You can learn about the “Senior Fitness Test” battery here: http://www.icaa.cc/1-Organizationalmember/member-wellness-programming/member-programmanagement/measuringfunctionalfitness2.pdf

Exercise and Older Adults SMR and static stretching are advised for this population. Simple forms of active-isolated or dynamic stretching can be recommended as part of the warm-up process.

Exercise and Older Adults Cardiorespiratory training: Stage I or Stage II Be aware of medications Monitor closely Progress slowly

Exercise and Older Adults Resistance training: Start with Level 1 – Phase 1 training (stabilization) Progress slowly Safety first Precise technique Basic Resistance Training Guidelines: Table 16.4

Exercise and Older Adults Review Table

Any questions?

Pre- and Postpartum Exercise Women should obtain physician clearance and guidelines before exercising. Pregnant women with the following health conditions should NOT exercise: Risk factors for pre-term labor Vaginal bleeding Premature rupture of membranes Generally, pregnant women should follow these guidelines: Do not begin a vigorous program shortly before or during pregnancy Use the RPE scale and choose an intensity that is comfortable After the first trimester, prolonged supine exercise is discouraged Avoid exercise during high temperatures or humidity Wear supportive clothing and shoes ACE

Pre- and Postpartum Exercise The general consensus is that most recreational pursuits are appropriate for all pregnant women. Those already engaged in an exercise program before pregnancy may continue with moderate levels until the third trimester.

Pre- and Postpartum Exercise The gradual growth of the fetus can alter posture, making flexibility and core training important. After the first trimester, AVOID: Exercises in a prone position Exercises in a supine position Uncontrolled twisting of torso Hip abduction/adduction machines

Pre- and Postpartum Exercise Women in the childbearing period are vulnerable to: Nausea Dizziness Fainting Pregnant women should immediately stop exercising: Abdominal pain Excessive shortness of breath Bleeding or leakage of amniotic fluid

Pre- and Postpartum Exercise Following delivery, women require some recovery time to regain strength Taking care of a newborn is a lot of work! The associated loss of sleep can easily lead to a fatigued state Generally, the goal during the 6 weeks following delivery is to gradually increase physical activity as a means of relaxation, personal time, and a regaining of the sense of control (not improving physical fitness)

Pre- and Postpartum Exercise Trainers should not allow a client to rush into a post-partum program. Postnatal women should be encouraged to re-educate: Posture Joint alignment Muscle imbalances Stability Motor skills Recruitment of deep core stabilizers

Pre- and Postpartum Exercise After delivery, women should adhere to the following guidelines: Obtain physician clearance and guidelines prior to resuming or starting an exercise program Begin slowly and gradually increase duration – and then intensity. Goal is to develop consistency Start with walking several times a week Avoid excessive fatigue & dehydration Wear a supportive bra Stop the exercise session if unusual pain is experienced Stop the exercise session and seek medical evaluation if bright red vaginal bleeding occurs that is heavier than a normal menstrual period Drink plenty of water and eat appropriately

Pre- and Postpartum Exercise Review Table

Pre- and Postpartum Exercise Review Table ACOG Exercise Recommendations: http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/co267.pdf?dmc=1&ts=20120408T0257068513

Any questions?