1. 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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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:

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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)

16. 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

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

18. 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”.

19. 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

20. 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!

21. Exercise and Youth
1. Review the guidelines found in Table

22. Any questions?

23. 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

24. 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

25. 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?

26. 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”.

27. 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)

28. Exercise and Older Adults

29. 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

30. 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

31. 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:

32. 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.

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

34. 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

35. Exercise and Older Adults
Review Table

36. Any questions?

37. 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

38. 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.

39. 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

40. 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

41. 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)

42. 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

43. 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

44. Pre- and Postpartum Exercise
Review Table

45. Pre- and Postpartum Exercise
Review Table
ACOG Exercise Recommendations:

46. Any questions?