1. Chapter 17 Exercise for Special Populations
EXERCISE PHYSIOLOGY
Theory and Application to Fitness and Performance, 6th edition
Scott K. Powers & Edward T. Howley

2. Objectives
1. Describe the difference between Type 1 and Type 2 diabetes
2. Contrast how a diabetic responds to exercise when blood glucose is "in control, " compared to when it is not
3. Explain why exercise may complicate the life of a Type 1 diabetic, while being a recommended and primary part of a Type 2 diabetic undertaking an exercise program

3. Objectives
4. Describe the changes in diet and insulin that might be made prior to a diabetic undertaking an exercise program
5. Describe the sequence of events leading to an asthma attack, and how cromolyn sodium and β-adrenergic agonists act to prevent and/or relieve an attack
6. Describe the cause of exercise-induced asthma and how one may deal with this problem

4. Objectives
7. Contrast chronic obstructive pulmonary disease (COPD) with asthma in terms of causes, prognosis, and the role of rehabilitation programs in the return to "normal" function
8. Identify the types of patient populations that one might see in a cardiac rehabilitation program and the types of medications that these individuals may be taking

5. Objectives
9. Contrast the type of exercise test used for cardiac populations with the test used for the apparently healthy population
10. Describe the physiological changes in the elderly that result from an endurance-training program
11. Describe the guidelines for exercise programs for pregnant women

6. 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 17 million with diabetes, only 11.1 million are diagnosed

7. Diabetes Type 1 Lack of insulin Develops early in life
10% diabetic population
Type 2
Resistance to insulin
Develops later in life
90% diabetic population

8. Diabetes

9. 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

10. Effect of Prolonged Exercise in Diabetics
Fig 17.1

11. Exercise and Type 1 Diabetes
Pre-exercise blood glucose level
80 to 250 mg•dl-1
Timing with insulin
Should not exercise at time of peak insulin action
Glucose monitoring
During/after exercise
Carbohydrate intake
During recovery

12. Effect of Plasma Insulin Levels in Type 1 Diabetics During Exercise
Fig 17.2

13. Exercise and Type 2 Diabetes
Blood glucose monitoring
In those taking oral hyperglycemic agents
Exercise prescription
4-7 times per week
Promotes weight loss and sustained increase in insulin sensitivity
Minimum of 1,000 kcal/wk
From all physical activity

14. American Diabetes Association Goals for Nutrition Therapy
Attain & maintain optimum metabolic outcomes:
Blood glucose levels in normal range
A lipid and lipoprotein profile that reduces the risk of macrovascular disease
Blood pressure level that reduces risk of vascular disease
Improve health through food choice and activity
Address individual nutritional needs

15. 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 muscosal cells
Hypersecretion of mucus
May be caused by allergic reaction, exercise, aspirin, dust, pollutants, and emotion

16. Asthma: Diagnosis & Causes
Diagnosed using pulmonary-function testing
Agent causes influx of Ca++ into mast cells
Release of chemical mediators
Triggers asthma attack
Bronchoconstriction
Bronchoconstrictor reflex
Inflammation response

17. Proposed Mechanism by which an Asthma Attack Is Initiated
Fig 17.3

18. Prevention and Relief of Asthma
Avoidance of allergens
Immunotherapy
Treatment
Cromolyn sodium
2-agonists
Theophylline

19. Mechanisms by which Common Medications Prevent/Treat Asthma
Fig 17.4

20. Exercise-Induced Asthma
Caused by cooling/drying of respiratory tract
Increases osmolarity on surface of mast cell
Reducing the chance of an attack
Warm-up
Short-duration exercise
Treatment
-agonist

21. Chronic Obstructive Pulmonary Disease (COPD)
Includes chronic bronchitis, emphysema, and bronchial asthma
Can create irreversible changes in the lung
Can severely limit normal activities
Treatment includes:
Medication (including supplemental O2)
Breathing exercises
Dietary therapy
Exercise

22. Testing and Training COPD Patients
Medical exam including exercise testing
FEV1
VO2max
Maximum exercise VE
Blood gasses (PO2 and PCO2)
Training goals include
Reduced reliance on O2 and medications
Improved ability to complete daily activities

23. Hypertension Defined as >140 or >90
Increase risk of coronary heart disease
Exercise can be used as a non-drug treatment
Precautions
Blood pressure should be monitored for those on medications

24. Hypertension ACSM Guidelines, Gordon 1997
Loss of 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

25. Cardiac Rehabilitation: Patient Population
Those who have or have had:
Myocardial infarction (MI)
Coronary artery bypass graft surgery (CABG)
Angioplasty (PTCA)
Angina pectoris
Medications
-blockers (reduce work of the heart)
Anti-arrhythmics (control dangerous heart rhythms)
Nitroglycerine (reduce angina symptoms)

26. 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
Determination of myocardial blood flow

27. 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

28. Exercise and the Elderly
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 are essential

29. Exercise During Pregnancy
Regular endurance exercise poses no risk to the fetus and is beneficial for the mother
Pregnant women should consult their physician prior to beginning any exercise program
Rating of perceived exertion may be the best method of setting intensity

30. Chapter 17 Exercise for Special Populations