Special population I - Department of Rehabilitation Sciences
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Transcript Special population I - Department of Rehabilitation Sciences
Exercise for the
Special Population
Exercise Science
2001
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
Special Populations
Target population
– Group vs. Individual, age group, gender
Identify Needs
– Goal Setting
Design Program
– Record Keeping
Evaluation
– Pre and post testing
So….
Who are they?
Special Population
Special Population = Adapted State
Population at risk
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–
–
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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…
Lifelong Fitness Lifestyle
Four phases of natural history
of exercise
Sedentary
Adoption
Maintenance
Time
Drop-out
Resumption
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
Guidelines (Cont’d)
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
Local Data 1
Report on Healthy Living Survey 1999
Department of Health
Cross-sectional telephone survey
n = 3,270
Aged 18-64 years
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)
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
Local Data 2 (1999)
Chinese University of Hong Kong
Interview survey
n = 26,111
Aged 10 to 20 from 48 primary and
secondary schools
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%
So….
What does it mean?
INACTIVITY - a major health problem
Association between sedentary
lifestyle and morbidity / mortality from
chronic disease - Evidence??
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
+
++
+
++
Effects of Physical Activity on
Health Outcomes in Adolescents
Aerobic Fitness
Body Fat
Blood pressure
HDL cholesterol
LDL cholesterol
0
Musculoskeletal injuries
BMD
Exercise Prescription
Considerations
An Example
Adolescence
Defined as ages 11 - 21
Pre-pubescent preadolescent
Post-pubescent adult
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
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
Implications
Can perform endurance task fairly well
Greater fatiguability in prolonged highintensity 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
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
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
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
Implications
Gradual progression of exercise
Avoid extremes in exercise duration
and intensity
Adequate period of warm-up,
stretching and cool-down exercises
Determinants of Physical Activity
Demographic
Biological
Psychological / emotional
Social and cultural
Physical Environment
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
Facts
Social influence strong++ - peer and
parents influence
Physical environmental strongly
associated with physical activity
(especially preschool children)
Local Data
Lindner and Sit, 1998
n = 4,690 (P.5 to F.7)
Reasons for participation:
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For Fun
For health and fitness
To be with friends
To become good at the activity
Local Data
Reasons for non-participation:
– Prefer to do one’s ‘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
Implications
Target high risk group - female
adolescents
Build perceptions of competence
or self-efficacy
Fun enjoyable activities
Implications (Cont’d)
Reduce perceptions of barriers
Social support from friends
Stimulate parental assistance
Increase time to spend outdoors
Physical Activity Guidelines
International Consensus Conference
on Physical Activity Guidelines for
Adolescents (Sallis and Patrick, 1994)
Health Education Authority (Biddle et
al, 1998)
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
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
Exercise for Obese Children
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!!
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
Think about:
Physical Activity Guidelines for
Adolescents
Determinants of Physical Activity
Principles of exercise training
Components of physical fitness
Evaluation Tools
Follow up period
Evaluation Tools
Measurements of:
Cardiovascular fitness
Body fat composition
Physical activity level
Components of the Program
Exercise
Nutrition
Social Support - parents involvement
Behaviour change
Relapse prevention
Characteristics of the Exercise
Programs
Home based vs. site-based
Build activity into child /
adolescent’s lifestyle
Negative energy balance
Think about the activity
guidelines
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 - > 70% VO2 max; HR >
169 beats/min; > 7.5 METS
HR monitoring considered for
assessing moderate to vigorous
activity
Initiatives in
Hong Kong
Exercise Program