Download Exercise Programming

Module 2 Lifestyle,
Fitness and Wellness
Aims: To heighten awareness of the
importance of choosing a
healthy and active lifestyle,
and to understand the effects
of stress and nutrition on
lifestyle.
Objectives Module 2
Objectives:
• To recognise the consequences of modern
society and identify the reasons for
choosing a healthy lifestyle
• To describe techniques used to motivate
individuals to participate in regular physical
activity
• To prescribe exercise modification for
people with special needs in a regular
exercise class
Objectives
• To describe appropriate stress reduction
techniques
• To describe the principles underlying
healthy eating and the relationship
between energy balance, physical activity
and weight management
Continuous Assessment
Procedures
Two written assessments 50% x 2
(6-7 questions per assessment,
40 mins for each assessment)
3.1.a.iv OH
What is a healthy
lifestyle?
Healthy Lifestyle
Stress Management
Diet
Physical Activity
Smoking
WHO/FAO (2003)
• “The burden of chronic diseases – which
include cardiovascular diseases, cancers,
diabetes and obesity – is rapidly increasing
worldwide. In 2001, chronic diseases
contributed approximately 59% of the 56.5
million total reported deaths in the world and
46% of the global burden of disease.”
• Global Strategy on Diet, Physical Activity
and Health (WHO/FAO June 2003)
Risk Factors for Chronic
diseases
•
•
•
•
•
High blood pressure
High cholesterol levels
Obesity
Low levels of physical activity
All of these risk factors could be easily
prevented.
Cigarette Smoking
• Cigarette smoking affects the heart
and the lungs
• Causes cancers and is a risk factor for
osteoporosis
• Passive smoking is a significant factor
in cardiovascular deaths each year
(American Heart Association,
American Lung Association, American
Cancer Society)
Stress Management
1.
2.
3.
4.
Continuous stress over time may
contribute to heart problems and other
illnesses.
Exercise, listening to music, meeting
friends are all ways to relax.
Everyone should find time to relax and
do something enjoyable.
Adequate rest and sleep are necessary
to avoid fatigue, a possible stressor.
Diet
• Eat a wide variety of foods – Food
Pyramid
• Reduce fat intake
• Increase intake of fruit and vegetables
• Drink more water
• Eat less sugary foods and drinks
• Reduce salt intake
• Alcohol in moderation – 14 units for
women, 21 units for men over one week
Physical Activity
• Undertake moderate-intensity physical
activity for at least an hour a day
(WHO/FAO, 2003).
• Choose activities you enjoy
• Choose activities that are dynamic and
use the major muscle groups.
• Examples – brisk walking, swimming,
cycling, dancing etc (AHA, 2002)
Physical Activity 2
• Simple rule – physical activity should
elevate heart rate and breathing
somewhat, but a person should still be
able to carry on a conversation.
(ACSM, 2001)
• Greater health benefits can be
achieved by increasing the amount
(duration, frequency or intensity) of
physical activity (Surgeon General’s
Report, 1996).
Health Benefits of
Regular Exercise
Energy
Levels
improved
Strengthen
muscles
Social
benefits
Body fat
reduced
CV
Endurance
improved
Stress
management
Bone
health
Lean body
tissue
increased
Improved
BP
CHD risk
reduced
Risk of
diabetes
reduced
Flexibility
improved
Reaction
time
improved
Arthritis –
Quality of life
Mental
wellbeing
Risk of
injury
reduced
Benefits of Daily Physical
Activity (AHA, 2002)
•
•
•
•
Reduces risk of heart disease
Healthy body weight
Healthy cholesterol levels
Prevents and manages high blood
pressure
• Prevents bone loss
• Boosts energy levels
Benefits of Daily Physical
Activity 2
• Stress management – releases tension,
improves sleeping patterns
• Improves self-image
• Counters anxiety and depression
• Improves muscular strength
• Accommodates socialisation
• Establishes good lifetime habits in
children
• Maintains independence and quality of life
in older adults
Precautions for a
Healthy Start
•
•
•
•
Suggestions?
Medical readiness
To avoid soreness and injury?
People with chronic health problems
should consult their physician (screening)
• Any other advise? – Footwear, clothing,
hydration, timing of exercise etc
Exercise for Fitness
(ACSM, 2000)
• Cardio-respiratory fitness and body
composition
• Muscular endurance and strength
• Flexibility
• FITT
Category
Cardiovascular
Frequency Intensity
3-5 days per 60-85% MHR
week
Time
20-60
minutes
Type
Large
muscle mass,
continuous,
rhythmic
Muscular
2-3 days per 8-12 RM range 1 set each of Major
Strength/Endurance week
60-70% 1RM 8-10
muscle
(LME)
exercises
groups, full
70-90% (MS) (less than
ROM,
1hr)
controlled
speed
Flexibilty
2-3+ days
To mild
15-30 secs Static or
per week
discomfort/point
assisted
of tension
(PNF)
ACSM’s Guidelines for Exercise Testing and Prescription (2000)
Wellness
• Integration of all parts of health and
fitness that expands one’s potential to
live and work effectively (Mind/body
concept)
• Self-responsibility
• How one feels as well as one’s ability
to function effectively
Domains of Wellness
(Mind/Body Concept)
• Social domain: Personal relationships
• Emotional domain:Positive self-concept
• Physical domain:Exercise, Diet and safe
practices
• Occupational domain: Productivity
• Intellectual domain: Critical Thinking
• Spiritual domain:Meaning and purpose
in life
How can adopting a
healthy lifestyle benefit
the domains of wellness?
•
•
•
•
•
•
Physical
Emotional
Social
Intellectual
Occupational
Spiritual
Hypokinetic
Risk Factors (What
diseases/illnesses may occur?)
•
•
•
•
•
•
•
Excessive weight
Low levels of physical activity
Poor dietary habits
High blood pressure
Excessive stress
Cigarette smoking
Excessive alcohol consumption
Revision
• Briefly define wellness and outline its
components.
• Explain the term ‘hypokinetic’.
• Name three hypokinetic diseases or
conditions.
• Identify risk factors that cause these
diseases.
Cardiovascular Disease
• Irish men and women have the highest
rate of death from CHD in the EU before
age 65. (WHO)
• Almost as many women die each year
from heart disease as men. (IHF, 2002)
• In 2001, just under 6,000 women died
from diseases of the heart and circulatory
system and just over 6,000 men. (IHF,
2002)
The Heart (M1 notes)
Coronary Heart Disease (CHD)
• Arteriosclerosis: hardening of the
arteries due to conditions that
cause the arterial walls to become
thick, hard and non-elastic
• Atherosclerosis: progressive
condition; deposits of cholesterol;
other lipids and cellular waste
products accumulate on the inner
walls of the coronary arteries;
plaque
Coronary Heart Disease (CHD)
• What Injures the Lining of Arteries?
High blood cholesterol levels,
excessive dietary cholesterol and
saturated fats, high blood pressure,
nicotine, reaction to perceived stress
• Ischemia: decrease in blood supply
to heart muscle
Heart Disease through
the Life Cycle
Damage to the Heart
Damaged Artery
Questions (1)
• What Is Angina Pectoris?
Coronary artery is partially blocked leading
to O2 debt. May be brought on by vigorous
exercise or sudden exertion. Individual
feels a sharp pain in the chest, jaw or along
the inside of the arm indicative of a mild
heart attack.
Questions (2)
• What Is Myocardial Infarction?
Results when one or more coronary
arteries are blocked by atherosclerosis
and a blood clot (thrombus) plugs the
remaining opening. Portion of heart
muscle beyond blockage is deprived of O2,
resulting in injury or death of that portion.
Questions (3)
• What Is a Stroke?
• Blood vessel bursts or artery is clogged
by clot or other matter. This causes nerve
cells to die. Brain cells cannot heal.
• Risk Factors for Stroke: hypertension,
heart disease, gender, diabetes, age,
race, stress, smoking, high cholesterol
levels
Risk Factors for CHD
• High blood pressure
• Smoking
• Obesity - android, high blood pressure,
high blood lipids, diabetes
• Stress
• Sedentary lifestyle
Risk Factors for CHD
• Family history
• Gender: oestrogen effect may raise
levels of HDLs
• Age: males after 45 years, Females
after 55 years
• Race: in the U.S., blacks are 33% more
likely to suffer from hypertension
Modifiable and NonModifiable Risk Factors
for CHD
•
•
•
•
High blood pressure
Cigarette smoking
Inactivity
High blood cholesterol
levels
• Obesity
• Stress
• Age
• Positive
family history
• Gender
• Race
• Diabetes
mellitus
Cholesterol
• Suggested “Healthy” levels of cholesterol – Total
cholesterol no greater than 5 mmol/L. LDL
cholesterol no greater than 4. HDL cholesterol
greater than 1.15 (IHF, 2003)
• LDLs: more prone to oxidation by macrophages at
an injured site on the arterial wall (plaque).
Smoking, emotional stress, diets high in saturated
fats increase LDLs.
• HDLs: protective against the development of
atherosclerosis. Acts as a scavenger. Exercise
may increase levels of HDLs.
Primary Risk Factors
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•
•
•
High blood pressure
High blood lipid levels
Cigarette smoking
Inactivity
Secondary Risk Factors
•
•
•
•
•
•
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Obesity
Stress
Age
Gender
Race
Positive family history
Diabetes mellitus
Exercise Programming
for Clients with CHD
• Frequency = 3-4 times per week
• Intensity = low intensity dynamic
exercise, gradually increasing to 60-85%
MHR, 4-7 RPE(11-15 RPE)
• Time (duration) = total exercise duration
should be gradually increased to 30-60
mins
• Type = aerobic exercise (long gradual
warm-up and cool-down); resistance
training: low weight, high reps; flexibility
Review
• Exercise for health – recommendation?
Give examples
• Exercise for Fitness should include what
components of fitness?
• Domains of wellness
• Why is exercise recognised as a means
of reducing the incidence of CHD?
Risk Factors for Coronary Heart
Disease
– Exam Question
• List 5 modifiable risk factors for CHD
and identify what lifestyle changes can
positively influence such risk factors. (15
marks)
• Answer may be given in table format
• Key words?
• Read question twice
• Underline key words
• Decide - Give answers in bullet
points/ table format/ diagram
• Read question again
• Check if you are on the right track
• Write answer
• Leave 8-10 lines blank – in case of
Divine Inspiration!
Risk Factor
+ Lifestyle
Modifications
High blood pressure Reduction in dietary fat;
aerobic exercise; stress
management
Cigarette smoking
Quit
Sedentary lifestyle
Adopt CV exercise
programme
High cholesterol
levels
Reduction in dietary fat;
aerobic exercise
Obesity
Diet; exercise
programme
Blood Pressure
• Is the force exerted against the blood
vessel walls
• Arterial blood pressure is the one most
commonly measured and most
important to our health
Blood Pressure 2
• BP is given in two numbers –
systolic/diastolic
• Systolic = that phase during which the
heart is pumping blood through the
arterial system
• Diastolic = that phase when the heart is
resting between beats and blood is
flowing back into it
Hypertension
(high blood pressure)
• Stage 1 (mild) 140/90
• Stage 2 (moderate)
160/100
• Stage 3 (severe)
180/110
• Stage 4 (very severe)
>210/>120
Factors That Influence
BP
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•

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Age
Body position
Time of day
Smoking
Alcohol intake
Caffeine
Exercise
Stressful situation
Risk Factors for
Hypertension
•
•
•
•
Family history
Gender
Race
Obesity

Sedentary lifestyle
Alcohol
Salt intake
Low potassium intake
(irregular heart beat)



Why is Hypertension
Dangerous?
• Drastically increases
workload on the heart
• Can damage the arterial walls
(CHD)
Measures to Prevent
Hypertension
• Drug therapy
• Dietary reduction of fat
• Dietary reduction of salt intake
Measures to Prevent
Hypertension
• Alcohol in moderation
• Aerobic exercise with large muscle
groups 3-5 times per week at an
intensity of 50-85% of maximal O2
uptake for 20-60 minutes duration
• What exercises may be dangerous
for someone suffering from
hypertension?
Exercise Recommendations
for Hypertensive Individuals
(ACSM 2000)
Frequency: 3-7 days per week to
maximize the benefits of blood
pressure reduction from exercise.
Intensity: lower end of heart rate
range (40-65% MHR) / 11-13 RPE
scale / client should be able to
carry on conversation while
exercising (talk test)
Exercise Recommendations
for Hypertensive Individuals
(ACSM 2000)
Time: Use a longer and more gradual warmup > 10 mins. Total exercise duration
should increase gradually from 30 to 60
mins.
Type: Aerobic exercise – walking,
swimming, cycling. Wts: low resistance,
high reps, compound exercises. Avoid
Valsalva manoeuver. Flexibility.
Revision of
Hypertension
• Explain blood pressure.
• List risk factors for Hypertension.
• Identify exercise guidelines for
hypertensive individuals (FITT).
Session 4
Objectives
At the end of the session, students will be
able to:
• identify psychological and social factors
that inhibit individuals from participating
in regular physical activity
• discuss how body image and selfconcept could cause perceived barriers
to exercise
• identify the different factors for internal
and external motivation to exercise
adherence
Session 4 Objectives
• outline strategies that will encourage
individuals to (a) become involved and
(b) stay involved in physical activity
• identify the role of the instructor in
aiding adherence to exercise
Why Do People Exercise?
Why Do People Not Exercise?
Characteristics of
Adherers
•
•
•
•
•
Enjoy physical activity
High self-motivation
High exercise knowledge
Positive attitude toward exercise
Perceive benefits outweigh the
costs
• Past participation in exercise
• At high risk for heart disease
Characteristics of Adherers 2
• Perceived good health
• Sufficient behavioural skills
• Receive social reinforcement for
exercise
• Perceived available time
Dishman et al, 1988
Characteristics of Dropouts
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Blue collar occupation
Smoker
Overweight
Psychological mood
disturbance
Perceived poor health
Low self-motivation
•
•
•
•
Low exercise
knowledge
Negative attitude
towards exercise
Perceived
disruptions in
exercise routine
Activity too
intense, too much
exertion
Reasons for Exercise
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•
•
•
•
•
•
Fun
Feeling good
Weight control
Challenge
Stress Reduction
Doctor’s advice
Social reasons
•
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Appearance
Achievement
Competition
Health
Skill Learning
Self-actualisation
Fitness
Perceived Barriers to Exercise
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Lack of time
Injuries
Expense
Lack of support
Limiting health
Lack of interest
• Previous
exercise
experience
• Lack of choice
• Lack of facilities
• Boredom
• Too much effort
Transtheoretical Model (Stages
of Change)
Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
(Prochaska & Marcus, 1994)

The Stages of Change

Typical Behaviour

Pre-contemplation
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Contemplation
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Preparation
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Action
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Maintenance
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The stayer

Relapse

The ‘stop/start’ client
Not interested, ‘in one
ear, out the other’
“maybe I should”, “if I
don’t lose weight ….”
“I’ve enquired about
classes in my area and
organised babysitter!”
The starter/novice
exerciser
TTM - Strategies
• Precontemplation (“never) – be nonjudgemental; information leaflets etc
• Contemplation (“someday”) – Assure
the client that change is worthwhile
• Recognition of source of motivation is
important at this stage – e.g. successful
weight loss by a friend
TTM - Strategies
• Use strategies such as free
introductory visit/discounts/before
and after pictures etc
• A contemplator weighs up the
pros and cons of initiating
behaviour
Preparation
• Preparation (“soon”) – encourage
client to set date to commence
exercise
• Guide the client into an exercise
programme that suits their
interests and personality type
Preparation
• Discuss potential barriers to
starting an exercise programme
and provide solutions for each.
E.g. Effort of getting to the gym,
physical discomforts etc
Action – Take Off!
• Encourage progression rather than
perfection
• Attendance goals vs improvement goals
• Increase exercise intensity gradually
• Identify the client’s strengths
• Praise their efforts and adherence
• Help clients to recognise the intrinsic
rewards of exercise (e.g. increased
energy).
Maintenance & Relapse
• Task now is to keep client motivated to
prevent relapse to sedentary lifestyle
• Create new challenges (long-term goals
– mini-marthon), use fitness assessments
• Encourage intrinsic and extrinsic
motivation
• Ensure variety to avoid drop out
• Acknowledge possible relapse situations
DISC System of Personality
Type
Dominant (D)
Driven, decisive,
competitive, confident,
assertive, goal-oriented
Interactive (I)
Optimistic, enthusiastic,
sensitive, disorganised,
emotional, social
Steady (S)
Reliable, easy-going,
patient, loyal, agreeable,
complacent, peoplefocused
Cautious (C)
Analytical, systematic,
diligent, accurate,
thorough, task-oriented
Strategies to Encourage
Exercise Adherence (Summary)
• Make exercise sessions easy,
interesting and fun
• Acknowledge exercise discomforts
• Use exercise reminders, cues and
prompts
• Encourage an extensive social
support system
Strategies to Encourage
Exercise Adherence
(Summary)
• Develop group camaraderie
• Emphasise positive aspects of
exercise
• Help develop intrinsic rewards
• Set attainable goals (SMART),
action-oriented not outcome-oriented
• A lady client in your gym is very
overweight and is keen to start an
exercise programme to help her lose
weight. She is shy and lacks confidence
and is very reluctant to exercise in public.
• How would you deal with this client?
• (Give evidence of relevant teaching
strategies/skills so as to promote exercise
adherence.)
• Headings/Table – bullet points
Initial
Meeting/
Screening
Tests
Goal
setting
Programme
(FITT)
A.O.A
Session 5 Objectives
At the end of this session, students will be able
to:
• define stress
• give examples of stress-inducing factors
• describe the positive and negative aspects
of stress
• describe and demonstrate a range of stress
management techniques for a variety of
situations
Stress Management
What Is Stress?
• Eustress – positive stress, motivates us
to act
• Distress – negative stress
• Stress response –
• Acute (quite intense but disappears
quickly)
• Chronic (lingers for prolonged periods
of time)
Stress Response/Alarm
Reaction
• Muscles tense and tighten
• Breathing becomes deep and
fast
• HR rises and blood vessels
constrict
• Blood pressure rises
Stress Response/Alarm
Reaction
• The stomach and intestines halt
digestion temporarily
• Thyroid gland is stimulated
• Perspiration increases, secretion of
saliva slows down
• Blood sugar and fats rise
• Sensory perceptions become
sharper
Types of Stressors
• Environmental stressors: heat, noise,
overcrowding, climate
• Physiological stressors: drugs, caffeine,
tobacco, injury, infection or disease,
physical effort
• Emotional stressors: life-changing events,
family illnesses, death, problems with
superiors, increased responsibilities
Ill Effects of High
Stress
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•
•
•
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Heart disease
Cancer
Infection
Suppressed immunity
Asthma attacks
• Back pain
• Chronic fatigue
• Gastrointestinal
distress
• Headaches
• insomnia
Stress Management
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Active exercise
Rest and sleep
Breathing
Meditation
Imagery
Autogenic training
Progressive relaxation
training
Stress Management 2
• Controlling stressors: Tackle it through
modification, reduction in numbers,
avoidance
• Managing stress reactions: Reframing/
the mind can choose a more positive
response to any particular stressful
event
• Seek the social support of others:
sharing emotional, social, physical,
financial support and assistance of
others rather than social isolation
Stress Management 3
• Diet: prudent intake of alcohol, caffeine,
fatty foods, sugary foods and salt
• Increase intake of fruit and vegetables
• Time management: prioritise, make lists,
plan ahead, learn to say “no”, take one
thing at a time, reward yourself for
getting things done
• Take time out for you – laugh!!
Session 6 Objectives
At the end of this session, students will be able to:
• identify the psychological, physiological and social
factors regarding back pain
• identify the main causes of back pain, e.g. incorrect
exercise techniques, muscular imbalances,
overuse, wear and tear and age
• discuss the importance of good posture in the
prevention of back pain
• identify the necessary exercises to alleviate back
pain, giving recommendations for client care in
different situations
Session 6 Objectives
• describe the safety guidelines
necessary when programming for back
pain sufferers
• design a positive exercise programme
for the back pain sufferer to include
resistance exercises, flexibility and CV
exercises
• identify and apply the necessary safety
concerns for clients taking exercise
with low back pain
Structure of the Spine
Examples of Causes of Lower
Back Pain (lbp)
Prolapsed intevertebral disc
Causes of back pain 2
• Wear and Tear – Arthritis/degenerative
disease
• Affects the joints between vertebrae
and joints as the back of the spine
• Discs may become thinner – spikes of
bone may press on nerve roots
• Causes pain/pins and
needles/numbness
Causes of back pain 3
• Strained muscles due to a sudden of
unexpected movement
• Muscles are more easily strained if
fitness is poor/not warmed up before
exercise/fatigued
• Strained ligaments – injured when joint
is stretched to its limit and held there too
long, or repeated too often
Causes of back pain 4
• Internal problems: kidneys,
gallstones, gynaecological problems,
shingles
• Emotional problems – chronic daily
stress
Prevention of Back Pain
•
•
•
•
•
Standing Posture – lowheeled shoes
Use ledge to relieve
stress on back
Work surfaces at correct
height
Seated posture – sit with
knees higher than hips
Use foot rest
•
•
•
•
•
•
•
•
•
Have a chair that
supports lower back
Adjust monitor height if
necessary
Have orthopaedic bed
Bend knees
Have supportive pillow
Lifting – (M8) 3Bs
Footwear while
exercising
Exercise technique
Exercise intensity
Why do the following
people suffer from back
pain?
What lifestyle changes could they
make to prevent back pain?
Exercise Programming
• CV exercise while maintaining spine in
neutral (stomach tight, back straight,
shoulders back, chest lifted)
• Suitable CV machines (stepper?)
• Strengthen the abdominal muscles –
Core stability, use of mats and stability
balls (M10)
• Stretch the hamstrings and erector
spinae (M10)
Exercise Programming
• Strengthen erector spinae (M10)
• Introduce clients to Pilates and Yoga
• Abdominal ptosis should be
prevented through use of diet and
exercise
• If in doubt, refer to a specialist!
Backache Risk Factors
(Corbin and Lindsey, 1994)
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•
•
Overweight
Frequent bending over (forward flexion)
Lack of lumbar flexibility
Lack of hamstring flexibility
Weak trunk extensor muscles
Trunk muscle imbalance
Age
Osteoporosis
Backache Risk Factors
• Previous back problems
• Participation in certain sports where
there is a repetitive and large range
or rapid acceleration or deceleration
of the spine
• Poor posture or postural
imbalances
• Incorrect exercise technique
Backache Risk Factors
•
•
•
•
Improper lifting technique
Poor fitness levels
Overuse
Poor footwear and mechanics
Exercise Programme for
Back Care - Question
• design a positive exercise programme for a
back pain sufferer(lbp) to include resistance
exercises, flexibility and CV exercises
• Chronic lbp sufferer – non-disc related
• Doctor’s approval to exercise
• FITT
• Specific exercises to be included (stretch &
strengthen)
• Modifications
In general, maintenance of regular physical
activity during pregnancy helps keep the
mother fit and healthy, causes no harm to the
growing foetus, and may improve the birthing
experience.
(Nieman, 1998)
Regular, moderate exercise is sufficient to
derive health benefits. Pregnant women
should listen to their bodies, stop exercising
when fatigued, and not exercise to
exhaustion.
ACOG (1994)
Screening – What Questions?
•
•
•
•
Doctor’s clearance?
First baby?
Any complications in previous pregnancies?
Pregnancy induced hypertension?
Screening – What Questions?
• Pre-term rupture of membrane?
• Any persistent bleeding,
dizziness, pain?
• Sudden swelling of ankles?
• Stage of pregnancy?
• Regular exerciser/previously
sedentary?
Warning Signs to Stop
Exercise
• Vaginal bleeding
• Abdominal/chest pain
• Leaking/gushing from
vagina
• Swelling of hands, feet or
face
• Severe headache
• Dizziness
• Reduction in fetal activity
• Painful, reddened
area in the leg
• Severe pain in
hip/pelvic area
• High temperature
(>38 degrees C)
• Persistent
nausea/vomiting
• Uterine contractions
• Heart palpitations
• Shortness of breath
Pre-class Advice
•
•
•
•
•
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•
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Intensity – low to moderate
4-6 RPE scale, <75% MHR, 140 bpm
Low impact
“easy” stretches
Floor exercise adjustments
No sudden changes in direction
Placement near exit
Hydration
Benefits of Exercise
•
•
•
•
•
•
•
Increase energy
Maintain fitness level
Control weight
Improve posture – decrease backache
Promote circulation
Decrease constipation
Reduce stress – enhance sleep
Changes in the body
•
•
•
•
•
•
Diaphragm
Internal organs (stomach & intestines)
Lumbar spine
Bladder
Uterus
Sciatic nerve
Breathing Changes
• Diaphragm pushes • Lift arms up and
upwards
out to ease
• Breathless, may
breathing
hyperventilate • Breathing rate
don’t over-exert
increases by 45%
• O2 consumption
• Avoid exercising in
increases
humid weather
Heart and Circulatory
Changes
•
•
•
•
•
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•
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Heart wall thickens, heart enlarges
Blood volume increases
Resting heart rate increases
Cardiac output increases
Cardiac reserve diminishes
Blood vessels soften and stretch
Varicose veins
Blood vessels constrict in some cases
Heart and Circulatory
Changes 2
• Supine Hypotensive Syndrome
Implications
•
•
•
•
•
•
Tire sooner
Moderate intensity – RPE 4-6
< 75% MHR
Change direction slowly
Rise slowly from the floor
No exercises in supine position after 12
weeks
Stomach and Intestinal
Changes
• Heartburn and indigestion
• Constipation
• “Morning sickness”
Implications:
• Exercise at the same time everyday
• Drink plenty of fluids
• Eat an hour before exercise
Kidney and Bladder
Changes
• Need to urinate more frequently
• Leaking urine
• Swelling
Implications:
• Pelvic floor exercises
• Placement in class
• Minipads
Muscular, Joint and
Postural Changes
•
•
•
•
•
Centre of gravity shifts
Lordosis
Kyphosis
Relaxin- joint looseness
Diastasis recti
Diastasis Recti
Muscular, Joint and
Postural Changes
Implications:
• Change direction slowly
• Keep choreography simple
• Strengthen back, buttocks
and abdominals
• Don’t stretch to maximum
Pelvic Floor Changes
• Sag due to weight of uterus
Implications:
• Pelvic floor exercises - 50 reps per
day
Potential Risk for the
Foetus
• Decrease in blood flow to the uterus
• Reduced glucose supply to the foetus
• Overheating
Implications:
• Do not exercise to exhaustion
• Reduce exercise time
Energy Intake
• Extra energy is required during
pregnancy (300 calories – ACOG)
• Extra demands on blood glucose
during pregnancy
• Balanced diet (food pyramid)
First Trimester
•
•
•
•
•
Fatigue
Nausea
Emotional changes
Frequent urination
Blood volume
increases
• RHR increases
• HRR decreases
• Shift to
maintenance
mode
• Watch for
overheating
• Holding of breath
• Overstretching
• Monitor intensity –
RPE, HR,
observation
Second Trimester
•
•
•
•
•
•
Changes in posture
Weight gain
Joint laxity increases
COG changes
Lordosis increases
Risk of diastasis recti
• All low impact work
• 4” or no step
• No sudden changes
in direction
• Care when getting
up from the floor
• No supine work
• Stationary
bike/treadmill
walking/swimming
Third Trimester
• Posture and Gait
changes
• Uterus is 1000 times its
normal size
• Increased fatigue
(insomnia)
• Decreased ROM
• Increased shortness of
breath
• Heartburn
• Avoid quick jerky
movements
• Do not exercise to
fatigue
• Opt for swimming and
stationary
cycling/treadmill
walking
• Use stability ball/wall
squats to relieve LBP
Benefits of Exercise
Postpartum
• Opportunity for weight
loss increases
• Urinary incontinence
decreases
• Favourite activities can
be resumed more
quickly
• Back pain is
reduced or
eliminated
• Energy levels
improve
• Anxiety, depression
decrease
significantly
(Clapp, 1998; Creager, 2001)
Post-partum
•
•
•
•
6-8 weeks normal delivery
10-12 weeks for c-birth
Doctor’s written clearance
Gradually resume prepregnancy
exercise levels (ACOG, 1994)
• A previously pregnant client should start
with short sessions and gradually build
up to desired level of activity (US Dept of
Health, 1996)
Postpartum 2
• Postural problems – backache, frequent
bending forward over changing table
• Feel fat (extra adipose tissue)
• Pelvic floor weak
Postpartum 3
• Fatigue – disrupted sleep patterns
• Start with non-weight bearing exercises
and walking
• Strength work – target abs, back, pelvic
floor (core stability)
• Ensure adequate calorie intake and
hydration
Postpartum 4
• Beware of any signs of overexertion –
dizziness, joint pain, bleeding
• Certain moves e.g. jumping jacks may
cause stress incontinence
• Keep stretches “easy”
Exercise and Pregnancy
• Identify the benefits of exercise for a
pregnant client.
• Outline 3 adaptations that should be
made for the pregnant client in an
exercise to music class. Give the
physiological reasons for these
adaptations.
“No one is too old to enjoy the
benefits of regular physical
activity.” US Surgeon General,
1996
Exercise and the
Older Adult
• 11% of the Irish
population is aged over
65. By 2026, it is
projected that 18% of the
population will be over
65. (Codd et al., 1998)
• This has serious
implications for
resources in health care
and for the HFI.
Exercise and Older
Adults 2
• National Survey of Involvement in Sport
and Physical Activity (1996) reported
that 40% of the adult population were
sedentary. This portion is
disproportinately drawn from older adults
– male and female.
• Sedentary = people who in the past 30
days have not sustained any activity for
20 minutes
Exercise and the Older
Adult 3
• The age-related decline in activity is also
shown by the Irish Universities Nutrition
Alliance (1997, 1999)
• It showed that activity levels are low
among Irish adults and that activity
declines significantly with age – 51% of
women aged 51-64 years reported no
vigorous activity
Exercise and the Older
Adult 4
• Comparing the results of the Institute of
European Food Studies (1997) & a
survey by Dept of Health and Children
(1998)
• Participation in “everyday” activities such
as walking and gardening was declining
Barriers to Participation
• Lack of money
• Community halls were unavailable
(licencing/insurance problems)
• Too few adequate paths and trails in
the country side
• Lack of information about activities,
events and courses.
• “Quality of Life” Survey, Limerick
County Development, 2001
Barriers to Participation 2
• Facility issues (lack of facilities, difficulty
of access)
• Lack of facilities specific to the needs of
older people
• Lack of transport
• Concerns about health/fitness/age
• (Ballymun Active Living Survey, 1999)
Overcoming Barriers
Realisation that
• It is possible to become active without
great cost
• Being active does not entail a large time
commitment
• It is not necessary to be sporty, have lots
of free time, or be a member of a gym
Overcoming Barriers 2
For older people the social element of
physical activity is very important
(Ballymun Active Living Survey (1999)
Reasons for Participation
•
•
•
•
Enhance their daily functionality
Play with their grandchildren
Socialise
Shop, cook and maintain independent
lives
• Enjoy recreational activities
• (Pruitt, 2003)
Screening Older
Adults
•
•
•
•
•
Moderate risk classification (ACSM, 2000)
≥45 years for men
≥ 55 years for women
Doctor’s written clearance
Detailed questionnaire that investigates
existing and prior medical conditions
Medical Concerns for
Older Adults
Heart disease, high blood pressure,
diabetes, stroke, cancer, arthritis,
orthopaedic impairments, hearing
impairments, cataracts, visual
impairments, osteoporosis, senile
dementia, depression,
overmedication
• As much as 50% of the functional
decline seen in ageing is related to
disuse and can be prevented with
regular exercise.
Physiological Changes
• VO2 max is reduced (8-10% per
decade ›25 years)
• Cardiac output is reduced (20-30%
by 65 years)
• Blood vessels become inelastic
• Max HR decreases
Physiological Changes
• Respiratory changes: vital lung
capacity reduces, chest wall
compliance, and alveolar size
decreases
• Body Fat increases – metabolic rate is
reduced
Physiological Changes
• Muscle mass and strength reduces
(particularly in the lower body)
• Loss in bone mass
• Connective tissue loses its elasticity,
muscle fibres shorten and joints produce
less synovial fluid
Physiological Changes
• Reduction in nerve conduction, number of
neurons and brain mass
• Reduction in haemoglobin
• TC increases and HDLs reduce
• Balance, taste, sight, hearing
Task
• What implications do these
changes have for the design of
physical activity programmes?
• (Intensity, length of warm up
and cool down, selection of
exercises, components of
fitness etc)
Benefits of Physical
Activity 1
• Primary and secondary prevention of
chronic diseases (e.g. CHD, adult onset
diabetes), disabling conditions (e.g.
osteoporosis), and chronic disease risk
factors (e.g. high blood pressure,
obesity) (CDC, 2002)
Benefits of Physical
Activity 2
• Greater life expectancy
• Delays the onset of functional limitations
& loss of independence
• Lowers risk of falls (balance work)
• Manages arthritis – maintains ROM,
reduces pain & improves function
Benefits of Physical
Activity 2
• Improves sleep patterns
• Reduces symptoms of depression
• May reduce the amount of cognitive
associated with ageing
Benefits of Exercise
While Ageing
(ACE, 2002)
– To increase bone density and prevent
osteoporosis
– Increases muscle mass and metabolism
– Create a sense of belonging through
social interaction
– To improve pulmonary function
Benefits of Exercise
While Ageing
(ACE, 2002)
– To help prevent and regulate noninsulin dependent diabetes by
regulating blood sugar levels
– To improve flexibility, joint ROM
– To improve blood circulation
– To improve cardiovascular endurance
Programming for the
Older Adult
• Many may not have exercised for 10, 20, 30+
years
• Start at low intensity levels – teach RPE, use talk
test, external observation
• Consider interest level, medical limitations, base
progression on the client’s functional capacity,
health status, age, preference and needs or goals
• Work on diaphragmatic breathing, making sure
clients avoid shallow breathing
Programming for the
Older Adult 2
• Work on enabling the client to get up and
down off the floor, develop static and
dynamic balance
• A minimum of 10 minutes should be given
to flexibility training, where stretches are
held for 10-15 seconds
• Ensure clients stay hydrated
• Remember their thermoregulatory
capacity is reduced with age – therefore
wear layers
Cardiovascular Training
for Older Adults
(ACSM, 2000)
Frequency
3 times per week on alternate days
Intensity
50-60% MHR initially
Increase gradually to 75% MHR
Time
5-15 minutes 2/3 times per day until
client can sustain exercise for 30
minutes
Type
Work within client’s orthopaedic
tolerance level. Walking/Aquatic
exercise/recumbent cycling
CV Programming for
Older Adults
• Frequency, intensity and duration
should be changed individually
• Altering them at the same time may
provide too much overload
Weight-training and
Older Adults
• Studies show that is it never too late
to improve muscular strength and
size through weight training, and that
elderly people who do so can greatly
improve function and life quality.
(Nieman, 1998)
LME/Strength
Recommendations
(Swain & Leutholtz, 2002)
• F: 3 times per week (alternate days)
• I: 8-12RM. Once client can lift wt 12
times increase wt by 10% to bring
client back to 8RM
• T: 20-30 minutes per session
• T: Machine wts, multijoint, linear,
pulling/pushing movements initially
e.g. leg press
LME
• Target legs, chest, back, shoulders,
arms, abdominals and cervical region
• Client with knee and/or hip concerns
should focus on multijoint linear
movements such as leg press rather
than single joint movements like leg
extension which can produce sheer
force.(Ensure proper technique).
Avoid rotional movements like leg
abduction and adduction.
LME/Strength
•
•
•
•
•
Focus on proper lifting technique
ROM through painfree arc
Proper breathing
Controlled speed of movement
Do not exercise during an acute
arthritic flare up
• Reduce the load by 50% or more
when returning after a layoff
Balance Work
• Balance training helps in the prevention
of falls
• One legged standing near a bar, wall or
chair
• Standing up and sitting down without
using hands
• Walking heel to toe along a line
• Use of step aerobics (118-122bpm)
• Tai chi has been shown to improve
balance in older adults (Kessenich,
2002)
Goal
• “to die young as late in
life as possible” (Ashley
Montague)
Osteoporosis
Osteoporosis, porous
bone, is a disease
characterised by low
bone mass and
structural deterioration
of bone tissue, leading
to bone fragility and an
increased susceptibility
to fractures, especially
of the hip, spine and
wrist (NOF, 2003).
The Silent Disease
• Bones become so weak that a
sudden strain, bump or fall causes
a fracture or a vertebrae to
collapse
• Collapsed vertebrae cause loss of
height, spinal deformities
(kyphosis) and severe pain
Osteoporosis
• Type 1 occurs primarily in women aged
45-60 years (postmenopausal). This is
associated with oestrogen depletion.
The most common fractures are in the
radius and the vertebrae.
• In the first 5-7 years following
menopause, women can lose as much
as 20% of their bone mass (Chopra,
2002)
Osteoporosis
(Brittle Bones)
• The rate of bone loss slows after this. By
age 65-70 men and women lose bone at
the same rate (NIA, 2000)
• Type 2 occurs in males and females over
70 years - hip fractures not only
associated with low bone mass but with
the ageing process.
• An average of 24% of hip fracture patients
50 years and older die in the year following
their fractures (NIH, 2002)
Bone Remodelling
• Osteoclasts breakdown old bone
• Osteoblasts replace it with new tissue.
Which then mineralises.
• With age more bone is broken down
than is replaced.
• From the fourth decade onwards,
more bone is absorbed than is formed.
The imbalance increases with age.
Microarchitecture of bone
deteriorates.
Stages of Osteoporosis
1.
2.
3.
Bone building – from childhood to early
adulthood (diet rich in Ca and vitamin D;
weight bearing exercise)
Osteopenia- evidence of reduced bone
mass is detected (stooped posture)
Osteoporosis – bone loss is
unmistakable (bone mineral density test)
Risk Factors
•
•
•
•
•
•
Low level of peak bone mass
Low lifetime intake of Ca
Smoking
Sedentary lifestyle
Family history
Heavy drinking
Risk Factors 2
•
•
•
•
Low body weight – small frame
Prolonged steroid use
Amerorrhea
Oestrogen deficiency due to
menopause
• Anorexia nervosa
• Advanced age
Nutrition
• Clients should ensure adequate intake of
Calcium and Vitamin D
• Sources of Ca: Milk and diary products,
broccoli, oranges, grapefruit, figs, fish with
bones
• Vitamin D: egg yolks, cod liver oil, fortified
milk and cereals.
• It is synthesized in the skin after exposure
to sunlight (15 mins of outdoor exercise
per day).
• Avoid heavy drinking and smoking
Oestrogen Deficiency
• Oestrogen deficiency is a stronger
stimulus for bone loss than Ca
deficiency (Raisz and Smith, 1989)
• Oestrogen influences bone three times
as much as exercise (Larsson et al,
1979)
Exercise Programming
for
Bone Health
• Mechanical stress must be applied
to those areas where osteoporotic
fractures occur
• Principle of specificity - bone only
responds at the site where
mechanical stress is placed
(Lanyon, 1992)
Exercise Programming
for
Bone Health
• Principle of overload
• Principle of reversibility
• Currently, further study is needed to
clearly outline the training variables
that promote bone health
Exercise Programming 2
• Walking is ineffective as a bonebuilding stimulus
• However adding impact e.g. walking
faster/jogging/skipping/Irish dancing
will increase strain/stress on bones
Exercise Programming 3
• Radius: sponge ball squeezing, press ups
(wall/floor)
• Hips: abduction/adduction with
dynabands/ankle weights, squats, leg
press
• Back: Focus on posture
• Rhomboids/traps, lats, erector spinae and
abdominals (stability work)
• Include flexibility for functional
independence
Contraindicated
Exercises
• Forward spinal flexion and spinal rotation
• Avoid side bending, abdominal work in
supine position
• No pilates/yoga exercises in supine position
or with spinal rotation
Diabetes
• Glucose is the main source of energy
for the body. It is the only source for
brain cells.
• Insulin is a hormone secreted by the
pancreas. It stimulates cells to absorb
glucose.
Diabetes
• Metabolic disorder - the body cannot
metabolise carbohydrates properly,
which leads to high levels of glucose in
the blood.
• The body then switches to fats and
proteins as an energy source.
•
•
•
•
•
•
•
Long-term
Complications of
Diabetes
Blindness
Kidney failure
Nerve damage
CHD
Stroke
High blood lipids
Amputation
Type 1 and Type 2
• Type 1 = <30 years,
• Type 2 = >40 years,
autoimmune disease
adult onset
• Insufficieny insulin
• Cells unresponsive
production keep body
to existing insulin
cells “locked” so glucose • Age, family history,
cannot be used as fuel
obesity & sedentary
source
lifestyle (risk factors)
• Smoking
accelerates the
disease
Hypoglycaemia
– Insulin Shock
• Insulin reaction (too much circulating
insulin) - always carry something sweet,
if unconscious seek medical attention
immediately
• Make sure the client monitors their blood
sugar levels
• Signs = Uneasy, nauseated, confused,
uncoordinated, moist pale skin
Hyperglycaemia
– Diabetic Coma
• Too little insulin available, dehydration
occurs, exercise exacerbates
hyperglycaemia
• Signs = dry mouth, sweet smelling
breath, weak rapid pulse, abdominal
pain, nausea/vomiting
• Insulin injection required immediately
and medical attention
Screening Diabetics
(Dr’s clearance)
As normal screening plus:
• Check for cardio-vascular complications,
i.e. high BP, HR abnormalities
• Medical screening and advice on insulin
and dietary changes if needed
• Have sugar or sweets at hand in case of a
hypoglycaemic reaction
• Ensure the diabetic does not exercise
alone/ overtrain
Exercise
Recommendations
•
•
•
•
•
ACSM (2000) Guidelines
3-5 times per week
60-90% MHR (progress gradually)
20-60 minutes
Aerobic: if client has foot or leg injuries
non-impact activity, cue participants to
keep legs moving to avoid blood
pooling (longer warm up & cool down)
• Include LME/strength work & flexibility
Benefits of Exercise
• Improved insulin sensitivity and
blood glucose control
• Prevention or management of
obesity
• Improved physical fitness
• Improved blood lipid profile
Benefits of Exercise 2
•
•
•
•
Reduced blood pressure
Reduced risk of thrombosis
Reduced risk of CHD
Psychosocial benefits
Asthma
• Can occur due to an allergy, anxiety or
exercise
• It is an inflammation of the lungs that
causes airways to narrow, making is
difficult to breathe.
• Results in breathing and speaking
difficulties, wheezing, coughing or
phlegm; person can also turn a grey-blue
colour
Exercise and Asthma
• Avoid exercise if the client has an obvious
wheeze or breathing difficulty
• Warm-up period may need to be longer
than usual; avoid stopping exercise
abruptly
• Always warm down for 10 minutes
• Exercise intensity should begin at low
levels and gradually increase as the
client’s fitness level improves
Exercise and Asthma
• Avoid exercises that necessitate lying
on dusty floors, carpets etc.
• Advise client to take oral medication
before and, if needed, during session
• If possible, encourage client to take
up swimming where the air is moist
and warm
Nutrients
• Carbohydrates: complex and simple
• Fats: monounsaturated, polyunsaturated,
saturated fats
• Proteins
• Minerals (Ca, Potassium, Iron)
• Vitamins
• Water – no calorific value, 6-8 glasses per
day
Carbohydrates (CHO)
• Simple: glucose, glycogen
• Complex: stored in muscle/liver
• Food containing complex
carbohydrates also contain fibre
which is important for a healthy
digestive tract
• Excess is stored as fat (adipose
tissue)
CHO
• Provides four calories per gram
• Should contribute to 60% of daily caloric
intake, 45-50% from complex CHO and
less than 10% from simple CHO
• Recommendation of 20-35 grams of
dietary fibre per day
Role of CHO
•
•
•
•
•
Energy source
Four calories per gram
Protein sparing
Fuel for the central nervous system
A metabolic primer for fat metabolism
Fats/Lipids
•
•
•
•
•
•
< 30% per day
Saturated fats
Monounsaturated fats
Polyunsaturated fats
Essential fatty acid - linoleic acid
Cholesterol is not a fat
Role of Fat
• Energy source and reserve: nine
calories per gram
• Cushion for the protection of vital
organs
• Insulation from the thermal stress of
cold environments
• Vitamin carrier (A, D, E, K) and hunger
depressor
Proteins (C, H, O, N)
•
•
•
•
Amino acids (20)
Animal sources (turkey, fish, skim milk)
Plant sources (beans on toast)
Excess protein causes liver and kidney
disease
• Four calories per gram
Functions of Proteins
• Growth and repair
• Main structural component of all tissues of
the body
• Formation of enzymes – all physiological
processes are dependent on this nutrient
• Formation of hormones
Vitamins (Micronutrients)
• Fat soluble vitamins: A, D, E, K
• Water soluble: C- & B-complex vitamins
• Regulate metabolism, facilitate energy
release and are important in the process of
bone and tissue synthesis
• Vitamin supplementation does not lead to
improved exercise performance or potential
for training – balanced diet is the key
Minerals
• Provide structure in the formation of
bones, teeth and muscles (Ca)
• Deficiency in diet particularly in
childhood and adolescence is a risk
factor for osteoporosis
• Iron is essential for the formation of
haemoglobin
• Deficiency causes fatigue, anaemia,
illness
• Sodium is needed for metabolism and
blood pressure
Dietary Fibre (Roughage)
• Fibre is found in plant foods like whole
grains, fruits and vegetables
• A high dietary fibre intake has been
associated with a lower risk of colon
cancer and heart disease
• It is an important component of the diet
used to help control blood glucose
levels in diabetics.
Water (H2O)
• 40-60% of body weight
• 65-75% of muscle weight and 25% of
fat weight
• Main transportation mechanism in the
body
• Regulates the acid-base balance in the
body
• Regulates body temperature
Signs & Symptoms
of
Dehydration
•
•
•
•
•
•
Exhausted but restless
Headaches
Tired and dizzy
Muscular cramps in stomach and legs
Pale face and skin is cold and clammy
Individual may faint on sudden
movement
Water Balance:
Intake versus Output
Intake
• 2-3 litres per day
• Liquids
• Foods
• During metabolism
Output
• Loss in urine
• Loss through skin
• Loss through lungs
• Loss in faeces
Hydration (2-3 litres)
• Drink fluids before, during
and after exercise
• Dispel myths about sweating
and weight loss
• Avoid exercise in extreme
temperatures
• Ensure adequate ventilitation
General Dietary
Guidelines
• Food Groups: Potatoes, breads
and starches; Fruit and
Vegetables; Dairy Products; Meat,
fish and alternatives
• Fluids
• Cooking and preparation of foods
Recommended Dietary
Intake
•
•
•
•
Fat: 30% or less
Water: 2-3 litres per day
Carbohydrates: 55-60%
Protein: 10-15%
Benefits of Healthy
Eating
• Less risk of coronary heart disease and
certain cancers
• Improved appearance, less weightrelated problems
• Less risk of nutrient deficiency-related
problems
• Increased energy and zest for life
Food Labels
•
•
•
•
•
•
Name
List of ingredients
Datemark: “use by” or “best before”
Nutritional information: per 100g/100ml
Weight and Manufacturer
Big e
Major Body
Components
•
•
•
•
•
•
Minerals
Carbohydrates – muscles and liver
Protein
Fat – essential and storage
Visceral and subcutaneous
Water – 60%
Determining
Body Composition
• Hydrostatic weighing (laboratory)
• Height/weight charts
• Body mass index (BMI) = Weight in
kgs/height in metres squared, 20-25
normal, > 30 = obese, > 40 =
morbidly obese
• WHR: Males > 0.9-0.95, females >
0.8-0.85
• Body fat percentage - skinfolds
Body Fat Percentage
Level
(18 to 30 years)
Rating
Males
Females
Athletic
Good
Acceptable
Too fat
Obese
6-10%
11-14%
15-18%
19-24%
25% or over
10-15%
16-19%
20-25%
26-29%
30% or over
Source: Williams (1996)
Obesity
• Accumulation and storage of excess
body fat
• > 25% body fat for men
• > 30% body fat for women
• BMI exceeds 30
• Be aware of client care, e.g.
measurement-taking, record-keeping
Hazards of Obesity
• Psychological
burden
• Increased incidence
of osteoarthritis
• Increased incidence
of hypertension
• Increased TC,
reduced HDLs
• Increased risk of
Type 2 diabetes
• Increased risk of
CHD
• Increased
incidence of
most cancers
• Increased risk of
premature death
Terms
•
•
•
•
• Thermic effect of
Calorie
exercise
Kilocalorie
• Thermic effect of
Metabolism
food
Basal metabolic rate • Energy balance
(BMR) / Resting
Energy Expenditure
(REE)
Metabolism
• Staying alive - anabolism and
catabolism
• BMR = calories per kg of body weight
per hour. 70 kg male uses 70 calories
per hour. 55 kg female uses 49.5
calories per hour (55 x 0.9)
• Resting energy expenditure (REE)
• Thermic effect of food (TEF)
• Thermic effect of exercise (TEE)
Daily Energy Expenditure
REE/
BMR
67%
TEF
10%
TEE
23%
Factors that affect BMR
•
•
•
•
•
•
Gender
Age
Body Surface Area
Fitness level
Fasting
Climate
Energy Balance
Nutritional Guidelines
for Fat Loss
• Combine decreased calorie
intake with exercise
• Reduce body fat gradually
• Eat a balanced diet – Food
Pyramid
• Drink plenty of water
• Food preparation
Weight Loss Steps
• Determine body
composition
• Establish reasonable
weight loss goals (1-2lbs
per week)
• Evaluate dietary habits –
fruit and veg intake, water
intake, cooking methods,
time of eating, breakfast?
Weight Loss Steps
• Avoid crash diets
• Train systematically (ACSM
2000 Guidelines)
• Utilise behaviour modification
techniques, e.g. set goals,
food diary, rewards etc.
Why Dieting Alone
Does Not Work
• Decrease in calorie intake = decrease
in BMR: body adapts to conserve
energy
• Body reduces energy-burning tissue
(lean muscle broken down to supply
energy)
• Every time weight is lost through
excessive dieting, BMR decreases and
food requirements drop even further
What’s the Best Type
of Exercise?
• An enjoyable activity that can be
maintained for 20-30 mins (to begin
with) three times per week (minimum)
• Low to moderate intensity with
emphasis on duration rather than
intensity
• Included CV, LME, and Flexibility in
all sessions
Combine Diet with
Exercise
• Exercise ensures BMR is kept high
• Muscles burning fuel are less likely
to be used as fuel themselves
• BMR remains elevated for 2-4 hours
after exercise (by 4-5% approx)
Myths and Fallacies
• Spot reduction
• Meal replacement powders and
pills
• Sauna and fluid loss
• Crash diets
• Vibrating belts/pounding
Behaviour Modification
Techniques
• Use a food diary: record places and
situations when fatty foods are eaten
• Rewards
• Set goals: long- and short-term using the
SMARTER principle
Behaviour Modification
• Never shop while hungry
• Eat slowly, leave down fork and knife
between mouthfuls
• Never eat while reading or watching TV
• Pre-plan meals/menus
Behaviour Modification
• Smaller plates – leave a little
each time
• Keep extras away from the table
• Get kids to make their own
snacks
• Always keep the fruit bowel full
• “Like puppies, diets are not just for
Christmas, they’re for life. And that’s
where the problem lies, not on our hips
but in our psyches.”
• “The Tribune Magazine”, Jan 1997
• What would be the most effective advice to
give to a client to lose weight?/ Information
for one page handout
• Exercise Advice
• Dietary guidelines
• Behaviour Modification
Exercising Programming
for Weight Loss
Energy Balance
Negative Energy Balance
• ACSM (2000) recommends a
balanced approach that results in
gradual fat loss of no more than 1kg
(2lbs)/week.
• Negative caloric balance of 5001,000 kcal per day
• At least 300 kcal should come from
exercise
• Initially emphasise duration and
frequency
Exercise Programming
• Arthur is sedentary man who has been
gradually gaining weight for 10 years. His
weight is 18 stone. He is 42 years old.
His doctor has referred him for exercise as
his brother died of a heart attack at age
47. He has a resting heart rate of 90 bpm.
Currently he has no signs or symptoms of
heart disease.
Exercise Programming 2
• Include CV, LME, Flexibility in his programme
• Use treadmill walking or stationary cycling
initially
• Keep intensity low for CV, use
duration/frequency to achieve negative caloric
balance
• Include gradual warm up and cooldown
• LME exercises should be compound, balanced
(agonist/antagonist), UML
• All muscles used in CV phase and LME should
be stretched
Cardiovascular
Endurance
• 3 to 5 times per week
• 60-85% MHR, may have to start at 50%
as client is deconditioned (always state
why)
• 20-60 minutes, may have to start with
intervals of 8-10 minutes
(deconditioned)
• Aerobic – using major muscle groups
Local Muscular
Endurance
• 3-5 times per week
• 10 – 12 reps x 1 set (60% 1RM)
• Increase reps to 15-20, increase
sets
• As long as it takes to do required
number of reps
LME 2
• Circuits, weights (machine and free
wts), body resistance
• Minimum of 6 exercises – U, M, L,
agonist/antagonist, compound (Keep
M exercises out of circuit)
• Circuit must be designed giving
exercises, W:R, paying appropriate
attention to U, M, L etc
Flexibility
•
•
•
•
•
3-5 times per week
To the point of tension
15-30 secs per stretch
Passive, Active, Active Assisted, PNF
Name muscles – relate to CV and LME
Design one exercise
session
•
•
•
•
•
Warm up & pre-stretch
CV phase
LME phase
Flexibility – post-stretch
Include information on time, intensity,
type etc
• Show balance in LME – have a
minimum of 6 exercises building up
to 8/10/12
Group Exercise Session
• Warm up and pre-stretch
• Main activity – Circuit (CV & LME), Step,
Exercise to music
• Circuit – layout, exclude floor work, W:R,
intensity
• Step/Exercise to Music – phases, intensity,
examples of moves for wave effect
• Floorwork – exercises, sets, reps
• Post-stretch – length of hold, muscles, type
Eating Disorders =
Body Image Distortion
Eating Disorders
• Eating Disorders – Why are they so
common in western society?
• What practices do they engage in?
• What are the longterm effects?
• Exercise Addiction – Telltale signs?
• Longterm effects?
• Positive/negative body image
Eating Disorders
• Term used to describe disturbances in
eating habits
• Often observed in young females attempting
to maintain or achieve an unrealistic weight
• May begin as simply calorie counting but
can escalate to self-induced vomiting and
laxative abuse
• Can lead to clinical eating disorders such as
anorexia nervosa or bulimia nervosa
Diagnostic Criteria for
Anorexia Nervosa American
Psychiatric Association (1994)
1. Refusal to maintain body weight at or
above a minimal normal weight for age
and height, e.g. weight loss leading to
maintenance of body weight less than
85% of that expected.
2.
Intensive fear of gaining weight or
becoming fat, even though underweight.
Diagnostic Criteria for
Anorexia Nervosa American
Psychiatric Association (1994)
3. Disturbance in the way in which body
weight, size or shape is experienced,
e.g.the person feels fat even when
emaciated, and/or believes that one area
of the body is ‘too fat’ even when
obviously underweight. Will deny the
seriousness of the current low body
weight.
Diagnostic Criteria for
Anorexia Nervosa American
Psychiatric Association (1994)
4. In females, absence of at least three
consecutive menstrual cycles when
otherwise expected to occur.
• NB. Physical illness that would account
for weight loss needs to be excluded.
Diagnostic Criteria for
Bulimia Nervosa
(APA, 1994)
3.
4.
The binge eating and compensatory
behaviour occur at least twice a week
for three months.
Persistent over-concern with body
shape and weight.
Diagnostic Criteria for
Bulimia Nervosa
(APA 1994)
1. Recurrent episodes of binge eating (rapid
consumption of a large amount of food in a
discrete period of time, with a feeling of lack
of control over eating behaviour during the
episode)
Diagnostic Criteria for
Bulimia Nervosa (APA 1994)
2. The person regularly engages in either
self-induced vomiting, the use of laxatives,
diuretics, strict dieting or vigorous exercise
in order to prevent weight gain.
The Female Athlete Triad
• Eating disorders
• Amenorrhea
• Osteoporosis
Amenorrhea
• Primary amenorrhea – delayed
menarche
• Secondary amenorrhea – absence
of three or more menstrual cycles
Amenorrhea
Suggested General Causes
• Acute effects of stress
• Previous history of menstrual
dysfunction
• Low body weight and fat
• Inadequate nutrition and disordered
eating
• Hormonal alterations
Athletes and
Amenorrhea
• In athletes,
amenorrhea is often
related to training
intensity
• Training intensity
either directly or
indirectly affects the
incidence of
amenorrhea
80
60
40
20
40
29
22
19
0
17
Weekly training
distance (miles)
The relationship between
training distance and the
incidence of amenorrhea
% incidence of am enorrhea
The Triad
• Poor nutrition from disordered
eating and intensive training can
lead to low body weight and fat
• Oestrogen is necessary for normal
menstrual function
The Triad
• If body fat is very low, may lead to
oestrogen levels being low amenorrhea
• Osteoporosis is a consequence of
amenorrhea
• Oestrogen has a protective effect on
bone-enhancing calcium absorption
and limits its withdrawal