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Chapter 17
Exercise for Special
Populations
EXERCISE PHYSIOLOGY
Theory and Application to Fitness and Performance, 6th edition
Scott K. Powers & Edward T. Howley
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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 endurancetraining program
11. Describe the guidelines for exercise
programs for pregnant women
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
Diabetes
Characteristics
Type 1
Insulin-dependent
Type 2
Non insulin-dependent
Another name
Juvenile-onset
Adult-onset
Proportion of all diabetics
~10%
~90%
Age at onset
<20
>40
Development of disease
Rapid
Slow
Family history
Uncommon
Common
Insulin required
Always
Common, but not always
Pancreatic insulin
None, or very little
Normal or higher
Ketoacidosis
Common
Rare
Body fatness
Normal/lean
Generally obese
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
Effect of
Prolonged
Exercise in
Diabetics
Fig 17.1
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
Effect of Plasma Insulin
Levels in Type 1 Diabetics
During Exercise
Fig 17.2
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
Proposed Mechanism by which an
Asthma Attack Is Initiated
Fig 17.3
© 2007 McGraw-Hill Higher Education. All rights reserved.
Prevention and
Relief of Asthma
• Prevention
– Avoidance of allergens
– Immunotherapy
• Treatment
– Cromolyn sodium
– 2-agonists
– Theophylline
© 2007 McGraw-Hill Higher Education. All rights reserved.
Mechanisms by which Common
Medications Prevent/Treat Asthma
© 2007 McGraw-Hill Higher Education. All rights reserved.
Fig 17.4
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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)
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
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
© 2007 McGraw-Hill Higher Education. All rights reserved.
Chapter 17
Exercise for Special Populations
© 2007 McGraw-Hill Higher Education. All rights reserved.