Transcript Clients with unique needs

BETTY HENSON
TRAINING SENIORS
In 2016, the baby boomers will start to turn 70. This
group and their parents have 47 times the wealth of
the young and will account for 70% of the disposable
income in the U.S. by 2017. Thus older clients have
the desire and the funds to pay for wellness services.
By 2050, 1 in 5 Americans (21%) will be 85 or older.
To train this population safely, there needs to be an
awareness of the physical, practical, and psychosocial
concerns.
BETTY HENSON
SENIORS
Roughly 1/5 of men and 1/3 of women over the age of 70 are
unable to perform at least one common functional task such as
walking, climbing stairs, or stooping.
On the flip side, this means that 70-80% of that population do not
have functional impairments. (Sipe & Ritchie)
BETTY HENSON
SENIORS
Be prepared for common issues and their implications when working with Seniors.
Chronic Disease
Arthritis
Hypertension
Heart Disease
Cancer
Diabetes
Stroke
Osteoarthritis (degeneration of joint cartilage) is the most common, affecting roughly half of men
and over 60% of women.
Second is hypertension which affects approximately 4 in every 10 men and half of all women in
this age bracket
Deconditioned Seniors are especially at risk for shoulder, spine, neck and knee problems.
(Sipes & Ritchie)
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MUSCLE LOSS
Between the ages of 50 and 70, muscular strength declines, on average, by 30%,
even with sharper losses after age 80.
Resistance training helps to improve the quality of life and prevent additional disease
or disability problems, along with improved functional abilities, reduced incidence
of back pain, enhanced insulin sensitivity, decreased body fat, and increased
muscle mass.
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CARDIOVASCULAR DISEASE
ACSM – Moderate resistance training 2-3 days/week with 8-10 exercises while
performing 10-15 repetitions is safe and effective for most CV patients.
Low to moderate intensity – 40%-50% of IRM or that which can be completed for 15
reps
In a large scale study, a 23% reduction in CVD was reported for men who participated
in resistance training exercises for a minimum of 30 minutes per week.
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HYPERTENSION
Affects about 1 in every 3 adults. Defined at 140+/90+mmHg
Known as the “silent killer”
Resistance training of 6-30 weeks have been found sufficient for lowering blood pressure
in patients diagnosed with hypertension
Clients with “controlled” hypertension can exercise with limited restrictions
Lifestyle modifications for clients with hypertension:
proper exercise
weight loss
dietary changes
adequate sleep
reduction in sodium
Medications are given to lower bp
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HYPERTENSION
CONTROLLED hypertensives can exercise without restrictions (simple precautions only
need to be applied based on the exercise mode)
Lower intensity exercise appears to be a more effective stimulus than moderate
intensity exercise because:
~More doable for the person
~A lower intensity with the client should not cause excessive stress or an acute
cardiac event. Begin with walking 3 days/week for 2 miles. Increase to 5
days/week for 2 miles.
Increase frequency and duration before intensity!
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GUIDELINES FOR HYPERTENSION
DO NOT EXERCISE if resting systolic BP>200 mmHg or diastolic BP>115 mmHg
Aerobic training:
Begin with a low intensity – 50% of max HR
Begin with a goal to expend ~700 calories/week and work up to 2000 calories/week
Frequency = 3-7 days/week
Duration = 20-60 minutes
Resistance Training:
In conjunction with, NOT IN PLACE OF, aerobic exercise
Lift lighter loads for more reps, 1-3 sets with extra rest (2-3+ minutes)
Circuit training is a good option
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HYPERLIPIDEMIA
BETTY HENSON
HYPERLIPIDEMIA
Low HDL’s and elevated triglycerides are a strong independent predictor of CHD
HDL’s transport cholesterol to the liver where it is changed to bile and eventually
secreted in the stool (body’s major method of reducing its cholesterol stores)
HDL’s <40 mg/dL is low
Triglycerides are partially degraded VLDLs
HDL’s >60 mg/dL is good
Normal levels = <150 mg/dL
Factors that increase triglycerides: overweight and obesity, physical inactivity,
smoking, excessive alcohol intake, high carbohydrate diet (>60% of calories),
Type II diabetes, genetic disorders
Treatment: Reduce saturated fat and cholesterol intake, exercise, lose weight, drug
therapy
BETTY HENSON
CLIENTS WITH DIABETES
Exercise is an essential form of treatment!
Type I – Insulin dependent; 10% of all cases; most diagnosed by age 25
Type II – 90% of diabetics; some take insulin; related to family history, obesity, age,
physical inactivity
Gestational – Glucose levels are elevated during pregnancy. Characterized by
resistance to insulin. Symptoms disappear after delivery, but there is an
increased risk of developing Type II
Blood glucose monitoring is essential. Check immediately before, during, and 15
minutes post workout. Cancel exercise if blood sugar >250. Consume CHO if
blood glucose is <80-100.
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CLIENTS WITH DIABETES
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DIABETES
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OLDER ADULTS
Men and Women aged 50 and over may begin sensible
conditioning programs.
Medical Conditions and health issues must be
considered.
An effective, well-rounded program should train the
major muscle groups of the body (chest, shoulders,
abdomen, back, hips, legs and arms)
Individual goals and current level of activity will
determine the focus of RET.
BETTY HENSON
TYPES OF RESISTANCE TRAINING
Body Weight
Weight machines
Free Weights
Bands and tubing
Water
Novice exercisers begin with 4-6 exercises with minimal resistance and increase as
form and confidence build.
ACSM suggests that 8-10 exercises be included that are multi-joint or compound
exercise and target more than one muscle or joint.
BETTY HENSON
ACSM GUIDELINES
Progress to a moderate (5-6) or vigorous (7-8) intensity for 8-12 repetitions for two to
four sets
Intermediate steps may include performing one set of 10-15 repetitions at a
comfortable weight, then performing one set of the same repetitions at the target
intensity and then adding more sets.
REST – 3 minutes between sets or perform a circuit of different exercises alternating
upper and lower body to provide rest
FREQUENCY – work the major muscle groups 2-3 times/week, with a day of rest in
between sessions
PROGRESSION – When a given set of an exercise can be completed at an RPE lower
than the recommended 5 to 8, then the resistance should be increased or when
15 repetitions can be completed increase by 5%
ORDER – If Seniors perform both aerobic and resistive training, complete the aerobic
activity first. If only doing resistive, complete a 5-10 minute aerobic warm-up.
BETTY HENSON
ACSM GUIDELINES
Intensity: Moderate intensity (i.e., 60%-70% one repetition maximum [1RM]). Light intensity (i.e., 40%-50% 1-RM) for older adults beginning a
resistance training program. When 1-RM is not measured, intensity can
be prescribed between moderate (5-6) and vigorous (7-8) intensity on a
scale of 0-10.
Type: Progressive weight-training program or weight-bearing calisthenics (810 exercises involving the major muscle groups; 1 set of 10-15
repetitions each), stair climbing, and other strengthening activities that
use the major muscle groups.
BETTY HENSON
ACSM GUIDELINES
Even though you are probably not training them for a body building
competition, a small amount of weight increased at regular
intervals will increase muscle mass and affect metabolism, bone
density, decrease insulin resistance and even aid in better sleep
patterns. Make sure to include sufficient core exercises to
improve balance and stability, which will reduce the risk of falls.
Add exercises that mimic daily activities in order to build
functional fitness-strength that seniors can use on a daily basis.
BETTY HENSON
BALANCE TRAINING
The ability to maintain control of the body movements whether in an attempt to
remain stationary or to move in a controlled fashion.
FREQUENCY – 2 to 3 days/week or as often as needed
INTENSITY – No specific recommendations. Progressing from loss of balance to
stability
TYPE –A. Include progressively difficult postures that gradually reduce the base of
support.(Two-legged with wide base to feet together) B. Use dynamic movements
that perturb the center of gravity. (Walk, stop, back step) C. Stress postural
muscle groups (e.g. heel stands, toe stands) D. Reduce sensory input (loosen
grip, one hand touching)
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BALANCE PROGRAM
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FLEXIBILITY FOR SENIORS
Flexibility is a key component in an exercise program, especially for
older inactive adults, and a necessity at the end of each workout.
Tight muscles will reduce the body's range of motion, can affect
balance, reduces fluidity to the joints, and reduces the ability to
perform daily tasks. Slow easy stretches are important due to
lack of elasticity in the muscles. Stretches can and should be
performed daily unless the client complains of too much
discomfort the next day. Progressing to deeper stretches will
begin to reduce discomfort until the muscles are accustomed to
the stretching.
BETTY HENSON
FLEXIBILITY FOR SENIORS
ACSM Recommends:
Frequency: At least 2 days/week
Intensity: Stretch to the point of feeling tightness or slight
discomfort. RPE of 5-6 on a scale of 0-10
Time: Hold stretch for 30-60 seconds.
Type: Any physical activities that maintain or increase flexibility using
slow movements that terminate in sustained stretches for each
major muscle group using static stretches rather than rapid
ballistic movements.
BETTY HENSON
SENIOR FITNESS TESTS
Assess the key physiological parameters (i.e., strength,
endurance, agility, and balance) needed to perform
common everyday physical activities that often become
difficult for older individuals
Two specific tests included in the SFT, the 30-s chair
stand and the single arm curl, can be used to assess
muscular strength and endurance in most older adults
safely and effectively.
BETTY HENSON
30 SECOND ARM CURL TEST
SENIOR FITNESS TEST MANUAL
HUMAN KINETICS
Protocol
 Women: 5 lbs Men: 8 lbs.
 Sit in chair with elbow extended, using “hammer grip”
 Test is conducted with dominant hand
 Tester can hold upper arm, so only lower arm moves
 Client curls the dumbbell upward, turning the palm up
(flexion with supination)
 Arm must be fully bent and then fully straightened
BETTY HENSON
SCORES – ARM CURL
AGE
MALE
FEMALE
60-69
15-22
12-19
70-79
13-21
11-17
80-89
10-17
8-15
BETTY HENSON
30 SECOND CHAIR STAND
SENIOR FITNESS TEST MANUAL
HUMAN KINETICS
Protocol
 Sit on chair, arms crossed at the wrist and held at the chest
 Count the number of times the client stands up in 30 seconds
 Rest is allowed, but the clock keeps running
BETTY HENSON
SCORES: 30 SEC. CHAIR STAND
AGE
FEMALE
MALE
60-64
12-17
14-19
65-69
11-16
12-18
70-74
10-15
12-17
75-79
10-15
12-17
80-84
9-14
10-15
85-89
8-13
8-14
90-94
4-11
7-12
BETTY HENSON
SENIOR FITNESS TESTS
6 Minute Walk for cardiorespiratory endurance – measure the maximum distance a
participant can walk in 6 min.
Two-minute step for cardiorespiratory endurance – assess the maximum number of
steps in place a participant can complete in 2 minutes
Chair sit-and-reach for lower body flexibility – sit in a chair and attempt to touch the toes
with the fingers
Back Scratch for upper body flexibility – to reach behind the back with the hands to
touch or overlap the fingers of both hands as much as possible
Eight Foot up and go for motor agility/balance – To stand, walk 16 ft and sit back down
in the fastest possible time.
ACSM
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PREGNANT CLIENTS
Healthy pregnant women without complications who exercise regularly can continue
participating in adjusted sessions of physical activity.
Careful guidance and motivation are necessary for sedentary women who choose to
start an exercise program during pregnancy.
Benefits of Exercise
Improved cardiorespiratory and muscular fitness
Faster return to pre-pregnancy weight, strength, and flexibility
Reduced postpartum belly
Improved mood and self-concept
Reduced feelings of stress, anxiety, and depression
May reduce the risk of developing preeclampsia (pregnancy-induced hypertension)
and gestational diabetes (a form of diabetes first diagnosed during pregnancy.)
BETTY HENSON
PHYSIOLOGICAL CHANGES IN PREGNANCY
Cardiovascular:
Increased heart volume by 15-20% (need to get more blood around)
Increased blood volume by ~40%
Increased cardiac output of ~40%
Early pregnancy – resting heart and exercise heart rates are elevated (can’t use
an exercise HR in 1st trimester because of this)
Mid pregnancy – relationship between heart rate and exercise intensity are
similar to before conception
Late pregnancy – in fit women, the combined effects of regular exercise and
pregnancy make it difficult to increase heart rates
Use RPE scale
BETTY HENSON
MUSCULOSKELETAL CHANGES IN PREGNANCY
Increased mechanical stress o the back, pelvis, hips and legs due to weight gain
(Prescribe cat/camel exercise)
Stretched and loosened ligaments that stabilize the pelvis, hips and low back (Avoid
sudden changes of movement)
Change in center of gravity which affects balance and body control
Possible problems:
Higher incidence of pubic pain
Higher incidence of knee and lower leg pain
May cause diastasis recti (separation of the rectus abdominis muscles along the
linea alba)
BETTY HENSON
NUTRITIONAL NEEDS IN PREGNANCY
Increased protein by +10 grams/day
Increased vitamin needs
Increased fluid needs
Combining regular exercise with pregnancy improves the baby’s supply of glucose and
oxygen under most circumstances if the mother has a healthy eating plan
BETTY HENSON
CONTRAINDICATIONS FOR EXERCISE
~Pre-eclampsia
~Ruptured membranes
~Premature labor during the pregnancy
~Persistent bleeding after 12 weeks
~A cervix that dilates ahead of schedule
~Significant heart disease or restrictive lung disease
~Multiple birth pregnancy that creates a risk of premature labor
~A placenta that blocks the cervix after 26 weeks.
~Poorly controlled Type I diabetes, seizures, hypertension
~Extreme obesity
(See pg. 480 for additional conditions)
BETTY HENSON
EXERCISE GUIDELINES FOR HEALTHY
PREGNANT WOMEN
*Perform at least 15 minutes of moderate intensity PA per day and increase to 30
minutes on at least 3, if not all, days/week
*Resistance train the major muscle groups with multiple repetitions (12-15) and
avoid isometric contractions
*Avoid exercise in the supine position after the first trimester.
*Exercise should not continue past the point of fatigue and should never reach
exhaustive levels.
*Maintain adequate hydration, appropriate clothing and optimal environmental
conditions during exercise.
*Sports that would present the potential for mild abdominal trauma or loss of
balance should be avoided (basketball, soccer, horseback riding, skating,
plyometric training.
BETTY HENSON
RESISTANCE TRAINING FOR YOUTH
Benefits of Strength Training for Youths:
 Increases in muscle strength and power
 Increases in local muscle endurance
 Increases in bone mineral density
 Improvements in blood lipid profile
 Improvements in body composition
 Increases in motor skill performance (jumping, throwing and sprinting)
 Improvements in athletic ability
 Increases in resistance to sport-related injuries
 Improvements in body image and self-confidence
 A more positive attitude toward lifetime physical activity
BETTY HENSON
YOUTH
RISKS AND CONCERNS
Risk of injury – about same for youth and adult.
Area of concern is the growth plates of the long bones – radius in the arms and the femur in the legs.
 Growth plate – section of cartilage where the growth of the long bones is initiated.
 This area is weak link in the developing skeleton because growth cartilage is not as strong as bone.
 This should not be a problem if programs are properly designed and supervised by QUALIFIED adults. The risk
of a growth plate fracture is minimal if boys and girls are taught how to strength train properly and the use of
appropriate training loads.
 Plate fractures have not been reported in any youth resistance training study published to date.
 Repetitive and overuse injuries to the soft tissue of the muscles, tendons and ligaments are of greatest
concern.
Programs need to be carefully designed and appropriately progressed with safety guidelines.
Many spend time developing the “mirror muscles” (Chest and biceps) and forget the abdominals, lower back.
Lower back injuries were a common site for injuries when injuries were reported.
BETTY HENSON
YOUTH GUIDELINES FOR TRAINING
*Qualified adults should provide supervision and instruction.
*The training environment should be safe and free of hazards
*Resistance training should be preceded by a 5-10 minute dynamic warm-up
*One to three sets of 6 to 15 repetitions should be performed on a variety of
exercises.
*Include exercises for the upper body, lower body and midsection.
*Increase resistance gradually (5-10%)
*Resistance train two or three, nonconsecutive days per week.
*Children should cool down with less intense calisthenics and static stretching.
*Vary the resistance training program over time to optimize gains and prevent
boredom.
BETTY HENSON
YOUTH TRAINING
MODE OF TRAINING
Can use body weight, rubber tubing, medicine balls, free weights, childsized weight equipment, stability balls.
Most kids are too small for adult machines, but some teens can use
them with additional pads.
Increments of weight stacks may be too much weight
CHOICE AND ORDER OF EXERCISES
Both single and multi-joint exercises can be used. Single-joint may be
more appropriate for beginners
Perform large muscle groups first, then smaller groups and multi-joint
before single joint
Perform more challenging exercises first before muscles fatigue.
BETTY HENSON
YOUTH TRAINING
TRAINING SETS AND REST
~Children should perform 1-3 sets on a variety of exercises. They do not need to
perform the same number of sets on all exercises.
~Begin with a single set, then add sets.
~Youth should rest about 1 minute between sets and exercises
~Those who are more advanced may need 2-3 minutes of rest
RATE OF PROGRESSION
Start with a basic workout for the first 4 weeks, using relatively light weights and
learn proper technique. TECHNIQUE BEFORE MORE WEIGHT
Allows child’s muscles, tendons and ligaments time to adapt to the demands of
exercise.
On average, a 5-10% increase in training load is an appropriate increment for
increasing the intensity of most exercises.
 Example: A teenager performing 2 sets of 15 reps with 20 lbs. on the dumbbell
bench press can probably progress to 22 lbs and reduce the reps to 10 to allow for
gains. Form and technique first!
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OVERWEIGHT AND OBESITY
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OBESITY
Increased risk for:
Hypertension
Hyperlipidemia
Type II diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea
Cancer
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CONTRACT
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OVERWEIGHT/OBESE
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MODERATE AMOUNTS OF PA
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RECOMMENDATIONS
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CLASSIFICATIONS
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ATHLETES
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ATHLETES
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ATHLETES
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ATHLETES
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ATHLETES
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