Module Three: Special Populations

• EXERSCI 271 is about exercise prescription for children and adolescents.
• The learning outcomes are outlining differences in exercise responses, describing exercise prescription guidelines, and special considerations for exercise testing and prescription in children and adolescents.

Definitions

• Child: < 11 years old.
• Adolescent: Girls = 12-18 years old, Boys = 14-18 years old.

Benefits of Physical Activity

• Essential for healthy growth and development.
• Increases fitness, strength, bone health, cognitive function, and psychosocial well-being.
• Decreases cardiometabolic risk factors and helps with weight control.
• Decreases sports-related injury.
• Improves lifestyle.

Bone Health

• Up to 90% of adult bone mass is accumulated by the end of adolescence.
• 25% of adult BMC is attained in just a 2-year period (11-13yr Girls, 12-14yr Boys).
• Peak BMC occurs ~1-1.5yrs after peak height velocity (PHV).
• Youth who are active show a 10-20% higher peak BMD than inactive peers.
• Strong bones can reduce risk of osteoporosis and fracture in later life.
• Osteoporosis is considered a childhood disease with old age consequences.

Muscular Strength

• Children and adolescents can increase strength by 30-40% following short-term (8-12 week) training programs (volume & intensity).
• Benefits are lost once training programme stops.
• Preadolescent: improvements in neural mechanisms (motor skills, coordination).
• Adolescence: both neural adaptations and increases in muscle size (puberty).

Responses to Physical Activity

• Lower: Absolute VO2 (body size), anaerobic capacity (limits ability to sustain exercise), blood pressure (smaller heart size), cardiac variables (cardiac output, stroke volume), and pulmonary variables.
• Higher: Relative VO2, Heart rate, and Breathing frequency.

Exercise Testing

• Cardiorespiratory fitness: Measured in laboratory using CPX or GXT. Field tests include 1-mile (1.6km) run or multi-stage 20m shuttle test.
• Muscular strength: Static, dynamic, isokinetic appropriate. Emphasis on technique, instruction, and equipment ergonomics.
• Physical performance: Power (vertical jump test), speed (linear running velocity), agility field tests.

Exercise Testing – Field-based

• FITNESSGRAM is a school-based assessment used to assess components of health-related fitness in children.
• Aerobic Capacity: Beep test, 1-mile walk/run.
• Muscular Fitness: Push-ups, curl-ups.
• Flexibility: Sit and reach or shoulder stretch, trunk lift.
• Body composition: BMI, skinfolds, % body fat.
• The most common field based fitness tests: Beep Test, Sit and Reach, Cooper 12-min Run.

Exercise Testing - Clinical

• Measure exercise capacity > clinical reason e.g Asthma.
• Equipment: Treadmill or cycle ergometry and appropriate size, set-up.
• Protocol selection - normalised to size/weight (incremental).
• TM: modified Balke (change % rather than speed)
• CYC: McMaster (calculated through height)
• Safety: Harder to follow safety precautions on TM Issues maintaining steady gait or cycling cadence.
• Familiarise: with the protocol, minimise stress, clear communication = better test outcome.
• Less co-operative: Difficult to differentiate exercise limitation from reluctance or poor effort. Ventilatory measurements where possible to use at.

Physical Activity Guidelines

• Children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous intensity physical activity daily.
• Aerobic Activities: Most of the 60 mins daily should be moderate-to-vigorous aerobic activity and include vigorous intensity physical activity at least 3 days/week, P.E. Walking, scootering etc.
• Muscle Strengthening Activities: Include on at least 3 days/week as part of 60 mins recommended per day.
• Bone Strengthening Activities: Include on at least 3 days/week as part of 60 mins recommended per day.

Prescription Guidelines

• Aerobic activity frequency is daily
• Muscle and bone strengthening - frequency ≥ 3x week
• Time: ≥ 60 minutes/day
• Type: Incorporates active transportation, physical education, sport, free play and planned exercise.
• Typically accomplished in short bursts rather than dedicated longer durations of exercise. Volume is benefits seen to help health with sporadic bouts of MVPA (<5mins)
• Progression: Muscle and bone strengthening as part of 60 min day
• Aerobic activity intensity: Moderate-to-vigorous, Moderate/intensity = activity that increases breathing, sweating and heart rate. RPE 5-6, Vigorous intensity= activity that substantially increases breathing, sweating and heart rate. RPE 7-8

Aerobic Activity

• Activities should be developmentally appropriate, enjoyable and varied.
• Moderate intensity aerobic: active recreation such as hiking, rollerblading, brisk walking and dance
• Vigorous intensity aerobic: Active games involving running and chasing (e.g., tag), Skiing.
• Average increase in VO₂peak 6.7% in males and 5.9% in females, independent of age puberty.
• Intense aerobic training required to produce shifts in aerobic fitness in youth (85-90% HRmax).
• Ex Px Recommendation: mixture of continuous and interval training using large muscle groups, minimum 3-4 sessions per week, 40-60 min, 85-90% maximum HR.

Resistance Exercise

• Frequency: Resistance exercise is RESISTANCE EXERCISE
• Type: Muscle strenthening activities can be unstructured or structured appropriately
• Time: Bone strengthening activities produce a strain on the bone due to impact.

Muscle Strength

• Intensity: Body weight or resistance. 8-15 repetitions to the point of moderate fatigue with good mechanical form.

Muscle Strength cont.

• Type and Volume: Bone loading - moderate-high loading through impact or force production dynamic.
• Progession: Increase resistance gradually (5-10%) as strength improves. Consider programme goals and individuals needs and ability.
• Practical considerations for prescription: Teach correct form and provide appropriate supervision.
• Begin each session with a 5-10 minute dynamic warm up.
• Select exercises that are appropriate for the child's body size, fitness level and exercise experience.
• Begin with BW or light load and focus on correct form and technique.
• Focus on symmetrical muscular development and appropriate muscle balance around joints.
• Start with simple exercises and gradually progress to more advanced multi-joint movements.
• Training programme should be varied over time to optimise training adaptations and prevent boredom.

Resistance Exercise - is it safe?

• Traditional concern would cause harm to developing skeletons.
• Injuries from RT? Usually accidental (~77%), unsupervised, likely avoidable!
• Prevent injury. WHO recommended.
• Beneficial to young athletes (enhance performance) and inactive OW/OB youth (increase confidence in ability to perform PA).
• Free weight RT showed the largest effect on muscle strength and agility. Complex training had greatest effect on sports-specific performance.

Other considerations

• Youth have immature thermoregulatory systems and are at greater risk of heat related injury. Ensure proper hydration and that appropriate clothing worn.
• Children and adolescence with diseases or disabilities should have their activity programme tailored to their needs.
• Children's Act 2014 - all people working with children (<17yr) are required to complete a Children's Worker Safety Check.

Meeting the Guidelines

• Only 7% 5-17yo greater than 60 min MVPA 38% 8-13y, 39% 13-18y.
• High prevalence of sedentary behaviour, Only 16% children (5-9y) and 9% youth (10-14y) had less than 2h screen time per day.
• 1 in 8 children in New Zealand are obese.

Summary

• Physical activity is important for optimal health, growth and development
• Youth have specific needs regarding physical activity that must take into account their growth and development
• Youth should be exposed to and encouraged to participate in a variety of physical activities, games and sports
• Recommend 60 minutes or more of moderate-to-vigorous intensity physical activity daily
• Aim to promote a life-long physical activity habit

Exercise Prescription for Older Adults

• In the context of older adults: Outline differences in exercise responses, Describe exercise prescription guidelines, Describe special considerations for exercise testing and prescription

Definition

• Older adults: Greater than 65 years old, 50-64y and clinical condition or physical limitation

Benefits of Exercise

• Neurological: Stroke, Anxiety, Cognitive function
• Musculoskeletal: Falls, Osteoporosis
• Cardiac: Mortality, CAD, BP, Cardiac rehab
• Endocrine: Weight, Diabetes, Improves lipid profile
• Weight: Prostate, breast, bowel

Benefits of Exercise

• Independence
• Rate of functional decline
• Life expectancy
• Optimize body composition
• Well-being: psychological and cognitive benefits
• Disease risk

Exercise in Older Adults

Age-related functional decline Increase in risk of disability, disease Increase in sedentary behaviour

• exercise responses
• Decrease Heart rate max
• Decrease Cardiac output
• Decrease VO2 (relative and absolute)
• Decrease Muscular strength
• Decrease Flexibility
• Decrease Balance, walking speed
• Decrease Reaction time
• Decrease Bone Mass
• Decrease Fat free mass Increase
• Blood pressure (rest and exercise)
• body fat

Exercise Responses

• VO₂ declines progressively with age -~10% per decade.
• Rate of decline can be slowed by regular physical activity. testing not required for light-moderate activity VO2max testing safe Likely to terminate early (prevalence CV, metabolic, orthopedic limiting factors)
• -Light initial workload ( < 3 METS), smaller increments (0.5-1 MET per stage)
• Balke treadmill protocol good option

Aerobic Testing Considerations

• •Modality Treadmill, handrails support, help walking risk, decrease accuracy
• cycle ergometry treadmill, Cycle ergometry great than treadmill for risk reduction on loss of balance, falls
• Aerobic Testing Considerations : exercise induced dysrhythmias are more common -Physical peformance testing : correlate to different fitness domains and prevent and help mortality.

Physical Activity Guidelines

• FITT. FITT Recommendations are following recommendations similar to adults, and they goals that follow like, To maintain health and physical independence or to continue activity to avoid enactivity, aerobic.

• Frequency : great than 5 d-wk for moderate and 3 d-wk for vigorous and 3-5 d-wk for a combination

• Intensity, on s scale of 0-10 5-6 for moderate and 7-8 for vigorous strength time is 30=^60 minutes for moderate and 20-30 for vigorous, a mobility of weight is not is acceptable"

AEROBIC and AEROBIC ACTIVITIES

• Aerobic >150minute.wk-1Moderate intensity
• with at least. 30%lower risk of morbidity mortality and functional dependence compared with being inacive-

Weight Training

• Goal for the exercise is to maintain independence and decrease the fall risk

Exercise Recommendations for Pregnant Women

• Physical activity and exercise is safe for pregnancy.
• Some modifications may be required due to anatomical and physiological changes.
• Clinical evaluation be recommended prior to initiating the exercise.

Contraindication for exercise during pregnancy

• Hemodynamically significant heart disease.
• Incompetent Carvix, cervial insifficiency or cerclage Intrauterine growth restriction.

Exercise Testing during pregnancy

• Avoid Maximal Testing
• Use Sub maximal Training
• No consensus on most suitable tests

Recommendation for Exercising During Pregnancy

• Follow similar exercise with those guidelines, talk test while exercising.
• Walking, jogging/running
• Stationery cycling

Resistance Testing for pregancy

• perform Light-motered weight testing , Limit repetitive , Aviod valsslva

Warning signs to stop training

• Amniotic fluid Leakage
• Chest paint, Calf pain or swellingl
• Head Ache

Considerations for pregnant women

• Avoid Exercising in hot humid environments
• Drink Appropriate
• Ensure Adequate caberotic intake
• avoid supino position after 1st trimester and motionless.

Recommendations For After pregnancy

• Perform PA as soon as medically safe.
• benefits Include improved recovery, Weight lost

Postpartum

• Perform pelvic-floor exercises and deep core exercises
• focus on abdominal bracing

Summary for Pregnacy

Physical activities must focus on all activity, check for baselinefitness