Table of Contents
Exercise Prescription For Special Populations
Important Ideas To Remember
Special Populations
Patients Who Are HIV +
Patients With Diabetes
All diabetics have special needs :
Type I Diabetes Mellitus
With loss of native insulin production, they are constrained to exogenously supplement themselves with insulin and to chronically exercise.
How does exercise help blood glucose clearance ?
Acute and chronic exercise improves glycemic control and stimulates improved GLUT-4 performance and #’s of transporters.
Type I Diabetes
Some Ideas :
Type II Diabetes
Some Ideas :
General Considerations
Practice scrupulous foot inspections
Learn to monitor your blood glucose and determine if there is a duration and intensity that regularly decreases your blood glucose in a dependable fashion.
Learn to decrease insulin requirements once exercise is a routine part of your daily schedule
Know the signs of hypoglycemia :
Tingling In The Extremities
Irritability
Patients With Hypertension
It will be important to find out the cause for the patient’s hypertension if it does not fall into the category of essential hypertension
Categories Of Hypertension
Any patient with moderate to severe hypertension should be evaluated for other coronary artery risk factors
Ideally, any male over the age of 40 years or a female over the age of 50 years must have a GXT before an exercise prescription is written.
Know The Rules
ACSM Guidelines Say …….
If the exercising blood pressure is /115, you should stop the exercise bout or at the very minimum reduce the intensity of the exercise bout.
Hypertension
Things To Think About …….
Avoid exhaustive exercise
Restrict alcohol consumption
Expectant Mothers
The ACSM Guidelines State….
multiple fetuses
There are relative contraindications to exercise. They are :
diabetes
history of bleeding during pregnancy
A Suggested Starting Ex. Program
Some things to Think About ….
Exercise with a partner in case Mother needs help
Patients Who Are HIV +
Things To Remember…..
A Suggested Starting Ex. Program
Patients With Intermittent Claudication
Intermittent claudication occurs because of obstruction of blood flow through the arteries of exercising leg muscles. It is the obstruction of blood flow by fatty plagues (arteriosclerosis) that leads to the intense pain during exercise.
When the patient walks for several minutes, the amount of blood that the muscle needs does not perfuse through the obstructed arteries. The patient then feels moderately intense to severe pain.
It has been shown that after a six week exercise program, the patient can walk three times more distance without leg pain than before the exercise training was begun.
A Suggested Starting Ex. Program
PPT Slide
Strategies…...
These patients may have to exercise several times a day for small durations of time in order to build up to a sustained intensity of steady state exercise.
Patients In End-Stage Renal Failure
Patients in renal failure typically are frail individuals and may have extensive muscle wasting, HTN, hyperlipidemia, muscle cramping, bone disease, fatigue & psychosocial problems.
Exercise is therapeutic for these patients because it blunts the wasting effects of sedentary living.
A Suggested Starting Ex. Program
Considerations……...
They should be encouraged to walk and perform weight bearing exercise on their off-dialysis days to blunt the osteoporosis that many of them sustain because of sedentary lifestyles.
Patients With Osteoporosis
Type I Osteoporosis
Type I osteoporosis is associated with :
Type II Osteoporosis
Other factors effecting osteoporosis :
By the age of 80 years, 1 out of 3 women will fracture their hips while only 1 out of 6 men will experience a fractured hip.
Some Solutions……...
Fosamax - encourages osteoblasis
Testosterone - increases bone mass in men and women
Bisphosphonates - etidronate, residronate, alendronate all inhibit bone resorption
A Suggested Starting Ex. Program
Exercise should be weight bearing
Water aerobics, swimming, kick boards and wogging are all good for conditioning even though they are not weight bearing
Rheumatoid Arthritis
Simultaneous involvement of bilateral joints
Rheumatoid nodules over bony prominences or next to joints
Functional Capacity Criteria American Rheumatology Association
Class 3 : ability limited to little or none of the duties of usual occupation or to self-care
Clinical Effects Of The Disease
Class 1 patients can do any type of exercise but should probably should not perform hard physical exercise.
Class 4 patients by definition are too incapacitated for weight bearing exercise but may participate in non-weight bearing exercise modes - i.e. - water exercises where their weight is supported
Exercise Prescription
Mode Choices Influenced By....
Good Mode Choices…..
Frequency…..
Duration……
Intensity…..
Monitoring the patient during exercise ……
Resources
Sports & Exercise for Children with Chronic Health Conditions, Human Kinetics Publishers, 1995 by Barry Goldberg.
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