NAFC Presents
Fitness Article Library:
Special Populations
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NAFC Presents Fitness Article Library:Special Populations
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This page features articles about the fitness needs of individuals with special conditions and medical concerns, or who are at special times of life.
by Pam Germain
Is a healthy person with a disability a contradiction in terms? Absolutely not!
Most sports now have a share of participants who are athletes with disabilities. One-legged skiers are hitting the slopes. Wheel chair tennis and basketball are favorite pastimes for some. Wheelchair mountain biking can be done in a special chair or on a regular bide for some amputees. Wheelchair marathons often accompany the most popular marathon races.
There are chair-bound aerobics instructors who have developed exercise programs for all people, using nearly identical routines for disabled and non-disabled participants, proving that almost all exercises can be done from a seated position.
I spent many hours assisting a wheelchair athlete named Evelyn who raced in a 1992 Half Marathon wheelchair event. She began training three months before the event in a regular wheelchair and got her racing chair two weeks before the event. She was the only wheelchair athlete participating in this marathon. She felt her race was a success and went on to do track racing in various events nationwide.
Disabled exercisers and athletes want the same thing as other active people. They desire fitness and enjoy the thrill of competition. Being on a regular program of exercise increases individual independence for any disabled individual and the necessary strength needed for daily living.
The principles of fitness training are the same for all people. Muscles must be overloaded for increased growth and strength, and the heart must be conditioned for cardiovascular fitness. The problem for many disabled people is where to go to train and finding instructors who understand the problems, at least to the extent of modifying exercises for their situation or changing the program as needed.
A person can work out with a variety of disease states, such as muscular dystrophy, ALS (Lou Gehrigs' disease), multiple sclerosis and arthritis. Most doctors insist on controlled exercise for disabled athletes, with carefully measured intensity and volume, to avoid over fatigue.
Diseases that involve nerves loosing their conduction capabilities are benefited by the neural inputs required in getting muscles to fire and work while exercising. In other words, by exercising disabled muscles, they get stronger.
Even persons so handicapped that conventional exercise won't work can do passive, assisted movement. Persons with conditions such as spasticity in tendons, which might be set off by exercise, can often do controlled mat exercises or calisthenics, and exercises for balance, coordination and strength. Safety is a concern, so a good instructor is necessary.
Some diseases have periods of flare-ups, in the acute stage or exacerbation, and the doctor should be consulted. Rest and therapy are usually called for until the condition is under control. A person with a systemic condition should not undertake any kind of exercise program with out the doctor's guidance.
Disabled exercisers need good instruction for safety and effectiveness. To help some there are national organizations that train physically disabled athletes for mainstream races with the use of crutches, wheel chairs, prostheses, or guiding "tethers."
Special Olympics trains developmentally challenged children and adults for sports competitions. This organization seeks to provide physical and emotional growth through friendship, family support, and opportunities for achievement and courage. The mission of Special Olympics is helping these athletes develop sports skills, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendships. This aids them to become a part of the mainstream community.
The fitness lifestyle is for all sorts of people. Disabled exercisers are an inspiration to those of us who want to look past our excuses for avoiding activity and get motivated to do something.
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DESIGNING EXERCISES FOR CLIENTS WITH DISABILITIES
As the general population ages there will be more clients with disabilities. There is a major growth in the number of clients in their 70s and 80s, and also a growing movement to get them more involved in physical activities. In turn there is more of a need to have effective programs for potential clients. Disabilities are defined as limitations in physical or mental functions caused by one or more health conditions. In America almost one in five people have a disability of some kind. The programs designed for these clients must be safe and not worsen their condition or cause injury. Always make sure they obtain proper medical clearance outlining any special limitations that may affect their abilities.
Physical Disabilities-
These clients have limited movement in their arms or legs, or both. First and foremost
your facility must be accessible to these people. They are most likely also receiving
medical physical therapy. Find out what movements they can perform. Most importantly, be
sensitive to the physical and psychological trauma they are experiencing, and make their
program enjoyable and rewarding.
Neuromuscular Disorders-
These are disorders, such as Multiple Sclerosis, that cause the gradual destruction of
nerves and muscles and the progressive loss of movement. Your job as a fitness
professional is to help slow the progression of the disease. Make sure the exercises are
not too strenuous and make the setting safe with areas they can use for support because
they may be lacking balance, so reduce the risk of them falling. Use machines that do not
require standing to use. The client probably will be experiencing muscle tightness so, use
flexibility exercises to reduce this. Also swimming is a good workout for them. Make sure
to allow them time to do the exercises and pay attention to the ventilation and
temperature of the room (Keep at @75 F).
Respiratory Disorders- (COPD) Chronic Obstructive Pulminary Disease-
These disorders decrease the ability to exchange air in the lungs, resulting in difficulty
in breathing (the most common are asthma, bronchitis, and emphysema). The best way to
organize programs for these clients is to perform short bouts of exercise at low intensity
with rest in between. Give them an adequate warm up of about 15-20 minutes. Swimming in a
heated pool is also good because it keeps a good temperature around as well as humidity.
Always monitor their breathing and make sure they have inhalers available. During exercise
stay away from routines that will cause fluctuations in their breathing rate. To cool down
use relaxation techniques and breathing exercises.
Mental Disorders-
These are people who have limitations on their cognitive functions. You should focus on
instruction with these clients. Use simple, straightforward exercises at a slow pace and
explain them clearly and frequently. With these clients always treat them like adults and
do not "talk down to them." You must be careful of emotional instability with
some of them. Lastly, deal with any inappropriate behavior right away; those who cannot
follow the rules should not be in the class.
Osteoporosis-
This disease causes a reduction in bone mass leading to weakened bones and pain. To be
safe with those clients avoid quick movements and provide support to reduce the risk of
falling. It is a good idea to include resistance training to improve muscular strength.
Parkinson's Disease-
This disease causes movement and postural problems and is characterized by tremors. To
reduce the tremors have them perform relaxation exercises along with stretching
activities. Encourage them to do cardiovascular and strength training exercises also.
With all clients who have a disability make sure to relate the exercises to their specific limitations, keep the exercises safe, and pay attention to their progress.
By Pam Germain
Arthritis is a term that refers to inflammation of the joints. There is no cure for arthritis and treatment includes learning the best way to live with the condition. It can cause a person to feel that activity must be severely limited. However, appropriate exercise is part of arthritis self-care, and can improve pain tolerance, mood, and the quality of life.
There are two kinds of arthritis. Osteoarthritis is the most common form. It is the degeneration of cartilage of the bones that form the joints. The fraying of the cartilage produces inflammation, which causes pain and results ion the disuse of affected joints, decreased range of motion and muscular atrophy. It is associated with aging, but obese people and athletes who suffer many injuries or over-train may develop arthritis, too.
Rheumatoid arthritis is an autoimmune disease in which the body attacks its own tissues, causing an inflammatory response. It is thought to be linked to the function of the adrenal glands, or stress glands. Characteristically, it appears after one suffers a form of severe stress or infection. It causes joint damage and can be crippling. Joints are stiff and often swollen, and may be hot to the touch. People with rheumatoid arthritis should not exercise during an inflammatory period.
The preferred treatment for arthritis is aspirin for the pain and exercise to preserve the range of motion. Movement makes the synovial fluid surrounding the joint more efficient at supplying nutrients and removing wastes from the joint. Appropriate movement also helps to lubricate the joints and keep them flexible, and strengthens muscles and other tissues.
Regular exercise, at least three times weekly, is a good beginning goal. Working up to daily exercises will maintain or improve the range of motion and increase muscle strength, making life more comfortable.
Exercise sessions should be of short lengths and increasing frequency. Working up to two 15 to 20 minute sessions daily is preferable to one long session. Those who are just beginning an exercise program to aid their arthritis should begin slowly and build up gradually. The best exercises to do depends on how severe the arthritis is and which joints are affected.
An extended warm-up is very important to activate the synovial fluid and prepare the joints for exercise.
The best aerobic exercise for people with arthritis is low impact activity, such as swimming or water aerobics. These activities minimize impact and the water helps support body weight. For those who find it comfortable, other low impact exercises like walking, rowing, or cycling may be done. It is very important not to place excess stress on the affected joints. Do not use wrist or leg weights during aerobics.
It is important to strengthen joints and muscles with calisthenics or resistance training. Light hand weights or weight machines on light resistance may also be used aa long as the pain is not aggravated. A good rule of thumb is: If an arthritic joint hurts for more than an hour after exercise, you have overdone it and need to cut back on the amount of exercise until your strength is built up.
Flexibility is important to preserve range of motion, so always end each session with static stretching of all muscle groups. Never bounce while stretching. Heat application before and after an exercise session can feel good and improve joint function.
Musculoskeletal disorders are common as people age. Staying fit can reduce the potential for such conditions as osteoarthritis, bone fracture, connective tissue tearing, and low back syndrome. As stated earlier, injury and trauma to cartilage increases the likelihood of developing arthritis, especially if surgery is required.
The following are some tips to help prevent arthritis:
Quality of life is becoming the standard by which all areas of our endeavors are measured. Whether or not you are afflicted with a limiting condition, a moderate fitness program can enhance each day.
by Pam Germain
Regular exercisers are thought of as being fit and healthy, free from disease. There are many people, however, who incorporate exercise into their lives to help them live with a medical condition. They, too, can be fit in spite of a chronic illness.
About 1 out of 10 adults are diabetic or display some form of glucose intolerance, totaling an estimated 11 million Americans. Blood sugar, or glucose, accumulates in the blood because of a lack of insulin, the hormone that processes glucose for the body's use, or because of the inability of the body to properly use the insulin it produces. Diabetes is a major coronary risk factor, and can also lead to blindness, liver, kidney, and nerve damage.
Type I or juvenile diabetes is insulin dependent, requiring daily injections because the pancreas is unable to produce any insulin. Type II or adult-onset diabetics have an insulin insensitivity rather than a lack of it. They usually are treated with oral medication, diet, and exercise.
There is some controversy regarding exactly how exercise can best enter the total treatment program for diabetics. A complete medical evaluation is important for all diabetics before entering a fitness program. Exercise is not recommended for those with poor blood sugar control and special modifications in activity are necessary in the presence of complications, such as eye or retina problems, or severe obesity. Diabetics who are supervised by a physician and have the "go ahead" for exercise can benefit greatly from a program.
People with diabetes find that exercise is very beneficial in assisting blood glucose regulation. In fact, one common result of using exercise to help control diabetes is a decrease in the amount of insulin needed therapeutically. During exercise, working muscles can absorb glucose and use it for energy without insulin, also decreasing the need for insulin. Physically active people have good blood sugar tolerance as a result of cells that are able to respond so effectively to insulin.
Exercise also helps lower body fat. Overweight people use more insulin, so with weight loss, less insulin is needed.
With the aid of a physical and a qualified exercise instructor, exercise can be adjusted for intensity and total calorie expenditure to match dietary and insulin habits. Daily exercise is most effective for maintaining blood sugar control. Type I Diabetics benefit because a regular pattern of diet and insulin can be maintained. The workouts should last 20 - 30 minutes.
Those people with Type II should work out 40 - 60 minutes at least five days a week to maximize the calories they burn, since adult onset diabetes in characterized by overweight. Both types can work at a target heart rate of 50-85%, depending on their individual level of fitness.
Strength training can improve glucose uptake by causing the muscles to work more efficiently. Without complications, diabetics can gradually do the same activities an non- diabetics.
Occasionally a diabetic might have a hypoglycemic, or low blood sugar, reaction during exercise. To avoid this:
Diabetes is not an excuse to avoid exercise. With the help of a physician and a trained exercise instructor, the diabetic can improve his or her body's ability to cope with the condition and become fit.
By Pam Germain
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone strength which leads to an increased risk of fracture. One in 3 people, mostly women, will suffer a fracture related to low bone mass.
The fractures related to osteoporosis occur most frequently in the wrist, hip, and spine. Compression fractures of the vertebrae are responsible for a loss of height and kyphosis or rounded back. Vertebral fractures cause the center of gravity to shift forward with a resulting increased risk of falling. Hip fractures are the most serious, causing a loss of mobility and quite often death from complications.
Men can develop osteoporosis, but it is not as prevalent because men reach a higher peak bone density during the growth years than do women.
A critical time for the actual onset of osteoporosis in women is during the first five years after menopause. During this time, women lose bone mass rapidly due to the decrease in estrogen production. Estrogen controls the rate of bone removal from the skeleton, so without it bone loss increases. The postmenopausal bone loss is the largest factor in development of osteoporosis.
The risk for osteoporosis is also determined by other factors:
1) Genetic factor: Women of Northern European or Asian decent who have a small, thin frame, those with fair complexions, and women with a family history of the disease are the most likely to develop osteoporosis.
2) Dietary factor: Calcium is the “bone” mineral. Abundant calcium intake during childhood and through the age of 30 is critical and helps build peak bone mass. After age thirty bone mass increases very little and without adequate calcium in the diet it is withdrawn from bones to maintain normal blood levels. During pregnancy calcium is withdrawn from the mother’s bones for the growing fetus. After menopause a woman needs 1500 mg of calcium per day just to help preserve her bone mass if she is not taking estrogen replacement therapy.
3) Exercise factor: Physical activity places force on the skeleton in a way that will increase new bone formation on the mature, non-growing skeleton. Research shows that physically active people have higher bone mass than sedentary people. Immobilization due to illness or injury produces high bone loss.
4) Lifestyle factor: Smoking and heavy alcohol use affect bone density in a negative way.
Bone density can be measured in several ways. Dual-energy x-ray absorptiometry (DXA) is a fairly new method which uses low level of radiation to assess the bones of the spine and hip. Bone density scans help physicians determine a patient’s risk of osteoporosis and track the progress of bone density changes. If a woman has any concerns about her bone density she should discuss getting a bone density scan with her doctor.
There is no cure for osteoporosis. The main treatments for the disease are estrogen replacement therapy and some other pharmaceutical therapies that help inhibit bone loss. Prevention before osteoporosis develops is the best bet for healthy bones your whole life. Regular bone building exercise and good nutrition is the best prevention. After menopause estrogen replacement therapy helps maintain the non-symptomatic woman’s bone mass. Of course hormone therapy is a decision to be made with one’s physician.
Exercise is the main way for an adult’s body to continue to build bone density. Exercise must overload the bone and push it beyond the normal daily movements and loads. Exercises that produce low forces, such as low impact walking does not promote bone mass increase. High force exercise, such as exercises involving jumping or running overload the bones sufficiently to promote an increase in bone density. Weight training also places a load on the bones that will increase mass, provided the weight is heavy enough to provide the overload.
The American College of Sports Medicine holds the position that weight bearing physical activity is essential for normal development and maintenance of healthy bones, but there are cautions if a woman is over the age of 40 and has been sedentary for most of her life. And exercise cannot be recommended as a substitute for hormone replacement therapy at the time of menopause.
1) Young healthy adults with no osteoporosis symptoms should perform high intensity strength training. They can also do high and abnormal impact loads. These are usually in the form of jumping and plyometric activities. Current research has shown that 50 two footed jumps three days per week for six months will increase hip bone density, and offer benefits to spinal density, too. Jumping in bare feet on a hard surface maximizes the ground reaction and load better than in shoes. Stand with feet no more than shoulder width apart and use the arms while jumping straight up as high as possible. Bend the knees while landing. This is a very intense activity that should be started gradually with only 5 jumps per session, adding on 2-3 jumps per session each week. Jumping is for younger and older non-osteoporotic women unless they have orthopedic limitations such as foot or knee pain or arthritis.
2) Healthy, non-osteoporotic postmenopausal women should do high intensity strength training and dynamic resistance exercises with weighted vests. Older women who have been regular exercisers for their adult life may also do jumping in place as their body will tolerate it. Healthy but sedentary women may increase bone mass slightly by becoming more active, but the primary benefit in activity is in avoiding further loss of bone from inactivity. These newly active older women should be very cautious about jumping, however a weight training program can be a very positive influence on their bone mass.
3) Osteoporotic women: There are several cautions for women who have osteoporosis regarding the exercises they perform. The goal of the exercise program is to improve mobility and dynamic balance, promote flexibility and strengthen the trunk. The optimal program for women with osteoporosis includes coordination exercises that may indirectly decrease the incidence of fractures by lessening the likelihood of falling.
Aerobic exercise should be low intensity (40-70% peak HR) for a minimum of 3 days per week for 20-30 minutes. General flexibility exercises improve range of motion. There should be special emphasis on stretching the chest or pectoral muscles since they shorten in people with kyphosis or rounded back.
Weight training for the legs, abdomen and back are most critical. This improves the lower body strength and postural control and may help prevent falls. Improvements in side to side balance may help reduce falls to the side and the resulting hip fractures. Perform all exercises slowly with control. Sudden twisting movements or large compressive loads may increase the risk of vertebral fractures. People with osteoporosis should avoid movements that increase the rounding of the back, such as standard curl-ups, and use modified exercises that keep the back in alignment.
BONE DENSITY
Childhood and the teenage years are the times that exercise has the most effect on bone density. However, many young women put themselves at risk due to lifestyle factors such as disordered eating, lack of exercise, and smoking. The effect on their bones is dramatic, long-lasting, and irreversible.
Even with a healthy lifestyle that emphasizes proper nutrition and exercise, one cannot totally protect bone density because 60-80 percent of our bone mass is genetically determined. However, the 20-40 percent that can be affected by environmental factors can definitely improve the quality of life as one ages.
by Pam Germain
One of the main purposes of a fitness program is to train the cardiovascular system. The rhythm of life is the heart beat. Each and every cell in your body depends on oxygen that the cardiovascular system delivers to it by means of the heart beat. This complex network can be simplified by comparing it to an electrically driven pump which sends water throughout many pipes.
The heart is the pump itself, made of four chambers, two upper atria and two lower ventricles. The right atrium receives returning blood from the body, sends it into the right ventricle, which pumps it into the lungs where it is renewed with oxygen. The left atrium receives this blood from the lungs and sends it to the left ventricle, which pumps it into the body through the main artery; the aorta.
The heart's electrical conduction system is located inside the heart, spread out across the four chambers like a home wiring system. The generator of this electric current is a group of highly specialized cell in the right atrium called the sinus node. This natural pacemaker sends electrical impulses to the right and left atria at regular intervals resulting in contractions that pump the blood into the ventricles. At the center of the heart is a delay point, the atrioventricular (AV) node, which synchronizes the contractions in the atria with the contractions in the ventricles so that they do not occur at the same time. After the AV node pause, the electrical impulse goes into the His-Purkinje system in the ventricles. This system speeds up the impulse to the ventricles so that they can efficiently pump the blood into the body. This electrical trip, or heart beat is repeated thousands of times throughout life. During normal daily activity the heart rate is 60 - 100 times each minute. This rate increases during exercise, emotional or hormonal changes, and with the use of substances such as alcohol, tobacco, caffeine, and some medications. During sleep, the heart rate can slow as low as 30 - 50 beats per minute.
Blood pressure is a measurement of the contraction in the left ventricle as the blood is propelled throughout the body. The systolic blood pressure is the pressure of the actual contraction, while the diastolic blood pressure is the amount of pressure remaining when the heart muscle relaxes between beats.
The heart itself needs a steady supply of oxygen which it receives, not from the blood inside the chambers, but from its own arteries, the coronary arteries. These are tiny arteries when compared to the aorta.
When the cardiovascular system is healthy and fit, the whole person tends to feel good. There are a number of disorders that do occur in this system. In fact disorders of the cardiovascular system is the leading cause of death in the U.S. for both men and women.
Coronary heart disease (CHD) is caused by a lack of blood supply to the heart muscle through the coronary arteries. This is also called atherosclerosis or hardening of the arteries. These small arteries become clogged with plaque which narrows or blocks the pathway for the blood supply. As a result the heart is damages and no longer functions properly. Heart attack results from a part of the heart receiving no blood supply and therefore dying.
Heart attack is signaled by accompanying pain similar to heartburn which can last for hours. After a heart attack, the dead portion of the heart muscle scars over. The remaining living heart muscle must do all the work of pumping blood.
Other disorders of the cardiovascular system MAY or MAY NOT occur with coronary heart disease. High blood pressure or hypertension is a primary risk factor for CHD. It develops when the body's arteries become lined with plaque, which slows down the blood flow. The heart has to work harder than normal all the time and the force of the blood is higher than normal.
Angina Pectoris is a symptom of coronary heart disease. It is the chest pain felt during physical exertion or mental stress, and is described as pressure or tightness that may radiate to the left arm, back or jaw. The pain lasts several minutes and is alleviated with rest and nitroglycerin.
Arrhythmia occurs when the heart loses its rhythm as indicated by irregular, fast, slow or skipped beats. Some of the reasons for this occurrence is a sinus node sending electrical signals abnormally, an electrical signal that starts elsewhere in the heart, a blockage that impedes the electrical signal, or the heart not pumping the blood efficiently. Palpitations or skipped beats happen to everyone occasionally, most of the time with no cause or risk. It is the disorder of heart disease than makes irregular heart beat significant.
Cardiac arrest, or a sudden collapse often followed by death, is usually not a heart attack. It results from life threatening arrhythmia that may or may not be associated with heart disease. A thickened heart muscle from high blood pressure may trigger cardiac arrest. Electrical shock is an accidental cause of cardiac arrest. CPR and defibrillation are needed quickly when cardiac arrest occurs.
When the cardiovascular system is affected by disease, there are various treatments used. For existing high blood pressure, drug therapy is considered to be the most effective form of medical treatment. Coronary heart disease (CHD) at its extreme requires surgery. Severe arrhythmia may be treated with medications, artificial pacemakers, or implantable internal cardioverter- defibrillators.
Non-medical treatment is based on health and lifestyle changes. CHD is often referred to as a "disease by choice" being strongly related to daily living habits. Treating these disorders with lifestyle changes is almost identical preventing cardiovascular disorders in the first place. The term risk factor is defined as a "characteristic, inherited trait, or behavior related to the presence or development of a condition or disease." Cardiovascular disease has both controllable and uncontrollable risk factors. There is not a method to change the risk factors of a family history of cardiac disease, one's age, one's race, or one's genetically programmed gender. However, there are more controllable risk factors that can cause an individual to develop CHD than the uncontrollable ones. The controllable risk factors are interrelated and controlled by the same healthy habits.
Cigarette smoking is the single most important risk factor for artery disease. Even regular exercise can't cancel out the effects of an active smoking habit.
High cholesterol is controllable limiting the amount and type of fat intake in the diet and also by medication in extreme cases. Obesity can contribute to the development of CHD, and a major part of controlling this risk factor involves a low-fat food intake. The reduction of body fat through improved eating habits and exercise is one of the most effective forms of control for high blood pressure and CHD that doesn't involve medicine.
Speaking of exercise, burning about 2000 calories per week through physical activity can lower the risk of heart disease by 25-40%. In studies assessing both physical activity and physiological fitness, sedentary living was associated with double the risk of developing CHD. These studies also demonstrated that physical activity rather endurance fitness was the essential element for protection against CHD. In other words, moderate activity is the "ticket" to cardiac health.
Regular exercise reduces the risk of coronary heart disease in several ways. It causes changes in cardiac function, including a reduction in the resting heart rate, enlargement of the coronary blood vessels, an increase in the amount of blood pumped with each beat, and improved muscular ability to extract oxygen from the blood. Regular exercise lowers both systolic and diastolic blood pressure. Physical activity also increases the efficiency of a clot dissolving protein found in the blood.
High blood pressure is a CHD risk factor which affects 60 million people in the US. People who are sedentary and overweight are more prone to develop high blood pressure. A family history of the condition is also a risk factor for it. Black Americans experience high blood pressure as the most common chronic disease. Even mild high blood pressure can reduce life expectancy. It is important to work with your health care provider to make changes in diet and exercise.
Learn to monitor and control your stress level. Impatience, anger and hostility are all harmful to the heart. The sensible measure of regular checkups of blood pressure, cholesterol, and blood sugar can alert you to unknown problems before they become severe.
The vast knowledge about the cardiovascular system and its health has been contributed to by agencies such as the American Heart Association. This organization was founded in 1924 and opened its members to the public (instead of just physicians) in 1948. It is a voluntary health agency whose purpose is to research and combat heart and blood vessel diseases. The AHA offers educational services to the public about heart disease and its prevention and treatment.
Rating of Perceived Exertion is an easy way to monitor exercise intensity. There is no equipment, you don’t have to stop moving to find your pulse. RPE helps you become very familiar with your body and its response to exercise. It is one of the preferred methods for monitoring heart rate for individuals on medicine for hypertension or heart disease, since these medications may affect the heart rate.
You use the RPE scale to describe your degree of effort while exercising and evaluate how hard you are working. You also evaluate your internal comfort and how you feel during activity.
Perceived exertion uses a scale of 0-10 to rate your degree of effort. A rating of 0 would reflect resting or lying down. A rating of 10 would mean total effort that cannot be sustained for very long because you feel exhausted. Moderate exercise would be rated about 4 and a somewhat hard feeling would be rated at 5. Beginners and individuals with medical conditions would want to keep their exertion lower than people who train or compete athletically.
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Instructors and trainers may have students and clients with medical clearance to exercise with High blood pressure and cardiac disorders. Exercise does have many benefits for "low risk cardiac clients" and the experienced instructor can use the following guidelines and precautions for these students:
by Pam Germain
One half of the population is very different from the other half of the population. In health and fitness, most of the attention and research on exercise has focused on the needs of active men and applied the findings to women. This may be due to the past tendency to discourage women from participating in exercise to the same degree as men.
However, whole areas of activity are dominated by women today. Some fitness businesses have begun targeting this half of the population. Bicycles, bike seats, and bike shorts are now designed specifically for the proportions of women. The fitness shoe industry has changed drastically in its sales approach as it produces shoes designed closer to the shape of female feet. Some of the largest health club memberships are found in women only facilities. These clubs are sensitive to women’s fitness needs and wants, and find a very loyal client base.
Are there enough differences between the sexes to justify this attention? Women are very different from men in fitness needs and injury potential.
Myths about women and exercise are still believed by some, such as the fear that exercise can damage the female reproductive system. It is very important for women to understand the way exercise affects them so that the wonderful benefits of a healthy lifestyle can be achieved.
In comparing the average woman and man, we find that she has a smaller heart and lungs, proportional to her body size, which results in a smaller cardiac output, the amount of blood pumped in one minute.
When the limits of the cardiovascular system to transport oxygen to the muscles have been reached, it is referred to as the maximal oxygen uptake. The average woman has a lower limit than the average man.
Cardiovascular endurance training improves the capability of the heart and lungs to pump and oxygenate blood, and lowers resting heart rate and blood pressure. Today, women suffer from heart disease at a similar rate to men, giving the average woman good reason to start and stay with an exercise program.
The average woman has smaller, less dense bones than the average man. Between the ages of 18 and 30, her system makes deposits of bone mineral in the skeleton. With a good routine of exercise and strength training, a regular menstrual cycle, and adequate nutrition, she can maximize her bone density and help prevent osteoporosis.
The most notable skeletal difference between the average woman and man is her wider pelvis, which can predispose her to lower extremity misalignment on her knees, hops, and ankles. Some women have a pelvic width that causes a relatively knock-kneed appearance with pronated feet. Specific strengthening exercises may help reduce the injury potential of this structural difference.
On the average, women have 2/3 the strength capability of men, due to 20 percent less muscle mass. Strength or resistance training benefits women, nonetheless, because the stronger a woman is, the better she can carry on the regular activities of daily life with less fatigue and greater endurance.
Many women fear strength training, believing that they will “bulk up.” While both sexes have the same types of muscle fibers, women in general lack significant levels of testosterone, preventing extreme muscle development.
Depending on genetic endowment, some women do develop a degree of muscle enlargement, but those who desire to control the amount of shape and definition they develop can do so by manipulating the amount of weight and repetitions they use.
Women naturally store more adipose (fat) tissue, which helps meet reproductive needs. The ranges for fat to muscle ratio are between 20 and 25% for healthy women, while men are healthiest at 15% or less. Female athletes often have body fat percentages under 20%, however it is strongly discouraged for any woman to allow her body fat to go below 12 percent.
Women who are beginning or intermediate level exercisers incur more injuries than men, perhaps due to their being in poorer physical condition initially. This makes it very important that women who are novices learn the basic principles of warm up, cool down, and stretching. Injuries in well conditioned women are at the same rate as men and are more sport specific to their activities.
When women exercise regularly, they receive the same health benefits as men, plus some added benefits in cancer prevention and alleviation of some PMS symptoms and cramps. Sticking to a fitness schedule may help ward off osteoporosis, heart disease, obesity, and depression as well.
Since men and women do have physiological differences that are affected positively by exercise, it is important to understand and apply the exercise techniques that work best for each individual. Women focused exercise services and expert instruction can help active women meet their fitness needs.
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WOMEN & HEART DIESASE
Heart disease is an equal opportunity disease, being the leading cause of death in women in the US. Most women do not try to prevent it while the are young and many miss the symptoms when they are older.
Too many women are sedentary and do not get enough physical activity at home or at work. Besides including exercise in the daily routine, eating nutritious food and giving up cigarettes would decrease the occurrence of heart disease in females. For women in menopause, hormone replacement therapy offers up to a 50 percent reduction in the risk of heart disease.
by Pam Germain
One of the most exciting and challenging events in the life of a woman is pregnancy. The mother’s health, nutrition and exercise habits do influence the baby and the birth. In past decades exercise was severely restricted during pregnancy. In 1994 the American College of Obstetricians and Gynecologists (ACOG) revised its guidelines for exercise during pregnancy, acknowledging that a regular activity schedule is beneficial for expectant mothers.
I’ve had several students in my fitness classes who have maintained a regular exercise routine until they delivered. Women with low-risk pregnancies should workout. Exercise is good during pregnancy and can be done safely if several guidelines are understood and followed.
Active women feel better during pregnancy. They experience less swelling, fewer backaches, and a chance of an easier labor, delivery, and recovery. Exercise helps improve the self image and allows a sense of control during a time the body is changing in new and unusual ways.
A mother’s exercise program may benefit the baby, too. Low birth weight in babies is a risk factor. Women who exercise moderately (burning 1000 - 2000 calories per week) deliver bigger babies. Heavier babies are healthier and better able to resist infection.
There will be some changes in the way a pregnant woman’s body reacts to exercise due to the changing shape and physiology of the body. Pregnancy and exercise share certain body systems such as circulation, respiratory and musculoskeletal, and metabolic. A woman may tire more quickly as pregnancy progresses since she has more weight to carry. An increase in the total blood volume (up to 50%) makes the heart work harder, even during rest. As pregnancy progresses, the heart adapts less easily to increased demands of exercise. Shortness of breath is caused by the expanding uterus pressing upward against the diaphragm. The center of gravity shifts and balance is different when moving.
Most women can workout safely throughout the childbearing year. Once the physician has determined that a woman’s pregnancy is low risk, she can participate in a comfortable, moderate routine. The routine should be done regularly, three times a week, not as an occasional activity. It is important to view exercise during pregnancy as a means of maintaining the fitness level, not training for large improvements or preventing weight gain.
Low risk pregnant women should exercise at an intensity that is comfortable for them. Instead of trying to reach the pre-pregnant target heart rate, the level of perceived exertion should be maintained. This is the feeling of intensity, not a specific measurable heart rate. A pregnant woman can safely exercise at the “feeling” of her usual workout.
Pregnant women should do activities that are familiar and comfortable. If a woman is used to higher impact activities, it’s OK to continue as long as she is comfortable. Most women find that after the third month, low impact aerobic activity feels better and protects the joints. For aerobic classes, as pregnancy progressed, it is best to do routines that have simple, smooth sequences, without turns and sudden moves. Coordination and the center of balance changes, and these recimmendations will keep movement comfortable.
Step aerobics can be used by prenatal exercisers. It should be modified for individual intensity at a moderate intensity and step height. While stepping, good posture and proper stepping form should be emphasized. Prenatal exercisers do best to avoid using weights while on the step.
There is also a place for weight training in a pregnant woman’s exercise routine. Done moderately, resistance exercise promotes good posture, helps prevent lower back pain, strengthens the pelvic floor muscles, and prevents excessive separation of the abdominal muscles. However, the joints and ligaments become more lax as pregnancy progresses, increasing the risk of injury if heavy weight is used. An expectant mother should use light enough weights to avoid straining and increase the number of repetitions.
It’s important to emphasize exercises that isolate the muscles and work them separately, instead of performing more complicated compound exercises. Normal breathing should accompany weight training, avoiding any tendency to hold the breath during a lift. By the fifth or sixth month, most women need to eliminate exercises performed lying on the back or front. Abdominal exercises can be modified to a side lying position. All stretches should be done gently and not hyperextended.
Safety is most important factor during exercise for both mother and baby. A few additional tips include:
1. Adequate hydration - drinking a lot of water before, during, and after exercise.
2. Wear clothing that permits adequate evaporation of sweat.
3. Exercise in comfortable environmental conditions - avoid excessive heat and humidity.
4. Avoid activities that have a risk of falling or being in an accident.
By following these guidelines, most women can achieve the benefits of regular exercise during pregnancy.
Tips for Instructors:
1) Ask your students to inform you if they are pregnant so that you can
discuss precautions and modifications that may help.
2) Pay attention to the body alignment and movement control of pregnant students.
3) Provide a longer warm-up for pregnant exercisers.
4) Teach expectant mothers how to use perceived exertion to monitor their exercise
intensity.
5) Weight training precautions include using lower weight/higher repetitions, avoid
excessive overhead lifting, slow continual breathing (do not hold the breath), and avoid
lying on the back.
6) Keep the pregnant students moving their legs while standing to aid circulation.
7) Encourage pregnant women to find the most comfortable position for each exercise.
Demonstrate several options with each exercise.
8) Complement expectant mothers on their desires to stay fit during pregnancy and focus on
positive comments about their changing bodies. Avoid “fat talk.”
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Sample Design for a Prenatal/ Postpartum Exercise Class
Pregnant women can safely exercise if they follow certain guidelines. They must always get medical clearance before exercising in your class. The need for trainers to have proper training in prenatal/postpartum exercise has increased dramatically. Planning of a class should incorporate exercises and moves that fit the women’s physical needs. As an instructor you need to understand the physiological changes that affect pregnant women and adapt your class accordingly.
Sample Workout
Warm up: 10-15 minutes
Emphasize posture, body alignment, and spine position. Use simple range of motion and
gentle stretches. Concentrate on the neck, shoulders, hips, calves, and lower back.
Cardio: 15-20 minutes
Remember, during pregnancy their center of gravity and alignment change, balance
decreases, and joints loosen. Use basic, low impact moves and simple choreography. Avoid
quick direction changes, bring movements back to the center for a clean change of
direction. Use music no faster than 130-135 bpm. Keep the intensity under control, the
safe heart rate is 60 to 75% of maximum, and perform heart rate checks periodically.
Conditioning: 15 minutes
Upper torso exercises release tension and enhance posture, remember they will be lifting
their babies and other objects. Back support is key. Emphasize proper breathing. For the
lower body squats and leg extensions work well to maintain flexibility and decrease
cramping.
Abdominals: 5 minutes
For abdominal workouts there are special modifications needed for those in each trimester.
For women in the first trimester, the same exercises can be performed as those who are not
pregnant. Once a woman has entered the second trimester they should not perform any supine
exercises, lying flat on their back. The abdominal exercises should be kept simple but
effective. A good movement is the C curve (while onhands and knees contract abdominals and
form a C with the spine, hold and relax) or a sidelying C curve (lie on left side,
contract abs and bring knees to chest, hold and relax).
Cool Down: 10 minutes
At the end of the class concentrate on flexibility and stress management. Use slow,
sustained stretching and relaxation techniques.
As a guideline always tell your students to:
Postpartum- After childbirth the body needs time to heal. Make sure they have proper medical clearance before they return. When they are back to classes boost their self esteem with positive reinforcement!
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SPECIAL EXERCISES FOR PREGNANCY
WONDERING ABOUT WATER FITNESS
"I am wondering what type of equipment I can incorporate into an aquatics class and a step class for pregnant women? What modifications should be used? Are the buoyancy dumbells okay to use and can the exercise balls be used in a land/step class? Thank you for any information you can provide."
Pat Gill an expert Water Fitness Instructor from Texas answers:
"Here's the answer to your questions on water aerobics, equipment and pregnancy. As
with any other exercise program, the pregnant participant should first check with a
physician for approval before beginning. The use of equipment in the water environment
should be limited to the experienced water exerciser. Water dumbbells are an excellent way
to tone and tighten however, the following precautions should be taken:
Change happens throughout everyone's life. Many of these changes occur during "mid-life." Mid-life is not the end of a productive existence, but the beginning of the second half where there are many wonderful adventures waiting to be taken. Your choice of lifestyle can help you maximize your physical and psychological well being at whatever age you are.
Women face a major change during mid-life; menopause. Since we now understand that lifelong fitness brings important health benefits, women approaching and going through menopause can apply the principles.
Menopause is the complete cessation of menstruation for at least a year. Peri-menopause, which means "around menopause," is the 5-10 years before menopause. Peri-menopause can mimic PMS (pre-menstrual syndrome) symptoms. If you keep a calendar of your cycles you can see that the changes are similar but the timing is different. If you are in your mid-40's and the changes are random it is probably peri-menopause. During this broad period of time there is a gradual change from the reproductive to the non-reproductive phase of life. In the late peri-menopausal period, the ovaries become less responsive to hormones, estrogen in particular, and gradually stop producing eggs, and your periods become irregular and finally stop. Menopause usually occurs around age 50 but can happen anytime between 38 and 55.
This lengthy time is often accompanied by some well known symptoms. The most common one is hot flashes and night sweats. The blood vessels to the skin dilate and the increased blood flow causes flushing, heat and sometimes profuse sweating. This "vasomotor instability," as the medical world terms it, is viewed by women as intrusive and often embarrassing since it can happen at anytime.
Additional signs of menopause may include vaginal dryness, reduced sex drive, incontinence and other urination problems, weight gain, headaches, insomnia, hair loss, mood swings, and depression. It's important to remember that not all women have the same symptoms or all of these symptoms.
During the postmenopausal stage, after your menopause is complete, several important hormonal changes occur which result in a reduction in serum estrogen levels. This can cause a decrease in the absorption of minerals by the bones, which puts women at risk for the long-term disease osteoporosis. Even active postmenopausal women can lose up to one-third of their bone mass. Since no pain or illness signals a tendency toward osteoporosis, it is hard to tell if you are at risk. There is an available test that measures bone density.
The low serum estrogen levels after menopause are also associated with elevated lipid levels (fat in the blood) and reduced HDL cholesterol, which is the "good cholesterol." This change increases a woman's risk of coronary heart disease.
One of the biggest issues women going through menopause face is hormone or estrogen replacement therapy (ERT). ERT is the most effective treatment for bone loss but there are a number of important variables that should be considered with your physician. ERT alleviates many of the symptoms during the peri-menopausal phase and cuts the risk of coronary artery disease in half. The downside of ERT is an increased risk of uterine and breast cancer. There are also some other drugs are available to counteract bone mass loss.
There are other methods that may help alleviate the peri-menopausal symptoms and the postmenopausal health risks. Out of all the strategies to help ease the symptoms, exercise is at the top of the list. Many studies have shown that fitness can improve at any point in the life span and exercise is one of the best ways to slow the age related decline in physical function and prevent many of the chronic diseases. Exercise may not decrease the severity of hot flashes, but when they occur during activity, they at least look normal. Regular exercise helps reduce weight gain, improves sleep quality and reduces insomnia. Exercise is a potent stress reducer that decreases anxiety and depression and improves self-image and confidence. Weight training exercise can increase metabolism, and build lean muscle mass and bone density by promoting bone mineralization. The pelvic floor (Kegel) exercise improves the tone of the muscles in pelvic area which helps control or prevent incontinence and other urinary problems.
Nutrition is another major factor in a healthy lifestyle. A healthful, low fat diet keeps blood sugar levels controlled, which may help depression and mood swings. A low fat food intake also helps fight the weight gain that many peri- and postmenopausal women experience. Adequate calcium intake from food sources is considered a help in fighting bone loss. In terms of prevention, early adulthood is the time for weight bearing exercise and a diet rich in calcium to help prevent bone loss later.
It's important to drink plenty of water to keep the skin and bladder elastic and help prevent bladder infections. Substances such as alcohol, caffeine, nicotine and many medications can actually make menopausal symptoms worse.
All people have the opportunity to greet life's changes with a healthy lifestyle. An important fact to remember is that it isn't too late to start!
Students both young and old are in school this time of year. Most of them are involved in full days of educational activities.In the past, some of my college students have made the comment that each teacher thinks his or her particular subject is the most important. I feel that way about the fitness classes I teach. And I hope that my students learn to appreciate and commit to exercise activity for the rest of their lives.
There is a trend in the US educational system of cutting back in physical education classes. PE requirements are being eliminated at every educational level in many areas of the country, with many classes offered only as electives or not at all. The reasons for these cutbacks include the budget, the academic priorities, and an attitude that these classes are just unnecessary in the school setting.
I think this is so very ironic in a time when the Surgeon General promotes the statement that lack of physical activity can be hazardous to your health. The very lengthy Surgeon General's Report issued several years ago detailed how important exercise is for everybody. However, you only have to sit and watch people in any public place to realize that America is getting more and more out of shape and unhealthy. Yet the educational system is trying minimize the availability of it.
Perhaps the powers in administration have forgotten or not considered that being healthy and fit affects mental and intellectual abilities. Research studies have demonstrated that the cognitive skills improve when school children participate in 1 hour a day of vigorous physical exercise. This means that their math scores are higher. The stress reduction benefits of exercise helps individuals be more productive in less time. People who exercise get better grades!!!
Another way that regular exercise helps people is that they may avoid chronic diseases and live longer. That means that they get to use their brain and the knowledge in it for more years! And they can keep on learning well into old age.
One unique benefit to teaching fitness classes is that I have the privilege of affecting the “whole person.” Through my sessions, I can help my students tap the physical, mental/emotional, intellectual, social, occupational, and spiritual/innermost self:
What a large accomplishment within one subject: health and fitness. I have the opportunity to affect all parts of my students. Does math affect the whole person? Perhaps, but it's a stretch. I do appreciate the need for academic classes in education, but without sacrificing something so important and crucial as the students’ health. The educational system is one of the most powerful influences in the lives of students and therefore should encourage “Whole Person Knowledge.”
If you are a parent with children in public school, request physical education requirements and support exercise activity. Encourage your children to focus on physical play before TV or computer time. Encourage teens to express themselves with exercise: dancing, playing sports, biking, skating, or whatever activity helps them get fit.
If you are a college student, take advantage of the fitness courses offered and try to fit one into each semester. Look at your schedule and use study and lunch breaks for short, brisk walks or stretching. Start or end your day with a short bout of exercise.
School has started and it promises to be a great year for learning. Remember to make the most of your life by including physical EDUCATION also.
For men between the ages of 40-64 lifestyle diseases become more prevalent. The high priority health issues for men are:
Family genetic predispositions can also be considered.
What men need to do:
© 2003 by I-NAFC/BodyBasics, Inc. All rights reserved.