NASM EXAM Chapter 16 Summary

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NASM EXAM Chapter 16 Summary
2015-08-01 16:59:31

Chapter 16: Chronic Health Conditions and Physical or Functional Limitations
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    • Both Children and adolescents(6-20) are encouraged to get 60 min. of moderate to vigorous physical activity daily.  Children tend to have lower peak oxygen uptake levels, sweating rates, and tolerance for temperature extremes compared with adults.  High-intensity or volume aerobic or anaerobic training should be discouraged in children. Youth fitness training should focus on physical activity and resistance and aerobic training that emphasizes skill and controlled movements. 
    • Regarding older adults, it is important to remember that many reductions in normal physiologic functioning with aging are normal and predictable. Older adults may have elevated resting and exercise blood pressures and reduced maximal heart rates and cardiac outputs.  Resistance training for older clients is recommended 3 to 5 days per week, using lighter weights and slower progressions.
  2. YOUTH
    • Personal trainers should be aware of important physiologic differences between children and adults that impact their response and adaptation to exercise.
    • Peak oxygen uptake: because children do not typically exhibit a plateau in oxygen uptake at maximal exercise, the term "peak oxygen uptake"  is a more appropriate term than Vo2max or maximal oxygen uptake.  Adjusted for body weight, peak oxygen consumption is similar for young and mature males, and slightly higher for young females.  Submaximal oxygen demand (or economy of movement):  Children are less efficient and tend to exercise at a higher percentage of their peak oxygen uptake during submaximal exercise compared with adults.  Children do not produce sufficient levels of glycolytic enzymes to be able to sustain bouts of high-intensity exercise.  Children have immature thermoregulatory systems, including both a delayed response and limited ability to sweat in response to hot, humid environments. Vigorous exercise in these environments should be restricted to less than 30 min including frequent rest periods.  Adequate hydration before, during and after.
    resistance training is both safe and effective in children and adolescents. the most common injuries are sprains (injury to ligament) and strains (injury to tendon or muscle) usually attributed to a lack of qualified supervision, poor technique and improper progression.  make sure to assess for any movement  deficiencies.
    • It is vital to note that various physiologic changes are considered normal with aging and some are considered pathologic(related to disease).  ex. for normal: higher blood pressure at rest and during exercise, Arteriosclerosis is also normal.  ex. for pathologic:  atherosclerosis, peripheral vascular disease. Blood pressure levels between 120/80mm Hg-139/89mm Hg are considered prehypertensive and should be carefully monitored.  

    Some of the normal physiologic and functional changes associated with aging include reductions in the following:  Maximal attainable heart rate; cardiac output; Muscle mass; Balance; Coordination; connective tissue elasticity; bone mineral density.

    • Start with Physical Activity Readiness Questionnaire (PAR-Q)
    • Movement assessments such as: the overhead squat assessment, sitting and standing from a seated position , or a single-leg stance.
    • Flexibility assessment
    • Self-myofascial release and static stretching are advised, provided there is sufficient ability to perform the necessary movements.  If not simple forms of active or dynamic stretching can be recommended to help get the client to start moving their joints during the warm-up period.
    • Stages 1 and 2 are appropriate levels of cardiorespiratory training.  However, older adults taking certain prescribed medications and those with other chronic health conditions must be carefully monitored and progressed slowly. Phase I of the OPT model , should be progressed slowly, with an emphasis on stabilization training(core, balance, progression to standing resistance exercises) before possibly moving on.
    • regular physical activity and exercise is one of the most important factors related to long term successful weight loss.  Important to note, obese and morbidly obese clients have unique problems associated with exercise.  the relationship between balance, muscular strength, and gait was such that heavier individuals exhibited worse balance, slower gait velocity, and shorter steps, regardless of their level of muscular strength.
    • Focus should be energy expenditure, balance, and proprioceptive training to help them expend calories and improve their balance and gait mechanics.  By performing exercises in a proprioceptively enriched environment(controlled, unstable), the body is forced to recruit more muscles to stabilize itself and potentially expend more calories.  For effective weight loss obese clients should expend 200 to 300 kcal per exercise session, with a min weekly goal of 1,250 from combined physical activity and exercise.  progress to 2,000kcal per week. Resistance training can gradually be added.  The same guidelines can be used to plan a training program as with healthy adults.  As always start with an assessment using pushing, pulling, and squatting assessments. Resistance training exercises for assessment or training may be best performed with cables, exercise tubing, or body-weight from a standing or seated position. A single leg balance assessment may be more appropriate than a single leg squat.  Flexibility exercises should be performed from a standing or seated position. Ex. using the standing hip flexor(rather than the kneeling hip flexor stretch), standing hamstring stretch, wall calf stretch, and seated adductor stretch.
    • Core and balance training is also important, use caution when putting them in a prone or supine position bc they are prone to hypotensive and hypertensive responses.  using a standing position may be more appropriate and more comfortable.  Ex. performing prone iso-abs (planks) on an incline or a standing medicine ball rotation versus supine crunches.  Resistance training exercises may need to be started in a seated position and progressed to standing.   Phases I and II of the OPT model .  ensure correct breathing and avoid straining or squeezing exercise bars too tightly (increase in blood pressure) Cycling or swimming are good weight supported exercise to decrease orthopedic stress.  Walking is great unless it causes issues that could lead to injury.
    • Diabetes impairs the body's ability to either produce or use insulin effectively.  Type I (insulin dependent) is typically found in younger individuals and if not controlled, using insulin and dietary carbs, before, during and after exercise, blood sugar levels can rise or fall rapidly and cause hyperglycemia and hypoglycemia leading to weakness, dizziness and fainting.  Type 2 diabetes(non insulin dependent) is associated with obesity , particularly abdominal.  Adequate amounts of insulin are produced however the cells are resistant which can lead to hyperglycemia. 
    • Exercise recommendations generally foloow those advised for obese adults and daily exercise is recommended for more stable glucose management and caloric expenditure.  Weight bearing activities may need to be avoided at least initially to prevent blisters and foot microtrauma that could result in foot infections.  Carbohydrate intake or insulin use should be stressed before exercise as well as afterward to reduce the risk of post exercise hyperglycemic or hypoglycemic events  Follow exercise guidelines for obese adults, using lower impact exercise modalities.  Special care should be given to self-myofascial release, and this may be contraindicated for anyone with a loss of protective sensation in the feet and legs.  Phases I and II of the OPT model are appropriate, but plyometric training may be inappropriate.
    • A normal blood pressure is considered >=120/80mm Hg.  Hypertension is defined as a blood pressure >=140/90mm Hg, whereas a blood pressure between 120/80 and 135/85mm Hg is considered prehypertensive.  Hypertension can be controlled through cardiorespiratory exercise, diet and other lifestyle changes; however, clients are encouraged to take all prescribed medications as directed by their physician.  These individuals should engage in low intensity aerobic exercise and may want to avoid high intensity, high volume resistance training.  Personal trainers are encouraged to measure and pay close attention to the heart rate response to exercise instead of relying on  estimates or equations.  Monitoring body position is very important as well.  Supine or prone positions may be contraindicated.  The majority of exercises for clients with hypertension should be performed in a seated or standing position.  The full flexibility continuum can be used, but static and active stretching may be easiest and safest.  Self myofascial release may be contraindicated depending on body position.  Cardiorespiratory training should focus on stage I and progress only with a physicians approval.  Plyometric training should be used with care, resistance training should be performed in a seated or standing position as well.  Phases I and II of the OPT model are appropriate.  Programs should be performed in a circuit style or using the peripheral heart action (PHA) training system
    • Core exercises in the standing ex. standing torso cable iso-rotations or cobra in standing position.
    leading cause of death and disability for both men and women.  Personal trainers must have a clear understanding about a clients disease, medication use, and upper safe limit of exercise imposed by the clients physician.  Participation must not proceed until the information is received.  Aerobic low intensity exercise is recommended, with a  weekly caloric expenditure goal of 1500 to 2000kcal.  Resistance training should not be started until the client has been exercising without any problems for at least 3 months.  Most exercises should be performed in a seated or standing position.  Flexibility exercises should be limited to static and active stretching in a seated or standing position.  Self-myofascial release should be pre approved by a doctor.  Cardiorespiratory training should focus on stage I and progress only with the physician's approval.  Plyometric training would not be recommended for this group in the initial months of training.  Resistance training should be performed in a seated or standing position as well.  Phases I and II of the OPT model are appropriate.  Programs should be performed in a circuit style or using the PHA training system.