Chapter 14 – Exercise and Special Populations

Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.

1. SOAP Notes
   1. Subjective: client’s personal report, symptoms, challenges, progress
   2. Objective: vital signs, anthropometrics, exercise and nutrition log
   3. Assessment: summary of subjective and objective observations
   4. Plan: description of what to do
2. Cardiovascular disorders
   1. Exercise should NOT continue if abnormal signs or symptoms are observed
      1. Angina, dyspnea, lightheadedness, dizziness, pallor, rapid HR above established targets
   2. Clients with documented coronary artery disease (CAD)
      1. Physician-supervised maximal graded exercise test
         1. Determines functional capacity and safe exercise levels
   3. Hypertension
      1. 150 min per week may reduce SBP by 2-6mmHg
      2. Acute post-exercise decrease in SBP and DBP
         1. Magnitude of 15 and 4mmHg for SBP/DBP
      3. Medications that alter heart-rate response
         1. Beta blockers, calcium channel blockers
      4. Hydration effected by diuretic medications
   4. Stroke
      1. Signs of a stroke
         1. Sudden numbness or weakness of face, arms, or legs
         2. Sudden confusion or trouble speaking or understanding others
         3. Sudden trouble seeing in one or both eyes
         4. Sudden walking problems, dizziness, or loss of balance and coordination
         5. Sudden severe headache with no known cause
      2. Exercise recommendation for someone recovering from stroke
         1. Depends on client’s condition and loss of function
         2. Can range from stationary cycling, water exercise, or adapted activities if needed
         3. Light to moderate intensity
         4. 3-5 minute bouts
            1. Build up to 30 minutes
            2. 3-5 days per week
   5. Peripheral vascular disease
      1. Muscular pain caused by ischemia, or lack of blood flow to the muscle
         1. Results in spasms or blockages (claudication)
      2. Exercise recommendations
         1. Non-impact endurance
         2. Low to moderate intensity
         3. 10 minutes or longer for warm up and cool down
         4. Gradually increase total exercise to 30-60 minutes
         5. Exercise daily
         6. Avoid cold air or cold water to reduce vasoconstriction
   6.  Dyslipidemia
      1. Elevated triglycerides
      2. Lowered HDL
      3. Elevated LDL
         1. Role in atherogenesis (early stages of atherosclerosis)
      4. Effects of exercise
         1. Reduce LDL cholesterol by 3-6 mg/dL average
         2. Non-HDL cholesterol reduction by 6 mg/dL average
         3. No consistent effect on TG
         4. No consistent effect on HDL cholesterol
         5. Moderate RT 3x/week may reduce LDL, TG, and non-HDL by 6-9 mg/dL average
            1. No effect on HDL
   7.  Diabetes
      1. Hyperglycemia: chronically elevated blood glucose
      2. Type 2 diabetes: non-insulin dependent diabetes mellitus (NIDDM)
         1. Most common form
         2. 90-95% of all diagnosed cases
         3. Presents insulin resistance (cells do not use insulin correctly)
         4. About 75% with type 2 are obese
      3. Gestational diabetes (GDM): glucose intolerance that occurs during pregnancy
      4. Type 1 exercise guidelines
         1. 3-5x/week (or everyday)
         2. 55-75% of functional capacity or 11-14 RPE (borg scale)
         3. Avoid long or high-intensity
            1. Increased risk of hypoglycemia w/ long-duration
            2. Increased risk of hyperglycemia w/high-intensity
      5. Potential complications
         1. Avoid exercise when fasting glucose is 250 mg/dL or higher
         2. Avoid if blood glucose levers are greater than 300 mg/Dl
         3. Avoid exercise during peak insulin activity
         4. Hydrate
   8. Metabolic syndrome (affects over 25%)
      1. Abdominal obesity, atherogenic dyslipidemia, elevated BP, insulin resistance, prothrombotic state, proinflammatory state
      2. Presence of 3 or more of the following
         1. Waist circumference
            1. Men 40 or more inches (102cm)
            2. Women 35 or more inches (88cm)
         2. Elevated triglycerides of 150 mg/dL or more
         3. Reduced HDL cholesterol
            1. Men less than 40 mg/dL
            2. Women less than 50 mg/Dl
         4. Blood pressure of 130/85 mmHg or more
         5. Fasting blood glucose of 100 mg/dL or more
      3. Primary treatment objective to reduce risk for development of CV disease and type 2 diabetes
      4.  Exercise
         1. Low-impact, non weight-bearing for obese
         2. RPE 11-13 on borg scale or 30-75% VO2R
         3. 200-300 total minutes accumulated throughout the week
            1. Gradually progress from short 10-15 minute bouts
         4. Should participate at least 3-5x/week

9. Asthma
   1. Clients need to have rescue medication with them at all times
10. Cancer
11. Osteoporosis
    
    2. Bone mineral density that is 2.5 standard deviations or more below the mean for young adults
    3. Osteopenia: less sever, BMD between 1 and 1.5
    4. Increasing BMD
       1. Plyometric exercise
       2. Weightbearing exercises
    5. Avoid for clients with spinal or other fractures
       1. Spinal flexion, crunches, and rowing machines
       2. Jumping and high-impact aerobics
       3. Trampolines and step aerobics
       4. Abducting or adducting the legs against resistance
       5. Pulling on the neck with hands behind the head

12. Arthritis
    1. Leading cause of disability in US
    2. Two most common
       1. Osteoarthritis
       2. Rheumatoid arthritis
    3. Classifications
       1. Class 1: completely able to perform usual ADL’s
       2. Class 2: can perform usual self-care and vocational activities, limited in avocational activities
       3. Class 3: can perform usual self-care, limited in vocational and avocational activities
       4. Class 4: limited in ability to perform usual self-care, vocational, and avocational activities

13. Fibromyalgia
14. Chronic fatigue syndrome
    1. 1:3 work:rest
15. Low-back pain
    1. Avoid
       1. Unsupported forward flexion
       2. Twisting at the waist with turned feet, especially when carrying a load
       3. Lifting both legs simultaneously when in prone or supine position
       4. Rapid movements

16. Weight management
17. Older adults
    1. Sensory system
       1. CNS
       2. Visual: relied on for balance
       3. Vestibular: provides info regarding position of head in space
       4. Somatosensory: impacts balance and coordination

18. Youth
19. Pre- and postpartum
    1. Pregnant should acquire physicians clearance
    2. Avoid
       1. Extensive jumping, hopping, skipping, bouncing, or running
       2. Deep knee bends, full sit-ups, double leg raises
       3. Contact sports
       4. Bouncing while stretching
       5. Activities where falling is likely
       6. After 1^st trimester
          1. Longer than 5 minutes in supine position should be discouraged
             1. Potential for fetal hypoxia

Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.