SP final exam

• Early childhood


  ages 3-8
• Middle childhood


  ages 9-11
• If general health or fitness assessment is all that is needed, use of the FITNESSGRAM is suggested
• Aerobic training Rx for children


  • Make activity fun and part of an active lifestyle
  • Effectiveness of resistance training depends on intensity, volume, and duration – and has NO MAX!!
  • Supervision to ensure proper technique is most important
• Aerobic guidelines for children


  • FITT needs to be based on the maturity of the child, medical status, and previous exercise experience
  • Exercise intensity should start low and progress gradually
  • RPE, Modified Borg, or OMNI scales are practical methods of monitoring exercise intensity in children (difficult to monitor HR)
  • Specific time should be dedicated to sustained aerobic activities
  • Adolescents should be physically active daily as part of play, games, sports, work, transportation, recreation, PE, planned exercise
  • Intensity and duration are probably less important than the fact that energy is expended and a habit of daily activity is established
  • Adolescents should engage in 3 or more sessions per week of activity that lasts 20+ minutes and that require moderate to vigorous levels of exertion
  • Children and adolescents should do 60+ minutes of PA each day
• Heat-related illness concern with children


  Children can get overheated quickly and become dehydrated
• Commonly diagnosed conditions in children and reasoning for referral to GXT

  • Asthma
  • Cystic fibrosis
  • Diabetes
  • Obesity
  • Various forms of heart disease
• Symptoms that might necessitate a GXT in children


  • Shortness of breath
  • Chest pain
  • Feeling faint
  • Dizziness
  • Syncope
  • Unusual fatigue
  • Exercise intolerance
• Benefits of resistance training


  • Improves muscular strength and endurance
  • Improves motor skills
  • Protects against injury (sports)
  • Has positive psychological benefits
  • Provides a forum for the introduction of safe and proper training
• Resistance training is safe for all age kids
• Flexibility is important in children and recommended at all ages to ensure safe activity
• Sweating rate of children

  • 40% lower in children
  • Greater increase in core temperature required to begin sweating
• Children acclimatization to heat

  • Longer and more gradual program of acclimatization required
  • Special attention required during early stages of acclimatization
• Body cooling in water for children

  Faster cooling because of higher surface-to-volume ratio and lower thickness of subcutaneous fat
• Children perception (RPE)


  Exercising at a given physiological strain perceived to be easier
• Aging exercise goals are to further life expectancy, period of fulfillment and independence, NOT progressive functional decline, frailty, and illness
• Older adults


  >65 years old
• Geriatrics


  Branch of clinical medicine that involves the diagnosis and management of individuals 65 and older
• Physiological changes that occur with aging

  • Lower HRmax, max cardiac output, and VO2max (8-10% decline to decade, 20%/decade after 70)
  • Higher resting and exercising BP and residual volume
• Modifications for GXT for aging

  1. ↓Initial workload (<3 METs)

  2. Small increments (0.5-1.0 METs)

  3. Bicycle preferred over the TM due to impairments in balance and arthritis; gait

  4. Using handrails on the TM to increase a person's confidence and decrease fear of falling (true VO2 max results may be skewed)

  5. 6 min walk may be useful for those without need for HR, BP, or ECG monitoring
• Considerations when prescribing exercise to the aging population

  • Increased CVD and recovery time
  • Decreased PA, adaptability, and bone mass
  • Impaired vision, comorbidities (HTN, type 2 diabetes, stroke)
• When is a GXT necessary for an aging individual?

  1. High Risk (sign/symptoms, known conditions)

  2. Mod-risk & vigorous activities

  3. If resistance training will be incorporated, you should also do strength, power, endurance, and ROM testing

  4. Balance assessment recommended (prevent falls)
• When is a GXT not necessary for an aging individual?

  1. Low and Moderate Risk

  2. Light to mod intensity (40-60%)

  3. Can start an exercise program (walking) without a GXT
• Common chronic condition(s) – most common


  • HTN, Type 2 diabetes, Stroke
• Recommended GXT protocol for elderly


  • Mod Balke (2 min stages, starts at 2 METs, increases by 1 MET)
  • 2mph @ 0%
  • 3mph @ 0%
  • ↑2.5% grade
• Benefits of community programming


  • Supervision, group exercise (motivation), socialization, adherence and greater increases
• Pre-exercise evaluation tools for frail older adults


  • Chair stand: ability and time required
  • Step-ups: ability and # of times
  • Walking speed: time and gait abnormalities such as asymmetry
  • Tandem walkability and time
  • Functional reach: inches
  • Timed up and go: time
  • ROM: degrees
• For frail elders, the priority types of exercises are strength and balance
• Cycle ergometer vs. treadmill (advantages/disadvantages)

  • Cycle ergometer is better if patient has impairments in balance and arthritis
  • Treadmill increases likelihood of submax CV response
  • Cycle = lower aerobic capacity and peak heart rate
• During GXT, make sure to have handrails or monitor them closely on the bike. HR, BP or ECG monitoring should be performed.
• Most common forms of arthritis

  • Osteoarthritis (OA), followed by Rheumatoid arthritis (RA)
• Osteoarthritis (OA) disease stage and related impairments


  Acute joint pain, often insidious
• Rheumatoid arthritis (RA) disease stage and related impairments

  • Acute disease in multiple joints with pain, limited range of motion, and worsened functional impairment
  • Joint stiffness, adverse body composition changes (rheumatoid cachexia; muscle loss and fat gain), muscle weakness, fatigue, and increased CVD risk
• Modifiable risk factors for osteoporosis

  • Diet
  • Smoking
  • Alcohol abuse
  • Medications
  • Body weight
  • Certain diseases
  • Physical inactivity
• Exercise training for BMD should include weight-bearing physical activity (aerobic and resistance)
• BMD


  Bone mineral density (bone strength, represented by calcium content)
• Appropriate exercise for those with osteoporosis

  • Aerobic, strength, balance, ROM, posture
• What to avoid with osteoporosis


  • Explosive movements and contact sports
  • High-impact, high fall risk - Jumping, Jogging, Running, Excessive compression of spine
  • Dynamic abdominal/spinal exercises - Sit-ups, spinal twists, kettlebell swings, etc.
  • Excessive trunk flexion - Bending to lift from a height below knees
  • Excessive bending and twisting
• Sarcopenia


  Degenerative loss of muscle tissue (mass and strength) due to aging and reduced PA
• Sarcopenia is clinically defined as


  • 2 standard deviations below the mean muscle mass of healthy young adults
  • A person with sarcopenia has muscles that are SIGNIFICANTLY SMALLER than the muscles of ~98% of healthy 20 y/o