1. Fitness and Healthy Lifestyle
Chapter 13

2. Introduction Major goal in adapted physical activity Role models
Detriments to achievement
Lack of knowledge
Lack of self-determination
Lack of self-confidence
Lack of self-esteem
Role models

3. Recent Changes in the Knowledge Base
NCPAD
WHO
Biocultural approach to physical activity
Healthy People 2010
American Association on Mental Retardation
Exercise and physical activity adherence focus

4. Recent Changes in the Knowledge Base
Increased use of FITNESSGRAM, the ACTIVITYGRAM, and the new Presidential Active Lifestyle Award - PALA
ACSM updated guidelines and resources
Minimal physical activity standard for health benefits

5. Recent Changes in the Knowledge Base
Minimal physical activity standard pertaining to calories expended during activity
Easy-to-understand information about conditioning, training, and testing people with disabilities
NCPERID standards

6. Definitions of Fitness, Activity, and Related Terms
Physical fitness
Physical activity
Exercise
Function or capacity
Health
Wellness

7. Rehabilitation Versus Fitness Programming
Rehabilitation - restoration and/or maintenance of physical function which allows an individual to perform activities of daily living without incurring high levels of stress or fatigue
Services provided in hospitals or centers that provide services for persons temporarily or permanently disabled
Medical model
Reimbursed by insurance

8. Rehabilitation Versus Fitness Programming
Fitness testing and training - conducted in many settings and follows many models
Associated with goals beyond activities of daily living
Prevention of hypokinetic conditions like obesity, heart disease, high blood pressure
Hypokinetic - insufficient movement or exercise
Hypokinetic disease begins in childhood

9. Lifestyle Problems of Americans
Everything that interferes with wellness and negatively affects lifespan
Various factors such as diet, stress, smoking, drug abuse, and physical inactivity are risk factors
SHPPS report on physical activity in schools
Healthy People increase daily physical education
Exercise adherence

10. Lifestyle Concerns Pertaining to Disability
Poor body alignment and inefficient movement patterns increase energy expenditure
Various factors negatively affect mechanical efficiency and energy level
Coping with barriers requires extra energy
Employment requires high levels of fitness
Obtain social acceptance and overcome discrimination

11. Lifestyle Concerns Pertaining to Disability
Relief of chronic depression and other mental health problems
Sedentary lifestyles are associated with lack of socialization into sport or physically active lifestyles
Success in programs can increase body image and self-concept
Activity deficit hypothesis
Obesity associated with movement problems in children

12. Components of Health-Related Fitness
Cardiorespiratory or aerobic endurance
Body composition
Muscular strength and endurance
Flexibility
Also beliefs, attitudes, and intentions that give persons the self-determination, self-confidence, and self-esteem to achieve and maintain fitness goals

13. The FITNESSGRAM
School-age individuals with functional capacity to perform the test items
Criterion referenced
Includes alternatives items for individuals who cannot perform the prescribed six tests
Unique aspects include the PACER, cadence tapes for curl-ups and push-ups, and alternative tests for upper body strength

14. Assessment of Physical Activity
ACTIVITYGRAM
Recall of physical activity over previous 24 hours in 30-minute blocks
Six categories examined as well as the intensity levels in each 30-minute block
Data is also gathered through the use of heart rate monitors, activity monitors, direct observation, and self-report

15. Brockport Physical Fitness Test
Parallels the FITNESSGRAM and is a health-related, criterion-referenced test
Presents standards for youth in the general population as well as five subgroups with various disabilities
Recommended adaptations and alternatives for testing students with various disabilities

16. Brockport Physical Fitness Test
Target Aerobic Movement Test
Seated Push-Up
Reverse Curl
Wheelchair Ramp Test
Modified Apley Test
Modified Thomas Test
Dumbbell Press
Target Stretch Test

17. Other Fitness Tests
Each country has its own test, norms, and minimal standards
President’s Council on Physical Fitness and Sport - uses norms and award structure
YMCA test is used worldwide
Various single fitness component tests

18. School Fitness Testing: History, Issues, Trends
Which tests to use
How high to set fitness standards
How much time to spend training and testing
Fitness over sports and motor skills training
Trend toward performance within healthy fitness zones
Personalization of fitness goals and tests

19. Types of Fitness: Physical and Motor
Physical fitness - health-related
Cardiorespiratory endurance, body composition, muscular strength and endurance, and flexibility
Motor fitness - skill-related
Agility, balance, coordination, speed, power, and reaction time
Included as part of definition of physical education in IDEA

20. The 1950s: Early Beginnings
Kraus-Weber research findings
American College of Sports Medicine
President’s Council on Youth and Fitness
First AAHPER Youth Physical Fitness Test
Contributions of Rarick

21. The 1960s to the 1980s
s focus on both physical and motor fitness
1980s AAHPERD tests changed focus exclusively to health-related fitness
Fitness tests for persons with mental retardation
Fitness norms developed for youth who were blind or visually impaired - later adjusted to match general population except running items

22. The 1980s Onward: Health-Related Fitness
Late 1980s AAHPERD moved to criterion-referenced
Physical Best replaced by FITNESSGRAM
Major research for fitness of various populations funded by U.S. government including four specifically targeted at various disability groups

23. Fitness Classifications Requiring Special Help
Various methods of classifying fitness and identification of individuals who require special help
Adapted physical activity generally focuses on those who are classified as having symptomatic clinical status

24. VO2max
Maximum amount of oxygen consumed by cells in the final seconds of exercise prior to total exhaustion
Age and gender both affect VO2max
Active muscle mass, understanding test instructions, and poor motivation affect results

25. METS Metabolic equivalents
Alternative way of indicating aerobic capacity
Ranges from 1 to 16
Those who function in the 1 to 6 range have severe fitness problems that interfere with daily living activities

26. Exercise Prescription: Five Components
Frequency - 3 to 5 times a week
Intensity - 60 to 90% of maximum heart rate
Time - 20 to 60 minutes
Modality - rhythmic, large muscle activity
Rate of progression - gradual increase in frequency, intensity, and time

27. Exercise Prescription: Five Components
Assessment
Goal setting
Decision making about training
Establishment of dates and program duration
Evaluation to determine if goals are being achieved

28. Personalizing Goals for Various Conditions
Severe developmental disabilities
Spinal paralysis and injury rehabilitation
Other health impairments
Limited mental function
Limited sensory function

29. Severe Developmental Disabilities
Postural reflex mechanism and muscle tone
Population includes those with limited mental and/or physical capacities
Major goals include ROM, functional ability to perform movement patterns used in fitness, and exercise capacity tolerance
For those with good intelligence, ROM is the primary fitness goal

30. Spinal Paralysis and Injury Rehabilitation
Strength is a major goal - often with ROM
Residual strength grading system
Also used in disability sport classification
Postural fitness is associated with imbalances in strength and flexibility

31. Other Health Impairments
Weight loss and aerobic endurance are generally the major goals
Sedentary lifestyles
Concurrent conditions
Distorted perceptions about ‘feeling good’
Realization of fitness level

32. Limited Mental Function
Same fitness needs as general population
Weight loss and cardiorespiratory endurance are generally most important goals
Understanding of speed and distance
Congenital heart disease
Autonomic nervous system regulation
Severe retardation - importance of fitness training over other goals

33. Limited Sensory Function
Same fitness needs as general population
Senior citizens - assistance with cardiorespiratory fitness

34. Aerobic Capacity or Cardiorespiratory Endurance
Most important component of health-related fitness
Improvement - performance of vigorous activities that elevate heart rate for a minimum of three minutes
Begin with interval conditioning
Bouts of 1 min of exercise interspersed with 1 or 2 min of rest

35. Assessment of Aerobic Capacity
Field tests - step tests, distance runs, and walking tests
Field tests provide estimates of ability
Laboratory tests are done on treadmills, bicycle and wheelchair ergometers, and arm-cranking devices
Awareness of cardiac resting and exercise recovery rates

36. Assessment of Aerobic Capacity
Resting heart rate is a good indicator of fitness
Recovery time helps determine whether exercise demands are appropriate or excessive
Recovery of breathing rate to normal should require less than 10 min

37. Prescribing Aerobic Exercise
Continuous (more than 3 min) low-impact exercise recommended
Four principles for low-fit people
Use low-impact activities
Match frequency, intensity, and time to ability
Pay attention to self-concept and motivation
Teach acceptance that rate of progression will be slower than for average people

38. Matching Frequency Intensity and Time to Ability
Frequency - daily when working with low-fit people
Time - as many minutes as can be tolerated and/or woven into a person’s schedule
Intensity can be prescribed by several methods - VO2 max, METS, or calories, maximal heart rate, rating of perceived effort, pain, and breathlessness

39. Intensity Prescribed by VO2max, METS, or Calories
40 to 70% VO2max
Moderate intensity is defined as 3 to 6 METS
300 calories per exercise session
Maintain heart rate in the target zone during exercise

40. Intensity Prescribed by Maximal Heart Rate
Fastest speed a heart can attain during exhaustive exercise without compromising or endangering life
Age-adjusted MHR formula
Exercise within a range of 60 to 90% of MHR
When active mass is limited MHR is not applicable
Some OHI conditions, environmental factors, stress, and medications can affect MHR

41. Perceived Exertion, Pain, and Dyspnea
Children from age 7 onward give RPEs that correlate highly with heart rate
Overweight persons tend to overestimate
Use for people whose hearts do not respond properly to exercise
Goal of exercise tolerance for individuals unable to maintain target heart rate

42. Perceived Exertion, Pain, and Dyspnea
Real pain versus discomfort
Increase intensity gradually
Coping with or ignoring discomfort may need to be taught
Use numerical scales to objectify ratings of pain and dyspnea (breathing discomfort)

43. Body Composition
Individual components that constitute the total body mass
Females have more fat, and males have more muscle tissue
Children have less body fat than adults
Largely genetically determined
Some disabilities affect body composition
Body fat percentage is a major fitness concern

44. Assessment of Body Fat
Measured using laboratory protocols and formulae
Estimated using skinfold caliper measures
Triceps is recommended if using one site
Best combination of skinfold measures is controversial

45. Body Mass Index: Substitute Measure
Substitute for body fat measures when skinfold calipers are not available
Ratio of body weight to the square of body height:

46. Body Mass Index: Substitute Measure
Interpret physical and motor fitness scores in relation to height, weight, and skinfolds
Height-weight tables heighten motivation for lifestyle changes but weight and percent body fat are not highly correlated

47. Prescribing Exercise for Fat Loss
Large muscle activity needs to use more calories then are consumed daily
ACSM recommends no more than 2.2 lb should be lost per week
Obesity is a medical problem
Long-duration activity at low intensity is as effective as short duration/high-intensity activity
Counseling and support groups are essential

48. Muscle Strength/Endurance
Strength developed when muscle exertion is near maximum
Endurance developed when a muscular activity continues for several seconds
Age and gender differences in strength parallel changes in muscle mass

49. Assessment of Muscle Strength/Endurance
Principle of specificity - benefits of exercises done in one position will not transfer when the muscle is used in other positions
Four general muscle groups tested
Focus is on the number of times an exercise is done in the prescribed posture or position

50. Prescribing Exercise for Muscle Strength/Endurance
Sedentary persons should take all muscle groups through strength and endurance exercises at least 2 days a week
Variety of different activities
Principle of overload - progressively increasing the demands made on a muscle group - increase reps then resistance

51. Prescribing Exercise for Muscle Strength/Endurance
Isotonic exercises - dynamic or moving
Endurance exercises - use lighter weights and more repetitions
Strength exercises - use heavier weights and fewer repetitions
Progressive resistance exercise
Strength should be coordinated with a good flexibility routine

52. Prescribing Exercise for Muscle Strength/Endurance
Isometric exercises - static
Maximum or near-maximum muscle contraction that is held for 6 sec and repeated several times
Highly specific, strengthening muscles only for work at the same angle as the training
Not based on the overload principle
Not recommended for individuals with heart disease and high blood pressure

53. Prescribing Exercise for Muscle Strength/Endurance
Isokinetic exercises - machine-generated
Constant resistance machines
Keep velocity of movement constant and match the resistance to the effort of the exerciser
Maximal tension exerted throughout the range of motion

54. Valsalva Effect and Contraindications
Increase in intraabdominal and intrathoracic pressure that results when breath is held
Causes
Heart rate to slow down
Return of blood to the heart to decrease
Blood pressure to elevate
Contraindicated for persons with high blood pressure conditions or glaucoma

55. Range of Motion and Flexibility
Ability to move body segments through the actions and planes designated normal for each joint
Range of motion (ROM) - when the movement capacity at a joint is measured in degrees
Flexibility - functional stretching ability
Gender, age, and musculoskeletal differences affect flexibility as well as some disabilities

56. Assessment of ROM/Flexibility
Flexibility is specific to each muscle group
Sit-and-reach measures hamstring, hip, and spine flexibility
Measurements begin from anatomical position and are either an average of two or three measurements or the maximum

57. Prescribing Stretching Exercises
Purposes are generally to maintain elasticity, to warm up and cool down, or to correct pathological tightness
Stretches should be slow and static not ballistic
Modalities can be active, passive, and/or combinations
Incorrectly done stretches can worsen disabilty or cause injury

58. Using Proprioceptive Neuromuscular Facilitation
A system of stretching that requires the help of an assistant that stimulates the proprioceptors to enhance functional flexibility
Based on the principle of reciprocal innervation
Recommended for individuals with cerebral palsy and arthritis
Two types of PNF
Contract-relax
Hold-relax - recommended if pain is an issue

59. Beliefs, Attitudes, and Practices
Application of theories can be used to help persons develop fitness and make changes in lifestyle
Belief, attitudes, and practices should be included when developing goals and objectives

60. Underlying Theories Reasoned action attitude theory
Self-efficacy or social cognitive theory
Perceived competence theory

61. Self-Reports
Assessment includes self-reports of motivation, food intake, physical activity, and attitudes about the body and exercise
Self-motivation information helps in counseling and individualized teaching
Diaries or logs of food intake and physical activity help structure goal setting

62. Weather and Temperature Concerns
Important in all aspects of fitness
Susceptibility to heat and cold extremes
ANS damage compromises temperature regulation - dehydration a major concern
Poikilothermy
Humidity and wind-chill factor
Body temperature responses - hypothermia, hyperthermia, and heat stroke

63. Space and Equipment Variety of physical activity spaces
Select equipment based on weakest muscle groups
Equipment for aerobic endurance
Instruction and experience in use of community health and exercise centers
Adaptable equipment for variety of levels

64. Organization of the Lesson: Five Parts
Warm-up
Aerobic conditioning
Flexibility exercises for each major muscle group
Muscle strength/endurance exercises
Cool-down

65. Teaching for Fitness: A Review of Principles
Individual differences
Overload/intensity
Frequency
Specificity/transfer
Active/voluntary movement
Correct breathing
Recovery/cool-down
Warm-up

66. Teaching for Fitness: A Review of Principles
Static stretch
Contraindication
Adaptation
Motivation
Maintenance
Nutrition
Environmental factors
Ecological or social validity

67. Exercise Conditioning Methods
Methods of teaching various exercise components
Interval or intermittent
Circuits
Continuous
Combinations
Built around one modality or incorporated in various games and movement activities

68. Interval or Intermittent Training
Especially beneficial for persons with asthma, MD, and MS
Exercise for short periods with rest intervals between
Generally planned for individuals or small groups
Sessions become more demanding each week

69. Interval or Intermittent Training
Associated terms:
Set
Work interval
Rest interval
Repetitions
Target time
Level of aspiration

70. Circuit Training Moving from station to station
Each station focuses on different muscles
Fewer stations for younger students
Amount of time at each station varies and transition time is kept short
Intensity increases gradually over time
Leaders at stations can be used if needed

71. Continuous Conditioning
Exercises that impose consistent submaximal energy requirements throughout the training session
Aerobics, including dance and hydroaerobics
Rope jumping, continuous

72. Combination Conditioning
Use both continuous and intermittent activity
Other examples include
Astronaut or football drills
Jogging, hiking, and cycling
Obstacle or challenge courses