1. Special populations

2. Who is special? Pregnant women Female adolescents Diabetics (covered in detail in endocrine lecture) Asthmatics Epileptic

3. Pregnant women

4. Demands on the body during pregnancy Foetus needs calories, nutrients, protein and a physiologically stable environment Blood volume increases 40- 50% O2 uptake slightly higher HR higher @ rest and exercise Cardiac output higher at rest 1 st 2 trimesters, and then lower 3 rd trimester

5. Safety precautions Need Dr’s permisson- full check up Concerns based around: –Increased body weight  additional discomfort/damage to joints –Inadequate availability of oxygen for exercising muscle and the foetus –Thermoregulation  Hyperthermia (Too hot) – may cause foetal distress or birth abnormalities –Increased uterine contraction –Joint laxity –Energy balance

6. Discomfort Urinary frequency and incontinence Breast size and tenderness Back pain Centre of balance General fatigue

7. What can they do? Aerobic continuous exercise (walking, hiking, low impact aerobics, cycling, swimming, rowing etc) at 60=70% MHR for no longer than 45 min (15-20 = ideal) Weight supported exercise (swimming) has less potential for injury. Resistance exercise at low weight high reps (>10) within limited R.O.M Caution during stretching No supine exercise in 3 rd trimester No risk of falls No joint stress (jogging, tennis)

8. Adolescent Females Runners Knee Widening of hips Menstruation

9. Widening hips Broader hips  more steeply angled femurs may cause some girls to throw out their heels when running attention needs to be paid to running technique

10. Runner’s knee

11. Menstruation Cycle of menstruation involves constant flux of female steroid hormones These can have physiological responses on –Substrate utilisation –Electrolyte and water balance –Nervous system –Blood sugar –Circulation –RPE

13. Affect on performance 8-69.7% women reported decreased performance 13-43% reported increased performance (LeBrun et al., 1995) 11% increase in quadriceps and hand grip strength mid cycle (Sarwar et al., 1996) Need to consider stage of menstrual cycle when doing time trials Plan cycle around major events

14. Menstrual Problems Dysmenorrhea  Painful menstruation Secondary Dysmenorrhea  caused due to IUD, PID, benign uterine tumors, obstruction of the cervix, endometriosis Amenorrhea  absence of menstruation –Primary- failure to begin to menstruate –Secondary- disruption of the established menstrual cycle (3 months or more)

15. Female athlete triad 31% female athletes not on the pill experience menstrual irregularity (Beals & Manore, 2002)

16. Type 2 diabetics Typically adult onset 90% of all diabetics Does not require insulin to be injected Control through food and exercise –Low fat diet Exercise is often recommended

17. Exercise recommendations for Type 2 diabetics High frequency – 4-7 x p/week Achieve 1000 calorie loss Moderate starting intensity to avoid injury- walking is the best –Minimises hypoglycaemic response Buildup  maintain overload Motivation Carry emergency glucose

18. Asthmatics Triggers: –Allergies –exercise, –aspirin, –dust, pollutants, –emotion  Mast cell (in resp tract) Reaction –Contraction of smooth muscle around bronchii –Swelling/inflammation mucosal cells –Hypersecretion mucous

20. Prevention Avoid allergen Medication. Works by; –Inhibiting chemical mediator release (histamines etc) –Relax bronchiolar smooth muscle (most inhalers) –Block influx Ca to mast cell

21. Exercise induced asthma Occurs 4-15 minutes (early phase) or 4-6 hours (late phase) after exercise 80% asthmatics experience EIA 3-4% non-asthmatics may also get EIA Causes- cold air, low PCo2, specific intensities and duration of exercise

22. Cold dry air Remember- as air is breathed in it is humidified and warmed before it gets to the lungs Respiratory fluid loss removes h20 from mast cell, inadvertantly increasing osmolarity  influx Ca  same allergic response

23. Type of exercise More attacks caused by running than cycling,walking and swimming (in that order) Intensity x duration Warm up critical If air is cold and dry, wear a scarf over mouth to trap moisture and humidify air Carry inhaler in case of attack

24. COPD Chronic obstructive pulmonary disease Chronic bronchitis- thickened bronchial wall and excess sputum production Emphysema- reduced elasticity bronchioles and alveoli bronchial asthma  decreased ability to exhale  wheezing

25. Exercise for COPD Walking, cycling, swimming, games, resistance training, breathing exercises Oxygen may be required Improve functional capacity (FEV/VC) And self confidence, reduce depression

26. Hypertension Normal = 120/80 Higher than this = increased chance coronary heart disease Hypertension is considered to be present when a person's –systolic BP is consistently >140 mmHg –diastolic blood pressure > 90 mmHg

27. Recommendations Reduce sodium intake Stop smoking & reduce alcohol Reduce dietary fat intake Endurance exercise (also helps reduce other RF for CHD –40-60% MHR for 30 minutes –Most if not all days of the week

28. Epilepsy Epilepsy = brain disorder characterised by recurring seizures or fits caused by sudden flurries of electrochemical activity in the brain, which disrupt the ‘conversation’ between neurones

29. Benefits of exercise for epileptics Heavy breathing associated with exercise stops the build-up of carbon dioxide in the blood (hypercapnia). Reduces stress -a known seizure trigger The release of serotonin may calm the brain. Concentration needed during sport may focus the brain so that seizures are less likely. The benefits of regular exercise, such as improved fitness and wellbeing, may contribute to a reduced seizure risk.

30. Considerations Before starting any new exercise program, consult with your doctor or specialist. Avoid known seizure triggers. Always take your medication as prescribed and keep an adequate supply of medication on hand Make sure your sporting companions are aware of your condition and know what to do if you have a seizure. Always wear a medical alert bracelet. Wear protective gear appropriate to your sport, such as helmet or knee pads. Always wear a life jacket when involved in water sports. Let family or friends know your walking, jogging or exercise route before you leave and how long you will be out.

31. Exercise related triggers Extreme fatigue Lack of sleep Dehydration Electrolyte loss, due to severe dehydration Hyperthermia (elevated body temperature) Hypoglycaemia (low blood sugar levels).

32. Avoiding seizures Drink plenty of water before, during and after exercise. Don’t push yourself to the point of physical exhaustion. If you are feeling very hot and tired, slow down or stop. Make sure you have at least two rest days every week. Make sure your diet is nutritionally adequate. Get plenty of rest and good quality sleep. Take all steps to avoid head injuries. Don’t abuse alcohol. Make sure you take your medication according to your doctor’s directions.

33. Contraindicated Contact sports Scuba diving Bungee jumping Boxing Motor sports Horse riding Gymnastics Ice activities, such as skating or hockey Skiing solo water (sailing or wind surfing) or aerial sports (hang gliding & skydiving) High altitude activities such as mountain climbing.

34. Summary Individual differences have huge effect on performance Additional factors are if athletes belong to any of these special populations Implications for coaching/ teaching- need to inform yourself