Chapter 17 Exercise for Special Populations EXERCISE PHYSIOLOGY Theory and Application to Fitness and Performance, 6th edition Scott K. Powers & Edward T. Howley

Objectives 1. Describe the difference between Type 1 and Type 2 diabetes 2. Contrast how a diabetic responds to exercise when blood glucose is "in control, " compared to when it is not 3. Explain why exercise may complicate the life of a Type 1 diabetic, while being a recommended and primary part of a Type 2 diabetic undertaking an exercise program

Objectives 4. Describe the changes in diet and insulin that might be made prior to a diabetic undertaking an exercise program 5. Describe the sequence of events leading to an asthma attack, and how cromolyn sodium and β-adrenergic agonists act to prevent and/or relieve an attack 6. Describe the cause of exercise-induced asthma and how one may deal with this problem

Objectives 7. Contrast chronic obstructive pulmonary disease (COPD) with asthma in terms of causes, prognosis, and the role of rehabilitation programs in the return to "normal" function 8. Identify the types of patient populations that one might see in a cardiac rehabilitation program and the types of medications that these individuals may be taking

Objectives 9. Contrast the type of exercise test used for cardiac populations with the test used for the apparently healthy population 10. Describe the physiological changes in the elderly that result from an endurance-training program 11. Describe the guidelines for exercise programs for pregnant women

Diabetes Characterized by an absolute (type 1) or relative (type 2) insulin deficiency that results in hyperglycemia A major health problem and leading cause of death in the United States More than 17 million with diabetes, only 11.1 million are diagnosed

Diabetes Type 1 Lack of insulin Develops early in life 10% diabetic population Type 2 Resistance to insulin Develops later in life 90% diabetic population

Diabetes

Exercise and the Diabetic Control of blood glucose is important Adequate insulin is required Ketosis Metabolic acidosis from accumulation of ketone bodies May result from a lack of insulin

Effect of Prolonged Exercise in Diabetics Fig 17.1

Exercise and Type 1 Diabetes Pre-exercise blood glucose level 80 to 250 mg•dl-1 Timing with insulin Should not exercise at time of peak insulin action Glucose monitoring During/after exercise Carbohydrate intake During recovery

Effect of Plasma Insulin Levels in Type 1 Diabetics During Exercise Fig 17.2

Exercise and Type 2 Diabetes Blood glucose monitoring In those taking oral hyperglycemic agents Exercise prescription 4-7 times per week Promotes weight loss and sustained increase in insulin sensitivity Minimum of 1,000 kcal/wk From all physical activity

American Diabetes Association Goals for Nutrition Therapy Attain & maintain optimum metabolic outcomes: Blood glucose levels in normal range A lipid and lipoprotein profile that reduces the risk of macrovascular disease Blood pressure level that reduces risk of vascular disease Improve health through food choice and activity Address individual nutritional needs

Asthma A respiratory problem characterized by a shortness of breath accompanied by a wheezing sound Due to: Contraction of smooth muscle of airways Swelling of muscosal cells Hypersecretion of mucus May be caused by allergic reaction, exercise, aspirin, dust, pollutants, and emotion

Asthma: Diagnosis & Causes Diagnosed using pulmonary-function testing Agent causes influx of Ca++ into mast cells Release of chemical mediators Triggers asthma attack Bronchoconstriction Bronchoconstrictor reflex Inflammation response

Proposed Mechanism by which an Asthma Attack Is Initiated Fig 17.3

Prevention and Relief of Asthma Avoidance of allergens Immunotherapy Treatment Cromolyn sodium 2-agonists Theophylline

Mechanisms by which Common Medications Prevent/Treat Asthma Fig 17.4

Exercise-Induced Asthma Caused by cooling/drying of respiratory tract Increases osmolarity on surface of mast cell Reducing the chance of an attack Warm-up Short-duration exercise Treatment -agonist

Chronic Obstructive Pulmonary Disease (COPD) Includes chronic bronchitis, emphysema, and bronchial asthma Can create irreversible changes in the lung Can severely limit normal activities Treatment includes: Medication (including supplemental O2) Breathing exercises Dietary therapy Exercise

Testing and Training COPD Patients Medical exam including exercise testing FEV1 VO2max Maximum exercise VE Blood gasses (PO2 and PCO2) Training goals include Reduced reliance on O2 and medications Improved ability to complete daily activities

Hypertension Defined as >140 or >90 Increase risk of coronary heart disease Exercise can be used as a non-drug treatment Precautions Blood pressure should be monitored for those on medications

Hypertension ACSM Guidelines, Gordon 1997 Loss of weight if overweight Limit alcohol intake Reduce sodium intake Maintain adequate dietary K+, Ca2+, Mg2+ Stop smoking Reduce dietary fat, saturated fat, and cholesterol intake

Cardiac Rehabilitation: Patient Population Those who have or have had: Myocardial infarction (MI) Coronary artery bypass graft surgery (CABG) Angioplasty (PTCA) Angina pectoris Medications -blockers (reduce work of the heart) Anti-arrhythmics (control dangerous heart rhythms) Nitroglycerine (reduce angina symptoms)

Cardiac Rehabilitation Testing Graded exercise testing ECG monitoring (12-lead) Heart rate and rhythm Signs of ischemia (ST segment depression) Blood pressure Rating of perceived exertion (RPE) Signs or symptoms (chest pain) May include radionuclide imaging Determination of myocardial blood flow

Cardiac Rehabilitation: Exercise Programs Exercise prescription Based on GXT results MET level, heart rate, signs/symptoms Whole body, dynamic exercise Intensity, duration, and frequency based on severity of disease Effects Increased functional capacity (VO2max) Reduced signs/symptoms of ischemia Improved risk factor profile

Exercise and the Elderly Benefits of participation Improved risk factor profile Increased strength and VO2max Increased bone mass Recommendations Similar to younger subjects Medical exam and risk factor screening are essential

Exercise During Pregnancy Regular endurance exercise poses no risk to the fetus and is beneficial for the mother Pregnant women should consult their physician prior to beginning any exercise program Rating of perceived exertion may be the best method of setting intensity

Chapter 17 Exercise for Special Populations