Module 10 (Lec 1) - Special Populations, obesity, diabetes, pregnancy

Module 10 (Lec 1) - Special Populations, obesity, diabetes, pregnancy

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Unformatted text preview: Exercise for Special Populations Populations Metabolic Problems Metabolic Pregnancy Pregnancy Advancing Age Outline Outline Exercise and metabolic problems Obesity Diabetes – Type I and Type II Exercise during pregnancy Exercise in advancing age Obesity Facts from Centers for Disease Control Disease Sixty-four percent of U.S. Adults are Sixty-four overweight or obese. (1999-2000) (1999-2000) Twenty-three percent of U.S. Adults are obese (BMI greater than or equal to 30.0). (1999(19992000) Percent of Adolescents (ages 12-19) Who Are Overweight: 15% (1999-2000) 15% Percent of Children (ages 6-11) Who Are Overweight: 15% (1999-2000) 15% Exercise and Obesity Exercise Emphasize duration, lower intensity initially Increased in 1­minute increments Increase energy expenditure (~300 Kcal/day) Improve cardiovascular fitness Exercise goal Exercise and Obesity Exercise Dietary and behavioral intervention may be (probably is) necessary Limitations Avoid hot/humid environments Lack of balance, flexibility Excess weight can increase chance of musculoskeletal injury Exercise and Diabetes Exercise What is diabetes mellitus? A metabolic disorder characterized by high blood glucose levels (inability to regulate blood sugar) Symptoms: Triad Polyuria (frequent urination) Polydypsia (excessive thirst) Polyphagia (excessive hunger/eating) And, glucosuria (glucose present in urine) Two Types of Diabetes – Type I Two Type I diabetes Insulin­dependent diabetes mellitus (IDDM) Juvenile onset Less common form (~10% of cases) Inability of pancreas to produce insulin NOT linked to obesity Must be treated by insulin Two Types of Diabetes – Type II Two Type II Diabetes Non insulin-dependent diabetes mellitus (NIDDM) “Adult onset” (but becoming more common among Adult children) children) More common form (~90% of cases) Insulin insensitivity – NOT a true lack of insulin Sometimes can be treated by exercise and diet, Sometimes sometimes also requires supplemental medication or insulin insulin Strongly linked to obesity, genetics Type II Type diabetes is not only for the adult population anymore anymore AZ Republic, AZ 11/4/02 11/4/02 13 yr old, 5’4” 13 and weighs 211 lbs. 211 Diabetes: Exercise Training Diabetes: Exercise Exercise training Improved glucose control Improved insulin sensitivity Body fat reduction Decreased risk of cardiovascular disease Stress reduction – as a means to improve Stress regulatory hormones regulatory Exercise and Type I Diabetes Exercise Consultation with a physician necessary Eat 1-3 hours before exercise, eat a carbohydrate snack Eat after exercise after Insulin dose may need to be adjusted to accommodate Insulin exercise exercise Keep a regular schedule or pattern Monitor blood glucose frequently, including during Monitor exercise exercise Generally, all sorts of exercise & sports activities are OK, Generally, with caution and careful planning with Neuropathy is a big issue with both Type I and Type II Neuropathy diabetics (i.e. Exercise and Type II Diabetes Exercise In general, we recommend a lot of the same In recommendations for Type II diabetics. However, the major difference is that Type II diabetics tend to be overweight. overweight. Medications and/ or insulin relative to exercise Small, frequent meals throughout the day Regularity May need physician supervision and/ or referral Exercise decreases the insulin insensitivity and can lower Exercise or eliminate the need for insulin supplementation or Exercise is good for weight reduction Emphasize duration and frequency of exercise (as with Emphasize obesity) obesity) Intensity can be fairly low (40-60% of VO2max) Special Precautions in those with Diabetes Diabetes Peripheral Neuropathy – Peripheral The patient must check feet before and after exercise The Wear proper shoes (may require special orthotic inserts) Wear Positional hypotension – i.e. the body doesn’t respond as Positional quickly to positional changes quickly Some medications may mask feelings of Some hypoglycemia (i.e. need to check glucose before and after exercise) after Medical I.D. tag – especially if they will be Medical exercising on their own exercising Exercise and Pregnancy - Concerns Exercise Safety concerns – for mother Musculoskeletal injury due to altered posture & center of gravity, and joint laxity (extra flexibility) caused by the hormone relaxin Hyperthermia – fetus relies on mother for heat loss so mother should not overheat Reduced uterine blood flow (due to high muscle blood flow) could cause low oxygen delivery, low nutrient delivery and ultimately low birth weight Cord entanglement, acceleration/decel impact trauma Increased risk of miscarriage or premature labor Safety concerns – for baby Exercise and Pregnancy Recommendations Recommendations 1. 1. 2. 3. 3. 4. 1. Recommendations for low intensity exercise OK to start or continue program of low intensity exercise exercise Very low risk to mother and fetus Some potential health benefits such as reduced insulin resistance, increased fitness, higher selfinsulin esteem Water activities (no impact) may be a good choice Avoid activities with high risk of abdominal Avoid impact, especially in third trimester impact, Recommendations, High Intensity 1. Exercise at intensities greater than 50% of VO2max can 1. be maintained during pregnancy (the 140 bpm rule is outdated) outdated) 2. Maximum work load will (in almost all cases) fall 3. If continued through third trimester, birth weight will be 3. reduced (average ~300g) and gestation length will be reduced by ~ 5 days reduced 4. Some research suggests shorter labor, reduced incidence 4. of c-section 5. Hyperthermia and dehydration must be avoided Hyperthermia Exercise and Pregnancy Recommendations Recommendations Exercise and Pregnancy Recommendations Recommendations High Intensity Exercise - Continued 6. Pain, hemorrhage, persistent uterine 6. contractions, lightheadedness, complications of pregnancy are all reasons to reduce intensity/stop exercise exercise 7. Caloric requirements of pregnancy vary with 7. month and individual, but caloric intake must take exercise expenditure into account exercise 8. Very high altitudes (>/= 3,000 m) and SCUBA 8. should be avoided should 9. Post-partum exercise should be limited to low 9. intensities to prevent complications intensities Exercise and Aging Exercise Physiological changes Slow, progressive decline in VO2max Decrease in max HR (estimate: 220­age) Slow, progressive loss of muscle mass Slow decline in basal metabolic rate May be loss of bone mass Figure 12.1 The decline in VO2max Figure with age. with Figure 12.2 Physiological changes with an increase in age. with Exercise and Aging Recommendations Recommendations A stress test may be recommended before an stress exercise program is started (to screen for heart problems) problems) Risk of musculoskeletal injury may be higher (esp. Risk with loss of strength and flexibility) so low or no impact activities are recommended impact A lower frequency of exercise (3-4 days/wk) may lower reduce injury risk by increasing time for recovery between exercise bouts between Otherwise, the same principles as discussed in Otherwise, Ch’s 4 & 5 apply and the same % gains as in younger people can be expected. younger Summary Summary Obese individuals should emphasize duration and increasing voluntary energy expenditure. Type I diabetics must learn to manage blood glucose during exercise. Exercise duration is the key difference between exercise for type I and type II diabetics. Summary Summary Pregnancy should not prevent women engaging in low­moderate intensity exercise. Aging causes a slow, progressive decline in some biological functions but exercise is still beneficial ...
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This note was uploaded on 04/12/2011 for the course BIO 154 taught by Professor Wilson during the Spring '11 term at N. Arizona.

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