Precautions with Seniors
inability to thermoregulate
Loss of ROM
Decrease in lean tissue
Loss of balance
Loss of CV fn
Reason for seniors thermoregulation deficiency
loss of blood vessels impairs radiative cooling
loss of sweat glands impairs evaporative cooling
loss of subcutaneous fat impairs heat retention in cold environments
Reasons for loss of ROM in seniors
spine loses flexibility and stiffens
Articular cartilage wears away promoting inflammation
synovial fluid production slows
Decrease in lean tissue in seniors
also known as sarcopenia
accompanied with loss of strength
Loss of balance in seniors
loss of muscle mass
weakened joints
decreased flexibility
promotes falling
falling often results in broken bones
Loss of CV fn in seniors
heart's functional ability declines
max heart rate drops
ejection fraction decreases
blood pressure rises
VO2max decreases
Barriers to exercise in seniors
fear of injury
lack of knowledge
lack of transportation to a facility
lack of skills, abilities, and confidence
physical limitations resulting from dz
limited income
Exercise testing in generally health seniors
initial workload of 2-3 METs
Use cycle erg if balance issues
be flexible during testing
be aware exe-induced dysrhythmias are common in seniors
ECG has higher sensitivity and lower specificity in seniors than in younger pops
Stop exercise testing a senior if
SBP drops >10 from baseline despite incr workload
moderately severe angina
dizzy, incoordination, LOC
cyanosis, pallor
subject requests to stop
v-tach
CV training in seniors
begin w/ at least 5 min low-int
30-60 min @ RPE 5-6 5days/wk
high intensity RPE 7-8 3x/wk
avoid rapid change in direction
avoid high-impact
Resistance training in seniors
1 set 10-15 reps
8-10 different exercises
target major muscle groups
moderate intensity 5-6 RPE to vigorous (7-8)
Pay extra attention to body alignment
Flexibility training in seniors
Stretch hip, back, shoulders, knees, upper trunk, and neck
hold static stretch at point of tightness not pain 15-30sec
2-4 reps per stretch
Tips for exs with seniors
avoid strenuous activity when hot/humid
avoid exs during flare up of arthritis or other chronic condition
encourage low-impact activity (walking, cycling, water aerobics)
Limit high-impack activity (running, jumping, bouncing)
Example of exs for senior
chest press with theratube
lateral pull down with theratube
shoulder press with dumbbell
bicep curl on machine
tricep ext on cable machine
step-ups
squats
calf raises
exercises for frail senior
warm-up 3-5 min
tap toes to front then side
tap heels to front then side
add arm movements and repeat
Split workout into 2 sessions 15 min ea
work upper body one day lower another
Considerations for exs with senior
patient's weight must be adequate resistance
may need to apply resistance with hands
elastic bands fine
sometimes practicing ADLs is sufficient
Examples of lower-body strengtheing exercises for frail seniors
sit-to-stand
single knee extension on chair
seated single-leg curl
seated heel raises
seated toe raises
Examples of upper body strengthening for frail senior
chest flies with elastic tubing
seated row with elastic tubing
lateral shoulder raises
bicep curls with 1lb dumbells
tricep dips in a chair
Precautions for exercise with skeletal system disorders
Avoid high impact
avoid explosive twisting movements
be aware of balance problems
take note of comorbidities
avoid heavy weight lifting
Exercise testing pt with osteoporosis
Same guidelines as general pop
for sever osteo in spine use cycle
severe kyphosis may reduce ventilitory capacity
avoid spinal flexions
stop if pain develops
CV training for those at risk for osteoporosis
8-15 min warmup including mild stretching
cool down 8 min
encourage wt bearing activity 3-5 days/week 30-60 min ea
resistance training in osteoporosis pt
2-3 days/week
moderate intensity (60-80%) perform 8-12 reps
high intensity (80-90%) 5-6 reps
Use wt machines, bands, or calisthenics
free wts risky due to balance
Flexibility training in osteoporosis
preserves joint funcions
perform as prescribed for the general pop
be gentle and slow
avoid spinal flexion
General tips for osteoporosis
encourage functional activities
2-5 days/week
avoid jumping, jogging, rowing, sit-ups, golfing, bowling, and certain yoga positions due to incr risk of fractre
Sample exercises for osteoporosis
lateral pull down with tubing
back extension on mat
shoulder press using tubing
bicep curl w/ light dumbbells
tricep extension w/cables
Exercise testing for arthritis patient
ensure proper warm-up
do not test during acute inflammation
stop if pain or fatigue develops
treadmill fine but cycle usually less painful
some may tolerate 1RM but may be limited by pain
Guidelines for arthritis patient
avoid exs during fare-ups
ask about meds some NSAIDS lead to anemia
5-10 min warmup
5-10 min cool down
ease into exercise and progress slowly
Pay attention to jt alignment
Order of exercise for arthritis pt
flexibility
resistance
cardiovascular
Flexibility training for arthritis pt
perform daily
Use pain-free ROM
static stretch all muscle groups
Repeat 4 times
avoid overstretch
resistance training for arthritis pt
2-3 days/week
machines, bands, tubing, isometrics, or free weights
initially 10% 1RM
Progress max of 10%/week as tolerated
one or more sets 10-15 reps/set
CV training in arthritis pt
walking, water, cycling
5-10 min bouts to accumulate 20-30 min
3-5 days/week
gradually incr duration by 5 min increments until 30 min reached
avoid high-impact activities, rapid change in direction, excessive reps
General guidelines for arthritis pt
daily activity focus on fn capacity
cross-train to avoid overstress
avoid walking at high speeds
allow 48 hrs b/w training sessions
choose shoes that absorb shock
Sample exs for arthritis
Stretching exs most important for preserving jt fn
traditional resistance and CV exs appropriate
Sample stretches for arthritis
gluteal wall stretch
outer thigh stretch
hamstring stretch using elastic band
chest, shoulder, bicep stretch
tricep stretch
back stretch
Precautions for cancer patient
Treatment-associated fatigue
Loss of fn capacity due to chronic pain, nausea, and vomiting
cachexia
anxiety, depression, low self-esteem
increased risk for infection
risk for dehydration
Additional precautions with cancer patients
avoid chlorinated water during radiation therapy
avoid public places for 1 yr following bone marrow transplant
avoid swimming pools if an indwelling catheter
avoid activities requiring extreme balance if experiencing peripheral neuropathies
Exercise testing for Cancer Patient
obtain medical clearance
make adaptations for limited mobility or impaired function
Use ___ for cv fn
a graded treadmill or bicycle ergometer
For pulmonary function test in cancer patient use
spirometer
For muscle strength and endurance testing in cancer patient use
dumbells or resistance machines
Flexibility test for cancer patient
modified sit-and-reach
Guidelines for exercise with cancer patient
Begin with 5-10 min warmup including limbering movements and stretching
End with 5-10 minute cool down
Heart rate precautions with a cancer patient
If heart rate exceeds 100bpm check with physician
If heart rate less than 100 bpm check again at end of warmup and continue if it has only gone up by 10-20 bpm
CV training in cancer patient
Use stationary bike, tmill, or outdoor walking programs
interval training highly effective
Plan for frequent short breaks to accomodate fatigue
Train 3-5 days/week at 40-60% VO2R work up to 20-60 min bouts
Resistance training in cancer patient
Not as well studied as CV training
Use free weights, weight machines, or bands
Train 2-3 days/week with at least 48 hours in b/w
Intensity should be b/w 40-60% of 1RM for 1-2 sets 8-12 reps
Plan an entire body workout that works all major muscle groups in
Flexibility training in cancer patient
Include static stretch and ROM exs
Perform on 2-7 days per week
Perform 4 reps per exs and hold stretch 10-30 sec
Additional guidelines for exercise in cancer patient
Monitor BP and HR during and after
Stop in dizzy, nausea, chest pain
start slowly and build slower than general pop
avoid exercise if body temperature exceeds 101 degrees
Postpone exs for 24 hrs post chemo or blood withdrawals
Drink plenty of water
Avoid
Ways to encourage compliance with exercise program in cancer patient
Set realistic STG and LTG
Make the workout fun
offer extra words of encouragement
add variety to maintian interest
encourage activity with fam/friends
use exercise logs to document progress
encourage client input
Contraindications to vigorous exercise in cancer patient
Acute onset of nausea
chest pain
decr HR and BP with incr workload
Irregular pulse during exe
disorientation and confusion
dizzy or blurred vision
IV chemotherapy within last 24 hrs
leg pain/cramping
bone weakness (long term prednisone)
numbness in legs o
Sample exercise program for cancer patient
Similar to exercise for general pop
Encourage any low-impact cv exe
Plan resistance exs that target mm of chest back arms abdomen and legs
Be careful with ___ in exs with cancer patient
with intensity and weights
bones become fragile during and immediately after cancer treatment
Exercise precautions in respiratory patient
exercise places greater demand on already insufficient resp system or asthma sufferer
astma pt often exs induced
Tips to reduce incidence of exs-induced asthma
Warm up and cool down
Use more short burst activities than long duration
breath through nose as much as possible
use bronchodilators as needed and prescribed
Exercise testing in resp patient
administer test in shorter increments with slower progression
terminate if arterial oxygend desaturation
Preferred mode for exercise testing in resp pt
walking
stationary bike without arm erg is acceptable
What test would you use in patient with severe pulmonary dz
6-minute walk test
ACSM's aerobic training guidelines for those with controlled asthma
Perform CV exs 3-5 days/week for 20-60 min of continuous or intermittent exe
Optimal intensity unknown
Walking or cycling
Initial duration only a few minutes
slowly increase duration as client's health improves
intensity 60-80% of peak work rate
COPD sufferers should follow __ guidelines
guidelins for seniors
Young people with asthma or cystic fibrosis should follow guidelines for
children and adolescents
Resistance training guidelines in resp patient
Train inspiratory muscles
Perform on 4-5 days/week
Target intensity 30% max inspiratory pressure measured at fn residual capacity
continue for duration of 30 min
Those with controlled asthma or COPD may follow guidelines for
general population
Those with moderate to severe COPD should follow guidelines for
Seniors
Special concerns for asthma sufferers
Include a longer warmup
progress slowly
Perform a longer cool down
EIA is more likely after certain forms of exercise
Activities that increase the likelihood of EIA
any activity in a cold dry climate
outdoor running
outdoor cycling or soccer
Aerobic classes with excessive arm movements
Exercise intensities at or above 80-90% max HR
Precautions with exercise in MS Patients
Debilitating fatigue
Muscle spacticity
Muscle weakness
Poor balance
Incoordination
Sensitivity to heat
Pain
incontinence
Barriers to exs with MS patient
Fear of worsening symptoms
fear of promoting disease progression
gerneral lack of energy
little self-confidence
limited disease-specific knowledge of fitness center staff
fear of falling due to balance problems
Exercise testing in MS patients
No standard guidelines currently
Always obtain med clearance
Capabilities of individuals vary considerably; even on daily basis
Professionals working with MS patients should
Seek post rehab specialty training b/c MS is so variable
Exercise duration, frequency, and intensity for MS patient
Highly variable
Choose activities for MS patient
that the client enjoys and can execute in neutral alignment
jogging
cycling
rowing
walking
Exercise guidelines for MS patient
5-10 min limbering warmup
avoid stretching early in warmup to avoid spasm
Keep intensity low throughout workout
Encourage proper hydration
exercise in cool environment
Frequent rest periods
Consider __ activities for MS patient to decrease risk of overheating
water aerobics or swimming
MS patients may benefit from this type of exercise
slow deliberate movements like
tai chi and yoga
environmental considerations for MS patient
avoid slippery floors due to decr balance
Ensure adequate lighting
mark equipment clearly
CV training for MS patient
Perform 3 x/week for 30 min
water exs may be for 60 min
Intensity of 60% of VO2max
Resistance training for MS patient
Full-body training 2-3x/week
One exs per m group
choose resistance that allows 20-30 reps/set
allow 30-90 sec b/w sets
Rest 48 hrs b/w sessions
Both Cancer patients and MS Patients
need 48 hrs between resistance sessions
Focus on full body resistance workout
common intensity for CV training
60% VO2R
Common duration for CV training
3-5 days / week
20-60 min
except arthritis 30 min
MS 30 (60 if in water)
Common resistance training guidelines
2-3 days / week (except reap 4-5)
60-80% 1RM (8-12 reps)