special population presentations day 3

OBESITY & OVERWEIGHTBrenton Orullian

Overweight and Obesity can be classified as extra body weight with a BMI most commonly used to describe the condition.

Overweight and Obesity are linked to numerous chronic diseases such as CVD, many forms of cancer, and diabetes.

Classification of BMI Underweight= <18.5 Normal= 18.5-24.9 Overweight= 25.0-29.9 Obesity

I 30.0-34.9 II 35.0-39.9 III ≥40.0

*Studies show that 68% of adults are in the overweight category, 32% are in class I obesity, and 5% are in class III.

Exercise Guidelines

F= ≥5 days per week I= Moderate to vigorous intensity

aerobic activity T= Minimum of 30 min per day

progressing to 60 min per day T= Primary mode of exercise should

be aerobic involving large muscle groups

P= 40%-<60% of VO2R progressing to more vigorous intensity ( ≥60% VO2R )

Resistance Guidelines

F= Large muscle groups (i.e. chest, back upper and lower, shoulders

Legs, 2-3 days a week I= 60-70% of 1 RM T= No specific Duration T= Resistance Exercises involving each

major muscle group are recommended P= A gradual progression of greater

resistance and or more repetitions per set

Works Cited

Exercise Works. (2011, 09). Exercise for Obesity Patients. Retrieved from http://www.exercise-works.org/storage/Obesitychapter.pdf

Lippincott, Williams & Wilkins. ACSM’s Guidelines for Exercise Testing and Prescription. Baltimore, MD: 2014

Arthritis and Exercise Recommendations

By Ben Bergdorf

ArthritisDescription: degenerative joint condition that

causes inflammation and pain.

Types: >100 types of arthritis. Most common are osteoarthritis and rheumatoid arthritis. Osteoarthritis is a local degenerative condition. Rheumatoid arthritis is a systemic joint condition.

Causes: Disuse or overuse can cause cartilage degeneration (osteoarthritis), rheumatoid arthritis is immunological in origin.

Arthritis (cont.)Prevention and prescription:

Moderate mechanical loading has been shown to preserve articular cartilage (Sun, 2010). Moderate exercise can help arthritis sufferers manage pain better and increase function (ACSM, 2013).

Cardiorespiratory exercise prescriptionFrequency: 3-5 days/week

Intensity: Undetermined. Light to moderate intensity is recommended 40-<60% of the VO2R (or HRR)

Time: ≥ 150 min/week. Shorten bouts if lengthy exercise sessions can not be tolerated (e.g. shorten bouts to 10 minutes).

Type: Walking, cycling, swimming or other low joint stress activities. Not recommended: running, stair climbing, etc.

Progression: progression is individual, and should increase gradually as they are able to tolerate it.

Resistance training prescriptionFrequency: 2-3 days/week

Intensity: Undetermined. Light and high intensity resistance training has shown improvements. Most research has focused on light/moderate intensity: higher repetitions (10-15) at 40-60% of the 1 RM.

Time: Undetermined. Same as for healthy adults.

Type: Major muscle groups are targets. Flexibility and ROM should be emphasized.

Progression: progression is individualized and should be gradually increased depending on the person’s pain or symptoms.

Special considerationsStrenuous activity that exacerbates pain during

inflammation or flare-ups should be avoided.

Some discomfort is normal after exercise, but if after 2 hours this pain is greater than before exercise, the training intensity or time should be reduced.

Rheumatoid arthritis patients may experience a worsening of symptoms through intense training. So keep grandma away from the heavy preacher curls.

ReferencesAmerican College of Sports Medicine. (2013).

ACSM's guidelines for exercise testing and prescription. (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Sun, H. (2010). Mechanical loading, cartilage degradation, and arthritis. Annals of the New York Academy of Sciences, 1211, 37-50. doi: 10.1111/j.1749-6632.2010.05808.x

OsteoporosisLogan Kupitz

What is Osteoporosis?

Osteoporosis is a disease that affects the skeletal structure in the body. It is characterized by a low bone mineral density, which causes the bones to become fragile, and more susceptible to fracture. 44 million American’s are at risk for this disease and is responsible for over 1.5 million fractures a year in the U.S.A.

Guidelines for Cardiorespiratory Fitness (CRF) exercise prescription

Frequency:

3-5 days per week

Intensity:

Moderate intensity; 40-60% VO2R or HRR

Time:

30-60 minutes a day

Type:

Weight-bearing aerobic activities (i.e stair climb/descent, walking, jogging)

Progression:

Start at lower intensities recommended and progress as situation permits

Guidelines for Resistance Training (RT) exercise prescription:

Frequency:

2-3 days per week

Intensity:

Moderate intensity; 60-80% 1-RM, 8-12 reps involving all major muscle groups

Time:

30-60 minutes a day

Type:

Resistance training involving major muscle groups

Progression:

Start at lower intensities, if situation permits raise intensity levels

Contraindications

Individuals who have osteoporosis don’t have many contraindications to exercise or physical activity. Activity/exercise should be discontinued/changed if it causes, or exacerbates pain. Those with severe osteoporosis should start at lower intensities as to lessen risk of injury. Max testing may be contraindicated for those who have severe osteoporosis. There are no established guidelines for contraindications for osteoporosis patients.

ASTHMA

ASTHMA• Asthma is a disorder that causes inflammation of the

airways. • Symptoms• Bronchial Hypertension• Airflow Obstruction• Recurring Wheezing• Dyspnea (labored breathing)• Chest Tightness• Severe Coughing (can be worse in the morning and

at night)Exercising can provoke and worsen symptoms

CRF Guidelines Exercise at least 2-3 days a week Intensity • 60% of VO2 Peak• 80% of max walking speed

20-30 minutes Mode• Walking• Running• Cycling• Swimming

Resistance Prescription

• Resistance Prescription is the same as healthy adults• 2-3 days a week• 48 hrs. rest between workouts of the same

muscle group

Contraindications

• Experiencing Symptoms do not exercise• Use of inhalers (short-acting bronchodilators)

may be necessary• Treatment with Corticosteroids• Exercise in cold environments or with airborne

allergens or pollutants restricts activity• Bronchoconstriction triggered by high intensity

exercise

Hypertension and ExercisePresented By: Michael Roller

Hypertension Approximately 76 million Americans have

hypertension.

Systolic Blood Pressure ≥140 mm Hg and/or Diastolic Blood Pressure ≥ 90 mm Hg.

Hypertension leads to an increased risk of cardiovascular disease, stroke, heart failure, peripheral artery disease, and chronic kidney disease.

Cardiorespiratory Fitness Frequency - Most days of the week, preferably all days.

Intensity - Moderate Intensity (40% - <60% VO2max) (RPE of 11 - 13 on Borg scale)

Time - 30 to 60 minutes per day. Can be broken up intermittently in at lease 10 minute bouts.

Type - aerobic exercise that they feel comfortable doing. (Walking, Cycling, Jogging, etc.)

Progression - Gradual progression. Avoiding any quick or large increases in intensity especially.

Evidence

Resistance Training Frequency - 2 to 3 days/week.

Intensity - 60% to 80% of 1 RM.

Time - At least one set of 8 - 12 repetitions for all major muscle groups.

Type - Machine or Free Weight exercises.

Progression - Gradual progression. Avoiding any quick or large increases in intensity especially.

Contraindications Must have medical exam and be managing blood pressure to begin exercise training.

Patients with target organ diseases should have non-symptomatic exercise test

monitored by a physician.

if Systolic Blood Pressure is ≥ 200 mm Hg and/or Diastolic Blood Pressure ≥ 110 mm

Hg exercising testing should be done ONLY if benefits outweigh risks.

Anti-Hypertensive medication can cause sudden excessive drops in post exercise

blood pressure.

Avoid Valsalva maneuver in resistance training.

Patients with severe uncontrolled hypertension (SBP ≥180 mmHg and/or DBP ≥ 110

mmHg) exercise training should only be started after being evaluated and cleared by

a physician.

References (2013). Acsm's guidelines for exercise

testing and prescription. (9th ed.). Lippincott Williams & Wilkins.

  Nelson, L., Jennings, G.L., Esler, M.D.

and Korner, P.I. (1986) ‘Effect of changing levels of physical activity on blood-pressure and haemodynamics in essential hypertension’, Lancet 2: 473-6.

Megan Galane

Cerebral Palsy

Cerebral PalsyNon-progressive lesion of the brain

occurring before, at, or soon after birth

Interferes with normal brain development.

It is caused by damage to areas of the brain that control and coordinate muscle tone, reflexes, posture, and movement.

Cardiorespiratory Fitness (CRF)Base on principles of ACSM guidelines, alter per

client.Modifications

Functional mobility abilities Number Type

Short bouts of exercise at an RPE of 12-13Include recovery period because this population

fatigues easilyStationary bikes and arm ergometers are

recommendedCan change the power output depending on client

Resistance Training (RT)Target weak muscles that oppose to stronger

muscle groups. Improves strength of weak muscles to

balance bodyExample: agonist/antagonist relationship

Neuromuscular stimulation Fatigue can throw off what they have been

working well on during exercise.Pair resistance training with stretching and

flexibilityDynamic stretching: full ROM

Contradictions/Special directions Concentrate on positioning of client

Because of weak muscles and hypertonic muscles posture can need correction

Example: Velcro gloves to hold hands in place, try to avoid strapping down because not helping with stabilizing and increasing strength

Difficulty generating sufficient muscle force Possible overuse because prone to obesity

and sedentary behaviors.Fatiguing quicker so split exercise

prescription into two parts, try and combine exercise

PregnancyRyan Hermansen

What is pregnancy Pregnancy is the fertilization and

development of offspring, known as an embryo or fetus, in a woman's uterus.

Childbirth usually occurs about 38 weeks after conception occurs.

Exercising during pregnancy minimizes losses, and can decrease the postpartum recovery time.

Effects such as diabetes mellitus, loss of balance, and extreme muscle fatigue/loss are all possible consequences of the pregnancy process.

CRF Prescription› Frequency: 3-4 days per week (frequency has been shown

to be a determinant of birth weight)

› Intensity: ACSM suggests maintaining a HR correspondent to a moderate intensity is recommended for women with a pre-pregnancy body mass index (BMI) ˂25, along with age and fitness levels taken into account. Light intensity exercise is recommended for women with a pre-pregnancy BMI ≥25. Nothing more than a moderate fatigue level should be achieved, and

a maximal test should never be performed without a physician present.

*Intensity depends on mothers BMI, fitness level, age, weight

› Time: ≥15 minutes per day gradually increasing to a maximum of 30 minutes per day of accumulated moderate intensity exercise to a total of 120/week. 10-15 minute warm up and 10-15 cool down is highly suggested,

resulting in 150 total minutes.

Cont’d…

› Type: Dynamic, rhythmic physical activities that use large muscle groups such as walking and cycling.

› Progression: Optimal time to progress is after the first trimester (13 weeks) because the discomforts and risks of pregnancy are lowest at that time. Progress from a minimum of 15 minutes, 3 days a week to a maximum of 30 minutes, 4 days a week, at the appropriate HR and RPE.

RT Prescription› Frequency: ≥5 days per week› Intensity: 1-2 Sets of 12-15 repetitions or until 12 repetitions

can be achieved. Heart rate does not exceed 140-150 BPM OR 60-70% max HR. An RPE of 12-14 should be maintained.

› Intensity: 1-2 Sets of 12-15 repetitions or until 12 repetitions can be achieved. Heart rate does not exceed 140-150 BPM OR 60-70% max HR. An RPE of 12-14 should be maintained.

› Time: 30 -60 minutes per day. (Workouts greater than 30 minutes have been attributed to heavier baby weights).

› Type: Walking, swimming, stationary cycling (due to the low impact), workouts that generally include the entire body.

› Progression: women should not start exercising once they are pregnant if they were not doing so before. They should stick to a routine their body was accustomed to before pregnancy, but retain the opportunity to build up to daily recommendations.

Benefits of Exercise Development of muscular strength Added flexibility may help

compensate for the progressive biomechanical changes that occur during pregnancy

Condition abdominal muscle against weakness and back pain.

Will contribute to an enhanced ability to minimize exaggerations in posture such as thoracic kyphosis and lumbar lordosis

Contraindications

› Physical activity should be avoided in the supine position. › Relative: severe anemia, unevaluated maternal cardiac

dysrhythmia, chronic bronchitis, poorly controlled type 1 diabetes mellitus, extreme morbid obesity, extreme underweight, history of extremely sedentary lifestyle, intrauterine growth restriction in current pregnancy, poorly controlled hypertension, orthopedic limitations, poorly controlled seizure disorder, poorly controlled hyperthyroidism, heavy smoker

› Absolute: hemodynamically significant heart disease, restrictive lung disease, incompetent cervix/cerclage, multiple gestation at risk for premature labor, persistence second or third trimester bleeding, placenta previa after 26 wk of gestation, premature labor during the current pregnancy, ruptured membranes, preeclampsia/pregnancy-induced hypertension

References

Graves, J. E., & Franklin, B. A. (2001). Resistance training in women. Resistance training for health and rehabilitation (pp. 133-146). Champaign, IL: Human Kinetics.

Brown, L. E. (2002). Resistance training during pregnancy. Strength and Conditioning Journal, 24(2), 53.

Martens, D., Hernandez, B., Strickland, G., & Boatwright, D. (2006). Pregnancy and exercise: physiological changes and effects on the mother and fetus. Strength and Conditioning Journal, 28(1), 78.

Whaley, M. H., Brubaker, P. H., Otto, R. M., & Armstrong, L. E. (2013). Exercise prescription for healthy populations with special considerations and environmental considerations. In ACSM's guidelines for exercise testing and prescription (9th ed., pp. 194-200).

Special Population Exercise Rx

Myocardial InfractionP Jordan Meldrum

Myocardial Infraction

Myocardial Infraction: is inflammation to the coronary artery walls that causes coronary atherosclerosis that slows blood to the myocardium which leads to muscle injury and or death.

Inpatients Prescription

• Frequency: 2 to 4 times per day of the first 3 day of hospitalization.

• Intensity: From a sitting or standing position take resting heart rate then target about 20 beats for MI and 30 beats for surgery patents above resting heart rate. RPE of <13 on 6-20 scale

• Time: 3-5min as tolerated rest period may be a slower walk that shorter than the duration of the exercise bout. Attempt to achieve a 2:1 exercise/rest ratio.

• Type: Walking

• Progression: When patients reach 10-15 min increase intensity as tolerated within the RPE and Heart rate limits.

Outpatient prescription

• Frequency: 3 days to most days of the week with several factors to consider: exercise tolerance, intensity, and fitness of the patient.

• Intensity: Based on results from the baseline exercise test, 40%-80% of heart rate reserve. 11-16 RPE 6-20 scale.

• Time: Warm up and cool-down 5-10min with the goal of 20-60min/ session

• Type: Aerobic should include rhythmic movement using large muscle. Example: Arm ergometer, Rower, Elliptical, or Recumbent bike

• Progression: Progression should be individualizing to patients tolerance.

Resistance Training

• Frequency: 2-3 days with at least 48hr rest.

• Intensity: 30-40% of 1 RM for upper body and 50-60% for lower body.

• Time: Perform 8-10 exercise 10-15 rep

• Type: Elastic bands, cuff and hand weights, free weights and machines etc.

• Progression: Increase slowly as the patient adapts to the program.

Contraindications

• Unstable angina • Uncontrolled hypertension • Significant aortic stenosis• Uncontrolled atrial or ventricular arrhythmias • Third-degree atrioventricular block without pacemaker• Orthostatic BP drop of >20 mm hg with symptom• Recent embolism

Reference

• Kluwer, W. (2014). Acsm's guidelines for exercise testing and prescription. (9th ed., pp. 236-256). Baltimore, Maryland: Williams & Wilkins.

• Thygesen, K., Alpert, J. S., & White, H. D. (2007). Universal definition of myocardial infarction. Journal of the American College of Cardiology, 50(22), 2173-2195.

OSTEOPOROSISBy- Tailor Pili

General Overview

Osteoporosis is a skeletal disease that increases your risk of bone fracture due to having low bone mineral density.

There are more than 10 million people in the United States who currently suffer from osteoporosis and that number is continuing to grow.

Categories for exercise prescription

There are 2 categories for designing exercise prescriptions for this population.

Category #1- Patients who are at risk for Osteoporosis : > or = 1 risk factor for osteoporosis. Risk factors are: Current low bone mass, age, and being female.

Category #2- Patients with osteoporosis.

Cardiorespiratory Fitness Guidelines for at risk patients

Frequency: 3-5 days per week of weight bearing activity.

Intensity: - moderate(40%-60% HRR) to vigorous (>60% HRR).

Time: 30-60 minutes per day of aerobic exercise Type: Weight-bearing aerobic activities such as

tennis, stair-climbing, walking with intermittent jogging.

Progression: Based on each individuals level of fitness and disease progression, but generally keeping intensity moderate and working to prevent further progression of the disease.

Cardiorespiratory Guidelines for Osteoporotic patients

Frequency: 3-5 days per week of weight bearing activity.

Intensity: Moderate (40%-60% HRR) Time: 30-60 minutes per day of aerobic exercise Type: Weight-bearing aerobic activities such as

stair-climbing, walking, other activities as tolerated.

Progression: Based on each individuals level of fitness and disease progression, but generally keeping intensity moderate and working to prevent further progression of the disease.

Resistance Training Guidelines for at risk patients

Frequency: 2-3 days per week . Intensity: Moderate (60%-80% 1-RM) 8-12

repetitions or vigorous (80%-90% 1-RM) 5-6 repetitions focusing on large muscle groups.

Time: 30-60 minutes or as long as it takes to complete the number of sets and repetitions.

Type: Focus on large muscle groups using both free weights as well as machine weights.

Progression: Increase load force only if no pain is present, and only after proper form is accomplished for each exercise . Again, you are working to prevent further progression of the disease.

Resistance Training Guidelines for Osteoporotic patients

Frequency: 2-3 days per week. Intensity: Moderate (60%-80% 1-RM) 8-12

repetitions focusing on large muscle groups. Time: 30-60 minutes or as long as it takes to

complete the number of sets and repetitions. Type: Focus on large muscle groups using both

free weights as well as machine weights. Progression: Increase load force only if no pain

is present, and only after proper form is accomplished for each exercise. Again, you are working to prevent further progression of the disease.

Contraindications

There are currently no specific contraindications for individuals at risk, or individuals with osteoporosis.

However, some general guidelines should be followed:

No explosive movement exercises No high-impact loading Exercises that involve twisting of the

spine should generally be avoided

References

Pescatello, L. S. (2014). ACSM's guidelines for exercise testing and prescription (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Todd, J. (n.d.). Osteoporosis and exercise. -- Todd and Robinson 79 (932): 320. Retrieved November 18, 2013, from http://pmj.bmj.com/content/79/932/320.short

EXERCISE PRESCRIPTION FOR PREGNANT WOMEN

By: MaKenzie Shumway

PREGNANCY Pregnancy is the fertilization and

development of one or more offspring in a woman’s uterus.

40 weeks

Average healthy weight gain is about 25-35 pounds

EXERCISE PRESCRIPTION Exercise programs should consist of a

warm up, cool down, and Kegel exercises.

Kegel exercisesPelvic floor exerciseRepeatedly contracting and relaxing the

muscles that form part of the pelvic floorHelp in the preparation for physiological

stresses of pregnancy

CARDIORESPIRATORY TRAINING Frequency: > 3 days per week Intensity: Moderate intensity – because of

heart rate variability during pregnancy, use the RPE scale or (12-14 on a scale of 6 – 20) or the “talk test”

Time: At least 15 minutes a day, increasing to 30 minutes a day

Type: Dynamic, rhythmic physical activities that use large muscle groups Weight bearing – walking, jogging Non-weight bearing – swimming

Progression: gradually increase from 15 to 30 minutes a day

RESISTANCE TRAINING Frequency: 2 days per week Intensity: 1 set of 12 – 15 repetitions

for multiple muscle groups Time: until moderate fatigue is reached Type: light weight – participate in

activities that won’t cause imbalance Progression: gradually increase

duration and then increase weight.

SPECIAL CONSIDERATIONS Pregnant women should avoid

contact sports Pregnant women should avoid

exercising in the supine position after first trimester

Pregnant women should avoid Valsalva maneuver

Pregnant women should exercise in a thermoneutral environment and stay well hydrated

CONTRAINDICATIONS Absolute:

Restrictive lung disease Incompetent cervix Risk of premature labor Persistent 2nd or 3rd trimester bleeding Ruptured membranes

Relative: Severe anemia Chronic bronchitis Extreme morbid obesity Heavy smoker Poorly controlled seizures and diabetes

DiabetesSpecial Populations Prescription

Alyssa Kriss

A Little bit About Diabetes

• Metabolic disease• Hyperglycemia ( >200 ml/dl)• Inability to secrete (Type 1) or utilize (Type II) insulin• Sustained hyperglycemia can put patients at risk for CVD

and vascular disorders• Effects 7% of US population, 90% of cases are preventable

type II.

Cardiovascular Fitness For people with Diabetes

• Frequency: 3-7 days/week with no more than two consecutive days of non-activity

• Intensity: 40%-60% of VO2R or 11-13 RPE

• Time: >150 min/week moderate + activity and increase to 300.

• Type: Emphasize use of large muscle groups and rhythmic motions

• Progression: Maximizing caloric expenditure is highest priority, progressively increase duration and to >2000 kcal EE/week

Muscle Strength and Edurance

• Guidelines for Resistance Training (RT) exercise prescription, • Same as general population

• Frequency- 2-3 days / week with 48 hours in between same muscle groups

• Intensity: 40-60% RM• Type: each major muscle group at least once a week• Reps:15-20• Sets: 2-4• Pattern: 2 min rest intervals, 48 hours b/t same groups• Progression: add resistance as client is not being challenged.

Affect of Exercise on Insulin Receptivity

• Exercising at moderate intensity (40-80%) of VOsR for 40-80 minutes improved expression of GLUT-4 significantly after exercises, and continued 3 hours after exercise.

• Increased GLUT-4 expression lead to increased glucose sensitivity

• Proving that exercise helps to reverse the main causes of type II diabetes

Contraindications

•  • Hypoglycemia- rapid drops in blood glucose my occur

with exercise, resulting in headache, visual disturbances, confusion, shakiness, weakness, abnormal sweating, loss of breath, amnesia, seizures, coma

• Dehydration from polyuria my contribute to a compromised thermoregulatory response

• Retinal detachment and hemorrhage• Ketosis• Complications due to nephropathy

References

• References• Craniou, G. N., Smith, D. C., & Hargreves, M. (2006).

Acute exercise and GLUT4 expression in human skeletal muscle: influence of exercise activity. Journal of Applied Physiology, 101. http://dx.doi.org/10.1152/japplphysiol.01489.2005

• Lupash, E. (Ed.). (2014). ACSM's guidelines for exercise testing and prescription (9th ed.). Philadelphia, PN: American College of Sports Medicine.

Exercise in Older Adults

Brock Duke

Definition of Older Adults

• Older adults are defined as individuals 65 years of age or older

• Or

• Individuals 50-64 with clinically significant conditions or physical limitations that affect movement, physical fitness or physical ability

Goals

• Improve Quality of Life• Improve health• Improve Activities of Daily Living• Improve Self-efficacy

Cardiorespiratory Fitness

• Frequency• Moderate 5+ days/wk, Vigorous 3+ or 3-5 of a combination of the

two

• Intensity• Use a 0-10 scale for RPE, 5-6 moderate, 7-8 for vigorous

• Time• Mod 30-60 per day or 150 total• Vig 20-30 per day or 75 total

• Type• Activities that don’t put excessive orthopedic stress on joints,

walking most common. Spin Bike and swimming also good choices

• Progression• Increase duration before intensity, 5-10 min every 1-2 weeks

Resistance Training• Frequency

• 2 or more days per week

• Intensity• Light 40-50% 1RM, Moderate 60-70% 1RM, Vigorous 70-80% 1RM• If 1RM not measured use RPE 0-10, Light 4-5 Moderate 5-6 Vigorous 7-8

• Type• Progressive weight training programs or weight-bearing calisthenics using

large muscle groups• 8-10 exercises, 1+ sets of 10-15 reps

• Time• Adequate rest should be given between sets, 1-2 minutes. If fatigued give

3-5 minutes

• Progression• gradual increase in progression, increase set, reps and frequency

Contraindications

• Balance is a large issue, put in good situations with trained instructor

• Specific to each clients needs• Tailor to meet their needs• Work with them to improve weakness• Remember we are trying to help them be

healthy, improve ADL’s and self-efficacy

References• Phillips, S., Wójcicki, T., & McAuley, E. (2013). Physical activity and

quality of life in older adults: an 18-month panel analysis. Quality Of Life Research, 22(7), 1647-1654. doi:10.1007/s11136-012-0319-z

• Pescatello, L. S., & American College of Sports Medicine. (2014). ACSM's guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

MULTIPLE SCLEROSISMatt Brotherton

MULTIPLE SCLEROSIS

MS is a chronic inflammatory disease of the central nervous system

Causes a decrease in the amount of myelin surrounding neurons

Exact cause is still unknown and there is no cure Disease is marked by periods of regression and

exacerbation Treatment often involves management of

symptoms Common issues include poor balance, poor

coordination, pain, weakness, poor vision, bowel and/or bladder dysfunction, impaired thermoregulation, and possibly psychological disturbances

CARDIORESPIRATORY FITNESS RECOMMENDATIONS

Frequency – 3-5 days/week Intensity – 40%-70% VO2reserve or HRR; RPE

11-14 Time – 20-60 mins per session or minimum

10 min bouts Progression – progress according to

individual’s performance and personal goals

Endurance-type activity resulted in improved CRF and even strength gains in some individuals; No contraindications to exercise found (Romberg et al, 2004)

RESISTANCE TRAINING RECOMMENDATIONS

Frequency – 2 days/week Intensity – 60-80% 1 RM Time – 1-2 sets of 8-15 repetitions Progression – as with CRF, progress according

to individual’s progress and personal goals

Resistance training can be highly beneficial to individuals with MS and even elicit reductions in chronic symptoms (Dalgas et al, 2009)

FLEXIBILITY RECOMMENDATIONS

Frequency – 5-7 days/week, 1-2 times/day Intensity – stretch to the point of tightness or

mild discomfort Time – hold static stretch 30-60 seconds, 2-4

reps Progression – progress as needed remaining

mindful of the goals and progress of the individual

CONTRAINDICATIONS TO EXERCISE

Exacerbations of the disease; acute symptom presentation

Uhthoff Phenomenon The key is risk prevention – make the

environment safe and easy to navigate; make restrooms easily accessible and have access to temperature regulation

Pool exercises and cycling may be preferable exercise modes for MS patients

Be aware of possible psychological disturbance that can be secondary to the disease

REFERENCES Pescatello, L. S. (2013). ACSM’s Guidelines For Exercise Testing and

Prescription: Ninth Edition. (pp. 311-315). Wolters Kluwer.

Dalgas, U., Stenager, E., Jakobsen, J., Petersen, T., Hansen, H. J., Knudsen, C., Overgaard, K., & Ingemann-Hansen, T. (2009). Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology, 73(18), 1478-1484. Retrieved from http://ovidsp.tx.ovid.com.ezproxy.lib.utah.edu/sp-3.10.0b/ovidweb.cgi?

Romberg, A., Virtanen, A., Ruutiainen, J., Aunola, S., Karppi, S. L., Vaara, M., Surakka, J., & Pohjolainen, T. (2004). Effects of a 6-month exercise program on patients with multiple sclerosis. Neurology, 63(11), 2034-2038. Retrieved from http://ovidsp.tx.ovid.com.ezproxy.lib.utah.edu/sp-3.10.0b/ovidweb.cgi?

MULTIPLE SCLEROSISExercise Prescription

By: Aubri Poulsen

WHAT IS MULTIPLE SCLEROSIS? Autoimmune disease

One's own immune system damages the nerves of the brain and spinal cord.

Buildup of scar tissue Demyelination of the CNS nerves

Disruption of electrical signalsLoss in muscle control, balance, sensation, vision

More common among females

F.Y.I.

Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis. The EDSS quantifies disability in eight Functional Systems (FS) and allows neurologists to assign a Functional System Score (FSS) in each of these.

“The following recommendations are limited to MS patients with an EDSS score of less than 7, because too little is known about the effects of exercise in the more severely impaired group of MS patients.” (Dalgas, Ingemann-Hansen & Stenager, 2007)

CARDIORESPIRATORY FITNESS RECOMMENDATIONS

The FITT recommendations 3-5 days a week working at 40-70% VO2R or

HRR. RPE of about 11-14. The subject should be begin with a minimum of

ten minutes of exercise before increasing the intensity.

If the subject has excessive fatigue they should start lower on the intensity scale and do discontinuous sessions of exercise.

RESISTANCE TRAINING RECOMMENDATIONS

Resistance training “must be performed under supervision from experienced personnel, until the MS patient is comfortable with the training program.” (Dalgas, Ingemann-Hansen & Stenager, 2007) 2 days a week at 60-80% of 1 RM. 1-2 sets of 8-15 repetitions. Higher rest time of 2-5 minutes to allow for

muscle recovery. In order to maximize their ADL’s, the prescription

should include functional activities.

PHYSICAL ACTIVITY/EXERCISE CONTRAINDICATIONS “resistance training more rarely than endurance training

will cause unpleasant experiences, because of increases in body temperature.” (Dalgas, Ingemann-Hansen & Stenager, 2007) 

Exercises, “affecting core temperature should always be considered and minimized, in order to make exercise as pleasant as possible”. (Dalgas, Ingemann-Hansen & Stenager, 2007) 

Don’t perform exercises in extreme heat environments.   Don’t exercise above the level of tolerance based on

any acute exacerbation of MS symptoms.   During an acute exacerbation of symptoms, avoid

testing.   Avoid a large amount of exercises in one bout of

exercise.

+

Special Population:Osteoporosis By: Brianna Turner

+Osteoporosis… is a progressive bone disease that is characterized

by a decrease in bone mass and density which can lead to an increased risk of facture.

This disease classified as primary type 1, primary type 2, or secondary

Most common is Primary Type 1, refers to postmenopausal osteoporosis.

+Types of activities recommended…

Strength training exercises

Weight-bearing aerobic activities

Flexibility exercises

Stability and balance exercises

Importance: work directly on your bones to slow mineral loss!!!!

+

Resistance Training

Importance: Strength training works directly on you bones to slow the mineral loss, helps reduce harmful stress on your bones and maintain bone density.

Frequency: ACSM: 2-3 days/week

Intensity: <60% of 1-repetition maximum (1RM)

Type: Free weights, resistance bands. 1-3 Sets, 8-12 Reps, 4-6 exercises

Time: 15-30 minutes

Progression: Additional weight added gradually, up to 10 pounds using weighted vest.

+Cardiorespiratory Fitness

Frequency: 3-5 days/week

Intensity: Moderate Intensity(40-60% HRR)

Time: 30-60 min.

Type: Walking, dancing, elliptical, stair climber

Progression: Add time of activities as tolerated.

+Contraindications

No current guidelines regarding contraindications.

Recommendations….

*Avoid explosive movements

*Avoid High-impact loading

*Avoid exercises involving twisting at the waist

*Avoid exercises with spinal extension, and spinal flexion