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KINES 430

Physical Activity for Special Populations

Dr. Kim Tucker

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Dr. Kim Tucker

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I want to hear from you!

Your Name
One thing about you - anything :)

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Syllabus

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Exercise is Medicine �in Chronic Care

They LOVE an acronym

Chapter 1

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Who is a “typical” patient?

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Role of Primary Care Physician

Annual wellness visit: Create and update the �patient’s plan for health and disease prevention.
Guide patient into regular exercise or refer them to a program.
Exam should include exercise vital sign as part of the �health risk assessment.

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Exercise is Medicine (EIM)

Increases longevity
Increases the length of disability-free life
Improves metabolic function / decrease onset of cardiovascular diseases and diabetes
Improves quality of life

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What are the downfalls �of prescribing exercise?

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How can a physician check �to see if a patient is exercising?

Exercise Vital Sign (EVS)

Over 90% of Adults �and 96% of 65+ patients �have EVS in their charts

Health Risk Assessment

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Exercise Vital Sign (EVS) Questions

On average how many days a week do you engage in at least moderate to vigorous activity like a brisk walk?

Response range: 0-7 days

How many minutes each day?

Response range: 10, 20, etc minutes

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Moderate to Vigorous Physical Activity (MVPA)

Multiply days by minutes
Adults should have more than 150 minutes/week
< 150 minutes/week are flagged

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Frequency

How often physical�activity is performed

F.I.T.T. Principle for Overload

F.I.T.T.

Intensity

How hard a person�performs physical activity

Time

How long a person does�physical activity

Type

The kind of activity a�person does to improve�their fitness

3-5�times per week

Cardiorespiratory Endurance

60-90%�maximum heart rate

20%�minutes or more

Running�Swimming

Cross-Country Skiing

Bicycling

Jump Rope

Hiking

Free Weights

Resistance Machines

Partner-Resisted Exercises

Body-Weight Exercises

Time required to do

12+ repetitions of

each exercise

3-5�times per week

12+�repetitions maximum

Time required to hold each

stretch for 10-30 seconds

Time required to do

3-7 repetitions of

each exercise

3�times per week

3-7�repetitions maximum

Tension & slight discomfort

Without a sensation of pain

Yoga/Pilates

Static Stretching

Dynamic Stretching

P.N.F. Stretching

Free Weights

Resistance Machines

Partner-Resisted Exercises

Body-Weight Exercises

3-5�times per week

Muscular Endurance

Muscular Strength

Flexibility

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Your Turn. Partner up. �Come up with a Case Study.

What is your age?
What is your chronic illness?
What is your fitness?
Meds?
What barriers to exercise?

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Final Considerations

Recommendation for majority of patients with chronic conditions is not different from guidelines for apparently healthy persons.

Considerations need to be taken with the barriers to exercise �for those with chronic conditions.

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Paper

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Next Class

Be ready to share your Google Slide.
You will have 1 minute to share:�A little about yourself.�What you want to do with your degree
Who are you - present

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Week 2

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Who are you?

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Comparison of Exercise Guidelines from Leading Organizations

Guidelines

Frequency?

Specific intensity?

Multiple modes of exercise?

Duration?

Are the guidelines designed specifically for chronic disease patients?

No, guidelines specifically designed for healthy adults

Yes, 150-300 min weekly

Yes, aerobic and muscle strengthening

No, only general intensities given (e.g., vigorous)

No, guidelines specifically designed for healthy adults

Yes, most days of the week recommended

No, only general intensities given (e.g., vigorous)

Yes, 150-300 min weekly

Yes, aerobic and muscle strengthening

No, guidelines specifically designed for healthy adults

Yes, most days of the week recommended

World Health Organization Physical Activity Guidelines

U.S. National Human and Health Services Physical Activity Guidelines

Yes, 150-300 min weekly

Yes, aerobic and muscle strengthening

No, only general intensities given (e.g., vigorous)

Yes, most days of the week recommended

No, only general intensities given (e.g., vigorous)

Yes, 30 min session

Yes, varies on volume of exercise used

No, guidelines specifically designed for healthy adults

Yes, varies for chronic condition

Yes

Yes, aerobic �and muscle strengthening, and flexibility

Yes, aerobic and muscle strengthening, and flexibility

No, only aerobic addressed in AHA general guidelines

Yes, but varies on the volume of exercise used

Yes, but varies for each chronic condition

Yes, 3-5 days per week for aerobic, �2-3 days for resistance training

Yes, 3-5 days per week

European Union Physical Activity Guidelines

American Heart Association Physical Activity Guidelines

American College �of Sports Medicine Position Stand for Exercise Prescription in Older Adults

Swedish NIPH Physical Activity in the Prevention and Treatment of Disease

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Frequency

How often physical�activity is performed

F.I.T.T. Principle for Overload

F.I.T.T.

Intensity

How hard a person�performs physical activity

Time

How long a person does�physical activity

Type

The kind of activity a�person does to improve�their fitness

3-5�times per week

Cardiorespiratory�Endurance

60-90%�maximum heart rate

20%�minutes or more

Running�Swimming

Cross-Country Skiing

Bicycling

Jump Rope

Hiking

Free Weights

Resistance Machines

Partner-Resisted Exercises

Body-Weight Exercises

Time required to do

12+ repetitions of

each exercise

3-5�times per week

12+�repetitions maximum

Time required to hold each

stretch for 10-30 seconds

Time required to do

3-7 repetitions of

each exercise

3�times per week

3-7�repetitions maximum

Tension & slight discomfort

Without a sensation of pain

Yoga/Pilates

Static Stretching

Dynamic Stretching

P.N.F. Stretching

Free Weights

Resistance Machines

Partner-Resisted Exercises

Body-Weight Exercises

3-5�times per week

Muscular

Endurance

Muscular

Strength

Flexibility

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0-10 Point RPE Scale

Rating of Perceived Exertion

Subjective Description

Nothing (rest)

Very, very light

Very light

Light

Moderate

Somewhat hard

Hard

Very hard

Very, very hard

0.5

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The “Intensity” Factor

Moderate Intensity:

Vigorous Intensity:

Moderate-to-Vigorous:

Ways to Monitor Intensity

To be physically active, �you need to meet the PA recommendations

Heart Rate
Metabolic Equivalent
Perceived Exertion

Combination of Moderate and Vigorous Intensities

>70% �Max Predicted Heart Rate �

75 min/week, 3+days/week

50–70% of �Age-Predicted�Max Heart Rate�

150 min/week,�4–5 days/week

Physical Activity and Well-Being

Intensity is an important component of exercise. Intensities that are too high can cause injury, while intensities that are too low might not lead to adaptations and desirable changes.

Moderate intensity activity refers to activity that increases your heart rate to 50–70% of your age-predicted maximal heart rate. You should get 150 minutes of moderate intensity exercise each week, and it should be spread over 4–5 days.
Vigorous intensity activity is activity that increases your rate rate more than 70% of your age-predicted maximal heart rate. You should get 75 minutes of vigorous intensity exercise each week, which should be spread over 3 or more days.
Moderate to vigorous physical activity is a mix of physical activity that meets the intensity threshold to promote health and fitness benefits.

There are several ways to measure intensity.

As we have mentioned, one way to measure intensity is heart rate. We commonly use maximum heart rate, but age-predicted maximum heart rate is also common.
Another way to monitor intensity is to use a metabolic equivalent, which is a unit based on the energy expended. One MET is considered to be the average energy expended at rest, and a 2 MET activity requires twice as much energy as 1 MET at rest.
We can also use perceived exertion to monitor intensity. One commonly used scale is Borg’s rating of perceived exertion, or RPE scale. Exercisers can use this scale to identify how hard they feel they are working using a series of numbers and descriptions.

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The “Intensity” Factor

Physical Activity and Well-Being

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Heart Rate

A special laboratory test can help us know our maximum heart rate or we can use an estimation equation such as HR_max= 207 – (0.7 x age) to determine it.

Metabolic Equivalent

A metabolic equivalent (MET) is a unit of measurement of PA intensity based upon energy expended. One MET is considered to be the average energy expended by a person at rest (rest = 1.0 MET). An activity labeled as 2.0 METs is thought to require twice the energy expended of 1.0 MET.

Perceived Exertion

Exercisers are shown a scale with number and word descriptors. They consider their overall bodily feeling and rate the exertion as a number.

Physical Activity and Well-Being

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CDD4 Recommendations for �Evaluation of Physical Functioning

At a minimum patients should be able to do these:

6 or 8 m gait > 0.6 m/s = about 20.75 or 26.25 feet
8 sit-to-stand repetitions in 30 s
8 arm curls with a 4 kg mass = 8.8 pounds
Ascending a flight of 10 steps in under 30 s
Chair sit-and-reach to the toes on both sides

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Cancer - page 115

Over 13 million people diagnosed with cancer every year

40 percent of all Americans diagnosed with cancer

4 out of 5 lung cancer / from tobacco
1 in 5 stomach cancer / from tobacco
Obesity and physical inactivity increase breast cancer by 50 percent

Over 200 Types of Cancer

Physical Activity and Well-Being

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Basic Pathophysiology �for your Selected Type of Cancer

Youtube Video

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Management and Medication for your Selected Type of Cancer

Mayo Clinic - Bladder Cancer

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PDR.Net

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Basic Pathophysiology - Cause

Unchecked accumulation of cells
Cancer cells reproduce quickly and the tumor has a greater and greater effect on the body
A sign, such as fever or bleeding, can be seen or measured by someone else
A symptom, such as pain or fatigue, is felt or noticed by the person who has it

Causes and Symptoms

https://www.cancer.org/healthy.html

Physical Activity and Well-Being

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Signs

Fatigue - doesn’t get better with rest
Weight loss or gain of 10 pounds or more for no known reason
Eating problems such as not feeling hungry, trouble swallowing, belly pain, or nausea and vomiting
Swelling or lumps anywhere in the body
Thickening or lump in the breast or other part of the body

cancer.org/healthy.html

Physical Activity and Well-Being

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Signs

Cough or hoarseness that does not go away
Unusual bleeding or bruising for no known reason
Change in bowel habits, such as constipation or diarrhea
Pain when passing urine or blood in the urine
Fever or nights sweats
Headaches

cancer.org/healthy.html

Physical Activity and Well-Being

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Management and Medications

Effects of diagnosis and treatment will vary

Chemotherapy (Usually Intravenous Injection)
Radiation
Surgery - Severing Muscles
Hormone Therapies
Targeted Therapies - Adverse Effects, Develop Leukemia

Physical Activity and Well-Being

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Effects on the Exercise Response

Large tumors could press on surrounding organs
Amputation
Vary by

Tumor Site
Stage of Cancer
Severity
Treatment Type

Physical Activity and Well-Being

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Effects of Exercise Training�

Quality of life
Helps with fatigue
Strength
Cardiorespiratory fitness
Flexibility
Depression and anxiety
Body composition
Sleep and energy level

100s of Studies Say that Exercise Benefits Individuals with Cancer.�

Physical Activity and Well-Being

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More likely to die from:

Prostate and breast cancer survivors are more likely to �die of cardiovascular disease than their cancer.

“Rest. Take it easy. Don’t push yourself…”�Very important that we get away from this mentality

Physical Activity and Well-Being

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Recommendation for Exercise Programing

Avoid being inactive
Basic CDD4 Recommendations
Start with light to moderate walking�(if the individual can walk)
Strength Training

Physical Activity and Well-Being

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How a Patient Can Integrate Exercise �into a Medical Home Model

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Open paper and presentation
Make a copy of the document
Start working on sections of the paper

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Presentation

7-10 Minute Presentation - worth 30 points

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Paper

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Past Student’s Paper

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Past Student’s Presentation