Special populations

Who is special?

• Pregnant women

• Female adolescents

• Diabetics (covered in detail in endocrine lecture)

• Asthmatics

• Epileptic

Pregnant women

Demands on the body during pregnancy

• Foetus needs calories, nutrients, protein and a physiologically stable environment

• Blood volume increases 40-50%

• O2 uptake slightly higher• HR higher @ rest and exercise• Cardiac output higher at rest 1st

2 trimesters, and then lower 3rd trimester

Safety precautions

• Need Dr’s permisson- full check up• Concerns based around:

– Increased body weight additional discomfort/damage to joints

– Inadequate availability of oxygen for exercising muscle and the foetus

– Thermoregulation Hyperthermia (Too hot) – may cause foetal distress or birth abnormalities

– Increased uterine contraction– Joint laxity– Energy balance

Discomfort

• Urinary frequency and incontinence

• Breast size and tenderness

• Back pain

• Centre of balance

• General fatigue

What can they do?

• Aerobic continuous exercise (walking, hiking, low impact aerobics, cycling, swimming, rowing etc) at 60=70% MHR for no longer than 45 min (15-20 = ideal)

• Weight supported exercise (swimming) has less potential for injury.

• Resistance exercise at low weight high reps (>10) within limited R.O.M

• Caution during stretching• No supine exercise in 3rd trimester• No risk of falls• No joint stress (jogging, tennis)

Adolescent Females

• Runners Knee

• Widening of hips

• Menstruation

Widening hips

• Broader hips more steeply angled femurs

• may cause some girls to throw out their heels when running

• attention needs

• to be paid to running technique

Runner’s knee

menstruation

• Poses no direct influence on sports performance

Female athlete triad

Type 2 diabetics

• Typically adult onset

• 90% of all diabetics

• Does not require insulin to be injected

• Control through food and exercise– Low fat diet

• Exercise is often recommended

Exercise recommendations for Type 2 diabetics

• High frequency – 4-7 x p/week • Achieve 1000 calorie loss• Moderate starting intensity to avoid injury- walking

is the best– Minimises hypoglycaemic response

• Buildup maintain overload• Motivation• Carry emergency glucose

Asthmatics

• Triggers:– Allergies– exercise, – aspirin, – dust, pollutants, – emotion

Mast cell (in resp tract)• Reaction

– Contraction of smooth muscle around bronchii– Swelling/inflammation mucosal cells– Hypersecretion mucous

Prevention

• Avoid allergen

• Medication. Works by;– Inhibiting chemical mediator release

(histamines etc)– Relax bronchiolar smooth muscle (most

inhalers)– Block influx Ca to mast cell

Exercise induced asthma

• Occurs 4-15 minutes (early phase) or 4-6 hours (late phase) after exercise

• 80% asthmatics experience EIA

• 3-4% non-asthmatics may also get EIA

• Causes- cold air, low PCo2, specific intensities and duration of exercise

Cold dry air

• Remember- as air is breathed in it is humidified and warmed before it gets to the lungs

• Respiratory fluid loss removes h20 from mast cell, inadvertantly increasing osmolarity influx Ca same allergic response

Type of exercise

• More attacks caused by running than cycling,walking and swimming (in that order)

• Intensity x duration

• Warm up critical

• If air is cold and dry, wear a scarf over mouth to trap moisture and humidify air

• Carry inhaler in case of attack

COPD

• Chronic obstructive pulmonary disease

• Chronic bronchitis- thickened bronchial wall and excess sputum production

• Emphysema- reduced elasticity bronchioles and alveoli

• bronchial asthma decreased ability to exhale

wheezing

Exercise for COPD

• Walking, cycling, swimming, games, resistance training, breathing exercises

• Oxygen may be required

• Improve functional capacity (FEV/VC)

• And self confidence, reduce depression

Hypertension

• Normal = 120/80

• Higher than this = increased chance coronary heart disease

• Hypertension is considered to be present when a person's – systolic BP is consistently >140 mmHg– diastolic blood pressure > 90 mmHg

Recommendations

• Reduce sodium intake

• Stop smoking & reduce alcohol

• Reduce dietary fat intake

• Endurance exercise (also helps reduce other RF for CHD– 40-60% MHR for 30 minutes– Most if not all days of the week

Epilepsy

• Epilepsy = brain disorder characterised by recurring seizures or fits

• caused by sudden flurries of electrochemical activity in the brain, which disrupt the ‘conversation’ between neurones

Benefits of exercise for epileptics

• Heavy breathing associated with exercise stops the build-up of carbon dioxide in the blood (hypercapnia).

• Reduces stress -a known seizure trigger • The release of serotonin may calm the brain. • Concentration needed during sport may focus

the brain so that seizures are less likely. • The benefits of regular exercise, such as

improved fitness and wellbeing, may contribute to a reduced seizure risk.

Considerations• Before starting any new exercise program, consult with your doctor

or specialist. • Avoid known seizure triggers. • Always take your medication as prescribed and keep an adequate

supply of medication on hand• Make sure your sporting companions are aware of your condition

and know what to do if you have a seizure. • Always wear a medical alert bracelet. • Wear protective gear appropriate to your sport, such as helmet or

knee pads. • Always wear a life jacket when involved in water sports. • Let family or friends know your walking, jogging or exercise route

before you leave and how long you will be out.

Exercise related triggers

• Extreme fatigue

• Lack of sleep

• Dehydration

• Electrolyte loss, due to severe dehydration

• Hyperthermia (elevated body temperature)

• Hypoglycaemia (low blood sugar levels).

Avoiding seizures

• Drink plenty of water before, during and after exercise. • Don’t push yourself to the point of physical exhaustion. • If you are feeling very hot and tired, slow down or stop. • Make sure you have at least two rest days every week. • Make sure your diet is nutritionally adequate. • Get plenty of rest and good quality sleep. • Take all steps to avoid head injuries. • Don’t abuse alcohol. • Make sure you take your medication according to your

doctor’s directions.

Contraindicated

• Contact sports• Scuba diving• Bungee jumping• Boxing • Motor sports • Horse riding • Gymnastics • Ice activities, such as skating or hockey • Skiing • solo water (sailing or wind surfing) or aerial sports (hang

gliding & skydiving)• High altitude activities such as mountain climbing.