Special population I - Department of Rehabilitation Sciences

Exercise for the
Special Population
Exercise Science
Using examples,
 To identify special populations
 To identify physical activity /
exercise needs of special
 To integrate principles of exercise
training in the implementation &
the evaluation of exercise training
Special Populations
Target population
– Group vs. Individual, age group, gender
Identify Needs
– Goal Setting
Design Program
– Record Keeping
– Pre and post testing
Who are they?
Special Population
Special Population = Adapted State
Population at risk
population with sedentary lifestyle
low cardiorespiratory fitness
women: aged, osteoporosis
children with obesity
Population with chronic disabilities
– e.g. ankylosing spondylitis, diabetes mellitus,
chronic obstructive pulmonary disease, cystic
fibrosis, rheumatoid arthritis, poliomyelitis, stroke,
amputations, spinal cord injury…
Lifelong Fitness Lifestyle
Four phases of natural history
of exercise
To implement an effective exercise
An understanding of the body
responses to exercise in
Unique adaptations to exercise training
in different age group with regard to
strength, functional capacity, motor
Guidelines (Cont’d)
 Identify risk factors / precautions /
contraindications prior to participation
in physical activity
 Identify determinants of physical
 Integrate the principles of exercise
 Define ways to monitor and evaluate
the effectiveness of the program
Local Data 1
Report on Healthy Living Survey 1999
Department of Health
Cross-sectional telephone survey
n = 3,270
Aged 18-64 years
Results of the Healthy Living Survey
51% of men and 47% of women
engaged in exercise (at least 30
minutes) within last one month
Participation in exercise drop
markedly for both sexes from 70% (in
age group 18-24) to less than 40% in
age group (age 45-54)
Results of the Healthy Living Survey
 52% had done something to improve
health or to prevent diseases in the
past year
 Exercise was the most common action
 Major barrier: lack of time
 On average spent 2.7 hours daily
watching TV
Local Data 2 (1999)
Chinese University of Hong Kong
Interview survey
n = 26,111
Aged 10 to 20 from 48 primary and
secondary schools
Results of the CUHK Survey
Have you engaged in any leisure
time exercise that make you sweat
last week? NO percentage:
– P4 to P6: 13.8%
– F4 to F7: 25.8%
Have you watched TV for 3 hours or
more last week? YES percentage:
– P4 to P6: 54.3%
– F4 to F7: 51.2%
What does it mean?
INACTIVITY - a major health problem
Association between sedentary
lifestyle and morbidity / mortality from
chronic disease - Evidence??
Evidence (Blair and Brodney,
Association of physical activity or
cardiorespiratory fitness to the outcomes
of mortality:
 Cardiovascular disease
 Coronary heart disease
 Hypertension
 Type 2 diabetes mellitus
 Cancer
Effects of Physical Activity on
Health Outcomes in Adolescents
 Aerobic Fitness
 Body Fat
 Blood pressure
 HDL cholesterol
 LDL cholesterol
Musculoskeletal injuries 
Exercise Prescription
An Example
Defined as ages 11 - 21
Pre-pubescent  preadolescent
Post-pubescent  adult
Physiologic Characteristics of
Exercise in Preadolescents (ACSM
Resource Manual, 1998)
 Immature cardiovascular system
 Higher O2 consumption per unit of body
mass (i.e. higher metabolic rate)
 Lower SV, compensated by higher HR
 Higher RR
 Poor sweating capacity
 Large surface-to-mass ratio
 RPE perceived as easier for a given
Physiologic Characteristics of
Exercise in Preadolescents
  concentration and rate of utilization of
  ability to utilize muscle glycogen and
produce lactate  lower anaerobic
capacity than adults
 Reach metabolic steady state faster,
lower oxygen deficit, faster recovery
 Rely more on aerobic metabolism
Can perform endurance task fairly well
Greater fatiguability in prolonged highintensity task
Ability to perform intense anaerobic task
lower than adults
Low tolerance to extreme heat / cold
Thermoregulation less efficient - less
tolerance for exercising in the heat
susceptible to heat exhausation
In planning exercise program:
 Preparticipation examination
 Avoid anaerobic training (concentrate on
skill and movement in aerobic sports such
as basketball and soccer)
 Intermittent activities preferred
 Intensity and duration should be lower
initially  gradually increase
In planning exercise program:
Special attention to acclimatization
(avoid high heat and humidity)
Fluid replacement
Be conservative / prescribe an easily
tolerable program
Have a high index of suspicion for
Skeletal System
Active musculoskeletal development
Muscle-tendon units accommodate to the
rapid growth of long bones  flexibility
At puberty, relative over-growth of long
bones to soft tissue  muscle imbalance
Repetitive microtrauma on vulnerable
prestressed muscle-tendon units 
tendinitis, bursitis, apophysitis, stress
Gradual progression of exercise
Avoid extremes in exercise duration
and intensity
Adequate period of warm-up,
stretching and cool-down exercises
Determinants of Physical Activity
Psychological / emotional
Social and cultural
Physical Environment
Boys more physically active than girls
Physical activity declines dramatically
with age (from age 13 to 16)
Self-efficacy strong predictor
Perceived barriers: lack of time and
lack of interest
Enjoyment a strong correlate
 Social influence strong++ - peer and
parents influence
 Physical environmental strongly
associated with physical activity
(especially preschool children)
Local Data
Lindner and Sit, 1998
n = 4,690 (P.5 to F.7)
Reasons for participation:
For Fun
For health and fitness
To be with friends
To become good at the activity
Local Data
Reasons for non-participation:
– Prefer to do one’s ‘own thing’ (? Not attracted by
the regularity, commitments and expectations
being involved in sports)
Reasons for withdrawal:
– Need time for studying
– Wanting to spend more fun time on other leisure
– Wanting time to be with friends
Target high risk group - female
Build perceptions of competence
or self-efficacy
Fun enjoyable activities
Implications (Cont’d)
Reduce perceptions of barriers
Social support from friends
Stimulate parental assistance
Increase time to spend outdoors
Physical Activity Guidelines
 International Consensus Conference
on Physical Activity Guidelines for
Adolescents (Sallis and Patrick, 1994)
 Health Education Authority (Biddle et
al, 1998)
International Consensus Conference
on Physical Activity Guidelines for
 All adolescents should be physically
active daily, or nearly every day
 Engagement in 3 or more days/week
of activities that last for 20 or more
minutes that require moderate to
vigorous levels of exertion
Health Education Authority (UK)
 Participation in physical activity of
moderate intensity for 1 hour/day
 Young people who currently do little
activity should participate in physical
activity of moderate intensity for at least
30 minutes/day (note: consistent with
adult guidelines)
 At least 2 days a week, engage in
exercise that enhance/maintain muscle
strength, flexibility and bone health
Exercise for Obese Children
Exercise for Obese Children
Local Data: Report from Department
of Health
Health services provided to schools
review 13.2% primary school children
as obese
Related to homework, watching TV,
computer games, surfing on the net 
all sedentary behaviours!!
Fitness or Fatness??
 Measures of adiposity and sedentary
behaviours are consistently related
 Children with high level of total body fat
mass and visceral adipose tissue have
increased factors for coronary artery disease
 Obesity predicts poor adherence to exercise
 Obesity in childhood  adulthood
 Physical activity best predictor of weight loss
Think about:
 Physical Activity Guidelines for
 Determinants of Physical Activity
 Principles of exercise training
 Components of physical fitness
 Evaluation Tools
 Follow up period
Evaluation Tools
Measurements of:
 Cardiovascular fitness
 Body fat composition
 Physical activity level
Components of the Program
Social Support - parents involvement
Behaviour change
Relapse prevention
Characteristics of the Exercise
 Home based vs. site-based
 Build activity into child /
adolescent’s lifestyle
 Negative energy balance
 Think about the activity
Physical Activity Levels
Low intensity - 30-50% VO2 max; HR
120-149 beats/min; 2-4 METS
Moderate intensity - 50-70% VO2 max;
HR 150--169 beats/min; 5-7.5 METS
High intensity - > 70% VO2 max; HR >
169 beats/min; > 7.5 METS
HR monitoring considered for
assessing moderate to vigorous
Initiatives in
Hong Kong
Exercise Program

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