Chapter 16: Foundations of strength training for special populations

Transcription

1 Chapter 16: Foundations of strength training for special populations

2 Thought Questions What is the relationship between resistance training and sarcopenia? Can resistance training have an effect on childhood obesity? How is resistance training beneficial in Post-Polio Syndrome? Arthritis? Muscular dystrophy? AIDS? Fibromyalgia? Should a pregnant female do resistance training exercises? Give examples.

3 Strength Training for Special Populations The health fitness instructor needs to design an individualized program in close consultation with the client They must understand the client's needs and precautions, where to get more information, be alert to problems and know when to take action or call for medical help Resistance training has become an important component of exercise programs for athletes and for overall health and fitness in the general population Bird, S.P., & Cannon, J. (2006). The role of resistance exercise in chronic disease: Prescription guidelines and application in clinical practice. [Review]. Critical Reviews in Physical and Rehabilitation Medicine, 18(4),

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5 Geriatrics People reaching age 65 have an average life expectancy of an additional 18.2 years, but many will have to deal with at least one chronic condition that will impact their quality of life yrs olds: 20% have difficulties with activities of daily living (ADLs); only 26% engage in regular physical activity 85 yrs old or above: over half have difficulties with ADLs 75 yrs old or above: only 16% engage in regular physical activity Galvao, D. A., Newton, R. U., & Taaffe, D. R. (2005). Anabolic responses to resistance training in older men and women: a brief review. Journal of Aging and Physical Activity, 13(3),

6 Normal Aging and Sarcopenia Typical aging process: deleterious effects on human skeletal muscle; associated with loss of muscle mass, muscle strength and power, and even ADLs Sarcopenia: progressive loss of muscle mass with advancing age; accompanied by loss of motor units Overall effects of sarcopenia contribute to decline in basal metabolic rate and progressive increase in percent body fat Resistance exercise: a powerful stimulus to lessen the effects of sarcopenia in the elderly Progressive resistance training (PRT): preserves both muscle mass and strength in older adults Increasing muscular strength and mass in the elderly improves functional status, independence, and overall quality of life

7 Osteoporosis Osteoporosis: a systemic process of diminishing bone mass and deterioration of internal bone structure that results in an increased risk of fracture; known as a silent disease because the first sign of disease may be a fracture More than 1.5 million fractures annually are attributed to osteoporosis Osteopenia: death of bone cells Exercise has become a primary treatment recommendation for osteoporosis Evidence suggests that resistance training and weight-bearing exercise are essential for a client with osteoporosis Bone mass attained early in life and maintained with exercise, diet, and lifestyle choices is the best way to prevent osteoporosis

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9 Arthritis Arthritis: one of the most prevalent chronic conditions worldwide; projected to affect 60 million individuals by the year 2020 in the U.S. alone Two common types Rheumatoid arthritis (RA) Osteoarthritis

10 Rheumatoid Arthritis Chronic, systemic, multijoint disease Affects the joints of the hands, wrists, elbows, shoulders, knees, feet, and cervical spine in a symmetrical pattern No known cure for RA, but it can be controlled with a combination of medications Range-of-motion exercises and/or non-weight bearing workouts have been the predominant modes of exercises prescribed by health care professionals However, a study has shown that dynamic exercise therapy is effective in increasing muscle strength with no negative effects or increase in pain

11 Osteoarthritis Also called degenerative joint disease Affects more than 20 million individuals in the U.S. Predicted to affect 70 million by 2030 Characterized by the degeneration of cartilage, which covers the ends of bones in a joint Although a number of treatment approaches such as pain relief techniques, surgery, and/or pharmaceutical interventions exist, recent research has found that exercise is one of the better treatments for osteoarthritis

12 Pediatrics Approximately 30% of children and adolescents are overweight; about 15% are obese This increases risk factors for conditions like asthma, diabetes, and hypertension. Some children are born with a disability, such as cerebral palsy, Down s syndrome, or muscular dystrophy All of these conditions and disabilities can significantly affect physical functioning during childhood Health fitness professionals can play a key role in getting the pediatric population started on a lifelong path of physical fitness

13 Healthy Children and Adolescents The process of growth and development in children (prepuberty) and adolescents (postpuberty) results in increases in muscle size and strength. There is an age effect which means older children and adolescents will be stronger, pound for pound, than younger individuals. Many studies have shown that resistance training in children and adolescents effectively increases muscle strength Prior to puberty, anabolic hormone concentrations are low; this limits the potential for resistance training to cause significant hypertrophy After puberty, both males and females are capable of changes in both muscle size and strength with properly implemented resistance training programs Major concern with youth resistance training is safety

14 Improper resistance training can cause damage to epiphyseal plates which leads to improper growth of the long bones Key to safe resistance training in youth is to ensure that there is proper supervision for training and that lighter weights and higher repetitions are used A properly designed and supervised resistance training program should incorporate periodization principles to vary volume and intensity throughout the year Progression should emphasize increases in repetitions relative to increases in resistance, very light loads should be used when new movements are being learned to ensure learning proper technique Wilson, G., Bird, S.P., O Connor, D., Baker, D., & Jones, J. (2007). Resistance training for children and youth: A position stand from the Australian Strength and Conditioning Association (ASCA). Beenleigh, QLD: Australian Strength and Conditioning Association 2007 ASCA National Conference Presentation

15 Cerebral Palsy Cerebral palsy: term used to describe a group of non-progressive infant-onset motor disorders typically caused by various sources of cerebral ischemia during the prenatal, perinatal, or postnatal period Common motor problems include spasticity, hyperreflexia, difficulties with fine motor control, and gait dysfunction Most common cause of childhood physical disability and occurs at a rate of between 2.0 and 2.5 cases per 1,000 live births Muscle weakness is often present in one (hemiplegia) or both limbs (diplegia) Resistance training shown to increase muscle strength in CP patients These increases in strength do not exacerbate symptoms of CP such as spasticity They may, however, help improve the performance of ADLs

16 Mental Retardation and Down s Syndrome One of the major causes of mental retardation is Down s syndrome. Down s syndrome: genetic disorder that affects approximately 1 in 600 to 1,000 live births Characterized by cognitive delay, distinct facial features such as epicanthal folds of the eyelids and a relatively flat occiput and nasal bridge, and short limbs People with Down s syndrome also often have poor muscle tone (hypotonia) and joint laxity, which can lead to increased risk of musculoskeletal and orthopedic problems Individuals with Down s syndrome have been shown to be significantly weaker than both age- and sex-matched controls This weakness is correlated with low bone mineral density; therefore the risk of osteoporosis is elevated in those with Down s syndrome Resistance training greatly benefits individuals with Down s syndrome by increasing muscle tone and motor activity

17 Muscular Dystrophy Muscular dystrophy: describes a family of genetic muscular diseases that involve dysfunction of the dystrophin glycoprotein complex in skeletal muscle; this leads to progressive muscle wasting, weakness, and disability The most common form is Duchenne muscular dystrophy (DMD) DMD: most common fatal childhood genetic disease (1 in 3,500 births); only found in boys Over time, repeated cycles of muscle degeneration and regeneration lead to a net degeneration of the muscle tissue, weakness, loss of mobility, and eventually death Alternative forms of progressive resistance training program can build muscle and maintain a healthy body in individuals with DMD

18 Neuromuscular Disease Can be due to damage or dysfunction in the CNS, the peripheral nerves, or the muscle tissue Complex multiple-system conditions can occur, like stroke and fibromyalgia Common symptoms: spasticity, rigidity, weakness, and sensory loss Resistance exercise can help in the rehabilitation of neuromuscular conditions where weakness is the main cause of loss of motor function Lindeman, E., Spaans, F., Reulen, J., Leffers, P., & Drukker, J. (1999). Progressive resistance training in neuromuscular patients. Effects on force and surface EMG. J Electromyogr Kinesiol, 9(6),

19 Stroke Stroke: death of brain cells as a result of impaired blood flow to the brain About 750,000 people experience a stroke each year in the U.S. Third leading cause of death in the U.S. and the leading cause of disability in adults. Two general categories of strokes: ischemic strokes and hemorrhagic strokes Ischemic stroke: similar to a heart attack in that occlusion of a cerebral artery occurs due to plaque formation Hemorrhagic stroke: results from the loss of structural integrity of a cerebral blood vessel and subsequent bleeding Both types can lead to muscle weakness and spasticity

20 Motor symptoms are typically most severe on one side of the body Several studies have shown that strength training has the potential to improve function Structured resistance training programs may improve a stroke patient s cardiovascular and respiratory efficiency, thus improving quality of life Harris, J. E., & Eng, J. J. (2010). Strength training improves upper-limb function in individuals with stroke: a meta-analysis. Stroke, 41(1),

21 Fibromyalgia Not a disease but rather a chronic pain syndrome Has a variety of symptoms; the main symptom is the presence of tender points at sites throughout the body (mainly muscle tissue) About 2% of the population has FMS; it is predominant in women and increases with age Diagnosis requires pain to be present in at least 11 of 18 common sites throughout the body Other symptoms include fatigue, sleep disturbances, and vision problems A deconditioning/ pain cycle is often seen in FMS, because those with this condition often avoid physical activity due to pain A resistance training program for FMS patients may help reduce pain and maintain muscle tone

22 Post-Polio Syndrome Poliomyelitis: viral disease in which the polio virus attacks alpha motor neuron cell bodies in the spinal cord and brainstem Individuals with post-polio syndrome are those who have recovered function after the initial poliomyelitis but develop symptoms of weakness and fatigue 30 or more years later Studies have found that exercise is safe and effective for individuals with PPS as long as individual tolerance is used to monitor exercise intensity

23 Multiple Sclerosis Chronic inflammatory autoimmune disease of unknown etiology that affects the central nervous system Causes a loss of myelin resulting in disruption of nerve conduction Symptoms may include weakness, tremors, spasticity, fatigue, sensory disturbance, heat sensitivity, and impairment of balance, coordination, vision, speech, swallowing, cognition, and bowel and bladder function MS affects about 400,000 people in the U.S. Studies show that people with MS can improve strength, fitness, and quality of life through aerobic and resistance training Exercise programs should be tailored to the individual de Souza-Teixeira, F., Costilla, S., Ayan, C., Garcia-Lopez, D., Gonzalez-Gallego, J., & de Paz, J. A. (2009). Effects of resistance training in multiple sclerosis. Int J Sports Med, 30(4),

24 Spinal Cord Injury Most often results from motor vehicle accidents (50.4%) and falls (23.8%), followed by violence (11.2%) and sports injuries (9%) Approximately 247,000 people live with SCI in the U.S. Categorization depends on the level of injury and whether it is complete or incomplete C1 to T1 injuries result in tetraplegia T2 to T12 injuries result in paraplegia These two groups are upper motor-neuron injuries T12 and below result in paraplegia and are considered lower motor-neuron injuries

25 Research on resistance training with SCI has focused on those with paraplegia Circuit resistance training has been shown to be the most effective method of improving strength and decreasing pain Several precautions must be taken due to the motor and sensory deficits that result from an SCI Willoughby, D. S., Priest, J. W., & Nelson, M. (2002). Expression of the stress proteins, ubiquitin, heat shock protein 72, and myofibrillar protein content after 12 weeks of leg cycling in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 83(5),

26 AIDS/HIV Human immunodeficiency virus (HIV): a pandemic disease that currently has no cure; may lead to acquired immunodeficiency syndrome (AIDS) Approximately 40,000 new cases of HIV/AIDS occur each year Along with its effects on the immune system, the disease is also associated with weight loss (muscle wasting) Wasting affects the musculoskeletal system resulting in weakness Incorporation of resistance training may increase muscle mass and facilitate health benefits Bhasin, S., et al. (2000). Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels. JAMA, 283(6),

27 Chronic Obstructive Pulmonary Disease COPD: a progressive respiratory illness that is not completely reversible Primary pathology is expiratory airflow limitation Encompasses a number of pulmonary conditions such as asthma, emphysema, and chronic bronchitis Biopsies from the quadriceps muscles of COPD patients have revealed a loss of type I muscle fibers and a reduction in oxidative enzymes Traditional treatments have included pharmacological intervention, oxygen therapy, lung transplantation, or lung volume reduction surgery Pulmonary rehabilitation clinics have also begun to incorporate exercise training as a standard part of treating COPD patients A beneficial effect of resistance training for COPD patients is reduced anxiety and fatigue as well as independence in performing ADLs

28 Cardiovascular Disease Includes coronary heart disease and stroke Is the leading cause of death among Americans Major risk factors include hypertension, elevated serum total cholesterol, cigarette smoking, and diabetes mellitus Higher levels of physical activity were associated with a lower risk of developing cardiovascular disease Effects of resistance exercise may also reduce cardiovascular risk factors A combination of aerobic exercise and circuit resistance training improves skeletal muscle function and vascular function Braith, R. W., & Stewart, K. J. (2006). Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation, 113(22),

29 Obesity Defined as a BMI greater than 30 Is associated with cancer, type II diabetes, hypertension, hyperinsulinemia, and coronary heart disease A combination of resistance training, aerobic exercise, and caloric restriction is the optimal method of reducing body fat safely and effectively in obese individuals Tresierras, M. A., & Balady, G. J. (2009). Resistance training in the treatment of diabetes and obesity: mechanisms and outcomes. J Cardiopulm Rehabil Prev, 29(2),

30 Diabetes Mellitus Two general categories of diabetes: Type I diabetes: characterized by pancreatic damage, resulting in diminished insulin secretion from the pancreas; often referred to as juvenile-onset diabetes Type II diabetes: characterized by insulin resistance; a given glucose challenge requires a greater insulin response Aerobic exercise can both decrease the risk of developing type II diabetes and aid in glycemic control Studies have shown that resistance exercise improves insulin sensitivity and glucose tolerance and improves glycemic control Zacker, R. J. (2005). Strength training in diabetes management. Diabetes Spectrum, 18(2),

31 Cancer In 2000, cancer was the second leading cause of death in the U.S. Treatment involves radiation, chemotherapy, surgery, or a combination of these Many of these treatments are intensive and affect physiologic function; this can cause fatigue, muscle wasting, and energy loss Resistance training and aerobic exercise can help counteract these effects Galvao, D. A., Newton, R. U., & Taaffe, D. R. (2005). Anabolic responses to resistance training in older men and women: a brief review. Journal of Aging and Physical Activity, 13(3),

32 Pregnancy Concerns about exercise during pregnancy: increased body temperature, impaired uterine blood flow and nutrient supply, and the risk of preterm labor Moderate, regular exercise during pregnancy has many benefits for the mother, including decreased weight gain, more rapid weight loss after pregnancy, improved sense of well-being and decreased risk of musculoskeletal pain and gestational diabetes A pregnant woman should always seek guidance from her physician prior to proceeding with an exercise program If a woman has been exercising prior to pregnancy, she can continue with minor modifications If a woman has not exercised previously, she may cautiously begin a gentle exercise program and must be alert to overexertion and complications

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34 Summary It is increasingly apparent that resistance exercise provides significant benefits to chronic disease patients. Nonetheless, caution should be applied in introducing progression into a program. Using a team approach with appropriate health care providers can enhance the safety and effectiveness of a program Future research needs to further delineate the program design variables (intensity, frequency, volume, etc.) that maximize benefits (including functional outcomes) while minimizing deleterious effects for different diseases and syndromes. In addition, longer-term studies need to be performed to assess the benefits and risks of prolonged resistance exercise for these special populations