Exercise prescription guidelines

Children and Adolescents

 Phases of Growth and Development

Infancy—first year of life

Childhood—age 1 to puberty
Puberty—development of secondary sex
characteristics and capability of sexual
reproduction
Adolescence—puberty to completion of
growth and development
VO₂
• Events such as distance running, children’s performance is far
inferior to adults. (smaller hearts, ↓ stroke volume
• Endurance training yields improvements that are 1/3 those
of adults.
• Children exert more energy compared to adults in wt.
bearing activities for the same relative intensity of work
compared to adults.
Endurance performance and economy of
movement
• Children are less economical runners

Higher metabolic rates

Disadvantageous stride rates to stride lengths

Anaerobic Performance

• Anaerobic capacity is lower than adults as measured by power

output (Wingate test).

Lower muscle glycogen (energy source).

Children differ in hormones response and reflect higher stress
response to exercise.

Implications: Activities of high intensity lasting 15 sec. to 2

minutes will be limited compared to adults.
Training program should be age/size group specific.
Training will improve anaerobic capacity.
Regarding Bone mass
in Children and Adolescents
• Young bone is more responsive to osteogenic stimuli.
• Evidence indicates that physical activity during growth (particular
running and jumping activities or multi-joint exercises) if preformed
progressively can significantly increase bone mass.
• Achieving peak bone mass as an adolescent will contribute to
maintaining more bone mass during later decades of life where bone
mass is diminished.
Vulnerability to Injury

• Overuse and traumatic injury can cause injury to the

growth plate of bones.
• Excessive throwing, or repetitive micro- trauma can
cause premature closing of growth plate and retard
normal bone growth.
Physiological Adaptations
to Exercise Training
• Aerobic training in children
• Little or no change in VO2max
• Performance  due to improved running economy

• Aerobic training in adolescents

• More marked change in VO2max
• Likely due to  heart size, SV
Strength in Children

• Prepubescent strength gains occur in the absence of

changes in muscle size.

• Children are able to get stronger because of growth

and:

• Improvements in neural mechanisms

• Learned motor skill coordination
• Increased motor unit activation
 Strength in Adolescents

• Strength gains at puberty are a result of growth,

increasing body weight and muscle mass.

• Boys experience greater strength because of the

anabolic effects of higher levels of circulating
testosterone.

• Boys can gain greater mass and strength than women

Resistance Training in Preadolescents
• May protect against injury and help build
bones
• Improves motor skill coordination
• Increases motor unit activation
• Results in other neurological adaptations
• Causes little change in muscle size
Potential Hazards with
Resistance Training
• Acute musculoskeletal injuries
Epiphyseal fractures- injury to growth plate at the end of long bones
Risks involve premature closure of growth plate

• Chronic musculoskeletal injuries

• Repeated micro-trauma due to overuse
Include stress fractures, cartilage damage
Heat Stress in Children
• Children have a lower capacity to lose body heat
through sweating.
Produce more body heat per mass unit than adults
A child has a greater ratio of body surface area to mass.
Children’s bodies rely on convection and radiation more
than adults. This ratio is advantageous unless the
environment temp. is higher than skin temp.
Acclimation rates of children are slower than adults.
Implications

• Children should take frequent breaks while exercising

in the hot temperatures and high humidity.
• Activities lasting more than 15 minutes should be
reduced
• Shade should be provided
• Frequent breaks for water and electrolytes is
imperative. Thirst mechanism is not sensitive enough
to replace fluid when needed.
• Protection from sun is a must.
• Allow more time for children a adolescents to
acclimate to new climates.
Cold Exposure in Children
• Because of the larger ratio of surface area to mass, children lose more
heat through conduction placing them at more risk for hypothermia

• Implication: Due to greater risks children should dress in more

clothing layers than the typical adult.

• Children may not realize they are at risk for frostbite.

Exercise Induced Asthma
• A condition brought on by faster breathing when exercising that
causes constriction of airways making breathing difficult.

• 13% of population have it, many athletes

• Symptoms: coughing, tight chest, wheezing, fatigue, shortness of

breath
Rhabdomyolysis
A life threatening condition that can lead to kidney failure and death

• Resulting from too much and too intense exercise

• Excessive muscle breakdown causing enzymes and
myoglobin to be released in the blood stream
• Kidneys try to filter out the muscle components,
but kidney failure could result.
• Rare occurrence but documented cases exist in
high school and college
• Risk factors- drugs, severe exertion, heat stroke
• Symptoms- dark urine, weakness, fatigue
Physical Activity Guidelines for Children and
Adolescents (Ages 6–17)
• Participate in 60+ minutes PA per day
• Most of this time should be aerobic
• Include vigorous-intensity PA 3+d/week
• Include muscle-strengthening and bone-
strengthening activity
Elderl
y
 Exercise for Older Adults

Exercise For Older Adults

• VO2 max declines ~1% per year
• Regular exercise may reduce rate of decline
• Benefits of participation
• Improved risk factor profile
• Increased strength and VO2 max
• Increased bone mass
• Recommendations
• Similar to younger subjects
• Medical exam and risk factor screening is essential
 Exercise for Older Adults

Osteoporosis
• Reduced bone mineral density and increased
fracture risk
• More common in women over fifty due to lack of
estrogen
• Prevention and treatment
• Dietary calcium
• >1000 mg/day through food and supplements
• Vitamin D
• 800 IU/day
• Hormone replacement therapy (HRT)
• Prevents bone loss and reduces fracture risk
• May increase risk of cardiovascular disease and cancers
• Exercise
 Exercise for Older Adults

Exercise for Bone Health

• Mode
• Weight-bearing endurance activities
• Activities that involve jumping
• Resistance training
• Intensity
• Moderate to high
• Frequency
• Weight-bearing activities 3–5 times/week
• Resistance exercise 2–3 times/week
• Duration
• 30–60 minutes/day
Strength Training (resistance training)
• Muscle strength declines by 15 percent per decade after age 50 and
30 percent per decade after age 70.
• greater degree in older women than men.
• Resistance training can result in 25 to 100 percent, or more, strength
gains in older adults through muscle hypertrophy and, presumably,
increased motor unit recruitment.
• Strength training also improves nitrogen balance and can, combined
with adequate nutrition, prevent muscle wasting in institutionalized
elderly persons.
Flexibility Training:
• If an elderly person is more flexible, he or she is less likely to become
injured or have low back pain.
• At the beginning, choose 4 to 6 stretches for the upper body and 2 to
4 stretches for the lower body. 2 to 3 times/ week are recommended.
• Stretches should be repeated 3 to 4 times each and held for 15-30
seconds.
• Exhalation should be done when moving into the stretch and
inhalation should be done when returning to the starting position
Balance training
• Exercise that helps maintain stability during daily activities and other
exercises, preventing falls.
• It can be static (e.g., stand on one leg) or dynamic (e.g., walk a
tightrope), with hand support as needed
 Exercise for Older Adults

Exercise in Elderly People:

The Training Effect
• ACSM and AHA exercise recommendations
• Aerobic (endurance) activity
• Moderate intensity, ≥30 min on five days per week
• Vigorous intensity, ≥20 minutes on three days per week
• Or both
• Strengthening exercises
• 8–10 exercises (major muscle groups), two days per week
• 10–15 repetitions per exercise
• One day per week may be sufficient for strength gains in those
>65 years of age
• Flexibility exercises
• 10 minutes on at least two days per week
• Maintain or improve balance to prevent falls
 Exercise for Older Adults

In Summary
 The “normal” deterioration of physiological function with
age can be attenuated or reversed with regular endurance
and strength training. The benefits of participation in a
regular exercise program include an improved risk factor
profile (e.g., higher HDL and lower LDL cholesterol,
improved insulin sensitivity, higher VO2 max, and lower
blood pressure), but the training effects may take longer to
realize.
 The guidelines for exercise training programs for older
adults are similar to those for younger people, emphasizing
the need for a medical exam and screening for risk factors.
The effort required to bring about the training effect may
be less than that for younger individuals.
Exercise prescription for Diabetics
Guidelines
• The exercise prescription for these two types of diabetic
populations is somewhat different.
• In the case of Type I diabetics, the emphasis is on glucose
regulation. Hence, these patients are encouraged to exercise 7 days
a week.
• In the case of Type II diabetics, the emphasis is on weight reduction
and increased physical activity. For these reasons they are
encouraged to exercise 3-5 times a week since they do produce
insulin and absolute glucose regulation is not the primal reason for
the exercise prescription.
Parameters Type I Diabetics Type II diabetics

Mode Aerobic/Anaerobic Aerobic/Anaerobic

Frequency 7 days/week 5 days/week

Duration 20-30 minutes 30-60 minutes

Intensity 45% - 85% MHR 45% - 70% MHR

Borg Scale 10-14 RPE 10-14 RPE

Precautions
 Avoid exercising during periods of peak insulin activity
 Know the signs of hypoglycemia - lightheadedness, diaphoresis,
palpitations, loss of motor control, changes in mood, etc.
 Wear good foot wear
 Practice scrupulous foot inspections for fissures, blisters or reddened
areas
 Inject the insulin into a muscle mass that does not directly participate in the
physical work
 Learn to drop insulin requirement as exercise effects the insulin needs
 Do not take beta-blockers because they mask the symptoms of hypoglycemia
 Never exercise if blood glucose is over 300 mg/dl
 If glucose is between 110 - 280 mg/dl, it is okay to start exercise
 Learn to monitor blood glucose every thirty minutes of continued exercise
Patients with Hypertension
Hypertension is divided up into several classes as seen in the table below :

Blood Pressure Classification Systolic Pressure in mm Hg Diastolic Pressure in mm Hg

Normal Blood Pressure Below 130 Below 85
High Normal Blood Pressure 130-139 85-89
Mild Hypertension 140-159 90-99
Moderate Hypertension 160-179 100-109
Severe Hypertension 180-209 110-119
Very Severe Hypertension >209 >119
Exercise prescription parameters

Exercise Parameters Exercise Prescription

Mode Aerobic Exercise
Frequency 3-4 times/week
Duration 15-30 minutes
Intensity 40%-70% of Exercise test values
40%-70% of Exercise test Systolic
Max. Exercise BP
Pressure
Borg Scale 10 -14 RPE
• As with any exercise program, it is important to have a 5-10 minute
warm up period during which the patient performs exercise at an
intensity lower than that which is performed during the steady state
exercise period of the prescription.
• Likewise, it is important that there be a 5-10 minute cool down period
after the exercise period is finished. Most coronary incidents occur in
the recovery period after exercise. The cool down period allows the
body to recover from the exercise in a sensible manner.
• Resistance weight training is not recommended until several weeks of
the aerobic exercise program has been completed
• in the case of weight lifting, can cause the blood pressure to rise
dramatically. You should always stress with your patients that all
exercise must be done without ever doing a Valsalva manuever.
• You should be very familiar with the medications your patient is taking.
In the case of anti-hypertension medications, it is critical that the patient
take them regularly. It is your responsibility to remind the patient and
insist that they take their medication for hypertension.
Case 1
• Design an exercise program for 14 year old female with body mass
index of 28.0. Mention all the relevant Physical fitness components to
be focused with emphasis on exercise prescription to achieve the
weight loss.
Case 2
• A 75-year-old male complains of joint pain and has
history of Osteoporosis and no known major
cardiovascular diseases. Design an exercise program
with the objectives of reducing the risk of falls and
non-traumatic fractures
Case 3
• Design an exercise program for a 45-year-old
Diabetic (history less than 3 years) and poor
sugar control who is on Insulin therapy.
Case 4
• 52-year-old with history of pre-hypertension is
referred for Exercise program to prevent the future
risk of Hypertension. Write the exercise prescription
plan for him.