Fitness and Healthy Lifestyle

Chapter 13

Introduction

• Major goal in adapted physical activity– Detriments to achievement

• Lack of knowledge

• Lack of self-determination

• Lack of self-confidence

• Lack of self-esteem

• Role models

Recent Changes in the Knowledge Base

• NCPAD• WHO• Biocultural approach to physical activity• Healthy People 2010• American Association on Mental

Retardation• Exercise and physical activity adherence

focus

Recent Changes in the Knowledge Base

• Increased use of FITNESSGRAM, the ACTIVITYGRAM, and the new Presidential Active Lifestyle Award - PALA

• ACSM updated guidelines and resources

• Minimal physical activity standard for health benefits

Recent Changes in the Knowledge Base

• Minimal physical activity standard pertaining to calories expended during activity

• Easy-to-understand information about conditioning, training, and testing people with disabilities

• NCPERID standards

Definitions of Fitness, Activity, and Related Terms

• Physical fitness

• Physical activity

• Exercise

• Function or capacity

• Health

• Wellness

Rehabilitation Versus Fitness Programming

• Rehabilitation - restoration and/or maintenance of physical function which allows an individual to perform activities of daily living without incurring high levels of stress or fatigue

• Services provided in hospitals or centers that provide services for persons temporarily or permanently disabled

• Medical model• Reimbursed by insurance

Rehabilitation Versus Fitness Programming

• Fitness testing and training - conducted in many settings and follows many models

• Associated with goals beyond activities of daily living

• Prevention of hypokinetic conditions like obesity, heart disease, high blood pressure

• Hypokinetic - insufficient movement or exercise• Hypokinetic disease begins in childhood

Lifestyle Problems of Americans

• Everything that interferes with wellness and negatively affects lifespan

• Various factors such as diet, stress, smoking, drug abuse, and physical inactivity are risk factors

• SHPPS report on physical activity in schools• Healthy People 2010 - increase daily physical

education• Exercise adherence

Lifestyle Concerns Pertaining to Disability

• Poor body alignment and inefficient movement patterns increase energy expenditure

• Various factors negatively affect mechanical efficiency and energy level

• Coping with barriers requires extra energy• Employment requires high levels of fitness• Obtain social acceptance and overcome

discrimination

Lifestyle Concerns Pertaining to Disability

• Relief of chronic depression and other mental health problems

• Sedentary lifestyles are associated with lack of socialization into sport or physically active lifestyles

• Success in programs can increase body image and self-concept

• Activity deficit hypothesis• Obesity associated with movement problems in

children

Components of Health-Related Fitness

• Cardiorespiratory or aerobic endurance• Body composition• Muscular strength and endurance• Flexibility• Also beliefs, attitudes, and intentions that

give persons the self-determination, self-confidence, and self-esteem to achieve and maintain fitness goals

The FITNESSGRAM

• School-age individuals with functional capacity to perform the test items

• Criterion referenced• Includes alternatives items for individuals

who cannot perform the prescribed six tests• Unique aspects include the PACER,

cadence tapes for curl-ups and push-ups, and alternative tests for upper body strength

Assessment of Physical Activity

• ACTIVITYGRAM – Recall of physical activity over previous 24

hours in 30-minute blocks– Six categories examined as well as the intensity

levels in each 30-minute block

• Data is also gathered through the use of heart rate monitors, activity monitors, direct observation, and self-report

Brockport Physical Fitness Test

• Parallels the FITNESSGRAM and is a health-related, criterion-referenced test

• Presents standards for youth in the general population as well as five subgroups with various disabilities

• Recommended adaptations and alternatives for testing students with various disabilities

Brockport Physical Fitness Test

• Target Aerobic Movement Test• Seated Push-Up• Reverse Curl• Wheelchair Ramp Test• Modified Apley Test• Modified Thomas Test• Dumbbell Press• Target Stretch Test

Other Fitness Tests

• Each country has its own test, norms, and minimal standards

• President’s Council on Physical Fitness and Sport - uses norms and award structure

• YMCA test is used worldwide

• Various single fitness component tests

School Fitness Testing: History, Issues, Trends

• Which tests to use

• How high to set fitness standards

• How much time to spend training and testing

• Fitness over sports and motor skills training

• Trend toward performance within healthy fitness zones

• Personalization of fitness goals and tests

Types of Fitness: Physical and Motor

• Physical fitness - health-related– Cardiorespiratory endurance, body

composition, muscular strength and endurance, and flexibility

• Motor fitness - skill-related– Agility, balance, coordination, speed, power,

and reaction time– Included as part of definition of physical

education in IDEA

The 1950s: Early Beginnings

• Kraus-Weber research findings

• American College of Sports Medicine

• President’s Council on Youth and Fitness

• First AAHPER Youth Physical Fitness Test

• Contributions of Rarick

The 1960s to the 1980s

• 1960-1970s focus on both physical and motor fitness

• 1980s AAHPERD tests changed focus exclusively to health-related fitness

• Fitness tests for persons with mental retardation• Fitness norms developed for youth who were blind

or visually impaired - later adjusted to match general population except running items

The 1980s Onward: Health-Related Fitness

• Late 1980s AAHPERD moved to criterion-referenced

• Physical Best replaced by FITNESSGRAM

• Major research for fitness of various populations funded by U.S. government including four specifically targeted at various disability groups

Fitness Classifications Requiring Special Help

• Various methods of classifying fitness and identification of individuals who require special help

• Adapted physical activity generally focuses on those who are classified as having symptomatic clinical status

VO2max

• Maximum amount of oxygen consumed by cells in the final seconds of exercise prior to total exhaustion

• Age and gender both affect VO2max

• Active muscle mass, understanding test instructions, and poor motivation affect results

METS

• Metabolic equivalents

• Alternative way of indicating aerobic capacity

• Ranges from 1 to 16– Those who function in the 1 to 6 range have

severe fitness problems that interfere with daily living activities

Exercise Prescription: Five Components

• Frequency - 3 to 5 times a week

• Intensity - 60 to 90% of maximum heart rate

• Time - 20 to 60 minutes

• Modality - rhythmic, large muscle activity

• Rate of progression - gradual increase in frequency, intensity, and time

Exercise Prescription: Five Components

• Assessment

• Goal setting

• Decision making about training

• Establishment of dates and program duration

• Evaluation to determine if goals are being achieved

Personalizing Goals for Various Conditions

• Severe developmental disabilities

• Spinal paralysis and injury rehabilitation

• Other health impairments

• Limited mental function

• Limited sensory function

Severe Developmental Disabilities

• Postural reflex mechanism and muscle tone• Population includes those with limited

mental and/or physical capacities• Major goals include ROM, functional

ability to perform movement patterns used in fitness, and exercise capacity tolerance

• For those with good intelligence, ROM is the primary fitness goal

Spinal Paralysis and Injury Rehabilitation

• Strength is a major goal - often with ROM

• Residual strength grading system– Also used in disability sport classification

• Postural fitness is associated with imbalances in strength and flexibility

Other Health Impairments

• Weight loss and aerobic endurance are generally the major goals

• Sedentary lifestyles

• Concurrent conditions

• Distorted perceptions about ‘feeling good’

• Realization of fitness level

Limited Mental Function

• Same fitness needs as general population• Weight loss and cardiorespiratory endurance are

generally most important goals• Understanding of speed and distance• Congenital heart disease• Autonomic nervous system regulation• Severe retardation - importance of fitness training

over other goals

Limited Sensory Function

• Same fitness needs as general population

• Senior citizens - assistance with cardiorespiratory fitness

Aerobic Capacity or Cardiorespiratory Endurance

• Most important component of health-related fitness

• Improvement - performance of vigorous activities that elevate heart rate for a minimum of three minutes

• Begin with interval conditioning – Bouts of 1 min of exercise interspersed with 1

or 2 min of rest

Assessment of Aerobic Capacity

• Field tests - step tests, distance runs, and walking tests

• Field tests provide estimates of ability• Laboratory tests are done on treadmills,

bicycle and wheelchair ergometers, and arm-cranking devices

• Awareness of cardiac resting and exercise recovery rates

Assessment of Aerobic Capacity

• Resting heart rate is a good indicator of fitness

• Recovery time helps determine whether exercise demands are appropriate or excessive

• Recovery of breathing rate to normal should require less than 10 min

Prescribing Aerobic Exercise

• Continuous (more than 3 min) low-impact exercise recommended

• Four principles for low-fit people– Use low-impact activities– Match frequency, intensity, and time to ability– Pay attention to self-concept and motivation– Teach acceptance that rate of progression will

be slower than for average people

Matching Frequency Intensity and Time to Ability

• Frequency - daily when working with low-fit people

• Time - as many minutes as can be tolerated and/or woven into a person’s schedule

• Intensity can be prescribed by several methods - VO2 max, METS, or calories, maximal heart rate, rating of perceived effort, pain, and breathlessness

Intensity Prescribed by VO2max, METS, or Calories

• 40 to 70% VO2max• Moderate intensity is defined as 3 to 6

METS• 300 calories per exercise session

• Maintain heart rate in the target zone during exercise

Intensity Prescribed by Maximal Heart Rate

• Fastest speed a heart can attain during exhaustive exercise without compromising or endangering life

• Age-adjusted MHR formula• Exercise within a range of 60 to 90% of MHR• When active mass is limited MHR is not

applicable• Some OHI conditions, environmental factors,

stress, and medications can affect MHR

Perceived Exertion, Pain, and Dyspnea

• Children from age 7 onward give RPEs that correlate highly with heart rate

• Overweight persons tend to overestimate• Use for people whose hearts do not respond

properly to exercise• Goal of exercise tolerance for individuals

unable to maintain target heart rate

Perceived Exertion, Pain, and Dyspnea

• Real pain versus discomfort• Increase intensity gradually• Coping with or ignoring discomfort may need

to be taught• Use numerical scales to objectify ratings of

pain and dyspnea (breathing discomfort)

Body Composition

• Individual components that constitute the total body mass

• Females have more fat, and males have more muscle tissue

• Children have less body fat than adults• Largely genetically determined• Some disabilities affect body composition• Body fat percentage is a major fitness concern

Assessment of Body Fat

• Measured using laboratory protocols and formulae

• Estimated using skinfold caliper measures

• Triceps is recommended if using one site

• Best combination of skinfold measures is controversial

Body Mass Index: Substitute Measure

• Substitute for body fat measures when skinfold calipers are not available

• Ratio of body weight to the square of body height:

€

BMI =Bodyweight(kg)

Height 2(meters)

Body Mass Index: Substitute Measure

• Interpret physical and motor fitness scores in relation to height, weight, and skinfolds

• Height-weight tables heighten motivation for lifestyle changes but weight and percent body fat are not highly correlated

Prescribing Exercise for Fat Loss

• Large muscle activity needs to use more calories then are consumed daily

• ACSM recommends no more than 2.2 lb should be lost per week

• Obesity is a medical problem• Long-duration activity at low intensity is as

effective as short duration/high-intensity activity• Counseling and support groups are essential

Muscle Strength/Endurance

• Strength developed when muscle exertion is near maximum

• Endurance developed when a muscular activity continues for several seconds

• Age and gender differences in strength parallel changes in muscle mass

Assessment of Muscle Strength/Endurance

• Principle of specificity - benefits of exercises done in one position will not transfer when the muscle is used in other positions

• Four general muscle groups tested

• Focus is on the number of times an exercise is done in the prescribed posture or position

Prescribing Exercise for Muscle Strength/Endurance

• Sedentary persons should take all muscle groups through strength and endurance exercises at least 2 days a week

• Variety of different activities

• Principle of overload - progressively increasing the demands made on a muscle group - increase reps then resistance

Prescribing Exercise for Muscle Strength/Endurance

• Isotonic exercises - dynamic or moving– Endurance exercises - use lighter weights and

more repetitions– Strength exercises - use heavier weights and

fewer repetitions– Progressive resistance exercise– Strength should be coordinated with a good

flexibility routine

Prescribing Exercise for Muscle Strength/Endurance

• Isometric exercises - static– Maximum or near-maximum muscle

contraction that is held for 6 sec and repeated several times

– Highly specific, strengthening muscles only for work at the same angle as the training

– Not based on the overload principle– Not recommended for individuals with heart

disease and high blood pressure

Prescribing Exercise for Muscle Strength/Endurance

• Isokinetic exercises - machine-generated– Constant resistance machines– Keep velocity of movement constant and match

the resistance to the effort of the exerciser– Maximal tension exerted throughout the range

of motion

Valsalva Effect and Contraindications

• Increase in intraabdominal and intrathoracic pressure that results when breath is held

• Causes– Heart rate to slow down– Return of blood to the heart to decrease– Blood pressure to elevate

• Contraindicated for persons with high blood pressure conditions or glaucoma

Range of Motion and Flexibility

• Ability to move body segments through the actions and planes designated normal for each joint

• Range of motion (ROM) - when the movement capacity at a joint is measured in degrees

• Flexibility - functional stretching ability• Gender, age, and musculoskeletal differences

affect flexibility as well as some disabilities

Assessment of ROM/Flexibility

• Flexibility is specific to each muscle group

• Sit-and-reach measures hamstring, hip, and spine flexibility

• Measurements begin from anatomical position and are either an average of two or three measurements or the maximum

Prescribing Stretching Exercises

• Purposes are generally to maintain elasticity, to warm up and cool down, or to correct pathological tightness

• Stretches should be slow and static not ballistic• Modalities can be active, passive, and/or

combinations• Incorrectly done stretches can worsen disabilty or

cause injury

Using Proprioceptive Neuromuscular Facilitation

• A system of stretching that requires the help of an assistant that stimulates the proprioceptors to enhance functional flexibility

• Based on the principle of reciprocal innervation• Recommended for individuals with cerebral palsy

and arthritis• Two types of PNF

– Contract-relax– Hold-relax - recommended if pain is an issue

Beliefs, Attitudes, and Practices

• Application of theories can be used to help persons develop fitness and make changes in lifestyle

• Belief, attitudes, and practices should be included when developing goals and objectives

Underlying Theories

• Reasoned action attitude theory

• Self-efficacy or social cognitive theory

• Perceived competence theory

Self-Reports

• Assessment includes self-reports of motivation, food intake, physical activity, and attitudes about the body and exercise

• Self-motivation information helps in counseling and individualized teaching

• Diaries or logs of food intake and physical activity help structure goal setting

Weather and Temperature Concerns

• Important in all aspects of fitness• Susceptibility to heat and cold extremes• ANS damage compromises temperature

regulation - dehydration a major concern• Poikilothermy• Humidity and wind-chill factor• Body temperature responses - hypothermia,

hyperthermia, and heat stroke

Space and Equipment

• Variety of physical activity spaces

• Select equipment based on weakest muscle groups

• Equipment for aerobic endurance

• Instruction and experience in use of community health and exercise centers

• Adaptable equipment for variety of levels

Organization of the Lesson: Five Parts

• Warm-up

• Aerobic conditioning

• Flexibility exercises for each major muscle group

• Muscle strength/endurance exercises

• Cool-down

Teaching for Fitness: A Review of Principles

• Individual differences• Overload/intensity• Frequency• Specificity/transfer• Active/voluntary movement• Correct breathing• Recovery/cool-down• Warm-up

Teaching for Fitness: A Review of Principles

• Static stretch• Contraindication• Adaptation• Motivation• Maintenance• Nutrition• Environmental factors• Ecological or social validity

Exercise Conditioning Methods

• Methods of teaching various exercise components– Interval or intermittent– Circuits– Continuous– Combinations

• Built around one modality or incorporated in various games and movement activities

Interval or Intermittent Training

• Especially beneficial for persons with asthma, MD, and MS

• Exercise for short periods with rest intervals between

• Generally planned for individuals or small groups

• Sessions become more demanding each week

Interval or Intermittent Training

• Associated terms:– Set– Work interval– Rest interval– Repetitions– Target time– Level of aspiration

Circuit Training

• Moving from station to station

• Each station focuses on different muscles

• Fewer stations for younger students

• Amount of time at each station varies and transition time is kept short

• Intensity increases gradually over time

• Leaders at stations can be used if needed

Continuous Conditioning

• Exercises that impose consistent submaximal energy requirements throughout the training session– Aerobics, including dance and hydroaerobics– Rope jumping, continuous

Combination Conditioning

• Use both continuous and intermittent activity

• Other examples include– Astronaut or football drills– Jogging, hiking, and cycling– Obstacle or challenge courses