PE400 Test 3

Ch.17:Special Considerations for Asthma, Interstitial Lung Disease, and Lung Transplant

Asthma is a heterogeneous disease usually characterized by chronic airway inflammation.

Asthma diagnosis is confirmed by a positive history of respiratory symptoms including the following:
Wheezing
Shortness of breath
Chest tightness
Cough that varies over time and in intensity, presenting with
expiratory airflow limitation

Factors known to trigger symptoms and airflow obstruction include the following:
Exercise, allergen or irritant exposure, changes in weather, or viral infections

Asthma action plans (AAPs) are written sets of instructions developed by patient and provider to recognize worsening asthma symptoms.
• Assist patients to modify treatment and seek appropriate medical attention when warranted
• Patients and providers collaborate to develop recommendations to add or adjust medications when symptoms increase.
• AAPs use colors to symbolize stages of symptom
control.
Green zone: Symptoms are generally well controlled.
Yellow zone: Symptoms are less controlled: increased cough,
and/or wheezing, with possibly reduced activity tolerance.
Red zone: represents most severe breathing impairment;
patients have not responded to treatment adjustments and
acute care is needed.

Interstitial lung diseases (ILDs) are diseases characterized by involvement of the lung parenchyma, development of inflammation and fibrosis, loss of alveolar-capillary integrity, and eventual gas exchange impairment.

• ILDs lead to restrictive pulmonary function and
circulatory limitations that contribute to a high degree
of disability.

• ILDs include the following types of diseases:
• Idiopathic pulmonary fibrosis
• Sarcoidosis
• Acute and chronic interstitial pneumonias
• Connective tissue diseases: rheumatoid arthritis (RA) and
scleroderma

There is limited data on postlung transplant exercise testing.
• As many have functional limitations, functional testing (i.e., 6MWT) may be appropriate.
There is a strong link to prognosis.
• Cardiopulmonary exercise test (CPET) may also be
appropriate.

After lung transplant, there is no consensus on the optimal
duration or intensity of exercise.
• Intensity can be based on RPE or 60%–80% of peak work rate.

Ch.18: Special Considerations for Overweight, Obesity, and Weight Management

Overweight and obesity are associated with increased risk
of:
• Type 2 diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, stroke, some forms of cancer, musculoskeletal problems, respiratory problems, and elevated risk of all-cause and cardiovascular disease mortality
• Maintenance of body weight is primarily determined by
the energy balance equation.
Energy Intake = Energy Expenditure
• Other contributing factors include, but are not limited to: Genetic, epigenetic, social and physical environment, biological, and psychological variables

Evidence suggests minimal weight loss of 2%–3% can reduce cardiovascular risk factors

The main goal for this population is to accumulate 250–300 minutes per week of aerobic exercise.

Because low exercise capacity is common, beginning with low volumes and intensities of exercise and then progressing over time is recommended.

Multiple daily bouts of exercise for at least 10 minutes can
achieve this goal.

Ch.21: Exercise for Bone Health across the Lifespan and for Those with Osteoporosis

Osteoporosis is a skeletal disorder characterized by compromised bone strength that results in an increased susceptibility to fractures.
• More prevalent in women and aging populations,
with approximately 12.3 million adults living in the
United States older than age 50 years currently
have osteoporosis

• Osteoporotic fractures are low-trauma fractures that occur with forces generated by a fall from a standing height or lower and are most common at the spine, hip, and wrist.
Fractures typically occur due to skeletal fragility caused by the disease process

Characteristics that determine bone strength or fragility include bone quantity, quality, and structure.
• Determined by cellular activities known as:
Bone modeling: action of osteoclasts (bone-resorbing cells) and osteoblasts (bone-forming cells) where new bone is added on some surfaces and removed from others

Bone remodeling: localized process where osteoclasts resorb older bone and osteoblasts form new bone in its place

Exercise testing is safe for individuals with osteoporosis; however, all of the following should be considered:

Cycle ergometry may be indicated for those individuals with severe vertebral osteoporosis.

Vertebral compression fractures can cause a forward shift in center of gravity, leading to balance issues.

Maximal muscle strength testing is contraindicated in individuals with severe osteoporosis due to the increased risk of fracture.

It may be difficult to achieve adequate HR and BP responses due to pain-related test termination.
Severe kyphosis and vertebral compression can cause respiratory muscle function limitations

Ch.22: Special Considerations for Anxiety and Depression

Depression and anxiety are forms of psychological distress, which are often comorbid with each other and with chronic disease.
• Both can affect the capacity of exercise testing
and training among healthy and special
populations.
• Exercise professionals should be able to recognize
symptoms of depression and anxiety and provide
recommendations based on evidence relevant to
each individual’s specific needs.

Depression is closely related to loss and involves states of grief or bereavement that would naturally occur after the death of a loved one; however, it exists in the absence of such loss.


Anxiety is a negative affective state characterized by
worry, apprehension, or tension in the presence of novel
or aversive stimuli.
Individuals experience unwarranted sympathetic nervous system (SNS) activation in response to a perceived future threat.

CRF testing is of particular importance for this population as individuals with anxiety and depression are often less active and thus physically deconditioned.
• Autonomic modulation of the cardiovascular response to stress is a common limitation during CRF testing.
Individuals with anxiety and depression display reduced heart rate variability (HRV) and autonomic imbalance.
Results from reduced parasympathetic drive or increased sympathetic drive
to the heart or both
Reduced HRV may result in the following:
Elevated resting HR
Abnormal sinus tachycardia with postural changes
Abnormal or inadequate HR responses to exercise
Abnormal arrhythmias and cardiac mortality

Exercise professionals should use behavioral strategies
to prevent nonadherence or reengage individuals after
periods of inactivity, including:
• Goal setting
• Action planning
• Identification and modification of negative
thoughts
• Enhancing self-efficacy
• Identifying barriers to exercise

Ch.23: Special Considerations for Physical Disabilities

​The spinal cord is part of the central nervous system and is composed of longitudinally oriented spinal tracts consisting of sensory and motor neurons making it possible for the
brain, body systems, and organs to communicate (Fig. 23.2).
• Spinal cord injuries (SCI) cause damage to the neural elements within the spinal canal and occur as a result of traumatic events or nontraumatic pathologies.
• Common causes of traumatic SCI
Motor vehicle accidents, falls, violence, and occupational or
sport injuries
• Common causes of nontraumatic SCI
Congenital-genetic disorders or acquired conditions

​Ch.24: Special Considerations for Neurodevelopmental Disorders

Neurodevelopmental disorders are a group of conditions characterized by developmental deficits that impair personal, social, academic, or occupational functioning.
• Autism spectrum disorder (ASD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Communication disorders
• Intellectual disabilities (ID)
• Motor disorders (e.g., Tourette disorder)
• Specific learning disorder (e.g., dyslexia)

• Neurodevelopmental disorders frequently co-occur.
• Example: Individuals with ASD may also have ADHD or ID.

• Common causes of intellectual disabilities (ID):
• Down syndrome, fragile X syndrome, fetal alcohol syndrome

For individuals with ASD, exercise has been shown to:
Decrease:
• Maladaptive or stereotypic behaviors
• For example, self-aggression, self-harm

Increase or improve:
• Desired behaviors
• For example, time on task, correct responding
• Social behaviors
• Physical fitness
• Motor skills

Determining the best way to communicate, keeping instructions simple, implementing EBPs, and planning for a variety of activities prior to the training session will afford
the participant with a neurodevelopmental disorder with the
greatest opportunity for:
• Success
• Enjoyment
• Improvement of health-related physical fitness

Provide simple and precise verbal instructions and verbal cues
accompanied by good physical demonstrations as methods to
convey important information.

The use of visual supports and other EBPs will be needed to
communicate exercise instruction and help achieve exercise goals.

Plan for a variety of exercises during a training session in order to
account for any attentional problems that may be present

Behavioral Theories

SCT is based on the principle of reciprocal determinism; that is, the individual, the behavior, and the environment all interact to influence future behavior.

Self-efficacy is central to SCT, and refers to one’s beliefs in a
capability to successfully complete a task, such as exercise.
Task self-efficacy refers to an individual’s belief to actually do the
behavior in question.
Barriers self-efficacy refers to whether an individual believes he
or she can regularly exercise in the face of common barriers such
as lack of time, poor weather, or feeling tired.

SCT is based on the principle of reciprocal determinism; that is, the individual, the behavior, and the environment all interact to influence future behavior.
Self-efficacy is central to SCT, and refers to one’s beliefs in a
capability to successfully complete a task, such as exercise.
Task self-efficacy refers to an individual’s belief to actually do the
behavior in question.
Barriers self-efficacy refers to whether an individual believes he
or she can regularly exercise in the face of common barriers such
as lack of time, poor weather, or feeling tired.

The higher the sense of efficacy, the greater the effort, persistence, and resilience an individual will exhibit, especially when faced with barriers or challenges.

Transtheoritical Model

Associated with the five stages of change are the constructs of
processes of change, decisional balance, and self-efficacy.

The 10 processes of change illustrate the strategies used by
individuals in attempting to advance through the five stages of
change.

Emphasizing experiential/cognitive processes of change is
recommended in earlier, pre-action stages, whereas promoting
behavioral processes of change is most helpful in later stages

Transtheoritical Model

The stages of change
o Precontemplation (no intention to be regularly active in the
next 6 mo)
o Contemplation (intending to be regularly active in the next 6
mo)
o Preparation (intending to be regularly active in the next 30 d)
o Action (regularly active for <6 mo)
o Maintenance (regularly active for ≥6 mo)

The HBM theorizes that an individual’s beliefs about whether or
not they are susceptible to disease, and individual perceptions of
the benefits of trying to avoid said disease, influence an
individual’s readiness to act.

In order to evoke readiness to change, an individual needs to
believe he or she is susceptible to a disease and believe that the
benefits of taking action outweigh the perceived barriers.

The underlying assumption of the self-determination theory (SDT)
is that individuals have three primary psychosocial needs that
they are trying to satisfy:
o Self-determination or autonomy
o Demonstration of competence or mastery
o Relatedness or ability to experience meaningful social
interactions with others

SDT theory proposes that motivation exists on a continuum from
amotivation to intrinsic motivation.

Individuals with amotivation have the lowest levels of self-
determination and have no desire to engage in exercise.

Individuals with intrinsic motivation have the highest degree of
self-determination and are interested in engaging in exercise
simply for the satisfaction, challenge, or pleasure it brings.

According to the TPB, intention to perform a behavior is the
primary determinant of actual behavior.

Intentions reflect an individual’s probability that she or he will exercise but do not always translate directly into behavior because of issues related to behavioral control

Self-monitoring

o Self-monitoring involves observing and recording behavior and has been shown to be important in exercise behavior change.

o Self-monitoring can be useful for tracking progress toward goals, identifying barriers to changing behavior, and as a reminder to exercise.

o Self-monitoring is most effective when paired with other strategies, such as goal setting, as merely monitoring behavior by itself may only have limited, short-term effects.

Relapse prevention
o An important part of helping individuals maintain their PA levels is developing strategies to overcome setbacks.
o Relapse prevention can be implemented across all behavioral approaches.
o Relapse prevention strategies include being aware of and anticipating high-risk situations and having a plan to ensure that a lapse does not become a relapse.
o A varied exercise routine or creating new goals may prevent a relapse.
o Don’t get discouraged when missing a session; therefore, avoiding “all-or-nothing” thinking.