Exercise Physiology in Special Populations. Advances in sport and exercise science series

359 Pages·2008·4.79 MB·English

by  John P Buckley

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Note
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vii
Dedications
Iwouldliketodedicatethisbookto:
FionaBuckley,forherpatienceinhelpingmefindthetimetowriteandeditthis
book.
ThecardiacrehabilitationteamattheUniversityHospitalofNorthStaffordshire
(DrJD,Alan,Lynn,Phil,Sue,Alison,LizandChris);aspecialgroupofpeoplewho
have influenced my understanding of key aspects of specialist clinical rehabilitation
andpatientcare.
All the patients, clients and staff, who have made working in this area highly
rewarding, including those at The Lifestyle Exercise & Physiotherapy Centre
(Shrewsbury), The Royal Shrewsbury Hospital, The North Staffordshire Hospital,
TheOswestryOrthopaedicHospital,TheCountessofChesterHospital,TheSchoolof
HealthandRehabilitation,KeeleUniversityandTheCentreforExercise&Nutrition
Science,UniversityofChester.
ix
Contributors
Karen M Birch, BSc(Hons)PhD
SeniorLecturerinExercisePhysiology,CentreforSportandExerciseSciences,Institute
of Membranes and Systems Biology, University of Leeds, UK
John P Buckley, BPEMScPhDBASESAccr
SeniorLecturer,CentreforExercise&NutritionScience,UniversityofChester;Founding
ManagingPartner,LifestyleExercise&PhysiotherapyCentre,Shrewsbury,UK
Rachel C Davey, BScMMedSciPhD
ProfessorofPhysicalActivityforPublicHealth,CentreforSportandExerciseResearch,
University of Staffordshire, Stoke-on-Trent, UK
Helen Dawes, MCSPMMedSciPhD
Reader, Movement Science Group, School of Life Sciences, Oxford Brookes University
andAssociateResearchFellow,DepartmentofClinicalNeurology,UniversityofOxford,
Oxford, UK
Susann M Dinan-Young, BEdMSc
Senior Research Fellow, Primary Care and Population Sciences, Royal Free and
UniversityCollege,MedicalSchool,London;SchoolofHealthInformatics,Universityof
Derby, UK
Patrick J Doherty, MCSPPhD
ProfessorofRehabilitation,FacultyofHealthandLifeSciences,YorkStJohnUniversity,
York, UK
Joseph I Esformes, BScMScPhDCSCSFHEA
Lecturer in Exercise Physiology, Discipline Director for Sport Conditioning,
Rehabilitation, and Massage, Cardiff School of Sport, University of Wales Institute,
Cardiff, UK
Paul Firth, BSc(Hons)
ExercisePhysiologist,LifestyleExercise&PhysiotherapyCentre,Shrewsbury,UK;Head
of Clinical Education (Physiotherapy), Keele University, Staffs, UK
Jacky J Forsyth, BA(Hons)QTSMPhilPhD
SeniorLecturer,ExercisePhysiology,CentreforSportandExerciseResearch,University
of Staffordshire, Stoke-on-Trent, UK
x CONTRIBUTORS
Victoria Goosey-Tolfrey, BSc(Hons)PhD
Senior Lecturer in Exercise Physiology, School of Sport and Exercise Sciences,
Loughborough University, UK
Adrienne R Hughes, BSc(Hons)PhD
Lecturer in Physical Activity and Health, Department of Sports Science, University of
Stirling, UK
Alan Leigh, MScOMT(NZ)MCSP
Managing Partner and Senior Physiotherapist, Lifestyle Exercise & Physiotherapy
Centre, Radbrook Professional Centre, Shrewsbury, UK
Alison McConnell, BScMScPhDFACSMBASESAccr
Professor of Applied Physiology, Centre for Sports Medicine and Human Performance,
Brunel University, Uxbridge, UK
Helen Mitchell, MSc
Exercise Physiologist, Lifestyle Exercise & Physiotherapy Centre, Shrewsbury, UK
Dawn A Skelton, BScPhD
ReaderinAgeingandHealth,HealthQWest,GlasgowCaledonianUniversity,Glasgow;
Scientific Co-ordinator of ProFaNE (Prevention of Falls Network Europe), School of
Nursing, Midwifery and Social Work, University of Manchester, UK
David Stensel, BA(Hons)PGCEMScPhD
Senior Lecturer in Exercise Physiology, School of Sport and Exercise Sciences,
Loughborough University, UK
Nick Webborn, MBBSFFSEMFACSMFISMMScDipSportsMed
Medical Director, The Sussex Centre for Sport and Exercise Medicine, University of
Brighton, UK
xi
Foreword
It is well documented that the lifespan ofman in many different modern social cul-
turesisconsiderablylongerthanitwasinthelastcentury.Itwasnotsolongagothat
youwereconsideredoldattheageoffifty,butnowitisnotuncommonforaperson
to live in excess of one hundred years – twice the lifespan. Why you may ask. Is it
becausewearenowabletotreatalotofconditionsthatusedtokillusoff?Isitthat
weareabletodiagnosetheseproblemsearlierandapplymoreappropriateinterven-
tions?Orisitaninfluenceofdietandbettergeneralliving?Thedebatecouldgoon.
Of relevance to this text though, is that alongside the increasing lifespan there is a
greaterneedforexerciseprescriptioninpeopleovertheageoffifty;peoplewhoneed
to maintain mobility to keep good health; people who have medical conditions that
need specific advice in exercise; and people whose medication can be reduced if
appropriate exerciseistaken.
Beyondretirementthereisanincreasingpopulationwhoarechallengingexercise
and healthcare professionals to help establish good exercise practice and principles
based on science, not myth. Having been successful during their working life, they
aresearchingforpersonalchallengeswhichincreasinglyrequireahigherleveloffit-
ness than sometimes they have ever had in their lives before – expeditions to the
North or South Pole, climbing Everest, running the London Marathon, to name but
afew,thelist goeson.
Converselyinthesamepopulationwearewitnessingareductioninthefitnessof
our children and teenagers. The advancement in technology, especially computers,
hasmade childhoodmoresedentary, andthis,combined withthe reducing require-
ments of the National Curriculum for Physical Education in schools, and repeated
security scares covered almost daily by the media, mean the youth of today (-) that
is,theelderlyoftomorrow(-)haveadiminishinglevelofbaselinefitnessandincreas-
ing prevalence of conditions such as diabetes, obesity, hypertension and cardiac
pathology.
The challenge is the same whether the individual wishing to exercise is an elite
athlete,achildwishingtoplaysocceroranelderlypersonwantingtofightthefunc-
tional decline of old age. The healthcare or exercise professional needs to ascertain
whatthebaselinefitnessis,definewheretheindividualisaimingtotaketheirfitness,
andworkout aplantoachievethischange.
Thistextbookisawelcomebreathoffreshair.Itlooksindepthatanumberofrel-
evant medical conditions, assesses the influence of the condition on the exercising
individual, provides research evidence to verify what is being said, and clearly lays
out a practical approach to exercising with specific conditions. It does not claim to
have all the answers, and, in fact, points out where science still needs to progress.
xii FOREWORD
Individual conditions are considered by experts in their field who draw on their
manyyearsofexperience.
During my own medical work in elite international sport, there have been two
notable occasions when I was confronted by significant medical conditions which I
had not previously had much exposure to. One was ulcerative colitis, newly diag-
nosed 16 weeks before the 1992 Olympic Games in Barcelona Spain. The other was
diabetesmellitus.
OfcourseIhadabasicknowledgeoftheconditionsbutthiswasnotsufficientto
provide reassurance to an aspiring Olympic medallist. I needed to understand how
the illness would affect the body, and the body’s response to exercise. I needed to
understandwhethercontinuingtotrainwouldbedetrimentalorbeneficial.Ineeded
so many answers. This textbook would have been invaluable and I congratulate all
whohavecontributedtoitspublication.ItwillIamsurebecomethebibleforsports
physiciansandexerciseprofessionals acrosstheWorld.
DrAnn Redgrave2008
xiii
Preface
Ithasbeenanhonourtoeditthisnewtextbookontwocounts.Thefirsthonouristo
havebeeninvitedbytwooftheUK’smostnotableexercisephysiologists,Professors
Don McLaren and Neil Spurway, to head up this project. The second honour is to
have been able to be associated with so many of the UK’s leading authorities on
thespecialisttopicsfound withineachofthechapters.
Thebookisaimedattwomaingroupsofreaders:i.Studentsstudyingthehealth
and rehabilitative aspects of exercise physiology at upper undergraduate or post-
graduate level; and ii. Healthcare and rehabilitation specialists requiring a reference
source in order to provide their clients and patients with exercise guidance based
onthebestevidence.
In reading this book, there is a general framework for most of the chapters. This
framework includes an initial review of the epidemiology of each disease or condi-
tion, which has either been strongly influenced by a history of physical inactivity
and low fitness or other poor health habits that influence low levels of activity and
fitness.Aftertheepidemiologysectionthereaderwillfindareviewofthepathophys-
iology and aetiology of the specific condition before moving onto exercise guidance
foreachcondition,eitherasameansofprimaryorsecondary(rehabilitative)health-
care and performance. Within the exercise guidance sections, the various forms of
exercisewillbeexplored,includingaerobicendurance,muscularstrengthandendur-
ance,flexibility,andbalanceandcoordination,andtheevidencerelatedtothesecom-
ponentsforeachofthechapter’sspecifichealthconditions.Thereareafewchapters
whichobviouslydonothaveaninitialsectiononphysicalinactivityanditsinfluence
on epidemiology, including lung disease, the female participant, certain acquired
neurologicalconditions, spinalcord injuryandageing.
1
1
Chapter
Introduction
John P Buckley and Adrienne R Hughes
CHAPTER CONTENTS
Increasingandmaintainingphysical Monitoring the exercise dose 11
activity 4 Physicalactivitymonitoring and
Client-centred approach 5 guidance 11
Stages of change 6 Relativeversusabsolute intensityof
Decisional balance 6 physical activity 12
Overcoming barriers to activity 7 Aerobic exercise 12
Social support 8 Muscular strength and endurance 14
Goal-setting and self-monitoring 8 Establishingthestrengthtraining
Enhancing self-efficacy 9 prescription 15
Preventing relapse 9 Flexibility 15
Psychologicaleffectsofphysical Balance/coordination/proprioception
activity 10 and movement control 16
Misperceptionsaboutphysical Summary 17
activity 10 References 17
Thistextonexercisephysiologyinspecialpopulationsaimstocoveranumberofthe
prevalenthealthconditionsthatarelinkedtoaninactivelifestyleorwhoseeffectscan
be ameliorated by increasing physical activity and physical fitness. Throughout the
textthetermsphysicalactivity,exerciseandfitnesswillbeused.Itisthereforeimpor-
tantatthispointtofirstdefinetheassumedmeaningsofthesethreeterms.Following
this,the concepts ofphysical activity behaviour and thevarious measurement para-
meters used by exercise professionals or healthcare practitioners to either monitor
orprescribe exercisewillbereviewed.
Physicalactivityisconsideredtobeanymuscularmovementoccurringaboverest-
ing levels. It is an all-encompassing concept that includes any physical movements
occurring within free daily living or planned leisure pursuits (exercise and sport).
As will be mentioned in a number of chapters, the prevalence of some diseases is
greater in those who expend less than 1500 kilocalories per week above their basal
metabolic rate. The arguments highlighted in the Chief Medical Officer’s (CMO)
report for England and Wales (Department of Health 2004) tend to suggest that
declines in health which are related to inactivity (hypokinesis) and obesity are due
more to the loss of physical activity infree daily living than to the debatable reduc-
tion in the population’s participation in organized exercise and sport (Cordain et al
2 EXERCISE PHYSIOLOGY IN SPECIAL POPULATIONS
1998, Eaton & Eaton 2003). One only has to look at the increased number of sports
andfitnesscentresthathavebeenbuiltintheUKinthelastdecadetorealizethatthere
is certainly not a decline in those already engaged in organized sport and exercise.
The reduction in energy expenditure in normal daily life, especially in non-sporty/
exercise participants, has greatly increased in the last two decades (Department
of Health 2004). This is a result of the increased preference for sedentary leisure
pursuits and decreases in the physicality of daily domestic-occupational tasks and
transportation.
The discussion thus far focuses on the correlation between inactivity and the
increasedprevalenceofchronicdiseases.However,anumberofchapterswithinthis
text consider exercise in individuals with conditions acquired by poor nutrition or
smoking, an accident, or an unfortunate health event, including pulmonary disease,
osteoporosis, Parkinson’s disease, multiple sclerosis, arthritis or spinal injury. These
conditionscanleadtodeclinesinphysicalactivitythatcontributetoaninactivelife-
style,thusputtingthesufferersatriskofchronicdiseasessuchascoronaryheartdis-
ease and diabetes. In these cases, exercise can be used as a means of combating the
future potential ills of inactivity as well as a therapeutic intervention in helping the
individual cope better in living with the physiological and psychosocial challenges
thatlieahead.
Exercise is typically a planned and/or structured physical activity which has an
aim. The aim is usually to satisfy either a physical, psychological or social need, or
oftenamixtureofallthree.Exercisewastraditionallyusedasameansofpreparing
soldiersforbattlebutinthelast50yearshasbecomeprominentinenhancingsport-
ingperformance,physicalhealthandpersonal‘bodyimage’.Sportsperformancetar-
getsprovideanaturalmotivationformaintainingexercisetraining.One’sself-image,as
promotedthroughthepopularpress,oftenrelatestopromotingshorter-termtargets
suchaslookinggoodinaholidayswimsuitorforalargesocialeventsuchasawedding
orimportantparty.Thebenefitofregularandsustainedparticipationinhealth-promot-
ing activity is less easy to quantify than athletic performance as the true health out-
comes may only be observed after years of participation. Enhancing social and
enjoymentaspectsofparticipationinhealth-basedexercisebecomesaveryimportant
aspect of sustaining any regimen (Biddle & Mutrie 2001). More frequent bouts (≧3
timesperweek)ofmoreintenseactivityprovideatrainingthresholdatwhichphysio-
logical fitness adaptations occur (i.e. enhanced cardiorespiratory fitness, improved
bloodlipidprofile,glucosecontrolandreducedinsulinresistance)(ACSM1998).
Physical fitness has seven components, which indicate the ability to perform a
given task or physical activity. The benefits of improving fitness for health are
twofold:
1. Being able to sustain an active life in order to contribute to one’s personal needs
and/orroleswithinfamily,communityandsociety.
2. Improvedfitnessisinverselylinkedwiththeincidenceofmorbidityofavarietyof
diseasesandall-causemortality.
Whether exercising for health or sport performance, the sevencomponents of fit-
nessarethesame(summarizedbelowandinFig.1.1),namely:
1. Aerobic (cardiorespiratory) power, typically described as V_O max. This is the maxi-
2
mal amount of oxygen the body can take in and utilize. It is influenced by three
factors:thelungs’abilitytooxygenatetheblood,thecardiovascularsystem’sabil-
itytodelivertheoxygenatedbloodtotheexercisingmusclesandthemuscles’abil-
itytoextractandutilizetheoxygentoproduceenergyforsustainedcontractions.
Introduction 3
(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:9)(cid:10)(cid:11)(cid:9)(cid:12)(cid:5)(cid:13)(cid:3)(cid:4)(cid:9)(cid:8)(cid:14)(cid:12)(cid:14)(cid:8)(cid:7)(cid:15)(cid:16)
(cid:27)(cid:14)(cid:22)(cid:14)(cid:17)(cid:8)(cid:3)(cid:28)(cid:12)(cid:4)(cid:5)(cid:12)(cid:4)(cid:7)(cid:5)(cid:8)(cid:3)(cid:12)(cid:15)(cid:7)(cid:5)(cid:17)
(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:9)(cid:3)(cid:17)(cid:18)(cid:19)(cid:4)(cid:14)(cid:17)(cid:8)(cid:3)
(cid:20)(cid:3)(cid:15)(cid:14)(cid:6)(cid:5)(cid:22)(cid:7)(cid:8)
(cid:20)(cid:19)(cid:21)(cid:8)(cid:19)(cid:22)(cid:14)(cid:4)(cid:9)(cid:21)(cid:15)(cid:4)(cid:3)(cid:17)(cid:23)(cid:15)(cid:24)
(cid:25)(cid:22)(cid:3)(cid:26)(cid:7)(cid:6)(cid:7)(cid:22)(cid:7)(cid:15)(cid:16)
(cid:20)(cid:19)(cid:21)(cid:8)(cid:19)(cid:22)(cid:14)(cid:4)(cid:9)(cid:3)(cid:17)(cid:18)(cid:19)(cid:4)(cid:14)(cid:17)(cid:8)(cid:3)
Figure1.1 Thecomponentsofphysicalfitness.
Inactivityand/ordiseaseimpaironeoracombinationofthesethreesystemsand
hencereduceanindividual’s abilitytofunction.
2. Aerobic (cardiorespiratory) endurance is the highest proportion of V_O max at which
2
an individual can sustain >20 minutes’ activity. It is closely allied to the lactate
thresholds described in standard exercise physiology texts, the point at which
muscularfatiguebeginstobehastened.Eliteenduranceathletescansustainactiv-
itytypicallyatgreaterthan80%oftheiraerobicpower,whereassedentaryordis-
easedindividualsmayonlybeabletosustainactivityat40–50%ofaerobicpower.
What this means is that the inactive or diseased person not only has a reduced
capacity but also cannot utilize as much of whatever capacity they possess com-
paredwith themoreactiveor fitterindividual.
3. Metabolic function from a health perspective relates to the ability to control blood
sugar levels better and from an exercise performance perspective the ability to
deal with or buffer exercise-related changes in muscle and blood pH. The latter
demonstratesthatthemoreactiveindividualisalsoabletotolerateanddealwith
higherlevels ofmetabolites, prolongingthetimebeforemuscularfatiguesetsin.
4. Muscular strength is the absolute amount of force that can be generated for one
maximal voluntary contraction. It also needs to be considered that movement
strength is a product of both the force produced by individual muscles and the
coordinated effect of a group of muscles. Strength is often represented by a one-
repetition-maximumliftknownasa‘1-REPmax’.Asdescribedinthenextfitness
component, muscular endurance, maintaining or increasing strength is function-
allyadvantageoustoolderindividuals.Therearealsometabolicandcardiovascu-
larbenefitsfromincreasedmuscularstrength.Thestrongerandlargermusclehas
agreaternumberofbloodvessels.Theoretically,onexertion,possessingagreater
number of blood vessels means a reduced rise in systolic blood pressure, com-
pared to a smaller muscle, and a resultant reduced workload on the heart, and
reduced sympathetic stimulation of the respiratory system. As discussed in a
number of the chapters, reduced exertion-related symptoms provide both real
andperceivedenhancementstomovement indailyliving.