Exercise considerations - pregnant, children, older adult, and lbp
Children and adolescents
Children and adolescents are those 6-19 years old. Liguori et al. (2021) recommends 60 minutes a day of moderate to vigorous activity and 60 minutes of resistance training three days a week. For years, there has been controversy over whether or not resistance training is appropriate for prepubescent children and those past puberty. According to Housh et al. (2017), prepubescent children should avoid resistance training because strength gains do not improve motor performance and do not reduce the risk of sports related injuries. What's more, the low levels of circulating androgens make it difficult to increase strength gains (Housh et al., 2017). However, Liguori et al. (2021) states that resistance training for prepubescent children can achieve similar strength gains to adolescents. There is also the concern of acute musculoskeletal injuries, such as epiphyseal growth plate damage, which can lead to improper growth of the limb (Housh et al., 2017). However, an article from Dehab and McCambridge (2009) claims that strength training can improve lipid profiles, fat free mass, balance, bone density and self-esteem in young adolescents. As long as strength training is monitored and properly prescribed, it can be a positively effective regimen for adolescents. Of course, there is a recommended prescription of exercise type, load, set and repetitions that are appropriate for an adolescent, which won’t lead to growth plate injuries (Dehab and McCambridge, 2009). Liguori et al. (2021) states that children have a lower anaerobic capacity, so they should limit sustained vigorous activity, but aerobic and resistance training positively impacts bone strength, weight control and psychological well being (Liguori et al., 2021).
When it comes to assessments, as long as there is no health concern, clinical testing is typically not necessary. Exercise programs should always be done in a temperature regulated area. If the workout takes place outside, avoid hot and humid days, and encourage proper hydration (Liguori et al., 2021). A child's thermoregulatory systems are still developing, causing a decreased tolerance to hot or humid environments (Clark et al., 2011). Furthermore, children have different physiologic responses to exercise compared to adults. For example, their heart rate and relative oxygen uptake will be higher than most adults, while blood pressure may be lower. Using a treadmill versus a cycle ergometer is a better option for children to gain a higher peak oxygen uptake, while keeping their focus (Liguori et al., 2021). There is no true correlation between strength training and growth related injuries in adolescents. Injury is caused by poor technique and too much weight (Dehab and McCambridge, 2009).
Lower back pain
Low back pain can be defined as acute (less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). Of patients suffering from lower back pain, approximately 20% of them suffer from chronic lower back pain, and 10% of those cases turn into a disability. Lower back pain can hinder mobility, coordination and radiate pain throughout different parts of the body. It can be very discouraging to start an exercise program when you're suffering from lower back pain. However, it is highly recommended to stay mobile and avoid bed rest after brief rest time, post episode (Liguori et al., 2021). Exercise professionals (EP) should still have their client engage in submaximal or maximal exercise assessments, but be cognisant of the pain and stop the test if the pain worsens or radiates into other areas of the body. What's more, muscular strength and endurance tests should adhere to the same guidelines as the general population. In regard to flexibility, there is no correlation between spinal flexibility and lower back pain, but there could be among the lower limbs and hips (Liguori et al., 2021).
Patients with lower back pain should be encouraged to stay active, but mindful of their symptoms. The exercise professional should include progressive resistance and aerobic training, but be mindful of specific tailoring, strengthening and stretching exercises. Also, for those with subacute and chronic lower back pain, the EP should emphasize coordination, and strengthening of the trunk. For movement and coordination impairments, motor control and strengthening exercises should be considered over flexibility exercises (Liguori et al. 2021).
Older adults
The older population is a combination of those over 65 years, along with 50-64 year olds who are experiencing physical limitations, affecting their physical activity. Exercise has a great positive impact on older individuals, and helps delay or prevent certain age-related symptoms. For exercise testing in older adults, a pre exercise evaluation is always recommended. Because older adults will show increased cardiovascular, metabolic or orthopedic problems, testing should be slightly adjusted for them. The initial workload should begin with light intensity of less than three METs. Using a cycle ergometer is the preferred and safer choice, especially due to the prevalence of balance and proprioceptive issues in older adults. It’s also essential to consider the medications being taken and the appropriate heart-rate-max formula to use; the FOX formula (220-age) is unreliable, since most older individuals exceed this. Finally, unless there are signs or a presence of cardiovascular disease, exercise testing can begin with light intensity, unless told differently by a medical professional. Some examples are the 6-minute walk test and the Senior Fitness Test, combining a variety of movements. Once the assessments are given and evaluated, lighter intensity for both aerobic and resistance training should be applied. This fact is especially true in those who are currently inactive. For individuals with sarcopenia, the EP should apply muscular strength exercises first before aerobic activity, because they are not physiologically capable yet (Liguori et al., 2021). Mayer et al. (2011) cites a study from Burke et al. who did an 8-week program for postmenopausal women with osteoporosis. They gave them several balancing and resistance training exercises. By the end of 8-weeks, the study showed an improvement in isometric muscle force of the knee and ankle joint, as well as increased balance (Mayer et al., 2011).
Pregnant women
Physical activity is typically encouraged in pregnant women, unless told otherwise by a medical professional. However, there are several contraindications for pausing exercise while pregnant. For example, if the woman is experiencing any bleeding during her second or third trimester. The EP must be knowledgeable about the various contraindications to look out for and know when to pause physical activity. Maximal exercise testing should not occur during testing. If the EP sees the benefit in doing a submaximal exercise test, this must be cleared by a medical professional first. A PARmed-X test can be given to women as their version of a physical activity readiness medical examination. Typically, 20-30 minutes of moderate intensity aerobic exercise is recommended for most days during the pregnancy. The EP should develop a program based on their current fitness level before they became pregnant, and consider any symptoms that show up during exercise. If the woman is feeling dizzy or having chest pain, the EP should immediately stop the workout. Also, the aerobic intensity should always be kept at a talking pace, to control the heart rate from increasing to an unhealthy level. The EP should use the current fitness level, along with preference to create an exercise program. Aerobic activities such as swimming, walking and cycling should be considered. Pelvic floor and kegel exercises can be performed daily and will continue to help postpartum. However, pregnant women should avoid contact and collision sports, jumping, hot yoga or pilates or holding a supine position for long periods of time, due to the restriction of blood flow to the uterus (Liguori et al., 2021).
References
Clark, M., Sutton, B. G., & Lucett, S. (2014). Nasm Essentials of Personal Fitness training. Jones & Bartlett Learning.
Dahab, K. S., & McCambridge, T. M. (2009). Strength training in children and adolescents: raising the bar for young athletes?. Sports health, 1(3), 223–226. https://doi.org/10.1177/1941738109334215
Housh, T. J., Housh, D. J., & DeVries, H. A. (2017). Applied Exercise & Sport Physiology With Labs. Routledge/Taylor and Francis Group.
Liguori, G., Feito, Y., Fountaine, C., Roy, B., & American College of Sports Medicine. (2022). ACSM’s guidelines for exercise testing and prescription (11th ed.). Wolters Kluwer.
