Programming for special
population
Arthritis
Arthritis
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Arthritis is a common disorder that affects your joints, it cause pain and inflammation, making it
difficult to move or stay active.
There are many types of arthritis. Each form causes different symptoms and may need different
treatments.
While arthritis usually affects older adults, it can develop in men, women and children of any
age.
Arthritis is most common in the following areas of the body:
Feet
Hands
Hips
Knees
Lower back
Types of Arthritis
The most common types of arthritis include:
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Osteoarthritis, or “wear and tear” arthritis: Develops when joint cartilage breaks down from repeated stress. It’s the
most common form of arthritis
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Ankylosing spondylitis, or arthritis of the spine (usually lower back)
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Juvenile arthritis (JA), a disorder where the immune system attacks the tissue around joints. JA typically affects
children 16 or younger.
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Gout, a disease that causes hard crystals of uric acid formation in joints.
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Psoriatic arthritis, joint inflammation that develops in people with psoriasis (autoimmune disorder that causes skin
irritation).
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Rheumatoid arthritis, a disease that causes the immune system to attack synovial membranes in joints.
Arthritis: how to dive into workouts
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The key to an arthritis exercise program is to identify an exercise regimen that best meets an
individual’s needs and expectations.
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It must be safe, effective, and personally enjoyable.
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As a rule, the fitness professional should design an exercise program that includes four major
types of exercise: Flexibility, Strength, Cardiovascular, body awareness.
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The recommendations for frequency, intensity, time, and type are similar to those for apparently
healthy clients with some additional considerations
Arthritis: workout routine
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Participating in joint-friendly physical activity can improve arthritis pain, function, mood, and quality of life.
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Joint-friendly physical activities that are low-impact, which means they put less stress on the body, reducing the risk of injury.
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Some examples of joint-friendly activities include walking, biking and swimming.
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Incorporating an adequate warm-up and cool down in the exercise plan to protect joints and decrease the potential of pain.
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The warm-up and cool-down periods should be 5 to 10 minutes in length and involve slow movements through a joint’s range of
motion.
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Adults with arthritis should aim for at least 150 minutes a week of moderate-intensity activity such as brisk walking or 75
minutes a week of vigorous-intensity aerobic activity, like cycling.
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Client should also aim for at least 2 days a week of activities that strengthen muscles and include activities to improve balance.
Cardiovascular issues
Cardiovascular issues
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India accounts for one-fifth of deaths due to CV issues worldwide especially in younger population.
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The results of Global Burden of Disease study state age-standardized CVD death rate of 272 per 100000 population in
India which is much higher than that of global average of 235.*
Different conditions which can lead to CV issues being:
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Narrowing of the coronary arteries that supply heart muscle with blood & oxygen as one of the primary factors, there
are others too.
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Inflammatory response within arterial wall (high blood pressure, elevated LDL cholesterol, elevated blood glucose,
chemical agents produced from cigarettes) & deposition of lipid-rich plaque & calcified cholesterol.
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Heart attack result from rupture of vulnerable plaques & release of thrombotic (blood-clotting) substance that narrow or
completely close diameter of artery.
Cardiovascular issues
Various types of CV issues:
• Dyslipidemia
Major contributing factors associated with CV
issues:
• Family history
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Coronary artery disease
Congestive Heart failure (CHF)
Hypertension
Stroke
Peripheral Vascular Disease
Atherosclerosis
Hypertension
Smoking
Diabetes
Age
Dyslipidemia
Lifestyle (physical inactivity & poor diet)
Cardiovascular issues: how to dive into workouts
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Exercise & CAD
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Low intensity endurance exercise like low impact aerobics, swimming, walking, stationary bike, any
ergometer.
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Gradual progression to moderate-intensity, resistance exercise with 12-15 repetitions & interval training.
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Emphasis on proper breathing mechanism through pain-free ROM (avoid valsalva)
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Isometric exercises to be avoided as they can increase BP
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Intensity: 40-50% HRR
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Duration: gradual increase to 30 mins conditioning time + warmup & cool down extra.
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Frequency: 3-5 days per week mix of aerobic & resistance training.
Cardiovascular Issues: What to check for
Certain primary indicators which are important and should be known to clients in order to report to
healthcare providers immediately at site:
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Angina (chest pain due to reduced O2 supply to heart)
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Dyspnea (labored respiration)
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Light-headed / dizziness
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Rapid heart rate
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Difficulty in breathing
Citation
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* Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360 degree overview. Med J Armed Forces India. 2020
Jan;76(1):1-3. doi: 10.1016/j.mjafi.2019.12.005. Epub 2020 Jan 13. PMID: 32020960; PMCID: PMC6994761.
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2. Singh S, Salvi S, Mangal DK, Singh M, Awasthi S, Mahesh PA, Kabra SK, Mohammed S, Sukumaran TU, Ghoshal AG,
Barne M, Sinha S, Kochar SK, Singh N, Singh U, Patel KK, Sharma AK, Girase B, Chauhan A, Sit N, Siddaiah JB, Singh V.
Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study. ERJ Open Res. 2022 May
30;8(2):00528-2021. doi: 10.1183/23120541.00528-2021. PMID: 35651368; PMCID: PMC9149387.
Asthma
Asthma
Asthma is a chronic inflammatory disorder that is characterized by variable & recurring symptoms like, shortness
of breath, wheezing, chest tightness & coughing.
Major triggers:
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Allergens (dust mites, mold, cockroaches, animal dander)
Irritants (cigarette, smoke, air pollution, strong odor, sprays, pollens etc.)
Cold air
Stress
Virus
Exercise
The recent Global Burden of Disease (GBD, 1990–2019) estimated the total burden of asthma in India as 34.3
million, accounting for 13.09% of the global burden.2.
Asthma: EIA (Exercise Induced Asthma)
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80% of people with asthma experience asthma during & after physical activity.
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Occurs after ventilation of large quantities of air, especially dry, cold containing environmental
allergens.
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Symptoms peak 5-10 mins after person stops exercising & may last 20-30 mins.
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Clearance from physician needed, specially if suffering from chronic conditions.
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A treatment plan to be shared by physician to prevent EIA.
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People with stable asthma can workout without supervision.
Asthma: workout routine
Guidelines:
• A prolonged warm-up & cool-down is essential.
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Rescue medication present at all times.
Plenty of fluid intake before, during & after session.
Understand & avoid triggers; eg. moving indoors on extremely cold / hot days or when pollen
count / air pollution is high.
Initial intensity to be low followed by gradual progression.
People with asthma respond best to sessions in mid-to-late morning.
Coaches should understand early signs & terminate exercise if needed.
Controlled Asthma patients can opt for cardiovascular & strength training.
Asthma: workout routine
Exercise Recommendations:
• Low to moderate exercises: walk, swim, cycle, jog / run (if well conditioned).
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Avoid exercises with higher ventilation demand.
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Intensity: Low to moderate dynamic exercises, begin easy & gradually progress.
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Duration: Gradual progression to 30 mins or more, extra 10 mins for warm up & cool down.
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Frequency: 3-5x a week; Clients with low functional capacity should prefer intermittent
exercise (2-3x 10 mins sessions or interval training).
Spinal, Ligament injuries and
Migraine
Spinal cord
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The spinal cord extends downward from the base of the brain.
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It comprises nerve cells and groups of nerves that carry messages from brain to rest of the body and vice versa.
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Spine has three main parts: Cervical (neck), Thoracic (chest), Lumbar (lower back).
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In most adults, the spine is composed of 33 individual back bones (vertebrae); split as 8 pairs of cervical, 5 lumbar, 12 thoracic, 5
sacral and 1 coccygeal pair of spinal nerves.
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Spine is as important as brain!
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Conditions like spine stenosis, sciatica, degenerative disc disease, herniated discs are few of many of many problems with spine.
Other issues like cervical, upper back pain, kyphosis, lordosis etc. are amongst others.
Spinal issues: how to dive into workouts
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Exercise can include stretching, aerobic exercises and strength training, depending on health and ability of the
person; nothing contraindicated under healthy / recovered individual.
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People with spinal issues need medical clearance from doctors before stepping into exercising hence making
condition worse. They should also workout under supervision to be on a safer side to avoid relapse.
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Primary workouts to focus upon strengthening the spine and back further. Exercises like pelvic tilt, dead-bugs,
cobra pose, downward dog, superman, scapular wall slide etc. help.
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Any kind of exercise engagement causing symptoms to worsen need to be observed and evaluated.
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Avoid overly strenuous, demanding and jerky movements, jumps, hops and undue stress on spine and disc;
heavy lifting only after getting totally recovered.
Ligament
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Ligaments are connective tissue that provide support to the organs and connects the bones
together.
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Ligament sprains are very common, especially in the ankle, knee, elbows, shoulders and other
joints.
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A sprain is a stretch or tear of a ligament. The ones most likely to get injured are the joints at
ankles, knees, and wrists.
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Improving the joint movements while maintaining a good "range of motion" helps to avoid
sprains.
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Riding a stationary bike or extending and flexing leg are some examples.
Ligament issues: how to dive into workouts
The goal for physical therapy is to get joint working normally and safely again in as short a time as possible.
Rehab can be on these lines:
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Weeks 1 - 3: The major aim is to increase range of motion and move around without external support.
Exercises can be weight training, riding an exercise bike, toe and heel raises etc.
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Weeks 4 – 6: Progress to exercises that are designed to stretch and flex joint as far as possible. Major aim is
being able to walk normal. Exercises like step-ups, modified lunges or machine based exercises like leg
extensions, hamstring curls, or leg press etc. can help.
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Weeks 7 – 16: The goal is to achieve full range of motion while preventing swelling and pain with exercising.
Using machines like a treadmill, elliptical, or stair stepper or else swimming and outdoor biking can be good to
include.
Migraine
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A neurological condition that is more often categorized with intense headache which can be
throbbing or a dull steady ache.
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Other symptoms being nausea, numbness, sensitivity to light and sound, vomiting etc.
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Often the symptoms range from food cravings. Neck stiffness, fatigue or low energy and
irritability.
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While there is no definitive cause of migraine, many factors like bright light, severe heat, loud
sounds, excessive stress etc. are some known triggers,
Migraine issues: how to dive into workouts
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A key benefit of a regular exercise routine of any type is that it relieves stress, which is often another trigger
for migraines. Releasing this tension through activity may cut down on the number of migraines you get.
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Hydrate: Being short of enough fluids in system can make migraine episodes often while working out. Staying
hydrated before, during, and after exercise will combat the issue.
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Fuel up: Starches and sugars from the foods ingested break down into glucose, also called blood sugar
releasing energy. Exercise can make your blood sugar level go down while utilizing energy.
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Start and end slowly: Take time to warm up. Then raise the intensity gradually. Give enough time for a cool
down. Sudden or hard activity can lead to a migraine or exercise headache.
Thank You!