10 Exercise For Special Population

LUNG FUNCTION TESTS
AND
PROCEDURES
Exercise for Special Population 1

EXERCISE FOR SPECIAL
POPULATION
Dr. M Farrukh Shahzad
BSPT, PPDPT
Isra University,
Islamabad Campus

Presented by
Dr. Bilal Ahmad

Qurashi

What is Diabetes
 Diabetes is a chronic (lifelong)
disease marked by high levels of
sugar in the blood.
The Types of Diabetes

 There are two Types of diabetes…..
One is Type 1 Diabetes
The other is Type 2 Diabetes
What is Type 1 Diabetes?
 Type 1 diabetes is a chronic (lifelong) disease
that occurs when the pancreas does not
produce enough insulin to properly control
blood sugar levels.
What Causes Type 1 Diabetes

 The body's own immune system attacks and
destroys beta cells in the pancreas that are
responsible for creating the hormone insulin.

What is Type 2 Diabetes
 Type 2 diabetes formerly called non-insulin-
dependent diabetes is a disorder that is
characterized by high blood glucose in the
context of insulin resistance and relative
insulin deficiency.
What Causes Type 2 Diabetes

 Type 2 diabetes occurs when the pancreas
doesn't make enough insulin or the cells of
the body become resistant to insulin.
What is Hypoglycemia?
 Hypoglycemia, also called
low blood glucose or low
blood sugar, occurs when
blood glucose drops
below normal levels.

Hypoglycemic Symptoms

Hyperglycemia
 Hyperglycemia, or high blood sugar, is a
condition in which an excessive amount
of glucose circulates in the blood plasma.

Signs and symptoms of
hyperglycemia
 Extreme thirst
 Frequent urination
 Dry skin
 Hunger
 Blurred vision
 Drowsiness
 Nausea

Hyperglycemia Can Cause Serious Long-
Term Problems

Exercise is boring.
 Vary your routine and

don’t be afraid to try
something new.
 Participate in things
you like to do.
 Exercise with a friend
 Use music or books on
tape to make the time
pass more quickly.

Tips for Safe Physical Activity

How should you treat low blood sugars?
 If you sugar is 70 or lower you should treat it
with….
½ a glass of juice
 ¼ glass of soft drink
 2 or more glucose tablets if necessary

How should you treat a high blood
sugar?
 If your sugar is above 240 you should do the
followings:
 Drink lots of sugar-free fluids like water or diet
drinks
 Eat the right food and the right amounts
 Check your blood sugars more often
 Take medicine in tablet form
 Inject insulin with the help of syringe.

B.E.A.T. DIABETES
 Be physical active….
 Eat a healthy diet
 Abcs(know and control) a1c, blood
pressure, cholesterol, and smoking
 Take your medication

Asthma
Overview
 Asthma – What is it?
 Symptoms of asthma
 What is work-related asthma?
 How common is work-related asthma?
 What substances trigger asthma?
 How asthma is treated?
 Clues that suggest asthma may be work-related
 What YOU can do if you have asthma

Asthma – What is It?
 Asthma is a chronic
lung disease that
obstructs airflow
 The obstruction is
reversible
 It involves difficulty in
breathing due to
 Inflammation (swelling)
 Mucus in the airways
 Tightening of muscles
around the airways

Types
 Types of asthma
 Two types
 Intrinsic asthma (etiology is unknown)
 Acquired asthma (etiology is known
 Caused by environments
 Dust ,cigarette smoking, industrial pollution

Respiration in asthma
 In asthma or other airway diseases (obstructive

diseases)
 the expiration is less then inspiration.
 And the air accumulates in the lungs
 Hypercapnia (more carbon dioxide accumulate
in the blood

Symptoms of asthma
 Coughing
 Wheezing, a whistling sound
 Shortness of breath
 Chest tightness

What is work-related asthma?
 Pre-existing asthma that is triggered or
made worse by exposure to one or more
substances in the work-environment
OR
 Asthma that is caused by exposure to
substances in the work-environment
 Signs and symptoms are the same for

asthma and work-related asthma

What substances trigger asthma?
Type of Substance Examples

Air pollutants, including dusts, Diesel exhaust; tobacco smoke;
smoke, mists & fumes mineral, rock, coal, & wood dusts;
gases; fumes & vapors from aerosol
agents, chemicals, cleaning materials,
solvents, paints, welding & from
heating & cooling metals quickly
Pollens, Trees, flowers, weeds, hay, plants
Animal dander Birds, cats, dogs
Medications Aspirin, anti-inflammatory drugs
Foods Egg, wheat, nuts

Can asthma be cured?
 Asthma can be controlled (but not cured) by:
 Avoiding triggers or reducing exposure to triggers
 Using medication to control symptoms
 Medications - generally two types are used

 Controller or long-term drugs
 Taken to prevent excess production of mucus & to reduce
the inflammation and constriction of airway muscles
 Rescue or quick-relief drugs
 Taken to relax muscles around the airways to improve
breathing

Poorly controlled asthma leads to:
 Increased visits to
 Doctor, Urgent Care
Clinic or Hospital ER
 Hospitalizations
 Limitations in daily
activities
 Lost work days
 Lower quality of life
 Death

What clues suggest that asthma is
work-related?
 Do symptoms:
 Occur only at work or
regularly after a work-
shift?
 Improve on weekends
or vacations?
 Increase over the
course of the work
week?
 Improve after changes
in the work
environment?
Information to share with doctor
 Discuss your symptoms.

 When do they occur?
 How often do they occur?
 Time of day or week that symptoms
are worse
 Times you feel better
 Identify
 Substances in the work-place to which
you are exposed
 Current and previous jobs, hobbies,
and smoking habits that may affect
your lungs

What YOU can do if you have asthma?
 Identify and minimize contact with your
asthma trigger(s)
 Understand and take asthma medications as

prescribed
 Recognize early signs that your asthma is
getting worse
 Know what to do when your asthma is
getting worse

CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE

WHAT IS COPD
 Chronic obstructive pulmonary disease
(COPD) is comprised primarily of three
related conditions chronic bronchitis,
asthma and emphysema.
 In each condition there is chronic obstruction
of the flow of air through the airways and
out of the lungs, and the obstruction
generally is permanent and may be
progressive over time.

COPD: Chronic Bronchitis
 In chronic bronchitis, the airways

that carry air to the lungs
(bronchial tubes) get inflamed
and make a lot of mucus. This can
narrow or block the airways,
making it hard for you to breathe.

COPD: Emphysema
 In a healthy person, the tiny air sacs in

the lungs are like balloons. As you
breathe in and out, they get bigger and
smaller to move air through your
lungs. But with emphysema, these air
sacs are damaged and lose their stretch.
Less air gets in and out of the lungs,
which makes you feel short of breath.

What Causes COPD?
 About 90% of people with COPD are current or

former smokers and their disease usually appears
after age 40
 Secondhand smoke and exposure to environmental
irritants and pollution also can increase your risk of
COPD.
 In rare cases, the DNA passed down through a
family can lead to COPD, even in "never smokers."
 One of these genetic conditions is called Alpha-1
Antitrypsin (AAT) deficiency.

Symptoms of COPD
 Inside the lungs, COPD can clog the airways and damage the
tiny, balloon-like sacs (alveoli) that absorb oxygen. These
changes can cause the following symptoms:
 Shortness of breath in everyday activities

 Wheezing(difficult breathing that makes a whistling sound)
 Chest tightness
 Constant coughing
 Producing a lot of mucus (sputum)
 Feeling tired
 Frequent colds or flu

 Severe COPD can make it difficult to walk, cook,
clean house, or even bath. Coughing up excess
mucus and feeling short of breath may worsen.
Advanced illness can also cause:
 Swollen legs or feet from fluid buildup

 Weight loss
 Less muscle strength and endurance
 A headache in the morning
 Blue or grey lips or fingernails (due to low
oxygen levels)

diagnosis
Physical Exam
First, your doctor will listen to

your chest as you breathe, then
will ask about your smoking
history and whether you have a
family history of COPD. The
amount of oxygen in your blood
may be measured with a blood
test or a pulse oximeter, a
painless device that clips to a
finger.

Spirometry Breath
Test
Spirometry is the
main test for
COPD. It measures
how much air you
can move in and out
of your lungs, and
how quickly you do
it. It also helps
determine the stage
of COPD.

Arterial Blood Gas
Test
An arterial blood gas
test. This blood test
measures the oxygen
level in your blood using
a sample of blood taken
from an artery. The
results from this test can
show how severe your
COPD is and whether
you need oxygen
therapy.

Chest X-Ray
A chest x ray or
chest CT scan. These
tests create pictures
of the structures
inside your chest,
such as your heart,
lungs, and blood
vessels. The pictures
can show signs of
COPD.

Forced Expiratory Volume in One Second
(FEV1) test
 The amount of air which can be forcibly exhaled from
the lungs in the first second of a forced exhalation
 graded exercise test to evaluate V02 max
 Vo2 max greater than 25 ml . kg- 1• min- l and those
with a V02 max less than 7 ml· kg - I. min- l . Little
exertion is required of those at Grade 4 to bring on the
sensation of dyspnea.
 Grade1 disability can follow the normal exercise
prescription process, those with a Grade 4 disability
are probably ,in respiratory and cardiovascular failure.

TREATMENT
Bronchodilator
Bronchodilators
are medications
that relax the
muscles of the
airways to help
keep them open
and make it
easier to breathe.
Corticosteroids
If bronchodilators don't
provide enough relief,
people with COPD may
take corticosteroids.
These are usually taken
by inhaler. They may
reduce inflammation in
the airways. Steroids
may also be given by
pill or injection to treat
flare-ups of COPD.

Antibiotics
These are used to
treat lung
infections.

Pulmonary
rehabilitation
Pulmonary
rehabilitation
may include
walking and
other exercises
that build up
your lung
strength.

Pulmonary rehab exercises
 Pulmonary rehab exercises include
 Lower-body exercises: Most centers provide a regimen of exercises that
centers on leg workouts. These exercises vary from simple walking on a treadmill
or around a track to more intense stair climbing. Most of the proven benefits of
pulmonary rehab come from studies in people doing leg exercises.
 Upper-body exercises: The muscles in the upper body are important for
breathing, as well as daily activities. Arm and chest exercises might include
turning a crank against resistance, or simply repetitively lifting the arms against
gravity.
 Exercises for breathing muscles: Breathing through a mouthpiece
against resistance during pulmonary rehab may increase the strength of the
breathing muscles. These exercises are infrequently used, but may be helpful for
people with very weak breathing muscles.

Oxygen Therapy
You may need to use
oxygen if you have
severe COPD. You
breathe in oxygen
through a nasal cannula
or a face mask. A nasal
cannula is a pair of
short, thin tubes that rest
just inside your nose.

HYPERTENSION
 Hypertension (HTN) or high blood pressure,
sometimes called arterial hypertension, is
a chronic medical condition in which the blood
pressure in the arteries is elevated. This requires
the heart to work harder than normal to
circulate blood through the blood vessels. Blood
pressure is summarized by two measurements,
systolic and diastolic, which depend on whether
the heart muscle is contracting (systole) or
relaxed between beats (diastole).

 Primary (essential) hypertension :
 is the most common form of hypertension, accounting for
90–95% of all cases of hypertension. In almost all
contemporary societies, blood pressure rises with aging
and the risk of becoming hypertensive in later life is
considerable.Hypertension results from a complex
interaction of genes and environmental factors. Numerous
common genetic variants with small effects on blood
pressure have been identified as well as some rare genetic
variants with large effects on blood pressure, but the
genetic basis of hypertension is still poorly understood.
Several environmental factors influence blood pressure.

 Secondary hypertension results from an
identifiable cause. Renal disease is the most
common secondary cause of hypertension.
Hypertension can also be caused by endocrine
conditions, such as Cushing's
syndrome, hyperthyroidism,hyperaldosteroism
.Other causes of secondary hypertension
include obesity, sleep
apnea, pregnancy, excertain prescription
medicines, herbal remedies and illegal drugs.

 Normal blood pressure at rest is within the
range of 100-140mmHg systolic (top reading)
and 60-90mmHg diastolic (bottom reading).
High blood pressure is said to be present if it is
persistently at or above 140/90 mmHg.

 What does the systolic blood pressure number
mean?
 When your heart beats, it contracts and pushes blood through
the arteries to the rest of your body. This force creates
pressure on the arteries. This is called systolic blood pressure.
 A normal systolic blood pressure is 120 or below. A systolic
blood pressure of 120-139 means you have normal blood
pressure that is higher than ideal, or borderline high blood
pressure. Even people with this level are at a greater risk of
developing heart disease.
 A systolic blood pressure number of 140 or higher is
considered to be hypertension, or high blood pressure.

 What does the diastolic blood pressure number
mean?
 The diastolic blood pressure number or the bottom
number indicates the pressure in the arteries when
the heart rests between beats.
 A normal diastolic blood pressure number is 80 or
less. A diastolic blood pressure between 80 and 89
is normal but higher than ideal.
 A diastolic blood pressure number of 90 or higher
is considered to be hypertension or high blood
pressure.
 How is blood pressure measured?
 Blood pressure is measured with a simple painless test usually
using an electronic blood pressure monitor. This consists of an
inflatable cuff that is wrapped around the upper arm (some blood
pressure cuffs wrap around the forearm or wrist) and is attached
to an electronic monitor that gives a digital readout of the blood
pressure and pulse.
 The systolic blood pressure number is always said first, and then
the diastolic blood pressure number is given. For example, your
blood pressure may be read as “120 over 80” or written 120/80.
 Blood pressure is measured in millimeters of mercury (mmHg).
However, usually the “mmHg” is not used when reporting the
blood pressure.

 How often should I get my blood pressure checked?
 If your blood pressure is normal (less than 120/80), get it
checked at least once every five years. However, as you get
older your blood pressure is likely to increase and you
should be checked more often, as frequently as your doctor
suggests.
 If your blood pressure is borderline high - systolic blood
pressure between 120 and 139 or diastolic blood pressure
between 80 and 89 - get it checked at least once a year, or
more often as your doctor suggests.
 If your blood pressure is 140/90 or higher, talk to your
doctor as this is high blood pressure and requires a doctor’s
attention.
Classification of blood pressure for adults
CATOGORY SYSTOLIC mm DIASTOLIC mm
Hg Hg
HYPOTENSION <90 <60
DESIRED 90-119 60-79
PREHYPERTENS 120-139 80-89

ION
STAGE1 140-159 90-99
HYPERTENSION
STAGE2 160-179 100-109
HYPERTENSION
HYPERTENSIVE >180 >110
CRISIS
Why Exercise During Hypertension
 Although there is little disagreement that
medication should be used to treat
Hypertension,many believe that non
pharmacological approaches should be used
for those with mild or borderline
Hypertension.
 The reasons nonpharmacological approaches
are recommended include the possibility of
side effects due to medication

 Generally, the person with mild hypertension
should have physical exam to identify potential
underlying problems, as well as the presence of
other risk factors.
 Kennel a physiologist indicates that while
medication might be used to control the blood
pressure when multiple risk factors(smoking,
high cholestrol, inactivity etc) are present.
 The simple act of stopping smoking confers more
immediate benefit against the overall risk of CHD
than any medication.
 Endurance Exercises are must to master or
reduce the hypertension in an individual.
 Endurance exercises is associated with a 10
mm hg reduction in resting blood pressure in
hypertensive individuals.
 Although not all hypertensive individuals
respond to endurance exercises in this way.
Exercises are recommended for all because
other changes occur to reduce the risk of CHD,
even if blood pressure is not reduced.

The Question is that, How much exercise?
 The standard college of American Sports
medicine exercise prescription for improving
V02 max, is also effective in reducing blood
pressure in hypertensive individuals
 The recommendation is to do 30 mints on most.
Preferabally all days of a week

We can prevent Blood pressure by :
 Maintaining a healthy weight. Being
overweight can make you two to six times
more likely to develop high blood pressure
than if you are at your desirable weight. Even
small amounts of weight loss can make a big
difference in helping to prevent and treat high
blood pressure.

 Getting regular exercise: People who are
physically active have a lower risk of getting
high blood pressure - 20% to 50% lower - than
people who are not active. You don't have to be
a marathon runner to benefit from physical
activity. Even light activities, if done daily, can
help lower your risk.

 Reducing salt intake: Often, when people with
high blood pressure cut back on salt, their
blood pressure falls. Cutting back on salt also
prevents blood pressure from rising.

 Reducing stress: Stress can make blood
pressure go up. Over time, stress may
contribute to the cause of high blood pressure.
 Dietary supplements may also help prevent
high blood pressure.

Cardiac Rehabilitation
It can be defined as
A customized programe of exercise and
education which will lead to better quality of
life.
C.R helps you rebuild your life,both physically
and emotionally.

Population
The persons served by cardiac rehabilitation
programes includes those who have
experienced following heart problems….
 Angina pectoris
 Myocardial infarctions
 Coronary artery bypass graft surgery (CABGS)
 Angioplasty

Angina pectoris
Angina pectoris is the chest pain related to

ischemia of the ventricle due to occlusion of
one or more of the coronary arteries.
Symptoms occur when the work of the heart

exceeds a certain value

Treatment
 Nitroglycerine is used to prevent an attack and/or
relieve the pain by relaxing the smooth muscle and
veins to reduce venous return and the work of the
heart.
 Beta blockers like propranolol (Inderal) are also
used to reduce the heart rate and blood pressure.
 Exercise training supports this drug effect. As the
person becomes trained the heart rate response at
any work rate is reduced.

Myocardial infarction
MI patients have actual heart damage (loss of
ventricular muscle) due to a prolonged
occlusion of one or more of the coronary
arteries.
The degree to which left ventricular
function is compromised is dependent on the
mass of the ventricle permanently damaged.

Treatment
 Beta blockers are used to reduce the work of
the heart and control the irretability of the
heart tissues so that dangerous Arrhythmias
do not occur.
 Training effect is similar to those who do not
have an MI

CABG
Coronary artery bypass graft surgery patients have
had surgery to bypass one or more blocked
coronary arteries.
Exercise improves the chance that the blood
vessels graft will remain open.
Finally the cardiac rehabilitation programe helps
the patients to differentiate angina pain from
chest wall pain related to surgery.

Angioplasty
In this procedure the chest is not open instead a

balloon – tipped catheter is inserted ino the
coronary artery.
Stents may be used in the angioplasty procedure
to help keep the artery open.

Exercise program
There are three phases of exercise program which

are
 Phase l
 Phase ll
 Phase lll

Phase l
This is used to help the patients make the
transition from the cardiovascular event to the
time of discharge from the hospital.
The specific signs and symptoms exhibited by the
patients are used to determine whether the
patient should be placed in an exercise
programe and if so, when to terminate the
exercise session.

Phase ll
After the patient is discharged from the
hospital,a phase ll programe can be started.
In this programe warm up with
stretching,endurance and strengthening
exercises and cool down activities are included.
The patients usually begin with intermittent low
intensity exercise(1 minute on,1 minute off)

Phase ll
In time, the patient increases the duration of the
work period for each exercise.
The strengthening exercises emphasize a low
resistance and high repitation format to involve
the major muscle groups.
Free and machine weights can be used in a circuit
programe format.

Phase lll
After a patient completes an eight to twelve week
phase ll programe the person may continue in
phase lll programe away from the hospital
where there is less supervision, except for the
ability to respond to an emergency.

Effects
Improved cardiovascular function

Exercise in old age

Exercise and aging
 Older age means age above 65 years.
 Their exercise tolerance is low because the
presence of chronic diseases and physical
inactivity.
 Maximal aerobic power decreases in the
average population after the age of 20 @ 1% .

Effect on VO2 maximum
 It decreases with age .
 And increases with physical activities
 It causes vicious cycle ;
 That lead to lower and lower level of
cardiopulmonary fitness ,
 Which may not allow them to performed daily
task .

Physical activity effects on
geriatric population
 It help in cardiopulmonary fitness.
 Help in osteoporosis prevention.
 E.g. hip fracture may cause inactivity or death.
 It help to regulate endurance, power and
strengthening programs.
 It help to provide flexibility to and reduce risk
factor.

Cont……..
 It help the integrity of bone.

Osteoporosis
 Decrease in bone mass(mineral parts) .
 Both male and females are effected
 More common in females .
 Its due to inactivity and sedentary life .
 Physical activity can decrease osteoporosis.
 Its start at the age of above 60 year.

TYPES….
 Type 1 ..Primary.
 It occurs between 50-60 years.

 It caused fracture of vertebral and distal radius
fracture.
 8 % more in females than males..

Types
 Type 2..Secondery;
 Its at the age of 70 years

 It caused hip ,pelvic and distal humrous
fractures
commonly in females.

H.R.T
 H.R.T stands for hormones receptor therapy
 It prevent bone loss and increase bone minerals
and also reduce fracture risk..
 It is more common in female.
 After the age of 50 due to menopause and lack
of estrogen hormones.
 It indicate h.r.t take place.

 Bone structure is maintain due to the force of
gravity and force related to muscles.
 Due to physical activities the bone and
muscles become more stronger.
 It nutrition become highly due to exercises.
 Walking ,jogging etc are help to maintain bone
health..

Exercise programs and guideline
 Best exercises for bone health and density in

the adult as well as in geriatric populations are
the followings
…MODE/TYPE.
 activities like stair climbing
tennis ,playing ,jagging ,football and volleyball.
 INTENSITY.
 moderate to high in term of bone

loading.

Cont….
 …
 Frequency .
 weight bearing activity 3-5 times per
week.
 Duration ..
 30-60 minutes per day with
combination of weight bearing endurance
activities
 i-e jumping ect.

Sarcopenia:
 It is a types muscles fiber disease.
 It is the actual loss of muscles mass.
 It occur in the age of 60-80.
 Causes;
 Lower level of physical activities in older age.
 It cause decrease in muscles mass.

THANK
YOU

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LUNG FUNCTION TESTS

Exercise for Special Population 1

Exercise for Special Population 2

Dr. Bilal Ahmad

Exercise for Special Population 3

The Types of Diabetes

What Causes Type 1 Diabetes

Exercise for Special Population 5

What Causes Type 2 Diabetes

Exercise for Special Population 7

Exercise for Special Population 8

 Hyperglycemia, or high blood sugar, is a

condition in which an excessive amount

of glucose circulates in the blood plasma.

Exercise for Special Population 9

Exercise for Special Population 10

Exercise for Special Population 11

 Vary your routine and

Exercise for Special Population 12

Exercise for Special Population 13

Exercise for Special Population 14

Exercise for Special Population 15

Exercise for Special Population 16

Exercise for Special Population 17

Exercise for Special Population 18

Exercise for Special Population 19

 In asthma or other airway diseases (obstructive

Exercise for Special Population 20

Exercise for Special Population 22

 Signs and symptoms are the same for

Exercise for Special Population 23

Type of Substance Examples

Pollens, Trees, flowers, weeds, hay, plants

Animal dander Birds, cats, dogs

Medications Aspirin, anti-inflammatory drugs

Foods Egg, wheat, nuts

 Medications - generally two types are used

Exercise for Special Population 25

Exercise for Special Population 26

 Discuss your symptoms.

Exercise for Special Population 28

 Understand and take asthma medications as

Exercise for Special Population 29

Exercise for Special Population 30

Exercise for Special Population 31

 In chronic bronchitis, the airways

Exercise for Special Population 33

 In a healthy person, the tiny air sacs in

Exercise for Special Population 35

 About 90% of people with COPD are current or

Exercise for Special Population 37

 Shortness of breath in everyday activities

Exercise for Special Population 39

 Swollen legs or feet from fluid buildup

Exercise for Special Population 40

First, your doctor will listen to

Exercise for Special Population 41

Exercise for Special Population 42

Exercise for Special Population 43

Exercise for Special Population 44

Exercise for Special Population 45

Exercise for Special Population 47

Exercise for Special Population 48