Fitness First

Chapter 5


Fitness First



Outline



Being Fit


Breathing



The Physical Fitness Program


Conditioning



Energy Use and Recovery



Physiologic Changes That Occur With Exercise



The Exercise Program



Strength Training



Flexibility Training



Sport-Specific Training


Summary



Objectives


After completing this chapter, the student will be able to perform the following:


1 Define fitness.


2 List the benefits of exercise.


3 Describe how exercise is part of a fitness program.


4 Explain the importance of proper breathing to fitness.


5 List and explain the components of a fitness program.


6 Explain intensity, duration, and frequency as these terms relate to a conditioning program.


7 Explain why it is important to include endurance, aerobic exercise, adaptation, and training stimulus threshold in a therapeutic exercise program.


8 Explain the importance of core strength as it relates to functional training.


9 List the major energy-producing systems in the body and their implications for fitness programs.


10 Identify the physiologic changes that occur with exercise.


11 List and describe the three main components of an exercise program that targets fitness.


12 Incorporate strength training into physical fitness.


13 Describe how flexibility supports an exercise program.


14 Explain the transition from fitness training to sport-specific training.



Key Terms




































Fitness is essential. Regular physical activity helps keep us healthy, mobile, strong, and flexible. The outcome of appropriate exercise, proper nutrition, and emotional and spiritual balance is the foundation for fitness.


Benefits from physical activity include the following:




Being Fit



Objectives




Fitness is about improving physical abilities, health, and well-being. Physical fitness, the target of this chapter, can be described as the capacity to perform physical activity. Because athletic performance is a physical activity, it makes sense that the foundation of physical performance is physical fitness. Exercise is essential in maintaining the body’s overall well-being. Even modest amounts of exercise can substantially diminish the chances of dying from heart problems, cancer, or other diseases. Performing physical work requires cardiorespiratory functioning, muscular strength and endurance, and musculoskeletal flexibility. To become physically fit, individuals must participate regularly in therapeutic exercise—that is, some form of physical activity that challenges all large muscle groups and the cardiorespiratory system, and promotes postural balance.


Any exercise and stretching program must begin slowly. Activity levels can be increased gradually each week. It takes about 8 weeks for those who are new to a program to reach a level of comfort. Additional activities may be added gradually once the body adapts. Whether a person is a competing athlete, is exercising as part of a weight reduction program, or is using exercise to support a wellness lifestyle, massage can assist in achieving and maintaining fitness. Peak athletic performance is achieved from a base of physical fitness.


Deconditioning occurs with prolonged inactivity. Its effects are frequently seen in someone who has had an extended illness. These effects are also seen, although possibly to a lesser degree, in the individual who is sedentary because of lifestyle or increasing age. Decreases in maximal oxygen consumption, cardiac output, and muscular strength occur very rapidly. Balance is needed between training and recovery to prevent both overtraining and deconditioning. People with disabilities require regular physical activity just as much as others without disabilities.


Additional benefits are especially important for people with disabilities because regular physical activity can lessen the probability of developing other physical or mental conditions associated with the disability. These secondary conditions include obesity, pressure sores, infection, fatigue, depression, and osteoporosis. Such conditions can lead to further disability and possible loss of physical independence.


Many people with disabilities are more prone than the general population to underuse, overuse, or misuse of various muscle groups. For instance, a person who uses a wheelchair may have very well-developed anterior muscles from pushing the chair but may need to develop the upper back muscles. Structured exercise and massage can help to balance out these differences. Because of adaptation of the body to compensate for a disability, other body areas are overused. If the lower extremities are affected, fluid movement (circulation and lymphatic) is compromised. Massage can target both of these areas and can support the fitness program.


Developing the physical capacity and strength to move around and perform daily life activities can assist those with disabilities to accomplish or sustain their independence. Physical fitness programs can also help lessen or even reverse some of the physiologic changes that are associated with aging, including loss of the following:



Staying active often helps if activity is limited because of medical conditions such as arthritis/arthrosis or osteoporosis, which may impair the individual’s ability to perform important daily activities such as driving, walking up stairs, and lifting groceries more comfortably.


Regular physical activity can prevent and in some cases reverse some of these changes. It can also help to prevent many conditions associated with aging, such as coronary artery disease, high blood pressure, stroke, diabetes, depression, and some cancers.


What used to be considered diseases of middle age are now showing up in adolescents. This is a major concern. These problems usually occur in conjunction with childhood and adolescent obesity.


Certain well-known risk factors lead to heart disease, including obesity, high blood pressure, high cholesterol, low levels of “good” (high-density lipoprotein [HDL]) and high levels of “bad” (low-density lipoprotein [LDL]) cholesterol, diabetes, cigarette smoking, and family history of heart disease. Exercise has a dramatic effect on almost all of these risk factors by



Any muscle, including the heart, is strengthened by exercise. A well-conditioned heart has a low resting heart rate. The fewer times it has to beat each minute, the longer it rests between beats, and the less strain is put on it.


Conditioning the heart involves identifying a safe and normal heart rate and determining an appropriate training range. The predicted maximum heart rate is the highest number of beats per minute that is safe during the exercise session. This rate can be determined in two ways. An exercise stress test can determine the heart rate by calculating it with a simple formula: 220 minus the person’s age. For example, a person 30 years old would have a predicted maximum heart rate of 190 beats per minute.


During exercise, the heart rate must be brought into the training range, which is 70% to 85% of the maximum rate. This is the heart rate that best conditions the heart. The 30-year-old individual with a predicted maximum heart rate of 190 would have a training range of 125 to 160 beats per minute.


Heart rate monitors are available, or you can take the pulse manually. The easiest place to take the pulse rate during exercise is at the side of the throat on the carotid artery. Place the index and middle fingers at the base of the neck on either side of the windpipe, and count the heartbeats for 15 seconds. Multiply this number by 4. This yields the number of heartbeats per minute.


The type of aerobic activity makes no difference as long as a training range is reached. Ideally, the heart rate is maintained in the training range for at least 20 minutes 3 times a week. However, research shows that even less exercise—10 minutes 3 times a week—can produce health benefits. A little exercise is better than none at all.


image Log on to your Evolve website for more information about weight management and physical activity guidelines.



Breathing




Overview of Breathing Function


Proper breathing at all times is important. If breathing is not effective, the ability to exercise is compromised. Breathing patterns, both functional and dysfunctional, serve as a direct link to altering autonomic nervous system patterns, which in turn affect endocrine function and mood, feelings, and behavior. Especially when working with athletes, the breathing function may be a causal factor in many soft tissue symptoms (Figure 5-1).



The shoulders should not move during normal relaxed breathing. The accessory muscles of respiration located in the neck area should be active only when increased oxygen is required during physical activity. These muscles (transverse, sternocleidomastoid, serratus posterior superior, levator scapulae, rhomboids, abdominals, and transverse lumborum) may be constantly activated for breathing when forced inhalation and expiration are not needed. This will result in dysfunctional muscle patterns and therefore dysfunctional breathing. This is the pattern for sympathetic dominance breathing.


If the athlete does not balance oxygen/carbon dioxide levels through increased activity levels, overbreathing in excess of physical demand can occur. Patterns of breathing dysfunction (overbreathing) are quite common in the athletic population. This can occur for a variety of reasons, including inability to achieve parasympathetic dominance (relaxation) after training or competition; dysfunction of respiratory muscles (Box 5-1); or restricted structure, particularly of the ribs and thoracic vertebrae.



Box 5-1


Breathing Pattern Disorder


Breathing pattern disorder is a complex set of behaviors that leads to overbreathing despite the absence of a pathologic condition. It is considered a functional syndrome because all parts are working effectively; therefore, a specific pathologic condition does not exist. Instead, the breathing pattern is inappropriate for the situation, resulting in confused signals to the CNS, which set up a whole chain of events.


Increased ventilation is a common component of fight-or-flight responses. However, when our breathing rate increases but our actions and movements are restricted or do not increase accordingly, we are breathing in excess of our metabolic needs. Blood levels of carbon dioxide (CO2) fall, and symptoms may occur. Because we exhale too much CO2 too quickly, our blood becomes more acidotic. These biochemical changes can cause many of the following signs and symptoms:



Cardiovascular: palpitations, missed beats, tachycardia, sharp or dull atypical chest pain, “angina,” vasomotor instability, cold extremities, Raynaud’s phenomenon, blotchy flushing or blush area, capillary vasoconstriction (face, arms, hands)


Neurologic: dizziness; unsteadiness or instability; sensation of faintness or giddiness (rarely actual fainting); visual disturbances (blurred or tunnel vision); headache (often migraine); paresthesia (numbness, uselessness, heaviness, pins and needles, burning, limbs feeling out of proportion or as if they “don’t belong”), commonly of hands, feet, or face, but sometimes of scalp or whole body; intolerance to light or noise; enlarged pupils (wearing dark glasses on a dull day)


Respiratory: shortness of breath, typically after exertion; irritable cough; tightness or oppression of chest; difficulty breathing, “asthma”; air hunger; inability to take a satisfying breath; excessive sighing, yawning, and sniffing


Gastrointestinal: difficulty swallowing, dry mouth and throat, acid regurgitation, heartburn; hiatal hernia; nausea, flatulence, belching, air swallowing, abdominal discomfort, bloating


Muscular: cramps, muscle pain (particularly occipital, neck, shoulders, and between scapulae; less commonly the lower back and limbs), tremors, twitching, weakness, stiffness, tetany (seizing up)


Psychological: tension, anxiety, “unreal” feelings, depersonalization, feeling “out of body,” hallucinations, fear of insanity, panic, phobias, agoraphobia


General: feelings of weakness, exhaustion; impaired concentration, memory, and performance; disturbed sleep, including nightmares; emotional sweating (axillae, palms, and sometimes whole body); woolly or thick head


Cerebrovascular constriction: a primary response to breathing pattern disorder; can reduce oxygen available to the brain by about one-half. Among resulting symptoms are dizziness, blurring of consciousness, and, possibly because of a decrease in cortical inhibition, tearfulness and emotional instability.


Other effects of breathing pattern disorder that therapists should watch for are generalized body tension and chronic inability to relax. In addition, individuals with breathing pattern disorder are particularly prone to spasm (tetany) in muscles involved in “attack posture”; they hunch their shoulders, thrust the head and neck forward, scowl, and clench their teeth.


(From Fritz S: Mosby’s fundamentals of therapeutic massage, ed 5, St Louis, 2013, Mosby.)


Appropriate massage is effective in treating soft tissue dysfunction, whereas joint manipulation of some type (e.g., chiropractic) may be necessary for treating facet and costal rib restrictions.


Overbreathing affects performance and decision making. Chronic breathing dysfunction patterns interfere with training by causing fatigue and interfering with sleep and recovery. Because overbreathing perpetuates the fight-or-flight response (sympathetic dominance), any performance or cognitive process requiring controlled and calculated movement and decision making is compromised. Athletes in general may have difficulty managing aggressive behavior. Sympathetic dominance may result in behavior such as a golfer hitting a putt too hard, a football player jumping offside because his timing is off, a quarterback overthrowing to receivers, and a receiver being a little ahead of the football. Baseball pitchers, fielders, and batters are affected when visual perceptions are altered. Basketball players are especially vulnerable, and shooting accuracy is affected by sympathetic dominance and overbreathing.


Assessment for functional breathing problems is very important. If breathing issues are apparent, the athlete should be referred to his or her physician for evaluation to rule out a serious pathology such as asthma, chronic bronchitis, and cardiac and endocrine disorders. Those with cardiac and/or respiratory conditions are prone to breathing dysfunction. To recognize and then develop an appropriate treatment plan, a brief overview of breathing functions is presented here, and an assessment and treatment plan are suggested with a basic protocol in Unit Two. It is strongly suggested that the text Multidisciplinary Approaches to Breathing Pattern Disorders1 be obtained and studied thoroughly.




Phases of Breathing


Breathing includes three categories of the phase of inspiration (bringing air into the body) and two categories of the phase of expiration (moving air out of the body).


Quiet inspiration takes place when an individual is resting or is sitting quietly. The diaphragm and external intercostals are the prime movers. When deep inspiration occurs, the actions of quiet inspiration are intensified. When people need more oxygen, they breathe harder. Any muscles that can pull the ribs up are called into action. Forced inspiration occurs when an individual is working very hard and needs a great deal of oxygen, such as during aerobic exercise. Not only are the muscles of quiet and deep inspiration working, but the muscles that stabilize and/or elevate the shoulder girdle to lift the ribs directly or indirectly are working as well. The expiration phase is divided into two categories: quiet expiration and forced expiration. Quiet expiration is mostly passive. It occurs through relaxation of the external intercostals and elastic recoil of the thoracic wall and tissues of the lungs and bronchi, with gravity pulling the rib cage down from its elevated position. Essentially no muscle action is occurring. Forced expiration uses muscles that can pull down the ribs and muscles that can compress the abdomen, forcing the diaphragm upward.


Normal breathing consists of a shorter inhale in relation to a longer exhale. The ratio of inhale to exhale is 1 count inhale and 4 counts exhale. The ideal pattern ranges between 2 and 4 counts for the inhale and between 8 and 16 counts for the exhale. Reversal of this pattern, in which the exhale is shorter and the inhale longer, serves as the basis of breathing pattern dysfunction. Massage methods, along with retraining breathing, can help restore normal function.


Observation indicates whether the client is using accessory muscles to breathe; in this case, chest movement is concentrated in the upper chest instead of in the lower ribs and abdomen. The shoulders should not move up and down during relaxed breathing. Accessory breathing muscles will show increased tension and a tendency toward the development of trigger points if the breathing pattern is dysfunctional. These situations can be identified by palpation. Connective tissue changes are common because breathing dysfunction is often chronic.


Therapeutic massage can normalize many of these conditions and support more effective breathing. It is difficult to breathe well if the mechanical mechanisms are not working efficiently. Many who have attempted breathing retraining have become frustrated by their inability to accomplish the exercises. They may have more success after the soft tissue and the mechanisms of breathing are more normal. Specific protocols that can be used to assess and address breathing dysfunction are discussed in Unit Three.



The Physical Fitness Program



Objective




Exercise and stretching programs are important parts of any comprehensive fitness program because they provide the activity the body was designed to perform. Exercise has become an essential purpose unto itself. A physical fitness program needs to be appropriate; it is important to modify exercise systems and stretching programs to fit individual needs. Age, maturation, body composition, muscular strength, cardiovascular endurance, state of heat acclimation, nutritional status, and psychological and emotional condition should all be considered when designing programs for different populations.


A physical examination should be conducted before an exercise program is begun. The increase in energy requirements during exercise requires circulatory and respiratory adjustments to meet the increased need for oxygen and nutrients; to remove the end products of metabolism, such as carbon dioxide and lactic acid; and to dissipate excess heat. The shift in body metabolism occurs through coordinated activity of all systems of the body—neuromuscular, respiratory, cardiovascular, metabolic, and hormonal.


Age is not as much a risk as is straining an unconditioned heart. If a sedentary person’s heart is only borderline healthy, a conditioning program could put him or her at risk for a heart attack. Appropriate exercise prescriptions should be developed and monitored by those with specialized training such as exercise physiologists and athletic trainers. The massage therapist does not develop specific therapeutic exercise protocols but does need to understand the aspects of an exercise program and to support the process with appropriate massage application.


When beginning an exercise program, the client should start slowly and gradually increase the duration of exercise up to 20 minutes or more during each session. The exercise should not be a long, strenuous workout on the very first day. Often people will overtrain, or attempt to proceed too fast. If this happens, risks for fatigue, muscle injury, and stress are increased. These individuals find, instead of benefits, that they are sore and become discouraged. It is common for the person to seek massage for these symptoms. However, because the problem is related to incorrect exercise plan implementation, the massage therapist may find it necessary to refer the client to an exercise physiologist or athletic trainer.


Overtraining may decrease immune function, which increases susceptibility to colds and infections. Several studies have shown that intense daily training reduces resistance to infectious diseases such as colds and the flu. The massage therapist should be aware that infection is a symptom of overtraining.


Long training sessions can decrease exercise effectiveness. Although exercise is a great way to reduce stress and anxiety and to lift mood, high-intensity training may counteract the pleasurable and mood-normalizing effects. Research has shown that increased training intensity can create feelings of tenseness, depression, and anger.


Those who are deconditioned; are rehabilitating from an injury, cardiac event, or stroke; or have experienced prolonged inactivity have to regain fitness.

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Jun 22, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Fitness First

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