There are certain populations which require specific care and attention in regards to the formulation of a fitness program. This may be because they are part of a minority group or they have a disability or their age is either very young or old. Thorough fitness orientation and pre-screening processes are required. Clients are assigned to one of three risk categories.
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Low-risk clients - May participate in aerobic physical activity/exercise up to a vigorous or high-intensity. There are minimal negative implications and no referral requirements necessary.
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Moderate risk clients - May participate in aerobic physical activity/exercise at a light or moderate intensity. Professional judgement should be used to decide whether further medical advice is required.
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Higher risk clients - Referral to a medical or allied health professional and ongoing collaboration with these third parties is highly recommended to help reduce the risk of adverse events occurring during exercise.
Children are different in relation to adults for fitness training purposes because their bones have not yet fully fused and instead have growth plates at the end of each bone which consists of soft growing tissue instead of strong, solid bones. In order to protect the growth stages of muscles and bones in children, it is recommended to avoid repetitious high impact activities and opt for short bouts of moderate to high impact activities, such as jumping, as this has proven to benefit bone growth.
When strength is the aim of the sessions, children eight years and over may participate in weight training, however using the child’s own body weight in exercises such as pushups, the plank or jumping over low obstacles is a safer option.
Refer the child to a medical professional if:
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They say they are experiencing severe pain.
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They appear to have a joint injury such as a dislocation, or the joint is very unstable.
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Have a loss of movement (e.g. they are unable to walk because of a twisted ankle or injured knee).
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Suffered a minor injury, however, t it has not healed within two weeks.
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Seem to have an injury which has become infected.
Technically there are no exercise limitations for women, they are able to do any of the same routines or use the same equipment as men. However, there are some physiological differences which affect how rapidly exercise benefits may be seen or which may predispose women to certain types of injury if appropriate care is not taken. Men and women also tend to have different preferences regarding exercise regimes.
The main differences are:
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Women have smaller hearts than men - Meaning they have a smaller output of blood from the heart even when a high heart rate is indicated.
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Women typically have a smaller body size - Therefore they have a lower lung capacity yet a higher respiratory rate than men.
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Women have more body fat and a smaller proportion of muscle and bone density - Meaning they usually weigh less than men (muscle weighs more than fat) and are not as strong.
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Reproductive system - Women experience menstruation and menopause and may experience pregnancy, child-birth, lactation. Hips/pelvis also differ in size and shape. Women who are pregnant are still encouraged to participate in exercise. Sports Medicine Australia has produced a pamphlet about Pregnancy and Exercise which is quite informative.
Although exercise can be beneficial for the ageing population, there are also considerations regarding the life-long changes that have naturally occurred. Major changes include:
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Declining muscle mass and bone density - Can predispose clients to strains and fractures.
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Less balance and coordination - Can mean a higher risk of falls.
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Heart complications, such as hypertension - Can restrict coronary circulation and predispose to a heart attack.
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Bone and joint issues - Some clients may suffer from Osteoarthritis.
Key considerations are to ensure programs gradually increase in intensity, and that clients wear appropriate clothing and footwear to help prevent overheating and/or falls. If clients experience pain, dizziness, weakness or shortness of breath then they should slow down or cease physical activity.
Clients with a disability generally live less active lives than those without. Physical disabilities can mean that they have no lower limb movement, as in the case of paralysis, or they may not be able to hold equipment in their hands due to conditions such as multiple sclerosis (MS). Depending on the disability, clients may need to lower blood pressure, blood sugar, manage weight or lower stress levels. Clients may need to restore balance to their body structure, building strength in areas that are used more or less frequently.
Due to the varied forms of disabilities, it is imperative that fitness professionals take into considerations all recommendations made by medical professionals or if no recommendations are provided then seek additional information.
People from around the world can differ physiologically1 and anatomically2, due to geographical locations, food sources and childhood nutrition, healthcare and/or education on exercise and health. Certain cultures may be prone to certain diseases or disorders due to different immunities and immunity levels, lower cardiovascular tolerances, prone to muscular or skeletal damage.
Language differences can present problems, confusion and misunderstanding regarding communication. Finding an effective method of communicating the benefits of and plans for exercise is important. Engaging with a person requires empathy, showing respect and valuing any attempts they make to communicate. Avoid making assumptions by asking for clarification when needed, checking that what has been discussed is properly understood, acknowledging limited understanding and asking for assistance to increase understanding.
Some other considerations could include; clients' possible reluctance to talk about mental health, seek initial medical support or continued support, exercise not a priority, cultural lack of acceptance of women engaging in fitness activities, segregation of men and women/children, and family responsibilities put before self-care.
CALD women in particular, have been shown to be at an increased risk of chronic diseases such as cardiovascular disease, diabetes, and poor mental health. Despite the high risk of these diseases, women from CALD groups are less likely to be proactive in accessing health care or undertaking preventative behaviours, such as physical activity participation.
The socio-cultural influences on the physical activity behaviours of CALD groups living in Australia can be examined by identifying the barriers, constraints and possible enablers to physical activity participation for this population.
Challenges and barriers that limit physical activity participation in CALD groups include; cultural and religious beliefs, issues with social relationships, socioeconomic challenges, environmental barriers, and perceptions of health and injury.
Strategies that may assist with overcoming these challenges and barriers consist of the need for cultural sensitivity, the provision of education sessions addressing health behaviours, encouraging participation of individuals from the same culture, exploration of employment situational variables, and the implementation of safe fitness activity zones in CALD communities. The development of culturally appropriate programmes designed to positively influence the physical activity behaviours of individuals from CALD populations.
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Physiology - The way in which a living organism or bodily part functions.
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Anatomically - Regards bodily structure or anatomy.
Educating clients on the benefits of exercise and the structural and physiological changes they will experience while reaching their goals is important so they know what is normal and expected of their body for the duration of their exercise program. This is specifically important for people who may not have exercised previously – including children or teens, the aged or clients that are post-operative.
When discussing these benefits with specific populations certain adaptations need to be made to communication techniques. For example, young children will need a simplified version of the benefits vs. risks and may be more engaged by images or videos. Elderly clients may have hearing difficulties and this clear speech is required, no mumbling or jargon. People for whom English is their second language may require an interpreter or translated brochures/information.
Benefits of exercise can include but not be limited to:
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Increased feeling of well being.
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Better sleep.
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Better brain function.
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Increased self-esteem.
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Increased levels of energy.
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May prevent diseases and long-term illness.
Clients must be made aware of the major risks such as musculoskeletal injury and acute cardiac events during vigorous exercise activities. However, always tailor this discussion to their individual circumstances following a health and fitness assessment. There is no need to unnecessarily alarm clients if their pre-exercise health screening indicates they are in the low-risk category. Also, educate them on ways to prevent and recognise any symptoms so they can make adjustments to their routine and/or seek assistance accordingly.
Risks associated with lack of physical exercise include;
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Heart disease.
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Depression and anxiety.
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Diabetes.
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High blood pressure.
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Decrease in bone density.
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Decrease in life expectancy.
Risks associated with excessive physical exercise include;
- Musculoskeletal injury.
- Acute cardiac events due to vigorous, high intensity exercise.
- Addiction to exercise.
