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Fitness Prescriptions

Professional Boundaries

As with all other groups in the population, the ‘special population’ groups covered
in this section are made up of individuals. General guidelines are discussed but it is vital
to remember that each group will contain people with a wide range of physical and
physiological capabilities. If the pre-participation screening reveals factors that could
contraindicate physical activity, individuals must be referred to the appropriate
professional; for example, their GP or other medical professional, before taking part in
physical activity.
If individuals have been advised to take part in physical activity by a healthcare
professional, it is imperative that they stick to the guidelines / restrictions provided. They
must also consult their healthcare professional regularly to ensure that their activity
program remains suitable for them. Fitness professionals working with special population
groups should observe their own professional boundaries and remember that it would be
foolish to work beyond their level of training. By stepping outside of professional
boundaries, fitness professionals will not be able to give their clients the service they
require or expect. More worryingly, those who work beyond their level of knowledge or
expertise risk ‘doing harm’ to a person, which may result in legal action. Those who are
not trained in ante and postnatal fitness, for example, should not work with this
population group as they would not be aware of the limitations of this physiological state.

Working with Antenatal and Postnatal Women

Many physically active women who become pregnant wish to continue exercising
throughout their pregnancy and, if they have a ‘normal’ pregnancy, there is no reason
why they should not do so. In fact, research shows that fitter women may have an
‘easier’ pregnancy and birth and find it easier to regain their pre-pregnancy fitness and
weight (Varassi et al., 1989)

General Considerations

Programming for antenatal and postnatal women needs to take

into account their current physiological state as well as their
previous exercise history. Some general considerations which
need to be considered when programming for this group include:

• Take advice: all newly pregnant women are advised to consult

their healthcare professional before beginning or continuing with an
activity program, regardless of how experienced an exerciser they
are.

• Balance: as a woman’s body shape changes so does her center of gravity which will
affect her balance, so this needs to be considered when prescribing activity: activities
that could cause a loss of balance need to be avoided.

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• Posture: changing body shape will also affect a woman’s posture so it is important to
include exercises to address this factor in the program.

• Overheating: pregnant women are more at risk of overheating which can be potentially
harmful for them and their baby. It is vital that pregnant women who are taking part in
exercise maintain adequate hydration levels.

• Type of exercise: pregnant women should avoid supine exercise after the first
trimester and avoid the Valsalva maneuver (forced expiration against a closed glottis –
most commonly seen as breath holding when lifting weights).

• Monitoring intensity: due to the variability in maternal HR response to exercise, target

HR cannot be used to monitor intensity during pregnancy. RPE is more appropriate.

• Energy intake: pregnant and breastfeeding women need to consume extra calories.
The recommended energy intake varies according to the woman and her stage of
pregnancy but is something that must be considered.

• Relaxing: the concentration of the hormone relaxing is increased during pregnancy

and for some time afterwards. Higher levels of relaxing make a woman’s joints ‘looser’
putting her more at risk of injury from overstretching or sudden changes in direction.

• Re-starting exercise postpartum: after a normal vaginal delivery, most women will be
able to begin exercising after four to six weeks postpartum. It is always recommended,
however, that women obtain clearance from their healthcare professional before
restarting an exercise program.

PROGRAMMING GUIDELINES

The American College of Obstetricians and Gynecologists guidelines for exercise

for pregnant women with no complications (Artal and O’Toole, 2003) are outlined in table
8.2. It is important that the woman’s capabilities and any symptoms or discomforts are
closely monitored during her pregnancy and the activity programme adjusted
accordingly. The appropriateness of the exercise alongside the woman’s safety and that
of her baby must be of the utmost consideration.

Table 1. Ante and postnatal exercise guidelines.

Training CV training Resistance Flexibility training
variable training

Frequency At least three days At least two days a At least two days a
a week. week. week.
Preferably every
day.

Intensity Moderate intensity. Moderate intensity. To achieve normal

Twelve to 14 RPE ROM.
on Borg scale.

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Time Up to 30 minutes a Perform exercises Perform at least

day. for all major muscle one stretch for all
Total of 150 groups. major muscle
minutes a week. Complete groups.
Beware of approximately 12 to
thermoregulation 15 repetitions.
if exercising for
more than 45
minutes.
Type Dynamic, rhythmic Avoid supine Avoid supine
activities exercise, isometric exercise.
that use large Actions.
muscle groups; for
example, walking,
cycling and
swimming.

Working with Young People

Physical activity levels have been shown to decline

markedly as children approach adolescence. It is important to
try to reverse this trend as people who are active as children
are more likely to continue exercising as adults. In addition,
young people who are active are less likely to be overweight:
this will help to protect them against certain conditions such
as diabetes and cardiovascular disease in youth and
adulthood.

General Considerations

It is important to remember that young people are not ‘mini-adults’ and that their skeletal,
muscular and cardiovascular systems are immature. Some of the general considerations
that need to be taken into account when programming for this group include:

• Supervision: young people require a higher level of attention and supervision during
an exercise program than adults to ensure that their technique is correct and that they
are not doing themselves any ‘harm’.

• Technique not weight: with young people it is recommended to focus on technique

rather than the amount of weight lifted.

• Developing skeleton: care must be taken when working with young people as their
skeletons are still developing.
A well-developed, supervised exercise program will not cause any growth defects and
will help to boost peak bone mineral density.

• Hydration: the thermoregulatory system of young people is immature and they need to
pay special attention to their hydration status during exercise. Where possible, they
should exercise in a ‘thermoneutral’ environment.

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PROGRAMMING GUIDELINES

Table 2. Guidelines for exercise prescription for young people.

Training CV training Resistance Flexibility training
variable training

Frequency At least three to Two to three days a At least two days a

four days a week. week on non- week.
Ideally, every day. consecutive days.

Intensity Moderate to Low to moderate Moderate.

vigorous intensity intensity.
Avoid maximal /
near maximal RT.

Time Aim for 30 minutes Perform exercises Perform at least

of moderate and 30 for all major muscle one stretch for all
minutes of vigorous groups. major muscle
daily. Complete groups.
Inactive / approximately eight
overweight to 15 repetitions.
individuals may
slowly progress to
60 minutes
Type Any activity that Bodyweight Developmental
uses major muscle exercises or circuit- stretching for all
groups; for based training major muscle
example, cycling, sessions are ideal. groups.
football, dance, Any RT as long as
tennis, walking, it is well performed
circuits. and supervised.

Working with Disabled People

The term ‘disabled’ incorporates a wide range of

conditions and it is impossible to be an expert in them
all. It is important, however, that fitness professionals
are able to work with disabled people in order to help
them benefit from improved fitness. In many cases,
disabled people themselves will be the ‘experts’ and
they will know their own capabilities. This being the
case, the fitness professional will simply need to elicit
this information and translate it to a balanced exercise
programme.

General considerations

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Some general considerations to be taken into account when programming for this group
include:

• Safety: any activity prescribed for disabled people mustbe safe for them to perform.
The relative safety of the activity will depend upon the disability of the person; for
example, a blind person may have difficulty using a treadmill but be fine on a stationary
bike.

• Suitability of exercises: the nature of a person’s disability will determine the suitability
of an exercise. Factors to consider include the person’s physical capability, mental
capability and sensory capability.

• Equipment modifications: some equipment can be modified and adapted to be made

suitable for certain disabled users. If this is the case, it is important that fitness
professionals are aware of how to make these modifications and for whom the
equipment is suitable.

• Respect differences: one of the most important considerations when working with
disabled people is to ensure that the focus is placed on the ‘can do’ not on the ‘cannot
do’. By concentrating on the capabilities of the disabled person, it encourages
participation and inclusion.

• Medication: some disabled people will be taking prescription medicine for their
condition. If this is the case it is important that they have medical clearance as there are
contraindications for exercise associated with certain medications.

• Take advice: in some cases it may be necessary to consult people’s medical

professional or carer, if they have one. If this becomes necessary, the disabled people’s
consent should be gained before speaking to anyone else about them or their program.

SUMMARY

When working with antenatal and postnatal women it is important to consider:

whether they need to consult a medical professional before beginning exercise how their
balance and posture have been affected by the pregnancy. How to maintain their
hydration status ways to avoid exercise in the supine position and the maneuver the fact
that they require an increased energy intake the fact that they have a higher
concentration of the hormone relaxing, and how long ago they gave birth and whether
they have had medical clearance to start exercising.

• When working with young people it is important to consider: the impact of the exercise
on their developing skeleton whether they need supervision, and how to maintain the
focus on technique not intensity.

• When working with disabled people it is important to consider: whether the exercise is
safe and suitable for them whether equipment can be modified to help make exercises
more appropriate any medication that they are taking, and whether they need medical
clearance to take part in exercise.

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