Other Health-Impaired Conditions

Other Health-Impaired Conditions Chapter 19

Introduction • An official U.S. Department of Education diagnostic category for limited strength, vitality, or alertness caused by chronic or acute problems that adversely affect educational performance • Chronic - long duration • Acute - rapid onset, severe systems, and short course

Common OHI Conditions • Multiple OHI problems • “Not feeling well” affects initiative and morale • Creation of support services in schools and community settings are essential as a supplement to general activity programs

Medication and Use of the PDR • Managed by drugs • Side effects and exercise indications and contraindications are essential • PDR

Diuretics • Manage obesity, heart disease, high blood pressure • Stimulate urination to rid the body of fluids and edema • Allow frequent bathroom breaks • Check for dehydration • Extreme caution when combined with vigorous exercise and hot weather

Blood Pressure Drugs • Lower blood pressure • May be combined with diuretics • Beta blockers prevent heart rate from increasing • Pulse - invalid indicator of effort • Early exercise fatigue • Lowered maximum oxygen uptake • Hypotension is a common side effect

Heart Medications • Nitrates - increase heart rate and oxygen supply and decrease blood pressure • Digitalis preparations - lower heart rate • Heart rhythm regulators - lower blood pressure • May also be taking medications for other conditions

Corticosteroids for Severe Inflammation • Mimic hormones secreted by the cortex • Systemic - influence biochemistry of all body systems • Used to treat arthritis, asthma, and cancer • Side effects include edema, hyperactivity, mood swings • May cause weight gain, growth retardation, diabetes, high blood pressure, and osteoporosis

Asthma Drugs • Dilate the bronchial tubes in the lungs • Increase heart rate • Come in several forms and may cause generalized irritability

Seizure Drugs • Side effects include poor reaction time, incoordination, attention problems, and drowsiness • Many people with cerebral palsy and severe mental retardation take seizure medications

Medication Guidelines • Written statement listing all medications individuals are taking and their side effects • Ask individuals about exercise adaptations they may need • Every person responds to medications differently, and responses vary from day to day

Lifestyle and Risk Factors • Medication is not enough to manage OHI problems • Must emphasize good eating, sleeping, and exercise habits and promote environments of healthy lifestyles • Zero tolerance policy • OHI problems are family concerns

Overweight/Obesity Syndrome • Obesity is a percentage of body fat greater than 25% for males and 30% for women • Overweight is 10-20% above ideal weight for sex and age on height-weight tables • Ideal weight depends on sex, age, body type, ethnic or cultural expectations, athletic goals, and work demands

Importance of Fat Distribution • Varies by age and sex • Females - buttocks and hips • Males - upper body/abdomen • Apple shape, common in both sexes with obesity, carries more health risk • Hormones and genes influence fat distribution more than diet and exercise

Incidence and Prevalence • Obesity affects 5 to 25% of school-age children and youth • Overweight and obesity affects 55% of the United States adult population

Causes of Obesity • Endocrine obesity - malfunctions of glands that secrete hormones - less than 10% • Medication-induced obesity - caused by corticosteroids use • Nonendocrine obesity - caused by interacting hereditary and environmental factors that result in an imbalance between caloric intake and output - most common

Long-Term Management of Obesity • Likened to that of alcoholism and drug abuse • Can be solved temporarily but never cured • Teach lifestyle prescriptions that focus on diet, food intake and exercise output, and self-responsibility for monitoring behaviors and seeking help

Long-Term Management of Obesity • ACSM guidelines • Maintain a minimum intake of about 1,200 calories per day • Engage in a daily exercise program that expends 300 or more calories per day • Lose no more than 2.2 lbs per week

Long-Term Management of Obesity • Number of calories targeted each day depends on sex, age, height, weight, and exercise • Formulas for estimating calories

Lifestyle Prescription and Caloric Balance • FIT acronym can be used to describe exercise and eating • F - Frequency - frequent small meals and daily exercise • I - Intensity - consume 1,200 cal distributed among the six food groups, expend at least 300 cal per day • T - Time - take lots of time in both eating and exercise • For weight loss, exercise expenditure must exceed food intake calories

Lifestyle Prescription and Caloric Balance • Six food groups • Food pyramid should guide daily amounts - least servings from top of pyramid and most from base • Variations for young children and persons with diabetes II • Exchange lists benefit those counting carbohydrates or fat grams by providing that information for each food group

Lifestyle Prescription and Caloric Balance • Principles Guiding Food Selection • Six Foods Principle • The 2.1 Food Group Principle • Dietary Fat Reduction Principle

Lifestyle Prescription and Caloric Balance • Principles Guiding Exercise Selection • Non-Weight-Bearing Activities • Walking for Long Duration • Exercise for Enjoyment • Partner and Support Group • Time Management Counseling • Teach Exercise Fallacies

Implications for Physical Education • Cooperative school/community endeavors that involve the entire family • Nonthreatening and nonchastising • Internalize as criticism of self and denial • Consider the physical characteristics of obesity • Dress policy • Avoidance of certain activities • Successive contracts

Distended abdomen Mobility of rolls of fat Excessive perspiration Thighs and other skin areas rub together Postural faults Skeletal immaturity Edema Broad base in locomotor activities Fear of falling Excessive buoyancy in water Physical Characteristics of Obesity

Blood Fats Associated with Obesity and Heart Disease • Triglycerides and cholesterol • Regular exercise and regulation of cholesterol consumption • Good and bad components of cholesterol • Medication can be used to lower cholesterol when caloric balance, weight loss, and exercise are not effective

Diabetes Continuum • Glucose intolerance • Insulin resistance • Syndrome X • Diabetes • Seen in both adults and children • Treatment focuses on exercise, nutrition, and medication

Prevalence of Prediabetic Conditions and Diabetes • Glucose intolerance and insulin resistance affect - >50% of North American population • Comorbid conditions place persons at risk for diabetes II • 17 million worldwide have diabetes • Increases the risk of blindness, coronary heart disease, amputations, and kidney and urinary conditions

Two Types of Diabetes • Type I Diabetes • Onset generally before the age of 25 • Pancreatic beta cells are capable of producing little or no insulin • Rapid weight loss, frequent urination, drowsiness, and fatigue are classic symptoms • Controlled by daily injections and balancing food intake and exercise

Two Types of Diabetes • Type II Diabetes • Occurs in overweight individuals of all ages • Non-insulin-dependent diabetes mellitus • More women than men • Frequent urination, drowsiness, and fatigue are classic symptoms • Treated with insulin but usually the emphasis is on diet and exercise

Glucose Monitoring • Glucose is a simple sugar that is converted to cellular energy, glycogen, or fat • Levels rise after eating, fall as the stomach empties and fall during aerobic exercise • Levels should be checked several times per day and adjusted with a carbohydrate snack if low, or medication if high

Ketosis, Usually in Type I • Ketosis - results from high fat diets and diabetes causes muscle cramps, decreased ability to fight infections, and increased loss of electrolytes • Leads to hyperglycemia - progression from lethargy to drowsiness to diabetic coma • Blood glucose 300 mg/dl or above is an indicator and urine should be checked for ketone bodies

Hypoglycemic Reaction, Usually in Type I • Opposite condition of hyperglycemia • More common than hyperglycemia • Prevention is a balance between food intake and exercise • Generally occur before meals and during strenuous exercise • Symptoms include excitement, perspiration, and rapid heartbeat - monitor students closely

Management of Diabetes • Control is based on proper diet, exercise, and insulin • Multiple daily insulin shots for Type I • Diet for Types I and II • Exercise for Types I and II • Insulin pump therapy for Type I

Implications for Physical Education • Development of healthy attitudes toward exercise and body care • List of all students with diabetes • Schedule students for physical education after breakfast or after lunch • Create a signal students can use to be excused from class • Provide frequent breaks for fluids

Implications for Physical Education • Protection against damage to the skin • Clean dry socks and proper shoes • Treat all students with dignity and expect them to be prepared to treat reactions • Evaluate fitness over several sessions and gradually increase duration • Teach students with diabetes to exercise with partners who understand diabetes • Be understanding of mood swings

Cardiovascular Problems • Acquired conditions - primarily affect the arteries that supply oxygen to the heart and brain • Congenital conditions - are typically defects in the structure of the heart walls and valves • 1% of newborns have a heart disorder • Chromosomal defects increase prevalence

Cardiovascular Problems • Over 20% of the population has acquired cardiovascular disease • Generally diagnosed after age 50 or 60 • Pathology begins in youth • Coronary artery disease (CAD) is the most common disorder • CAD is more prevalent in males • Blacks have higher death rate than Whites

Atherosclerosis and Coronary Heart Disease • Degenerative process that leads to heart attacks, strokes, and circulatory problems • Accumulation of fatty substances inside the arteries • CAD caused by atherosclerosis is leading cause of death for men and women in the U.S. • Begins in early childhood • Symptoms generally noticed between 40 and 60

Atherosclerosis and Coronary Heart Disease • Indications include: • High blood pressure • Discomfort or pain during exercise • Blood analysis that shows high levels of triglycerides • Without changes atherosclerosis develops into heart attacks, strokes, circulatory dysfunctions, and aneurysms

Heart Attack • Myocardial infarction (MI) occurs when the oxygen demand of the heart muscle cells is greater than the coronary arteries can supply • Angina - (chest pain) occurs behind the breast bone and radiates in different locations • Commonly occurs in males ages 50 and over with high-risk profiles

Stroke • Sudden loss of function caused by ischemia or hemorrhage affecting the brain cells • Strokes can be massive, or small episodes called transient ischemic attacks • Higher prevalence in males until age 75 • African Americans and Asian Americans are more prone to strokes than European Americans • Cerebral thrombosis related to atherosclerotic degeneration is the most common cause

Problems of the Extremities • Reduction of oxygen supply to muscles, skin, and nails • Minimize time spent lying and engage in low-intensity exercise • Indication is pain, aching, and cramping in the calf called claudication • Advanced stages increase susceptibility to injury, disease, and temperature extremes

Congestive Heart Disease, Usually in Old Age • A weak heart muscle can result from: • Cell death caused by heart attacks • Work overload caused by structural defects • Sedentary lifestyles • Progressive weakness causes accumulation of fluid in body parts

Congestive Heart Disease, Usually in Old Age • Review parts of the heart and direction of normal blood circulation • Systemic circulation • Pulmonary circulation • Sides of the heart react differently to congestion • May progress slowly over years • Sitting upright, breathing exercises, and gentle exercise can all be beneficial

Conduction Abnormalities and Heart Rate • Abnormalities in the heart’s conduction system cause: • Dysrhythmias - fast, slow, or irregular heartbeats • Blocks - interruptions or delays in conditions • Ectopic heartbeats may be an exercise contraindication

Conduction Abnormalities and Heart Rate • Chronotropic incompetence - causes a chronically slow heart and sluggish response to aerobic activity • Quadriplegics and high-level paraplegics • Common in severe developmental disabilities • Endurance activities may be contraindicated or need to be adapted to a lower-than-normal target heart rate range

Conduction Abnormalities and Heart Rate • Sick sinus syndrome - dysrhythmias that stem from problems of the sinus node, ANS, and hypothalamus • Wide-spread, though not necessarily serious, abnormalities of rhythm • May cause fatigue, dizziness, and temporary unconsciousness during exercise

Conduction Abnormalities and Heart Rate • Fibrillations - are incomplete contractions of heart fibers caused by conduction disturbances and heart is unable to pump blood • Flutters are similar but less severe disturbances • Ventricular fibrillation is the cause of most cardiac arrests and deaths in adults • Artrial fibrillation compromises ventricular filling • Wolff-Parkinson-White syndrome

Conduction Abnormalities and Heart Rate • Tachycardias - resting heart-rate is faster than 100 beats per minute; higher in infants and children • Sinus tachycardias - originate in the sinus and are between 100-150 beats per minute, triggered by alcohol, caffeine, and nicotine in healthy persons • Some fast rhythms may contraindicate exercise

Other Health-Impaired Conditions