PART 1 Chronic Fatigue Syndrome

1. Exercise Prescription for the Development of Aerobic and Anaerobic Fitness using a Rhythm and Dance Medium. And Chronic Fatigue SyndromeLAB 11BY: Patricia CreightonMargot EllisChris Thorpe& Kaitlyn Watson

2. PART 1 Chronic Fatigue Syndrome • What is it? • Someone who is suffering from Chronic Fatigue Syndrome (CFS) feels completely worn out and over tired. • The extreme tiredness makes it very hard for the person to perform regular daily activities such as getting dressed, having a bath or even eating. • Sleep and rest do not make the person feel less tired or more energetic. • The feeling of fatigue gets worse with exercise, house work and sometimes even thinking. • CFS can come on over time or cab be sudden. Those who get it over time feel fine one day and exhausted the next. • Someone with CFS may have muscle pain, insomnia, and may have trouble focusing. • This extreme tiredness must go on for 6 months before a diagnosis can be made.

3. Sings and Symptoms • Forgetfulness and trouble focusing • Feeling tired even if the person has had rest • Muscle pain and ache • Pain in joints without the presence of swelling or redness • Feeling discomfort for up to 24 hours after exercising • Sore throat • Headaches which possess a new pattern, type or strength • Tender lymph nodes under the arms or in the neck • Low grade fevers

4. Possible Causes or Triggers • Viral infection • Immunological dysfunction • Abnormal hypothalamic pituitary adrenal • Hypotension • Nutritional deficiency • Profound psychological stress

5. Management: • Based on symptom reduction as opposed to reversal of syndrome • Medications vary with symptoms and philosophy of physician • Variety of medications such as antidepressants, anti- inflammatory, antihistamines, and anti-hypotensives. • Non traditional approach includes diet manipulation, vitamin and mineral supplements, herbal preps, and massage therapy. • Exercise testing includes a standard ECG, testing for HR, blood pressure, respiratory gases and ventilation • De-conditioning often requires lower protocols and work rate increments.

6. Exercise Response to Chronic Fatigue Syndrome • Exercise training us not a part of the dignosis • Mild reduction in peak O2 consumption and ventilor threshold • Exercise response apprears to be the same as other discontinued patients • Cause appears to be the central nervous system • Exercise testing may be required to diagnose and excluse other conditions

7. Exercise Effects • post exercise period fatigue extreme – push crash phenomenon • Reason for post causal symptoms not clearly understood • Client may relapse as a result • Prescription needs to consider response pattern • Overall improvement of symptoms reported in many patients • Exercise benefits promoted • Modest gains – perceived outcomes and benefits.

8. Contraindictions for Exercise • Avoid exercise that focus on optimizing aerobic capacity • Avoid push-crash phenomenon where the patients over exert themselves, then crash and rest and once the feel better over exert themselves again • Psychological Considerations • Often accompanied by depression • Frustration and disillusionment due to variety of treatments • Counseling in supportive and understanding environment • Need to budget their energy • Provide information as to what to expect when referred for testing and evaluation

9. References • Chronic Fatigue Syndrome. (2006, June). The Federal Government Source for Women’s Health Information. Retrieved March 19, 2007 from http://www.4woman.gov/faq/cfs.htm • What Causes Chronic Fatigue Syndrome? (2004). Living Well with Chronic Fatigue Syndrome and Fibromyalgia. Retrieved March 23, 2007 from http://www.cfsfibromyalgia.com/info/cfscauses.htm • Shell, C. (1984). The dancer as athlete. Vol. 8. IL: Human Kinetics Publishers, Inc. • http://www.shape.bc.ca/resources/pdf/dancernutrition.pdf • http://podiatry.curtin.edu.au/ballet.html#military • http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=2 • http://cs.beloit.edu/~chavey/Dance/General/Shoes.html

10. PART 2 DANCE • Dance consists of structured movement and is an art form used for both enjoyment and expression. Dancing describes the simple joy of physical movement. Rhythmic movement represents a natural reaction to emotion and aesthetic dance. Matching intellect & emotion, discipline and spontaneity, aesthetic dance such as ballet combines both spirituality as well sex appeal. So…

11. WHY DANCE? • - More efficient gas exchange - More Mitochondria/cell • - Increased O2 uptake - Improved fat metabolism • - Stronger heart muscle - Faster recovery rate • - Greater SV, venous return, storage of glycogen and CO • - Decreased resting HR and BP • - Reduced risk of hardening of the arteries

12. Fitness Coomponents • - Cardiorespiratory fitness is the major determinant of a dancer’s endurance and efficiency. • - Dance, of any kind, has positive effects on cardiorespiratory fitness because they have high rates of energy expenditure. • - Dancers usually report with higher than average VO2 Max values, endurance capacity expressed as HR and Ventilation rate (Ve). • - Core strength and muscle balance is critical for balance, which is important in dancing. • - Flexibility among dancers is higher than the average athlete. • - Agility and coordination are also important components to dancing and need to be strong.

13. Footwear • - Specific shoes are made for specific fitness activities, this is no different in dancing. • - Many aerobic dancers work out on concrete surfaces covered by thin carpet and must wear proper shoes to protect their feet. • - Design needs flexibility, shock absorbing qualities and durability. • - Ballet shoes specifically should fit your foot like a glove - a bit tighter than regular street shoes so the shoe can provide close support for your foot and so that the shoe doesn't fly off your foot during quick moves.

14. Nutritional Needs of Dancers • -To perform at their best, dancers need to be well fueled for classes, rehearsals, and performances • - The desire to maintain the dancer figure (dance-ideal body weight) often dictates the quantity and frequency of food • - The easiest rough estimate of how many calories a dancer requires during heavy training is 45-50 calories per kilogram of body weight for females and 50-55 calories per kilogram of body weight for males • - Nutritional needs require an adequate supply of fluids, calories matched to work demands, good quality protein and vitamins and minerals in correct amounts • A dancer's diet should be composed of about 55-60% carbohydrate, 12-15% protein, and 20-30% fat

15. Nutritional Needs cont’d… • CARBOHYDRATES: Times when carbohydrate ingestion is important. About 1-2 hours prior to these activities, a small carbohydrate snack should be consumed. During long rehearsals it is also important to ingest some carbohydrate to maintain circulating levels of glucose to prevent fatigue. It is important to ingest carbohydrate as soon as possible after a long or strenuous exercise period to refill muscle stores and be ready for the next activity. The best time frame recommended is within 40 minutes after a class. • FAT: A diet too low in fat can have serious health consequences and ultimately can impair performance. • PROTEIN: Adequate protein ingestion is essential for all dancers who are training. For those dancers who are not building muscle, protein is needed to repair the breakdown of muscle fibers that are stressed by constant use. • FLUID: A cup (8 ounces or 250 ml) of fluid every 15 minutes is recommended. Whenever there is a break in class or rehearsal, the dancer should have ready access to fluid, and they should be encouraged to drink because the thirst mechanism does not keep up with the body's need for fluid.

16. Common Dance Injuries • - Low back muscle strain and spasm • - Bursitis OR Tendonitis • - Sacroiliac joint sprain- sprain in pelvic joint • - Stress Fractures • - Patellar malalignment • - Meniscus tear • - Perostitis • - Achilles tendinitis • - Chronic exertional compartment • syndrome • - Bunion, Callous, Corns • - Ingrown toenails • - Plantar Fascitis

17. Injury Prevention and Treatment • - Always Warm Up and Stretch • - Constantly emphasize correct alignment • - Wear correct shoes • - Dance on appropriate floor surfaces • -Strengthen the abdominals* • - NSAIDs • - Use ice on injury after workout for 10-15 minutes • - Sleeves, braces, splints, casting, orthotics, pads - these restrict mobility and lower stress on injured areas • - Physical therapy exercises

18. Structure and Content of a Dance Class: (3-5 Days/Week if not more) • The Warm Up: 5-10 Minutes • - Before stretching a warm up is recommended, especially important in the morning • - Raises core temp of the body, HR and increases blood flow to the muscles • - Lubricates the joints, reducing chance of injury • - Increases muscle elasticity • Today this will include running on the track with different variations. • Stretching: 10-15 Minutes • - Be sure not to bounce when stretching • - Emphasize breathing and relaxation and utilize a gentle, slow, progressive approach • - At minimum, stretch the following muscles: erector spinae, abdominals, groin, hamstrings, gastrocnemius, quads, iliopsoas AND ankles (which are often forgotten).

19. Structure and Content of a Dance cont’d… • Strength Training: • - Flexibility should be balanced with strength in order to control ROM of a joint and to prevent stress on the tendons and ligaments. • - Emphasize control, ensuring correct muscle use and technique. • - Work the muscles in pairs, starting with larger muscle groups. • Today this will be split between two groups of stations. The first are various core strength stations set up on the field and the second group is ballet specific, in the dance studio. • Aerobic Workout: 20-30 Minutes • - Aim for 60-80% of maximum HR • - Progression is important – start students at the lowest threshold and increase load gradually. • Usually this consists of practicing a dance routine or new dance moves specific to the type of dance. • Cool Down: 10-15 Minutes • -Gradually reduce movement intensity. • - A good time to work on technique. • - Progress to the floor for stretching and relaxation. • - Make sure students are under 100 beats/minute

20. References: • Shell, C. (1984). The dancer as athlete. Vol. 8. IL: Human Kinetics Publishers, Inc. • http://www.shape.bc.ca/resources/pdf/dancernutrition.pdf • http://podiatry.curtin.edu.au/ballet.html#military • http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=2 • http://cs.beloit.edu/~chavey/Dance/General/Shoes.html

21. Exercise Prescription for the Development of Aerobic and Anaerobic Fitness using a Rhythm and Dance Medium. • Warm Up: 10 Minutes • - Play a game of handball. • Stretching: • - Whole body basic stretching. • - Target both major and minor muscle groups. • -Focus is on flexibility and preparing muscles for full ROM exercises. • Exercises: • Group #1 • These stations focus on core strength, stability, balance and flexibility. Students will be paired up and spend about 4 minutes at each station out on the field, before going to the dance studio for more specific dance exercises.

22. Exercises • Station #1: One Leg Circle with Exercise Band • This exercise is about using the abdominal muscles to maintain stability of the pelvis and trunk as the leg moves independently in the hip socket. The core abdominal muscles keep the motion of the leg from affecting the trunk. The resistance band will work the leg and hip muscles. • - Lie on your back with your legs outstretched. Bring one leg up and place the middle of your exercise band around the ball of your foot. Extend that leg toward the ceiling.With your head and shoulders down on the mat, keep your chest and back wide as you adjust the tension in your band so that it provides some resistance, but does not strain your arms or shoulders, or strongly push the leg down into the hip socket. • - You are going to do leg circles. Imagine that the energy extends from your leg so that you are drawing circles on the ceiling. Start with small circles. As your ability to control the movement increases you can expand your circles. • - Do five circles with each leg, in both directions.

23. Station #2: Hip Extension with Exercise Ball • This exercise focuses on gluts. • - Lie down with feet heels propped on ball.  • - Keeping abs tight, slowly lift your hips off the floor (squeezing the gluts) until body is in a straight line.  Hold for a few seconds and lower.  For added intensity, lift the hips and then take one leg off the ball, hold for a moment and lower.  • - Repeat, lifting the other leg off the ball. • - Repeat 10X with each leg.

24. Station #3:Balance on Exercise Ball • This activity stresses the importance of balance. Be sure to use your partner for help if needed. • - Using partner for stability, kneel on the exercise ball. • - Hold balance for 30 seconds then switch with partner.

25. Station #4: Balancing Lunges • Again, balance and core strength are the focus here. • - Put one foot on exercise ball, with leg extended backwards. Lunge forward. • - Do 5 lunges for each leg, holding each for 5 seconds in flexed position.

26. Station #5: Trunk Rotation with Medicine Ball • - Sit on the ground with knees flexed 90 degrees and feel off the floor. • - Hold medicine ball with both hands in front of torso and rotate from side to side. • - Repeat 3 set of 10 reps.

27. Dance Specific Exercises • -In dance studio as a group, instructor teaches the class basic ballet positions. • - Students should be in socks. • First Position: • - Stand with heels together, toes pointed outwards. • - Hold arms at your side with palms facing inwards. • Second Position: • - From position #1, spread feet 1 foot apart • - Extend arms to sides at shoulder height. • Third Position: • - Bring feet back together, with heel of right foot in the arch of the left foot. • - Flex arms 90 degrees at the shoulder, with palms always facing the body.

28. Fourth Position: • - Step forward with right foot turned out, placing right heel in line with big toe of left foot. • - Bring right arm above the head and left arm to side of the body. • - Palms should be facing each other. • Fifth Position: • - Bring right foot back so the heel is against the big toe of the left foot. • - Both arms should be raised above the head, palms facing in. • In sequence looks like:

29. Plies on Barre: • Get in first position. - Standing beside wall facing forward, rest fingers on the wall with straight arm. - Demi plies, keeping heels on floor while abducting the arm. - Return to first position. - Flex arm at shoulder 90 degrees, swing right arm out to the side. - In a continuous motion, adduct the arm and flex the knees bring heels off the floor and extend the knees while returning arm to starting position. This is a full plies. • Get in second position. - Demi plies, keeping heels on the floor while abducting the arm. - Return to second position. - Full plies in second position, however do not raise heels off the ground. • Get in third position. - Demi plies, keeping heels on the floor while abducting the arm. - Return to third position. - Full plies in third position, similar to first position, remembering to raise heels off the floor.

30. Get in fourth position. - Demi plies, keeping heels on the floor while abducting the arm. - Return to fourth position. - Full plies in fourth position. • Get in fifth position. - Demi plies, keeping heels on the floor while abducting the arm. - Return to fifth position. - Full plies in fifth position. • Pirouettes: • Get in first position. - Abduct the arms to 90 degrees at the shoulder while abducting the right leg with pointed foot. - Move right leg behind to body to be in fourth position. At the same time, bring right arm into third position. - Push onto the ball of the left foot while abducting right leg at the hip and flexing right leg at the knee. Bring right foot to the left knee with pointed toes. - Bring both arms to third position. - Spin clockwise 360 degrees, landing in third position.

31. Stretching: - Whole body basic stretching. - Target both major and minor muscle groups. -Focus is on flexibility and preparing muscles for full ROM exercises. -Acts to cool down the body, focusing on breathing and relaxation. • Neck Stretches: hold each for 10 count, 2 reps. ( look to the left, to the right, Up and down) • Upper Arm Stretches: hold for 10 count, 2 reps. The wrestler bends elbow so hand reaches down the back and uses the other hand to put slight pressure on the bent arm downwards.

32. Shoulder Stretches: hold for 10 count, 2 reps. Reach one arm across body and hold with opposite arm close to the body. • Lower Back Stretches: hold each for 10 count, 2 reps. Kneel on knees and hands and arch back down and up. • Sitting or standing simply rotate to each side of the body at the • trunk.

33. In lunge position, drop your back leg to the ground. Keeping the hips square, bend the leg in front to 90 degrees and slightly move forward until a slight stretch is felt. This will also stretch your quadriceps muscles. • Hip Stretches: hold for 10 count, 2 reps. • Calf Stretches: hold for 10 count, 2 reps. Laying on your back, pull both knees up to your chest. Take one foot and place it on the other bent knee. Use your hands on your bent knee to pull it closer to your chest until you feel a stretch. Facing a wall, place your hands on the wall and step back with one of your feet. Keeping your heel on the ground of your back leg, move your body closer to the wall, bending at the ankle until you feel a stretch in the back of your lower leg.

34. Challenge Activity: • In groups of four, students will have to make up their interpretive dance to music given. • They will have a small period of time to prepare and each group will present to the class. • The winning group will be chosen based on creativity, expressiveness and intensity.