`

PREVENTION PRACTICE: A HOLISTIC

PERSPECTIVE FOR PHYSICAL THERAPY
CHP # 1
HEALTH AND WELLNESS
 “ The doctor of future will give no medicine, but will
interest his patient in the care of the human frame, in
diet, and in the cause and prevention of disease.”

THOMAS EDISON
 HEALTH
• Derived from Old English term “hal” meaning
sound, or whole
• Health is essentially a purpose of medicine, the
promotion and restoration of wholeness.
• By Webster Dictionary “stat of being healthy,
happy, and prosperous”
 According to WHO
“A stat of complete physical, mental, social and
spiritual well-being.”
 In community health & education and promotion
manual health is defined as a more dynamic
process,
“A quality of life involving dynamic interaction and
independence among an individual’s physical well
being, his/her mental and emotional reaction, and
the social complex in which he/she exist”.
 HEALTH
• Spiritual health or passion::: to fulfill a need or
personal goal another aspect of health.
• Physical, mental social and spiritual components are
key factors for comprehensive health examination.
• Medical professionals notice a shift in their health
care paradigm perspective from one emphasizing
illness to one stressing health, function, quality of
life and wellbeing
• Shift in health care --prevention-- disease by
helping & modifying life style--optimal health
• Optimal health:
• Balance of physical, mental, spirtual, and social health
• Life style changes:
• 1. enhance self awareness and knowledge of healthy habits
• 2. change behaviors interfere with good health
• 3. create environment support good health
 POOR HEALTH
• Include physical ailments --acute & chronic
disabilities,
• mental health issues--limit independent
functioning.
• Poor health --significant impact on individual,
family, community and society--- depending on
severity individual lose functional independently
and opportunity to fulfill role in community and
home.
• Family members lose support who are ill and
disabled.
 POOR HEALTH
• Musculoskeletal disabilities in US cost more than 1
trillion dollar/year in total costs.
• National center for chronic disease prevention and
health promotion.: unhealthy life style lead to early
diseases-chronic diseases--disabilities & early
deaths- as well increase risk factors for heart,
kidney diseases and diabetes.
• Life style risk factors include: smoking, tobacco,
eating high fat/trans fat food,/ low fiber diets,
sedentary life style, alcohol & drug abuse
• . Emphasis is on effective prevention, active
intervention for disability progression.
 WELLNESS
• an active, life long process of becoming aware
of choices and making decisions toward a more
balanced and fulfilling life.
• Wellness involves choices about one’s life and the
priorities that determine one’s lifestyle.
• Wellness integrates mental, social, occupational,
emotional, spiritual, and physical dimensions of
one’s life and reflects how one feels about life as
well as one’s ability to function effectively.
`
 WELLNESS
• A state of good health often achieved through
healthy lifestyle choices including the following six
dimensions of wellness described by the National
Wellness Institute
1:Social wellness:
perception of having support from family or friends in
time of need; and perception of being valued
support provider.
Interacting and contributing to one’s community or
environment establish meaningful relations that
enhance quality of life
Social support valuable asset for health and wellness
as well recovery from injury.
• ■ 2:psychological wellness:
General perception that one will experience
positive outcomes to events and circumstances
in life.
The mix qualities of optimism, determination,
hope; are vital in preventive practice and
positively dealing with life problem.
• ■ 3:Spiritual:
• Belief in unifying force b/w mind and body.
• Finding and living a life that has meaning and
purpose.
• It include person’s ability to establish values and act
on system of belief as well as to establish meaningful
& constructive lifetime goals
• ■ 4: Physical:
• Positive perception and expectation of health.
• It include ability to meet daily demands at work & to
use free time.
• Making appropriate nutritional choices and
participating in regular physical activity.
 WELLNESS
5. Intellectual:
Perception of being internally energized by an
optimal amount of intellectually stimulating
activities.
Actively using your mind to develop new skills
and learn new information.
■ 6.Emotional: progression of secure, self
identity and positive sense of self regard & self
esteem.
Ability to cope with daily circumstances & to deal
with personal feeling in positive, optimistic &
constructive manner.
 WELLNESS
• Howard clinebell provide more
comprehensive seven dimension of wellness:
• 1. The Spiritual Well being dimension
incorporates healthy religious beliefs,
practices, values, and institutions that
energize and enrich all aspects of our lives.
it addresses an individual’s need for purpose,
guidance, meaning and values.
• 2.The Mental Well being dimension represents
profound interdependence of the mind and body
that manifests itself in our mental and physical
health. it incorporates problem solving ,creativity,
clarity in thinking ,services and productivity.
• 3. The Physical Wellbeing dimension reflects the
body’s health. Physical well being is evidenced by
ability to experience sensations without pain, to
effectively function with adequate energy to be
responsible for self care and to care others.
• 4.The Relationship Wellbeing dimension
represents the most important factors for our
healing and general wellness. It incorporates
the need for progress and love, forgiving and
receiving, for empowering others and for
creating interpersonal bonds.
• 5. The Work wellbeing dimension satisfies the
thirst for purpose. It addresses the need for
fulfilling the purpose in one’s profession.
• Self worth, satisfaction and personal fulfillment
are all related to individual's ability to serve
community in meaningful way.
• 6.The Play Wellbeing dimension acknowledges that
play provides the individual with laughter, cheer,
energy and balance. It is ability to successfully play
that provides the needed healing and revitalization
to meet the demands of other dimensions.
• 7.The Wellbeing of Our World dimension
reflects an individual’s perspective on living in a
healthy environment and protecting natural
resources.
• it incorporates a broad overview of the world. it
includes responsibility, justice, an earth caring
lifestyle, desire of wellbeing for all and adequate
health care.
Seven dimensions provide a framework for
exploring various aspects of health & wellness,
including versatile individual & perspective of
world.
 Models of wellness
Provide multidimensional aspects of wellness give
framework for clients needs for management of
illness
Signs….. Symptoms…… Disability….. Premature death
Signs:
changes due to any pathology that is detected
on diagnostic tests(i.e. lab test) by a pathologist, or by
a physician, or therapist.
• They are physiological and anatomical markers of
pathology
• Example ; Hb levels, findings of CBC, PCR etc
Symptoms:
sensation or changes in the bodily function
experienced by a client or patient
• Pain….. etc
Disability :
Inability to engage in gainful activity or work, often
results from chronic and long term illness and has
significant impact on an individual’s well-being
Advantage of model: help in early identification of
sings &symptoms of pathology -early intervention-
 prevent disability and premature death.
`
 Holistic health .
• Holistic Health is actually an
approach to life. Rather than
focusing on illness or specific
parts of the body, this ancient
approach to health considers the
whole person and how he or she
interacts with his or her
environment.
• It emphasizes the connection of
mind, body, and spirit.
• American holistic health
association.
 HOLISTIC HEALTH

• This holistic perspective looks beyond the physical

functioning of the individual and recognizes the
importance of multiple factors contributing to good
health and optimal wellness, emphasizing the unity
of mind, spirit, and body.
• According to American Holistic Health Association,
perspective of holistic health considers “the whole
person and the whole situation”
 Principles of Holistic Medical Practice
1. The goal of holistic medical practice is achieving
optimal health for each client. Optimal health involves
both a conscious awareness of wellness domain(
social, spiritual, mental, emotional, physical, and
environmental) and achieving balance in these
domains.
2. Practitioner offer “holistic care” i.e, care to entire
person(mind, body, and spirit)
3. Holistic medicine is person-centered, treating the
individual with pathology rather than focusing on the
pathology itself.
4. Practitioners helps clients take control of their health
and use their innate abilities to heal.
5. Holistic medicine involves health promotion, preventive
care, and education designed to increase awareness of
factors contributing to illness while emphasizing options
that optimize well-being
6. Holistic medicine incorporates a variety of healing
system, including lifestyle changes, conventional
medicine(drugs and surgery), and alternative and
complementary medicine, to meet each individual’s
unique needs.
7. The relationship of the practitioner and client focuses
on the client’s autonomy and needs.
8. Using love, kindness, acceptance, grace, humor,
enthusiasm, and hope, practitioners help clients
optimize their lives while managing any illness
9. Practitioners serve as role models of optimal
care by incorporating the principles of holistic
medicine into the healing relationship shared with
their client
10. Life experiences(birth, suffering, and dying) are
viewed as profound learning experiences for both
the client and the practitioner of holistic medicine.
The quality of life is emphasized as key
component of healing.
 Comparing Holistic Medicine and Conventional Medicine
Holistic Medicine Conventional Medicine
Philosophy Based on allopathic, Based on allopathic
osteopathic, naturopathic, medicine
energy
To cure and reduce
Primary objective of care To promote optimal health pathology
To prevent and treat disease

Diagnosis Medical history, physical exam, Medical history,

laboratory data, holistic health physical exam,
care sheet laboratory data
Primary method of care Empower patient to heal
themselves through health Eliminate sign and
promotion and lifestyle changes symptoms
Primary care treatment
option Diet, Ex, environmental
measures, attitudinal,&
behavioral modification; Medication & surgery
relationship & spiritual
counseling
Secondary Botanical(herbal) medicine,
care homeopathy, acupuncture, manual Diet, Ex, PT and
medicine, biomolecular therapies, PT, stress medicine
treatment medications, & surgery
options
Shortage of holistic physicians and Ineffective in
Weakness training prog; time-intensive, requiring a preventing and
commitment to a healing process, not a curing chronic
quick fix disease; expensive
Teaches patinet to take
responsibility for their health, cost
effective treating both acute and
Strength Highly therapeutic in
chronic illness, therapeutic in treating both acute
preventing and treating chronic and life-threatening
disease, and essential in creating illness and injuries
optimal health
 Prevention Practice
Prevention practice encompasses health acre
designed to promote health, fitness, and wellness
through education and appropriate guidance
designed to prevent or delay the progression of
pathology
It also minimizes the impairments and functional
limitation
Health care profession are involved in three types
of preventive practice
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
 Primary Prevention
Preventing a target condition in a susceptible or
potentially susceptible population through
specific measures, such as general health
promotion efforts.
 Secondary Prevention
is decreasing the duration of illness, severity of
disease, and numbering of squeal (abnormalities
following or resulting from disease, injury, or
treatment)through early diagnosis and prompt
intervention.
 Tertiary Prevention
involves limiting the degree if disability and
promoting rehabilitation and restoration of function
in patients with chronic or reversible disease.
 Risk Reduction
• Risk factors that may predispose an individual to
diminished well-being and health problems include
• physical risk factors: poor nutrition, physical inactivity, a
poor physical environment, and substance abuse;
• psychological, spiritual, and social risk factor: low self-
esteem, and lacking values and a direction in one’s life;
• environment risk factors: person, things, or conditions
that negatively influence other dimensions.
• Identifying and addressing these risk factors, the health
professional can reduce the incidence of injury and
illness
• Populations that are susceptible to illness or injury are
in particular need of this awareness, accomplished
through appropriate education and guidance
 The Physical Therapist’s Role in
Promoting Health and Wellness
• Physical therapist play a major role in prevention
practice
• Physical therapist were traditionally involved in the
management of physical impairments.
• Their current role, identifying the risk factors and
developing health promotion strategies.
• Physical therapist are experts in examining and
evaluating the motor capabilities, goals, and functional
limitations of individual with
• Musculoskeletal
• Neurological
• Cardiopulmonary
• Integumentary
• And other body system
Health and wellness

 Chapter no 2

 Healthy people 2010

 Healthy people 2010 is a federal health agenda
developed to promote healthy lifestyles for
American
 Two main goals
1. To increase the quality and years of healthy life
2. To eliminate the health disparities among
various populations
 1. Increase quality and years of
healthy life
 One primary goal of Healthy people is
increase the life expectancy and improve
the quality of life of all individuals
 At the beginning of twentieth century
average life expectancy was 47 years
 Now it is 77 years varied with
1: Gender :::
Women outlive men by 6 years
 Americans Caucasians
2:::Income relationship
 10,000 25,000dollars
2: eliminate health disparities among various
population

Gender
Race or
ethnicity
Education
Income
Geographic
location
 2: eliminate health disparities
among various population
 GENDER:  Female
 Male 1. Longer than male
1) Shorter life span 2. Expl
2) Gender specific 3. cervical spine prob
diseases 4. Depression, anxiety,
3) prostate cancer Mood disorder
4) Suffer leading causes 5. Somatoform
of death,e.g Lung disorders( physical
cancer, symptoms appear as
5) Substance use medical condition but
disorder lack measureable
 2: eliminate health disparities
among various population
 Geographic locations, race ethnicity
 DEATH RATES:
 Heart disease death rate ; cancer
death rate ;
 Prostrate cancer death rate
 Breast cancer death rate>>>> in
white & African -Americans than in
Caucasian.
 HIV > in African-american than
white.
People in rural areas have more risk
of injuries, heart diseases, cancer &
diabetes.
 2: eliminate health disparities among various
population
Geographic locations, race ethnicity
 Factors are contribute health
disparities:
1. excessive cv risk factors ie high bp,
diabetes, obesity, physical inactivity and
psychological stress.
2. Unfamiliarity with personal risk
factors to atherosclerosis and heart
disease
3. Cultural factors,,,,, desire to seek
heath care
4. Economic factors
5. Psychological Stress, racism,
frustration
6. Genetic predisposition to
pathologies
Different for american and asians
 2: eliminate health disparities
among various population
Income and education
 Go hand by hand & relate to access
to health care information , activities
& programming.
 Low income & low education:
increased risk of heart diseases,
diabetes, obesity, elevated blood
levels, low birth weight. (having
increased health disparities)
High income & high
education:make gains in their
health
People >12 year education twice
death rate than 13 & more yr
education.
2: eliminate health disparities among various
population
 People with chronic disease or disabilities
has more health disparities related to their
low level physical activities. -Suffer more
anxiety, pain, sleeplessness, days of
depression leading to diminished quality of
life.
 Recent research showed: mortality rate
linked with childhood conditions including
lower socioeconomic status, family living
arrangements, mother work status, rural
residence & parent nativity play key role in
2: eliminate health disparities among various
population

Strategies to deal with health disparities:

 Health promotion , risk factor modification,
culturally competent health care delivery,
continued research on racial & ethnic variance
in disease & injuries.
 Income & education findings suggest that economic
& education policies targeted children’s wellbeing
are health policies with implicate effects that reach
into adult life course.
 As health care providers; physical therapist
must acknowledge their role in promoting health
education particularly disables children &
adults.
 Objectives to improve
health
 Healthy people 2o1o _____467
objectives 28 areas…
 Theses areas are
 Access to quality health services
 Arthritis,
 Osteoporosis,
 Chronic back condition
 Cancer chronic kidney disease
 Stroke
 HIV
 Maternal, infants and child health
 Mental safety and mental health
 Goals directly related to physical therapy are
 Increase the quality and years of healthy life
 Inc. incidence of people reporting healthy days
 Reporting active days
 Reduce activity limitations
 Reduce days of pains for arthritis,
osteoporosis, chronic back pains
 Increased adaptation of daily
physical life
 Increase leisure time
 Exercise: Muscle fitness increase
 Reduce incidence of death from cancer
 Increase diagnosis & reduce incidence of type 2
diabetes
1. Dec. incidence of depression
2. Heart diseases, stroke, high bp
3. Dec incidence High cholesterole
level
4. Eliminate health disparities
5. Dec personal stress levels n
mental health problems
6. Reduce steroid use
7. Reduce accidents, destructive
habits, pollution
8. Access to health information
9. People with good eating habits
10. Healthy weight and over weight
Leading Health Indicators
 Are factors that provide information about the
health and wellbeing of population
 Not used individually but for whole population
 9 leading health indicators are
1. Physical activity
2. Over weight and obesity
3. Tobacco use
4. substance abuse
5. Mental health
6. Injury and violence
7. Environmental quality
8. Immunization
9. Access to health care
 Health education resources
 parents of young children

 Healthy nutrition
 Fitness activities for young children
 Protecting young children from
preventable injuries
 Effective discipline for young children
 Protection against childhood illness
 Protection in childhood sports activities
 Proper nutrition for physical activity
 Reduce childhood obesity
 Safety when swimming (including
protection against skin cancer)
Children ages 8 to 12
 Good nutrition
 Fitness activities
 Safety issues for children
 Playing it safe(protection in sports
activities)
 Proper nutrition for physical
activity
 Getting in shape(managing
childhood obesity)
 Safety at the swimming
pool/protection against skin cancer
 Ergonomics for children(including
wearing backpacks and playing at
the computer)
 Adolescents
 Good nutrition
 Fitness activities
 Safety issues for athletes
 Protection against infection
 Screening for fitness
 Red flags for depression
 Prevention and management of obesity
 Pregnancy:::healthy ways for baby & to
reduce back pain
 Screening for poor posture (including
scoliosis)
 Changing your life to engage in healthy
lifestyle habits
 Screening for stress
 Stress management
 Ergonomics for the workplace (computer
usres)
 Ergonomic for manual labor
 Young and middle aged adults
 Good nutrition
 Fitness activities
 Choosing the right shoes for fitness training
 Proper nutrition for physical activity
 Screening for fitness
 Ergonomics for work place()
 Red flags for depression
 Prevention n management of obesity
 Pregnancy ways to reduce back pain
 Child development for new mothers
 Healthy lifestyle habits
 Screening for poor posture, diabetes, heart disease, stress,
 Stress management
 Prevention of low back pain
 Medications benefits n risks
 Prevention of skin cancer
 Older adults
 Reducing risk of fall
 Good nutrition
 Physical activities for health n
wellness
 Fitness training for older adults
 Choosing the right shoes for
fitness training
 Proper nutrition for physical
activity
 red flags for depression
 How to maintain healthy bones
 Ergonomics for computer use
 Ergonomics for the home
 Screening for stress
 Stress management
 medications
 Physical Therapist role
 Play key role in meeting the national health goals
of healthy people 2010
 Identify risk factors, as PT well prepared to identify
pathologies & associated functional limitations
 Explain risk factors in understandable manner
 Develop strategies to maintain healthy life style that
reduce risk of disease & injuries
 While recognizing importance of self responsibilities
in life behaviors, PT can work collaboratively with
others interested in health care, to encourage
universal access to health care, engagement in
physical activity and reduction of unhealthy habits.
KEY CONCEPTS OF FITNESS
CHP # 3
FITNESS
• Pertains two components
1. MENTAL HEALTH
2. PHYSICAL HEALTH

• Overall fitness involves commitment, motivation and

responsibility for one’s physical and mental well-being
MENTAL HEALTH

• Far more than the absence of

mental illness
• It involves
i. Individual’s self perception
ii. A realistic perception of
others
iii. And having the ability to
meet the demands of daily
living
• MENTAL FITNESS:
 Stat of mind involving
 enjoyment of one’s social
and physical environment,
 belief in one’s creativity
and imaginations,
 and using one’s mental
abilities to the fullest
extent by taking risk,
 asking questions, accepting
alternative point of view,
 and having an openness to
continual growth and
change
• Maintaining mental fitness requires
1. Paying attention to ones lifestyle, by
balancing work and leisure
2. Maintaining social contacts
3. Reviewing one’s aims and goals and
planning to meet these goals
4. Awareness of mind-body interaction and
need to get adequate diet, sleep, and
exercise
5. Finally mental fitness relies on problem
solving abilities, using personal and
other resources judiciously, and taking
the needed steps to resolve these
problems.
• An individual mental health is jeopardized
by chronic stress, when theses problems
are mishandled.
 Physical Fitness
• Fitnessis a general term used to
describe the ability to perform physical
work. Performing physical work
requires cardiorespiratory functioning,
muscular strength and endurance, and
musculoskeletal flexibility.
• Optimum body composition is also
included when describing fitness.
• To become physically fit, individuals
must participate regularly in some form
of physical activity that uses large
muscle groups and challenges the
cardiorespiratory system.
 Physical Fitness
• Individuals of all ages can improve their
general fitness status by participating in
activities that include walking, biking,
running, swimming, stair climbing, cross-
country skiing, and/or training with weights.
• Fitness levels can be described on a
continuum from poor to superior based on
energy expenditure during a bout of physical
work.
• These ratings are often based on direct or
indirect measurement of the body’s
maximum oxygen consumption (VO2 max).
• Oxygen consumption is influenced by age,
gender, heredity, inactivity, and disease.
PHYSICAL FITNESS
PHYSICAL FITNESS enables the
individual to withstand
physiological stressors and
extreme demands on body.
• Individual with pre existing
levels of fitness are less
vulnerable to illness and
recover from injury and
disease more readily than
individuals who are
hypokinetic ( physically
inactive or sedentary)
• PHYSICAL FITNESS include
1. Metabolic fitness
2. Physiological fitness/ Health related fitness
3. Motor fitness/ Skilled related fitness
METABOLIC FITNESS
• Reflects the health status of
physiological system at rest, such as
blood lipid profile, blood sugar, resting
B.P, insulin levels.
• Metabolic fitness shows positive
responses to moderate physical
activity& reduce risk of chronic
diseases such as DM or heart diseases.
• Physical inactivity A major lifestyle risk
factor related to metabolic fitness of
muscles as:
• Metabolic fitness of muscle= ratio b/w
mitochondrial capacity of substrate
utilization & max. oxygen uptake of
muscle.
 Measures of metabolic fitness
1::::::lipid profile
• Common measure of metabolic fitness, Include
• Total cholesterol, HDL cholesterol( good
cholesterol increase with exercise), LDL
cholesterol( damaging cholesterol ),
Triglycerides
• These lab values are often used to determine
risk for coronary heart disease or stroke
treated with target values according to risk
factors as: Target LOW Density lipoprotein
LEVELS
• LDL<100mg/dl if you have heart disease
• LDL<130mg/dl if you have two or more risk
factors
• LDL <160mg/dl if you have zero or one risk
factors.
Still their role in heart disease
not clear as it appears that TAGs
level increase or HDL level
decrease or both at same time
may result heart disease or DM .
The complex interaction of
these three types of lipid is
altered when a person has
hypercholesterolemia
Hereditary hyperlipidemias
(genetic causes of abnormal
cholesterol and triglycerides)
difficult to treat
• Hypercholeterolimia are associated
with diabetes, overly fatty diet with an
inactive lifestyle & obesity. While
individual lipid values are important to
note, the two most imp. Values are
1: cholesterol/HDL ratio:
• Dividing the total cholesterol by the
HDL value and multiplying by 100
• HDL ratio should be > 25 & preferable in
30s
• HDL ratio < 15 heart attack is likely
• HDL ratio >40 diminished risk of heart
attack
2: Triglyceride/HDL ratio :
• Should be below 2.0
 BLOOD INSULIN:
• Insulin Is a peptide hormone produced
by beta cells of the pancreatic islets. It
regulates
the metabolism of carbohydrates, fats and p
rotein by promoting the absorption of,
especially, glucose from the blood
into fat, liver and skeletal muscle cells.
• In these tissues the absorbed glucose is
converted into
either glycogen via glycogenesis or fats (trigl
ycerides) via lipogenesis, or, in the case of
the liver, into both.
• Glucose production (and excretion into the
blood) by the liver is strongly inhibited by
high concentrations of insulin in the blood.
 BLOOD INSULIN:
• Circulating insulin also affects the
synthesis of proteins in a wide variety
of tissues.
• It is therefore an anabolic hormone,
promoting the conversion of small
molecules in the blood into large
molecules inside the cells.
• Low insulin levels in the blood have
the opposite effect by promoting
widespread catabolism.
• Normal values: 5-20
microunits/mililiters(µU/mL) fasting.
• Lower value= DM, Higher values
suggest obesity, or other insuline
related disease process.
• GLUCOSE TESTS
• Oral glucose tolerance
test
• Fasting plasma glucose
• Random
• Normal values in
healthy individual rarely
above than 140 mg/dl
(ADA)
• & fasting <126mg/dl
Plasma
glucose Normal Prediabetes Diabetes
test
Random N/A
Below 200 mg/dl 200 mg/dl or
more

Fasting
Below 108 mg/dl 108 to 125 126 mg/dl or
mg/dl more

2 hour
post- Below 140 mg/dl 140 to 199 200 mg/dl or
prandial mg/dl more
 PULSE RATE
• Normal range 60-100
pulse/mint. Indirect indication of
hearts activity , as well status of
blood flow through peripheral
arteries,
• Regular rhythm Count for 30sec
multiplied 2 for 1mint.
• Factors: affecting the pulse rate:
age activity, increased
temperature, medication,
gender, stress or body build.
• Pedal pulses
• Bruit pulse : high pitch voice___
suggest aneurysm, av fistula,
stenosis
 Blood pressure (BP)
• pressure of circulating blood on the walls
of blood vessels. When used without
further specification, "blood pressure"
usually refers to the pressure in
large arteries of systemic circulation. Blood
pressure is usually expressed in terms of
the systolic (maximum during one heart
beat) pressure over diastolic (minimum in
between two heart beats) pressure and is
measured in millimeters of mercury
(mmHg).
• It is one of the vital signs, along
with respiratory rate, heart rate, oxygen
saturation, and body temperature.
 hypertension
• Arterial hypertension can be an indicator of
other problems and may have long-term
adverse effects. Sometimes it can be an
acute problem, for example hypertensive
emergency.
• Levels of arterial pressure put mechanical
stress on the arterial walls.
• Higher pressures increase heart workload
and progression of unhealthy tissue growth
(atheroma) that develops within the walls of
arteries.
• The higher the pressure, the more stress
that is present and the more atheroma tend
to progress and the heart muscle tends to
thicken, enlarge and become weaker over
time.
• Persistent hypertension
is one of the risk factors
for strokes, heart
attacks, heart
failure and arterial
aneurysms, and is the
leading cause of chronic
kidney failure.
• Even moderate
elevation of arterial
pressure leads to
shortened life
expectancy.
 Hypotension:
• Blood pressure that is too low is
known as hypotension.
Hypotension is a medical concern if
it causes signs or symptoms, such
as dizziness, fainting, or in extreme
cases, shock.
• When arterial pressure and
blood flow decrease beyond a
certain point, the perfusion of the
brain becomes critically decreased
(i.e., the blood supply is not
sufficient), causing
lightheadedness, dizziness,
weakness or fainting.
orthostatic hypotension
• Sometimes the arterial
pressure drops significantly
when a patient stands up
from sitting. This is known
as orthostatic
hypotension (postural
hypotension); gravity
reduces the rate of blood
return from the body veins
below the heart back to
the heart, thus reducing
stroke volume and cardiac
output.
• BLOOD PRESSURE
• Normal: 120/80
• Systolic. 120-130
• Diastolic. 70-80
• Krotokoff sounds
• I _______ sharp thud
• II _______ loud blowing sound
• III _______ soft thud
• IV _______ soft blowing sound
• V _______ silence / diastole
PHYSIOLOGICAL FITNESS/ HEALTH
RELATED FITNESS
• Cardiorespiratory fitness/endurance
• Muscular endurance
• Flexibility
• Posture
• Body composition
• CARDIORESPIRATORY FITNESS
• The individual aerobic capacity to
perform large muscle, whole body
physical activity of moderate to
high intensity over extended
periods
• Important for prevention of heart
disease, stroke diabetes. Etc.
• Measurement of cardiorespiratory
fitness;
• vo2 max:
• The volume (V) of oxygen(O2) used
when a person reaches his or her
max ability to supply oxygen to
muscle tissue during exercise
• Vo2 resting:
• Resting value of oxygen
usage
• MET
• 3.5 milligrams(mg) of oxygen
consumed per minute per
kilograms(Kg) of body
weight
• Respiratory reserve
• Difference between VO2
max and VO2 resting
• VO2 max _ VO2 resting
• Speed at which the heart rate returns
to pre exercise levels after
performing extended exercise(
another way to assess
cardiorespiratory fitness)
• Max heart rate:
• 220 minus the individual’s age (HR
max)
• RESTING HEART RATE: is the lowest
heart rate, measured at rest
MUSCULAR ENDURANCE
“Is the ability to perform gross motor activity of
moderate to high intensity over a long period.”
Muscle strengthAbility of muscle to produce force
at high intensities over short periods of time
Both are determinant of good health and
physically active life
Isometric contractions
Isotonic contractions
How to measure?????
1. MMT
2. Hand held dynamometry
3. 1RM
4:YMCA bench press
test
Male lift 80 pounds
barbell and female
lift 35 pounds
barbell
5:The push ups test
• Sarcopenia: age
related loss of
muscle mass,
• Prevented by regular
exercise
FLEXIBILITY
“Is the ability to move muscles and
joint through their full range of
motion”
> Functional reach test
>Sit and reach test
Spinal flexibility is contributed
to functional reach, Balance
control, Range of motion
End feels
POSTURE
“Maintenance of correct alignment of body parts”
Good posture
Poor posture
Lordosis …….. Sway back
Kyphosis ………Huntch back
Scoliosis……….. Lateral curvature deviation
BODY COMPOSITION
Body Mass Index
BMI= M/H.H
M= body mass in kilogram
H=height in meters
Body mass index scoring
<18.5 Underweight
18.5 to 24.9 Normal
25.0 to 29.0 Overweight
30.0 to 39.9 Obese
> 40 Extremely obese
Women typically have more body fat
than men
 SKILLED RELATED AND MOTOR FITNESS
POSTURE BALANCE
Equilibrium:
body ability to maintain an intended position,
is static balance,
The body ability to progress through various
movements without losing postural control
dynamic balance
Tests
One leg stance test
Rhomberg test
Functional reach test
Timed up and go test
COORDINATION
Coordination is harmonious movement,
reflecting the coordination of muscle
contractions and their timing for desired
movement
Test
finger to nose test
Lower extremity coordination test
REACTION TIME
Amount of time needed to produce movement
in response to stimulus
• POWER
• SPEED
• AGILITY
• is the ability to move in a quick
and easy fashion or the ability
to perform a series of explosive
power movement in rapid
succession in opposing
direction.
Fitness Training

Chapter # 4
 Improving physical fittness
• Exercise can be any physical exertion to improve mental &
physical health including prevention or correction of
impairments,
• Exercise must be performed to certain extent to achieve
benefits.
 Improving Physical Fitness
Types of Exercise
Aerobic Exercise
exercise requiring the continual use of oxygen or any activity
that uses large muscle groups ,can be maintain continuously
,and is rhythmic in nature.
Exp: bicycling, walking, jumping rope, running, stair climbing,
skating etc.
Duration
10 min/day ____ 2-3 times/day, 5dys/week
30 min session is optimal for many people
Benefits
• Improve cardiovascular fitness
• Improve body composition
• Improve mental fitness
• Skeletal muscle endurance
• Better sleep, less depression, improved mood.
 Benefits of aerobic exercises
• Exercise increases your stamina and endurance.
• Exercise reduces stress. Exercise activates your
endorphins, causing a natural high and a sense of
well-being.
• Exercise reduces your risk for heart disease and
stroke. Coronary heart disease is the leading killer in
the United States, and nearly half of them are
women.
• Exercise strengthens your immune system. It
actually increases your resistance to stress and
illness.
• Exercise strengthens your bones and joints
&decrease a woman’s chance for osteoporosis.
 Benefits of aerobic exercises
• Exercise decreases your appetite. You won’t be
as hungry because exercise acts as a natural
appetite suppressant.
• Exercise will increase the number of calories you
burn. This increase will accelerate your weight
loss and encourage weight control.
• Exercise will strengthen your heart and lungs so
that they will work more efficiently.
• Exercise decreases a woman’s risk for breast
cancer.
• Exercise decreases blood pressure and blood
cholesterol. Exercise decreases LDL, or bad
cholesterol, while raising your HDL, or good
cholesterol.
Anaerobic exercise
Performed in the absence of continual oxygen source.
Short in duration and high in intensity, involving short burst
of exertion followed by periods of rest. Eg, weight lifting,
etc.
Benefits
• Increase caloric consumption
• Increase metabolism
• Shorter workouts
• Improved brain function
• Increased lean muscle tissue
Isometric exercise (care in cardiac and respiratory
patients)(heavy wt lift-valsalva effect)
Isotonic exercise
Isokinetic exercise
concentric muscle work
eccentric muscle work
 Comparison of isometric, isotonic, isokinetic
Advantages Disadvantages
• Isometric • Isometric
• Not aggravate sensitive joint surfaces • Not functional
• Improvement speed n angle specific
• Easy to perform & remember
• Many contraindications
• Reproducible, Convenient • Not efficient in term of strength
• Cost effective • No endurance improved
• Isotonic ISOTONIC
• Functional • Max loading at specific angle
• Momentum key factor
• Easy to monitor
• Unsafe for joints
• Convenient • Likelihood of injuries
• Best improve strength n endurance • Gives DOMS
• Isokinetic • Many contraindications
• max loading through whole ROM • Difficult to monitor
• Isokinetic
• Objective, reproducible
• Time consuming
• Muscle easily isolated • Requires time and skill to use
• Safest form of exercises • Costly
• Few contraindication • Not functional
Sports Exercise
Any type of exercise involving
physical games and competition.
Benefits
• Physical activity and playing
sports are among best
preventive medicine
• Combating obesity and
osteoporosis
• Enhancing cardiovascular fitness
• Psychological benefits
Therapeutic Exercise
Corrective exercise, used bodily movements to
restore normal function in diseased or injured
tissue to maintain well being.
Goals
• Improve ambulation
• Releasing contracted muscle, tendons, fascias.
• Mobilizing joints
• Improving circulation, respiratory capacity,
coordination
• Reducing rigidity
• Increasing balance and muscle strength
• Promoting relaxation etc etc etc
exercise
• Active assisted ex.
• AROM AAROM PROM
 Benefits of physical activity
• Table 4-1
1. Lower overall mortality
2. Lower risk of cancer, including colon cancer and breast cancer
3. Lower risk of diabetes
4. Lower risk of hypertension, also treat it
5. Lower risk of obesity
6. Lower risk of depression
7. Improved mood and lower the symptoms of depression
8. Improved quality of life and improved functioning
9. Improved function in persons with arthritis
10. Lower risk of fall and injury
 Cont……
 Prevention of bone loss and post menopausal
fractures
 Improved quality of sleep
 Improved memory
 Increased endurance
 Increased strength
 Reduce stress and tension
 Increased energy
 Slowed aging process
 Boasted confidence
Therapeutic activities for special populations
• Aquatherapy
Therapeutic intervention using
water as an environment for
performing aerobic exercise or
relaxation activities.
Aquatic immersion provides various
types of stimulation, including
hydrostatic pressure, buoyancy,
resistance and heat n affect the
cardiopulmonary, neurological and
musculoskeletal system in
individuals with or without
impairments
 TAI CHI
T‘ai-chi (Mandarin: is
an internal Chinese martial art
practiced for both defense
training and its health benefits.
Is an ancient chinese practice
designed to exercise body, mind
and spirit. These are slow
controlled movements which are
gentle and continuous and
circular.
Require proper motor control
and Improve balance.
 YOGA
•Yoga is a group of physical, mental,
and spiritual practices or disciplines
which originated in ancient India
•Type of exercise to attain body and
mental control through variety of
postures,
•the root of yoga means to bind or to
connect referring spiritual aspects of
these exercise and suggesting a
connection of soul with GOD.
•Designed to incorporate breathing &
meditation to calm mind.
•HATHA yoga is physical path of yoga
and use physical poses & breathing
techniques designed to develop a
strong, healthy, and flexible body.
•Use stretching techniques for Physical &
spiritual relaxation.
 Consideration for exercise and physical activity
1.:::Weather condition:
•bad weather pose significant hazards for
outdoor activities
•Vigorous exercise not advised when
temperature is over 98F & humidity is high.
•Hazards are dehydration.
•Introduce electrolyte replacement ie diluted
fruit juices
•Not coffee n cola drinks as they are diuretics
2:::::::::::Proper attire:
clothing according to the weather & allow
body to breathe yet protect from excessive
sunlight
Fit the body properly, light colored (reflect
sunlight)
Absorb moist
Early morning and late afternoon decrease
weather hazards
Exercise should be limited when temp. below
freezing point and accompanied by wind. During
cold weather individual wear layered clothe.

3::;;Time of the day:

avoid peak sunlight
2 to 3 hours after meal
30 min break postexercise is suggested
4::::Proper nutrition:
balanced diet, hydration during exercise
Small meals 4 hours before ex.
Older adults should monitor nutrient intake for
glucose and protein
Illness:
if patien has cold and no other medical condition: low intensity
ex unless
Contraindicated in fever, sore muscle or joints, diarrhea or a
productive cough.
First resolve these symptoms then go to ex.
Medications:
1. Caffeine, cold medication, diet pills, allergy remedies, and
certain herbal teas, can elevate heart rate
2. Antihistamine…. Individual feel drowsy, increase in reaction
time, poor balace….so avoid these medicine
3. Some medications can enhance performance hense banned
by International Olympic Committee ie steroids, diuretics, pain
relievers
4. Fluoroquinolones has linked with serious tendon injuries,
ankle , shoulder and hand
5. Anti inflammatory drugs: stomach problem
6. anti-angina
All Carefully monitor before exercise
Preparation for ex/exercise prescription
• Fitte equation
• F: frequency:
• ( how often) no of session, twice per day
• I : intensity:
• ( how hard) resistance exercise, max weight, submax,
to the point of fatigue etc.
• T : time duration:
• (how long) time of exercise with adequate rest periods
• T : type: (specificity of activity)
• E : enjoyment:

General exercise principle:::: overload principal &

specificity principal
 Exercises that can cause injury
• Hyperextending or overextending any joint
• Placing excessive stress on joints, such as performing double leg
lifts
• Performing ballistic movements with the spine either the low back
or cervical spine
• Performing excessive hyperflexion of joints, potentially damaging
ligaments, bursae, cartilage, and other joint structures
• Moving into positions that pinch nerves in the head, neck, trunk,
extremities
 Hyperkinetic conditions
Certain individuals are at risk of too much exercise. These
individuals have a conditions called “ Activity Nervosa” (strain,
sprain, shin splint etc)
“ too much activity and too little rest”
often seen in conjunction with pathological eating disorders
1 anorexia nervosa(too little eating)
2 bulimia nervosa(too much eating)
 Factors influence maintenance of physical activity
• Multiple theories and models related to health promotion that
explain how change occurs & individual adopt physical activity.
• whether the person is ready to change there are many factors
influence physical activity & maintenance of activity.
1:Behavioral Change Theories
• Social cognitive theory (SCT)
Deals with belief systems of individuals. An individual must believe
that he or she can change a particular behavior and that changing
that behavior will lead to the desired outcome.
Example, a patient may want to lose weight.
• In addition to change behavior , the patient needs to believe that
he or she is capable of succeeding and that the outcome will
improve his or her health.
• If the patient decides to use exercise to lose weight, clear
instructions on how to perform and progress the exercise program
must be given.
Factors influence maintenance of physical activity
Health belief model (HBM)
Based on several factors.
 First: concern about developing illness (perceived
threat).
Next step….following the health recommendations it
is possible to achieve desired outcomes….. (perceived
benefits) at an acceptable cost (perceived barriers).
Example:
over weight…………..>heart disease,….threat family
history… …> understand modifying diet and physical
activity can help with weight…..> joining a weight
loss program but may not be sure he or she can
 2: Trans-theoretical model(TTM_
• looks at the 5-stages required to make changes.
• Precontemplation: no intention of making any changes
within next 6 months
• Contemplation: intend to make changes within next 6
months
• Preparation: has begun to take steps toward desired change
and plan to make the changes within the next 30 days
• Action: has changed the behavior for less than 6 months
• Maintenance: keep changed behavior for more than 6
months ,
• the physical therapist can assist in planning the
intervention, particularly if individuals are not ready to
make any changes. It allows the therapist to give
information needed at the appropriate time.
• Several studies point to “self efficacy”, as single most imp
factor.
• That determine a persons change, including exercise program
participation.
• Factors that contribute to relapse include negative emotional
or physiological states, limited coping skills, social pressure,
interpersonal conflicts, limited social support, low motivation,
high risk situations and stress.
 TABLE 4-6
BARRIERS TO EXERCISE ADHERENCE
• Personal barriers
• Lack of time
• Lake of motivation
• Injury
• Rapid fatigability
• Misconception
• Physical discomfort
• Emotional discomfort
• Control in life
• Attitude towards exercise
• Assessment of benefits of exercise
• Self efficacy in performing exercises
• difficulty changing life style behaviors
• Isolation
• Environment barriers
• Access: don’t access to facilities of exercise
• Cost: health clubs are too expensive
• Climate: weather unsafe for outdoor activities for 6months
(excessive cold or hot weather)
HEALTH FITTNESS AND WELLNESS ISSUES
DURING CHILDHOOD AND ADOLESCENCE
Chapter # 6
The Dynamic process of growth and development
• Neonates, infants, children and adolescents face
unique changes as they dynamically grow and
develop into adults.
• Many people contribute to this dynamic process
involving families, communities, educators and
health care professionals.
• So health care professionals should be aware of
physical and psychosocial transformations taking
place early in life.
• Genetics and environment both play an
important role in a child's physical and
psychosocial development.
 The Dynamic process of growth and
development
• Childhood/Juvenile (Childbirth) (0 – 19years)
– Infant (baby) (0 month - 12 months)
– Toddler (1 – 3 years)
– Play age (3 – 5 years)
– Primary school age (middle childhood also
called prepubescence) (6 - 11)
• Preadolescence (9 – 11 years)
– Adolescence (12 – 19 years)
• Adulthood (20+ years)
– Young adulthood (20 – 39 years)
– Middle adulthood (40 – 60 years)
– Elder/Senior citizen (60+ years)
• Death (unpredictable)
 Early childhood screening
• APGAR test
• A------ infants activity or (muscle tone)
0 Limp; no movement
1 Some flexion of arms and legs
2 Active motion
• P------ pulse or heart rate
0 No heart rate
1 Fewer than 100 beats per minute
2 At least 100 beats per minute
• G----- grimace/infantile reflex tone)
0 No response to airways being suctioned
1 Grimace during suctioning
2 Grimace and pull away, cough, or sneeze
during suctioning
 APGAR test
• A----- appearance(in term of normal skin color)
0 The baby's whole body is completely bluish-gray or pale
1 Good color in body with bluish hands or feet
2 Good color all over
• R----- Respiration (breathing)
0 Not breathing
1 Weak cry; may sound like whimpering, slow or irregular
breathing
2 Good, strong cry; normal rate and effort of breathing
• This test provide a quick screening of the newborn’s body function
at 1 minute and 5 minute after birth
• Used by obstetricians
• Each point score 2
• Score analysis
• 7-10 normal
• 4-6 require some immediate medical assistance
• Below 4 require immediate medical attention and are at risk for
problems
Denver II Developmental Screening Test

A screening test for

children from birth to age 6
Includes
1. Personal social skills
2. Fine motor adaptive
skills
3. Language skills
4. Gross motor skills
 Factors influencing growth and development in early
children
• Two main factors are
• Genetics
• Environmental factors
• During first 6 month body undergoes dramatic changes to
accommodate the dynamic physical changes of an infants
• On average babies grow 10 inches in height while tripling
birth weight upto 1year
• After age 1: growth in length slows
• By age 2 : growth in height becomes steady about 2.5
inches per year
• Prepubescent growth spurts begins at age 8 in girls and at
10 in boys
Then development of secondary sex characteristics, age 18
youth has reached physical maturity.
 Lack of physical activity
• 12 to 21 years of age
• Lack of vigorous activity
• Leads to:- Obesity
• Type 2 diabetes mellitus
• Problem with musculoskeletal and cardiopulmonary system
• Fertility problems
• Psychosocials consequences in the form of a negative self image,
• Emotional and behavioral problems
• Depression
 Common health problems of infants
and young children
1. Excessive crying
(under 3 months of age) colic, acute abdominal pain.
2. Sleep disorders
•In school going children. 9 hrs of sleep for
elementary school children is recommended.
•Less sleep may be due to sleep disorders, that are acute but if not
addressed then become chronic.
3. Fevers
Common in children, not always necessitate a doctor visit unless
and until
1. Feverish child is under the age of 3 months
2. Fever + localized pain(headache, chest, throat, abdominal)
3. Fever more than 4 days, duration unexplained & other illness
4. No above conditions but child’s parents are very concerned.
4. Otitis media
• inflammation behind the eardrum affects 70%
children before age of 2 years,
• child may cry, irritable, reduced appetite, difficulty
sleeping.
•Chronic otitis media may lead to hearing loss. Pain
refer to TM joint also indicate otitis media in older
child.
5. Urinary tract infection(UTI)
Age 0 -23 months
Accompanied with fever
Also include vomiting, diarrhea, irritability, and
poor feeding
Urine smell foul
6. Skin pathologies
1. Dermatitis, also known
as eczema, is a group of
diseases that results
in inflammation of the skin.
These diseases are characterized
by itchiness, red skin, and a
rash.
In cases of short duration there
may be small blisters while
in long-term cases the skin
may become thickened.
The area of skin involved can
vary from small to the entire
body
2:::Hemangiomas
a benign tumor of blood vessels,
often forming a red birthmark
.
• 3. Warts (yellowish or brownish
usually on hands)
• A wart is a skin growth caused by
some types of the virus called
the human papillomavirus (HPV).
HPV infects the top layer of skin,
usually entering the body in an
area of broken skin. The virus
causes the top layer of skin to
grow rapidly, forming a wart. Most
warts go away on their own within
months or years.
• Warts can grow anywhere on the
body

4.Tinea capitis(a scalp fungal

infection, round or irregular patches
of broken hair)
7. Trauma accidental
Fall, burn, fracture, drowning, motor vehicle injuries etc
8. Allergies
- seasonal allergies present with nasal congestion,
sneezing, rhinorrhea
- Food allergies: cow’s milk protein, egg white, wheat,
soybean, peanuts, sea food, citrus fruit and chocolate.
Symptoms: red itchy mouth and throat
then rashes , abdominal pain, vomiting, diarrhea,
Rx: antihistamine
9. Asthma
10. Chronic pain
• Teething pain
• Growing pains: age--- 3—10 years, area __ legs,
evening pain awaken the child from sleep
• Abdominal pains
• Headaches: intracranial disease, migraine, exposure to
sun rays, nuts, caffiene
11. Enuresis and constipation
• Nocturnal enuresis(urinary incontinence)
• Encopresis (involuntary defecation)
12. Seizures
With fever, last for less than 5 minutes
Longer------ consult physician
13. Developmental delays
Emotional disturbance, learning disabilities, health
impairments, visual impairments, traumatic brain injuries,
mental retardation, speech or language impairments etc.
14. Attention deficit/hyperactivity disorder
15. Other behavioral problems
Poor appetite, shyness, aggression and spoiled behavior
16. Obesity in childhood
Healthy diet habits, low calorie diet, increase physical
activity, reduce sedentary life style especially television
viewing
17. Anorexia and bulimia
Anorexia: a disordered self image of being over weight
when they may be grossly under weight
Bulimia: people engage in binge eating followed by self
induced vomiting.
• Limited physical activity Risk behavior during
• Poor nutrition
• Poor stress management
preadolescents and
• Exposure to infective agents adolescents years
• Sun exposure
• Substance abuse
• Sports injuries
• obesity
• Riding with a driver who had been drinking alcohol
• Watching TV more than 3 hours a day
• Under age alcohol use
• Cocaine use
• Cigarette use
• Desire to commit
• Even for those who engage in physical activity, increased risk of injuries if
not wearing the appropriate protective gear
 Exercise for children and youth
Purpose
1. Controlling weight
2. Reducing blood pressure
3. Raising HDL cholesterol
4. Reducing the risk of
diabetes and some kind
of cancer
5. Improving in many areas
of psychological
wellbeing, including
gaining more self
confidence and higher
self esteem.
 Recommendation
 Engage in regular, moderately
 intense physical activity for
at least 30 min. a day
 Vigorous physical activity: 3 or more days per week for at
least 30 min, develops and maintain cardiorespiratory
fitness
 Learn and use self management skills(goal setting,
monitoring, barrier minimization) to maintain active life
styles
 Know the amount and types of physical activity
associated with the benefits(social, emotional, health,
physical) and participate in these.
 Increase physical activity by reducing the time spent in
watching TV, playing video games etc
 Develop skills and learn how to participate in
developmentally appropriate physical activities
 Suggested physical activities
For age 2 to 3
• Running
• Jumping
• Walking in a yard or play ground
• Swimming or slid in child sized
playground set.
• Water play etc.
• Children can not understand the
concept of performing in a team, so
plan exercise in their playtime.
• All physical activities should be
closely supervised and provided on
soft play surface
Age 4 to 6( school going age)
• Capable of higher level of balance
and coordination activities
• Capable of sharing toys
• Engage in social activities with
other children
• Jumping rope
• Playing catch with ball
• Riding a tricycle
• Dancing etc.
• Age 7 to 10
• team sports including
• Baseball, gymnastic, soccer,
swimming, tennis etc
Age 10 and older
• Cycling
• Aerobic exercises
• Strength training
• Hiking
• Organizing team sports
• Running
• Track and field events
Precautions
• Avoid risk of over use injuries
• Risk to damage to epiphyseal growth plates of bones
• Careful in forceful external rotation of ankle and foot as
this can cause the rotational injuries of the distal tibial
growth plate
• Higher risk of anterior cruciat ligament of knee
• Forearm fracture
• So use protective athletic gear
 Exercise prescription
According to FITTE principle
Frequency: strength training twice per week, but participate
in various forms of physical activity for fitness and enjoyment
daily.

Intensity: overstressing must be avoided, resistance training

not on maximum weights or to the point of muscle fatigue.
achieve frequency rather intensity

Time and duration: initially perform slowly,1 to 2 sets(with 8

to 12 repetitions per set) of 8 to 10 exercise

Type: variety of exercise that work on different major muscle

group

Enjoyment: encourage to participate in physical in activities

for the sake of enjoyment rather competition
 Other considerations
• Provide instruction show the child proper breath and
exercise techniques to ensure safe execution of the
desired movement
• Supervise for safety and good techniques
• Warm up cool down: 5 to 10 min of warm up activity
as walking, jogging, jumping etc. 5 to 10 min of cool
down activity
• Thinking light weight, controlled repetitions12 to 20
repetition with lighter weight
• Rest between workout: rest periods at least a day b/t
strength training workouts. 2 to 3 session per week are
adequate
• Track progress
• Add weight gradually
• Keep it fun
HEALTH, FITNESS, AND WELLNESS DURING
ADULTHOOD
Chapter 7
 Unique Challenges During Adulthood
Adult: the term “adult” suggests both physical
maturation and a psychosocial transition from being
dependent on others to becoming more self reliant
and responsible for personal behaviors.
Adult Health and Wellness Risk
Affect all major body system, including the
integumentary, cardiovascular, neuromuscular and
musculoskeletal system commonly treated in physical
therapy.
 ADULT HEALTH & WELLNESS RISKS:
1:Skin conditions: warts, acne, impetigo, are more
common in adults.
Others are dermatitis: inflammation of skin.
redness edema swelling, oozing and crusting, scaling
when long standing called contact dermatitis:
 psoriasis: dry, well circumscribed, silvery scaling
plaques.
 2.Skin cancer:
3.Diabetes mellitus: type 1 diabetes mellitus: can occur
at any age, but most commonly develops in childhood or
adolescence and is diagnosed before age 30.
type 2 diabetes mellitus: diagnose after age 30
generally present with hyperglycemia,
polyuria(frequent urination), polydipsia(excessive
thrust), weight loss due to dehydration
4. Cancer and uncontrolled cellular proliferation
5. Obesity: health risk associated with obesity include
premature death, type 2 DM, hyperlipidemia,
hypertension, coronary artery disease,
gastroesophageal reflux, gallstone, liver disease,
pregnancy complications, osteoarthritis etc.
6. Metabolic syndrome: thyroidism, DM,etc
7. Heart disease:
8. Insomnia: is an individual’s perception that sleep
quality is inadequate or non restorative despite having
the opportunity to sleep.
It includes difficulty falling asleep, sleeping too lightly,
easily disrupted, Early morning awakening and inability
to fall back asleep.
9. Sexually transmitted disease: HIV
 Health risk factors for adults & associated
symptoms
• Table 7-2: cancer symptoms
• Table 7-3:care for obesity
• Table 7-4:risk factor for metabolic syndrome
• Table 7-5 clinical sign and symptoms of HIV infection
• Table 7-7 symptoms of prostate cancer
• Table 7-8 symptoms of testicular cancer
 Obesity & Preventive Care for Obesity
1. Advocate lifestyles to promote a healthy weight.
2. Alert individual to the risk of inappropriate weight gain and
benefits of weight loss.
3. take baseline measures of weight, height, BMI, waist
circumference, and blood pressure to monitor the individual’s
progress.
4. Asses the current levels of physical activity, eating habits, and
readiness to make long term lifestyle changes.
5. Guide individual towards weight management programs under
the supervision of their physician.
6. Provide ongoing support and encouragement for individuals in
weight treatment programs.
7. Recognize behavioral and environmental factors that may
contribute to overweight and obesity.
8. Identify health professional in community who are critical to the
treatment of adults who are obese including registered dieticians,
bariatric surgeons, and mental health professional.
9. Provide relevant health education material.
10.Become aware of and share community resources that can assist
in the management of overweight and obesity problem.
 Risk Factor for Metabolic syndrome
1. Abdominal or “central obesity”( waist size of greater than 40
inches in men, greater than 35 inches in women)
2. High levels of triglycerides in the fasting blood greater than 150
mg/dl
3. Low levels of HDL cholesterol(men less than 40mg/dl and women
less than 50 mg/dl)
4. High blood pressure(>130/85)
5. High levels of glucose(fasting > 110mg/dl)
6. Insulin resistance
 Cancer Symptoms
1. Persistent cough and 10. Hoarseness
blood tinged saliva 11. Persistent lumps or
2. Cough (>1 month) +blood swollen glands
in coughed sputum 12. Obvious change in warts
3. A change in bowel habits or a mole
4. Blood in stool 13. Indigestion/ difficulty in
5. Unexplained anemia/ swallowing
fatigue 14. Unusual vaginal
6. Breast lump or breast bleed/discharge
discharge 15. Unexplained weight loss,
7. A lump in testicles night sweats, fever
8. A change in urination 16. Non healing sores
9. Heamaturia 17. Headache
18. Back pain
 Clinical Sign and Symptoms of HIV Infection
1. Chronic, dry, scratchy cough, 11:Herpes simplex viral infection
SOB, tightness or pressure on 12:Loss of appetite
chest. 13. red, pink, brown or purplish blatches
2. Rapid weight loss on/under skin
14. Pain/difficulty swallowing
3. Profuse night sweats
15. Constant headache
4. cont,. Unexplained fatigue. 16. Confusion & forgetfulness
5. Diarrhea longer than a week 17. Unexplained change in vision
6. Swollen lymph glands 18. Chronic yeast infection(women)
7. Sores, white spots, blimishes 19. Pelvic inflammatory disease(women)
in the mouth,gums, on 20. Cervical abnormalities(women)
tongue 21.Skin condition, rash, sore, spots etc.
22. Receding gums
8. Burning sensation and an
23. Constant fever
altered sense of taste
9. Pneumonia
10. Excessive bruising & bleeding
 Symptoms of Prostate Cancer
1. Nocturia
2. Difficulty in starting urination and holding back urine.
3. Weak or interrupted flow of urine
4. Painful or burning urination
5. Blood in urine or semen
6. Frequent pain or stiffness in lower back, hip or upper thigh
 Symptoms of Testicular Cancer
1. Lump in either testicle
2. Enlargement of a testicle
3. Feeling of heaviness in scrotum
4. A dull ache in lower abdomen or the groin
5. A sudden collection of fluid in the scrotum
6. Pain or discomfort in testicle or in scrotum
7. Enlargement and tenderness of breasts
 Health Risk For Adult Males
• Cancer: most common cause of death for
men is lung cancer, link to cigarette
smoking. Prostate cancer second leading
cause of death.
• Chronic Obstructive Pulmonary disease:
• Stroke:
• Accidents and Unintentional injuries:
• Diabetes:
• Pneumonia and Influenza
• Kidney disease:
• Liver disease;
Screening Guidelines for Both Men and Women
• Blood cholesterol level test:
• Electrocardiogram(ECG):
• Chest x-rays:
• Blood chemistry test:
• Complete blood count(CBC):
• Thyroid stimulating hormone(TSH):
• Transferring saturation test:
• urinalysis
 Oral Health
• Oral health is essential, dentist and
physiotherapist should be aware of following
potentials indicators of disease.
1. Sore in mouth that does not heal.
2. Lump or thickening in the cheek.
3. White or red patch on gums, tongue, or
lining of the mouth.
4. Soreness or the feeling that something is
caught in the throat.
5. Difficulty in chewing and swallowing.
6. Difficulty in moving the jaw and tongue.
7. Numbness of the tongue or other area of
mouth.
8. Swelling of the jaw
Fitness in Adulthood
Fitness is assessed by different screening tests and information
obtained can guide a physiotherapist to plan an exercise
regime for a person.
• Individual with unstable medical condition(cardiopulmonary
or metabolic disease process) or conditions exacerbated by
exercise are considered high risk individuals.
• Individuals at moderate risk factors for exercise are male 45
yrs or older, female 55 yrs and older, and individual of either
gender with two or more risk factor of coronary artery
disease.
• Those below these ages with no more than one risk
factors(cvs) are considered low risk individuals
• Suggested Adult Physical Activities 30 min or of moderate
intensity physical activity such as brisk walking on most and
preferably all days of the week
 No of calories burned by adult per activity

1. Cycling 6mph 1. 240cal/h

2. Bicycling 12mph 2. 410 cal/h
3. Jogging 5.5 mph 3. 740
4. Jogging 7mph 4. 920
5. Jumping rope 5. 750
6. Running in place 6. 650
7. Running 10mph 7. 1280
8. Skiing 8. 700
9. Swimming 25 yds/min 9. 275
10. Swimming 50 yds/min 10. 500
11. Tennis 11. 400
12. Walking 2mph 12. 240
13. Walking 4mph 13. 440
Women’s health issues:
focus on pregnancy
CHP # 8
 THE FEMALE ATHLETE TRIAD
• Includes
1. Anorexia nervosa and bulimia
2. Amenorrhea/oligomenorrhea
3. Osteoporosis and osteopenia
Increased physical activity in female and their increased
participation in organized athletics has revealed these medical
conditions resulting from hormonal shift and life style habits
altering female regulatory systems
• Anorexia nervosa: eating disorder involving limited eating and
weighing at least 15% less than the ideal weight.
• Anorexia bulimia: binge eating and purging
• Amenorhea:
cessation of menstrual cycle( normal in child bearing age)
• Primary Amenorrhea: delayed onset of menstrual cycle related to
delayed puberty commonly occur in thin girls.
• Secondary Amenorrhea: previously menstruating women fails to
menstruate for three consecutive months
naturally : by pregnancy, breast feeding, menopause
other than above is pathological.
• Oligomenorrhea
infrequent or very light menstruation in a women with previously normal
periods
• Osteoporosis
• Estrogen is compromised
• Risk of stress fractures
• Decreased calcium intake due to eating disorders
• Management :
1. Encourage healthy diet
2. Exercise moderately
3. Healthy stress management
4. Reduce emotional stress
5. Balanced lifestyle
6. Proper calcium intake
7. Estrogen replacement therapy
 SYMPTOMS OF BREAST CANCER
• A lump or thickening in the breast or armpit
• A change in the breast size and shape
• A change in the color of breast or areola( area around the nipple)
• Any dimpling or puckering of the skin
• Change in the color or texture of the skin
• An abnormal discharge from the nipple
• Scaling of the nipple or nipple retraction
• NOTE: all these are self examination of breast cancer, any
symptoms noticed should be reported immediately to a physicians
PREMENSTRUAL SYNDROME(PMS)
• PMS is a constellation of physical and psychological symptoms seen
among women of reproductive age.
• While all women may experience some discomfort prior to
menstruation.
• Women with PMS have such sever symptoms that they interfere
with the individuals lives.
• Monthly symptoms are both psychological and physical, including
• Irritability
• Anxiety
• Depression
• Diminished self esteem
• Difficult concentrating
• Sleep problems
• Appetite changes
• low energy
• Bloating
• Headache
• Breast swelling and tenderness
 Management
• Apart form medicine like diuretics, prostaglandins
inhibitors(such as Mortin), ovulation inhibitors vitamins(
pyridoxine), lithium and antidepressants,
• The following suggestions may reduce the impact of PMS
on women engaged in regular physical activity
1. Eat smaller meals or snacks throughout the day. Snack
include plain yogurt, unsalted nuts, unsalted popcorn,
whole wheat bread with peanut butter, pumpkins, grapes,
grapefruit, or orange slices
2. Eliminate or reduce caffeine, i.e. coffee, tea, colas and
chocolate. Caffeine can make breast symptoms(swelling
and tenderness) and headache worse.
3. Reduce salt. May worsen water retention symptoms.
4. Reduce alcohol intake
5. Relaxation exercise
 PERIMENOPAUSAL, MENOPAUSAL, AND
POSTMENOPAUSAL CHANGES
• Menopause: the physiological aging process after which a
women no longer menstruates.
• typically commencing age is 50 years old, result from hormone
alterations affecting not only reproductive capabilities, but
other body systems as well.
• Perimenopause : the period prior to menopause as the
women’s body transitions into menopause.
• Symptoms
• Hot flashes and skin flushing
• Night sweats
• Insomnia
• Mood swings including irritability, depressions
and anxiety
• Irregular menstrual periods
• Spotting of blood in between periods
• Vaginal dryness
• Vaginal infections
• Urinary tract infections UTI
• Of particular interest to physical therapist are
bone loss “ osteoporosis”
• Factors that reduce the age of onset of menopause
are, smoking, hysterectomy, and living at high altitudes
• Prevention from osteoporosis and fracture include:
• Encouraging healthy life style habits
• Sufficient calcium and vitamin D intake
• Regular weight bearing activities
• Measures to reduce fall risk
• Smoking cessation
• Reduce alcohol intake
• Bisphosphonate
• Selective estrogen receptor modulators
 CHANGES WITH PREGNANCY
From conception to birth, a pregnant woman’s body
undergoes significant changes. Although these changes
are vital for the process of pregnancy, the woman will
develop discomfort because of them. These
changes(which are important for physical therapy point of
view) are:
• Diaphragm elevate up to 4cm, to create room for
enlarged uterus, rib cage expandes;
• Stress on rib articulation leads to back pain( thoracic
region)
• Hormonal levels raise in pregnancy and remain
elevated few months after child birth. These hormones
are mainly estrogen, progesterone and relaxin.
• Relaxin: is responsible for laxity in ligaments, symphyses and
fibro cartilage of pelvis as well as of peripheral joints.
• Sacroiliac joint, due to this laxity, become hypermobile and
lead to pain during activities like bed mobility, transfer, gait and
stair negotiation.
• Altering hormonal levels are also responsible for mood
changes, periods of fatigue and decrease tolerance to heat.
• Average weight gain during pregnancy is about 27.5 pounds.
• Abdomen enlarges, center of gravity shifts forward, so
increased lumbar lordosis (sway back) and eventually more
thoracic kyphosis(humpback).
• Diastasis recti, leads to decreased back stability and pain
sometime.
• Sacroiliac dysfunction, leads to sciatica or pain directly in the
low back.
• pubic symphysis separation: 4 to 7 mm to prepare the pelvis
for vaginal delivery; wearing sacroiliac belt will help
• Pelvic muscle weakness: leads to incontinence and pelvic organ
prolapse.
 Urinary Incontinence
• Incontinence: involuntary loss of bladder control.
• Urinary Incontinence: means ones lose urine when
one does not want to, along with leakage there may be
some other symptoms
• Types: there are 3 types of urinary incontinence
1. Stress incontinence: leakage of urine during an event
of increased abdominal pressure such as sneezing,
coughing, laughing or lifting.
2. Urge incontinence: leakage of urine due to an
inability to delay a strong, sudden urge to
urinate(over active bladder syndrome)
3. Mixed incontinence: combination of both stress and
urge incontinence.
cause: pelvic floor muscle weakness
treatment : strengthening of pelvic floor muscles i.e. “
kegel exercise”
• Kegels
• You must figure out the proper muscles to tighten
• The pelvic floor muscles are the ones that allow you to “hold
it” when you have the urge to pass gas or urinate at an
inappropriate time
• That also include the vaginal muscle
 Instructions of kegels
• To, begin lie on the floor and squeeze or pull in
the pelvic muscles
• Keep them tight for a count of three
• Rest for a few seconds
• Repeat
• Remember to keep breathing
• 10-15 repetitions per set during three times a day
• Standing, sitting, lying
• Some times tighten the muscles for 5-10 seconds,
and other time to quickly contract and release.
• As muscle build strength, your bladder control
will improve
• The length of time depends on woman
• It can be any where from 3 weeks to 12 weeks
 Healthy Bladder Habits( table 8-3)
1. Normal voiding frequency is to urinate every 2-5 hours if
one is drinking 6-8 glass of water/day. Total voiding in a 24
hr period should be approx 6-8 times.
2. Normal nocturnal voiding should be 0-1 time/night for
children and adults upto 65, and 1-2 times for adults
above 65.
3. Going to bathroom just in case is not recommended
because it may train the bladder to empty before it is
sufficiently full.
4. Avoiding bladder irritants such as caffeinated and
decaffeinated coffees/teas/sodas, fruit juices high in
acidity, alcohol, chocolate, spicy food, nicotine and various
medications can decrease bladder urgency and frequency.
5. The stream of urine last at least 8 seconds from start to
finish and should be steady, not exceedingly slows or fast.
6. It is important to use proper hygiene after going to the
bathroom by wiping the perineum from front to back. This
ensures that feces from the anus are not introduced to
the vaginal region.
• Nerve compression syndromes: due to fluid
retention within the connective tissues, like
carpal tunnel syndrome, tarsal tunnel syndrome,
lateral femoral cutaneous nerve entrapment,
inlioinguinal nerve compression, intercostal
neuralgia.
• Respiratory system: oxygen consumption
increase about 14%( half going to fetus and
placenta and other half to uterine muscles and
breast tissues) so mother may develop dysnea or
hyperventilation( helps with diffusion of CO2)
• Breathing pattern: more “chest breathing” than
“abdominal breathing”
BENEFITS OF EXERCISE DURING PREGNANCY
1. Increased muscle tone
2. Increased endurance/energy level
3. Decreased tensions/ stress
4. Decreased swelling
5. Improve posture and body mechanics
6. Improve circulation
7. Improved pelvic floor muscle strength
8. Decreased discomfort/ pain
9. Better sleep patterns
10. Preparation for the intensity of labor and delivery
11. Quicker return to pregnancy shape
12. Improve self esteem
13. Networking with other pregnant women
GUIDELINES FOR EXERCISE DURING PREGNANCY
1. Exercise regularly(3 times/week minimum)
2. Avoid ballistic movement,quick change in direction, or any
exercise that requires extreme ranges of ranges of joint
motion
3. Warm up prior exercise and cool down after exercise
4. Avoid anaerobic exercise
5. Avoid exercising in the supine position after the first
trimester to avoid “supine hypotension syndrome”
6. Strenuous exercise should be limited to 15-20 minute
intervals to avoid overheating
7. Avoid prolong periods of motionless standing especially in
the third trimester
8. Modify the intensity of exercise according to signs of
overexertion
9. Do not exercise to levels of exhaustion
10. Resting in a left side-side position, after an
adequate cool down, may improve cardiac output.
11. Increase caloric intake to 500kcal/day if
regularly exercising
12. Consume plenty of water before, during, and
after exercising to avoid dehyderation
13. To avoid gastrointestinal discomfort, avoid
eating less than 1.5 hours before exercising
14. Do not go by “no pain, no gain” when exercising
during pregnancy
15. Non weight bearing exercises, such as aqautic
exercise are favored over weight bearing exercise
16. Stop exercising immediately if any unusual
symptoms develops
 EXERCISES
• ROM exercises
• Aearobic exercises
• Pelvic floor exercises, kegels.
• Exercises for back support.
 SIGN AND SYMPTOMS TO STOP
EXERCISE AND CONTACT A PHYSICIAN
• Pain
• Vaginal bleeding
• Uterine contractions that are <15 minutes apart or are not
affected by rest or a change in position
• Persistent dizziness, numbness, or tingling
• Visual disturbances
• Faintness
• Shortness of breath
• Heart palpitations and tachycardia
• Persistent nausea and vomiting
• Leakage of amniotic fluid
• Decreased fetal activity
• Generalized edema
• Sever headache
• Sever calf pain, swelling, or redness
ABSOLUTE CONTRAINDICATIONS TO EXERCISE
IN PREGNANY
• Pregnancy- induced hypertension(BP>140/90mmHg) or
preeclampcia(toxemia; increased blood pressure, excessive
edema{especially in hands and face} rapid weight gain and protein
in urine)
• Diagnosed cardiac disease
• Premature rupture of membrane
• Abruptio placentae
• Preterm labor or history of preterm labor prior to 37 th of gestation
• History of recurrent miscarriage
• Persistent vaginal bleeding
• Fetal distress
• Intrauterine growth retardation
• Incompetent cervix
• Placenta previa
• Toxemia
• Polyhydramnios(amniotic fluid volume> 2000ml)
• Oligohydramnios(abnormally low volume of amniotic fluid)
RELATIVE CONTRAINDICATIONS TO EXERCISE IN
PREGNANCY
• Multiple gestation(twins, triplets, etc)
• Renal and cardiac transplant
• Cigarette smoking
• History of back pain
• Fever
• Obesity
• Unwilling or unable to exercise
• Chronic hypertension
• Asthma
• Physically strenuous employment
• Hot, humid environment
• Acute infectious illness
 PRENATAL CARE
• To promote the good health of unborn child
• Avoiding smoking, alcohol use, risky behaviors, drug
use.
• Maternal factors that can negatively impact a
developing embryo and fetus include exposure to
infections(rubella, syphilis, genital herpes, AIDS,
cytomegalovirus)
• phenoketonuria; is a hereditary enzymatic defect that
result in an accumulation of phenyalanine in the body
and its conversion to abnormal metabolites-if this
condition continues unrecognized, the child may
appear normal at birth but, within a year, can develop
progressive mental retardation.
• Preaclamsia: can prevent the placenta from providing
sufficient blood to the fetus
• Gestational diabetes:
CHP # 9
Aging
 Typical aging result in highly variable
changes in the function and overall
health status of older adults.
 Exercise tolerance, strength, and
balance frequently experience a decline
with age,
 yet regular physical activity and exercise
have been shown to preserve these
function over time and in some cases,
reverse the usual decline
ANATOMICAL AND PHYSIOLOGICAL CHANGES
WITH AGING
 MUSCLE STRENGTH
 Loss of type II muscle fiber
 Loss of muscle mass
 Loss isometric & dynamic strenght
 Loss of bone density
 If they are forced to bed rest due to illness or injury muscle strength and aerobic
capacity declines swiftly
 Less muscle mass leads to increased rate of disability
 Note: regular strength training 3/week minimizes and in some cases even
reverse this loss
 But stop of 2 weeks training diminish the Gained advantage of R.E
 CHANGES IN BONES AND JOINTS
 Age related bone density differs from site to site
 Peripheral sites, like radius experience relative stability in
density until menopause.
 While more central skeletal structures like spine and the
neck of the femur.
 These changes can be reduced and reversed by vitamin
supplementation.
 Weight bearing exercise minimizes bone loss
 Loss of joint fluid, wear and tear leads to osteoarthritis
 Excercises. Like postural alignment and strength training
can reduce these changes
 Postural changes: are
related to
intervertebral discs
lose water, flatten,
become porous, and
changes at cellular level
 So loss of disc height,
and decreased strength
of intra scapular
muscles lead to
kyphosis(rounding of
shoulders with a
forward lean
CHANGES IN CARDIOPULMONARY
 Aerobic capacity generally declines with
aging,
 Rate of decline can be diminished through
physical activity.
 Maximum ventilatory uptake(the maximum
amount of oxygen inhaled)drops 5-10%/
decade b/w age 20-80years in sedentary
individuals.
 Decline in VO2 max(maximal rate of oxygen
consumption) attributed to decrease in
maximum heart rate, decrease muscle mass
and decrease muscle demands
 Rx: aerobic training
 CHANGES IN PSYCHOMOTOR AND
PSYCHOLOGICAL FUNCTION
1. A decrease in choice reaction time(where a decision has
to be made between tasks or in sequencing)
2. An increase in processing time for working memory
for complex task.
3. Alziemer’s disease:
4. memory loss due to demination of nerve fibers.
5. Parkinson’s disease:I
6. t is a chronic, progressive neurological syndrome due
to lesion in basal ganglia resulting in
 Resting tremors.
 Rigidity.
 Bradikinesia
 Postural instabilities
5. Stroke
are most common
pathologies
 Depression, lethargy,
dementia
a
MOBILITY FOR OLDER ADULTS
 Decrease in walking speed
 Decrease in leg strength
 Lack of confidence in mobility
 Fear of falling
 Increase response time to environment stimuli
 Altered gait pattern
 Walking should be encouraged for all older adults to maintain
functional independence and stamina
COMMON HEALTH PROBLEMS
 OSTEOARTHRITIS:
 degeneration of cartilage of joints, exercise will help in reducing pain,
stiffness and maintenance of ROM.
 Walking, aquatic exercise, non weight bearing exercises like bicycling
 CARDIOVASCULAR DISEASES: stroke
 DIABETESE MELLITUS: type II
 CHRONIC OBSTRUCTIVE PULMONARY DISEASES(COPD): bronchitis,
emphysema, asthma
Assessment
 Fall history
 Medical diagnosis
 Medication review Physical activity
 Cognition/memory
 Fear of falling
 Environment
 Living situation
Resistance training
 RM ……….Endurance ……Strength…..
The American College of Sports Medicine recommends that
healthy sedentary adults undertake a strength training
programme involving one set of 8–12RM
of 8–10 different exercises twice weekly.
Shoes
 Evidence to support the suggestion that shoes may influence postural
stability
 50% of falls

 Advantages of high heel ???

 Advantages of flat shoes??
 Disadvantages of high heel ???
 Disadvantages of flat shoes??
 Which one is best ??
Disadvantage of high heel
 Joint Pain. Unlike other types of shoes, heels
lack any significant shock absorption. ...
 Callouses. ...heel bony spurs on
calcameumplanter facsitis.
 Shortened Achilles Tendon. ...calf pain
 Lower Back Pain. ...
 Lack of Cushion:: When you wear heels, your
entire body’s weight is placed on the ball of
your foot and your heel is used for balance
only. Surprisingly, this can cause a wearing
away or pushing away of the natural padding
you have on the ball of your foot....RX: butox
injections
 Falling and Sprained Ankles. ...
Heel elevation
Research into the effects of heel elevation

 Increased loading on the forefoot

 Alterations in the function of the big toe joint during the propulsive phase
of gait
 Decreased stride length
 Increased energy consumption
 Increased arch height
 More effort …..Maintained balance….COG ….high
Advantages
 However, further research needs to be undertaken to ascertain the
optimum heel elevation for women’s shoes, as many older women report
that they feel safer in a ‘slight’ heel,

 Heel elevation may have some beneficial effects in older people with
Parkinson’s disease to facilitate forward propulsion.
Shoes
 Flat shoes
 A pair of flats is best worn in several different situations.
 these shoes are prime footwear for office wear.
 For those women who seem to walk endlessly at work or who often
need to stand a great deal at the office, flats are definitely the best
choice.
 Advantages
 One of the most obvious advantages wearing flats is that they
are much more comfortable than wearing heels.
 They do not put as much strain on the legs and feet as their
taller counterparts, and they can be worn in a wide variety of
situations and environments.
 Flats are also easier to pack because they are not as bulky. In
fact, many types of flats are flexible and can sometimes even
be rolled up to take up minimal space.
 This makes them ideal for suitcases and for toting in a purse
or bag to put on after a pair of heels starts to hurt the feet.
 Flat shoes
 Disadvantages
 One of the main disadvantages of wearing flats is that
they can cause blistering on the feet.
 This often happens when the shoes have not been
broken in and are still stiff or, if they are worn for lengthy
periods of time.
 Some blisters can be prevented by using heel
cushions and similar items, which can be inserted into
the flat to protect the area susceptible to blistering.
 When looking to purchase a pair of flats, it is always a
good idea to carefully look through the reviews of the
shoes to see how they have worked for other customers.
Fall assessment
 Identification of individual risk factors-fall
 Identification of environment risk factors-
 Identification of risk factors associated with
movement of individual such as reaching, lifting,
twisting, walking
 Improve physical mobility with exercise program
 Properly mange medication & supplements
 Educating family members about risk of fall
 Continence promotion & toileting program
 assessing other factors that potentially cause fall
The Four C’s
 Fall Prevention must be:

Consistent
Cross Disciplines
Coordinated
Culture
 Risk factor and solution
Risk factor Solution
Lightening ???
Slippery floor surface ???
Loose rugs ???
Up-ended carpet edges ???
Wet surface ???
Low chairs ???
Stairs ???
Toilet seat ???
Toilet safety ???

such as adequate lighting In such a case, incandescent light

bulbs are preferred over fluorescent lighting, because they react
instantaneously while a FL takes time to warm up and become
bright. , without glare,
non-slip bath mats, stair rails, rails next to the toilet and in the
shower or tub, and raised toilet seats should be considered.
Researchers have identified common elements
in falls on stairs.
 • Slipping is the primary cause of stair falls.
 • Most stairway falls that cause injuries occur while people
are walking down the stairs.
 • Absence of handrails account for a large percentage of
falls on stairs that result in injuries.
 • Unexpected location of stairs leads to many falls. For
example, stairs of just one or two steps in a hallway or
doorway
 Solution:
 Stairs height b/w two stairs will be minimum & made of
non-slippery material,
 use hand rails/ supporting device during ascending &
descending of stairs
a
 Intervention strategies
INTERVENTION
RISK FACTOR

• Muscle weakness • Resistance training

• Impaired balance • Trainig, assistive devices

• Impaired gait • Training, environment

• Transfer skills • Training, grab rails

 Intervention strategies
INTERVENTION
RISK FACTOR

• Visual impairment • Glasses

• Cognitive Minimise or treat

impairment&
Depression
 Intervention strategies
RISK FACTOR INTERVENTION

• >4 • Review
prescribed
drugs

• Sedative use • Educate, withdraw

 Intervention strategies
RISK FACTOR INTERVENTION

 Environmental hazards  Give Advice

 Handrails
 Remove items
 Secure rugs/carpets

 Footwear  New shoes

Hip protectors
 Screening guidelines
 Blood cholesterol level ………
 hypercholestremia -cvs diseases
 ECG.. Abnormalities in heart & function
 Chest X-ray-
 lung condition/ shape & size of heart
 CBC
 anemia, infection, leukemia
 Transferrin saturation test: normal range 170 to 370 mg/dl.
 used to detect hemachromatosis- arthritis ,diabetes, cardiac &
liver disease… iron deficiency anemia(liver disease
,hemolytic anemia)
 Urine analysis…
 Glucose level, RBC..GIT tumor ,internal problems, WBC.infection
 Thyroid stimulating hormone test…
 hypo& hyperthyroidism
Intervention & Prevention—
Age-Related Risk Factors
 Assessment & management of chronic
conditions, vision, & hearing
 Encourage health with exercise & nutrition
 Osteoporosis screening
 Dexa scan(t-score)=………………………
 Medication review (reduce if possible)
 Referrals for at-risk
 Physical Therapist for balance & gait,
vestibular rehabilitation
 Occupation Therapist for assistive devices
Intervention & Prevention—
Lifestyle & Behavioral Risk Factors
 Mental activity & focus training
 Exercise—Tai Chi classes/yoga, strength
training
 Education to improve home environment
Intervention & Prevention—
Assistive Devices
 Walkers:
improve balance
relieve or reduce weight bearing
provide 4-way stability
 Canes:
improve balance
provide support for one side of the
body
 Intervention & Prevention—
Assistive Devices

Reachers
Portable seat lift
Special step stools
Intervention & Prevention—
Environment: Home
 Kitchen—keep items within easy reach
 Bathroom—grab bars for toilet and
bathtub
 Bedroom
 nightlights
 bed and night stand at
proper height
Intervention & Prevention—
Environment: Home & Yard
 Living room
Remove extra things
 Porch
 railings
 clear pathways
 Throughout
 clear paths
 good lighting
Intervention & Prevention—
Community: Referral System
Physical
Therapy  Home Health
Occupational Nurse
Therapy  Community
Dieticians Programs
Social  exercise, etc.

Workers  Support Groups

Balance Retraining
Strength Training
Aerobic Training
Balance training
Flexibility training
Combined Exercise Programs
Sensory Orientation Training
Frenkel's Exercises????
Tai Chai/yoga exercise??
 Common features of effective exercise
programmes for falls reduction
1-Type of exercise to include
 Balance exercises
 Exercises conducted in weight-bearing positions
 Exercises with the aim of reducing the amount of support
provided by the arms
 Functional activity practice (i.e. stair climbing/sit-to-stand)
 An additional component of endurance exercise to increase
general fitness (but not a walking programme on its own)
 An additional component of moderate-intensity resistance
training
 (2) Exercise prescription
 Progressive in intensity
 Individually prescribed intensity
(3) Nature of programme
 Sessions with a duration of 60 minutes (may need to build
up to this level)
 Undertaken by participants at least three times a week
 Conducted for a minimum of six weeks (but long term
exercise is probably required for sustained benefits)
 Either delivered in a group setting or on an individual basis
 Contain support mechanisms to motivate participants to
maintain adherence
(4) Design and delivery

 Programmes designed by a trained professional (a

physiotherapist in most cases)
 Exercises delivered by a trained instructor (to ensure
exercises are challenging yet safe)
Conclusion
 Importance of fall prevention
education
 Fall risk assessment
 Identification of risk factors
 Interventions & prevention
 Healthcare providers,
communities, and seniors work together
RESOURCES TO OPTIMIZE HEALTH AND
WELLNESS
Chapter 10
 COMMON IMPAIRMENTS ENCOUNTERED WITH
CHRONIC PATHOLOGY
• Chronic pathology include single system impairments:
• muscle weakness
• Decreased cardiovascular endurance
• Multisystem impairments:
• Metastasized cancer
• Diabetes
• Hypokinesia
• Other health concern:
• Altered psychological status
• Changes in social interactions
• Altered sleep pattern
• Changes with digestion and elimination
• Reduced balanced & altered cognitive status.
 Life style changes
• Identify individual belief about behaviors and
adjust accordingly & individually
• Provide rational for each recommendation,
develop realistic time frame for achievement
• Add new behavior &adopt good habits
• Link +ve behaviors with daily routine,. Explain
how behavior integrated into daily activities
• Trained teams that can educate about chronic
diseases more effectively. Another way is to refer
novice patient to a talk with successful patient
• A call from health professional about progress of
recoveries is very effective in changing behaviors.
 STRESS MANAGEMENT
• Stress: is a description of how an individual
reacts(physically and emotionally)to a change.
• Eustress: +ve stress
• Distress: -ve stress
• Neustress: (neutral stress)= loss of loved ones
• One situation may be stressful to one but not to
other individual
• Sources of stress
• Employment or job issues
• Money problems
• Health problems
• Child care issues
 STRESS MANAGEMENT
• Some physical distress symptoms
• Nail biting: worry or tense
• Fists or tight fingers, reflect anxiety
• rounded shoulders reflect anxiety/fear
• Foot tapping or toe jiggling reflect: impatience/
irritability
• furrowed brow indicate worrying, fatigue or
depression.
• Stress lead to chronic overstimulation of organs
leading to organ failure
• Chronic stress related illness
• Migraine headaches
• Tension headaches
• Psoriasis
• Panic attacks
• Ulcers
• Colitis
• Gastritis
• Cancer
• Non cardiac chest pain
• Heart attacks
• Dizzy spells
• Low back pain
• Rheumatoid arthritis
• High blood pressure
• Behavioral consequences of stress
• Over eating or loss of appetite
• Smoking
• Alcohol abuse
• Sleeping disorders
• Emotional out burst
• Violence and aggression
• Steps for managing stress include
1. Identifying the stressors
2. Using a relaxation or coping strategy to relieve the stress
3. Seeking solutions for avoiding or controlling the stress
4. Changing the way of thinking, as needed
• Healthy nutrition
• Adequate rest
• Relaxation techniques
• Time management
• Positive attitude and physical activity helps effectively to reduce
stress
 NUTRITION
• Good nutrition: involves receiving and
using the optimal nutrients to
manage variations in health and disease
• Sign of good nutrition include; toned and well developed
body, ideal body weight, smooth skin, clear bright eyes,
glossy hair and alert face expressions
• Under nutrition: a diet that lacks a full complement of
healthy nutrients.
• Under nourished individuals are; limited in their physical
work capacity, immune function, mental activity, and their
ability to recover from illness and injury
• Malnutrition: when nutritional stores are depleted and the
body lacks sufficient nutrients for the demands of daily
living
• Individual with chronic disease may also lack sufficient
stores of nutrients
• Over nutrition: severely obese individuals
 SLEEP
• Individuals need adequate sleep to function normally
• Sleep allows the body to repair and restore itself
• Over 70% of body’s daily dose of growth hormone is
circulated during sleep
• An important time for regeneration of immune system
• Essential for mental ability and concentration
• Missing sleep reduces body’s ability to resist and fight
infections
• sleep deprivation(sleep limited to 4 or 5 hours /night) has
adverse effects on sugar metabolism
• So leads to obesity and weight gain
• Insomnia(difficulty falling sleep, sleeping too lightly, being
easily disrupted with multiple spontaneous awakening,
early morning awakening with difficulty fall asleep)
• All these factors contribute to stress,
• Manage by relaxation techniques
 RELAXATION TECHNIQUES
• Reduces stress and improve sleep problems as well
1. Progressive muscle relaxation
• Commonly used by physiotherapist
• Reduces stress, anxiety, insomnia
• Some chronic pains
• Muscle contraction technique is performed on succession
of muscles from lower extremity towards head ending with
contraction of facial muscles
• e.g: tighten the muscle of foot
• Contraction for 5 to 8 sec & Relaxation for 30 sec
• Then move to other muscle group
• At the end keep the relaxed posture for as long time as
possible for complete general relaxation
• 2. visual imagery: using ones imagination to create mental
pictures in a way that promote relaxation and sleep.
3. MASSAGE
• Involves the manipulation of soft tissues reducing msl
tension
• Types
• Relaxation massage(to promote general relaxation,
improve circulation, ROM & decrease muscle tension)
• Therapeutic massage(to restore function of injured tissue &
joint)
• Sports massage (to enhance sports performance)
• Pressure massage (applying pressure at multiple
pain/acupressure points

• Techniques of massage
• Petri-ssage( kneading and rubbing with force to manipulate
tissues and muscles)
• Effleurage(stroking)
• Deep transverse friction massage
4. Tai chi
5. Yoga
6. Biofeedback:
It is technique employing feedback from body functions to increase the
person’s awareness of internal body workings. Body function is measured
with electrodes and displayed on the monitor that both the participant
and his or her practitioner can see.
 TIME MANAGEMENT
• These factors contribute to increase stress
• Increased working time
• Decreased leisure time
• Poor time management
• Poorly established priorities
• Establish priorities
• SWOT analysishelpful in pointing what needs to be done and
putting problem into perspective.
• Monitor and analyze current time use
• Track the schedule of time spent the past seven days
• Highlights how much time is spent on priorities versus non-
prioritized activities
• Time spent must match the priorities
• Setting goals
• Make “To do” list in order of priorities
• Like educational goals, career goals, family goals etc
• List the short term goals and long term goals
 Spirituality and Religion
• Can be defined as search of meaning and connectedness with
others, nature, the self, and the great power
• Purpose of This search is the need for forgiveness, hope, life
purpose, giving and receiving love in life
• Those whose spiritual needs are met will have the sense of
peace, meaningfull life, supportive and caring relationships,
sense of hope and less morbidity and mortality
• Religion: is the code of conduct
• Prayer:
• Providers should be aware that prayer may
take many silent or vocal forms, Including
meditation, thankfulness for things recieved,
requesting needs to be met, reading written
prayers, conversing with God and expressing
anger and emotion.
• Spiritual meditation: Silence, prayer, music or
other practices may facilitate meditation.
• Music: Music helps one to express deep spiritual
feelings, is present in all religions, and can be
calming .
• Some of music’s positive effects include
relaxation, lower blood pressure, improved
mood, enhanced cognitive function, relief of
boredom and pain control.
• Forgiveness: it is letting go of negative feelings
toward others in a way that restores and repairs
relationships.
• Hope : Hope may be best evidenced by the
person’s ability to imagine and participate in the
enhancement of a positive future.
• Hope has been associated with lower anxiety,
higher functional status and better physical
health.
a
PREVENTION PRACTICE FOR
MUSCULOSKELETAL SYSTEM
CHP # 12
Skeletal Development During Infancy (Birth-2 years)
 Many changes take place in babies during their first two years of life.
 Most babies grow 9-10 inches during their first year of life and double or
triple their weight.
 When babies are first born, their skeleton is made mostly of cartilage. They
are born with 300 bones, and there are many large spaces in between their
bones to prevent them from breaking. They cannot stand or walk well
because their bones are not sturdy enough to hold their body weight.
Three major changes occur during this time period:
 The length of bone increases. Ossification begins. This
helps the infant's skeletal frame become more sturdy, allowing
them to sit up and eventually stand and walk.
 The number of bones changes. As mentioned before, babies
are born with 300 bones, while adults have 206 bones. The
bones in a baby's body begin to fuse together. Also happens in
the skull, several skull bones fuse.
 No & size of cardiac muscle increase
 Spine c shaped, at 6 month holds neck develop lordosis against gravity.
 Muscular changes 3-6 years
Muscle strength of trunk muscle & lower
extremity increase to support bipedal
movement.
Muscle fiber & strength increase with increase
activity.
Muscle of left ventricle grow more than rights
Sphincter muscle develop to allow toilet
training
Arches of foot, fat pad & muscle of foot
developed for weight bearing
At end of 5 years children have adequate
manipulation skills to begin hand writing.
 Muscular changes pre-
adolescence & adolescence
 6 year fully developed lordosis
 Skeleton growth linear increasing height
 Cartilage is being replaced by bones at
epiphyses(bone growth completed.
 Articular cartilage cover the end of
bones
 Linear growth complete at end of pre-
adolescence
 More lateral growth more evident in
adolescence (e.g clavicle & pelvis
bones growth)
 At end of adolescence posture
resemble to adult posture
 Max skeletal growth occurs earlier in
female 10-14 and age of 12-14 in
males.
Typical changes with increased aging in the musculoskeletal system
1::::::Muscle strength
Loss of isometric and dynamic strength
Loss of type II, fast twitch muscle fibers
Loss of muscle mass(sarcopenia)
Disuse due to injury or inactivity, muscle strength is lost
at approximately twice the rate it takes to regain it
Older women (non exercising) risk losing one quarter
pound of skeletal muscle per year from age 40 on.
Less muscle mass leads to increased rate of disability.
Threshold value for quadriceps strength is necessary
to rise from chair and toilet;
strengthening programs are needed for older
adults to make them functionally active
Skeletal system
Age related bone density differs from site to site
Peripheral sites, like radius experience relative
stability in density until menopause.
While more central skeletal structures like spine
and the neck of the femur.
These changes can be reduced and reversed
by vitamin supplementation.
Weight bearing exercise minimizes bone loss
Loss of joint fluid, wear and tear leads to
osteoarthritis
Exercise and activity that promote optimal
postural alignment and strength assist in
suppressing the occurrence of these changes
Postural changes
Changes in spine are:
Intervertebral disc lose water
Changes at cellular level
Disc become flattened
Bones of spine become more porous
So loss of disc height and compression of
spinal column leads to height loss in all
older adults
So loss of disc height, and decreased
strength of intra scapular muscles lead to
kyphosis(rounding of shoulders with a
forward lean)
Ergonomics: prevention practice in adulthood

 Definition: study of work performance with an emphasis on

worker safety and productivity
 compasses changes in job process
and equipment to allow for pain free work
 A certain amount of fatigue is normal at the end of a physically
demanding work day
 Normal fatigue dissipates with adequate rest
 Fatigue or pain that is always present is a warning sign that an
injury will probably or has already occurred
 Ergonomic can help to work with this kind of problems
 A multidisciplinary program
 The goal of ergonomic program is to reduce musculoskeletal
disorders(MDs) or Cumulative trauma injuries
 Cumulative Trauma Injuries(CTIs)
 CTIs are caused by too frequent, uninterrupted,
repetitions of an activity or motion , unnatural or
awkward motions such as twisting the arm or
wrist, overexertion, incorrect or sustained
posture, or muscle fatigue
 CTIs occur most commonly in hands, wrist,
elbows, and shoulders but are also present in
the neck, back, hips, knees, feet, legs and
ankles
 These disorders are characterized by pains,
tingling, numbness, end range strains, visible
swelling or redness of affected area and
eventual loss of flexibility and strength
CTIs can cause temporary or permanent damage to
the soft tissues like muscle, nerve, tendons, and
ligaments and compression of nerves or tissues.
These clients typically perform work tasks like
sewing, packing, playing musical instruments, and
computer work
Some recreational activity like gardening and tennis
Muscles and tendons are especially stressed with
repetitive motions, with severity of potential risk
dependent on the frequency of the motion, its speed
and requisite force
 Some Common CTIs
1:CARPEL TUNNEL SYNDROM
This is a condition involving
compression of the median nerve
cause by the swelling of tendons in
the carpel tunnel.
The tunnel is bounded by
transverse carpal ligament on the
palmer surface and the carpal
bones on the dorsal surface.
As a result of poor wrist
position/repetitive motion the
tendons or the tendon sheaths
running through it become inflamed
The mechanism of injury is sustained flexion or
extension while typing for many hours of the day
Sign may include anesthesia, paresthesia, pain and
increased temperature sensitivity
Too much pressure on the median nerve can limit the
movement and sensation in the thumb and fingers
Symptoms reported may be dropping things due to
decreased strength/control, pain at night, and stiffness
similar to arthritis
A preferred position for the wrist is neutral as much as
possible
 2::THE HERNIATED SPINAL DISC
 It is a condition in which part or all of the
soft, gelatinous central portion of the
intervertebral disc ( the nucleus pulposus)
is forced through a weakened part of the
disc.
 Resulting in back pain and leg pain due to
nerve irritation
 Herniated disc referred as:::Ruptured
disc, lumber rediculopathy(pain in low
back) cervical rediculopathy(pain in neck
region) a prolapsed intervertebral disc, or
slipped disc
 3::TENSION NECK SYNDROME
 Also known as costoscapular syndrome
 Characterized by muscle tightness,
palpable hardening, tender spots with pain
on resisted neck lateral flexion and rotation.
4::SCIATICA
Pain along the sciatic nerve, that
runs along the back of the leg.
When nerve is irritated; it can
result in;
decreased ability to flex the
knee;
decreased ability to move the
foot and toes;
 numbness, burning, tingling in
leg, pain in lower back and may
travel to the back of the thigh
and calf
 5::EPICONDYLITIS
 Is a painful inflammatory condition of
muscle and soft tissues around an
epicondyle or bony prominence
 Tennis elbow:
 Refers to lateral epicondylitis of the
humerus
 characterized by elbow pain that
gradually worsen, radiating to forearm
and back of the hand when grasping
and twisting and a weakened grasp
 Usually caused by overuse of the
upper extremity especially repeated
wrist extension
 Golfers elbow:
 Medial epicondylitis of humerus
 Repeated elbow/wrist flexion
 6: HAND ARM VIBRATIONAL SYDROME
 Vibration-induced white fingers, traumatic vasospastic disease,
dead fingers, spastic anemia.
 Chronic progressive disease that affect vascular, sensor neural,
and musculoskeletal structure of the hand.
 It can result in permanent, painful numbness and tingling in the
finger and hand
 Damage to the bones of hands and arms
 Painful joints and muscle weakness
 Prevalence increase with increasing exposure time and vibration
intensity

 Prevention Practice for Back Pain
and Back Injuries
 Keeping back in anatomical position is best for spine health
 Natural curves are concave “C” for cervical and lumber and
convex “C” for thoracic region
 Lifting heavy objects while twisting is dangerous
 Lifting rather than pulling and pushing objects may be a potential
problem
 Less physically demanding jobs, posture while sitting and
standing is equally important to prevent upper back and neck
pain
 While typing and viewing a computer screen much of the time
during day so proper posture is necessary.
 Neck is in neutral position,
 Keyboard is placed so the wrist is neutral position or slightly
flexed, rather than extended
301
 PREVENTION PRACTICE FOR
CARDIOPULMONARY CONDITION
CHP# 13
 HEART DISEASE
• CAD Causes angina(pain associated with
poor heart circulation)and ultimately, heart
attack(myocardial infarction)
• Women often experience a more silent form
of heart disease
• Cardiopulmonary condition may be primary
impairments or secondary complications
resulting from ineffective preventive
strategies for other pathologies.
• Heart diseases, hypertension, hyperlipidemia,
arteriosclerosis, coronary artery disease,
congestive heart failure, peripheral vascular
disease, brochitis, asthma, and emphysema
are all conditions impairing the cardiovascular
and pulmonary system
• Physical therapy practice patterns for delivering all levels of primary,
secondary and tertiary care for patient with cardiopulmonary conditions
include the following
1. Prim. Prevention/risk reduction for cardiovascular and pulmonary
condition
2. Impaired aerobic capacity/endurance associated with deconditioning
3. Impaired ventilation: respiratory exchange, and aerobic
capacity/endurance
4. Impaired aerobic capacity/ endurance associated with cardiovascular
pump dysfunction or failure
5. Impaired ventilation and respiration/ gas exchange associated with
ventilatory pump dysfunction
6. Impaired ventilation and respiration/gas exchange associated with
respiratory failure
7. Impaired circulation and anthropometric dimensions associated with
lymphatic system disorders
Changes in the cardiopulmonary system across the
lifespan
• The cardiopulmonary system begins functioning
as early as 4 months of utero and continues to function
through out life
• During fetal development, the heart differentiates and
enlarges, then begins beating at approximately 4
months gestational periods
• Defects in heart structure, such as atrial or ventricular
septal defect, can reduce the efficiency of heart
• Typically respiratory rate and pulse rate declines as a
child matures into adulthood
• Blood pressure rise
• Myocardium become more forceful.
• Resting heart rate at age 10 is 60-100beats/min
• Beginning of age 25, aerobic capacity generally
begins to declines but rate of decline can be
diminished through physical activity
• Maximum ventilatory uptake(the max amount
of oxygen the body inhales) usually drops
between age of 20 and 80
• VO2 max declines with aging
• Decline in VO2 max can be attributed to a
decrease in max heart rate with aging
• Decrease in muscle mass
• Decrease in muscle demands, requiring less
oxygen
• Note: Improving lung’s functional capacity and
functional reserve are keys to slowing the rate
of decline of VO2 max.
Screening for Cardiopulmonary Conditions
• Simple way to assess the pulmonary system is
• Checking the respiratory rate
• Watching the rate of chest expansion\or shoulder elevation
• Pneumonia present with elevated respiratory rates
• Also screen for asthma
• Patient with chest pain, shortness of breath, cough and
wheezing need comprehensive examination
• Chronic smoker are on risk of developing lung, throat and
mouth cancer
 Common Cardiovascular Pathologies
• HEART DISEASES
• Includes a wide variety of cardiac and vascular
conditions affecting the entire body
• Congenital heart disease: is caused by
abnormal heart development before birth and
is responsible for more deaths in first year of
life than any other birth defects.
• Prevention is focused on maternal health
education to reduce risk associated with drug
use alcohol and medications
• Coronary artery disease, congestive heart
failure, ischemic heart disease, rheumatic
heart disease and myocardial infarction are
problem of adulthood
• Chest pain near the heart, before
during and after exercise needs
special attention
• Pleurisy (inflamed membranes around
the lung)
• Indigestion (often causing heartburn)
• Dizziness when standing up,
potentially due to inadequate venous
return heart & its output
• Rheumatic heart diseases best
prevented through infection control to
reduce the incidence of rheumatic
fever
Modifiable contributors to heart disease: 13-2
• High BP
• High cholesterol
• High LDL
• Low HDL
• DM
• Obesity
• Overweight
• overeating
• Smoking
• Physical inactivity
• High fat diet
• High level of stress
312
• Suggested Secondary prevention interventions
include the following
• Controlling weight
• Eating a healthy, low saturated fat diet
• Quitting smoking
• Controlling diabetes
• Controlling blood pressure
• Controlling cholesterol
• Controlling homocysteine
• Taking antioxidants
• Considering the benefits and risk of hormone
replacement therapy
• Taking low dose aspirine( side effects are ulcers,
kidney disease, liver disease, hemorrhagic stroke
 Suggested Secondary prevention
interventions include the following
• Physical therapy indirectly decrease LDL
levels
• When heart condition is stabilized, the
training should continue outside the
hospital
• Suitable activities are daily walking,
jogging, cycling, swimming, aerobic, and
dance etc.
• Using healthy interventions to manage
stress.
• one effective intervention includes:
aerobic ex training for 35min, 3 times/per
week for 16 weeks+1.5 hour stress
management training for 16 weeks
 HYPERTENSION
• “ systolic blood pressure of 140 mm
and a mean diastolic blood pressure of
90 mmHg or currently taking
antihypertensive medication”
• Obesity and metabolic disorders can
put the hypertensive patient at the risk
of more seriously pathologies such as
coronary artery disease or
enlargement of left ventricle
• Physical inactivity major risk factor for
coronary artery disease and stroke
• Other factors are; obesity, HT, low HDL
cholesterol and diabetes
 Hypertension
• Desired exercise includes at least 2 to 3 times/week for
1 hour, while carefully keeping a regular heart rate of
70% to 85% of the theoretic age related max. rate
• More specifically; 30 min of moderate-intensity
activities on most of the week and 30 min of vigorous
activities at least 3 to 4 days/week
• Non-pharmacological measures to control
hypertension(borderline and mild) include, diet and
lifestyle changes.
• Reduce coffee consumption to a max of two cup a day
• Increase intake of potassium, calcium and magnesium
rich substance like fruits( banana, apricot, kiwi, dates
,oranges) vegetables(beans, brocoli, carrots)and mineral
water.
• Increase intake of polyunsaturated fats(mainly contain
in white meat and sea fish)
• Hypertension continueeeeeeeeeeeee:
• Reduce saturated fats(mainly due to all
animals derived products)
• Obese patient can benefit from weight loss
• Alcohol users can reduce their intake to20-
30 gm/day
• Diet of low sodium(max of 5gmNaCl/day)
• Low calorie
• High fiber(at least 30gm/day, 50%soluble
and 50% insoluble)
• Control of associated diabetes(either by
dietry or therapeutic measures)
• Discontinuation of any estroprogestinic
contraceptive treatment
•
HYPERLIPIDEMIA
• Is an increase in blood levels of triglycerides and
cholesterol that can lead to cardiovascular diseases and
other chronic pathologies
• Lipid lowering therapy can prevent cardiovascular
mortality and morbidity for patient with known coronary
artery diseases and type II diabetes.
• Risk factors for hyperlipidemia include; fatty diet, diabetes,
hypothyroidism, Cushing’s syndrome, kidney failure, certain
medications(birth controle pills, estrogens, corticosteroids,
diuretics, beta blockers), lifestyle factors(excessive alcohol
use and lack of exercise, leading to obesity)
• Physical therapist can play a key role in secondary
prevention by aggressive training program, coupled with
diet recommendations and appropriate medical
intervention.
• Clients with hyperlipidemia can reduce their cholesterol,
and increase their exercise capacity, lower blood pressure
and loose weight, reducing risk for pathologies.
 ATHEROSCLEROSIS
• Disease characterized by Loss of elasticity and thickening of
arterial wall
• Atherosclerosis is characterized by deposition of plaques
containing cholesterol and lipids on the inner most layer of
walls of large and medium sized arteries resulting in
narrowing of vassals leading to HT and impaired blood flow
• Arteriosclerotic damage of arterial endothelium initiated by
risk factors
• Dyslipidemia
• Hypertension
• Diabetes
• Smoking
• Normal artery supply the body with needed nourishment
• Vascular diseases can affect all the vital organs and
ultimately lead to death .i.e. coronary artery disease,
arteries to brain and peripheral vascular system
PERIPHERAL VASCULAR DISEASES
• People age 50 or older who have diabetes, smokers
have high BP or have high cholesterol levels are at risk
of peripheral vascular disease or damage to their
peripheral vascular system, impaired normal blood
circulation
• Diseases is treatable in early stages and can be
detected by appearance of extremities,
• Hands and feet: appear swollen or may be discolored
• Individual may complaint of coldness, numbness,
tingling or pain
• May have family history or will have evidence of
varicose vein prominent on their legs
• Bruises may also indicate PVD
• Warning signs: heart attacks, stroke, or aneurysms
• Treatment: lifestyle changes(?), medications or both
SUDDEN INFANTS DEATH SYNDROME
• (crib death) - the sudden death of an infant, usually
under 1 year of age, which remains unexplained after a
complete postmortem investigation, including an
autopsy, examination of the death scene and review of
the case history
• Leading cause of death in infants 1 month to 1 year old
• 95% occur between 1 & 6 months of age - peak period
between 2 & 4 months
• Sudden & silent in an apparently healthy infant
• Unpredictable & unpreventable
• Quick death with no signs of suffering - usually during
sleep
• Usually occurs in colder months
• Mothers younger than 20 years old
 SUDDEN INFANTS DEATH SYNDROME
• Usually occurs in colder months
• Mothers younger than 20 years old
• Babies of mothers who smoke during pregnancy or are exposed to
second hand smoke
• 60% male Vs 40% female
• Premature or low birth weight
• Upper respiratory infections, 60% in prior weeks
• Occurs quickly and quietly during a period of presumed sleep
• Rx: sleep on the back
CHRONIC OBSTUCTIVE PULMONARY DISEASE
• COPD is the forth leading cause of death
• Primary resulting from smoking
• Emphysema: damaged lung alveoli or air sacs become
enlarged as they lose elasticity for ventilation
• Chronic bronchitis: excess mucus in large airways
• Obstructive bronchitis: small airway obstruction,
inflammation and fibrosis
• In early stages COPD are asymptomatic, but sever cases can
lead to death
• Risk factors include;
• genetic predisposition
• Premature birth
• Deficiency of antioxidants(vit A,C and E)
• Vehicle fumes
• Industrial pollution
• Bacterial and viral infection
Sign and symptoms
• Changes in chest shape to increase lung efficiency(barrel
shape chest)
• Dyspnea or difficulty breathing(shortness of breath, SOB)
• Coughing
• With progression, chronic cough and cyanosis(bluish
coloring, especially of skin, lips and nail beds as the body
copes with lung efficiency)
• Physiological and psychological impairments include;
dyspnea, peripheral msl weakness, exercise intolerance,
decrease health related quality of life and emotional stress
• Pulmonary rehabilitation:
• patient education
• Medications ; bronchodilators
• Postural drainage
• Breathing exercise
• Aerobic exercise
 Pneumonia
• Inflammation or infection of the lung commonly
caused by lung infection or aspiration of food into
the lung oftentimes develops as a secondary
complication in individuals who have restrictive lung
diseases and difficulties with pulmonary hygiene
• Pneumonia may present with high fever, shaking
chills, cough with sputum production or very
gradually worsening cough, headaches, muscle aches
• Ideally infectious pneumonia is treated with infection
control
• Immunosuppressed and elderly patients are at risk of
pneumonia
•
TUBERCULOSIS(TB)
• Is a contagious bacterial infection caused by inhaling
droplets sprayed into air from a cough or sneeze by an
infected person
• TB is a preventable disease, even in those who have been
exposed to an infected person
• Skin testing (PPD) for TB is used in high risk populations or
in individual who may have been exposed to TB
• Pulmonary impairments include;
• Localized sign like;
• Coughed up blood, hemoptesis
• Wheezing
• Chest pain
• Difficulty breathing
• Systemic sign like;
• Fever
• Fatigue
• Excessive sweating at night
• Weight loss
328
SECONDARY PREVENTION FOR
INTEGUMENTRY DISOEDERS
CHP#15
Lifespan Changes in the Integumentary Disorders
• The integumentary system contains the largest organ of the
body, skin
• System also includes subcutaneous tissues(responsible for
storing energy and absorbing trauma)
• The nails, the hair, and the structure immediately under the
superficial skin layers(dermis)
• The function of integumentary system
• Protection against infection and injury
• Helps to regulate body temperature
• Removes waste products against the body
• Protect internal structure from UV radiations
• Produces vit.D responsible for maintaining normal levels of
blood calcium and phosphorus
• When skin is compromised from over exposure to radiation,
infectious agents, toxins, allergens, insect bites, and other types
of injurious agents the entire body becomes vulnerable
• Maintaining skin integrity is essential for health and wellness
• A healthy full term baby is born with extra fat and
increased skin elasticity
• With babies having proportionately greater skin surface
than adults
• They are prone to losing heat
• As soon as infant become more active, some of this baby
fat is lost
• Changes in the skin become more apparent during puberty
when hormones influence sexual changes in hair and fat
distribution
• In some cases increased secretion from sebaceous glands
• With aging and exposure to toxin and UV, skin lose its
elasticity
• In older adults, skin function is compromised with graying
of hair
• Physiological changes include impaired wound healing
 INTEGUMENTARY PATHOLOGIES
• Skin pathologies are related to
• Amputation
• Congestive heart failure
• Diabetes
• Malnutrition
• Neuromuscular dysfunction
• Obesity
• Peripheral nerve involvement
• Spinal cord injury
• Vascular diseases
• Skin impairments are limiting levels of activity,
reducing sensations,edema, inflammation, pain etc
• Monitor your patient and send to the treferrals
 SKIN CANCER
• ABCDE rule of skin cancer to identify any abnormal skin
lesion includes
A. Asymmetry in the lesion(one half of the lesion is unlike the
other half)
B. Borders are irregular or poorly circumscribed
C. Represent color variation in the lesions(melanomas tend to
have color variations that include tan, brown, black, white,
red, and blue)
D. Represent diameter greater than 6mm, since cancerous skin
lesions tend to grow
E. Represents elevation since normal skin lesions tend to be
flat and raised lesions may represent abnormal growth
• Most common areas involved are: areas mostly expose to
sun like; scalp, face, lips, ears, neck, chest, arm, and hands
• It may develop on unexposed areas like palms, the spaces
between toes, and genital area
• Primary prevention: includes the educating the person as well
as to use full thorough examination
• During physical therapy: skin examination should be performed
regularly
• Secondary prevention
• Reducing risk factors that can cause e recurrence of malignant
skin lesions, and early diagnosis
 PRESSURE SORES
• Skin breakdowns during the periods of immobility,
prolonged pressures on the bony prominences, poor
nutrition, incontinence of bowel/bladder, lower mental
alertness
• Areas : supine lying; occiput, scapula, elbow, wrist, sacrum,
heal
side lying; ASIS, PSIS, shoulder, ankle, knee joint and hip
joint
• Management;
• Positioning: change every 2 hour
• Water bags, under heels, hands
• Soft cushions under pressure areas
• Whole body passive and active movements
• Precautions
• Prevent creases on sheet, pillows
• Prevent hard beds
• Prevent prolong positioning
 HEALTH EDUCATION FOR SKIN CARE
• Individuals with type I and II diabetes and frail skin should
keep their nails trimmed, avoid scratching the skin, and
bathing in non fragranced warm water rather than hot
water
• Lower extremity amputation; prominences of metatarsal
heads, dry skin, callus formation, unable to perceive 10 g
force, finally decreased thermal and vibrational sensation
• Avoid allergens and skin irritants such as fabric softeners,
perfumed soaps, house hold cleansers
• Bathing is essential following swimming to remove drying
pool chemicals
• Avoid peak sunshine; 10.00am-4.00pm
• Use full body clothing and sunscreen
•
 COMMON INTEGUMENTARY SIDE EFFECTS OF
MEDICATIONS
• Most common drug reaction is urticaria(itchy, swollen,
red bumps or patches on the skin
• Aspirin and NSAIDs can cause angioedema(swelling
beneath the skin) and urticaria
• NSAIDs can also cause pruritis(itching),morbilliform
rash(rash appearing like measles) urticaria and
photosensivity
• Other reactions like purpura(bruiselike coloration) and
cutaneous vasculitis(allergic inflammatory reaction of
vessels)
• Skeletal msl relaxant can cause a cutaneous reaction
like large hivelike swellings on face( eyelids,mouth,
lips,or tongue)itching and redness,
• Other reaction due to muscle relaxants are tenderness,
swelling over blood vessels, pinpoint red spots on skin,
sore/ulcers/white spots on the lips or in mouth,
unusual bruising or bleeding