Health and Social care A2

Fitness is the capacity to do work without becoming exhausted.

It is a combination of strength, flexibility and endurance.

There are two types of fitness. These are:

• Aerobic fitness
• Muscular fitness

A persons capacity to take up and use sufficient oxygen to sustain work for long periods.

Respiration - getting oxygen from the air into the body cells where it can be used in a chemical reaction that releases energy, and to remove carbon dioxide.

External respiration - involves breathing in and breathing out. This is known as ventilation.

Oxygen transport - blood transports oxygen around the body in arteries and veins.

Oxygen uptake - oxygen combines with other chemicals from food to release energy.

Short Term Effects (during exercise)

• Decreased blood pH
• Increased breathing rate
• Breathing through the mouth
• Deeper breathing
• Increased heart rate
• Increased stroke volume
• Dilation of capillaries in skeletal muscles
• Sweating
• Flushing

Long Term Effects (over weeks/months)

Increased:

• Endurance
• Capacity to do work
• Lung capacity
• Stoke volume
• Rate of oxygen transfer
• Maximum heart rate
• Elasticty of blood vessels
• Size of skeletal muscles

Reduced:

• Stress on heart
• Resting pulse rate
• Proportion of body fat to muscle

VO2 Max - is the maximum volume of oxygen a person can use per minute, per kilogram of body mass during exercise.

VO2 Max = Oxygen uptake (ml/min) / Body mass (kg) = ?? ml/min/kg

Age - As we get older our lung capacity and cardiac output decline.

Sex - males have higher VO2 Max than women as generally women have more body fat.

Genotype - significant individual differences will causes differences in aerobic fitness.

Disease - some diseases (especially of the aerobic system) reduce aerobic fitness directly. Other diseases may have an indirect effect e.g. obesity.

The capacity of a persons muscles to exert force.

Strength

• Maximum strength - the greatest force a muscle can exert in a single contraction e.g. holding up a heavy weight.
• Dynamic strength - the ability of a muscle to contract at speed whilst overcoming resistance e.g. sprinting or cycling.

Stamina

• Also called endurance. The ability to exert power over an extended period without excessive fatigue. It depends on muscular and aerobic fitness.

Mobility

• The ability to move. Depends on muscular strength and joint flexibility.

Flexibility

• The range of movement without pain a person has in their mobile joints.

Height and Weight charts - shows the normal range of weight for people at any particular height. Overweight = unlikely to be very fit, underweight = may suggest they are very fit e.g. a marathon runner.

Strengths - standardised and easy to use.

Limitations - Doesn't take account of body build or fat content

Body Mass Index (BMI) - a way of indicating a persons body weight in relation to their height. Less than 18.5 kg/m2 = underweight, 18.5-24.9 kg/m2 = normal range, 25-29.9 kg/m2 = overweight, 30 kg/m2 and over = obese.

BMI = Weight (kg) / Height (m)2

Strengths - Standardised and easy to use.

Limitations - Doesn't take account of body build or fat content and requires calculation.

Exercise Pulse Rates - a measure of how fast the heart is beating. Can give an idication of aerobic fitness. People who are aerobically fit have lower resting pulse rates than others. Average adult's resting pulse rate = 60bpm - 80bpm

Strengths - Standardised and easy to use when stationary.

Limitations - Requires equipment when measuring during exercise. Pulse rate can be affected by other factors e.g. anxiety.

Lung Function Tests

• Peak Flow
• Spirometry

Total Lung Capacity - maximum volume of air the lungs could contain (around 5 litres)

Tidal Volume - the amount of air inspired or expired during normal breathing (around 500ml)

Vital Capacity - the maximum amount of air a person can breath out after taking in one deep breath.

Residual Volume - the volume of air remaining in the lungs after breathing out after taking in one deep breath

Total Lung Capacity = Vital Capacity + Residual Volume

There are several tests to measure lung function.

Peak Flow - measures how fast air can be expired (exhaled). This is measured in litres per minute. It is the maximum rate if flow of air out of the lungs on a forced expiration following full inspiration. For an average adult this is around 400-600 litres per minute. This depends on height and build. Men have higher peak flow than women. A peak flow metre is used to measure peak expiratory flow rate.

Strengths - simple, useful for people with respiratory diseases.

Limitations - only measures peak flow which on its own is not a good measure of fitness.

Spirometry - can be used to measure a whole range of lung function indicators e.g. breathing rate, tidal volume, forced vital capacity, forced expiratory volumes 1 and peak expiratory flow rate. Minute ventilation can be found by multiplying tidal volume by breathign rate (l/min). Average adultt = 6 l/min resting and 159l/min during exercise.

Strengths - provides several measures, gives more information about fitness.

Limitations - requires expensive equipment and expertise to use.

Percieved Exertion Scales - measures the amount of effort a person feels he/she is putting into an exercise activity. It is not actually a measure of fitness and is usually used to monitor an individual during an exercisse programme.

Strenghts - easy to use, helps keep exercise at safe levels.

Limitations - Doesn't directly measure fitness, subjective, can't use to compare individuals.

Regular exercise can maintain and improve the health of the respiratory and cardiovascular systems as well as the indirect benefits of weight control.

Weight control - exercise can reduce body weight or help a person avoid becoming overweight. It does this by:

• helping to balance the energy equation - taking in the same amount of energy as you put out keeps weight the same. By adjusting this to having less energy in and more out, weight can be lost.
• helping to control appetite - maintains the effective working order of the appestat in the brain which controls appetite.
• reducing exposure to stimuli that motivate eating - e.g. tv adeverts, won't be bored and are more distracted so reduces food intake.

Combatting Ageing - as we age our body systems become less efficient.

• lung capacity decreases
• max heart rate decreases by 1 bpm a year
• stroke volume decreases
• all these factors combined lead to a decline in cardiac output
• Muscles lose tissue and become weaker
• joints lose flexibility
• blood pressure increases as arteries become less elastic and obstructed
• bone density reduces (can lead to osteoporosis)

Exercise cannot prevent this but it can slow the rate of decline.

• stretches tendons and muscles maintaining flexibility
• weight-bearing exercise helps to stimulate bone growth which reduces risk of osteoporosis and fractures
• reduces the risk of diseases that affect older people e.g. cardiovascular diseases

Many sports and exercise activities are social as it can involve meeting other people with similar interests. This can provide a basis for developing friendships.

• Membership of a sports team can give a sense of belonging, social approval and social support, as well as a positive social identity.
• Social contact often helps a person to feel better about themselves.
• For those people in a relationship, a shared interest in exercise can make the relationship more enjoyable as well as providing companionship in activities that may otherwise be solitary e.g. cycling.

Sports and exercise provide psychological benefits by providing occupation and stimulation, reducing stress, raising self-esteem and maintaining cognitive skills.

Controlling Stress - stress can occur partly because of the presence of stressors e.g. time presure, job insecurity, anxiety about family members etc. Stress can lead to increased blood pressure, heart rate and breathing and reduced activity in the digestive system. Extended periods of stress can lead to illness, particularly of the digestive system.

Exercise can help control stress by:

• making the person tired and therefore more relaxed. This can improve sleep patterns and reduces blood pressure and aids digestion.
• stimulating the secretion of chemicals called endorphins and encephalins from the pituatary gland in the brain. These are chemicals also known as happy hormones as they prevent pain and give a sense of well-being and satisfaction. This makes exercise more rewarding.

Raising Self-Esteem - exercise can improve a persons self-esteem in several ways.

• those with a positive attitude towards exercise will find exercise will make them more satisfied with themselves
• overweight or obese people may have a negative attitude about their body image. exercise can help them to achieve a body shape they are happy with.
• achievement in exercise can make people value themselves higher e.g. completing a marathon.

Maintaining Cognitive Skills - there is some evidence to shows that older people who take regular exercise suffer less brain tissue loss than people of the same age that don't exercise. Older people who exercise also tend to do better on cognitive ability tests than those who don't.

While exercise makes an important contribution to health and well-being, it does carry some risks.

Risks in exercise

• Acute conditions - heart attacks and strokes are extreme examples of acute conditions related to exercise. Others include broken bones, dislocations, head injuries, drowning (water sports) and muscle tears.
• Chronic conditions - repeated jarring and overuse can cause damage to joint surfaces, particularly in the knee. This is likely to occur in long distance cross country runners as the terrain is uneven so there is high impact on the joint on every stride.

Who is most at risk?

• Those who are unfit or inexperienced
• Older people
• Those working to the limit of their ability

Most risks can be reduced by adhering to the following principles of good practice and safety:

• Medical checks before commencing exercise - examination by the GP to prevent over-exertion.
• Expert advice - to maximise the benefits of exercise and minimise the risks. They can help with the type of exercise and level of demand most appropriate for the individual.
• Correct use of monitoring equipment - before beginning to exercise an assessment of fitness should be made by using monitoring methods. This can help decide the level of demand of the programme and help monitor improvements over time. Can prevent over-exertion and injury.
• Appropriate equipment and clothing - to prevent injury and make exercise more comfortable.
• Warm up and warm down programmes - prepare the body for greater exertion and stop the build up of lactic acid and prevent dizziness.
• Avoiding dehydration - exercise results in a loss of water from the body in the form of sweat or through ventilation. It is important to replace this by drinking lots of water to prevent dizziness and headaches.

There are several factors that can make it less likely a person will undertake exercise.

Costs - These include:

• buying suitable clothing and footwear - overcome by taking part in exercise that doesn't require expensive clothing.
• buying equipment - overcome by jogging or do sit-ups and press-ups at home.
• paying for transport to the activity - overcome by walking to the activity to get more exercise done.
• paying entry and/or membership fees - overcome by doing exercise at home.

Skill and Fitness Level

• Fitness level - people with a low fitness level sometimes have poor body image. This can be overcome by attending classes specifically aimed at people who have a low fitness level.
• Skill Level - it can be much less rewarding for those with a low level of skill. To overcome this the person could go to beginners classes to begin with.

Facility Locations - people who live in urban and rural areas may find it more difficult than those who live in cities to find suitable places to exercise.

Work and Family Commitments

• Exercise for most people is something they do if they have spare time.
• To overcome this they may be able to walk to work or take up a sport that their partner and children can take part in.

Cultural Attitudes

• Some people just have anegative attitude towards exercise because they don't enjoy it, family and friends laugh at them for doing it, they think it is a waste of time etc.
• For some people it may be against their religion to take part in mixed sex classes so they may have to go to same sex classes.

Principles (FITA) for designing an exercise programme:

• Frequency - How often should the programme should be carried out per week to meet the clients needs? How many reps/sets?
• Intensity - The level of demand for the persons needs
• Type - Aerobic or muscular exercise. What does the client wish to improve on?
• Adherence - Is the programme at a level that the client can manage? Will the client get bored and stop the programme?

A programme for someone:

• Controlling Weight - start with a low level of demand to reduce risk of illness or injury. Unlikely to include much weight bearing activity. Activities such as swimming, exercise bikes, and using rowing machines.
• Rehabilitation following illness - depending on the illness the client will need different types of exercise.
• Disease Prevention - can be tailored to help with a range of diseases so they can be regulated/prevented.
• Combating Ageing - to slow down the rate of decline.