This is an excerpt from NSCA's Essentials of Training Special Populations by NSCA -National Strength & Conditioning Association & Patrick L. Jacobs.
The exercise professional with expertise in the training of special populations (via formal education and professional certifications) is properly positioned to meet the growing need for professionals with appropriate background in this area. Various special populations are expected to grow in size with the increasing rate of inactivity in the general population compounded with specific growth in certain special populations. Almost one-half of all U.S. adults (117 million) have at least one chronic medical condition (e.g., hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis), with more than two chronic conditions reported in over one-quarter of adults (60 million). The current number of Americans over the age of 65 is calculated at over 40 million and is expected to increase to approximately 72 million persons by the year 2030. Because chronic conditions increase in prevalence in older populations, these figures indicate that an overwhelming number of persons in our society and a growing segment of our society will be classified as a part of special populations.
Health care costs associated with obesity and sedentary lifestyles are greater than $90 billion annually in the United States alone. These escalating costs place undue stress on both individual and employer health insurance systems. The medical system has made dramatic advances in the care of persons with disease, in particular in the area of emergency care. Survival and recovery have significantly improved in many conditions considered to have questionable outcomes only a few decades ago. This dramatically extended life expectancy, from 66 years in males and 71.7 years in females in 1950 to 72.1 years in males and 79.0 years in females in 1990. By the year 2009, the predicted life span from birth had grown to 76.0 years for men and to 80.9 years for women. Thus, during the same period of time in which length of life increased by approximately 10 years, our society became increasingly inactive. This has resulted in progressive extension of the length of life (quantity of life) with significant reductions in the level of functional independence during the later years of life (quality of life).
The medical system may be an important referral source of new clients to the exercise professional with expertise with special populations. Chapter 2 of this text provides detailed discussions of the health appraisal process and the steps to determine the appropriateness of a medical clearance for a particular potential client. The medical clearance process establishes a means of communication between the exercise professional and a licensed health care professional. Medical clearance provides professional authorization for exercise testing and training in persons who exhibit particular risk factors. This process may also establish a line of communication between the exercise professional and the medical professionals with regard to future patients and their need to engage in purposeful exercise programming outside of the medical treatment environment.
Discharge plans from medical care, particularly physical therapy, usually involve some recommendations for activities and exercise strategies for the patient. Patients may have a limited background in exercise and active lifestyles, and their only experience in these areas may be the therapeutic activities in the rehabilitative setting. Thus, it is unlikely that they will seek to begin a structured exercise program with professional support even if this has been recommended by the clinician. It is recommended that the exercise professional establish working relationships with medical professionals in the community. In this way, the patient can be directly referred by the medical professional to an associated exercise professional who can provide the appropriate guidance and supervision.
Unfortunately, in many situations the rehabilitation plan must be carried out with time limitations related to the patient's medical insurance coverage. The therapeutic plan of care often must concentrate on the most vital skills of daily living in order to enhance the level of functional independence in the limited time available. Thus, many patients are discharged from the rehabilitation setting in a condition that warrants continued physical training. Exercise professionals with advanced background in training of special populations can certainly provide the needed assessment and training of these discharged patients, with clearance and recommendations from the clinician.