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ACE-CPT · Chapter 14

Exercise Considerations across the Lifespan

How trainers safely adapt programming for three special populations — youth, women during pregnancy & postpartum, and older adults — across the stages of life.

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Youth · Pregnancy · Postpartum · Older Adults · ACE IFT Application

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The Three Populations

PopulationDefining detail
Youth≥60 min/day moderate-to-vigorous PA; bone-mass gains peak just before & during puberty
Pregnancy≥150 min/week moderate over ≥3 days; avoid supine after 20 weeks
Older adult≥65 years; 150–300 min/week moderate or 75–150 vigorous

Youth FITT (Table 14-2)

AerobicResistance
FDaily≥3 d/wk
IMod→vig; vig ≥3 d/wkBody wt or 8–15 submax reps
TAll within ≥60 min/day total
Bone strengthening≥3 days/week — running, jump rope, basketball, tennis, hopscotch. Greatest bone gains before/during puberty.

Pregnancy FITT (Table 14-3)

AerobicResistance
F≥3–5 d/wk2–3 nonconsec d/wk
IMod 3–5.9 METs, RPE 12–138–10 / 12–15 submax reps
T~30 min → ≥150 min/wk1 set begin; 2–3 adv
Intensity gaugeUse the talk test (stay below VT1), not heart rate. PARmed-X for Pregnancy in screening.

Older Adult FITT (Table 14-4)

AerobicResistance
F≥5 d/wk mod; ≥3 vig≥2 d/wk
I0–10 scale: 5–6 mod, 7–8 vig40–50% → 60–80% 1-RM
T30–60 min mod (bouts ≥10 min)8–10 exercises, 1–3 × 8–12
Add balance trainingImproves proprioception & reduces falls. Introduce early in the session.

Pregnancy Safety

⚠ STOP exercise (ACOG 2020)Vaginal bleeding · abdominal pain · regular painful contractions · amniotic fluid leakage · dyspnea before exertion · dizziness · headache · chest pain · muscle weakness affecting balance · calf pain or swelling
✗ ContraindicationsPoorly controlled anemia · hypertension · seizure disorder · hyperthyroidism
Supine ruleAvoid lying on the back after 20 weeks — aortocaval compression → hypotension. Healthy gain 25–35 lb (11.4–15.9 kg).

Youth & Bone

Physical literacyAbility, confidence & desire to be active for life. Prioritize effort over performance.
Strength is safe9-yr-old girls: BMD +6.2% vs +1.4% (4× more). No growth-plate damage with proper supervision.
Growth plateEpiphyseal plate = cartilage, not fully formed. No single-max or explosive lifts. Free weights / body weight preferred.
Wolff's LawBone strengthens under unaccustomed forces.

Postpartum & Older Adults

Diastasis rectiRectus abdominis separation 1–2 in (2.5–5.1 cm); 45% in pregnancy, 33% at 12 mo. TA + pelvic-floor isometrics help.
Postpartum returnDuration → frequency → intensity. 10-min blocks. Pre-pregnancy intensity over 9–12 months. C-section needs MD protocol.
Aging & balanceVisual, vestibular & somatosensory systems all decline → fall risk. ~20% of hip-fracture elders die of complications.
CognitionPA improves cognition over age 50 (Northey 2018). Arthritis affects 49.6% over 65 — assess posture/flexibility first.