Professional Documents
Culture Documents
Senior Editor
Dr. Khalid Walid Al-Bibi, CETT, CHFS, CNS
Director, Sport Science
Professor, Health and Human Performance
College of Arts and Sciences
Qatar University
Doha, Qatar
PREFACE
This book was written as a practical guideline reference and not as a scientific resource.
Distilled from the latest scientific evidence and driven by local realities, the intention of
this book is to be an immediate and easy source of information for practitioners, physicians,
educators, and individuals who wish to prescribe or engage in regular physical activity. We
limited the number of beneficiary populations in the first edition of the National Physical
Activity Guidelines for Qatar (NPAG-Q) to the most prevalent epidemiologies currently facing
the nation. Subsequent or special e-addendums will include special populations, such as
people with disabilities, cerebral palsy, Down syndrome, restrictive and obstructive pulmonary
disease, spinal cord injuries, asthma, multiple sclerosis, cancer patients, etc.
Behavior modification cannot be considered independently from cultural norms, local
sensibilities, and environmental factors. Hence, we were careful to address social and
environmental factors that are unique to Qatar. Sport scientists, epidemiologists, public
health experts, health promotion specialists, health care professionals, and physicians from
Qatar and the world contributed to the development of these guidelines.
It is our hope that Qatari citizens and residents alike will use NPAG-Q as a guiding reference
as they prepare to lead more physically active lives. It is also our hope that this text becomes
ever-present in the office of every health care practitioner in Qatar and shared with patients
at every appropriate opportunity. Given the strong scientific body of evidence, it is our belief
that the practice of state-of-the-art health care is incomplete without the careful consideration
of the physical fitness of its population.
To make the guidelines as useful and as up-to-date as possible, a dedicated companion
webpage (www.namat.qa/NPAG-Q) was developed to provide practitioners, educators, and
citizens with an extensive array of resources, including data sheets, scientific references,
screening tools, health questionnaires, warm-up and flexibility exercises, basal metabolic
rate calculators, body mass index calculators, nutrition guidance, and much more. We also
added two ask the expert blogs, one for health care practitioners (HCPs) and another for the
general public.
ACKNOWLEDGMENTS
Aspire Zone Foundation (AZF) would like to acknowledge the contributions made by various
partners in the development of the first National Physical Activity Guidelines for Qatar. Among
the notable ones are the Aspetar, Aspire Academy, Qatar University, the Supreme Council of
Health, Primary Health Care Corporation, and Hamad Medical Corporation for providing the
experts to support the development of these guidelines.
Our sincere gratitude goes to our colleagues; members of the Advisory Group and the
subgroups, for their valuable input in ensuring that the guidelines are matched with the latest
scientific evidence and tailored towards meeting the various needs of the population of Qatar.
Lastly, our appreciation is extended to Aspetars management for their financial support to
this project as a part of their contribution to promote physical activity as a healthy lifestyle
in the community.
ADVISORY GROUP
Dr. Mohamed Ghaith Al-Kuwari
EXTERNAL EXPERT
READERS
We wish to thank the following experts for lending their valuable
expertise in the finalisation of the guidelines:
Dr. Dennis W. Koch, CHFS
Associate Professor of Professional Studies
Director of Health and Human Performance
Canisius College
Buffalo, New York
United States
TABLE OF CONTENTS
Evidence, Rationale, and Need
10
First Do No Harm
12
15
Goal Setting
15
Relapse Prevention
17
18
19
24
27
28
30
31
32
Diabetes Mellitus
33
Type I Diabetes
35
Type 2 Diabetes
35
36
38
39
41
44
Recommendations for asthmatic children and children with chronic pulmonary disease:
48
49
Environmental Considerations
52
53
Fasting Ramadan
54
55
56
56
Glossary 59
Appendixes 63
Contraindications to Exercise
63
64
65
66
70
10
Evidence, Rationale,
and Need
Lack of regular physical activity is a significant contributing factor for many of the most
prevalent acute and chronic diseases that have become alarmingly common in the State of
Qatar. Evidence to support the inverse relationship between a physically active lifestyle and
the incidence of cardiovascular disease, hypertension, stroke, osteoporosis, type 2 diabetes,
obesity, colon cancer, breast cancer, anxiety and depression is indisputable.
Over the past two decades, numerous epidemiologic studies, enrolling tens of thousands of
individuals from around the world, have documented a dose-response relationship between
physical activity and risk of cardiovascular disease and premature mortality. The evidence
supporting the effect of exercise on the quality of life as well as affective disorders is
very strong. A meta-analysis of 23 cohorts, representing over 1.2 million person-years of
follow-up, showed a dose-response relationship between physical activity and the risks of
cardiovascular disease. It is clear that additional amounts of physical activity or increased
physical fitness levels provide added health benefits.
In Qatar, deaths attributable to chronic non-communicable diseases (NCD) collectively
ranked as the number one cause of death in the last 10 years. The National STEPS Survey
(NSS) recently examined the health and behavior of 2,496 adults in Qatar. The results were
alarming, revealing:
41.4% of the respondents were obese
21.9% of the respondents had high blood cholesterol level
16.7% of the respondents had diabetes mellitus (vs. 11.3% in the United States,
4.9% in the United Kingdom, and 2.5% in Yemen) According to International Diabetes
Foundation (2012), Qatar ranks as the worlds 8th highest nation in the prevalence of
diabetes
To slow down or reverse these trends, health care practitioners (HCP), government
institutions, and citizens must work together to increase the levels of physical activity
in the nation. The NSS study revealed that between the ages of 18-64 years old, 63.3%
of the population reported no participation in recreational physical activity, and
86.2% of the women between 45-65 years old reported no participation in any form
of vigorous physical activity. The 2011 Global School-Based Student Health Survey
(GSHS), conducted in 32 schools and on 2,021 students in Qatar in grades 7, 8, and 9, showed
that only 15% of the students reported being physically active for a total of 60 minutes or
more on 5 or more days per week.
Although Qatar is a sports-loving nation, we fall short of meeting our minimal physical activity
needs. The dual purposes of the NPAG-Q are: 1) to encourage and help Qataris lead more
physically active lifestyles, and 2) to enlist the support of HCPs in monitoring and prescribing
more daily physical activity for their patients. Research evidence suggests that patients
counselled by their physicians to participate in physical activity are more likely to exercise.
Unfortunately, only 13% of patients in this study reported that their physician gives them
advice concerning the benefits of regular physical activity
11
Economic Benefits
The logical assumption has always been that employees who are more physically active
in their place of employment incur lower medical costs, exhibit less absenteeism, reduced
disability expense, and are generally more productive. This assumption is supported by
research that reports benefit/cost ratio ranging from 0.76 to 3.43, meaning that the return
rate can be as high as three times the investment in the physical fitness of the employees.
Inactivity greatly contributes to medical costs. As an example, in the United States of America
and Canada, the total economic costs of physical inactivity and obesity represented 2.6%
and 2.2%, of the total health care costs, respectively. Therefore, investing in the health of
employees does not only make common sense, it makes economical sense as well.
12
First Do No Harm
Generally, exercise does not cause untoward events in apparently healthy individuals. When
exercise is performed according to established exercise guidelines, the risk of sudden cardiac
complications or heart attack is very low in healthy individuals performing low to moderateintensity activities. There is an increased risk of sudden cardiac death and/or heart attack
in individuals performing vigorous exercise with either diagnosed or undetected underlying
cardiovascular disease. It is therefore incumbent on the person who wishes to engage in
moderate to high intensity physical activity to rule-out such conditions if exercise is to be
conducted in clinically unsupervised settings. In clinically diagnosed individuals, carefully
prescribed exercise must be conducted under the supervision of trained specialists until
medical clearance for unsupervised exercise is given.
The risk of sudden cardiac death in individuals less than 35 years of age is small due to the
low prevalence of cardiovascular disease in this population, with the most common causes of
death in young individuals being congenital and hereditary abnormalities. The absolute risk
of non-traumatic exercise related death among high school and college athletes is one per
133,000 men and one per 769,000 women.
Studies on injuries from exercise show that the most significant factors in determining the
risk of injuries are physical condition, age, training intensity, and impact of the activity.
Exercise duration can also increase the risk of musculoskeletal and heat-related injuries. For
example, the incidence of orthopedic injuries more than doubles when comparing 45 minute
exercise sessions versus 30 minute sessions. Table 1 lists common exercises and their impact
classification. With appropriate conditioning and gradual increases in duration and intensity,
most injuries can be avoided.
For some individuals the risks associated with a high intensity physical activity programme
outweigh its potential benefits (Appendix A). In such cases, it is important to seek medical
consultation before engaging in high intensity exercise. A pre-exercise test evaluation in
the clinical setting generally includes a medical history, physical examination, laboratory
tests, and a possible submaximal or maximal graded exercise test. These evaluations provide
valuable information that help in individualising the exercise prescription (ExRx), and also
assessing the efficacy of the training programme.
13
The evidence on the effect of regular exercise on the human body is no longer anecdotal.
Over the past two decades, much research has been conducted on the effects of regular
physical activity on the physiology, psychology and health of human beings. The body of
evidence collected over the past two decades has proven unequivocally that regular physical
activity can:
14
15
16
Goal Setting
No matter how many times you lapse, you can still reach your
goal as long as you do not give up
(collapse).
Realistic goal setting is a critical part of behaviour modification. Unrealistic goal setting (e.g.
to lose 10 Kg of fat weight in three weeks) ultimately leads to failure. This negative experience
reinforces ones aversion to the healthy behavior making it tougher to face the same attempt
in the future. The NPAG-Q is designed around scientific evidence, which maximises the
chances of success by setting realistic goals and minimising the risk of injury and discomfort.
It is important to remember that everyone struggles to reach his or her health goals (e.g.
smoking cessation, better eating habits, weight loss, exercising regularly). We all experience
numerous lapses on our way to reaching our goals. The primary mistake committed by
individuals who embark on behaviour modification is that they consider lapses as failure
by telling themselves that they cannot control their behaviour or that they do not deserve
to succeed. This is far from the truth, as we all are subject to lapses in any behaviour
modification endeavour we may embark on.
In the context of becoming healthier by becoming more physically active, the goal is to
increase the amount of physical activity in your daily life. The NPAG-Q will provide you with
an optimal but regimented way to do that. However, whenever complying with the exercise
prescription becomes impossible (travel, visitors, family matters, weather, work) there are
numerous creative ways to continue to supplement physical activity into your daily schedule
(Table 2).
17
Table 2. Simple ways to add more activity into your daily routine
Relapse Prevention
1. Accept responsibility
2. Examine the context
3. Rehearse new actions
18
The General
Principles of Exercise
Prescription
The scientific principles for a safe and effective exercise programme presented in the NPAG-Q
are intended to assist in the development of an individually tailored exercise prescription.
These principles are based on the application of scientific evidence and include all healthrelated components of physical fitness. For more information about indicated (safe) and
contraindicated (unsafe) exercises please visit www.namat.qa for a more comprehensive
list. In this chapter the general components of an ExRx are presented. Chapter V will cover
population and condition-specific modifications to the general ExRx. The NPAG-Q provides
recommendations for basic activity (i.e. minimal or maintenance) as well as aerobic activity
(optimal).
19
20
Fairly light
Little or no effort
Somewhat hard
11
12
13
14
15
Hard
16
17
18
19
20
Very hard
Very, very hard
Hoow you felt with the hardest work you have ever
done.
Maximum exertion
21
While doing physical activity, rate your perception of exertion (Appendix C). This feeling
should reflect how heavy and strenuous the exercise feels to you, combining all sensations
and feelings of physical stress, effort, and fatigue. Do not concern yourself with any one
factor such as leg pain or shortness of breath, but try to focus on your total feeling of
exertion.
Look at the RPE Scale while you are engaging in an activity. The scale ranges from 6 to
20, where 6 means no exertion at all and 20 means maximal exertion. Choose the
number that best describes your level of exertion. This will give you a good idea of the
intensity level of your activity, and you can use this information to decrease or increase
the exercise intensity to reach your desired range. Examples of common physical activities
by intensity of effort can be found in Table 3.
22
Moderate/Somewhat Hard
Hard
Walking, slowly
Cycling, stationary
Swimming, slow treading
Calisthenics, stretching
Golf, power cart
Fishing, sitting
Boating, power
Home care, sweeping/
vacuuming
Mowing lawn, riding
mower
Walking, briskly
Cycling, pleasure
Swimming, moderate
Calisthenics, general
Racket sports (leisure)
Golf, pulling/carrying clubs
Fishing, standing/casting
Canoeing, leisure
Home care, general
cleaning
23
There is a positive continuum of health and fitness benefits with increasing exercise
intensity. A minimum intensity threshold - an intensity level below which the body is not
challenged sufficiently to adapt - exists for most people, with the possible exception of very
deconditioned persons. Exercise of at least moderate intensity that increases heart rate and
breathing is recommended as the minimum exercise intensity for adults to achieve health/
fitness benefits. However, a combination of moderate and vigorous intensity exercise is
ideal for the attainment of improvements in health/fitness in most adults. It is important to
take into consideration that in moderate to low fit individuals, high exercise intensity is the
primary reason for failing to comply with an ExRx.
Moderate: 30 minutes, 5
days per week
Vigorous: 20 minutes, 3 days
per week
Avoid vigorous intensity
exercise performed more
than 5 days per week
24
Exercise Descripition
Endurance activities
requiring minimal skill
All adults
or physical fitness to
perform
Walking leisurely
cycling ,aqua
aerobics slow
dancing
Jogging,running
Rowing,aerobics
Spinning,elliptical
Exercise,stepping
Exercise,fast dancing
Endurance activities
requiring skills to
perform
Recreational sports
Racquet sports,
basketball, football
down skiing, hiking
Recommended for
Examples
25
1. Warm-up: This phase consists of a minimum of 5-10 minutes of low intensity cardiovascular
(aerobic) and muscular endurance activity designed to increase body temperature. Knee
lifts, walking in place or around a track while doing shoulder circles, or light stationary
cycling are all good forms of a gentle and proper warm-up.
2. Pre-Exercise Stretching: This phase should focus on range of motion exercises that targets
the joint(s) most used in the conditioning phase of the ExRx. For example, if you plan
to focus on strengthening your shoulder or chest muscles, one should perform range of
motion exercises for the shoulder.
3. Conditioning Phase:
Frequency:
For general muscular fitness, particularly
among those who are untrained or
recreationally trained, an individual should
Allow for 48 hours recovery
resistance train each major muscle group
2-3 days per week with at least 48 hours
separating the exercise training sessions for
the same muscle group. Depending on the
individuals daily schedule, all muscle groups
to be trained may be done so in the same session (whole body) or each session may split the
body into selected muscle groups so that only a few of them are trained in any one session.
For example, muscles of the lower body may be trained on Mondays and Thursdays, while
upper body muscles may be trained on Tuesdays and Fridays. This split weight training
routine entails 4 days per week to train each muscle group twice weekly; however, each
session is of shorter duration than a whole body session used to train all muscle groups
of the body. Both methods are effective as long as each muscle group is trained 2-3 days
per week. Having these different resistance training options provides the individual with
more flexibility in scheduling, which may help to improve the likelihood of incorporating a
resistance-training regimen into his/her daily schedule.
26
Adults:
Should train each muscle group for a total of 2 - 4 sets with 8 -12 repetitions per set with a
rest interval of 2 - 3 minutes between sets to improve muscular fitness.
For older adults and very deconditioned individuals:
1 set of 10 - 15 repetitions of moderate intensity (i.e., 60% 70% 1-RM), resistance exercise
is recommended.
Type:
Resistance training regimens should include
multi-joint or compound exercises, i.e.
Use multi-joint exercises
exercises that affect more than one muscle
group. These exercises should focus on the
Training opposing muscles
major muscle groups of the chest, shoulders,
equally
upper and lower back, abdomen, hips, and
legs.
Examples of multi-joint exercises
include the chest press, shoulder press, pulldown, dips, lower-back extension, abdominal
crunch/curl-up, and leg press. Single joint
exercises targeting major muscle groups, such as biceps curls, triceps extensions, quadriceps
extensions, leg curls, and calf raises, can be included in a resistance-training programme.
In order to avoid creating muscle imbalances that may lead to injury, train opposing muscle
groups. Examples of these types of complementary resistance exercises are lower back
extensions (to target for the lower back muscles) and abdominal crunches (to target the
abdominal muscles). For a more complete listing of exercises please visit www.NPAGQ.com.
27
Population-Specific
ExRx Guidelines
Healthy Adults: Asymptomatic, apparently
healthy 18-64 years
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Light to moderate
intensity
RPE = 10-13
TIME
15 to 30 minutes
per day
TYPE
Low to moderate
impact continuous
physical activity
utilising
large
muscle
groups
such as walking or
leisurely cycling
STRENGTH
At least two days a week. Physical
activities that strengthen muscles
involve using body weight or
working against a resistance.
This should involve using all the
major muscle groups. Examples
include:
carrying or moving
heavy loads such as groceries,
activities that involve stepping
and jumping, aerobics.
28
Frequency
29
Aerobic Fitness
FREQUENCY
INTENSITY
Initial
workload
should be light.
Additional increase
in intensity should
be
incremental
and small
RPE = 10-13
RPE = 13-15
TIME
Up to 50 minutes
per day
TYPE
Stationary
equipment is
preferred initially,
particularly for
those with poor
balance (e.g. cycle
ergometers).
Leisurely walking
STRENGTH
At least two days a week. Physical
activities that strengthen muscles
involve using body weight or
working against a resistance.
This should involve using all the
major muscle groups. Examples
include:
carrying or moving
heavy loads such as groceries,
and activities that involve
stepping.
30
Basic Activity
Aerobic Fitness
FREQUENCY
INTENSITY
TIME
Walking, climbing
stairs, gardening
STRENGTH
It is important to include a warm-up and cool-down activity of a lower exercise
intensity.
Resistance training should be done 2-3 times per week. The focus should be on more
repetitions and low resistance
1-3 sets of 8-10 different exercises, each 20-30 repetitions
31
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Every day
RPE = 10-12
TIME
STRENGTH
2-3 sessions per week
8-10 different exercises, each
8-12 repetitions or until near
muscle exhaustion
Movements using body weight
as resistance, resistance bands,
weights, resistance equipment
32
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
INTENSITY
RPE = 10-12
>30 minutes every day
TIME
TYPE
RPE = 12-13
STRENGTH
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
Please refer to the general precautions and exercise tips earlier in this chapter. In addition
you need to consider the following:
Water exercises (hydrotherapy) are a good form of exercise for patients with heart
failure
Training of respiratory muscle 3-7 times per week for 30-60 minutes will help to
improve the symptoms of heart failure
33
Diabetes Mellitus
Type 1 diabetes is a chronic disease characterised by high blood sugar levels due to the body
not being able to make enough insulin. Regular physical activity and a low carbohydrate diet
help to reduce insulin requirements and will lower the risk of heart disease and stroke.
34
Hydration:
Proper hydration should be easily accessible during exercise
Hydration should not be with sodas or sugary beverages, which will alter blood glucose
levels
Hydration with water should occur before the onset of thirst
Sugar Snack
A sugary snack can be given to increase the blood glucose concentration before
exercise if it is below 6 mmol/L
A sugary snack should also be available during exercise, and not only in vending
machines. The risk of hypoglycemia is decreased with the intake of a sugary snack
A carbohydrate snack should be eaten for every 30 minute session of exercise
Aerobic Exercise versus Resistive Training
Aerobic exercise is the best form of exercise for Type 1 or 2 diabetic patients because
it does not require quick bursts of energy
Resistance training may also be appropriate, depending on overall health status
35
Type I Diabetes
Basic Activity
(diabetes well controlled)
Aerobic Fitness
(diabetes well controlled)
FREQUENCY
Every day
INTENSITY
TIME
TYPE
STRENGTH
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
Type 2 Diabetes
Type 2 diabetes is a chronic disease characterised by high blood sugar, which can lead to heart
attack, stroke, and abnormal blood lipids. Regular physical activity, a weight loss programme,
and a low carbohydrate diet help to reduce insulin or oral medication need and will lower the
risk of heart disease and stroke.
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
INTENSITY
TIME
TYPE
Strength
2-3 sessions per week
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
36
Basic Activity
Aerobic Fitness
FREQUENCY
Every day
INTENSITY
RPE = 12-13
TIME
TYPE
STRENGTH
2-3 sessions per week. The focus should be on more repetitions and low resistance
Low to moderate muscle contractions
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
37
38
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
RPE = 11-13
RPE = 13-15
20-60 minutes total over 24 hours
TIME
TYPE
STRENGTH
2-3 sessions per week. The focus should be on more repetitions and low resistance
Until near muscle exhaustion
8-10 different exercises, each 8-12 repetitions
Movements using body weight as resistance, resistance bands, weights, resistance
equipment
39
40
FREQUENCY
INTENSITY
Basic Activity
Aerobic Fitness
Everyday
Moderate: Heart is
beating faster and
breathing is harder
than normal. It is still
possible to talk during
the activity
RPE = 10-12
TIME
TYPE
STRENGTH
At least 3 times per week
Calisthenics: Push-ups, Sit-ups, Pull-ups, etc.
High intensity weight training is permissible if physical maturity is reached.
Safety tips
Base activities on physical maturity rather than chronological age to reduce the risk
of injury
Use of appropriate protective equipment (bicycle helmets, shin guards, etc.)
Use appropriate footwear
41
42
Less active children can start with smaller amounts of physical activity and gradually
increase duration, intensity and frequency
Children should participate in Physical Education classes
Enroll children in scheduled age specific sporting activities
Daily activity can be accumulated in various settings (including outdoor activities
whenever possible): at home, in school and in the community
Encourage children to progressively reduce amount of time spent sitting and in front
of electronic devices
Remove TV and computers from bedrooms
Take an energy break after every one hour of sitting
43
Basic Activity
FREQUENCY
INTENSITY
TIME
TYPE
Bike riding, tricycle, scooter, playground activities (races, tag, etc.), sport
games (football, basketball tennis), swimming, gymnastics, jumping,
running, folk dancing
Exercise should not be over-structured for this age group. Children
want to make their own gameplay rules. Excessive over-structuring of
gameplay reduces the fun and discourages the children from the game
STRENGTH
Children should not be discouraged from participating in strengthening exercise, but they
should not be pushed to overexert. Children generally know their physical limitations and
are prone to get injured more readily when subjected to external pressure
Safety tips
Base activities on physical maturity rather than chronological age to reduce the risk
of injury
Use of appropriate protective equipment (bicycle helmets, flotation devices, sun screen
lotion, shin guards, etc.)
Use appropriate footwear
Exercise in the Heat
Avoid participation in physical activity during the hottest parts of the day
Use shaded areas whenever possible and especially between 10 am and 3 pm, when the sun
is at its hottest
In cases of extreme heat and humidity, restrict excessive physical activities outdoors
Remind children to drink enough water before, during and after physical activity
Drinking milk after physical activity in the heat can be good for replacing the fluids because
it contains salt
Children should wear loose-fitting white or light-coloured clothes and clothes that expose the
skin to the air in order to help sweat evaporate and cool the body
Use sunscreen (sunblock) 20 minutes before going outdoors to protect your childs entire skin
exposed to the sun (SPF of at least 30)
Physical activities in hot weather should only be at moderate level
Splash your childs body with water to cool down before physical activity and during breaks
44
Any child or adolescent should avoid or limit exercise, sport participation, or other physical
activity in the heat if he or she is currently ill or is recovering from an illness especially those
involving gastrointestinal distress (e.g., vomiting, diarrhoea) and/or fever
Warning signs: dizziness, headache, nausea (desire to vomit), shivering, hot dry skin,
exhaustion, or collapse. In these cases get professional medical help without delay.
Vitamin D deficiency
Vitamin D deficiency continues to be prevalent in this group and supplementation may be
needed. The amount of sun exposure needed to meet the bodys vitamin D requirements
varies from one person to another and is also dependent on location, skin colour, time of year,
time of day, and atmospheric conditions. However, as a general guide, exposure to the sun
with the appropriate exercise attire, for 15 minutes per day will help reduce or eliminate the
need for vitamin D supplementation.
Infants:
< 1 Year Old
Toddlers:
1-2 years old
Preschoolers:
3 4 years old
At own but
encourage more
active play
FREQUENCY
INTENSITY
At own
At own
TIME
Unstructured Play
Interaction with caregiver
TYPE
Crawling
Rhythmic activity
Body awareness
Introduce to music
45
46
47
Vitamin D deficiency
In infants and children, requires a supplementation of vitamin D of 400 IU. Vitamin D deficiency
continues to be prevalent in this group and doses may need to be increased, especially in light
of the evidence that the amount of vitamin D needed for sufficiency can vary with weight
or BMI. Overweight and obese children are at higher risk for vitamin D deficiency and may
need a higher intake.
Sun exposure
The amount of sun a person needs to meet their vitamin D requirements varies hugely,
depending on location, skin type, the time of year, the time of day, and even the atmospheric
conditions. However, it is safe to state that 5 to 30 minutes of exposure to the face, arms,
back or legs (without sunscreen) two times every week is sufficient. Individual factors that
influence how much Vitamin D a person needs include: 1) how much time they spend outdoors
2) the colour of their skin, 4) age, 5) diet, and 6) body weight.
48
49
Inactive or Unfit
(high risk)
Low intensity
Moderate Intensity
RPE = 9-11
RPE = 12-15
TIME
TYPE
FREQUENCY
INTENSITY
STRENGTH
2-3 times per week.
40-60% 1RM, Pilates, Yoga, Kegel exercises
Pregnancy is not a time to lose weight, diet, nor train to compete. Intense or vigorous exercise
is discouraged. Exercise intensity should not exceed pre-pregnancy levels.
Additional Precautions:
Avoid hot and humid places.
Pool temperature should be 28-31C.
The following conditions should be considered contraindications to exercise during
pregnancy. Women with these conditions should not exercise:
Pregnancy-induced hypertension
50
51
52
Environmental
Considerations
In Qatar, the weather, traditions, culture, and faith play a very important role in how we
schedule our daily work and school routines, our social life, and our physical activities
throughout the day. Although winters are very pleasant and conducive to outdoor activities,
summers tend to be hot with strong and dominant sunshine. When considering partaking
in physical activity in the summer, precautions must be considered to safeguard our health
from untoward consequences of overexposure to the elements. This chapter will discuss
precautions that must be considered for healthy individuals, individuals with known disease,
during pregnancy, as well as for fasting the holy month of Ramadan.
Heat illness and all its variants (Table 5) are preventable illnesses, and can also include
dehydration (loss of body fluid), heat cramps (cramping of skeletal muscle), that result from
exposure to environmental temperature (classic or non-exertional) or from strenuous exercise
(exertional) and can progress to severe and life-threatening illnesses characterised by a core
body temperature that rises above 40C that is accompanied by hot, dry skin and central
nervous system alterations (delirium, convulsions or coma). These illnesses are often fatal
and under diagnosed.
DEFINITION
Heat wave
Heat stress
Heat strock
Heat exhaustion
Hyperthermia
Multiorgandysfunction
syndrome
53
In Saudi Arabia, for example, incidence varies seasonally, from 22 to 250 cases per 100,000
population and the mortality rate associated to these conditions is 50 percent. It is important
to highlight that there are genetic factors that determine the susceptibility to develop these
illnesses.
The balance between heat production and heat loss determines the body temperature. Normal
body function depends upon a relatively constant core temperature because biochemical
reactions function optimally at narrow temperature ranges. In response to the rise of heat,
the mechanisms of cutaneous vasodilation, sweating, and increased respiration come into
effect to increase heat loss. Once blood temperature increases, thermal sweating is initiated.
This will also cause heart rate to go faster (tachycardia), increasing the work from the heart
as well as the volume of blood ejected (Cardiac Output) and the respiratory frequency (minute
ventilation). Nonetheless, most people might be able to adapt to hot environments.
Some physiologic conditions like pregnancy, cardiovascular diseases and some medications
may interfere with the cardiac function and impair heat tolerance increasing the susceptibility
to develop any heat illness. If heat production exceeds heat dissipation capacity, for example
during exercise in hot, humid conditions or during very high intensity exercise, the core
temperature will continue to rise. During prolonged exercise, loss of fluid as sweat may
compromise heat dissipation. Maintenance of euhydration (good or appropriate hydration) is
critical to heat balance.
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The best ways to prevent heat illnesses are acclimatise to heat, schedule outdoor activities
in the coolest time of the day (early morning and late at night), reduce the level of physical
activity, increase the amount of water drank daily, ensure electrolytes such as sodium and
potassium, and try to be in air conditioned areas as much as possible.
Exercise recommendations for preventing hyperthermia suggest that the pregnant woman
should:
Acclimatise gradually to ambient conditions
Exercise during the cooler times of the day or in well-ventilated and air-conditioned
environments
Wear comfortable clothing that will permit free evaporation of sweat. Clothing should
be lightweight, loose fitting, and light in colour
Drink plenty of fluids before, during, and after exercise
Be aware of the early symptoms of heat illness: nausea, dizziness, headache, poor
coordination, and apathy
Train with a partner who is aware of the symptoms of heat disorders (heat cramps,
heat syncope, heat exhaustion, and heat stroke)
Exercise at her own pace, and at a length of personal comfort
Avoid swimming in warm or hot water and avoid immersion in hot tubs
Fasting Ramadan
The holy month of Ramadan incorporates refraining from food or fluids during the daylight
hours of the holy month. This can last from12-16 per day and is dependent on the season
the holy month of Ramadan coincides with. There have been many concerns regarding the
engagement of exercise and physical activity during Ramadan, especially during the summer
months. Research has shown that fasting for 30 consecutive days without any form of
exercise or physical activity results in decrease of strength and fitness. Therefore, Muslims
should maintain their physical activities level during the month of fasting in comprehensive
ideal way to avoid any health complications.
Physical Activity should be undertaken in non-competitive settings in dark hours (post
fasting). If the activity is in competitive settings, it should be performed on non-consecutive
days. Efforts to optimise sleep and to stay hydrated before and after the activity are of
paramount importance to avoid any possible deleterious effects of intense physical activity
during Ramadan. Also, an individual can perform the activities in very early morning after
the last meal of the post-fast (Suhor), but as this activity will not be followed by any food and
liquid replenishment, it has to be light in intensity, and short in duration. Also, avoid direct
exposition to the sun and/or heat for this early day exercise.
During cold/temperate seasons:
Ninety minutes before sunset would be a good time to perform in non-competitive activities
(e.g. walking).
During hot season:
When Ramadan coincides with the summer months any pre-Iftar (pre-fast-break) moderate or
vigorous activities are not recommended in open-sky settings unless it is of short duration.
If the individual cannot perform any form of activity at night, it would be recommended that
she/he should find an air-conditioned space to practice.
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Component
Intensity
Duration
Warm-up
(Light) RPE = 10
7-10 minutes
Stretching
Aerobic
Training
~20 minutes
Strength
training
Cool-down
(Light) RPE = 9
5 minutes
Table 6 shows the structure of a proposed session with either (1) cardiovascular training, or
(2) strength training as a core of the session. Warm-up, light stretching, and Cool-down being
constant parts of any session.
Frequency: 3 to 6 days/week
Example: 3 times a week: One can have Cardiovascular sessions on days 1 and 5 of the week
with a Strength training session for day 3. Days 2, 4, 6, and 7 being resting days.
Example: 5 times a week: One can have Cardiovascular sessions for days 1, 4, and 6 of the
week, and Strength training for days 2 and 5. Resting for days 3 and 7.
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57
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If possible, cool down (especially if the exercise is long or repeated): bathe in cold
water, drink ice-water or wear a cooling vest during warm-up or in between exercise
sessions
Wear sensible clothing:
Wear clothes that expose your skin to the air, to help sweat evaporate and cool the
body
Wear white or light-coloured clothes, to help reflect heat
Wear loose-fitting clothes made of natural fibres or special absorptive sports fibres
In general:
Stay out of the sun, and go into the shade, as often as possible, for as long as possible
Use sunscreen (sunblock) to protect all exposed skin
Sleep and rest well, because properly rested athletes may tolerate heat for longer
Splash the body with water to cool down before exercise and during breaks
Tell coaches or team leaders about conditions such as asthma which make heat illness
worse
Get medical help immediately for shivering, muscle cramps, headache, fatigue or
collapse
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Glossary
Glossary Of Terms
TERM
DEFINITION
Acute/Chronic Diseases
Aerobic Fitness
(see physical fitness)
Agility
(see skill-related physical fitness)
Balance
(see skill-related physical fitness)
Behaviour Modification
Cardiovascular Disease
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Congenital
Contraindicated Exercise
Coordination
Dose-Response Relationship
Exercise
Flexibility/Stretching
Health
Health-Related Attributes
Hyperglycemia
Hypertension
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Hypoglycemia
Incidence/ Prevalence
Insulin Sensitivity
Intermittent Exercise
Interval Training
Lapse
Leisure Activities
Meta-Analysis
Metabolic End-Products
Multi-Joint/Compound Exercises
Muscular Endurance
Muscular Fitness
Non-Communicable Diseases
Obesity/Overweight
Osteoporosis
Physical Activity
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Physical Activity
Physical Fitness
Power
Quality of Life
Range of Motion
Relapse
Resistance Training/Resistive
Exercise
Skill-Related Attributes
Stationary Equipment
Stroke
Valsalva Manoeuvre
Vigorous Exercise
Well-Being (Wellness)
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Appendixes
Contraindications to Exercise
You should NOT exercise:
If you have
chest pain,
unusual shortness of breath,
sudden or new irregular heartbeats,
dizziness or lightheadedness.
If you experience any of the above symptoms at rest or during exercise you should
seek immediate medical attention
If you have low or very high blood sugar levels
If you have very high blood pressure (>200/115)
If you have any infection with fever
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8
9 Very Light Low Intensity
10
11
Fairly Light
12
13
Somewhat Hard
14 Moderate Intensity
15
Hard
16
17
Very Hard
18 Vigorous Intensity
19
20
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66
67
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PURPOSE
EXAMPLE
Upper back
Lower back
Abdomen
Pelvic oor
(Kegels)
Wave, elevator
Upper body
Buttocks,
lower limbs
EFFECTS OF PREGNANCY
Body Position
Joint Laxity
Abdominal Muscles
Posture
Precautions
for
Resistance Exercise
EXERCISE MODIFICATIONS
I, _____________________________________ PLEASE PRINT (patients name), have discussed my plans to participate in physical
activity during my current pregnancy with my health care provider and I have obtained his/her approval to begin participation.
Signed: ___________________________________________
(patients signature)
Date:____________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
(health care providers signature)
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70
Name: _________________________________
Date: _______________________
Medications: _________________________________________________________________________________________
BASIC ACTIVITY
AEROBIC FITNESS
FREQUENCY
INTENSITY
TIME
TYPE
Strength
Lack of activity destroys the good condition of every human being, while movement and
methodical physical exercise save it and preserve it ~Plato