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The fitness program would run for a period of 4 weeks. There
would be variety of physical activities that would be performed on daily bases.
The fitness program would help to improve the cardiorespiratory endurance,
muscular strength and enhance muscular endurance of the patient. The
types of fitness activities that to be conducted would be in the form of circuit
training activities, lifestyle physical activities and cardiorespiratory
endurance exercise.

In a circuit, you undertake a sequence of exercises. Each
exercise is performed at a station.
There are usually between 8 and 15 of these stations in a circuit. Performers
spend a set amount of time at each station in turn, e.g., 1 or 2 minutes at
each. Alternatively, you can do a set number of repetitions or exercises for
each activity. When designing a circuit you can organize the stations to suit a
particular activity or fitness goal. Muscle groups between each station should
be alternated to delay muscle fatigue specific muscle groups should be targeted.

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Weight training activities could be included to increase
strength. The length of each activity could be increased to train the aerobic
system. However, skill-based activities can be performed. Circuit training is
one such training method used in a strength and conditioning program, and in
this fact sheet we provide information related to the correct design and
implementation of a circuit training program. Effective program design and implementation
can result in improved athletic performance (Rhea
& Alderman, 2004). The circuit training would be made as functional as
possible to ensure that as persons with SCDs engage in these activities, they
would be functionally independent as well (Wang
et al., 2010).  All training sessions would begin with a
warm-up, walking at usual pace for 10 minutes, and end with a cool-down,
stretching for 5 min. These sessions would be performed under the supervision
of a physical and occupational therapists.

Lifestyle physical activities are activities that all people
can do regardless of age and physical ability (Haskell
et al., 2007).
It can be performed at home or at work, and they are of low to moderate
intensity. This means that they take four to seven time as much energy as being
sedentary, lifestyle physical activities include housework such as mopping,
yard work such as raking the leaves or mowing the lawn, and work-related
activities such as carpentry or bricklaying. Walking (rather than driving) and climbing
stairs (rather than taking elevator) are also consider lifestyle activities
because they can be done at home, at work, or at school. Some activities are
often thought of as recreational in nature re also classifies as lifestyle
physical activities (Pate, O’neill, &
Lobelo, 2008).

Cardiorespiratory endurance exercise
helps the body become more efficient and better able to cope with physical
challenges. It also lowers risk for many chronic diseases (Haskell et al., 2007). Some major changes occur
in the cardiorespiratory system when you exercise, which include increases in
cardiac output and blood pressure, breathing rate, blood flow to the skeletal
muscles, and sweating. In the short term, all these changes would help the body
to respond to the challenge of exercise. When performed regularly, endurance
exercise also leads to permanent adaptations in the cardiorespiratory system (Jones, Eves, Haykowsky, Freedland, & Mackey, 2009).
These improvements reduce the effort required to do everyday tasks and make the
body better able to respond to physical challenges. This, in a nutshell, is
what it means to be physically fit (Ericsson, 2006).

Endurance exercise enhances the heart’s
health by: maintaining or increasing the heart’s own blood and oxygen supply, increasing
the heart muscle’s function – so it pumps more blood per beat. This improved
function keeps the heart rate lower both at rest and during exercise. The
resting heart rate of a fit person is often 10–20 beats per minute lower than
that of an unfit person (Stevens, Cai, Evenson,
& Thomas, 2002). This translates into as many as 10 million fewer beats
in the course of a year. The heart’s contractions is strengthened, the heart’s
cavity size (in young adults) is increased. There is increased blood volume such
that the heart pushes more blood into the circulatory system during each
contraction, and a reduction in blood pressure (Vlachopoulos,
O’Rourke, & Nichols, 2011).

Regular exercise may also help protect
cells from chemical damage caused by agents called free radicals (Valko et al., 2007).
Fitness programs that best develop metabolic efficiency include both
long-duration, moderately intense endurance exercise and brief periods of more
intense effort. For example, climbing a small hill while jogging or cycling introduces
the kind of intense exercise that leads to more efficient use of lactic acid
and fats (Faria, Parker, & Faria, 2005). Regular
endurance exercise lowers your risk of many chronic, disabling diseases. It can
also help people with those diseases improve their health. The most significant
health benefits occur when someone who is sedentary becomes moderately active (Warburton, Nicol, & Bredin, 2006).



Physically fit people can increase their
metabolic rate substantially, generating the energy needed for powerful or
sustained exercise. People who are not fit cannot respond to exercise in the
same way (Argandoña & von Weltzien Hoivik, 2009).
Their bodies are less capable of delivering oxygen and fuel to exercising
muscles; they can’t burn as many calories during or after exercise; and they
are less able to cope with lactic acid and other substances produced during
intense physical activity that contribute to fatigue. Because of this, they
become fatigued more rapidly—their legs hurt and they breathe heavily walking
up a flight of stairs, for instance. Regular physical training can
substantially improve the body’s ability to produce energy and meet the
challenges of increased physical activity.

In designing an exercise program, focus
on the energy system most important to your goals, because improving the
functioning of the cardiorespiratory system is critical to overall wellness,
endurance exercise that utilizes the oxidative energy system—activities
performed at moderate-to-high intensities for a prolonged duration—is a key
component of any health-related fitness program (Janssen
& LeBlanc, 2010). The fitness program would employ the FITT Principle, which is a great way
of observing the exercise program. This acronym outlines the main
components of an effective exercise program, and the initials F, I, T, T, stand
for: Frequency, Intensity, Time and Type. Frequency refers to the occurrence of
exercise carried out or how often a person exercises. Intensity on the other
hand is the force of exercise performed or how tough a person exercise. Time is
the duration spent exercising or how long you exercise. The type of exercise
refers to what kind of exercise to be performed by an individual (Walker, 2007). 

The fitness program would start with a
warm-up exercise. Mobility exercises which would be performed after 2-3 minutes
of aerobic exercise before the main part of the fitness session. Each exercises
would be performed 3-5 times. The exercises include; Body hug – whereby you stand
with your feet shoulder width apart and your arms outstretched at shoulder
height by the sides of your body. Then you bring your arms in across your body
and give yourself a big hug and return to the starting position and repeat.
Trunk rotations – this is whereby you stand upright with your feet shoulder
width apart with your hands across your chest and turn your body to look over
your left shoulder. Then you return to centre, turn your body to look over your
right shoulder and repeat rotation. Leg Swing – with leg swing you stand on one
leg using a wall for support if needed and swing your non-weight bearing leg in
front of your body and behind (McAtee & Charland,

We would then do muscular endurance
circuit exercises which is a bodyweight resistance circuit consisting of
multiple exercises and repetitions. These exercises include; Plank – whereby you lie on your
front with your elbows under your shoulders and your forearms flat on the
floor. Raise your hips off the floor until you make a straight line with your
body. You would hold this position for a required amount of time and place feet
wider apart. Sit-Up – this is whereby you lie on your back with
your knees bent at right angles and your feet in contact with the floor. Then
you place your fingers in contact with your temples and you raise your torso
off the floor until your elbows touch the top of your knees and lower shoulders
to the floor in a controlled manner.

Press-up – whereby the patient would lie
on his front with his hands in line with his shoulders and straighten his arms
raising his body off the floor, ensuring that his head is neutral and the back
is kept straight. The patient would then lower the body until upper arms are
parallel (90°) to the floor then straighten the arms back to the starting
position. Lunge – this is whereby you stand with your feet and hip width apart
and your hands by your sides and take a step forward and bend your rear knee to
just above the ground. Make sure your upper body stays upright and your front
knee does not go over your toes and you push off the front leg to return to the
starting position and repeat the exercise on your opposite leg. Squat – this is
done by standing upright with your feet and shoulder width apart. Bend at your
hips and knees until your thighs are parallel to the floor and maintain a rigid
back and keep your chest upright with your head looking forward. You would
straighten your knees and hips to return to the starting position. Dorsal Raise
– whereby you lie on your front and keep your feet in contact with the ground
at all times. Place your finger tips on your temples and lift your chest off
the floor keeping your hips and feet in contact with the ground. You would hold
for 2 seconds and lower body to the floor under control (Lorenz 2002; Vella 2008).

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