Growth and Deveiepment A person's age and musculoskeletal and nervous system devel-- opment affect posture, body proportions, body mass, body movements, and reflexes.For apparellfly acme 3n tee:emy people, the prescription can immediately include mo era bic conditioning, strength training, and stretching.1"" tensity on most if not all days of the week. Thorough .Chmcal evaluations should be completed prior to recommending any exercise regimen. In addition, the report indicates that exel'ClSe can prevent gestational diabetes, even in very obese chants. Nutrition Both undernutritiuizt .mti wrcwttlt'itiou can influence body alignment and uzubzitt}. l'onrl} tourishcd people may have \fitamin D deficiency causes muscle weakness and fatigue. bone deformity during grouth. li..idCL]ULlIC calcium intake and vitamin D synthesis and intake increase the risk of osteoporo- sis. Obesity can distort mmcment and stress joints, adversely affecting posture. balance. and joint health. Personal Values and Attitudes Whether people value regular exercise is often the result of family influences. In families that incorporate regular exercise in their daily routine or spend time together in activities. chil- dren learn to value physical activity. Sedentary families. on the other hand, participate in sports only as spectators. and this lifestyle is often transmitted to their children. With the increase in TV, computer, and video activities. youth are increasingly sedentary with attendant declines in health. Values about phys- ical appearance also influence some people's participation in regular exercise. People who value a muscular build or physi- cal attractiveness may participate in regular exercise programs to produce the appearance they desire. Choice of physical activity or type of exercise is also influ- enced by values. Choices may be influenced by geographic loca- tion and cultural role expectations. For many, thinking of exercise more as "recreational movement," "enhancement Well'beinga" and essential part of daily self-care" may help overcome perceptions that exercise is drudgery.Nurses must assess each client for potentially motivating factors such as the follow-- ing: degree of fun or challenge of any given activity; use of mu-- sic; opportunities for socializing and group cohesion and having an exercise partner; positive sensations of the exercise experi-- ence; pleasurable feelings associated with increased stress reduc- tion; increased energy and fitness; mastering the activity; goal setting and progress; daily logs or weekly written schedules; competition with oneself or others; promotion of a sense of ac- complishment; weight management; empha31s on self--talk about how exercise will prevent fatigue, depression, weight gain, or anxiety; and the need to explore less intense and challenging, noncompetitive activities (Oberg, 2007).Clients Who experience orthostatic hypoten-- sion, impaired equilibrium, and gait dlsturbance should befginlex- ercising in supervised environments: For example, athatl 0r sedentary person may need to begin Wlth a Prescnptionf 13:18:11: phasizes stretching, strengthemng, and developinen 0d h 1th rather than aerobic training. The most recent recommendations from the Ameflcan College of Obstetricians and Gynecologists (Olson, Slkkat Hayman, Novak, & Stavig, 2008) suggest that healthy pregnemt women should exercise 30 minutes or more with modefa'te.The design of individualized exercise prescriptions that tailor exercise mode and dose and address these varying states with each person will ensure greater adher-- ence to an exercise program (Ruppar & Schneider, 2007).Initially, walk- ing involves a wide stance and unsteady gait, thus the term toddler.O I ' Nurses, taking into account motivation to part1c1pate, medical conditions and level of fitness, and safety issues, can use individ- ualized exercise prescriptions to encourage exercrse and activity in all of their clients.From 6 to 12 years of age, refinement of motor skills con-- tinues and exercise patterns for later life are generally deter-- mined.In adolescence, growth spurts and behaviors such as carrying heavy book bags on one shoulder and extended computer use may result in 1305' tural changes that often persist into adulthood.For example, preschoolers master riding a tricycle, dancing, running, jumping, using crayons to draw, fastening or using zippers, and brushing their teeth.Adults between 20 and 40 years of age generally haYe few PhySiCal Changes affecting mobility, with the exceptlon of pregnant women.Exercise behavior may be improved by address- ing an individuals' awareness of their physiological response to activity and exercise.All extremities are generally flexed but can be pas- sively moved through a full range of motion.As the neurologic system matures, control over movement progresses during the first year.Pregnancy alters center of graVitY and aff'eCtS balance.Motiva- tional states influence our behavior and choices, and vary widely from day to day.In those who are building toward a fitness goal, these parameters will change over time to increase the client's level of conditioning (Oberg, 2007).Gross motor development occurs in a head--to--toe fashion, that is, progression from head control, to crawling, to pulling up to a standing position, to standing, and to walking, usually after the first birthday.Immobility can impair the social and motor development of young children.Many schools provide physical education and competitive sports programs to enhance physical activity.Pre- scriptions should include frequency of the activity, intensity, and time (the FIT model).Newborn movements are reflexive and random.Gross motor development precedes fine motor skills.Pos- ture in school-age children is usually excellent.Options include informal and fun activities such as dancing to music.The contralateral motion of crawling, however brief, is an important building block for walking.From ages 1 to 5 years, both gross and fine motor skills are refined.