Adapted physical activity at different stages of life: definition, objectives and safety principles
Definition
The adapted physical activity (APA) It involves the planning and pacing of movement tailored to each person’s age, physiological condition, functional abilities and circumstances. It incorporates aerobic, strength, mobility and balance components, with adjustments to volume, intensity and type of activity to promote safe and meaningful exercise during childhood and adolescence, adulthood, pregnancy and the postnatal period, and old age, as well as in the presence of disability or chronic conditions, where applicable.
Objectives
It aims to maintain or improve the functional capacity, maintaining cardiorespiratory and muscular fitness within safe limits, encouraging participation and independence, supporting the management of risk factors without replacing prescribed treatments, and promoting a healthy relationship with physical activity. Among children and adolescents, it prioritises the development of motor skills and the prevention of sedentary behaviour; in adulthood, compatibility with work and family demands; during pregnancy and the postnatal period, it focuses on maternal-foetal protection and progressive recovery; and in older age, it focuses on maintaining balance, strength and gait to reduce the risk of falls.
Safety principles
- Risk stratification: initial assessment of medical history, comorbidities and medication; identification of warning signs (chest pain, disproportionate shortness of breath, dizziness, palpitations, acute joint pain) which require the activity to be stopped and a clinical assessment to be carried out.
- Individualisation and gradual progression: start with manageable loads and increase them gradually; allow sufficient recovery time; use perceived exertion scales when heart rate is not a reliable indicator (e.g. when taking beta-blockers); avoid sudden changes during growth, pregnancy or in cases of bone fragility.
- Technical and environmental control: warm-up and cool-down, correct technique, suitable footwear and stable surfaces, hydration and safe environmental conditions; adapting equipment and tasks to individual ability.
- Monitoring and adjustment: observe haemodynamic response and symptoms; in cases of hypertension, diabetes or other conditions, monitor relevant parameters and adjust the session accordingly; discontinue the session in the event of neurological, respiratory or musculoskeletal exacerbation.
- Considerations by life stage: in childhood, varied active play under supervision; during pregnancy, avoid the Valsalva manoeuvre, impacts and prolonged supine positioning after the first trimester; postpartum, progression in line with pelvic floor recovery; in older adulthood, emphasis on multi-component programmes (strength, balance, mobility); for those with chronic conditions or disabilities, follow specific recommendations and liaise with qualified professionals.
Recommendations for adapted physical activity at different stages of life, by age group
Childhood and adolescence
- Prioritise the development of motor skills and enjoyment through a variety of daily activities such as moderate to vigorous intensity, depending on your fitness level, alternating between more demanding days and recovery days.
- Active games, running, cycling, swimming and team sports; focusing on strength, using one’s own body weight or light equipment, whilst taking care to technique and full ranges of motion. Avoid maximum loads and manoeuvres whilst holding your breath.
- Include mobility, coordination and simple tasks such as balance (controlled jumps, throws, circuits).
- Limit prolonged periods of inactivity by taking active breaks every 60–90 minutes whilst studying or using screens.
Adulthood (18–64 years)
- A personalised plan that combines aerobic, force y mobility, tailored to the level of fitness and the time available.
- Aerobic exercise: brisk walking, gentle jogging, cycling or swimming. The “talk test” helps you gauge the intensity: if you can speak in short, broken sentences, this suggests moderate intensity.
- Strength: 2–3 non-consecutive days, 1–3 sets of 8–12 repetitions targeting large muscle groups, with a perceived exertion of 5–7/10; gradual progression once the movement is stable and controlled.
- Mobility and core work 2–4 days a week. If resuming after a period of inactivity, start with low volumes and small increases, prioritising technique and recovery.
Older people (aged 65 and over)
- Main objective: to maintain function, reduce the risk of falls and preserve muscle mass and strength.
- Low-impact aerobic exercise (walking, aqua aerobics, exercise bike) 3–5 days a week, depending on your fitness level; can be split into short sessions.
- Force 2 days or more of light to moderate training for the legs, back and grip, with a controlled cadence and steady breathing.
- Balance and agility: 2–3 days (tandem, one-legged balance near a support point, exercises inspired by Tai Chi); gentle flexibility at the end.
- Safety: clear surroundings, sturdy footwear, and adjustment of the session in the event of dizziness, excessive shortness of breath, chest pain or palpitations.
Cross-cutting principles of safety and adaptation
- Gradual progression in volume or intensity, changing just one variable at a time.
- Warm-up for 5–10 minutes, followed by a cool-down; stay hydrated and protect yourself from the elements depending on the weather.
- Monitoring of the perceived effort (on a scale of 0–10) and the technique; stop immediately if you experience sharp, stabbing pain, instability or neurological symptoms.
- Allow at least 48 hours between high-intensity sessions targeting the same muscle group, and aid recovery through adequate sleep and nutrition.
Adapted physical activity at different stages of life during pregnancy and the postnatal period: common adjustments and precautions
Pregnancy: common changes and warning signs
During pregnancy, priority is given to a moderate intensity (ability to hold a conversation), forms of low impact and good management of intra-abdominal pressure. Prolonged supine positioning is generally avoided from the second trimester onwards, as are Valsalva manoeuvres, very hot environments and dehydration. The programme is tailored to the progression of the pregnancy by trimester: in the first trimester, volume and intensity are adjusted according to fatigue and nausea; in the second and third trimesters, impact and sudden movements are reduced, the base of support is widened, and lumbopelvic stabilisation and balance are strengthened. Alarm signals Conditions requiring the procedure to be suspended and clinical assessment: chest pain, dizziness or syncope, disproportionate shortness of breath, vaginal bleeding, loss of amniotic fluid, regular contractions, persistent severe headache, marked pelvic pain or sudden oedema.
- Pregnant teenagers: Progressive, conservative training; postural and energy-based training; avoiding loads that compromise technique during growth spurts.
- Aged 35 and over: more gradual increases in workload and monitoring of common comorbidities; particular attention to balance and functional strength.
- Previous sedentary lifestyle or high BMI: Start with low volumes, take frequent breaks and monitor your response (excessive fatigue, joint pain).
- Experienced athletes: Maintain familiar patterns whilst adjusting impact and load levels; avoid “maximum” efforts and replace prolonged supination or high instability in advanced stages.
- Marked joint laxity: emphasis on neuromuscular control, mid-range of motion and pelvic-scapular stability.
Postnatal period: progression in stages and considerations based on individual profile
In the postnatal period, the gradual return It is guided by tissue healing and symptoms, not by fixed dates. Initially, the focus is on gentle movement, diaphragmatic breathing and activation of the pelvic floor and transverse abdominal exercises with low-intensity tasks, progressing to brisk walking, strength training and, later on, impact exercises if these are well tolerated. The type of delivery (tears, episiotomy, caesarean section), pain, continence, and the presence of abdominal bulging or pelvic pressure are taken into account. Valsalva manoeuvres and exercises that increase bleeding or cause marked abdominal bulging are avoided. Breastfeeding may influence hydration and joint stability; session duration, breast support and recovery are adjusted accordingly.
- Adolescents in the postnatal period: short, frequent sessions, prioritising technique and signs of fatigue over potential sleep and energy deficits.
- Aged 35 and over: A slower pace of progression is usually required; the focus is on lower-body strength, balance and progressive bone loading.
- After a caesarean section: protection of the scar, tissue management and avoidance of activities that cause pain in the abdominal wall until the patient can tolerate them; gradual mobilisation of the trunk.
- Athletes: Return to running and jumping after passing functional tests for strength, impact control and stability; gradual increases in volume and intensity.
- If they appear In cases of persistent pelvic pain, persistent urinary leakage, significant abdominal distension or increased bleeding on exercise, the workload is adjusted and an individualised clinical assessment is recommended.
Adapted physical activity at different stages of life for people with diabetes, high blood pressure or arthritis: clinical considerations
Childhood and adolescence
At these stages, priority is given to moderate intensity and the range of movement, with monitoring and adjustment according to symptoms. In diabetes, it is advisable to plan your exercise around mealtimes and medication, and to watch out for signs of hypoglycaemia and to have fast-acting carbohydrates available; if the patient is unwell, has a fever or is experiencing metabolic instability, it is postponed. In high blood pressure, dynamic activities are recommended, and sustained maximum exertion or breath-holding manoeuvres should be avoided. In arthritis, the volume is adjusted in inflammatory flare-ups, prioritising gentle movement, progressive strengthening and low-impact exercises such as swimming or cycling on a stationary bike.
Adulthood
The plan is tailored to the individual based on clinical assessment and comorbidities. In diabetes, the timing of insulin or other medication administration, the condition of the feet (neuropathy, suitable footwear) and possible complications such as retinopathy or nephropathy are taken into account when choosing the type and intensity of exercise; the aim is to achieve tolerance without sudden drops in blood glucose levels. In high blood pressure, it promotes regular aerobic exercise and the force with moderate loads and smooth breathing, avoiding intense isometric exercises and maximum lifts; attention is paid to dizziness, chest pain or headache. In arthritis, the approach combines periarticular strengthening, mobility exercises and low-impact activities, with a progressive warm-up and adjustment of the intensity level depending on pain and stiffness, whilst avoiding repetitive, high-impact movements that place strain on sensitive joints.
Older people
Priority is given to security, functionality and recovery, with an emphasis on balance and mobility to reduce the risk of falls. In diabetes, there may be a lower perception of the hypoglycaemia and an increased risk of dehydration; short blocks, slow progression and checking support points are preferred if neuropathy is present. In high blood pressure, patients are monitored for excessive blood pressure and orthostatic responses, with appropriate rest periods and avoidance of activities requiring prolonged straining. In arthritis, frequent, short sessions help to manage stiffness; low-impact exercise, joint mobility within comfortable ranges and the use of assistive devices where necessary promote adherence without exacerbating pain.
How to adjust the intensity and volume of adapted physical activity at different stages of life without causing overexertion
Reliable grading principles
- Define intensity using perceived exertion scales (RPE (0–10) and the speech test: moderate when the patient is able to hold a conversation using full sentences; vigorous when only short phrases are uttered. The heart rate may not be reliable when chronotropic drugs are being taken.
- Monitor the volume (total time, distance or sets × repetitions × load) and its weekly distribution. Prioritise the technique stable and the recovery (sleep, post-exercise pain, energy levels) as markers of tolerance.
- Use progression Gradual: small increases (e.g. 5–10% in volume or load every 1–2 weeks), alternating between more and less demanding sessions, and 48–72 hours between similar stimuli when starting out or when there is increased sensitivity to the load.
- Signs to look out for and investigate: joint pain that does not ease with warm-up, fatigue lasting longer than 24–48 hours, worsening sleep or coordination, instability or unusual shortness of breath.
Childhood and adolescence
- Prioritise variety in movement and technique over increasing the load. Intensity should be guided by RPE and the ability to speak; avoid formal maximum tests.
- Strength training with weights that allow you to do 3–4 reserve repeats (RIR), short sets and long rest periods. Moderate training volumes, with at least 1–2 days per week without a structured training load.
- During growth spurts, monitor tendon and bone sensitivity; reduce repetitive impacts and increase technical and control-based training.
Adulthood
- Cardiorespiratory: start at RPE 3–5 and progress according to tolerance; break the session into blocks if fatigue requires it.
- Strength: 2–3 days a week, 1–3 sets of 6–12 repetitions, with 2–3 rest days RIR. Progress initially by increasing the number of repetitions, then the load; incorporate weeks with a lower load if fatigue builds up.
- Adjust the dose according to work and sleep requirements; if either of these factors worsens, maintain the dose or reduce it temporarily.
Older people or those with stable chronic conditions
- Start “low and slow”: RPE 2–4, short sessions (10–15 mins) spread throughout the day. Prioritise lower-body strength, balance and activities of daily living.
- Avoid relying solely on heart rate when multiple medications are being taken; place greater emphasis on symptoms, RPE and quality of movement.
- Strength training with light to moderate weights, 2–3 RIR, with an emphasis on postural control. Introduce power training with light loads only once technique has been firmly established.
- Extend the recovery intervals and adjust the dose in the event of persistent pain, dizziness, disproportionate shortness of breath or recent falls.
