Chapter 19b Nutritional and Metabolic Concerns

1. Chapter 19b Nutritional and Metabolic Concerns NSCA’s Essentials

2. Eating Disorders • There is a huge pressure in society to be thin and present a glamorous look • People are compromising their health daily to meet societal image expectations • 1%-5% of adolescents and young adult women have eating disorders • Trainers have a responsibility to educate clients on dangers of engaging in disordered eating • However, in the course of the process, do not inadvertently or intentionally promote weight loss or goals that are unhealthy • Inappropriate comments can serve as triggers points for someone to engage in disordered eating

3. Disordered Eating • Clients may start out to lose weight, but when it does not come off fast enough they get frustrated and resort o unhealthy eating practices many times • Medication (causes more urination and lose water weight) • Diet pills • Self-induced vomiting • Food faddism (eating only one kind of food or fad diets • Saunas (sweat weight off) • Laxatives or Enemas

4. Disordered Eating • Engaging in disordered eating is the first step in development of eating disorders such as anorexia nervosa and bulimia • Keys to preventing development of a eating disorder • Trainer must recognize this condition in clients • Picking up on some disordered eating habits • Talking to client about his/her diet • Have client fill out self-monitoring form

5. Disordered Eating • Questions to ask a client if you notice they have disordered eating: • 1. Do you feel fat even though people tell you you’re thin? • 2. Do you get anxious to exercise? • 3. Do you worry about what you will eat? • 4. Do you feel guilty when you eat? • 5. Do you have a secret stash of food?

6. Disordered Eating • The big concerns here: • The person can experience short term and long term medical and psychological conditions characteristic of persons with anorexia nervosa and bulimia • Earlier individual seeks help the better

7. Anorexia Nervosa • Characterized by extreme weight loss • Refusal to maintain body weight • Intense fear of gaining weight • Fear of becoming fat although underweight • Distorted body image • Amenorrhea (loss of menstrual cycle for at least three consecutive cycles)

8. Anorexia Nervosa • Weight loss is facilitated by severe restriction of food intake in conjunction with excessive exercise • Psychological and emotional problems may include low self-esteem and distorted body image • May also lead to apathy, confusion, social isolation, etc.

9. Anorexia Nervosa • Two types of anorexia nervosa • Restricting type • Severe restriction in food intake • Most common type • Binge eating/purging type • Regularly binge eat followed by purging • Refer to page 507 for the warning signs of anorexia nervosa • If you notice these signs then refer to his/her physician for treatment • Realize it will be hard for the person to acknowledge they have a problem many times

10. Bulimia Nervosa • Recurring episodes of binge eating followed by purging behaviors • Person eat large amounts of food over short period of time • Purging behaviors can include: • Self-induced vomiting • Taking laxatives • Diuretics • Enemas • Excessive Exercise

11. Bulimia Nervosa • Diagnosis of bulimia • Binging and purging behaviors at least twice a week for at least three months • Lack of control to stop eating, how much to eat or both • Further diagnosis is use of one or more methods of purging • Refer to page 508 for Warning Signs for Bulimia

12. Female Athlete Triad • Eating Disorders can result in a female athlete triad: • Disordered Eating • Amenorrhea • Osteoporosis • This condition first discovered in female athletes • However, it happens to a wide range of women

13. Female Athlete Triad • What happens? • Start with disordered eating practices • Body in energy deficit…results in amenorrhea which puts in women hormone deficiency for bone density accruement • Leads to lack of normal bone formation and irreversible loss in bone mass…resulting in osteoporosis and its complications

14. Exercise Prescription and Program Design for Clients Recovering From an Eating Disorder • De-emphasize weight loss and emphasize exercise with a low energy demand • Refer client back to physician if problems persist • If they client will not see physician then you cannot train the client • Program Design • See Table on p. 509 for program design specifics for clients recovering from eating disorders

15. Hyperlipidemia • Blood lipid disorder that plays a big role in development of arteriosclerosis, which then can lead to conditions such as coronary heart disease, angina, myocardial infarction (heart attack), chronic heart failure, etc. • Hyperlipidemia is general term for elevated levels of lipids (fats) in the blood • Cholesterol • Triglycerides • Lipoproteins

16. Hyperlipidemia • Term usually indicated high levels of LDLs and VLDL’s (these are the bad type of lipids that contribute to development of arteriosclerosis) • National Cholesterol Education Program Adult Treatment Panel III (ATP III) has set guidelines for detection, evaluation and treatment of cholesterol: • Lower LDLs • Raise HDLs (help to remove cholesterol from the blood stream) • Lower triglycerides • TLC (therapeutic lifestyle change) as the first line of therapy • Diet • Physical activity • Weight loss

17. Hyperlipidemia • Possible causes: • Elevated LDLs have become a major concern in relation to possible cause of the condition (≥130)…need to shoot for <130 mg/dL) • Low HDLs are also designated as a strong independent predictor of CHD (<40 mg/dL) • Elevated Triglycerides are also a major concern as well • See Table 19.6 (pg. 511) for possible causes and treatments • See Table 19.5 (pg. 510) for ATP Classification of LDLs, HDLs, Total Cholesterol and Triglycerides

18. Hyperlipidemia • Clients with Hyperlipidemia should see a registered dietitian in addition to visiting physician regularly • Personal trainer’s role is to provide support in following TLC program, but exercise is your focus

19. TLC Diet • Major emphasis and most important phase of the TLC for high HDLs is the consumption of anti-atherogenic diet (heart healthy diet) • Lower levels of cholesterol combined with physical activity and weight loss • Maintain of diet: • <7% of saturated fats • <200 milligrams per day of cholesterol • Table 19.7 (pg. 512) shows overall diet plan

20. TLC Physical Activity: Exercise Prescription and Program Design for Clients with Hyperlipidemia • Regular exercise lowers risk by reducing VLDL levels with a subsequent decrease in triglycerides, raising HDLs and in some instance lowering LDLs • Regular exercise lowers blood pressure, reduces insulin resistance and improve cardiovascular function • Long-term exercise (at least a year) is necessary to obtain long lasting results • Programs should involve a relatively high frequency of sessions per week (acute exercise has been shown to improve both insulin action and lipid profiles up to 48 to 72 hrs after each session) • Resistance training may have positive effects on lipid profiles as well • See Table 19.8 (pg. 512) for specific exercise prescription for clients with hyperlipidemia

21. Metabolic Syndrome • A cluster of major cardiac risks factors and abdominal obesity • Also called Syndrome X • People with this condition are at increased risk for developing diabetes mellitus and CVD

22. Metabolic Syndrome • Persons with Metabolic Syndrome must meet the threeof the following criteria: • 1. abdominal obesity: waist circumference >102 cm (>40 inches) in men and >88 cm (>35 inches in women) • 2. Hypertriglyceridemia: >150 mg/dL • 3. Reduced HDL-cholesterol <40 mg/dL in men and <50 in women • 4. Elevated blood pressure >130/85 mmHg • 5. Elevated fasting glucose > 110 mg/dL

23. Metabolic Syndrome • The condition’s prevalence is at about 27% and increases with age • Poor blood glucose regulation due to insulin resistance is thought to be the underlying cause of this syndrome • People with Metabolic Syndrome typically have hyperinsulemia, which means high levels of insulin in the blood, which means the cells are not responding appropriately to insulin • People with Metabolic Syndrome typically have an apple shaped or android body type (high amount of fat in the trunk and abdomen)

24. Metabolic Syndrome • Metabolic Syndrome usually develops slowly and even several years before the affected individual meets the criteria for medical intervention • People with a family history of diabetes should be especially careful • Exercise is the first line of treatment for the metabolic syndrome because it influences all components of this disorder

25. Diabetes Mellitus • Group of Metabolic diseases that are characterized by an excessively high blood glucose level • Signs and symptoms include: • Increased frequency or urination • Increased thirst • Increased appetite • General weakness

26. Types of Diabetes • Type 1 • Insulin dependent (need injection or pump) • Less prominent than type 1 (10% of diabetes patients) • Autoimmune deficiency • Develop before age 25 usually • Type 2 • Non-insulin dependent • Resistance to insulin • More common (90% of diabetes patients) • Usually adult onset • High associated with family history

27. Types of Diabetes • Gestational Diabetes • Elevated glucose levels and other diabetic symptoms during pregnancy in women • Not lack of insulin, but insulin resistance • Usually disappear following delivery, but affected mothers are at an increased risk of developing type 2 later on in life • 2-5% of all pregnant women in US are diagnosed with this condition

28. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • See page 515 for contraindications to Exercise for Clients with Diabetes • Exercise increases insulin sensitivity and glucose utilization, thus lowering blood glucose levels • Regular physical activity reduces other risk factors related to CVD (e.g. hypertension, obesity, etc.) • A potential complication from exercise is hypoglycemia (blood glucose level of 65 mg/dL or lower…See page 515 for signs and symptoms of hypoglycemia) • Before exercise clients with diabetes should have medical evaluation to assess their glycemic control and to screen for any complications that exercise might exacerbate. • Stress cardiac testing is also recommended for all clients with diabetes considered at risk for heart disease

29. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • Glycemic Control • Principle risk is in type 1 diabetes than for type 2 • Factors that predispose to hypoglycemia durning exercise include: • Increased exercise intensity • Longer exercise time • Inadequate caloric intake prior to exercise • Excessive insulin dose • Insulin injection into exercising muscle • Colder environmental temperatures

30. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • Exercise induced hypoglycemia is related to the fact that exercise increased exogenous insulin, increases muscle uptake of glucose and impairs the mobilization of glucose in blood • Once again…See page 515 of signs and symptoms of Hypoglycemia • Managing hypoglycemia as a trainer involves giving the client something sugary or drinks with glucose or fructose (soft drinks, fruit juices, etc.) when affected individuals are unable to treat themselves… See page 515 for procedure for responding to a client with hypoglycemia

31. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • Aerobic Conditioning • 3-7 days a week • 20-60 minutes (150 min/week) at 50%-80% VO2R or HRR, or a 12-16 RPE. • Eventual goal: 300 min/week • Exercise should begin with low intensity warm up and stretching and conclude with a cool down • Work clients to voluntary fatigue, not exhaustion • Monitor blood glucose before and after exercise • A snack may be needed before exercise

32. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • Resistance Training • 2-3 non-consecutive days per week • 2 to 3 sets, for 8-12 reps per set (60-80% 1RM) with weight increase for individual where they can complete 12 reps • 12-15 may be more suitable for older (50+ years old) diabetic clients • Up to 8-10 multi-joint exercises for all major muscle groups in the same session (whole body) or sessions split into selected muscle groups • Can begin with body weight exercises and progress to free weights and resistance machines • Clients with well-controlled diabetes can progress to strength training

33. Exercise Prescription and Program Design for Clients with Diabetes Mellitus • Flexibility Training • >2 or 3 days/week • ≥ 4 reps per muscle group • Hold static stretches for 15 to 60 seconds