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ACE Personal Trainer Manual 5 th Edition. Chapter 14: Exercise and Special Populations Lesson 14.1. EXERCISE GUIDELINES FOR SPECIAL POPULATIONS. Clients with health conditions should follow a low- to moderate-intensity program that gradually progresses.
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ACE Personal Trainer Manual 5th Edition Chapter 14: Exercise and Special Populations Lesson 14.1
EXERCISE GUIDELINES FOR SPECIAL POPULATIONS Clients with health conditions should follow a low- to moderate-intensity program that gradually progresses. Many clients have comorbidities that will also impact their program. The program must be individualized: Specific client characteristics Appropriate modifications Safe and effective A personal trainer has a responsibility to expand his or her knowledge and skills and communicate with healthcare professionals when training clients with health conditions or special considerations.
WORKING WITH CLIENTS WHO HAVE HEALTH PROBLEMS Do you feel comfortable working with clients who have health problems? Given that the overall population is aging and becoming increasingly overweight and that with aging and/or obesity often comes an increased prevalence of health disorders, personal trainers must consider that their services will be offered to clients who are dealing with health challenges. Are you prepared to work with clients who have special health and fitness issues? How will you increase your knowledge in this important area? Is there a specific population with which you would like to work? How will you promote your services to this clientele?
DOCUMENTATION AND SOAP NOTES Documentation is important to appropriately adjust each client’s program and prepare communication to the health provider: Client encounters Health status Progress The SOAP note is commonly used to document progress: S – Subjective: The client’s own observations (e.g., status report, symptoms, challenges, and progress made) O – Objective: Measurements (e.g., vital signs, height, weight, age, posture, exercise, and test results) and exercise and nutrition log information A – Assessment: A brief summary of the client’s current status based on the subjective and objective observations and measures P – Plan: A description of the next steps in the program based on the assessment
CARDIOVASCULAR DISORDERS • 80.7 million Americans have one or more types of cardiovascular disorders: • Dyslipidemia • Coronary artery disease (CAD) • Congestive heart failure (CHF) • Hypertension • Stroke • Peripheral vascular disease • Know common manifestations of atherosclerosis • Page: 516
CVD SIGNS AND SYMPTOMS Abnormal signs or symptoms that necessitate delaying or terminating the exercise session: Angina Dyspnea Lightheadedness or dizziness Pallor Rapid heart rate Teach clients to recognize signs and symptoms that indicate they should stop exercising and contact their physician.
HYPERTENSION Hypertension is sometimes referred to as the “silent killer” and is defined as: Systolic BP ≥140 mmHg Diastolic BP ≥90 mmHg Or taking antihypertensive medication Prehypertension is defined as: Systolic BP of 120−139 mmHg Diastolic BP of 80−89 mmHg
HYPERTENSION AND EXERCISE Personal trainers should use the following guidelines: Obtain the physician’s release, guidelines, and recommendations Be aware of the client’s medications and potential impact on exercise Teach clients to pay careful attention to hydration, especially in warm environments and if taking diuretics Teach clients to use RPE to monitor exercise intensity, change positions slowly, and follow exercise with a gradual and prolonged cool-down period Avoid isometrics and inverted exercises; emphasize technique and breathing Include yoga or tai chi to add variety and promote relaxation Measure the client’s pre- and post-exercise blood pressure: Monitor blood pressure during exercise initially, and possibly long-term Discontinued if the SBP or DBP rise to 250 mmHg or 115 mmHg, respectively, or if the SBP fails to increase with increasing workload or drops ≥20 mmHg
STROKE Hemorrhagic stroke: a blood vessel in the brain bursts Ischemic stroke: blood supply to the brain is cut off Approximately 80% of all strokes are ischemic Strokes dramatically reduce a client’s quality of life and can lead to metabolic disorders and an increased risk of recurrent stroke and myocardial infarction. Risk factors for stroke include: High blood pressure Smoking Heart disease Previous stroke Physical inactivity Transient ischemic attacks
STROKE AND EXERCISE Personal trainers should be aware of the warning signs of a stroke: Sudden __________or ____________of the face, arms, or legs Sudden confusion or trouble ____________or understanding others Sudden trouble seeing in one or both eyes Sudden walking problems, dizziness, or loss of balance and coordination Sudden severe headache with no known cause
PERIPHERAL VASCULAR DISEASE (PVD) PVD is caused by atherosclerotic lesions in one or more peripheral arterial and/or venous blood vessels: Peripheral artery occlusive disease (PAOD): results from atherosclerosis of the arteries of the lower extremities; most common form of PVD Peripheral vascular artery disease (PVOD): characterized by muscular pain caused by ischemia, or lack of blood flow to the muscle. PVD risk factors are similar to those of CAD: Hyperlipidemia Smoking Hypertension Diabetes Family predisposition Obesity Stress
PVD AND EXERCISE People with PVD may also have underlying CAD. Some clients may develop CAD symptoms as walking distance and/or speed increases: Stop the exercise session The client must be evaluated by his or her physician and released back to activity Proper foot care is essential: Pay close attention to the client’s feet, especially if diabetic Encourage proper footwear Avoid exercising in cold air or water to reduce the risk of vasoconstriction.
DYSLIPIDEMIA The highest correlation to CVD involves: Elevated total cholesterol levels Elevated LDL levels Suboptimal HDL levels Elevated triglyceride levels
DYSLIPIDEMIA AND EXERCISE Exercise and dietary modification: Considered effective in managing high serum cholesterol and triglyceride levels Particularly effective in elevating low HDL levels The impact of exercise on blood lipid profiles is most profound with corresponding decreases in body fat. Therefore, exercise, when combined with dietary changes that lower body weight, is an effective means of improving lipid profiles.
DIABETES Diabetes: a fasting blood glucose level of ≥126 mg/dL Prediabetes: a fasting blood glucose level between 100 and 125 mg/dL Causes abnormalities in the metabolism of carbohydrate, protein, and fat If inadequately treated, results in chronic disorders or death Type 1 diabetes: develops when the body’s immune system destroys pancreatic beta cells responsible for producing insulin Type 2 diabetes: typically presents as insulin resistance, a disorder in which the cells do not use insulin properly; the pancreas gradually loses the ability to produce insulin Gestational diabetes: glucose intolerance that occurs during pregnancy
DIABETES CONTROL AND EXERCISE The primary treatment goal for diabetes control: Normalize glucose metabolism Prevent diabetes-associated complications and disease progression Proper management requires a team approach: Physicians Diabetes educators Dietitians Exercise specialists The client with diabetes The personal trainer’s role: Assist with client motivation Program regular physical activity Provide feedback regarding progress and responses to the team
METABOLIC SYNDROME Metabolic syndrome (MetS) is identified as the presence of 3 or more of the following components: Elevated waist circumference Elevated _____________ Reduced HDL cholesterol Elevated ____________________ Elevated ___________________ MetS is also characterized by abdominal obesity, and a prothrombotic and pro-inflammatory state. MetS has been associated with: Physical inactivity Excessive caloric intake Genetics Aging
METABOLIC SYNDROME The primary treatment objective for MetS: Reduce the risk for developing cardiovascular disease Reduce the risk for developing type 2 diabetes Lifestyle interventions are typically the initial strategies implemented: Weight loss Increased physical activity Healthy eating Tobacco cessation
ASTHMA A cascade of events set off by environmental triggers activating an inflammatory response This inflammatory response leads to: Constriction of smooth muscle around the airways Airway hyper-responsiveness and airway obstruction Swelling of mucosal cells Increased secretion of mucus Exercised-induced asthma (EIA) An asthma attack during and/or after physical activity Occurs after breathing dry, cold air with allergens or pollutants Severity depends on exercise intensity and environmental conditions Happens during or after vigorous activity, or by sudden intense activity
EXERCISE AND ASTHMA Exercise can help to reduce the ventilatory requirement, making it easier for clients with asthma to participate in any activity. EIA is brought on by hyperventilation: Clients should perform gradual and prolonged warm-up and cool-down periods. This allows clients to utilize the refractory period to lessen the bronchospastic response during subsequent higher-intensity exercise.
CANCER Cancer is a group of more than 100 diseases Uncontrolled growth and metastasis of cells in the body Develops when DNA is damaged producing cell mutations Cell growth causes tumors and may spread through blood and lymph systems May eventually interfere with organ function and lead to death Malignant: harmful cells that typically metastasize Benign: local; cells do not spread, yet may still interfere with functioning Physical activity: Can help protect active people from acquiring cancer Improves risk factors associated with cancer development May improve immune function
CANCER AND EXERCISE The goal of exercise in the treatment of cancer is to: Maintain and improve cardiovascular conditioning Prevent musculoskeletal deterioration Reduce symptoms such as nausea and fatigue Improve the client’s mental health outlook and overall quality of life The specific exercise program should be tailored to the client’s: Needs Type of cancer Current treatment Current medical and physical-fitness status
OSTEOPOROSIS Low bone mineral density and deterioration in bone microarchitecture Results in structural weakness and increased risk for fracture Affects more women than men Most common fracture sites: Proximal femur (hip) Vertebrae Distal forearm (wrist) Osteopenia: Less severe condition of low bone density Possible precursor to osteoporosis Physical inactivity, poor nutrition and other lifestyle factors impact bone density.
OSTEOPOROSIS AND EXERCISE _______________________exercises and _________________________are keys in the prevention of osteoporosis: Bone strain stimulates bone deposition and gains in bone mass and strength Forces above ADL: jogging, jumping, and plyometric exercises Higher-intensity strength-training (8-RM) may be most beneficial Improved strength assists in reducing the risk of falling To prevent further injury and falls, some clients may need to avoid: Spinal flexion, crunches, and rowing machines Jumping and high-impact aerobics Trampolines and step aerobics Abducting or adducting the legs against resistance Pulling on the neck with hands behind the head
ARTHRITIS Osteoarthritis (most common type): Degenerative joint disease Leads to deterioration of cartilage and development of bone spurs at joint edges Results from overuse, trauma, obesity, and aging Rheumatoid arthritis (most crippling type): A chronic and systematic inflammatory disease; classified as an autoimmune disorder Affects more women than men Characterized by joint pain, swelling, stiffness, and contractures
ARTHRITIS AND EXERCISE The primary goals for an exercise program for clients with arthritis: Improve cardiovascular fitness and lower CAD risk Increase muscular strength and endurance Improve range of motion and flexibility around the affected joint(s) Additional benefits of exercise: Improved daily function and associated quality of life Improved psychosocial well-being Decreased pain and stiffness Improved neuromuscular coordination Exercise programs should be carefully designed in conjunction with a physician and/ or physical therapist, and must be based on the functional status of the individual.
FIBROMYALGIA The exact cause remains unclear; common symptoms include: Aches and pains similar to flu-like exhaustion Multiple tender points Stiffness Decreased exercise endurance Excessive fatigue Muscle spasms Paresthesis Disruptive sleep patterns Bowel and bladder irritability Anxiety and depression Temporomandibular joint (TMJ) disorders Allergy symptoms
FIBROMYALGIA AND EXERCISE People with fibromyalgia are typically deconditioned: They shy away from exercise and are fearful of making symptoms and fatigue worse This inactivity brings further decreases in fitness resulting in more fatigue and pain Exercise eases symptoms and prevents the development of other chronic conditions. Low- to moderate-intensity aerobic exercise: Has an analgesic and antidepressant effect Can significantly reduce pain, depression, and anxiety
CHRONIC FATIGUE SYNDROME • Characterized by profound, incapacitating fatigue lasting at least 6 months • Results in a substantial reduction in everyday activities: • Occupational • Recreational • Social • Educational • Fatigue does not improve with bed rest • Fatigue may worsen with physical and/or mental activities
CHRONIC FATIGUE SYNDROME AND EXERCISE The primary objective of exercise for people with CFS: Create a balance, avoiding post-activity malaise. Prevent deconditioning to improve function and quality of life. Utilize rest periods and stop activity before illness and fatigue are worsened. The following guidelines apply to people with CFS: Exercise should be followed by a rest period at a 1:3 ratio. Deconditioned clients should start with ADL. Several daily sessions of brief, low-impact activity can be beneficial. Sessions can increase by 1−5 minutes per week, or as tolerated. If symptoms worsen, clients should return to the most recent manageable level of activity.
LOW-BACK PAIN Very complex and given a specific diagnosis according to the duration of pain: More recently considered a recurring or persistent condition with a fluctuating course over time Acute or short term LBP: lasting <3 months in duration Mechanical in nature Lasts from a few days to a few weeks Typical causes: Trauma (e.g., sports injury, car accident, and lifting) Certain disorders such as arthritis or aging
LOW-BACK PAIN The causes of chronic low-back pain (lasting >3 months) are challenging to determine: Spinal strain or compression (disc rupture or bulge) Spinal stenosis Osteoporosis or other fractures Spinal degeneration Spinal irregularities (e.g., scoliosis, kyphosis, and lordosis) Lifestyle factors may also be a cause: Physical inactivity Being overweight or obese Poor posture or sleeping positions Stress Smoking
LOW-BACK PAIN AND EXERCISE The primary programming components for a client with LBP include: Cardiorespiratory training Resistance training Basic core exercises Clients with LBP should avoid the following: Unsupported forward flexion Twisting at the waist with turned feet, especially with load Lifting both legs simultaneously when prone or supine Rapid movements, such as: Twisting Forward flexion Hyperextension
WEIGHT MANAGEMENT Rising obesity rates have significant health consequences and contribute to chronic diseases, such as: Type 2 diabetes Hypertension CAD Some cancers Arthritis Alzheimer’s disease Dementia They key to successful long term weight-stability is the adoption of: Lifelong physical activity Sensible eating habits
