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This chapter discusses the impact of chronic health conditions on exercise training variables and the physiological and functional limitations to exercise in different age groups. It also covers guidelines for exercise in youth, senior adults, obesity, diabetes, hypertension, coronary heart disease, osteoporosis, and arthritis.
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Chapter 16Chronic Health Conditions and Physical or Functional Limitations
Objectives • Define and describe the cause and symptoms of selected chronic health conditions. • Describe the characteristics of selected health and age-related physical and functional limitations to exercise. • Recognize how the conditions discussed in this chapter affect exercise training variables within the Optimum Performance Training (OPT™) model. • Recognize how acute and chronic responses to exercise vary in clients with chronic health conditions or physical or functional limitations compared with apparently healthy clients.
Age Considerations • There are physiologic differences between children and adults. • Children have a “peak oxygen uptake” instead of max VO2. • Children are less efficient and exercise at a higher intensity of their maximum VO2. • Children do not produce enough glycolytic enzymes to perform sustained high intensity exercise. • Children are not as efficient at thermoregulation.
Resistance Training for Youth • Lower risk of injury than most sports commonly participated in • Most common injuries are sprains to ligaments or muscle strain • Children will build strength and bone density but very little increase in muscle mass
Senior Adults • Many physiological changes create challenges for senior adults. • Chronic diseases like arteriosclerosis, atherosclerosis, and peripheral artery disease can hamper exercise and increase caution.
Senior Adults Some of the normal physiological and functional changes associated with aging include reductions in the following: • Maximal attainable heart rate • Cardiac output • Muscle mass • Balance/coordination (neuromuscular efficiency) • Connective tissue elasticity • Bone mineral density (BMD)
Obesity • Fastest growing health problem in America. • ~66% of Americans older than age 20 are overweight, and of these, 34%, which equates to approximately 72 million Americans, are obese • Body mass index (BMI) a measurement of height to weight ratio 18−24.9 is normal range, 25−29.9 is overweight, and a BMI over 30 is obese. • Obesity is complex in cause; as we age we lose muscle and gain fat as a natural effect of aging.
Obesity and Exercise Phase 1 and phase 2 of the OPT™ model are best for obese populations: • Slow gradual weight loss achieved through increased caloric expenditure daily through decreased intake, cardiorespiratory training, and resistance training
Diabetes • Two types: type 1 diabetes and type 2 diabetes • Seventh leading cause of death in the United States • 23.6 million children have type 1 diabetes • Exercise will improve type 2 diabetes by decreasing amount of insulin required and increasing insulin sensitivity
Hypertension Hypertension is high blood pressure (≥140 or diastolic ≥90 mm Hg): • Research has shown that exercise can have a modest impact on lowering elevated blood pressure by an average of 10 mm Hg for both systolic and diastolic blood pressure. • Resistance training should be performed in a seated or standing position as well. Phases 1 and 2 of the OPT™ model will be appropriate for this population.
Coronary Heart Disease Coronary heart disease (CHD) remains the leading cause of death and disability for both men and women despite a significant (29.2%) reduction in death rates from CHD between 1996 and 2006. • Resistance training should be performed in a seated or standing position. Phases 1 and 2 of the OPT™ model will be appropriate for this population. • Clients with stable coronary artery disease should know or be taught information on the importance and benefits of exercise.
Osteoporosis • Osteopenia is a condition in which BMDis lower than normal and is considered a precursor to osteoporosis, whereas in osteoporosis,BMD is significantly reduced. • Research has shown that the risk of hip fractures doubles every 5 years in postmenopausal women older than the age of 50.
Osteoporosis Resistance training should be performed in a seated or standing position. Phases 1 and 2 of the OPT™ model will be appropriate for this population. • Flexibility should be limited to static and active stretching. The use of self-myofascial release may be contraindicated for this population. • Focus on load-bearing exercise, but use caution.
Arthritis • Arthritis is an inflammatory condition that mainly affects the joints of the body. Arthritis is the leading cause of disability among U.S. adults. • Osteoarthritis is caused by degeneration of cartilage within joints. • Rheumatoid arthritis is a degenerative joint disease in which the body’s immune system mistakenly attacks its own tissue.
Arthritis Clients with osteoarthritis have a decrease in strength and proprioception and a loss of knee-extensor strength in some cases. Symptoms of arthritis (such as joint pain and stiffness) are heightened through inactivity as a result of muscle atrophy and lack of tissue flexibility. Functional capacity and balance can be increased by progressing exercises so that they are performed in the seated position (without support) to a standing position.
Cancer • Cancer is the second leading cause of death in the United States behind cardiovascular disease, with more than one half million deaths annually. It has been estimated that American men have about a 44% probability and women have a 38% probability of developing cancer during their lifetimes. • Exercise is an important intervention for clients recovering from cancer. It can improve exercise tolerance, reduce the cellular risks associated with cancer, and also improve quality of life.
Pregnancy • There has been substantial research documenting the beneficial effects of exercise during pregnancy on the physiology and health of both the mother and developing fetus. • The gradual growth of the fetus can alter the posture of pregnant women, making flexibility and core training important, particularly core-stabilization exercises to improve strength of the pelvic floor musculature. • Care should be taken in postpartum fitness.
Chronic Lung Disease In restrictive lung disease or disorders, lung tissue may be fibrotic and, thus, dysfunctional: • In chronic obstructive lung disease, the lung tissue may be normal, but air flow is restricted. • Clients with lung disease are often short of breath (dyspnea) and fatigue at low levels of exercise. Exercise can improve functional capacity and decrease the symptoms of dyspnea. In some clients, inspiratory muscle training can specifically improve the work associated with breathing.
Vascular Issues • Intermittent claudication is the name for the manifestation of the symptoms caused by peripheral arterial disease (PAD). • PADis characterized by narrowing of the major arteries that are responsible for supplying blood to the lower extremities. • Exercise in an intermittent format, with rest as necessary between exercise bouts, is recommended. Physician clearance for exercise is necessary for the client with PAD. Exercise programming should follow the OPT™ methodology.
Summary • Clients with special conditions, pathologies or dysfunctions require an alteration in their assessment and/or program design. • Thus, the consideration of individuals with special needs is twofold: to provide a margin of safety and to optimize training.
