Training Clients with Medical Conditions
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What is asthma?
- Asthma is a chronic (long term) lung disease that inflames and narrows the airways.
- Makes breathing difficult.
- Asthma causes recurring periods of
- - wheezing
- - chest tightness
- - shortness of breath
- - coughing (often occurs at night or early in the morning)
What are the exercise guidelines in relation to asthma?
- Seek medical advice.
- Avoid exercise if client has a cold/virus or is wheezing.
- Gradual warm up and extended cool down is particularly important.
- Progress program gradually / slowly.
- Take care regarding lying exercises if floor is dusty.
- Environment: cold, dry weather may irritate.
- Swimming is ideal.
- Inhalers - preventative and reliever.
What is Osteo-Arthritis? What is it also known as? What can it be caused by?
- Also known as 'degenerative arthritis'.
- May result from joint injury, misuse or overuse.
- May be caused by ageing process.
- Hyaline cartilage breaks down.
- Often occurs in weight bearing bones and is localised.
What is Rheumatoid Arthritis?
- Auto-immune disease.
- Affects synovial membrane first.
- Continues to affect hyaline cartilage and bone.
- Acute and chronic phases.
- Systemic as opposed to local.
What is Osteoporosis? What is it also known as? Who is it most common in? What are the most commonly affected areas?
- 'Brittle Bone Disease'.
- Bones become porous.
- Calcium deficiency in the bones (simple explanation).
- Most common in post menopausal women, then older women and men.
- Can lead to unexpected fractures following falls.
- Most commonly affected areas;
- 1) Wrists
- 2) Hip
- 3) Vertebrae
What advice would you give to someone wanting to promote bone health and prevent osteoporosis in children?
High-intensity, high impact activities for children to build bone (especially around the onset of puberty).
- Guidelines to Help Build Bones
- Frequency: at least three days per week.
- Intensity: high, but with appropriate weights for resistance training (no more than 60% of the 1RM)
- Time: 10 -20 minutes with multiple sessions within the same day potentially being more effective.
- Type: impact activities such as gymnastics and jumping activities combined with moderate resistance training.
What advice would you give to someone wanting to promote bone health and prevent osteoporosis in adults?
Moderate to high intensity weight bearing activities for adults to maintain bone mass.
- Guidelines to Help Build Bones
- Frequency: weight bearing activities 3 to 5 times per week, resistance exercise 2 to 3 times per week.
- Intensity: moderate to high
- Time: 30-60 minutes a day combined.
- Type: weight bearing endurance activities such as tennis and jogging, activities that involve jumping, and resistance exercise (weight lifting).
What should you always do before training a client with a medical condition?
- 1) Get medical clearance.
- 2) Get specific recommendations.
What would your main goals be if training a client with osteoporosis?
- Muscle strength and endurance
- Balance and stability
- Mobility and quality of life
- Prevention of falls
*primary exercise goals for osteoporosis should focus on preventing falls via improved fitness, muscle strength, posture, balance and stability.
What would the F.I.T.T. be for training someone with osteoporosis?
AVOID TOO MUCH SPINAL FLEXION
- Frequency: 2-3 times per week.
- Intensity: moderate.
- Time: 15-60 minutes.
- Aerobic: walking, stationary bike etc.
- Resistance: Single set of 8-10 exercises strength training, approx 15 reps.
- Balance: standing on one leg etc.
- Flexibility: appropriate stretching.
Why should someone with osteoporosis avoid too much spinal flexion?
Osteoporosis can cause compression fractures in the spinal column. These fractures often lead to a stooped posture, increasing the pressure along the front of the spinal column, and result in even more compression fractures. Exercises that gently stretch the upper back, strengthen the muscles between the shoulder blades and improve posture can all help to reduce harmful stress on the bones and maintain bone density. Avoid stretches that flex your spine or cause you to bend at the waist.
- Dynamic abdominal exercises eg. situps
- Twisting movements eg. golf swing
- Trunk flexion
- Abrupt or explosive loading
- High impact loading eg. jogging, running, jumping.
What would your main goals be when training someone with osteo-arthritis or rheumatoid arthritis?
- 1) Weight Loss: helps to reduce pressure on the joints.
- 2) Pain Relief: aerobic exercise releases endorphins.
What type of training should you include for someone with osteo-arthritis or rheumatoid arthritis?
- 1) Low intensity.
- 2) Low impact
- 3) Less weight bearing is better.
- Aqua fitness / aqua aerobics
- Water walking, strengthening and stretching
- Cross Trainer
- Tai Chi
to lubricate and help maintain the joints
Gentle daily stretching
- avoid over stretching
Muscle strength work
to help maintain and allow the muscle to take the pressure instead of the joints.
Build up a programme gradually
to avoid increasing pain.
Start into a session gradually
What type of exercises should you avoid when working with someone with osteo-arthritis or rheumatoid arthritis?
- 1) Heavy weights
- 2) Very high impact
What can help someone with rheumatoid arthritis before and after exercise?
- 1) Heat/Warmth prior to exercise.
- 2) Cold after to relieve pain.
What are some of the possible causes of high blood pressure (hypertension)?
- Hereditary factors
- Narrowing or hardening of the arteries
- Sedentary lifestyle
- Excess alcohol intake
What are the effects of hypertension?
- Angina - blood supply to heart restricted -> chest pain.Heart attack.
- Blood clots.
- Stroke - interuption to blood supply to the brain.Organ problems eg. kidneys.
What are some of the possible causes of low blood pressure (hypotension)?
- Blood / fluid loss.
- Hormonal glands (eg. under-active adrenal gland).Injury to brain / spinal cord.
- Certain heart conditions.
- Severe insufficient food / fluid intake (starvation).
What are the effects of hypotension?
While exercising what two things should someone with hypertension avoid?
- 1) Holding their breath.
- 2) Isometric holds.
How does exercise help prevent or slow heart disease?
- 1) Heart becomes more efficient and so does not need to work so hard.
- 2) Increased output (stroke volume), leading to decreased RHR.
- Blood Pressure
- 1) Lowers blood pressure which reduces strain on the heart.
- 2) Reduces all other risks associated with hypertension.
- 1) Increases good cholesterol (HDL-High Density Lipoprotein) which helps prevent fat build up in the arteries.
- 2) May help reduce levels of 'bad' cholesterol (LDL-Low Density Lipoprotein).
- 1) Improves circulation, reducing the risk of clotting -> less strokes and heart attacks.
- Body Composition
- 1) Fat loss - less strain on heart.
- 1) Reduces stress by releasing endorphins -> helps reduce pain and stress.
What are the exercise guidelines for a woman who is in her 1st trimester?
- 1) Blood pressure and pulse reacts similar to normal.
- 2) Client may fatigue sooner.
- 3) Avoid big increases in body temperature
- - monitor exercise intensity.
- - suitable, loose fitting clothing.
- - environment.
- - good hydration.
*Only low amount of weight gain (0-10lbs)
What are the exercise guidelines for a woman who is in her 2nd or 3rd trimester?
- 1) Balance and agility is affected.
- 2) Water based exercise is helpful.
- 3) Avoid supine position (lying horizontally on back, face-upwards).
- 4) Caloric intake may need to be increased for extended / strenuous exercise.
*22-35lbs weight gain
What are the F.I.T.T. guidelines during a pregnancy?
- Frequency: Most days of the week.
- - for women who exercised regularly prior to pregnancy, moderate to hard is safe.
- - keep at or below previous intensity levels.
- - avoid competitive attempts.
- - for women who are new to exercise, light exercise, building to moderate is ok.
- - <75% MHR
- Minimum 30 mins per day (same as general population)Type:
- 1) Mixture of weight bearing and non weight bearing.
- 2) Walking, jogging, low-impact aerobics, light to moderate weights.
- 3) Swimming and water based exercise / stationary bike are good.
What guidelines should you follow when giving an weight training program to a pregnant woman?
- 1) Emphasise seated exercises and versions.
- 2) Machine weights may be safer.
- 3) Do not stress the lower back (further).
- 4) Abdominal exercises will need to be modifies.
What types of exercise should be avoided during pregnancy?
- 1) Flexibility training / excessive stretching.
- 2) Heavy weight-lifting.
- 3) Vigorous racquet sports, such as squash (risk of falling)
- 4) Generally, anything that involves excessive straining.
What are the warning signs to terminate exercise with a pregnant client?
- 1) Vaginal bleeding / Amniotic fluid leakage.
- 2) Shortness of breath prior to exertion.
- 3) Dizziness.
- 4) Headache.
- 5) Chest pain.
- 6) Muscle weakness.
- 7) Calf pain or swelling (need to rule out blood clot).
- 8) Decreased fetal movement.
How soon can a woman return to exercise post partum?
- 1) Seek medical advice.
- 2) Depends on type of birth.
- - Normal guidelines: 6 weeks + for natural birth.
- - 8 to 12 weeks + after caesarian delivery, surgery etc.
- 3) Fitness levels - some highly trained athletes are able to return to exercise within days.
- 4) Start back GRADUALLY.
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