Working with clients who suffer from one or more chronic disease conditions presents unique and serious challenges. When it comes to training a client who fits a chronic disease profile, the purpose of exercise becomes one of a therapeutic nature versus a performance nature you would typically see with a generally healthy, low-risk client. Show
As a certified health and fitness professional, you are part of the client’s healthcare and health-promotion team. While you do not have a medical scope of practice, you are responsible for taking the necessary steps to consult with a client’s physician on a regular and continual basis while the client is in your care. As with any client, you begin by gathering a complete and robust health-history inventory, which includes primary and secondary diagnosis’ and any past complications the client has experienced with exercise and general activity. Once these steps are completed and you identify the appropriate risk profile based on the known risk factors, you can start to design a safe and effective exercise program. Chronic diseases are numerous and present different challenges to both the sufferer and the health and fitness professional. This article discusses the basic principles and considerations associated with the following chronic disease types:
ArthritisThe most common types of arthritis are osteoarthritis (a degenerative joint disease that breaks down cartilage and leads to the development of bone spurs) and rheumatoid arthritis (autoimmune disease characterized by crippling pain, swelling, stiffness and contractures). Many people are surprised to learn that exercise is a crucial and therapeutic component to the management of arthritis. To ensure a client is working within his or her functional level and the program is safe and effective, work in partnership with the client’s physician to create a program focused on cardiorespiratory fitness, muscular endurance and strength, and joint range of motion (American Council on Exercise, 2014). Exercise Guidelines
(American Council on Exercise, 2014) Precautions
(American Council on Exercise, 2014) AsthmaThe limitations associated with asthma, like many other chronic conditions, depend upon the severity of the client’s condition. It is important to understand that asthma itself is not a contraindication to exercise; however, those suffering from asthma should receive medical clearance prior to beginning an exercise regimen. A physician will have a better understanding of what might trigger a client’s asthma and can prescribe specific medications to mitigate those triggers. In general, exercise is a benefit to those with controlled asthma. Exercise Guidelines
(American Council on Exercise, 2014) Precautions
(American Council on Exercise, 2014) CancerThis category of chronic conditions is extremely complicated because there are numerous types of cancers, each with its own associated treatment path. For many cancer patients, the ability to participate in exercise will greatly depend on their day-to-day stamina (mental and physical), health and where they are at in their journey. Certain cancer treatments may affect the lungs and heart, so before starting even the most conservative of exercise programs, contact the client’s physician to find out which activities are considered safe and which ones should be avoided (American Cancer Society, 2012). Exercise Guidelines
(American Council on Exercise, 2014; American Cancer Society, 2012) Precautions
(American Council on Exercise, 2014; American Cancer Society, 2012) Chronic Obstructive Pulmonary Disease (COPD)Chronic obstructive pulmonary disease (COPD) is defined as a dysfunction of the pulmonary system and often includes chronic bronchitis, emphysema and even asthma. While guidelines for working with these types of clients vary between organizations, at minimum, before beginning an exercise program, confirm that your client has been seen by a doctor, cleared for physical activity, and given recommendations for appropriate activities and/or activities to avoid. Clients with COPD are likely to be on medications that can affect his or her response to exercise. Confirm these side-effects with the client’s doctor. Depending on the severity of an individual’s COPD, he or she may be required to exercise in a formal pulmonary and respiratory rehabilitation clinic, rather than under the direction of a health and fitness professional. Minimum Exercise Guidelines
Precautions
DiabetesDiabetes is a group of diseases characterized by high blood glucose resulting from dysfunctional insulin production, insulin action or both. There are three types of diabetes: type 1, type 2 and gestational diabetes, which occurs in pregnancy. It is necessary to work with your client’s healthcare team to establish the most effective and safest exercise program possible. To begin, obtain medical clearance for any client with diabetes. Type 1 diabetes is a condition where the body attacks the beta cells of the pancreas, which are responsible for producing insulin. Clients with this form of diabetes require insulin injections (or a pump) to regulate and manage blood glucose levels. Research has not yet revealed a specific role exercise has in controlling blood sugar levels associated with type 1 diabetes; however, we do know exercise helps lower the risk for heart disease and improve functional capacity. In other words, exercise is still recommended. Exercise Guidelines
Precautions
(American Council on Exercise, 2014) Type 2 diabetes is the most common form of diabetes and generally presents as insulin resistance, which means the cells stop using insulin properly. To combat this issue, individuals are generally placed on oral medication. In more severe cases, injectable insulin is prescribed. As with type I diabetic clients, a full medical evaluation and appropriate diagnostic studies are necessary. Obtain physician clearance and any exercise recommendations from the primary care provider or endocrinologist (American Diabetes Association, 2017). Unlike type 1 diabetes, research has consistently shown substantial benefits of exercise to those with type 2 diabetes. Exercise helps reduce body weight, control cholesterol and reduce triglycerides. Furthermore, exercise reduces the risk of coronary artery disease, stroke and peripheral vascular disease. Exercise Guidelines
(American Council on Exercise, 2014) Precautions
The following are contraindications to exercise for clients with diabetes:
While type 1 diabetes appears most often in childhood and type 2 diabetes typically arises in adulthood and is associated with a lack of physical activity and poor nutritional habits, gestational diabetes occurs during pregnancy. This condition is a result of insulin resistance, but symptoms usually resolve after the birth of the baby. However, affected mothers are at an increased risk for developing type 2 diabetes later in life. This condition can also be addressed through diet, exercise and, if necessary, insulin injections. For these clients, it is best to work closely with the client’s obstetrician and follow established prenatal exercise guidelines and recommendations. DisabilitiesThis category of chronic conditions is probably the most complicated because disabilities can include a wide range of issues, such as uncontrolled hypertension, certain heart conditions, progressive diseases such as multiple sclerosis, stroke, cerebral palsy, muscular dystrophy, sensory nerve damage, depression and more. To best address exercise and these conditions, the first step is to always obtain medical clearance and identify what is within your scope of practice to handle effectively and safely. Secondly, to work with clients living with a specific disability, you must learn about the condition itself. Exercise guidelines frequently vary between organizations and between specific disabilities. For example, it is not appropriate to write a program for a hypertensive client and then use the same or similar guidelines for a client who has had a stroke. Further, the presence of a disability is often accompanied by other comorbidities. Working closely with other medical personnel associated with each client’s case will help you to design and execute an exercise program that minimizes potential negative effects and complications. HypothyroidismHypothyroidism, or underactive thyroid, is a dysfunction of the thyroid gland characterized by a number of symptoms including thinning hair, extreme fatigue, weight gain, forgetfulness, slow heart rate, deepening voice, intolerance to cold, irregular menstrual cycles, infertility, constipation, depression/anxiety and dry or itchy skin. This condition is particularly frustrating for clients who wish to lose weight. An underactive thyroid directly impacts the metabolic rate and can cause it to slow down. However, hypothyroidism is not a contraindication to exercise. Exercise Guidelines
Precautions
OsteoporosisOsteoporosis is defined as a “bone mineral density (BMD) that is 2.5 standard deviations or more below the mean for young adults” (American Council on Exercise, 2014). As research demonstrates, physical activity is crucial to the maintenance of bone health; therefore, engaging in regular weight-bearing exercise plays a role in primary prevention. As with any chronic condition, if you feel uncomfortable or lack experience working with special populations, connect with your client’s physician. Exercise GuidelinesThe following guidelines are for clients with osteoporosis and are intended to help prevent the progression of the disease.
(American Council on Exercise, 2014) Precautions
(American Council on Exercise, 2014) Regardless of which conditions you encounter in your work with clients, it is essential that you always obtain medical clearance from each client’s physician prior to recommending any exercise regimen. Working with individuals who are dealing with chronic conditions requires you to maintain a consistent and regular open line of communication between the client and his or her healthcare team. However, if you do not feel comfortable working with any client with a chronic condition, use your professional judgement and refer to other health and fitness professionals who have more experience with these types of conditions. Want to make a difference in the fight against Diabetes? Check out our Diabetes Prevention Coaching online course and equip yourself with evidence-based disease-prevention strategies you can use with clients coping with, or at risk, for diabetes. References American Cancer Society (2012). Summary of the ACS Guidelines on Nutrition and Physical Activity. American Council on Exercise. (2014). ACE Personal Trainer Manual (5th ed.). (C.X. Bryant, Ed.) San Diego, Calif.: ACE. Centers for Disease Control and Prevention (2017). Arthritis. What should a client with an arthritic condition avoid before an exercise session?Avoid jarring movements and high-impact activities such as running. Respect pain, do not ignore it, and monitor for pain during exercise. Start slow and increase activity gradually. Pay attention to posture and alignment.
What activities should be avoided with arthritis?For arthritis that affects the joints, running, jogging, jumping rope, high impact aerobics or any other exercise where both feet are off the ground at the same time are to be avoided. Hot yoga, also known as Bikram yoga, is a new exercise trend.
What exercises should you not do with osteoarthritis?You may need to avoid activities that put too much strain on the joints, such as running and sports that involve jumping, quick turns, or sudden stops — tennis and basketball, for example. Swimming and pool exercises have several advantages for people with osteoarthritis. Warm water is soothing to muscles and joints.
Which exercises are recommended for clients with arthritis?Low-impact aerobic activities do not put stress on the joints and include brisk walking, cycling, swimming, water aerobics, light gardening, group exercise classes, and dancing.
|