Download Chronic Health Conditions and Physical/Functional Limitations

Chapter 16
Chronic 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
Resistance Training for Youth
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:
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•
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Maximal attainable heart rate
Cardiac output
Muscle mass
Balance/coordination (neuromuscular efficiency)
Connective tissue elasticity
Bone mineral density (BMD)
Basic Exercise Guidelines for Senior Adults
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
Overweight and Obesity
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
Diabetes
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.
Hypertension
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.
Coronary Heart Disease
Osteoporosis
• Osteopenia is a condition in which BMD is
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.
Osteoporosis
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.
Arthritis
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.
Cancer
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 corestabilization exercises to improve strength of
the pelvic floor musculature.
• Care should be taken in postpartum fitness.
Pregnancy
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.
Lung Disease
Vascular Issues
– Intermittent claudication is the name for the
manifestation of the symptoms caused by peripheral
arterial disease (PAD).
– PAD is 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.
Intermittent Claudication/PAD
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.