NASM: Chapter 23 - Chronic Health Conditions and Special Populations Part 2

• Large muscle group activities: stationary cycling, treadmill walking, or rowing

• 3-5 days per week

• 40-85% of maximal heart rate reserve

• Talk Test may be appropriate as medications may affect heart rate

• Stage I cardiorespiratory training

(30-60 minutes total)

• 5-10 min warm-up

• 20-40 minutes of exercise

• 5-10 minute cool-down

• Push, pull, OH squat

| - Single-leg balance (squat if tolerated)

• Static and active in a standing or seated position

• Examples for core: prone iso-abs (plants) on an incline, standing torso cable iso-rotations, or cobras in a standing position (2-leg or single-leg)

• 1-3 sets of 10-20 repetitions 2-3 days per week

• Phases 1 and 2 of the OPT Model

• Tempo should not exceed 1 sec for isometric and concentric portions (ex 4/1/1 instead of 4/2/1)

• Use circuit or PHA weight training as an option, with appropriate rest intervals

• Be aware that clients may have other diseases to consider as well, such as diabetes, hypertension, peripheral vascular disease, or obesity

• Modify tempo to avoid extended isometric and concentric muscle action

• Avoid heavy lifting and Valsalva maneuvers - make sure client breathes normally

• Do not let client over-grip weights or clench fists when training

• Perform exercises in a standing or seated position

• Allow client to stand up slow to avoid possible dizziness

• Progress client slowly

• A decrease in the calcification or density of bone as well as reduced bone mass.

• Bone mineral density (BMD) is lower than normal

• Precursor for osteoporosis

• Condition in which there is a decrease in bone mass and density as well as an increase in the space between bones, resulting in porosity and fragility.

• Disease of bones in which BMD is reduced, the bone microstructure is disrupted, and the actual proteins in bone are altered.

• Two types

• Primary type of osteoporosis
  Associated with:

• Normal aging;

• Most prevalent in postmenopausal women due to deficiency in estrogen
  Attributable to:

• A lower production of estrogen and progesterone (both regulate the rate at which bone is lost)

• Characterized by an increase in bone resorption (removal of old bone) with a decrease in bone remodeling (formation of new bone) which lead to a decrease in BMD

• Treatable

• Secondary type

• Caused by certain medical conditions (and diseases) or medications that can disrupt normal bone reformation (also includes alcohol abuse and smoking)

• Treatable

• For clients with osteopenia (and not contraindications to exercise), resistance training is recommended to build bone mass

• Loads >75% of 1RM have been shown to improve bone density, but the client must be properly progressed to be able to handle these loads

• Circuit-training format is recommended: 8-10 exercises, 1 set of 8-12 reps/exercise with rest as needed between sets

• Treadmill with handrail support

• For clients with severe osteoporosis, exercise modality should be shifted to water exercise to reduce the risk of loading fracture.

• If aquatic exercise is not feasible, use other weight-supported exercise, such as cycling, and monitor signs and symptoms

• 2-5 days per week

• 50-90% of maximal heart rate reserve

| - Stage I cardiorespiratory training progressing to stage II

• 20-60 minutes/day

| - 8-10 minute bouts

• Push, pull, OH squat

| - Sitting and standing into a chair (if tolerated)

• Static and active stretching

• 1-3 sets of 8-20 repetitions at up to 85% on 2-3 days per week

• Phases 1 and 2 of the OPT Model should be mastered before moving on

• Progression should be slow, well monitored, and based on postural control

• Exercises should be progressed if possible toward free sitting (no support) or standing

• Focus exercises on hips, thighs, back and arms

• Avoid excessive spinal loading on squat and leg press exercises

• Make sure client is breathing in normal manner and avoid holding breath as in a Valsalva maneuver

• Reinforce other lifestyle behaviors that will optimize bone health, including smoking cessation, reduced alcohol intake, and increase dietary calcium intake

• Chronic inflammation of the joints

Osteoarthritis:

• Arthritis in which cartilage becomes soft, frayed, or thins out, as a result of trauma or other conditions

• Lack of cartilage creates a wearing on the surfaces of articulating bones, causing inflammation and pain at the joint
  Commonly affected:

• Hands, knees, hips, and spine

Rheumatoid arthritis:

• Arthritis primarily affecting connective tissues, in which there is a thickening of articular soft tissues, and extension of synovial tissues over articular cartilages that have become eroded

• The body’s immune system mistakenly attacks its own tissue (joints or organs in this case) leading to pain and stiffness
  Commonly affected:

• Hands, feet, wrists, and knees

• Oral corticosteroids: clients may have osteoporosis, increase body mass, and if a history of GI bleeding, anemia.

• Steroids may also increase fracture risk

• Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics

• 3-5 days per week

• 60-80% of maximal heart rate reserve

| - Stage I cardiorespiratory training progressing to stage II (may be reduced to 40-70% of max heart rate if needed)

• 30 minutes

• Push, pull, OH squat

| - Single-leg balance or single-leg squat (if tolerated)

• SMR, static and active stretching

• 1-3 sets of 10-20 repetitions 2-3 days per week

• Phases 1 of OPT Model with reduced repetitions (10-12)

• May use a circuit or PHA training system

• Avoid heavy lifting and high reps

• Stay in pain-free ranges of motion

• Only use SMR if tolerated by client

• There may be a need to start out with only 5 minutes of exercise and progressively increase, depending on severity of conditions

Cancer: any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to recur after attempted removal and to cause death of a patient unless adequately treated

• Peripheral nerve damage

• Cardiac and pulmonary problems

• Skeletal muscle myopathy (muscle weakness and wasting)

• Anemia (as well as frequent nausea)

• Treatments frequently result in a diminished quality of life

Fatigue and weakness, if common:

• Aerobic exercise should be done at low-moderate intensity (40-50% of peak capacity),

• 3-5 days/wk using typical aerobic modes (treadmill, elliptical trainer, cycle, depending on patient preference)

• Avoid higher-intensity training during periods of cancer treatment

• Excessive fatigue may result in overall diminished activity

• Diminished immune function

• Decreased lean muscle mass

• Treadmill walking, stationary cycling, rowers, and low-impact or step aerobics

• 3-5 days per week

• 50-70% of maximal heart rate reserve

| - Stage I cardiorespiratory training progressing to stage II (may be reduced to 40-70% of max heart rate if needed)

• 15-30 minutes

• Push, pull, OH squat

| - Single-leg balance (if tolerated)

• SMR, static and active stretching

• 1-3 sets of 10-15 repetitions 2-3 days per week

• Phases 1 and 2 of OPT Model

• May use a circuit or PHA training system

• Avoid heavy lifting in the initial stages of training

• Allow for adequate rest intervals and progress client slowly

• Only use SMR if tolerated by the client - avoid SMR for clients undergoing chemotherapy or radiation treatments

• There may be a need to start out with only 5 minutes of exercise and progressively increase, depending on the severity of conditions and fatigue

• Transverse abdominis,

• Internal oblique

• Pelvic floor musculature

• Persistent bleeding 2nd to 3rd trimester

• Medical documentation of incompetent cervix

• Intrauterine growth retardation

• Pregnancy-induced hypertension

• Preterm rupture of membrane

• Preterm labor during current or prior pregnancy

• 300 kcal

• Low-impact or step aerobics that avoid jarring motions, treadmill walking, stationary cycling, and water activity

• 3-5 days per week

• Stage I cardiorespiratory training and only enter Stage II on a physician’s advice

• 15-30 minutes per day.

• They may be a need to start out with only 5 minutes of exercise and progressively increase to 30 mins, depending on severity of conditions

• Push, pull, OH squat

| - Single-leg balance or single-leg squat

• SMR, static and active stretching

• 2-3 days per week using light loads at 12-15 reps

• Phases 1 and 2 of OPT Model (use only phase 1 after first trimester)

• Resistance training (if cleared by DR):

• a circuit-training format is recommended

• 1-3 sets

• 12-15 reps per exercise

• Emphasize breathing control and rest as needed in between sets

• Avoid exercises in a prone (on stomach) or supine (on back) position after 12 weeks of pregnancy

• Avoid SMR on varicose veins and areas of swelling

• Plyometric training is not advised in the second and third trimesters

• Advise clothing that will dissipate heat easily during exercise

• Postpartum exercise should be similar to pregnancy guidelines, as the physiologic changes that occur during pregnancy may persist for up to 6 weeks.

• The condition of a fibrous lung tissue, which results in a decreased ability to expand the lungs

• Can be caused by fractured ribs, a neuromuscular disease, or even obesity

• The condition of altered airflow through the lungs, generally caused by airway obstruction as a result of mucus production

• Lung tissue may be normal, but airflow is restricted
  Causes:

• Characterized by chronic inflammation (caused primarily by smoking, although asthma cases may be caused by environmental irritants) and airway obstruction via mucus production

Types include:

• Asthma

• Chronic bronchitis

• Emphysema

• Cystic fibrosis (genetic disorder)

• Upper extremity exercise should be programmed carefully and modified based on fatigue

• Resistance training can be helpful; use conservative guidelines

• Circuit training in a PHA format is recommended

• 8-10 exercise

• 1 set

• 8-15 reps per exercise

• Emphasize breathing control and rest as needed between sets

• Treadmill walking, stationary cycling, steppers, and elliptical trainers

• 3-5 days per week

• 40-60% of peak work capacity (what’s the difference between that and maximum heart rate reserve?)

• Stage I cardiorespiratory training

• Work up to 20-45 minutes

• Push, pull, OH squat

| - Single-leg balance or single-leg squat

• SMR, static and active stretching

• 1 set of 8-15 repetitions 2-3 days per week

• Phase 1 of OPT Model

• PHA (peripheral heart action) training system recommended

• Upper body exercises cause increased dyspnea (shortness of breath) and must be monitored

• Allow for sufficient rest between exercises

• The manifestation of the symptoms caused by peripheral arterial disease

• Commonly used to describe the activity-induced symptoms that characterize this disease

• A condition characterized by narrowing of the major arteries that are responsible for supplying blood to the lower extremities

• Resistance exercise should be complementary to but not substituted for aerobic exercise

• A Circuit-training format is recommended

• 8-10 exercises

• 1-3 sets

• 8-12 reps per exercise, progressing up to 12-20 reps

• An intermittent format of exercise may be necessary with intensity guided by pain tolerance

• Typical guidelines suggest exercise into moderate to severe discomfort, rest until subsided, and repeat until total exercise time is achieved (20-30 minutes)

• Always screen for comorbidities

• Treadmill walking is preferred, stationary cycling, steppers, and elliptical trainers

• 3-5 days per week working up to every day

• 50-85% of maximal heart rate

• Work up to 20-30 minutes

• Push, pull, OH squat

| - Single-leg balance or single-leg squat

• Static and active stretching

• 1-3 sets of 8-12 repetitions 2-3 days per week and slowing creasing up to 12-20 reps

• Phase 1 of OPT Model

• Allow for sufficient rest between exercises

• Workout may start with 5-10 minutes of activity and slowly progress client to 20-30 minutes

• PAD frequently results in decreased aerobic capacity and endurance

• Focus on aerobic exercise activities, with an emphasis on walking

• Patients with coexisting coronary artery disease: do not exceed established heart rate upper limit (usually this limit is established from a walking test, in which leg pain is the limiting factor)

• Switching modalities so that leg pain will not limit exercise may result in a higher and possibly inappropriate cardiac workload

• If possible, a continuous format of exercise using walking is preferred