chapter 20 clients with cardiovascular and respiratory concerns nsca’s essentials
TRANSCRIPT
Chapter 20 Clients with Cardiovascular and Respiratory Concerns
NSCA’s Essentials
Introduction Cardiovascular disease and respiratory
conditions are of a great concern for personal trainers
Hypertension is a major consideration when training clients
Heart attacks, strokes and hypertension are the most common cardiovascular diseases personal trainers will encounter
Hypertension Hypertension is NOT a disease of
just elderly people…it also affects younger individuals as well
Over 50 million Americans age 6 and above have this disease, which is defined by: Systolic 140 + mmHg Diastolic 90 + mmHg
Hypertension Hypertension is an idiopathic disease, meaning
it occurs without a known cause This is why it is considered the “silent killer” Look at it this way…a doctor can look at 10
different people in a room and not be able to pick out the ones who have and the ones who do not have it
90% of cases are idiopathic 10% are curable because they are due to
secondary causes (other diseases…hyperthyroidism, renal artery stenosis, etc.)
Hypertension Anyone under age 35 with hypertension needs
to be aggressively evaluated for one of a couple of diagnoses
Any client observed to be hypertensive must be referred to a doctor for further evaluation
Be aware that you cannot diagnose someone as being hypertensive, you can however say that their blood pressure is above the normal range and that you recommend they see a doctor to get a confirmed or unconfirmed reading
Hypertension Elevated blood pressure puts a person
at risk for: Heart attack Stroke Both
Mildly elevated can lead to: Kidney disease Generalized vascular disease
Hypertension Blood pressure risk stratification is shown
in table 20.1 (pg. 523) The stages are identified in four stages;
Normal: <120/<80 Prehypertension: 120-139/80-89 Stage 1 hypertension: 140-159/90-99 Stage 2 hypertension: ≥ 160/≥ 100
These groups are based on presence of major risk factors (e.g. smoking, diabetes, etc.)
Let’s take a look at the table…
Management of Hypertension Non-medicine interventions such as proper exercise,
weight loss and dietary changes are recommended Lifestyle changes include:
Adequate sleep Reduction in daily sodium intake to 1 teaspoon of
salt daily Adequate potassium intake Limiting alcohol intake Increasing aerobic activity to 30-45 minutes four or
more days a week Cessation of smoking Decreasing stress levels with appropriate activities
DASH Diet Is a blood pressure lowering diet
Entails reducing: Saturated fats Cholesterol Total fat intake
Emphasis on increasing: Fruit intake Vegetables intake Low-fat dairy products Whole grains
Hypertension Clients with hypertension will be taking one or
more medications such as beta-blockers, calcium channel blockers, etc. (they all lower blood pressure)
These medications can cause blood pooling, which means you need clients to do a longer cool down
Beta blockers slow heart rates and prevent the heart rate from elevating as a normal response to exercise…this makes it difficult to follow heart rate as a measure of intensity
Use RPE scale instead of heart rate monitor watches, etc.
Safety Considerations for Clients with Hypertension Clients with controlled hypertension can
exercise with limited restrictions Studies have shown that exercise can
reduce resting blood pressure levels after long-term (chronic) exercise
Meta-analysis (review of many studies) studies have indicated that chronic exercise can lower systolic levels 4.5 mmHg and diastolic levels 3.8 mmHg
Safety Considerations for Clients with Hypertension Questions to be raised for clients
with hypertension: 1. At what intensity level can a client
be placed in order to cause the desired response?
2. Are any exercises contraindicated 3. What exercises can be given to the
client?
Safety Considerations for Clients with Hypertension Intensity
Lowering resting blood pressure can achieved with 40-50% maximal oxygen uptake
Lower intensity exercise in the literature appears to be better for lowering BP than high intensity exercise
Safety Considerations for Clients with Hypertension Contraindications
Any type of activity that would increase intrathoracic pressure, which will ultimately decrease necessary blood flow to the heart
Basically any exercise with prolonged valsalva maneuver (longer then 1-2 seconds)
Make sure breathing is proper (exhale on the exertion)
Safety Considerations for Clients with Hypertension Safe Exercises
Controlled hypertensive clients may participate in a variety of exercises including free weights, weight machines, body weight, walking, jogging, etc.
Only change would be clients with comorbid conditions (degenerative joint issues, neurologic, and vascular diseases)
Exercise Guidelines for Clients with Hypertension First note…if in Stage 1 (140-159/90-99) in BP, cancel
session and advise client to speak to his/her doctor Aerobic Conditioning
Goal is improve VO2 max as well as ventilatory threshold
Low-moderate intensity is fine Start at 40-50% VO2 max Ultimately want to attain 50-85% VO2 max RPE should 8-10 initially with a goal of 11-13 Each session should last 15-30 with a goal of 30-60
minutes 3-7 days per week Weekly calorie expenditure of 700-2000 kilocalories
Exercise Guidelines for Clients with Hypertension Resistance Training
Reps: 16-20 per set 50-60% of 1RM 2-3 minutes rest interval Client can do as little as 1 set per exercise
with a maximum of three Over time (4-6 months) reps can decrease
to 8-12 range Frequency should be 2-3 per week 30-60 minutes per session
Exercise Guidelines for Clients with Hypertension
Goals for clients with hypertension Increase VO2 max Increase maximal work and
endurance Increase caloric expenditure Control blood pressure Increase muscular endurance
Myocardial Infarction, Stroke or Peripheral Vascular Disease All of these serious conditions can
have ramifications physiologically and psychologically
True psychological effects can be: Fear of another acute event Fearlessness of participation
Pay attention to these signs!
Risk Factors Hypertension Hypercholesterolemia Diabetes Smoking Obesity Family history
Risk Factors Diabetes can exert an accelerated
effect on vascular disease thus having an independent effect on heart attacks
Obese individuals require more blood vessels to feed the adipose (fat) tissue thereby increasing cardiac workload
Family history: First degree relative (parent or sibling) with
known cardiac disease before age of 55 males or 65 females has an increased risk
Myocardial Infarction As a trainer you might be working with
someone who has had a heart attack and who has gone through cardiac rehabilitation and then been discharged from physician to continue with exercise
Get recent test data on new client: Exercise stress tests Letter of clearance Recommendations from cardiologist
Myocardial Infarction These reports are good as they let
the trainer know where the doctor left off and where you can begin
Be aware though that clients who are post MI and that have existing coronary artery disease without associated pain must be medically monitored while exercising
Myocardial Infarction Exercise Guidelines for Clients Post-
Myocardial Infarction Get clearance Get intensity guidelines from medical
professional Should provide MET or VO2 max base for
personal trainer to work with Program should be placed in client’s medical
file or sent to doctor for approval Monitor abnormal signs and symptoms:
Chest pain Palpitations Shortness of breath, neck pain, arm pain (R or L), back
pain, and a sense of impending doom.
Myocardial Infarction Exercise Program Components for
Clients Post-Myocardial Infarction Goals
Increase VO2 max Decrease blood pressure Reduce risk for further coronary artery
disease events Increase ability to perform leisure,
occupational and daily living activities
Myocardial Infarction Exercise Program Components for Clients
Post-Myocardial Infarction Aerobic
40% of VO2 max or RPE of 9-11 15-40 minute sessions, three to four times per week Additional time devoted to warm up and cool down Follow up stress test performed by a cardiologist
Resistance 20 reps One to three sets Two to three days per week Stress never performing valsalva maneuver
Cerebrovascular Accident (CVA) This is commonly called a stroke These clients generally have
neurological deficits (balance, etc.) and are best served by being monitored by health care professionals
However, if no neurological deficit and released by physician in unmonitored setting, you can provide guidelines coming up here…
Cerebrovascular Accident Exercise Guidelines for Post-
Cerebrovascular Accident Clients Many individuals have problems post CVA with daily
tasks because of decreased motor functioning Usually in arms, legs, face or mouth Some have trouble hearing, speaking, etc. However, a properly instituted program can
definitely improve the life of people who have had CVA
Trainer must stay in close contact with the rehabilitation team in order to ascertain the direction of training and proper establishment of goals.
Cerebrovascular Accident Exercise Program Components for
Post-Cerebrovascular Accident Clients Ergometers need to be the mainstay
of aerobic conditioning for post CVA clients
Balance is an issue with CVA clients No treadmills, etc.
Cerebrovascular Accident Exercise Program Components for Post-Cerebrovascular
Accident Clients Aerobic
Intensity can begin as low as 30% peak VO2 since clients are severely deconditioned
Post-CVA clients may eventually get to 40-70% peak VO2 Sessions between 5-60 minutes Frequency three times per week
Resistance Will help to build new neurologic pathways for affected limbs Start out slow with weights Encourage the client to strive for three sets of 8-12 reps, two to
three days a week Flexibility
Is important to prevent “freezing” and calcification of joints Balance exercise are good to do as well Performed before and after each training session, as well as on
non-training days
Peripheral Vascular Disease PVD clients have a real challenge due to pain
upon walking They cannot walk for more than two to five
minutes without having to stop and rest because of the searing pain in their calves
The goal is to increase the length of their activity to improve quality of life and possibly avoid the need for surgical intervention
If experiencing anything suggestive of cardiac compromise, he or she must stop immediately, sit or lie down flat, and use the prescribed nitroglycerin while someone calls emergency services (typically 911).
Peripheral Vascular Disease Clients must be aware that
exercise may facilitate a cardiac event in PVD clients
Make sure client is cleared form a cardiac viewpoint by an exercise stress test before starting a training program
Peripheral Vascular Disease Exercise Guidelines for Clients with Peripheral Vascular
Disease Aerobic Conditioning
To be able to walk pain free for greater distances The pain will hurt a lot for them, not a little (the pain is the rate-
limiting factor) Walk until it hurts, stop, do it again and so on Duration between 10-30 minutes Goal is to lengthen time and shorten rest until exercise becomes
one long continuous activity Resistance Training
Same as hypertensive client (low intensity) PVD with angina pectoris is a group that is felt to be at too high
a risk for a personal trainer who is functioning in a typical health club
Such clients should be trained and monitored at a medical facility
Chronic Obstructive Pulmonary Disease COPD includes asthma, chronic bronchitis and
emphysema Asthma
Reversible airway disease with associated hyperreactivity, characterized by ease of developing bronchspasm, constriction or both
A common asthma is exercise induced asthma Usually self-limiting Rarely results in hospitalization Begins 15-20 minutes (sometimes as early as five
minutes) into exercise Prevention can be achieved by using a bronchodiolator
15-20 minutes prior to exercise
Asthma Exercise Guidelines
Use RPE scale to monitor intensity, many clients are unable to achieve a training heart rate
Asthmatic clients do better with mid-to late morning exercise sessions because of natural release of cortisol from adrenal glands
Avoid extreme temperatures as they can induce an asthma attack
Asthma Exercise Program Components for
Clients with Asthma Aerobic Training Program
RPE of 11-13 with continuous monitoring for dyspnea (shortness of breath)
1-2 times daily 3-7 days per week Around 30 minutes per session
In the beginning may only be able to perform 5-10 min.
Resistance Training A general resistance training program is
recommended Resistance training should try to increase
maximum repetitions (to desensitize to shortness of breath), increasing the amount of training volume,and increase lean body mass
Lighter loads (16 or less) 2-3 days per week