ACE CPT Chapter 14 – Exercise and Special Populations

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Notes on SOAP

• Subjective: These are the client’s personal symptoms, challenges, progress, and report.
• Objective: These are exercise, nutrition log, vital signs, and anthropometrics
• Assessment: This is the summary of all objective and subjective observations
• Plan: This is the description of what needs to be done

Cardiovascular disorders

• It’s important to note that exercise should not go on if abnormal symptoms/signs are observed in the client.
  1. Symptoms include lightheadedness, Pallor, angina, dizziness, dyspnea, or quick heart rate above target zones.
• Clients with CAD (coronary artery disease)
  1. Need a physician-supervised exercise test for maximal grade
     • This helps determine the safe exercise levels in the functional capacity of the client
• Hypertension
  1. 150 minutes weekly may reduce SBP 2-6mmHg
  2. Acute post-exercise lowering of DBP and SBP
     • And the magnitude of 15 and 4mmHg for DPB/SBP
  3. Heart rate response altering medications
     • Calcium channel blockers and beta blockers
  4. Clients’ hydration can be affected by diuretic medications
• Stroke
  1. The signs of a stroke:
     • Sudden weakness/numbness of arms, face, and legs
     • Sudden confusion or difficulty speaking/understanding
     • Difficulty seeing in both or one eye
     • Sudden difficulty with balance, coordination, and walking
     • Sudden extreme headache with no apparent cause
  2. Exercise recommendations for people recovering from a stroke
     • A lot depends on how many functions were lost from the stroke
     • Aquatic exercise adapted exercises and stationary cycling are possibilities
     • Light-moderate intensities only
     • Bouts of 3 to 5 minutes
       1. Try to build up to 30 minutes
       2. 3 to 5 sessions per week
• Peripheral vascular disease
  1. Muscular pain that is caused by a lack of blood flow or ischemia
     • Can result in blockages/claudication or spasms
  2. Recommendations for exercise
     • Non-impact endurance exercise
     • Low-Moderate intensities
     • 10 minute+, four cool down and warm-ups
     • A gradual increase to 30 to 60 minutes
     • Daily exercise
     • Have the client avoid cold water/cold air to prevent vasoconstriction
• Dyslipidemia
  1. This is elevated triglycerides
  2. Lowered HDL
  3. Elevated LDL
     • Plays a role in earlier stages of atherosclerosis (atherogenesis)
  4. Effects from exercise
     • Can reduce LDL cholesterol on average by 3 to 6 mg/dl
     • Can reduce non-HDL cholesterol on average by 6 mg/dl
     • No consistent change in TG
     • No consistent change in HDL cholesterol
     • Three times a week may reduce LDL, non-HDL, and TG by 6 to 9 mg/dl on average
       1. Note no effect on HDL
• Diabetes
  1. Hyperglycemia – Chronic elevation of blood glucose
  2. Type II diabetes: Also known as non-insulin dependent diabetes mellitus or NIDDM
     • This is the most common form of diabetes
     • Approximately 90% to 95% of diagnosed diabetes
     • Cells cannot use insulin correctly (insulin resistance)
     • Approximately 75% of patients with type II diabetes are obese
  3. Gestational diabetes or GDM: This is a glucose intolerance that happens during pregnancy
  4. Exercise guidelines for type I diabetes
     • 3 to 5 sessions per week or every day
     • Training at a 55% to 75% of functional capacity or 11 to 14 RPE on the Borg scale
     • Avoid high intensity or prolonged training
       1. With prolonged duration, there is a risk of hypoglycemia
       2. Increased risk of hypoglycemia with higher intensity exercises
  5. Potential complications
     • Do not exercise if fasting glucose levels are at 250 mg/dl or more
     • Avoid exercise if blood glucose levels are higher than 300 mg/dl
     • Do not exercise during peak insulin activity
     • Keep client hydrated
• Metabolic syndrome (affects more than 25%)
  1. Elevated blood pressure, abnormal obesity, atherogenic dyslipidemia, insulin resistance, pro-inflammatory state, pro-thrombotic state
  2. Indicated as three or more of the following:
     • Waist circumference
       1. More than 40 inches or 102 cm for men
       2. More than 35 inches or 88 cm for women
  3. High triglyceride levels (more than or equal to 150 mg/dl)
  4. Low HDL cholesterol levels
     • Less than 40 mg/dl four men
     • Less than 50 mg/dl for women
  5. Blood pressure readings of more than or equal to 130/85
  6. A fasting blood glucose level of 100 mg/dl or more
• The primary objective is to reduce the risk of developing type II diabetes and CV
• Exercise
  1. Very low impact, non-weight bearing for obese clients
  2. Borg scale between 11 and 13 RPE or 30% to 75% VO2R
  3. Approximately 200 to 300 total minutes of exercise weekly
     • Progress from short 10-15 minute bouts of exercise to longer ones
  4. The client should train at least 3 to 5 times per week

Asthma

• Clients have to have rescue medication on their bodies at all times

Osteoporosis

• Defined by a bone mineral density of 2.5 or more standard deviations below the mean for young adults.
• Osteopenia – not as severe as osteoporosis, Bone mineral density between one and 1.5 deviations
• Increasing bone mineral density
  1. Weightlifting exercises
  2. Plyometric training
• Avoid the following exercises for clients that have spinal problems/fractures
  1. Crunches, spinal flexion, and rowing machines
  2. High-impact aerobics/jumping
  3. Step aerobics/trampolines
  4. Abducting and adducting legs against resistance
  5. Pulling on the neck while hands are cusped behind the head

Arthritis

• The biggest cause of disability in the United States
• Most common forms
  1. Osteoarthritis
  2. Rheumatoid arthritis
• Classifications
  1. Class number one: Can completely perform usual ADLs
  2. Class number two: can perform self-care as well as vocational activities but are limited with avocational activities
  3. Class number three: Can do normal self-care but is limited with vocational/avocational activities
  4. Class number four: Is limited in what they can do with their normal self-care as well as vocational/avocational activities

Chronic fatigue syndrome

• Work/rest = 1/3

Lower back pain

• Avoid the following
  1. Forward flexion that is unsupported
  2. Twisting at the waist (with turned feet)
  3. Lifting both legs at the same time while in a supine or prone position
  4. Quick/rapid movements

Older clients

• Sensory system
  1. The visual system is relied on for balance
  2. Central nervous system
  3. Vestibular – Provides head position information
  4. Somatosensory – Impacts the coordination and balance

Pre-and postpartum

• Pregnant clients need clearance from a physician
• Avoid the following
  1. Hopping, bouncing, skipping, jumping, and running
  2. full sit-ups, knee bends (deep), double leg raise
  3. In a contact sport
  4. Stretching that involves bouncing
  5. Any activity where falling is a possibility
  6. After the first trimester
     • It’s discouraged to have clients stay in the supine position for more than five minutes.
       1. This is because it has a fetal hypoxia potential.

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