ISSA Chapter 16: Chronic Conditions
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ISSA Chapter 16: Chronic Conditions 1

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    Chapter Goals:

    • Discuss the risk factors for hypertension.
    • Find interventions that are safe and effective for impacting blood glucose levels.
    • Find the different types of arthritis.
    • Discuss the conditions and behaviors that contribute to heart disease.
    • Know the exercise considerations for people that have asthma.

    Exercise and Hypertension

    The CDC has found that 1 in 3 adults have high blood pressure levels, also called hypertension.

    People with high blood pressure will have readings of over 140 systolic and 90 diastolic.

    Hypertension is rough when starting a new program.

    Hypertension increases the risk for both heart disease and stroke, which are the two leading causes of death in Americans.

    A stroke is when the blood flow to the brain is interrupted long enough to cause damage to the tissues.

    Increasingly seen are cases of youth being diagnosed with high blood pressure.

    At the root of the causes are a person’s diet and exercise.

    Medications are often prescribed to help control blood pressure, but it is better to first modify lifestyle choices and physical activity for a lasting healthy change.

    Postexercise hypotension defines a drop in blood pressure that follows the first minutes after an exercise session.

    Some hypertensive causes are hereditary, which means they relate to the biological process responsible for passing traits from one generation to the next.

    Blood Pressure Risk Factors

    The values of blood pressure are measured in millimeters of mercury.

    The average healthy blood pressure is 120 / 80 mm Hg or less.

    Prehypertension is systolic of 120 – 139 and/or a diastolic of 80 – 89.

    High blood pressure is seen as a combination of factors like obesity, unhealthy diet, and physical inactivity, with some relation to smoking and alcohol consumption for people that partake in those.

    Diabetes Mellitus

    Diabetes is a condition that shows an elevated level of glucose in the blood.

    Diabetes changes the way the body manages insulin and blood vessel damage.

    This leads to reductions in nitric oxide levels, which are used for the regulation of blood pressure.

    Low nitric oxide can lead to atherosclerosis, which is a buildup of fats, cholesterol, and other things in the walls of the arteries.

    Unhealthy Diet

    High sodium and low potassium are two of the first thoughts when it comes to diet and high blood pressure.

    Physical Inactivity

    Sedentary behavior is responsible for many cases of hypertension.

    It is important to stay physically active to help prevent weight gain and lessen the chance of other health issues starting.

    Alcohol Consumption

    Excessively consuming alcohol can raise blood pressure.

    The mechanism as to how it occurs is not entirely conclusive but there are multiple theories.

    Hypertensive Program Design

    In around eight weeks, there can be improvements in lean body mass, cardiorespiratory fitness, strength, and diastolic blood pressure.

    Changes in blood pressure values are not expected to be seen until around week 12 of training.

    For cardiorespiratory exercise, it is recommended to get 150 minutes of moderate-intensity exercise each week, or 75 minutes of vigorous activity, or any combination of those two aspects.

    For resistance exercise, it is recommended to do moderate-intensity exercise two days each week and increase the intensity over time, as well as warm-up and cool down.

    Concurrent training is defined as both cardio and resistance training put into a fitness program.

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    Concurrent training is one of the best options for someone looking to improve their blood pressure.

    Some special considerations are: controlled breathing, maintaining intensity, and the warm-up and cooldown.

    Clients should not hold their breath when exercising, and should instead aim to breathe normally.

    Holding one’s breath causes intravenous pressure to rise and may result in syncope and injury.

    The valsalva maneuver is the act of forcibly exhaling with a closed windpipe, where there is no air that is exiting the nose or mouth.

    The valsalva maneuver should be avoided when someone has high blood pressure.

    The max heart rate formula needs adjustment when someone has blood pressure issues.

    Beta-blockers are some of the medicines which are most widely used to treat hypertension.

    Estimated heart rate = 162 – (0.7 times Age) when working with hypertensive clients.

    Warm-up is especially needed for hypertensive clients. Somewhere in the realm of 10 minutes of time is required if the client has been inactive for a long time.

    The cooldown is equally important and it should never be allowed to just stop activity immediately.

    Both the warming up and cooling down of the workout needs to be focused on and implemented well.

    The DASH diet stands for the dietary approach to stop hypertension. This diet method looks to implement low sodium, whole foods which are created for the treatment of hypertension.

    Exercise and Diabetes

    When someone eats, the food is going to be converted to energy for use in the body. Healthy people will secrete insulin from the pancreas to regulate many of the processes in the metabolism.

    For diabetic clients, the body is either going to not make enough insulin, or it does not use the insulin very sufficiently.

    The result for both conditions is an excess amount of glucose in the blood, which can lead to issues like heart disease, loss of vision, or kidney disease over time.

    Men with diabetes are 2 – 3 times more likely to suffer cardiovascular disease, and women are 3 – 5 times more likely.

    Cardiometabolic means a combination of metabolic dysfunctions which are characterized by resistance to insulin, impairment of glucose tolerance, dyslipidemia, hypertension, and central adiposity.

    Prediabetes is a condition where blood glucose is higher than it needs to be, but not in the rage of diabetes yet.

    Type 2 diabetes is a long-term metabolic disorder that has high blood sugar, resistance to insulin, and a lack of insulin. This form is developed later in life.

    Type 1 diabetes is a chronic condition where the pancreas has little to no insulin.

    Gestational diabetes is a condition that has an elevated level of glucose in the blood during pregnancy, typically resolving after birth.

    Risk Factors

    There is a chance that blood glucose gets too low, which is hypoglycemia. This needs to be treated quickly.

    Being overweight is a main risk factor for prediabetes, type 2 diabetes, and gestational diabetes.

    Diet and lifestyle choices do not affect type 1 diabetes as it is an autoimmune response.

    Diabetes can happen at any age, but the risk for prediabetes increases post 45 years old.

    Type 1 diabetes is more often going to develop as a young child, teen, or maybe even young adult.

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    Family history can be a strong indicator of the likelihood of developing diabetes. In most cases, the risk for prediabetes increases when a client has a parent or sibling with type 2 diabetes.

    Lacking physical activity is a lifestyle choice that puts one at a higher risk for prediabetes.

    Working out and staying active helps to prevent unhealthy types of weight gain.

    Ethnicity is a risk factor for all types of diabetes. Typically, black, Hispanic, American Indian, and Asian Americans are at a higher risk for type 2 diabetes.

    Also, Caucasians are at a higher risk for Type 1 diabetes than other ethnicities.

    Diabetes Program Design

    It is important for a trainer to ensure they have all of the necessary records and medical information regarding a new client.

    Low-to-moderate intensity activity is safe and effective for helping clients with prediabetes and type 2 diabetes lower their risk for cardiovascular events and complications.

    Retinopathy is a disease of the retina that results in impairment or loss of vision.

    Neuropathy is a disease or dysfunction of one or more peripheral nerves, typically causing weakness or numbness.

    Nephropathy is a disease or damage of the kidney.

    Advanced peripheral neuropathy is a result of damage to peripheral nerves that often causes weakness, numbness, and pain.

    Proliferative retinopathy is an overgrowth of blood vessels around the retina.

    An exercise stress test is recommended for all people with type 2 diabetes who have been diagnosed with one or more comorbidities.

    It is important for these clients to monitor blood glucose before and after exercise to help prevent cases of hypoglycemia and ketoacidosis.

    Exercise and Arthritis

    Arthritis is inflammation of the joints and has several forms and impacts over 50 million Americans.

    Osteoarthritis is a degenerative joint disease that is caused by wear and tear of the joints. The hands, hips, and knees are most often affected and this causes loss of strength, less flexibility, and joint pain.

    Rheumatoid arthritis is an autoimmune and inflammatory disease that most commonly affects the hands, wrists, and elbows. Around 1 percent of Americans have this condition, 2/3 are women.

    Fibromyalgia is a condition that causes pain all over the body, problems sleeping, fatigue, and emotional and mental distress. Clients with this will have abnormal pain perception processing, a side effect of the condition, which causes them to be much more sensitive to pain.

    Gout is inflammatory arthritis that affects one joint of the body at a time. This condition comes and goes unpredictably.

    Risk Factors

    Age is a significant factor in rheumatoid arthritis and osteoarthritis, and the risk increases with age.

    The highest onset of rheumatoid arthritis is around age 60, while most cases of fibromyalgia are diagnosed by middle adulthood.

    Sex matters with arthritis as women are more likely to get it than men are.

    Obesity is a big risk factor for all types of arthritis as being at a greater weight puts more load on the joints and increases stress.

    Genetics matters with rheumatoid arthritis and osteoarthritis.

    Overuse happens to the joints over time and this is a major risk factor for arthritis, and especially fibromyalgia.

    Smoking is another risk factor that plays a role in arthritis risk.

    Health history and nutrition also need to be taken into account for arthritis risk.

    Arthritis Program Design

    Clients can rest assured that exercise is safe and effective at helping manage symptoms, reduce arthritis pain, and reduce or prevent complications of comorbidities.

    Clients need to ensure that they warm-up and slowly move their joints through full ranges of motion.

    After 1 – 2 weeks depending on the client, isotonic exercises can be done.

    Aerobic Exercise should meet these recommendations:

    • 150 minutes of moderate activity, or
    • 75 minutes of vigorous activity, or
    • a combination of these two aspects
    • The activity done can be anything from brisk walking, cycling, swimming, water aerobics, gardening, and group classes.

    Strength training should have arthritic clients training for 2 – 3 days per week.

    Clients should look to achieve around 80 percent of their one rep max.

    The SMART plans of action for clients with arthritis is:

    • S: starting low and going slow
    • M: modifying activity when symptoms increase but trying to stay active
    • A: activities should be “joint friendly”
    • R: recognizing safe places and ways to be active
    • T: talking to a health professional or certified exercise specialist

    Exercise and Coronary Heart Disease

    Coronary artery disease shows a narrowing or blockage of the coronary arteries.

    Heart disease is the leading cause of death in the US for both men and women, and the leading cause of heart attacks is this coronary artery disease.

    Arrhythmia is a description of an irregular or unusually fast or slow heartbeat.

    Cardiomyopathy is when the heart becomes enlarged or stiff. It makes it tougher for the heart to pump blood.

    Heart failure is also known as congestive heart failure, and this is when the heart is too weak to pump blood to meet the body’s needs.

    Peripheral arterial disease is when the blood vessels in the arms and legs become narrowed or stiff, usually due to atherosclerosis.

    Angina is the most common coronary artery disease symptom, and it progressively weakens the heart muscle, which leads to arrhythmia or heart failure.

    The risk factors for CAD are obesity, physical inactivity, high blood pressure, smoking, and diabetes.

    The programs should be in line with cardiac rehabilitation. This has an acute phase, subacute phase, intensive outpatient therapy, and independent ongoing conditioning.

    A program like this will last 12 weeks or more and is quite beneficial in recovery.

    It has the same time requirements as the other forms of exercise and the program recommendations.

    The signs and symptoms of a heart attack are:

    • chest pain or discomfort
    • upper body pain
    • shortness of breath
    • nausea, lightheadedness, or cold sweats

    Exercise and Asthma

    Asthma is a chronic respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing.

    Hyperresponsiveness is the acute, early phase of an asthma attack.

    Asthma has many triggers, like:

    • smoke
    • dust mites
    • outdoor pollution
    • cockroach allergen
    • pets
    • mold
    • infections

    Hyperventilation means breathing at an abnormally rapid rate, increasing the rate of loss of carbon dioxide.

    The risk factors for asthma are sex, family history, allergies, smoking, and obesity.

    Exercise-induced asthma is known as exercised-induced bronchoconstriction, and it is an asthma attack triggered by doing sports or physical activity.

    Gastroesophageal reflux disease is a condition where acidic gastric fluid flows backward into the esophagus, resulting in heartburn.

    Chronic obstructive pulmonary disease is a lung disease characterized by chronic obstruction of the lung’s airflow that interferes with normal breathing and is not fully reversible.

    ISSA Chapter 16: Chronic Conditions 2
    ISSA Chapter 16: Chronic Conditions 3
    ISSA Chapter 16: Chronic Conditions 4

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