NSCA CPT Chapter 20 – Clients With Cardiovascular and Respiratory Conditions

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Chapter Objectives:

• Know the Pathology and risk factors of hypertension, heart attack, cerebrovascular accident, peripheral vascular disease, asthma, and exercise induced asthma.
• Know the stages of various diseases and how exercise can be used to enhance client quality of life.
• Understand the time it is appropriate to refer a client to a medical professional.

Health Screening and Risk Stratification

This is a critical component before beginning any fitness assessment or program. For these clients with cardio and respiratory conditions, physician approval is needed before starting, too. 

Trainers must also have additional training that relates to the condition that the patient has so that they can be prepared to know how various treatments and conditions react with other variables of training.

Hypertension

Hypertension is basically high blood pressure, and more specifically it is a systolic reading of 140 or more and/or a diastolic reading of 90 or more. It is found in all age groups, not just the old.

This is an idiopathic disease, so it doesn’t have a known cause.

These elevated blood pressures put the client at risk for strokes, heart attacks, or possibly both. 

Mild elevation of blood pressure will possibly lead to kidney disease and generalized vascular disease. There is no way to determine if your blood pressure is high based on how you feel.

The risk stratifications are:

• Normal = systolic < 120 and diastolic < 80
• Prehypertension = systolic 120 – 139 and diastolic 80 – 89 
• Stage 1 hypertension = systolic 140 – 159 and diastolic 90 – 99
• Stage 2 hypertension = systolic > 160 and diastolic > 100

Clients who have stage 1 hypertension or greater do not need to be trained until their blood pressure is better controlled or their doctor clears them.

Management of Hypertension

Managing hypertension typically includes things like proper exercise techniques, losing weight, and changing the diet. Some other general changes are things like getting enough sleep, reducing daily intake of sodium, taking in enough potassium, limiting alcohol, and increasing the amount of aerobic activity to 30 to 45 minutes for four or more days within a week.

People with hypertension will likely be taking medications like beta blockers, calcium channel blockers, ACE inhibitors, ARBs, alpha blockers, and diuretics.

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Safety Consideration for Clients With Hypertension

Intensity

People will receive positive training results when working out at a 40 – 50% max oxygen uptake.

This will keep the client likely away from risk increases.

Contraindications

Exercises that are contradicted include the activities that increase thoracic pressure. These decrease blood flow to the heart and therefore will decrease the cardiac output.

Safe Exercise

Safe things are things like free weights, weight machines, body weight, or elastic bands. Aerobic exercise and circuit weight training are also allowed.

Exercise Guidelines for Clients With Hypertension

Aerobic Conditioning

The goal is to increase VO2 max and ventilatory threshold.

The advised intensity level to begin the program is 40 – 50% VO2 max. The RPE should be from an 8 – 10 on the 20 point scale with an eventual goal of 11 – 13. On a weekly basis we would like to expend 700 – 2000 kcals. 

Resistance Training

Rep ranges should consistently be at 16 – 20. This will have them working at 50 – 60% of 1RM on the exercises. Rest intervals will all be 2 – 3 minutes or longer if the client needs. A max of three sets per exercise is advised. The client will be working toward moving into 8 – 12 reps per set and a duration of 30 – 60 minutes per session.

Myocardial Infarction, Stroke, and Peripheral Vascular Disease

Pathophysiology

This is the same for all three of the diseases because they all represent the end result of vascular occlusive diseases at various body levels. Plaque forms within the lumen of a blood vessel. Focal inflammation occurs around the plaque area which will lead to some instability. Collagen develops so that it can stabilize the area by use of a subsequent overlaying by smooth muscle. There are different results next, depending on the timeframe.

Risk Factors

Risk factors for these three are things like hypertension, hypercholesterolemia, diabetes, smoking, obesity, and also family history.

Myocardial Infarction

Cardiac muscle will potentially die during a myocardial infarction. Because the client will have gone through rehab and is cleared by the physician, the trainer will have access to a lot of recent and thorough testing to improve their program.

Exercise Guidelines for Clients Postmyocardial Infarction

These clients are not to train until they have clearance from the required doctors. The doctors must provide the intensity level and training range for the trainer to follow. 

Exercise Program Components for Clients Postmyocardial Infarction

The goals for these clients should be:

• Increase aerobic capacity. 
• Decrease blood pressure. 
• Reduce risk of coronary artery disease. 
• Increase ability to perform leisure, occupational, and daily living activities. 
• Increase muscle strength and endurance. 

Clients who have had a myocardial infarction should not do the Valsalva maneuver.

Cerebrovascular Accident

Exercise Guidelines for Post-Cerebrovascular Accident Clients

These clients may face big challenges when starting a program, and it depends on which part of the brain has been affected.

The trainer needs to be in close contact with the rehab team that worked with the client, because the program will have to be very specific to the client.

Exercise Program Components for Post-Cerebrovascular Accident Clients

Ergometers are the main equipment to be used by post-CVA clients. Exercise may begin as low as 30% of the client’s VO2 max, but they may eventually reach 40 – 70%. Sessions will be 5 – 60 minutes. Range of motion is emphasized in the program, and the exercise for it will be done before and after the training sessions. Coordination and balance are the other large portion of the program typically.

The goals following a CVA accident are: 

Increase daily living activities. 

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Increase strength for both involved and uninvolved limbs. 

Increase range of motion of the involved side. 

Prevent joint contractures. 

Peripheral Vascular Disease

These patients cannot typically walk for more than 2 or 5 minutes without stopping and resting. They have the ability to make really impressive gains with their programs.

Exercise Guidelines for Clients With Peripheral Vascular Disease

Exercise for a client with a PVD may cause a cardiac event, so it’s important to keep that in mind.

The trainer will work with the physician closely to make a program because they vary so much.

Exercise Program Components for Clients With Peripheral Vascular Disease

The goals are to:

• Improve pain response; be active for increasingly longer periods. 
• Reduce risk of coronary artery disease. 
• Improve gait.
• Increase daily living activities. 
• Increase work potential. 
• Improve quality of life. 

Chronic Obstructive Pulmonary Disease

This is used to describe a lung disease that becomes worse due to it not being reversible completely. Patients with COPD need to exercise in a rehab facility that specializes in formal pulmonary and respiratory care, and not under the guidance of a personal trainer in their own facility.

Asthma

This is a reversible airway disease that is associated with hyperactivity and characterized by ease of developing bronchospasm, constriction, or even both of these.

Exercise Guidelines for Clients With Asthma

For asthma clients, the intensity needs to be monitored with the RPE scales and the sense of having a shortness of breath. Many asthma clients won’t achieve training heart rate, but they will probably exhibit physiological improvements.

Exercise Program Components for Clients With Asthma

Large muscle aerobic helps to improve the VO2 max and endurance of clients. There will be a decrease in the shortness of breath and an increase in activities of daily living will occur.

Clients should maintain an RPE of 11 – 13 and they will be monitored the whole time for dyspnea. Sessions are typically 30 minutes, but they may only start at about 5 minutes if that’s what’s best for them. 

General resistance programs are recommended. It will use lighter loads and more reps and take place 2 – 3 days per week.

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