Ch. 13 Considerations for Clients w/ Chronic Disease Flashcards
What should modifications to an exercise program with a client who has a chronic disease be based on?
- Characteristics of the disease
- Any restrictions that the disease places on clients and how they will respond to exercise
- Disease severity
- Safety concerns
- Activities to emphasize
- Activities to avoid
What is the leading cause of death and the leading cause of disability in men and women in the US?
- Cardiovascular disease (CVD) such as heart disease and stroke
Reducing what 3 risk factors would dramatically reduce the incidence of chronic disease?
- Poor diet
- Physical inactivity
- Smoking
What is a SOAP note?
- Subjective: observations that include the client’s own status report, a description of symptoms, challenges with the program, and progress made
- Objective: measurements taken (HR, BP, height, weight, age, posture, result from assessments), as well as exercise and nutrition log information
- Assessment: brief summary of client’s current status based on the subjective and objective observations and measurements
- Plan: a description of the next steps in the program based on the assessment
What is coronary artery disease (CAD)?
- AKA atherosclerotic heart disease
- Narrowing of the coronary arteries that supply the heart muscle w/ blood and oxygen
- Narrowing of arteries is an inflammatory response due to high BP, elevated levels of low-density lipoprotein cholesterol, elevated glucose levels, and chemicals from cigarettes
- Continues to be the leading cause of death in the developed world
What percent is attributed to US deaths caused by heart disease, stroke, and type 2 diabetes in 2012 were attributable to dietary habits?
- 45%
What does a low-risk CAD client entail?
- An uncomplicated clinical course in the hospital
- No evidence of resting or exercise-induced ischemia
- Functional capacity >7 metabolic equivalents (METs) three weeks following any medical event or treatment that required hospitalization (angina, heart attack, or cardiac surgery)
- Normal ventricular function w/ an ejection fraction greater than 50%
- No significant resting or exercise-induced arrhythmias (abnormal heart rhythms)
What are the 2 types of hypertension?
- Essential hypertension (primary hypertension): no known or evident cause (90-95%)
- Secondary hypertension: result of some identifiable cause (5-10%)
What are the categories of blood pressure in adults?
- Normal = <120 mmHg systolic AND <80 mmHg diastolic
- Elevated= 120-129 mmHg systolic AND <80 mmHg diastolic
Hypertension - Stage 1= 130-139 mmHg systolic OR <80-89 mmHg diastolic
- Stage 2= >140 mmHg systolic OR >90 mmHg diastolic
What things can lead to essential hypertension?
- Stress
- Body weight (especially excess body fat)
- Sleep
- Excessive sodium intake
- Increase alcohol intake
- Physical inactivity
What are some of the lifestyle modifications (treatment) to manage hypertension?
- Weight reduction
- Adopt DASH eating plan
- Dietary sodium reduction
- Physical activity
- Moderation of alcohol
What is the DASH eating plan?
- Dietary Approaches to Stop Hypertension
- Advocates consuming fiber and potassium via fruits, vegetables, and whole grains, reducing sodium intake, reducing total and saturated fat, and getting adequate protein via lean meat and low-fat dairy products instead of high fat or processed meat
What type of medication can put individuals at higher risk for dehydration?
- Diuretic
What is a stroke?
- Occur when blood supply to the brain is compromised (ischemic stroke 80%) or when a blood vessel in the brain bursts (hemorrhagic stroke)
What is an aneurysm?
- Balloon-type bubble in the vessel at a weak spot that can rupture if left untreated
What is the most important modifiable risk factor for stroke? And what are other factors?
- Hypertension
- Smoking, heart disease, previous stroke, physical inactivity, and transient ischemic attack (TIA)
What are some of the warning signs of a stroke?
- Sudden numbness or weakness of the face, arms, or legs
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble seeing in one or both eyes
- Sudden walking problems, dizziness, or loss of balance and coordination
- Sudden severe headache with no known cause
What is peripheral arterial disease (PAD)?
- Results from atherosclerosis of the arteries of the lower extremities
What are the 2 most prominent risk factors for peripheral arterial disease?
- Smoking
- Diabetes
What is the major carrier of cholesterol in the blood?
- Low-density lipoprotein (LDL)
- Containing 60-70% of the body’s total cholesterol
- Frequently referred to as the “bad” cholesterol because of its role in atherogenesis (the early stages of atherosclerosis)
What do high-density lipoproteins do?
- Transports lipids to the liver for recycling and removal
- Referred to as the “good” cholesterol
- Carries 20-30% of the body’s total cholesterol
What is dyslipidemia?
- Undesirable levels of lipids
What is diabetes?
- Group of metabolic disorders involving an absolute or relative insufficiency of insulin secretion
- Main ones are type 1 & type 2 diabetes
What is type 1 diabetes?
- Caused by an absolute insulin deficiency after the body’s immune system attacks and destroys the beta cells of the pancreas, which make insulin
- Because of that destruction, insulin must be injected or infused to regulate blood sugar
What is type 2 diabetes?
- Due to the fact that the cells of the body are not sensitive (responsive) to insulin (i.e., relative insulin deficiency), such that more is needed for the same effect. Over time, the production of insulin cannot be increased enough and blood glucose levels rise
- More than 90% of people with diabetes have type 2 diabetes
What is insulin resistance?
- The inability of insulin to effectively promote the uptake of glucose into cells to lower blood glucose levels
What are 2 of the most important changes one can make to lower systemic inflammation and the risk of developing metabolic diseases?
- Being active
- Eating more fiber
What is metabolic syndrome (MetS)?
- Not a disease but rather a cluster of conditions that increases a person’s risk for developing heart disease, type 2 diabetes, and stroke
How can MetS be identified? (3 or more of the following)
- Elevated waist circumference (men >40 in & women>35 in)
- Elevated TG (>150 mg/dL)
- Reduced HDL cholesterol (men <40 mg/dL & women <50 mg/dL)
- Increased BP (systolic and/or diastolic >135/85 mmHg)
- Elevated fasting blood glucose (>100 mg/dL)
What is chronic obstructive pulmonary disease (COPD)?
- Result of chronic airway inflammation due to exposure to substances such as tobacco smoke and various other environmental and occupational pollutants
What are the 3 most common COPDs?
- Asthma
- Chronic bronchitis
- Emphysema
What is asthma?
- Chronic inflammatory disorder of the airways in which many cells and cellular elements play a role
- Causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing
What are asthma attacks during and/or after exercise called?
Exercise-induced bronchoconstriction (EIB)
What general activity guidelines can help a PT develop, monitor, and progress an exercise program for clients with asthma?
- Clients should have rescue medication with them
- Clients should drink plenty of fluids before exercise and consider moving indoors on extremely hot/cold days or when pollen counts are high
- Clients should utilize prolonged warm-up and cool-down periods
- Initial intensity should be low and gradually increase
- PTs should closely observe clients for early signs of EIB
- People w/ asthma often respond best to exercise in mid-to-late morning
What is bronchitis?
- Characterized by the chronic production of sputum, often resulting in airflow obstruction due mainly to thickened bronchial walls and secretions
What is emphysema?
- Characterized by distention and destruction of the alveoli
What is cancer?
- A collection of approximately 200 related diseases characterized by the uncontrolled spread and growth of abnormal cells
What does a malignant tumor mean?
- It can invade nearby tissues
What does metastasize mean?
- Result of cancer cells breaking off from the original tumor and traveling to distant sites via the blood or the lymph system to form new tumors
What does a benign tumor mean?
- Tumors that do not spread to other tissues
What are the 3 general phases of cancer survivorship?
- ) Treatment & recovery
- ) Living after recovery
- Advanced cancer and end of life
What are the 5 leading behavioral and dietary risks associated to dying from cancer?
- High BMI
- Low consumption of fruits and vegetables
- Physical inactivity
- Tobacco use
- Alcohol intake
What benefits does exercise bring to individuals with cancer?
- Preservation of muscle mass
- Increase in muscular strength and endurance
- Improved balance and overall physical function
- Reduction in fatigue, nausea, anxiety, and depression
- Decreased risk for heart disease, osteoporosis, and diabetes
What are the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention?
- Limit processed meat and red meat
- Consume 2.5 cups of vegetables and fruits daily
- Choose whole grains instead of refined grain products
- If alcoholic beverages are consumed, limit consumption to no more than one drink daily for women or two drinks daily for men
What is the dose-response association between physical activity and mental health?
- Being physically active up to the point of approximately 50 minutes of moderate-to-vigorous physical activity or 16000 steps per day correlated with positive mental health benefits
- Sedentary time hampered the benefits of physical activity
What is osteoporosis?
- Characterized by low bone mass and disrupted microarchitecture
- Affects more women than men
What health conditions can increase the likelihood of osteoporosis?
- Autoimmune
- Hematologic
- Endocrine
- Gastrointestinal
- Neurological disorders
- Cancer
- Mental illness
What are the 2 most important nutrients to consider in bone health?
- Calcium
- Vitamin D
What is arthritis? What are the most common types?
- Chronic degenerative condition of the joints
- Osteoarthritis (OA) & Rheumatoid arthritis (RA)
What is rheumatoid arthritis?
- Characterized by joint swelling, pain, and stiffness that can lead to severe motion impairment
What kind of diet is good for someone with osteoarthritis or rheumatoid arthritis?
- Diet rich in omega-3 fatty acids, antioxidants, and phytochemicals provide the body with powerful anti-inflammatory nutrients
- Mediterranean-style eating plan
