Chapter 13 - Considerations for Chronic Disease Flashcards
Chronic conditions that general exercise guidelines apply to.
The general guidelines apply to conditions such as uncomplicated coronary artery disease, hypertension, dyslipidemia (blood lipid disorder), diabetes, MetS (metabolic syndrome), asthma, cancer, and osteoarthritis
Modifications to exercise programs for someone with a chronic disease should be based on:
- Characteristics to the disease
- Restrictions that the disease places on someone
- Disease severity
- Activities to emphasize
- Activities to avoid
Three factors that would dramatically reduce chronic disease
Smoking, Physical Activity, Poor diet
Information a PT should gather from a client’s physician
Medical release (permission to exercise) Exercise limitations - HR limitations Exercise guidelines
SOAP Notes
A way to document client progress. Documents patterns of self image vs actual performance.
Subjective - client observations of status, description of symptoms, challenges w/program, progress made
Objective - Measurements taken, exercise & nutrition log (include date)
Assessment - Summary of client status based on S and O
Plan - Description of next steps based on assessment
PT Responsibility When Working with Clients Who Have Chronic Disease
Expand knowledge and skills through continuing education and close communication with healthcare professionals
Nutrition Statistics Regarding Chronic Disease
45% of deaths caused by heart disease, type 2 diabetes, and stroke were attributable to dietary habits. (US study)
Recovery from a cardiac event (MI, procedure, surgery, angioplasty, stent)
Recovery is almost always improved with an appropriate exercise program. Avoid Valsalva maneuver. Stop exercise if angina, dyspnea, lightheadedness, dizziness, pallor, or rapid HR.
Description of low-risk CAD clients (Cardiovascular Disease)
- Uncomplicated clinical course in hospital
- No evidence of resting or exercise induced ischemia
- Functional capacity >=7 METS after 3 wks post treatment
- Normal ventricular function (ejection fraction >50%)
- No resting or exercise induced arrhythmias
FITT Recommendations for Clients with Cardiovascular Disease
Frequency - cardio 3-5days/wk, strength 2-3days/wk
Intensity - moderate to vigorous, moderate
Time - cardio goal of 20-60 min w/warm up and cool down, no specific duration for strength
Type - Rhythmic large muscle groups, various exercises for strength one set initially
Two types of hypertension
Essential or Primary Hypertension - most prevalent, no know cause
Secondary Hypertension - caused by another disease such as kidney disease
Lifestyle Changes to Manage Hypertension
- Maintain normal bodyweight (5-20 mm/Hg)
- Adopt DASH eating pattern (dietary approaches to stopping hypertension) (8-14 mm/Hg)
- Dietary sodium reduction (2-8 mm/Hg)
- Physical activity (4-9 mm/Hg)
- Moderation of alcohol (2-4 mm/Hg)
FITT Recommendations for Clients with Hypertension
Frequency - cardio every day preferable, strength 2-3 days/wk
Intensity - cardio RPE 12-13, strength 40-50% or 60-80% 1-RM
Time - 30min, 2-4 sets, 8-12 reps
Type - rhythmic large muscle , free weights or machines no Valsalva maneuver
Stroke definition
Stroke occurs when the blood supply to the brain is compromised by a blocked vessel (ischemic stroke) or when a blood vessel bursts in the brain (hemorrhagic stroke). Number one cause of disability globally.
Signs of Stroke
FAST - Face drooping, arm weakness, speech difficulties, time to call EMS
- Sudden numbness or weakness in arms, legs, face
- Sudden confusion or trouble speaking or understanding others
- Trouble seeing in one or both eyes
- Sudden walking problems, dizziness, loss of balance or coordination
- Sudden sever headache with no known cause
FITT Recommendations for Clients with Stroke
Follow same guidelines as CAD & Hypertension
Frequency - cardio 3-5days/wk strength 2days/wk
Intensity - light to vigorous RPE 11-14, 50-70% 1-RM
Time - 20-60min/day multiple bouts ok, 1-3 sets, 8-15 reps
Type - consider cognitive ability, consider safety
Peripheral Artery Disease PAD definition & considerations
Atherosclerosis of the arteries of the lower extremities. Most prominent risk factors are smoking and diabetes. Causes pain due to ischemia or lack of blood flow to the muscle. Pain is brought on by exercise and sometimes at rest. Medical evaluation required before exercise. Proper foot care important.
FITT Recommendations for PAD
Frequency - cardio 3-5 days/wk, >=2days/wk
Intensity - moderate, 60-80% of 1-RM
Time - 30-45min, 6-8 exercises 2-3 sets 8-12 reps
Type - weight bearing, whole body-large muscles-lower muscles
FITT Recommendations for Dyslipidemia
Frequency - cardio >=5 days/wk, 2-3days/wk
Intensity - below VT2, 50-85% of 1-RM
Time - 30-60min, 6-8 exercises 2-4 sets 8-12 reps or more for endurance
Type - rhythmic large muscle, variety
Exercise considerations for Dyslipidemia
Decreasing total and LDL cholesterol involves exercise of at least 250-300 minutes per week, expending approx 2,000 cal/week. Definition - undesirable levels of lipids
Lipid definition
A group of organic compounds that are oily to the touch and insoluble in water. Includes fatty acids, oils, waxes, sterols, triglycerides (TG). They are a source of stored energy and a component of cell membranes.
Cholesterol is manufactured in liver and transported in plasma while attached to protein.
Lipid Types
LDL - low density lipids-bad- 60-70% of body chol.
VLDL - very low- carrier of TG, 10-15% of body chol.
IDL - Intermediate, similar to LDL, from VDL breakdown
HDL - high density, good, 20-30% of body chol
Non-HDL - Total cholesterol minus HDL
Cholesterol Classifications - LDL
<100 - Optimal 100-129 - Near Optimal 130-159 - Borderline High 160-189 - High >190 - Very High
Cholesterol Classifications - HDL & Total
HDL - low <40, high >=60 Total Cholesterol <200 - desirable 200-239 borderline high >=240 high
Triglyceride (TG) Classifications
<150 desirable
150-199 borderline high
200-499 high
>=500 very high
FITT Recommendations for Diabetes
Frequency - cardio 3-7 days/wk, 2-3days/wk
Intensity - mod to vigor, below VT2, 50-85% of 1-RM
Time - 150min/wk, 6-8 exercises 1-3 sets 8-10 reps
Type - rhythmic large muscle, variety
Type 1 Diabetes Considerations
With advances in insulin delivery systems, persons with type 1 diabetes can eat and exercise just a a person without the disease.
Characteristics of Type 1 Diabetes
Onset <35 years Abrupt onset Family history not always Normal to thin body composition Reduced or absent blood insulin Absent or minor cell insulin resistance Treatment - Insulin, diet &/or exercise
Characteristics of Type 2 Diabetes
Onset >40 years
Gradual
Family history - yes
Usually obese (central type) body composition
Normal or increased blood insulin
Present- cell insulin resistance
Treatment - Weight loss, drugs, insulin, diet
FITT Recommendations for Metabolic Syndrome (MetS)
Frequency - cardio >=5 days/wk, 2-3days/wk
Intensity - below VT1, 50-85% of 1-RM
Time - 30-60min/day, 8-10 exercises 1-3 sets 8-10 reps
Type - rhythmic large muscle, variety
MetS definition
A cluster of conditions that increases a person’s risk for developing heart disease, type 2 diabetes and stroke. Identified by the presence of 3 or more of these:
Elevated Waist Circumference W - >35in, M - >40in
Elevated TG >=150 or on drug treatment
Reduced HDL w,<50, m<40 or on drug treatment
Increased BP - >= 130/85
Elevated fasting glucose - >= 100mg/dL or on drug treatment
Asthma Considerations
In general, people with asthma should be able to participate in regular exercise and sports with minimal restrictions if properly medicated.
- Always have rescue medication
- Drink plenty of fluids
- Avoid asthma triggers - heat or cold
- Utilize prolonged warm up and cool down
- Start with low intensity and gradually increase
- PT should closely observe client for EIB
- Activate EMS if medication isn’t helping
- Mid to late morning workouts may be better
- If well controlled, client can use regular guidelines for exercise
FITT Recommendations for Asthma
Frequency - cardio 3-5 days/wk, 2-3days/wk
Intensity - initially below VT1, 50-85% of 1-RM
Time - increase to at least 30-40min/day, 8-10 exercises 1-3 sets 8-10 reps
Type - rhythmic large muscle, variety
FITT Recommendations for Bronchitis and Emphysema
Frequency - cardio at least 3-5 days/wk, 2-3days/wk
Intensity - mod to vigor, 50-85% of 1-RM
Time - 20-60min/day intermit., 2-4 sets 8-12 reps
Type - walking/cycle/upper body, variety
Cancer Stats
Cancer is the second leading cause of morbidity and mortality worldwide. Cancer death has declined 27% in the past 10 years. Lifetime risk of cancer for women is 38%, for men 41%. Exercise helps reduce risk.
FITT Recommendations for Cancer
Frequency - cardio 3-5 days/wk, 2-3days/wk
Intensity - mod to vigor, 30% of 1-RM and increase 5% increments
Time - 150min/wk mod or 75min vigor, >=1 sets 8-12 reps
Type - prolonged rhythmic large muscle, variety
American Cancer Society Guidelines for Cancer
- Aim for a healthy weight
- Regular physical activity including cardio & strength, avoid inactivity
- Nutrition - avoid processed meats & red meat, 2.5 cups fruit/veggies per day, whole grains, limit alcohol
Osteoporosis Considerations
Characterized by low bone mass and disrupted microarchitecture. Defined as Bone Mineral Density (BMD) that is >=2.5 deviations below mean. Affects more women than men. Hip fractures are caused by falls 90% of the time. Common areas for fracture are hip, vertebrae and wrist. One in two women will break a bone due to osteoporosis and 1 in 4 for men.
Osteopenia Definition
1-2.5 deviations below mean for BMD
Osteoporosis Nutrition
Calcium and Vitamin D
Vitamin D aids calcium absorption
If calcium is inadequate it gets resorbed from the bones
Excessive alcohol is detrimental to bone health
FITT Recommendations for Osteoporosis
Frequency - cardio 4-5 days/wk, 1-2 to 2-3days/wk
Intensity - mod some to vigor, adjust so 2 reps are challenging - high intensity if tolerated
Time - 20min progress to 60min, start at 1 sets 8-12 reps then 2 sets no more than 8-10 exercises
Type - weight bearing, emphasize balance, gait, function movement
FITT Recommendations for Arthritis
Frequency - cardio 3-5 days/wk, 2-3days/wk
Intensity - light to mod, 50-80% of 1-RM
Time - 150min/wk mod or 75/wk vigor, 2-4 sets 8-12 reps
Type - low impact large muscle, variety within pain free ROM
Arthritis Considerations
- People with arthritis have higher rates of depression & anxiety
- People with diabetes are almost twice as likely to have arthritis
- Having arthritis increases risk of developing CVD
- Higher uric acid with gout is linked to higher risk of hypertension
- Obesity increases risk of OA due to higher load on joints
- Obesity is also associated with RA and lupus
- Higher in women than men
Arthritis OA cause
Overuse, trauma, obesity, or degeneration of joint cartilage that takes place with age.
Arthritis RA cause
RA is an autoimmune disease in synovial tissue and progresses to an erosion of articular cartilage and bone. More disabling than OA and causes greater deformity. Exercise is integral part of treatment.
