Exercise In Chronic Disease and Disability Flashcards
AIDS origin
Progressive destruction of CD4 or T-helper cells results in immunosuppression Increased susceptibility to infection Decreased food consumption Loss of lean body mass Advanced tissue wasting Death
AIDS origin
Progressive destruction of CD4 or T-helper cells results in immunosuppression Increased susceptibility to infection Decreased food consumption Loss of lean body mass Advanced tissue wasting Death
AIDS stages
Stage 1
Asymptomatic seropositive HIV
Exercise capacity unaffected
Stage 2
Early symptomatic HIV
Reduced VO2 peak and ventilatory threshold
Will NOT be able to tolerate exercise well
Stage 3
AIDS
Dramatically reduced VO2 peak
High intensity levels may elicit nervous and endocrine abnormalities. No reason to perform substantial exercise testing.
AIDS Complications
Cardiovascular and metabolic abnormalities
Fatigue
Depression
Chronic diarrhea
Anemia
Muscle wasting
Pneumocystis pneumonia
Peripheral neuropathy (VERY COMMON)
Exercise and AIDS aerobic
AEROBIC TRAINING
Frequency: 3-5 days per week
Intensity: 40-60% VO2 or HRR
Time: 10 minutes initially, progressing to 30-60 minutes per day
Type: Individually dependent
Include weight-bearing activities if osteopenia is a concern
Avoid high-risk and high-contact activities
Overall Goal: Improved aerobic capacity over 3-6 months
Exercise and AIDS resistance
RESISTANCE TRAINING Frequency: 2-3 days per week Intensity: 2-3 sets of 10-12 repetitions @ approximately 60% 1RM Type: Individually dependent Free Weights Weight Machines
Overall Goal: Improved muscular strength, power, and/or endurance over 3-6 months
AIDS Special Considerations
Must adhere to strict universal precautions
No evidence of exercise induced immunosuppression
No established guidelines regarding contraindications for exercise
Dizziness, joint swelling, or vomiting preclude exercise
Increasing fatigue, lower GI distress, or DOE should be reported
Symptomatic individuals and those with comorbidities should be supervised
Anti-retroviral treatment may be associated with dyslipidemia, abnormal body composition, and insulin resistance
Spinal Cord Injury (SCI) Complications
Paresis and atrophy
Spasticity
Impaired skin integrity
Osteopenia / Osteoporosis
Autonomic dysreflexia
Respiratory dysfunction
Bowel and bladder dysfunction
Impaired thermoregulation
Autonomic Dysreflexia
person doesn’t feel something crushing their toe = body goes into overdrive, BP increases, potentially lifethreatening. Complains of headache, blurred vision.
SIT THEM UP, then find cause, get help, check clothing..
Oxygen Consumption and SCI
VO2 peak may decrease as much as 26%
Exercise may improve VO2 peak by 10-20%
UE ergometry reduces VO2 values by approximately one-half compared to LE ergometry
Quadriplegia reduces VO2 values by one-half to one-third compared to paraplegia
T6 and above are at risk for autonomic dysreflexia
Disruption of sympathetic innervation may limit HR to 115-130 bpm
Many individuals will experience muscular fatigue before achieving sufficient cardiovascular capacity
Disruption of vagus nerve and HR
HR max very low, 100 bpm
Exercise and SCI aerobic
AEROBIC TRAINING
Frequency: 3-5 days per week
Intensity:
Initially 40-60% VO2 reserve
Progress to 60-80% of VO2 reserve
Time: 30-60 minutes total
Initially 5-10 minutes of moderate intensity activity alternated with 5 minute active recovery periods
Progress to 10-20 minutes of vigorous intensity activity alternated with 5 minute active recovery periods
Type: Arm or w/c ergometer, swimming, adapted aerobics, FES
Aerobic Training Goals
Increase active muscle mass and strength
Maximize overall strength for functional independence
Improve efficiency of manual W/C propulsion
Flexibility Goals
Improve / maintain ROM
Prevent contracture
Prevent injury (rotator cuff!!!)
Exercise and SCI resistance
RESISTANCE TRAINING Frequency: 2-4 days per week Intensity: 2-3 sets of 8-12 repetitions Type: Weight machines or free weights Wrist weights if hand function impaired
Overall Goals:
Increase strength and muscle mass
Maximize functional independence
Facilitate w/c propulsion
SCI Special Considerations
Depression
TBI
Improvements may be small (
Diabetes origin
Chronic metabolic disease resulting in absolute (type I) or relative (type II) insulin deficiency
Hyperglycemia (blood glucose > 120 mg/dL)
Macrovascular complications:
Cardiovascular disease
Cerebrovascular disease
Peripheral vascular disease
Microvascular complications
Retinopathy
Nephropathy
Neuropathy (peripheral and autonomic)
DM Benefits of Exercise
Improves insulin sensitivity
Improves lipid profiles
Reduces blood pressure
Promotes weight loss
Increases strength
Improves well-being
ACSM 2014 Guidelines
Testing may not be necessary for asymptomatic and low risk individuals beginning light to moderate intensity exercise
GXT with EKG should be conducted in those > 35 years old or with type I DM > 15 years or type II DM > 10 years who want to begin moderate to vigorous intensity exercise
CVD risk factors should be reassessed annually
DM aerobic
Frequency: 3-7 days per week
Intensity: 40-60% VO2 reserve or RPE 11-13/20
Improved glycemic control may be achieved at intensities > 60%
Time: 150 minutes per week in bouts of > 10 minutes
Additional benefits may be achieved by increasing to > 300 minutes of moderate to vigorous intensity activity per week
Type: Emphasize large muscle groups
DM resistance
RESISTANCE TRAINING
General population guidelines apply in the absence of retinopathy or other complications
Adjust parameters as needed to accommodate comorbid conditions
DM complications
Retinopathy: Avoid vigorous intensity activity and resistance training
Peripheral neuropathy: Enforce regular foot checks, limit weight bearing activities if evidence of Charcot joint
Autonomic neuropathy: Monitor BP and HR closely
Nephropathy: No restrictions for tolerable moderate intensity activity
