Training for Clients Living with Chronic Conditions Flashcards
Arthritis
describes over 100 conditions involving joints. Often have difficulty with physical activity due to pain, stiffness, decreased ROM. education and exercise are important parts of treatment.
Benefits of PA for those with arthritis
decrease sedentary behaviour and promote weight loss, decreasing stress on joints.
aerobis- helps cardivascular fitness.
ROM exercises help reduce stiffness
blaance an agitily- improve balance and decrease fall
resisitance- help maintian or build strength to suppirt joints.
Pre participation health screening- arthritis
identify arthritis in question 4 of get active questionnaire. Probe clients for additional info about medical history.
Understanding risk of PA- arthritis
may be at increased risk of adverse effects especially if: experince joint pain, severe swelling or stiffness for >14 days, has limited mobility, comorbid conditons- (refer).
Disease and treatment considerations- arthritis
NSAID have no significant impact on exercise response, tollerance, HR or BP. Initiate and progress PA cautiously. Back pain- antidepressants and muscle relaxants- montior for drousiness.
Prescription parameters- arthritis
adapt 24h movment guidline depending on fitness level. Include aerobic, resisistance, and flexibility. Montior joint pain- pain should not exceed 2hrs after sessation or increase by >=2 points on pain scale.
Prescription parameters: frequency- arthritis
aerobic 3-5x/week accumulation 150mins. Resistance training daily at low intensity. Flexibility training= beneficial.
Prescription parameters: intensity - arthritis
MVPA (40-90% HRR/ 2-12 RPE) for aerobic. Resisitance training start at lower end and progress slowly (30-60% 1RM). Isometric exercises may be prescriped to minimize inflamation response. carfully monitor technique.
flexibility- slow static stretching to point of tension.
Prescription parameters: time - arthritis
aerobic: 10-30mins/session
resitance: 1-3 sets 1-10 reps
Prescription parameters: type - arthritis
aerobic: rhythmic low impact incorporating major muscle groups.
Resistance: isometric (to minimize inflammatory response) with body weight or light free or machine weight
low back pain- focus on core strengthening.
Safety considerations- arthritis
monitor pain.
fear of pain is major limiting factor
refer to care provider if pain >2hrs after exercise (sharp, stabbing, constant, gets worse at night, lots swelling, hot joints)
carcinoma
cancer involving skin or tissue covering internal organs
sarcoma
cancer involving msucle, bones, connective tissue
leukemia and myelomas
cancer involving blood forming tissues
lymphomas
cancer involving lymphatic tissue and immune system
melanomas
cancer involving pigment producing cells
Benefits of regular PA- Cancer
PA can help manage adverse effect of cancer and treatment. Aerobic and/or resiitant traninge can decrease anxiety, depression, fatige, imporve phyical functioning and QOL. Exercise may decreases progression, recurrance and cancer specific mortality
Canadian cancer statistics
most common in 50+, leading cause of death (30%)- lung, prostate, breast, colorectal are most common
disease treatment considerations- cancer
primary treatment= preferred treatment
adjuvant therapy- given after primary treatment to decrease risk of recurrence (ie hormone, chemo, radiation), can also be given before primary treatment (neo-adjuvant)
local therapy: directed to specific region vs systemic therapy- travels via bloodstream. Trageted therapies are systemic therapies that target cancer cells.
Pre-participation health screening- cancer
indentify history of cancer on get active questionaire- probe for more info of medical history and cancer-type, treatment, ect. refer cleints with comorbid considons.
Understanding risk- cancer
can be at increased risk of adverse effects
Prescription parameters- cancer
aim >=150mins moderate intensity PA and 2x/week resitance trianing- focus on major muscle groups adapting for fatigue , encouraging decreased sedentary time.
Prescription parameters: frequency - cancer
aerobic 3-5days/week- accumuate 150 mins
resistance 2-3x/week w/ 48hrs rest b/w
flexibility taining may be appropriate
Prescription parameters: intensity- cancer
light-moderate intensity for areobic and resitance especailly those previosuly inactive or weak.
aerobic 20-60% HHR; RPE 9-13
resitance 40-60% 1RM
flexibility- slow static stretch to point of tension
Prescription parameters: time- cancer
aerobic up to 60 mins/session, shorter as needed (10mins).
resitance 1-3 sets of 8-10 as tollerated for each muscle group
stretch 10 min cool down
Prescription parameters: type- cancer
rythmic low impact appropritate. resitance- body weight, free wieght, bans- to help increase functional capacity. Yoga, taichi and dance can help can help add exercise and fatigue.
Exercise before cancer treatment- prehab
treatment outcomes can be improved by optimixing wellbeing prior to treamtent- interventions help imporve health, decrease incidence and severity of furutre impairments.
Safety considerations- cancer
start with mild intensity for deconditoned or weak cleints- build slowly. Can have highly variable episotic symptoms, capacity can fluctuate. Advanced cancers , matatesis to bone- at high risk of injury- refer to specilaized QEP. Stop exercise immediately if chest pain, SOB, high risk of bleeding, uncontrolled vomitong or diherrea, ect. Avoid public fitness centres due to comprimized immune systems.
Coronary heart disease (CHD)
circulation to heart comprimized- partil blockage to 1 or more coronoary artery- can resilt in shortage of O2 to heart - causes chest pain, SOB. total blockage casues nerosis or heart attack.
cerebrovascular disease
circulation b/in brain comprimized- blocked for mins to hours: TIA
most common invlove ischemic stroke- often due to athlesclerosis of carotid artery.
less common: hemeragic stroke: occurs when weakness of BV causes rupture- risk facotr= high BP.
Peripheral artery disease
impacts circulation in limbs causes pain in muscles especailly at high exercise demands common woth cornoary arety disease
heart failure
heart cant provide enouhg blood to the body typically due to heart dmage. have increased sympathetic activity, volume retention and peripheral muscle dysfunction. typically suffer from SOB, swelling of lower limbs. exercise important for managment.
arrythmias
irregular heart beat often due to electrical circuitry. can casue deecreased exercise capacity and or increased HR
congenital heart disease
variety of birth defects in heart, some result in death, others disability.
hypertension
high BP related to CDV, mortality doubles w. every 20/10mmhg. medication helps decrease BP, lifestyle changes important
hyperlipidemia
high cholesterol and/or cholesterol- major risk factor for CVD. can lead to buildup and narrow arteries. high LDL is of concern- deit and exercise.
Benifits of regular PA- CVD
can help decrease mortality and need for surgical intervention.
regular aerobic can increase fitness, endurance and cardiovascular function. increase in fitness decreases resting HR, BP and increases SV at rest and at submax exercise. cardiac demads at given intensity decrease. increases skeletal muscle function and increase VO2 max.
disease treatment considerations- beta blockers
decrase HR and BP at rest and attenuate increase during exercise- use RPE
disease treatment considerations- diuretics
increase fluid loss- ensure proper hydration
no impact on HR
disease treatment considerations- ACE
decrease resting BP and attenuae bp response to exercise but dont impact tollerance.
disease treatment considerations- calcium channel blockers
depress AV and SA node conduction and produce peripheral vasodialtion- decrease BP and HR at rest and exercise.
disease treatment considerations- anticoagulants
for those with clotting risk. dont impact HR or BP but increase risk of bleeding- cautin for impact sorts.
disease treatment considerations- statins
lower toal or specific subparticles of cholesterol- dont impact HR or BP or tollerance.
disease treatment considerations- Nitrates
control acute angina symtoms- increase HR and decrease BP- can increase tollerance for exertional angina
disease treatment considerations- Acetylsalicylic acis (ASA)
asprin. prescribed after event or if at hogh risk. anticoagulent- at minster at sign of heart attack. long term use associated with proloned clotting and brusing.
Pre-prescription health screening CVD
identify on get active questionaire- probe for additonal info- detemine if in scope.
Prescription parameters- CVD
canadian 24 hr guilnine appropriate- alter intensity to prevent triggering symptoms
Prescription parameters: frequency- CVD
aerobic 3-5x/week–> 150mins
resistnace 2-3x/week w/ 48+ hrs b/w sessions. flexibility appropriate for some.
Prescription parameters: intensity- CVD
light-moderate effor for resitacne and aerobic.
aerobic- for deconditoned start on lower end (20-40% HHR or 9-11 RPE) and increase progressively to moderate intensity (40-60% HRR or 12-13 RPE).
resistance- work 30-60% 1 Rm, low risk clients work 60-80% 1RM- closely monitor technique
Flexibility- slow static stretch to tension
HR considerations for CVD
if max HR unavailable then use resting +20bpm
if have pacemaker target 10bpm below device threashold.
dont use age max hr prediciton for those on certain meds like beta blockers.
Prescription parameters: time- CVD
aerobic 20-40 mins/day as tollerated (as short as 10mins). Resistance 1-3 sets of 8-12 reps
Prescription parameters: type - CVD
all aerobic modalities. Low impact may be suitable for older/overweight. resistance can be body, or mahcine weight
Prescription parameters: HIIT- CVD
confers similar or greater changes in VO2max over shorter periods- has been sucessful for patients w/ coronary hear disease and failure. should be introduced progressively for those in suitable/ well managed disease state.
Safety considerations CVD
stop immediately if have chest pain, symptoms of myocardial ischemia, excessive sweating, ect. Exercise may not be suitble if condition very unstable. start slowly and progress slowly.
Clinical exercise testing
may be necessary prior to initiating training. American heart association produces absolute and relative contraindications to testing. If have absolute- refer to QEP with advanced training.
Type I diabetes
autoimmune… immune system attacks/destroys insulin producing cells of pancreas. Must use insulin to manage blood glucose. Typically occurs before 40
type II diabetes
metabolic disease- body doesnt properly use insulin produced or body doesnt produce enough. higher risk if overweight, often diagnosed after 40.
pre-diabetes
high blood glucose indicates increased risk of type II diabetes- lifestyle interventions can help.
Gestational diabetes
hyperglycemia during pregnancy- decreases after delivery, at risk of type II diabetes w/in 5-10 years.
benefits of regular physical activity- diabetes
can prevent and manage diabetes. IMproves how body responds to insulin. Can help protect against heart disease. Aerobic and resistance training both independently influence blood glucose uptake.
Disease treatment considerations
may be prescribed >=1 blood glucose reducing medication.
May need to supplement w/ carbohydrates to prevent drop in blood glucose to <5-6mmol/L
HR and BP response may be blunted in diabetes clients- particulary if on CVD meds or have neurapathy
hypoglycemia
blood glucose <4mmol/L
causes: too much insulin, skip meals, alcohol, lots exercise, ect
symptoms: weakness, shaking, increased BP, hunger, ect
Treatment: 15g carbs; 5-6 hard candies, 1 tbsp sugar honey or sugar, 3-4 glucose tabs, 1/2c fruit juice
retest sugar 15min- retreat 15g if <4mmol/L
Pre-participation health screening- diabetes
identify on get active questionaire- probe about history- what ype, when diagnosed, medications, comorbid conditions- refer if needed. If within scope get more info from physicians PA clearance form
Understanding the risk of PA- diabetes
may be at increased risk of adverse effects- ie hypoglycemia, lightheadedne srs, ect. refer if have certain comorbid conditions
Prescription parameters- diabetes: Aerobic training
frequency: 4-7days/week- 150 mins/week- daily exercie recommended w/ no more htan 2 consecutive days w/out exercise.
intensity: MVPA recommended- vigorous may be accpetable for experienced exercises and those with weel contolled doabetes
Time: 20-60 min sessions (as short as 10 mins)
Type: rythmic, continous incorporating major muscle groups. Aquatic based exercise have similar benifits
Prescription parameters-diabetes: Resistance training
Frequency: 2 days/week, preferably 3. flexibility also appropriate for some
intensity: MVPA. Work low-mod range (30-40% 1RM) at out set progressing towards 60-80% 1RM. Greatest benifit for glucose control for those progress 3 sets ~8rps 3x/week. increase intensity resitance training may only be exepriened for those with well controlled diabetes
Time: 1-3 sets of 8-12 reps for all major muscle groups
Type: body, free, machine cn be used
Safety considerations diabetes
be aware of comorbid conditions that may impact exercise tollerance.
start slowly and progress gradually frequency and duration and intensity
may have decreased ability to detect heat- and can impair ability to maintain body temp.
may need to delay exercise if blood sugar too low or high
when to delay exercise- diabetes
<5.5mmol/L- ingest 15-30g carbs prior to exercise
>16.7 mmol/L and client doesn’t feel well
Dementia and mild cognitive impairment
dementia- set of symptoms; experience decline in cognitive function severe enough to decrease ability to perform everyday tasks.
if decline doesn’t impact daily living- mild cognitive impairment.
depression and anxiety common with dementia
Person 1st language- dementia
person living with dementia
Benefits of regular physical activity- dementia
helps improve aerobi fitness, strength, blance, mobility- helps daily living. Aerobic and resitance may help cognitive function by changing chemicals in brain. PA may also help mental and social wellbeing- can feel more confident and cpable, give sense of control.
Disease treatment considerations- dementia
may or may not be on medication. Acetylcholine inhibitors can decrease HR especially when combined with other drugs that decrease HR- may need to use RPE. May also be on medication for vascular disease.
Pre-participation health screening- dementia
may or may not identify self in Q 4 of get ative questionaire. Clarification needed on medical history, if need extra guidance- Pa clearance form.
Prescription parameters- dementia
24h movment guideline for 65+ appropriate for most. decreased volume- (60mins 2X/week) may improve functional and cognitive function. Adapt to current fitness
Prescription parameters: frequency- dementia
aerobic 2-5 days/week aiming for >=150mins/week
resistance >=2x/week w/ 48+hrs b/w- except core which can be performed daily.
flexibility for some
if poor balance- do balance trianing but expect less gains
Prescription parameters: intensity- dementia
moderate effort-aerobic and ressitance
aerobic: 40-60% HHR (RPE 12-13)- vigorous possible for more fit
resistance- ensure proper form-go lighter if needed- progress to 8-15 reps at max intensity (while maintaining good form) Progress to higher intensity with supervision if appropriate.
core- encourage endurance- more reps at lower intensity
Prescription parameters: time- dementia
aerobic can be accumualted in bouts from 10-60mins
resitance- time depends on number of exercises, sets and reps
Prescription parameters: type- dementia
carefully monitor if inexeprience- may be more sucessful w/ familliar activities/
focus on functinl mocments for resitance training
walking safe for most.
Safety considerations- dementia
at higher risk of injury, abilities can fluctuate
may have decreased insight to abilities- need to monitor closely.
speak slowly and use common language
mood disorders
people feel prolonged emotions negatively impacting weelbeing, physical health, relationships and behaviour. 10% people experience at some point.
Anxiety disorder
people living in state fo constant worry and fear that can be overwelming
eating disorders
serious emotional and physical problems that have life threatening consequences if QEP senses client has ED refer to health care provider. May encounter client that engage in disordered eating and/or over exercising.
Benefits of regular exercise- mental health and illness
good for mental health- prevents symptoms of mental illness, increases QOL, wellbeing ect among those with anxety and mood disorders. Has demonstrated greater impact than other atlernative therapies. Impacts brain chemicals and stress system, providing distraction for coping.
Disease treatment consideration- mental health and illness
program must be flexible and planned during time with hogh enerfy levels for those wood mood disorders
antidepressants can cause drousiness- dont impact HR, BP or decreased tollerance.
axiety disorder- start with low intensity- so dont mimic symtoms, home based programs may be more approriate
Pre-participation health screening- mental health and illness
may not identify self on get active questionaire- if do dislose probe for more info to better understand conditon- refer if needed.
Prescription parameters: frequency- mental health and illness
aerobic 3-7x/week
resitance 2-3x/week w/ 48+ hrs b/w
flexiblity may be appropriate
Prescription parameters: intensity- mental health and illness
MVPA for aerobic and resistance
erobic: 40-60% HRR (12-13 RPE), vigorous (60-90% HRR) may be appropriate for experienced.
Resistance 40-50% 1RM at outset, progress ti 60-80% 1RM according to abilities- closely monitor inexperienced for technique
lighter intneisty ok to set foundation
Prescription parameters: time- mental health and illness
aerobic 20-60mins/session
resistance 1-3sets of 8-12 reps for all major muscle groups
Prescription parameters: Type- mental health and illness
all modalities appropriate- limited by client abilites and comorbidiites- enjoyment is importamt
group may help engagment- w/in comfort of cleint
Safety considerations- mental health and illness
if suspect eating or substance use disorder refer. Don’t push too hard when just starting out
disease treatment considerations risk classification- osteoporosis
based on screening placed in 1 of 3 categories based on risk of fracture in next 10yrs; low: 10%, moderate 10-20%, high >20%- those with spine or hip fractures or with very low bone mineral density (even with absence of other risk factors) automatically considered high risk- should refer high risk. risk helps tailor exercise programs
those at low risk often don’t need medication
Risk factors for osteoporosis or bone loss
age, histort of fractrues, low BMI, parental hip fracture, rhematoid arthritis, ect
Pre-participation health screening- osteoporosis
may identify on question 4 of get active questionaire- probe for additional info
understanding risk- osteoporosis
risk of fracture may be elevated for certian tyes and intensities especially if had fragility fracutre over 40, taken systemic corticosteroids for 3m+, recent fall or >=2 falls in last 12m, prexisit conditon, hisotry of spine or hip fracture.
Prescription parameters- spine sparing strategies; osteoporosis
loads to avoid: apllying rapid, repetitive, weighted, loaded, sustained, or end range flecion or twisting torque to the spine.
Prescription parameters- challenging balance exercises; osteoporosis
most effective program to prevent falls–> functional strength and blance training- should be challenging balnce DAILY
tai chi can be effective
Prescription parameters- progressive resistance training; osteoporosis
should be inlcuded in all programing and performed 2+ days/week. if new start at low intensity and build up- high intensity may not be appripriate for those at a high risk of fractures.
Prescription parameters- impact activities; osteoporosis
participation in MVPA can prevent early death and disability- walking (weight bearing) has shown modest impact on bone density higher impact may incrase hip bone mineral density. best to start lower then progress
Beniftis of regular PA- respiratory conditons
can improve strength and endurance, respiratory symptoms and exercise capacity
Pre participation health screening- respiratory conditions
asthma- identify on screening- probe for more info
if have comorbid conditions- at higher risk of adverse events- refer
Disease treatment considerations- respiratory conditions
copd and athsma mediacation help decrease inflammation and decrease risk and severity of subsequecnt exasp[eration and increase exercise performance.
2 types of drugs: releiver and maintence
nearly all drugs help experice tollerance
Prescription parameters: respiratory conditions
24h movment guidelines appropriate with some modifications- pay attention to early signs and symtoms to prevent an attack
Prescription parameters-frequency: respiratory conditions
aerobic 3-5x/week aim for >=150mins/week
resitance 2-3x/week w/ 48h b/w sessions working same muscle group. flexibility training may help some
Prescription parameters-intensity : respiratory conditions
low-mod aerobic for those w/ COPD and athsma who are deconditoned
Asthma- aerobic-work w/in 40-59% HHR if well tolerated progress to 60-70%
COPD- aerobic- 50-80% or 4-6 on Borg scale of dyspnea
resiitance- copd and athsma work at 60-70% 1RM for beginer and >=80% for exeriecned, tain at <50% for endurance training- monitor closely for technique and breathing
Prescription parameters-time : respiratory conditions
asthma and COPD
aerobic 20-60mins (as short as 10)
resitance 2-4 sets of 8-12 reps for strength trianing and sets of <=2 of 15-20 for endurance
Prescription parameters-type: respiratory conditions
rhythmic activities incorporating major muscle groups
resitance should be body weight, or loght weights or machine
PA recomendatins for COPD
stretching and breathing and daily walks are good
try to exercise >=3x/week.
3 types of exercise to incorporate: stretch for relaxation and flexibility, aerobic for fitness, resitance for strength and endurance.
PA recomendations for Athsma
shouldnt avoid exercise if well controled- ensure to always have enhaler. emphasize proper warmip and cool down. avoid triggers- be mindful of temp and air quality. stop and take enhaler- then wait a few mins, if have symptoms - take another does if symptoms still presnt
