Asthma

1
Asthma Hypertension Review

• Intro to Disease Prevention

2
Asthma

• COPD
• Is asthma manageable?
• EIA
• Triggers
• Is there a cure for asthma?
• Exercise induced asthma occurs about __ to ___
  minutes after strenuous exercise.
• What usually triggers exercise induced asthma?
• What was the breathing device called that we used
  in class?

3
Asthma

• Dyspnea
• Bronchospasms (bronchides narrowing) can last
  _____ to _____ min. if left untreated and can
  often lead to ________.
• The best environment to exercise in is one that
  is ______ and _______.
• Would swimming in a heated pool be a good or poor
  exercise choice for an asthmatic?
• Proper use of _________ is a key factor in
  prevention of an asthmatic attack.

4
Asthma

• Two types of drugs
• ________
• ________
• What type of drug would the following be
• Ventolin
• Corticosteroids
• Albuterol
• teophylline

5
Asthma

• Borg scale in appedix B - review
• Dyspnea Scale (p. 14) review
• Individuals with a high ____ have an increased
  risk for developing asthma.
• Exercise moderate (60-75 max. HR)
• 11-14 Borg scale
• The warm-up should be _________.
• Always have __________ medications.
• Pre-_________ and drink lots of fluids.
• Practice _________ breathing. (try this)

6
Asthma

• F 3-5 days/wk
• I based on RPE, Dyspnea Scale and HR from a
  graded exercise test 50-60 max. HR
• T CRE 20-30 min. goal may need 3-5 min.
  intervals initially
• T strength training high sets reps low
  intensity (4-5 days/wk) 2X15 min or 1X 30 min.
• 2. Safety precautions -

7
Hypertension

• What is blood pressure?
• High blood pressure is called the ____ ___ 52
  of people dont know they have it and 21 are not
  getting the proper medical therapy to reduce it.
• Blood pressure is measured in millimeters of __.
• Systolic (top number) pressure that blood
  exerts on the arterial walls as the heart beats
• Diastolic (down number) pressure that blood
  exerts on the arterial walls as the heart rests
  and blood flows back to the heart
• Normal average blood pressure is ____ over __.

8
Hypertension

• Effects of high blood pressure
• Makes the _________ work harder and puts the
  _____ under strain.
• _______ may become enlarged and less efficient
  (______ _________ ________)
• Fatty plaque deposits build up on walls of
  _______ and they may become scarred or damaged
  ____________.
• Damage reduces the flow of blood and ____ to
  kidneys, heart, brain and eyes, or can lead to a
  _______ due to a blood clot.

9
Hypertension

• Hypertension is the most common risk factor for
  diseases of the
• _________________ (congestive ____ ____)
• _________________ (kidney failure)
• _________________ (atherosclerosis)
• Primary hypertension cause is _______ in at least
  ____ percent of HTN cases however it is linked
  to ______, ______, ______ and ___________.
• Secondary hypertension has a known _____.
• Uncontrollable risk factors include
• Factor that can help prevent, reduce or postpone
  HP include

10
Hypertension

• F 5-6 days/wk
• I - Low intensity exercise (40-70 max. HR) can
  lower systolic by 5-25 mm Hg and diastolic by
  3-15 mm Hg in mild to moderate hypertensives
  high intensity _____
• Use RPE (__ - __) for those on antihypertensive
  meds
• T 20 30 min. working to ___ to ____ min.
• T - Non-weight bearing activities? CRE?
• Circuit training (3 sets 12-20 reps no _______)
• Stress correct _____________

11
Hypertension

• Why a longer warm-up? Cool-down?
• Why avoid isometric exercises? Dynamic
  resistance exercises?
• Lower systolic 2 mm Hg reduce risks for heart
  disease by ___ percent and stroke by ___ percent
• Put daily physical activity into life
• Examples of moderate p.a.

12
Blood Pressure Ranges - adults

• Adults 18 years or older
• Systolic (when diastolic is less than 90)
• Less than 140 normal
• 140-159 borderline systolic hypertension
• 160 isolated systolic hypertension
• Diastolic
• Less than 85 normal
• 85-89 high normal
• 90-104 mild hypertensive
• 105-114 moderate hypertensive
• 115 severe hypertensive

13
ACSM GUIDELINES Adults age 18 and older
SYSTOLIC (mm Hg) lt 130 130-139 140-159 160-179 180
-209 gt 210
DIASTOLIC (mm Hg) lt85 85-89 90-99 100-109 110-119
gt120
CATEGORY Normal High Normal Mild (Stage 1)
HTN Moderate (Stage 2) HTN Severe (Stage 3)
HTN Very Severe (Stage 4) HTN

• No exercise 200 systolic 100 diastolic
• Essential HTN 140/90

14
Hypotension

• Healthy to have a low blood pressure providing
  there is no ill effects, such as vertigo or
  syncope (fainting)
• Body does not get enough oxygen carrying blood
  (impairs breathing, movement, and brain function)
• High BP meds, pregnancy, diabetes (hypoglycemia),
  low thyroid/adrenal function
• Tilt table test to diagnose
• Orthostatic hypotension occurs when a person
  rises too quickly from a supine position
  (light-headed and unstable)
• Drop of systolic pressure by at least 20 mm Hg
• (Foundations of Nursing, Christensen and Kockrow)
• (Textbook of Medical-Surgical Nursing, 6th
  ed.,Brunner and Suddarth)

15
Hypotension

• Normal postural responses are increased heart
  rate (to offset reduced stroke volume and
  maintain cardiac output)
• A slight to a 15 mm Hg drop is systolic pressure,
  and a slight drop to an increase of 5-10 mm Hg in
  diastolic pressure.
• (Foundations of Nursing, Christensen and Kockrow)
• (Textbook of Medical-Surgical Nursing, 6th
  ed.,Brunner and Suddarth)

16
Diabetes

• Sugar or glucose cannot be used by cells
• Cells need fuel to perform functions
• Glucose used by most cells
• Insulin allows sugar to be transported via the
  blood stream to cells (where energy production
  occurs)
• Diabetes cant get glucose into cells to use
• Cells starve quit eventually die

17
Diabetes

• Normal insulin opens doors on cells surface
  called receptors to let glucose enter
• Insulin made by pancreas and released after meals
• Not enough insulin, glucose builds up in
  bloodstream usually results in hyperglycemia

18
Diabetes Prognosis Diagnosis

• Prognosis
• Familial, severe cases (blindness, kidney damage,
  nervous system, hardening of the arteries, foot
  and leg infections, skin ulcers, gangrene)
• Blood sugar 60-120 mg/dL depending when person
  eats
• Fasting state can sometimes fall below 60-50
  mg/dL but below 45 mg/dL abnormality
• Diagnosis
• Sudden in children slow in Type II
• Symptoms urinate often, increased thirst, weight
  loss, increased appetite, levels of sugar in
  blood and urine are high

19
Diabetes Treatment

• The goal of treatment is to maintain a sugar and
  insulin balance.
• Mild, early or late onset of the disease can
  often be controlled by diet alone
• Insulin tablets are sometimes used in type II
• In more severe diabetes, insulin injections used
• Diet limits sugars or simple carbs and increases
  complex carbs, proteins, and unsaturated fats

20
Diabetes Two Types

• Insulin Dependent (Type 1) (IDDM) 10
  population
• Children and young adults
• More intensive
• Pancreas cannot make insulin or destroyed, person
  takes insulin injections usually 2Xs daily
• Non-insulin Dependent (Type II) (NIDDM)
• Pancreas makes insulin but it doesnt work
  properly
• Have fewer insulin receptor cells and an
  intracellular defect
• Overweight and adults over 40 years old
• Due to lifestyle obesity number one risk factor
  and heredity may play a role

21
Diabetes

• Type I
• Risk factors viral infection and immune
  disorder
• Type II
• A viral infection
• B - pancreas makes too much insulin and cells
  lose receptors obesity
• Treatment meds, diet and exercise (acts like
  insulin lets glucose enter cells glucose
  control)
• I use less insulin when exercise
• II lose weight reverse disease process and
  symptoms heredity is also a factor

22
Diabetes Other Types

• Type III gestational, glucose intolerance
  occurs during pregnancy intolerance may remain,
  but not be serious enough to be treated
• Type IV includes other types associated with
  pancreatic diseases and hormonal abnormalities

23
Diabetes

• Blood always has some glucose in it
• Hyperglycemia too little insulin ?too much
  glucose in blood Diabetic Coma
• Hypoglycemia too much insulin ? too little
  glucose in blood Insulin Shock
• Heavy sweating, dizziness, shaking, fainting,
  weak, drowsy, confused, rapid pulse, cold
  clammy, irritable, loss of consciousness ? coma
  mostly Type I
• Miss/delay meal, eat too little food with
  insulin, exercising too hard, drinking too much
  alcohol

24
Diabetes

• Glucose control measurement of glucose in the
  blood to see if insulin is working properly
• Ketoacidosis (blood acidity increases as toxic
  substances increase in blood) caused by failure
  to take insulin

25
Diabetes Exercise

• Exercise capacity and metabolism is decreased
• Diabetic responds normally and appropriately to
  exercise (increase physical work capacity, c-v
  stability, self-image lipid profile and
  reduction in insulin requirements to achieve
  glucose control)
• Anti-obesity effect (burn more calories)
• Inspiration to persevere as compete in
  non-diabetic environment and athletic performance

26
Exercise and Diabetes

• Complex Timing of exercise and meals,
  measurement of glucose, timing of injections,
  amount of insulin taken, amount of exercise must
  be in balance for exercise to be effective
• Exercise joined with diet helps to lower
  long-term diabetic complications by reducing
  cholesterol, blood sugar, BP, and body weight

27
Ask A Trainer

• Complete history and physical exam
• Stress test over age 35 or standard
  health-related fitness assessment

28
Exercise Precautions

• Control diabetes (blood glucose not over 250
  mg/dl)
• Neuropathy increased risk of injury cant feel
  pain
• Proliferative retinopathy increased risk of
  hemorrhages and retinal detachment (no high
  impact)
• Type I no exercise if hypoglycemia exists or
  fasting blood glucose level is gt 250-350 mg/dl) ?
  exercise makes it worse
• Avoid climate extremes
• Proper foot care and selection of good shoes
• Blisters ? major medical problems (amputation)
• Never exercise alone always have food present

29
Training Guidelines

• Check blood glucose 30 min. prior to exercise and
  1 hour after
• Review symptoms of hypoglycemia with client
• Keep an activity record, BG reading and symptoms
• Know clients meds (especially if they affect HR
  and BP)
• Injections away from muscles to exercise, use
  abs, inject 1 hour prior to exercising

30
Exercise Prescription

• F - 3-5 days/wk. to 5-6 days/wk.
• I - 3-5 RPE to 2-5 RPE (new scale)
• T - 30 min. aerobically
• - 2030 min. glucose control work to
  40-60 min
• T - aerobic (low impact) low impact strength
  training 2-3 days/wk, 40-60 1RM, 2-3 sets per
  exercise use 5-10 min. warm-up and cool-down

31
Safety Tips

• Good fitting shoes
• Protective gear contact sports
• Petroleum jelly in friction areas
• Loose fitting clothing
• Self-glucose monitoring
• gt250 no high intensity exercise
• lt100 eat carbo snack
• 100 250 mg/dl ok
• Type I diabetic 15-30 grams carbos every 30 min.
  to avoid low blood sugar levels
• Wear ID bracelet

32
Healthy Back

• 80 Americans will experience some type of back
  problem in their life due largely to lifestyle
  factors long term poor posture, lack of
  exercise, improper body mechanics and years of
  sitting
• Causes
• Disc wear problems (chronic lasting more than 3
  months) dry out and degenerate poor posture
• Sprains or strains (acute less than 3 months)
  excessive bending, twisting or lifting physical
  activity, accidents or awkward movement
• Degenerative conditions aging or trauma leading
  to fractures or misalignment (chronic)

33
Spinal Curvature

• Cervical neck 6 vertebra
• Thoracic middle back (abdomen) 12 vertebra
• Lumbar lower back 5 vertebra most people
  suffer pain here
• Sacral tail bone (5 tiny bones fused together)
  1
• Coccyx 1
• Total 26

34
Research Indications

• 2 days of bed rest can slow recovery rate
• Exercise 20-30 min./day walking, swimming,
  stationary biking w/in 2 weeks of pain onset

35
Ask A Trainer

• Train abdomen, pelvis, and legs to reduce stress
  on back
• Practice good body mechanics to reduce stress to
  lower back
• Dont bend at waist
• Keep the 3 curves (when lifting and lowering wt.)
• Sit w/hips against chair, head up with shoulders
  and back straight
• No overhead press

36
Exercise Prescription

• F - 3-5 days/wk.
• I - 60-80 Max HR (Vo2 max)
• T - 20-60 min.
• T - Aerobic non-weight bearing or low impact
  avoid jumping, twisting, and bending activities
• Stretching (hams, low back, hip flexors, hip
  rotators)
• Perform 1-2xs/week

37
Exercise Prescription Continued

• Resistance abs, iliopsoas, hams, piriformis,
  glutes, quads, low back extensors, trunk flexors,
  postural stabilizers
• Muscle endurance/submaximal effort and progress
  as tolerated
• Prolong warm-up
• Weight Room tips
• Feet onto bench when lying down
• Good posture
• No back hypertension
• Flat-soled shoes with good support
• Avoid pain, numbness or tingling in legs and
  weakness
• Monitor body mechanics/postural positions
• Avoid prolonged sitting, repetitive bending or
  twisting
• Meds ?know the affects with exercise