Maintenance Strategies

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Maintenance Strategies
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Maintenance Strategies

• Relapse prevention
• Prepare client for relapses
• Identify those factors that account for relapses
  and seek solutions
• Behavior rehearsal
• Reinforcement
• Positive reinforcement is most powerful
• Tangible and intangible
• Tie reinforcements to accomplishments
• Each short term goal should have a reinforcement

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Maintenance Strategies

• Monitoring
• Keeping a log, assessment data, etc.
• Allows client to see progress
• Contracting
• Formalizes the agreement to exercise
• Contract includes goals
• Should be realistic and achievable
• Goals should be updated regularly

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Maintenance Strategies

• Essentials of the contract
• Agreement to exercise
• Times for exercise and agreements on missed
  sessions
• Agreement on monitoring and testing
• Long and short term goals
• Agreement to review goals and rewards regularly
  and to discuss problems related to exercise
  program
• A brief description of the exercise program
• Agreement on part of trainer to discuss problems
  and identify solutions
• Any other items considered essential to
  client-trainer relationship
• signatures

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Instructor Qualities

• Instructors are most effective if the client
  feels they are competent, likes them, and is
  interested in them
• Instructors greatest frustration is a client who
  is unwilling to change. Overpersistance on the
  part of the instructor plays against the
  instructor
• Attempt to be sensitive to the clients needs and
  serve them as to the degree possible

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Informed Consent

• Important ethical and legal consideration
• Content and extent of consent forms vary but
  enough information must be present to ensure that
  the participant knows and understands purposes
  and risks.
• INFORMED CONSENT
• Most legal action results from a failure to
  obtain adequate informed consent
• Frequent complaint resulting in legal action
• Negligent in explanation of procedure including
  the risks
• Breach of confidentiality

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Health History Questionnaire

• Divided into three sections
• Known diseases
• Signs/symptoms
• Risk factors
• Assessment of risk is a two step process
• Starts with assessment of the aforementioned
  factors
• Proceeds to assignment of individual to a risk
  strata and need for medical clearance/supervision

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Health History Questionnaire

• Purposes for screening
• ID those who need further testing
• ID those with contraindications
• ID those who need medically supervised programs
• ID those with special needs
• Determination of known diseases, signs/symptoms

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Health History Questionnaire

• Determination of known diseases, signs/symptoms
• Known Diseases
• Cardiovascular cardiac, peripheral vascular, or
  ceerebrovascular disease
• Pulmonary COPD, asthma, interstitial lung
  disease, or cystic fibrosis
• Metabolic disease Type I or II diabetes
  mellitus, thyroid disorders, renal or liver
  disease

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Signs and Symptoms

• Pain or discomfort in the chest or surrounding
  area
• Manifestation of CAD
• Ischemic in nature
• Constricting, squeezing, burning, heaviness
• Substernal in both arms and shoulders up into
  neck and cheeks in upper back down into
  forearms and fingers
• Provoked by exertion, excitement, stress, cold
  weather, post-prandial
• Often misdiagnosed in women and diabetics
• Non-Ischemic
• Provoked by body position
• Stabbing pain in left submammary area

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Signs and Symptoms

• Shortness of breath with mild exertion
• Dyspnea define
• normal at high workloads
• Abnormal at levels of exertion not expected to
  cause shortness of breath
• Suggestive of left ventricular dysfunction or
  COPD
• Dizziness or Syncope
• Syncope define
• caused by loss of perfusion of the brain
• During exercise likely due to cardiac disorders
  restricting normal rises in cardiac output
• Causes severe CAD, enlarged heart, aortic
  stenosis, and dysrhythmias
• Can occur post-exercise due to post-exercise
  hypotension reducing venous return

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Signs and Symptoms

• Orthopnea and Paroxysmal Nocturnal Dyspnea
• Orthopnea sob in reclined or horizontal
  position
• Relieved by sitting upright or standing
• PND sob occurring when asleep onset 2-5 hours
• Both can be signs of left ventricular failure
• PND may be caused by COPD

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Signs and Symptoms

• Ankle edema
• Progresses through day and is worse in evenings
• Bilateral may be sign of heart failure or chronic
  venous insufficiency
• Unilateral results from venous thrombosis or
  lymphatic blockage
• Generalized edema (anasarca) may arise from heart
  failure or cirrhosis of the liver

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Signs and Symptoms

• Palpitations or Tachycarida
• Disorders of rhythm including sudden onset
  bradycardia
• Intermittent Claudication
• Pain in muscle due to inadequate blood flow
• Onset during exercise stopping 1-2 min after
  cessation
• More severe when climbing a grade or stairs
• Sign of PVD

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Signs and Symptoms

• Known Heart Murmur
• May be harmless or may indicate valvular or other
  CVD
• Important to exclude enlarged heart or aortic
  stenosis
• Unusual fatigue or shortness of breath with usual
  activities
• May be benign but could indicate a change in
  status

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Risk Factors

• Positive RF
• Age Men 45yr, Women 55yr
• Family History 1st degree male relative before
  age 55 or 1st degree female relative before age
  65
• Cigarette smoking quit within 6 mos or
  environmental exposure
• Hypertension - 140 mmHg / 90 mmHg or on
  antihypertensive meds
• Hypercholesterolemia LDL 130 mg or HDL lt 40
  mg or lipid lowering meds total serum chol
  alone 200 mg
• Prediabetes - Impaired fasting glucose fasting
  plasma glucose 100 mg but lt 126 mg Impaired
  glucose tolerance 2 hr values on oral glucose
  tolerance test 140 mg but lt200 mg, confirmed
  on two occasions

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• Obesity BMI 30 or waist girth gt102 cm (40 in)
  for men and gt88 cm (35 in) for women
• Sedentary lifestyle Not particiapting in 30 min
  moderate pa on at least 3 d/wk for at least 3 mos
• Negative RF
• High HDL-C - 60mg

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ACSM Risk Stratification

• Using health status and RF information
  participants can be placed into a risk strata for
  preliminary screening decisions
• Low risk
• asymptomatic and meet no more than one risk
  factor threshold
• Moderate risk
• Asymptomatic and meets the threshold for two or
  more risk factors
• High Risk
• Individuals with one or more signs/symptoms or
  diagnosed cardiovascular, pulmonary, or metabolic
  disease

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ACSM Recommendations for (A) Current Medical
Examination and Exercise Testing Prior to
Participation and (B) Physician Supervision of
Exercise Tests

• Low Risk Moderate Risk High Risk
• A.
• Moderate exercise NN NN R
• Vigorous exercise NN R R
• B.
• Submaximal test NN NN R
• Maximal test NN R R
• NN - Not Necessary R - Recommended

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Other Health-Related Factors That May Affect the
Exercise Prescription

• Alcohol or other substance abuse
• Diet/Nutrition
• Diseases (in addition to those previously noted)
• Eating Disorders
• Environmental Considerations
• Medications
• Past and Present Exercise History
• Personality/Behavior Pattern
• Pregnancy and Breastfeeding