Chapter%2020%20Clients%20with%20Cardiovascular%20and%20Respiratory%20Concerns

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Chapter 20 Clients with Cardiovascular and
Respiratory Concerns

• NSCAs Essentials

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Introduction

• Cardiovascular disease and respiratory conditions
  are of a great concern for personal trainers
• Hypertension is a major consideration when
  training clients
• Heart attacks, strokes and hypertension are the
  most common cardiovascular diseases personal
  trainers will encounter

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Hypertension

• Hypertension is NOT a disease of just elderly
  peopleit also affects younger individuals as
  well
• Over 50 million Americans age 6 and above have
  this disease, which is defined by
• Systolic 140 mmHg
• Diastolic 90 mmHg

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Hypertension

• Hypertension is an idiopathic disease, meaning it
  occurs without a known cause
• This is why it is considered the silent killer
• Look at it this waya doctor can look at 10
  different people in a room and not be able to
  pick out the ones who have and the ones who do
  not have it
• 90 of cases are idiopathic
• 10 are curable because they are due to secondary
  causes (other diseaseshyperthyroidism, renal
  artery stenosis, etc.)

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Hypertension

• Anyone under age 35 with hypertension needs to be
  aggressively evaluated for one of a couple of
  diagnoses
• Any client observed to be hypertensive must be
  referred to a doctor for further evaluation
• Be aware that you cannot diagnose someone as
  being hypertensive, you can however say that
  their blood pressure is above the normal range
  and that you recommend they see a doctor to get a
  confirmed or unconfirmed reading

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Hypertension

• Elevated blood pressure puts a person at risk
  for
• Heart attack
• Stroke
• Both
• Mildly elevated can lead to
• Kidney disease
• Generalized vascular disease

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Hypertension

• Blood pressure risk stratification is shown in
  table 20.1 (pg. 523)
• The stages are identified in four stages
• Normal lt120/lt80
• Prehypertension 120-139/80-89
• Stage 1 hypertension 140-159/90-99
• Stage 2 hypertension 160/ 100
• These groups are based on presence of major risk
  factors (e.g. smoking, diabetes, etc.)
• Lets take a look at the table

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Management of Hypertension

• Non-medicine interventions such as proper
  exercise, weight loss and dietary changes are
  recommended
• Lifestyle changes include
• Adequate sleep
• Reduction in daily sodium intake to 1 teaspoon of
  salt daily
• Adequate potassium intake
• Limiting alcohol intake
• Increasing aerobic activity to 30-45 minutes four
  or more days a week
• Cessation of smoking
• Decreasing stress levels with appropriate
  activities

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DASH Diet

• Is a blood pressure lowering diet
• Entails reducing
• Saturated fats
• Cholesterol
• Total fat intake
• Emphasis on increasing
• Fruit intake
• Vegetables intake
• Low-fat dairy products
• Whole grains

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Hypertension

• Clients with hypertension will be taking one or
  more medications such as beta-blockers, calcium
  channel blockers, etc. (they all lower blood
  pressure)
• These medications can cause blood pooling, which
  means you need clients to do a longer cool down
• Beta blockers slow heart rates and prevent the
  heart rate from elevating as a normal response to
  exercisethis makes it difficult to follow heart
  rate as a measure of intensity
• Use RPE scale instead of heart rate monitor
  watches, etc.

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Safety Considerations for Clients with
Hypertension

• Clients with controlled hypertension can exercise
  with limited restrictions
• Studies have shown that exercise can reduce
  resting blood pressure levels after long-term
  (chronic) exercise
• Meta-analysis (review of many studies) studies
  have indicated that chronic exercise can lower
  systolic levels 4.5 mmHg and diastolic levels 3.8
  mmHg

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Safety Considerations for Clients with
Hypertension

• Questions to be raised for clients with
  hypertension
• 1. At what intensity level can a client be placed
  in order to cause the desired response?
• 2. Are any exercises contraindicated
• 3. What exercises can be given to the client?

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Safety Considerations for Clients with
Hypertension

• Intensity
• Lowering resting blood pressure can achieved with
  40-50 maximal oxygen uptake
• Lower intensity exercise in the literature
  appears to be better for lowering BP than high
  intensity exercise

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Safety Considerations for Clients with
Hypertension

• Contraindications
• Any type of activity that would increase
  intrathoracic pressure, which will ultimately
  decrease necessary blood flow to the heart
• Basically any exercise with prolonged valsalva
  maneuver (longer then 1-2 seconds)
• Make sure breathing is proper (exhale on the
  exertion)

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Safety Considerations for Clients with
Hypertension

• Safe Exercises
• Controlled hypertensive clients may participate
  in a variety of exercises including free weights,
  weight machines, body weight, walking, jogging,
  etc.
• Only change would be clients with comorbid
  conditions (degenerative joint issues,
  neurologic, and vascular diseases)

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Exercise Guidelines for Clients with Hypertension

• First noteif in Stage 1 (140-159/90-99) in BP,
  cancel session and advise client to speak to
  his/her doctor
• Aerobic Conditioning
• Goal is improve VO2 max as well as ventilatory
  threshold
• Low-moderate intensity is fine
• Start at 40-50 VO2 max
• Ultimately want to attain 50-85 VO2 max
• RPE should 8-10 initially with a goal of 11-13
• Each session should last 15-30 with a goal of
  30-60 minutes
• 3-7 days per week
• Weekly calorie expenditure of 700-2000
  kilocalories

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Exercise Guidelines for Clients with Hypertension

• Resistance Training
• Reps 16-20 per set
• 50-60 of 1RM
• 2-3 minutes rest interval
• Client can do as little as 1 set per exercise
  with a maximum of three
• Over time (4-6 months) reps can decrease to 8-12
  range
• Frequency should be 2-3 per week
• 30-60 minutes per session

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Exercise Guidelines for Clients with Hypertension

• Goals for clients with hypertension
• Increase VO2 max
• Increase maximal work and endurance
• Increase caloric expenditure
• Control blood pressure
• Increase muscular endurance

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Myocardial Infarction, Stroke or Peripheral
Vascular Disease

• All of these serious conditions can have
  ramifications physiologically and psychologically
• True psychological effects can be
• Fear of another acute event
• Fearlessness of participation
• Pay attention to these signs!

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Risk Factors

• Hypertension
• Hypercholesterolemia
• Diabetes
• Smoking
• Obesity
• Family history

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Risk Factors

• Diabetes can exert an accelerated effect on
  vascular disease thus having an independent
  effect on heart attacks
• Obese individuals require more blood vessels to
  feed the adipose (fat) tissue thereby increasing
  cardiac workload
• Family history
• First degree relative (parent or sibling) with
  known cardiac disease before age of 55 males or
  65 females has an increased risk

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Myocardial Infarction

• As a trainer you might be working with someone
  who has had a heart attack and who has gone
  through cardiac rehabilitation and then been
  discharged from physician to continue with
  exercise
• Get recent test data on new client
• Exercise stress tests
• Letter of clearance
• Recommendations from cardiologist

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Myocardial Infarction

• These reports are good as they let the trainer
  know where the doctor left off and where you can
  begin
• Be aware though that clients who are post MI and
  that have existing coronary artery disease
  without associated pain must be medically
  monitored while exercising

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Myocardial Infarction

• Exercise Guidelines for Clients Post-Myocardial
  Infarction
• Get clearance
• Get intensity guidelines from medical
  professional
• Should provide MET or VO2 max base for personal
  trainer to work with
• Program should be placed in clients medical file
  or sent to doctor for approval
• Monitor abnormal signs and symptoms
• Chest pain
• Palpitations
• Shortness of breath, neck pain, arm pain (R or
  L), back pain, and a sense of impending doom.

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Myocardial Infarction

• Exercise Program Components for Clients
  Post-Myocardial Infarction
• Goals
• Increase VO2 max
• Decrease blood pressure
• Reduce risk for further coronary artery disease
  events
• Increase ability to perform leisure, occupational
  and daily living activities

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Myocardial Infarction

• Exercise Program Components for Clients
  Post-Myocardial Infarction
• Aerobic
• 40 of VO2 max or RPE of 9-11
• 15-40 minute sessions, three to four times per
  week
• Additional time devoted to warm up and cool down
• Follow up stress test performed by a cardiologist
• Resistance
• 20 reps
• One to three sets
• Two to three days per week
• Stress never performing valsalva maneuver

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Cerebrovascular Accident (CVA)

• This is commonly called a stroke
• These clients generally have neurological
  deficits (balance, etc.) and are best served by
  being monitored by health care professionals
• However, if no neurological deficit and released
  by physician in unmonitored setting, you can
  provide guidelines coming up here

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Cerebrovascular Accident

• Exercise Guidelines for Post-Cerebrovascular
  Accident Clients
• Many individuals have problems post CVA with
  daily tasks because of decreased motor
  functioning
• Usually in arms, legs, face or mouth
• Some have trouble hearing, speaking, etc.
• However, a properly instituted program can
  definitely improve the life of people who have
  had CVA
• Trainer must stay in close contact with the
  rehabilitation team in order to ascertain the
  direction of training and proper establishment of
  goals.

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Cerebrovascular Accident

• Exercise Program Components for
  Post-Cerebrovascular Accident Clients
• Ergometers need to be the mainstay of aerobic
  conditioning for post CVA clients
• Balance is an issue with CVA clients
• No treadmills, etc.

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Cerebrovascular Accident

• Exercise Program Components for
  Post-Cerebrovascular Accident Clients
• Aerobic
• Intensity can begin as low as 30 peak VO2 since
  clients are severely deconditioned
• Post-CVA clients may eventually get to 40-70
  peak VO2
• Sessions between 5-60 minutes
• Frequency three times per week
• Resistance
• Will help to build new neurologic pathways for
  affected limbs
• Start out slow with weights
• Encourage the client to strive for three sets of
  8-12 reps, two to three days a week
• Flexibility
• Is important to prevent freezing and
  calcification of joints
• Balance exercise are good to do as well
• Performed before and after each training session,
  as well as on non-training days

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Peripheral Vascular Disease

• PVD clients have a real challenge due to pain
  upon walking
• They cannot walk for more than two to five
  minutes without having to stop and rest because
  of the searing pain in their calves
• The goal is to increase the length of their
  activity to improve quality of life and possibly
  avoid the need for surgical intervention
• If experiencing anything suggestive of cardiac
  compromise, he or she must stop immediately, sit
  or lie down flat, and use the prescribed
  nitroglycerin while someone calls emergency
  services (typically 911).

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Peripheral Vascular Disease

• Clients must be aware that exercise may
  facilitate a cardiac event in PVD clients
• Make sure client is cleared form a cardiac
  viewpoint by an exercise stress test before
  starting a training program

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Peripheral Vascular Disease

• Exercise Guidelines for Clients with Peripheral
  Vascular Disease
• Aerobic Conditioning
• To be able to walk pain free for greater
  distances
• The pain will hurt a lot for them, not a little
  (the pain is the rate-limiting factor)
• Walk until it hurts, stop, do it again and so on
• Duration between 10-30 minutes
• Goal is to lengthen time and shorten rest until
  exercise becomes one long continuous activity
• Resistance Training
• Same as hypertensive client (low intensity)
• PVD with angina pectoris is a group that is felt
  to be at too high a risk for a personal trainer
  who is functioning in a typical health club
• Such clients should be trained and monitored at a
  medical facility

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Chronic Obstructive Pulmonary Disease

• COPD includes asthma, chronic bronchitis and
  emphysema
• Asthma
• Reversible airway disease with associated
  hyperreactivity, characterized by ease of
  developing bronchspasm, constriction or both
• A common asthma is exercise induced asthma
• Usually self-limiting
• Rarely results in hospitalization
• Begins 15-20 minutes (sometimes as early as five
  minutes) into exercise
• Prevention can be achieved by using a
  bronchodiolator 15-20 minutes prior to exercise

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Asthma

• Exercise Guidelines
• Use RPE scale to monitor intensity, many clients
  are unable to achieve a training heart rate
• Asthmatic clients do better with mid-to late
  morning exercise sessions because of natural
  release of cortisol from adrenal glands
• Avoid extreme temperatures as they can induce an
  asthma attack

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Asthma

• Exercise Program Components for Clients with
  Asthma
• Aerobic Training Program
• RPE of 11-13 with continuous monitoring for
  dyspnea (shortness of breath)
• 1-2 times daily
• 3-7 days per week
• Around 30 minutes per session
• In the beginning may only be able to perform 5-10
  min.

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• Resistance Training
• A general resistance training program is
  recommended
• Resistance training should try to increase
  maximum repetitions (to desensitize to shortness
  of breath), increasing the amount of training
  volume,and increase lean body mass
• Lighter loads (16 or less) 2-3 days per week