Special Populations: Diabetes, Obesity and Hypertension Based on NASM CPT Textbook & ACE CPT Textbook © 2017 NPTI Colorado  | Slide 1 | Revision 6 (4/6/17) JR

Lecture Objectives After this lecture, you will be able to: Define and describe the cause and symptoms of selected chronic health conditions. Describe the characteristics of selected health-related physical and functional limitations to exercise. Recognize how acute and chronic responses to exercise vary in clients with chronic health conditions or physical or functional limitations compared with apparently healthy clients. Describe how to modify program design for clients with chronic health and physical or functional limitations.

Obesity & Exercise Key Facts regarding obesity: Worldwide, obesity has more than doubled since 1980 In 2008, 1.5 billion adults age 20 and older were overweight. Of these, more than 200 million men and nearly 300 million women were obese. Overall, more than one in ten of the adult population is obese Nearly 43 million children under the age of 5 were overweight in 2010 Source: World Health Organization (2011)

Obesity & Exercise Rising obesity rates have significant health consequences and contribute to chronic diseases, such as: Type 2 diabetes Hypertension CAD Some cancers Arthritis Alzheimer’s disease Dementia They key to successful long term weight-stability is the adoption of: Lifelong physical activity Sensible eating habits Briefly review each bullet point

Obesity & Exercise The diagnosis and treatment of obesity can be challenging: Medical, physical-activity, and dietary histories are necessary to determine the cause(s) of obesity. Caloric consumption and physical inactivity are directly related to obesity, but they are not the only causes. In many cases, obesity is caused by complex psychosocial issues that may require referral to a psychologist or professional counselor.

Obesity & Exercise “More is better” may be correct ( to a certain extent): Relationship between the volume of exercise, training duration, and fat loss: 150 minutes per week of aerobic exercise is associated with modest weight loss. 225−420 minutes per week results in greater weight loss.

Obesity & Exercise Regular physical activity is one of the most important factors related to long-term successful weight loss Obese and morbidly obese clients have unique problems associated with exercise Exercise training should focus on energy expenditure, balance, and proprioceptive training Obese clients should expend 200 to 300 kcal per session (weekly goal of 1,250 kcal expended)

Obesity & Exercise Resistance training can be added, but aerobic exercise should remain the priority The same exercise training guidelines for apparently healthy clients can apply to obese clients Health and movement assessments should be performed Core and balance training is important for this population Use caution with prone and supine positions

Obesity & Exercise Psychosocial Aspects of Working with Obese Clients: Obesity can alter the emotional and social aspects of a person’s life Trainers should pay attention to a client's emotional and physical well-being Proper exercise selections and positions are very important Walking is often a preferred activity

Obesity & Exercise Review Table 16.5

Obesity & Exercise Review Table 16.6

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Diabetes & Exercise Diabetes is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action or both Diabetes causes abnormalities in the metabolism of carbohydrate, protein and fat When left untreated, diabetes results in a variety of chronic disorders and premature death

Diabetes & Exercise People with diabetes are at an increased risk for developing health conditions like heart disease, stroke, kidney failure, nerve disorders and eye problems ~25.8 million Americans children and adults (8% of the populations) have diabetes 18.8 million have been officially diagnosed Because symptoms aren’t always evident early, about 7 million people are unaware they have the disease (American Diabetes Assoc. 2011)

Diabetes & Exercise Health care professionals use a fasting plasma glucose test or an oral glucose tolerance test to diagnose diabetes Diabetes: a fasting blood glucose level of ≥126 mg/dL Pre-diabetes: a fasting blood glucose level between 100 and 125 mg/dL

Diabetes & Exercise There are three (3) primary types of diabetes Type 1 diabetes Type 2 diabetes Gestational diabetes

Diabetes & Exercise Type 1 diabetes: Previously called juvenile diabetes or insulin-dependent diabetes mellitus (IDDM) Develops when the body’s immune system destroys pancreatic beta cells responsible for producing insulin Most frequently occurs in children and young adults but can occur at any age People with Type 1 diabetes require regular insulin delivered through injections or a pump to regulate blood glucose levels Accounts for 5-10% of all diabetes diagnoses

Diabetes & Exercise Type 2 diabetes: Formerly referred to as non-insulin dependent diabetes mellitus (NIDDM) Most common form of diabetes; about 90-95% of all diagnosed cases Typically presents as insulin resistance, a disorder in which the cells do not use insulin properly; the pancreas gradually loses the ability to produce insulin The combination of insulin resistance and impaired insulin production leads to frequent states of hyperglycemia

Diabetes & Exercise Type 2 diabetes: Initial treatment usually includes weight loss, diet modification and exercise ~75% of people with type 2 diabetes are obese or have a history of obesity Weight loss can improve and in some cases reverse the condition Many with Type 2 diabetes are put on oral medication and less frequently, injectable medications

Diabetes & Exercise Exercise and Diabetes: Most important goals: glucose control & weight loss Need to prevent “hyperglycemia” and “hypoglycemia” In most cases, exercise programming matches programs given to inactive and overweight/obese clients Care must be taken when recommending walking Daily exercise is recommended for glucose management and caloric expenditure

Diabetes & Exercise Exercise and Diabetes: -Low-impact exercises are ideal to start -Resistance training is advised as part of a complete program -SMR should be used with caution

Diabetes & Exercise 1. Review Table 16.7.

Diabetes & Exercise 1. Review Table 16.8

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Cardiovascular Disease 80.7 million Americans have one or more types of cardiovascular disorders: Dyslipidemia Coronary artery disease (CAD) Congestive heart failure (CHF) Hypertension Stroke Peripheral vascular disease Dyslipidemia is covered in depth in Module 1. Other conditions listed (and not covered in depth) require more extensive training/education to train those populations.

Hypertension & Exercise Cardiovascular Disease is the leading cause of death for both men and women in the United States Risk factors that contribute to cardiovascular disease: Family history Hypertension Smoking Diabetes Age Dyslipidemia Lifestyle (poor diet, physical inactivity)

Hypertension & Exercise Blood pressure is defined as the pressure exerted by blood against the walls of the blood vessels. Factors affecting blood pressure: Strength of heartbeat Elasticity of arterial walls Volume and viscosity of blood Health status Age Physical condition

Hypertension & Exercise Hypertension occurs when arterial blood pressure remains abnormally high. A client is considered to have hypertension if they have had two or more resting blood pressure measurements on separate days that include one of the following: Systolic BP: ≥ 140 mm Hg Diastolic BP: ≥ 90 mm Hg Taking BP medication

Hypertension & Exercise New guidelines published by the AHA have changed the definition of normal blood pressure to “less than 120 and 80 mm Hg”. Most common causes of hypertension: Smoking High fat diet Excess weight

Hypertension & Exercise Health risks associated with hypertension: Increased risk of stroke Increased risk of cardiovascular disease Chronic heart failure Kidney failure

Hypertension & Exercise Traditional methods for controlling hypertension: Antihypertensive medication Comprehensive lifestyle changes Regular physical activity Supportive nutrition Smoking cessation

Hypertension & Exercise Research has shown that exercise can have a modest impact on lowering elevated blood pressure (~10 mm Hg). Low-to-moderate intensity aerobic training has been shown to be just as effective as high-intensity activity in reducing blood pressure.

Hypertension & Exercise It is important to emphasize the importance of an overall plan to reduce blood pressure: Exercise Diet Weight loss (if appropriate) Compliance with medical treatment

Hypertension & Exercise Personal trainers should evaluate their client’s heart rate response to exercise. Personal trainers are encouraged to learn how to accurately asses both resting and exercise blood pressures with all of their clients.

Hypertension & Exercise It is important to monitor the body position of clients with hypertension at all times during a session. Supine and prone positions can often increase blood pressure, making them potentially contraindicated. Keep in mind, hypotensive and hypertensive responses to exercise are possible in clients with hypertension.

Hypertension & Exercise

Hypertension & Exercise

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