1. 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

2. 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.

3. 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)

4. 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

5. 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.

6. 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.

7. 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)

8. 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

9. 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

10. Obesity & Exercise
Review Table 16.5

11. Obesity & Exercise
Review Table 16.6

12. Any questions?

13. 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

14. 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)

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Diabetes & Exercise
1. Review Table 16.7.

23. Diabetes & Exercise
1. Review Table 16.8

24. Any questions?

25. 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.

26. 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)

27. 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

28. 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

29. 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

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

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

32. 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.

33. 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

34. 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.

35. 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.

36. Hypertension & Exercise

37. Hypertension & Exercise

38. Any questions?