1. Chronic Health Conditions and Physical or Functional Limitations
Chapter 16
Chronic Health Conditions and Physical or Functional Limitations

2. Purpose
To cover important information and recommendations for assessing and designing exercise programs for clients with selected chronic health conditions and physical or functional limitations.

3. Objectives
Define and describe the cause and symptoms of selected chronic health conditions.
Describe the characteristics of selected health and age-related physical and functional limitations to exercise.
Recognize how the conditions discussed in this chapter affect exercise training variables within the Optimum Performance Training™ (OPT™) model.
Recognize how acute and chronic responses to exercise vary in clients with chronic health conditions and physical or functional limitations compared with apparently healthy clients.

4. Age Considerations
There are physiologic differences between children and adults.
Children have a “peak oxygen uptake” instead of max VO2.
Children are less efficient and exercise at a higher intensity of their maximum VO2.
Children do not produce enough glycolytic enzymes to perform sustained high intensity exercise.
Children are not as efficient at thermoregulation.

5. Resistance Training for Youth
Lower risk of injury than most sports in which youth commonly participate.
Most common injuries are sprains to ligaments or muscle strain.
Children will build strength and bone density but very little increase in muscle mass.

6. Resistance Training for Youth

7. Senior Adults
Many physiologic changes create challenges for senior adults.
Chronic diseases like arteriosclerosis, atherosclerosis, and peripheral artery disease can hamper exercise and increase caution.

8. Senior Adults
Some of the normal physiologic and functional changes associated with aging include reductions in the following:
Maximal attainable heart rate
Cardiac output
Muscle mass
Balance/coordination (neuromuscular efficiency)
Connective tissue elasticity
Bone mineral density (BMD)

9. Basic Exercise Guidelines for Senior Adults

10. Obesity Fastest growing health problem in America
Approximately 66% of Americans older than age 20 are overweight, and of these, 34% (~72 million) are obese.
Body mass index (BMI), a measurement of height to weight ratio.
18−24.9 is normal range.
25−29.9 is overweight.
over 30 is obese.
Obesity is complex in cause; as we age we lose muscle and gain fat as a natural effect of aging.

11. Obesity and Exercise
Phase 1 and phase 2 of the OPT™ model are best for obese populations.
Slow, gradual weight loss achieved by decreased daily intake and through increased caloric expenditure through cardiorespiratory training and resistance training.

12. Basic Exercise Guidelines for Overweight and Obesity

13. Diabetes Two types of diabetes: type 1 and type 2.
Seventh leading cause of death in the United States.
23.6 million children have type 1 diabetes.
Exercise will improve type 2 diabetes by decreasing amount of insulin required and increasing insulin sensitivity.

14. Basic Exercise Guidelines for Diabetics

15. Hypertension
Hypertension (high blood pressure): systolic ≥140 or diastolic ≥90 mm Hg.
Research has shown that exercise can have a modest impact on lowering elevated blood pressure by an average of 10 mm Hg for both systolic and diastolic blood pressure.
Resistance training should be performed in a seated or standing position. Phases 1 and 2 of the OPT™ model will be appropriate for this population.

16. Basic Exercise Guidelines for Hypertension

17. Coronary Heart Disease
Coronary heart disease (CHD) remains the leading cause of death and disability for both men and women despite a significant (29.2%) reduction in death rates from CHD between 1996 and 2006.
Resistance training should be performed in a seated or standing position. Phases 1 and 2 of the OPT™ model will be appropriate for this population.
Clients with stable coronary artery disease should know or be taught information on the importance and benefits of exercise.

18. Basic Exercise Guidelines for Coronary Heart Disease

19. Osteoporosis
Osteopenia is a condition in which bone mass density (BMD) is lower than normal and is considered a precursor to osteoporosis.
Osteoporosis is a condition in which BMD is significantly reduced.
Research has shown that the risk of hip fractures doubles every 5 years in postmenopausal women older than age 50.

20. Osteoporosis
Resistance training should be performed in a seated or standing position. Phases 1 and 2 of the OPT™ model will be appropriate for this population.
Flexibility should be limited to static and active stretching. The use of self-myofascial release may be contraindicated for this population.
Focus on load-bearing exercise, but use caution.

21. Basic Exercise Guidelines for Osteoporosis

22. Arthritis
Arthritis is an inflammatory condition that mainly affects the joints of the body.
Arthritis is the leading cause of disability among U.S. adults.
Osteoarthritis is caused by degeneration of cartilage within joints.
Rheumatoid arthritis is a degenerative joint disease in which the body’s immune system mistakenly attacks its own tissue.

23. Arthritis
Clients with osteoarthritis have a decrease in strength and proprioception and a loss of knee-extensor strength in some cases.
Symptoms of arthritis (such as joint pain and stiffness) are heightened through inactivity as a result of muscle atrophy and lack of tissue flexibility.
Functional capacity and balance can be increased by progressing exercises so that they are performed in the seated position (without support) to a standing position.

24. Basic Exercise Guidelines for Arthritis

25. Cancer
Cancer is the second leading cause of death in the US after cardiovascular disease, with more than one half million deaths annually.
It has been estimated that American men have about a 44% probability and women have a 38% probability of developing cancer during their lifetime.
Exercise is an important intervention for clients recovering from cancer. It can:
Improve exercise tolerance.
Reduce the cellular risks associated with cancer.
Improve quality of life.

26. Basic Exercise Guidelines for Cancer

27. Pregnancy
Substantial research has documented the beneficial effects of exercise during pregnancy on the physiology and health of both the mother and developing fetus.
The gradual growth of the fetus can alter the posture of pregnant women, making flexibility and core training important, particularly core-stabilization exercises to improve strength of the pelvic floor musculature.
Care should be taken in postpartum fitness.

28. Basic Exercise Guidelines for Pregnancy

29. Chronic Lung Disease
In restrictive lung disease or disorders, lung tissue may be fibrotic and, thus, dysfunctional.
In chronic obstructive lung disease, the lung tissue may be normal, but air flow is restricted.
Clients with lung disease are often short of breath (dyspnea) and fatigue at low levels of exercise.
Exercise can improve functional capacity and decrease the symptoms of dyspnea.
In some clients, inspiratory muscle training can specifically improve the work associated with breathing.

30. Basic Exercise Guidelines for Lung Disease

31. Vascular Issues
Intermittent claudication is the name for the manifestation of the symptoms caused by peripheral arterial disease (PAD).
PAD is characterized by narrowing of the major arteries that are responsible for supplying blood to the lower extremities.
Exercise in an intermittent format, with rest as necessary between exercise bouts, is recommended.
Physician clearance for exercise is necessary for the client with PAD.
Exercise programming should follow the OPT™ methodology.

32. Basic Exercise Guidelines for PAD

33. Summary
Clients with special conditions, pathologies or dysfunctions require an alteration in their assessment and/or program design.
Consideration of individuals with special needs is twofold:
Provide a margin of safety.
Optimize training.