SPECIAL POPULATIONS, DISEASES AND ACTIVITYThe following section is devoted to discussion of the health and fitness concerns and needs of those individuals who are affected by certain disease states or special conditions. Fitness Facts believes that, regardless of such conditions, many of the individuals who fall into these populations can still enjoy and participate in exercise and activity.
However, Fitness Facts does not offer medical advice concerning the activities of these individuals. It is imperative that such people take the time to consult their personal physician concerning their specific needs and the appropriate considerations of such activity.
Coronary Heart Disease
Coronary Heart Disease, or CHD, accounts for approximately one half of the total deaths in the United States each year. Although recent years show a slight decline in CHD mortality rates, it is still the biggest killer and the most common cause of premature death in the United States today. Clinical manifestations of heart disease include the following conditions: angina pectoris, left ventricular dysfunction, cardiac arrest, myocardial infarction, and cardiac dysrhythmias among others.
Identifying Risk Factors
There are many risks for developing CHD. These factors have a combined effect, causing increased chances of CHD development. The risks, whether modifiable or not, include the following:
Testing for CHD
In addition to using these risk factors for estimating your chances of developing heart disease, there are additional methods to estimate your susceptability to heart attack and disease. The most reliable method for doing this involves a stress ECG or maximal graded exercise test. You can participate in such a test through your personal physician, local medical center, hospital or medical school.
Fitness Facts agrees with the American College of Sports Medicine that even seemingly healthy individuals 45 years and above should have such exercise testing done prior to beginning an exercise program. Fitness Facts also agrees that anyone 35 or over and at higher risk for CHD or metabolic disease, whether or not they have symptoms, should have a maximal exercise test. Moreover, people who have already been diagnosed with CHD or metabolic disease should have a maximal exercise test, regardless of their age.
If you are already involved in an exercise regimen and fall into one of these categories, it is still recommended that you undergo testing.
Reducing CHD Risk
Since the risk factors have a synergistic effect on increasing one's chances for CHD, reduction of as many factors as possible may result in the greatest chance for prevention. Indeed, seeking medical treatment for high blood pressure and diabetes, and quitting cigarette smoking, should help those affected by these conditions to reduce their risk of developing CHD. In addition, achievement and maintenance of optimal body weight and composition through combined caloric reduction and exercise will decrease your risk of heart disease. Improved dietary habits and regular exercise have also been proven to have a positive effect on lowering high cholesterol levels.
The benefits of well-planned, medically-sound, regular aerobic exercise with regard to decreasing the risk of coronary heart disease include the following:
Recovering cardiac patients should be aware of certain adjustments to their exercise program. Any such exercise program, whether it involves aerobic exercise or resistance exercise or both, should be prescribed by the proper medical authorities. Do not try to put your own exercise routine together without your physician's aid and approval. Strength training programs have been noted to be safe and beneficial for many cardiac patients. It is imperative that such a program be properly supervised.
In any case, consult your doctor before attempting any activity that has not been specifically prescribed by that doctor or a cardiac rehabilitation specialist.
Hypertension, or high blood pressure, affects 60 million Americans. As previously stated, high blood pressure is also a CHD risk factor. Hypertension occurs when blood vessels become "silted" with fatty deposits. As the arteries narrow because of this silting, the heart is forced to work harder against the increased resistance to pump blood through the body. The greater the amount of resistance, the higher the blood pressure.
A real risk concerning high blood pressure stems from the fact that the arteries' inner walls can become so narrow from deposited plaque and fats that a blood clot may result. Blocked blood vessels of the heart will result in a heart attack while blocked vessels in the brain could cause a stroke.
About 90-95% of hypertensive patients have primary, or essential, hypertension. This means that there is no one evident cause for the presence of the hypertension. It most likely involves the interaction of several genetic and environmental influences. The remaining five to ten percent of hypertensive patients do have an identifiable cause of high blood pressure. This situation is referred to as secondary hypertension.
The ideal value for blood pressure is usually 120/80 mm Hg. or less. The first value, systolic, may be considered high if over 140 mm Hg. The diastolic value is often considered high if it is over 90 mm Hg.
A number of methods are utilized in the management of hypertension. These may include behavior modification, prescribed medication, dietary modifications of caloric or salt intake, and the initiation of a moderate endurance exercise regimen.
People suffering from advanced hypertension should concentrate on maintaining and improving their state of fitness. The major theme behind any new exercise regimen for hypertensives should be moderation. Moderate, regular endurance training exercise has been shown to lower resting blood pressure by as much as 5-25 mm Hg.
Recommended activities for hypertensive exercisers include brisk walking, jogging, cycling, swimming and dancing. Such activities should be performed initially at low intensities and durations, gradually building up to three sessions a week of 30-60 minutes duration, performed at a moderate level of intensity.
Hypertensives should also avoid activities or exercises that involve intense straining, holding, hanging, overhead lifting, or pushing. It is thus extremely important that activities like wrestling, the throwing events of track and field, football, weight lifting and other types of resistance exercise be approved by a physician and closely monitored by trained personnel.
As with any program, consult your physician prior to beginning a new activity or exercise. Important questions to ask include possible exercise-medication interactions, suitability of activity/exercise, predicting proper training heart rate zones, and program specifics including intensity, duration, and frequency. Diabetes
Diabetics are not only at high risk for CHD, but also have a high incidence of eye problems, kidney failure, obesity and various nerve disorders. As of 1985, diabetes represented the fifth leading cause of death in America. The frequent, and often prolonged, elevation of blood sugar levels causes diabetics to suffer a progressive accumulation of glucose in their body tissues, thus interfering with their proper function.
Diabetics may also suffer regularly from elevated blood fats, increased tendency for blood to clot, reduced clot dissolving ability, low levels of cardiorespiratory fitness, and often obesity, especially in cases of type II diabetes.
The signs and symptoms of diabetes include the following:
Type I vs. Type II Diabetes
There are two types of diabetes. The majority of diabetics, some 85-90%, suffer from type II diabetes, or non-insulin-dependent diabetes mellitus (NIDDM). The remaining diabetics have Type I, or insulin-dependent diabetes.
Type II diabetes (NIDDM) involves a decreased number and function of insulin receptors that line the body cells. Even though these diabetics produce insulin, often in greater amounts than non-diabetics, it does not attach easily to the cell linings. The result is that glucose/blood sugar does not move as readily into the cells as it should.
Listed below are a few facts concerning NIDDM, or type II diabetes:
Type I diabetics have the following characteristics:
Treatment of Diabetes
The main objective of any diabetes sufferer is to maintain a normal level of blood sugar as long and as often as possible. A proper program of diabetic management can be accomplished with exercise, diet, glucose assessment and possible use of medication or insulin.
The benefits of proper diabetes control include the following:
Exercise and Diabetes
The primary objectives of an exercise program for the type I diabetic aim at improving glucose regulation, reducing risk of CHD, and establishing a regular pattern of diet and insulin dosage with regards to daily exercise. Diabetics should always get medical clearance from their doctor prior to beginning an exercise program.
Type I diabetics should begin with 5-10 minute intervals of aerobic activity performed at moderate intensity levels, interspaced with several minutes of rest. As exercise tolerance increases, begin working toward a goal of 20-40 minutes per day, 5-7 days per week. Precede each session with a 5-10 minute warm-up and finish it with a 5-10 minute cool-down. Such exercise is often best performed in the morning.
In addition, type II diabetics also use their exercise programs to aid weight control. Since approximately 75-80% of NIDDM sufferers are overweight, the combination of regular exercise and proper diet can help promote weight loss, thereby causing a potential drop in the amount of oral medication required. The type II diabetic should also concentrate on improving functional capacity, and reducing other CHD risk factors like high blood pressure, if applicable.
The choice of exercise for type II diabetics should be endurance training. Long-duration, low intensity aerobic activity reduces the possibility of severe insulin reaction due to the fact that it allows trained muscles and the liver to store glycogen more efficiently. Combined with a concurrent drop of body fat, increased physical activity boosts the capability of the insulin receptors that line the body's cells. Moreover, endurance training exercise may reduce cholesterol levels, blood pressure, tendency of blood to clot, body fat stores, and uric acid levels.
After receiving medical clearance, type II diabetics should begin their program in a similar fashion to type I diabetics. As exercise performance increases, the NIDDM patient should work towards a goal of 40-60 minutes, 4-5 days per week at low intensity. The same rules apply to warm-up and cool-down for the type II diabetic. Such exercise can be performed throughout the day.
Both diabetic groups generally should avoid high-intensity, prolonged exercise. It is also important for the diabetic to be aware of the signs of hypoglycemia, or low blood glucose levels. These signs include excessive perspiration, trembling, dilated pupils, drowsiness, blurred vision, dizziness, irritability and nervousness.
Hypoglycemia can occur during exercise or as late as 24-48 hours after the session. This condition seems to occur most commonly with high-intensity, long-duration exercise bouts.
The diabetic exerciser should avoid exercising immediately after insulin injection. Likewise, injecting insulin into the site of a muscle that is to be involved in the upcoming activity should also be avoided. Moreover, the diabetic should cancel the exercise session if he has ketones in the urine, elevated blood sugar above 300 mg%, or feelings of irritability, nervousness or strangeness.
Diabetic exercisers sometimes need to adjust their insulin or carbohydrate intake based on their activity schedules. By exercising at the same time each day, it is easier for the diabetic to plan his food intake for the day.
Most diabetics tend to increase their carbohydrate intake prior to exercise, usually in the range of 1 starch exchange, 15 grams carbohydrate, for each 30 minutes of anticipated activity. Snacking every 30-60 minutes may also help ward off possible insulin reaction during or after exercise.
Those diabetic individuals who do not increase their carbohydrate intake prior to exercise sometimes choose to decrease their insulin, if applicable. Such dietary, exercise, or medical practices should not be undertaken without consulting your physician.
An important point for diabetic exercisers to remember is that certain medications may exert a considerable effect on blood sugar. Examples include beta blockers, birth control pills, diuretics, and decongestants, all of which are capable of elevating blood sugar. In addition, beta blockers can mask the symptoms of hypoglycemia, creating potential problems during or after exercise sessions. In any matter concerning the interactions of medications and exercise, the individual should always make a point of talking with his or her physician.
It is important to remember that all of the preceding guidelines are simply general suggestions. As with any exercise program or activity, the diabetic should always consult his physician prior to participating.
In addition to having a maximal graded exercise test, diabetics should learn from their physicians the type and amount of medication they should take, when to do so, when to exercise, and whether to snack before, during or after exercise.
For further information concerning diabetes, please refer to the Nutrition Guide.
Obesity can be defined as excess body fat, or the excessive storage of energy in the form of fat. Some authorities describe obesity as a condition in which the individual exceeds his or her desirable body weight by more than twenty percent. Obesity is closely associated with hypertension, high cholesterol levels, NIDDM, some cancers and a host of other medical complications.
Causes of Obesity
There are a number of different theories concerning the causes of obesity.
Hyperplastic obesity involves the presence of too many fat cells. All of these cells work hard to retain their fat stores, thus making weight gain easy and weight loss difficult.
Hypertrophic obesity involves a normal number of cells. Each cell has too much fat stored within itself. It may be easier to achieve weight loss with this type of obesity.
Another idea concerning the causes of obesity has been termed the brown fat theory. This theory holds that obese people may either lack the normal amount of brown fat cells or be deficient in their ability to increase brown fat activity. Since brown fat tends to have a higher blood volume and is more metabolically active than ordinary fat cells, it tends to increase heat production at rest. This process has been called thermogenesis. The increased heat production is often able to increase metabolism when excess calories are consumed. Obese people may lack this useful metabolic tool.
Heredity may also play an important part in obesity. In families where one parent is overweight, 40-50% of their children end up overweight. Moreover, people who have overweight siblings are often overweight themselves. When both parents are overweight, 75-80% of their children wind up overweight. Alternatively, when neither parent is overweight, only 14% of their children turn out to be overweight themselves.
In addition to these causes, there is a specific population of obese people who owe their condition to a combination of overeating and lack of physical activity.
Negative Effects of Obesity
The disadvantages and health risks of obesity are numerous. They include:
Obese people often have an abundance of abdominal fat. Such fat has been shown to increase blood cholesterol levels, elevate blood pressure, and decrease the body's ability to effectively utilize insulin. In such a manner, abdominal fat can increase the risk of CHD.
Extreme levels of obesity can lead to serious disease states. Above levels of 30% excess fat, there exists a linear relationship between obesity and disease. And at levels exceeding 50% excess fat, the body approaches a point of no return, where the damage is not easily reversed. In simple terms, the human body is just not built to deal with great overloads of bodyfat or bodyweight for any extended period of time. The eventual result is breakdown.
To make matters worse, obesity forces an individual into a negative cycle. Since it is more difficult for the heavier individual to engage in meaningful activity for any length of time, obese people often become sedentary to even greater degrees than they had been. This contributes to increased storage of bodyfat, in turn contributing to a more severe degree of obesity.
Obesity makes exercise and activity harder, more awkward and less enjoyable. For these reasons, obese individuals need to tailor their exercise regimens to fit both their capabilities and their preferences.
Obesity and Exercise
For the obese person, exercise and dietary adjustments should work together to create a negative energy balance, where the calories expended are greater than the calories consumed. Such a program should be set up to promote caloric expenditure through low intensity, long-duration aerobic activity.
Aerobic endurance exercise helps increase the body's ability to use stored body fat as an energy source during exercise. The value of regular, consistent exercise among the obese should not be underestimated. Even if there is no weight or fat loss, an exercise program will still produce many benefits, including increased strength, endurance, and flexibility, feelings of well-being, and improved quality of life.
Obese people should avoid high-intensity, high-stress activities due to the increased forces that act on their joints and tissues.The most acceptable exercise for many obese individuals seems to be walking, although a physician should always be consulted prior to beginning any type of new activity or exercise.
A realistic attitude is essential to a successful, fufilling exercise program. Unrealistic expectations can overshadow the positive benefits of any fitness regimen. Similarly, "miracle cures" of saunas, vibration devices, and bodywraps should be avoided. Unfortunately, there are no "quick-fix" approaches to improved health and fitness.
A well-planned, medically-approved exercise plan acting in tandem with a sound dietary regimen of safe caloric restriction and behavior modification should always underlie any approach to dealing with obesity.
Approximately forty thousand people die annually from chronic respiratory disease. Chronic obstructive respiratory disorders (CORD) include asthma, chronic bronchitis and emphysema.
Asthma is characterized by a narrowing of the bronchial airways due to bronchial muscle spasm/contraction. The degree of narrowing varies greatly with time. Asthmatics usually have a family history of the disease or allergies. Asthma attacks, or severe constriction of the bronchial tubes can be provoked by specific allergic reactions, non-allergic environmental sources like cold air or smoke, or exercise.
Chronic bronchitis is characterized by the constant production of sputum for a period of at least three years. There are three types of chronic bronchitis:
Emphysema involves air flow obstruction due
to loss of elasticity of pulmonary tissue, which leads to airway
narrowing. Alveolar destruction usually occurs as
a result. The causes behind this condition include air
pollution, smoking, and family history.
CORD and Exercise
People with significant limitations should not engage in any type of exercise program without first receiving medical clearance from qualified personnel. Low-level, interval activity is usually prescribed for such individuals by their doctors. Fitness Facts recommends that such people participate in a medically-supervised program.
People suffering from moderate impairment should follow the same recommendations as above, working with medical personnel. At all costs, avoid high-intensity, long-duration activity. Those persons with pronounced impairment of bronchial function should have qualified supervision throughout their activity training sessions.
Those with extreme CORD-related impairments should not attempt to train, but rather adapt to their disability and gain energy for everyday tasks. Such individuals are often unable to walk even one block without experiencing serious difficulty or problems.
For those people who have CORD but are not limited by any form of impaired function, exercise is very possible. Such individuals often work up to daily sessions of 30-60 minutes of low to moderate intensity activity.
In addition, those that are least affected by their CORD should concentrate on a balanced regimen of cardiorespiratory activity, muscular strength and endurance, flexibility, and stress management. The main thrust of such a program should be aerobic training modes like walking, cycling and treadmill work. By choosing activities that vary little in intensity level and thus, oxygen consumption, the CORD sufferer can avoid sudden intensity spikes that could lead to breathlessness and discomfort.
Recreational sports, calisthenics and dancing can pose potential problems for individuals with respiratory disorders. The CORD sufferer should always be alert to daily changes in his condition and not hesitate to modify his exercise plans accordingly.
Strength training should initially concentrate on low-intensity, high-repetition resistance movements that work small muscle groups with the objective of promoting muscular endurance. Once an initial level has been reached, the CORD sufferer can advance to higher-intensity, lower-repetition muscular contractions to improve strength levels. CORD sufferers should avoid holding their breath during any resistance training exercise.
Warm-up sessions should stress gradually increasing activity that allows breathing to safely adapt to the exercise demands of the activity. In similar fashion, the cool-down should incorporate exercise of gradually decreasing volume and intensity.
Many people, including children and teens, suffer from exercise-induced asthma (EIA). Such individuals should be encouraged to participate in supervised exercise activity. Of course, the supervisor needs to be aware of the potential for asthma attacks and learn appropriate responses.
Fortunately, many of the following suggestions should serve to make EIA episodes a rare occurrence. Such precautions include:
Abnormal Blood Lipids
As previously mentioned, abnormal levels of lipids in the bloodstream can increase the risk of developing heart disease. It is important to be aware of individual blood lipid levels. For more information on cholesterol and other blood lipids, refer to your Nutrition Guide.
Some of the factors that influence this condition include:
Blood Lipid Profiles and Exercise
A safe, consistent and well-planned exercise program can benefit those suffering from health-threatening levels of blood lipids. Regular exercise has been associated with lower levels of plasma triglycerides, total cholesterol and LDLs. In addition, the positive HDLs usually experience an increase in response to consistent exercise.
Moderate to high-intensity aerobic and endurance type activities appear to be of the greatest benefit in this respect. Such beneficial activities include walking, cycling, swimming, jogging and cross country skiing.
Unfortunately, very low intensity activities like bowling, baseball, and archery do not have the same beneficial effects on blood lipids.
Prior to starting any new exercise or activity, consult your doctor concerning its suitability for your individual circumstances.
There are two types of arthritis: osteoarthritis and rheumatoid arthritis.
Osteoarthritis is the most common and is usually associated with old age. Signs can show up as early as forty years old, but usually make their presence known during the sixties. As we age, our cartilage begins to show the cumulative effects of years of normal, everyday wear and tear. Those joints most commonly affected are the weight-bearing ones like the knees and hips. The results are creaky, stiff joints.
Alternatively, rheumatoid arthritis appears at any time in one's life, typically sometime between 25 and 60 years old. Females seem to be more prone to the condition than their male counterparts. Rheumatoid arthritis involves the active inflammation of joint linings and related connective tissue. Skeletal muscle is also sometimes affected by this inflammatory process. Symptoms include swelling, pain, stiffness, and often a limited range of motion. Moreover, the incidence of pain can start suddenly or slowly build in intensity. Such periods of increased tenderness are often unpredictable.
In the beginning stages of the disease, activity and movement can aggravate the inflammatory process. Oddly enough, as the condition progresses, stiffness and pain are more prominent after rest while movement seems to bring some relief of pain.
Arthritis and Exercise
With regard to exercise, arthritis sufferers should avoid high-impact movements and may even choose to avoid exercise entirely during phases of high disease activity.
If you do decide to exercise, choose movements that do not involve painful ranges of motion. In fact, certain weight machines have adjustable range-of-motion pins that can prove quite useful in avoiding the painful portions of a specific movement pattern.
During periods of disease inactivity, you should concentrate on exercise movements that involve a full range of motion. Light to moderate levels of exercise are usually quite safe for most arthritis sufferers.
Be sure to allow adequate time for warm-up activity in order to raise body temperature and thus prepare connective tissue and muscle for the upcoming stresses they will be exposed to. In such a manner, you may decrease the chance of injury.
Appropriate modes of exercise for most arthritis sufferers include biking, rowing, swimming in warm water, water calisthenics and resistance training. Such activities allow you to avoid full body weight loading on your joints and lower limbs.
Resistance training exercises should involve light to medium loads. You should be especially careful to avoid heavy loads during periods of disease activity. An alternative to conventional weight training for arthritis sufferers involves the use of static contractions, or isometric exercise. In such a manner, it is possible to avoid painful ranges of motion.
Regardless of your exercise preference, always consult your doctor concerning the suitability of a certain type of activity or exercise prior to participation.
For sufferers who are not used to exercise, there exists an increased risk of sprain or dislocation due to the weakened nature of the joint structures and surrounding connective tissues. In addition, individual bouts of exercise have been associated with some degree of discomfort for many arthritis sufferers. Such joint discomfort has been reported to last from hours to days.
Once again, a doctor should be consulted prior to starting a new activity or exercise regimen.
Many arthritis sufferers use analgesics or local cortisone injections to help reduce pain and inflammation. While these drugs are successful to a certain degree, they can also dull pain that might serve as a warning of impending injury during exercise. Use appropriate caution in such situations.
Since many arthritic individuals have a low exercise capacity due to the nature of the disease, a properly-structured, medically-approved exercise program will usually lead to rapid improvements. As a result of participation in such a program, many arthritis sufferers gain new proficiency in handling everyday work tasks.
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