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How to Work with Clients Who Have Chronic Conditions

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Working with clients who suffer from one or more chronic disease conditions presents unique and serious challenges. When it comes to training a client who fits a chronic disease profile, the purpose of exercise becomes one of a therapeutic nature versus a performance nature you would typically see with a generally healthy, low-risk client.

As a certified health and fitness professional, you are part of the client’s healthcare and health-promotion team. While you do not have a medical scope of practice, you are responsible for taking the necessary steps to consult with a client’s physician on a regular and continual basis while the client is in your care. As with any client, you begin by gathering a complete and robust health-history inventory, which includes primary and secondary diagnosis’ and any past complications the client has experienced with exercise and general activity. Once these steps are completed and you identify the appropriate risk profile based on the known risk factors, you can start to design a safe and effective exercise program.

Chronic diseases are numerous and present different challenges to both the sufferer and the health and fitness professional. This article discusses the basic principles and considerations associated with the following chronic disease types:

Arthritis

The most common types of arthritis are osteoarthritis (a degenerative joint disease that breaks down cartilage and leads to the development of bone spurs) and rheumatoid arthritis (autoimmune disease characterized by crippling pain, swelling, stiffness and contractures). Many people are surprised to learn that exercise is a crucial and therapeutic component to the management of arthritis.

To ensure a client is working within his or her functional level and the program is safe and effective, work in partnership with the client’s physician to create a program focused on cardiorespiratory fitness, muscular endurance and strength, and joint range of motion (American Council on Exercise, 2014).

Exercise Guidelines Obtain medical clearance before beginning work with a client suffering from arthritis. Incorporate a variety of low-impact aerobic activities (avoid jarring activities such as running or plyometric exercises) three to five days a week, and up to 30 minutes each session. Start slowly with deconditioned clients (10- to 15-minute bouts). Extend the warm-up and cool-down sessions beyond the general recommendations. For aerobic exercise, focus on duration. For resistance exercise, focus on increasing the number of repetitions versus the amount of weight lifted. Start with two to three reps and increase to 10 to 20 (based on client’s abilities). Consider the use of isometric exercises when appropriate. Monitor your client’s response to exercise. If he or she experiences pain for more than two hours after exercise, modify the intensity. Encourage warm-water exercise. Encourage movement through a full range of motion.

(American Council on Exercise, 2014)

Precautions Monitor a client’s response to exercise. If he or she experiences pain for more than two hours after exercise, modify the intensity and report pain experience to the client’s physician. Stay in touch with the client’s primary care physician to ensure that a change in medications won’t interfere with the protocol you have in place. Clients afflicted with arthritis are generally less active and are likely to present with other mild-to-moderate risk factors. For less-fit individuals, participating in physical activity increases the metabolic cost by 50% due to pain, stiffness, inefficient biomechanical patterns and poor gait patterns. Repetitive motions may be problematic, so use variety in all activities.

(American Council on Exercise, 2014)

Asthma

The limitations associated with asthma, like many other chronic conditions, depend upon the severity of the client’s condition. It is important to understand that asthma itself is not a contraindication to exercise; however, those suffering from asthma should receive medical clearance prior to beginning an exercise regimen. A physician will have a better understanding of what might trigger a client’s asthma and can prescribe specific medications to mitigate those triggers. In general, exercise is a benefit to those with controlled asthma.

Exercise Guidelines Encourage proper and continuous hydration before, during and after exercise. Extend the warm-up and cool-down periods beyond general recommendations. Keep the intensity low (before the point at which breathing becomes challenging). Consider pool-based exercise as the air is moist and may lessen the likelihood of an attack. Encourage three to four days a week of aerobic activity. Incorporate resistance training a few days a week, aiming for one to three sets of 15-20 repetitions. Reduce the intensity of your client’s activity if you notice asthma symptoms occurring. Keep in contact with the client’s primary care physician and report any

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