Exercise Prescription Guidelines for Common Medical Conditions

Given the role of the exercise instructor it is not surprising that he or she is often asked to advise clients on a range of medical issues. However, regardless of an individual's personal experience or expertise it is neither appropriate nor ethical for those without medical qualifications to attempt to diagnose or counsel clients from a medical point of view.

The following paragraphs will therefore concentrate on the exercise prescription guidelines appropriate for a number of common medical conditions.

1. Arthritis
Arthritis involves the inflammation of one or more of the joints and is characterized by swelling, pain and restricted movement. There are more than 80 diseases known to cause arthritis and only the most common form, osteoarthritis, is examined below.

Osteoarthritis, which is most common in load bearing joints of the elderly, involves the degeneration of articular cartilage which may result from long term over-use or an acute injury. As the cartilage degenerates more load is placed on the underlying bone and spurs (roughened nodules known as osteophytes) may develop.

Whilst the treatment for osteoarthritis commonly involves reducing the load on the joint via the use of walking aids, exercise is not inappropriate. In fact, well designed programs may help prevent the loss of joint mobility which might otherwise eventually incapacitate the patient. Obviously weight-supported activities like swimming and cycling are preferable to running as excessive weight bearing may accelerate joint degeneration. Warm-ups for osteoarthritic exercisers should be extensive and concentrate on improving the range of motion available at the damaged joints.

2. Asthma
Asthma is a condition characterized by 'attacks' in which the bronchial airways of the lungs become restricted causing difficulty in breathing. Asthma attacks may be associated with exercise, allergens (such as dust and pollen), severe emotional conditions and infections.

Exercise induced asthma (EIA) probably causes the most concern for exercise instructors, however, the sensible use of asthma sprays before and during exercise usually limits the extent of bronchospasm.

Whilst the exact cause of EIA is unknown it is thought that the rapid ventilation during exercise may be responsible as this results in drying and cooling the airways mucous lining. This theory is partially supported by the observation that for many asthmatics, attacks are more common in cool and dry conditions.

Sensible guidelines for exercise prescription include the following;

a. If asthma sprays have been prescribed these should be used prior to, and during exercise as required.

b. Asthmatics should avoid exposing themselves to conditions known to aggravate their condition. Some may need to avoid exercising in the cool of the morning, whilst others may have to seasonally restrict their outdoor exercise because of the pollens in the air. Dust particles in carpet may also cause asthma in some cases so the amount of 'floor work' should be limited.

c. Swimming is recommended as the humidified air from near the surface of the pool is less likely to trigger an attack.

Diabetes Mellitus
Diabetes mellitus results from any condition which interferes with either the secretion of insulin from the pancreas or its action on the cells of the body.

Insulin is a vitally important hormone responsible for storage of glucose in the muscle fibers and liver as well as the other cells of the body. It also controls the storage of fat in adipose tissue.

In the absence of sufficient insulin blood glucose levels rise (hyperglycemia) as glucose can not be transported into the cells. As a result of this and other more direct effects of insulin lack, the reliance on fat breakdown increases enormously resulting in the deposition of fatty deposits in the walls of the blood vessels. Insulin also enhances protein synthesis so, in its absence, protein stores are broken down resulting in the wasting of muscle and other organs. As a consequence of these effects the diabetic tends to tire easily and lose weight.

Diabetes is classified as either insulin dependent, or non-insulin dependent in nature. Heredity seems to play a role in the development of both types of diabetes although the non-insulin dependent condition is also associated with obesity. Given this association with obesity the course of the latter condition can often be reversed if significant weight loss is achieved.

Exercise, like insulin, increases the rate of glucose transport into muscle fibers. As a result regular exercise has the very positive effect of decreasing the diabetic's insulin requirements. However, insulin dosages will need to be recalculated by a physician or diabetic clinician when a new exercise program is planned.
When either too much insulin is taken or an excessive amount of unplanned exercise performed, the diabetic's blood sugar levels become lower than normal, a condition known as hypoglycemia. Minor hypoglycemia may cause light headedness and fainting but, if severe and unremedied, death may occur. The early signs of hypoglycemia indicate the urgent need for glucose, which can be provided by consuming a source of simple carbohydrates such as a barley sugar or fruit juice.

Exercise prescription guidelines.

1. Insulin dependent.
a. Activities with predictable and consistent energy requirements are advised.
b. Regular exercise is recommended (daily if possible).
c. Extra carbohydrates should be eaten before activity.
d. A form of simple sugar should be available in case of a hypoglycemic reaction during the exercise session.
e. Better control of blood glucose is achieved if short acting insulin is used. Insulin should be injected into areas such as the abdomen which are distant from the exercising muscles.

2. Non-insulin dependent.
a. Weight loss, and then maintenance of low body fat levels, should be a priority.
b. Exercise as often as possible (4-7 days per week) to maximize energy expenditure.

source:Exercise Prescription: A Case Study Approach to the ACSM Guidelines by David P., Ph.D. Swain and Brian C. Leutholtz