I currently work as a L4 Exercise Referral Specialist (Obesity, Diabetes, MSK / Low Back Pain, and Falls Prevention / Postural Assessment) on an Exercise Referral Scheme (Active for Health) in Rotherham. Before this job, I worked as a Personal Trainer in two Sheffield gyms. I came across many, many members who had chronic (long term) conditions. I achieved my Exercise Referral qualification with Envisage, and now teach the course with them. Through my L3 Exercise Referral knowledge, I enjoy helping clients to get fitter and healthier with condition-specific exercises.
The L3 Exercise Referral course with Envisage covers many of the chronic conditions you will come across when training clients. It gives an understanding of the physiology of each condition, and provides ACSM-issued guidelines for exercise. Over the next few months I’ll be writing articles on each specific condition. In this first article however, I’ll summarise the conditions to give you a great overview.
Cardiovascular Disease – today’s modern society has brought about many positives, but it’s also created the perfect environment for cardiovascular disease (CVD) to increase. The cardiovascular system has the essential role of supplying the body with oxygen and nutrients to support life. However, this system is being destroyed by excessive food consumption and inactivity.
The course covers two main aspects of CVD – Hypercholesterolemia (high levels of cholesterol in the blood) and Ischemia (where heart tissue demands more blood than can be delivered).
In the UK, roughly 66% – that’s 2 out of 3 people – have a total cholesterol level of 5mmol/L or above. This puts them at risk of developing CVD. Even more depressing is the statistic that the UK population has one of the highest average cholesterol concentrations in the world!
There are many risk factors for developing CVD, and equally several effective ways of reducing these risks: increasing levels of physical activity, improving a poor diet, stopping smoking, reducing the intake of alcohol, and taking medications called ‘Statins’.
Exercise will benefit the condition by improving cholesterol management, increasing the HDL / LDL (good & bad) cholesterol ratio, reducing the risk of CVD, and managing body weight.
Respiratory Conditions – these include Asthma and COPD (Chronic Obstructive Pulmonary Disease) which both affect the lungs and air passages.
The respiratory system is fully developed in an adult by the age of 25, but does not reach full maturity until the adult is in their early 40s. This is due to the continual increases in power, posture of the thorax, respiratory muscles and stature.
Asthma affects 1:12 adults (more common in women than men) and 1:11 children in the UK. It is disabling and disrupts work and leisure pursuits as well as normal everyday life. If left untreated, asthma can go on to cause chronic lung damage.
Wheezing, coughing, breathlessness and tightness in the chest are all signs and symptoms of asthma. An attack can be brought on by many different things: smoking, dust mites, stress, animals, chemicals, genetics or a viral / bacterial infection.
Although asthma can greatly affect a sufferer’s life, exercise brings many benefits: improved cardiovascular function, reduced risk of CVD, improved respiratory fitness, and improved performance in activities of daily living.
COPD is an irreversible condition, which is a combination of bronchitis (inflammation of the bronchi, which increase mucus production, which in turn produces phlegm, which then results in a cough) and emphysema (where the air sacs in the lungs lose their elasticity, causing the airways to narrow, resulting in shortness of breath).
The benefits of exercise for COPD are the same as for asthma, but also include decreased breathlessness, improved gaseous exchange efficiency, and increased muscular strength in the chest.
Endocrine conditions – the endocrine system is used for making and transporting the wide variety of hormones around the body. It also works closely with the nervous system. Hormones are the body’s way of keeping everything in homeostasis (balance), maintaining a stable internal environment.
Conditions covered on the Exercise Referral course are Obesity, Overweight, and Diabetes Mellitus.
Diabetes Mellitus (DM) consists of two main variations – Type 1 and Type 2.
Although different physiology, they share many of the same signs and symptoms: fatigue, recurrent infections, slow wound-healing, blurred vision, weight loss or gain, hunger, excessive thirst and urination, and abnormally high blood sugar levels.
In the UK, 1:16 people have diabetes – some of these are undiagnosed. Approximately 700 people are diagnosed with DM each day! There are currently four million people living with diabetes in the UK, and this is predicted to rise to five million by 2025.
Type 1 is caused by the complete absence of insulin production, as the cells which produce insulin are destroyed. The cause of this is not yet fully known, but is thought to be partly due to genetics, and partly environmental. Onset is generally rapid, and more often occurs in childhood or during teenage years.
Type 2 is often lifestyle related. It is due to either a lack of insulin being produced in the pancreas, or more commonly as a result of resistance to the action of insulin. T2 is responsible for 90% of the total DM diagnoses. It has a very gradual onset, remaining undiagnosed for years. However, it still carries risks of complications, and should not be seen as a ‘milder’ form of the disease.
As with the previous conditions, exercise has many benefits for the person diagnosed with DM: improved blood sugar control, improved insulin sensitivity, weight loss, reduced blood pressure, reduced risk of CVD, and prevention of developing T2DM for those shown to be at risk.
Obesity and being overweight are chronic conditions caused by the body storing too much fat. Much research is being done into the complex causes and equally complex solutions to the disease. The Foresight Report (2007) outlined that the prevalence of obesity has more than doubled in the UK over the past 25 years. In England, nearly 25% of adults are obese (having a BMI of 30 and above) and this is forecast to rise to 60% of men and 50% of women by 2050 if no effective action is taken.
Causes and risk factors include: poor diet, sedentary behaviour, an increase in the availability of fast food, reliance on technology, physiological factors (e.g. altered metabolic rate), alcohol misuse, some medical conditions, and medication side effects. Genetics is also a risk factor being studied at the moment. I was recently filmed as part of the BBC Horizon programme on genetics and obesity, which is due to be aired in June 2016 – so keep your eyes open for me!!
The benefits of exercise are: reduced weight, improved weight management, reduced risk for CVD factors, improved metabolism, strengthened joints to support weight, and improved mental and emotional state.
Skeletal and Mobility conditions – these include Osteoarthritis (OA), Rheumatoid Arthritis (RA), Osteoporosis (OP), Joint Replacements, and Simple Mechanical Low Back Pain (SMLBP).
Most people have heard of these conditions, but many will be unaware of just how debilitating and life-changing they are. Reduced mobility, often accompanied by significant pain, can considerably lower quality of life and lead to a poor psychological state. Individuals may be affected by a reduced ability to perform basic day-to-day tasks, and have difficulty getting out and about, resulting in less independence and an increased risk of slips, trips and falls.
If no effective intervention takes place the situation can worsen, with the obvious implications of further health complications and increased health care costs. However, with a good level of personal responsibility from the patient, and the knowledge and skill from a suitably qualified exercise professional, along with good medical intervention, the outcome can be greatly enhanced.
The aims of an Exercise Referral scheme are varied: to improve overall levels of mobility, to decrease the risk of trips and falls, to reduce the rate of deterioration of the condition, to reduce pain, to improve functional capacity, to increase levels of independence, to provide greater social opportunities, to enhance overall feelings of well-being and quality of life, and to reduce the risks or improve the management of other medical conditions such as CVD or DM.
Osteoarthritis (OA) is the most common of over 200 forms of arthritis. In the UK, approximately 8.5 million people live with OA. Out of these, women and older adults are the most likely to be affected.
Signs and symptoms include: pain (at rest or during exercise), stiffness, swelling, muscle weakness, limited range of movement (ROM), joint deformity, and joint instability.
The benefits of exercise include: boosting synovial fluid in the joints, stabilising affected joints, maintaining ROM, weight loss, reducing the risk of CVD, and maintaining functional movement.
Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by the inflammation of the synovial membrane around the joint. It tends to severely damage the affected joint, making it difficult to treat. The disease may also attack other tendons and ligaments, which in turn will greatly affect the type of exercise which can be done safely. However, the benefits of exercise are the same as for OA.
Osteoporosis (OP) literally means ‘porous bones’. On a bone scan, the bones have an aerated appearance, and break easily. An estimated 3 million people have OP in the UK. By the age of fifty, 1:2 women and 1:5 men will have broken a bone mainly due to poor bone health. Every year there are 300,000 new fragility fractures in the UK caused by OP.
There are NO visible signs and symptoms of early stage OP – the first sign is usually a fracture caused by only slight impact. Common risk factors include: poor diet low in calcium and Vitamin D, sedentary lifestyle, smoking, alcohol, caffeine, carbonated drinks (I’ll explain more about this fascinating risk factor in the main article on OP!), long-term corticosteroid use, gender, age, hormones, genetics / family history, body type (particularly having low levels of body fat), ethnicity, nulliparity (I’ll explain that later too!), and some medical conditions.
The benefits of the right exercises will: maintain bone density, reduce the risk of CVD, and maintain functional movement.
Joint Replacements can become necessary due to chronic obesity, the effects of being overweight, general wear and tear, and OA.
New joints will be unstable for the first few weeks after surgery, and are also prone to dislocation. However, normal functioning should be possible after six months, and the average lifespan of an artificial joint is roughly 10 years – although this is improving as technology progresses.
Low Back Pain (LBP) in incredibly common – 80% of people will experience symptoms at some point during their lifetime. The majority of these will also experience a recurrence of symptoms. The NHS spends £1 billion each year on costs relating to LBP.
Risk factors include: smoking, psychosocial stress, low self-esteem, lack of general fitness and activity levels, obesity, sustained compromised posture (I now sit up tall as I type this!), awkward postures and movements, prolonged sitting / standing, frequent bending and twisting, heavy and / or repetitive lifting, incorrect manual handling, exposure to vibration, pregnancy, age, previous history of LBP, pain in other regions, major scoliosis (covered in main LBP article), and physical trauma e.g. car accident.
The benefits of exercise include: reduced risk of CVD, maintenance of or improved functional movement and ability, improved posture, strengthened core muscles and support for lumbar spine, restored timing and efficient recruitment of local stability system, increased exercise tolerance, and promotion of self-efficacy.
Mental Health conditions – anxiety, depression and stress are the three conditions covered on the Exercise Referral course. They all relate to a person’s psychological health, which is a vital component of overall health. There is increasing evidence of the effects of mental health on our physical wellness. Indeed, CVD, IBS, respiratory disease and some cancers are all believed to be linked with mental health disorders.
A quarter of the UK population will experience a mental health problem at some point in their life. At any one time, 1:6 people will be affected by anxiety, stress or depression. Sadly for 1:12 people, their condition will last for more than a year.
Risk factors include: family history, traumatic life events, a pessimistic personality, low self-esteem and self-worth, long-term stress, early developmental experiences (e.g. loss of a parent), physical illness, viral infection, side effects of medication, and chemical imbalances within the body.
Benefits of exercise are numerous: improved mood, reduced anxiety, improved self-esteem and self-confidence, increased physical self-worth, improved body image, improved cognitive function, reduced risk of CVD, maintenance of functional movement, opportunities for socialising, and building a routine and purpose.