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An Intro to Chronic Conditions for the Fitness Professional

With the future of health being unknown, one thing is known — that Americans are living longer and with age often comes a chronic condition. Living with a chronic disease/condition is often an exhausting and frustrating ordeal.  Too often the person may feel burdened and burned out! When the stress of pain and fatigue, coupled with normal life stresses, the client may feel overwhelmed. When the client is overwhelmed, they often don’t take care of themselves and that only contributes to more fatigue and pain.  Just a few weeks of neglecting themselves can contribute to further disability.  What is the goal of the fitness professional – be positive and supportive and don’t contribute to making they condition worst.

The 3 E’s of Fitness Therapy

Your job as a fitness therapist is the 3 E’s: Educate, Empower and Encourage.

Educate yourself and client about their condition and effects their medications may have on exercise performance. Stay abreast of corrective exercise research. Knowledge is power!

Empower clients to be their own best advocate and to take control of their life not become a victim of their condition. Empower them to take the “dis” out of disability.

Encourage clients about ways to be the best they can be. Think of all methods to foster healthy lifestyles, provide hope and set realistic attainable goals

The purpose of this article is that knowledge is power, and the more you know about a condition, the more you will be an equal partner on your client’s health care team. Not every application is perfect for every client. Always stay alert that what is accepted as a “norm” today can change tomorrow with new research. That is why it is strongly encouraged that your client discuss their fitness plan with their medical professionals. You are not expected to know everything, but you are expected to know when to seek advice!

The Fitness Therapist is first and foremost an educator of the psychomotor domain.

Do NO Harm!

Sometimes clients with a chronic condition will be afraid to embark on an exercise program in fear that it will cause them injury or more pain. They may know intellectually that they should, but the apprehension about what might occur can be paralyzing.  They might tell you I know how I feel now and if I feel worst I might not be able to work or take care of my family.  Your first and foremost job as a fitness therapist is to DO NO harm and NOT make matters worse.  This is why having the client get prior approval and recommendations from their health professional can go a long way in motivating the client. In order to overcome a chronic condition, ask your clients to re-define their paradigm and focus on what they can do rather than what they cannot do! Ask them to think about the benefits of your successes.

Unfortunately, many people with a chronic condition are fearful that exercise may aggravate their condition, so they play it safe and do nothing. Too many people give up on an exercise program long before they experience the benefits of what regular exercise can provide. Be sensitive to your client’s concerns. Never minimize their condition, by saying, “You do not have it so bad I have a friend with ______ and she is doing fine.” What might be a small issue to one person could be a major issue to another. Always start the person where they are at and progress with care from there.

Very often improved fitness empowers the person with a chronic condition to live a richer and fuller life. Ask the client to decide what they want as an end goal of their exercise program and then design the program with small attainable steps to match their goals and abilities. Too often when a person with a chronic condition has lost control of their lives, everybody is telling them what medications to take, what to do and not do. Remind the client that they are the Captain of their wellness ship. You, their doctor and their family can be cheerleaders but they are the Captain.

As their personal trainer, do your best to make their body the best it can be. Never make promises that your program will cure them. Stay alert that many chronic conditions will ebb and flow with periods of exacerbations and remissions. While study after study supports that exercise, when done properly and prudently, produces good outcomes, exercise is never a replacement for medical care.

Regular exercise is therapy for the mind and body.

Some experts project that soon the integration of health care, fitness and wellness will intersect. The anticipated model of wellness and healthcare foresee the role of medicine will be to heal and fitness/wellness to restore health and vitality to those who participate in pro-active lifestyle.

Working definition of Wellness includes attention to the mind, body and spirit.

Today, doctors understand the importance of both passive therapies and rehabilitative exercise. While medical science continues to make great advances in surgical and pharmacologic treatments, exercise physiologists are also proving that simple interventions, such as proper body mechanics and corrective exercise, can play a significant role in decreasing the incidence and severity of orthopedic conditions and other chronic conditions. One of the goals of fitness therapy is to maximize the potential for full function and minimize the chance of re-injury.

Keep in mind that not every exercise is correct for every person or every condition. Depending upon diagnosis, certain movements will not be best for your client. Every program for a person with a chronic condition should be individualized and adapted as needed.

One size does NOT fit all in Fitness Therapy. The cookie cutter approach has no place in fitness therapy! Make the corrective exercise session a positive experience so the client will want to continue to make fitness an important aspect of their treatment plan.

It is important to stay mindful that “Recovery” of a condition may take weeks or even months depending upon the diagnosis or severity of the problem. Also, in the case of some chronic conditions, maintaining is all that can be hoped for. Slow and steady is the best approach. Progressing too quickly will only set the person up for re-injury. As the client embarks on the recovery process, you need to encourage clients to be their own health advocate and wellness trainer.

Exercise: The Miracle Cure All?

It can:

  • reduce cardiac mortality by 30%
  • improve self-image
  • reduce prostate cancer progression by 50%
  • assist in decreasing hypertension
  • reduce the risk of type-2 diabetes by greater than 50 %
  • reduce bowel cancer by 45%.

For more information see aomrc.org.uk/publications/reports.

Some General Guidelines for Working with Clients with Chronic Conditions

The world of health and fitness is a complex one. Lack of exercise contributes to diabetes, high blood pressure and other assorted sedentary health concerns, but too much exercise causes overstress and injury to joints and muscles. While exercise can make us feel good, too much can bring on pain and soreness. The answer is to train smart. If a client is hurting, let them know it is OK to back off.

  1. Consider asking the client to consult their health professional for suggestions regarding exercise and their condition. The information given by their health professional supersedes the information in any textbook, because the health professional is familiar with their unique situation.
  2. Perform their exercise program when they are having the least amount of pain/discomfort. Teach the client to listen to your body and heed what it says. Keep in mind the 2-hour rule; if the client hurts more 2 hours post-exercise, back off until they are pain-free, but don’t quit. Avoid any activity that aggravates your client’s condition. If they say, “I am fatigued”, don’t force one more repetition.  If they say, after a workout, “I hurt!” Back off!
  3. Never allow the client to mask pain with pills or lotions. Pain is the body’s way of informing them that something is going on inside. To prevent a re-injury or unnecessary pain, execute motions in a pain-free range of motion with proper form. If you suspect a re-injury, ask them to schedule an appointment with their doctor. If you suspect the person is abusing pain medications, seek advice. The client is more important than any exercise program!
  4. Encourage them to carry ID and medical information with them to sessions.
  5. Always teach and ideal proper posture and proper body mechanics in all movements when possible given their health status.

Exercise Do’s And Don’ts for Your Clients

  • DO carry identification when you exercise.
  • DO check heart rate before, during, and after exercise.
  • DO listen to your body, if it hurts, STOP!
  • Do prepare the body for movement and stretch and relax after a session.
  • DO drink plenty of water before, during, and after each exercise session.
  • DO consider solitary versus social aspects of your chosen program.
  • Do teach mindfulness when exercising.
  • DON’T bounce when stretching, and stop a stretch if it hurts.
  • DONT squeeze a week’s worth of exercise into one day.
  • DON’T overestimate your client’s capacity to exercise. However, DON’T underestimate it either. Remind the client that the body is designed for movement, but let it adapt slowly and gradually.
  • DON’T allow the person to hold their breath during exercise.
  • DON’T allow the person to go directly into a sauna, hot whirlpool (Jacuzzi), or steam bath after exercising.
  • DON’T use perspiration (sweating) as an indication of how good (or bad) your workout is: we all perspire at different rates and in different amounts.

Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.



Arthritis Today Sept/Oct 2015

MFN Contributing Author