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Fitness & Cardiovascular Disease

A Look at the Numbers of CVD

“Approximately every 34 seconds, 1 American has a coronary event, and approximately every 1 minute 23 seconds, an American will die of one.”(1)

In 2008, the Center for Disease Control (CDC) reported that 515,000 Americans experienced their first heart attack and over 200,000 Americans were treated for a second or third heart attack. In that year alone, 720,000 Americans suffered a heart attack and approximately 600,000 died of cardiovascular disease (CVD).(2)

HealthThe most common type of heart disease seen in the United States is coronary heart disease, which is a condition that occurs once plaque has built up on the walls of the arteries (atherosclerosis). With this build-up follows an inability of the heart to get the much needed blood supply it requires to function at optimal levels and risk of heart disease or stroke are elevated. Cardiovascular disease, however, encompasses more than this, including: hypertension, heart diseases (coronary, cerebrovascular, peripheral, rheumatic, congenital, deep vein thrombosis, arrhythmia, and failure) and strokes.

Consider research compiled by physicians:(1)

♥ First time coronary patients increased from 515,000 in 2008 to 620,000 in 2010; this did not include those who suffered silent heart attacks, which is estimated at another 150,000.
♥ Coronary heart disease (CHD) was responsible for 1 in every 6 deaths; CVD was responsible for every 1 in 3 deaths.
♥ 2,150 Americans die daily from CVD; this is an average of 1 death every 40 seconds.
♥ In 2010, 34% of CVD deaths occurred before age 75; current life expectancy is 78.7 years of age.
♥ Although the overall percentage of death due to CVD has declined in recent years, total expenditure including the cost of treatment, for CVD disease and stroke has been estimated at over $315 billion dollars.

Globally, the US fares a bit better than the growing, trend. As reported by the World Health Organization (WHO), in 2008, 17.3 million people died from CVD and this is projected to reach 23.3 million by 2030. Although CVD is preventable, and people have been able to recover from the initial diagnosis, cardiovascular disease continues to be the number one cause of death in the United States and across the globe.(3)

A Look at Symptoms of CVD

The American Heart Association (AHA) and CDC list the most common coronary warning signs and symptoms as: (4) (6)

  • Pain or discomfort in the jaw, neck, or back.
  • Feeling fatigue, weak, light-headed, or faint.
  • Feeling like the heart is skipping a beat or beating too quickly.
  • Chest pain, chest fullness, or chest discomfort.*
  • Pain or discomfort in arms or shoulder.
  • Shortness of breath, labored or difficulty breathing.

Trainers beware: when discussing the symptoms of CHD with your female clients, it is valuable to note that while chest pain, fullness, or discomfort is experienced, this pain frequently occurs co-morbidly with flu-like symptoms, including nausea and vomiting, and general feelings of malaise.

A Look at Preventing CVD

As with many conditions, risk factors that increase the chances of developing heart disease include: smoking, the use of tobacco-related products, a sedentary lifestyle and lack of regular cardiovascular exercise, an unhealthy diet, obesity, stress, and excessive consumption of alcohol. Research supports that CVD is largely preventable, and fitness professionals – trainers, instructors, and coaches – can directly influence the overall wellness and decreased likelihood of CVD through client education, retention, and adherence to exercise training programming.

As clients train to reach their goals, trainers should spend time educating them about the impact their physical activity, dietary, and other lifestyle choices have on their overall health, fitness, wellness, and their ability to stave off cardiovascular disease. This education should include options such as:

♥ Creating programs that motivate clients to continually pursue their goals while inviting others to participate in life-changing fitness regimes, will also increase a client’s exercise adherence
♥ Using supportive dialogue and monitoring tools to keep clients accountable and aware of the decisions they make increases a client’s retention
♥ Offering suggestions and options that keep clients active and informed, creates an awareness of patterns and increases a client’s success

In addition to inspiring more frequent physical activity, encourage a clean diet filled with a variety of fruits and vegetables. Clients should reduce their consumption of sugary-processed foods and sodium intake, while minimizing their consumption of trans and saturated fats and oils. Offering ideas, or creating connections with dieticians or nutritionists who can offer ideas, will empower clients to create the change that will prevent their ascent towards disease.

A Look at Training CVD Clients

Prior to beginning an exercise program, the National Association for Certification (NAFC) recommends that all clients complete Physical Readiness Questionnaire (PAR-Q) and health history forms. This knowledge not only enables trainers to identify a client’s genetic and individual susceptibilities, it also paves the way for behavior modification and client education.

Remember, for clients with CVD, a physician’s consent must be gathered prior to implementing exercise programming. Once this information has been obtained, the following are tips to successfully training clients with CVD:

♥ Identify target heart rates. While this is a good starting point, know it will not be the best measure of intensity for all of your clients with CVD.
♥ Start slowly. Trainers need to learn to communicate with their clients. This is especially important as the client’s body learns to adapt to exercise, exertion, and increased effort. Learn to listen, but to also look for signs of excessive demand.
♥ Know the effect medication has on blood pressure, heart rate and intensity. Medications can moderate cardiac output, thus diminishing the effects of exclusively measuring the heart rate.
♥ Discuss perceived exertion with your client. This is particularly important if they are on medication, such as beta blockers, to stabilize heart rate and blood pressure.
♥ Be sure clients prepare for exercise by completing a warm-up lasting approximately 5 – 10 minutes and also cool down the body with stretches and flexibility training.
♥ During cardiovascular conditioning ask clients to talk. Exercise should be moderately challenging, which will enable them to speak, but clients should not be gasping for air.
♥ Intensity for CVD clients may range from 50 – 80% of their perceived exertion.
♥ When needed during resistance training, use an incline bench and props to keep the head above the heart.
♥ Be sure clients do not hold their breath during training. This may require reducing the amount of heavy weights being lifted, and increasing the number of repetitions instead.
♥ Encourage clients to listen to their body. If they feel lethargic, short of breath, nauseous, experience chest pains, or become dizzy, exercise should be terminated immediately.
♥ Maintain a relationship with the client’s physician. As changes occur medically, fitness programming may require altering physically.


Becoming aware of indicators suggesting cardiovascular health has been compromised can be a frightening awareness, but it is one that can promote a complete lifestyle change. Exercise participation creates change within the total body; it increases strength, improves cardiovascular functioning, and enhances mood. Although prevention is ideal, for clients who have experienced a CVD event, developing this strength is important, and fitness professionals have the ability to make a difference in the cardiovascular, muscular, and mental health of this population. When needed, it is imperative that fitness professionals make modifications for their CVD population, but these modifications can benefit all clients. Developing dynamic and preparatory warm-ups, using various methods to assess intensity, being mindful of exercise progressions, and steadily monitoring clients are some of the necessary practices that should be implemented when working with a CVD client. In this supportive atmosphere, clients will be able to thrive and benefit from exercise participation.

Dr. Brown serves as Director of Education for the National Association for Fitness Certification. Learn more about NAFC at their website.


(1) Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.

(2) Center for Disease Control. (2009). Heart disease facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm

(3) World Health Organization. (2013). Cardiovascular disease. Retrieved from http://www.who.int/mediacentre/factsheets/fs317/en/

(4) American Heart Association. (2012). Symptoms and diagnosis of Heart attack: http://www.heart.org/HEARTORG/Conditions/HeartFailure/SymptomsDiagnosisofHeartFailure/Symptoms-Diagnosis-of-Heart-Failure_UCM_002047_Article.jsp

(5) Mayo Clinic (2014). Strategies to prevent heart disease: http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/ART-20046502

(6). Center for Disease Control. (2013). Prevention: What can you do. Retrieved from http://www.cdc.gov/heartdisease/what_you_can_do.htm

MFN Advisory Board and Industry Expert