To read part one in this series, click here
Part 2: Medical Co-Morbidities and Training Considerations
A history of Alcohol Use Disorder (AUD) poses a set of challenges for the fitness professional working with this population. Clients affected by AUD can benefit greatly from working one-on-one or in a group setting, however, specific medical co-morbidities must be considered when designing programming for and working with individuals in this population.
Malnutrition, specifically protein deficiency, and low levels of physical activity can cause the individual to have significantly reduced muscle mass as alcohol adversely affects anabolic and catabolic processes in the body. Additionally, high volumes of alcohol consumption lead to a decrease in the function of muscle progenitor cells reducing the body’s ability to rebuild damaged muscle tissue (Simon et al., 2017).
Alcoholic myopathy can present as an acute or chronic case. Chronic alcoholic myopathy is rare in individuals under the age of 30 and most common in individuals between the ages of 40 and 60 years who have a long-term history of alcohol abuse (Simon et al., 2017). Clients in the training setting affected by alcoholic myopathy will present with the chronic form. Aerobic and strength training has been shown to improve muscle endurance and maximal oxygen uptake in patients with alcoholic myopathy, but training regimens must be moderate in intensity and clients should be closely supervised. High-intensity activity should be avoided (Brown et al., 2014). Likewise, consultation with a registered dietician is recommended to optimize nutrition intake for these clients.
Long-term alcohol abuse can lead to impairments in cognition and motor coordination. Although poor cognition and motor coordination improve as the patient recovers, there may be some lingering effects. There is little research specifically targeting enhancing proprioception and cognition through exercise in this population, however, proprioceptive training has been found to improve these markers in the elderly, stroke patients and in otherwise healthy adults (Linke & Ussher, 2014). Rooge et al. (2017) conducted a trial with 70 sedentary adults and found that there was an average of a 52% increase in all markers of cognitive function and spatial awareness for participants (Rogge et al., 2018).
It is important for the fitness professional to understand limitations that may stem from poor motor coordination in these clients. A thorough fitness assessment including balance assessment such as the Berg Balance Scale should be included when starting with a client recovering from AUD. Additionally, these individuals may also benefit from an extended stabilization phase of training with progressions introduced slowly (Sanders, 2014).
Reduced Aerobic Capacity
Physician clearance for exercise is critical in this population, however, it is important for the fitness professional to note that the client may have longer-lasting organ dysfunction leading to the need for exercise modifications. Liver inflammation and dysfunction of the pancreas and kidneys and congestive heart failure are possible long-term effects of AUD. Kidney dysfunction can lead to anemia and electrolyte disturbance decreasing aerobic capacity and contractile strength and frequency of working muscles during exercise. Likewise, congestive heart failure can considerably decrease aerobic capacity via limited capability for the circulatory system to pump blood to working muscles (Osna & Kharbanda, 2016). Likewise, the client may be deconditioned from lack of physical activity at baseline or nutritional disturbances.
The fitness professional should be aware of these potential conditions and modify exercise accordingly. However, exercise can be quite beneficial for individuals with organ dysfunction as a result of AUD such as reducing the hepatic pressure gradient in those with cirrhosis of the liver (Locklear et al., 2018). Low to moderate exercise intensity is recommended in this population. Tests to estimate VO2 max are recommended for this population, though graded assessments are contraindicated. The 6-minute walk test or 3-minute step tests can be safe effective methods for determining VO2 max for clients with these potential comorbidities (Pollentier et al., 2010). They should be conducted upon initial assessment of the client and repeated periodically to check for improvements before increasing exercise intensity.
In the final article in this series, I’ll discuss other considerations that may not be quite as obvious, but equally important.
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Substance Use Disorder affects a huge number of individuals. More than 20 million Americans are diagnosed with Substance Abuse Disorder. Research has demonstrated that exercise therapy can help these patients a great deal from improving long-term neurological outcomes to relapse prevention. There are physiological and psychological considerations you must understand to design and implement successful exercise programs for this population.
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Nicole Golden is a NASM Master Trainer, CES, BCS, FNS and AFAA certified group fitness instructor and graduate student at Concordia University Chicago where she is earning her Master of Science in Applied Exercise Science/Sports Nutrition. She has been a health/fitness professional since 2014 when she left the field of education to pursue a full-time career in fitness. Nicole is the owner of FWF Wellness where she specializes in corrective exercise, weight loss coaching, nutrition coaching and group fitness.
- Brown, R. A., Abrantes, A. M., Minami, H., Read, J. P., Marcus, B. H., Jakicic, J. M., Strong, D. R., Dubreuil, M. E., Gordon, A. A., Ramsey, S. E., Kahler, C. W., & Stuart, G. L. (2014). A preliminary, randomized trial of aerobic exercise for alcohol dependence. Journal of Substance Abuse Treatment, 47(1), 1–9. https://doi.org/10.1016/j.jsat.2014.02.004
- Brown, R. A., Abrantes, A. M., Read, J. P., Marcus, B. H., Jakicic, J., Strong, D. R., Oakley, J. R., Ramsey, S. E., Kahler, C. W., Stuart, G. G., Dubreuil, M. E., & Gordon, A. A. (2009). Aerobic exercise for alcohol recovery: Rationale, program description, and preliminary findings. Behavior Modification, 33(2), 220–249. https://doi.org/10.1177/0145445508329112
- Locklear, C. T., Golabi, P., Gerber, L., & Younossi, Z. M. (2018). Exercise as an intervention for patients with end-stage liver disease. Medicine, 97(42), e12774. https://doi.org/10.1097/md.0000000000012774
- Manthough, E., Geogakouli, K., Fatouros, I. G., Gianoulakis, C., Theodorakis, Y., & Jamurtas, A. Z. (2016). Role of exercise in the treatment of alcohol use disorders. Biomedical Reports, 4(5), 535–545. https://doi.org/10.3892/br.2016.626
- Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., Leggio, L., Gasbarrini, A., & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353–365. https://doi.org/10.1007/s40265-015-0358-1
- Osna, N., & Kharbanda, K. (2016). Multi-organ alcohol-related damage: Mechanisms and treatment. Biomolecules, 6(2), 20. https://doi.org/10.3390/biom6020020
- Pollentier, B., Irons, S. L., Benedetto, C. M., DiBenedetto, A.-M., Loton, D., Seyler, R. D., Tych, M., & Newton, R. A. (2010). Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: A systematic review. Cardiopulmonary Physical Therapy Journal, 21(1), 13–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845244/
- Rogge, A.-K., Röder, B., Zech, A., Nagel, V., Hollander, K., Braumann, K.-M., & Hötting, K. (2018). Balance training improves memory and spatial cognition in healthy adults. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-35957-5
- Sanders, M. E. (2014). Personal balance training in focus, part II. ACSMʼs Health & Fitness Journal, 18(6), 30–35. https://doi.org/10.1249/fit.0000000000000076
- Simon, L., Jolley, S. E., & Molina, P. E. (2017). Alcoholic myopathy: Pathophysiologic mechanisms and clinical implications. Alcohol Research : Current Reviews, 38(2), 207–217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513686/