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The Importance of Exercise, Part IV: Special Populations

This is the fourth blog in a series on the importance of exercise. This will focus on diseases and disorders which receive unique benefits from exercise, as well as special considerations for exercise prescription in those populations.

For healthy adult populations a summary of an exercise program is found in the table below:

 

 

Component	Frequency	Intensity	Duration	Activity
Cardio-respiratory	3-5 days/week	70% - 94% Max Heart Rate	20 – 60 minutes	Large muscle groups
Resistance	2-3 days/week	Volitional fatigue	1 set of 3-20 repetitions	8-10 exercises of all major muscle groups
Flexibility	Minimal: 2-3 days/week, Ideal: 5-7 days/week	Stretch to tightness at end of range of motion but not to pain	15-30 seconds, 2-4 X per stretch	Static stretch all major muscle groups

 

Arthritis

Benefits:

The benefits of exercise for those suffering from arthritis are similar to the general public. Regular exercise will improve cardio-respiratory fitness, balance, flexibility, and endurance, enhance the ability to perform activities of daily living, and decrease the risk of mortality, cardiovascular diseases, diabetes, obesity, colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety. Maintaining a healthy body weight is especially important for those with arthritis. Every pound of excess body weight doubles (up to quadruples, depending on the activity)  the amount of force on your joints (so if you have 25 pounds to lose, that feels like a minimum of 50 pounds on your knees!).

Special Considerations:

1. Avoid exercise during arthritic flare-up.
2. Focus on improvement of both functional status (activities of daily living) as well as physical fitness. Functional activities (stair climbing, etc.) should be performed daily.
3. Perform flexibility exercises 1-2 times per day.
4. Use low-intensity and low-duration activities during initial phases of exercise programming.
5. Rheumatoid arthritis patients should avoid morning exercise if suffering from significant morning stiffness.

Diabetes

Benefits:

Outcomes of regular exercise in diabetics include improved glucose tolerance, increased insulin sensitivity, and decreased insulin requirements. In addition, diabetic patients who implement a regular exercise program will see improved lipid profiles, blood pressure reduction, weight management, increased exercise capacity, and improved well-being. Exercise is a very effective way to naturally decrease blood glucose. Exercise affects the body in a similar way to insulin by enhancing the uptake of glucose. This effect is both short term (immediate) and long term (adapted).

Special Considerations:

1. Type 2 diabetics should strive to accumulate a minimum of 1,000 calories of physical activity every week. Greater than 2,000 calories per week may be necessary for weight loss.
2. Make sure you check your blood glucose levels before and after exercise. Bring a carbohydrate snack to eat/drink if your blood sugar is low to prevent against a hypoglycemia-related incident either during or after exercise.
   1. Hypoglycemia (<80mg/dl) is a risk during and after exercise and rapid drops in blood glucose are common. Hypoglycemia may last as long as 48 hours after exercise.
   2. Hyperglycemia (>300mg/dl) may occur during exercise, especially for type 1 diabetics who are not in under good control.
3. Exercise with a partner or under supervision to reduce the risk associated with hypoglycemic events.
4. Intense resistance training often produces an acute hyperglycemic effect. Post-exercise hypoglycemia in the hours following basic resistance training is an increased risk for patients on insulin or oral hypoglycemic agents.
5. For those who suffer from diabetes-related neuropathies, monitor your vision, blood pressure, and any foot injuries and contact your doctor if you notice any changes.

Obesity

According to the most recent National Health and Nutrition Examination Survey (NHANES III, 2008), 34% of Americans are considered obese (BMI ≥30) and an additional 34% are considered overweight but not obese (BMI ≥25, <30). That’s 68% of Americans! Obesity is associated with an increased risk of a number of chronic diseases including high blood pressure, atherosclerosis, diabetes, early mortality, and decreased life expectancy. Ultimately, a net positive energy balance causes obesity. This means that if you are taking in more energy (i.e. calories from food and beverage) than you are burning (like during exercise or activities of daily living), you will gain weight. Physical activity and sound nutrition form the basis of obesity prevention and treatment.

Special Considerations:

1. Increase the overall energy expenditure of each training session as well as for daily activities (i.e. take the stairs rather than the elevator).
2. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes or more of physical activity may be necessary.
3. Physical activity is the best predictor of long-term weight maintenance. Small amounts of weight loss (5-10%) are associated with health benefits. Remember, even in the absence of weight loss, exercise can reduce the risk of cardiovascular disease.
4. The optimal approach to weight loss is one that combines diet changes (calorie restriction) with regular endurance exercise.

Osteoporosis and Osteopenia

Osteoporosis involves a reduction in both bone mineral density and bone quality which subsequently leads to general skeletal fragility (frailty). Osteopenia is defined as low bone density and puts the patient at risk for osteoporosis.

Benefits:

Exercise therapy has been shown to increase bone material and modify risk factors for fractures. Exercise improves muscle strength, bone-mineral density, and balance. Together this can help prevent against falls and fall-induced fractures. Exercise programming can positively affect peak bone mass in children and adolescents and can maintain and even increase bone density in adulthood.

Special Modifications:

1. Specific exercises focusing on improving balance by improving muscle strength.
2. Perform cardiovascular endurance exercise with low- or non-weight bearing (i.e. walking, aquatics, cycling).
3. Resistance training should be performed 2 days/week, for 8-10 repetitions at sub-maximal intensity (“somewhat hard”) for 1-2 sets.
4. Take special care to avoid exercises with spinal flexion and be sure to perform all exercises in an upright posture.
5. Flexibility exercises should be performed 5-7 days/week.
6. Functional exercise activities should be performed a minimum 2-5 days/week (preferably daily). This includes activities that are essential to an independent lifestyle like chair exercises (sit and stand) and vigorous walking.
7. Avoid explosive-type exercises such as jumping and running, as well as excessive trunk bending exercises like sit-ups, and twisting movements like those involved in a golf swing.

Kathleen Stewart, M.S.

Kathleen Stewart has a Masters degree from the University of Montana in Exercise Physiology. She works with Dr. Bayes as his Physician Extender and she is also a DFM certified personal trainer.