Exercise for Secondary Complications: Clinical Exercise Physiologist

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Exercise for Secondary Complications: Clinical Exercise Physiologist

Despite the advancement of prescription medicine in the management of complex conditions, secondary complications continue to be problematic. This has resulted in patients experiencing an increasing frequency of medication and lifestyle related problems, which can significantly impair the benefits of these medications (Ciccolo et al, 2004).

Exercise prescribed by a clinical exercise physiologist is one possible management strategy for addressing these issues and has consistently been listed as one of the most popular self-care therapies for persons living with metabolic syndrome related disorders, heart diseases, muscle, bone and joint diseases, HIV, COPD, and cancer (Conn et al, 2009; Mock et al, 2000). Exercise has potential preventative benefits associated with increased lean body mass, improved cardiovascular fitness and psychological well-being (Pederson &Saltin, 2006; ACSM, 2009).

We encourage exercise training to serve as an alternative or adjunct therapy to assist in the management of these chronic diseases, with the goals always focused on improving the patients’ quality of life.

Benefits of exercise include:

    • Reduced fatigue by 25% in woman with breast cancer (Schwartz, 2000; Ahlberg et al, 2003; Mock et al, 2000)
    • 8 weeks of progressive resistance training increased leg strength by 50% in adults infected by HIV (Roubenoff et al, 1999)
    • Aerobic fitness (maximum oxygen uptake) increased by 10% in patients with COPD following 2 months of supervised exercise training (Ries et al, 1995)
    • 8 weeks of circuit training reduced abdominal and trunk fat and normalised flow-mediated dilation of the brachial artery in obese adolescents (Watts et al, 2004)
    • Regular exercise habits adopted later in life reduced occurrence of metabolic abnormalities (Petrella et al, 2005)
    • Lean tissue mass increased by 10% in premenarcheal girls following a 10 month strength building program (femoral neck BMD increased by 12%) (Morris et al, 1997)
    • Significant improvement in 4 of 5 quality of life indices following 16 weeks of group based exercise in persons with rheumatoid arthritis (Perlman et al, 2005)
    • Exercise improved psychological well-being (24%) and self-efficacy (38%) in adults aged over 45 (Netz et al, 2005)
 The following information is to assist a clinical exercise physiologist with prescribing exercise for individuals with complex conditions.

Exercise Frequency, Intensity, Duration and Mode
Benefits can be attained safely from a combination of continuous aerobic exercise and progressive resistance training for at least 20 minutes three times per week. The number of weekly exercise sessions should be increased until the patient can tolerate three to five sessions weekly (US department of health, 1996). Aerobic exercise should be performed at a moderate intensity (from 3 – 6 on the modified Borg scale, a light sweat). Resistance training should consist of 8-10 different exercises that target the major muscle groups (Feigenbaum& Pollock, 1999). The intensity should be moderate (set at 60% to 80% of the one repetition maximum) and progressively increased (ACSM, 2006).

Special Considerations
Important considerations include neuropathy, fatigue, fat redistribution, and mental health; all of which need to be addressed during exercise prescription. A clinical exercise physiologist that prescribes exercise in conjunction with goal setting has been shown to have a positive effect on all of the above considerations; however in order to gain the most from the exercise and achieve increased adherence it may be necessary to include targeted psychological support

“We know of no single intervention with greater promise than physical exercise to reduce the risk of virtually all chronic diseases simultaneously” – Booth et al, Journal of Applied Physiology 2000.

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References

American College of Sports Medicine.Guidelines for Exercise Testing and Prescription. 4th ed. Philadelphia, Pa: Lea &Febiger; 2006

American College of Sports Medicine. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. Champaign, Ill: Human Kinetics Inc, 2009

Ciccolo JT, Jowers EM, Bartholomew JB. The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era. Sports Medicine. 2004;34(8):487–499

Conn VS, Hafdahl AR, Brown LM. Meta-analysis of quality-of-life outcomes from physical activity interventions. Nurs. Res. 2009;58(3):175–183

Feigenbaum MS, Pollock ML. Prescription of resistance training for health and disease. Med Sci Sports Exerc. 1999; 31: 38–45

Mock V, Atkinson A, Barsevick A, et al. National Comprehensive Cancer Network oncology practice guidelines for cancer-related fatigue. Oncology 2000; 14: 151–61

Morris FL, Naughton GA, et al. Prospective Ten-Month Exercise Intervention in Premenarcheal Girls: Positive Effects on Bone and Lean Mass. J Bone Min Res, 1997; 12(9): 1453-1462

Netz Y, Wu MJ, Becker BJ, Tenenbaum G. Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychol Aging. 2005; 20: 272–284

Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports. 2006;16:3–63

Perlman SG, Connell KJ, Clark A, Robinson MS, Conlon P, Gecht M, et al. Dance-based aerobic exercise for rheumatoid arthritis. Arthritis Care Res 1990; 3: 29–35

Petrella RJ, Lattanzio CN, et al. Can adoption of regular exercise later in life prevent metabolic risk for cardiovascular disease? Diabetes Care, 2005; 28:694-701

Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med, 1995; 122:823–832

Roubenoff R, McDermott A, Weiss L, Suri J, Wood M, Bloch R, Gorbach. Short term progressive resistance training increases strength and lean body mass in adults with human immunodeficiency virus. AIDS 1999; 13:231-9

Schwartz AL: Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract 8:16-24, 2000

US department of health and human services.Physical activity and health: a report of the surgeon general. Atlanta, Ga. US department of health and human services, centers for disease control and prevention, national centre for chronic disease prevention and health promotion; 1996

Watts K, Beye P, Siafarikas A, et al. Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. J Am Coll Cardiol.2004;43 (10):1823– 1827

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