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Regular Exercise and Chronic Disease

Mahmoud Ibrahim, Certified Personal Trainer with a Bachelor's Degree in Athletic Training and Sports Science.

Individuals who choose to be more physically active lower their risk of developing certain degenerative diseases such as osteoporosis, diabetes, obesity, and cardiovascular disease. Regular exercise is associated with several health benefits, which I have listed below. However, it's important to consult your physician before and after starting an exercise program.

1. Reduction of risk of cardiovascular disease through:

  • Increasing HDL cholesterol.
  • Decreasing LDL cholesterol.
  • Decreasing triglyceride levels.
  • Promoting relaxation and relieving stress and tension.
  • Decreasing body fat and favorably changing body composition.
  • Reducing blood pressure, especially if it is high.
  • Making blood platelets less sticky.
  • Reducing cardiac arrhythmias.
  • Increasing myocardial efficiency by lowering resting heart rate and increased stroke volume.
  • Increasing the oxygen-carrying capacity of the blood.

2. Helps control diabetes through:

  • Making cells more permeable to insulin.
  • Reducing body fat.

3. Prevention of osteoporosis and arthritis through:

  • Developing stronger bones that are less susceptible to injury and fractures.
  • Increasing muscular strength.
  • Increasing the strength of ligaments, tendons, cartilages and connective tissue.

4. Help in increasing the feeling of wellness through:

  • Improving self-image and self-esteem.
  • Acting as a stimulus for other lifestyle changes.

This article discusses the special considerations of exercise program design for the following populations with these diseases: hypertension, coronary artery disease, diabetes mellitus, asthma, osteoporosis, and arthritis.

1. Hypertension

Hypertension is a condition in which blood pressure is chronically elevated above
levels desirable for an individual’s age and health. A lot of individuals suffering from hypertension don’t even know it although it is a very serious health problem. Hypertensive people run a very high risk of coronary heart disease and strokes.

Effect of exercise on hypertension:

Endurance exercise appears to be related to vasodilation, which results in a reduction in vascular resistance as well as a reduction in resting heart rate. Therefore, regular physical activity results in lower blood pressure. A combination of weight-reduction. Salt restriction and regular physical activity have all been recommended as treatments for reducing blood pressure.

Special Exercise Considerations for Exercisers With Hypertension:

  • Should not hold your breath and/or strain during exercise (Valsalva Maneuver)
  • In resistance training, use low weights and high reps.
  • Avoid isometric training (static muscle contraction).
  • Monitor intensity since medications may affect heart rate during exercise.
  • Track your blood pressure before and after exercise
  • Move slowly when transitioning from the floor to standing, since hypertensive individuals are more susceptible to orthostatic hypotension if on anti-hypertension medication.

Both hypertensive and hypotensive responses are possible during and after exercise for individuals with high blood pressure due to the lack or presence of medication.

2. Coronary Artery Disease (CAD)

The majority of heart attacks are caused by the buildup of plaque in the arteries supplying blood to the heart muscle (coronary arteries). This process is referred to as atherosclerosis. The plaque consists of fatty substances, cholesterol, and other blood chemicals, This plaque deposit enlarges over time, progressively narrowing the arterial channel through which blood travels. Eventually, clot forms and completely closes the vessel, resulting in a heart attack.

Cardiovascular Disease Risk Factors:

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People showing two or more of the following risk factors should be considered at high-risk of developing heart problems, They should obtain a medical clearance before exercising:

  • Males over 45 and females over 55.
  • History of heart problems in the immediate family.
  • Obesity.
  • High Cholesterol.
  • Cigarette smoking.
  • Sedentary lifestyle.
  • Diabetes Mellitus.
  • Previous heart problems.
  • Hypertension.

The role of exercise in CAD:
Exercise plays an important role in preventing heart disease, as well as in the rehabilitation of' individuals with heart disease. Physical inactivity is now recognized as an additional major risk factor for CAD. Even moderate exercise can produce favorable improvements in cardiorespiratory endurance and thus, reduce CAD risk. All individuals with a recent CAD, as well as high-risk individuals should obtain a medical clearance before exercising.

Special exercise considerations for clients with CAD (High risk or diagnosed):

  • Follow physician’s guidelines.
  • Start with a heart-rate range of 40% to 60% and gradually increase to 60% to 85% of Heart-rate reserve.
  • Avoid the Valsalva Maneuver.
  • Avoid isometric training (static muscle contraction).
  • When working with weights, avoid extended resting periods between sets.
  • Keep moving and keep the intensity moderate.
  • ln case of chest pain or any other warning signs (dizziness, arrhythmia, unusual shortness of breath), Stop exercise immediately.
Development of atherosclerosis

Development of atherosclerosis

3. Diabetes Mellitus

There are two types of diabetes mellitus:

Type I:

  • Insulin-dependent (childhood onset), under 20 years of age.
  • Destruction of insulin beta cells in the pancreas. they produce little or no insulin.
  • Overweight is very uncommon.
  • Familly history is infrequent.
  • Always use insulin.

Type II:

  • Non-insulin dependent (adult onset), over 40 years of age.
  • Reduced sensitivity of insulin target cells thus disabling them from using the available insulin.
  • Frequent overweight.
  • Frequent family history.
  • Not always use insulin.

Effect of Exercise on Diabetes Mellitus:

  • Exercise makes muscle cells more permeable to glucose.
  • Aerobic exercise seems to allow the body to make better use of available insulin.
  • Weight-loss through reduction of blood fats, thus reducing the risk for heart disease.

Special exercise consideration for Diabetics:

  • Diabetics requiring insulin injections should not be injected in primary muscle groups that will be used during exercise. This might cause insulin to be absorbed too quickly, resulting in hypoglycemia. On the other hand, lack of insulin might cause hyperglycemia.
  • Diabetics need to check their blood glucose frequently in order to determine the right insulin dosage with their physician according to their response to exercise.
  • They should be encouraged to always carry a rapid-acting carbohydrate (juice or candy) to rapidly counteract hypoglycemia.
  • Diabetics should be encouraged to exercise at the same time each day for better control and monitoring of results.
  • Exercise should be avoided during peak insulin activity.
  • A carbohydrate snack should be consumed before and during prolonged exercise.
  • Diabetics should take very good care of their feet, They need to regularly check them for cuts, blisters or any signs of infection.
  • Good quality exercise shoes are a must.

Exercise Prescription for Diabetics

Type I Diabetes Mellitus:

Thier goal is getting better glucose regulation and reduced risk for heart disease. Aerobic training intensity should be gradually increased from low to high, 5 to 7 days/week, 20 to 40 minutes.

Type II Diabetes Mellitus:

Thier goal is weight loss and weight control, Aerobic training intensity should be low, the frequency is 4 to 5 days/week, and duration is 40 to 60 minutes.


4. Asthma

Asthma is a reactive airway disease characterized by shortness of breath, coughing, and wheezing. It is due to constriction of the smooth muscle around the airways, a swelling of the mucosal cells and increased secretion of mucus. It can be caused by an allergic reaction, exercise, infections, emotion or other environmental irritants.

Approximately 80% of asthmatics experience asthma attacks during exercise (exercise-induced asthma).

Effect of exercise on asthma:
Although exercise has no direct effect on asthma treatment and/or prevention, asthmatics should be encouraged to exercise due to the other benefits of exercise on their general wellness.

Special exercise considerations for clients with asthma:

  • Before starting an exercise program, You should have a medication plan to prevent exercise-induced asthma.
  • Asthmatics should have a bronchodilator with them at all times and be instructed to use it at the first sign of wheezing.
  • Keep exercise intensity low and increase it gradually,
  • A longer warm-up is necessary (more than 10 minutes).
  • Using an inhaler several minutes before exercise might reduce the risk of an exercise-induced asthma attack.
Asthma attack

Asthma attack

5. Osteoporosis

Osteoporosis is defined as the reduced density of the bone. Causes of osteoporosis seem to be multiple but, inadequate storage of calcium during the younger years and a rapid loss of calcium after middle age are the main culprits. ln almost everyone with osteoporosis, the density of the bone in the lower lumbar and femoral neck regions is most affected by the mineral loss. Strength training enhances the uptake of minerals by the bone in order that they may handle the stress imposed by lifting weights.

The most important areas that need muscular and bone development:

The hip area:

Comprised of the largest muscles in the body, the hip area is the foremost section of the body to train. The most important types of machines to condition this area are the leg press and the total hip machine,

Upper body (chest, Shoulder, and Back):

Working these muscles provides resistance to the bones of the upper vertebrae, long bones of the arms, and the ribs. A weight-assisted machine can be used for working the chest area (dip exercises) and the back (pull up exercises).

Exercise guidelines for osteoporosis:

  • The most important element here is training progression as the goal is to strengthen weak and porous bone, bringing it back to its natural density.
  • A beginning program would start with low intensity and more repetitions. After a period of adaptation, it is time to increase the intensity and change the number of sets and reps.
  • Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength. The goal is to progress to a level that is perceived as difficult, This strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). Medically, the density should improve from 10% loss to normal (close to 0% loss in bone).
In osteoarthritis of the spine, disks narrow and bone spurs form.

In osteoarthritis of the spine, disks narrow and bone spurs form.

The hip joint shown on the left side of the image is normal, but the hip joint shown on the right side of the image shows deterioration of cartilage and the formation of bone spurs due to osteoarthritis.

The hip joint shown on the left side of the image is normal, but the hip joint shown on the right side of the image shows deterioration of cartilage and the formation of bone spurs due to osteoarthritis.

6. Arthritis

Scientists and modern researchers suggest that there are over 100 types of arthritis
known to us today. The two most prevalent types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common of the two. It is a non-systemic disease and usually attacks one specific joint in the body. Rheumatoid arthritis, on the other hand, is a systemic disease. It is an inflammation disease that occurs most frequently in females.

The main goal for people who suffer from arthritis is to keep the joints in good working order, relieve pain (mainly through proper nutritional support and anti-inflammatory medication), increase mobility and independence, thus alleviating depression. Another once in training people suffering from arthritis is reducing the incidence of fibromyalgia (poorly developed muscles).

Exercise guidelines for arthritis:

  • Frequent muscle toning and ROM programs for the entire body help maintain joint range of motion and clear waste products that accumulate in the joints,
  • Water exercise is also one of the most efficient and most gentle exercise programs for people suffering from arthritis. It is gentle to the joints, it allows a full range of motion and increases strength without causing much muscular stress.

It is not advisable to offer strength training exercises to people with severe joint pain. They should be advised to first seek medical help to adjust their nutritional system and offer them proper medication. These clients need a written medical clearance before they can participate in any type of exercise.

Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. With rheumatoid arthritis, the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and

Osteoarthritis, the most common form of arthritis, involves the wearing away of the cartilage that caps the bones in your joints. With rheumatoid arthritis, the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and

Finally, it's necessary for individuals with any of the previous health conditions to talk to their physician before joining any kind of exercise programs. Also, consulting of an experienced and knowledgeable personal trainer could help you to exercise safely, effectively, and could have a very positive effect on your quality of life by educating you and inculcating certain healthy habits into your lifestyle.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2016 Mahmoud Ibrahim

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