Exercise, Meds & Age-related DiseaseNorvasc •Used to treat hypertension, angina & congestive heart failure •Used to improve survival after heart attack •Possible side effects:

Webinars on Demand, 2017

(C) 2012,2016 by Exercise ETC Inc. All rights reserved. 1

Exercise, Meds & Age-related Disease

Laura Abbott, MS, LMT • Master’s Degree, Sports Medicine

• Licensed Massage Therapist

• Undergraduate degree in Exercise Science

• Instructor of Kinesiology, Georgia State University

• ACE Certified Personal Trainer

• Guest speaker at Atlanta area massage schools and at the Georgia State University Physical Therapy department.

• Owner of Premier Performance, Atlanta, GA

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

http://www.exerciseetc.com/



Learning Objectives (5)

• After viewing this webinar you will be able to:

– Identify common exercise statistics

– Explain medication statistics

– List the top 10 medications for seniors

– Provide side effects of various medications and how they may affect exercise

– Explain exercise adjustments for diabetics

REMINDER:

• Obtain medical clearance and physician’s release prior to beginning an exercise program for clients with medical or orthopedic concerns.

• The information in this program is to help you understand possible exercise related possible side effects to common medications. It is not intended to replace specific information provided by pharmacists, medical doctors or drug manufacturers.

• Report any unusual symptoms or possible side effects to a physician immediately.

Exercise Stats • Less than 50% of

Americans exercise 3 times per week, 30 minutes per session

• 31%: no exercise at all

• The higher the income & educational level, the more frequent the exercise

• Men, people on the West Coast, adults between 18 -29 are the most frequent exercisers



According to the CDC…… • Adults over age 18 who meet US standards for cardio

activity: 47%

• Adults over age 18 who meet US standards for strength training: 22%

• Adults over age 18 who meet US standards for both: 18%

• Adults over 65 who report NO physical activity:

• National: 33%

• Highest: Kentucky: 40%

• Lowest: Hawaii: 19%

Life Expectancy in the USA Middle age: 45 – 65 yrs; Old age: 65 +

• General

population: 77.8 years

• Longest expectancy: – White

women: 80 years

• Shortest: – Black men: 69

years

Exercise, Disease & Medications Stats

• 75% of all American deaths due to:

– Stroke

– CAD

– Cancer

• Average 65 year old is on 4 prescription meds

• Average 85 year old is on 14

• Approximately 85% of Americans will have at least one of the following chronic diseases by age 65:

– Hypertension

– CAD

– Diabetes



The Top 10 Medications for Seniors*

* Includes brand names & generic equivalents

1. Narcotic Pain Relievers: Pain management

2. Statin Drugs: High cholesterol

3. Beta Blockers: Hypertension, CHF, Angina

4. Calcium Channel Blockers: Hypertension, CHF, Angina

5. Thyroid Hormone: Thyroid disease

The Top 10 Medications for Seniors*

* Includes brand names & generic equivalents

6. Proton Pump Inhibitors: Antacid, anti-ulcer

7. Antibiotics: Bacterial infection

8. Biphosphonates: Osteoporosis

9. Oral hypoglycemics: Diabetes

10. NSAIDs: Arthritis, rheumatoid arthritis

General Modifications for all Special Populations

• Physician release

• Strength: Low resistance and higher repetitions

• Cardio: Low to moderate intensity and longer duration

• Observe side effects of meds

• Generally, do not use HR to determine intensity (except for specific types of CAD)



Effects of Medications on HR

Beta Blockers Lower HR

Amphetemines Raise HR

Diuretics Do not

affect HR

Everything

else

Raise or

do not

effect HR

RPE, Exertion & Talk Test

RPE % VO2 Exertion Talk Test

9 50% Very light Speaks normally

11 60% Fairly light Speaks normally

13 70% Somewhat hard

Endurance

Slightly short of breath

15 75% Hard

Stamina phase

Speaks haltingly

17 85% Hard to very hard

Economy phase

Can gasp out 1 or 2 words

19 95% Very, very hard

Speed phase

Cannot speak

1) Narcotic Pain Relievers : What They Do

• Hydrocodone, Vicoden

• Used for severe, chronic pain

• Combination of codeine & acetiminophen

• Highly addictive

• Possible Side Effects: – Nausea, dizziness,

constipation

– May cause irritability



Pain Management: Exercise Protocol

• Work within limits of pain

• Keep intensity low to prevent acute pain response

• Choose seated or standing exercises to prevent dizziness, reduce fall risk

• Work with physician to schedule meds appropriately before & after workout

2) Statin Drugs: What They Do

• Lipitor, Crestor, Luxor

• Reduces the amount of LDL (bad) cholesterol made by liver

• Reduces triglyceride level in blood

• Increases HDL (good) cholesterol

Statins: Possible Side Effects

• May cause muscle weakness, tenderness or pain,especially with exertion

• May affect liver function:

– Yellowish skin/eyes

– Abdominal pain, nausea

• May result in kidney failure: rhabbdomyolysis

– Dark brown urine

• May increase risk for Type II Diabetes



High Cholesterol: Exercise Protocol

Cardio Strength Flexibility

Frequency 3 – 7 times per

week to burn 1500

– 2000 kcals

2 – 4 times

per week

Near daily

Intensity 40 – 70% VO2 10 -15 reps Point of

tension

Duration Start with 2 short

sessions, progress

to 40 – 60 minutes

1 – 3 sets 10 – 30

seconds

Type Low impact if

obese

Machines to

start

Static, active

3) Beta Blockers & 4) Calcium Channel

Blockers: What they Do

• Lisinopril , Inderol , Norvasc

• Used to treat hypertension, angina & congestive heart failure

• Used to improve survival after heart attack

• Possible side effects: – Dizziness, lightheadedness,

fatigue, dry cough

Heart Disease: What to Learn from the Physician

• Is patient suitable for non-clinical program?

• Diagnosis • Are there specific

guidelines for HR & BP? • Any contraindications?

Any pain? • Ischemia? If yes, is it

predictable? • Angina? Stable or

unstable? • Are there other health

issues?



Responding to Angina

• Stop exercise immediately

• If pain does not subside, client takes 1 nitroglycerin tablet every 5 minutes

• If after taking 3 tablets (or after 15 minutes) the pain persists, or if symptoms of a heart attack become present, call 911

• Seat client & monitor BP after nitroglycerin due to the likelihood of hypotension

Congestive Heart Failure: Symptoms

• Shortness of breath while lying flat,

with exercise or other exertion

• Coughing

• Swelling in the legs, feet, or ankles

• Trouble sleeping and a need for more pillows for comfortable breathing

• Waking up short of breath during the night

• Weakness or fatigue after small amounts of effort (e.g., climbing a flight of stairs)

• Symptoms usually develop gradually

Sample CAD Program

Cardio Strength Flex

Frequency 3-4X per wk, 2-3X per wk 3X per week

Intensity 40-85% VO2,

RPE 9 – 16;

Angina: 10 – 25

bpm below

angina

threshold

15 – 20

reps, 40 –

50% 1RM

Point of

tension

Duration 30 – 60 minutes 1 – 3 sets 10 seconds

Mode Any type they

enjoy

Circuit

training, no

Valsalva

Active, static,

tai chi



Exercise Guidelines for Hypertension:

BP >140/90 OR on meds

• Be aware of effects of BP meds on heart rate (Beta Blockers)

• Avoid isometrics, decline positions, arms higher than head

• No exercise if client forgets to take their medications

• Take blood pressure before, during, after exercise

• Stop exercise if systolic goes above 250 or diastolic goes above 110

Lifestyle Modifications

• Increase physical activity and/or exercise

• Reduce body fat

• Reduce dietary intake of saturated fat & cholesterol

• Eat more fiber

• Stop smoking

• Monitor alcohol intake

• Avoid excess sodium

Sample Hypertension Program


Frequency 3-7X per wk,

to burn up to

2000 kcals/wk

2-3X per

week

3X per week

Intensity 40-70% VO2 16 – 20

reps, 50 –

60% 1RM

Point of

tension

Duration 30 – 60

minutes

1 – 3 sets 10 seconds

Mode Any type they

enjoy

Circuit

training

Active, static,

tai chi



5) Thyroid Hormone: What it Does

• Synthroid

• Treats hypothyroidism (low thyroid function)

• Hypothyroidism implicated in lethargy & weight gain, especially in post-menopausal women

Synthroid: Possible Side Effects

• Increased sweating

• Poor thermoregulation

• Shortness of breath

• Mood swings

– Nervousness, anxiety

• Tiredness

• Diarrhea

Thyroid Disease: Exercise Protocol

• Untreated or uncontrolled hyperthyroidism or hypothyroidsim affect stamina, energy, exercise capacity

• Hypothyroidism is associated with lethargy and weight gain

• If the disease is controlled with medication there is no change in exercise capacity no need to alter exercise routine.



6) Proton Pump Inhibitors (PPIs): What They Do

• Prilosec, Prevacid

• Used for acid reflux, GERD, ulcers, heartburn & other GI tract disorders

• Reduces the amount of acid produced by the stomach

• Cures erosion of the esophogus; may prevent cancer of esophogus

• Possible side effects: headache, dizziness, vomiting, diarrhea

Acid Reflux, GERD, GI Distress Exercise Protocol

• No exercise immediately after heavy meal

• Client may do better with several smaller meals per day

• Watch for signs of GI distress

• The symptoms of GERD, acid reflux & indigestion may mimic the symptoms of an MI; don’t assume chest pain is GI distress; call 911

7) Antibiotics: What They Do

• Keflex, Cipro, Z-paks & many more

• Used to treat bacterial infections throughout the body

• Ineffective against viruses (common cold)

• Common side effects:

– Vomiting, diarrhea, changes in bowel habits, fatigue



Infections: Exercise Protocol

• No exercise during acute infection phase

• Exercise may compromise immune system & delay healing

• Some antibiotics (Cipro) specifically prohibit exercise during/after course of treatment

• Client may be weak, lethargic after course of treatment

• Gradual return to exercise after treatment has concluded

8) Biophosphonates: What They Do

• Fosomax, Actonel, Boniva, Reclast

• Increases bone density at spine and hips.

• Possible side effects:

– Heart burn, upset stomach, esophogeal regurgitatio

Understanding Osteopenia & Osteoporosis

• Osteopenia

–BMD deviation of >1 below young normal values

• Osteoporosis –BMD deviation of

>2.5 below young normal values



Modifiable Risk Factors • Smoking

• Alcohol abuse

• Excessive caffeine consumption

• Excessive dietary protein consumption

• Lack of dietary calcium

• Lack of sunlight exposure (to generate vitamin D)

Osteoporosis: Exercise Protocol

• Use high intensity strength training using free weights & structural exercises: – Squats, shoulder presses, deadlifts, shrugs

– Old school, free weight exercises

• If tolerated, impacting activities such as jogging, jumping & plyometrics – 50 two-footed jumps 3 days per week

– Squat jumps, jumping rope, side cone hops, stair bounding, split jumps

9) Oral Hypoglycemics: What They Do

• Glucophage, Metformin

• Increases insulin sensitivity to lower blood sugar

• Most effective with proper diet and an exercise program

• Possibleside effects: – Nausea, diarrhea,

vomiting, upset stomach



Understanding Diabetes Mellitus

• Type 1

– “Juvenile Diabetes”

– Insulin Dependent Diabetes Mellitus (IDDM)

– Treatment: • Exogenous Insulin

(injected)

– 5% of all diabetics

• Type 2

– “Adult Onset Diabetes”

– Non-Insulin Dependent Diabetes Mellitus (NIDDM)

– Treatment: • Diet

• Exercise

• Oral medication

– 95% of all diabetics

Exercise Adjustments • Physician may need to

adjust insulin dosage to prevent hypoglycemia

• If exercise is unplanned or of long duration, encourage use of supplemental carbohydrate to support increased glucose needs

• Replace carbohydrate stores post-exercise (30 minutes)

Blood Glucose Variations

• Client MUST monitor blood glucose before, during and after exercise

• If blood sugar >100, defer exercise until it raises

• Hypoglycemia: low blood glucose – Results from too much

exercise, too much insulin or too little food



Symptoms of Hypoglycemia

• Defined as blood sugar levels <60 mg/dl

– Dizziness

– Light headedness

– Unsteady

– Confused irritable

– Nervous

– Unconscious

Blood Glucose Variations

• Delayed hypoglycemia biggest danger – Increased glucose

uptake following exercise can cause hypoglycemia 6-15 hours after exercise

– Insulin sensitivity increases following exercise

Diabetes: Exercise Protocol


Frequency 3-6X per wk 2- 3X per week 2-3 X per wk

Intensity 40 – 70% VO2 10 – 15 reps

To the point

of tension

Duration 20 - 60

minutes

1-3 sets 10 – 30

seconds

Mode Any Free Weights,

Machines,

Tubing, etc.

Static



10) NSAIDs: What They Do

• Nonsteroidal Anti-inflammatories

• “Celebrex”

• Relieves pain & swelling

• Used for arthritis, rheumatoid arthritis

• Possible side effects: – Gastrointestinal distress,

gas

– Serious or fatal stomach bleeding

Arthritis & Rheumatoid Arthritis: Exercise Protocol

• Exercise Goals

– Increasing ROM

– Increasing strength

– Improving cardiovascular endurance

– Increasing joint stability

Abnormal Exercise Responses

• Unusual or persistent fatigue

• Increased weakness

• Decreased range of motion

• Increased joint swelling

• Continuing pain (pain that lasts more than 1 hour after exercising)



Additional Exercise Concerns • Avoid exercising red,

swollen painful joints

• Pain free joint ROM is encouraged & appropriate during flare ups

• Avoid neck strengthening & flexibility exercises in clients with a history of cervical instability due to rheumatoid arthritis

• Avoid joint stress at the wrist

• Perform shoulder exercises in the safe zone

• Stress management, anger management and any type of mind/body program have been shown to decrease symptoms

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on” • Log on to our website: www.exerciseetc.com • Click on “Administration” • Click on “Webinar on Demand Certificates” • Complete all required fields & click “submit” • Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

Post-course Learning Assessment This assessment must be completed if you are certified by BOC, CSCS or NSCA

Question 1

What percentage of Americans do not exercise at all?

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Question 2

The average 85 year old is on _____ different prescription medications

Question 3

Antibiotics are the _____ most common medication prescribed to seniors

Question 4

A possible side effect of statin drugs that could affect exercise is:

A. Muscle weakness and tenderness

B. Increases in HDL cholesterol

C. Dry cough

D. Lightheadedness



Question 5

For someone with diabetes, if their blood sugar is ______, they should defer exercise until it

rises.

Correct Your Work: Answer Key

1. 31%

2. 14

3. 7th

4. A

5. Less than 100

Make sure to keep this assessment with your other recertification documents for 4 years. Questions about any answer? Email us at: [email protected]

PLEASE NOTE:

• Remember to complete this webinar and print the certificate

by December 31 of this year.

• Certificates with next year’s date may not be accepted by your

credentialing organization.

mailto:[email protected]



Documents

Exercise, Meds & Age-related DiseaseNorvasc •Used to treat hypertension, angina & congestive heart failure •Used to improve survival after heart attack •Possible side effects: