In this lesson you will learn about common chronic conditions and safety tips for working with them.
- Focus on how you can integrate the minimum 3s for posture, breathing, perceived exertion, and hydration (Instructor Safety Skills) into the way you teach.
- Think about your emergency action plan and your strategy to adhere to general safety guidelines for all participants within the class.
- Answer the 33 questions on this lesson in the unit study guide.
Chronic conditions are those that last a year or more and require ongoing medical attention and/or limit activities of daily living. Examples include arthritis, diabetes, heart disease and hypertension. Behavioral health conditions are also increasingly common and include substance use and addiction disorders, as well as mental illnesses, dementia, and other cognitive impairments.
According to the Centers for Disease Control and Prevention, it is estimated that about two-thirds of older adults live with two or more chronic conditions (Ward, Schiller and Goodman, 2014). In 2014, 22 percent of the population age 65 and over reported having a disability as defined by limitations like vision, hearing, mobility, communication, cognition, and self-care. (Older Americans 2016: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. August 2016) The role of the SilverSneakers class instructor is to follow general safety recommendations for common chronic conditions. The guidelines presented address exercise-related posture, proper breathing, monitoring intensity and hydration.
Instructor Safety Skills for Chronic Disease Management
Hydration: Water is an essential component of the human body. Water aids in the transportation of nutrients, elimination of waste products, and regulation of body temperature. During exercise, the body may lose water faster than it can be absorbed into the digestive system. Therefore, consistent and regular hydration is recommended. Be aware of common signs of dehydration such as muscle cramps, nausea, or disorientation.
Instructor safety skill:
Always cue a minimum of three hydration breaks during each SilverSneakers class.
Posture: The effects of aging and disease on joint range of movement can lead to a decrease in proficiency for performing daily activities. Instructors must be ready to accept a wide-range of postural demonstration during exercise.
Instructor safety skill:
To encourage safe exercise demonstration, instructors must cue for posture a minimum of three times during each SilverSneakers class.
Breathing: Even and continuous breathing is an integral part of circulation. Not only does the process of breathing draw vital oxygen into the body, but breathing also allows for the removal of carbon dioxide. Breathing during exercise can help regulate blood pressure and exercise intensity. Never encourage retention or breath holding.
Instructor safety skill:
Instructors must cue for breathing a minimum of three times during each class.
Exercise Intensity: Perceived exertion is the primary method used for monitoring exercise intensity in SilverSneakers classes. Intensity checks help maintain exercise safety while encouraging participants to work hard enough to meet their exercise goal and make improvements. Be aware of common signs of cardiac emergencies such as shortness of breath, nausea, dizziness, and changes to skin color.
Instructor safety skill:
Cue a minimum of three times for perceived exertion.
Coronary heart disease (CHD) describes a group of cardiovascular diseases including peripheral vascular occlusive disease (PVOD), hypertension, and congestive heart failure (CHF). CHD, also known as coronary artery disease (CAD), is characterized by a range of conditions, from reversible myocardial injury and discomfort, or angina, to acute myocardial infarction or heart attack. Fatty plaque collecting inside the arterial walls causes the arteries to become narrow or blocked, ultimately leading to CHD. Heart disease is the leading cause of death among both men and women in the United States (Kochanek, Murphy, Xu, Tejada-Vera & Betzaida, 2014).
Regular exercise positively counteracts the primary risk factors for heart disease.
Peripheral vascular occlusive disease (PVOD) indicates arterial obstruction(s) causing restricted blood flow to the lower extremities. PVOD is very painful and may lead to the development of gangrene or an eventual amputation.
Hypertension, or high blood pressure, is defined as blood pressure that is consistently higher than normal and is the most important risk factor for a cerebrovascular incident or stroke. High blood pressure adds to the workload of the heart and arteries. Research has shown that low-intensity aerobic exercise can lower both systolic and diastolic blood pressure (American Heart Association, 2017)
Congestive heart failure (CHF) refers to the inability of the heart to provide adequate cardiac output to meet the oxygen requirements of the body. Inadequate oxygen intake can result in shortness of breath, rapid pulse rate, low tolerance to exercise, and occasional mental confusion. Causes of the disease include a dysfunction of the left ventricle, heart valve disease, and infectious myocarditis.
Instructor tips for coronary heart diseases:
- Remind participants to hydrate by sipping water and drinking slowly.
- Encourage even and continuous breathing to avoid “breath-holding” and straining during exercise.
- Avoid exercises that might produce an increase in blood pressure, such as isometrics and sustained overhead arm work.
- Create a safe environment with clean air and comfortable temperatures.
- Follow all physician’s directives.
Cancer is defined as abnormal or uncontrolled cellular growth brought on by changes to the genetic messages a cell’s DNA sends to its chromosomes for continued cellular growth and function. While the body can repair itself, mutations within chromosomes can take hold during the process of cellular division. This genetic change creates an abnormal chromosome within the cell, thus the rapid and unorganized growth of a tumor. Cancer cells are cells that divide abnormally and can form tumors. Tumors are classified as either benign or malignant. Breast cancer, for example, is the second leading cause of death in women (American Cancer Society, 2016). The current decline in death rates from breast cancer, cervical cancer and colorectal cancers is a direct result of improved screening methods resulting in early detection and intervention.
Instructor tips for persons recovering from cancer:
- Encourage participants to progress gradually and add resistance and/or intensity within comfort levels.
- Remind participants to pace themselves. Bouts of fatigue may compromise a workout following radiation and/or chemotherapy sessions.
- Be sure that participants drink water before, during, and after exercise.
- Create a safe environment with modifications and options for participation.
- Encourage participants to follow their physician’s directives regarding all surgical procedures.
Diabetes is a pancreatic disease that causes affects the organ’s ability to produce adequate insulin, a hormone that aids in transferring glucose into cells for conversion into energy. Without insulin or appropriate insulin response in cells, glucose remains in the bloodstream, resulting in hyperglycemia (i.e., high blood sugar).
Type I diabetes often occurs in children and young adults. These individuals are “insulin-dependent” because the pancreas produces little or no insulin and must depend on daily insulin injections.
Type II diabetes is common among adults over the age of 40 and affects a cell’s ability to respond to insulin. This type of diabetes is usually less severe and can often be controlled with diet, exercise, and weight management.
Instructor tips for participants with diabetes:
- Encourage participants to exercise at the same time each day for consistency in maintaining blood glucose levels.
- Remind participants to exercise one or two hours after a meal and carry carbohydrate snacks.
- Be sure that participants drink water before, during, and after exercise.
- Create a safe environment with clean air and comfortable temperatures.
- Encourage participants to consult a physician for bruises, cuts, or foot injuries.
Obesity is defined as total body weight 30 percent over ideal for women and 23 percent for men. However, the fat distribution and structural instabilities caused by excess body weight may be more significant indicators of an individual’s overall health status.
Instructor tips for obesity:
- Encourage low to moderate exercise intensity that begins with more frequent workouts performed for short time periods.
- Follow SilverSneakers FITT Guidelines for exercise.
- Encourage participants to hydrate often and avoid exercising in hot/humid environments.
- Be prepared to demonstrate choreography modifications and body positions appropriate for a larger body and avoid quick transitions, fast music and/or movements.
- Caution participants to avoid overexertion, and joint stress and overuse by participating in a variety of classes like non-impact aerobics, walking, aquatic exercise and strength training.
Arthritis is a chronic, degenerative disease of the joints causing painful inflammation. There are more than 100 different arthritic diseases, and it is estimated that most adults over the age of 65 suffer from a form of arthritis (Arthritis Foundation, 2017). The two most common forms are osteoarthritis and rheumatoid arthritis.
Osteoarthritis, the most prevalent form of arthritis, is a chronic disease resulting in degeneration of joint cartilage (Arthritis Foundation, 2017). Osteoarthritis commonly affects weight-bearing joints like the feet, ankles, knees, and hips.
Rheumatoid arthritis is a systemic disease of the auto-immune system which causes it to produce antibodies that attack the synovial membranes that surround joints. Symptoms include fever, fatigue, pain, stiffness and/or swelling. Rheumatoid arthritis can also affect the heart, lungs, nervous system, spleen and eyes.
Instructor tips for participants with arthritis:
- Closely monitor use of resistance tools. Strength training with weights may not be recommended; gripping or squeezing a resistance tool may be harmful.
- Introduce modified isometric exercise options to participants not being treated for coronary heart disease.
- Caution participants to avoid forcing a stretch to increase the range of motion.
- Ask for feedback from participants regarding the “two-hour rule.” If post-workout joint pain or discomfort lasts longer than two hours, subsequent workouts should be modified.
- Participants should avoid exercising in cold temperatures.
- Inform affected participants that exercise during “flare up” symptoms is contraindicated for the condition.
Joint replacements offer participants an opportunity for pain-free mobility. The most common joint replacements among SilverSneakers participants are of the knee or hip. Exercise recommendations for joint replacements is not a “one size fits all” approach. Encourage participants to speak with their physicians about safe recommendations for exercise.
Instructor tips for participants with joint replacements:
- Be sure participants follow all physician’s directives.
- Avoid teaching exercises that require excessive hyper-flexion/hyper-extension, rotation and/or abduction/adduction of the joint beyond physician-recommended directives.
- Communicate regularly with the participant to encourage gradual increases in exercise intensity.
- Be prepared to individualize and demonstrate modifications for progressive strength and range of movement exercises.
Back pain is often associated with acute injury, poor physical conditioning, poor posture, or obesity. Spinal misalignments like scoliosis, kyphosis and lordosis are common and may cause discomfort.
Instructor tips for participants with back pain:
- Teach exercises that strengthen the abdominal and lower back muscles.
- Include stretches for the hip flexor and hamstring muscles.
- Encourage participants to sit forward in the chair with a ball placed behind them for support.
- Remind participants to practice proper postural alignment and body mechanics for seated and standing exercises. Encourage the proper exercise technique.
- Avoid excessive or unsupported forward flexion from the hip or spine.
Chronic bronchitis, asthma, exercise-induced asthma, and emphysema are common lung and respiratory system diseases in which expiration is difficult or inadequate. Restrictive breathing does not allow sufficient intake of oxygen or sufficient elimination of carbon dioxide. As a group, these conditions are referred to as chronic obstructive pulmonary disease (COPD). Chronic bronchitis symptoms include a persistent cough occurring daily with clear, colorless sputum.
Participants with COPD are taught to breathe out slowly through pursed lips. This type of breathing creates enough back pressure in the lungs to keep smaller airways open.
Common respiratory system conditions:
- Asthma attacks occur when smooth bronchial muscle around the small airways in the lungs constricts. Symptoms include shortness of breath, episodes of difficult breathing, and wheezing. Allergic reactions to foreign substances can cause asthmatic symptoms.
- Exercise-induced asthma can be triggered when exercising in a cold, dry climate. As air enters the lungs, it is humidified and heated to body temperature. During exercise, heating and humidifying a large volume of air results in a heat and water loss from airways. As airways become cooler and drier, chemicals are released to narrow the airways. This obstruction causes an out-of-breath feeling that may last for up to an hour after exercising.
- Emphysema is a pulmonary disease that gradually destroys lung alveoli (air sacs) and surrounding connective tissues. Fewer alveoli create an uneven exchange between carbon dioxide and oxygen, inducing rapid breathing and/or dyspnea (i.e., difficult or labored breathing). These participants may require rescue or emergency medications to relax the smooth bronchial muscle and increase respiratory capacity. Regular exercise at low to moderate levels in a controlled environment helps decrease the frequent use of and/or dependence on medication.
Instructor tips for participants with pulmonary diseases:
- Encourage participants to bring inhalers or oxygen to class if needed.
- Encourage participants to seek a physician’s guidance and ask:
- How soon before exercise should I take bronchodilator medications?
- How long do the protected effects last?
- Is it appropriate to take my medication during class?
- Encourage participants to arrive early and begin a longer, progressive warm-up.
- Create a safe environment with clean air and comfortable temperatures.
- Promote participation in SilverSneakers Yoga to learn diaphragmatic breathing rather than relying on the upper chest and shoulder muscles for respiration.
- Teach participants to exhale with a “steady blow” rather than to exhale forcefully. Participants should practice a 2:1 breathing pattern = exhaling twice as long as inhaling.
Instructor safety skill:
If a participant experiences shortness of breath, utilize the SilverSneakers Dyspnea Scale. Count how many times a class member takes a breath in 15 seconds. More than seven breaths would indicate severe difficulty, and the participant should stop exercising.
Structurally, the nervous system has two components: the central nervous system and the peripheral nervous system. The central nervous system is made up of the brain, spinal cord, and nerves. The peripheral nervous system consists of sensory neurons, ganglia, and nerves that connect to one another and to the central nervous system. Together they control all the workings of the body.
When something goes wrong with a part of the nervous system, symptoms such as difficulty moving, speaking, swallowing, breathing, or learning may be present. Memory, senses, and mood can also be affected.
Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses (Merriam Webster, 2017). Exercise can be a powerful tool for enhancing mental performance and cognitive health (Vidoni, Johnson, Morris, Sciver, Greer, Billinger & Burns, 2015).
Common nervous system conditions:
- Epilepsy, in which abnormal electrical discharges from brain cells cause seizures.
- Parkinson’s disease, which is a progressive nerve disease that affects movement.
- Multiple sclerosis (MS), in which the protective lining of the nerves is attacked by the body’s immune system.
- Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a motor neuron disease which weakens the muscles and progressively hampers physical function.
- Huntington’s disease is an inherited condition that causes the nerve cells in the brain to degenerate.
- Alzheimer’s disease covers a wide range of disorders that impact mental functions, particularly memory.
Alzheimer’s disease causes unusual losses of memory, a deterioration of language skills, perception, and judgment during daily living activities, emotional agitation, and behavioral problems. Dementia is clinically confirmed by tests measuring cognitive loss accompanied by memory loss. Next to the fear of falling, the group of cognitive disorders that include Parkinson’s disease, dementia, and Alzheimer’s disease ranks among top concerns for older adults. According to the Alzheimer’s Association of America, one in 10 people age 65 and older has Alzheimer’s dementia and almost two-thirds of Americans with Alzheimer’s are women (2017).
Instructor Tips for participants with nervous system conditions:
- Encourage participants to arrive early and begin a longer, progressive warm-up.
- Create a safe environment with clean air and comfortable temperatures.
- Encourage “fun” in agility, balance and coordination drills.
- Advise participants to follow physicians’ directives regarding progressive cognitive changes.
- Be sure that participants drink water before, during and after exercise.
- Be prepared and have a plan for a sudden outburst or disruption.
- Highlight relaxation and recall techniques to improve cognition.
Congratulations!
You’ve completed Unit 2. Now you’re ready to check your understanding of the content by completing the Unit 2 Review Quiz.
Good luck!