Contraindications and screening prior to exercise For a minority of individuals, exercise may be contraindicated. As practitioners increasingly participate in direct access patient care, they must have knowledge of the absolute and relative contraindications to exercise. Generally, absolute contraindications result from severe or uncontrolled cardiac disorders that place an individual at an increased risk for sudden cardiac death or other cardiac complications. Absolute contraindications suggest that it is currently unsafe for individuals with these disorders to exercise, and exercise should be postponed until such time as these conditions are brought under better medical control. In some cases, the patient may require surgical intervention before starting an appropriate exercise program. Patients with any of these absolute contraindications who are seeking to participate in an exercise program should always be referred to their physician for further follow-up and care (Fletcher et al., 2013; Williams et al., 2007; WHO, 2020). Relative contraindications suggest that a patient may still benefit from aerobic and resistive exercise but that further testing or screening by a physician prior to starting an exercise program may be necessary to ensure the safety of the patient. Generally, relative contraindications suggest that an individual has comorbid conditions that place them at higher risk for potential cardiac complications with exercise and that an exercise stress test may be necessary before starting to exercise. To ensure their safety, individuals with relative contraindications may also benefit from close monitoring of their vital signs during the initial stages of participating in an exercise program (Liguori & American College of Sports Medicine, 2020). For individuals with relative contraindications, the advice of their physician should be sought prior to initiating an exercise program. A list of both absolute and relative contraindications to exercise can be found in Table 14. Table 14: Absolute and Relative Contraindications to Exercise Absolute Contraindications • Unstable chronic heart disease. • Unstable angina (chest pain). • Uncontrolled heart arrhythmias such as ventricular tachycardia. • Worsening congestive heart failure. • Acute myocardial infarction. • Severe pulmonary hypertension. • Severe aortic stenosis. • Acute infection of the heart. • Aortic dissection. • Unstable eye disease such as advanced diabetic retinopathy. Note : Adapted from Fletcher et al. (2013); Williams et al. (2007). Special populations Safety should always be the practitioner’s primary concern when establishing an exercise program for an older adult. To ensure safety, all older adults' vitals should be taken before and after all exercise sessions. Many older adults have comorbid conditions— such as diabetes, osteoarthritis (OA), or dementia—that warrant specific recommendations or adjustments for exercise. While most individuals with comorbid conditions will still be able to fully participate in an exercise program, some adjustments to the exercise prescription may be necessary to ensure safety. Such adjustments will ensure that older adults with these conditions are able to safely complete both aerobic and resistance training. In general, any progressive, degenerative neurological disorder such as multiple sclerosis, amyotrophic lateral sclerosis, or Parkinson’s disease will require adjustments to the exercise • Acute severe infection. • Pulmonary embolism.
An exercise stress test is not a necessary screening tool for everyone prior to the start of exercise (Liguori & American College of Sports Medicine, 2020; Riebe et al., 2015). In general, healthy older adults with no comorbid conditions and no signs of symptoms suggestive of comorbid conditions do not require medical clearance prior to initiating a light to moderate exercise program (Riebe et al., 2015). Further, these participants may progress to vigorous exercise if desired if the above guidelines are followed. Older adults with known cardiovascular, metabolic, or renal disease should seek medical clearance from their physician prior to starting a new exercise program (Riebe et al., 2015). Medical clearance is left to the discretion of the physician and may include a resting electrocardiogram, an exercise stress test, or even an angiography if warranted. Close communication should be maintained between the practitioner and the physician in case new signs or symptoms develop during the exercise program. If older adults are currently participating in an exercise program and are asymptomatic, medical clearance is not necessary before altering or continuing the program as long as it is done at a light to moderate intensity. All exercise participants should be educated as to the importance of chest, arm, or jaw discomfort; abnormal shortness of breath; or heart palpitations as symptoms of cardiac dysfunction (Riebe et al., 2015). If any cardiac symptoms become apparent with exercise, that exercise should be stopped and the individual should be referred to their physician for further follow-up and testing. An exercise stress test is recommended prior to the start of any vigorous exercise program for anyone with a known metabolic (such as type 2 diabetes), cardiovascular, or renal disease (Riebe et al., 2015). It is important that all patients be educated on the difference between moderate and vigorous exercise so that appropriate screening and testing can be completed as needed for the safety of the patient.
Relative Contraindications
• Moderate aortic stenosis. • Hypertrophic cardiomyopathy (enlarged heart). • Coronary artery disease. • Diabetes. • Uncontrolled hypertension with systolic above 200 mm Hg or diastolic above 110 mm Hg. • Stable congestive heart failure. • Recurrent or chronic infection. • Uncontrolled metabolic disorders such as uncontrolled thyroid disorders. • Implanted pacemakers or defibrillators. • Very low functional capacity. • Recent blood clot. • Acute illness. • Recent fracture. • Metastatic cancer. plan. Such adjustments may include a slower progression or a decrease in the intensity of exercise. Acute musculoskeletal conditions or extreme deconditioning will also require adjustments to the exercise plan. Any individual who has recently undergone surgery should also be carefully evaluated prior to starting an exercise program due to the potential of stress on healing tissues. While a full review of all comorbid conditions likely to be seen in clinical practice is beyond the scope of this course, a brief discussion of diabetes, OA, and dementia follows. Diabetes Diabetes is a group of systemic metabolic disorders that are characterized by an elevated blood glucose concentration (Liguori & American College of Sports Medicine, 2020). It is most often chronic, its prevalence increases with age, and the
EliteLearning.com/ Physical-Therapy
Book Code: PTNY1024
Page 102
Powered by FlippingBook