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Status:Closed    Asked:Apr 22, 2013 - 11:31 AM

I'm working with a client who is 57 year old she has low back pain, is hypertensive and is looking to lose weight. Any general suggestions?

age 57

gender female

risk factor hypertension , lower back pain , she want to reduce weight,

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The likelihood of a person experiencing hypertension and low-back pain (LBP) as he or she ages is high, given that more than half of older adults have high blood pressure and, according to some estimates, up to 80% of people have LBP at some point in their adult lives. The following lists provide some general guidelines for both conditions.

Exercise Guidelines for High Blood Pressure

• Obtain medical clearance : The American College of Sports Medicine recommends a pre-exercise screening and assessment before developing an exercise program for persons with hypertension. Since there are other factors to consider in older clients with hypertension (e.g., age, number of chronic conditions, and medication), their physician should provide specific guidelines for exercise intensity, frequency, and duration.

• Use perceived exertion to monitor intensity : Use RPE to monitor exercise intensity, especially in clients taking medications that alter heart rate response, such as beta-blocking drugs. Consult with their physicians to determine the RPE value that should be targeted.

• Check the client’s blood pressure before, during, and after exercise : Pay special attention to clients’ pre-exercise blood pressure to ensure they have taken their antihypertensive medication (older persons who have forgotten to take their medication may have an elevated blood pressure). To avoid potential problems, clients should not exercise on days when they have not taken their medication and/or when their SPB >200 mmHg and/or DBP >110 mmHg.

• Be aware of the potential for post-exercise hypotension (PEH): A single bout of mild to moderate exercise can lead to a post-exercise decrease in blood pressure in both normotensive and hypertensive individuals. In many cases, this is a positive effect of exercise training in that it helps to lower blood pressure for up to 13 hours after physical activity. However, for some hypertensive individuals on antihypertensive medication, blood pressure can be drastically reduced after a bout of exercise leading to syncope (loss of consciousness or fainting) or pre-syncope symptoms. Fitness professionals should stay with their older hypertensive clients for several minutes after the end of the exercise session to ensure that the clients have support if they do experience symptoms of syncope.

• Approach recommending high-intensity exercise with caution: Traditionally, the recommendation has been that hypertensive individuals avoid high-intensity exercise. However, several studies suggest that high-intensity interval training (HIIT), which consists of several bouts of high-intensity exercise (~85% to 95% of VO2max) lasting 1 to 4 minutes combined with intervals of rest or active recovery, is superior to continuous endurance exercise (e.g., moderate-intensity for 30 minutes) for improving cardiorespiratory fitness and cardiovascular function in hypertensive patients and normotensive individuals. Furthermore, research supports HIIT as a viable solution for improving physical work capacity as well as desirable metabolic responses even in older adults with disease-imposed limitations. Although the optimum dosage of HIIT still needs to be established, and as such fitness professionals should practice on the conservative side, this type of training for older adults with hypertension could result in better compliance with exercise because it decreases the time required pursuing increased fitness.

• Focus on low resistance.: A resistance-training program for clients with limited strength should emphasize a high number of repetitions at a low resistance.

Exercise Guidelines for Low-back Pain

An exercise program for a person experiencing an acute bout of LBP should be developed by the person’s physician and/or physical therapist. However, once he or she is cleared to return to full physical activity, fitness professionals can play an important role in preventing another occurrence of LBP.

• Prevent deconditioning of the muscles surrounding the spine : A major goal of an exercise program for persons with chronic LBP is to prevent deconditioning. The person may avoid movement for fear of re-injuring the back; in the interim, the muscles weaken and the low back loses some of its extensibility. Examples of exercises for improving the health of the back muscles can be found in the source link below.

• Avoid painful ROM : The exercise program must remain within the client’s pain threshold and should not exacerbate any underlying conditions. Sharp pain may be an indication that the exercise is harmful to the condition.

• Choose low- or nonimpact activities : Aerobic exercise that puts minimal stress on the back may help to maintain cardiorespiratory endurance. Walking or recumbent cycling while maintaining good posture may be good modalities for mitigating LBP in some clients.

• Focus on core function and fundamental movements : Strength and flexibility exercises may be helpful for some clients with LBP. Be sure to check with the client’s physician or physical therapist regarding any contraindications and exercise limitations for an older client with LBP. Exercises that focus on core function and functional movement patterns are ideal for working with clients who have chronic LBP.



Apr 22, 2013 - 11:37 AM

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