Common Chronic Conditions Overview

To work effectively with clients who have chronic conditions, you need foundational knowledge about these conditions and their exercise implications. This chapter provides an overview of common chronic conditions you may encounter, focusing on what fitness professionals need to know for safe program design.

Remember: This information is for educational purposes to inform exercise programming. Diagnosis, treatment, and specific medical advice must come from healthcare providers.

Cardiovascular Conditions

Hypertension (High Blood Pressure)

What it is: Sustained elevated blood pressure, typically defined as systolic >130 mmHg and/or diastolic >80 mmHg.

Why it matters for exercise:

• Most common chronic condition in adults
• Affects cardiovascular response to exercise
• Many medications affect exercise response
• Exercise is beneficial but needs appropriate management

Exercise considerations:

• Avoid breath-holding (Valsalva maneuver)
• Moderate intensity preferred initially
• Monitor for excessive blood pressure response
• Extended warm-up and cool-down important
• Avoid isometric exercises at high intensity
• Regular, consistent exercise is beneficial

Red flags during exercise:

• Headache or visual disturbances
• Chest discomfort
• Significant shortness of breath
• Dizziness or lightheadedness
• Nausea

Coronary Artery Disease (CAD)

What it is: Narrowing of coronary arteries due to plaque buildup, reducing blood flow to the heart.

Why it matters for exercise:

• Risk of cardiac events during exercise
• Many have had heart attacks, stents, or bypass surgery
• Exercise is essential for management but requires careful programming
• Usually referred from cardiac rehabilitation

Exercise considerations:

• Require medical clearance with specific guidelines
• Know their target heart rate or RPE range
• Avoid high-intensity without clearance
• Be prepared for cardiac emergencies
• Consistent moderate exercise is protective
• Beta-blockers affect heart rate response

Red flags during exercise:

• Chest pain, pressure, or tightness
• Pain radiating to arm, jaw, or back
• Unusual shortness of breath
• Dizziness or fainting
• Excessive fatigue

Heart Failure

What it is: The heart cannot pump efficiently enough to meet the body's needs.

Why it matters for exercise:

• Exercise tolerance significantly reduced
• Fatigue and shortness of breath with activity
• Exercise improves function when appropriately dosed
• Requires careful intensity management

Exercise considerations:

• Low to moderate intensity only
• Shorter sessions may be necessary
• Monitor for signs of fluid retention
• Allow adequate rest between exercises
• Avoid extreme temperatures
• Progress very gradually

Red flags during exercise:

• Unusual weight gain (fluid retention)
• Increased shortness of breath
• Swelling in legs or ankles
• Persistent fatigue
• Irregular heartbeat

Metabolic Conditions

Type 2 Diabetes

What it is: Impaired insulin function leading to elevated blood glucose levels.

Why it matters for exercise:

• Very common, often with other conditions
• Exercise is primary treatment strategy
• Blood glucose management during exercise
• Potential for hypoglycemia with certain medications

Exercise considerations:

• Both aerobic and resistance exercise beneficial
• May need to check blood glucose before/after
• Have fast-acting carbohydrates available
• Be aware of hypoglycemia signs
• Proper footwear essential (neuropathy risk)
• Avoid exercise if blood glucose >250 mg/dL with ketones
• Timing relative to meals and medication matters

Hypoglycemia signs:

• Shakiness or trembling
• Sweating
• Confusion or difficulty concentrating
• Rapid heartbeat
• Irritability or anxiety
• Hunger

Obesity

What it is: Excess body fat accumulation, typically defined by BMI >30.

Why it matters for exercise:

• Affects exercise tolerance and mechanics
• Often accompanies other conditions
• Joint stress considerations
• Exercise is crucial for management

Exercise considerations:

• Start with low-impact activities
• Progress gradually to protect joints
• Modifications for body size
• Heat intolerance—monitor temperature
• May need longer rest periods
• Focus on building habits, not rapid weight loss
• Seated or supported exercises may be needed initially

Practical considerations:

• Equipment accommodations (bench width, etc.)
• Comfortable, breathable clothing
• Access to water
• Non-judgmental environment

Respiratory Conditions

Asthma

What it is: Chronic inflammatory airway disease with reversible obstruction.

Why it matters for exercise:

• Exercise can trigger symptoms in some
• Well-controlled asthma shouldn't limit exercise
• Many elite athletes have asthma
• Proper management enables full activity

Exercise considerations:

• Ensure client has rescue inhaler available
• Warm-up helps prevent exercise-induced symptoms
• Cold, dry air may trigger symptoms
• Learn client's triggers
• Swimming often well-tolerated
• Pollen and pollution may affect outdoor exercise

Signs of asthma symptoms:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath out of proportion to exertion

Chronic Obstructive Pulmonary Disease (COPD)

What it is: Progressive lung disease causing airflow obstruction (includes emphysema and chronic bronchitis).

Why it matters for exercise:

• Significant exercise limitation
• Shortness of breath with activity
• Exercise improves quality of life
• Often referred from pulmonary rehabilitation

Exercise considerations:

• Low to moderate intensity
• Expect breathlessness—this is normal for them
• Use dyspnea (breathlessness) scale, not heart rate
• Allow pursed-lip breathing
• Rest periods as needed
• Upper body exercises may be more challenging
• Supplemental oxygen if prescribed

Guidelines for breathlessness:

• Mild breathlessness during exercise is acceptable
• Severe breathlessness requiring stopping is too much
• Should recover within a few minutes of stopping

Musculoskeletal Conditions

Osteoarthritis

What it is: Degenerative joint disease with cartilage breakdown.

Why it matters for exercise:

• Very common, especially in older adults
• Affects joint function and pain levels
• Exercise is primary treatment strategy
• Requires appropriate modification

Exercise considerations:

• Low-impact activities preferred
• Avoid aggravating activities
• Strengthen muscles around affected joints
• Range of motion work important
• May need modified exercises
• Pain should not significantly increase during or after exercise
• Warm-up is essential

Joints commonly affected:

• Knees
• Hips
• Hands
• Spine
• Shoulders

Osteoporosis

What it is: Reduced bone density increasing fracture risk.

Why it matters for exercise:

• Fall risk is primary concern
• Weight-bearing exercise helps bone health
• Some exercises contraindicated
• Often accompanies aging

Exercise considerations:

• Weight-bearing exercise beneficial
• Avoid excessive spinal flexion under load
• Balance training essential
• Reduce fall risk in training environment
• Impact exercise if tolerated and cleared
• Strengthen muscles to protect bones

Exercises to avoid or modify:

• Deep forward bending with load
• Twisting movements under load
• High fall-risk activities
• Sit-ups and crunches (spinal flexion)

Rheumatoid Arthritis

What it is: Autoimmune condition causing joint inflammation.

Why it matters for exercise:

• Joint inflammation and pain
• Fatigue is significant symptom
• Exercise benefits function and mood
• Flare periods require modification

Exercise considerations:

• Avoid exercise during acute flares
• Low-impact preferred
• Protect affected joints
• Water exercise often well-tolerated
• Fatigue management important
• Consistency with appropriate intensity

Neurological Conditions

Parkinson's Disease

What it is: Progressive neurological condition affecting movement.

Why it matters for exercise:

• Balance and coordination affected
• Exercise may slow progression
• Specific exercise types particularly beneficial
• Fall risk is significant

Exercise considerations:

• Balance training essential
• Large-amplitude movements may help
• Aerobic exercise benefits cognition
• Resistance training maintains strength
• Timing may be affected by medication
• Fall prevention is priority

Multiple Sclerosis

What it is: Autoimmune disease affecting the central nervous system.

Why it matters for exercise:

• Fatigue is primary symptom
• Heat sensitivity common
• Exercise benefits function and quality of life
• Symptoms vary greatly between individuals

Exercise considerations:

• Avoid overheating
• Shorter sessions may be needed
• Water exercise often well-tolerated
• Fatigue management essential
• Cool environment preferred
• Morning may be better for some
• Highly individual—adjust to response

Mental Health Conditions

Depression and Anxiety

What they are: Common mental health conditions affecting mood, thoughts, and behavior.

Why they matter for exercise:

• Exercise is evidence-based treatment
• May affect motivation and adherence
• Often co-occurs with chronic conditions
• Some medications affect exercise

Exercise considerations:

• Exercise can improve symptoms
• Consistency matters more than intensity
• Social support aspect valuable
• Patience with motivation fluctuations
• Don't push too hard initially
• Create positive experiences

Important note:

Exercise is supportive, not replacement for mental health treatment. Refer to mental health professionals when appropriate.

Multiple Conditions

Reality of Comorbidity

Many clients have multiple chronic conditions simultaneously:

• Diabetes + hypertension + obesity is common
• Heart disease + diabetes + depression
• Arthritis + osteoporosis + hypertension

Implications:

• More complex programming needed
• More conservative approach required
• Multiple medications affecting response
• Multiple restrictions to consider
• Greater need for medical coordination

Managing Complexity

Strategies:

• Prioritize safety
• Start conservatively
• Address all conditions in programming
• Communicate with healthcare team
• Progress slowly
• Monitor carefully

Key Takeaways

1. Foundational knowledge of conditions informs exercise programming
2. Exercise benefits most chronic conditions when appropriately programmed
3. Each condition has specific considerations and contraindications
4. Red flags requiring referral vary by condition
5. Many clients have multiple conditions—program accordingly
6. Medical clearance and guidelines are essential
7. When in doubt, err on the side of caution
8. This overview is educational—specific guidance comes from healthcare providers