Safety Considerations and Contraindications

Working with older adults requires heightened awareness of safety considerations. While exercise is beneficial and should be encouraged, certain conditions and situations require modification, medical clearance, or referral to healthcare providers.

This chapter covers essential safety knowledge including contraindications, medication effects, emergency preparedness, and when to refer clients to medical professionals.

Pre-Participation Screening

Essential Health History Information

Before beginning any program with an older adult, gather comprehensive health information:

Medical conditions:

• Cardiovascular disease (heart attack history, arrhythmias, heart failure)
• Pulmonary conditions (COPD, asthma)
• Metabolic conditions (diabetes, thyroid disorders)
• Musculoskeletal conditions (arthritis, osteoporosis, joint replacements)
• Neurological conditions (Parkinson's, stroke history, neuropathy)
• Recent surgeries or hospitalizations

Medications:

• Complete list of current medications
• Timing of medication doses
• Known side effects affecting exercise

Functional information:

• Fall history (any falls in past 12 months)
• Use of assistive devices
• Current activity level
• Previous exercise experience

When to Require Medical Clearance

Require physician clearance before training if the client has:

• Known cardiovascular, pulmonary, or metabolic disease
• Signs or symptoms suggesting cardiovascular, pulmonary, or metabolic disease
• Two or more cardiovascular risk factors
• Been sedentary and plans to begin vigorous exercise

Cardiovascular risk factors include:

• Age (men 45+, women 55+)
• Family history of heart disease
• Cigarette smoking
• Hypertension
• Dyslipidemia
• Prediabetes or diabetes
• Obesity
• Sedentary lifestyle

Absolute and Relative Contraindications

Absolute Contraindications to Exercise

Do not train clients with these conditions—refer to physician immediately:

• Unstable angina
• Uncontrolled arrhythmias causing symptoms
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Suspected or known dissecting aneurysm
• Acute systemic infection with fever

Relative Contraindications

These conditions require medical consultation and program modification:

• Known cardiovascular disease
• Uncontrolled hypertension (systolic >180, diastolic >110)
• Uncontrolled diabetes
• Severe orthopedic limitations
• Recent stroke (timing depends on recovery)
• Mental impairment affecting ability to follow instructions
• Uncontrolled seizure disorders

Medication Considerations

Many older adults take medications that affect exercise response. Common categories include:

Beta-Blockers

Common medications: Metoprolol, atenolol, propranolol

Effects on exercise:

• Blunt heart rate response to exercise
• Maximum heart rate significantly reduced
• Cannot use heart rate to gauge intensity

Training implications:

• Use RPE (Rate of Perceived Exertion) instead of heart rate
• Client may feel limited despite safe capacity
• Ensure adequate warm-up time

Diuretics

Common medications: Furosemide, hydrochlorothiazide

Effects on exercise:

• Increased fluid loss
• Electrolyte imbalances possible
• Increased dehydration risk

Training implications:

• Monitor hydration carefully
• Watch for signs of dehydration or electrolyte imbalance
• Avoid training in heat
• Symptoms: muscle cramps, dizziness, confusion

Blood Pressure Medications

Various classes: ACE inhibitors, ARBs, calcium channel blockers

Effects on exercise:

• May cause dizziness with position changes
• Post-exercise hypotension more likely

Training implications:

• Careful transitions between positions
• Extended cool-down periods
• Monitor for dizziness or lightheadedness
• Avoid rapid standing from lying positions

Blood Thinners

Common medications: Warfarin, aspirin, clopidogrel, newer anticoagulants

Effects on exercise:

• Increased bleeding risk from injury
• Bruising more easily

Training implications:

• Avoid activities with high fall or collision risk
• Monitor for unusual bruising
• Report any suspected internal bleeding to physician

Diabetes Medications

Including: Insulin, metformin, sulfonylureas

Effects on exercise:

• Hypoglycemia risk, especially with insulin or sulfonylureas
• Blood glucose changes with exercise

Training implications:

• Know signs of hypoglycemia (shakiness, confusion, sweating)
• Have fast-acting carbohydrates available
• Monitor glucose before training if possible
• Adjust exercise timing around meals and medication

Warning Signs During Exercise

Stop Exercise Immediately If:

Cardiovascular warning signs:

• Chest pain, pressure, or tightness
• Pain radiating to arm, neck, jaw, or back
• Unusual shortness of breath
• Dizziness or lightheadedness
• Heart palpitations or irregular heartbeat
• Unusual fatigue

Neurological warning signs:

• Sudden severe headache
• Confusion or difficulty speaking
• Sudden vision changes
• Weakness or numbness on one side
• Loss of coordination

Other warning signs:

• Nausea or vomiting
• Unusual sweating (cold, clammy)
• Skin color changes (pale, bluish)
• Loss of consciousness
• Severe pain anywhere

Emergency Response Protocol

Have a clear plan for emergencies:

1. Stop all activity and have client sit or lie down
2. Stay calm and reassure the client
3. Assess the situation quickly
4. Call emergency services (911) if symptoms are severe or don't resolve quickly
5. Do not leave the client alone
6. Be prepared to perform CPR if trained and needed
7. Have emergency contact information readily available

Fall Prevention Strategies

Environmental Safety

Training space requirements:

• Clear of obstacles and tripping hazards
• Non-slip flooring
• Adequate lighting
• Stable support surfaces nearby
• Temperature controlled

Equipment considerations:

• Sturdy chairs without wheels
• Wall or rail for support
• Non-slip mats
• Appropriate footwear (non-slip, supportive)

Exercise Safety Measures

During balance exercises:

• Always position near support
• Spotter within arm's reach
• Clear space for potential falls
• Start conservatively

During resistance exercises:

• Ensure stable positions
• Avoid exercises requiring rapid position changes
• Progress balance challenges gradually

Fall Response

If a client falls:

1. Stay calm and reassure the client
2. Do not rush to get them up
3. Assess for injury (ask about pain, check visible areas)
4. If no injury, help them get up safely using proper technique
5. Document the incident
6. Monitor for delayed symptoms
7. Report to appropriate parties

Scope of Practice Boundaries

Within Scope for Fitness Professionals

You CAN:

• Design and implement appropriate exercise programs
• Provide general fitness education
• Teach exercise technique and progressions
• Monitor exercise responses
• Refer to healthcare providers when appropriate
• Follow physician-provided exercise guidelines

Outside Scope

You CANNOT:

• Diagnose medical conditions
• Prescribe exercises for specific medical conditions (without physician guidance)
• Provide nutritional advice beyond general healthy eating guidelines
• Interpret medical test results
• Recommend medication changes
• Provide physical therapy or rehabilitation

When to Refer

Refer to appropriate healthcare provider when:

• Client reports new or worsening symptoms
• Exercise produces unexpected adverse responses
• Client's condition changes significantly
• Client needs diagnosis or treatment
• You're unsure about safety of exercise for their condition
• Client's needs exceed your training or expertise

Documentation Best Practices

Initial Documentation

• Complete health history
• Emergency contact information
• Physician contact information
• Signed informed consent
• Liability waiver
• Exercise clearance (if required)

Ongoing Documentation

• Session notes (exercises, sets, reps, responses)
• Any adverse events or incidents
• Progress assessments
• Communications with healthcare providers
• Program modifications and reasons

Incident Reporting

For any adverse event:

• Date, time, and location
• Description of what happened
• Client's symptoms and response
• Actions taken
• Follow-up plans
• Witnesses present

Key Takeaways

1. Thorough pre-participation screening is essential
2. Know absolute and relative contraindications to exercise
3. Understand how common medications affect exercise response
4. Recognize warning signs that require stopping exercise
5. Have emergency response protocols in place
6. Create safe training environments to prevent falls
7. Maintain clear scope of practice boundaries
8. Refer to healthcare providers when appropriate
9. Document thoroughly and consistently