Managing and Responding to Exercise Risk

Managing & responding to risk prior to exercise

Repeated measures

Sometimes, on a given day, you might find a client with a higher blood pressure than normal.  It’s important to be careful but not to over-react if the measure is ‘border-line’.  If a client’s blood pressure is 140/90 and it’s normally lower, ask them how their day has been.  Sometimes caffeine, work stress, exercise or rushing to the session can all raise a clients blood pressure slightly.  For this reason when you measure your client’s blood pressure it is more valid when taken on two successive occasions. 

As an example I have had clients whose blood pressure is within the normal range in the morning and just outside of normal range in the afternoon.  One such client was a divorce lawyer and you could almost guarantee in the afternoon his blood pressure would be up, which is exactly why he was coming to the fitness club to have some time away from work and get some exercise.  After detecting this, and discussing the findings with him, he decided to continue to exercise, monitor his blood pressure and complete his fitness appraisals in the mornings. 

Delve deeper during screening/consultation

Sometimes you will need to use questioning to get a better picture of the nature of the risk of each and every client.  One example is when someone says they are on blood pressure medication.  You’ll want to know what medication it is exactly, how long they’ve been taking it, what other instructions they received from the doctor at the time, what the recommendations for exercise were, what was going on when they first took it, how they have responded to the medication, if they’ve exercised since, what type of exercise and any complications during or after, what happens if they miss their medication, how recently they had a check up and what the outcomes were etc. 

By digging deeper and working through what may trigger an ‘excessive exercise response’ you are managing the risk for your client.  If, for whatever reason, you can’t get all the answers you need to put your mind at ease you can ask for your client’s permission to speak to their doctor about the condition and/or you can ask that they get a doctor’s referral for exercise

Referral

If a client has several risk factors that are not to your liking then you can refer them out for further medical screening.  This usually occurs with a doctor.

We see thousands of people in the fitness industry and very few are referred out to doctors at the moment.  Given we know a large proportion of our population is carrying some significant risk factors it may be prudent to refer more often.  There is a strong likelihood that we are missing the opportunity to help our clients get clear and purposeful medical advice and support when they are becoming unwell or diseased.  Don’t be afraid to refer.  It’s your client’s choice as to whether they action the referral but it is your responsibility to screen and refer for safety.

Finally, there may well be times when the risk factors are such that you refer and refuse (in the nicest possible way) to train someone without that doctor’s referral taking place.  This is prudent where there are multiple significant risk factors present.

Post exercise monitoring

If a client has some risk factors but they do not require referral it’s also a good idea to measure their blood pressure and heart rate post (after) exercise.  This will give you an insight into how their body is responding after the stress of exercise has been introduced.  Post exercise measures of blood pressure have been shown to be better predictors of cardiac events (such as myocardial infarctions – heart attacks) than pre-exercise blood pressures for this exact reason.

So, after your first workout with a client take their blood pressure and trace their heart rate immediately after they finish their exercise.  Take the heart rate for three to five minutes recording the beats per minute every 30 seconds, and then take their blood pressure.  Keep an eye on this monthly, or weekly if you have concerns.  If the blood pressure and heart rate recovery don’t improve as your client gets ‘fitter’ then refer them to their doctor.

Managing and responding to risk during exercise

Understanding excessive exercise stress

Exercise should make our personal training clients feel good, however if the exercise variables (frequency, intensity and duration) in combination with individual client circumstances (such as tiredness and stress) are not right on any given day then excessive exercise stress can develop.  

Excessive exercise stress occurs where the client’s body is no longer responding as you would expect it to for the exercise that is being undertaken.  For example, during a run you notice that your client is becoming more and more un-coordinated and looking increasingly pale.

The normal acute responses to exercise

A normal response to exercise, where the training volume and the capabilities of the client are matched, should result in the following responses:

• An increased heart rate
• An increase in stroke volume
• Cardiac output  will increase
• Oxygen uptake rises
• Sweating increases but not excessively
• Ventilation (breathing) rate increases
• Heat production increases 

What are the symptoms of excessive exercise stress?

An abnormal response to exercise, where the training volume is greater than the capabilities of the client on that given day, may result in the following responses which are all symptoms of excessive exercise stress:

1. Pale skin

Instead of blood rushing to the surface of the skin for cooling during exercise and as a means for controlling our internal temperature resulting in flushed skin colour, the skin may appear to be pale and white.

This can be due to the body pumping blood to the core organs (brain, heart, lungs, liver) instead of the periphery (surface).  This is a sign that the body is not coping or responding appropriately and is in fact starting to go into shock.

2. Excessive sweating

This normally relates to an individual sweating much more than they usually do in conjunction with showing some other signs of excessive exercise stress such as a loss of coordination. The cause of this symptom is mainly associated with the overheating of the body, and thus excess sweating is employed as the body’s attempt to cool itself down.  

3. Minimal sweating

Some people do naturally sweat less than others during exercise.  However any personal training client who displays other excessive exercise stress symptoms, and is sweating less than normal, should be monitored closely. A lack of perspiration is commonly associated with a decrease in blood plasma volume which consequently reduces the rate of sweating.  That is, the client is dehydrated and struggling to sweat to cool down as well as provide enough blood to the working muscles and brain.

4. Loss of coordination

When the body overheats and is dehydrated, the result can be a loss of coordination in clients involving issues such as clumsiness, perception difficulty, poor memory and performance, and looking confused.

5. Slumped posture

This normally involves the body being in a forward bending position such as sitting or standing, often with the person looking exhausted. Clients with excessive exercise stress tend to get into this position as it relaxes the respiratory muscles (the diaphragm and intercostals) and reduces blood pressure as the heart no longer has to work against gravity in this position.   

6. Shallow and rapid breathing

Rapid breathing patterns shown by a client, along with some other symptoms of excessive exercise stress are good indicators that they are not coping well with the physiological demands of exercise.  If their breathing rate is shallow, or higher than expected or does not decrease when the exercise intensity is decreased it’s likely excessive exercise stress is occurring.

What actions should you take when you see anyone displaying signs of excessive exercise stress?

Additional actions which may be taken depending on the level of excessive exercise stress displayed include the following:

1. Follow emergency procedures

For example call for help or an ambulance, put person in recovery position, or provide CPR if required.

2. Recommend the client visits a doctor for a clearance or a check up

This may be simply providing the client with peace of mind, and/or serve to identify a potential underlying health problem which was not detected through the health screening / consultation process.

3. Recommend an exercise programme review

This should be conducted by the personal trainer, and involve reassessing the client’s current health status in addition to their risk profile. It may simply consist of altering the frequency, intensity and duration aspects of their programme, which may have been pitched too high for the fitness levels of the client initially.