Risk Factors and Exercise

The 'stress' response

All exercise involves some increase in stress on the systems of the body, this is what creates the fatigue, which is then ‘repaired and adapted to’ in order for (ideally) positive progress to be made. 

Because exercise involves introducing some level of stress to cause change any underlying health issue, or a client’s condition on the day (for example if they are; dehydrated, allready stressed, ill or under-recovered), or a programme that is too hard for the client’s capabilities can be problematic.  For this reason a personal trainer must gather sufficient health related information during the consultation with every client, and observe and act on any unexpected responses that occur in clients during or after exercise.

How can we screen for risk during the consultation?

Collecting written information

The first step when working with a client on their health and fitness is to conduct a consultation with them to establish their exercise readiness and to ensure all relevant health issues are identified and considered before a training prescription occurs.  An example of a consultation form designed to help you collect all the vital information you need, and instruction on how to use the form can be found in detail in the pages here at ptdirect.

Questioning

Another important way to gather information about your client, their state at any time and how they are responding to exercise is to question them.  Throughout your work with a client in personal training sessions you need to be asking a few pertinent questions consistently.  The answers to these questions (for example rating their perceived exertion) will give you a guide as to your client’s situation at any given time.

Observation

Some of the information you need is written on your client’s face, their skin colour and their body position.  It is important that you learn to observe very carefully your client’s physical response to training and act upon these observations accordingly.

Why do we record risk factors?

Measurable risk factors such as blood pressure, cholesterol, and body fat percentage and blood glucose levels are recorded more often as we get older.  This is because our risk of disease increases as we age.  Risk factors are recorded so that diseases such as diabetes and heart disease can be detected as early as possible. This allows treatments such as lifestyle changes and drug treatments to be started quickly, increasing the persons chances of preventing the disease from becoming more serious or life threatening.

With many diseases such as heart disease and diabetes there can be very few symptoms to let a person know they are ill.  Often the first sign (and unfortunately the last) might be a fatal heart attack. This is why recording factors like blood pressure allow someone to know how likely it is they will have heart disease or an event (such as a heart attack) if they don’t change something.

What factors should be considered when assessing exercise risk?

There are modifiable factors (things we can change) and non-modifiable factors (things we can’t change) that need to be considered when assessing risk.

How do risk factors relate to common diseases?

Basically the more risk factors you have the more likely you are to have or contract one or more of the common diseases (diabetes, cardiovascular diseases, asthma, cancer).  Some risk factors carry a greater risk than others for certain diseases.  Generally a combination of risk factors significantly increases the overall risk of disease (for example being overweight, smoking, being inactive and being stressed will greatly increase disease risk).

The non-modifiable risk factors

As an example let’s look at Coronary Heart Disease (CHD) and see what the risk factors are and how they relate to the disease.

Age

In general, a persons risk for heart disease increases as they grow older. Specifically age is a risk factor for:

• Men older than 45 years
• Women older than 55 or with premature menopause without oestrogen replacement therapy

Gender

Women in general run a lower risk of developing heart disease than men, until menopause. After that, the hormonal changes brought on by menopause cause the heart disease risk to increase at a much faster rate. Of course, women who smoke have just as great a chance as men for developing heart disease.

Personal health history:

If you have a history of risk factors like high blood pressure, high cholesterol and being overweight you have a much higher risk of developing diseases like diabetes, cardiovascular disease and stroke. If you have already been diagnosed with any of the following this increases your risk of more serious complications:

• Cardiovascular disease 
• Pulmonary disease including asthma
• Metabolic disease including diabetes

Personal health history is a non-modifiable risk factor as you cannot change your past. You can give up smoking now and reduce your risk, but your risk will still be higher than someone who never smoked.

Family health history

Research has shown that a person’s risk of developing heart disease is higher if they have a close relative (grandparents, parents, siblings) with a history of heart disease or stroke at an early age.

While genetics are thought to contribute, a family's lifestyle (lack of exercise, being overweight, smoking, eating large amounts of saturated fats and cholesterol) contributes significantly to heart disease.

The specific risk factors to look for are:

Myocardial infarction, coronary revascularization, or sudden death

• before 55 years of age in father or other male first degree relative (i.e. brother or son)
• before 65 years of age in mother or other female first degree relative (i.e. sister or daughter)

The modifiable risk factors

Smoking

Smoking is the single most important risk factor for many diseases. People who smoke run twice the risk of developing heart disease compared to their non-smoking peers. Smoking speeds up the development of arteriosclerosis by damaging the inner lining of the blood vessels' walls. It constricts the coronary arteries, the blood vessels which supply oxygen and nutrient-rich blood to the heart, causing an increase in heart rate and blood pressure.

Smoking also reduces the amount of oxygen available to the heart and other parts of the body. Smoking is a risk factor for someone who is

• Currently a smoker or quit in the last 6 months.

Poor Nutrition

Poor nutrition such as a diet high in saturated fat and sugar contributes directly to high cholesterol, high blood pressure, obesity, diabetes and heart disease.  Signs of a poor diet can be measures like high cholesterol and triglyceride levels and high blood sugar levels.

Some of the high risk levels are total cholesterol above 200 mg/dL, triglyceride levels above 150 mg/dL and fasting blood glucose levels above 100 mg/dL

Sedentary Lifestyle

A sedentary lifestyle or a lack of exercise is a major risk factor for heart disease.  Exercise helps to reduce risk factors including lowering blood pressure, lowering cholesterol, reducing stress, achieving and maintaining a healthy body weight, helping to quit smoking and improving your blood sugar levels. Low exercise levels are a risk factor if someone is:

• Not accumulating 30 minutes or more of moderate intensity physical activity on 5 - 7 days of the week

Obesity

Obesity or being very overweight causes the heart to work harder to pump blood throughout the body. Consequently, it is a risk factor in the development of heart disease.

Obesity raises blood pressure, raises blood cholesterol and triglyceride levels, lowers HDL and contributes significantly to developing diabetes as well.

How a person’s weight is distributed is also important. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. Guidelines for obesity as a risk factor are: 

• Waist hip ratio; greater than 0.95 (men) and greater than 0.86 (women)
• Waist girth; greater than 102 cm (men) and greater than 88 cm (women)

Excessive alcohol consumption

Excessive use of alcohol has been shown to have a number of negative effects on the circulatory system, including the heart.  Alcohol in moderation may not be harmful, but any positive effects have yet to be proven conclusively.  On the other hand, too much alcohol has been shown to raise blood pressure, promote weight gain, raise triglyceride levels, produce irregular heart rhythms and lead to heart failure, in addition to causing diseases of the liver, pancreas and nervous system.

Check out your national nutrition guidelines to find out what your countries guidelines are for a safe intake of alcohol. 

High blood pressure

High blood pressure or hypertension is sometimes called the silent killer, since there are usually no specific symptoms or warning signs. Uncontrolled hypertension adds to the workload of the heart, causing it to enlarge and become weaker. Without treatment, the risks for heart failure, heart attack, stroke, kidney failure and reduced eyesight increase.

Normal blood pressure is generally between 90/60 mmHg and 120/80 mmHg. When high blood pressure is combined with risk factors such as obesity, smoking, high cholesterol or diabetes, the risk for developing heart disease increases several times. If you have a client with blood pressure at or above the risk threshold below then proceed to exercise with caution and if other risk factors are also present then refer them to a doctor before starting an exercise programme.

• Systolic blood pressure: 140 mmHg or greater
• Diastolic blood pressure: 90 mmHg or greater
• Using antihypertensive medication

Cholesterol level

High lipid (fat) or cholesterol levels in the blood have been shown to speed the development of arteriosclerosis and heart disease.  Cholesterol can't be dissolved in the blood, so it is carried via two types of lipoproteins:

• LDL (low-density lipoproteins), or ‘bad’ cholesterol, can build up fatty deposits and clog arteries. A good LDL reading is less than 100 mg/dL (mg/dl means milligrams per 100 millilitres of blood).  A high risk level is more than 130 mg/dL.
• HDL (high-density lipoproteins), or ‘good’ cholesterol, helps remove bad cholesterol from the body. A good range for HDL is greater than 60 mg/dL.
• Total cholesterol is a risk factor above 200 mg/dL. Lowering cholesterol can decrease or stop the build-up of fatty deposits on the artery walls and decrease the risk of heart attack and stroke.
• Triglycerides are another form of fat. High levels of triglycerides contribute to high cholesterol levels and heart problems. A good level for triglycerides is less than 150 mg/dL.

Stress

Stress, both physical and emotional, is dealt with differently by every individual.  Some stress has a positive effect on the body however continual stress is a risk factor for disease.

In a normal stress response situation (boo!) the levels of the hormones adrenaline and cortisol are increased causing increased blood flow to the muscles and brain, accelerated respiration and heart rate. These hormones also stimulate the release of stored energy sources into the blood.  This prepares the body for fast or demanding movement such as running away from the car.  If you didn’t get away and injury to the body occurs, the hormones then ready the body for the healing process.

If you are under too much stress or are under stress too often, the normal stress responses such as increased heart rate, respiration, and blood pressure put more physical stress on bodily organs (they have to work harder all the time). Long-term stress can be a contributing factor in heart disease, high blood pressure, stroke, enlarged adrenal glands, and other illnesses.