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Diploma in Exercise Referral Level 3 Student Manual

Contents

Table of Contents

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Table of Contents Section Page

The Public Health Epidemic

Introduction to Exercise Referral

Health, Safety and Welfare

Professional Practice in Exercise Referral

Gathering Information for Exercise Referral

Communicating and Supporting Referred Clients

Assessing Referred Clients

Planning Exercise for Referred Clients

Teaching and Monitoring Exercises for Referred Clients

Asthma

Arthritis

Atherosclerosis

104

Chronic Obstructive Pulmonary Disease

110

Depression 114

Diabetes

118

Hypercholesterolemia

126

Hypertension

131

Joint Replacement Surgery

136

Mechanical Back Pain

140

Obesity

146

Section 01

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

The Public Health Epidemic

Section 01

The Public Health Epidemic The UK‘s average life expectancy in 2010 reached an all-time high at 79.9 years. While life expectancy has increased, the prevalence of chronic illnesses like cancer, heart disease, strokes, osteoporosis, arthritis, obesity and respiratory dysfunction have also reached peak levels. In order to meet the needs of a deteriorating nation, today’s health and fitness professional must be equipped with a thorough understanding of these conditions and the impact that they have on health and exercise performance- especially when concerning exercise referral schemes. Provided by the NHS’s Information Centre, the following statistics outline the current state of the UK’s national health and clearly justify the need for professional and accessible exercise referral schemes. From the perspective of the exercise referral instructor, these statistics should be considered an opportunity to make a real difference to the health and wellbeing of the nation.

Obesity • In 2006, 24% of adults (aged 16 or over) in England were classified as obese. This represents an overall increase from 15% from 1993. • Men and women were equally likely to be obese; however, women were more likely than men to be morbidly obese (3% compared to 1%). • 37% of adults had a raised waist circumference in 2006 compared to 23% in 1993. Women were more likely than men to have a raised waist circumference (41% and 32% respectively). • For people aged 35 and over who were classified as having a raised waist circumference, men were twice as likely and women were 4 times more likely to have type 2 diabetes.

Physical Activity • Overall, physical activity has increased among both men and women since 1997, with 40% of men and 28% of women meeting the recommended levels in 2008. 3

• Adults with low physical activity levels were more than twice as likely to have a raised waist circumference than those with high levels of physical activity. • In 2005/6, 3 in 10 adults had not participated in active sport in the last 12 months.

Diet and Nutrition • In 2006, 28% of men and 32% of women consumed 5 or more portions of fruit and vegetables per day. Among children aged 5 to 15, the equivalent figures were 19% for boys and 22% for girls. • The proportion of adults and children consuming 5 or more portions of fruit and vegetables per day remained steady between 2001 and 2004. There were increases among adults in 2005 and 2006. For children, there was an increase among both boys and girls in 2005, and further increase among girls in 2006.

Prescription Drugs • In 2006, 1.06 million prescription items were dispensed for the treatment of obesity. Overall, the number of prescriptions in 2006 was more than 8 times the number prescribed in 1999, when there were 127,000 prescription items dispensed.

Reducing the Health Gap The following reports provide those involved in health promotion with guidance on a range of factors influencing the gap between the healthy and unhealthy in the UK, and how these gaps can be reduced. It is beyond the scope of this programme to detail any specific conclusions from these reports; exercise professionals working with referred patients should familiarise themselves with these findings independently.

The Social Exclusion Unit exists to promote prosperous, inclusive and sustainable communities that create opportunity and provide a better quality of life for all. They provide a variety of documents that cover a wide range of topics, including: • Children and young people • Crime • Employment and opportunity

Section 02

Introduction to Exercise Referral

The patient agrees to be referred into an exercise referral scheme.

Patient is referred back to GP for review, additional assessment and to monitor medication

Healthcare professional makes the referral and provides the required information.

Exercise Referral Process

The programme is implemented and the patient is monitored and data is collected on the patientâ&#x20AC;&#x2122;s level of participation, experience and progress.

The exercise professional begins the planning of the programme.

An exit strategy is implemented for the patient where they then take control of their own programme. Follow up takes place 6 and 12 months post exit.

Patient relapses and discontinues participation in a structured programme of exercise and physical activity.

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

The scheme co-ordinator/ manager accepts/rejects the referral.

The patient meets with the exercise professional for an initial consultation, screening, assessment and stratification of risk(s).

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Professional Practice in Exercise Referral

P R I M A RY

tic

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ian s

Department of Health (DH) funding, directing and supporting the NHS

rac

S ce walk ntr es in

Dentists

p GP

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Pha

NHS Direct

Care

Choice

Am bu Tru lance sts

Car

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ust

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NHS Trusts

Patient/ Public

y& nc re e g er t ca Em rgen u

Section 04

C O N D A RY

Primary Care Trusts (PCTs) asessing local needs and commissioning care

s Strategic Health Authorities (SHAs) managing, monitoring and improving local services

Occupational Competencies The following model, adapted from the Department of Health’s NQAF, provides an illustrated guide to the various levels of care for referred clients and the appropriate qualifications and expertise required to deal with such patients.

Note: The medical conditions provided are not exhaustive; refer to the NQAF for more detailed information on this subject.

Typical Medical Conditions • Phase 3 cardiac rehab

• Stroke

• Phase 3 osteoporosis

• Mental health

• Phase 3 falls prevention

• Dementia

• Phase 4 cardiac rehab

• Arthritis

• Phase 4 osteoporosis

• Back care

• Phase 4 falls prevention

• Parkinson’s

• Special populations

• Weight control

• Older adults

• Mild anxiety

• Pre-post natal

• Depression

Occupational Qualifications

High Risk Populations

Medium Risk Populations

Low Risk Populations

Clinical Exercise Specialist Programme Director

Personal Trainer and Level 4 Exercise Specialist qualification

Personal Trainer and Level 3 Exercise Referral Certificate

• Disabilities

• Apparently healthy Individuals

General Populations

Fitness Instructor / Personal Trainer

Section 05

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Gathering Information from Referred Clients

Stratification Process

Medium risk patients may also be permitted to partake in an individualised and structured programme of exercise, however this programme must be supervised by an appropriately qualified person (exercise referral instructor or level 4 exercise specialist).

Patients should be medically screened using the PAR-Q screening tool and a full health and fitness assessment must be carried out by the exercise referral instructor on entry into a scheme. Providing that the patient answers ‘no’ to all of the questions presented, and that their resting measurements for blood pressure (less than 140/90 mmHg) and heart rate (less than 100 BPM) are satisfactory, the risk of exercise is low. Low risk patients may remain within the exercise referral scheme and are therefore permitted to undertake a wide-range of programmed exercises. While these exercises must be programmed by the exercise referral instructor, they do not necessarily need to be supervised.

Patients with cardiac disease, who are assessed as high risk by the Irwin and Morgan method, must be referred back to their clinician for a referral to a Phase 3 and then on to a Phase 4 cardiac rehabilitation service. Where high-risk non-cardiac patients are identified, they must be referred to a multidisciplinary team for further assessment before embarking on an exercise programme (JCF, 2010).

If the patient answers ‘yes’ to one or more questions, the instructor must move on to the Irwin and Morgan assessment tool. This uses a traffic light system whereby a patient will be classified as low (green), medium (amber) and high (red) risk.

All patients taking part in an exercise referral programme must be monitored appropriately by an exercise referral instructor throughout the period of exercise. Finally, it is not the role of the exercise professional to diagnose a condition; risk stratification is designed to assess the level of risk of associated with a particular patient before participation, and then to refer to GPs and medical practitioners as is appropriate.

Irwin and Morgan Risk Stratification Model Low Risk Overweight

No complications

High normal blood pressure

(130-139/85-89) not medication controlled

Deconditioned

Due to age or inactive lifestyle

Type 2 diabetes

Diet controlled

Older people aged >65

No more than 2 CHD risk factors and NOT AT RISK OF FALLS

Antenatal

No symptoms of pre-eclampsia /no history of miscarriage

Postnatal

Provided 6/52 check complete and no complications

Osteoarthritis

Mild where physical activity will provide symptomatic relief

Mild bone density changes

BMD >1SD and <2.5 SD below young adult mean

Exercise induced asthma

Without other symptoms

Smoker

One other CHD risk factor & no known impairment or respiratory function

Stress/mild anxiety Seropositive HIV

Asymptomatic

Section 05

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Gathering Information from Referred Clients

Exercise Referral Transfer Form Physical activity referral is one way of increasing physical activity levels of patients with specific medical conditions. It may not be the most appropriate route for patients where there is no underlying medical condition or risk. A general recommendation to increase physical activity levels in order to gain health benefits may be all that is required if you consider the patient has reasonable motivation and resources to safely increase their physical activity levels. Please refer to the scheme inclusion criteria and use your professional judgement to determine whether the exercise referral scheme is the most appropriate route for the patient. Please complete this form if the patient is being referred. This form should only be completed by Referring Practitioner.Incomplete forms may be returned and your patient may be temporarily deferred until all relevant medical information is obtained.

Patient Details: D.O.B:

Name: Address: Phone:

Email:

Gender:

NHS No:

Referring Practitioners Details: Name:

Practice:

Position:

Phone:

Address: Email:

Referral No:

Patient’s Registered GP Details (if different from above).

Referral Reasons (please circle) Asthma

Diabetes

Mental Health

Parkinson’s Disease

Stroke

Arthritis

Herniated disc

Multiple Sclerosis

Postural Disorder

Other

Atherosclerosis

Hypercholesterolemia

Obesity

Spondylosis

Chronic Obstructive Pulmonary Disease

Hypertension

Osteoporosis

Stress

Additional Referral Information (any other medical conditions not detailed above, including the date of diagnosis):

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Body Mass Index BMI = W(kg)/H(m)2

(Feet) Height (M) 2.2

7.2 7.1

(1bs) weight (kg) 30

2.15

7 6.9

6.8 2.05

6.6

100 2.1

6.7

Section 07

Assessing Referred Clients

60 150

6.4

80 25

1.95

6.3

1.9

6.2 6.1 6

1.85

1.75

5.7 5.6

1.7

5.5 5.4 5.3 5.2 5.1 5 4.9 4.8 4.7 4.6

100 35

1.8

5.9 5.8

200

BM I

6.5

110

250

120 130

300

140

150

1.65

350

1.6

160 170

1.55

180

400

1.5

190

1.45 1.4

BMI (kg.m-2)

200

Classification

Disease Risk* Relative to Normal Men < 102 cm Women < 88 cm

Men- >102 cm Women > 88 cm

< 18.5

Underweight

18.5-24.9

Ideal

25-29.9

Overweight

Increased

High

30-34.9

Obesity class 1

High

Very high

35-39.9

Obesity class 2

Very high

>40

Obesity class 3

Extremely high

The above data combines the results from the calculation of BMI data and abdominal circumference measurements. Because abdominal adipositry increases the risk of cardiovascular disease, a relationship exists between BMI and these results.

Waist-Hip Ratio The waist-to-hip ratio is calculated by simply dividing the waist measurement by the hip measurement and supports the notion that an android body shape increases oneâ&#x20AC;&#x2122;s risk of cardiovascular disease. Individuals with greater abdominal fat, relative to the circumference of their hips, carry an increased risk of obesity and cardiovascular-related conditions. 72

Section 08

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Planning Exercise for Referred Clients

REPS 100% 90% 80% 70%

30%

MUSCLE ENDURANCE

40%

HYPERTROPHY

POWER

50%

MUSCLE STRENGTH

60%

20% 10%

%1RM

Progress must never be rushed and exercises must only be included into the training programme if the client is likely to reap significant value from the exercise and if they are happy to perform them. It would not be appropriate to encourage extremely deconditioned, elderly or frail patients to undertake more advanced and demanding exercises if they lack sufficient strength and motor fitness to progress to such exercises, and if their daily activities and ability to perform these exercises do not necessitate such levels. Fitness professionals will therefore need to closely match the functional requirements of the patient with the exercises included in the resistance training programme. The following table provides a small sample of resistance exercises which may help many referred clients with many daily activities and to lead a more independent lifestyle. This list is only provided as a sample and is by no means exhaustive.

Section 10

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Asthma

Non-Modifiable Risk Factors Allergies - as discussed above, some sufferers may be allergic to animals but one of the most common allergies responsible for bouts of asthma is hay fever. If the asthma sufferer also suffers from hay fever, then their symptoms are likely to be much worse, especially during summer months when pollen levels are higher. Other common allergens include mould, yeast and fungi. Genetic factors - the onset of asthma also appears to be hereditary, and as such, some people may be genetically pre-disposed to the onset of asthma and its symptoms. This is particularly common in children who are also obese. Viral or Bacterial Infection - acting like other allergens, infections can also trigger an inflammatory response resulting in the onset of asthmatic symptoms.

Modifiable Risk Factors Smoking - the toxic carbon monoxide and tar found in cigarettes initiate ‘bronchoconstriction’, which impedes normal breathing; this can occur from both passive and active smoking. Animals - those allergic to some animals may also experience asthmatic symptoms. It is unlikely that the sufferer will be aware of all of the animals that they are allergic to. Dogs and cats appear to be amongst the most common culprits, although this may simply be because they are the most commonly encountered. Chemicals - those used in household cleaning, gardening, toiletries, paints, or any other chemical-based products, may also trigger asthmatic symptoms. Due to the wide range of chemical products encountered by most people as part of their daily routine, the identification and isolation of such agents can be extremely difficult. Dust - dust mites around the house can be troublesome for a person with asthma. Even the cleanest of houses will have some presence of mites, and so this can be a particularly difficult factor to deal with. Asthma sufferers should use anti-allergy bedding and ensure that their house is as clean and aired as possible. Asthma sufferers should also be extremely regimented with their use of medication to ensure that their defences are maintained. Stress/Emotion - this can lead to hyperventilation, and panic attacks which can cause asthma attacks. Individuals will usually self-manage their stress levels and often use psychological therapy to reduce the effect of stress on their physiology.

Management of Asthma In almost all cases, those diagnosed with asthma are likely to be prescribed with some form of medication by their G.P. to help manage the condition. A doctor may prescribe an inhaler or nebuliser, which may be used to ‘prevent’ or ‘relieve’ asthmatic symptoms. In most cases, inhalers are prescribed for relieving (blue inhaler) and preventing (brown inhaler) the symptoms. Patients can reduce their asthmatic symptoms by minimising the contact they have with the known triggers. Unfortunately, asthmatic symptoms can sometimes be delayed, so it is not always easy to identify the precise trigger. When asthmatic symptoms are the result of exposure to allergens, the sufferer should seek to identify the exact cause of the allergy and minimise their contact with it. This can often be an extremely difficult task and is likely only to be achieved through trial and error.

Breathlessness Scale The rapid assessment and monitoring of pulmonary patients during exercise is essential to ensure that they are able to continue to exert themselves for a duration that would be beneficial to their health, and without causing the airways to spasm. The Borg scale of breathlessness is based on the same principles as Ratings of Perceived Exertion (RPE), and patients are asked to grade their level of breathlessness, or dyspnea, on the scale which ranges from 0-10. The scale should be presented to patients at regular intervals throughout the exercise bout, or displayed continually throughout the session so that patients can make regular reference to it. In order to avoid respiratory distress during exercise, patients should seek to keep their level of breathlessness below 5 on the scale.

Section 11

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Arthritis

Section 11

Arthritis Arthritis, also known as degenerative joint disease (DJD), is a condition which primarily affects the weight-bearing synovial joints and has over 100 different types. Those with arthritis tend to be sedentary and deconditioned, which further exacerbates the progression of the

fingers and toes. The effects of the inflammation also affect other tissues, such as bones, ligaments and tendons, and cause movement to be painful and joints to be swollen and stiff.

Signs and Symptoms- OA

disease. Articular cartilage is ‘avascular’ and

The diagnostic signs of OA can include:

has no direct blood supply; it therefore relies on

• Steady or occasional pain

movement in order to nourish it with nutrients

• Discomfort with movement

through a process known as ‘imbibition’. It is especially important that those at risk of, or suffering with, arthritis, remain active in order to prevent the symptoms from worsening.

• Crepiitus - grinding or popping feelings when moving • Synovitis - inflammation of the synovial membrane • Joint instability • Deformity - due to osteophytic growth • Swelling and stiffness

Signs and Symptoms- RA Rheumatoid arthritis has two distinct phases: • Active - bodily tissue are inflamed • Remission - inflammation subsides During the active phase, the physical symptoms of RA include: The 2 most common forms of arthritis include Osteoarthritis (OA) and Rheumatoid Arthritis (RA), both of which affect the condition of the articular cartilage on the epiphysis of bones, within the joint capsule. Other types of arthritis include gout, anklylosing spondylitis and juvenile rheumatoid arthritis. Osteoarthritis is the degeneration of the articular cartilage, usually due to wear and tear. In this form of the condition, the cartilage becomes thinner and rougher, which makes joint movement painful. To compensate for the loss of bone and cartilage, the body forms new bone mass (osteophytes) on the ends of the bone. The new bone mass changes the structure of the synovial joint, often creating deformity and more pain. Rheumatoid arthritis is an auto-immune disease that is associated with higher than normal levels of antibody rheumatoid factor (RF), which results in chronic inflammation, usually in the joints of the wrist, ankle, 99

• Fatigue • Loss of appetite • Aching muscles • Flu symptoms • Joint stiffness • Swollen, painful and red joints • Discomfort with breathing (inflammation of lung tissue) • Limited range of motion • Deformity of joint in progressed stages

Important Note: any pain associated with the above symptoms does not arise from the articular cartilage because it is ‘aneural’ (not controlled by nerves); the pain typically occurs from the inflammation and interference with the surrounding structures.

Section 12

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Atherosclerosis

The atherosclerosis process can rapidly progress to other, previously non-diseased arteries throughout the body. In cases where atherosclerosis is unilateral (present on only 1 side of the body), it can also spread to the opposing side of the body in a relatively short space of time. It is, therefore, imperative that individuals who are at risk of this condition are identified and assessed as early as possible, so that the appropriate treatments and interventions can be implemented to prevent the disease from worsening.

Modifiable Risk Factors Smoking - approximately 19% of all CVD deaths in people under 75 are smokers. Hypertension - high blood pressure dramatically increases the workload and physical strain on the cardiovascular system, especially the heart. Additionally, the increased intra-arterial pressure places a greater strain on the myocardial tissue of the heart, because with each heart beat, the heart requires more force to push the blood through the narrowing vascular system. When the disruption in blood supply is prolonged, the tissue(s) that are deprived of oxygen may experience permanent or temporary damage, depending on the duration and severity of the disruption. Atherosclerosis of the artery walls is accelerated when higher levels of the â&#x20AC;&#x2DC;low densityâ&#x20AC;&#x2122; plasma lipoproteins, or LDLs, are consumed in the diet. LDLs become trapped in the wall of the vessel and are subsequently oxidised by the endothelium (lining of the artery). This process ultimately degrades the tone and strength of the artery and increases the risk of further disease to the arteries.

Hypercholesterolemia - high levels of cholesterol, particularly LDL cholesterols, accelerate the rate in which atherosclerosis occurs. Sedentary lifestyle - inactivity reduces the performance and health of the cardiovascular system, especially when combined with other unhealthy practices. Obesity - an increased presence of adipositry, particularly around the mid-section, dramatically increases the strain on the cardiovascular system. Diabetes - research has consistently demonstrated diabetes to dramatically worsen the condition of atherosclerosis, even though the precise cause is still unknown. Diabetes can also be considered a nonmodifiable risk factor when it is congenital, as in type 1. Excessive alcohol consumption - moderate alcohol intakes can help to manage atherosclerosis because alcohol reduces the viscosity of the blood and increases HDL concentrations. When alcohol consumption is excessive however, HDL levels are reduced and greater low-density plasma lipoproteins (LDL) circulate with cholesterol - this has an adverse affect on the health of the cardiovascular system. Stress - research undertaken in this area has revealed that the rate at which atherosclerosis occurs in those exposed to high levels of chronic stress is greater than that in individuals who consume a diet rich in fat. Hormone responses, especially cortisol are believed to be significant in the acceleration of this process.

105

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Diabetes

Section 15

• Genetics • Environment • Increased fat breakdown, although rarely to the extent of ketoacidosis • Increased glucose production in the liver (from glycogen) • Insulin abnormalities in the liver • Defective hormone secretions in the liver

hyperglycaemia because the body is unable to utilise the glucose it has released from the ingested foods. Because fats are used instead of glucose, (gluconeogenesis), ketones acids build up in the blood and urine, which can become toxic and poisonous if permitted to accumulate. One of the key signs and indicators of ketoacidosis is the distinctive acetone breath odour associated with high levels of ketone acids within the blood. The cause of type 1 diabetes is believed to be associated with an autoimmune response which attacks the β cells of the pancreas and ultimately results in their destruction, thus preventing the subsequent production of insulin. The factors that trigger this response are, however, unclear but may include exposure to specific viruses or toxins. Type 1 diabetes can occur at any age, but usually presents itself before the age of 30. Most cases occur in childhood or adolescence where symptoms present abruptly. Type 2 diabetes is defined as a ‘relative’ insulin deficiency which can result in elevated, reduced or even normal insulin levels. Whilst type 2 diabetics still experience hyperglycaemia, regardless of their insulin status, the precise physiology surrounding this condition remains unclear. According to the ACSM (2009), a multitude of factors are believed to contribute to type 2 diabetes, including:

Insulin resistance in type 2 diabetes is incredibly common and results in a desensitisation of the bodily cells which interact with insulin during the absorption of glucose. As such, the glucose that normally enters the muscle and liver remains in the blood, resulting in hyperglycaemia. Rising blood glucose levels stimulate the β-cells of the pancreas to secrete even more insulin in a further attempt to maintain glucose stability. Unfortunately, this additional insulin is usually ineffective in lowering blood glucose and is likely to further contribute to insulin resistance; in extreme cases, the β-cells become overloaded and exhausted over time, which destroys their ability to produce insulin. Approximately 80% of people with type 2 diabetes are overweight or obese, which clearly contributes to the condition. There is also a strong genetic influence with type 2 diabetes; children of parents with the condition are about 2 times more likely to develop the condition. The risk of developing type 2 diabetes also increases with physical inactivity, hypertension and hypercholesterolemia. Silent myocardial ischemia (SMI) 2 times more frequent in diabetic patients than in non-diabetic patients. Additionally, diabetics are also at a higher predictive risk of other cardiovascular events than any other risk factors. Regular cardiovascular screening and assessment is therefore essential for diabetic patients.

Microvascular Disease Microvascular diseases can often present in diabetic patients due to the high and sustained levels of circulating blood glucose, these include neuropathies and retinopathies. Diabetic neuropathies are a family of nerve disorders, which over time develop into more severe nerve damage. Some diabetics with nerve damage have no symptoms while others may experience pain, tingling, or numbness in the hands, arms, feet, and legs. Nerve problems can occur in every organ, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk increases with age and duration of diabetes.

120

Exercise Referral for Clients with Specific Conditions Level 3 Student Manual

Hypertension

Section 17

Hypercholesterolemia - this condition, which is characterised by increased cholesterol and plasma lipoproteins concentration, impedes blood flow by depositing atherosclerotic plaques within the walls of the arteries, and thus increasing peripheral resistance. Type 2 Diabetes - it is estimated that about 25–47% of persons with hypertension have insulin resistance or impaired glucose tolerance. When higher levels of glucose are present in the blood, the viscosity of the blood is increased, which causes blood pressure to rise further.

Non-Modifiable Risk Factors Age - hypertension is more prevalent in older populations as a consequence of decreased organ function (particularly the kidneys), hardening of arteries and reduced physical activity due to functional deterioration. The contributing factors of secondary hypertension are much clearer due to the condition’s link to other underlying medical conditions.

Family history - individuals with a family history of hypertension are twice as likely to develop the condition than those who have no history. Inherited factors are estimated to form approximately 30% of all primary hypertensive cases.

Hypertension is a serious condition which if allowed to Ethnicity - studies have suggested an increased progress can cause strokes, transient ischemic attacks (TIA), kidney failure, retinopathy, heart failure and peripheral prevalence of hypertension in Black and Asian populations compared to Caucasians. artery disease. It is extremely important therefore that this condition is identified and treated as early as possible.

Management of Hypertension

Modifiable Risk Factors Sedentary Lifestyle - sedentary individuals have been found to be up to 50% more likely to develop arterial hypertension; these risks are further increased when individuals are overweight or obese Obesity - obesity is one of the main contributory factors of hypertension, especially when associated with the android distribution of body fat that is particularly prevalent in males. Smoking - in the short-term, smoking causes a sudden or transient increase in blood pressure because of its action on the sympathetic nervous system. Long-term smoking causes arteriosclerosis and atherosclerosis, and can also cause more severe cardiovascular conditions, the symptoms of which may be present for many years after the cessation of smoking. Alcohol - the exact mechanisms are unclear, however, the presence and accumulation of alcohol in the bloodstream interferes with the transport of oxygen and nutrients to the heart through the coronary arteries; thus, the heart has to work harder to achieve its energy supply.

Hypertension can be effectively managed through lifestyle modifications, and when necessary, with medications. Pharmaceutical interventions like beta blockers, calcium channel blockers and ace inhibitors all help to reduce the viscosity of blood, dilate the blood vessels and reduce the strength of the heart’s contractions. Medications, such as aspirin or statins, may also be used when hypercholesterolemia is also associated with hypertension. Most people requiring medication to control this condition will likely need 2 or more antihypertensive drugs in order to achieve their target blood pressure. In order to control hypertension and prevent the condition from accelerating, it is recommended that hypertensive patients make the following lifestyle adjustments: • Reduce weight when overweight or obese • Cut alcohol intake to no more than the recommended intake of 2-3 units for women and 3-4 units for men • Perform 30 minutes or more of aerobic physical activity between 5-7 days per week • Initially, exercise should seek to increase energy expenditure by approximately 700 kcals per week; 132

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Diploma in Exercise Referral Level 3 Student Manual