June 15, 2006 "Myth" Gets Another Look
Table of Contents
"Myth" Gets Another Look (The common cold)
Good Timing (Smoking cessation)
Help for Cancer Patient Caregivers (Psychological wellness)
Blood Pressure Basics (Healthy aging)
Attention Fitness Professionals: Monitoring Exercise Blood Pressure (Program management)
Once it was widely held that getting chilled and wet outdoors could lead to a cold. Later, experts said that this belief was not substantiated by medical research.
British scientists at Cardiff University's Common Cold Centre recently decided to revisit the issue, according to The Pulse wire report. They recruited 90 volunteers to soak their bare feet in ice water for 20 minutes, while 90 others rested their feet in empty bowls.
Only about 10 percent of the dry-feet participants developed colds during the following 4-5 days, but about 30 percent of the icy-wet-feet participants did. This study is unlikely to end the debate, but it might boost the popularity of galoshes among those who want to be on the safe side!
A recent HealthDay report provides encouragement for patients who choose to quit smoking before surgery. They stand to have less trouble with nicotine withdrawal symptoms, which may be suppressed by the medications and therapies received in connection with surgery.
Stopping smoking before surgery also makes anesthesia safer thanks to better functioning of the cardiopulmonary system. Moreover, it makes for a smoother postoperative recovery (through faster healing and a reduced risk for infection).
Surgical patients who stop smoking have an uncommon opportunity to avoid some of the discomforts typically associated with quitting. The timing is favorable for success.
Help for Cancer Patient Caregivers
A study of 354 family caregivers of cancer patients in a community hospice, published by the journal Cancer, found that being taught specific coping skills can improve caregivers' quality of life. Researchers observed that supplying emotional support alone was not as effective at reducing the stress felt by family caregivers, compared to providing the coping skills curriculum.
The training addressed everyday problem-solving and practical steps to take for patients enduring pain or shortness of breath. Compared to caregivers who were not taught coping strategies, those who learned the skills experienced greater improvement in their sense of well-being.
Blood Pressure Basics
This article and the article that follows (Monitoring Exercise Blood Pressure) both address hypertension. The latter will be of interest primarily to health-fitness professionals. The former is geared toward general readers seeking to foster healthy blood pressure levels.
The Good Health Fact Book, a publication of Reader's Digest, provides an overview of fundamental issues related to hypertension, including the following information:
- High blood pressure affects many older adults. Factors that increase susceptibility include family history, obesity, race (a higher incidence is seen among African-Americans as compared to Caucasians), and gender (men are at higher risk than women). In some cases, intemperate drinking or cigarette smoking contributes to the disease. Stress also may have a role.
- Sometimes hypertension arises from an underlying medical condition (for example, a kidney disorder), but in most cases the exact cause cannot be pinpointed.
- Helpful lifestyle measures include stress management, smoking cessation, limiting or eliminating the use of alcohol, curtailing the amount of salt in one's diet, losing excess body fat, and performing regular medically-approved physical exercise.
- When the physician prescribes antihypertensive medication, it must be taken faithfully according to directions. If any unpleasant side effect occurs (such as dizziness, drowsiness, or dry mouth), the doctor should be advised. Adjusting the dosage or trying a different prescribed medication often will alleviate the problem.
- After drug therapy begins, do not abandon exercise and other positive habits. While there are no guarantees, a step in the right direction (such as weight loss) could make it possible to decrease -- perhaps even suspend -- the use of medication. That decision, however, should be made by one's physician. Remember, the overriding objective is to control blood pressure! Another critical pointer: If and when antihypertensive medication is reduced or discontinued, it should not be done abruptly. Instead, follow physician instructions for making the change safely by degrees, which usually takes a period of from one to two weeks.
Attention Fitness Professionals: Monitoring Exercise Blood Pressure
The following information has been adapted from new material slated for publication in upcoming editions of American Senior Fitness Association professional training manuals.
Fitness professionals are advised to take blood pressure readings before and after physical activity when their exercise participants have, or may be at risk for, cardiovascular disease including hypertension. What exactly should one look for when conducting pre- and post-exercise blood pressure measurements? What can the results tell you?
Emotional strain, as well as other factors such as the ingestion of caffeine or nicotine, can act to elevate blood pressure. Since some individuals tend to feel nervous about having their blood pressure checked in the first place, you may need to let participants relax peacefully for about 5 or 10 minutes before measuring.
The pre-exercise (resting) blood pressure check is especially important with respect to clients who use antihypertensive medications. If a participant has forgotten to take his or her medicine you can expect the individual's blood pressure to be elevated above its controlled level, and no physical exercise should be performed that day.
With medical consent, older adults whose pre-exercise blood pressure naturally falls below 140/90 mmHg should follow a moderate exercise routine. This is also generally true of persons whose hypertension is controlled to a level below 140/90 mmHg. Do not initiate an exercise program for someone with high blood pressure until medical treatment, likely to entail drug therapy, has commenced; any untoward medication side effects have been resolved; pressure is contained; and the physician's release to exercise has been obtained.
If a person has medical clearance to exercise even though his or her pre-exercise blood pressure routinely exceeds the 140/90 marker -- notwithstanding healthful behavioral changes and a physician-prescribed drug regimen -- only low-intensity activity should be undertaken. Regarding strength training, this means low resistance with higher repetitions (one example: 50-60% 1RM or less, 15-20 reps/set, 1 set initially and up to 3 over time, performed 2-3x/wk followed by at least 48 hrs muscle recovery, slow progression as well-tolerated). Regarding cardiovascular exercise, it means a mellow pace that easily permits carrying on a normal conversation (one example: walking at comfortable speed, 30 mins/session or 30 accumulated mins/day, performed daily, 5-min increases in duration up to 60 mins as endurance improves). Under these circumstances, the participant's doctor should specify the highest pre-exercise blood pressure acceptable for the individual to perform his or her low-intensity workout. The doctor may also wish to set the training-variable parameters. Keep in mind that such participants need to continue working with their physicians on the goal of stabilizing their resting blood pressure below 140/90 mmHg. For example, the doctor may order medication adjustments and/or prescribe dietary guidelines to expedite weight loss.
For exercisers with hypertension, consistency and regularity are particularly important for preventing the upward movement of blood pressure. Focus on promoting adherence and compliance among this group of fitness participants.
In all senior fitness programming a complete, incremental warm-up period is necessary in order to allow the heart and circulatory system to gradually accommodate participants' targeted training intensity. American Senior Fitness Association (SFA) guidelines call for avoiding stress-producing isometric exercises, breath-holding, the Valsalva maneuver, rigorous high-intensity workloads, and other practices known to elevate blood pressure -- not only in programming for persons with hypertension, including controlled hypertension, but also in community-based fitness programming for all older adults since this population presents increased cardiovascular risks. Editor's note: The terms listed above are defined (and related exercise precautions are discussed in detail) by SFA professional training texts and by other educational publications.
A resting blood pressure reading greater than 200/110 mmHg is an absolute exercise contraindication for senior adults. It is, moreover, an emergency situation that requires immediate medical intervention.
Most physical activity settings are not conducive to reliable blood pressure measurement in the course of exercise performance. However, if the facility is equipped and the staff qualified and experienced in monitoring blood pressure response during exercise, a trainer will look for certain predictable results. Diastolic pressure should remain the same or slightly decrease with physical exertion; a decline of up to 10-20 mmHg is considered to be within normal range. Systolic pressure, on the other hand, should increase as work intensity does so. These adaptations allow for greater blood flow, which is needed to sustain physical exercise.
Undesirable blood pressure responses that require exercise cessation include: (1) a rising diastolic pressure; (2) a reduction in systolic pressure of 10 mmHg and/or a systolic pressure that does not ascend along with increasing exercise intensity; (3) an excessive rise in systolic pressure.
Regarding #3 above, recommendations vary regarding the systolic threshold indicative of a hypertensive response during exercise. Figures provided by the sources used to develop this article include 220, 225, 220-240, and 250 mmHg. SFA recommends the conservative endpoint of 220 mmHg for exercise cessation in community-based senior fitness programming.
Likewise, regarding #1 above, sources vary on the diastolic threshold indicative of a hypertensive response during exercise, with figures ranging from 90 to 110 mmHg. A prudent policy is simply to terminate exercise if diastolic pressure is seen to rise as training intensity increases during a workout.
Persons with hypertension also should stop exercising if they experience or exhibit chest pain, marked shortness of breath, disorientation, faintness, nausea or vomiting, pallor, inappropriate fatigue, or an exercise heart rate that decreases more than 10 beats a minute when their work rate has remained constant or increased.
It is the American Senior Fitness Association's position that if a hypertensive client's exercise session is terminated due to any adverse response, his or her physician should be notified at once.
Certain antihypertensive drugs such as beta-blockers can suppress exercise heart rate and, in some cases, blood pressure. Therefore, it is important to constantly monitor intensity via RPE (rating of perceived exertion) rather than by pulse-count -- and to stay alert for signs of excessive fatigue. Avoid overheating during exercise, as certain blood pressure-lowering medications hinder the body's ability to regulate temperature. When drugs with the potential to alter exercise response are in use, ask participants' physicians for the RPE level at which they should endeavor to work. A study published by the Journal of the American College of Cardiology has found beta-blockers more effective, compared to other medications, at holding exercise blood pressure to 210 mmHg (or lower) in older men. Nonetheless, special care must always be maintained when training hypertensive African-Americans, as blood pressure is better controlled in Caucasians regardless of the antihypertensive therapy employed.
A thorough, gradual cool-down period that prevents blood-pooling in the lower extremities must be observed as an integral component of all physical exercise activity. Afterward, expect a period of post-exercise hypotension. A decrease of 5-7 mmHg commonly occurs and may remain for as long as 22-24 hours after an exercise session. Some experts view this beneficial response as the means through which regular exercise eventually succeeds at lowering resting blood pressure. For persons with hypertension and for older adults in general, effective cool-down activity (lasting, at the very minimum, longer than 10 minutes) can deter a sudden sharp and potentially dangerous drop in blood pressure.
A University of Kentucky report on exercise-electrocardiogram testing notes that following the cool-down portion of the procedure, some individuals' ECG and blood pressure may take 10-20 minutes to return to near-normal. In community fitness programming, if blood pressure remains elevated or measures abnormally low after proper cool-down activity and a brief rest, the participant's personal physician needs to be consulted. With this in mind, fitness professionals must ensure that the cool-down phase they implement is optimal.
References and Recommended Reading
In addressing this topic, we relied both on current literature and classic texts proven by the test of time. Sources follow:
Acierno, L.J. (1985). Comprehensive cardiac rehabilitation and prevention: A model program. New York: Immergut & Siolek.
American Heart Association (2006). Your high blood pressure question answered: Blood pressure and exercise. Online: http://www.americanheart.org/presenter.jhtml?identifier=3034814.
American Senior Fitness Association (2004). Special Population Imperatives for Custom Older Adult Training. New Smyrna Beach FL: SFA.
Bryant, C.X., & Green, D.J. (Eds.) (2005). Exercise for older adults: ACE's guide for fitness professionals. Champaign IL: Human Kinetics.
Divine, J.G. (2006). Action plan for high blood pressure: Your guide to managing exercise and medication to relieve hypertension (ACSM Action Plan for Health Series). Champaign IL: Human Kinetics.
Gladwin, L.A. (Ed.) (2002). Fitness theory & practice. Sherman Oaks CA: Aerobics and Fitness Association of America.
Howley, E.T., & Franks, B.D. (1992). Health fitness instructor's handbook. Champaign IL: Human Kinetics.
Kokkinos, P., Chrysohoou, C., Panagiotakos, D., Narayan, P., Greenberg, M., & Singh, S. (2006). Beta-blockade mitigates exercise blood pressure in hypertensive male patients. Journal of the American College of Cardiology, 47(4), 794.
Pollock, M.L., Wilmore, J.H., & Fox III, S.M. (1984). Exercise in health and disease: Evaluation and prescription for prevention and rehabilitation. Philadelphia: W.B. Saunders.
Sudy, M. (Ed.) (1991). Personal trainer manual. San Diego: American Council on Exercise.
University of Kentucky (2006). Exercise electrocardiogram. Online: http://www.ukhealthcare.uky.edu/content/content.asp?pageid=P07973.
Warner, J. (2004). New guidelines for exercise and hypertension (re: Medicine & Science in Sports & Exercise, 36, 533). Online: http://onhealth.webmd.com/script/main/art.asp?articlekey=56826&p.
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