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Personal trainers and special population fitness professionals can get all too familiar asking the same health-related questions and receiving the same answers on a Physical Activity Readiness Questionnaire (PAR-Q).
Even if you interview 10 clients with no known health conditions or exercise contraindications, you have to be ready for the eleventh client that suffers from a heart condition resultant of something akin to a previous myocardial infarction (MI).
An initial reaction to this type of client can be fear and hesitation, but these clients should not be avoided. Explore the client’s interest in exercise and find out about their physician’s recommendations. Regardless of what you think and how you perceive their health status, a heart disease patient must have clearance from a physician before participating in any exercise program (3).
In addition, a detailed description of exercise intensity restrictions must be documented by the physician.
Designing a Program for Physician Approval
Once you receive these restrictions, aim to construct a basic exercise program that includes the exercise intensity, frequency, and type of exercise to resubmit for physician approval. Intensity, typically based on heart rate, RPE, or both, should be documented by the physician prior to formulating an aerobic exercise program.
Use RPE and heart rate monitoring (watch or hand sensors available on most cardiovascular equipment) to evaluate intensity. Frequency should gradually increase according to each client’s health history and symptoms.
Aerobic exercise can begin as early as one week following hospital discharge. Resistance training is a newly researched field of study for post-MI clients. Current recommendations advise that resistance training not be administered until 2-6 weeks post-MI, after participating in an aerobic exercise program (4).
Resistance exercise should begin with resistance bands and bodyweight exercises before transitioning to machines and free weights.
Formulating exercise guidelines for clients might require more time than for other clients but the investment is worth the success of the program.
Table 1 outlines some exercise guidelines for a post-MI patient that will help you in developing a program for physician approval.
Table 1. Exercise Program Recommendations
Figure adapted from ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities (2); Clinical Exercise Physiology (5); Exercise Standards for Testing and Training: A Statement for Healthcare Professionals from the American Heart Association (1).
Practical ApplicationFull comprehension of all the aforementioned training variables requires that you keep your client’s goals in mind at all times.
If you lose sight of the goal of an exercise program, then it no longer suits the needs of an individual.
A post-MI client will verbalize some of their goals but it is up to you to reiterate health improvement goals including:
One goal not mentioned in the above list is to improve the client’s confidence. This requires careful intervention on your part and it is not always something that is verbalized by you or the client.
You can improve the client’s confidence by providing positive feedback when he/she completes an exercise, remembers a take-home message, or completes a leisure activity that was previously too challenging. As a personal trainer, or special population fitness professional, your role is not only to train the client, but also to support, motivate, and educate the client.Interested in gaining more expertise to work with special population clients? Why not become a Certified Special Population Specialist (CSPS®)?
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Derek Grabert, MS, CSCS,*D is an Education Content Coordinator for the NSCA. He holds a master's degree in nutrition and has experience as a university instructor for human nutrition, anatomy, and physiology classes. He has coached high school athletes, special populations clients, and general fitness enthusiasts on the health benefits of strength training, aerobic training, and the integration of proper nutrition.
Fletcher, GF, Balady, GJ, Amsterdam, EA, Chaitman, B, Eckel, R, Fleg, J, Froelicher, VF, Leon, AS, Pina, IL, Rodney, R, Simons-Morton, DA, Williams, MA, and Bazzarre, T. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104(14): 1694-740, 2001. Franklin, BA. ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. (3rd ed.) Champaign, IL: Human Kinetics; 49-65, 2009. Malek, M. NSCA's Essentials of Personal Training. (2nd ed.) Champaign, IL: Human Kinetics; 525-528, 2012. Pollock, ML, Franklin, BA, Balady, GJ, Chaitman, BL, Fleg, JL, Fletcher, B, Limacher, M, Pina, IL, Stein, RA, Williams, M, and Bazzarre, T. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine. Circulation 101(7): 828-33, 2000. Visich, P, and Fletcher, E. Clinical Exercise Physiology. (2nd ed.) Champaign, IL: Human Kinetics; 281-299, 2009.