LO2 of Unit 3 – Understand prevention and management of common health conditions

Understand prevention and management of common health conditions

Learning outcomes
By the end of this section, you will be able to:

2.1 Discuss health and exercise statistics for the UK

2.2 Describe how physical activity can prevent and manage common health conditions

2.3 Describe the professional boundaries and scope of practice of Gym Instructors when offering health, exercise and wellbeing advice

2.4 Identify relevant exercise or health professionals that clients can be signposted to for specialist advice.

2.1
Health and exercise statistics for the UK

Physical inactivity is responsible for one in six UK deaths (equal to smoking) and is estimated to cost the UK £7.4 billion annually (including £0.9 billion to the NHS alone).

The UK population is around 20% less active than in the 1960s. If current trends continue, it will be 35% less active by 2030.

Around 1 in 3 (34%) of men and 1 in 2 (42%) women are not active enough for good health. According to the All Our Health’ research, Men are more likely to report being active at the recommended level than women.

Physical activity varies with age and life stage. People tend to get less active with age, especially in older years. And people with disabilities or long-term conditions are twice as likely not to be active enough for good health.

However, one in four people would be more active if advised by a healthcare professional, so this presents a unique opportunity for you to support people to be more active.

The UK Chief Medical Officers’ Guidelines recommend each week adults do:

At least 150 minutes of moderate-intensity activity, 75 minutes’ vigorous activity, or a mixture of both
Strengthening activities on two days
Reducing extended periods of sitting

Physical activity has significant benefits for health, both physical and mental. It can help prevent and manage over 20 chronic conditions and diseases, including some cancers, heart disease, type 2 diabetes and depression.

Living a sedentary lifestyle without sufficient exercise is seriously damaging to health. Being inactive often leads to being overweight, which can lead to pre-diabetes and type 2 diabetes. Staying active decreases insulin resistance and helps bodily insulin to be more effective.

Diabetes is a serious metabolic disease in which the body’s ability to produce or respond to the hormone insulin is impaired. This results in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Left untreated, it can lead to a number of serious long term complications, or even death.

More than 4 million adults in the UK have been diagnosed with diabetes

Around 4.8 million people are living with diabetes in the UK
It’s estimated that as many as 700,000 people in the UK have undiagnosed Type 2 diabetes.
Around 90 per cent of those diagnosed are living with Type 2 diabetes and 10 per cent have either Type 1 or rarer types.
One in 15 people in the UK have diabetes, including one million people who have type 2, but haven’t been diagnosed.

Linked conditions

Adults with diabetes are 2-3 times more likely to develop heart and circulatory diseases and are nearly twice as likely to die from heart disease or stroke as those without diabetes
In the UK, one-third of adults with diabetes die from a heart or circulatory disease

Obesity is the major type 2 diabetes risk, with millions of people throughout the world facing obesity. Almost a quarter of adults in the UK are recorded as being obese.

The World Health Organisation (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that presents a health risk. Although researchers agree that there is a genetic susceptibility, obesity is generally caused by eating too many calories from foods high in sugar and fat and not burning off the energy through regular physical activity participation.

It is classed as a serious global health hazard of the 21st century, having a profound social and medical impact and placing a significant financial burden on health services. Obesity promotes many comorbid diseases, and there is also a higher mortality rate.

Additionally, the numbers continue to climb, both amongst adults and children. The number of children being diagnosed with type 2 diabetes caused by obesity is climbing everywhere. In the UK, about one in three children are classed as obese.

The UK currently ranks as the country with the highest level of obesity in Europe, with more than 1 in 4 (28.1%) adults obese and nearly two out of three (63.4%) overweight.

Over the next 20 years, the number of obese adults in the country is forecast to soar to 26 million people.

Obesity statistics

In the UK in 2015, 58% of women and 68% of men were overweight or obese. Obesity prevalence increased from 15% in 1993 to 27% in 2015.
In the UK in 2015/16, there were 525,000 admissions to NHS hospitals where obesity was recorded as a factor.
In the UK, over three-quarters of bariatric surgery patients were aged between 35 and 54, and over three-quarters of patients were female.

The WHO suggests that more than 1 in 4 (28.1%) of adults in the UK are obese (BMI of 30 or more).

Obesity is preventable!

It is therefore unsurprising that obesity imposes a considerable economic burden. The Health Select Committee (HSC)33 reported that the cost of obesity in England is between £3.3 and £3.7 billion per year. This figure is 27% to 42% higher than the previous estimate by the National Audit Office (NAO)35 due to higher NHS and drug costs, the availability of more accurate data, the inclusion of comorbidities and increased prevalence of obesity.

The HSC estimate includes £49 million for treating obesity, £1.1 billion for treating the consequences of obesity, and indirect costs of £1.1 billion for premature death and £1.45 billion for sickness absence. The cost of obesity plus overweight is estimated between £6.6 and £7.4 billion per year.

Cardiovascular disease

Cardiovascular disease refers to diseases that affect the heart and circulatory system; it is an illness that afflicts many individuals in the United Kingdom. In 2016/17, there were over 1.7 inpatient episodes with the main diagnosis of circulatory system disease in the United Kingdom.

Almost 433 thousand diagnoses in 2016/17 were for coronary heart disease, also known as ischemic heart disease. The mortality rate from cardiovascular disease in the UK in 2016 was 251 deaths per 100,000 population; in that year, Scotland had the highest death rate of the devolved nations with 306 deaths per 100,000 people. Furthermore, Scotland also has the highest mortality frequency for coronary heart disease, with 134 deaths than the UK average of 108 per 100,000 population.

Cardiovascular disease statistics

Coronary heart disease remains the number 1 killer in the UK
42,000 people die prematurely from CVD every year in the UK
Death rates from coronary heart disease are the highest in areas of greatest deprivation
Overall, CVD is estimated to cost the UK economy £19 billion – 46% for direct healthcare costs, 34% in productivity losses and 20% for informal care of people with CVD
Someone in the UK has a heart attack every 7 minutes

2.2
How physical activity can prevent and manage common health conditions

Regular physical activity is a key strategy in the prevention of chronic disease and contributes significantly towards the lowering of mortality rates. It provides a range of physical and mental health, and social benefits, many of which are increasing issues for individuals, communities and society.

These include:

Reducing the risk of many long-term conditions
Helping manage existing conditions
Ensuring good musculoskeletal health
Developing and maintaining physical and mental function and independence
Supporting social inclusion
Helping maintain a healthy weight
Reducing inequalities for people with long-term conditions

Regular physical activity is associated with a reduced risk of a range of diseases including some cancers and dementia. There is also evidence that it can help to prevent and manage over 20 common chronic conditions and diseases, many of which are on the rise and affecting people at an earlier age, such as:

1: Some Cancers – Not all cancers can be prevented, but there are proven ways you can reduce your risk. There is lots of evidence that it can also reduce the risk of developing breast, bowel and womb cancer. Keeping active could help to prevent around 3,400 cases of cancer every year in the UK.

Exercise has many biological effects on the body, some of which have been proposed to explain associations with specific cancers. These include:

Lowering the levels of sex hormones, such as estrogen, and growth factors that have been associated with cancer development and progression [breast, colon]
Preventing high blood levels of insulin, which has been linked to cancer development and progression [breast, colon]
Reducing inflammation
Improving immune systemfunction
Altering the metabolism of bileacids, decreasing exposure of the gastrointestinal tract to these suspected carcinogens
Reducing the time it takes for food to travel through the digestive system, which decreases gastrointestinal tract exposure to possible carcinogens
Helping to prevent obesity, which is a risk factor for many cancers

2: Obesity – Physical activity increases people’s total energy expenditure, which can help them stay in energy balance or even lose weight, as long as they don’t eat more to compensate for the extra calories they burn. Regular physical activity and exercise will elevate basal metabolic rate (burn energy/calories more efficiently) helping to maintain a normal body weight thus reducing the risk of obesity and type 2 diabetes.

Physical activity decreases fat around the waist and total body fat, slowing the development of abdominal obesity.
Resistance training, and other muscle-strengthening activities build muscle mass, increasing the energy that the body burns throughout the day-even when it’s at rest-and making it easier to control weight.
Physical activity reduces depression and anxiety, and this mood boost may motivate people to stick with their exercise regimens over time.

3: Type 2 Diabetes – The primary benefits of exercise on diabetes management and prevention is the result of acute and chronic improvements in insulin action. The benefits of regular exercise include:

Improves blood glucose control through increasing insulin sensitivity in non-insulin dependent tissues.
Increases glucose uptake via glucose transporter 4 (GLUT4) to the skeletal muscle.
Moderate aerobic exercise leads to maintenance of blood pressure in diabetic neuropathy patients.
High-volume aerobic exercise increases weight loss, with significant improvement in insulin sensitivity.
Aerobic exercise can restore endothelial function, thus reducing arterial stiffness which is a risk factor for developing cardiovascular complications in diabetics.
Resistance training improves glucose control and promotes less insulin resistance among Type 2 diabetics patients.
Resistance training has been shown to enhance insulin sensitivity, daily energy expenditure and quality of life.
Resistance training increases muscle strength, lean muscle mass and bone mineral density, which could enhance functional status and glycaemic control, assisting in the prevention of sarcopenia and osteoporosis.

4: Cardiovascular Diseases (CVD) including coronary heart disease and stroke – Exercise has also been shown to revert aspects of cardiovascular disease and play a preventive role in the progression of pathological conditions. Cardiovascular exercise in particular induces functional and structural adaptations of the cardiovascular system, all beneficial to the prevention and progression of CVD.

Acute and chronic responses to aerobic exercise training include:

Increased oxygen uptake
Increased cardiac output
Increased heart rate
Increased stroke volume
Increased systolic blood pressure
Slight decrease in diastolic blood pressure
The widening of pulse pressure (the difference between systolic and diastolic blood pressure)
Decrease in peripheral vascular resistance.

Resistance Training – it is only recently that researchers have discovered the benefits of resistance training on the heart. Recent research suggests that chronic resistance training can lower oxidative stress, as shown by reductions in lipid and DNA oxidation, in healthy older adults (Parise, Brose and Tarnopolsky, 2005; Parise, Phillips, Kaczor, Tarnopolsky, 2005). The Proposed mechanism is thought to be from the result of a contraction-induced antioxidant enzyme up-regulation. It appears that resistance training increases superoxide dismutase, a potent antioxidant, which scavenges free radicals.

5: Hypertension – Regular exercise has been shown to prevent the development of hypertension by lowering blood pressure. In particular, programs that primarily involve endurance activities can lower blood pressure in adults with hypertension by 5-7mmHg.

This creates a stronger heart muscle, which is able to pump more blood (stroke volume and cardiac output) with less effort (lower heart rate) thus reducing resistance in arteries so that blood can flow more freely.

6: Osteoarthritis and lower back pain – The benefits of exercise for people with arthritis and lower back pain are maintenance of muscle mass, improvement in strength, preservation of joint range of motion, a reduction in symptoms and improvement in overall functional capacity for daily activities (Ettinger et al. (1997); Bennell et al. (2005)). Furthermore, weight loss should be a primary goal if weight is an issue.

Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help control joint swelling and pain.
Regular activity replenishes lubrication to the cartilage of the joint and reduces stiffness and pain. Exercise also helps to enhance energy and stamina by decreasing fatigue and improving sleep.
Exercise can enhance weight loss and promote long-term weight management in those with arthritis who are overweight.
Improving circulation to better distribute nutrients through the body, including to the spinal discs
Releasing endorphins, which can naturally relieve pain. A frequent release of endorphins can help reduce reliance on pain medication. Endorphins can also elevate mood and relieve depressive symptoms, a common effect of chronic pain.
Minimising the frequency of back or neck pain episodes and reducing the severity of pain when it does occur.

7: Mental health conditions including depression and anxiety – Regular physical activity has a positive effect on brain development and function. It stimulates the development of new brain cells and releases feel good chemicals called endorphins thus improving your mood and how you feel about yourself. Exercise has been proven to positively affect people suffering from depression.

8: Dementia – Research into the potential for physical exercise to reduce the risk of dementia is continuing. While we do not yet have definitive evidence from randomised trials, several studies have found that physical activity in early, mid and late life is associated with a lower risk of cognitive decline and dementia.

Physical exercise is also essential for maintaining adequate blood flow to the brain and may stimulate brain cell growth and survival.
People who exercise regularly are less likely to experience heart disease and stroke, both factors that are associated with an increased risk of developing dementia.
Exercise is also important in reducing the risk of high blood pressure, type 2 diabetes and obesity, all of which are risk factors for dementia.

9: Chronic Obstructive Pulmonary Disease (COPD) and Asthma – Exercise is highly effective and has many benefits, including improved exercise tolerance, reduced perceived breathlessness, improved health-related quality of life, improvement in depressive and anxiety symptoms, improved sleep quality, enhanced effect of long-acting bronchodilators, decreased hospitalisations and number of days in the hospital, improved recovery time after an exacerbation, and improved survival.

10: Musculoskeletal Conditions – Regular weight-bearing exercise is good for bone health for the prevention of Musculoskeletal Conditions such as Our bones respond when they are stressed, allowing them to bear more weight than they are used to. Regular loading with weight bearing or impact exercises is an important strategy for bone health and the prevention of osteoporosis. Exercise in these groups has been shown to:

Minimise bone loss and possibly reduce the risk of broken bones
Increase muscle strength
Improve balance
Improve your sense of wellbeing
Improve cognitive (brain) function
Increase ability to carry out daily tasks and activities
Maintain or improve posture
Relieve or decrease pain associated with other conditions such as osteoarthritis
Reduce the risk of falls
Reduce the risk of many medical conditions

Remaining active is particularly important in those people who have broken bones as a result of osteoporosis. Suitable physical activity has been shown to:

Decrease the risk of falls and further fractures
Improve balance
Improve muscle strength and stamina
Improve posture
Improve wellbeing
Reduce pain

2.3
The professional boundaries and scope of practice of Gym Instructors when offering health, exercise and wellbeing advice.

What are professional boundaries:

Professional boundaries are the legal, ethical, and organisational frameworks that protect both clients and employees, or workers, from physical and emotional harm, and help to maintain a safe working environment. author Marilyn Peterson, who defines them as ‘The limits that allow for a safe connection based on the client’s needs.’ Professional Boundaries serve to protect the integrity of the professional relationship and are intended to keep people safe from harm.

What is Scope of Practice

Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency.

It describes the services that a qualified health professional is deemed competent to perform and permitted to undertake – in keeping with the terms of their professional license.

How does this apply to the Gym Instructor?

A primary responsibility of a Gym Instructor is to minimise the risks of exercise, whilst at the same time maximising the beneﬁts. A gym instructor must demonstrate duty of care at all times and show that you have matched activities to the client’s personal circumstances, including their health and ability. The instructor’s role and duty of care is to deliver exercise tailored to the client’s needs and physical capacity in a safe environment and support them to adhere to the program.

Failure to do so could lead to client litigation if something were to go wrong. It is therefore important that you know as much about the client’s exercise and health history as possible.

Screening and Assessing

Through pre-exercise screening, you may identify a health risk or condition that will impact your client’s exercise programme, and that is outside your scope of practice. During this process of gathering information about a person’s health, medical conditions, lifestyle and exercise history, the instructor is able to find out more about the client. It also includes administering some popular or well-known health and exercise tests.

Screening clients prior to personal training allows you to:

Obtain baseline information about the client which can be used for completing health and ﬁtness tests.
Identify any potential risks of participation that may need to be referred to an appropriate professional.
Guide the planning of the personal training programme.
Establish a relationship and build trust.
Answer any questions about the programme.

It is unlikely a client you will be working with has a medical, fitness or nutritional requirement that they do not know about. However, there are several medical conditions, fitness and dietary needs that will prevent you from working with a client unless you have specialist training and qualiﬁcations.

It is important not to step outside the scope of practice of fitness and qualiﬁcations. You cannot be an expert in all things ﬁtness, and some clients may need a trained specialist’s services to design a safe and effective exercise programme for them.

The specialist professional’s role is to manage the client’s health condition and support safe exercise and physical activity. In this way, ongoing client care is provided by a team or partnership.

Here is a list of medical, exercise and nutritional conditions that require specialist intervention:

Orthopaedic diseases such as arthritis and osteoporosis
Cardiovascular diseases such as hypertension and coronary heart disease (CHD)
A musculoskeletal issue or disfunction
Metabolic diseases such as diabetes
Pulmonary diseases such as asthma
Raised cholesterol
High blood pressure
Clients diagnosed with injury or surgical procedures– prolapsed disc, hip replacement.
An eating disorder or digestive system
A pre and post-natal client
A child or young person
A disabled client requiring specialist needs
A sport or performance-based client, requiring specialist coaching and training

Therefore, a gym instructor should be aware, in the interest of client safety and welfare, where there will be instances where clients may need to be referred to another professional.

Working with specialist professionals means the professional qualified to deal with the risk, condition or training needed has the authority around what the client can and cannot do. As the exercise professional, they will look to you to advise programme design, client responses to exercise, and program results.

If the client was referred to another professional, it is a good idea to contact them to ﬁnd out how they are. You would want to know if it is okay to resume training, what other resources or education you may need to successfully work with your client and adapt to meet their needs. The client will appreciate your genuine concern for their wellbeing.

2.4
Relevant exercise or health professionals that clients can be signposted to for specialist advice.

Client referral represents two or more professionals working together to benefit the client – to optimise client experience and health outcome. Effective client referral will help to ensure that clients receive the proper care at the right time to meet their individual needs – a key priority for professionals of all disciplines across the health and fitness spectrum.

To achieve this, health and fitness professionals require planned and systematic strategies for referring clients between services. Ultimately, a collaborative and team-oriented approach to the referral will optimise client care.

The specialist professionals that Registered Exercise Professionals might typically need to connect with include:

General Practitioners

GPs are responsible for the overall management of each patient’s care programme. GPs are excellent in promoting physical activity to their patients as 85% of the population visits their GP surgery annually (RESEARCH and the Health and Social Care Information Centre, 2008).

GPs are also responsible for:

Deciding on who should be referred into an exercise referral system.
Obtaining consent from the patient to transfer information to an exercise professional.

Physiotherapists

Physiotherapy is a degree-based healthcare profession. Physiotherapists use their knowledge and skills to improve a range of conditions associated with different systems of the body, such as:

Neurological (stroke, multiple sclerosis, Parkinson’s)
Neuromusculoskeletal (back pain, whiplash associated disorder, sports injuries, arthritis)
Cardiovascular (chronic heart disease, rehabilitation after a heart attack)
Respiratory (asthma, chronic obstructive pulmonary disease, cystic fibrosis).

Physiotherapists work in a variety of specialisms in health and social care. Additionally, some physiotherapists are involved in education, research and service management. Physiotherapists often work as part of a multidisciplinary team in various areas of medicine and settings, including:

hospitals
community health centres or clinics
some GP surgeries
some sports teams, clubs, charities and workplaces

Strength and Conditioning Coaches

A Strength and Conditioning (S&C) Coach plans, delivers, and reviews athletes’ physical and physiological preparation aligned with specific sports performance outcomes.

To do this, Strength and Conditioning Coaches have a deep understanding of the physical characteristics required to excel in sports performance. They understand what it takes for an athlete to be resilient to the intensity and volume within their training environment, thus maximising the technical training opportunities in their respective sports. Plans can then be specifically tailored to the adaptations required and maximised in the strength and conditioning coaching environment in-line with the sport’s culture.

Paediatrician

A Paediatrician is a medical doctor who manages the physical, behavioural, and mental care of children from birth until age 18. Paediatricians are trained to diagnose and treat a broad range of childhood illnesses, from minor health problems to serious diseases.

Dietician

Dietician is a legally protected title, meaning it is against the law to call yourself a dietician unless you have received an honours degree in nutrition or dietetics.

Dieticians must be registered with the Health and Care Professions Council (HCPC).

Dieticians promote good dietary health and treat medical conditions by devising eating plans for nutrition science patients. Dietitians usually work in the NHS.

Dieticians perform a variety of roles:

Providing health advice and promoting healthy eating
Helping people come to terms with their illnesses
Providing advice on special diets (medical nutrition therapy)
Educating health professionals and the public about nutrition
Establishing and addressing fundamental health needs, helping to facilitate dietary changes

Nutritionists

Nutritionists use their scientiﬁc knowledge of food to give information and advice about the effects of diet and nutrition on health and wellbeing.

Unlike ‘dieticians’, ‘nutritionist’ is not a protected term in the UK, so anybody can claim to be a nutritionist.

Nutritionists generally work in a preventative role on a one-to-one and group basis with patients of all ages. Unlike dieticians, who primarily work with ill people, nutritionists mostly work with healthy people.

To become a nutritionist, it is necessary to gain a degree in nutritional science or dietetics. It is also advantageous to register with the associated professional body, the Association for Nutrition.

Sport and Exercise Physicians
Osteopaths
Podiatrists
Psychologists

Occupational Therapists

Is a healthcare profession that focuses on developing, recovering, or maintaining the daily living and working skills of people with physical, mental, or cognitive impairments.

Occupation Therapists help people of all ages to overcome any permanent loss or lack of physical, sensory, mental or communication function.

They aim to help improve their ability to function independently as possible to participate in whatever activities are meaningful and important to them. Occupational therapists mainly identify and eliminate environmental barriers to independence and participation in everyday daily life.

Pregnancy and Post-natal Exercise Specialists

Have the ability to communicate with pregnant and postpartum women and promote their engagement in specific exercise and health programmes. They can also communicate with medical and healthcare professionals about the pregnant participant’s conditions and understand the standard medical conditions or contraindications related to exercise.

They can programme and supervise group or individual exercise, adapting the different forms of exercise to each stage of pregnancy and the postpartum period, according to available exercise guidelines and physical fitness assessments. Additionally, they have the ability to develop a prenatal exercise programme for previously inactive or for active women, including athletes.

Pregnancy and Post-natal Exercise Specialists will take a holistic approach to their pregnant and postpartum women’s wellness. This includes advising on lifestyle, healthy eating and stress management, and the benefits of exercise relevant to the condition, but always with respect to professional boundaries.

Exercise Referral Instructors

are responsible for the management or supervision of patients for the referral scheme’s duration. Instructors must provide patients with a duty of care and remain professional at all times.

The exercise referral instructor is critical to the exercise referral scheme’s success because they possess the skills to build the relationship between the patient and regular exercise.

Exercise Referral Instructors are responsible for:

Safe and effective exercise programming.
Working closely with patients.
Initial assessment and obtaining informed consent.
Referring the patient back to their GP or other health care professional if required.
Designing safe and effective sessions.
Motivating the patient/behavioural change strategies
Monitoring progress.
Understanding operational procedures, policies and legislation.
Maintaining skills, qualifications and competency, and maintaining insurance.
Reporting back to the scheme coordinator.

Other specialist professions able to refer clients include:

Chiropractors
Accredited Exercise Physiologists
Remedial Massage Therapists
Diabetes Educators
Specialists might include: Obstetricians, Cardiologists, Oncologists, Orthopaedics etc.

Private: Level 2 – Certificate in Fitness Instructing (Feb 2021)