Medical Explanations

Below we have provided some useful definitions to support the reasons why we have included them in the Current Medical History section on our forms. This list is in progress and we aim to complete it soon. Please ask for any additional information you require by using the Suggestion Forum link to your left.

Important Notice: Whilst we continue to research to ensure an up-to-date accuracy of the information provided we strongly advise you to consult your local doctor or specialist if you have concerns or questions about any of this information or the health status of any client you may see. If you have reason to believe any of the information below should be amended please email us on info@mystudiosoft.com

Diabetes? If yes, please circle whether IDDM or NIDDM. Are your Glucose levels normalised?
High or Low Blood Pressure? If high, is your BP stabilised on medidcation or Beta Blockers
Epilepsy? If yes, have your seizures been stabilised on medication?

Diabetes

There are two basic types of diabetes - type 1 (IDDM) and type 2 (NIDDM)

Type 1 Diabetes

Type 1 Diabetes, was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes.

It exists when the body fails to produce insulin, the hormone required for controlling blood sugar levels. Sufferers of Type 1 diabetes require insulin injections to correct this. There is no known dietary cause of Type 1 diabetes.

Although diet may not be a direct cause, for patients who suffer from Type 1 diabetes, diet is an important element of their clinical care. All patients with Type 1 diabetes should have access to a qualified dietician. They should also regularly self-measure their blood sugar levels.

Type 2 Diabetes

Type 2 Diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for 90-95% percent of all diagnosed cases of diabetes and is increasingly being diagnosed in children and adolescents.

Type 2 diabetes reduces the body's ability to control it's blood sugar levels. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. Individuals can reduce their risk of developing this type of diabetes by losing weight and by increasing their physical activity. If an individual currently uses medicine to control their blood sugar, weight loss and physical activity may make it possible for their doctor to decrease the amount of medication they need.

Type 2 diabetes often presents later in life, and is usually associated with being overweight. In this case, too much insulin is produced by the body, but still has little or no effect on blood sugar.

Type 2 can often be treated with diet alone. In the later stages of the disease insulin production may decline and some people will need tablets or insulin injections.

The risk of Type 2 diabetes rises as body fat increases. If you are an obese man, your risk of developing diabetes is 40 times higher than if you are a healthy weight. This risk more than doubles in obese women.

Achieving and maintaining a healthy weight is the only treatment known to improve the life expectancy of people with Type 2 diabetes without using tablets or insulin injections.

Diabetic Athlete

Because exercise lowers the blood sugar levels and helps improve the body's use of insulin, an athlete often needs to reduce the insulin dose before exercise. Exercise also increases the blood flow to the skin and muscle tissue, and increases the amount of insulin in the blood stream. Exercise also acts as a stimulant to the liver, which releases glucose to the blood stream. Because blood concentrations of glucose may continue to rise if the diabetic begins exercise with a high glucose level, it is best to bring the level down prior to beginning exercise.

The Symptoms

Most individuals with Type 1 are diagnosed early. With Type 2, it may be more difficult to diagnose simply because, for the sufferers, the symptoms seem relatively harmless. The following are typical symptoms of diabetes and should be taken seriously:

Frequent urination	Decreased physical performance
Extreme hunger	Unusual weight loss
Excessive thirst	Irritability
Dry skin	Variable mood
Blurry vision	Paleness
Tremor	Headache
Sweating	Dizziness
Increased fatigue

Safety First

Obviously, blood sugar levels are critical no matter what type of diabetes someone has. Exercise can effect their blood sugar, often dropping the levels in what is known as hypoglycaemia, so pay attention to possible warning flags during their workout such as:

change in heartbeat
start sweating more
feel shaky, anxious or hungry
dizziness

What to do for hypoglycaemia

If a diabetic senses the onset of low blood sugar they can take measures by eating or drinking food with a high concentration of carbohydrates. If the athletes does not realize that she is experiencing a low blood sugar problem, it is important for a coach or training partner take action and offer carbohydrates to the diabetic. In very extreme situations, the athlete may not be able to swallow or may become unconscious. If this happens, call for help immediately. A physician or paramedic may inject glucagon, which is a hormone that releases glucose from the liver into the blood stream. After receiving glucagon, the person should soon regain consciousness.

Their doctor should have made them aware of what to do in these situations and it is suggested that people treating individuals with diabetes keep candy or juice nearby to treat a hypoglycaemic episode.

Safety Tips for Diabetic Athletes

Check your blood sugar levels before and after workouts and every 20 to 30 minutes during prolonged exercise.
If blood sugar is under 100 mg/dL, take a snack containing 15 to 30 grams of carbohydrate before you exercise.
If blood sugar is excessive (over 250 mg/dL for type 2 diabetes or over 200 mg/dL for type 1, postpone exercise until you bring it down.
Know the signs of hypoglycaemia and be prepared with available snacks.
Exercise 1 to 2 hours after a meal.
Avoid exercise at times of peak insulin activity. Morning exercise is ideal. People who have type 1 diabetes should avoid evening exercise, if possible.
Adjust your insulin dosage, if necessary. (Follow your doctor's advice, but this usually means reducing the dose of short-acting insulin before exercise.)
Patients who take oral antidiabetic drugs may need to change their dosages. Follow your doctor's advice.
After prolonged or intense exercise, you may need extra carbohydrate foods for up to 24 hours to refill muscle starch reserves. Beware of delayed hypoglycaemia.
Drink plenty of fluids: about a pint 2 hours before exercise, and drink after exercise to replace fluids lost in sweat.
Pay attention to your feet. Wear proper shoes and socks.
Avoid alcohol around the time of exercise (even the night before a morning workout).
Wear an ID band of some sort in case of emergency.
Pay attention to your body, and become aware of your own pattern of blood-glucose response to exercise.

High or Low Blood Pressure

High or low Blood Pressure

Blood pressure measures the force that the blood applies to the walls of the arteries as it flows through them. It's normal for blood pressure to increase when you exert yourself, or when you feel stressed or anxious. But if the blood pressure is consistently higher than normal at rest, this is high blood pressure, also known as hypertension

When a nurse or doctor takes your blood pressure, the result is expressed as two numbers, such as 120/80 ("one hundred and twenty over eighty"). The top figure - the systolic blood pressure - is a measure of the pressure when your heart muscle is contracted and pumping blood. The bottom figure, the diastolic blood pressure, is the pressure when the heart is relaxed and filling with blood.

In the UK, high blood pressure is defined as a systolic blood pressure of 140 or over and/or a diastolic blood pressure of 90 or over. If your blood pressure is around this level, your doctor will probably want to monitor it regularly.

If someone suffers from diabetes, it is even more important that their blood pressure is lower than this - ideally less than 130/80.

People with hypertension have an increased risk of major illnesses including:

cardiovascular disease such as angina, heart attack and stroke
kidney damage
eye problems
circulation problems in their legs, which could eventually lead to gangrene

Medicines

If your blood pressure remains high, one or more of the following antihypertensive drugs may be prescribed for you.

Diuretics (e.g. bendrofluazide) - these increase the amount of water and salt removed from your blood by your kidneys, and widen your arteries.

Beta-blockers (e.g. atenolol) - these drugs reduce the work your heart has to do, by reducing your pulse rate. During exercise there is minimal increase in heart rate and so should not be used as an indicator to the level of intensity the individual is exerting. Knowing if a someone is taking a Beta-Blocker is therefore important in developing an exercise program with them.

ACE inhibitors or angiotensin 2 receptor antagonists (e.g. captopril, losartan) - these block enzymes that constrict the blood vessels.

Calcium channel blockers (e.g. nifedipine) or alpha blockers (e.g. prazosin) - these help widen the blood vessels.

High blood pressure during pregnancy

One in every twenty women will develop high blood pressure whilst they are pregnant. If their blood pressure rises by a small amount and your urine contains no protein, then this is called gestational hypertension. If your blood pressure rises by a large amount, and your urine contains protein then this is called pre-eclampsia. It is thought that gestational hypertension may be the first stage of pre-eclampsia.

Pre-eclampsia is caused by a problem with the placenta, which joins mother and baby and supplies the baby with nutrients and oxygen from the mother's blood. It is potentially very dangerous for both mother and baby if it is undetected. The signs and symptoms are a rise in blood pressure and protein in the urine. Sometimes the baby may be slow to grow and the mother may have swollen hands and feet, though there are other things that can cause these symptoms. It is very important that all pregnant women have regular checks by their midwife throughout their pregnancy, so that any problems can be spotted early and dealt with.

Do relaxation techniques and yoga work to lower blood pressure?

Studies on meditation have shown falls in blood pressure, but this is due to the fact that you can learn to lower your blood pressure when it is being measured. When blood pressure was measured over 24 hours in these studies, disappointingly, there was no overall fall in blood pressure in those who meditated against those who did not. You should not, therefore, use yoga or meditation as a method to lower your blood pressure.

Are there any sports or activities that someone cannot take part in if they have high blood pressure?

Individuals with high blood pressure should aim to work at a level they feel is light to moderate, NOT hard or very hard. Think carefully about how the activity feels, for example, how hot they feel, how hard they are breathing and how tired their muscles are. If they cannot hold a conversation whilst they are exercising, then they are working too hard!

Individuals with high blood pressure should not do the following, as they can raise their blood pressure to dangerous levels for a short period of time:

Lift heavy weights without supervision from a qualified exercise trainer
Vigorous short bursts of exercise like boxing or squash
If they are interested in scuba diving and have high blood pressure there are some restrictions.
These will depend on the level of their blood pressure and any medications that they are taking.
They will need to be passed to dive by a diving medical specialist.
Other sports and activities, which might involve speed and changes in atmospheric pressure, may also require a medical certificate, for example parachuting and motor racing. If you are in any doubt, you should suggest your client contacts the governing body for the activity they want to try.

Exercise Guidelines and Recommendations

The available evidence indicates that endurance exercise training by individuals at high risk for developing hypertension will reduce the rise in blood pressure that occurs with time. Thus, it is the position of the American College of Sports Medicine that endurance exercise training is recommended as a non-pharmacological strategy to reduce the incidence of hypertension in susceptible individuals. The exercise recommendations to achieve this effect are generally the same as those prescribed for developing and maintaining cardiovascular fitness in healthy adults. However, exercise training at somewhat lower intensities appears to lower blood pressure as much, or more, than exercise at higher intensities, which may be more important in specific hypertensive populations.

Since many hypertensive individuals have several coronary artery disease (CAD) risk factors, including obesity, non drug-therapy is usually the first line of treatment. A combination of weight reduction, salt restriction, and increased physical activity has been recommended as treatment for reducing and controlling high blood pressure. Factors to be considered when recommending exercise for hypertensive individuals include (1) clinical status, (2) medications, (3) the frequency, duration, intensity, and mode of exercise the individual is currently participating in, and (4) how well the individual manages his or her hypertension.

Exercise Guidelines for Hypertension

All hypertensive individuals should be instructed to avoid holding their breath and straining during exercise (Valsalva manoeuvre).
Weight training should be used as a supplement to endurance training, not as the primary exercise. Circuit training is preferred over free weights. The resistance should be kept low and the repetitions high.
Exercise intensity may need to be monitored by the rate of perceived exertion (RPE) scale, since medications such as Beta-Blockers can alter the accuracy of the total heart rate response (THR) during exercise.
Any changes in medications and/or any abnormal signs or symptoms before, during, or immediately following exercise should be reported and documented.
Physicians will often have patients with documented hypertension record their blood pressures before and after exercise.
Individuals with hypertension should be instructed to move slowly when transitioning from the floor to standing, since they are more susceptible to orthostatic hypotension if taking antihypertensive medication.
Both hypertensive and hypotensive responses are possible during and after exercise for individuals with hypertension.

Individuals with severe hypertension need to be carefully monitored during exercise initially, and possibly long term. Such individuals will likely be taking one or more hypertensive medications which can affect their response to exercise. A detailed treatment plan, including specific exercise guidelines and blood pressure cut-off points, should be developed with the patient's physician and exercise staff so that the exercise training is both safe and effective.

Individuals with hypertension may have multiple CAD risk factors, which should be considered when developing the exercise prescription.

Epilepsy

Information on epilepsy: What is epilepsy?

Epilepsy is one of the most common and serious neurological disorders that affects the brain. Around 1 in every 200 adults in the UK has epilepsy. About 1 in every 100 children has the condition. This means that there are at least 300,000 people with epilepsy in the UK.

Epilepsy is the tendency to have repeated seizures that originate in the brain. The brain is a highly complex structure composed of millions of nerve cells (neurones). Nerve cells in the brain are responsible for a wide range of functions including:

consciousness
awareness
movement
body posture

Nerve cell activity is usually well organised. A sudden, temporary interruption in some or all of the functions of the nerve cells may be called a 'seizure' or 'fit'.

Many people have a single seizure at some point in their lives, but this does not mean that they have epilepsy. If a person has a tendency to experience repeated seizures which originate in the brain, then they may be diagnosed as having epilepsy.

Typical symptoms of adults with epilepsy may include mood swings, depression, and loss of memory (particularly short-term memory, like walking into a room to get something and forgetting what it is). More noticeable physical symptoms (specifically, outward symptoms that other people will notice) are repetitive blinking, staring, head nodding, and involuntary muscle jerks.

Physical Activity and Epilepsy

Exercise has important benefits for patients who have epilepsy, but several factors must be considered when making activity recommendations. Seizures during sports activity are rare, and exercise may have anti-epileptic effects acutely, but physicians, trainers, and parents should know what to do if a seizure occurs. Many sports activities are permissible as long as patients avoid overexertion, dehydration, and hypoglycaemia. Some antiepileptic drugs may adversely affect sports performance, and exercise in turn may reduce serum drug levels by increasing circulating liver enzymes.

The major concerns regarding epilepsy and sports participation are that a head injury in an epileptic athlete could worsen the condition and that a head injury could trigger seizures in a previously healthy person.

Epilepsy clients and their families are commonly concerned about seizures during exercise. Fear often results in overprotection, feelings of isolation, and needless activity restrictions. Thus, an understanding of how exercise affects both epilepsy and its electroencephalographic (EEG) correlates is essential.

Seizures during exercise are rare, but there are a few reports of exercise-induced ictal events. One such report described three patients who had seizures during exercise.

How Epilepsy Treatments Affect Exercise

Pharmacologic treatments. Antiepileptic drugs (AEDs) are the most common therapy for epilepsy and seizures, but most have side effects that cause fatigue and lethargy, which are obstacles for some active patients. Other side effects--blurred or double vision, concentration difficulty, and impaired coordination--can also influence performance. Some medications contribute to poor physical fitness. Valproic acid and lamotrigine may cause weight gain, but a regular exercise program may cancel this effect. Antiepileptic drug selection must consider individual concerns. A drug such as Valproic acid may be an appropriate choice for a marathon runner, but not for an ice skater or gymnast.

Sports Participation Recommendations

The most important consideration when making a participation decision is the risk for injury in the client's particular fitness activity. Clients who are seizure-free have few, if any, absolute contraindications for specific sports. Clients who have reliable auras and those who have nocturnal seizures may participate in most activities with supervision. However, contact sports, aviation sports, and unsupervised water sports must be avoided. Epilepsy clients who have more frequent or uncontrolled seizures should be more cautious when choosing sports or working in crowded conditions such as gyms and fitness studios; they require supervision and safety precautions on the playing field. The choice of a sport must be individualized for each client. Common sense should always prevail, and the decision to pursue a particular activity should be based on discussions between client, trainer, and physician.

When making activity participation decisions, the client and physician need to know common seizure precipitants during exercise. Risk factors include:

Excessive fatigue
Sleep deprivation
Hypoxia associated with high-altitude activities
Hyponatremia associated with electrolyte loss
Hypernatremia associated with dehydration
Hyperthermia related to physical exhaustion and heat, and
Hypoglycaemia associated with poor nutrition before activity.

When a Seizure Occurs

When a person has a seizure on the playing field or in the gym/fitness studio, the most important task is to protect him or her from self-injury. This includes helping the client to the ground and clearing the area of dangerous objects. One should never insert objects into the patient's mouth or attempt to restrain a seizing individual. Seizures are usually self-limiting and typically stop after 2 to 5 minutes.

After seizure, assessment of airway, breathing, and circulation is essential. In the postictal period, most patients exhibit a transient disturbance of mentation, consciousness, or motor or sensory function. If pulse or breathing is absent, cardiopulmonary resuscitation (CPR) should be initiated. The emergency medical system (EMS) should be called when the client has difficulty breathing, requires CPR, has cluster seizures without returning to baseline, or is confused for more than 30 minutes. EMS should also be summoned when a patient has a seizure for the first time.