Chronic Disease Management and Special Populations
What this domain tests
Adapting exercise for hypertension, dyslipidemia, type 2 diabetes, obesity, COPD, osteoarthritis, osteoporosis, pregnancy, older adults, and cardiac rehabilitation, plus recognizing when to refer rather than train.
Core rules and concepts
- Hypertension: aerobic work totaling about 150 minutes per week plus 2–3 days of resistance training; avoid heavy straining and Valsalva; do not train with BP ≥180/110 - refer.
- Type 2 diabetes: combine aerobic and resistance training; check glucose before and after sessions for clients on insulin or sulfonylureas. If glucose is <70 mg/dL, give 15–20 g of fast-acting carbohydrate, recheck in 15 minutes, and repeat if still low. Defer and refer if glucose is >250 mg/dL with ketones, or uncontrolled and very high. Inspect feet, ensure proper footwear, and hydrate.
- Obesity: low-impact, progressive activity; 200–300 minutes per week supports weight maintenance; prioritize enjoyment and joint protection.
- COPD: steady-state or interval aerobic work, inspiratory muscle training, pacing and pursed-lip breathing, bronchodilator timing; watch for desaturation.
- Osteoarthritis: low-impact and aquatic exercise, quadriceps strengthening; reduce loading during flares.
- Osteoporosis: weight-bearing and resistance training; avoid spinal flexion, twisting, and high-impact loading when vertebral fracture risk is present.
- Pregnancy: about 150 minutes per week of moderate activity; avoid supine exercise after the first trimester, contact sports, and high fall risk; do not exercise to exhaustion.
- Cardiac rehabilitation: medically supervised phases with symptom monitoring and MET-level progression.
Worked example
A 58-year-old with type 2 diabetes on insulin arrives with a fingerstick of 68 mg/dL and wants to train. Do not start the session. Give 15–20 g of glucose, recheck in 15 minutes, repeat if still below 70, then provide a snack containing carbohydrate plus protein before exercise. Document the episode and review insulin timing and meals with the care team.
Traps that cost marks
Mistaking hypoglycemia for ordinary fatigue; permitting Valsalva in a hypertensive client; prescribing supine exercise late in pregnancy; assuming every client with the same diagnosis needs identical intensity; missing referral red flags such as chest pain, uncontrolled BP, or retinal complications.