There are many chronic conditions that your clients may present with, including cardiovascular disease, arthritis and hypertension. A common condition, which, unfortunately is on the rise, is diabetes. This doesn’t mean they are unable to train with you, it simply means that there may be other things you need to think about when completing screening or developing a training program for them. Here, Rob Hadley, Australian Institute of Fitness Master Coach, is here to share how you, as a Personal Trainer, can screen and train a client with diabetes.
According to the Authoritative information and statistics to promote better health and wellbeing (2011-2012). There are 1 in 19 people affected by diabetes in Australia, with almost 90% of them diagnosed with type II diabetes.
Remember there are two types of diabetes; Type 1 and Type 2. In people with Type 1 diabetes, their pancreas is faulty and does not produce enough or any insulin. The Type 1 diabetic will be required to inject themselves with insulin daily. If they do not, their body will begin to accumulate lots of ketone bodies which is potentially life threatening.
Type 2 diabetes is an acquired condition, resulting from a combination of genetic and environmental factors, such as being overweight, not exercising, smoking, eating a poor diet and being hypertensive. In this form, the pancreas no longer works effectively because of the repeated stress placed upon it.
Here are 5 tips to follow when working with a client who has diabetes;
As you would be aware, there are many AHPs that you can work with, depending on who your clients are. In particular, with a diabetic client, you may work with their General Practitioner (GP), Exercise Physiologist (EP) or a Diabetes Educator. Your key role is to develop their exercise based program and ensure all parties involved are aware of what is going on, and you are all working towards helping achieve the best outcomes for the client. You may work closely with the EP as they are educated in working with clients that have chronic conditions and you will also need to keep the GP up to date on their exercise and progressions (particularly important if weight loss is involved for type 2 diabetic clients).
It is important to understand their condition, but they also need to know what is happening. Ensure they know how to monitor their blood glucose levels (they should see the GP or a diabetes educator) and have a ‘plan of action’ if their glucose levels vary away from their normal levels, e.g. have lollies on hand for a sugar hit.
You need to also understand the condition. For example, when you exercise, you use glucose for energy. In diabetic clients, as their glucose levels may fluctuate, it would be important to know that it may lower then even more, so be careful or ensure the levels are correct before exercising.
Keep learning and you can’t go wrong. If you are unsure ask a professional or do some research.
Goals are very important, for any client. In regards to diabetes you may need to help them set goals regarding their management of diabetes and glucose levels, depending on the stage of their condition and what they need to achieve. You will also need to establish other health and fitness goals with them regarding lifestyle modification and weight management. These will improve their overall health and assist managing diabetes. Think of the goals you would establish with them! Some examples are provided in the table with training guidelines, related to different components of fitness.
Once you have worked closely with the AHPs to develop a suitable exercise program to help your diabetic client, you need to ensure that it is in line with best practice and follows the recommended guidelines for those with diabetes. Your clients GP will be able to provide these guidelines, and advise if there is anything in addition you need to be aware of for this particular client. If needed you can always modify them if needed as long as you are not putting your client at risk and you continue to work closely with any involved AHPs.
You need to always review the program you have written to make sure it is helping achieve the goals that have been set and also geared toward helping manage the diabetes. Monitoring can involve; adherence and changes to the program but also the condition itself. That may include glucose levels, signs and symptoms, reactions to exercise, changes in condition and dosage for medication (if being taken). Make sure you involve your client in these processes so they are aware of how things are changing but can also see how exercise is improving their wellbeing, helping them continue on their journey!
Furthermore, the client may need review of diet and other lifestyle changes, if so, provide them some great advice, within your scope of practice or refer them on to the correct professional.