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Training a Client on Blood Thinners: Anticoagulants Don't Always Indicate Anti-Exercise

As Personal Trainers, we are well versed in the subtleties of tweaking clients' workouts to accommodate a variety of chronic health issues. I work with many such individuals on a regular basis: clients who are hearing-impaired, visually challenged, suffer from Multiple Sclerosis, and a former golfer/ avid motorcyclist who has had to re-learn everything physical after a biking accident left him with Central Cord Syndrome. I cherish the opportunity to learn about these challenges, and to observe the positive changes that accompany hard work and dedication on the part of the clients.

While these are fairly pronounced health situations, some are not as readily observable; as such, it is incumbent upon us to ascertain any potential pitfalls during an initial client assessment. One situation, which usually remains masked and silent until it presents itself quite dangerously, is the mysterious case of blood clots and pulmonary embolisms. Unless a client reveals that he is on blood thinners, it often does not occur to us to ask, and what a judgmental error that may turn out to be.

Anticoagulants are a class of pharmaceutical drugs that help prevent blood clots. They are sometimes prescribed for individuals believed to be at a higher risk of developing clots, or to reduce their chances of suffering strokes and/or heart attacks.

A clot is little more than a seal created by the blood to ease the bleeding that results from wounds. While we count on them to stem the tide when we incur a cut or a more serious injury, blood clots can also block blood vessels and impede or stop the flow of blood to vital organs such as the brain, heart or lungs if they should develop in the wrong place. Often referred to as blood thinners, anticoagulant medications work by interrupting the process of blood clot formation.

Patients for whom such drugs are prescribed generally take them on a daily basis. They can certainly be life affirming and lifesaving; however, this course of treatment does place the user at an increased risk of heavily bleeding from what others may consider to be an incident requiring minor first aid. Given the injury potential of many sports, it is of critical importance that we are not only aware of a client's health history, but also able to plan careful yet effective workout programs for such an individual.

Falls or injuries that occur during vigorous exercise can cause serious internal bleeding for a client who regularly takes a blood thinner. Blows to the head or body can potentially proceed in a dangerous direction. Symptoms of internal bleeding include dizziness, weakness, unusual bruising, bleeding from the nose and gums, or black stool, according to the Agency for Healthcare Research and Quality. Understanding the potential health risks that could accompany such symptoms, Personal Trainers may wish to exercise caution and steer such clients away from contact sports such as wrestling, boxing, football and hockey. Resistance-training under a watchful eye is considered safe, as are swimming, walking and jogging.

Another important consideration is determining the reason a client has been prescribed an anticoagulant medication. This can run the gamut from preventing strokes/heart attacks/blood clots to having had a history of deep vein thrombosis (blood clots that form in the large veins of the limbs), pulmonary embolus (a clot that travels to/develops within the lungs), atrial fibrillation (irregular heartbeat) or after having received an artificial heart valve.   In such cases, a cardiologist may have recommended that his client remain active enough to cultivate or maintain a healthy cardiovascular system. Options for effective exercise do indeed exist, such as swapping rides on a rough-terrain mountain bike for a stationary cycle or a Spin class. If the client has been given medical clearance to cycle outdoors, a helmet is a must, whether or not he resides in a state requiring the use of protective headgear.

While we may typically see such situations with our elderly and non-athletic population, these same risks have also been observed in younger, healthy and athletic individuals. The lifestyle of an athlete might seem to paint “the picture of health”; yet several mechanisms do exist that could potentially place an athlete at “higher risk” for development of a clot:

• A disparity between the two systems that balance the clotting process ~ either excessive activity of the proteins and blood platelets that form clots (the procoagulant system), or a dearth of activity within the system that dissolves blood clots as they form (the fibrinolytic system);


• Trauma to the blood vessel wall, which may occur after a bone fracture, not uncommon in athletes;


• Dehydration, which renders the blood “thicker” than usual.

Unfortunately, there are few studies currently underway that are investigating the influence of physical training on blood clot formation and dissolution. It is taken as fact, for example, that blood levels of the clotting protein “factor VIII” increase with exercise and persist during recovery. Theoretically, while this could lead to an increased risk of blood clots in athletes, data also indicate that the fibrinolytic system dissolving any potential blood clots is also overactive in avid exercisers.  With such over-activity, the athlete may be protected from developing clots. The net effect of these changes remains in dispute, pending further research and study.

During a typical hour-long session with a client, the trainer may observe signs that the exercises being performed are hitting the mark. Sometimes, though, a client will begin to complain about some aspects of discomfort (being tired, muscles feeling sore, etc.) While this is fairly common, especially for a dedicated, hard-working client, it is worth noting that the following can also be warning signs of a deep-vein thrombosis or pulmonary embolism:

• Swelling, usually in the leg (can also occur in the arm, especially in weight-lifters, gymnasts, rowers, etc.)


• Leg (or arm) pain or tenderness, usually described as a cramp


• Reddish or bluish skin discoloration


• Leg warm to the touch


• Sudden shortness of breath


• Stabbing chest pain that may worsen with deep breaths


• Rapid heart rate


• Fainting


• Unexplained cough, sometimes accompanied by bloody mucus

We must remain vigilant to these cues, especially in clients whom we know are currently on a regimen of daily anticoagulant medication. Armed with knowledge, we can feel reassured in assisting such individuals and helping them lead a healthy, confident life.

REFERENCES:

http://www.livestrong.com/article/500700-blood-thinners-and-exercise/

https://www.starspt.org/exercising-taking-blood-thinners/

http://www.webmd.com/dvt/guide-to-dvt-13/blood-thinner-tips

http://patientblog.clotconnect.org/2011/03/02/athletes-and-blood-clots/

http://www.healthline.com/health/heart-disease/blood-thinners#4

http://www.muscletalk.co.uk/Blood-thinners-having-possbile-effects-on-muscle-building-growth-m4913021.aspx

http://www.everydayhealth.com/pictures/how-to-steer-clear-of-side-effects-from-blood-thinners/#04

https://www.stoptheclot.org/news/athletes-and-blood-clots.htm

http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.html

http://www.lifebridgehealth.org/Main/FrequentlyAskedQuestionsaboutAnticoagulants.aspx

http://www.pressurepositive.com/blog-posts/blood-clots-and-the-endurance-athlete

http://www.outsideonline.com/1811456/running-blood-thinners

http://www.nhs.uk/conditions/Anticoagulant-medicines/Pages/Introduction.aspx

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Get Medicaid & Children's Health Insurance Program (CHIP) health insurance any time

Open Enrollment for a 2016 Marketplace health insurance plan is over. But if you qualify for Medicaid or the Children's Health Insurance Program (CHIP), you can get health insurance any time of year, with coverage starting immediately.

Starting a Personal Training Business

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Exercise and Aging: Can You Beat Father Time?

Chronological vs Physiological Age

Time marches on, and all of us experience physical changes that cannot be reversed. Chronological aging, also called primary aging, appears to be inevitable. But as a wise person once said, it is not the years in your life that count, but the life in your years. Physiologically, you can take measures to slow secondary aging and reduce disease and frailty while improving your quality of life. Exercise makes all the difference.

Exercise Effect on Metabolic Health

Regular vigorous exercise has been shown to improve cardiovascular and digestive health. It reduces the risks of hypertension, diabetes, heart disease, dyslipidemia and atherosclerosis. Improved bone mineral density and increased muscle mass from exercise contribute to healthy joints that help prevent falls. Balance training can also reduce your risk of falls. With regular ongoing exercise, you lower your risk of obesity and improve your overall vigor. Exercise has been shown to be protective of mental health, reducing your risks of dementia and depression.

Exercise Effect on Physical Appearance

Regular exercise can have a profound effect on your physical appearance. Strong balanced bones, joints and muscles from resistance training will give you an upright youthful posture and greater fluidity of movement. Regular flexibility exercises offset stiffness in muscles and joints, help prevent injury, and promote more efficient movement. Both resistance training and cardiovascular exercise increase oxygen flow to your skin and other vital organs, promoting healthy function and defying the force of gravity on soft tissue.

You Can't Out-Train Your Fork

While exercise is fundamental to a youthful vigorous body, poor nutrition can undermine all your hard work. Restricting your daily calories will prolong primary aging while reducing secondary aging. Eating nutrient-dense fresh whole foods and steering clear of chemical-laden processed food will help your digestive system function at optimal levels and provide essential nutrients needed for peak performance. When possible, choose organic food to reduce exposure to harmful cancer causing chemicals.

It's Never too Late to Begin

You can begin an exercise program at any age. If you are a novice, a fitness professional can coach you through the basics. If you have chronic medical conditions, inform your health care provider of your intentions to begin an exercise program. Be aware that some medications may cause side effects that limit your performance. Some drugs can interfere with balance, putting you at higher risk for falling during exercise.

Resources

Working with older adults can be gratifying and financially rewarding. However, before you take on an older client, be sure you are equipped to deal with the many physical changes associated with aging. W.I.T.S. has got you covered with many courses that address aging, including Older Adult Specialist Certification, Older Adult Fitness Foundations, Certified Personal Trainer and Able Bodies Balance Training, all available online.

References

Rowland, TW (2010). The Athlete's Clock. Human Kinetics, Champagne, IL.

*Images courtesy of freedigitalphotos.net.

Poorly Managed Protein Can Undo Your Goals

If your personal trainer, athletic coach, or dietitian has ever preached to you about the merits of protein in your diet, consider yourself to be in good hands. Most athletes, whether they consider themselves to be recreational, competitive, professional, or even Olympic hopefuls, do have a unique set of requirements when it comes to consuming sufficient protein to meet their muscular/endurance demands. However, the story is far from complete if this is the only macronutrient receiving any attention as you plan your daily or weekly meals.

While it is true that proteins contain amino acids, the building blocks of muscular tissue, too much of a good thing is not always ideal…especially when it comes at the cost of under-consuming other vital components of a healthy diet. In our weight-conscious modern society, many individuals view grains as the enemy, and fats even more so. However, understanding the delicate balance between all 3 of these macronutrients will help elucidate the need to fuel your physique with more than just lean beef, chicken breasts, salmon, and protein powder!

Just what are the dangers that lurk in that excessive mountain of protein on your plate? According to Wayne Campbell, professor of Nutrition Science at Purdue University, “Americans consume an adequate amount of protein in their diets” already. So, why the push for more, and what harm can there really be? The Institute of Medicine has set guidelines for a recommended daily intake of protein for adult males at 56 grams, while adult females need only 46 grams of lean protein.   If you have ever carefully read a restaurant menu, you may notice that, for example, an 8-ounce steak is often featured as standard fare.   While this may sound sumptuous for a carnivore, this portion contains a whopping 70 grams of protein, or significantly more than a day's supply, in a single meal!

What are some of the downfalls of excess protein consumption? It can lead to dehydration, an athlete's worst performance nightmare. A study conducted at the University of Connecticut demonstrated that athletes who consumed large doses of protein (up to 4x the recommended daily amount) produced urine samples that were strongly indicative of a dehydrated state, even if the subjects did not perceive themselves to be overly thirsty. Furthermore, excess protein consumption means the body has an excess of nitrogen to expel, which may cause undue strain upon the kidneys.

While it is true that stronger muscles do a superior job of building and protecting our bones, excessive amounts of protein consumption can lead to an increased loss of calcium through urination. Since adequate calcium supplies are required for a healthy body to build strong bones, overconsumption of protein may eventually lead to osteoporosis. Likewise, if your protein choices are fatty, sodium laden, or overly processed, they may end up doing more harm than good. Focusing on lean meats and dairy products, and including many more plant-based protein sources such as beans and legumes, will facilitate a balanced intake. Whole grains and “good” fat sources round out the equation, since protein itself cannot be a magical fuel source in and of itself, for any athletic endeavor.

If the fear of weight gain has had you avoiding any other macronutrient food group, consider this: 1 gram of protein contains 4 calories. If a meal plan that is heavily focused on protein consumption is not coupled with an exercise level to compensate for these extra calories, the body is at risk of storing the excess as fat. Once again, by balancing the amounts of protein, carbohydrates and fats consumed with the appropriate level of exercise, you can create a healthy, strong, and muscular physique while still remaining lean and fit.

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Gaining it Back: The Science behind The Biggest Loser's Failure

An article recently appeared in Obesity Journal that suggest that the future of America's health is in danger. The article, which followed former contestants of The Biggest Loser, gives a graphic description of the difficulty of maintaining weight loss for any considerable length of time. Scientists and media have been talking about the problem for... Read more »