LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page i Aptara (PPG-Quark) ACSM’s Resources for Clinical Exercise Physiology Musculoskeletal, Neuromuscular, Neoplastic, Immunologic, and Hematologic Conditions SECOND EDITION LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page ii Aptara (PPG-Quark) > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > SENIOREDITORS SECTION EDITORS Jonathan Myers, PhD, FACSM Georgia Frey, PhD, FACSM Clinical Professor Associate Professor Cardiology Division Department of Kinesiology Veterans Administration Palo Alto Health Care System Indiana University Stanford University Bloomington, Indiana Palo Alto, California Kenneth Pitetti, PhD, FACSM David Nieman, PhD, FACSM Professor Professor College of Health Professions Department of Health, Leisure, and Exercise Science Wichita State University Appalachian State University Wichita, Kansas Boone, North Carolina David Nieman, PhD, FACSM Professor Department of Health, Leisure, and Exercise Science Appalachian State University Boone, North Carolina William Herbert, PhD, FACSM Professor Department of Human Nutrition, Foods, and Exercise Virginia Tech Blacksburg, Virginia Anthony S. Kaleth, PhD Associate Professor Department of Physical Education Indiana University—Purdue University Indianapolis Indianapolis, Indiana LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page iii Aptara (PPG-Quark) ACSM’ S > > > > > > > > > > > > > > > > Resources for Clinical Exercise Physiology Musculoskeletal, Neuromuscular, Neoplastic, Immunologic, and Hematologic Conditions SECOND EDITION AMERICAN COLLEGE OF SPORTS MEDICINE LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page iv Aptara (PPG-Quark) Acquisitions Editor: Emily Lupash Managing Editor:Andrea M. Klingler Marketing Manager: Christen D. Murphy Project Manager: Debra Schiff Designer: Doug Smock Production Services: Aptara, Inc. ACSM Publication Committee Chair: Jeffrey L. Roitman, EdD, FACSM ACSM Group Publisher: D. Mark Robertson Copyright © 2010 and 2002 American College of Sports Medicine 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages, and precautions. Printed in China Library of Congress Cataloging-in-Publication Data ACSM's resources for clinical exercise physiology : musculoskeletal, neuromuscular, neoplastic, immunologic, and hematologic conditions / American College of Sports Medicine. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-6870-2 (alk. paper) 1. Exercise therapy. I. American College of Sports Medicine. II. Title: Resources for clinical exercise physiology. [DNLM: 1. Exercise Therapy–Practice Guideline. 2. Exercise–physiology–Practice Guideline. WB 541 A1875 2010] RM725.A34 2010 615.8'2--dc22 2008047172 The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com.Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. For more information concerning American College of Sports Medicine Certification and suggested preparatory materials, call (800) 486-5643or visit the American College of Sports Medicine web site www.acsm.org. 9 8 7 6 5 4 3 2 1 LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page v Aptara (PPG-Quark) > > > > > > > > > > > > > > > > > > > > > Preface The application of exercise as a preventive and therapeutic role of exercise in managing individuals with a particular medium was once largely limited to patients with pul- condition. monary or cardiovascular disease, mainly those who had Although this text is intended to be a resource for in- recently sustained a myocardial infarction. Over the last dividuals preparing for the RCEP examination, it is also three decades, many resources and guidelines have been an appropriate resource for any individual trained in the published that have been directed toward the application exercise sciences working in the clinical setting among of exercise evaluation and therapy in cardiovascular and persons with chronic conditions and disabilities beyond pulmonary disease. The range of individuals for whom ap- cardiovascular and pulmonary disease. It should serve as propriately prescribed exercise has documented benefits a reference for physical therapists, nurses, physicians, has broadened considerably in recent years. This text was and other rehabilitation specialists who deal with the written in response to the need for guidance among exer- conditions addressed in these chapters. These resources cise clinicians working with patients with a broad range of generally apply to patients with chronic disease who, in chronic diseases and disabilities beyond cardiovascular the opinion of their physician provider, are clinically sta- and pulmonary disease, including orthopedic, neurologic, ble and have sufficient functional capabilities to partici- metabolic, musculoskeletal, neoplastic, and immunodefi- pate in individually prescribed exercise that is aimed at ciency conditions—populations that have been largely un- improving fitness, function, physical work potential, and derserved. It is intended to complement and extend exist- quality of life, and which reduces exercise-related risk ing ACSM publications, including ACSM’s Guidelines for factors that have an impact on progression of their dis- Exercise Testing and Prescription and ACSM’s Resource ease. Much recent research has been performed related to Manual for Exercise Testing and Prescription. the benefits of exercise for patients with the wide variety The ACSM Registered Clinical Exercise Physiologist of conditions described in this text. Many physicians and (RCEP) pilot examination, initiated in 1999, was de- other health professionals have embraced the use of exer- signed to establish the existence of appropriate knowl- cise in the diagnosis, prevention, and treatment of vari- edge, skills, and abilities for healthcare professionals ous chronic health problems. However, similar to cardio- working with individuals with a broad range of chronic vascular disease, exercise as an intervention is greatly diseases and disabilities. Ten years later, the RCEP has be- underutilized for most of these conditions. The multi- come established as a standard certification for individu- tude of disorders associated with a sedentary lifestyle ap- als working in clinical settings among patients with plies to individuals with chronic disabilities just as it ap- chronic diseases and disabilities. The ACSM has defined plies to those without such disabilities. An important the RCEP as a “healthcare professional who works in the goal must be to better convey the value of appropriately application of exercise and physical activity for those clini- applied exercise therapy for these patients so that it is an cal and pathological situations where it has been shown to integrated part of the healthcare paradigm. This text rep- provide therapeutic or functional benefit. Patients for whom resents another step, however small, in bringing this re- services are appropriate may include, but are not limited to, search to the public and the medical community to foster those with cardiovascular, pulmonary, metabolic, muscu- a greater appreciation of the value of the therapeutic ben- loskeletal, neuromuscular, neoplastic, immunologic, and efits of exercise across a broad spectrum of patients. hematologic diseases and conditions. The RCEP applies ex- In this new edition of the RCEP resources, chapters ercise principles to groups such as geriatric, pediatric, or ob- from the first edition have been updated and a section has stetric populations, and to society as a whole in preventive been added on Clinical Practice Issues for the RCEP. The activities. The RCEP performs exercise evaluation, exercise Clinical Practice Issues section includes chapters on the prescription, exercise supervision, exercise education, and evolution of the clinical exercise physiologist, demon- exercise outcome evaluation.” For each of the conditions strating functional outcomes for health and fitness, legal covered in this text, the chapters are therefore organized and ethical considerations, and client referral and con- by epidemiology, pathophysiology, diagnosis, medical sulting relations with allied professions. The latter sec- and surgical treatments, exercise/fitness/functional test- tion was included to help provide the RCEP and other ing, and exercise prescription and programming. Where healthcare professionals with a better the understanding appropriate, case studies are included to underscore the of their role and how they can have an important and vv LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page vi Aptara (PPG-Quark) vi PREFACE integral place in today’s healthcare environment. In- important role of the exercise physiologist in the clinical cluded in the Appendix are the updated knowledge, setting, as well as to extend the principles and recom- skills, and abilities that have been developed to address mendations of exercise programming to a broader spec- the role of the clinical exercise physiologist in the exercise trum of the population. management of patients with chronic diseases and disabil- ities. We hope that this text serves not only as resource for Jonathan Myers, PhD credentialing by ACSM, but also to help further define the David Nieman, PhD LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page vii Aptara (PPG-Quark) > > > > C> >o>n>tr>i>b>u>to> r>s> > > > > > > Contributors Mark A. Anderson, PT, PhD, ATC Nadine M. Fisher, EdD Department of Rehabilitation Sciences Assistant Professor University of Oklahoma Health Sciences Center Department of Occupational Therapy Oklahoma City, Oklahoma State University of New York at Buffalo Buffalo, New York Yagesh Bhambhani, PhD Lisa Fleisher, MS, PT Professor Department of Occupational Therapy School of Physical Therapy University of Alberta Texas Women’s University Edmonton, Alberta, Canada Dallas, Texas Richard Glazier, MD, MPH Thomas J. Birk, PhD, MPT, FACSM Associate Professor Associate Professor Health Policy, Management and Evaluation Department of Physical Therapy, Physical Medicine Faculty of Medicine and Rehabilitation University of Toronto Wayne State University Toronto, Ontario, Canada Detroit, Michigan D. Shaun Gray, MD, PhD, CCFP, FRCPC Louise Burke, MD Associate Professor Head, Department of Sports Nutrition Division of Physical Medicine and Rehabilitation Australian Institute of Sport University of Alberta Belconnen, Canberra, Australia Edmonton, Alberta, Canada Department Chief Kerry S. Courneya, PhD Halvar Johnson Centre for Brain Injury Professor David Thompson Health Region Department of Physical Education Ponoka, Alberta, Canada University of Alberta Edmonton, Alberta, Canada David Herbert, JD Senior Partner Timothy J. Doherty, MD, PhD, FRCPc David L. Herbert and Associates, LLD Associate Professor Canton, Ohio Departments of Clinical Neurological Sciences and Rehabilitation Medicine Schulich School of Medicine Kurt Jackson, PhD, PT, GCS and Dentistry Neurology Coordinator The University of Western Ontario Doctor of Physical Therapy Program London, Ontario Department of Health and Sports Science University of Dayton Kieran Fallon, PhD Dayton, Ohio Associate Professor Head, Department of Sports Medicine Anthony S. Kaleth, PhD College of Medicine and Health Sciences Associate Professor The Australian National University Department of Physical Education Canberra, Australia Indiana University—Purdue University Indianapolis Indianapolis, Indiana Stephen F. Figoni, PhD, RKT, FACSM Research Health Scientist Jennifer Kaleth, PT Physical Medicine and Rehabilitation Service Department of Rehabilitation Veterans Administration West Los Angeles The Shelbourne Knee Center at Methodist Hospital Los Angeles, California Indianapolis, Indiana vii LWBK191-4034G-FM_i-xii.qxd 6/11/08 6:02 pm Page viii Aptara (PPG-Quark) viii CONTRIBUTORS Steven J. Keteyian, PhD, FACSM David L. Nichols, PhD Division of Cardiovascular Medicine Assistant Research Professor The Henry Ford Heart and Vascular Institute Institute for Women’s Health Henry Ford Hospital Texas Women’s University Detroit, Michigan Denton, Texas Carl N. King, EdD Terry Nicola, MD, FACSM President and CEO Director of Sports Medicine and Rehabilitation Cardiovascular Consultant Department of Orthopedics Hickory, North Carolina University of Illinois Medical Center Chicago, Illinois B. Jenny Kiratli, PhD Research Health Scientist David Nieman, PhD, FACSM, Section Editor Spinal Cord Injury Center Professor Veterans Administration Palo Alto Health Department of Health, Leisure, and Exercise Science Care System Appalachian State University Palo Alto, California Boone, North Carolina Cliff Klein, PhD, MA, BA Stephanie Nixon, PhD, MSc, BHSc(PT), BA Assistant Professor Assistant Professor Department of Physical Therapy Department of Physical Therapy University of Toronto University of Toronto Toronto, Ontario, Canada Toronto, Ontario, Canada John J. LaManca, PhD Kelly O’Brien, BSc, BScPT Research Coordinator/ Exercise Physiologist Lecturer Heart Failure and Cardiac Transplantation Department of Physical Therapy New York Presbyterian Hospital University of Toronto New York, New York Toronto, Ontario, Canada James J. Laskin, PT, PhD Robin Parisotto, BAppSci Department of Physical Therapy Laboratory Manager University of Montana Sports Haematology and Biochemistry Laboratory Missoula, Montana Australian Institute of Sport Leverrier Crescent Laurel T. MacKinnon, PhD, FACSM Bruce, Australian Capitol Territory, Australia Freelance Writer and Editor Queensland, Australia Jonathan Peake, PhD School of Human Movement Studies Robert C. Manske, MPT, CSCS The University of Queensland Associate Professor Queensland, Australia Department of Physical Therapy Wichita State University Carolyn J. Peddle, MS Wichita, Kansas Department of Physical Education and Recreation University of Alberta Margaret L. McNeely, PT, MSc, PhD Edmonton, Alberta, Canada Professor Department of Physical Education and Recreation Mark T. Pfefer, RN, MS, DC University of Alberta Cleveland Chiropractic College Edmonton, Alberta, Canada Overland Park, Kansas Janet A. Mulcare, PhD, PT, FACSM Kenneth Pitetti, PhD, FACSM, Section Editor Professor of Physical Therapy Professor Department of Health Sciences College of Health Professions College of Mount St. Joseph Wichita State University Cincinatti, Ohio Wichita, Kansas