High Cholesterol and Exercise: Helping Your Clients Lower Their Numbers
By Jennifer Green, B.S.
|Jennifer Green, NCHPAD Visiting Information Specialist|
While an increase in physical activity can have little to no effect on total and LDL cholesterol, it can decrease triglycerides, as well as increase HDL, or the "good cholesterol." And we know that a high level of HDL cholesterol (>60 mg∙dLˉ1) is a negative risk factor and can positively affect the clearance of LDL cholesterol. The exercise prescription for individuals with dyslipidemia without comorbities is very similar to an exercise prescription for healthy adults. A major distinction in the exercise prescription for patients with dyslipidemia as compared with healthy adults is that healthy weight maintenance should be emphasized. As a result, aerobic exercise becomes the foundation of the exercise prescription. Resistance and flexibility exercises are adjunct to an aerobic training program designed for the treatment of dyslipidemia, primarily because these modes of exercise do not substantially contribute to the overall caloric expenditure goals that appear to be advantageous for improvements in blood lipid and lipoprotein concentrations. It is important to note that the increase in muscle mass from strength training can increase one's basal metabolic rate, which increases calorie burn at rest, therefore supplementing the caloric expenditure of exercise.
Since weight maintenance and calorie burn are crucial to these individuals, we want to focus on frequency and time. It is suggested by the American College of Sports Medicine (ACSM) that these individuals exercise ≥ 5 days per week to maximize caloric expenditure for 30-60 minutes per day. However, in order to promote or maintain weight loss, 50-60 minutes or more of daily exercise is recommended. An effective alternative to continuous physical activity is performing intermittent exercise of at least 10 minutes at a time to accumulate the recommended duration. Intensity is suggested at 40%-75% of Vo2R or HRR, and as discussed before, the mode should be primarily aerobic physical activities involving large muscle groups, while also including flexibility and resistance training to supplement caloric expenditure.
There are several things to keep in mind when training individuals with hypercholesteremia. One of the most important is to consider other conditions your client may have and modify the exercise prescription to accommodate those needs. Some individuals who are taking lipid-lowering medications, specifically statins, may experience muscle soreness and weakness, also known as myalgia. If your clients begin to experience unusual muscle soreness when exercising and are taking these medications, you should advise them to contact their physicians. Finally, it is important to remember that improvements in blood lipids and lipoproteins with aerobic exercise training may take several weeks to months, depending on a variety of factors. These include initial blood lipid and lipoprotein levels, weekly caloric expenditure, and the blood lipid parameter that is being targeted with exercise training.
While aerobic physical activity does not typically affect total and LDL cholesterol directly, the decrease in triglycerides, as well as the increase in HDL, has been shown to help in the clearance of LDL cholesterol. Many lipid-lowering medications that are prescribed to those with dyslipidemia tend to have severe side effects, and avoiding the use of these medications is a goal that fitness professionals can assist their clients with achieving. It is important to take into account other conditions that your client may be experiencing, and tailor the exercise prescription to those needs. It is your responsibility as a health professional to prescribe an exercise program that will meet both the health needs and the personal goals of your clientele.
Thompson, W. R., PhD, FACSM, Gordon, N. F., MD, PhD, MPH, FACSM, & Pescatello, L. S., PhD, FACSM (Eds.). (2010). ACSM's guidelines for exercise testing and prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
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