With many chronic diseases, the actual cause of mortality isn't the disease process itself, but rather the health problems related to physical inactivity. Even though research has shown a strong relationship between physical fitness and reducing the risk of death from all causes - specifically cardiovascular disease - many people remain perilously inactive.

Dealing with elderly patients means you'll see two common conditions of aging: multiple sclerosis (MS) and diabetes. You can blunt the effects of both diseases through aerobic exercise and strength training.

Through physical activity, a patient with MS can limit trophic effects on the musculoskeletal system and improve psychological well-being and functional capabilities. A person with MS usually presents with localized weakness and a diminished capability to perform activities of daily living.

Initially, use strength training to focus on the affected muscles and joint movements. As the program progresses, movement-specific exercises and functional strength training should dominate, but be aware of the precautions. A person with MS may use large amounts of energy and strength moving between exercises, therefore, a session shouldn't exceed 75 minutes.

If your client complains of fatigue later in the day or the next day, cut down the workout time. Clients with MS should always drink plenty of water to minimize the inability to deal with heat stress, a common symptom of MS. They should also dress in layers so it's easy to remove clothing as the core body temperature increases.

Diabetes can be more difficult to handle. Due to a lack of insulin, diabetes can produce a catabolic homeostasis. Strength training is essential for people with diabetes, since it helps establish an anabolic state. People with diabetes must be properly trained in exercise technique, especially proper breathing during exercise. Strength training for diabetics should focus on predominantly hypertrophic loads, with some basic strength loads. Circuit training programs using these types of loads benefit the cardiovascular system, although it doesn't replace the need for traditional aerobic exercise.

Another pressing concern for diabetics is insulin dosage. Clients with diabetes should contact their physician before starting an exercise program so the physician can make changes to insulin dosage. This also gives you an opportunity to establish contact with a potential new referral source. If the doctor sees the success you're having with the first patient, he may begin referring other diabetics for exercise or treatment. 

During exercise, diabetics can experience two types of blood sugar emergencies: hypoglycemia and hyperglycemia. Hypoglycemia ranges from mild (trembling or shakiness, nervousness, tachycardia, palpitations, increased sweating, excessive hunger) to severe (unresponsiveness, unconsciousness, coma).

Hyperglycemia is potentially life-threatening and usually occurs during or following exercise and can rapidly progress from mild to severe hypoglycemia. People with pre-exercise hyperglycemia shouldn't exercise. Diabetics can avoid these problems by monitoring blood glucose levels regularly, especially pre- and post-exercise.

--Advance staff