Exercise is often prescribed to remedy and rehabilitate a wide range of medical conditions, but sometimes there are limitations to what can, or should, be recommended. In this article, we detail the absolute and relative contraindications to exercise to help you when devising client care plans.
So, what are the contraindications to exercise? Prescriptive exercise has a number of absolute and relative contraindications, including heart-related conditions, breaks, fractures, and sprains, diabetes, DVT, hypertension, hyperthyroidism, and stroke, amongst others.
Read on to learn more about the contraindications to exercise prescription.
What are the Key Contraindications to Exercise?
Many different types of healthcare interventions will often prescribe exercise as treatment but, sometimes, it is best to be cautious and check that clients don’t exhibit any of the key contraindications to exercise, absolute or relative.
Absolute contraindications
Absolute contraindications (1, 2) are conditions in clients in which exercise should not be prescribed under any circumstances until, or if, these conditions are treated or managed appropriately. Examples include:
- Unstable angina
- Systolic blood pressure higher than 180, and/or diastolic blood pressure over 100mmHg
- Blood pressure drops below 20mmHg during ETT
- Resting heart rate above 100bpm
- Uncontrolled arrhythmias
- Heart failure
- Unstable diabetes
- Illnesses accompanied by fever
- Deep vein thrombosis
Relative Contraindications
Relative contraindications (1) should be evaluated on a case-by-case basis, depending on individual circumstances. Examples include:
- Severe hypertension
- Severe electrolyte imbalance
- Severe hyperthyroidism
- Aortic stenosis
- Coronary artery stenosis
- Insufficiently controlled arrhythmias
- Stroke within the past month
Types of Contraindicated Exercises
Following on from conditions that are contraindicated for exercises, there are also a range of, or types of, exercises that are themselves contraindicated (3) for some clients, although this will largely depend upon their individual health status and medical history. As such, it is vitally important to conduct a thorough history before recommending exercise as treatment.
Cardiovascular Limitations
In severe heart-related conditions, such as heart attack, or replacement or bypass surgery, there may be contraindications on some cardiovascular exercise (3). Whilst therapies can include cardiovascular exercise, there will be limitations to reduce stress on the heart.
As clients progress, it is recommended to refrain from prescribing exercise that increases the heart rate more than 20bpm until they are fully cleared by their primary doctor. Shortness of breath, extreme fatigue, chest pain, paleness or a faint feeling are all indications that clients have breached their limitations on cardiovascular exercise and should stop.
Range of Motion Exercises
In cases where a client’s range (3) of motion is significantly affected, such as after surgery, breaks, fractures, or in musculoskeletal conditions, there will be restraints on the types of, and levels of exercise, as advertised by the client’s primary doctor. Not adhering to this advice can worsen the condition.
Weight-Bearing Exercises
In cases where there are restrictions on weight-bearing ability, exercises (3) in relation to the affected area will also be limited. Only once the client has been cleared for partial weight-bearing, can they begin to exercise the area with light weights, or even just bodyweight. Ignoring advice on weight-bearing exercises can prolong overall recovery time.
Stress Tests
Exercise stress tests are often used to determine the cardiovascular ability in relation to certain conditions (1). However, there are contraindications on such tests, largely in line with the absolute and relative contraindications listed above.
Gentle Exercises and Activities for Relative Contraindications
Below are a few examples of gentle exercises and activities (4, 5, 6) that may be suitable for those with relative contraindications, although it is imperative that any recommendations are in line with each client’s medical status.
Gentle Exercise Examples
- Sitting exercises, such as
- Chest stretches
- Upper body twists
- Hip marching
- Ankle stretches
- Arm raises
- Neck rotations and stretches
- Gentle walking
- Gentle swimming
- Yoga/chair yoga
- Pilates
Gentle/Light Activity Examples
- Getting up to make a cup of tea
- Moving around your home
- Walking at a slow pace
- Cleaning, dusting, vacuuming, making the bed
- Standing up periodically
- Gardening
Final Thoughts
There are a wide variety of contraindications to exercise, informed by all manner of health conditions. Contraindications can impact everyone, from young and relatively healthy children, to injury-ridden adults, and frail elderly people.
As such, if you are not a client’s primary doctor, it is advisable to conduct a thorough history and/or physical examination before exercise prescription is recommended. At Breeze Academy, we offer strength and conditioning courses for healthcare professionals looking to safely and effectively apply the principles of exercise prescription in their clinics.
We also offer clinical yoga teacher training that helps healthcare professionals understand why yoga is a safe, gentle, and effective way to rehabilitate the body.
Learn more about our CPD courses for healthcare professionals online today. Alternatively, if you're interested in contraindications to healthcare treatments, take a look at our blogs on the Contraindications of Sports Massage and Is Acupuncture Safe?.
Sources
- ECG and Echo Learning - Indications, Contraindications and Preparations for Exercise Stress Testing
- GIG Cymru NHS Wales - Contraindications to Starting Exercise
- Livestrong - Contraindicated Exercises
- NHS - Physical Activity Guidelines for Older Adults
- NHS - Sitting Exercises
- Medical News Today - 9 Best Exercises for Rheumatoid Arthritis Pain