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Special Populations, Chronic Disease, and How Exercise May or May Not Be Beneficial.
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ABSTRACT
Many medical professionals and allied practitioners of health have done a lot of research in the effort to come up with practical ways to help the special population to be able to better manage their health statuses. The special population could include people living with chronic diseases such as disorders of the cardiovascular system, high blood pressure or hypertension, stroke commonly referred to as brain attack, peripheral vascular disease, diabetes, osteoporosis, arthritis, low back pain, and the likes. One of the solutions that have proven to work effectively is physical exercise. Physical exercise is basically the activity performed on one’s body with the aim of either developing or maintaining one’s physical fitness and overall body health. Physical exercise has been classified into two types, dynamic and static exercise. In dynamic exercise, external work is usually involved, which brings about isotonic muscle contractions. On the other hand, static exercise usually involves isometric muscle contractions. Basically, these physical exercise types are all effective depending on the type of disease state in question. However, physical exercise may as well bring about adverse and undesirable results depending on the type of chronic disease. In this case, physical exercise can be discouraged by the medical personnel. Physical exercise has been applied in the medical field to manage various diseases and illnesses to improve the overall health of these individuals. This has had a significant improvement on medicine as a field and the victims at large.
Keywords: Cardiovascular disorders, Obesity, Stroke, Hypertension, Peripheral vascular occlusion

INTRODUCTION
Among the leading causes of death worldwide are chronic diseases. Research has shown an increasing prevalence of these diseases worldwide across all genders, ages, and groups of people. Chronic disease can be described to be a noncontagious illness lasting a long time with relatively slow progression brought about by the environment, genetics, or general poor eating habits (10). Children, adolescents, and adults are now being affected by multiple diseases that are chronic. A major cause of these chronic diseases is inactive and the lack of physical exercise.
The increased prevalence of chronic diseases continues to impact heavily and negatively on global societies when it comes to matters of national expenditures on health cases, recruitment of personnel to the military, and general academic performance. When physical exercise is increased, a marked decrease in chronic disease cases is observed. In the human body, most physiologic systems, such as the cardiovascular system, benefit a lot from physical exercises (11). Once the diagnosis of chronic disease is made, physical exercise is used as a medical management plan. This prevents primary and secondary disease occurrence by a great percentage, hence providing a higher life quality, and the longevity is increased.
In chronic disease risk factors, some factors can be modified while others can not be modified. Factors such as lifestyles and eating habits can be modified, while age, gender, genetics, and ethnicity can not be modified in any way. Modifiable risk factors are the ones most targeted by physical exercises. Physical exercise positively impacts some of the risk factors for chronic illnesses such as obesity, cancer, diabetes(type II), cardiovascular diseases, and others.

Effects of Physical Exercise on Cardiovascular Disease
Among the leading causes of death and disabilities, cardiovascular disorders have been identified among the major ones. These are disorders that generally affect the heart and its blood vessels(4). It comes about due to deposition and build-up of fat particles in the inside of arteries ( a condition called atherosclerosis), blood clots increase, angina, and claudication(4). It can also be caused by artery damage in vital organs, including the brain, the eyes, the kidney, and the heart(5). Other risk factors that are likely to increase the chances of getting cardiovascular diseases may include smoking, high levels of blood cholesterol, specifically low-density lipids, diabetes, being overweight or obese, family history of cardiovascular disease, ethnic background, age, gender, alcohol, and the overall diet(2).
A major risk factor of cardiovascular disease is inactive. Research has shown that moderate physical exercise can lower the risk of cardiovascular disease by 20%, while a higher and more amount of physical exercise lowers the risk by up to 30%(4). A therapeutic form of a regimen that can be employed by patients with cardiovascular disease is physical exercise training(4). The patients have to be examined by their respective physicians, especially when two or more risk factors are involved(4). The patients need to determine their functional capacity by having a maximal graded exercise test done(4). The medical personnel is supposed to consult with the personal trainer concerning the exercise programs to be employed. Majorly the adults are sensitized to try 150 minutes of activity moderately within a week. This could be through walking briskly, cycling a bicycle, etc. If the patients find this difficult to do, they can commence a level that feels fairly comfortable and slowly add to the intensity and time taken in physical exercise as the fitness increases(5).
Exercise has various benefits on cardiovascular risk factors. Some of these benefits include an increase in insulin sensitivity, an increase in good cholesterol (high-density lipids), a decrease in bad cholesterol(low-density lipids), reducing blood pressure, and reducing body weight. Physical exercise also increases one’s tolerance to exercise(4).
Exercise and Hypertension
Hypertension which is also referred to as high blood pressure, is usually the pressure of blood above 140/90(5). If the blood pressure rises above 180/120, then it is considered severe and should be checked immediately(5). It can be chronic, lasting for years, and usually requires a medical diagnosis. It is treatable by a medical professional. It usually does not require lab tests or imaging. Hypertension can exhibit minimal to no symptoms. If it goes untreated over a long period of time, it can result in various heart diseases(5). It can also cause strokes.
High blood pressure and physical exercise are connected in that regular physical exercise strengthens the heart and enables it to pump much more blood with a lot less effort(5). If the force used by the heart to pump blood is reduced, then the force on arteries reduces as well, and this leads to the lowering of the general blood pressure. More activity works to lower systolic blood pressure. In some instances, just enough exercise is enough to serve as the remedy for high blood pressure(5).
In normal cases, where the blood pressure is below 120/80, physical exercise serves to maintain it at this level as well as to prevent it from rising with increasing age(5). Another benefit of exercise is that it plays a huge role in helping to maintain a healthy weight. Weight plays a significant role in the control of one’s blood pressure(5). In order for physical exercise to be effective, it should be done regularly. Physical exercise should be done consistently for three months in order to have an impact on the blood pressure. The benefits of exercising will only persist as long as the exercise is continued. It should be noted that any physical activities that increase the breathing rate and the general heart rate are referred to as aerobic activities. They could include activities such as dancing, some household chores, active sports, walking, taking jogs, swimming, and riding bicycles(5).
One is advised to avoid isometric exercises and adopt a breathing technique that is proper. Also, circuit training has been proven to be a safe choice when it comes to this kind of exercise(5).
Exercise and stroke
Stroke is the third most common cause of disability and also relatively expensive to treat. A stroke can also be referred to as a cerebrovascular accident(8). It is basically the interruption of blood supply to the brain leading to its damage. Stroke is usually a medical emergency(8). Some of the symptoms of stroke include paralysis and numbness of the face, arm, or leg, difficulty in speaking, understanding, and walking(8). Stroke is a serious medical condition that usually requires a medical diagnosis. Here lab test or imaging is always required. It’s a critical condition that needs emergency care. This condition can not be cured but can be managed by proper treatment(8).
Research has shown that approximately 30% of stroke cases recur in nature(8). A person who’s had a stroke in the past is more likely to reactivate it more than a different person is likely to acquire it. Physical exercise and activity have been proven to prevent incidences of stroke recurrence(8). Physical exercise in stroke should focus mainly on activities of daily living, getting back one’s balance, and being independent functionally(9). These generally improve the deconditioning of the stroke victim. Functional capacity has been witnessed from water exercises, bicycle cycling, treadmills that are weight supported, and coordination with balance exercises(8).

In the primary and secondary stroke prevention strategies, physical activity and exercise have been highlighted to be of high importance. There is a broad and fairly complex interface that exists between physical exercise and cerebrovascular disease. This has been of great interest to researchers in the medical field for many years. This relationship keeps making more sense as time passes by(8). As a result, training on physical fitness is being encouraged at all costs. This majorly serves as a stroke rehabilitation component in rehabilitation programs. Long-term physical activity in patients who have had strokes has proved to be of great impact and is very beneficial.
Also, activities such as walking, jogging, participating in active sports such as tennis, house chores have been proven to increase aerobic activity, which impacts greatly on cerebrovascular disorders(8).
Peripheral Vascular Disease and Exercise
Peripheral vascular disease is a disease caused by atherosclerotic lesions. This can be on either one or more than one venous blood vessel or arterial blood vessels. The most common forms of peripheral vascular disorders are peripheral venous occlusive disease and peripheral artery occlusive disease. The peripheral venous occlusive disease leads to pain in the muscle which is caused by ischemia leading to muscle spasms, which are referred to as claudication. In peripheral artery, occlusive disease there occurs atherosclerosis of the arteries of the lower extremities. Distal to the lesion, blood flow is usually distracted, causing ambulation. Some of the major risk factors involved are diabetes, stress, obesity, inactivity, family genetics, smoking, hypertension, and hyperlipidemia. Among the risk factors, the most predominant ones are diabetes and smoking.
Exercise has been shown to be greatly effective in improving the distances of ambulation. Physical exercise is also influenced by the enhancement of pain perception and the mechanics of walking. In this particular condition, walking has been greatly recommended as the exercise of choice(3). During the walking exercise, the patients are advised to pay close attention to their feet and make sure to have proper and comfortable footwear. The patients should walk before stopping to the point of intense pain. They should then take a rest until the pain subsides then repeat the whole process. With time exercising has proven to be an effective way to treat peripheral vascular disease and should therefore be undertaken seriously and with much precision(5).
Obesity and Exercise
Obesity which is also known as excessive weight gain, has recently become a public health crisis worldwide(3). It has greatly affected all populations, from children to adults. Weight gain has many undesirable consequences on the general health of individuals(1). Such include Alzheimer’s disease, certain types of cancers, dementia, arthritis, diabetes(type II), and hypertension. An adult is considered overweight when their BMI is 25.0 and 29.9(2).
Some of the factors which contribute to weight gain are sedentary activities, less home cooking, high intake of calories, high intake of high-fat foods, and preferring vehicle transport rather than walking on foot. Studies have shown significant weight loss is observed with 150 minutes of aerobic activities(2). However, it’s still unclear on the amount of exercise required to fully reduce or maintain weight. In order to produce the best long-term weight loss results, a combination of physical exercise and sensible eating plans should be employed. Aerobic exercise, as well as strength training, have been shown to impact greatly on weight management programs (3).

CONCLUSION
Chronic diseases take the lead as the major cause of death worldwide as rates of disease incidence continue to rise. Chronic diseases such as obesity and diabetes continue to rise among adolescents and youths(2). It has been clearly shown that integrating physical exercise into daily living can help a great deal in providing long-term chronic disease prevention as well as proving social development. An important area for future research should be about how people are able to overcome barriers to physical exercise and have a better understanding of how physical activities impact their health(3). Research to determine the relationships of childhood cancers and their relation to their disease, such as obesity and others (6).
Clinical Applications
Physical exercise can be employed as a remedy to various chronic illnesses to improve the quality of health of many people living with such illnesses. Among these illnesses, we have obesity, certain types of cancers, cardiovascular disorders, high blood pressure, low back pain, stroke, peripheral vascular disease, among others.
Physical exercises have proved to be the most effective and easiest way of managing chronic illnesses across all ages, genders, and ethnicities. This should be useful in the medical field to improve the health of the patients living with these chronic diseases.

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