In Special Populations

August 01, 2008

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We all have those exercises that we hope won't pop out of the hopper. Mine include heavy thrusters and Tabata pull-ups. Why? Because they test my abilities and highlight my weaknesses-- they're hard! If you gathered your potential clients into a hopper, are there some you're hoping you won't have to deal with? Maybe you dread getting a call from that client with heart disease because you have less experience or the challenge is risky. Training the unfit or sick is hard. It can test our abilities not only as a trainer but as a person.

Working with special populations is a new challenge for many CrossFit trainers. As more and more people discover the benefits of CrossFit, we will see a corresponding increase in clients with a variety of maladies such as coronary arterial disease, multiple sclerosis, lymphoma, and cancer. CrossFit can uniquely benefit these patients who struggle for health. Every client who walks through our door has a purpose: to get better. Every workout, every rep, every grueling second is all about getting better.

Trainers walk a fine line when they work with clients who are medically fragile. A common thread with cardiac and pulmonary patients, as well as many other types of special populations, is that the client's capacity to do work is often greatly diminished.

Furthermore, they are typically being told by the medical community not to push themselves beyond what feels good. As a result, they suffer a lack of confidence in their ability to do anything physically demanding. The CrossFit approach to performance based measurements is a great tool for assisting clients who, in the end, just want to see an improvement in their quality of life.



7 Comments on “Training for Special Medical Populations: Cardiac Concerns”


wrote …

I agree with what you are saying but may I add that clients should have a long hard talk with the doc before they decide to give a 100% or just walk away and forget it. I had a heart attack almost two years ago at age 33. I wasted the first year waiting for the doctor to give me the green light to push it when I was training. Now I am on my third heart doctor one that will shut up long enough to listen to what I am saying and answer the direct questions I have. I have only been back to crossfit for about 6 months but what a difference on my mood and sense of well being. Just as a side note I had the heart attack doing the Barbara workout 3rd round and everything went to crap. Thanks and keep up the good work.


wrote …

I (age 48) had quaduple bypass 3 months ago and was looking for articles about rehab for those who were active before their heart attack. I had been doing Crossfit for about a year (running and cycling too) prior to my surgery so I was concerned about how hard to push it. My doctor wouldn't give me specifics just reminded me I wasn't rehabing a torn ACL so the "no pain no gain" strategy didn't apply, slow and steadly increasing effort is what's needed. I'm allowed to do anything that doesn't mess with my chest ie no pushups, no benchpress. Squats, pullups, thrusters and most other Crossfit exercises have the medical green light and so that's what I do. And I'm very thankful that I can.


wrote …

I have been crossfitting for the past three years. I will be 60 in about a month. Crossfitting and a paleo diet have transformed me.

Three weeks ago I was diagnosed with a benign tumor called a myxoma. It was inside my heart, the left atrium to be exact. It occupied about 80% and was restricting my oxegen rich blood flow by about 50%. I underwent emergency open heart surgery to have it removed. I am now in recovery and rehab. The cardiologist and my personal doctor have not had any experience with an asyptomatic, fit individual who has undergone cardiac surgery in terms of rehabilitation. To an extent, they are treating my situation like any other. They want slow walks, heart rate kept below 100 bpm, gradual increase in effort over time. I went for a long walk yesterday (3.5 miles) during which I jogged a little, about 3/4 of a mile in total. I felt fine and feel fine. I think I could do more. Is there anyone in the Crossfit community that has dealt with a similiar situation?


replied to comment from Brian Mallard

I am crossfitter and I work with cardiovascular and pulmonary patients in a hospital outpatient rehab setting. You should be able to return to your prior crossfitting. It just takes time for the sternum to heal. Your rehab team will be monitoring for arrhythmias, abnormal blood pressures ect. I usually start patients walking, cycling, elliptical ect. and lower extremity strengthening(BW squats)then six weeks after surgery start upper extremity range of motion exercises and progress to light resistance training. By the end of rehab(usually 3 months for the type of surgery you had) the goal is to be doing what you were doing prior to your event. I use crossfit training on post heart attacks, bypass, stents, transplants and most do very well. You will bounce back quick due to being a crossfitter before. Good luck Crossfit Bro.


replied to comment from John Shelton

Hi John

I thought I would drop you a note to belatedly thank you for your words of encouragement. They were very timely and appreciated. It has been more than 8 months since I had my surgery. My recovery has been a journey I don't want to ever repeat. My rehab consisted mainly of rowing on a C2 with increasing duration and intensity over a six week period. I then was able to start doing some WODs but had to avoid anything that could cause trauma to the sternum like chest to bar, bench press, cleans, and presses. I wore a heart monitor through this period and until the end of February. I kept track of my maximum HR through the wod and then my recovery rate afterwards. This information lead cardiologist to speculate that there was some damage to the SA node during surgery. He indicated that my heart likely was using a new portion of the SA to regulate blood pressure etc.

I still have vascular episodes of dizziness and lightheadedness but they are mainly triggered when I don't get enough sleep and have had an extra tough WOD. I competed in the 60+ cate4gory in the Crossfit games open and finished in the middle of the pack (86th) so I guess your assurance that I would bounce back were not only appreciated but true. I will do better next year.
I think I am an example of how Crossfit prepares you anything. Fit people really are harder to kill and generally more useful.



wrote …

I recently completed my Level 1 cert and I am looking to program for my father. He had open heart surgery one year ago due to an aortic aneurysm. He receive a pig valve and has had a long haul of a recovery due to sepsis. My dad is 50 year old, 6'4", active man who has lifted weights all of his life. What worries me is that he also has high blood pressure. He has not participated in any CrossFit workouts so to speak, but he is extremely interested in doing so now. I am nervous to program for him because his doctor advised him to no longer bench press etc. I need to ask him more about what his doctor has said, but in the meantime I am looking to gather as much information/advice as I can as to what could be best for my dad. He has a home gym with almost everything he would need for CrossFit workouts. Right now he is working out on his stationary bike and trying out the Rogue rings I bought him every once in awhile. Now that he is finally starting to feel healthy and anxious to get back into shape, I would like to compile multiple wods for him, but I need to know more before I start doing so and scheduling for him. I'm scared to death to push him farther than I should. Any advice that anyone could give me would be greatly appreciated.



wrote …

I had a stent last year on a 90% blockage of a major artery. Unfortunately they couldn't get a stent into a 95% blockage, afraid or perforating the artery. Since it was a minor artery, my cardiologist advise against bypass surgery. Prior to this I had done CrossFit for 2 1/2 years. Just couldn't sustain 100% effort but able to perform respectably and run 7 miles. Before the surgery and after I started having chest pains and shortness of breath after a walk of 1/4 mile. My cardiologist wanted me to exercise to build a natural bypass with collateral capillaries. He stacked a couple of nitrates to reduce chest pain. So I went back to CrossFit 6 months ago. At first I had to do a couple of lifts and catch my breath. I briefed the coaches on difference between out of breath and shortness of breath. They watch me like a hawk and seem to pick up immediately if it is more than just out of breath. The difference in the quality of life is amazing. My wife comments that there is a pep in my step and outlook on life is improved. I will never reach the level of fitness I had before the surgery. (Military special ops) but I do a workout 5 days a week and am now competing in the open. If I can do this anyone can. Just know your symptoms and just try to get better each day.

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