Hyperlipidemia or dyslipidemia is categorized by having elevated blood cholesterol levels. Lipids have the density of 0.9g and float when submerged in water. They are hydrophobic and are transferred as lipoproteins through the plasma membrane. A lipoprotein has a lipid core packed inside with triglyceride (TG) and cholesterol esters (CE), and surrounded by free cholesterol, phospholipids, and apolipoprotein (apo). There are about 17 different apoproteins that function to interact with enzymes, transport, and bind to receptors. Primary lipoprotein classifications include chylomicron, VLDL, LDL, and HDL.
High-density lipoprotein (HDL) is half protein and is the “good” cholesterol that function as a lipid scavenger. HDL removes excess cholesterol from cells to the liver for bile synthesis, which is then secreted in the stool. Other classifications are: HDL2 and HDL-3. The denser HDL3 that picks up additional cholesterol and free triglyceride and interacts with the liver. Chylomicrons are made in the liver, stored in adipose tissue, and transport fat-soluble vitamins A, D, E, and K. In the liver, cholesterol combines with triacylgerol to form VLDL. Very low-density lipoprotein (VLDL) is composed of lipid, a little protein, and lots of triglyceride (TG). Lipoprotein lipase (LPL) is located inside capillary beds and hydrolyzes VLDL. VLDL looses a triglyceride to become denser and forms LDL molecules. Low-density lipoprotein (LDL) delivers cholesterol to the cells of the arterial wall. Plaque forms from oxidized LDL deposits on the inside of the arteries. LDLs are mostly composed of lipids and function as the primary carrier of cholesterol in the bloodstream
Exercise Testing Guide for Hyperlipidemia
A through medical history is required before physical assessments are conducted to avoid medical risks. Those with elevated LDL-C are at risk for CAD so it is important to be aware of all the signs and symptoms. Risk stratification and medical supervision is imperative for men over the age of 45 and for females over the age of 55 with more than 1 CAD risk factor.
Aerobic Training
o Mode: Cycle or treadmill
o Protocol: Submaximal YMCA
o Measurements: HR, Blood pressure, VO2 and VCO2
Muscular Strength
o Free weights and machine weights
o 1 RM bench press and leg press
Muscular Endurance
o Push-up and curl-up maximal tests
Flexibility
o Static stretching
o Sit and reach (hip flexion) for ROM at hip joint
Exercise Prescription for Hyperlipidemia
Exercise prescription for this dyslipidemia population should be aimed at aerobic exercise to maximize caloric expenditure.
Aerobic
o Frequency: 5 days per week
o Intensity: 40-75% VO2R or HRR
o Type: Aerobic exercise that require large muscle group activation
• Example: walk 1 hour, 5 days per week
o Time: 30-60 minutes
o Progression: Increase duration versus intensity
o Goal: Maximizing caloric expenditure
Resistance
o Frequency: 2-3 days per week
o Intensity: 1 set of 8-15 repetitions to fatigue
o Time: 8-10 different exercises for major muscle groups
o Type: free weight, machine weights, and elastic bands
o Goal: maintain or increase lean body mass
Flexibility (ROM)
o Frequency: 4-7 days/week
o Intensity: stretch to end of range of motion without pain
o Type: Static
o Time: 15-30 second stretch, 2-4 times per stretch
o Goal: increase range of motion of hip, thigh, and lower back
References
Biggerstaff, Kyle D. (2011, November). Hyperlipidemia & Hypertension. Exercise Evaluation
and Prescription. Lecture conducted from Texas Woman’s University, Denton.
Ehrman, Gordon, Visich & Keteyian, eds. Clinical Exercise Physiology, 2nd ed. Champaign, IL:
Human Kinetics, 2009.
Thompson, WR, ed. ACSM’s Guidelines for Exerise Testing and Prescription, 8th ed.
Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins 2010.
McArdle, Katch, F., & Katech, V. Exercise Physiology Energy, Nutrition, & Human
Performance, 6th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins
2007.
Haslam, B; Gordhandas, A; Ricciardi, C; Heldt, T; Verghese, G. Relating Noninvasive Cardiac
Output and Total Peripheral Resistance Estimates to Physical Activity in an Ambulatory
Setting (2011). Computational Physiology and Clinical Inference Group in the Research
Laboratory of Electronics.
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