9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline
Key Takeaways
Under the CSEP-CPT Health Screening Tool, a client with asthma who has symptoms on more than 2 days a week or more than 1 night a week, or who used rescue medication more than twice in the last week, is referred before training.
For exercise-induced bronchoconstriction, use a long gradual warm-up, keep the client's reliever inhaler at hand, and avoid cold, dry or polluted air.
Cancer is not on the CSEP-CPT Health Screening Tool, so a CSEP-CPT works with a survivor only if they have the knowledge to do so safely; otherwise the client needs clearance or a CSEP-CEP.
Regular physical activity reduces depressive and anxiety symptoms, but a CSEP-CPT supports, and does not replace, mental health care; anyone with suicidal thoughts is directed to urgent help, such as Canada's 9-8-8 crisis line.
Signs that a stable condition is deteriorating, such as rising blood pressure, more frequent hypoglycemia, increased rescue-inhaler use or new symptoms, mean pausing progression and referring.
9.5 Asthma, Cancer & Mental Health: Precautions and Signs of Decline
The CSEP-CPT may work with one stable, lower-risk medical condition. Competency 5.3 asks you to describe precautions for clients with a stable chronic condition such as a musculoskeletal disorder, cancer, cardiovascular disease, diabetes, mental health conditions or asthma. Competency 3.4 asks you to recognize symptoms that may signal a negative change in health status. Sections 9.2 to 9.4 covered hypertension, diabetes, osteoporosis and osteoarthritis. This section completes the list.
Important
The CSEP-CPT Health Screening Tool lists only the more common conditions. For a condition that is not on it, such as cancer or a mental health condition, CSEP's screening flowchart asks: Do you have the knowledge, skills and abilities to conduct thorough pre-screening and provide exercise advice for that condition? If not, the client obtains clearance from an appropriate health care provider or is referred to a CSEP-CEP.
Asthma
Screening (CSEP-CPT Health Screening Tool): refer for clearance or to a CSEP-CEP if the client:
- has chest tightness, wheeze, shortness of breath or cough on more than 2 days a week or more than 1 night a week; or
- has used rescue medication more than 2 times in the last week.
The GAQ Reference Document adds that if shortness of breath at rest is asthma relieved by medication, light to moderate activity is safe. If it is not relieved by medication, the client consults a doctor.
Precautions for a stable client:
- Confirm the client has their own reliever inhaler with them. They use it as their physician has directed, which may include before exercise.
- Use a long, gradual warm-up (10 minutes or more) and a gradual cool-down. Warm, humid air is better tolerated than cold, dry air; consider indoor exercise or a scarf over the mouth in winter.
- Avoid known triggers: smoke, pollen, heavy air pollution, strong fragrances and chlorine for some swimmers.
- Interval or intermittent activity is often better tolerated than long continuous vigorous efforts.
- Watch for exercise-induced bronchoconstriction: cough, wheeze, chest tightness or unusual breathlessness, often 5 to 15 minutes into exercise or soon after it.
Signs of decline: needing the reliever more often, night-time symptoms, reduced exercise tolerance, or an asthma attack during a session (see Section 9.6 for the response).
Cancer
Exercise during and after cancer treatment is safe for most people and improves fatigue, anxiety, depressive symptoms, physical function and quality of life. Typical evidence-based targets come from the 2019 ACSM roundtable (Campbell et al.): moderate aerobic exercise about 30 minutes, 3 times a week, plus resistance training twice a week, for at least 8 to 12 weeks. The general message is to avoid inactivity.
Scope: cancer appears as an example on GAQ Question 4 but not on the CSEP-CPT Health Screening Tool. Clients in active treatment, with treatment complications, or with more than one condition usually belong with a CSEP-CEP or a supervised oncology exercise program. A survivor whose condition is stable may train with a CSEP-CPT who has the needed knowledge, ideally with clearance from the oncology team.
Precautions to know:
| Issue | Why it matters | Precaution |
|---|---|---|
| Cancer-related fatigue | Energy fluctuates day to day | Flexible plan; start low; use RPE; short bouts |
| Low blood counts during treatment (anemia, low white cells, low platelets) | Breathlessness; infection risk; bleeding or bruising risk | Follow the oncology team's guidance; clean equipment; avoid contact or fall-risk activities |
| Bone metastases | Fracture risk | Avoid high-impact and heavy loading on affected bones; requires specialist guidance |
| Lymphedema or risk of lymphedema | Swelling after lymph node treatment | Supervised, gradually progressed resistance training is appropriate; watch for increased swelling |
| Peripheral neuropathy from chemotherapy | Reduced sensation and balance | Stable surfaces, balance support, low-impact modes |
| Surgical sites, ports, ostomies | Tissue healing; device protection | Follow surgeon's restrictions; avoid pressure on devices |
Mental Health Conditions
Regular physical activity reduces symptoms of depression and anxiety and improves sleep and wellbeing. CSEP offers an Exercise and Depression Specialization for professionals who want advanced competence.
Role boundaries: the CSEP-CPT supports activity and healthy behaviours. They do not diagnose, counsel or treat mental illness, and they refer to mental health professionals when needed. If a client discloses thoughts of suicide or is in crisis, the trainer stays with them and helps them reach urgent help: 9-8-8 (the Suicide Crisis Helpline, call or text in Canada), 9-1-1 for immediate danger, or their care team.
Practical precautions:
- Keep goals small, flexible and enjoyable. Missed sessions are expected and are not failures. Use autonomy-supportive language (Section 10.6).
- Consider social or outdoor activity if the client enjoys it, and keep sessions predictable for clients with anxiety.
- Medications can change the exercise response. Some antidepressants and antipsychotics affect heart rate, blood pressure on standing (dizziness), thermoregulation, weight and alertness. Monitor RPE and symptoms, and avoid rapid position changes and exercising in heat.
- Watch for over-exercise used to cope, or links with disordered eating, and refer if present (Section 4.4).
Recognizing a Negative Change in Health Status (Competency 3.4)
Clients with a stable condition can become unstable. Re-screen at each check-in and act on warning signs:
| Condition | Possible signs of decline | CSEP-CPT action |
|---|---|---|
| Hypertension | Resting BP above 160/90 mmHg, new headaches or dizziness, medication changes | Do not exercise; refer to health care provider |
| Type 2 diabetes | More frequent hypoglycemia; new foot sores or numbness; vision changes | Refer (Health Screening Tool flags) |
| Asthma | Increased reliever use; night symptoms | Refer before continuing |
| Heart disease | New or worsening chest discomfort, breathlessness, palpitations, swelling | Stop; urgent medical assessment |
| Osteoarthritis | Pain, stiffness or swelling lasting more than 14 days; new loss of mobility | Pause the aggravating exercise; refer |
| Osteoporosis | A new fracture, a fall, or new long-term corticosteroid use | Refer |
| Any condition | New diagnosis, a second condition, or a change in medication or treatment plan | Re-screen; a second condition means a CSEP-CEP |
Remember that "stable" means no change in medication or treatment plan in the past 6 months. A recent change resets the clock.
A client with asthma reports using their rescue inhaler four times in the past week and waking at night with wheeze twice last week. What should the CSEP-CPT do?
Proceed with the planned vigorous intervals, because asthma control improves with training over time.
Refer for clearance or to a CSEP-CEP first; this exceeds the Health Screening Tool asthma limits.
Have the client double their usual inhaler dose before each session and then continue as planned.
Replace aerobic training with breath-holding drills to strengthen the respiratory muscles first.
A client who completed breast cancer treatment two years ago, has no other conditions and is cleared by her oncologist, wants to start resistance training. She had lymph nodes removed from one armpit. Which approach is most appropriate if the CSEP-CPT has the necessary knowledge?
Avoid all upper-body resistance training permanently because of the risk of lymphedema in that arm.
Train only the lower body until she reaches a target body weight, then add upper-body exercises.
Begin with maximal 1-RM testing on each lift so that training loads can be set precisely from day one.
Start light, supervised upper-body training, progress slowly, and watch the arm for swelling.
During a session, a client being treated for depression says they have been thinking about ending their life. What is the CSEP-CPT's most appropriate response?
Continue the workout as planned, because exercise is an effective treatment for depression and may lift their mood.
Suggest they increase their training to five days a week, because more exercise will improve their mood faster.
Stay with them, listen without judgement, and help them reach urgent support now, such as 9-8-8 or 9-1-1.
Promise to keep the disclosure confidential and raise the topic again gently at their next scheduled session.
Sections you finish are checked off in the contents.