Metabolic, Endocrine, GI, Genitourinary and Lymphatic Systems

Why it matters on this exam

Individually small, collectively bigger than the integumentary system, and frequently the reason an otherwise correct plan of care is unsafe.

Key concepts

• Diabetes and exercise: hypoglycaemia recognition and the 15-15 rule, exercising with insulin peaks, foot inspection and footwear with peripheral neuropathy, autonomic neuropathy blunting heart-rate response.
• Endocrine: hypo- and hyperthyroid effects on exercise tolerance, corticosteroid effects on tissue integrity and bone.
• Lymphoedema: stages 0–III, complete decongestive therapy (manual lymphatic drainage, compression bandaging, exercise, skin care), contraindications including acute infection and untreated cardiac failure.
• Pelvic health: stress versus urge incontinence and the different training approaches, pelvic-floor muscle training principles, red flags for referral.
• Gastrointestinal: positioning after abdominal surgery, reflux precautions in supine and inverted positions, ostomy considerations during exercise.

Common mistakes

• Prescribing aggressive manual lymphatic drainage during cellulitis.
• Using target heart rate in a patient with autonomic neuropathy whose heart rate cannot respond.

Worked example

A patient with type 1 diabetes reports shakiness and sweating 40 minutes into a session. Stop, check glucose, treat with 15 g of fast-acting carbohydrate and recheck in 15 minutes — continuing the session to "finish the set" is the wrong answer regardless of the plan of care.