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Hadyn Luke posted this on Tuesday 24th of June 2014 Hadyn Luke 24/06/2014

Tags: Anatomy and physiology


While personal trainers and fitness professionals may often work with clients who have obvious medical conditions, others such as hypercholesterolaemia, the subject of this blog, may be hidden.

The average levels of cholesterol in the UK are among the highest in the world.

Although in some cases the client themselves may not be aware that they have hypercholesterolaemia, any fitness professional working with a new client should ensure they conduct a thorough fitness test before setting an exercise programme (see our blog on The importance of fitness testing).

This will give the client the opportunity to mention that they have high cholesterol levels and for the personal trainer to tailor their exercise accordingly.

How is hypercholesterolaemia defined?

The definition of hypercholesterolaemia is simply the presence of high levels of cholesterol in the bloodstream.

Because cholesterol is not soluble in water, the main carrier of cholesterol in the blood is low density lipoprotein (LDL).

What are the guidelines for cholesterol levels?

These can vary from one organisation to another. The levels recommended by the National Institute for Health and Clinical Excellence (NICE) and the Department of Health are as follows:

Total cholesterol: less than 5.0mmol/l

LDL cholesterol: less than 3.0mmol/l

Guidelines within Europe and from other organisations are stricter for those who have hypercholesterolaemia or are at risk of developing it:

Total cholesterol: less than 4.0mmol/l

LDL cholesterol: less than 2.0mmol/l

It is particularly important for those at risk to keep to these guidelines, especially anyone with a history of cardiovascular disease.

A cholesterol level of between 5 and 6.4mmol/l is considered mildly high, between 6.5 and 7.8mmol/l is moderately high and over 7.8mmol/l is very high.

What causes hypercholesterolaemia?

Diet can be a key factor, including (but not only) for those who are obese or have diabetes. Alcohol abuse and smoking can also play a part, as can the use of certain drugs, including diuretics, beta blockers and oestrogens.

High cholesterol can also be an inherited condition (familial hypercholesterolaemia), often accompanied by early-onset atherosclerosis, or thickening of the artery walls.

How can a personal trainer help someone with hypercholesterolaemia?

Because cholesterol can be lowered through diet (see our blog on Do you know your macronutrients?), anyone with hypercholesterolaemia should take advice from their GP and may benefit from a referral to a dietician. The advice is likely to include:

  • Reducing intake of saturated fat and eating a moderate amount of unsaturated fat
  • Using rapeseed oil to cook at high temperatures
  • Eating more fruit, vegetables and oily fish and fewer fatty foods
  • Consuming food such as beans, porridge, fruit and vegetables that are high in soluble fibre.
  • Reducing alcohol intake

However, another key component of reducing cholesterol is to exercise regularly and to lose any excess weight, whether working with a personal trainer, taking part in sport or joining in a fitness class.

What kind of exercise is recommended for those with high cholesterol?

Aerobic, resistance and flexibility training can all have a part to play in the exercise programme designed by a personal trainer for a client with high cholesterol.

Aerobic exercise – such as running, cycling, walking and swimming – will help lower blood pressure and heart rate response and increase myocardial blood flow. It will also decrease the total concentration of cholesterol and triglyceride.

Resistance training – whether with machines, free weights or using body weight – is helpful in conjunction with aerobic exercise, as well as for increasing bone mass and increasing the strength of connective tissue (see our blog on Resistance training for hypertension).

Flexibility work – from yoga, pilates and T’ai Chi to stretching exercises before and after exercise (see our blog on Flexibility and warming up) – it can help reduce the risk of injury.


A client with hypercholesterolaemia should be trained in the same way any other client would be, based on their fitness levels and overall ability (see our blog on Personal Training – The FITT Principle).

As with every form of exercise, a personal trainer should tailor the programme to the client’s specific needs and ensure that they are aware that results should be achieved over time with realistic goals, rather than pushing for immediate results.

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