Welcome To The Exercise Prescription Room

Instructions : Please take the case study that is presented and write an exercise prescription for this patient. Please include information on a weight loss program, and design a weight lifting program to aid in the acquisition of lean body mass. This assignment is worth 100 points.

I. The Patient's Case Study Information:

Patient Information

• 72 year old Caucasian male with the following medical history and risk factor profile :
1. Diabetes : He has had type 2 diabetes for the past 12 years

He currently takes the following medications :

• Glucophage (metformin hydrochloride) - two 500 mg tabs at each meal
• Actos (pioglitizone hydrochloride)- one 30 mg tablet in the AM
• Prandin (repaglinide) - four 1 mg tablets per meal
• Zestril (lisinopril) - one 40 mg tablet in the AM

Note : This patient has lost 90% feeling in his feet such that he is a candidate for neuropathic injuries.

Note : Family Diabetes Prevalence : His brother and an uncle are also type 2 diabetics

2. Albuminuria : He has had a history of albumin loss in his urine.
3. Hypertension : He has a history of stage 1 hypertension : 152/90

He currently takes the following medication :

• Propranolol (propranolol hydrochloride) - 20 mg tablet TID
4. Hypercholesterolemia : He has a history of hypercholeterolemia : 320 mg/dl

He currently takes the following medication :

• Zocor (simvastatin) - 40 mg tablet before sleep
5. Hypertriglyceridemia : He has a history of hypertriglyceridemia : 300 mg/dl

He currently takes the following medication :

• Lopid (gemfibrozil) : one 600 mg tablet BID
6. Weight : He weighs 275 lbs.
7. Height : His height is 5' 10"
8. Lifestyle : He is sedentary

He has recently had a GXT as a part of his annual physical exam with the following information :

• Resting HR = 70 BPM
• Max Exercise HR = 158 BPM
• Resting BP = 158/90
• Max Exercise BP = 240/90
• Max Mets Obtained = 9 METs
9. PFT results :

	Predicted Values	Measured Values	% Predicted
FVC	5.00 Liters	3.90 Liters	78 %
FEV1	3.80 Liters	2.00 Liters	53 %
FEV1/FVC	76 %	51 %	68 %

10. EKG : The patient recently had an EKG which had the following information :
• PR interval of 6 mm
• Q wave duration of 3 mm
• RSR' in V1, V2, V3
• Disruption of the R wave progression
• ST segment depression and T wave inversion in V5 and V6

II. Assignment :

This patient's physician's prescription states the following :

"Please write a comprehensive exercise program for Mr. Heitner. I have sent along his medical history and the data from some recent tests that I have had him undergo. I would like to see him loose a substantive amount of weight and have his physical work capacity significantly improve. Please evaluate him and then keep me informed over the next 6 months of his progress. Thank you very much, Dr. Tim Wadell."

Your assignment is to write a comprehensive fitness program for this patient which includes the following information :

1. Musculoskeletal, Neuromuscular and Integumentary Screening (20 points) : You must select the screening tests that you will use and explain why you feel they are important. Then present the data that you felt these tests would reveal about this patient knowing that the results of your screening will impact the rest of the fitness program.
2. Exercise (20 points) : An exercise prescription that lasts for 6 months that includes the following :
• Modes of Exercise : how would you variable exercise this patient
• Frequency of Exercise : how many times per week
• Duration of Exercise : how many minutes per bout
• Intensity of Exercise : state the increase of exercise intensity
• Rate of Progression : discuss how you would alter the frequency and duration
3. Weight Reduction (20 points): A weight loss program that presumes a safe weight loss of no more than 2 lbs per week. Knowing that a pound of fat has 3,500 kcals, what level of dietary manipulation added to the caloric utilization from exercise would contribute to an annualized weight loss. Please describe a reasonable 6 month weight-loss program and project a reasonable end-target weight goal for this patient. Suggest strategies to encourage and check-up on your patient to assist them in this endeavor.

   If you wish to include BMI as part of your discussion, then BMI is simply your body mass in Kilograms divided by your height in meters squared. If the Internet site is still functioning go to a BMI Calculator by Clicking Here

4. Weight Training Program (10 points): Please describe the weight training program you would employ to help your patient increase their lean body mass, their overall total body strength and ROM. Please include in your description the name of the exercise, the repetitions, the % of 1 RM that each exercise would involve, and any strategy that you might have in the progression of the sets within a training bout. Please explain a reasonable rate of progression that you might utilize over a four-month program beginning with the idea that your patient is a novice weight lifter.

5. Stratagies and Other Less Traditional Methods (10 points): What other strategies for developing fitness would you include - please describe and justify your reasons for choosing these strategies. Would this include Tae Kwon Do, Tai Chi, Hypnosis, Behavior Modification Techniques, Kendo, Mind-Body Imaging Techniques, Allopathic Pharmaceutical Agents, Vitamin, Mineral and Food Supplementation, Massage Therapy, etc. ?
6. Outcome Measures (20 points): How will you determine how successful you as well as the patient have been in meeting the targeted changes for this patient ? Please be specific about how you will document your outcomes.

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Last Updated : December, 2001