Question

For exercise prescription:

Ms. Case Study-WM is a 48-year-old woman who works 5 days per week as a bank executive. She previously walked up the stairs to her third floor office but has started to use the elevator because, in the past month, she has experienced shortness of breath when walking up the stairs. The patient was physically active throughout college as a club lacrosse player but has not exercised regularly since she gave birth to her children who are now 16 and 14 years old. Ms. Case Study-WM is 167.6 cm (66in), weighs 102.7 kg (226 lb), and drinks one to two glasses of wine per day due to the stress of her job and divorce 1 year ago. Lab results from her physical examination 1 month ago revealed total blood cholesterol: 230 mg/dL, LDL: 150 mg/dL, HDL: 48 mg/dL, and blood glucose: 110 mg/dL. Her blood pressure was recorded as 132/84 mmHg at this doctor’s visit. Ms. Case Study WM has a family history of heart disease with her father dying at 53 years of age of a myocardial infarction and her brother’s coronary revascularization at 48 years of age. She is a nonsmoker. Current medications for Ms. Case Study-WM include Atorvastatin (Lipitor) for hypercholesterolemia and Lisinopril for high BP.

            Ms. Case Study-WM’s body fat percentage was obtained using bioelectrical impedance analysis (BIA). Waist circumference (WC) was measured at the narrowest circumference above the umbilicus and below the xiphoid process. Height was measured using a wall-mounted stadiometer, and weight was measured on a calibrated balance beam scale (Box 1). Submaximal exercise test results obtained from a modified Balke protocol are presented in Table 1. Muscle strength, seen in Box 2, was assessed by a five repetition maximum (5-RM) protocol using plate-loading resistance training machines. Flexibility testing results are shown in Box 3.

Box 1. Anthropometric measurements for Ms. Case Study-WM with obesity

Height: 167.6 cm / Weight: 102.7 kg / BMI: 36.5 kg/m² / Body fat: 32.4% / WC: 98 cm

Table 1. Submaximal exercise test results from a modified Balke protocol
Stage	minute	Grade (%)	Speed (mph)	HR (bpm)	BP (mmHg)	RPE (6-20 Borg Scale)
1	1	0	3.0	98
	2	0	3.0	102	152/86	11
2	3	2.5	3.0	126
	4	2.5	3.0	127	164/86	14
3	5	5	3.0	140	180/88	16

Box 2. 5-RM, muscular fitness testing results

Chest press: 35 lb / Leg press: 165 lb / Biceps curl: 12.5 lb / Leg extension: 50 lb /

Latissimus dorsi pull-down: 35 lb / Leg curl: 30 lb / Triceps extension: 15 lb

Box 3. Flexibility testing results

Trunk forward flexion using a sit-and-reach box: 21cm

Shoulder and upper arm flexibility: fail for both right (-7 cm) and left (-10 cm) sides

1. Is medical clearance recommended for this individual prior to exercise testing and prescription? Why or why not? (1 point)

2. What additional information is important to consider from the review of this patient’s case study for the exercise preparticipation health screening? (2 points)

3. What further questions would be helpful prior to initiating an exercise program? (2 points)

4. Why was the 5-RM used to assess muscular strength in Ms. Case Study-WM? Do you agree or disagree? Justify your answer. (3 points)

5. Identify some potential barriers to Ms. Case Study-WM completing the exercise prescription. What are some behavioral strategies you could potentially utilize to help her overcome these barriers? (2 points)

Answer 1

1. Yes medical clearance is required before exercise training.

Bcz she is having nyha grade 3 difficulty of dyspnea

2.additional information is required about::

Liver function test

lung capacities

Complete lipid profile

renal function test

Glucose tolerance test

3.

Assesing her mental status

Her socio economic status

4.

The 5-RM strength test is a reliable and simple measurement method in healthy men and women and can be used by athletic coaches, health and fitness professionals as well as rehabilitation specialist to quantify the level of muscle strength, to assess muscle strength imbalances, to evaluate strength training programs

5.

I would like to suggest

rigid lifestyle changes

proper exercise training

proper cardio

Low fat diet

high fibre diet

Proper testing and routine health checkups

answered by: anonymous