Subjective
Ms. TH is a 62 yr old Caucasian female who joined your medical fitness center with the intention of reinitiating an exercise program. Ms. TH revealed that she has struggled with her mood for the past year and that her primary care physician recently diagnosed her with major depression. She complains of fatigue and recent weight gain. She does not complain of any cardiac symptoms or shortness of breath with exertion. Her medical history is significant for obesity and hypothyroidism, for which she takes daily levothyroxine. She states no food or drug allergies. Family history indicates that her father is alive at 92 yr, having suffered a prior stroke. Mother is deceased due to motor vehicle accident. No siblings. Social history indicates that she is married (husband living, retired, with diabetes), has three grown children, does not smoke, drinks wine fewer than 3 times per week, and denies substance abuse. She noted that before becoming depressed she enjoyed walking around her neighborhood several times per week but has been sedentary since. She is referred from her physician to the fitness center to increase her activity level as a means to help manage recent weight gain and mood.
Objective and Laboratory Data
Her BMI is 32.1 and resting heart rate and blood pressure are 73 beats · min–1 and 118/76 mmHg, respectively. She does not regularly exercise and is ambivalent about exercise.
Ms. TH recently underwent exercise testing through her physician’s office, results of which showed that she exercised for 6 min (Bruce protocol, approximately 7 METs) and achieved a maximum heart rate of 136 beats · min–1 and peak blood pressure of 165/76 mmHg. The test was free of ischemia, chest pain, and arrhythmia. It was noted in the test report that, although the patient was not experiencing symptoms, she required much prompting throughout the test to continue.
Assessment and Plan
Ms. TH has a major depressive disorder, for which she was started on sertraline by her primary care physician to manage her symptoms. The plan to re-initiate her exercise program will not differ significantly from what is recommended for other healthy but sedentary adults. Specifically, over several weeks, as tolerated, she will progressively increase her daily exercise levels from initially 20-30 min up to 45 to 60 min, 3 to 5 d per week. During walking, elliptical, or cycling, she should achieve an intensity that corresponds to 70% to 80% of heart rate reserve, which is 117 to 123 beats · min–1. Slowly incorporate resistance training involving the major muscle groups at 1 set of 15 repetitions, at a lift intensity of 60% of 1RM for upper body activities and 70% of 1RM for lower body lifts. To improve flexibility, she is to attend yoga class 1-2 d per week and initiate static, passive stretching of the major joints and muscle groups 1-2 d per week.
Case Study Discussion Questions
Ans) The heart muscle becomes stronger and able to pump more blood with each contraction, which results in a lower heart rate. Lung capacity and oxygen transfer also increase. Blood vessels become wider and more elastic, blood pressure decreases and new capillaries form.
- Mental health benefits of exercise
Exercise releases chemicals like endorphins and serotonin that
improve your mood. If you exercise regularly, it can reduce your
stress and symptoms of mental health conditions like depression and
anxiety, and help with recovery from mental health issues.
- In summary, exercise appears to be an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacotherapy and psychotherapy.
Get Answers For Free
Most questions answered within 1 hours.