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Pre-Exercise Health Screening – Interview Summary
The patient I interviewed was a 64 years male. Judging by the patient’s current level of cardiovascular disease, this patient has high risk stratification. He has heart palpitations and has had a minor stroke a few years ago. He is currently on medication for high blood pressure because of his hypertension. His family history includes his mother having a heart attack under the age of 65. He currently does aerobic exercises about twice a week for only twenty minutes of walking on a treadmill. He performs a moderate intensity of about a 6 on the RPE scale (0-10). He only performs a minimum of twenty minutes due to his knees giving out pain with too much exercise. His lifestyle includes sitting at home, playing poker, and looking for sales online. He has a sedentary lifestyle when he is not exercising. When he goes out to stores, this involves a car to drive to the destination. He feels as though the exercise is mandatory because of his previous stroke but if it was not for that, he would not continue exercises. Patient feels he is in a healthy state because he is still able to walk and move with ease compared to others of his age. He feels that retirement is for relaxing all day with no stress in world. His knees potentially make him feel like he is limited to a certain amount of work which would be a consideration to strengthen. This client’s goal is to pursue more exercise and decrease the amount of knee pain that begins when too much exercise is involved. The client would also like to gain muscle strength because he isn’t as strong as he used to be. I will show alternate ways he can continue to exercise by avoiding maneuvers that irritate the knee. I will help him by informing the potential regression he is causing from having a sedentary lifestyle even with the two bouts of exercise he performs. The little exercise he does will not give him the full benefits that the regular 3-5 times of moderate exercise for at least 30 minutes will give. Overall, I hope to help him achieve his ultimate goal in improving muscle strength.
Section 2: Exercise Prescription
Warm Up and Cool Down:
The client will begin with warm-ups before performing any exercise, including assessments to get muscles warmed up and blood flow going to the muscles. A warm-up is important in those with cardiovascular diseases because their cardiovascular system needs to adjust to work. Cool-downs will be completed after every exercise because his cardiovascular system needs to adjust back to resting state. This client is at risk for blood pooling when they stop exercise suddenly.
|Neck Up and Down||Look up as high as you can and down as far as you can; from the ceiling to your shoes.|
|Shoulder Circles||Move the shoulders up, then back, then down, then forward in circular fashion. Getting the maximum range of motion.|
|Arm Swings Across||Arms should be straightened out and about chest level as you swing. Try to go back as far as you comfortably can.|
|Arm Swings Forward||Arms are straight. Swing back behind your hips and then forward and up as high as you can go.|
|Trunk Twists||Bend your arms to 90 degrees and rotate your spine, trying to look behind you, and then twist all the way to the other side. Heels can come off the ground as you rotate.|
|Side Stretchers||Sit upright in the chair with both feet flat on the floor in front of the body. Grasp the chair on one side with the hand on that same side. Now lean the head and body away from the side while reaching the opposite hand down toward the floor. Repeat on other side. (3x) per side.|
|Leg Swings Forward||Hold on to something sturdy and swing one leg forward like you’re kicking a ball then swing back as far as you can.|
|Knee Bends||Hold on to something sturdy and bend one knee so the foot moves backwards off the ground. Then bring it back down and alternate between both feet. The thigh should not move, just the lower leg.|
|Foot Shakes||Sit up straight in the chair then extend one leg straight out in front of the body. Now relax the foot and shake it briskly from the ankle, for about 10 seconds. Repeat the same exercise with the other foot.|
Patient will perform the following fitness tests: chair stand, arm curl, chair sit & reach, and step in place. He will be re-evaluated in each of these every 4 weeks.
Chair Stand Test:
Purpose: This test assesses leg strength and endurance.
Objective: To complete as many chair stands as possible.
Equipment required: Chair without arm rests, stopwatch.
Purpose: This test measures upper body strength and endurance.
Objective: To complete as many correctly executed arm curls as possible.
Equipment required: 8 pound weight, chair without armrests, stopwatch
Chair Sit & Reach:
Purpose: This test measures lower body flexibility.
Objective: To sit in a chair and attempt to touch toes with fingers.
Equipment required: 18inch ruler, folding chair
2 Minute Step:
Purpose: This test measures aerobic endurance.
Objective: To assess maximum number of steps in place within two minutes.
Equipment required: tape, stopwatch , wall.
This exercise program will produce an increase in maximal oxygen uptake, stroke volume, reduction in heart rate, blood pressure at rest, lowering blood pressure, improving cholesterol, strengthening heart and cardiovascular system.
The client is to avoid isometric exercises such as pushups and sit-ups because he has high blood pressure. Having isometric exercises can be a danger in increasing his already high blood pressure. The client should also avoid extreme temperatures which can interfere with circulation and make breathing difficult. If the exercise program has been stopped for whatever reason for more than a few days, make sure to ease back into the routine by starting with a reduced level of activity. Then gradually begin to increase until you are back where you ended. Stop any exercise if you get too tired or short of breath and tell your doctor.
Schedule for 1st Month:
|Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Warm-up, Aerobic, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Rest Day||Rest Day||Rest Day|
Schedule for 2nd Month:
|Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Warm-up, Aerobic, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, Flexibility||Rest Day|
Schedule for 3rd Month:
|Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Warm-up, Aerobic, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, resistance, Flexibility||Rest Day|
Schedule for 4th Month:
|Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Warm-up, Aerobic, Balance and Mobility, Flexibility||Rest Day||Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Warm-up, Aerobic, Flexibility||Warm-up, Aerobic, Resistance, Balance and Mobility, Flexibility||Rest Day|
Note: This schedule will continue to increase in frequencies as directed by turning to the training method table in the progression section. Try to follow schedule, but can be modified if needed for any reason by an inability to pursue active days.
Training Method Table
|Exercise training method||Mode||Intensity||Frequency||Duration||Progression||Goals||Special Considerations and Comments|
|Warm-up||Turn to warm-up table for procedure||N/A||Before every exercise||10-15min for a warm-up and cool-down||N/A||-Get heart pumping -warm up muscles||N/A|
|Aerobic Endurance||Jogging Cycling Dancing||-Begin moderate (5-6)on the RPE scale (0-10) -Progress to vigorous (7-8) on the RPE scale (0-10) after 3 months||-3 to 5 times a week||-At least 30 minutes for moderate or 20 minutes for vigorous||-Advance duration to 5 additional min every 2weeks -Advance frequency to 4 times a week in two months and 5 times a week in four months. -increase intensity approximately 3 months in.||-increase endurance and functional capacity -achieve 60 to 90minutes at the end of program -Achieve regular exercise pattern for consistency after program||-keep hydrated -keep lookout on knee -cycling uses less impact on knee joint -Currently does 20min twice a week at moderate intensity so we need to increase this duration and frequency slowly by starting with 30min and 3 times a week.|
|Resistance Training||-Turn to resistance training table for type||-Begin moderate (5-6)on the RPE scale (0-10) -Progress to vigorous (7-8) on the RPE scale (0-10) -begin with 8lbs upper and 10lbs lower||-2 to 3 times a week||8-10 reps for each muscle group||-Progress to an additional set for upper body every 1-2 months -Progression to 12-15reps at 3months -Progression of 3 times a week by 3months -progression to 12lbs upper and 15-20lbs lower at the fourth month||-increase upper muscle strength by end of two months -increase lower muscle strength -increase lean body mass -prevent loss of lean body.||-Because of high incidence of hypertension, consider reducing breath hold( Valsalva maneuver) -Must breathe exhale through whole movement and controlled|
|Balance and Mobility Training||-Turn to balance and mobility Training table for procedures||As long as there is a balance challenge||-3 to 5 times a week||10min||-Once mastered lower level then increase to higher level of balance with eyes closed -Advance frequency every two months||-Improve balance -improve quality of life||-patients can self-monitor and must remain safe|
|Flexibility Training (Cool-Down)||Full-body stretching (See Flexibility training chart for procedure)||-hold 15 to 60 seconds and repeated up to four times/ only causing mild discomfort||-3 to 7 times a week||10min||-Same exercise performed over time with more flexibility in 2-3months -longer holds of at least two seconds expected every two weeks||Improvement in range of motion||-certain stretching techniques might be difficult to perform that involve the knee bent over a certain period of time.|
Resistance Training Exercises
|Upper Body Exercises||· wrist curls – 1 set of 8-10 reps · arm curls – 1 set of 8-10 reps · side arm raises – 1 set of 8-10 reps · elbow extensions – 1 set of 8-10 reps · chair dips – 1 set of 8-10 reps · seated rows with resistance band 1 set of 8-10 reps|
|Lower Body Exercises||· back leg raises – 2 sets of 8-10 reps · knee curls – 1 sets of 8 reps · toe stands – 2 sets of 8-10 reps|
Flexibility Training Chart
|Upper Body: 3 times per week, Stretches held for 30 seconds|
|Shoulder and Upper Arm Stretch –Arm across chest stretch|
|Chest Stretch – Doorway stretch|
|Back Stretch – Seated twist|
|Neck Stretch – Gentle neck circles|
|Upper Body Stretch – Reach arms overhead arch back|
|Lower Body: 3 times per week, Stretches held for 30 seconds|
|Calf Stretch – Heel drop off stair|
|Hip Stretch – Supported high lunge|
|Thigh Stretch – Supported standing quad stretch|
|Back of Leg Stretch – Seated forward bend|
|Ankle Stretch – Ankle circles|
|Type of Balance & Mobility Training||3 Recommendations|
|Seated||1. Hip Marching – Sit upright and do not lean on the back of the chair. Hold on to the sides of the chair. Lift your left leg with your knee bent as far as is comfortable. Place your foot down with control. Repeat with the opposite leg. Do five lifts with each leg.|
|Standing||1. Standing on One Foot – Stand on one foot behind a sturdy chair, holding on for balance. Hold position for up to 10 seconds. Repeat 10 to 15 times with each leg. 2. Back Leg Raises – Stand behind a sturdy chair, holding on for balance. Slowly lift one leg straight back without bending your knee or pointing your toes.. Hold position for 1 second. Breathe in as you slowly lower your leg. Repeat 10 to 15 times with each leg. 3. Side Leg Raises – Stand behind a sturdy chair with feet slightly apart, holding on for balance. Slowly lift one leg out to the side.. Hold position for 1 second. Breathe in as you slowly lower your leg. Repeat 10 to 15 times with each leg.|
|Dynamic||1. Balance Walk – Raise arms to sides, shoulder height. Choose a spot ahead of you and focus on it to keep you steady as you walk. Walk in a straight line with one foot in front of the other. As you walk, lift your back leg. Pause for 1 second before stepping forward. Repeat for 20 steps, alternating legs 2. Walking Heel to Toe – Position the heel of one foot just in front of the toes of the other foot. Your heel and toes should touch or almost touch. Choose a spot ahead of you and focus on it to keep you steady as you walk. Take a step. Put your heel just in front of the toe of your other foot. Repeat for 20 steps. 3. Sideways Walking – Stand with your feet together, knees slightly bent. Step sideways in a slow and controlled manner, moving one foot to the side first. Move the other to join it. Avoid dropping your hips as you step. Perform 10 steps each way or step from one side of the room to the other|
This patient has a sedentary lifestyle, currently has cardiovascular disease, and is at high risk stratification but he still thinks of himself as extremely healthy. I was astonished to find that he feels invincible even though he had a stroke a few years ago, has heart palpitations, and is under medications prescribed by a physician. He thinks that comparing himself to others of his age group signifies that he is healthy because he is more mobile and looks overall better than others. He seems to be very confident and will not listen to professionals when they say he is still unhealthy and needs more exercise.
I used various assessments to test overall fitness aspect of this patient at the fundamental and health-related fitness testing level (switching between the two type of assessments to make the best battery of tests for him) and so I can measure and show if he truly is as mobile as he thinks he is. I wanted to show him that he may not be flexible and have enough leg strength as others in his age group which is why I chose to have him perform chair sit & reach and chair stand test. If he saw the areas he lacked in, I feel as though he would realize he is not as great as he thought. I am glad he has confidence within himself, but my first goal was to motivate him into pursuing more exercise by showing where he has faults.
One area that he knows he lacks in is endurance because of his bad knees affecting him. I wanted to have a baseline of what his status is through the 2min step test. Putting him through strengthening and endurance exercises while trying to avoid knee problems as much as possible was my next step. For his aerobic endurance, cycling should benefit him because it is less impact on his knee joint while still improving his endurance. He currently walks but he needs to increase this intensity. He loves to dance during parties so I made as an option for exercise for his endurance program. Dancing will not have as much impact on the knee joint so therefore would be a good choice for him. By the end of the program, there should be a greater increase in his endurance performance and I will test this with the 2min step test to see how well he has improved.
Another area this patient knows he lacks in is his upper arm strength and I wanted to have another baseline for this by using the arm test. I am having him start off slow and progress through the program so he can attain the strength he needs properly and not injure with high intensity in the beginning. I started with a lower weight and only one set for upper body since he is weaker in that area. I still want him to get an increase in strength for his lower body so I added an increase in weight and sets to begin with. After a significant amount of time weight, sets, and reps will increase so that he will further his strength. My goal is to increase his strength so he is able to pick up his grandkids with ease. By the end of the program, he should have an increase in repetitions for the arm curl strength test.
I learned that people can be blind-sided when it comes to their health. Just because someone looks healthy may not directly mean they are which for this patient will be a barrier in his program success. I will use his current scores on his assessments to motivate him to realize he needs to do more physical activity as they will reflect his current health. Overall, this patient’s program will be much more successful once he realizes the current need to make changes in his current health status.
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