KIN 187. Clinical Exercise Physiology Dr. Areum Jensen
NAME: _______________________
CASE STUDY 8. Sam
Sam is a 62 year old male who has had a quadruple (coronary artery) by-pass surgery. He has just finished cardiac rehabilitation and his doctor confirmed that he can start exercising with caution. He would like a program to keep him on the road to recovery. He has high cholesterol and is on medication. He likes to have fun doing leisure activities (e.g., jet skiing) even though he has never done any structured exercise. He owns a popular and busy restaurant. However, since the day of surgery he has been thinking of retiring and enjoying life.
He is ready to start exercising.
Height: 5’6’’
Weight: 150 lbs
Set up a realistic 1 year exercise program that will help Sam improve his ability to function, and enjoy life. He is open to beginning an exercise program and really needs specific guidance for beginning and maintaining a program.
Case Study Individual Report-George
Case Study: George
Case Description:
George is a 73 year old male with no medical history other than diagnosed arthritis. He has
difficulty getting out of bed and maintaining balance. His goal is to gain strength to prevent any
further loss in his ability to function.
Section 1: Critical Analysis/ Evaluation
Critical Analysis:
Age: 73 years old, > 45 years (Positive Present)
Family History: None (Absent Neutral)
Smoking: None (Absent Neutral)
Sedentary lifestyle: Difficulty getting out of bed and maintaining balance (Positive
Present)
Does not meet the minimum threshold of XXXXXXXXXXMET for physical activity
criteria.
Obesity: 172 lbs
BMI/ Waist Circumference: 22.7 kg/㎡, ≱ 30 kg/㎡ (Absent Neutral)
Blood Pressure: Resting BP 125/72 (Absent Neutral)
Lipids: Absent Neutral
LDL: None
HDL: None
Total Cholesterol: 180 mg/dL (Absent Neutral)
Diabetes: HbA1C 5.9% > 5.7% = Pre-Diabetic (Positive Present)
Total Risk Factors: 3
Health Screening and Evaluation:
George is 75 years old and has extreme difficulty sitting bedside or getting out of bed.
This categorizes him as a fall risk client. The Par Q health questionnaire will be provided
to determine whether medical clearance is needed. George does not have any medical
history of stroke or myocardial infarction and he does not have any history of metabolic
or renal disease. He does not present with obesity or high blood pressure. He is
Pre-diabetic with an HbA1C of 5.9% above the healthy limits of 5.7%. Based on the
PAR-Q assessment, he is ready for physical activity at a low intensity. George does not
participate in regular physical activity. ACSM preparticipation algorithm indicates that
medical clearance is not necessary for light to moderate intensity exercise. With the
given information, informed consent is obtained from the client which explains the risk,
enefits and plans of assessments.
Section 2: Goals
Specific:
George’s goal is to gain strength and improve balance to prevent any further loss
in his ability to function. He also wants to maintain a healthy BMI, lower his HbA1C, and
lower his blood pressure.
Measurable:
George will start out with flexibility and dynamic exercises to improve overall
mobility and function. His workouts will increase in intensity as he shows progress in
alance and strength endurance.
Attainable:
These goals are attainable because George will begin with low intensity flexibility
and body weight strength training 2-3 times a week.
Relevant:
These goals align with George’s objective to gain strength and improve his
overall function.
Time:
A 4 week exercise program will be designed based on the ACSM guidelines fo
arthritis and Senior Adults.
Section 3: Special Consideration
George is a high fall risk client. During his exercise sessions he will need to utilize a gait
elt in the event of losing balance. A goal of George’s is to lower his blood pressure and
glucose. Both will be monitored at each session. Exercises will need to be modified as
needed to accommodate his ability to perform the exercise.
Section 4: Testing / Assessment
Assessment will include Berg’s balance test to determine his static and dynamic
alance. The Senior Fitness test which includes seven movements; 1. 30s chair stand,
2. 30s arm curls, 3. 8 ft up and go (modified to 3 ft due to inability to maintain balance),
4. 6-min walk, 5. 2-min step test, 6. Sit and reach, and 7. Back scratch. Another test that
will be conducted will be the Usual Gait speed to asses the time it takes George to walk
a short distance (3-10m) at a usual pace.
A 4 week exercise program will be designed based on the ACSM guidelines for arthritis
and Senior Adults. The Borg’s Rating of Perceived Exertion 6-20 scale will be used to
assess the intensity of exercise throughout the 4 week program.
Section 5: Exercise Prescription
Week 1-2 Aerobic Resistance Flexibility
Frequency 2 days/week 3 days/week 3 days/week
Intensity RPE 0-10 scale RPE scale 0-10
light intensity.
Stretch to point of
feeling tightness o
slight discomfort
Time 20-30 mins light to
moderate
20-30 mins light to
moderate
Hold stretch fo
30-60 seconds
Type Recumbent cycling Balance & Body
weight
Dynamic stretches
& Static stretches
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Flexibility Flexibility Rest Day Flexibility Flexibility Rest Day Flexibility
Aerobic Resistance Resistance Aerobic Resistance
Resistance and Flexibility
Warm UP Set Reps/Duration Intensity
Recumbent Bike 1 2 minutes Light
Seated Arm Circles 1 12 Front/Back Body Weight
Seated Overhead reach 1 12 each side Body Weight
Seated Hamstring toe touch 1 30s-60s hold point of slight discomfort
Exercise Set Reps/Duration Intensity
Assisted Stand and Sit XXXXXXXXXXBody Weight (RPE 0-10)
Seated RB External
Rotation XXXXXXXXXXea side Light RB (RPE 0-10)
Seated RB internal Rotation XXXXXXXXXXea side Light RB (RPE 0-10)
2 Feet Airex Pad balance XXXXXXXXXXs Body Weight (RPE 0-10)
Cool Down Set Reps/Duration Intensity
Seated Arm Circles 1 12 Front/Back Body Weight
Seated Overhead reach 1 12 each side Body Weight
Seated Hamstring toe touch 1 30s-60s hold point of slight discomfort
Week 2 will be reassessment of Berg’s balance and Senior Fitness test.
Week 3-4 Aerobic Resistance Flexibility
Frequency 2 days/week 3 days/week 3 days/week
Intensity RPE 6-10 scale RPE scale 6-10
moderate intensity.
Stretch to point of
feeling tightness o
slight discomfort
Time 20-30 mins light to
moderate
30-55 mins light to
moderate
Hold stretch fo
30-60 seconds
Type Aquatics
Swimming,
Treadmill
Light to moderate
(40-50% Body
weight)
Dynamic stretches
& Static stretches
Warm UP Set Reps/Duration Intensity
Gait supported Treadmill
Walk 1 2 minutes XXXXXXXXXXmph
Standing Arm Circles 1 12 Front/Back Body Weight
Walking lunge with
Overhead reach 1 12 each side Body Weight
Walking Hamstring scoops 1 12 ea side point of slight discomfort
Exercise Set Reps/Duration Intensity
Modified Stand and Sit to
alance XXXXXXXXXXBody Weight (RPE 0-10)
Seated Cable Row XXXXXXXXXXea side 40-50% Body Weight
Seated Leg Extension XXXXXXXXXXea side 40-50% BW
2 Feet Airex Pad balance XXXXXXXXXXs Body Weight (RPE 0-10)
Seated Machine Rope Pull XXXXXXXXXXs 40-50% BW
Cool Down Set Reps/Duration Intensity
Standing Arm Circles 1 12 Front/Back Body Weight
Walking Lunge with
Overhead reach 1 12 each side Body Weight
Walking Hamstring Scoops 1 12 ea side point of slight discomfort