This is an excerpt from Laboratory Assessment and Exercise Prescription With HKPropel Online Video-Loose-Leaf Edition by Jeffrey M. Janot & Nicholas M. Beltz.
Case Study 1
Height: 6 ft 0 in. (183 cm)
Weight: 222.2 lb (101 kg)
Race or Ethnicity: White
Your client’s family history reveals the father (age 75), mother (age 72), paternal grandmother (age 92), and paternal grandfather (deceased at age 62) were diagnosed with diabetes and high cholesterol, and a brother (age 48) was diagnosed with high blood pressure at age 38. The father had a coronary artery bypass graft surgery on two coronary vessels (CABG × 2) at age 54, and the paternal grandfather died of a myocardial infarction (MI) at age 62.
A recent physical assessment revealed the following health information. Your client’s resting heart rate (HR) was 72 beats·min−1, and resting blood pressure (BP) was 122/88 mmHg (confirmed from a previous measurement). The client’s waist circumference measurement was 110 cm (43.3 in.), and a bioelectrical impedance analysis (BIA) showed a %BF of 26%. The blood chemistry panel showed a total cholesterol of 247 mg·dL−1, an HDL of 42 mg·dL−1, an LDL of 168 mg·dL−1, and a triglyceride (TGL) level of 300 mg·dL−1. Fasting blood glucose (FBG) was measured at 114 mg·dL−1. A submaximal aerobic test utilizing a basic step test protocol showed a predicted maximal oxygen consumption (1O2max) value of 32 mL·kg−1·min−1. No other data are available at this time.
Your client has a 15 yr smoking history but quit 2 yr ago and remains a nonsmoker at this time. Otherwise, your client does not report any past medical issues.
Behavior and Risk Assessment
The client works as a branch manager at a suburban bank and undertakes no physical activity during their leisure time. Their healthcare provider, who is concerned about the overall sedentary lifestyle and blood chemistry panel data, has referred this client to you. The healthcare provider prefers trying lifestyle modification before considering medication. Your client used to be very physically active, having played basketball in college and maintained an active lifestyle in the off-season. However, over the past 5 yr, they have become progressively less active because of work and family commitments and is considered sedentary at this time. Your client also reports drinking two or three cups of coffee every morning, one or two soft drinks each afternoon at work, and 10 to 12 alcoholic beverages (mostly beer) every week. A 5 d dietary recall analysis shows a diet of 3,000 to 4,000 calories per day, with a fast-food choice for lunch or supper and no breakfast on most days of the week. Overall composition of the dietary intake shows high amounts of simple carbohydrates and fat followed by protein and low amounts of fruits and vegetables. Please answer the following questions:
- Does your client participate in regular exercise?
- Does your client have signs and symptoms (S & S) of disease or known disease?
- Is medical clearance needed at this time?
- What is your current recommendation for exercise intensity?
- What are the client’s CVD risk factors (RFs), and what are some ways to reduce CVD risk?