Chronic Disease and Exercise Rehabilitation

INSTRUCTIONS: • Scroll down to the portions that indicate Discussion Questions. Provide answers to the posed questions with as much detail as deemed necessary. As a guideline, your answers to each question should not exceed 100 words (if it is slightly over, though, no grade penalty will be applied). • When submitting your answers for Case study 1, make sure to save your document as .PDF file so that we will be able to open it.

SUBJECTIVE Medical History Acute periodic episodes of elevated blood glucose levels but without experiencing hyperosmolar hyperglycemic nonketotic syndrome or diabetic ketoacidosis. Two-vessel coronary artery bypass surgery 5 yr prior, moderate peripheral neuropathy (loss of most sensation in soles of feet), and early stages of diabetic kidney disease. Medications: metformin taken two times per day, captopril (for blood pressure control and protection of kidneys), and Lipitor for control of hyperlipidemia. Diagnosis Mr. SD is 63 yr old and was diagnosed with type 2 diabetes 5 yr ago. Discussion Questions a. Based on the medical history, what is the primary disease of concern, and are there any comorbidities? b. Describe the patient’s diagnosis and comorbidities (pathophysiology). c. What major symptoms or signs are reflective of the disease of concern and comorbidities if applicable?

OBJECTIVE Physical Examination Results Blood pressure 130/80 mmHg, resting heart rate 70 beats · min−1 , height 71 in. (190 cm), weight 230 lb (104 kg) with 27% body fat (skinfold) Blood Chemistry Test Results Last HbA1c = 7.8% (normal 4%-6%); cholesterol 200 mg · dL−1; LDLc 130 mg · dL−1; HDLc 35 mg · dL−1; triglycerides 160 mg · dL−1; microalbuminuria Other Clinical Diagnostic Test Results No other tests were conducted. Exercise Test Results No abnormal electrocardiogram changes, maximum blood pressure 180/83 mmHg, maximum heart rate 150 beats · min−1 , V̇ O2max 25.5 mL · kg−1 · min−1 , blood glucose before test 180 mg · dL−1 Discussion Questions a. Are there any results from the physical examination or blood chemistry or other diagnostic test results that may influence any recommendations for exercise or physical activity? b. Based on the exercise testing results, if applicable, are there any considerations regarding the safety of exercise training for this individual? Exercise Assessment and Plan The goals of the exercise program, mutually agreed on by the individual and the clinical exercise professional, are to lose weight and improve body composition, lower blood glucose levels, and reduce risk for another cardiac event. When asked about interests and hobbies, the individual indicates that he enjoys traveling, wine tasting, playing with his dog, and classic movies. Participation in a supervised exercise program and frequent contact with an exercise professional are advised. Mr. SD is instructed to increase the frequency of blood glucose monitoring to assess the effect of exercise on his blood glucose levels. He is also advised to monitor his feet daily for redness, sores, or other areas of trauma that must be treated early to prevent further issues. Discussion Questions a. Based on the information provided, what might you consider when determining whether this patient should perform exercise training, and what benefits would you expect to observe? b. Are there any signs, symptoms, medications, or other items listed that would need to be considered when assessing this patient for an exercise training program? c. Develop a 12 wk exercise prescription for cardiorespiratory, resistance, and range of motion training if applicable. Use the FITT principle when developing your prescription. d. Discuss issues that might affect this individual’s ability to begin and adhere to exercise training. e. What considerations might affect decisions for exercise workload or intensity progression? f. Based on the subject’s medical history and test results, identify areas for which the patient should be further educated (e.g., weight control, diet modification). Are there other resources that you might use?