103.1 kg in stones and pounds

Case Study / Course Exercise Program For Spe Popu Attached Is The Reference

EXERCISE PRESCRIPTION/PROGRAMMING CASE STUDIES:

DIABETES

(286 Points)

Show all your mathematical work for evaluating METs, target heart rates, and target body weights.

CASE STUDY 1

A 54 yo diabetic woman has joined the hospital diabetes care program. In this program she will receive diabetes education and exercise instruction. She was diagnosed diabetic eight months ago. She has been put on Glucovance BID and told to diet and exercise. So she recently began to walk for 30 minutes, four days a week at a light intensity. Her hospitalizations include routine childbirth (x3) and kidney stones at age 18 year old. Usual childhood diseases. No family history of heart disease, however, her grandmother was diagnosed with diabetes at age 58 year old. She is a past smoker, having smoked 1 pack/week for 35 year and recently tapered off. Her laboratory data: Height 64.2” Weight 210.3 pounds Resting HR 75/min Resting Blood Pressure 119/80-80 Cholesterol 210 Vital Capacity 3.5 L HDL 40 FEV1 2.3 L/sec Triglycerides 438 Percent Fat 38.4% Glucose 125 Waist Circumference 103.1 cm HbA1C 8% Hip Circumference 125.0 cm

1. Is physical activity/exercise appropriate for this patient at this time? (5 pts)

a. Explain (5 pts)

2. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)

a. Explain (5 pts)

3. Her exercise prescription/physical activity advice should be. Explain. (12 points)

a. Mode:

b. Frequency:

c. Duration:

d. Intensity:

4. What precautions would you give her about the time of day for physical activity/exercise? (5 pts)

a. Explain (5 pts)

5. What precautions would you give her about the timing of medications and physical activity/exercise? (5 pts)

a. Explain (5 pts)

6. If her pre-exercise blood sugar is 115 mg/dl, what medication/diet precautions would you give her about exercising that day? (5 pts)

a. Explain (5 pts)

7. If her pre-activity blood sugar is 240 mg/dl, what medication/diet precautions would you give her about exercising that day? (5 pts)

a. Explain (5 pts)

b. What is her risk for an activity related hypoglycemia? (5 pts)

i. Explain (5 pts)

8. If she presented with retinopathy how would you adjust her exercise/physical activity prescription? (5 pts)

a. What additional precautions would you consider? (5 pts)

CASE STUDY 2 This 69 yo retired engineer is participating in the Diabetes Care Clinic at the hospital. He was diagnosed with diabetes 13 years ago, but has not been in good control. It was believed that he should go through diabetes education again. Part of the diabetes education classes is full evaluation and individualized exercise prescription. He had the usual childhood diseases with the exception of Whooping Cough at age 1 year. At age 23 years old he was hospitalized for an appendectomy. His grandfather had a stroke at age 83 and died at 84 years old. His uncle had adult onset diabetes. His insulin regimen is

10:00 am: 5 units of Regular and 13 units of Lente 10:00 pm: 5 units of Regular and 5 units of Lente He is currently recovering from arthroscopic surgery of his left knee (torn

meniscus). For the past year, he has been lifting weights 60 to 80 minutes (hard), 3 days a week; plays tennis (moderate) 30 to 50 minutes, twice a week; and does calisthenics (moderate) 30 to 60 minutes, 3 days per week.

He is a past smoker, having smoked 5 to 8 cigaretttes a day for 29 years. He

quit 19 years ago. Other data include: Height 167.6 cm Weight 63.9 kg Glucose 234 mg/dl Vital Capacity Cholesterol 201 mg/dl FEV1 Triglycerides 152 mg/dl Resting Heart Rate 52 HbA1C 12.3% Resting BP 146/88-78

9. Is physical activity/exercise appropriate for this patient at this time? (5 pts)

a. Explain (5 pts)

10. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)

a. Explain (5 pts)

11. His exercise prescription/physical activity advice should be. Explain. (12 points)

a. Mode:

b. Frequency:

c. Duration:

d. Intensity:

12. What precautions would you give him about the time of day for physical activity/exercise? (5 pts)

a. Explain (5 pts)

13. What precautions would you give him about the timing of medications and physical activity/exercise? (5 pts)

a. Explain (5 pts)

b. If his pre-exercise blood sugar is 130 mg/dl, what medication/diet precautions would

you give him about exercising that day? (5pts)

c. Explain (5 pts)

14. If his pre-activity blood sugar is 280 mg/dl, what medication/diet precautions would you give him about exercising that day? (5 pts)

a. Explain (5 pts)

b. What is his risk for an activity related hyperglycemia? (5 pts)

i. Explain (5 pts)

15. What, if any, additional precautions would you give him if you increased his exercise intensity? (5 pts)

a. Explain (5 pts)

16. If he presented with autonomic neuropathy how would you adjust his exercise/physical activity prescription? (5 pts)

a. What additional precautions would you consider? (5 pts)

CASE STUDY 3 This 57 yo diabetic man has joined the fitness program to become more fit and lose weight. He is not currently active. He was diagnosed diabetic 21 years ago. He was put on insulin from the very beginning. He is now taking 42 units of NPH daily at 6:00 am and 24 units at 6:00 pm. At age 20 years he was hospitalized for shrapnel in his thigh; at age 32 year for hepatitis; and at 34 years for a hernia. He had the usual childhood diseases. His father died of a heart attack at 52 years old. He has had no other relatives with diabetes. He has never smoked. Other information: Height 193.5 cm Weight 91.8 kg Cholesterol 221 mg/dl Heart Rate 63 Triglycerides 100 mg/dl Blood Pressure 130/80-78 Glucose 52 mg/dl HbA1C 5.7%

17. Is physical activity/exercise appropriate for this patient at this time? (5 pts)

a. Explain (5 pts)

18. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)

a. Explain (5 pts)

19. His exercise prescription/physical activity advice should be. Explain. (12 points)

e. Mode:

f. Frequency:

g. Duration:

h. Intensity:

20. What precautions would you give him about the time of day for physical activity/exercise? (5 pts)

a. Explain (5 pts)

21. What precautions would you give him about the timing of medications and physical activity/exercise? (5 pts)

a. Explain (5 pts)

b. If his pre-exercise blood sugar is 90 mg/dl, what medication/diet precautions would you

give him about exercising that day? (5pts)

c. Explain (5 pts)

22. If his pre-activity blood sugar is 150 mg/dl, what medication/diet precautions would you give

him about exercising that day? (5 pts)

a. Explain (5 pts)

b. What is his risk for an activity related hyperglycemia? (5 pts)

i. Explain (5 pts)

23. If he presented with periphearal neuropathy how would you adjust his exercise/physical activity prescription? (5 pts)

a. What additional precautions would you consider? (5 pts)