Unit 4 Project



Unit 8 Project

Jacqueline Taylor

Kaplan University

Current Trends in Exercise and Fitness - Aging Well Across the Lifespan

EF310-01

Heather Reiseck

July 27, 2012

Unit 8 Project

Introduction

The purpose of this paper is to evaluate and conduct an actual physical assessment for a 40-year-old male who has both type 2 diabetes and metabolic syndrome in order to develop an adequate exercise fitness program.

PAR-Q Rating

Mr. Conner is 40 years of age. His height is 5 feet 9.5 inches, and his weight is currently at 265 pounds. He has completed the PAR-Q Rating form found in the Fitness Professional’s Handbook (Howley & Franks, 2007, p.23). Because of his diagnosis of diabetes and metabolic syndrome, Mr. Conner’s physician gave medical approval to begin an exercise program. Mr. Conner's physician recommends that he proceed with a supervised program because of his medical issues and his history of inactivity in order to lose weight and lower his blood glucose along with other health issues.

Health Status

Mr. Conner does not smoke, but he does have a history of high blood pressure and high stress. He also has high cholesterol at 270 mg/dl with his LDL level (low-density lipoprotein or bad cholesterol) is high at 190 mg/dl, and his HDL level (high density lipoprotein or good cholesterol) falls within normal values at 32 mg/dl. He has a high fasting glucose level of 132 mg/dl His VO2 max (measure of aerobic fitness) score is way below normal at 22 mL/kg/min. There was no ischemia on graded exercise testing (GXT).

General Medical History

Mr. Conner has indicated that he has diabetes and takes prescription medications in the General Medical History section of the Health Status Questionnaire in the Fitness Professional’s Handbook (Howley & Franks, 2007, p. 26). The prescription medication does not put him in a problem area, but the fact that he has indicated that he has diabetes clearly requires him to have physician approval. The fact that his physician has recommended this testing is sufficient for this approval.

Assessment Results on testing CRF, Endurance, Flexibility, and Strength

• Vitals: Mr. Conner’s blood pressure measured at 148/94, which put him in the mild hypertension (Stage 1) category ("Exercise tolerance testing," 2002), and advised a recheck in 2 months. Precautions taken and monitored throughout the testing.

• Flexibility: The Sit and Reach Flexibility text measured his flexibility. This test was chosen because of the length of time it has been since he has attempted any exercise regimen, and because he is overweight. As he sat on the floor with his legs out straight ahead, his feet placed with the soles flat against a wall, shoulder-width apart. Both knees held flat against the floor. With his hands on top of each other and his palms facing down, Mr. Conner reached forward along the measuring line as far as possible. His first resulted in a reach 1-1/2 inches away from his toes, a second attempt about an inch away, and finally on the 3rd attempt, the reach held for 2 seconds while the distance was recorded. He was able to reach 8 inches, putting him a little below the 14th percentile and 14 in the population average. He was rated as poor ("Exercise tolerance testing," 2002).

• Endurance: For this test, we chose the Rockport Walk Test. This was chosen similarly because of Mr. Conner’s previous sedentary lifestyle without much structured exercise and his overweight status.

The Rockport Walk test was developed for those people who are unable to run a mile to discover their heart rate and fitness level. It is good for both women, and men, as it is relatively inexpensive, takes very little equipment and can be self-administered. The Rockport Fitness Walking Test is the best test available for cardiorespiratory fitness and determining what the overall fitness level is. There are a variety of other tests available to assess the fitness level, but the Rockport One Mile Walking Test is the best and most widely used ("Rockport Walk Test," 2011).

Mr. Conner’s results were calculated as follows after walking as briskly as possible for one mile taking 25 minutes and 30 seconds, with an ending heart rate of 145 bpm:

METs = -0.7616999999999956

VO2 Max = -2.6659499999999845

Population Average = 40.66

This put him in the “poor” range with a score of -1, and a 20-week walking program recommended for Mr. Conner.

• Muscular Strength & Endurance: This analysis was accomplished by doing the Senior’s Chair Stand test, which is calculated by the number of times the subject can stand up and sit down in a 30-second time period with arms folded across the chest. Although Mr. Conner is not a senior, this study was chosen because of his fitness level at the present time. He was able to complete 16 standups in the time allotted, which put me in the 20th population average, with a score of 19 and a rating of fair ("Senior’s Chair Stand," n.d.).

Risk Factors and Precautions

Mr. Conner has a risk factor of having a blood pressure over 140/90, and blood cholesterol over 200 mg/dl on the completed Health Status Questionnaire (Howley & Franks, 2007, p. 27). We discussed this risk factor with the physician along with his diabetes and metabolic syndrome. The physician asked that he be kept notified of any proposed fitness plan so it can be part of Mr. Conner’s medical record and referred to if necessary.

According to the Centers for Disease Control and Prevention, Adults need at least

2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that use all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms); or, 1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week and muscle-strengthening activities on 2 or more days a week that use all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms); or, an equivalent combination of moderate- and vigorous-intensity aerobic activity and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).. This should include 60 minutes or more at least 3 days per week of aerobic activity, 60 minutes or more at least 3 days a week of muscle strengthening, and 60 minutes or more at least 3 days a week of bone strengthening ("How much physical activity do adults need?" 2012).

Medications

Mr. Conner’s physician recently prescribed a diuretic in order to reduce his blood pressure and a medication to help lower his cholesterol level. That is the only prescription medication he is on at the present time. He has not indicated any other medications, including over-the-counter medications, in his history.

Health and Lifestyle Behaviors

Mr. Conner is a single, overweight adult male who has experienced fatigue and headaches, and has been diagnosed with type 2 diabetes and metabolic syndrome. He lives a sedentary lifestyle and does not exercise on a regular basis. He also does not eat the proper foods and regularly eats at fast food restaurants instead of preparing his meals himself.

Body Composition

The body is composed of water, protein, minerals, and fat. A two-component model of body composition divides the body into a fat component and fat-free component. Body fat is the most variable constituent of the body. The total amount of body fat consists of essential fat and storage fat. Fat in the marrow of bones, in the heart, lungs, liver, spleen, kidneys, intestines, muscles, and lipid-rich tissues throughout the central nervous system is called essential fat, whereas fat that accumulates in adipose tissue is called storage fat. Essential fat is necessary for normal bodily functioning. The essential fat of women is higher than that of men because it includes sex-characteristic fat related to childbearing. Storage fat is located around internal organs (internal storage fat) and directly beneath the skin (subcutaneous storage fat). It provides physical protection and serves as an insulator to conserve body heat. The relationship between subcutaneous fat and internal fat may not be the same for all individuals and may vary during the life cycle (Kravitz & Heyward, n.d., para. 4).

Lean body mass represents the weight of your muscles, bones, ligaments, tendons, and internal organs. Lean body mass differs from fat-free mass. Since there is some essential fat in the marrow of your bones and internal organs, the lean body mass includes a small percentage of essential fat. However, with the two-component model of body composition, these sources of essential fat estimated and subtracted from total body weight to obtain the fat-free mass. Practical methods of assessing body composition such as skinfolds, bioelectrical impedance analysis (BIA), and hydrostatic weighing based on the two-component (fat and fat-free mass) model of body composition (Kravitz & Heyward, n.d., para. 5).

Table 1. Standards of Fatness for Women and Men in Percent Body Fat:

| |Women |Men |

|Essential fat |25% |

(Kravitz & Heyward, n.d., Table 1)

The BMI calculator ("BMI Calculator," 2001) was used with the results being BMI 38.7 at 69.5” and 265 pounds. He rated in the 25.9% population average with grade 2 obesity.

Because of measurements taken, in order to get to the desired body weight of 247 pounds as recommended by his physician, Mr. Conner will have to lose 18 pounds over a 3-month weight loss and supervised exercise program.

Nutrition

| | |Meals from 07/27/12 - 07/29/12 |

| | | |Con317's Meals |

| | | |Con317, your plan is based on a 2400-Calorie allowance. |

| | |D| |Breakfast |Lunch |Dinner |

| | |a| | | | |

| | |t| | | | |

| | |e| | | | |

| | | |Con317's Food Groups and Calories Report 07/27/12 - 07/28/12 |

| | | | |

| | | |Your plan is based on a 2400-Calorie allowance. |

| | | | |

| | | | |

| | |Food Groups |Target |Average Eaten |Status | | | | |Grains |8 ounce(s) |7 ounce(s) |Under | | | | |Whole Grains |≥ 4 ounce(s) |1 ounce(s) |Under | | | | |Refined Grains |≤ 4 ounce(s) |6 ounce(s) |Over | | | | |Vegetables |3 cup(s) |2¾ cup(s) |OK | | | | |Dark Green |2 cup(s)/week |0 cup(s) |Under | | | | |Red & Orange |6 cup(s)/week |¼ cup(s) |Under | | | | |Beans & Peas |2 cup(s)/week |0 cup(s) |Under | | | | |Starchy |6 cup(s)/week |5 cup(s) |Under | | | | |Other |5 cup(s)/week |¼ cup(s) |Under | | | | |Fruits |2 cup(s) |2 cup(s) |OK | | | | |Whole Fruit |No Specific Target |2 cup(s) |No Specific Target | | | | |Fruit Juice |No Specific Target |0 cup(s) |No Specific Target | | | | |Dairy |3 cup(s) |2¼ cup(s) |Under | | | | |Milk & Yogurt |No Specific Target |1 cup(s) |No Specific Target | | | | |Cheese |No Specific Target |1¼ cup(s) |No Specific Target | | | | |Protein Foods |6½ ounce(s) |7½ ounce(s) |Over | | | | |Seafood |10 ounce(s)/week |0 ounce(s) |Under | | | | |Meat, Poultry & Eggs |No Specific Target |7½ ounce(s) |No Specific Target | | | | |Nuts, Seeds & Soy |No Specific Target |0 ounce(s) |No Specific Target | | | | |Oils |7 teaspoon |3 teaspoon |Under | | | | |Limits |Allowance |Average Eaten |Status | | | | |Total Calories |2400 Calories |3184 Calories |Over | | | | |Empty Calories* |≤ 330 Calories |1107 Calories |Over | | | | |Solid Fats |* |761 Calories |* | | | | |Added Sugars |* |346 Calories |* | | (ChooseMyPlate website, 2012)

These tables show the meals and the nutrition received from 2 days of meals. The calories exceed the amount of calories recommended for Mr. Conner, and suggest an overabundance of fast food and prepared food, which provide inadequate all-around nutrients. It also shows that he does not prepare meals for himself on a regular basis.

Readiness for Change

According to the text, Mr. Conner is in Stage 2 of the readiness for change scale, “thinking about change” (Marcus & Forsyth, 2009, Chapter 2). This was chosen because Mr. Conner is now thinking about changing his lifestyle because of his doctor’s recommendations and in order to prevent further problems with his diagnoses of type 2 diabetes and metabolic syndrome.

Motivational Strategies and Techniques

Selecting an exercise that is right, is just the first step in a successful exercise program. Making the necessary adjustments in life to accommodate this new lifestyle change can be difficult. Procrastination, social pressures, stress, and busy schedules can impede progress (Thygerson & Thygerson, 2007).

• Develop an exercise habit. Keep at it, knowing the more consistent in the beginning, the more fixed the new activity will become.

• Reserve a time slot each day for working out, and do not let anything interfere.

• Do not let others lead you astray. Inform everyone of the exercise time and that you would appreciate them respecting your choice.

• Seek support from friends and family, and believe that you can succeed.

• Be patient with yourself. Some days you will be more motivated or have more time than other days. A brief period of not exercising is not a failure.

• Plan ahead and follow your plan. Decide when, where, how often, and with whom you will work out. Be prepared to exercise (Thygerson & Thygerson, 2007).

Recommendations

The FITT principle is an easy way to remember the components necessary in a complete fitness program. FITT is a programming model that is suitable for all aspects of fitness: strength training, cardiovascular training, and flexibility training, and is appropriate for all ages and special populations. The FITT principle incorporates the four variables that must be managed when developing any individualized exercise program ("FITT Programming," 2012)

The overall exercise objective is to have Mr. Conner engage in regular exercise to improve his fitness and assist with his weight loss and caloric expenditure averaging 250 calories per day, which will lead to a weight s of approximately 18 pounds during the 3 months supervised program. Recommendations for Mr. Conner are as follows:

Nutritional

It is recommended that Mr. Conner eat fewer prepared meals from fast food restaurants and frozen prepared foods, and prepare healthier meals for himself at home consisting of more leafy, green vegetables, fruits, and cut down on saturated and trans fats, along with his carbohydrate intake, by watching the labels on the food he chooses and keeping a journal each day of what he eats in order to stay on track.

Physical

• Frequency: Initially, supervised aerobic activity for 30 minutes 3 days a week is recommended. If there are no problems for the first 2 weeks, he can be educated on the signs of hypoglycemia and then encouraged to walk without supervision, gradually building up his aerobic exercise to 45 to 60 minutes on 5 or more days a week.

• Intensity: The exercise should be low to moderate intensity as his body acclimates to an exercise routine. If there are no problems for the first 2 weeks, he can be educated on the signs of hypoglycemia and then encouraged to walk without supervision, and build his aerobic intensity to moderate to vigorous.

o Examples of moderate activity would be: Walking (up to 3.5 mph), bike riding (less than 10 mph), dancing, weightlifting (light), and stretching. Increase in speed and intensity can occur gradually and as the body adapts, using the target heart rate range from 140 to 105 bpm.

o Examples of vigorous activity would be: Fast walking (4.5 mph), fast bike riding (more than 10 mph), jogging or running, and aerobics, using the same guidelines as above with target heart rate.

• Resistance training (moderate intensity): This should be performed 3 days a week under supervision. He should complete 2 sets of 10 to 15 repetitions of exercises such as leg press, leg extension, leg curl, bench press, shoulder press, rowing, biceps curl, and triceps extension. His focus should be to engage the large muscle groups of the upper and lower body in order to assist with glucose control.

• Time (duration): Plan on a total time of at least 30 minutes of activity each day. This can be done all at once or added together over several shorter 10- to 15-minute blocks of activity. Breaking it up into smaller blocks of time is an excellent way to start a new program or fit activity into a busy schedule.

• Type: The type of activity can include a variety of recreational activities, family activities, active hobbies, and walking or bicycling for fun and transportation. Several times every week do weight-bearing activities that promote muscle strength, flexibility, and bone health. The most important thing is to choose something fun ("The FITT Plan for Physical Activity," 2011).

After the 3-month supervised fitness routine, it is recommended that Mr. Conner continue in this regimen and make it a part of his lifestyle in order to keep his diabetes and metabolic disorder symptoms under control.

Summary

Mr. Conner’s health could seriously decline if he does not adhere to the above recommendations both nutritionally and physically.

References

BMI Calculator. (2001). Retrieved from

ChooseMyPlate website. (2012).

Exercise tolerance testing. (2002). Retrieved from

FITT Programming. (2012). Retrieved from

How much physical activity do older adults need? (2012). Retrieved from

Howley, E. T., & Franks, B. D. (2007). Fitness Professionals Handbook (5th Ed.). Champaign, IL: Human Kinetics.

Kravitz, L., & Heyward, V. H. (n.d.). Getting a Grip on Body Composition. Retrieved from

Low Fitness Level? Try the Rockport Walk Test. (2011). Retrieved from

Marcus, B. H., & Forsyth, L. H. (2009). Motivating People to Be Physically Active. Champaign, IL: Human Kinetics.

Seniors Chair Stand. (n.d.). Retrieved from

Thygerson, A. L., & Thygerson, S. M. (2007). Fit to be Well (2nd Ed.) [2nd].

Vital Signs Calculator. (n.d.). Retrieved from

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