David Gladden

9/27/2014

Exercise Prescription

Phase 1 Case Study

My client is a twenty two year old female, who answered NO to all questions in

the Par-Q questionnaire. Along with answering no, she has no preexisting medical

concerns. According to her PARmed-X she is 67 inches tall or 5’7’’, and weighs 182

pounds. Her blood pressure is normal at 112/68. Her BMI is higher at about 28 putting

her in the overweight category. The only question on the first page she answered yes to

was an excessive fat accumulation around waist. On the second page and third pages of

the physical activity readiness medical examination she did not check off a single box,

meaning that she has none of the implied conditions meaning that she is okay with

unrestricted physical activity (starting slowly and building up gradually). The next thing

we went over was the lifestyle evaluation. She has smoked cigarettes, cigars, and a pipe,

though she is not a current smoker. She says she had her first tobacco product at 18 years

old, and has never been a regular smoker. When we got to the drinking section she was a

little bit hesitant as she does drink. In the past month she says she has drank on about 8

separate occasions averaging about 6 beers a week. She says only three of these times

were more then 5 drinks. Her physical activity is pretty vigorous as she runs, jogs, and

walks her dogs. She says she averages about 2 miles a workout and the workouts last

around 20-30 minutes a session depending on what she is doing. These workouts occur

on average about 4 times a week and she has light work in her everyday life and job. She

isn’t much of a snacker and does not enjoy eating sweets as she says she has dessert 0

times in a week. I did however suggest that she get a fasting lipid profile, just for her

own health benefits.

Once again, my client is a twenty two year old female who is 67 inches tall and

weighs 182 lbs. She is a full time student, and she used to play lacrosse at the collegiate

level. When I asked her questions about stress she said that she does stress at times, but it

is not very often, thus saying she handles her stress pretty well. She is overall a pretty

healthy medical history. No preexisting conditions, and no problems that prohibit her

from participating in exercise. In her CHD risk profile she scored a total of 77; putting

her in the very good range. Since she is young, her age is not a big factor, and seeing

since there is no bad family history that helps a lot as well. She does engage in smoking,

but it is not regularly. She was in the normal range for her BP at 112/68. I suggested that

she get a fasting lipid profile that way we could further discuss this and go from there. At

this time she does not believe she is prediabetic. Though she is not obese, she is in the

overweight category, and wants to start a new lifestyle so she can lower her BMI and be

in a more healthy level. She is fairly active now, but she needs to incorporate more lifting

and stretching into her routine. She also needs to extend the frequency, time, and

intensity of her workouts if she wants to become healthier. In her lifestyle choices there

were a few things I believe could be problems. For instance, her drinking could be cut

down, and she could completely stop smoking to better her health. It seems as though she

doesn’t particularly enjoy sweets, but does enjoy pretzels and salty foods such as that. On

the question about salt she said that she does add salt to her food after she tastes it, which

could be a problem for blood pressure later in life it that does not cease. I also think that

if she ate on a more regular pattern she would be healthier as well.

I would have to say that the American Physical Therapy Association is best in line

with my future career paths or was I don’t actually know if I still want to go in to this

field or even use my major. I’m thinking about going into the military or to become at

state police officer. I feel like when it comes to projects or in the real world case studies

it’s always prudent to be professional in areas. As far as ethical I feel the is completely up

to the person running the tests and the client is they don’t agree with a question being

asked then they shouldn’t answer and for the tester, trainer, or doctor if it was me I

wouldn’t answer or do certain things if it was against my ethical viewpoints. I would look

for alternatives ways to get around the same information or close to it.

CLASS PROJECT

Part II: Cardiorespiratory Fitness Assessment and Aerobic

Exercise Program

Instructions for Analysis and Write-Up

I. Demographics

List the following information for your client:

1. Age 22

2. Gender female

3. Height 5’7”

4. Body weight 182

5. Resting BP and HR 116/69 and 68

6. HRmax (measured or age predicted) 192.6

7. Primary CHD risk factors (if any) obese and BMI

8. Special considerations (if any) n/a

9. Aerobic activity interests jogging outside alone or with her dogs

and lifting

II. Cardiorespiratory Fitness Assessment

A. GXT protocol

1. Explain why the specific protocol and mode (cycle or

treadmill) were selected. We did the treadmill test

because that was what she felt most comfortable doing

2. Was this a submaximal or maximal GXT? Submaximal

3. Give reasons for GXT termination. If heart rate increases

to about 80% of max heart rate, or if they want to quit or

need to.

4. Evaluate HR and BP responses during the GXT and

recovery.

Bp=130/76

5. Graph the HR versus METs for each stage of the GXT

(Cycle). N/A

6. Calculate the client's VO2max using the multistage model

equation if a submaximal GXT was administered. Show all

formulas and calculations. She finished in 12:26. Her

absolute was 2.98 her relative was 36.03 which is good

and her mets were 9.2. I calculated to get her relative

score by taking her absolute score 2.98x1000 divided

by her weight in KGs and got 36.03

7. Include the GXT data collection form.

CLASS PROJECT

Part III: Body Composition Assessment

Instructions for Analysis and Write-Up

I. Demographics

List the following information for your client:

1. Age-22

2. Gender-female

3. Height-5’7”

4. Weight-182lbs

5. %BF (HW) Her BIA-32.3 and skinfold sums 142 off the chart

I did some looking up online to and from what I found it put

her estimated BF% at 44.1

6. BMI-31

7. Healthy %BF (use norms pg. 220) 19-23.5%

8. Body fatness classification Her classification would be above

average and obese

III. Skinfold Method

A. Use Jackson-Pollock Modified Protocols- 3 Sites Men/ 3 Sites

Women

B. Follow all standardized ACSM testing procedures. Record two

readings within 1-2mm of each other for each site. Average these

two readings.

C. Show all readings.

D. Take the sum of the skin folds and find the client’s %BF using the

appropriate charts.

Greysons Skinfold scores

Thigh- 55 and 56

Tricept-40 and 42

Suprailiac-42 and 44

Her some comes to 142

Her results are not on the chart that were handed out in class

IV. Other Anthropometric Methods

A. Calculate your client's BMI and compare to BMI nomogram value.

Classify your client's BMI value.

On the hand held BIA reader the thing said her BMI was 31 which is obese but it doesn’t match up with the charts on the with the weights and heights shes telling me she is which say it would be around 28. I don’t want you to say anything to her because I don’t want her to get upset but its messing with my results for this stuff.

B. Measure your client's waist and hip circumferences. Calculate the

WHR and compare to WHR nomogram value. Classify your

client's WHR score. Didn’t realize I had to do this

V. BIA Method

A. Follow all pretest guidelines and standardized testing procedures.

B. Record manufacturer's estimate of %BF. 32.3% this again is if

she’s telling me the right weight and height. Shes been in the

lab so shes always just told me her weight and height and I

believed her because I was sure shed know that because of

playing lacrosse and keeping track of it like me with football,

but I don’t know now if shes actually telling me the truth.

VI. Comparison of Methods

A. Make a table that compares each %BF estimate to the %BF

obtained from HW. How large and in what direction (over- or

underestimation) were the differences? N/A

B. Which field technique gave the closest estimate of %BF obtained

from hydrostatic weighing? Suggest reasons why this field method

was best. N/A

C. Which field technique gave the worst estimate of %BF (HW)?

Suggest reasons why this field method was worst.

I couldn’t compare the results because her skinfold result sums are off the chart, and we didn’t get to use the hydrostatic tank. I still made a chart of her skinfold numbers the lighter green column are the the numbers used to find her total of 142.

VII. Classification of Body Fatness and Calculation of Healthy Body Weight

A. Using the hydrostatic weighing results, classify and evaluate your

client's body fatness. N/A

B. Based on a healthy %BF goal for your client, calculate his or her

healthy BW, assuming no change in FFM. Show all work.

C. Make recommendations to help your client achieve the healthy

body weight and body composition goals. I think my client needs

to improve her daily diets and get more exercise in each. She

should do more cardio and also do some weight training

during the week. Her diet and cardio workouts I think will

help her the most to obtain a more healthy body weight and

BF%.

VIII. Exercise Prescription for Body Composition Change

A. Set a short-term, realistic body composition goal for your client.

She should reduce her BF% to 29-30% which would be good improvement as well try to reduce her BMI below 28

B. Write an exercise prescription for either FFM gain, %BF loss, or a

combination of the two. Be certain to include the following: mode,

intensity, frequency, duration, and length of program.

Cardio Week1 Week2 Week3 Week4

Intensity moderate Moderate Moderate-vigorous

Mainly vigorous

Frequency 5 times a week 5 times a week 4 times a week 3 to 4 depends on how she feels

Duration 2hr 2hr 1 ½ hrs 1hr

Type Bike Treadmill Treadmill/elliptical Treadmill/bike/stair stepper

David Gladdens project

CLASS PROJECT

Part IV: Musculoskeletal Fitness Assessment and Resistance

Training Program

Instructions for Analysis and Write-Up

I. Demographics

List the following information for your client:

1. Age-22

2. Gender-female

3. Height-5’7”

4. Body weight-182

5. Special considerations (if any)-none

II. Musculoskeletal Fitness Assessment

A. Administer the push-up and curl-up muscle endurance test

battery.

Grip Strength- L=35 and R=34 total=70

Push up-21

Curl up-25

B. Classify the client's overall muscular endurance. Compare push-

up and curl-up values to age-gender norms.

Both her push up and curl up results scored very good when compared to age-norms

C. Identify muscle groups in need of improvement in endurance.

I think she needs to improve upper body strength. Ex=tricepts, chest

D. Administer the sit-and-reach and back scratch tests.

Sit-and-reach-48cm

Back Scratch-R=-2 L=-31/2 median=-2.75

E. Compare client's values on these tests to age-gender norms or

average values.

Sit-and-reach-scored very good

Back Scratch-scored poor

III. Resistance Training Program

A. Explain the objective and type of program as well as the

equipment to be used (variable- or constant-resistance exercise

mode?).

Dynamic Resistance Training Program

I chose this program to help increase her upper body strength

Bench, dumbbells, pull up bar, tricept machines, barbells, 10 and 5 pound plates

B. Outline the program as follows (1 RM testing is not required for

this project. Base it on your client’s perceived max):

Exercise

1.Incline bench

2.Db bench

3. Upright row

4. Db row

5.Db bicept curl

6.Tricept rope extensions

7. Pull ups reverse grip

8. Push-ups 3 grip

Joint actions

1-8 all work the shoulder and elbow joints

Muscle groups 1.Tricepts, chest, shoulders

2.Tricepts, chest, shoulders

3. three deltoid heads and the trapezius

4. the whole lat, the upper back, and the trap muscles

5. Bicept

6. Tricept

7. latissimus dorsi, bicept, and scaps, and other main shoulder muscles

8. anterior deltoids and pectoralis and triceps brachii muscles

Intensity % 1-RM

1-8. 60/70%

Weight

1. 115lbs

2. 45lbs

3. 80lbs

4.30lbs

5. 20lbs

6. 80lbs

7. body weight, weight added each week

8.body weight, weight added each weight

Reps

1.10

2.10

3.10

4.10

5.12

6.12

7. 8

8. 8 each grip

Sets

1.3

2.3

3.3

4.3

5.3

6.3

7.4

8.3

Progressive overload

1-6.

Add 2.5 to 5lbs a week

7-8. Add weight to the pull ups up to ten lbs. a week and add 5 to 10 lbs on your back with a spotter each week

Frequency

1-8.

2 to 3x a week

C. Be certain to include at least one exercise for all major muscle

groups and more than one exercise for the weakest muscle

groups identified in II.C.

D. List exercises in the program in the order that will be performed by

the client (generally, larger to smaller muscle groups).

IV. Flexibility Assessment and Exercise Prescription for Flexibility

A. Administer a sit-and-reach test and back scratch test. Identify

joints and muscle groups in need of improvement in flexibility. She

scored very good in the sit and reach however her shoulder

joints need work she scored poor.

B. Name two stretching exercises for each of the muscle groups

identified in IV.A.

Standing Shoulder Stretch-Stand or sit straight and bring your right arm across your chest. Hold this arm at the elbow with your left arm. Relax your shoulders, keep your elbow

straight but not locked, and hold this position for 30 seconds. Repeat on the left side. Do not bounce and overstretch with this pose.

Anterior Shoulder Stretch-Stand up straight and clasp your hands behind your lower back. Lift your arms back and away from your body, keeping palms together and elbows straight. If you find this difficult to do, you can use a small rolled up towel or band as well. Keeping your back straight, lift your arms as far back as you feel comfortable. Hold for a minimum of 30 seconds and release.

C. Write an exercise prescription for your client. Make sure to include

each of the following elements:

1. Mode of stretching

Static stretching

2. Number of exercises—list stretching exercises for each

muscle group

1.Rotation Shoulder Stretches

2. Anterior Shoulder Stretch

3. Standing Shoulder Stretch

4. Posterior Shoulder Stretch

5. Internal Rotation Stretch

6. External Rotation Stretch

3. Intensity

<pain-free ROM

4. Frequency

2 days/week minimum; can be daily

5. Time of each stretch

Time of total stretching program should be at least 15minutes long

6. Repetitions

2-4; accumulate 60 sec per exercise

7. Duration of each workout

Duration: 10-30 sec/stretch; total time may be more important than stretch duration

V. Balance Assessment and Recommendations

A. Administer the one-leg stand tests.

Blind-Left-53sec Right-103sec

Normal-Left-4:30 Right-3:28

B. Compare scores to norms (see tables 12.1 and 12.4).

Greyson’s score were outstanding compared to the norms for her age

Norms-45.1 sec for eyes open (Left-4:30 Right-3:28) 13.1 sec for eyes closed (Left-4:30 Right-3:28). She is a lacrosse player which explains her outstanding scores. She has great balance and body control.

C. Make activity recommendations to improve your client's balance.

Pilates

Yoga

Tai chi

Dance