Purpose: The intent of this assignment is to engage you in critical thinking with respect to assessing risk for exercise engagement and appropriately prescribing/recommending exercise as an intervention based upon the patients health promotion and disease prevention/management needs. The student will also reflect upon the changing health care team related to exercise science integration.
· For this you are asked to determine a max HR and recommend a realistic exercise plan for the patient in the scenario.
1. Read the scenario and assess the patient’s risk using the ACSM Exercise is Medicine for Primary care Par-Q/Risk stratification tools (pp16-19Links to an external site.)
o Identify the patients risk – high, medium or low from the Par-Q/Risk stratification tool
2. Write a brief paragraph explaining the type of exercise that you believe would benefit this patient.
o Support your answer with citation
3. Identify the following
o What would be the maximal heart rate (HRmax)Links to an external site. for this patient – (remember that 220 is the number that we use in the beginning of the equation to determine this)
o Write an appropriate exercise prescription for the patient. ** Remember to take into account his current level of exercise understanding/status.
§ Use the exercise prescription form below this page for this assignment **Remember as you are filling this out its about “now” and how you want them to start
§ You will need to include, frequency, intensity, duration and type (mode)
§ See Principals of Exercise prescription in this weeks readings
§ See page 21 ACSM Exercise is Medicine for Primary careLinks to an external site. for the prescription form
4. Write a paragraph in laymans terms in which you explain the exercise, the purpose it and safety related to engaging in it.
The Scenario
Sam is a 43-year-old man with known history of hypertension on medication under good control. He has just completed his yearly physical with body matrix being recorded as a body height of 173cm and body weight of 80kg, whereas blood test showed total cholesterol to be 230 and fasting glucose of 129. HR 87 RRR; B/P 129/86 SAO2 99% RA. He states he wants to get healthier and has heard that exercise can help and wants to do this. He wants your help in setting up a exercise plan.
He works as a construction worker. He smokes one and a half pack of cigarettes per day, and has done so for over 25 years. Sam has no signs and symptoms of cardiorespiratory disease at this time. He denies any cardiac symptoms with any activity ever. He states that with his job his knees have really gotten beaten up and with stair walking he sometimes can hear a “crunching” sound. He denies his knees being unstable and states that he does not feel that exercise would make this any worse. He states that he has no trouble with balance and he frequently is up on roofs without any issues occurring. His physical exam demonstrates no pathology that would inhibit exercise engagement and current medications do not impact his ability to participate in exercise.
· Meds: Lipitor 40mg PO QD; Triamterene/HCTZ 75/50 PO QD
· Allergies: NKA
· FmHX: His father died from a heart attack at age 60. Mom is well, brothers x2 both with hypertension
ROS:
Cardiac: Denies experiencing any C/P, palpitations or unusual racing heart with past physical activity
Resp: Denies any SOB, difficulty breathing, asthma type symptoms or cough now or prolonged following past physical activity
MSK: Bil knee crepitus,; no swelling, or pain to his upper or lower extremities with normal activity. States that his legs do get tired after long walks (about 3 blocks) but otherwise no problems. He denies any back pain.
Neuro: Denies any vision changes, H/A’s, vertigo, paresthesia’s to his extremities or any balance issues.
Diagnostics:
Component Results
Component
Your Value
Standard Range
Triglycerides
255 mg/dL
499 mg/dL Very High
Cholesterol
219 mg/dL
240 mg/dL High
HDL
35 mg/dL
40 – 60 mg/dL
NCEP ATP III guidelines: 60 mg/dL Desirable, less than average risk
LDL Calculated
102 mg/dL
189 mg/dL Very High
**Due to the limitations of the Martin Hopkins Calculation, a direct LDL measurement is recommended in cases of Elevated BMI, Triglycerides >400 or calculated LDL’s 190 Very High
Assignment format:
· Title page
· Text page(s) – 1-3 pages
o Make sure to include the Par-Q information
· Exercise prescription
· Reference page
Rubric
Individual assignment Exercise
Individual assignment Exercise
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeAnalysis and synthesis of initial question(s) . Exercise prescription (20 points)
20 to >17.0 pts
Exemplary
Articulately and concisely demonstrates a thorough analysis of the initial question(s). The response is expansive, relevant in a meaningful way. Answer is correct based upon the readings and lecture. Exercise prescription applies clinical reasoning that reflects understanding of the patients exercise exposure appropriately
17 to >12.0 pts
Proficent
Writing contains a clear and convincing analysis of the initial question(s) being explored. The response is relevant and illustrates the writer’s ideas in a meaningful way. The answer may not be absolutely correct based upon the readings and lecture. Exercise prescription applies clinical reasoning that reflects some understanding of the patients exercise exposure, all factors not taken into account in writing the prescription appropriately
12 to >8.0 pts
Minor improvment
Writing addresses the initial question(s) being analyzed. Some details maybe briefly explained so the reader has a limited view of the writer’s ideas. Ideas are relevant though superficial. The answer may not be absolutely correct based upon the readings and lecture. Exercise prescription clinical reasoning demonstrates several areas of incorrect knowledge application in answering the questions. Brevity of answer reducing student’s knowledge clearly maybe present.
8 to >0 pts
Improvement needed
Writing contains partial explanation regarding the initial question(s) being analyzed. The explanation offered is limited or incomplete and conveyance of the writer’s ideas can be confusing to understand at times. Answer / exercise prescription is not correct based upon the readings and lecture (8 or less points)
20 pts
This criterion is linked to a Learning OutcomeEvidence utilization 5 points
5 to >4.0 pts
Exemplary
The literature is cited to support understanding and expand the discussion of the writer’s thoughts.
4 to >2.0 pts
Proficient
The literature may be cited to support understanding and expand the discussion of the writer’s thoughts
2 to >0.0 pts
Minor improvement
Literature may be cited relationship to support answer difficulty to correlate to question
0 pts
Improvement needed
No support from literature
5 pts
This criterion is linked to a Learning OutcomeProfessional reflection 3 points
3 to >2.0 pts
Exemplary
Articulately and concisely demonstrates personal value/belief associated with the focus of the discussion question(s)
2 to >1.0 pts
Proficient
Writing contains a clear and convincing reflection of the writers value/belief associated with the discussion question(s)
1 to >0.0 pts
Minor improvement
Writing reflects value/belief of the discussion question(s), some values/beliefs maybe briefly explained so the reader has a limited view of the writer’s views
0 pts
Improvement needed
Values/beliefs not clearly presented or able to be discerned by reader. Improvement in clarity of view needed.
3 pts
This criterion is linked to a Learning OutcomeSpelling and grammar, APA (2 points)
2 to >0.0 pts
Full Marks
2 points No errors
0 pts
Errors present
1 or less points Errors present
