Ehrman5E_HKPA_Chapter03_CaseStudy- John Coggins
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Valdosta State University *
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3430
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Medicine
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Feb 20, 2024
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Subjective
Medical History and Diagnosis
Mr. MT is a 46 yr old white male with a family history of cardiovascular disease, high blood pressure, and dyslipidemia. He complains of no cardiopulmonary symptoms, including chest pain or pressure, palpitations, wheezing, or syncope. Because he is at high risk for cardiovascular
disease, his primary care physician has started him on the following medications:
Metoprolol, 100 mg/d (a β-blocker)
Atorvastatin, 10 mg/d (
a cholesterol-lowering agent)
Niacin, 1,000 mg/d (an agent that will increase HDLc)
No known allergies
Mr. MT is referred for an exercise prescription as part of a comprehensive therapeutic lifestyle modification program as a means to address his cardiovascular risk factors.
Discussion Questions
a.
Based on the medical history, what is the primary disease of concern, and are there any comorbidities?
In Mr. MT case, the primary disease of concern is CVD because he has a family history of CVD, high, blood, and dyslipidemia, so the primary focus will be on managing and reducing CVD risk factors
Comorbidities: With the current medical history and diagnosis provided, it does not explicitly mention any other medical conditions or diseases aside from the cardiovascular
risk factors. The medications he is taken though would suggest that he is either struggling
with high BP and dyslipidemia or the medications are a preventative measure; further investigation is required to determine if comorbidities are present
b.
Describe the patient’s diagnosis and comorbidities (pathophysiology).
Mr. MT is a 46-year-old white male with a family history of CVD, BP, and dyslipidemia;
therefore, he is on medication to manage symptoms and lower his overall risk of CVD. Also, to lower his CVD risk factors he is being referred for an exercise prescription as part of a comprehensive therapeutic lifestyle medication program. With the current medical history and diagnosis provided, it does not explicitly mention any other medical conditions or diseases aside from the cardiovascular risk factors. The medications he is taken though would suggest that he is either struggling with high BP and dyslipidemia or the medications are a preventative measure; further investigation is required to determine if comorbidities are present
c.
What major symptoms or signs are reflective of the disease of concern and comorbidities if applicable?
d.
What are the recommendations for medical clearance to exercise or become physically active? Is an exercise test required?
e.
Are there any absolute or relative contraindications to exercise testing?
f.
Discuss any medications the patient is prescribed and describe the following:
Mode of action and physiological effects
Indications, usage, and side effects
Influence on exercise and physical activity if applicable
1
From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology HK
Propel Access, 5th ed.
(Champaign, IL: Human Kinetics, 2023).
Objective
Physical Examination Results
Blood pressure 150/94 mmHg, pulse 78 beats · min
−1
, respiratory rate 12 breaths/min. Lungs clear to auscultation.
Blood Chemistry Test Results
Recent laboratory data revealed total cholesterol = 284 mg · dL
−1
, HDLc = 35 mg · dL
−1
, and fasting blood glucose = 106 mg · dL
−1
.
Other Clinical Diagnostic Test Results
No other test results were available.
Exercise Test Results
No prior exercise tests results were available.
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?
BP levels: BP levels reveal that the patient is in stage 2 hypertension, and according to information stated prior in chart doesn’t currently have CVD and current exercise status is not stated. Exercise recommendation would then be to perform interval-based training alternating between moderate intensity exercise and a light intensity rest period
All Blood Chemistry Results (total cholesterol, HDLc fast, and blood glucose): All of their blood work meets the requirements to be considered a risk factor for CVD, so exercise prescription exercise program would need to satisfy FITT principle for aerobic, resistance training, and flexibility exercise to lower patient’s
CVD risk factors and promote improve overall health
b.
Based on the exercise testing results, if applicable, are there any considerations regarding the safety of exercise training for this individual?
Without the patient’s specific exercise testing results, we cannot assess the client’s safety for exercise training based on exercise testing results. However, their BP and cholesterol levels warrant caution (moderate to vigorous PA could prove to be too difficult at the movement so interval training is best now). Further testing is needed to provide insight into cardiovascular fitness and risks during PA. Exercise Assessment and Plan
The patient has hypertension and dyslipidemia, for which patient is being started on metoprolol and atorvastatin, respectively, by his primary care physician. Additionally, an appropriate exercise regimen needs to be developed. Given the absence of a recent exercise test and the potential influence of his medical therapy (
metoprolol is a β-adrenergic blocking agent) on heart rate response, rating of perceived exertion (RPE) can be used to determine the appropriate exercise intensity.
2
From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology HK
Propel Access, 5th ed.
(Champaign, IL: Human Kinetics, 2023).
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?
Hypertension and Dyslipidemia: Both conditions can be improved by regular PA, which contributes to overall cardiovascular health, improved lipid profile, and other positive health benefits. Regular PA is recommended to promote better overall health.
Medications (is exercise unsafe with this combination of medication?): Patient is taking metoprolol, which is β-adrenergic blocking agent causing HR and PB to lower; With the patient not having angina, exercise capacity may decrease or stay the same so monitoring to determine the effects of the drug on the patient is important. Atorvastatin lowers LDLc and total cholesterol and can be used with metoprolol just lower dosage; However, potential side effects such as muscle pain
or weakness can occur. Overall, exercise with these medications should not be unsafe but it is important to monitor patient’s condition while exercising for muscle pain or weakness so exercise can be terminated and call medical professionals (muscle pain or weakness is a severe side effect of atorvastatin so it is advised to call Primary Health Care provider or 111 if these symptoms are present)
Collaboration with Primary Care Physician: Communication with Primary Care Physician who prescribes their medication will be important to help ensure exercise is safe and effective with their current medications
Monitoring: Regular monitoring of the patient’s response to exercise and exercise testing will be important to determine if exercise is unsafe since no prior exercise testing was done Expected benefits:
Improved cardiovascular health specifically lowered BP
Positive effects of lipid profile
Enhanced overall well-being and quality of life
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?
Sign and Symptoms: Patient does not have any cardiopulmonary symptoms that could potentially limit exercise; Patient does have hypertension, dyslipidemia below average RHR so exercise capacity could be severely affect meaning interval training may be best to start with
Medication: Patient is taking metoprolol and with the patient not having angina, exercise capacity may decrease or stay the same; Atorvastatin may cause headaches, nausea, cold-like symptoms, and in severe cases muscle pain or weakness, jaundice, or stomach pain (if severe side effects are present and atorvastatin is thought to be the cause stop exercise and have them care primary care physician or 111 straight away)
Collaboration with Primary Care Physician’s: Communicate with the primary care
physician to ensure exercise regimen aligns with the prescribed medications and overall treatment plan; Communication with primary care physician should help 3
From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology HK
Propel Access, 5th ed.
(Champaign, IL: Human Kinetics, 2023).
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to avoid as much adverse side effects as possible and help boost intended results of medications prescribed
Individual Fitness level, Health Status, and Goals: Assess patient’s current fitness level, any other pre-existing conditions not previously stated, any recent past injuries, and overall fitness goals to help create a tailored exercise plan that ensures safety and effectiveness
Determine patient’s perceived barriers and Self-efficacy to create strategies to promote adherence since client is changing their lifestyle 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?
4
From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology HK
Propel Access, 5th ed.
(Champaign, IL: Human Kinetics, 2023).