Medical History:
Mr. AB, a 60 yr old Caucasian male, comes to your fitness center for an exercise program. He is apparently healthy but has a 15 yr history of hypertension. His goal is to improve his health and fitness and reduce his risk for heart disease. In the past he did heavy resistance training and powerlifting. At present he has a body mass index of 31 kg · mâ2. His medications include aspirin (325 mg daily) and atenolol (50 mg daily). He has a familyhistory of premature CHD; his low-density lipoprotein (LDL) cholesterol is elevated (165 mg · dlâ1); his resting BP is 148/88 mmHg; and his resting heart rate is 60 beats · minâ1. He drinks three or four cans of beer with dinner each evening.
Diagnosis:
Mr. AB has a lengthy history of hypertension. Additional risk factors include obesity, age, family history, dyslipidemia, sedentary lifestyle, and elevated alcohol consumption.
Exercise Test Results:
During a recent maximal exercise test, Mr. AB exercised for 6 min using the Bruce treadmill protocol and achieved a maximum heart rate of 130 beats · minâ1 and BP of 240/90 mmHg. He did not develop any significant arrhythmias or ST-segment changes.
Exercise Prescription:
Mr. AB achieved 81% of his age-predicted maximal heart rate (HRmax). The test was negative for underlying cardiovascular ischemia. The initial prescription should be set at a modest intensity (40% V.O2R), and emphasis should be placed on building exercise duration to increase energy expenditure. Non-weight-bearing activities should be emphasized initially to minimize risk of musculoskeletal injury.
Questions:
1. Is it necessary for Mr. AB to exercise at high intensity to help manage his hypertension?
2. How will atenolol (a b-blocker) affect the prescription of a target heart rate range for Mr. AB?
3. What is an appropriate aerobic exercise prescription for Mr. AB?
4. What advice would you give Mr. AB about going back to heavy resistance training and powerlifting?
5. What additional lifestyle modifications should be discussed with Mr. AB to optimize his BP control?
