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25 May 2018

Medical History:
Ms. PW, a 58 yr old Caucasian woman, is referred by her physician for the development of an exercise prescription. She is 6 yr postmenopausal and has never been on hormone replacement therapy. In 1987, she was diagnosed with hyperthyroidism (overactive thyroid gland), which was treated with radioactive iodine. Since the treatment, Ms. PW has been on synthroid, a drug used when the thyroid gland does not produce enough thyroid hormones. She has mild hypertension, which is regulated by blood pressure–altering medications. Ms. PW is 5 ft 5 in. (165 cm) tall with a weight of 128 lb (58 kg), and her body mass index is in the normal range. She does not follow a regular exercise regimen but reports that she enjoys biking.

Diagnosis:
A few months ago, Ms. PW was diagnosed with osteopenia. Considering her medical history, she is likely to become osteoporotic. Her risk factors are age, sedentary lifestyle, being Caucasian, being petite in stature, loss of menstrual function, and lack of thyroid hormone production.

Exercise Test Results:
She recently underwent an exercise stress test that was normal, but no physiological testing was done other than regular blood chemistries.

Exercise Prescription:
A walking program is surely the best choice because it has the potential of improving not only her cardiorespiratory fitness, but also her bone density. However, Ms. PW is particularly fond of bicycling, and therefore the exercise prescription will incorporate some biking activities, as that is likely to increase her adherence to exercise. These cardiorespiratory activities will start slow and gradually progress over time. Ultimately, her goal would be to walk (3.5 mph [5.6 kph] or faster) or bike 30 to 45 min five times a week. In order to reach this goal, Ms. PW may need to start walking or biking at a slower pace and for a shorter distance, but she should strive to exercise five times a week. After it is determined that she can comfortably handle the speed and distance used for the first 2 wk, these two components should be gradually increased. The best choice is to increase the speed a couple of days a week and increase the distance covered on the other days of the week.
A resistance training program should also be implemented, and may be more beneficial with respect to bone than the cardiorespiratory program. Resistance training should also start slowly, with the frequency beginning at 2 d/wk and moving up to 3 or 4 d/wk. Initially, resistance should be low enough that she can easily complete 12 repetitions of an exercise without undue strain. Exercises that target all the major muscle groups should be incorporated, especially for the legs and back. However, exercises that involve spinal flexion should be avoided. In order to strengthen abdominal muscles, Ms. PW can do leg lifts or modified sit-ups, in which only the head is being lifted off the floor. Upon completion of the first 2 wk, during which the patient does one set of 12 repetitions of each exercise, she can add a second set. This same progression can be used after Ms. PW completes another 2 wk. At this point, the patient should start increasing the intensity by slowly increasing the resistance. An adequate resistance at this point would allow the patient to complete no more than 10 repetitions on the second set. All exercises should be performed with slow, controlled movements. Based on Ms. PW’s medical history, this exercise prescription should be well tolerated and should provide optimal health benefits. Individual cases vary, however, and for a woman who has suffered fragility fractures as a result of osteoporosis, even the minimal exercise described here may not be tolerated initially. Such a patient will need a more gradual, less intense program.

Questions:
1. What other information should be obtained from Ms. PW?

2. What other physiological tests might be recommended?

3. Explain the difference in benefits achieved through cardiorespiratory training versus resistance training for this patient. Why is it always important to incorporate both?

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Tod Thiel
Tod ThielLv2
25 May 2018

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