Medical History and Physycal E x a m i n a t i o n:
At age 7, Mr. AT suffered a series of seizures, and after a physical e x a m, lab tests, and electroencephalography, he was diagnosed with epilepsy and put on epileptic medication. He has gained 25 lb (11 kg) over the last 2 yr. He complains about excessive postural sway and loss of balance while walking and therefore uses his fatherâÂÂs cane. He has no history of smoking or alcohol consumption, but he has a familial history of diabetes. At a recent physical e x a m his low-density lipoprotein cholesterol (LDL-C) was 178 mg Ă¡ dlâÂÂ1, high-density lipoprotein (HDL) was 61 mg Ă¡ dlâÂÂ1, fasting glucose was 88 mg Ă¡ dlâÂÂ1, and waist circumference was 42 in. (107 cm). He is currently on Carbatrol (carbamazepine) and baclofen.
Diagnosis:
Mr. AT, now 28 yr old, was born prematurely along with his twin sister at 34 wk. His mother experienced a severe infection early in her pregnancy and was hospitalized for several days; upon birth he had an Apgar score of 4. At age 1 he was diagnosed with spastic hemiplegia.
Exercise Test Results:
Because Mr. AT is ambulatory but has balance difficulties, leg cycle ergometry was chosen as the method of aerobic exercise testing. His resting blood pressure and heart rate in a seated position were 134/80 mmHg and 82 beats Ă¡ minâÂÂ1, respectively. A small face mask was used to provide an adequate seal. A toe clip on his right side was used to maintain proper foot positioning on the pedals, and an adaptive glove was used to help his right hand grip the handlebar throughout the test. Mr. AT performed a 2 min warm-up without resistance. The leg cycle ergometry test began at 25 W at a cadence of 50 to 60 rpm. The protocol consisted of 2 min stages with an increase of 15 W per stage. The following data were collected during the exercise test.
The exercise test was terminated at 5:15 because of increased hip adductor spasticity and inability to maintain speed of 50 rpm, and by request of the participant because of shortness of breath. No signs of electrocardiogram abnormalities were present during the test. His V.O2 at 5:00 was 16 ml Ă¡ kgâÂÂ1 Ă¡ minâÂÂ1. The RER was <1.00 and the heart rate and V.O2 failed to reach peak. This was not a valid peak V.O2 test.
Because of the termination of the clinical leg cycle ergometry test, a more functional approach was chosen. The Timed Get Up and Go test was used as a baseline measure. This test used the following protocol.
Test Instructions
1. Starting position: Sit upright against the chair.
2. Stand up from the chair (time start).
3. Move quickly along the line toward the opposite end.
4. Touch the end and pivot back toward the chair.
5. Move quickly all the way back to the chair.
6. Pivot.
7. Sit back down (time end).
The total distance was 10 ft (3.05 m). The test was performed three times. Mr. ATâÂÂs scores were 42 s, 38 s, and 40 s. (A score over 30 s suggests a higher risk of falls.) Mr. AT used his assistive device during all testing.
Exercise Prescription:
Using the information presented in the medical history and exercise testing sections and in tables 27.9 through 27.11, develop an exercise prescription that encompasses aerobic, strength, flexibility, and neuromuscular training. Consider the different modes for each of the exercise training domains and the frequency, duration, intensity, and progression of each.
Questions:
1. How would the clinical exercise physiologist best determine the appropriate resistance levels to prescribe for this person?
2. What factors represented in the ICF model should the clinical exercise physiologist take into consideration to increase the adherence level and success of this client?
3. What fall prevention strategies should be incorporated into the exercise prescription for an individual who is at increased risk for falls?
4. Is the assistive device described in this case study appropriate for use by Mr. AT?
5. How should the clinical exercise physiologist incorporate weight loss strategies into the goals for this client?
