Medical History:
Mrs. KY is a 45 yr old Caucasian female, married with two teenage sons. She is employed as a senior manager at a large bank and reports experiencing an “above average” level of tension and stress. She presents at the referral of her primary care physician, who has observed that the client has elevated blood pressure and cholesterol levels that may be attributed to her stressful and highly sedentary job. In addition, the client admits that she would like to lose 30 to 40 lb (14 to 18 kg) and improve her fitness so that she can ride her bike with her husband on a community rail trail recently installed by her neighborhood.
Diagnosis:
Mrs. KY is a sedentary but otherwise healthy middle-aged female with significant risk factors for cardiovascular disease including obesity, dyslipidemia, and psychosocial stress. At the request of her physician she seeks to start exercising as part of a disease prevention program.
Exercise Test Results:
The client is 5 feet 6 in. tall (168 cm) and weighs 196 lb (89 kg), with a body mass index of 31.7. She has a resting heart rate of 85 beats · min–1 and a resting blood pressure of 136/89 mmHg. Her total cholesterol is 198 mg · dl–1 untreated, and her high-density lipoproteins are 34 mg · dl–1. Her graded treadmill stress test revealed that she has a V.O2max of 20.5 ml · kg–1 · min–1, which is normal for an unfit woman of her age range. Her electrocardiogram was also unremarkable at rest, as well as during and following her test. In addition, she reported smoking from ages 17 to 40. She also complains of occasional joint stiffness in her hands and ankles. The client describes herself as nonathletic and admits to never participating in an organized sport or exercise setting. She is aware of the benefits of exercise but did not feel an incentive to begin a formal program until her doctor’s recommendation. The client jokes that although her workday is highly organized and structured, the rest of her life is chaotic and that it is due only to the support of her husband and kids that anything gets done at home. She laments that her eating habits are atrocious and that she is so tired when she gets home from work that she has only enough energy to make dinner before crashing in front of the television. She presents to you to start a workout program that will help achieve her goals.
Exercise Prescription:
The exercise plan including the traditional components—frequency, intensity, duration, and modality (discussed in detail in later chapters)—may be tailored to address specific risk factors. The subject’s medical history, however, clearly indicates that this person had not prioritized exercise participation until she received her doctor’s recommendation. Moreover, she presents with numerous potential barriers to engaging in a physically active lifestyle, as well as behaviors that contribute to her overweight status. The clinician should assist the participant in establishing awareness and developing strategies to address those barriers. Furthermore, the clinician should consider tailoring strategies for motivating the participant toward the adoption of a healthy, physically active lifestyle.
Questions:
1. Applying the transtheoretical model, at what stage of exercise adoption is this client?
2. Based on your response to question 1, what types of interventions are most appropriate for this stage of change and why?
3. If you used the health belief model, what factors would you emphasize to achieve optimal exercise adherence?
4. How would Bandura’s social cognitive theory be relevant to fostering exercise adherence for this client?
