Subjective
Mr. AK is a 62 yr old air traffic controller at AtlantaHartfield International Airport. He is seen today to “start anexercise program to help manage his occupational stress” (currentlyworking 55 h/wk). He plans to exercise prior to work and onweekends.
He does not smoke; denies chest discomfort with exertion,syncope, or excessive shortness of breath; and has a history oftreated hypertension (lisinopril), prostate cancer treated withradiation and medical therapies in 2012, and intermittent limitinglow back pain. Family history negative for heart disease, and he ismarried with 2 grown children. Through his primary care provider anexercise stress echocardiogram was ordered and completed 3 moago.
Objective
Body mass index is 33.1, given height of 69 in. (175.3 cm) andweight of 224 lb (101.8 kg). Results from prior exercise stressechocardiogram revealed no chest pain and no ECG orechocardiographic evidence of exercise-induced myocardial ischemia;total time = 9 min using the Bruce protocol (~9-10 METs); restingheart rate = 72 beats · min–1; resting blood pressure =118/72 mmHg; resting ECG showed normal sinus rhythm with rarepremature atrial contraction and first degree AV delay; peak heartrate = 157 beats · min–1 (100% of age predicted); peakblood pressure = 205/84 mmHg; and exercise ECG showed rarepremature atrial and ventricular contractions. At peak exercisethere was 0.75 to 1.0 mm J-point depression with horizontal STsegments noted in leads III and V6, with quick resolution within 1min of recovery. Test was read as negative for exercise-inducedmyocardial ischemia.
Assessment
- Obesity based on body mass index of 33.
- Average exercise tolerance, estimated at 9-10 METs.
- Normal exercise test.
Plan
- Meet with a registered dietitian to manage caloric intake forprogressive weight reduction equivalent to ~1-2 lb per week topatient’s identified goal of 190 lb. Achieve through portioncontrol and reduction in number of servings and caloric content offoods, as well as increased caloric expenditure.
- Initiate a progressive indoor or outdoor walking program up to150 min per week. Set intensity at 60% to 80% of heart ratereserve. Consider introducing higher-intensity interval training upto a heart rate reserve set at 90%.
- Initiate a strength training program 1-2 d per week at localtraining facility, focusing on 8-10 large muscle groups. 1-2 setsper muscle group for 12-15 repetitions per set.
Case Study Discussion Questions
- Given the above data, what would be the appropriate exerciseintensity (i.e., heart rate range) during moderate continuousexercise for Mr. AK?
