1. Dear Mr. Mike Poteat,
Congratulations on making the decision to enhancing your life through
physical activity. I am ecstatic to assist you on reaching your goals to a healthier
lifestyle. Thanks to your compliance with taking the many health assessments, I
surmised your information and determined where you rank, based on age and sex,
with the “American College of Sports Medicine’s Guidelines for Exercise Testing and
Prescription”.
During your interview with Mr. McCammon, you stated that your long-term
goal is to weigh between 175-178 lbs.; and your short term goal is to lose about 5
pounds and participate in more aerobic activity, in order to build endurance for
tennis. The semester will be ending in the next 5-6 weeks, and I am very confident
that I can help you reach your short-term goal and with more time even your long
term goal! Previously, you stated that you participated in both strength training and
aerobic activity, but during Christmas break you stopped. Since then, you mainly do
aerobic exercise with the stationary bike for about 2-3 hours, 5 days a week, 32-34
minute sessions, at a speed of 12 mph. Also, that you currently participate in
strength training twice a week. That is great; it seems your physical activity level is
very good! Although, I would encourage at least another strength training day
incorporating vigorous and explosive exercise to further your strength and
endurance levels. However, this assessment is not a replacement for professional
2. medical care, but to take into consideration that incorporating this program can
help lessen medical problems in the future.
Throughout the paper, I will be summarizing your current health
assessments and review over the recommended values for several variables
including blood pressure, cholesterol levels, blood glucose, body mass index (BMI)
and many others that could be detrimental to your health, if left unchecked. I will
also be discussing your past surgeries and what I plan to do to help strengthen your
muscles to help relieve some discomfort. As well as the medications you were
prescribed for hypertension, mood, and sleep aid. Exercising regularly and
maintaining a healthy lifestyle can provide many benefits towards your health in the
future. Exercising can help prevent or delay the chance of contracting Type 2
Diabetes, stroke, and myocardial infarction. I would say exercising can help save you
a lot of money on prescription medications; being active is great for the body and
the mind.
I would like to commend you again on seeking help with your health, because
I know the hardest step is asking for help. By doing so, I can now give you proper
guidance and support to help you reach your goals and beyond. As long as you stay
motivated and believe in the program, and me; I know we can achieve your goals!
4. Aerobic
fitness Level
50th
percentile
60th percentile and above
Values highlighted in red represent positive risk factors.
Values highlighted in blue represent negative risk factors.
I will first discuss your baseline vitals; these are your Body Mass Index (BMI),
waist measurement, regional body fat, blood pressure and heart rate. First, your
BMI was measured at 27 kg/ m2, the recommended range for age and sex is between
18.5-24.9 kg/ m2. This would place you outside of the normal average range for a
white adult male and into the overweight category. This is not a positive risk factor,
although you are considered overweight, you are not obese. If you had a BMI greater
than or equal to 30 kg/ m2, then you would be considered a positive risk factor. A
positive risk factor means you are classified as being at risk. [1] Second, your waist is
38.5 inches, which meets the recommended of being less than or equal to 40 inches.
Third, the results for your regional body fat was 30.1 percent, the recommended
optimal range for body fat, for your age and sex, is between 11-23 percent. Fourth,
your blood pressure was measured at 118/84; 118 is your systolic blood pressure, it
is the maximum arterial pressure occurring during the contraction of your left
ventricle of the heart. The value 84, represents your diastolic blood pressure, and is
the minimal arterial pressure occurring during the relaxation of the ventricles of the
heart. Your systolic is within the recommended range, but your diastolic is a little
high. This value categorizes you into prehypertension, making this a positive risk
5. factor. It is possible to reduce this value through exercise, so do not let this risk
factor discourage you. [7] Lastly, your resting heart rate was 69 beats per minute
(bpm), the recommended range is 60-100 bpm. Considering your results, you are
doing very well, thus far, with only one risk factor, so let us continue to your blood
test.
Next, I will be covering your blood test results, which includes your total
cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and
triglyceride levels. First, let us discuss your total cholesterol, your blood test shows
a value of 193 mg/ dL, which is within the normative range of being less than 200
mg/dL. Second, your HDL value was 71 mg/ dL, this is really good! The
recommended range is greater than or equal to 40. Additionally, since your HDL
value is so high it is considered a negative risk factor. This is due to the cardio
protective effect of HDL, having greater than or equal to 60 mg/ dL, the more high-
density lipoprotein you have, the better it is. [1] Third, your results for LDL was 100
mg/ dL, the recommended value is being less than 130 mg/ dL; for LDL lower is
better, if it were high you would be at risk for developing atherosclerosis.[1] A great
way to prevent a high LDL level would be to incorporate a healthier diet. One in
particular is called the “TLC diet”, TLC stands for the therapeutic lifestyle changes,
and it influences one to eat a more low saturated and low cholesterol diet.
Additionally, to incorporate more fiber, whole grains, fruits and lean meats.[4] Lastly,
your triglyceride values are 108 mg/ dL, the recommended value is less than 150
mg/ dL. If you were to be over 150 mg/ dL, you would be a positive risk, but it
would also indicate an elevated risk of stroke and heart disease. [6] A great way to
6. keep your triglyceride levels low and maintain healthy HDL and LDL values is
through regular exercise for 30 minutes, 4-5 days a week of moderate intensity. If
you do not have time for a 30 minute bout, try for 10 minute bouts three times a
day. Physical activity exercises, as, easy as, a brisk walk, or swimming is good; if you
are at work, simple exercises such as push-ups, sit-ups, or climbing stairs are also a
great workout. [6]
Finally, I will go over your cardiovascular tests; which includes max heart
rate (HR), Balke Treadmill Test (with percentile), and VO2 max (with percentile).
First, your max heart rate result was 151 bpm, the normative range is 155 bpm,
based on your age. The maximum heart rate is used to help determine target heart
rate zones. Maximum heart rate can be estimated by calculating 220 minus one’s
age. [1]Second, the results for your Balke Treadmill test was 13:20, placing you
between the 50-55 percentile, ranking your fitness level as fair. This ok, but the
recommended range is remaining on the treadmill between 16:39-27:00. This
would categorize your fitness level in the good to superior; also place you in the 60-
99 percentile. [1] Considering your fitness level, you are fine, only if you were below
the 20th percentile for your age and sex, would you be considered at risk for being
sedentary. A sedentary lifestyle is indicative of having an increased risk of death. [1]
Overall, the key to good health is maintaining a healthier lifestyle, an active lifestyle
and incorporating a healthy diet.
7. Explanation:
Now, let us go over your “Know Your Number” report. I would first like to
begin with your current risk of being diagnosed with a disease in the next 5 years.
This is comparing you to 100 people who have the risk factor information and the
likeliness of you being diagnosed with that disease; it will be translated into your
percent of risk for disease onset. On your report it shows that have a 2.5% chance of
contracting coronary heart disease (CHD), meaning approximately 2 or 3 out of 100
people with similar results to you will be diagnosed with CHD. Additionally, 1.7%
will develop a stroke, 3.4% will be getting diabetes and 1.4% will contract coronary
heart failure (CHF). So within the next 5 years, it is projected that 1 to 4 of the 100
people with your related risk factors will be diagnosed with one of these
corresponding diseases. This is considered relatively low to below average on the
risk percentile graph. Your modifiable risk is the percentage of your current risk and
how modifying your behavior can decrease your chance of developing the specific
disease listed. On the report it shows you have a 33% modifiability for CHD, 29%
towards stroke, 64% to diabetes and 11% for CHF. Below the percentile chart is a
graph that shows your modifiable risks and what is being modified. It shows seven
modifiable factors, smoking, cholesterol, blood pressure, weight, glucose, exercise,
and aspirin. With these factors considered, it shows us the amount of what each
factor contributes based on the disease. For example, 64% your risk of developing
diabetes is modifiable, with a large percentage contributed to glucose followed by
weight. Lastly, the “Know Your Number” report shows your current percentile risk
as it is compared to other Americans in your same age and gender group. It
8. represents the percentage of individuals who are at a lower risk than you for that
particular disease. Your results show 3% for CHD, 12% for stroke, 50% for diabetes,
and 22% for CHF. Understandably, in your results it shows that 50% of relatable
Americans have a lower risk of developing diabetes, compared to you.
Regarding your “Know Your Number” results, let us discuss it comparing it to
heart disease. Heart disease is also known as coronary heart disease; it is related to
plaque buildup in the walls of the arteries, or atherosclerosis. It makes it more
difficult for blood to flow and creates a risk for a heart attack or stroke. [2] Heart
disease is the leading cause of death for men in the United States; it contributes to 1
in every 4 male deaths. Also, between 70% and 89% of sudden cardiac events
occurs in men. Some key risk factors are high blood pressure, high LDL cholesterol,
and smoking. [3]Referring to your blood pressure which was 118/ 84 mmHg, your
systolic is within the recommended range; whereas, your diastolic is not, as I
discussed earlier. Because, your diastolic blood pressure is considered to be a
positive risk factor for prehypertension, you are in danger of having high blood
pressure. High blood pressure is classified as having a blood pressure higher than
140/90 mmHg, people with this statistic often become patients treated for serious
cardiovascular problems. [2] Also, if you had high cholesterol that would be a factor
as well, but your levels were great! Your HDL was 71mg/ dL, LDL was 100 mg/ dL,
and triglycerides were 108 mg/ dL; these results were all in the recommended
range for good health. Furthermore, you mentioned you use to smoke in the past,
9. but that was more than 6 months ago, congratulations on quitting! Because you
stopped smoking so long ago this is not considered a risk factor.
Next, I want to discuss type 2 diabetes. Diabetes is a disease in which blood
glucose levels are higher than normal, greater than or equal to 126 mg/ dL. Type 2
diabetes can affect anyone, no matter the age; people who are overweight and live
an inactive lifestyle are more likely to develop type 2 diabetes. It usually begins with
insulin resistance, a condition that occurs when fat, muscle, and liver cells cease to
use insulin and carry glucose into the body to use as energy. Then the pancreas try
to keep up by producing more insulin. Eventually, the pancreas will not be able to
make enough insulin when blood sugar levels increase. When this happens you will
need to start treating for type 2 diabetes. [5] According to your results, you had a
blood glucose level of 115 mg/dL, placing you in the prediabetes section.
Prediabetes is when the amount of glucose in your blood is above normal yet not
high enough to be called diabetes. Because of this your chances of contracting type 2
diabetes, heart disease, and stroke are higher. Fortunately, with some weight loss
and moderate physical activity, you can delay or prevent type 2 diabetes. You can
even return to normal glucose levels, possibly without taking any medicines. [5]
Lastly, atherosclerotic stroke, heart disease and stroke are the usual
consequence of atherosclerotic stroke and even hypertension. Atherosclerosis
consists of concentrated areas of atheromas within the arterial wall that often
become encrusted or hardened by deposits of calcium, thus resulting in plaque
10. build-up. This plaque weakens the arterial wall, lowering blood flow to the heart,
the brain, and lower extremities. Should this plaque be unchecked, it can continue to
build until it ruptures resulting in a heart attack or stroke. About half of all strokes
are due to atherosclerosis, the same process of narrowing and hardening of the arteries
that cause heart attacks inhibiting blood flow to the brain.[7] Ishemic strokes accounts
for 87% of all strokes, this occurs when there is an obstruction within the blood
vessel that feeds blood to the brain. Hemorrhagic strokes, another form of stroke,
occurs when a weakened blood vessel ruptures and bleeds into the brain after it breaks.
This form of stroke is commonly caused by uncontrolled hypertension. Keep in mind that
there are such things as “mini strokes,” also known as TIA or transient ischemia attack.
These are caused by a temporary blood clot. It is an important to pay attention to your
body and recognize the sign and symptoms associated with it. An easy way to remember
the sudden signs and symptoms of a stroke is by an acronym known as F.A.S.T; Face
drooping, Arm weakness, Speech difficulty, Time to call 911. [7] If these signs should
occur you will know to call 911 or ask for immediate assistance. Furthermore, high
blood pressure, hypertension, can also cause heart disease or stroke by exacerbating
the effects of other risk factors in accelerating the progression of atherosclerosis,
through continued, excess work on the heart. [3] Considering you are categorized as
prehypertensive, for having a diastolic value of 84 mmHg and taking prescription
and anti-hypertensive medication, you should make modifiable decisions to become
physically active. Being more physically active can help improve diastolic value to
the recommended range of less than 80 mmHg.
11. A great way to prevent heart disease, type 2 diabetes, or atherosclerotic
stroke is to be physically active and maintain a good diet. The guidelines from the
ACSM exercise prescription for cardio, strength and flexibility are great ways to
ensure a healthy, active lifestyle. Cardiorespiratory exercise should be at least 150
minutes per week of moderate intensity; 30-60 minutes of moderate intensity or 20-
60 of vigorous activity per session for 3-5 days a week. It recommends strength
training 2 or 3 days a week, approximately 10-15 repetitions for 2-4 sets, targeting
major muscle groups. Lastly, flexibility should be done 2 or 3 days per week, to
improve range of motion, holding each stretch 10-30 seconds, repeating each
stretch 2 to 4 times to accumulate 60 seconds. [1] Also, incorporating a healthy diet
will contribute to one’s risk of contracting a potential health risk.
When prescribing an exercise program, the trainer is trying to meet to
client’s heath and fitness goals, because what works for one person may not work
for the next person. Each person is genetically made differently, so when prescribing
exercise to a client it should match their goals. The components to be address here
are cardiovascular fitness (aerobic exercise), muscular strength, as well as
flexibility.
First, aerobic exercise has many benefits, it increases efficiency of
respiration, blood volume to muscles, stroke volume, cardiac output, body
composition, and many more. It can also help decrease the risk of developing
coronary heart disease, cancer and diabetes, which is very beneficial for someone
12. with a family history of diabetes. [1] Not only does aerobic exercise help with
lowering health risks and improving cardiovascularity, pumping more blood to the
heart per beat, reducing heart rate during rest and exercise; also, it has
psychological benefits. According to the ACSM Guidelines for Exercise Testing and
Prescription, regular exercise can help improve self-esteem and lower rates of
depression. When you exercise the body releases endorphins, these are considered
natural painkillers that reduces your perception of pain and triggers a positive
feeling in the body. I know you cycle often, it is the feeling you get after you
complete your cycling session, known to runner’s as the “runner’s high”; you feel
really good and you have that sense of achievement! Also, aerobic exercise involves
using large muscle groups such as your lower body, quadriceps, hamstrings and
glutes. The body works the hardest when there is multiple muscles being recruited
in a single movement, increasing caloric expenditure. Thus, incorporating a variety
of aerobic exercises will help improve your health, mobility, well-being, self-efficacy,
cardiovascular health, and strengthen your muscles. I have devised a 4 week
aerobic exercise program for you to partake in, based on your Heart Rate Reserve
(HRR) and your VO2 Reserve (VO2R). [1]
Aerobic Exercise Program
Week
Intensity
(HRR) Duration
Frequenc
y Mode Work Rate VO2R
1
40%-50%
(101-120
bpm) 20-30 mins
3-4 days/
week Treadmill
Speed=3.0
mph
Elevation=9%
15.62-18.65
ml/kg/min
2
40%-50%
(101 -120 20-30 mins
3-4 days/
week Treadmill
Speed=3.0
mph
Elevation=10
15.62-18.65
ml/kg/min
13. bpm) %
3
50%-60%
(120-141
bpm) 30-40 mins
4-5 days/
week Treadmill
Speed=3.0
mph
Elevation=12
%
18.65-21.68
ml/kg/min
4
50%-60%
(120-141
bpm) 30-40 mins
4-5 days/
week Treadmill
Speed=3.0
mph
Elevation=13
%
18.65-21.68
ml/kg/min
This 4 week plan shows a steady increase in your intensity, duration, and
work rate. Using your VO2 max I have determined your elevation and gradually
increased it each week. The purpose to the gradual increase is because with time
your body will begin to adapt and get stronger. When this occurs, your body needs
to be challenged in order to become stronger. By week 4, you should be able to
clearly see results, not only in your aerobic capacity, but externally as well; such as,
your body composition.
Also, to go along with aerobic exercise you should incorporate strength
training into your schedule. Practicing strength training is really good for your body,
especially at an older age, your bones begin to get weaker and your muscles will
suffer from atrophy. To ensure optimal health/ fitness gains and minimize any
possible injury it is imperative to practice strength training. Below I have devised a
4-week resistance program to help you get back in the routine of strengthening your
muscles.[1]
4-week Resistance Program
14. Week Frequency
Time
(min) Intensity (%) Repetitions Sets
1
2-3 days/
week N/A 40-50% 1-RM 8-12 1
2
2-3 days/
week N/A 40-50% 1- RM
8-12
1
3
2-3 days/
week N/A 60-70% 1-RM
10-15
1-2
4
2-3 days/
week N/A 60-70% 1-RM
10-15
1-2
In this 4-week resistance program, I have increased your intensity,
repetitions, and sets gradually. The purpose to this is to continue to increase
muscular strength and mass, this is known as “progressive overload”. Progressive
overload can be accomplished many ways, in this exercise program I have increased
the number of sets. A single set of resistance exercise is effective especially among
older adults and novice strength trainers such as yourself. I increased the number of
sets in order to improve strength and power. Based on your age I increased the
repetition levels from 8-12 to 10-15 repetitions; 10-15 repetitions is effective in
improving strength in middle-aged and older adults. The intensity range is also
based on your age, 20%-50% based on 1 repetition maximum is good for older
adults to improve power. Also, intensity levels in the 40%-50% range of 1 repetition
max is very beneficial for older adults and beginners in strength training. It is also
great for improving strength in sedentary individuals beginning a strength training
program. I increased your intensity to 60%-70% of 1 repetition max because it is
recommended for older adults and very deconditioned individuals. The type of
exercises you should participate in should involve your major muscle groups that
incorporate multijoint exercises to single joint exercises. Exercises can include
15. lunges, squats, push-ups, overhead shoulder press, bench press, bicep curls, tricep
curls, hamstring curls, leg extensions, etc. These exercises can be performed with
barbells, dumbbells, or even your own body weight. There are a variety of ways to
increase strength, but it is important to maintain and adhere to the program to
promote longevity and a strong, healthy body. [1]
Lastly, incorporating flexibility into your regimen can be very beneficial; it
can enhance posture, improve balance and coordination. You will also want to
develop range of motion in major muscle tendon groups, such as your shoulder,
girdle, chest, neck, trunk, lower back, hips, legs, and ankles. Be sure that your
muscles are warm before you stretch. The best time to stretch is immediately after
exercise since your muscles will have been warmed up through exercise. There are
six types of flexibility stretches known as ballistic, dynamic, static, active static,
passive static, and proprioceptive neuromuscular facilitation (PNF). Ballistic
stretches use the momentum of the body segment in order to produce the stretch,
also known as “bouncing”. Dynamic stretching involves a gradual transition from
one body position to another, progressively increasing the range of motion through
repeated movement. Static stretching is slow stretching a muscle/tendon group and
generally holding the stretch for 10-30 seconds. Active static stretching involves
holding the stretch using the strength of the agonist muscle, it is quite common in
yoga. Passive static stretching involves assuming a position while holding a limb or
other part of the body with or without assistance of a partner or device; such as
elastic bands or a ballet bar to assist with balance. PNF methods has many forms but
16. typically involves an isometric contraction of your muscle/ tendon group and is
then followed by a static stretch of the same muscle/tendon group. [1] Below is a
detailed summary of the FITT-VP principle of Ex Rx for flexibility exercises.
Flexibility Training
Frequency
≥2-3 d . wk-1 with daily being most effective
Intensity
Stretch to the point of feeling tightness or slight
discomfort
Time
Holding a static stretch for 10-30 s is recommended for
most adults.
In older individuals, holding a stretch for 30-60 s may
confer greater benefit.
For proprioceptive neuromuscular facilitation (PNF)
stretching, a 3-6 s light-to-moderate contraction (e.g.,
20%-75% of maximum voluntary contraction) followed
by a 10-30 s assisted stretch is desirable.
Type
A series of flexibility exercises for each of the major
muscle-tendon units is recommended.
Static flexibility (i.e. active or passive), dynamic
flexibility, ballistic flexibility, and PNF are each effective
Volume
A reasonable target is to perform 60 s of the total
stretching time for each flexibility exercise.
Pattern
Repetition of each flexibility exercise 2-4 times is
recommended.
Flexibility exercise is most effective when the muscle is
warm through light-to-moderate aerobic activity or
passively through external methods such as moist heat
packs or hot baths.
17. Mike, I want to commend you for making the decision to live a healthier
lifestyle that will overall benefit your life. As I have discussed chronic diseases have
an effect on one another and early detection is good to promote a prolonged life.
Exercise adherence directed toward strength, aerobic, and flexibility will also assist
in promoting a stronger body, which will help you maintain your independence.
Paired with maintaining a generally healthy diet are key factors to lessening health
risks, building muscle, and promoting a healthy life. You are not in horrible
condition, but there are some areas to improve on. With this exercise program,
specifically designed for you based on your health and current lifestyle. The harder
you work, the better results you can expect to see. I am honored to have been able to
help you improve your life, because I know it takes a lot of courage to ask for help. If
you ever need assistance or have any questions, I am here for you! From the words
of Mahatma Gandhi, “ The future depends on what you do today”, so always strive
for a better future!
18. Bibliography
[1] American College of Sports Medicine, Thompson, W. R., Gordon, N. F., &
Pescatello, L. S. (2014). ACSM's guidelines for exercise testing and prescription
(9th ed.). Philadelphia: Lippincott Williams & Wilkins.
[2] American Heart Association. (n.d.). Conditions. Retrieved from
http://www.heart.org/HEARTORG/Conditions/Conditions_UCM_001087_SubHome
Page.jsp
[3] Center for Disease Control and Prevention. (2013, August 26). Men and Heart
Disease Fact Sheet|Data & Statistics|DHDSP|CDC. Retrieved from
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm
[4] Cholesterol Levels: What You Need to Know | NIH MedlinePlus the Magazine.
(2012). Retrieved from
http://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/summ
er12pg6-7.html
[5] National Diabetes Information Clearinghouse. (2014, February 12). Your Guide to
Diabetes: Type 1 and Type 2: Learn about Diabetes - National Diabetes Information
Clearinghouse. Retrieved from
http://www.diabetes.niddk.nih.gov/dm/pubs/type1and2/index.asp
19. [6] Triglycerides: Why do they matter? - Mayo Clinic. (2012, September 28).
Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-
cholesterol/in-depth/triglycerides/art-20048186?pg=2
[7] Types of Stroke. (n.d.). Retrieved April 15, 2015, from
http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Type
s-of-Stroke_UCM_308531_SubHomePage.jsp
[8] What Is High Blood Pressure? - NHLBI, NIH. (2012, August 2). Retrieved from
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