Indiana university department of kinesiology clinical exer

1. INDIANA UNIVERSITY
DEPARTMENT OF KINESIOLOGY
CLINICAL EXERCISE PHYSIOLOGY K562
EXERCISE PRESCRIPTION/PROGRAMMING CASE
STUDIES:
DIABETES
(286 Points)
Show all your mathematical work for evaluating METs, target
heart rates, and target body weights.
CASE STUDY 1
A 54 yo diabetic woman has joined the hospital diabetes care
program. In this program she will
receive diabetes education and exercise instruction. She was
diagnosed diabetic eight months ago. She
has been put on Glucovance BID and told to diet and exercise.
So she recently began to walk for 30
minutes, four days a week at a light intensity.
Her hospitalizations include routine childbirth (x3) and kidney
stones at age 18 year old. Usual
childhood diseases. No family history of heart disease,
however, her grandmother was diagnosed with

2. diabetes at age 58 year old. She is a past smoker, having
smoked 1 pack/week for 35 year and recently
tapered off.
Her laboratory data:
Height 64.2” Weight 210.3 pounds
Resting HR 75/min Resting Blood Pressure 119/80-80
Cholesterol 210 Vital Capacity 3.5 L
HDL 40 FEV1 2.3 L/sec
Triglycerides 438 Percent Fat 38.4%
Glucose 125 Waist Circumference 103.1 cm
HbA1C 8% Hip Circumference 125.0 cm
1. Is physical activity/exercise appropriate for this patient at
this time? (5 pts)
a. Explain (5 pts)
2. What is/are the appropriate exercise/physical activity
facility/location for this patient? (5 pts)

3. a. Explain (5 pts)
3. Her exercise prescription/physical activity advice should be.
Explain. (12 points)
a. Mode:
b. Frequency:
c. Duration:
d. Intensity:

4. 4. What precautions would you give her about the time of day
for physical activity/exercise? (5
pts)
a. Explain (5 pts)
5. What precautions would you give her about the timing of
medications and physical
activity/exercise? (5 pts)
a. Explain (5 pts)
6. If her pre-exercise blood sugar is 115 mg/dl, what
medication/diet precautions would you give
her about exercising that day? (5 pts)

5. a. Explain (5 pts)
7. If her pre-activity blood sugar is 240 mg/dl, what
medication/diet precautions would you give
her about exercising that day? (5 pts)
a. Explain (5 pts)
b. What is her risk for an activity related hypoglycemia? (5 pts)

6. i. Explain (5 pts)
8. If she presented with retinopathy how would you adjust her
exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)
CASE STUDY 2
This 69 yo retired engineer is participating in the Diabetes Care
Clinic at the
hospital. He was diagnosed with diabetes 13 years ago, but has
not been in good
control. It was believed that he should go through diabetes
education again. Part of the
diabetes education classes is full evaluation and individualized
exercise prescription.

7. He had the usual childhood diseases with the exception of
Whooping Cough at
age 1 year. At age 23 years old he was hospitalized for an
appendectomy. His
grandfather had a stroke at age 83 and died at 84 years old. His
uncle had adult onset
diabetes.
His insulin regimen is
10:00 am: 5 units of Regular and 13 units of Lente
10:00 pm: 5 units of Regular and 5 units of Lente
He is currently recovering from arthroscopic surgery of his left
knee (torn
meniscus). For the past year, he has been lifting weights 60 to
80 minutes (hard), 3
days a week; plays tennis (moderate) 30 to 50 minutes, twice a
week; and does
calisthenics (moderate) 30 to 60 minutes, 3 days per week.
He is a past smoker, having smoked 5 to 8 cigaretttes a day for
29 years. He
quit 19 years ago.
Other data include:
Height 167.6 cm Weight 63.9 kg
Glucose 234 mg/dl Vital Capacity
Cholesterol 201 mg/dl FEV1
Triglycerides 152 mg/dl Resting Heart Rate 52
HbA1C 12.3% Resting BP 146/88-78

8. 9. Is physical activity/exercise appropriate for this patient at
this time? (5 pts)
a. Explain (5 pts)
10. What is/are the appropriate exercise/physical activity
facility/location for this patient? (5 pts)
a. Explain (5 pts)

9. 11. His exercise prescription/physical activity advice should be.
Explain. (12 points)
a. Mode:
b. Frequency:
c. Duration:
d. Intensity:
12. What precautions would you give him about the time of day
for physical activity/exercise? (5
pts)
a. Explain (5 pts)

10. 13. What precautions would you give him about the timing of
medications and physical
activity/exercise? (5 pts)
a. Explain (5 pts)
b. If his pre-exercise blood sugar is 130 mg/dl, what
medication/diet precautions would
you give him about exercising that day? (5pts)
c. Explain (5 pts)

11. 14. If his pre-activity blood sugar is 280 mg/dl, what
medication/diet precautions would you give
him about exercising that day? (5 pts)
a. Explain (5 pts)
b. What is his risk for an activity related hyperglycemia? (5 pts)
i. Explain (5 pts)

12. 15. What, if any, additional precautions would you give him if
you increased his exercise intensity?
(5 pts)
a. Explain (5 pts)
16. If he presented with autonomic neuropathy how would you
adjust his exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)

13. CASE STUDY 3
This 57 yo diabetic man has joined the fitness program to
become more fit and
lose weight. He is not currently active. He was diagnosed
diabetic 21 years ago. He
was put on insulin from the very beginning. He is now taking
42 units of NPH daily at
6:00 am and 24 units at 6:00 pm.
At age 20 years he was hospitalized for shrapnel in his thigh; at
age 32 year for
hepatitis; and at 34 years for a hernia. He had the usual
childhood diseases. His father
died of a heart attack at 52 years old. He has had no other
relatives with diabetes.
He has never smoked.
Other information:
Height 193.5 cm Weight 91.8 kg
Cholesterol 221 mg/dl Heart Rate 63
Triglycerides 100 mg/dl Blood Pressure 130/80-78
Glucose 52 mg/dl
HbA1C 5.7%
17. Is physical activity/exercise appropriate for this patient at
this time? (5 pts)
a. Explain (5 pts)

14. 18. What is/are the appropriate exercise/physical activity
facility/location for this patient? (5 pts)
a. Explain (5 pts)
19. His exercise prescription/physical activity advice should be.
Explain. (12 points)
e. Mode:

15. f. Frequency:
g. Duration:
h. Intensity:
20. What precautions would you give him about the time of day
for physical activity/exercise? (5
pts)
a. Explain (5 pts)
21. What precautions would you give him about the timing of
medications and physical
activity/exercise? (5 pts)

16. a. Explain (5 pts)
b. If his pre-exercise blood sugar is 90 mg/dl, what
medication/diet precautions would you
give him about exercising that day? (5pts)
c. Explain (5 pts)
22. If his pre-activity blood sugar is 150 mg/dl, what
medication/diet precautions would you give
him about exercising that day? (5 pts)
a. Explain (5 pts)

17. b. What is his risk for an activity related hyperglycemia? (5 pts)
i. Explain (5 pts)
23. If he presented with periphearal neuropathy how would you
adjust his exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)