Answer Happy

Case study 7 Font Mrs. Hilary Nunez is a 68 year old female with known end stage renal disease (ESRD). She has been on hemodialysis for 28 months, and her treatment prescription is for 3 days per week with 3 hour treatment sessions each day. She has a graft in her right upper arm as her dialysis access site. She presents with the complaints of lack of energy, weakness, and decreased endurance. Her nephrologists refer her to the staff exercise physiologist. The exercise physiologist reviews her chart to find that her ESRD is secondary to long- term non-insulin dependent diabetes (about 15 years.) Mrs. Nunez has also developed severe peripheral neuropathy as a result of her diabetes. The exercise physiologist then conducts a battery of physical function tests using the seniors fitness test (SFT) to assess the patients' physical ability. These tests consist of the sit and stand test, the 6 min walk and the 20 font gait speed test at both a comfortable and a fast pace. The results of these tests are as follows: sit to stand 33.01 s, 6 min walk-350 foot; 20 ft normal gait speed-55.01 cm/s. Her self reported physical function scale on the SF-36 (senior fitness) Health status questionnaire is 55. During her walking tests, Mrs. Nunez exhibits poor balance and endurance as a result of her peripheral neuropathy and general weakness, respectively. She was a past smoker (quit 5 years ago), brother had MI at age 54. Total cholesterol is 178 mg/dL during last test. You have been asked to develop an exercise prescription for Mrs. Nunez. Her goals include increasing her stamina so that she can return to normal physical activities without weakness and to improve her A1C, maybe even decrease dialysis. She is interested in trying different types of activities that you would be interested in prescribing Seniors stand calculator: 8 reps Seniors arm curl test: 12 reps Sit and reach: 5 inches Skinfolds: Tri: 34mm, Supcailliac 24mm, quadriceps 20 mm Height: 5'6" Weight: 198 Ihs RHR: 82 bpm RBP: 132/68 mm/Hg Current medications: erythropoietin, vitamin D, iron, insulin The facility that you work at (and she attends) is medically supervised and has an abundance of equipment. She has had experience in aerobics and walking in the past hurt is sedentary at this time. She is not currently involved in an exercise program.
PART II =(75 points total) A. Program description: The purpose of this is to ensure students know how to complete the design of an exercise program using the FITT-VP. See assignment worksheet to see how to present. I Cardiorespiratory Portion of ExRx Apply the FITT-VP principle to cardiovascular endurance training by: 1. Calculate a heart rate prescription for low, moderate and vigorous exercise using the heart rate reserve method. 2. Determine the frequency of cardiorespiratory training. 3. Recommend the time of training for the exercise session (and total for the week). 4. Verify whether the prescription is the appropriate volume (determine volume and determine appropriateness based on information in text). 5. Discuss progression for continued overload and improvement. 6. Explain the make-up of the entire exercise session. 7. Utilize metabolic equations in exercise prescription. Choose one or more of the metabolic calculations that we learned previously in the semester and determine an actual workout for patient. For example, if you want them working at 75% of VO2max, use that VO2 and determine how fast they should be walking on a level track. SHOW WORK II. Resistance Exercise Portion of Ex Rx
Apply the FITT-VP principle to resistance training by: 1. Indicate which exercises should be performed. 2. Determine the initial intensity for each exercise. 3. Recommend the frequency of training and provide the reason for this. 4. Prescribe the combination of sets and reps and provide the reason they were selected 5. Designate the rest pattern during and between exercise sessions. III. Flexibility Exercise Portion of Ex Rx Apply the FITT-VP principle flexibility training by: 1. Identify the flexibility exercises to include in the prescription. 2. Indicate the type of stretch to be used; static, dynamic, etc. 3. State how often stretching should be done. 4. Define the intensity of stretching to be used. 5. Designate the time for each stretch 6. Determine the volume of stretching to be done. V. Additional Considerations for ExRx 1. Identify the bone strengthening exercises to include. 2. Suggest the time and frequency of bone strengthening activities. 3. Identify the neuromuscular exercises to include. 4. Suggest the time and frequency of neuromuscular exercises to include. 5. Last and describe any other special considerations/modifications that are important for your patient and conditions that they have (diabetic, children, pregnancy, medications, etc.) V. Warm up and cool down Describe activities your patient should do before the exercise session and why. Describe activities your patient should do after session is completed and why.