Hypertension Exercise prescription Alexandra Basciano Exercise prescriptionAlexandra Basciano

Client demographics and medical history 44 year old man; overweight (104.5 kg height 5ft 11in.) recently began walking for 30 minutes a day on the treadmill every morning before work. Lives with family in the Jersey. Insurance broker, works in New York. Smoker his entire life, quit three weeks ago. Recently limited alcohol intake to 1-2 days a week, only having 1-2 drinks. However in the past, alcohol intake was 3-4 days a week, having up to 6 drinks at times. Moderate to high stress / overall mood varies by stress. Heart disease on paternal side of his family (father died of heart attack at 52). No other diseases or complications. Normal range of motion. No shortness of breath, angina, or any other CAD risk factors Has persistent heart burn which he takes Aciphex for. Was diagnosed with hypertension 5 years ago and is currently taking Diovan hct. Systolic 130 Diastolic 80 (130/80)

Life Style Modifications Limit sodium intake <2.3 g/d (grams a day) Limit alcohol intake 1-2 drinks a day Lose weight (about 18+ lbs) Exercise Stop smoking Reduce stress (by relaxing, exercising, and eating right!)

Weight loss Rx % fat calculated from skin folds using chest, abdomen, and thigh readings % fat calculated from skin folds using chest, abdomen, and thigh readings Exercise is vital to conserve lean mass, improve insulin sensitivity, and improve lipid utilization. Exercise is vital to conserve lean mass, improve insulin sensitivity, and improve lipid utilization. Current weight 230lbs. 31% fat 69% lean. Desired = 25% fat 75% lean. Fat Free Mass = 159lbs. 159 /.75 = 212lbs. He must lose 18lbs Current weight 230lbs. 31% fat 69% lean. Desired = 25% fat 75% lean. Fat Free Mass = 159lbs. 159 /.75 = 212lbs. He must lose 18lbs

Exercise Testing Moderate Risk: exam needed prior to vigorous training (75% HRmax) Moderate Risk: exam needed prior to vigorous training (75% HRmax) Cardio is the best exercise! Testing modality = Treadmill Cardio is the best exercise! Testing modality = Treadmill Max testing provides more information, i.e.: true HRmax, VO2 max. Physician supervision needed. Duration and intensity will be emphasized. VO2 results from stress test to max exertion in hospital. If maxHR available from this test we would use that instead because it is more accurate than 220-age

Exercise Prescription Resting Heart rate (RHR) : 82 bpm 40-70% Karvonen Method : = 176, = 94 (HRR) 94*.4= 38+82= 120 bpm. 94*.7= 66+82=148 bpm. So, is the range. RPE 11-14, min, 3-7 days/week (cardio) Always monitor BP before, after, and during session. 200/110 do not exercise that day! 180/110 no resistance training that day! Warm up = minutes. It is important because it may prevent exaggerated BP response. Stretch before exercise as well. Cool down for 10 minutes after exercise. Always watch out for post exercise hypotension.

Resistance Training Resistance training with moderate intensity of about 40-60% of 1 RM 2-3 days/week Resistance training with moderate intensity of about 40-60% of 1 RM 2-3 days/week Leg press Arm Curls Abdominal Exercises

Week %VO 2RVO2 MET s Karvonen % kcal/ min RPERPE Treadmill speed mph Grad e Durati on 1 week40% bpm week45% bpm week50% bpm week50% bpm week55% bpm week60% bpm week65% bpm week70% bpm Week Progression

Goals Weight loss Decreased blood pressure Improved muscular and aerobic fitness Improved circulation Best possible life quality Do not start smoking again

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