Question

Chapter 15, Special Considerations for Metabolic Syndrome, Hypertension, and Dyslipidemia

The patient is a 53-year-old Hispanic female who runs a successful business from home. Her job is extremely stressful and requires working long hours. She has known hyperlipidemia and has been taking a daily multivitamin and Crestor (rosuvastatin) 10 mg daily for the past 5 years. She is a previous smoker (one pack per day for 20 years) but quit around the same time she was diagnosed with hyperlipidemia. Several years have lapsed since she has gone to the doctor, but at one of her church screenings, she was told that her blood pressure was “above optimal.” She went to her doctor, and on exam, she was 65 in tall and 249 lb, and her waist circumference was 50 in. Her blood pressure and heart rate were 144/72 mm Hg and 74 bpm, respectively. Her blood lipids were within normal ranges; however, her HbA1c was elevated to 7.4%. Although her physician was concerned about her blood pressure, she was most concerned with this sudden onset of weight gain and diabetes since she quit smoking. The physician notes that the patient has something called the “metabolic syndrome” and writes a prescription for her to start taking glipizide and HCTZ to get her blood sugar and blood pressure under control. The patient leaves the office feeling shocked and saddened by this diagnosis but decides that she is going to make some lifestyle changes as she has a new granddaughter on the way.

She now presents to your facility for a supervised exercise program with no history exercising with the exception of “playing table tennis at her family picnic once a year.” She denies any symptoms suggestive of cardiovascular, metabolic, or renal disease.

Case Study Questions

1.   According to current ACSM guidelines for preparticipation health screening, does the patient require medical clearance prior to beginning an exercise program?

2.   Based on what the patient has told you, what exercise prescription guidelines should be most closely followed and why?

3.   List the medications that the patient takes daily and determine how they may adversely interact with an exercise training program.

Answer 1

1. The existing American College of Sports Medicine (ACSM) exercise preparticipation health screening recommendations stipulate that persons at moderate risk for CVD undergo a medical examination prior to starting a exercise program .

In this case the patient should undergo a medical clearance as she is having hypertension .

2. Cardiorespiratory Exercise: Adults should get at least 150 minutes of moderate-intensity exercise per week. Exercise recommendations can be met through 30 to 60 minutes of moderate-intensity exercise five days per week or 20 to 60 minutes of vigorous-intensity exercise three days per week. One continuous session and multiple shorter sessions of at least 10 minutes are both acceptable to accumulate the desired amount of daily exercise.

Resistance Exercise: Adults should train each major muscle group two or three days each week using a variety of exercises and equipment. Very light or light intensity is best for older individuals or previously sedentary adults just starting to exercise. Two to four sets of each exercise, with anywhere between eight and 20 repetitions, will help adults improve strength and power.

Flexibility Exercise: Adults should do flexibility exercises at least two or three days each week to improve range of motion. Each stretch should be held for 10 to 30 seconds, to the point of tightness or slight discomfort. Repeat each stretch two to four times, accumulating 60 seconds per stretch.

3) 1. Multivitamin - it is recommended that we take vitamins before working out because Vitamin deficiencies can ruin your workout, you can't build muscle with protein alone, and nutrients also improve your recovery times.

5 Vitamins That Become Depleted When You Sweat

Sodium (Na)

Chloride (Cl)

Magnesium (Mg)

Calcium (Ca)

Potassium (K)

2. Crestor (rosuvastatin)- Statins and exercise are a powerful combination that can help preserve your heart health. Most people are not affected by statins when they exercise. However, up to 10 percent of patients do have some muscle pain and weakness with statins.

Glipizide - On its own, exercise lowers your blood sugar, too. So, combining high-intensity exercise with these medications can be risky

HCTZ - Much like clients who take ACE inhibitors, individuals on diuretics will have both lower resting and exercise blood-pressure values.In this case, a principle concern is that the combination of the reduction in blood pressure from the diuretics, coupled with the naturally occurring post-exercise hypotension, can result in excessive reductions in blood pressure.