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Subjective Medical History Mr. AB, a 60 yr old Caucasian male, presents to your fitness center for an exercise program. He is apparently healthy but has a 15 yr history of hypertension. His goal is to improve his health and fitness and reduce his risk for heart disease. In the past he did heavy resistance training and powerlifting. At present he has a body mass index of 31 kg ·m-2. His medications include aspirin (325 mg daily) and atenolol (50 mg daily). He has a family history of premature heart disease; his LDL-C is elevated (165 mg. dL-?);
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his resting BP is 148/88 mmHg; and his resting heart rate is 60 beats · min-1. He drinks three or four cans of beer with dinner each evening. Objective and Laboratory Data Exercise Test Results During a recent maximal exercise test, Mr. AB exercised for 6 min using the Bruce treadmill protocol and achieved a maximum heart rate of 130 beats · min-1 and BP of 240/90 mmHg. He did not develop any significant arrhythmias or ST-segment changes. Assessment and Plan Diagnosis Mr. AB has a lengthy history of hypertension. Additional risk factors include obesity, age, family history, dyslipidemia, sedentary lifestyle, and elevated alcohol consumption. Exercise Prescription Mr. AB achieved 81% of his age-predicted maximal heart rate (HRmax). The test was negative for underlying cardiovascular ischemia. The initial aerobic exercise prescription should be set at 30 min of light intensity (<40% VO2R or HRR) aerobic exercise, progressing gradually to 60 min or more at moderate (40-59% VO2R or HRR) and vigorous (760% VOR or HRR) if tolerated, 25 but preferably 7 d/wk. Emphasis should be placed on building exercise duration to increase caloric expenditure. Resistance training 2-3 d/wk at 40-50% 1RM and progressing to 60-70% 1RM should be emphasized to minimize risk of musculoskeletal injury, enhance strength and muscle mass, and complement aerobic exercise training to manage his hypertension (i.e., concurrent training). Flexibility training 22-3 d/wk can be recommended as an adjuvant lifestyle therapy for its general health benefits. Case Study Discussion Questions 1. Is it necessary for Mr. AB to exercise at high intensity to help manage his hypertension? 2. How will atenolol (a B-blocker) affect the prescription of a target heart rate range for Mr. AB? 3. What is an appropriate aerobic exercise prescription for Mr. AB? 4. What advice would you give Mr. AB about going back to heavy resistance training and powerlifting? 5. What additional lifestyle modifications should be discussed with Mr. AB to optimize his BP control? Get  Nursing Assignments  Help Today
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