HypertensionHypertension

Exercise prescriptionExercise prescription

Alexandra BascianoAlexandra Basciano

Exercise prescription

Alexandra Basciano

Client demographics and medical Client demographics and medical historyhistory44 year old man; 44 year old man; overweightoverweight (104.5 kg height 5ft 11in.) recently (104.5 kg height 5ft 11in.) recently began walking for 30 minutes a day on the treadmill every morning began walking for 30 minutes a day on the treadmill every morning before work. before work. Lives with family in the Jersey. Insurance broker, works in New York.Lives with family in the Jersey. Insurance broker, works in New York.

SmokerSmoker his entire life, quit three weeks ago. his entire life, quit three weeks ago. Recently limited alcohol intake to 1-2 days a week, only having 1-2 Recently limited alcohol intake to 1-2 days a week, only having 1-2 drinks. However in the past, drinks. However in the past, alcohol intake was 3-4 days a week, alcohol intake was 3-4 days a week, having up to 6 drinks at times.having up to 6 drinks at times.

Moderate to high stress / overall mood varies by stressModerate to high stress / overall mood varies by stress..Heart disease on paternal side of his family (father died of heart Heart disease on paternal side of his family (father died of heart attack at 52). attack at 52). No other diseases or complicationsNo other diseases or complications. Normal range . Normal range of motion. No shortness of breath, angina, or any other CAD risk of motion. No shortness of breath, angina, or any other CAD risk factorsfactors

Has persistent heart burn which he takes Has persistent heart burn which he takes AciphexAciphex for. for. Was diagnosed with Was diagnosed with hypertensionhypertension 5 years ago and is currently 5 years ago and is currently taking taking Diovan hctDiovan hct. Systolic 130 Diastolic 80 . Systolic 130 Diastolic 80 (130/80)(130/80)

Life Style ModificationsLife Style Modifications

Limit sodium intake <2.3 Limit sodium intake <2.3 g/d (grams a day)g/d (grams a day)

Limit alcohol intake 1-2 Limit alcohol intake 1-2 drinks a daydrinks a day

Lose weight (about 18+ Lose weight (about 18+ lbs)lbs)

ExerciseExercise

Stop smokingStop smoking

Reduce stress (by Reduce stress (by relaxing, exercising, and relaxing, exercising, and eating right!)eating right!)

Weight loss Rx•% fat calculated from skin folds using % fat calculated from skin folds using chest, abdomen, and thigh readingschest, abdomen, and thigh readings

•Exercise is vital to conserve lean mass, Exercise is vital to conserve lean mass, improve insulin sensitivity, and improve improve insulin sensitivity, and improve lipid utilization.lipid utilization.

•Current weight 230lbs. 31% fat 69% Current weight 230lbs. 31% fat 69% lean. Desired = 25% fat 75% lean. Fat lean. Desired = 25% fat 75% lean. Fat Free Mass = 159lbs. 159 / .75 = 212lbs. Free Mass = 159lbs. 159 / .75 = 212lbs. He must lose 18lbsHe must lose 18lbs

Exercise Exercise TestingTesting•Moderate RiskModerate Risk: exam needed prior to : exam needed prior to

vigorous training (75% HRmax)vigorous training (75% HRmax)•Cardio is the best exercise! Testing modality Cardio is the best exercise! Testing modality = = TreadmillTreadmill

Max testingMax testing provides more provides more information, i.e.: true HRmax, VO2 information, i.e.: true HRmax, VO2 max. Physician supervision needed.max. Physician supervision needed.Duration and intensity will be Duration and intensity will be emphasized.emphasized.VO2 results from stress test to VO2 results from stress test to max exertion in hospital. If max exertion in hospital. If maxHR available from this test maxHR available from this test we would use that instead we would use that instead because it is more accurate because it is more accurate than 220-agethan 220-age

Exercise PrescriptionResting Heart rate (RHR) : Resting Heart rate (RHR) : 82 bpm82 bpm

40-70%40-70% Karvonen Method : 220-44= 176, Karvonen Method : 220-44= 176, 176-82= 94 (HRR) 94*.4= 38+82= 176-82= 94 (HRR) 94*.4= 38+82= 120 120 bpm. 94*.7= 66+82=bpm. 94*.7= 66+82=148 148 bpm. So, bpm. So, 120-120-148148 is the range. is the range.

RPE 11-14, 30-60 min, 3-7 RPE 11-14, 30-60 min, 3-7 days/week (cardio)days/week (cardio)

Always monitor BP before, after, and Always monitor BP before, after, and during session. during session. 200/110 do not 200/110 do not exercise that day!exercise that day! 180/110 no 180/110 no resistance training that day!resistance training that day!

Warm up = 5 -10 minutes. It is Warm up = 5 -10 minutes. It is important because it may prevent important because it may prevent exaggerated BP response. Stretch exaggerated BP response. Stretch before exercise as well. Cool down for before exercise as well. Cool down for 10 minutes after exercise. Always watch 10 minutes after exercise. Always watch out for post exercise hypotension.out for post exercise hypotension.

Resistance Training

•Resistance training Resistance training with moderate intensity with moderate intensity of about 40-60% of 1 RM of about 40-60% of 1 RM 2-3 days/week2-3 days/week

Leg press

Arm Curls

Abdominal Exercises

Week%VO2R VO2

METs

Karvonen %

kcal/min

RPE

Treadmill speed mph

Grade

Duration

1 week 40%21.72

4 6.21 120bpm 11.3 11 3.4 0 25-30

2 week 45%21.72

4 6.21 125bpm 11.3 11 3.4 0 30-35

3 week 50%21.72

4 6.21 129bpm 11.3 11 3.4 0 35-40

4 week 50% 24.94 7.13 129bpm 13 12 4 0 40-45

5-7 week 55% 24.94 7.13 134bpm 13 12 4 0 45-50

8-10 week 60% 27.62 7.89 138bpm 14.4 13 4.5 0 50-55

11-13 week 65% 27.62 7.89 143bpm 14.4 13 4.5 0 55-60

14-16 week 70% 30.3 8.66 148bpm 15.8 14 5 0 55-60

16 Week Progression

GoalsWeight lossWeight loss

Decreased blood pressureDecreased blood pressure

Improved muscular and aerobic fitnessImproved muscular and aerobic fitness

Improved circulationImproved circulation

Best possible life qualityBest possible life quality

Do not start smoking againDo not start smoking again

The end