Running head: UNIT 8 PROJECT

Unit 8 Project Lisha Vecchiarelli Kaplan University

UNIT 8 PROJECT Unit 8 Project

Introduction
Obesity not only causes us to feel uncomfortable when we are physically active, but it can increase the risk of diabetes and cardiovascular disease. Unfortunately obesity has increased in the United States to proportions that are staggering. According to the Centers for Disease Control and Prevention one in three adults over the age of twenty years old is obese (CDC, 2011). It is very important for all people of various ages to add physical activity and exercise to their busy lifestyles, as it is critical in prevention of obesity, disease and minimization of morbidity. Physical activity helps facilitate continued health and helps to reduce certain diseases that are caused by inactivity. The increase in obesity is thought to be caused by the intake of too much energy combined with not enough physical activity to burn off the excess energy (Howley, 2007). The culprit may very well be high caloric density in certain foods that are not filling due to the lack of fiber, excess simple carbohydrates and fat combined with a sedentary lifestyle (Schlenker & Roth, 2011). People who are obese may find success in weight reduction with moderate aerobic physical activity and calorie reduction over a period of time. My evaluation and plan will be done with the case study provided on a 51 year old female named Marsha, who is morbidly obese.

Par Q & You

The health questionnaire I used is called Par-Q & You. My subject is a 51 year old female who is morbidly obese with hypertension. She has not seen a physician in over three years so before I allowed her to start I gave her an immediate referral for physicians consent and recommended she get full medical screenings. We also need to check her resting heart rate and blood pressure before we get started. Her physician sent her to get lab work done and she was

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negative for diabetes however her cholesterol levels were elevated. Her primary care physician also assessed that she was hypertensive and placed her on two prescriptions to help control both of her issues. The doctor also gave permission to start an exercise program and recommended she come back in a couple of months for rescreening and evaluation.

Health Status
She is at higher risk due to her weight, blood pressure and elevated cholesterol serum levels; nevertheless her physician has approved her for physical activity and exercises after he placed her on a calcium channel blocker for her blood pressure. (DHHS, http://www.health.gov, 2008). Her physician also placed her on medication for her high cholesterol due to her family history of cardiovascular disease, her sedentary lifestyle, weight and serum levels which were considered borderline high (Mayo Clinic, 2012). She did not show any other signs or symptoms for any other disease or illness such as diabetes.

General Medical History

My 51 year old female subject was assessed with high blood pressure at 152/88, her resting heart rate was 79 which is considered just below average and her cholesterol levels are at 218 milligrams per deciliter which is considered borderline high (http://ehealthmd.com, n.d.). My subject is on a calcium channel blocker and a statin which are both prescribed and used to treat those health issues (http://www.mayoclinic.com, 2012).

Assessment Results on testing Cardio Respiratory Fitness, Endurance, Flexibility, Strength

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Subjects resting heart rate is 79 before administering assessments and fitness testing. Rockport Walk Test 21 minutes and 55 seconds to complete one mile. Heart rate afterwards was 125 bpm. MET = 1.001735714285717, VO2 Max = 3.50607500000001, Population Average = 29.705000000000002, Score = -1, subjects results were poor (http://www.exrx.net, 2007). I had my 51 year old female subject do the seniors chair stand test because of her weight and health; her results are as follows population average = 19, subjects score = 13 and her rating is considered poor as her repetitions = 10 (http://www.exrx.net, 2007). I also had my subject do the seniors arm curl; her results are as follows population average = 17, subjects score = 13 and her rating is considered poor as her repetitions = 11 (http://www.exrx.net, 2007).

Risk Factors and Precautions

She is at a higher risk due to her blood pressure and elevated cholesterol levels; however her physician has approved her for physical activity and exercise. Because of subjects age and additional risk factors such as morbid obesity, hypertension and elevated cholesterol levels she is considered high risk and should be monitored while in the exercise program until she is no longer has these health issues. Her physician should continue to assess and evaluate her health. For protection against disease, obese adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or even 300 minutes (5 hours) a week of moderate-intensity aerobic and strength training to control weight. This may be very hard when first beginning so the subject may want to start off at 150 minutes a week and then eventually build up to 300 minutes a week as she is able. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week (DHHS, http://www.health.gov/, 2008). She should do strength training as this will be helpful in building and conditioning up her endurance and strength for aerobic activities such as walking (Howley,

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2007). The subject would also benefit from adding swimming to her physical activities because this is considered a low impact physical activity and can help in avoiding injury (Howley, 2007).

Medications
My 51 year old female subject is on certain medications that allow me to see that they are a class of drugs called calcium channel blockers and used for high blood pressure and another medication that is a statin widely used to lower cholesterol levels in the blood (http://www.mayoclinic.com, 2012).

Health and Lifestyle Behaviors

My 51 year old subjects health and lifestyle behaviors have not included any physical activity and she has never exercised regularly. She has a desk job so she would be considered inactive and sedentary.

Body Composition
The subjects BMI = 40, Population average is 24.9 and classification= Grade 3 (morbid obesity) (http://www.exrx.net, 2001).

Nutrition
Subject needs to lose quite abit of weight and is capable of do this if she follows her exercise program. She should take part in cardiovascular exercise, and weight resistance exercises. She would do well to increase her physical activity and aerobic activity to 300 minutes a week and adding muscle strengthening or weight resistance twice a week to lose excess weight (DHHS, http://www.health.gov, 2008). I recommend that she follow a diet low in saturated fat and high in micro and macro nutrients. She should not try to lose more than one to two pounds a week.

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Readiness for Change

Subjects readiness for change is at a two which means she has thought about making a change but has not implemented the change yet (Bess Marcus, 2009). The fact that she has come into the fitness facility and wants to purchase a membership and has gotten her physicians consent reveals where she is at in the readiness for change model (Bess Marcus, 2009).

Motivational Strategies and Techniques

Motivational strategies that would be beneficial would include reward strategies such as buying herself a new workout outfit every time she loses ten pounds. Friends and family are great motivators and can help encourage her also. Also another reward for physical activity can be where she allows herself time on the weekends to relax and go out to a movie after she has completed her weekly fitness activities.

Recommendations
I would recommend that she start with 150 minutes a week of physical exercise, aerobic activity and strength training for the first month and then move up to 200 minutes a week during the second month and then 300 minutes a week during the third month (DHHS, http://www.health.gov, 2008). She can include weight resistance and weight training twice a week starting now also. She can also chart her progress by using a wall calendar and total her daily minutes as this is a good visual aid and reminder to keep active and exercise daily (DHHS, http://www.health.gov, 2008). Another great way of motivating herself is to put her goals on post it notes on or around her desk at work to encourage her to take walks during her breaks and use the stairs instead of the elevator at work also.

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Reference Alton Thygerson, S. T. (2011). Fit To Be Well. Sudbury: Jones & Bartlett Publishing. Bess Marcus, L. F. (2009). Motivating People to Be Physically Active. Chapaign: Human Kinetics. CDC. (2011). http://www.cdc.go. Retrieved July 31, 2012, from http://www.cdc.go: http://www.cdc.gov/nchs/fastats/overwt.htm/ DHHS. (2008). http://www.health.gov. Retrieved July 31, 2012, from http://www.health.gov: http://www.health.gov/paguidelines/adultguide/part1.aspx Howley, E. T. (2007). Fitness Professionals Handbook. Champaign : Human Kinetics. http://ehealthmd.com. (n.d.). Retrieved July 30, 2012, from http://ehealthmd.com: http://ehealthmd.com/content/your-blood-cholesterol-level-too-high-0 http://www.exrx.net. (2001). Retrieved July 31, 2012, from http://www.exrx.net: http://www.exrx.net/Calculators/BMI.html http://www.exrx.net. (2007). Retrieved July 31, 2012, from http://www.exrx.net: http://www.exrx.net/Calculators/SeniorChairStand.html http://www.exrx.net. (2007). Retrieved July 31, 2012, from http://www.exrx.net: http://www.exrx.net/Calculators/Rockport.html http://www.exrx.net. (2007). Retrieved July 31, 2012, from http://www.exrx.net: http://www.exrx.net/Calculators/SeniorArmCurl.html http://www.mayoclinic.com. (2012). Retrieved July 31, 2012, from http://www.mayoclinic.com: http://www.mayoclinic.com/health/statins/CL00010/ Mayo Clinic. (2012). http://www.mayoclinic.com. Retrieved July 31, 2012, from http://www.mayoclinic.com: http://www.mayoclinic.com/health/statins/CL00010/

Schlenker, E. D., & Roth, S. L. (2011). Williams Essentials of Nutrtion and Diet Therapy. St. Louis: Elsevier. YMCA. (n.d.). http://www.exrx.net/. Retrieved July 2, 2012, from http://www.exrx.net/: http://www.exrx.net/Calculators/CurlUp.html