A 10-Week Physical Activity Program for a Hypertensive Obese Adult

Abstract

Obesity is a chronic health problem affecting increasing numbers of people worldwide and is now recognized as a global epidemic. Many serious medical problems, including hypertension, which predisposes to cardiovascular disease, are associated with obesity. In adults, the occurrence of hypertension rises with increasing body weight (1). This report outlines the application of a hypertensive obese man with BMI of 30 kg/m2. The BMI test was used to measure the percentage % of his body fat (2,3). His blood pressure was on medication under good control. Both aerobic (endurance) and muscle-strengthening (resistance) exercises were included on physical activity program (8,10,12). Before and after the exercise of each session a sphygmomanometer was used to measure blood pressure BP (4) in order to avoid risk of high blood pressure and to stop exercise under these circumstances. The exercise program was shown the beneficial effects for the obese adult. After 10 weeks of matched, evidence based intervention, the patient has demonstrated a loss of his weight. He improved his cardiorespiratory and muscular fitness and he was not in pain in his back or his knees because of the loss of his weight.

Introduction

Client Characteristics

Mr X is a 45-year-old man with known history of hypertension on medication under good control. He works as a taxi driver eight hours per day. He smokes one and a half pack of cigarettes per day and has done so for over 20 years. His father died from a heart attack at age 60. He has no signs and symptoms of cardiorespiratory disease. He has just completed a body check-up and the report showed body height of 173cm and body weight of 88kg, whereas blood test showed total cholesterol was found to be 8 mmol/L and fasting glucose of 5.4 mmol/L. His BMI (2,3,5) is 30 kg/m2, his hip circumference is 40 inches (102 centimeters) and his waist girth is 47 inches (119 centimeters).

Case Presentation

Mr. Maps has many risk factors (5,8,10) such as cigarette smoking, hypertension (because he is on medication, even though his current blood pressure is under controlled), hypercholesterolaemia (based only on knowing his total cholesterol), and obesity, his BMI which has recently been measured is at 30 kg/m2, and is regarded to be obese according to the WHO’s International Classification of adult underweight, overweight (2,3). He would be classified as sedentary because of his non physical job nature and daily activities. He does not have a family history of heart disease for screening purposes, because his father’s heart attack occurred after the age of 60. His fasting glucose is normal. Although Mr. Maps is considered to be young (less than 45), he is in the moderate-risk category, because he does not have any signs or symptoms of cardiorespiratory disease like pulmonary, cardiovascular or metabolic disease but he is in the low risk category for exercise participation. He was concerned about his body shape and about the symptoms of the over-weight such as the pain in his joints (5,6).

Management and Outcomes

I am going to suggest Mr. Maps to perform regular aerobic and muscle-strengthening exercises as some primary preventive measures for future cardiovascular events (5). At start, for performing low to moderate-intensity physical activity, further medical workup and exercise testing are not necessary, although a sub-maximal exercise test of his cardiovascular fitness can offer a comprehensive appraisal of his condition. However, for embarking on a vigorous exercise program after 10 weeks, he would need further medical clearance from specialists or equivalent professionals according to the recommendations from the American College of Sports Medicine. Prescribing Exercise to Obese Adult Program (5,7,8,9,10,11): Mr. Maps is sedentary, he should build up to his physical activity targets over several weeks, starting with 10 to 20 mins of physical activity every other day during the first week or two, to minimise potential muscle soreness and fatigue for enhancing compliance. If he has difficulty completing this level, i need to reduce the intensity/duration. If he finds that at this level is very easy, increase the intensity/duration until it feels somewhat hard.

Walking is most commonly recommended type of activity. Weight-bearing physical activity may be difficult for the obese man. Gradually increasing moderate-intensity physical activities should be encouraged (8). Based upon Mr Maps information, the program will be for moderate intensity. This means he will be working out at least 5 days a week at a moderate intensity. Considering Mr. Maps has four risk factors, I have decided to keep his target heart rate to be about 40% of his VO2R (9,10). To do this I will plug his resting heart rate and age predicted heart rate max into the Karvonen equation (13), where his % intensity desired will be between 40% and 50% I think this is an important way to start considering his previously sedentary life style. From this equation I will find a target heart rate that will be able to be monitored through out his workouts to determine an increase or decrease in intensity. Program: Aerobic exercise 5 times per week for 20 min (8,10). Walking around a track or on a treadmill (7) Warm Up: 5 to 10 min

Dynamic Stretching of entire body. The main goal of this is to get blood flowing and the heart rate increased. Treadmill Walk for at least twenty minutes (7).He will be instructed to walk for one minute with the incline to be increased, and one minute with a leisurely walk. He is not able to jog because of his pain in joints. As Mr. Maps progresses through his program, the duration of this exercise can be increased in a variety of ways. This program is intended to be progressive as his fitness improves. Cool Down: 5 to 10 min Slow walk to gradually decrease an elevated heart rate but still keep muscles moving to avoid cramping

Stretching: 10 minutes (He should partake in a variety of static stretches that engage his whole body, especially his legs). Resistance Training (8,12): 2 times per week after the aerobic exercise. It is my goal to improve his muscular endurance and technique. Each exercise requires approximately <1 minute rest in between each set. The program is designed so that while one muscle group is resting, the other can be worked by alternating the exercises each set.

Work Out: Leg extension: 3 x 10 Leg curls: 3 x 10 Bench Press: 3x12 Row: 3x12 Dumbbell Shoulder: 3x 12 Tricep kickbacks: 3x 12 Biceps curls: 3x 12 Abdominal crunches: 4x 10 Side crunches: 4x 10 Back extensions: 3x10

Warm Up: 5-10 min Walking/ a track or on a treadmill for 20 min Cool Down/Stretch: A variety of static stretches focusing on the muscles worked

After 10 weeks, Mr. Maps has demonstrated a loss of his weight. The BMI test showed a loss of 5 kg/m2 after the exercise program. His cardiovascular endurance was improved and he increased responsiveness to antihypertensive medications (8).

Discussion

Studies showed that physical activity provides many health benefits. Being physically active and fit reduces obesity-related chronic diseases and decreases risk for early death. In this study the patient demonstrated a loss of weight after 10 weeks of physical activity. Systematic reviews (14,15,16,17) consistently report a decrease in Systolic Blood Pressure (SBP) of about 1 mmHg per kg of weight loss with follow-up of 2 to 3 years. There is attenuation in the longer-term, with a decrease of about 6 mm Hg in SBP per 10 kg of weight loss. Intervention programs appropriate for obesity-hypertension combine diet, physical activity, and behavioral modification and aim to achieve long-term change in health-related behaviors. Aerobic exercise can reduce weight and BP. In a meta-analysis (18) that included assessment of ambulatory BP it was reported that in studies lasting 4 to 52 weeks, with physical activity as the only intervention, aerobic exercise reduced BP by 3/2.4 mm Hg. A few studies (18) also examined the effects of resistance training on BP. The estimated decrease in was similar to the effects of aerobic exercise, although not statistically significant for SBP and without statistically significant weight change. In conclusion, a moderate intensity exercise intervention produced improvement in body weight, BMI, waist and hip circumferences and blood pressure.