questions 1-6 Čase Study BSubjectiveMedical HistoryMrs. HK is an 84 yr old active woman with a history of hypertension and hyperlipidemiafor which she takes hydrochlorothiazide (12.5 mg), simvastatin (10 mg), and 81 mgaspirin daily. She has been experiencing progressive weakness, particularly in her legs,and associated breathlessness when she is active. She states, "I can't seem to do asmuch as I could two years ago." While still independent in all ADLS, she is no longercomfortable walking with her friends and tends to stay home watching television. Lastmonth, while she was carrying groceries to the car, she became so weary that shealmost fell as she stepped from the curb. Her weight has been stable. She has no otherconstitutional2 From J.K. Ehrman, P.M. Gordon, PS. Visich, and SJ. Keteyian, Clinical Exercise Physiolagy Web Resource, 4th ed.(Champaign, IL: Human Kinetics, 2019).complaints. She is compliant with her medications, eats a well-balanced diet, and hasbeen sleeping reasonably well.DiagnosisRecently, on the advice of her children, Mrs. HK went to see her internist. Her exam wasnormal, including BP 142/70 mmHg on her medications, heart rate 72 beats - min, andBMI 22 kg - m?. The lipid profile showed total cholesterol of 170 mg - dL, with LDLC 102mg - dl, TG 80 mg - dL, and HDL 32 mg - dL. The internist noted a normal physicalexam, although the ECG showed left ventricular hypertrophy with a strain pattern. Heordered an exercise stress test to explore the possibility that cardiac ischemia was thecause of her symptoms. Since the baseline ECG was abnormal, he ordered that sestamibiradionuclide imaging be included to ensure better diagnostic specificity.Objective and Laboratory DataExercise Test ResultsMrs. HK walked 6 min on a modified Bruce protocol, achieving 5 METS. Peak HR was 152beats - min, and peak BP was 170/70 mmHg. There were no additional ECG changesand no significant ventricular or supraventricular rhythm abnormalities. However,radionuclide imaging showed a small area of reversible inferior wall ischemia.Mrs. HK's doctor added metoprolol (12.5 mg twice daily) to her regimen and raised hersimvastatin from 10 to 20 mg. He told her that if things did not improve, he would likelyrecommend a heart catheterization. Over the next few weeks she experienced morefatigue plus myalgias and lapsed into even greater inactivity. Despite some initialapprehension, she is now inclined to undergo a heart catheterization since she believes itwill help improve her exercise capacity, quality of life, and presumably her longevity.Assessment and PlanExercise PrescriptionWhile morbidities such as coronary artery disease are likely to occur in the elderly,especially in the context of chronic hypertension and hypercholesterolemia, herprogressive exercise decline does not necessarily indicate that coronary artery disease isthe cause or that she will benefit from revascularization. Moreover, the recently Assessment and PlanExercise PrescriptionWhile morbidities such as coronary artery disease are likely to occur in the elderly,especially in the context of chronic hypertension and hypercholesterolemia, herprogressive exercise decline does not necessarily indicate that coronary artery disease isthe cause or that she will benefit from revascularization. Moreover, the recentlypublished COURAGE trial (4) indicates that even if patients like Mrs. HK arerevascularized percutaneously by coronary stents, they will not live longer.Instead, Mrs. HK will likely benefit from an exercise training program, one that is inclusiveof strength training in association with aerobic, flexibility, and balance training. Whileissues of coronary artery disease as well as iatrogenic medication effects can complicatetraining goals, they do not preclude training. In Mrs. HK's case, side effects of B-blockersand statins are often temporary, but they need to be carefully monitored over time,especially in association with an exercise training regimen.3 From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology Web Resource, 4th ed.(Champaign, IL: Human Kinetics, 2019).A clinical exercise physiologist will need to be cognizant of Mrs. HK's multiple medicaldisorders and medications superimposed on age-associated physiological changes andthe inevitable dynamics of her own hopes and frustrations and those of her children.Exercise must begin at low levels and progress in small increments to ensure that theregimen is well tolerated and that it addresses the spectrum of needs underlying herfunctional limitations and health requirements.Case Study Discussion Questions1. What are the major concerns for Mrs. HK during exercise activity?2. Based on Mrs. HK's medical history and living situation, what are important barriers toher continued participation in the physical activity program?3. What special precautions were likely taken during her exercise test?4. What motivational strategies can be used to ensure her exercise adherence? 5. What arethe major risks of Mrs. HK's participation in an exercise program? 6. What might beappropriate recommendations for advancing Mrs. HK to walking three times a week for 30min or on a daily basis?

Question

questions 1-6 Čase Study BSubjectiveMedical HistoryMrs. HK is an 84 yr old active woman with a history of hypertension and hyperlipidemiafor which she takes hydrochlorothiazide (12.5 mg), simvastatin (10 mg), and 81 mgaspirin daily. She has been experiencing progressive weakness, particularly in her legs,and associated breathlessness when she is active. She states, &#34;I can't seem to do asmuch as I could two years ago.&#34; While still independent in all ADLS, she is no longercomfortable walking with her friends and tends to stay home watching television. Lastmonth, while she was carrying groceries to the car, she became so weary that shealmost fell as she stepped from the curb. Her weight has been stable. She has no otherconstitutional2 From J.K. Ehrman, P.M. Gordon, PS. Visich, and SJ. Keteyian, Clinical Exercise Physiolagy Web Resource, 4th ed.(Champaign, IL: Human Kinetics, 2019).complaints. She is compliant with her medications, eats a well-balanced diet, and hasbeen sleeping reasonably well.DiagnosisRecently, on the advice of her children, Mrs. HK went to see her internist. Her exam wasnormal, including BP 142/70 mmHg on her medications, heart rate 72 beats - min, andBMI 22 kg - m?. The lipid profile showed total cholesterol of 170 mg - dL, with LDLC 102mg - dl, TG 80 mg - dL, and HDL 32 mg - dL. The internist noted a normal physicalexam, although the ECG showed left ventricular hypertrophy with a strain pattern. Heordered an exercise stress test to explore the possibility that cardiac ischemia was thecause of her symptoms. Since the baseline ECG was abnormal, he ordered that sestamibiradionuclide imaging be included to ensure better diagnostic specificity.Objective and Laboratory DataExercise Test ResultsMrs. HK walked 6 min on a modified Bruce protocol, achieving 5 METS. Peak HR was 152beats - min, and peak BP was 170/70 mmHg. There were no additional ECG changesand no significant ventricular or supraventricular rhythm abnormalities. However,radionuclide imaging showed a small area of reversible inferior wall ischemia.Mrs. HK's doctor added metoprolol (12.5 mg twice daily) to her regimen and raised hersimvastatin from 10 to 20 mg. He told her that if things did not improve, he would likelyrecommend a heart catheterization. Over the next few weeks she experienced morefatigue plus myalgias and lapsed into even greater inactivity. Despite some initialapprehension, she is now inclined to undergo a heart catheterization since she believes itwill help improve her exercise capacity, quality of life, and presumably her longevity.Assessment and PlanExercise PrescriptionWhile morbidities such as coronary artery disease are likely to occur in the elderly,especially in the context of chronic hypertension and hypercholesterolemia, herprogressive exercise decline does not necessarily indicate that coronary artery disease isthe cause or that she will benefit from revascularization. Moreover, the recently Assessment and PlanExercise PrescriptionWhile morbidities such as coronary artery disease are likely to occur in the elderly,especially in the context of chronic hypertension and hypercholesterolemia, herprogressive exercise decline does not necessarily indicate that coronary artery disease isthe cause or that she will benefit from revascularization. Moreover, the recentlypublished COURAGE trial (4) indicates that even if patients like Mrs. HK arerevascularized percutaneously by coronary stents, they will not live longer.Instead, Mrs. HK will likely benefit from an exercise training program, one that is inclusiveof strength training in association with aerobic, flexibility, and balance training. Whileissues of coronary artery disease as well as iatrogenic medication effects can complicatetraining goals, they do not preclude training. In Mrs. HK's case, side effects of B-blockersand statins are often temporary, but they need to be carefully monitored over time,especially in association with an exercise training regimen.3 From J.K. Ehrman, P.M. Gordon, P.S. Visich, and S.J. Keteyian, Clinical Exercise Physiology Web Resource, 4th ed.(Champaign, IL: Human Kinetics, 2019).A clinical exercise physiologist will need to be cognizant of Mrs. HK's multiple medicaldisorders and medications superimposed on age-associated physiological changes andthe inevitable dynamics of her own hopes and frustrations and those of her children.Exercise must begin at low levels and progress in small increments to ensure that theregimen is well tolerated and that it addresses the spectrum of needs underlying herfunctional limitations and health requirements.Case Study Discussion Questions1. What are the major concerns for Mrs. HK during exercise activity?2. Based on Mrs. HK's medical history and living situation, what are important barriers toher continued participation in the physical activity program?3. What special precautions were likely taken during her exercise test?4. What motivational strategies can be used to ensure her exercise adherence? 5. What arethe major risks of Mrs. HK's participation in an exercise program? 6. What might beappropriate recommendations for advancing Mrs. HK to walking three times a week for 30min or on a daily basis?

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1. What are the major concerns for Mrs. HK during exercise activity? 2. Based on Mrs. HK's medical history and living situation, what are important barriers to her continued participation in the physical activity program? 3. What special precautions were likely taken during her exercise test?