Coronary Heart Disease (CHD)
CHD is the term that describes the process where the walls of the arteries become furred up with fatty deposits. If the coronary arteries become narrow, due to this build up, the blood supply to the heart will be restricted and potentially cause angina. If a coronary artery becomes completely blocked, it can cause a myocardial infarction or heart attack (McArdle et al, 2006).
CHD is the UK's biggest killer, with one in every four men, and one in every six women dying from the disease. In the UK, approximately 300,000 people have a heart attack each year (WHO, 2006).
Ischaemic Stroke
Strokes, or as they are correctly termed, Ischaemic strokes occur when blood clots block the flow of blood to the brain. Blood clots typically form in areas where the arteries have been narrowed, or blocked by fatty deposits. Strokes are a medical emergency and prompt treatment is essential. If the supply of blood is restricted, or stopped, brain cells will begin to die; this can quickly lead to brain damage and possibly death.
High blood pressure
High blood pressure (hypertension) is usually defined as having a sustained blood pressure of 140/90 mmHg, or above (McArdle et al, 2006).
High blood pressure often causes no symptoms, or immediate problems, but it is a major risk factor for developing a serious cardiovascular disease (conditions that can affect the circulation of blood around the body), such as a stroke, or heart disease (NHS, 2008).
Osteoarthritis
Osteoarthritis is a condition that affects the joints, such as the hips, knees and spine. It is the most common type of arthritis in the UK, and is sometimes referred to as 'wear and tear' arthritis.
There is no cure for osteoarthritis, but the symptoms can be eased by using a number of different treatments. Mild symptoms can often be managed through exercise or by wearing suitable footwear. However, in more advanced cases, other treatments may be necessary, such as analgesics, physiotherapy, or surgical intervention.
Psychological problems
In addition to the immediate and long term problems of obesity, many people may also experience psychological problems, such as low self esteem or poor self image. This can have the effect of reducing confidence levels, thus nurturing a feeling of societal isolation (Brookfield, J. 2004). These feelings often have a tendency to exacerbate issues as quite often, individuals are, as a result of poor self image, reluctant to embark on an exercise regime.
Clearly then, this complex array of problems that are associated with obesity may negatively affect a patient’s rehabilitation potential and their ability to participate in fitness activities. It must be stated however that an individual may not be obese but still succumb to one or more of these health problems as a result of age, poor diet and lack of exercise. By looking at obesity however, we can also consider all of these ailments under one umbrella.
As a result of lifestyle choices and poor diet, an individual may slowly, over time, become out of shape and over weight. Fortunately, if tackled early enough these effects can be reversed, and those ‘lost years’ can be, to a certain extent, regained. Thus the spectre of medical intervention becomes less of a reality. By simply making changes to ones lifestyle, such as exercising more regularly, eating a healthier diet, and cutting back on ones consumption of alcohol the negative effects of ill health can be staved off.
Preventative and remedial exercise prescription
The first consideration should be that the individual is examined by a GP, thus giving the fitness professional a sound basis from which to begin an exercise prescription plan. With this important information they can then tailor the regime to meet the needs of the individual. As a general rule the GP will look at several ‘base’ values, the most common of these being age, height and weight (thus giving a body mass index (BMI) score), resting heart rate and blood pressure (NHS, 2008). As an integral part of this assignment it was necessary to examine an individual using these measurements, and subsequently make an assessment of their overall physical, and to a lesser extent, psychological condition, with the aim being to formulate a fitness plan. There now follows the results of the interview and examination.
Health and Fitness Assessment
The subject, a 39 year old married mother of two has, during her life, been extremely keen on sports. Her not insignificant sports experience ranges from full time swim training from the age of 8 to15, where she swan the butterfly stroke. After then taking a 2 year break from swimming, and under her own admission putting on some weight, she then took up club running which included half marathons. She was subsequently instrumental in the formation of the Newcastle-Under-Lyme Women’s Rugby Club, where she was an active player.
As a keen sports participant in the past, the subject does realize the importance of exercise, but since getting married in 1996, almost 12 years ago, has felt that she has been too busy to engage in sporting activities. This is due to a clear dedication to her work, her children and the unfortunate aspect of having to travel almost 40 miles each day in order to work. The individual also reports that, at times, she has suffered problems relating to her Achilles tendons, with the left Achilles presenting a specific problem. As a result of this she is reluctant to engage in high impact activity as she fears the onset of further problems, she has however expressed an interest in swimming and cycling, thus negating the need for high impact activities.
The subject scored well during a Wellness Self Perception chart examination, falling mostly in the higher levels of psychological self perception ‘wellness’, this is echoed by her enjoyment and enthusiasm for gardening, a position within her church and her sparkly demeanor. There was however a marked reduction in positive self perception regarding physical wellness, this was a noticeable trait which was clearly seen during interview.
The subject clearly knows what she is eating, and although not a terribly bad diet, does admit to having chocolate and crisps on a daily basis, whilst on the weekends enjoys substantial amounts of food. She is also a non smoker who drinks red wine, but not in vast quantities. Supplementary information can be found in the Health and Fitness Assessment Questionnaire in appendix 1.
Statistical measurements
The following measurements were taken at the time of interview and form, alongside the interview appraisal, the basis for a fitness and diet plan.
- Weight 88.5 kg (Ideal weight – 64 kg)
- Height 163 cm
- % Body Fat 40.4
- Resting HR 72 BPM
- BP 150/88 mm/Hg
-
% H2O 43.7
Firstly by calculating the height to weight ratio of the individual it can be seen that she has a BMI score of 33.47. In the UK, people with a BMI between 25 and 30 are categorised as overweight, and those with an index above 30 are categorised as obese (WHO, 2008). This is backed up with a reading of 40.4 % body fat. The resting heart rate falls within accepted parameters at 72 BPM, but with a BP of 150/88 mm/Hg it can be seen that the systolic phase pressure is much higher than normal. This is known as stage one hypertension and can be attributed to being primarily overweight. It is strongly recommended that the individual consult her GP regarding this matter.
Recommendations
Given that the individual has expressed and interest in swimming and cycling, the recommended fitness plan will centre on these two disciplines. Concurrently, minor changes to lifestyle and diet will bring about necessary health benefits which will enhance both her fitness and sense of wellbeing.
Fitness plan
The individual has expressed an interest in both swimming and cycling, thus the recommendation is to undertake a cross training regime. With swimming three times a week and the other two days a 30 minute cycle. Swimming and cycling are very good forms of exercise as they both work the major muscle groups of the body, are non impact and easily accessible. Cycling also has the added benefit of providing a cardiovascular workout.
Simple swimming programme: (based on a 25m pool) 3 x per week.
4x front crawl
30 sec rest
2x legs only with kickboard, arms extended in front
30 sec rest
2x full stroke front crawl
30 sec rest
2x arms only with a pull buoy between your legs
30 sec rest
2x full stroke
30sec rest
This is a simple exercise plan, but ideal for retraining. Clearly, as an accomplished swimmer, she can tailor this to her needs and ability.
Simple cycling programme:
Cycle 30 minutes 2 x per week. The session should be enough to get the muscles working, but not enough to be entirely out of breath. As a general rule one should be able to maintain conversation during this level of exercise. After consultation, or if the individual desires, the time can be increased to accommodate for the health benefits of physiological adaptations.
Dietary considerations
This diet is nutritionally well balanced, so it is safe to stay on if you still have further weight to lose. To monitor your progress it is recommended to perform a weekly weigh and make a record, with the aim being to reach an ideal weight of 64 kg. Combined with the exercise regime the individual will see improvements in how they feel and look. The diet is designed to help them lose slightly less than 1 kg per week, although they may lose more in the first couple of weeks. By starting on 25th June, they could expect to lose around 13 kg by 25th September. The diet can be used by families as well as single people as there are lots of choices that would make great family meals, this diet would be well suited to the individual as it does allow for red wine, the odd biscuit and other naughty but nice things! The diet plan along with supplementary materials can be found in appendix 2.
If you are in doubt regarding anything about this diet then please feel free to make contact at any stage. It is recommended that you consult your doctor before beginning this combined diet and exercise plan.
Diet overview
In order to keep things as simple as possible, the plan has been divided into three sections where each plan lasts for approximately one month:
Plan A - which consists of around 1,500 calories a day. The aim should be for a weight loss of around 1-2 lbs per week, although this may be greater in the first couple of weeks. If it is seen that weight loss drops to less than one pound per week on Plan A (and the individual is sticking to the diet!), then move to:
Plan B - which contains around 1,200 calories per day. Once they have been dieting for a while or they have only a few pounds left to lose, they may find that their weight loss on Plan B falls below 1 lb per week. they may then move to:
Plan C - which contains around 1,000 calories per day. The temptation must be resisted to start on Plan C. If they were to start on too low a calorie intake then the weight loss may begin to slow down or even stop, which can be de-motivating. The aim of the programme is to firstly give 2 weeks to get used to the ideas contained and make ‘mental’ preparations. By doing this the chances of success will be greatly improved - prepare like an athlete and pace yourself, losing weight is a marathon, not a sprint!
Source: http:.coolnurse.com
Appendix 1
Health and Fitness Questionnaire
Appendix 2
Diet plan and supplementary information
References and Bibliography
http://www.feelingok.co.uk/downloads/festivediet.doc
http://lust-for-life.co.uk/Health_Monitoring.html
http://www.brianmac.co.uk/idealw.htm
http://www.coolnurse.com/calories_burned.htm
Brookfield, J. Self Perception in a Moving World. Butterworth and Heinman, New York. 2004
McArdle, WD. Katch, FI, Katch, VL. Essentials of Exercise Physiology, 3RD Edition. 2006. Lipcott Williams and Wilkins, Baltimore.
National Audit Office. 2001. http://www.nao.org.uk/pn/00-01/0001220.htm
National Health Service. http://www.publications.parliament.uk/pa/cm200607/ cmhansrd/cm070123/text/70123w0029.htm
Quesenberry, C.P. 1998. Pubmed accessed 14/06/2008 .http://www.ncbi.nlm.nih.gov/ pubmed/9508224
Shankar, K. Exercise Prescription. 1999. Hanley and Belfus, Inc. Philadelphia. ISBN 1-56053-258-0
World Health Organization, online Q & A. Nov 2006. http://www.who.int/features/ qa/49/en/index.html
