The Pathophysiology Of Atherosclerosis

Narrative

From all outward appearances, Frank seems to be an average middle-aged man. He has been an executive accountant for the past 28 years, and since starting this position as an accountant, Frank has consistently been physically inactive. Often, he will enthusiastically start an exercise program but is very unpredictable and inconsistent with exercising regularly and quits soon after starting. His eating choices and habits are poor and not consistent for good health. He consumes almost no vegetables but lots of saturated fat while consuming several beers with most meals. His most recent endeavor into exercising was spurred on by his daughter, who recommended that he needed to see someone qualified to help him start a program and stay faithful to that exercise program. On this recommendation, Frank went to his college’s wellness center to see one of the EP-Cs on staff. During the initial meeting, a comprehensive assessment was carried out to determine Frank’s initial fitness level and his readiness to participate in a program.

Physical Information

Age: 49 years old

Height: 5 ft 10 in

Weight: 203 lb

BMI: 29.19 kg ∙ m−2

Body fat percentage (DEXA scan): 29.22

Resting blood pressure: 138/92 mm Hg

Resting HR: 64 bpm

 

ACSM Guidelines Risk Factors

Age: He is a man, 45 years or older.

Family history: His father had a heart attack at the age of 47 years.

Cigarette smoking: Does not smoke

Physical Activity: Sedentary

Obesity: None (but is considered overweight borderline obese by both his body fat and BMI)

Hypertension: BP is within Stage 1 hypertensive levels, 138/92 mm Hg.

Dyslipidemia: Total cholesterol: 238 mg ∙ dL−1; LDL-C: 161 mg ∙ dL−1; HDL-C: 39 mg ∙ dL−1

Prediabetes: None (resting blood glucose, 88 mg ∙ dL−1)

The following results were from exercise testing:

Aerobic fitness (O2max) (Balke protocol): approximately 19.8 mL ∙ kg−1 ∙ min−1

Bench press weight ratio for 1-RM: 0.77

Leg press weight ratio for 1-RM: 1.55

YMCA bench press test (total lifts): 15

Partial curl-up test (total repetitions): 12

Forward flexion using a sit-and-reach box: 29 cm

Frank’s lifestyle is riddled with long periods of inactivity and no sustained exercise. His low fitness level is affecting his quality of life. He loses his breath and is easily fatigued from menial physical tasks. Unfortunately, Frank isn’t really too worried about his health, but his daughter is. He only wants to exercise enough to stop his daughter from nagging him.

QUESTION

What is the biggest problem concerning Frank’s health right now?

What sort of disease is Frank setting himself up for, and does he already have symptoms of the disease?

Do you think that Frank’s workouts should be supervised?

Should Frank have his aerobic exercise broken up into intermittent exercise sessions or one longer continuous exercise session?

References

  1. American College of Sport’s Medicine. ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. 4th ed. Champaign (IL): Human Kinetics; 2016. 416 p.
  2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 10th ed. Philadelphia (PA): Wolters Kluwer; 2018.
  3. American College of Sports Medicine. ACSM’s Resources for Clinical Exercise Physiology. 2nd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2010. 368 p.
  4. American College of Sports Medicine. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. 7th ed. Philadelphia (PA): Wolters Kluwer/Lippincott Williams & Wilkins; 2014. 896 p.

SUMMARY

Regular physical activity and exercise participation can provide primary and secondary prevention health fitness benefits. Medications, specialized diets, and surgeries are generally viewed as first options before exercise is considered as an intervention. Nonetheless, daily physical activity and exercise training are effective tools in developing health fitness benefits for persons with chronic diseases. Although exercise is beneficial, the challenges and limitations presented by diseases must be addressed to properly design the most effective and safest physical activity and exercise program. By adapting the ACSM (62) and U.S. physical activity recommendations (31) for prescribing physical activity and exercise programs, the EP-C is better able to meet the needs of the cardiovascular, metabolic, and pulmonary clients while ensuring program safety. The EP-C must know the limitations and challenges these diseases present for the exercising client and how to adapt the physical activity and exercise programs accordingly.

STUDY QUESTIONS

  1. Explain the pathophysiology of atherosclerosis, including the role of the major risk factors.
  2. Explain why the patient with asthma may have difficulty breathing, particularly during exercise.
  3. Explain the major pathologic differences between Type 1 and Type 2 diabetes, within the context of exercise.
  4. Briefly describe the effect of OTC medications on exercise in CAD and pulmonary disease.
  5. Describe key differences in prescribing exercise for specific clinical populations.

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