Clinical Exercise Prescription Case Study

A male came into a clinic for a clinical physiological assessment with the following medical history, laboratory assessment measurement values, and signs/symptoms. With this information, please answer the following questions as they pertain to exercise prescription. Along with this assignment, please download two documents: one containing the patient’s GXT form and the other containing the patient’s spirometry results. Must include at least 4 peer-reviewed journal articles.
Patient Medical History and Laboratory Assessment
           Age: 61 yrs. 
            Gender: Male
            Smoking Status: Current, 250 pack years
            BMI: 40 kg/m2
            BP: 140/82 mmHg
            Lipids:  Total Cholesterol – 192 mg/dL, LDL – 104 mg/dL,
            HDL – 41 mg/dL, Triglycerides – 188 mg/dL
            Fasting Blood Glucose: 116 mg/dL
            Family History:  Father diagnosed with CAD at age 55 years (died of MI – age 66)
            Ejection Fraction:  40%
            Arterial O2 saturation: 89%
            Hemoglobin: 16
            Hematocrit: 48%
            Patient is considered physically inactive
            Medications: Carvediol, pravastatin, Spiriva, Hydrochlorothiazide (HCTZ), Losartan, 
Patient signs and symptoms: Patient complains of having to sleep while in seated position, swelling in the lower extremities, generalized fatigue, and chronic chest pain occurring with patient-perceived high intensity activity which dissipates with rest. 
Question 1: Based upon the findings on the GXT summary sheet, what was the primary symptom that caused the termination of the GXT? Based on this information, prescribe an aerobic exercise regimen that is deemed safe and effective using the FITT principle. Please justify your FITT prescription.
Question 2: Is it plausible that resistance training can improve this patient’s VO2? If so, explain what you perceive to be the major physiological mechanism by which this occurs. Support your answer with peer-reviewed research.
Question 3: What can a properly prescribed aerobic exercise training program do to this patient’s ischemic threshold? How do you monitor this during exercise and what is actually meant by ischemic threshold. Support your answer with peer-reviewed research.
Question 4: Your patient has a slightly elevated hemoglobin level. Why does this make sense based upon the other lab findings? Explain your reasoning.
Question 5: Based upon the spirometry findings, would adjunct respiratory therapy be advisable? If so, how would this training be beneficial physiologically? Explain your reasoning.

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