Question

Box 21 Case Studies to Determine Need for Exercise Preparticipation Medical Clearance CASE STUDY I A 50-yr-old nonsmoking male was recently invited by colleagues to participate in a 10-km trail run. He reports currently walking 40 min on Monday, Wednesday, and Friday — something he has done for years." His goal is to run the entire race without stopping, and he is seeking training services. He reports having what he describes as a "mild heart attack at 45 yr old, completed cardiac rehabilitation, and has had no problems since. He takes a statin, an angiotensin-converting enzyme (ACE) inhibitor, and aspirin daily. During the last visit with his cardiologist which took place 2 yr ago, the cardiologist noted no changes in his medical condition. CASE STUDY II A 22-yr-old recent college graduate is joining a gym Since becoming an accountant 6 mo ago, she no longer walks across campus or plays intramural soccer and has concerns about her now sedentary lifestyle. Although her body mass index (BMI) is slightly above normal, she reports no significant medical history and no symptoms of any diseases, even when walking up three flights of stairs to her apartment. She would like to begin playing golf CASE STUDY III OA 45-yr-old former collegiate swimmer turned lifelong triathlete requests assistance with run training. His only significant medical history is a series of overuse injuries to his shoulders and Achilles tendon. In recent weeks, he notes his workouts are unusually difficult and reports feeling constriction in his chest with exertion --- something he attributes to deficiencies in core strength. Upon further questioning, he explains that the chest constriction is improved with rest and that he often feels dizzy during recovery. CASE STUDY IV A 60-yr-old woman is beginning a professionally led walking program. Two years ago, she had a drug-eluting stent placed in her left anterior descending coronary artery after a routine exercise stress test revealed significant ST-segment depression. She completed a brief cardiac rehabilitation program in the 2 mo following the procedure but has been inactive since. She reports no signs or symptoms and takes a cholesterol- lowering statin and antiplatelet medications as directed by her cardiologist CASE STUDY V A 35-yr-old business consultant is in town for 2 wk and seeking a temporary membership at a fitness club. She and her friends have been training for a long distance charity bike ride for the past 16 wk; she is unable to travel with her bike and she does not want to lose her fitness. She reports no current symptoms ofCV or metabolic disease and has no medical history except hyperlipidemia, for which she takes a HMG-CoA reductase inhibitor (statin) daily.

****For each case study, state whether or not the individual should be recommended medical clearance before participating in exercise (explain your reasoning) and what is the recommended intensity of exercise.

Answer 1

1. He should receive clearance. As long as he's followed the correct rehab guidelines and exercise protocols, he can get back on track. After thorough physical assessment ( example: using a treadmill at various intensities), he can resume running marathons. However, since the past history is significant for heart attack, medical assessment is necessary.

2. Golf is not a physically taxing exercise per se. She is young, has had no significant medical problems in the past, thus she doesn't need clearance. She will benefit from beginning HIIT training or any form of aerobic exercise which will lead to fat loss so that her BMI is in the healthy range.

3. According to the history, the person clearly has a cardiovascular pathology. He needs to undergo clearance. Recommended exercise is treadmill test.

4. Yes, she will need medical clearance before participating. Even though the walk is professionally organized, given her medical history she needs at least one medical consultation.

5. She does not need medical clearance. She can start her physical training as and when she pleases.