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Throughout history, there has always been a link made between physical activity/exercise, and health.This link can be traced back to at least the Ayur-Veda in the th century BC, where "exercise and massage are recommended for the treatment of rheumatism" (Ryan, A., cited in American Academy of Physical Education, pg 4).
Today, however, even though the link is still being documented, the way in which our society liveswith the increased technology, where "the physical demands of everyday activities like cleaning the house, washing the dishes, mowing the lawn and travelling to work" (Heyward, pg 1), that would have taken about an hour at one time, "can now be accomplished in just a few seconds by pushing a button, or setting a dial" (Heyward, pg 1).
Instead of the time saved by these improvements being used in a positive way to pursue recreational activities, people are using this time to become increasingly sedentary.Add to this the fact that even though it has been much documented "that appropriate exercise programs may be expected to yield improvements not only in physical fitness, but also in blood lipid levels, blood pressure, body composition, bone density, insulin sensitivity, and glucose tolerance." (Dishman, pg 1), there is still 0-50% of people who withdraw from an exercise program within the first six months (Dishman, 188; Robison and Rogers, 14; cited in Bull, pg ).
Write my Essay on Design a realistic and effective training program for a client (case study), underpinning the theory and reasoning behind choices made.
The client, himself, shows these sorts of qualities in his approach to smoking cessation.The fact that he has tried to stop, but has not yet been successful, shows that he may have adherence issues.
However, he does seem intent on making some major lifestyle changes due to the fact that now he has reached middle-age, he is beginning to experience back and knee painsa sure fire sign of the beginnings of arthritis.The sorts of changes he would be making would be behaviourali.e, smoking cessation, integrating physical activity into his lifearound his obviously busy schedule as a headmaster.His family medical history speaks volumes as to why he has decided upon a sudden change in his lifestyle.The fact that his father died of heart disease at the young age of forty-five, and "0% of Coronary Heart Disease (CHD) is attributable to smoking" (Marks, B.L; cited in ACSM, 001, chapter 4), is one of the most poignant reasons for this turnaround.
"Though relative risk of smoking for lung cancer is higher, absolute risk is greatest for CHD" (Marks, B.L).This shows that the most detrimental habit he has is also the most modifiable risk factor for CHD.By cutting out such a factor, the client will not only reduce the risk of himself suffering from chronic illness, but he is also helping his family. ("Both active smoking and passive exposure to ETS demonstrate similar dose-response relationships for increased risk" (Marks, B.L)(ETS= Environmental Tobacco Smoke)).
Smoking not only has an effect on the incidence of CHD, but also, a positive relationship has been found between smoking and non-insulin dependant diabetes (NIDDM) (the nurses health study.).This is of particular importance to the client as his mother has diabetes and so he is leaving himself vulnerable to developing the disease.As well as smoking having an effect on the risk of diabetes and CHD; CHD is also the most common cause of death amongst Type 1 diabetes' patients.
The client's mother also suffers from osteoporosis, an affliction which is more commonly related to the elderly.However, at 5 years of age, the client is showing the first signs of it, with the pains in his knees and back that he's been suffering from.The process of this disease can be sped up by smoking, as the use of tobacco saps the goodness from the bonesit makes them more porous (honeycombed) in structure.
Exercise prescription
The subject will undergo a health evaluation.As the purpose of these evaluations "is to detect the presence of disease and to asses the initial disease risk classification of your clients" (Heyward), as many components should be tested as possible.For this reason, six of the twelve recommended components for a comprehensive health evaluation as cited in Heyward would be used to identify any risks
• PAR-Q (Physical Activity Readiness Questionnaire)
Comprises of seven questions that are designed to highlight certain individuals that require clearance from their GP before they can undergo any type of fitness assessment, or take on a full-blown exercise program.If the client in question was to answer 'yes' to any of the questions, he would be advised to gain Medical clearance before taking part in any sort of physical activity.An example of this can be found in the appendices.
• Medical History Questionnaire.(See appendices)
Clients need to complete these, as they include questions referring to not only, their own illnesses, injuries or hospitalisations, but also those of their family.This is important as it aids in the risk identification by pinpointing factors, which may increase the risk of Coronary Heart Disease (CHD).Also, conditions may come to light that require the expertise of a GP, and drugs (medication) may be being used that change the clients heart rate, ECG, blood pressure and capacity for exercise, E.g., diuretics and beta-blockers.
• Coronary Risk factor analysis
From the Medical history questionnaireas already stated, certain risks can be identified that can be related to the risk of CHD.As epidemiological research has shown, there are many factors associated with the risk of CHD.These factors are
o Agegenerally men over the age of 45, and women over the age of 55 (or during premature menopause, without HRT)
o Family Historycardiac event (MI) or a sudden death, before the age of 55 for the father (or another first-degree male relative); or before 65 years old in the mother (or another first-degree female relative).
o Current smoking cigarettes
o Hypertensionblood pressure over 140/0mmHg, or someone on antihypertensive medicine.
o Hypercholesterolemia
o Diabetes mellitusPeople with either non-insulin- or insulindependant diabetes, who are either over the ages of 5 and 0 (respectively) or have suffered the disease for more than 15 years.
o Physical activityindividual living a sedentary lifestyle lifestyleboth at work and at home.
The greater the number of factors, the higher the probability of CHD.
• Signs and symptoms of disease
This could be included as part of the medical history questionnairea section at the end, asking the client to mark any of the symptoms/ disease, they have that are listed.Some may include
 Fainting/dizziness
 Palpitations
 Asthma
 Coughing up blood
 Diabetes
 Lower back pain
 Chest pain
 Stroke
 Bronchitis
 Breathlessness during or after mild exertion
 Obesity
 Swollen joints
For any of the symptoms marked, the client would be advised to obtain advice from their GP before starting an exercise program, or even undergoing a fitness test.
Due to the nature of the information received from the client, an additional Graded Exercise Test, and twelve-lead ECG should be conducted.
Before these tests are carried out it will be explained to the client the reasoning behind the tests (ie the purpose) and also any questions should be answered and any worries dissipated (and the clients informed consent form should be obtained (an example of which is in the appendices)).
The purpose of the ECG is to monitor the client's heart rate during exercise.This is to determine whether there are any complications (ie irregular beat, heart murmur etc).The twelve-lead ECG "is a composite record of the electrical events in the heart during the cardiac cycle" (Heyward).Because of its efficiency in comparing voltages between limbs on both the left- and right-hand sides of the body (due to the placement of the electrodes), the twelve-lead ECG can highlight contraindications (as set out by the American College of Sports Medicine (ACSM)), too exercise testing, Eg, previous MI's, left ventricular hypertrophy etc.
Although the twelve-lead ECG can be administered by the exercise prescriber, the reading of it must be left up to a Physician, as it requires a great deal of skill and practice.
As "Coronary Heart Disease often is not detectable from the resting ECG, and abnormalities may not appear until the individual engages in relatively strenuous exercise" (Heyward), it is likely that the physician would recommend that the client take part in a Graded Exercise Test.From the following table taken from the ACSM guidelines 000, it can be seen that as the client is at a high risk of CHD, their physician should be present at the testing
Also, that both submaximal and maximal testing is recommended.However, due to the other factors highlighted in the screening questionnaires (the fact that the client never does any structured exercise anymore, smokes etc.), it would be plausible to only make him perform a submaximal test, so as to reduce the risk of a cardiac event.
In the actual prescription of the exercise, the client's lifestyle has to be taken into account.As a school headmaster, he is likely to be working long hoursgenerally between 8am and 6pm, Monday, to Friday.This means that the most feasible means of increasing the amount of physical activity is for the client to get involved in something that relates to the school in some way.For example, he could take responsibility for a school sports teamtake them out training, and generally get more involvedslowly weaning him out of his sedentary way of life (By starting off at one or two days a week, then steadily increasing his involvement after one or two weeks)
From the nature of the responses of the client to the pre-prescription screening, it can be worked out that the main goal in undergoing the program is to improve his general health.As this is the case, following the guidelines given by the U.S. Department of Health and human sciences (16(cited in Heyward, pg 84)), a typical week in the program would look like this
Monday Tuesday Wednesday Thursday Friday
Jogging-0mins Use the school pool to swim at lunchtime for 0mins-0mins Walkingmiles in 0mins. (could take family along with him for some quality time. Training a school sports team for about one hour. Shooting baskets in basketball for 0mins.
The intensity of these exercises is low, so as not to overtax the cardiovascular system.Generally, the exercise all works at around about 45% VO max to start off with, due to the previous sedentary lifestyle of the client.
Progression within the training program is necessary, due to the physiological changes that occur when undergoing aerobic endurance training.It is in the first 6-8 weeks of the program that the majority of the conditioning takes placethe time for the vast majority of improvement.It is after then, that another graded exercise test will be done, to assess the improvement of the client.
Throughout the program, however, the client will be asked to keep a training diary, recording exactly what he has done each day, and for how long.This method of monitoring has its limitations as the client could quite easily lie about what training he has been doing.However, it is probably the least time-consuming way, and being headmaster, he is obviously a very busy man.
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