Unit 8: Cardiovascular Disease

Unit 8: Cardiovascular Disease EF310-01 Tiffany Stein Kaplan University December 11, 2012

Unit 8: Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death in the United States. According to Howley & Franks (2007), cardiovascular disease refers to any disease of the heart and the blood vessels or circulation. In 1998 CVD accounted for the deaths of 433, 825 males and 493, 623 females. However, there are ways to prevent CVD as well as hope for those who have been affected by CVD. Studies have been shown that you can reverse CVD by changing your diet and making healthy changes in your lifestyle (Howley & Franks, 2007).

I recently met Jane, a 61 year old female who is recently retired. She is at a place in her life where she feels overwhelmed, hopeless and exhausted from the events that have recently taken place in her life. Jane was ready to enjoy her new life of retirement when she was faced with a health scare that has changed her perspective on life. Jane was recently diagnosed with cardiovascular disease and underwent angioplasty for two blocked arteries. Jane is at a place in her life where she isnt quite sure where to turn. Her health is at risk if she doesnt start making healthy lifestyle changes. I have spent time with Jane going through the PAR-Q and Health Status questionnaire (Howley & Franks, 2007). She admits that it is time for her to begin taking care of herself and is willing to do what it takes to make that happen.

PAR-Q Rating Jane took the PAR-Q (Physical Activity Readiness Questionnaire)(Howley & Franks, 2007), she had to answer yes to the questions that asked about having being told by her doctor that she has a heart condition and that she has had pain in her chest when doing physical activity. Jane does not lose balance or become dizzy and has never lost consciousness. She does not have bone or joint problems that will worsen by change in physical activity. Jane is on a prescription

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drug called atenolol for her cardiovascular disease and needs to be closely monitored when she begins physical activity.

Health Status The Health Status Questionnaire (HSQ)(Howley & Franks, 2007), helps to determine whether it is appropriate for a person to become physically active and list all personal and emergency contact information and general medical history which is very important to have on hand in case of an emergency. Jane had to check that she has had a Coronary Angioplasty and had to check that she has experienced chest discomfort with exertion and that she has to take prescription heart medication. Her risk factors include that she is a woman older than 55 years old and she is postmenopausal. Jane admits that other than taking care of her grandchildren she is physically inactive. She is currently taking atenolol, a beta blocker for her heart. Janes physical activity is very low to moderate and she has goals of becoming a healthy and fit 61 year old mother and grandmother. Jane used to smoke and drink on a daily basis but after her angioplasty decided to quite.

General Medical History

Jane is a 61 year-old retired female. Jane has a family history of heart disease and lost her father due to a massive heart attack. Jane recently underwent a left heart catheterization, which revealed significant occlusion in the left anterior descending artery and the circumflex artery. Therefore, a balloon angioplasty procedure was performed.

Assessment Results on testing CRF, Endurance, Flexibility, Strength

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Due to Janes cardiovascular disease, medical history, and current surgery it is important that Jane undergo a specialized test in a hospital with a physician and proper medical equipment close by. Jane completed a graded exercise test (GXT) approximately two weeks after her angioplasty was performed. The GXT is a special diagnostic test that is always performed in a hospital with a physician present. The GXT consist of a 12-lead electrocardiogram (ECG) and monitors the patients at discrete intervals during the GXT. The doctors and nurses are constantly watching the patients blood pressure, rating of perceived exertion (RPE) as well as other signs and symptoms. The GXT is most commonly performed on a treadmill unless the patient is not able. Other tests available are a cycle test or arm ergometer test. There are certain criteria for terminating the GXT. These are pathological signs like S-T segment depression on the ECG or symptoms like angina pectoris that would cause termination (Howley & Franks, 2007). Janes results: Protocol: Balke (3.3 mi hr1, or 5.3 km hr1) Resting: HR = 72 beats min1, BP = 130/72 mmHg

End point: stage 3 for 1 min (approximately 7 METs

HR = 126 beats min1, BP = 160/90 mmHg

Reason for termination: Fatigue

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No S-T segment depression, no reported symptoms

Risk Factors and Precautions It is important that Jane understands that there are precautions she needs to be make when beginning an exercise routine. Janes maximal heart rate is low because she is taking a betablocker for her heart. It is important for Jane to know that when she exercises her target rate will be based on the Borg Rating of Perceived Exertion (RPE) which ranges from 6 no exertion to 20 maximal exertion(CDC, 2012).

Medications

Jane is currently taking a prescribed medication called atenolol which is a beta-blocker. Side effects include hives, difficulty breathing, swelling of face, lips, tongue or throat. Serious side effects include slow or uneven heartbeats, fainting, shortness of breath with mild exertion, swelling of ankles or feet, nausea, loss of appetite, depression, and cold feelings in hand and feet(emedicinehealth.com, 2012).

Health and Lifestyle Behaviors Jane is a 61 year old retired woman who continues to live a very busy, fast paced life and does not take time to take care of herself. Jane used to work two very high stress jobs that kept her up late at night. Now that Jane is retired she takes care of her five young grandchildren during the day and stays up late at night and does not get the required sleep her body needs. Jane always puts her familys needs before herself. Jane admits that she does not eat well and that she loves to bake cakes and pies for family and loves to eat them as well. Jane also consumes red

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meat 4-5 times a week and rarely eats fruits and vegetables. Jane would love to exercise but does not feel that she has time to exercise to incorporate exercise into her daily life since she is busy with her grandchildren. Jane is very stressed and is always exhausted and overwhelmed but will not take time for herself or tells her family members that she needs to take a break. Janes lifestyle has begun to affect her health. Jane started to feel fatigued and short of breath while she was carrying around her youngest grandchild. Jane also experienced tightness and pain in her neck so she decided to have her children take her to the emergency room. After many test doctors confirmed that Jane needed to have an angiogram and they discovered that she had blockages in two of her arteries

Body Composition

My client is 62 inches tall and weighs 164 pounds. Her measurements are 34 inches around the waist and 38.5 inches around her hips. In order to calculate her BMI or Body Mass Index you take the clients height in inches which is 62 and their weight in pounds which is 156. You multiply the clients weight by 703. 156 x 703=109,668. You then divide that number by your height 109,668/62=1,768.8387. You take that number and divide it again by your height 1,768.8387/62=28.53. My patients BMI is 28 which is considered Overweight according to the classifications for BMI Ratios in Fit to Be Well (Thygerson A. & Thygerson, H., 2007).

Nutrition Jane admits that she does not eat well and that she loves to bake cakes and pies for family and loves to eat them as well. Jane also consumes red meat 4-5 times a week and rarely eats fruits and vegetables.

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Readiness for Change The Transtheoretical Model of Change, known as the Stages of Changes model helps us to change a problem behavior (Marcus & Forsyth, 2007). There are five stages that an individual progresses through in order to adopt healthy behaviors or eliminate unhealthy ones. During each stage different intervention strategies help them progress to the next. Stage 1: Precontemplation-A person has an increased awareness but is not ready to make a change in his or her life in the foreseeable future. Stage 2: Contemplation-The person is aware of the problem and thinking about overcoming it. This stage may take some time. Stage 3: Preparation-Goals are set, record and analyze behavior. A person in the stage my make a firm commitment to change and believe that it can be done. Stage 4: Action-Replaces old, unhealthy behavior with new, healthy behavior and maybe vulnerable to barriers. Stage 5: Maintenance-You will still need to reward yourself and be aware of any environmental control to avoid falling into old habits (Marcus & Forsyth, 2009). My client is in stage 3, the Preparation stage. Jane is ready to make a firm commitment to change and has set goals to reward herself with a day at the spa when she reaches her first goal.

Motivational Strategies and Techniques One of the most important things for Jane to know is that there have been studies that have demonstrated that lifestyle modification can reverse cardiovascular disease (Howley & Franks, 2007). Knowing that she can reverse her cardiovascular disease is motivation in itself. When Jane heard those words her face lit up and she had a new sense of hope and a second chance at life. Jane and I have also set short term goal and long term goals together and she has decided to reward herself with a day at the spa if she meets her short term goal in two months of losing ten pounds.

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Recommendations In order to have success Jane needs to change her lifestyle completely. She needs to stop focusing on everyone else and start focusing on herself. Jane needs to reduce her stress and tell her kids that she will no longer be able to babysit on a regular basis. She will also need change her diet and stop eating red meats and start consuming more of a vegetarian diet. This change wont be able to occur overnight but with small steps in the right direction Jane can began incorporating more of a plant based diet as the weeks go on. I would recommend that Jane begin tracking her food tracker online from livestrong.com or a daily food log so that she can monitor her caloric intake on a daily basis and see what she is lacking in her diet. Jane has already stopped smoking and drinking which is a huge step in the right direction. She also needs to begin to practice yoga and meditation on a daily basis in order to reduce her stress level. Last but definitely not least Jane needs to begin light to moderate physical activity. Exercises that I would recommend for Jane would be treadmill walking, stationary cycling, and arm cranking. Light resistance exercises using dumbbells and elastic bands with resistance that would allow her to perform 12 to 15 repetitions with good form. (Howley & Franks, 2007)

I believe that Jane is on the right track with her positive attitude and readiness for change. It is important that as a health professional I continue to support, encourage and reward Jane as she continues on her lifelong health and wellness journey. As Jane begins to see the short term and long term benefits of incorporating a healthy lifestyle and nutrition she will be more likely to maintain her healthy lifestyle and habits throughout the remainder of her life.

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References:

Howley, E. & Franks, B.D., (2007). Fitness Professionals Handbook 5th Edition, Human Kinetics; Retrieved on December 11, 2012 from EF310: Current Trends in Exercise and Fitness: Course Home: Direct Digital Bookshelf.

EMedicinehealth.com. (2012). Medication and Drugs. Retrived on December 11, 2012 from: (http://www.emedicinehealth.com/drug-atenolol/article_em.htm

CDC (2012). Physical Activity: Perceived Exertion (Borg Rating of Perceived Exer tion Scale. Retrieved on December 11, 2012from: http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.html Marcus, B. H. & Forsyth, L. H. (2009). Motivating People to be Physically Active Second Ed. Champaign, IL. : Human Kinetics

Thygerson, A. L. & Thygerson, S. M., (2011). Fit to Be Well. Chapters 1, 2,3,4,5, & 7.

Livestrong.com. (2012). Daily Caloric Intake. Retrieved 27 November 2012 from https://www.livestrong.com

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