Clay Metz, Maddy Moore, Alyssa Powell

Case Study 2

Jack is a 50 year old Phys Ed teacher and high school football coach who is 5’11” and 200 lbs.
He is an avid walker who walks on the treadmill at 3.8mph at 6% grade on Monday, Tuesday
and Saturday for 25 minutes and swims 1 mile in 20 minutes on Monday and Saturday. His
resting HR is 60 bpm. On Jack’s bucket list is running in a 5k race. However, he indicates that
he hasn’t jogged continuously since college. Jack has hired you as a personal trainer and can
commit to coming to the fitness facility on Wednesday and Thursday in addition to exercising on
Monday, Tuesday and Saturday

Jack has no signs or symptoms nor known disease or family history of heart disease. At his last
doctor’s visit, the following was reported:
Total Cholesterol: 232
LDL: 150
HDL: 45
BG: 98
BP: 142/92
Currently, Jack takes Lipitor daily for his cholesterol; Lisinopril for his BP and a BSA (baby
aspirin). He is a former smoker who quit when he was 40 years old.

He has completed a fitness assessment at your facility with the following results:
CV fitness: Max GXT – VO2 of 11 METS
HRMAX – 185 bpm
BC: 22% on 7-site test
Flexibility: Sit and Reach score was “below average”
Passed back scratch on Left, Failed on Right
Mus Endurance: 1 min Crunch test was “average”
Mus Strength: Bench Press 1RM was “average”
Leg Press 1RM was “above average”

Client Information:
 Summary of Client Information Considerations for Exercise Prescription

50 years old, physical education and
football coach, avid walker
Hasn’t jogged continuously since college
On cholesterol medication (Lipitor)
On BP medication (Lisinopril and BSA)
No known disease or signs/symptoms
BMI = 27kg/㎡, Weight = 200lb,
Height = 5’11
VO2 - 11 METS or 38.5 ml/kg/min
Currently exercising 3 days/wk (treadmill 3.8
mph at 6% incline)
***wants to exercise 5 days/wk
Good resting HR
Wants to run a 5K
Poor flexibility
Good HRmax (above estimated)
Watch BP: 142/92 (on daily medication)
Former Smoker (watch for dyspnea)

Preparticipation Medical Clearance: YES NO

Justification:
- Participates in regular exercise, no known cardiovascular, renal, or metabolic
disease, and showing no signs/symptoms
- Can continue moderate and/or vigorous intensity exercise

Cardiovascular Disease Risk Factor Assessment:

Risk Factor +/- Justification

Age + >45 yr old

Family History - No immediate family

diagnosed with CAD

Cigarette Smoking - Quit greater than 6 months

ago

Obesity - BMI < 30

Hypertension On BP medication
+ (Lisinopril and BSA)
Systolic >140mmHg
Diastolic >80mmHg

Physical Inactivity - Completing 115 min of

moderate-vigorous intensity
exercise per week

Risk Factor +/- Justification

 Dyslipidemia TC > 200 mg/dL
+ LDL > 130 mg/dL
**on cholesterol medication
(Lipitor)

Diabetes - No known DM

HDL >60 mg/dL - HDL < 60 mg/dL

Total Risk Factors: 3

Client Availability:

2x per week (Wednesday and Thursday) // will continue to exercise Monday, Tuesday, and
Saturday independently

Current Exercise and/or Physical Activity: 115 min/wk aerobic exercise

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

25 min 25 min 25 min treadmill

treadmill walk treadmill walk walk (3.8 mph; 6%
(3.8 mph; 6% (3.8 mph; 6% incline)
incline) incline) 1 mile swim (20 min)

1 mile swim (20

min)

Client exercise-related Intended Outcomes (write as many as applicable):

· IO: to run a 5K
· IO: to improve flexibility/muscular strength
· IO: to improve overall health

Time Breakdown of Two 60 minute Exercise Sessions:

 CD WU CD WU

F
CR CR

RT
RT CR

First Day: Second Day:

WU (Warm Up) - 5 minutes WU (Warm Up) - 5 minutes
RT (Resistance Training) - 30 minutes RT (Resistance Training) - 25 minutes
CR (Cardiorespiratory Training) - 20 minutes CR (Cardiorespiratory Training) - 20 minutes
(two 10 min sessions) F (Flexibility) - 5 minutes
CD (Cool Down) - 5 minutes CD (Cool Down) - 5 minutes

Current Exercise and/or Physical Activity with 2 newly designed sessions:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

50min 30 min 60 min 60 min 50 min

(CR, F) (CR, F) (RT, CR) (RT, CR, (CR, F)
F)

Aerobic Training Zones:

Identify the % training zone: 55-65%

THR and RPE zones (show the math):

● Currently within the recommended requirement for moderate-to-vigorous intensity

physical activity by completing 115 min/wk of exercise; also has a job that will require
constant standing/walking. However, client has not jogged since college for longer bouts,
so we want to start him off at a slow jogging pace and increase his speed/duration over
time

HRmax = 185 bpm (higher than estimation by 220-age)

** use a higher moderate intensity / lower vigorous intensity ( 55%-65%)

 Low: (185 bpm - 60 bpm) x 55% + 60 bpm = 129 bpm
High: (185 bpm - 60 bpm) x 65% + 60 bpm = 141 bpm
Desired HR Range = 129 bpm - 141 bpm

To stay within the THR range, our client will begin his program walking/jogging on the
treadmill at a speed of between 3.8-4.5 mph (used the walking equation, made slight
adjustments based on age, height, little recent experience with jogging)

Desired RPE range - 13-15 (to begin)

VO2RESERVE zone (show the math):

** use a higher moderate intensity / lower vigorous intensity ( 55-65%)

Low: (38.5 ml/kg/min - 3.5 ml/kg/min) x 55% + 3.5 ml/kg/min = 22.75 ml/kg/min
High: (38.5 ml/kg/min - 3.5 ml/kg/min) x 65% + 3.5 ml/kg/min = 26.25 ml/kg/min

Desired VO2 Range = 22.75 ml/kg/min - 26.25 ml/kg/min

How did you come to prescribing this zone? Why? Provide your justification for the
range selected.

We prescribed this zone because the client is already participating in moderate intensity
aerobic activity 3 days a week. To prepare him for a 5K, we want to slowly increase the
intensity of his aerobic exercise to a higher moderate/lower vigorous intensity. The
client’s maximum achieved VO2 was calculated in a GXT to be 38.5 ml/kg/min, so we
will begin his training program anticipating a VO2Reserve Zone of about 22.75-26.25
ml/kg/min. Another reason why we will have our client start at a higher moderate
intensity is because the client has not jogged for a long time, so we want to start him off
at a slower pace and increase the time that he is able to sustain the jog over time until he
reaches approximately 30-40 minutes at a jogging pace (estimated time of a 5K). This
zone has an intensity of 3.8-4.5mph which we are assuming will be a taxing walk to a
light jog. With time, our goal is to increase the client’s exercise capacity with increasing
speeds. Upon beginning the program, we acknowledge that we will have to monitor his
blood pressure even though it is to be controlled by his blood pressure medication. Once
we see that he is able to handle the exercise without significant increases in blood
pressure, we will continue to progress his activity at a safe rate.

Precisely outline the prescription including warm-up, conditioning phase, and cool-down.

Steady-State Session
__55___ % VO2R

__55-65___ % THR zone ___129-141___ THR Range (bpm)

___12-14_____ RPE Range

Precisely outline steady-state session WU, conditioning phase, and CD:

WU: TM Walking 2.5mph, 0% grade, 5 minutes at RPE 8-9

Conditioning: TM jogging 4.5mph (assumed jogging pace for client), 0% grade for 10 minutes
(one 10min session before RT, one 10min session after RT for a total of 20min CR), at RPE 12-
14, THR 129-141bpm
CD: TM Walking 2.5mph, 0% grade for 5 minutes at RPE 8-9

Interval Session
____60____ % VO2R

____129-134____ % THR zone __135-144__ THR Range (bpm)

_13-15___ RPE Range

Precisely outline steady-state session WU, conditioning phase, and CD:

WU: TM Walking 2.5mph, 0% grade, 5 minutes at RPE 8-9

Conditioning: TM Intervals - total duration 20 minutes, RPE 13-15
Low - walk 3mph, 5% grade with RPE 12-13, THR 129-134 for 2.5 minutes (2x)
High - jog 4.5mph, 0% grade with RPE 13-15, THR 135-144 for 5 minutes (3x)
CD: TM Walking 2.5mph, 0% grade, 5 minutes at RPE 8-9

Resistance and Flexibility Exercise Prescription Design

**Consider that the client is available to come to the facility on back to back days so work
different parts of the body during resistance training to prevent overuse/fatigue injuries.
 Day 1 Day 2
Chest, arms, Legs, back,
shoulders abdominals

RT Exercise Weight Sets Rep RT Exercise Weigh Sets Rep

Range t Range

Bench Press T&E 3 8-12 Lat PD T&E 3 8-12

DB Flies T&E 3 8-12 Bent Over Rows T&E 3 8-12

Bicep Curls T&E 3 8-12 Deadlift T&E 3 8-12

Tricep Dips BW 3 8-12 Split Squat T&E 3 8-12

Shoulder Press T&E 3 8-12 Russian Twists MB 3 25-30

Lat/Front Raise T&E 3 8-12 Plank BW 3 Hold 30s

Day 1 Day 2
Repeated on Same as Day 1
M, T, R, S

Flexibility Sets Duration Flexibility Sets Duration

Hamstring stretch 2 30 seconds Hamstring stretch 2 30 seconds

Hip Flexor stretch 2 30 seconds Hip Flexor stretch 2 30 seconds

Quad Stretch 2 30 seconds Quad Stretch 2 30 seconds

Shoulder stretch 2 30 seconds Shoulder Stretch 2 30 seconds

Calf Stretch 2 30 seconds Calf Stretch 2 30 seconds

3 weekly BGs (Aerobic, Resistance, Flexibility) that represent the entire week.

CR: The client will go to the McKenna gym at 7pm on Wednesday to complete two 10 minute
sessions on the TM for conditioning phase at 4.5mph, 0% grade, with an RPE of 12-14 and THR
of 129-141 bpm. One 10 minute session will be completed before the resistance training and the
second session will be completed after the resistance training. On Thursday at 7pm, the client
will complete interval training on the TM alternating between 3mph, 5% grade, RPE 12-13 and
THR of 129-134bpm for 2.5 minutes and 4.5mph (jog), 0% grade, RPE 13-15 and THR of 135-
144bpm for 5 minutes for a total of 20 minutes.

RT: On Wednesday at 7pm, the client will go to McKenna gym and complete a workout
including exercises to work the chest, arm and shoulder muscles. Each exercise will be
completed in 3 sets of 8-12 repetitions at the prescribed intensity before aerobic activity. On
Thursday at 7pm, the client will complete a workout including exercises that work the legs, back
and abdominal muscles. Each exercise will be completed in 3 sets of 8-12 repetitions or for the
prescribed amount of time at the prescribed intensity before aerobic activity.

F: On Monday, Tuesday, and Saturday when the client does his individual workouts, he will now
end them with complete static stretching; each prescribed stretch will be done twice held for 30
seconds to the point of mild discomfort. On Thursday at 7pm, the client will complete the same
static stretches (two sets held for 30 seconds to the point of mild discomfort) upon finishing the
prescribed resistance training exercises.

Hypothetical Progression and Justification towards IOs.

Hypothetically, after 3 weeks, we would like to increase the speed and/or the duration that the
client is jogging on the treadmill. On Wednesdays, we begin doing two separate 10 minute
sessions of a jog at 4.5mph. Our goal is to improve his aerobic endurance so that he is able to
complete a single 20 min session instead of two separate bouts of 10 minutes to better prepare
him for a 5K. Similarly, if the client is comfortable, we would also like to improve upon his
speed to jog at 5mph (12 minute mile time) with a similar RPE range to what it would be at the
beginning of training at a 4.5 mph pace. Depending upon the client’s personal goals of how fast
he wishes to complete his 5K, will depend on how high we increase the speed of the treadmill
over time. At the end of his training program, we hope to have our client jogging at a 10-12
minute mile pace (6mph) in a single session of 30-40 minutes at an RPE of 13-15.

For resistance training, Jack should spend about 25-30 minutes progressing through both
machines and free weight exercises. Once the client is showing that he is able to partake in an
exercise with two extra repetitions on two consecutive resistance training sessions, we will
increase the amount of weight. To improve upon muscular endurance, we also may progress the
client to higher amounts of repetitions (15+ reps) after 4 weeks to help better prepare his muscles
for the duration of a 5K.

We would like our client to spend 5 minutes stretching four days a week so that he can improve
his flexibility which was assessed as poor before beginning the training program. Our goal for
the client is to be able to pass the Back Scratch flexibility test for both of his hands and improve
upon his Sit-and-Reach score. Flexibility will help our client lower his risk for injury while being
active most days of the week.