Dear Mr. Mike Poteat,

Congratulations on making the decision to enhancing your life through

physical activity. I am ecstatic to assist you on reaching your goals to a healthier

lifestyle. Thanks to your compliance with taking the many health assessments, I

surmised your information and determined where you rank, based on age and sex,

with the “American College of Sports Medicine’s Guidelines for Exercise Testing and

Prescription”.

During your interview with Mr. McCammon, you stated that your long-term

goal is to weigh between 175-178 lbs.; and your short term goal is to lose about 5

pounds and participate in more aerobic activity, in order to build endurance for

tennis. The semester will be ending in the next 5-6 weeks, and I am very confident

that I can help you reach your short-term goal and with more time even your long

term goal! Previously, you stated that you participated in both strength training and

aerobic activity, but during Christmas break you stopped. Since then, you mainly do

aerobic exercise with the stationary bike for about 2-3 hours, 5 days a week, 32-34

minute sessions, at a speed of 12 mph. Also, that you currently participate in

strength training twice a week. That is great; it seems your physical activity level is

very good! Although, I would encourage at least another strength training day

incorporating vigorous and explosive exercise to further your strength and

endurance levels. However, this assessment is not a replacement for professional

medical care, but to take into consideration that incorporating this program can

help lessen medical problems in the future.

Throughout the paper, I will be summarizing your current health

assessments and review over the recommended values for several variables

including blood pressure, cholesterol levels, blood glucose, body mass index (BMI)

and many others that could be detrimental to your health, if left unchecked. I will

also be discussing your past surgeries and what I plan to do to help strengthen your

muscles to help relieve some discomfort. As well as the medications you were

prescribed for hypertension, mood, and sleep aid. Exercising regularly and

maintaining a healthy lifestyle can provide many benefits towards your health in the

future. Exercising can help prevent or delay the chance of contracting Type 2

Diabetes, stroke, and myocardial infarction. I would say exercising can help save you

a lot of money on prescription medications; being active is great for the body and

the mind.

I would like to commend you again on seeking help with your health, because

I know the hardest step is asking for help. By doing so, I can now give you proper

guidance and support to help you reach your goals and beyond. As long as you stay

motivated and believe in the program, and me; I know we can achieve your goals!

Results:

Variable Value Recommended/Normative Ranges

Height (in) 70 N/A

Weight (lb) 188 N/A

BMI (kg/m2) 27 <25 kg/m2

Waist Girth (inches)

38.5 <40 in

Percent Fat 30.1 11-23%

Blood Pressure (mmHg)

118/84 <120/80 mmHg

Resting HR (bpm)

69 60-100 bpm

Cholesterol (mg/dL)

193 <200 mg/dL

LDL-Cholesterol (mg/dL)

100 <130 mg/dL

HDL-Cholesterol (mg/dL)

71 >40 mg/dL

Triglycerides (mg/dL)

108 <150 mg/dL

Glucose (mg/dL)

115 <100 mg/dL

Treadmill time (mm:sec)

13:20 > 14:15 (Good and above)

Maximal Heart Rate

151 220-age=155

VO2

(ml/kg/min)

33.8 – 34.8 35.6 – 54.0 (Good and above)

Aerobic fitness Level

50th percentile

60th percentile and above

Values highlighted in red represent positive risk factors.

Values highlighted in blue represent negative risk factors.

I will first discuss your baseline vitals; these are your Body Mass Index (BMI),

waist measurement, regional body fat, blood pressure and heart rate. First, your

BMI was measured at 27 kg/ m2, the recommended range for age and sex is between

18.5-24.9 kg/ m2. This would place you outside of the normal average range for a

white adult male and into the overweight category. This is not a positive risk factor,

although you are considered overweight, you are not obese. If you had a BMI greater

than or equal to 30 kg/ m2, then you would be considered a positive risk factor. A

positive risk factor means you are classified as being at risk. [1] Second, your waist is

38.5 inches, which meets the recommended of being less than or equal to 40 inches.

Third, the results for your regional body fat was 30.1 percent, the recommended

optimal range for body fat, for your age and sex, is between 11-23 percent. Fourth,

your blood pressure was measured at 118/84; 118 is your systolic blood pressure, it

is the maximum arterial pressure occurring during the contraction of your left

ventricle of the heart. The value 84, represents your diastolic blood pressure, and is

the minimal arterial pressure occurring during the relaxation of the ventricles of the

heart. Your systolic is within the recommended range, but your diastolic is a little

high. This value categorizes you into prehypertension, making this a positive risk

factor. It is possible to reduce this value through exercise, so do not let this risk

factor discourage you. [7] Lastly, your resting heart rate was 69 beats per minute

(bpm), the recommended range is 60-100 bpm. Considering your results, you are

doing very well, thus far, with only one risk factor, so let us continue to your blood

test.

Next, I will be covering your blood test results, which includes your total

cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and

triglyceride levels. First, let us discuss your total cholesterol, your blood test shows

a value of 193 mg/ dL, which is within the normative range of being less than 200

mg/dL. Second, your HDL value was 71 mg/ dL, this is really good! The

recommended range is greater than or equal to 40. Additionally, since your HDL

value is so high it is considered a negative risk factor. This is due to the cardio

protective effect of HDL, having greater than or equal to 60 mg/ dL, the more high-

density lipoprotein you have, the better it is. [1] Third, your results for LDL was 100

mg/ dL, the recommended value is being less than 130 mg/ dL; for LDL lower is

better, if it were high you would be at risk for developing atherosclerosis.[1] A great

way to prevent a high LDL level would be to incorporate a healthier diet. One in

particular is called the “TLC diet”, TLC stands for the therapeutic lifestyle changes,

and it influences one to eat a more low saturated and low cholesterol diet.

Additionally, to incorporate more fiber, whole grains, fruits and lean meats.[4] Lastly,

your triglyceride values are 108 mg/ dL, the recommended value is less than 150

mg/ dL. If you were to be over 150 mg/ dL, you would be a positive risk, but it

would also indicate an elevated risk of stroke and heart disease. [6] A great way to

keep your triglyceride levels low and maintain healthy HDL and LDL values is

through regular exercise for 30 minutes, 4-5 days a week of moderate intensity. If

you do not have time for a 30 minute bout, try for 10 minute bouts three times a

day. Physical activity exercises, as, easy as, a brisk walk, or swimming is good; if you

are at work, simple exercises such as push-ups, sit-ups, or climbing stairs are also a

great workout. [6]

Finally, I will go over your cardiovascular tests; which includes max heart

rate (HR), Balke Treadmill Test (with percentile), and VO2 max (with percentile).

First, your max heart rate result was 151 bpm, the normative range is 155 bpm,

based on your age. The maximum heart rate is used to help determine target heart

rate zones. Maximum heart rate can be estimated by calculating 220 minus one’s

age. [1]Second, the results for your Balke Treadmill test was 13:20, placing you

between the 50-55 percentile, ranking your fitness level as fair. This ok, but the

recommended range is remaining on the treadmill between 16:39-27:00. This

would categorize your fitness level in the good to superior; also place you in the 60-

99 percentile. [1] Considering your fitness level, you are fine, only if you were below

the 20th percentile for your age and sex, would you be considered at risk for being

sedentary. A sedentary lifestyle is indicative of having an increased risk of death. [1]

Overall, the key to good health is maintaining a healthier lifestyle, an active lifestyle

and incorporating a healthy diet.

Explanation:

Now, let us go over your “Know Your Number” report. I would first like to

begin with your current risk of being diagnosed with a disease in the next 5 years.

This is comparing you to 100 people who have the risk factor information and the

likeliness of you being diagnosed with that disease; it will be translated into your

percent of risk for disease onset. On your report it shows that have a 2.5% chance of

contracting coronary heart disease (CHD), meaning approximately 2 or 3 out of 100

people with similar results to you will be diagnosed with CHD. Additionally, 1.7%

will develop a stroke, 3.4% will be getting diabetes and 1.4% will contract coronary

heart failure (CHF). So within the next 5 years, it is projected that 1 to 4 of the 100

people with your related risk factors will be diagnosed with one of these

corresponding diseases. This is considered relatively low to below average on the

risk percentile graph. Your modifiable risk is the percentage of your current risk and

how modifying your behavior can decrease your chance of developing the specific

disease listed. On the report it shows you have a 33% modifiability for CHD, 29%

towards stroke, 64% to diabetes and 11% for CHF. Below the percentile chart is a

graph that shows your modifiable risks and what is being modified. It shows seven

modifiable factors, smoking, cholesterol, blood pressure, weight, glucose, exercise,

and aspirin. With these factors considered, it shows us the amount of what each

factor contributes based on the disease. For example, 64% your risk of developing

diabetes is modifiable, with a large percentage contributed to glucose followed by

weight. Lastly, the “Know Your Number” report shows your current percentile risk

as it is compared to other Americans in your same age and gender group. It

represents the percentage of individuals who are at a lower risk than you for that

particular disease. Your results show 3% for CHD, 12% for stroke, 50% for diabetes,

and 22% for CHF. Understandably, in your results it shows that 50% of relatable

Americans have a lower risk of developing diabetes, compared to you.

Regarding your “Know Your Number” results, let us discuss it comparing it to

heart disease. Heart disease is also known as coronary heart disease; it is related to

plaque buildup in the walls of the arteries, or atherosclerosis. It makes it more

difficult for blood to flow and creates a risk for a heart attack or stroke. [2] Heart

disease is the leading cause of death for men in the United States; it contributes to 1

in every 4 male deaths. Also, between 70% and 89% of sudden cardiac events

occurs in men. Some key risk factors are high blood pressure, high LDL cholesterol,

and smoking. [3]Referring to your blood pressure which was 118/ 84 mmHg, your

systolic is within the recommended range; whereas, your diastolic is not, as I

discussed earlier. Because, your diastolic blood pressure is considered to be a

positive risk factor for prehypertension, you are in danger of having high blood

pressure. High blood pressure is classified as having a blood pressure higher than

140/90 mmHg, people with this statistic often become patients treated for serious

cardiovascular problems. [2] Also, if you had high cholesterol that would be a factor

as well, but your levels were great! Your HDL was 71mg/ dL, LDL was 100 mg/ dL,

and triglycerides were 108 mg/ dL; these results were all in the recommended

range for good health. Furthermore, you mentioned you use to smoke in the past,

but that was more than 6 months ago, congratulations on quitting! Because you

stopped smoking so long ago this is not considered a risk factor.

Next, I want to discuss type 2 diabetes. Diabetes is a disease in which blood

glucose levels are higher than normal, greater than or equal to 126 mg/ dL. Type 2

diabetes can affect anyone, no matter the age; people who are overweight and live

an inactive lifestyle are more likely to develop type 2 diabetes. It usually begins with

insulin resistance, a condition that occurs when fat, muscle, and liver cells cease to

use insulin and carry glucose into the body to use as energy. Then the pancreas try

to keep up by producing more insulin. Eventually, the pancreas will not be able to

make enough insulin when blood sugar levels increase. When this happens you will

need to start treating for type 2 diabetes. [5] According to your results, you had a

blood glucose level of 115 mg/dL, placing you in the prediabetes section.

Prediabetes is when the amount of glucose in your blood is above normal yet not

high enough to be called diabetes. Because of this your chances of contracting type 2

diabetes, heart disease, and stroke are higher. Fortunately, with some weight loss

and moderate physical activity, you can delay or prevent type 2 diabetes. You can

even return to normal glucose levels, possibly without taking any medicines. [5]

Lastly, atherosclerotic stroke, heart disease and stroke are the usual

consequence of atherosclerotic stroke and even hypertension. Atherosclerosis

consists of concentrated areas of atheromas within the arterial wall that often

become encrusted or hardened by deposits of calcium, thus resulting in plaque

build-up. This plaque weakens the arterial wall, lowering blood flow to the heart,

the brain, and lower extremities. Should this plaque be unchecked, it can continue to

build until it ruptures resulting in a heart attack or stroke. About half of all strokes

are due to atherosclerosis, the same process of narrowing and hardening of the arteries

that cause heart attacks inhibiting blood flow to the brain.[7] Ishemic strokes accounts

for 87% of all strokes, this occurs when there is an obstruction within the blood

vessel that feeds blood to the brain. Hemorrhagic strokes, another form of stroke,

occurs when a weakened blood vessel ruptures and bleeds into the brain after it breaks.

This form of stroke is commonly caused by uncontrolled hypertension. Keep in mind that

there are such things as “mini strokes,” also known as TIA or transient ischemia attack.

These are caused by a temporary blood clot. It is an important to pay attention to your

body and recognize the sign and symptoms associated with it. An easy way to remember

the sudden signs and symptoms of a stroke is by an acronym known as F.A.S.T; Face

drooping, Arm weakness, Speech difficulty, Time to call 911. [7] If these signs should

occur you will know to call 911 or ask for immediate assistance. Furthermore, high

blood pressure, hypertension, can also cause heart disease or stroke by

exacerbating the effects of other risk factors in accelerating the progression of

atherosclerosis, through continued, excess work on the heart. [3] Considering you are

categorized as prehypertensive, for having a diastolic value of 84 mmHg and taking

prescription and anti-hypertensive medication, you should make modifiable

decisions to become physically active. Being more physically active can help

improve diastolic value to the recommended range of less than 80 mmHg.

A great way to prevent heart disease, type 2 diabetes, or atherosclerotic

stroke is to be physically active and maintain a good diet. The guidelines from the

ACSM exercise prescription for cardio, strength and flexibility are great ways to

ensure a healthy, active lifestyle. Cardiorespiratory exercise should be at least 150

minutes per week of moderate intensity; 30-60 minutes of moderate intensity or

20-60 of vigorous activity per session for 3-5 days a week. It recommends strength

training 2 or 3 days a week, approximately 10-15 repetitions for 2-4 sets, targeting

major muscle groups. Lastly, flexibility should be done 2 or 3 days per week, to

improve range of motion, holding each stretch 10-30 seconds, repeating each

stretch 2 to 4 times to accumulate 60 seconds. [1] Also, incorporating a healthy diet

will contribute to one’s risk of contracting a potential health risk.

When prescribing an exercise program, the trainer is trying to meet to

client’s heath and fitness goals, because what works for one person may not work

for the next person. Each person is genetically made differently, so when prescribing

exercise to a client it should match their goals. The components to be address here

are cardiovascular fitness (aerobic exercise), muscular strength, as well as

flexibility.

First, aerobic exercise has many benefits, it increases efficiency of

respiration, blood volume to muscles, stroke volume, cardiac output, body

composition, and many more. It can also help decrease the risk of developing

coronary heart disease, cancer and diabetes, which is very beneficial for someone

with a family history of diabetes. [1] Not only does aerobic exercise help with

lowering health risks and improving cardiovascularity, pumping more blood to the

heart per beat, reducing heart rate during rest and exercise; also, it has

psychological benefits. According to the ACSM Guidelines for Exercise Testing and

Prescription, regular exercise can help improve self-esteem and lower rates of

depression. When you exercise the body releases endorphins, these are considered

natural painkillers that reduces your perception of pain and triggers a positive

feeling in the body. I know you cycle often, it is the feeling you get after you

complete your cycling session, known to runner’s as the “runner’s high”; you feel

really good and you have that sense of achievement! Also, aerobic exercise involves

using large muscle groups such as your lower body, quadriceps, hamstrings and

glutes. The body works the hardest when there is multiple muscles being recruited

in a single movement, increasing caloric expenditure. Thus, incorporating a variety

of aerobic exercises will help improve your health, mobility, well-being, self-efficacy,

cardiovascular health, and strengthen your muscles. I have devised a 4 week

aerobic exercise program for you to partake in, based on your Heart Rate Reserve

(HRR) and your VO2 Reserve (VO2R). [1]

Aerobic Exercise Program

WeekIntensity

(HRR) DurationFrequenc

y Mode Work Rate VO2R

1

40%-50% (101-120 bpm) 20-30 mins

3-4 days/ week Treadmill

Speed=3.0 mphElevation=9%

15.62-18.65 ml/kg/min

2 40%-50% (101 -120

20-30 mins 3-4 days/ week

Treadmill Speed=3.0 mphElevation=10

15.62-18.65ml/kg/min

bpm) %

3

50%-60% (120-141 bpm) 30-40 mins

4-5 days/ week Treadmill

Speed=3.0 mphElevation=12%

18.65-21.68ml/kg/min

4

50%-60% (120-141 bpm) 30-40 mins

4-5 days/ week Treadmill

Speed=3.0 mphElevation=13%

18.65-21.68ml/kg/min

This 4 week plan shows a steady increase in your intensity, duration, and

work rate. Using your VO2 max I have determined your elevation and gradually

increased it each week. The purpose to the gradual increase is because with time

your body will begin to adapt and get stronger. When this occurs, your body needs

to be challenged in order to become stronger. By week 4, you should be able to

clearly see results, not only in your aerobic capacity, but externally as well; such as,

your body composition.

Also, to go along with aerobic exercise you should incorporate strength

training into your schedule. Practicing strength training is really good for your body,

especially at an older age, your bones begin to get weaker and your muscles will

suffer from atrophy. To ensure optimal health/ fitness gains and minimize any

possible injury it is imperative to practice strength training. Below I have devised a

4-week resistance program to help you get back in the routine of strengthening your

muscles.[1]

4-week Resistance Program

WeekFrequenc

yTime (min) Intensity (%) Repetitions Sets

12-3 days/ week N/A 40-50% 1-RM 8-12 1

22-3 days/ week N/A 40-50% 1- RM

8-121

32-3 days/ week N/A 60-70% 1-RM

10-151-2

42-3 days/ week N/A 60-70% 1-RM

10-151-2

In this 4-week resistance program, I have increased your intensity,

repetitions, and sets gradually. The purpose to this is to continue to increase

muscular strength and mass, this is known as “progressive overload”. Progressive

overload can be accomplished many ways, in this exercise program I have increased

the number of sets. A single set of resistance exercise is effective especially among

older adults and novice strength trainers such as yourself. I increased the number of

sets in order to improve strength and power. Based on your age I increased the

repetition levels from 8-12 to 10-15 repetitions; 10-15 repetitions is effective in

improving strength in middle-aged and older adults. The intensity range is also

based on your age, 20%-50% based on 1 repetition maximum is good for older

adults to improve power. Also, intensity levels in the 40%-50% range of 1 repetition

max is very beneficial for older adults and beginners in strength training. It is also

great for improving strength in sedentary individuals beginning a strength training

program. I increased your intensity to 60%-70% of 1 repetition max because it is

recommended for older adults and very deconditioned individuals. The type of

exercises you should participate in should involve your major muscle groups that

incorporate multijoint exercises to single joint exercises. Exercises can include

lunges, squats, push-ups, overhead shoulder press, bench press, bicep curls, tricep

curls, hamstring curls, leg extensions, etc. These exercises can be performed with

barbells, dumbbells, or even your own body weight. There are a variety of ways to

increase strength, but it is important to maintain and adhere to the program to

promote longevity and a strong, healthy body. [1]

Lastly, incorporating flexibility into your regimen can be very beneficial; it

can enhance posture, improve balance and coordination. You will also want to

develop range of motion in major muscle tendon groups, such as your shoulder,

girdle, chest, neck, trunk, lower back, hips, legs, and ankles. Be sure that your

muscles are warm before you stretch. The best time to stretch is immediately after

exercise since your muscles will have been warmed up through exercise. There are

six types of flexibility stretches known as ballistic, dynamic, static, active static,

passive static, and proprioceptive neuromuscular facilitation (PNF). Ballistic

stretches use the momentum of the body segment in order to produce the stretch,

also known as “bouncing”. Dynamic stretching involves a gradual transition from

one body position to another, progressively increasing the range of motion through

repeated movement. Static stretching is slow stretching a muscle/tendon group and

generally holding the stretch for 10-30 seconds. Active static stretching involves

holding the stretch using the strength of the agonist muscle, it is quite common in

yoga. Passive static stretching involves assuming a position while holding a limb or

other part of the body with or without assistance of a partner or device; such as

elastic bands or a ballet bar to assist with balance. PNF methods has many forms but

typically involves an isometric contraction of your muscle/ tendon group and is

then followed by a static stretch of the same muscle/tendon group. [1] Below is a

detailed summary of the FITT-VP principle of Ex Rx for flexibility exercises.

Flexibility Training 

Frequency ≥2-3 d . wk-1 with daily being most effective

Intensity

Stretch to the point of feeling tightness or slight discomfort

Time

Holding a static stretch for 10-30 s is recommended for most adults.

In older individuals, holding a stretch for 30-60 s may confer greater benefit.

For proprioceptive neuromuscular facilitation (PNF) stretching, a 3-6 s light-to-moderate contraction (e.g., 20%-75% of maximum voluntary contraction) followed by a 10-30 s assisted stretch is desirable.

Type

A series of flexibility exercises for each of the major muscle-tendon units is recommended.

Static flexibility (i.e. active or passive), dynamic flexibility, ballistic flexibility, and PNF are each effective

Volume

A reasonable target is to perform 60 s of the total stretching time for each flexibility exercise.

Pattern

Repetition of each flexibility exercise 2-4 times is recommended.

Flexibility exercise is most effective when the muscle is warm through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths.

Mike, I want to commend you for making the decision to live a healthier

lifestyle that will overall benefit your life. As I have discussed chronic diseases have

an effect on one another and early detection is good to promote a prolonged life.

Exercise adherence directed toward strength, aerobic, and flexibility will also assist

in promoting a stronger body, which will help you maintain your independence.

Paired with maintaining a generally healthy diet are key factors to lessening health

risks, building muscle, and promoting a healthy life. You are not in horrible

condition, but there are some areas to improve on. With this exercise program,

specifically designed for you based on your health and current lifestyle. The harder

you work, the better results you can expect to see. I am honored to have been able to

help you improve your life, because I know it takes a lot of courage to ask for help. If

you ever need assistance or have any questions, I am here for you! From the words

of Mahatma Gandhi, “ The future depends on what you do today”, so always strive

for a better future!

Bibliography

[1] American College of Sports Medicine, Thompson, W. R., Gordon, N. F., &

Pescatello, L. S. (2014). ACSM's guidelines for exercise testing and prescription

(9th ed.). Philadelphia: Lippincott Williams & Wilkins.

[2] American Heart Association. (n.d.). Conditions. Retrieved from

http://www.heart.org/HEARTORG/Conditions/Conditions_UCM_001087_SubHome

Page.jsp

[3] Center for Disease Control and Prevention. (2013, August 26). Men and Heart

Disease Fact Sheet|Data & Statistics|DHDSP|CDC. Retrieved from

http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm

[4] Cholesterol Levels: What You Need to Know | NIH MedlinePlus the Magazine.

(2012). Retrieved from

http://www.nlm.nih.gov/medlineplus/magazine/issues/summer12/articles/

summer12pg6-7.html

[5] National Diabetes Information Clearinghouse. (2014, February 12). Your Guide to

Diabetes: Type 1 and Type 2: Learn about Diabetes - National Diabetes Information

Clearinghouse. Retrieved from

http://www.diabetes.niddk.nih.gov/dm/pubs/type1and2/index.asp

[6] Triglycerides: Why do they matter? - Mayo Clinic. (2012, September 28).

Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-

cholesterol/in-depth/triglycerides/art-20048186?pg=2

[7] Types of Stroke. (n.d.). Retrieved April 15, 2015, from

http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/

Types-of-Stroke_UCM_308531_SubHomePage.jsp

[8] What Is High Blood Pressure? - NHLBI, NIH. (2012, August 2). Retrieved from

http://www.nhlbi.nih.gov/health/health-topics/topics/hbp