Which of the following recommendations would reduce risk of cardiovascular disease (CVD)? ?reduce his intake of soluble fiber ?consume more saturated fat ?smoke no more than one pack of cigarettes a day ?become more physically active
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According to the Nurse's Health Study, replacing 5% of calories from saturated fats with monounsaturated fats would heart disease risk. Question 47 Which cardiovascular disease risk factors can all be modified with lifestyle changes? diet weight and age diet level of physical activity, and smoking status diet where You Live and age alcohol intake, gender family history; serum LDL, and gender Question 48
Adi S.
Madhur L.
Medical History: Mr. AB, a 60-year-old Caucasian male, comes to your fitness center for an exercise program. He is apparently healthy but has a 15-year history of hypertension. His goal is to improve his health and fitness and reduce his risk for heart disease. In the past, he did heavy resistance training and powerlifting. At present, he has a body mass index of 31 kg·m–2. His medications include aspirin (325 mg daily) and atenolol (50 mg daily). He has a family history of premature CHD; his low-density lipoprotein (LDL) cholesterol is elevated (165 mg·dl–1); his resting BP is 148/88 mmHg; and his resting heart rate is 60 beats·min–1. He drinks three or four cans of beer with dinner each evening. Diagnosis: Mr. AB has a lengthy history of hypertension. Additional risk factors include obesity, age, family history, dyslipidemia, sedentary lifestyle, and elevated alcohol consumption. Exercise Test Results: During a recent maximal exercise test, Mr. AB exercised for 6 minutes using the Bruce treadmill protocol and achieved a maximum heart rate of 130 beats·min–1 and BP of 240/90 mmHg. He did not develop any significant arrhythmias or ST-segment changes. Exercise Prescription: Mr. AB achieved 81% of his age-predicted maximal heart rate (HRmax). The test was negative for underlying cardiovascular ischemia. The initial prescription should be set at a modest intensity (40% VO2R), and emphasis should be placed on building exercise duration to increase energy expenditure. Non-weight-bearing activities should be emphasized initially to minimize the risk of musculoskeletal injury. Questions: 1. Is it necessary for Mr. AB to exercise at high intensity to help manage his hypertension? 2. How will atenolol (a beta-blocker) affect the prescription of a target heart rate range for Mr. AB? 3. What is an appropriate aerobic exercise prescription for Mr. AB? 4. What advice would you give Mr. AB about going back to heavy resistance training and powerlifting? 5. What additional lifestyle modifications should be discussed with Mr. AB to optimize his BP control?
Sri K.
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