Medical History: Mrs. KY is a 45 yr old Caucasian female, married with two teena
ID: 94700 • Letter: M
Question
Medical History:
Mrs. KY is a 45 yr old Caucasian female, married with two teenage sons. She is employed as a senior manager at a large bank and reports experiencing an “above average” level of tension and stress. She presents at the referral of her primary care physician, who has observed that the client has elevated blood pressure and cholesterol levels that may be attributed to her stressful and highly sedentary job. In addition, the client admits that she would like to lose 30 to 40 lb (14 to 18 kg) and improve her fitness so that she can ride her bike with her husband on a community rail trail recently installed by her neighborhood.
Diagnosis:
Mrs. KY is a sedentary but otherwise healthy middle-aged female with significant risk factors for cardiovascular disease including obesity, dyslipidemia, and psychosocial stress. At the request of her physician she seeks to start exercising as part of a disease prevention program.
Exercise Test Results:
The client is 5 feet 6 in. tall (168 cm) and weighs 196 lb (89 kg), with a body mass index of 31.7. She has a resting heart rate of 85 beats · min–1 and a resting blood pressure of 136/89 mmHg. Her total cholesterol is 198 mg · dl–1 untreated, and her high-density lipoproteins are 34 mg · dl–1. Her graded treadmill stress test revealed that she has a V.O2max of 20.5 ml · kg–1 · min–1, which is normal for an unfit woman of her age range. Her electrocardiogram was also unremarkable at rest, as well as during and following her test. In addition, she reported smoking from ages 17 to 40. She also complains of occasional joint stiffness in her hands and ankles. The client describes herself as nonathletic and admits to never participating in an organized sport or exercise setting. She is aware of the benefits of exercise but did not feel an incentive to begin a formal program until her doctor’s recommendation. The client jokes that although her workday is highly organized and structured, the rest of her life is chaotic and that it is due only to the support of her husband and kids that anything gets done at home. She laments that her eating habits are atrocious and that she is so tired when she gets home from work that she has only enough energy to make dinner before crashing in front of the television. She presents to you to start a workout program that will help achieve her goals.
Exercise Prescription:
The exercise plan including the traditional components—frequency, intensity, duration, and modality (discussed in detail in later chapters)—may be tailored to address specific risk factors. The subject’s medical history, however, clearly indicates that this person had not prioritized exercise participation until she received her doctor’s recommendation. Moreover, she presents with numerous potential barriers to engaging in a physically active lifestyle, as well as behaviors that contribute to her overweight status. The clinician should assist the participant in establishing awareness and developing strategies to address those barriers. Furthermore, the clinician should consider tailoring strategies for motivating the participant toward the adoption of a healthy, physically active lifestyle.
Questions:
1. Applying the transtheoretical model, at what stage of exercise adoption is this client?
2. Based on your response to question 1, what types of interventions are most appropriate for this stage of change and why?
3. If you used the health belief model, what factors would you emphasize to achieve optimal exercise adherence?
4. How would Bandura’s social cognitive theory be relevant to fostering exercise adherence for this client?
Explanation / Answer
The Transtheoretical Model was proposed by Prochaska and DiClemente in 1970's. The whole idea behind proposing this model was to emphasise on the intentional behaviour change of an individual instead of only concentrating on factors like social and biological influences. It is a model and not a theory which was developed to understand modification of behaviour and what lead to it. Other theories proposed by Bandura, Skinner or Pavlov focused on manipulating external factors in order to observe a change in the behaviour of a person. The Transtheoretical Model emphasises on how a person intentionally tries to or wants to change his or her habitual behaviour. This model when proposed was used to understand why some people are more capable of quitting smoking or any habitual habit like drinking or over-eating on their own instead of putting them in rehabs.
In The Transtheoritical Model, an individual goes through a series of stages of change. It includes a person starting at stage one and getting through the last stage with the help of different intervention strategies.
There were originally five stages to TTM, Precontemplation (not ready), Contemplation (getting ready), Preparation (ready), Action and Maintainence.
In the above case study, the client is at the Precontemplation stage with regard to her exercise adoption. It's clearly mentioned that the client "had not prioritized exercise participation until she received her doctor’s recommendation". She contemplated on losing weight but definitely did not intend on taking action for her everyday workout routine which plays an important role in her losing weight.
Motivation by family and her clinician to adapt to a healthier lifestyle, and explaining the pros and cons of doing so, perhaps would help the client to make progress through other stages of The Transtheoritical Model.