Medical History: JT is a 10 yr old white male. He is sedentary most of the time
ID: 96379 • Letter: M
Question
Medical History:
JT is a 10 yr old white male. He is sedentary most of the time and would rather play computer games than play outdoors or participate in sports. His mother has noticed that he has shortness of breath when exercising, and she is worried about his health. She took JT to see his pediatrician due to these concerns.
Diagnosis:
The pediatrician completed a physical e x a m and referred JT for an exercise test.
The results were as follows:
BMI = 31
Maximal functional capacity = 8 METs
Blood lipids and glucose:
• Total cholesterol = 200 mg · dl–1
• High-density lipoprotein = 32 mg · dl–1
• Triglycerides = 190 mg · dl–1
• Low-density lipoprotein = 220 mg · dl–1
• Glucose = 119 mg · dl–1
Resting blood pressure = 130/86 mmHg
Resting HR = 90
Questions:
1. Is JT at risk with respect to body mass index?
2. Is JT at risk with respect to his aerobic capacity?
3. Is JT at risk with respect to blood lipids, glucose, or blood pressure?
4. What would be an appropriate exercise test for JT (mode, protocol) and why?
5. As you sit down with JT and his mother following testing, how would you approach this patient regarding his results?
6. What suggestions would you give JT to improve his results? If you suggest increasing physical activity, how would you justify this to him? Explain why physical activity would or would not be beneficial for JT.
7. Write an exercise prescription for JT to improve the following: aerobic endurance, muscular endurance and strength, and range of motion.
Explanation / Answer
1. Is JT at risk with respect to body mass index?
Yes, JT is at risk with respect to body mass index (BMI) because, a BMI of 31 is considered obese. (Normal BMI = 25)
2. Is JT at risk with respect to his aerobic capacity?
The aerobic capacity is a greater proportion of lean body mass to fat. Since JT is obese, he is at risk.
3. Is JT at risk with respect to blood lipids, glucose, or blood pressure?
• Total cholesterol = 200 mg · dl–1 - looks normal
• High-density lipoprotein = 32 mg · dl–1 (HDL cholesterol below 40 mg/dL is considered too low and appears to be an independent risk factor for coronary artery disease)
• Triglycerides = 190 mg · dl–1 (a normal triglyceride level should be less than 150 mg/dL)
• Low-density lipoprotein = 220 mg · dl–1 (normal value is between 130-159 mg/dL)
• Glucose = 119 mg · dl–1 (is normal)
• Resting blood pressure = 130/86 mmHg (pre-hypertension range)
• Resting HR = 90 (looks good)
So he is at risk in terms of HDL, triglyceride and blood pressure)
4. What would be an appropriate exercise test for JT (mode, protocol) and why?
He should engage in activities such as walking, swimming or water exercises, and cycling. His dietary plan has to be revised and the calorie intake has to be monitored. This would help him reduce HDL and blood pressure.
5. As you sit down with JT and his mother following testing, how would you approach this patient regarding his results?
JT should be politely advised for dietary change to take care of his obesity and he should be told that reducing high carb diet would reduce the HDL and blood pressure.