INDIANA UNIVERSITY
DEPARTMENT OF KINESIOLOGY
CLINICAL EXERCISE PHYSIOLOGY
K562
EXERCISE PRESCRIPTION/PROGRAMMING CASE STUDIES:
DIABETES
(286 Points)
Show all your mathematical work for evaluating METs, target heart rates, and target body weights.
CASE STUDY 1
A 54 yo diabetic woman has joined the hospital diabetes care program. In this program she will
receive diabetes education and exercise instruction. She was diagnosed diabetic eight months ago. She
has been put on Glucovance BID and told to diet and exercise. So she recently began to walk for 30
minutes, four days a week at a light intensity.
Her hospitalizations include routine childbirth (x3) and kidney stones at age 18 year old. Usual
childhood diseases. No family history of heart disease, however, her grandmother was diagnosed with
diabetes at age 58 year old. She is a past smoker, having smoked 1 pack/week for 35 year and recently
tapered off.
Her laboratory data:
Height
Resting HR
Cholesterol
HDL
Triglycerides
Glucose
HbA1C
64.2”
75/min
210
40
438
125
8%
Weight
Resting Blood Pressure
Vital Capacity
FEV1
Percent Fat
Waist Circumference
Hip Circumference
210.3 pounds
119/80-80
3.5 L
2.3 L/sec
38.4%
103.1 cm
125.0 cm
1. Is physical activity/exercise appropriate for this patient at this time? (5 pts)
a. Explain (5 pts)
2. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)
a. Explain (5 pts)
3. Her exercise prescription/physical activity advice should be. Explain. (12 points)
a. Mode:
b. Frequency:
c. Duration:
d. Intensity:
4. What precautions would you give her about the time of day for physical activity/exercise? (5
pts)
a. Explain (5 pts)
5. What precautions would you give her about the timing of medications and physical
activity/exercise? (5 pts)
a. Explain (5 pts)
6. If her pre-exercise blood sugar is 115 mg/dl, what medication/diet precautions would you give
her about exercising that day? (5 pts)
a. Explain (5 pts)
7. If her pre-activity blood sugar is 240 mg/dl, what medication/diet precautions would you give
her about exercising that day? (5 pts)
a. Explain (5 pts)
b. What is her risk for an activity related hypoglycemia? (5 pts)
i. Explain (5 pts)
8. If she presented with retinopathy how would you adjust her exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)
CASE STUDY 2
This 69 yo retired engineer is participating in the Diabetes Care Clinic at the
hospital. He was diagnosed with diabetes 13 years ago, but has not been in good
control. It was believed that he should go through diabetes education again. Part of the
diabetes education classes is full evaluation and individualized exercise prescription.
He had the usual childhood diseases with the exception of Whooping Cough at
age 1 year. At age 23 years old he was hospitalized for an appendectomy. His
grandfather had a stroke at age 83 and died at 84 years old. His uncle had adult onset
diabetes.
His insulin regimen is
10:00 am: 5 units of Regular and 13 units of Lente
10:00 pm: 5 units of Regular and 5 units of Lente
He is currently recovering from arthroscopic surgery of his left knee (torn
meniscus). For the past year, he has been lifting weights 60 to 80 minutes (hard), 3
days a week; plays tennis (moderate) 30 to 50 minutes, twice a week; and does
calisthenics (moderate) 30 to 60 minutes, 3 days per week.
He is a past smoker, having smoked 5 to 8 cigaretttes a day for 29 years. He
quit 19 years ago.
Other data include:
Height
Glucose
Cholesterol
Triglycerides
HbA1C
167.6 cm
234 mg/dl
201 mg/dl
152 mg/dl
12.3%
Weight
Vital Capacity
FEV1
Resting Heart Rate
Resting BP
63.9 kg
52
146/88-78
9. Is physical activity/exercise appropriate for this patient at this time? (5 pts)
a. Explain (5 pts)
10. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)
a. Explain (5 pts)
11. His exercise prescription/physical activity advice should be. Explain. (12 points)
a. Mode:
b. Frequency:
c. Duration:
d. Intensity:
12. What precautions would you give him about the time of day for physical activity/exercise? (5
pts)
a. Explain (5 pts)
13. What precautions would you give him about the timing of medications and physical
activity/exercise? (5 pts)
a. Explain (5 pts)
b. If his pre-exercise blood sugar is 130 mg/dl, what medication/diet precautions would
you give him about exercising that day? (5pts)
c. Explain (5 pts)
14. If his pre-activity blood sugar is 280 mg/dl, what medication/diet precautions would you give
him about exercising that day? (5 pts)
a. Explain (5 pts)
b. What is his risk for an activity related hyperglycemia? (5 pts)
i. Explain (5 pts)
15. What, if any, additional precautions would you give him if you increased his exercise intensity?
(5 pts)
a. Explain (5 pts)
16. If he presented with autonomic neuropathy how would you adjust his exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)
CASE STUDY 3
This 57 yo diabetic man has joined the fitness program to become more fit and
lose weight. He is not currently active. He was diagnosed diabetic 21 years ago. He
was put on insulin from the very beginning. He is now taking 42 units of NPH daily at
6:00 am and 24 units at 6:00 pm.
At age 20 years he was hospitalized for shrapnel in his thigh; at age 32 year for
hepatitis; and at 34 years for a hernia. He had the usual childhood diseases. His father
died of a heart attack at 52 years old. He has had no other relatives with diabetes.
He has never smoked.
Other information:
Height
193.5 cm
Cholesterol 221 mg/dl
Triglycerides 100 mg/dl
Glucose
52 mg/dl
HbA1C
5.7%
Weight
Heart Rate
Blood Pressure
91.8 kg
63
130/80-78
17. Is physical activity/exercise appropriate for this patient at this time? (5 pts)
a. Explain (5 pts)
18. What is/are the appropriate exercise/physical activity facility/location for this patient? (5 pts)
a. Explain (5 pts)
19. His exercise prescription/physical activity advice should be. Explain. (12 points)
e. Mode:
f.
Frequency:
g. Duration:
h. Intensity:
20. What precautions would you give him about the time of day for physical activity/exercise? (5
pts)
a. Explain (5 pts)
21. What precautions would you give him about the timing of medications and physical
activity/exercise? (5 pts)
a. Explain (5 pts)
b. If his pre-exercise blood sugar is 90 mg/dl, what medication/diet precautions would you
give him about exercising that day? (5pts)
c. Explain (5 pts)
22. If his pre-activity blood sugar is 150 mg/dl, what medication/diet precautions would you give
him about exercising that day? (5 pts)
a. Explain (5 pts)
b. What is his risk for an activity related hyperglycemia? (5 pts)
i. Explain (5 pts)
23. If he presented with periphearal neuropathy how would you adjust his exercise/physical activity
prescription? (5 pts)
a. What additional precautions would you consider? (5 pts)