SGIM Exercise cases, page 1
LEARNING OBJECTIVES FOR OUR SMALL GROUP:
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Describe exercises that have been associated with improved outcomes for specific medical
conditions
Assess your patient’s interest and willingness to exercise, using the “stages of change”
model
Describe approaches to increase your patients’ self efficacy in exercising
Develop an approach to writing an exercise prescription using the FITTS method
(frequency, intensity, type, time, and specific modifications)
Use the 5 step method to write an exercise prescription for these people.
EXERCISE RX OUTLINE:
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Determine what type of exercise is most important for your patient
Determine Your Patient’s Values
Determine where in the “Stages of Change” model your patient is
Tailor intervention to patient stage
Write FITTS exercise rx
CASE #1
Mr. Fine is a 70 year old man who is fairly healthy and active. He has hypertension,
hyperlipidemia, and early cataracts. He is on aspirin, a multivitamin, HCTZ, and simvastatin.
He is retired, but enjoys reading, movies, friends, and occasional gardening. He occasionally
takes walks with his wife, but becomes quite winded if he goes up any hills, and finds that he
has to stop to rest. He used to be a very active hiker, but has dropped this over the past 10
years.
His exam is normal today. His blood pressure is 140/88, P 84, R 16
Scenario A. His wife is concerned that he has put on 5 pounds over the past few years, he is
becoming a “couch potato” and is going to have a stroke like his brother Harry. He thinks things
are OK and says “you can’t teach an old dog new tricks”.
Use the five step method to write an exercise prescription in him.
Scenario B: The patient’s son wants to take the patient and his wife and him on a hiking trip in
the Sierras in 6 months. His son, a mountaineer, says that the trails he has picked out are
“easy compared to what I usually do. They are only at 6000 feet, are mildly hilly, and we can
walk an easy 5 miles a day”. We’ll have horses to pack our things.” He further states that his
parents need to get more active and see more.” Your patient wants to go, but thinks he should
probably start a vigorous exercise program first.
Use the five step method to write an exercise prescription in him.
SGIM Exercise cases, page 2
CASE #2
Ms. Good is a 79 year old woman who lives alone in an apartment building. She is obese, has
osteoarthritis, type II Diabetes, CAD, and HTN. Recently her osteoarthritis has been acting up,
she has increased pain, decreased mobility, and has had a couple of falls recently. She also
says she is a “little unsteady at times”. She is now fairly scared that she may be “heading
downhill”. She very much wants to continue living where she is and interacting with her
daughter and grandchildren who live in the neighborhood. She rarely leaves home, unless her
daughter accompanies her and assists. She is on aspirin, HCTZ, metformin, Tylenol, atenolol,
and simvastatin.
On exam, her BP is 130/80, P 64, R 16. She is moderately obese, and in no distress. Her
heart, lung, and abdominal exams are normal. She has changes of osteoarthritis of both her
hands, and her right knee. She has decreased range of motion of both of her hips. Her
neurological exam shows mild peripheral neuropathy. Her “up and go test” shows that she has
difficulty with going from a sitting to standing position without using her arms to assist and her
gait is slightly wide based. Although she is able to walk without a cane, she prefers to use a
cane on the left for walking.
Use the five step method to write an exercise prescription in her.