Emphysema Pathophysiology and Management - Literature review Example

Emphysema pathophysiology Name: Unit: Course: Supervisor: Date of submission: Introduction General overview and background Hutchinson (1994) &Contran, Kumar & Collins (1999) Emphysema (Chronic Obstructive Pulmonary Disease; COPD) is a disease of the respiratory system. It affects the alveoli causing them to permanently enlarge. The enlargement forces the capillaries to rupture narrowing the airways. This disease does not have a known cure. The narrowed airway leads to inhaling difficulties and gives out carbon dioxide. Antiproteases is an enzyme which protects the lungs; basically alpha1-antitrypsin. However, its activity is reduced by smoke. Research have, therefore, concluded that emphysema crops in when this enzyme can not act against the proteases production Copstead & Banasik2000, Porth, 2005. The consequences of this enzyme inactivity are collagen and elastic tissue breakdown and destruction of walls of alveolar. Gas exchange surface area is reduced following alveolar tissue loss and there is an increased blood flow through the capillary system of the pulmonary. Contraction of the lungs increases blood flow and can result to hypoxia. However, hemoglobin saturation takes very short time and therefore, perfusion is generally not severely affected. Size of respiratory bronchioles on the other hand reduces significantly following pulmonary fiber and elastic tissue loss. These factors in turn lead to radial traction reduction thus forcing the outside of airway lumen to increase pressure. Following these factors, bronchiole can easily collapse; air is trapped within distal alveoli, alveoli then appears as distended air sacs. Consequently, airflow is decreased and there is increase in airway resistance Copstead & Banasik2000, Porth, 2005. Sundararajan, Balani & packhan (2010) found that treatment on the other hand, improves the functioning of the lungs and there is decreased dyspnea especially with pulmonary rehabilitation. Medications in addition, improves excise tolerance, reduces symptoms, exacerbations severity and frequency is reduced and there is improved airflow obstruction. Basically treatment declines disease progression in the lungs rather than curing. In this case study Anthony zdrilic 62 years old suffers from moderate emphysema, hypertension, osteoarthritis and hyperlipidemia with a normal BMI of 24. Types of emphysema There are three types Hutchinson (1994) paraseptal, panacinar and centriacinar emphysema. In Paraseptal emphysema the disease is localized on the lung pleura or septae. It involves alveolar sacs and alveolar ducts. Panacinar emphysema on the other hand affects the whole alveolus destroying the lung’s lower part consistently. This type is common among homozygous α1 -antitrypsin deficiency person. Centriacinar (centrilobular) emphysema: This type begins from the bronchioles and moves to the surrounding regions. Basically this type is associated with tobacco or marijuana smoking and involves the lungs-upper-parts. Anthony suffers from type three. Signs and symptoms Emphysema signs and symptoms involve, Hutchinson (1994). Kumar, (2002) general body fatigue arising from difficulty in breathing and low oxygen supply, reduced weight arising from eating difficulties, productive mild or chronic cough, reduced physical activity and shortness of breath which worsens with disease progression, breathing problems during episodes of flu and colds when lying down. Risk factors and causes of emphysema According to Hutchinson (1994) & Kumar (2002) The following factors are predisposing to emphysema occurrence or severity: age above 50 years, smoking marijuana or tobacco Wright & Churg (1994), hereditary, pollutant exposure for example burning fuel fumes, exhaust from vehicles etc., passive smokers, ageing affecting the lungs with symptoms seen after 50 years, congenital condition arising from connective tissue disorders which affects the tropoelastin and elastin synthesis, obstructive lung disease triggered by vasculitis syndrome, pneumocystis carinii infection and immune deficiency syndrome which damages cortical and apical bolus lungs and pulmonary vascular damage caused by intravenous (IV) drugs Emphysema diagnosis Talley & O’Connor (2001), Celli (1995), Mckenzie, et al., (2003) &Talley & O’Connor (2001) found that, symptoms and signs are used in diagnosing this ailment such as; chest x-ray can be suggested to endorse the diagnosis. Electrocardiogram is done to find out whether the heart has been affected by the lung disease. Red blood cell count is done to find out amount of RBC’s and amount of CO2 andO2 gas in the blood is measured using arterial blood gas test. Exhaled and inhaled air is measured using spirometer and stethoscope is used to listen to perforation sounds in the lungs which indicate ruptured alveoli. Family and medical history is carried out to find out whether there is history of respiratory disease in the family lineage and person’s social lifestyle is examined to find out whether he is a smoker of tobacco or marijuana. Thorough body examination is done to find out whether the body receives sufficient O2 Treatment Celli (1995) Mckenzie et al., (2003) & Talley & O’Connor 2001) The aim of treating emphysema is to slow down the disease progression, alleviate suffering, prolong life, decrease mortality and control disease exposure. The Main treatment advocacy is encouraging the client to quit smoking as part of management. In addition, there are a few treatment modalities geared to avoid complications and alleviating suffering. Such include: Protein therapy for those persons with genetical protein deficiency. In severe emphysema cases lung volume reduction surgery is done to remove dead lung tissues in order to improve lung functioning. Person at high risk of both respiratory diseases and emphysema are encouraged to have pneumonia shots after every 5-7 years and annual shot of flu. Broad spectrum is advocated to curb the effects and reduce episodes of influenza, pneumonia, and acute bronchitis. Cases of emphysema represented with low oxygen supply are better managed with O2 supplements. Constricted airways leads to troubled breathing, shortness of breath and cough this effect is reduced significantly using bronchodilators although Hutchinson (1994) the drug not as effective as in other cases such as asthma and Acetylcysteine agents are advocated to reduce the amount of sputum. Inhaling aerosol sprays containing corticosteroids reduces emphysema symptoms and in extreme cases failure of positive impacts from other form of treatment calls for lung transplant. Emphysema prevention The following guidelines help prevent emphysema: Wright & Churg (1994) Stop smoking, avoid passive smoking, wear dust mask to prevent inhaling dust and chemical fumes, avoid inhaling or exposure to fuel fumes, paint fumes and vehicle exhaust gases, do regular exercises and follow simple breathing techniques as indicated in training program. Contran, Kumar & Collins (1999).High consumption of non-alcoholic drinks is emphasized to prevent mucus getting stuck on the air passages. Avoid spasm of bronchial passages using mask to prevent from cold air and prevent respiratory infection using pneumonia and flu vaccine. Mckenzie et al.,(2003) Balanced diet consumption with sufficient nutrients such as chewing 2-3 cloves of garlic, lemon juice, use of aniseed oil, green leafy vegetable with amaranth as reference, take food enriched with antioxidants vitamin C and E or supplements. In addition, Hutchinson (1994) & Mckenzie et al., (2003) vitamin E improves the tissue elasticity, Vitamin A and C promotes the health of pulmonary connective tissues and boosts the immune activity. Ensure you take frequent small feeds to maintain normal body weight. Osteoarthritis Studies show that osteoarthritis is basically caused by injuries Sambrook & Eisman (2000). Anthony being a sports man was injured on his left knee and now has osteoarthritis. Prevention and management Sambrook & Eisman (2000) exposure to sunlight especially in the morning and late evening hours to absorb vitamin D is important. Also Hutchinson (1994) & Mckenzie et al., (2003), take diets rich in vitamin D, K and calcium to replenish bone tone. Although Crimmins (2004), prolonged Vitamin D supplement causes other condition such as diabetes, cataract, and hypertension and weakens bones. In general, consume balanced diet with carbohydrates, protein. Fats, vitamin, minerals and take plenty of water 8 or more glasses daily. Hyperlipidemia Is raised fat level more so cholesterol. The condition predisposes a person to coronary heart disease like hypertension and atherosclerosis Grundy et al,(2004). Age, smoking and sex is among predisposes factors. Grundy et al,(2004). Exercise will burn calories and fats. However, consume poly unsaturated fats (vegetable oils) like olive and in small amounts. Hypertension Hypertension occurs when the systolic is above 139mmHg and diastolic is 90 and above. Hypertension generally does not have a specific cause but there are predisposing factors like smoking Seknhon H.S., Wright & Churg (1994), obese or overweight, minimal or no exercise, age, inheritance, taking a lot of alcohol more than 1-2 bottles daily or being on saturated fatty diet for a long time. Prevention Take foods with minimal amount of iodized salt and avoid processed foods they may contain un-explained amount of salts, stop smoking and avoid alcohol. Planned Exercise program For Anthony who has moderate emphysema, shortness of breathe which is making the body tire easily; it is advisable to start with less demanding exercises and upgrade as time progresses Hutchinson, 1994. Breathing exercise This involves pursed-lip breathing. The exercise is performed when lying down with bent knee or sitting on a firm chair. Place one hand on your abdomen and the other on your chest. The hand on the abdomen should be seen rising when breathing and that on the chest remain still. Inhale for 2 seconds through the nose and breathe out for 4 seconds through the mouth as though blowing a candle. Repeat this for several times. Celli (1995) & Ries et al., (1995) The exercise is vital undertaking to strengthen the lung muscles and open airway passages. Bicep curls Using dumbbells sit on a chair which is firm. Slowly lift up the weights with elbows facing your body to above your shoulder as you inhale through the nose and exhale through the mouth. Repeat breathing as you bring down the weights. Remember to breathe in as you relax and out when applying effort. Do this five times Shoulder press Hold the weights still seated on your shoulder. Take a deep breathe and lift the weight above your head and breathe out through the mouth. Repeat five or more times daily. Leg exercises The exercises are aimed at improving blood circulation on the lower limbs and also improve on joint movement affected with osteoarthritis Sambrook & Eisman (2000). With knees together in a firm chair, slowly raise one leg until straight then lower to the floor and repeat this 10 times. Do the same for the other feet. Change position and stand on a firm chair then raise one leg sideways five times. Do the same with the other leg. Stairs climbing This can be either indoor or outdoor stairs. Breathe out and start step with right foot. Breathe in as you step with left foot. Repeat the process until last stair up and come down repeating the breathing exercise. Arms workout Use pedal exerciser. Placing the exerciser on the table; with your hands on the stirrups grasp the pedals. Do exercise adjustment as per instructions. Carry the exercise for five or until your tired. Lower body work out Still using pedal exerciser placed on a table in front of a chair, take a sit, place your feet on the stirrups. Adjust the exercise as per guidelines. Do five minute pedaling or more. Walking Do 20-30 minutes *1 times weekly. This will ensure the endurance and capacity of exercise is improved Celli (1995). You can do so strolling with friends, either brisk walking or jogging. Improve the level with time. To pass time, you can use a CD player or MP3 of your choice. Note that Ries et al., (1995) & Celli (1995) these exercises are aimed at strengthening the upper and lower limb muscles, the thoracic cavity and the respiratory system as a whole and allowing effective oxygen circulation. Reduce stress and depression. This will ensure disease progression is slowed, prolong life with less emphysema ailments and lower multimorbidity effects such as arthritis, hypertension etc. In addition, Grundy et al,(2004) the metabolism arising from increased activity will also work on the high cholesterol in the body. Aerobic exercise Kuys eta l., (2011) reported higher adherences to a training program through gaming consoles such as Wii over traditional forms of exercise such as cycling or running. The aerobic training methods were diversified to ensure adherence, therefore, we put a diversity of different aerobic training methods, in addition to the gaming consoles. These include swimming, stationary cycling and running 2-3 kilometers*3 times per week. Swimming has been proven to be an effective exercise to clear mucus in the lungs and improve ventilatory function (Zach, Purrer & Oberwaldner, 1981). In addition, swimming builds stamina. The remaining aerobic exercises, boxing, treadmill and cycling, were both chosen as alternative exercises to avoid monotony in swimming adherence. The exercise intensity of cycling and video game consoles for emphysema are equally physically demanding (Alison, at al., 1997), and so these aerobic exercises are beneficial for optimal aerobic fitness. Short-term physiological alterations of aerobic exercise on pulmonary function. Ramirez-Sarmiento, 2002 state exercise will block the amiloride-sensitive sodium channels, within the respiratory epithelium of emphysema sufferers. Consequently this could lead to decreased sputum viscosity (mucus which blocks airways), due to reduced sodium production across the epithelium. Thus bronchodilation will occur where resistances in the respiratory airway is decreased leading to increased airflow to the lungs. Long Term physiological alterations of aerobic exercise on pulmonary function Ramirez-Sarmiento, 2002 ,Long term benefits of exercise within emphysema patients are difficult to determine as most research articles have difficulty maintaining adherences from their participants. Thus the results are not that accurate. On the other hand, the rate of lung deterioration might not be positively affected by exercises. Patients, who undergo exercise, have reported a decreased level of breathlessness. Therefore this is significant because it will improve their quality of life Conclusion Emphysema is a chronic illness whose management when followed keenly improves and prolongs the patient’s life quality. Management varies from exercise to drugs and to operation in severe and extreme cases. Client Details Name: Anthony zdrilic Age: 62 years old Gender: Male Assessment Advice planned actions Resources History Quitline: 131 848 Smoking Yes Stop Heartline: 1300 36 27 87 Diet/nutrition High Fibre, Fruit and Vegetables Balanced diet with poly unsaturated fats like olive oil. High consumption of uncooked vegetable juices and fruit juices, vitamin D,E,C,K and calcium rich sources Directline: 1800 888 236 A 24 hour telephone counselling, information and referral services for drug and alcohol related issues Alcohol Yes Stop Heartline: 1300 36 27 87 Go For Your Life info Line: 1300 73 98 99 Physical Activity minimal Physical Activity 2*15 mins a week Need to perform planned exercise routine with a higher intensity. Depression No osteoarthritis Yes Take diets rich in vitamin D, K and Calcium; expose to low temperature sunlight and acetaminophen Asthma Yes (7-20 years old) Osteoporosis No Examination Bodyweight/BMI weight 71kg, height 172cm, Waist circumference = 86 cm BMI 24 Blood pressure 143/91mmHg Antihypertensive drugs Diabetes None Skin cancer None Moderate emphysema Yes Bronchodilator, Acetylcysteine, broad spectrum antibiotics, oxygen concentrators Tests Lipids LDL 4.2mmol/L , HDL – 1.1mmol/L, Total cholesterol = 6.3mmol/L (high), Avoid saturated fats and do exercise Diabetes Fasting Glucose = 4.1 Mmol/L Cervical Cancer N/A Prostate None Other as appropriate (e.g. colorectal, cancer, breast cancer) None Medical History For emphysema : Bronchodilators although not effective in emphysema as it is in asthma Vitamin D, K and Calcium- prevent or slow arthritis and on general vitamin supplementation to improve the disease condition On hypertensive drugs Pain killers-acetaminophen, myalgia and hyaluronan to relive knee pain Family History Social History Mother: died at 86 years Smoking: yes Father: Died at 71years of age due to heart attack Smoking: yes General Recommendations (if appropriate): Due to Anthony’s chronic disease (emphysema) it is recommended that he undertake an exercise program under the supervision of an exercise scientist to improve quality of life, reduce symptoms associated with this disease and to increase life expectancy. Summary of 4 week Training Program – in order from left to right Inspiratory muscle training Warm Up (5 mins) Breathing program/ lower limb exercises (15 mins) Aerobic Training (30 mins) Cool down Inspiratory muscle training Nintendo Wii Sunday Rest day Monday A-D* Wk 2,4, 400m run Wk 1,3 Star jumps Stairs climbing Skipping Light jog E-G Wii Sports Tuesday All Exercises Wk 2,4,: 400m run Wk 1,3 Star jumps Pursed breathing Swimming Light jog All exercises Wii Sports Wednesday E-G Wk 2,4: 400m run Wk 1,3,5,7: Star jumps Bicep curls Stationary bike Cycling Light jog A-D Wii Sports Thursday Rest day Friday A-D Wk 2,4 400m run Wk 1,3 Star jumps Shoulder press/ arms work out Treadmill/ Outdoor Run 2km Light jog E-G Wii Sports Saturday All Exercises Wk 2,4, 400m run Wk 1,3, Star jumps Lower body work out/leg exercise/walking Boxing Light jog All Exercises Wii Sports Warm Up Weeks 2,4, 400m Run – no intensity, just needs to complete the run at any speed. Weeks 1,3, Star Jumps for 2 minutes/ Play music in background to motivate client. Cool down for all weeks 5 minute light jog Breathing exercise This involves pursed-lip breathing refer in text. 10 mins Bicep curls * Shoulder press * Leg exercises * Stairs climbing * Arms workout * Lower body work out * Walking * See details in text Inspiratory Muscle Training Exercises A: Stretching the muscles of the chest wall 1. Starting Position: Stand up, hands by your sides, palms facing inwards 2. Rotate palms facing forwards 3. Extend arms, and bring arms above the head so hands touch 4. As arms are rising, inhale through the nose 5. turn palms outwards, and exhale through mouth as arms move down to starting position 6. Repeat 10 times B: Opening the Chest 1. Sit down: back straight, feet flat on the floor 2. Fully extend arms in front of your shoulders, with palms facing towards each other 3. Bring arms as far back as possible by keeping the arms straight, and inhale 4. Bring arms back to the front, and exhale. 5. Always keep arms fully extended. 6. Repeat 10 times C: Sniffles (good workout for diaphragm) 1. Keep mouth closed 2. Breath in and out through nose as quickly as possible 3. Repeat for 15 seconds D: Elbow Circles 1. place hands on shoulders, with elbow pointing laterally, fingertips touching shoulders 2. Rotate elbows in backwards circular motion, keeping the fingers on the shoulders 3. Inhale as elbows are brought up 4. Exhale as elbows are brought down E: Shoulder Shrug 1. Place arms by your side, palms facing forwards 2. Inhale, as shoulders are lifted in front of body, moving towards ears 3. Exhale as shoulders roll back down, towards the back of the body 4. Repeat 10 times, then do 10 repetitions in opposite direction. F: Chest Fly 1. Cover ears with the palms of your hand, elbows pointing outwards 2. Inhale, as you bring elbows towards the front 3. Exhale, as you move elbows back to the side 4. Repeat 10 times G: Stirring the pot 1. Interlock hands in front of the body, keeping elbows pointing outwards 2. Rotate arms in a circular motion, keeping the hands interlocked. This resembles a 'stirring' motion 3. Inhale has hands are brought out to the furthest point away from the body 4. Exhale as hands are brought back towards the body 5. Repeat 10 times. Aerobic Training Monday: Skipping (30 mins). 15 minutes each variation Week 1: Standard Skip Week 2: Standard + Criss-cross legs Week 3: criss cross legs + Running Jumps Week 4: Running Jumps + Feet apart, Feet together Tuesday: Swimming Week Distance Rest (s) Stroke 1 2 x 200m 60 freestyle swim. 60 seconds rest. 2 2 x 250m 60 breaststroke. 60 seconds rest 3 300m backstroke 4 4 x 100m 100m butterfly 100m backstroke 100m breastroke 100m freestyle Wednesday: Cycling (30 mins) Week Type Location Intensity 1 Outdoor Bike Riding local park 50% - 60% HRmax 2 Indoor Bike Gym 50% - 60% HRmax 3 Outdoor Bike Riding Suburban Streets 50% - 60% HRmax 4 Indoor Bike Gym 50% - 60% HRmax Friday: Running (30 mins) Week Type Location Intensity 1 Treadmill Gym 50% - 60% HRmax 2 Outdoor Run shore of the beach 50% - 60% HRmax 3 Treadmill Gym 50% - 60% HRmax 4 Outdoor Run local park 50% - 60% HRmax Saturday: Kick Boxing (30 mins) Week Kickboxing Exercise Duration (mins) 1 Shadow boxing uppercuts 15 15 2 Shadow boxing high knee kicks (combination of left and right knee) 15 15 3 Upper cuts Jabs (Left and right jabs) 1-2 Punch 10 10 10 4 High kicks on punching bag low kicks on punching bag combination of high and low kicks 10 10 10 Nintendo Wii Play 'Wii: Sports' video game for as long as client wants. References Alison J.A., Regnis J.A., Donnelly P.M., Adams R.D., Sutton J.R., Bye, P.T. (1997) Evaluation of supported upper limb exercise capacity in patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 156, 1541–1548. Celli B.R. (1995) pulmonary rehabilitation in patinets with COPD. Am J Respir crit care med 152: 861-864 Contran R., Kumar V. & Collins (1999). Pathological basis of disease sixth ed. Saunders, Saunders company Copstead C.L. & Banasik L.J. (2000). Pathophysiology biological and behavioral perspectives. 2nd ed Elsevier: Philadelphia: Crimmins E (2004) Trends in the health of elderly. Annu Rev Public Health 25:79–98 Grundy S.M., Cleeman J.I., Merz C.N. et al,(2004) Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation 110:227 Schram M, Frijters D, van de Lisdonk E, Ploemacher J, et al., (2008) Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol 5:1104–1112 Hecker, T., Aris, R. (2004). Management of Osteoporosis in Adults with Cystic Fibrosis. Division of Pulmonary and Critical care medicine, 64(2), 133-147. Hutchinson D. (1994). Pulmonary emphysema, BMJ 309: 1244-1245 Kumar C. (2002). Clinical medicine, 5th edition, Saunders Kuys, S., Hall, K., Peasey, M., Wood, M., Cobb, R., Bell, S. (2011). Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised cross-over trial. Journal of physiotherapy, 57, 35-40. McKenzie D., Firth P., Burdon J. & Town G. (2003). The COPDX plan: Australian and New Zealand guidelines for management of chronic obstructive pulmonary disease Porth M.C. (2005). Pathophysiology concepts of altered health states 7th ed. Lippincott Williams & Wilkins: New York Ramirez-Sarmiento, A., Orozco-levi, M., Guell, R., Barreiro, E., Hernandez, N., Mota, S., Sangenis, M., Broquetas, J., Casann, P., Gea, J. (2002). Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease. American journal of respiratory and critical care medicine, 166, 1491-1497. Reilly J., Silverman E. & Shapiro S. (2006).Chronic Obstructive Pulmonary Disease in Kasper et al., Harrison’s principles of internal medicine 16th edition, McGraw-Hill Ries A.L., Kaplan R.M., Limberg T.M. & Prewitt (1995). Effects of pulmonary rehabilitation on, physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann intern med 122:823-832 Robine J.M &Mitchel J.P. (2004) Looking forward to a general theory on population aging. J Gerontol A 59(6):M590–M597 Sambrook P.N. & Eisman J.A (2000). Osteoarthritis prevention and treatment. Med J Aust; 172:226-229 Seknhon H.S., Wright J.L. & Churg A. (1994). Cigarette smoke causes rapid cell proliferation in small airways and associated pulmonary arteries. Am J physiology 267: 557-563 Sundararajan L., Balani J. & packhan S (2010). Effectiveness of outpatient pulmonary rehabilitation in elderly patient with chronic obstructivepulmonary disease. J Cardiopulm Rehabil Prev. 30:121-125 Talley N.J. & O’Connor S.(2001). Clinical examination- a systematic guide to physical diagnoses, 4th edition. Sydney Moorcroft, A., Dodd, M., Webb, A. (1998). Exercise limitations and training for patients with cystic fibrosis. Disability and Rehabilitation, 20(6/7), 247- 253. Zach, M, S., Purrer, B. & Oberwaldner, B. (1981). Effect of swimming on forced expiration and sputum clearance in cystic fibrosis. The Lancet, 318 (8257), 1210 – 1203. Accredited Exercise Physiologist (ESSA) PhD (ACU) Email: drad.aarons@medical-practice.com Phone: 0473 691325 Medicare provider number: 8275903 B Date: 26/03/2013 Appointment: 23/04/2013 Referring Doctor: Dr Maguire Name: Anthony zdrilic DOB: (04/03/1951) Age 62 years Gender: M Dear Dr. Maguire, Thank you for getting Mr. zdrilic into contact with me for exercise prescription to aid and improve airway capacity and increase life expectancy as well as quality of life related to emphysema. Initial consultation with Mr. zdrilic revealed that he does smoke, drink alcohol and has a diet high in fibre and plant foods. Mr. zdrilic takes Bronchodilators drugs, although not effective in emphysema as it is in asthma. Vitamin D, K and Calcium- prevent or slow arthritis and on general vitamin supplementation to improve the disease condition and is on hypertensive drugs. He is also on pain killers-acetaminophen, myalgia and hyaluronan to relive knee pain. He has expressed that these medications helps improve breathing and relieve pain as well as strengthening bone tone of which my research has justified his comment. However, due to disease multimordality he is quite unwell for now. As on the date of 26/03/2013 Mr. zdrilic is: Height- 172cm Weight- 71kg BMI- 24kg/m2 Waist circumference- 86cm Resting BP- 143/93mmhg Lipids LDL 4.2mmol/L, HDL 1.1mmol/L Total cholesterol = 6.3mmol/L (high), Fasting blood sugar4.1mmol/L Mr. zdrilic body measurements shows that he is hypertensive and has hyperlipidemia so the aims of the training program will be targeting aspects of quality of life for Mr. zdrilic, lower choletsrol level and ensure blood pressure remains at normal level Desired Outcomes of Exercise Physiology Intervention: Improve inspiratory muscle strength via inspiratory muscle training Increased muscle mass via breathing exercises, lower and upper limb exercise Improve bone health via lower limb exercises and upper limb work outs Reduction in infection frequency and severity via enhanced immune system Decrease breathlessness via aerobic training Improved quality of life through combination of all benefits of intervention. Mr. Zdrilic has received appropriate guidelines for the exercise intervention regarding adequate hydration, especially in regards to salt intake for sweat replacement. Mr Zdrilic has been advised to exercise in immediate access to oxygen supplementation and Mr. Zdrilic’s gym has been advised as to the needs of Mr. Zdrilic. A follow up session has been made for the 23/04/2013 to address any issues Mr. Zdrilic.has with the training program as well as providing a fully supervised training environment where measurements can be accurately obtained. Exercise program consists of different varieties of moderate intensity aerobic training, breathing and lower limb exercises and high intensity boxing sessions. This is complimented by inspiratory training and sessions using an at home interactive workout. A copy of Mr. Zdrilic.training program is attached for you to review. If you have any questions feel free to contact me. Signed Dr. Adam Aarons Dr Adam Aarons Accredited Exercise Physiologist (ESSA) PhD (ACU) Email: drad.aarons@medical-practice.com Phone: 0473 691325 Medicare provider number: 8275903 B Date: 26/03/2013 Appointment: 23/04/2013 Referring Doctor: Dr. Maguire Name: Anthony zdrilic DOB: (04/03/1951) Age 62 years Gender: M Dear Mr zdrilic, Thank you for coming in to see me for the consultation and fitness level evaluation. The measurements that we took during the session will be used in the formation aims as well as the formation of your exercise plan. This is so you will experience the greatest possible adaptations to help with your immune system, functional capacity, reduce disease progression and quality of life. I have split the measurements into body composition and physical capacity for you to look at with a comparison to the normal values. Body Composition Measurement Anthony zdrilic Healthy Range Height 175cm n/a Weight 71kg 55-73kg BMI 24kg/m2 18.5-25kg/m2 Waist Circumference 86cm Read More