- Identify the underlying disease based upon the information given
Based on the information provided, Mike is suffering from PAD (Peripheral Artery Disease). This is because he has pain in his legs when walking at a fast pace and has an ABI (Ankle Brachial Index) score of 0.8. This score indicates that he is in the abnormal status and at a risk of developing PAD disease. The score also indicates that Mike has pain in the foot or buttocks while exercising.
- List and describe three palliative medications that you would suggest the subject begin taking?
- Aspirin, which is the first line of defense to inhibits platelet aggregation
- Plavix, which is a very popular platelet aggregator. In PAD disease, there is a reduction in the flow of blood to the limbs which may cause clotting of blood. Both aspirin and plavix are useful in preventing blood from clotting.
- Cilostazol may also be used since it is also an inhibitor of platelet aggregation, vasodilator and helps in adjusting ABI score. Giving this medication to Mike may help in expanding blood vessels and helps to alleviate legs pain.
- Provide a two week example exercise prescription that includes detailed (i.e. daily) information regarding Aerobic, Resistance, Flexibility, and Neuromuscular exercise.
The best aerobic exercise that would prescribe for Mike is walking. This would entail walking as fast as he can and if he feels pain in his leg, I would recommend that he slow down or stop exercising. I would keep a work-rest cycle with him in order to keep him active. For two weeks, Mike can do the aerobic activities for about 15 or 20 minutes per day making sure that the intensity of the exercise should be 40-60% VO2 max or 40-70% HRR. The most important point with PAD patients is that they are very sensitive to cold weather and in the case of Mike this will be considered. Cold weather usually worsens the symptoms of PAD disease and leads to extended warm-up time. The main aim of my aerobic exercise plan for him is to reduce the claudication pain and the risk factors for cardiovascular disease. Another important aspect is monitoring Mike when exercising especially his BP and HR. Since Mike is a sedentary person, the exercise time and intensity will be increased gradually starting with 15-20 minutes in the first two weeks. This will be increase to 60 minutes of exercise for a period of sixth months of exercising. Cycling and upper body ergometer will be used as aerobic activities for him but will be used as warm up and cool down exercise since they are known not to improve the claudication pain. During exercise, once 4 points of the claudication are attained, Mike will be advised to stop exercise. However, the exercise will focus more on walking since this is the best aerobic exercise for his situation.
Resistance exercise is effective for Mike to maintain his muscle mass and improve his bone density. I will include lower extremity strength exercising in his resistance program because he has reduced proximal and distal muscle strength as a result of his PAD disease. My plan with Mike involves 3 sets and 8 repetitions of leg press, knee extensions and leg curl exercise. Since he is sedentary person with PAD disease, I will start exercising him at 50% 1-RM. I also plan to perform 3 sets and 8 repetitions of toe rise and squat exercises with him. Many research findings have reported that resistance training is not as effective as aerobic training with PAD patients. However, the lower extremity training has a great benefit in improving the walking performance and the overall quality of life especially the stairs climbing. The quality of life is a measurement for PAD patients to recognize the walking limitations. It consists of three fields: walking speed, stair climbing and walking distance. Each field has a range score from 0-100, where 0 reflects extreme pain and 100 reflect no pain when walking a long distance and walking rapidly. I will allow Mike to do endurance training twice a week in the first two weeks of his exercise. I will also include biceps curl, triceps extensions, overhead press, lateral press, bench-press, pull-up, bent-over, seated row, adductor and abductor in his endurance schedule.
I plan to include flexibility training in his aerobic exercise three days a week each taking 0 to 30 seconds until he feels a mild discomfort. My main goal with this type of exercise is to improve ROM (joints range of motion), function and improve muscular effectiveness. I will include a stretching program two days per week in order to stretch his muscles and tendons. In addition, stretching exercise will help him increase his walking distance.
My plan with Mike also includes yoga exercises. Yoga has great benefits in rehabbing cardiovascular patients and in preventing ischemic heart disease. Since Mike is above 40 years old, his cardiovascular parameters are expected to changes with age and thus introducing yoga will help to slower these alterations. Since he is a sedentary person, I will start the exercise at the beginning level and then increase gradually as he adapts.