Programming of Physical Activities for a Special Case

This study material provides a comprehensive overview of programming physical activities for a special case. It covers critical review, pathophysiology, analysis of the situation, and behavior change strategies. Perfect for assignments and research.

Running head: PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Name of the Student
Name of the University
Author Note

1PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Table of Contents
Section A: Critical Review and Justification.............................................................................2
Introduction............................................................................................................................2
Review....................................................................................................................................3
Justification.............................................................................................................................3
Section B: Pathophysiology.......................................................................................................4
Section C: Analysis of the Situation..........................................................................................6
Section D: Behaviour Change Strategies...................................................................................7
Section E: 12 Week Physical Activity Programme....................................................................9
Table 1....................................................................................................................................9
Section F: Session Design Plan................................................................................................11
Table 2..................................................................................................................................11
Section G: Evidence Based Rationale......................................................................................14
Conclusion............................................................................................................................15
Section H: References..............................................................................................................16

2PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Section A: Critical Review and Justification
Introduction
American College of Sports Medicine defines physical fitness as the aptitude to
perform daily errands with the expected amount of vigour and vigilance, without any
unjustifiable fatigue, along with sufficient energy (American College of Sports Medicine,
2013). An individual with any kind of special disease or condition is not competent medically
to perform exercises like a physically fit person. Therefore, it is crucial to plan a physical
activity programme for patients as they are not capable of doing the same exercise with equal
intensity like a physically fit person. Along with this, it is also essential that a patient cannot
perform all kind of exercises due to the lack in physical ability. So, it is the responsibility of
the patient to share all health related information with the health care professional along with
the exercise planner, so that a proper exercise programme is structured according to the needs
of the patient. Therefore, all vital safety and medical emergency related scenarios must be
kept in mind prior to detailing the physical activity framework and delivering the exercise
care plan to the patients.
The case study reports that the patient named Steven Smith is suffering from high
levels of cholesterol along with clinically diagnosed depression. The depression of the patient
might be attributed to his poor health condition. In order to enhance the physical condition of
the patient, various types of activity plans could be suggested to the patient after considering
the health status of the patient (Swain et al., 2014). In this case study, the cardiac condition of
the patients must be taken into consideration while planning the physical activity programme.
Moreover, the age related factor must be well thought-out for the patient, as with increasing
age the competence and tenacity of performing physical activities decreases manifold due to
the reduced range of heart rate. This essay comprises of the physical activity plan of Steven

3PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Smith, the pathophysiology of his diseased condition, strategies to change the behaviours of
the patients, physical activity plan along with specific session plan and the rationale for
selecting this activity plan are discussed in a comprehensive manner.
Review
The physical activity referral scheme is a health promotional programme delivered
through primary health care institutions with the intention of increasing physical activity
amongst the high-risk population (Martín-Borràs et al., 2018). In different countries, the
initiates of this programme improve the health and wellbeing of public health. As discussed
by Ekelund et al. (2016), physical activity can improve public health since during exercise,
body releases endorphin which interacts with brain receptors to reduce the perception of pain
experienced by patients, improving the health status and quality of life. The hormone
endorphin also triggers the feeling of positivity in the body, similar to the effect of morphine
(Colberg et al., 2016). Hence, in order to improve the health and wellbeing of public health
and reduce the high morbidity rate, it is crucial to involve eligible target groups in health
promotional programme like physical activity referral scheme.
A person with severe chronic disease such as obesity, overweight, cardiovascular
disease is referred to as the exercise professionals who are responsible for designing and
organizing physical activity programme. The eligible patients with health conditions
discussed above are first assessed through detailed physical screening that further referred to
involve in these health promotion programmes. As discussed by Martín-Borràs et al.
(2018), this program usually offered at a local community leisure facility and usually
provided by a physiotherapist or health professionals with excellent skills of assisting
physical exercise.

4PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Justification
In order to evaluate the effectiveness of the health promotional programme conducted,
a systematic review and meta-analysis of 37 studies that were conducted in 11 different
countries (Arsenijevic & Grout, 2017). The inclusion criteria of the study included
experimental study, population group older than 18 years, studies published after 2000 and
reported one of the outcomes such as adherence rate to the physical activity and self-reported
physical activity level. The result of the study suggested that 80% of the population with
severe diseases must adhere to physical activity (Arsenijevic & Grout, 2017). The patients
who adhere to the physical activity up to 6 months or 12 months exhibited a better health
condition and reduced rate of mental illness. They are empowered, confident after involving
themselves in physical activity. Another study suggested a similar result as this study such as
improvement of health conditions (Hawkins et al., 2016). Hence, this activity is effective in
improving the health conditions of patients. However, the limitation of the physical activity is
that intensive physical activity may contribute to severe health conditions and associated
morbidity rate. It can be suggested that this programme should be recommended to the
patients with specific health condition according to their need (Arsenijevic & Grout, 2017).
Senior patients with a chronic health condition are required to involve this activity according
to health conditions. As observed in this case study, the patient is 59 years old with angina.
Hence, in order to involve the patient in this health promotional programme, moderate to low
physical activity is recommended instead of intensive physical activity which might facilitate
the progression of angina and other cardiac complications.
Section B: Pathophysiology
The case study highlighted three crucial health condition in patients namely angina,
high cholesterol, and depression. Angina is defined as a chest pain caused by reduced blood
flow to the heart. Considering the pathophysiology of angina, it is developed when reduced

5PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
coronary blood flow observed because of plaque formation in coronary arteries and damage
arteries (Puelacher et al., 2018). As observed in this case study, Steven Smith works as a
lawyer and lives a sedentary lifestyle and has high cholesterol levels. Sedentary lifestyle is
defined as a type of living, which involves little to no exercise (Villano, Lanza & Crea,
2018). Individuals with sedentary life engaging in little physical activity have the highest risk
of developing high cholesterol and obesity (Harris et al., 2016). High level of low density
lipoprotein (LDL) attributes to increased level of cholesterol which is caused by an unhealthy
diet containing high lipid foods. High cholesterol level facilitates the formation of plaque and
hence reducing the supply of blood in arteries (Sehara et al., 2017). The inadequate blood
supply causes myocardial cells to switch from aerobic metabolism to anaerobic metabolism
with progressive impairment of metabolic, mechanical and electrical functions. As discussed
by Marx et al. (2017), during angina, adenosine may be the prime mediator of angina pain.
During ischemia, adenosine tri phosphate is degraded to adenosine and causes the diffusion to
the extracellular specs. Consequently, this diffusion to the extracellular space causes
arteriolar dilation and angina pain. Apart from the medical history, the case study highlights
that the patient is 59 years old. As per prior discussions, age is one of the crucial risk factors
for the development of angina in significant number of patients. With a rapid increase in age,
the cardiac muscles become damaged and fail to pump adequate amount of oxygen. The
weak heart muscles facilitate the process of developing angina in patients (Marx et al., 2017).
Considering the pathophysiology of depression, genetic studies highlighted that there
are specific genetic factors and neurotransmitters that facilitate the development of
depression when individuals are exposed to emotional stress (Stewart & Vigod, 2019). In this
current context, he is divorced with two grown-up children. Due to divorce with his wife, he
might be experiencing the persistent feeling of grief and sadness. Due of this feeling of loss
and anxiety, the imbalance in the levels of neurotransmitters such as serotonin, nor

6PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
epinephrine, and dopamine might trigger depression. Another study highlighted that there is a
direct association between cardiovascular disease and depression (Löwe et al., 2017).
Clinical depression might also cause increased heart rate and development of the
cardiovascular disease (Sehara et al., 2017). Hence, the health conditions patients are
suffering from are interlinked and require immediate interventions to support the wellbeing of
patients.
Section C: Analysis of the Situation
In this case study, the medical condition of the patient named Steven Smith is
described. From the patient referral form, it can be reported that the patient is suffering from
two major types of complications, namely depression and angina. Along with this, it is also
evident that, the patient leads a sedentary life style. The patient is 59 years old and his heart
rate is 74 beats per minute, which is within the heart rate range. On the other hand, the blood
pressure level is almost 135/ 87, suggesting the systolic blood pressure to be 135 mm hg and
the diastolic blood pressure is almost 87 mm hg. So, while designing the physical activity
plan for Steven, it is very crucial to consider the aforesaid physical ailments and conditions of
the patients.
Evidence based study suggests that the Siconolfi step test is effective in addressing
the cardiopulmonary fitness of the older patients (Stevinson, Lydon & Amir, 2014). The
Siconolfi step test suggested that, the maximum oxygen uptake capacity of the patient,
Steven, is almost 23.6 Ml/kg/ min and the BMI of the patient is 22.5kg/m2 and it is within
normal range. According to this study, it is reported that, the assessment of the physical
condition of the individual and the exercising regular physical activity will help in the
improvement of the health condition (Stevinson, Lydon & Amir, 2014). Thereby, the use of
this particular test in case of Steven Smith is quite appropriate to generate accurate results.

7PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
The development of angina is associated with the increasing age of the patient and
article substantiation suggests patient suffering from angina are either in the age group of 55
or above (American College of Sports Medicine, 2014). It has been reported that along with
the advancement of the age, the prevalence of angina is also enhanced (Lee et al., 2017). The
study also reports the association of growing age with the elevated risk of having a heart
attack. On the other hand, the patient also had the problem of high cholesterol and it might be
attributed to the practice of sedentary lifestyle along with lack of physical activity. Evidence
based study suggests that low amount of physical activity among the older adults with
sedentary life style, is associated with having high levels of low density lipoprotein and
triglyceride levels among the patients (Ekblom-Bak et al., 2014). Sedentary lifestyle also
leads to development of heart diseases (Menezes et al., 2014). Thus, in case of Steven Smith,
his sedentary lifestyle is directly associated with the high levels of cholesterol and cardiac
ailment.
Section D: Behaviour Change Strategies
As indicated by the case study, the patient lives a sedentary life and therefore, it is
crucial to encourage and motivate him to participate in physical activity programmes as there
is a significant positive relationship between developing good behavioural strategy and
starting routine physical exercises (Goisser et al., 2015). Development of behavioural
programmes amongst the older adults with sedentary lifestyle is directly associated with the
adherence to the exercise programme as well. In order to engage the patient in the exercise
activity, motivational interviewing technique can be used as behavioural change strategy. The
health care providers should strategize ways to inspire the patient so that they can understand
the importance of the physical activity in improving the health condition and initiate fit
lifestyle. It is the duty and obligation of the physical activity planner to arrange proper
physical activities for the patient as per the requirement.

8PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Recent studies claim that the motivational interviewing strategy is the most efficient
technique along with the cognitive behavioural therapy (CBT) to reach maximum
effectiveness (Pignataro & Huddleston, 2015). Along with this, it is also true that CBT also
plays an invaluable role in the modification of a person’s behaviour (Pignataro & Huddleston,
2015). It has been reported that CBT is capable of stimulating any patient’s behaviour and it
will help them to participate in the physical activity programmes. This engagement of the
patient will enhance their physical fitness and thereby improve the overall health condition.
The cognitive behavioural therapy is also influential in setting achievable goals and self-
monitoring among the patients (Tan et al., 2014). Hence, self- monitoring and goal setting by
the patients will motivate them to engage oneself into the custom planned physical exercise
programme.
Face to face interviews regarding the importance of physical activity in improving the
health condition of the patients will also stimulate them to participate in the physical activity
programmes (Bock, Jarczok & Litaker, 2014). Evidence related to the dearth of physical
activity in the senior population is highlighted in studies as the elder adults avoid tasks
involving many movements (Bock, Jarczok & Litaker, 2014). In such condition, community
setting is one of the promising techniques in engaging older people to perform physical
activity together.
The effectiveness of the community based physical activity intervention was
examined in this study. A total of fifty five studies regarding this topic were examined in this
systematic review, in which almost half of the total studies reported that community based
exercise interventions were successful in improving the condition of physical activity
behaviour amongst the older adults. Apart from that, the systematic studies also reported that
the community based intervention for physical activity with face to face interview sessions
were most efficient, with a net 35% positive change (p value= 0.014, thus indicating

9PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
significant change). The study concluded that, the community based intervention can also be
used as a behavioural change strategy for the older adult population so that they can engage
themselves in various physical activities and thereby the health of the older adults may also
improve by initiating physical activity in a regular manner. Regular physical activity is
essential for the wellbeing of the individuals in their older age (Motalebi et al., 2014).
However, in recent times various studies have identified that 75% of the older population is
not at all engaged in regular physical activity and thus, it is required to engage them in the
physical activity programmes to promote healthy lifestyle (Motalebi et al., 2014).
As a part of the behavioural change strategy, theory of planned behaviour (TBP) can
be used as per the suggestions of the authors (Rogers et al., 2018). It is reported that the TBP
is quite successful in generating the positive behaviour towards the daily physical activities
among the older adults (Rogers et al., 2018). This study showed that, the TBP is successful in
generating the positive attitude of the patients with older age towards the regular physical
activities and this modification of the attitudes of the patients is promoting the positive
behaviour regarding physical activities in their daily life. So, it can be said that, the aforesaid
strategies can be used for the patient named Steven Smith. However, it is also true that,
during promoting the behavioural change strategy, the physical activity planner must include
the subjective norms that are age gender, physical condition, cardiac condition of the patient,
performance of the patients as well. After considering all the perspective related to the health
condition of the Steven a physical activity plan should be made for 12 week.
Section E: 12 Week Physical Activity Programme
Table 1
The 12 week physical activity programme has been tabulated below.

10PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Week Frequency Session Mode Duration Intensity
Week
1
2 days a week
Tuesday
Thursday
Morning Warming up and
Stretching exercise
15 minutes
Evening Warming up
Stretching
15 minutes 2-4 RPE
Week
4
3 days a week
Tuesday
Thursday
Saturday
Morning Warming up
exercise
Stretching and
Aerobic exercise
15 minutes of
warming up
followed by
aerobic exercise
for 10-15 minutes
Afternoo
n
warm up, stretching
and Aerobic exercise
15 minutes of
warming up
followed by 10
minutes of
stretching and
after that 15
minutes of aerobic
exercise with a
low intensity
2-5 RPE
Week
8
3 days a week
Monday
Wednesday
Morning Warming up
followed by
resistance training
with repetition of 10-
20-30 minutes 4-5 RPE

11PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Friday 12 times with lower
resistance
Afternoo
n
Muscular endurance
Walking in a brisk
manner
10-20 minutes 5 RPE
Week
12
4 days a week
Monday,
Wednesday,
Friday and
Sunday
Morning Cardiovascular
endurance after
aerobic exercise of
low to moderate
intensity
25-30 minutes 6 RPE
Afternoo
n
Cycling or Treadmill
walking in a low
intensity
10-20 minutes 6RPE
Section F: Session Design Plan
Table 2
The session design framework for the 12 week physical activity programme has been
tabulated below.
Week Session Name of Exercise Name of
Equipment
Week 1 Morning Warming up- Head
and Shoulder rolls
and repeat it for 10-
No equipment
required.

12PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
15 times. Knee
circles and repeat it
for 10 to 12 times.
Rotate arms in clock
wise and anti clock
direction and repeat
it for 10 times
Evening Warming up and do
repeat the same.
Stretching exercise-
Quadriceps stretch
and repeat it for 6-8
times for both the
legs. Torso Stretch
and repeat it for 6-7
times for each side
and must rest for a
10-15 seconds after
each cycle.
No equipment
required.
Week 4 Morning Warming and
Stretching is same as
above depicted.
Then it is followed
by aerobic exercise
that includes the use
Bicycle ergo meter

13PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
of exercise bike and
the individual must
monitor the heart
rate. During this
process, initially a
lower intensity
exercise is useful.
Afternoon Same as above
Week 8 Morning Warming up
exercise is same as
week 1. For
resistance training
Dumbbell press
(Seated) can be
recommended with a
lower weight and 2-
3 sets should be
recommended.
Dumbbell
Afternoon Walking briskly and
repeating the process
for 2-3 times with 10
minutes interval
after each cycle
No equipment
required
Week 12 Morning For enhancing
cardiovascular
No equipment is
required.

14PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
endurance, walking
can be recommended
and along with this
breathing exercise is
also recommended.
This process should
be repeated for 2-3
times after 10-20
seconds intervals
with each period.
Evening Cycling with a low
intensity by using a
bicycle ergo meter.
This process may be
continued for 3-4
cycles with an
interval of 10
minutes.
Section G: Evidence Based Rationale
The aforesaid exercise plan is associated with the restoration of healthy normal life of
the patient named Steven Smith. The case study reported that he is suffering from angina and
high cholesterol while simultaneously leading a sedentary life style therefore it is of utmost
importance to engage him in physical activities which might aid the improvement of his
physical ailments. According to the study of McGowan et al. (2015), warm up exercises have

15PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
been reported to be crucial for all leading a sedentary lifestyle as it will help them in coping
up with the exercises in a better manner. It has also reported that the lack of adequate amount
of warm up exercises can cause injury to the person as well (McGowan et al., 2015). The
importance of stretching exercise in case of the patients with cardiac problem of age group 50
or above has been highlighted by studies too (Silber et al., 2015). Activities such as walking
or cycling are associated with the improvement of the cardiovascular health of the patients
and along with resistance training (Schnohr et al., 2015). These kind of exercises or training
are advisable for the patients with cardiac problems as such exercises help in enhancing the
endurance of the cardiac muscles and thereby causing improvement of the cardiac condition
of the patients (American College of Sports Medicine, 2014). Mild to moderate intensity
exercise is preferable in case of Steven as the patient is suffering from angina and
simultaneously has high levels of blood cholesterol. Therefore, all the factors should be
considered along with the age of the patient. Sufficient resting period between the exercises is
also recommended to maintain stability of the patient (Gielen et al., 2015).
Conclusion
Hence it can be concluded that proper custom planning of exercise programme is
crucial for patients with any kind of cardiac disease. Designing such exercise programmes
must include age of the patient with proper intensity and frequency. In case of cardiac
patients, low intensity exercises are generally recommended. Moreover, it is also true that,
the older adults generally do not practice regular exercises due to their age. Therefore, in
order to inspire them, engaging them with various exercise programmes along with
behavioural change strategies can be implemented to improve their health condition along
with upgrading the lifestyle.

16PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
Section H: References
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physical activity: a systematic review of interventions considering mode of delivery,
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Gielen, S., Laughlin, M. H., O’Conner, C., & Duncker, D. J. (2015). Exercise training in
patients with heart disease: review of beneficial effects and clinical recommendations.
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18PROGRAMMING OF PHYSICAL ACTIVITIES FOR A SPECIAL CASE
effect on adherence to physical activity sustainable in the long term? A 15-month
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Fahrni, G. (2018). P1730 Redefining unstable angina: novel insights regarding incidence,
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Schnohr, P., O’Keefe, J. H., Marott, J. L., Lange, P., & Jensen, G. B. (2015). Dose of jogging
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reports in medicine, 2017.
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among cancer support group participants. European journal of cancer care, 23(2), 199-
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Stewart, D. E., & Vigod, S. N. (2019). Postpartum Depression: Pathophysiology, Treatment,
and Emerging Therapeutics. Annual review of medicine, 70, 183-196.
Swain, D. P., Brawner, C. A., & American College of Sports Medicine. (2014). ACSM's
resource manual for guidelines for exercise testing and prescription. Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Tan, L., Wang, M. J., Modini, M., Joyce, S., Mykletun, A., Christensen, H., & Harvey, S. B.
(2014). Preventing the development of depression at work: a systematic review and meta-
analysis of universal interventions in the workplace. BMC medicine, 12(1), 74.
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