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Case Study: Type 2 Diabetes in an Older Adult (final part)- Talaiah M. 

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Case Study: Type 2 Diabetes in an Older Adult (final part)- Talaiah M. 

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Overall the 74-year-old woman had some major comebacks and some setbacks. One comeback was that the client used to be an athlete, which means that she would benefit from group exercises. The podcast talked about some of her setbacks. One setback she had was that her husband had started to pick up the drinking and the abuse. Another setback she had was the worsening of her knee and was unable to do flexion/extension exercises. The client's rotator cuff symptoms increased after starting chest press and lat pull-down. Depressive symptoms increase and she was not motivated to come into the clinic for exercise sessions.

Suggestion
- Substitute isometric for dynamic resistance exercises; rule out gout attack;
check the need for orthotics to reduce medial loading; add gait modification-
trunk lean/toe-out
-Eliminate overhead movements; rule out acute tear on L; physio-directed RC exercises then home-based; postural control-feet off the floor when sitting; pillow
under the elbow to sleep
- Assess for presence of suicidality; refer for counseling or cognitive-behavioral therapy; focus on a small volume of high-intensity exercise at least 3 days per week until full Rx can be achieved again

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Case Study: Type 2 Diabetes in an Older Adult (Part 2) - Talaiah M. 

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Case Study: Type 2 Diabetes in an Older Adult (Part 2) - Talaiah M. 

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Exercise Program:
Non-exercise investigations and treatments needed:
- Reduce thyroid supplement, switch to statin with less potential for myopathy, reduce or eliminate anti-reflux med, switch to non-ACE inhibitor due to cough
- Treat vitamin D and B12 deficiencies
- Ultrasound shoulder and knee to rule out rotator cuff tear, Baker's cyst
- Low Gl/High protein diet; DASH diet, Mediterranean Diet, avoid high purine load foods
- Orthotics and galt modification to reduce medial loading of knee joint

Exercise Prescription
Modalities: progressive resistance training (PRT), Aerobic training beneficial
Setting: Supervision initially; structured exercise most effective, integrated into daily life as well
Staging: resistance first to prepare joints for weight-bearing exercise
volume: up to 60 minutes/ every day desirable, 30 minutes/ every day minimum
Intensity: PRT mod-high; Aerobic mod-high (depends on tolerance)
Progression: each session via perceived exertion as tolerated

Monitoring outcomes and adherence
Encourage logging of exercise and diet, establish goals relevant to an athlete, record resolution
of key symptoms: WOMAC pain, Gait speed, 6MWD, Depressive symptoms, Fatigue, Muscle
aches, SOB. Monitor HbA1c, Renal function, LFTs, Vit D, TSH, Ambulatory BP. Watch for emergence of angina, claudication, falls, foot trauma, worsening joint pain.

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Case Study: Type 2 Diabetes in an Older Adult- Talaiah M. 

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Case Study: Type 2 Diabetes in an Older Adult- Talaiah M. 

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Background:
74 year old women with Type 2 Diabetes for 10 years, self-referred herself for an exercise program to help with fatigue and musculoskeletal pain

Key Knowledge/Findings
Type 2 diabetes, obesity, osteoarthritis, coronary artery disease, hyperlipidemia, sleep apnea, depression, fatigue, musculoskeletal pain, gout, and many other conditions

Patient's goal:
To lose weight, increase activity levels, and reduce stress

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Part 5: End Evaluation of the woman with Chronic Low Back Pain

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Response's from the panelists simplified:

-Get rid of compensating issue

-Start a Cognitive behavioral approach: Needs multidisciplinary approach: Find ways to ease pain

-Keep the woman active/continue normal activities

-More assessments before MA approach

-Bigger picture approach: whole body exercise

-Look at previous treatment

-Person may need to be encouraged to do activities??

-May be a case where she may never return

-A bunch of different professional advice was given, but not one panelists completely agreed with the other. Some thought getting her to continue her daily activities including working out on the daily would greatly benefit her as long as it was light weight and done with the correct form/posture. Others would disagree and say more assessment must be taken to fully understand the main cause.

-All in all, no one had a clear image of what would be most beneficial for this lady. They all came to agree that this lady would more than likely continue to have these pains in her low back. She would just have to take thing at slower rates and more carefully. Everything she does from here on out has to be with precision. With work, she would either have to find another job that had her moving and not sitting all the time, she would have to have a job that caused less of the movements that put constant triggers on her back, and would need to take her job at a slower pace as well.

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Three phases were put in place to help decrease the severity of the woman's low back pain: (Cognitive, Associative, and Autonomous Phase's)

First Stage: Cognitive stage- This stage's goal was rehabilitation and retaining of the deep lumbar-pelvic muscles. To decrease activity of superficial paraspinal muscles.
-Exercises done in this phase included:

Diaphramic breathing

Co-activation TrAB and pelvic floor muscles: Real time ultrasound imaging and some carry over into multifidus (group of short, triangular muscles that along with the semispinalis and rotatores comprises the transversospinal group of deep back muscles) training.

Second Stage: Associative Stage- The goal was coordination between deep and superficial muscles to meet functional demands and improve force transfer and recruitment of myofascial slings (posterior).
-Exercises done:

Four-point kneeling progressions: alternating leg or arm raises

Bridging: maintaining neutral lumbar lordosis

Side-lying 1/2 planks > full planks

Crook-lying dissociation exercises: Bent knee fall outs and single knee raises

Seated alt. arm raises/knee extensions: rotational control

Squats

Single limb loading

Third Stage: Autonomous Stage- The goal was to reduce the need for extrinsic feedback (Reduced frequency of appointments, tactile and visual cues.
-Exercises done:

Dynamic lunges, squats, dead bugs + progressions

Deadlifts+progressions

Star Excursions: Increasing speed

Continue cardiovascular exercise

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Part 1: Case Study on Chronic Low Back Pain (Little Overview)

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Video of myself giving a simple overview of the case study I reviewed. Other parts I post will go in deeper detail!

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Part 1: Case Study on Chronic Low Back Pain (Little Overview)

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Dr. Kelly V. went over her patient who was a woman with chronic low back pain. This woman's symptoms were as followed:
-Central/right sided low back pain
-Back pain radiates into right buttock when back pain is at it worst
-Flexion, bent, or rotated-based postures lit her back up
-Weak right hip Adductor during dynamic movements, such as sit-to-standing movements
-Her prime hip extensor was the main muscle contributing to her pain.

Dr. Kelly and the woman made a list of goals to help ease/prevent her low back from igniting and lighting up badly:
-Goals included: To be able to lift weight without lighting her back up, to return to work on a part-time basis (2-3 times a week), and be able to cope with having another pregnancy for the first one put her on bed rest.

As of right now, the woman is not able to work and it's been more than 2 years and, in the beginning, she was put on maternity relieve as well.

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Inactivity is worse for arthritis than being active. Your bones get ample strength from being exercised at least every day. The best exercises to do is to go on walks and doing yoga/stretches. The biggest concern for arthritis is the fatigue that comes along with it. When finding the best time to work out, pick the time that your energy is at peak to make it more enjoyable.

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-Maintain or increase flexibility of the muscles and joints
-Lowers inflammation and increases range of motion in joint

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Pace is the most known workout program for the arthritic. It helps add range of motion and gentle strengthening. There are 2 levels to pace. The second level is more intense than the first.

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The best way for people with arthritis is to exercise in water. The warmth of the water makes it easier to use the joints and creates a less painful experience. It adds less weight and pressure to the joints while working the mobility of them. Pool workouts have been proven to be easier on the body and create lower recovery time.

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High Intensity Interval Training in Chronic Disease

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High Intensity Interval Training in Chronic Disease

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The best type of exercise for patients with chronic disease is... exercises that the patients will do! High Intensity Interval Training is alternating periods of anaerobic exercise with periods of lower intensity or no exercise. The most commonly used protocol for doing high intensity interval training in chronic disease is the 4 by 4 approach. It has the 4 intervals of 4 minutes of length with 3 minutes of rest periods. The important part of this is that you take two minutes to get your heart rate up to a 85-95% max. Individuals tend to get confused on the difference between High Intensity Interval Training and Sprint Interval Training. Someone with Chronic Disease should NOT be attempting Sprint Interval Training, this is because it is a form of exercise where you go all out and stress your body. High Intensity Interval Training however does have the break periods in between exercises to let your body regenerate and relax before moving onto the next exercise. In a study, the Norwegian group compared the difference between moderate traditional exercise with interval training over a 35 minute period, the results of interval training doubled the moderate exercise over a 4 week period. Instead of a 35 minute 4 by 4 approach, they took a look at something for even less exercise, which was a 1 by 4 approach. During this, the warm up is shorter and consists of one interval of exercise. After research was done, it was said that the 1 by 4 approach had a 10% increase compared to the 4 by 4 with a 13 % increase. For many chronic disease patients, the absolute intensity of High Intensity Interval Training is low and reflects activities of daily living such as walking up stairs and hurrying to catch a bus. Another study that was done consisted of the effects of appetite during the Interval Training. It showed that the individuals who where completing High Intensity Interval Training sessions had a positive response to their appetite. After the exercise, there was a decrease in the desire to eat. This could mean that there was an energy balance that affected appetite. High Intensity Interval Training is not suitable for everyone, however, there was still an excellent approach to increase cardiorespiratory fitness. It has been used safely and successfully in many clinical populations, and patients were stable and training was in a controlled environment.

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When diagnosing back pain, it is crucial for physicians to know/understand the specific cause of the pain in order to prescript effective treatments. 95% of lower back pain cases are Acute Non-specific, meaning that the pain not attributed to a certain causative agent. Through one of the studies it was determined that regular exercise is more effective at decreasing back pain than regular heat and massage treatments. There are various treatment types that can be implemented to alleviate back pain. Deconditioning treatments focus on stretches, walking, aerobic & strength training exercise to combat back pain. Control and coordination techniques focus on regaining control of the muscle and overall stabilization. Psychological treatments work through cognitive exercises such as gradual exposure and functional restoration of both the mind and muscle. Finally, Mind & Body exercises help with decreasing pain within the body along with alleviating  mental stressors related to the pain. While specific to each case, the direction to which the exercises are performed correlate with distinct patterns of effectiveness/ rehabilitation of the muscle. Overall, the most successful way to relieve back pain is to combine frequent, supervised exercising that are individually designed for the patient.

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When exercising as an arthritic, the biggest fear is that it is not safe. Joint protection in exercise programs is something that is often overlooked. Doing research on the workout programs you are doing and calling your doctor beforehand. Any exercise that contains jumping, running, and jogging are not good exercises for the arthritic to strengthen their joints. Using resistance bands, swimming, and light walking are great exercises to do.