Final Paper Client Project 2

Running Head: Client Training Program for Cardiac Patients 1
Client Training Program for Cardiac Patients
Erika Shelly
College of Western Idaho

Client Training Program for Cardiac Patients 2
Table of Contents
Client Information.........................................................................................................................3
Risk Stratification................................................................................................................3
Recommended Actions Prior to Training............................................................................3
Client Goals.........................................................................................................................4
Training Plan Reasoning………………………………………………………………………...5
Training Plan Short-Term…………………………………………………………………5
Training Plan Long-Term…………………………………………………………………8
Data.................................................................................................................................................9
Conclusion....................................................................................................................................10
Appendix A...................................................................................................................................11
Appendix B...................................................................................................................................16
Works Cited..................................................................................................................................17
Client Information:
Client is a 52-year-old male who has previously had a heart attack. Client is 180 lbs. and
is 5’1’’. Client’s body fat percentage is 22% and hip to waist ratio is .82. Client is currently
taking the prescription medications Pradaxa, Lipitor, and Metoprolol to help regulate
anticoagulant, cholesterol, and blood pressure levels at a normal capacity. Client’s blood
pressure with medication is 94/58. Client spends time golfing and likes spending time with
family. Client is currently not exercising regularly, other than golfing, and has not been to a gym
in a long time.
Risk Stratification:
Risk Level: High Risk
Client has previously had a heart attack, which is considered a cardiovascular disease
(CMR), so client is ranked as a “high-risk” client and will need further testing prior to exercising
to prevent future risk.
Risk Factors:
Client has several risk factors. Risk factors will include any unknown factors to prevent
potential risks from not being included. Client risk factors include the following: his age of 52,
unknown family history, unknown history of cigarette smoking, client is physically inactive,
unknown obesity, unknown cholesterol, and unknown HDL. Client is known to golf each week,
but number of times each week is not specified, so it is considered a risk.
Recommended Actions Prior to Training:
As per ACSM, client is not physically active, has heart disease, and has signs/symptoms
of CMR disease. Client must undergo a medical screening from a doctor prior to physical
activity (ACSM 302).

Client Goals:
Personal Goal:
Client’s goal is simply to live longer. No specific information on what is wanted to be
accomplish. Client has had a heart attack in the past and would like to have a better lifestyle.
While this goal is realistic as there are many ways to help prolong the client’s life.
Unfortunately, the goal is not specific, it cannot be measured, and has no time frame to achieve
it. A specific goal will need to be incorporated so that a certain period of time can be measurable
and achieved (ACSM 222).
Main Goal:
The main goal for the client is to lose weight to live longer. By achieving this goal, the
client will need to lose 6% body fat in 6 months. The client’s body fat percentage has been
previously calculated and has been resulted in an equivalency to 12 kilograms or approximately
26lbs in body weight.
Micro Goal #1:
The smaller goal of the client is to lose 1% of body fat each month. 1% of this client’s
body fat is equivalent to 2 kg per month or 4.5lbs per month. Each week the client will strive to
lose .5 kg to meet target goal. As per ACSM, a gradual weight loss of 1kg per week or less is
recommended (573).
Micro Goal #2:
The second smaller goal is for the client to increase is VO2 by 6.5 percent each month to
help gradually gain a higher intensity for aerobic activity. Client will be starting at a very low
intensity due to heart conditions and will increase intensity with time.
Training Plan Reasoning
Client has cardiovascular disease and has had a heart attack in the past. Training plan is
designed to work around his CVD so that there is no physical risk to the client. Studies have
shown that the main focus for CVD should be aerobic exercise. As aerobic exercise primarily
focuses on the heart, a research project was undergone to see the effects of exercise on patients
with hypertension. The exercise included aerobic exercise on a 12-week program with one hour
per session, four times a week. The results concluded that those who exercised saw that their
blood pressure was lowered substantially (Hong, Lee, & Lee, 2018).
Training Plan Short-Term
Aerobic
The first month of the client’s training plan is primarily focused on three main aspects.
The first aspect is focused on aerobic training. Due to the fact that the client is a beginner, client
will be starting out at a very low level of 7 on the 6-20 RPE scale and 20 min of exercise per day.
Client will be exercising 3 days a week with aerobic exercise. Client’s intensity will consist of a
Vo2 of 20%. The first day will only consist of walking for a 10 minutes period twice a day. This
will be set at a low intensity of a level two on the RPE scale. For day two client will be leisurely
cycling for 10 minutes twice a day. For day three the client will be walking for 10 minutes twice
a day. These activities can be completed at home or at the gym, giving the client the option to do
either. These exercises were chosen and for a specific duration because as per ACSM, it is
recommended that cardiac patients exercise 3-7 days per week, 20-60 min per day, and perform
low intensity exercises (578). Client will start at lower end of the suggested numbers so that
there is no risk of overworking his heart. For the first week he will have a few minute warm up
and cool down. After that, client will have a five-minute warm-up and cool-down.
Research has shown that older adults endeavoring exercise may feel negative toward the
program due to lack of strength and stamina causing them to lessen their will for exercising
(Brunet, Guérin, & Speranzini, 2018). To prevent discouragement of the client, each week the
client will add 5 minutes of duration to aerobic activity so that the client is slowly progressing to
a longer duration of exercise until 60 minutes of exercise per day is met. To elaborate, for week
one exercise will consist a total of 60 min (3 days x 20 min per day), week two will consist
exercise for a total of 75 min (3 days x 25 min per day), week three will consist exercise for a
total of 90 min(3 days x 30 min per day), and week 4 will consist exercise for a total of 105 min
(3 days x 35 min per day).
Strength
The second aspect is focused on strength. A fully developed plan will include a full body
workout that will incorporate eight exercises. These exercises will target the six main muscle
groups in the body including: the shoulders, chests, legs, back, lower back, and abdominals.
(ACSM 362). I will be incorporating 2 additional exercises to the 6 as per the suggested
modification for cardiac patients (ACSM 562). These exercises include the following: Machine
shoulder press: targets shoulders, chest, and triceps. Leg press: targets quads, hamstrings, and
glutes. Seated row: targets all areas of back. Hanging knee raise: targets abdominals, rectus
abdominals, and external obliques. Lat pull down: targets upper back and biceps. Seated calf
raises: targets lower legs. Machine biceps curl: biceps. Machine leg curl: hamstrings.
These exercises were chosen because they target the main areas of the body as specified
in ACSM, and they will not be hard for the client to perform. A study was undergone to
determine how power assisted exercises affect older individuals. After 12 weeks of training, it
was concluded that powered exercise equipment allows a secure exercise of muscular endurance
(Jacobson, Smith, Fronterhouse, Kline, & Boolani, (2012). This is one reason why it is
recommended to have novice and elderly clients starting out with machines, as they are easy to
operate prevent risk for injury. These exercises were organized in this order because they start
with exercises that cover the most muscle groups in the body. The exercises are also designed to
alternate muscle groups so that he is not working one area to often. This prevents delayed
soreness and overworking the client (ACSM 391).
The client will be required to perform an intensity of 20% of his 1 rep max. Most CVD
clients will be advised to perform at a 40-60% intensity however, since this client is not regularly
exercising, ACSM advises to start at a 20-30% intensity. I will be having him perform 15
repetitions starting with one set because he is an older client. Since the client will increase his
intensity by 8% each month, the client will be increasing his intensity on the machines by 2%
each week. For the first month, the number of reps will be lowered by one every month as
intensity increases. Client will perform strength workouts 2 days a week because the client is a
beginner and so that the strength workouts alternate with his aerobic workout days.
Flexibility
Lastly, a flexibility program was designed for the client. The exercises that have been
chosen will include static and dynamic stretches because they will be easier to complete for a
beginner and older client (ACSM 469). Each stretch will be held for 30 seconds because client is
an older client as per ACSM (477). The flexibility program will be completed after every
strength day, so, it will be completed twice a week. The following includes the stretches that will
be performed and what areas they will cover. Lateral Flexion: neck. Arm circles: shoulders.
Chest stretch: chest. Elbow extension: arms. Trunk rotation stretch: back. Torso twist: torso.
Seated hip rotator level 1: hips. Prone quadriceps: Thigh (anterior). Seated hamstring: thigh
(posterior). Seated calf stretch: calves.
Training Plan Long-Term
As for the long-term program, there will be some various changes to the one month
exercise plan and some aspects that will remain the same. Long-term plan will allow client to
lose at least 1.2 lbs each week so that the client will lose a total of 28.8 lbs and 6% body fat
percentage. As per experts, keeping a goal of 1-2lb weight loss per week is recommended ("6
Proven Strategies,” 2016).
Aerobic
A 35 min workout for each aerobic day will remain the same, however, intensity will
gradually increase. Client will keep the 5 minute warm-up and cool-down for each aerobic day
worked, however, month two will increase the rating on the RPE scale to 8. Each month, the
client will increase the number by one on the 6-20 RPE scale so that by the time the client
reaches month 6, the number on the RPE scale will have reached 13. This means that the client
will be performing moderately instead of lightly (ACSM 436). This plan also prevents the client
from exceeding the 4 hours of time that was allotted prior to training.
Strength
Exercise program will be kept the same for the client. Each week 2-5 lbs of weight for
upper body exercises and 5-10 lbs for lower body exercises will be added to each exercise. One
set will also be added every three months so that by month six the client will be executing 2 sets
of 15 instead of one set (ACSM 562). Each month Vo2 will be increased by 8% so that the client
is at a total of 66% intensity by month 6.

Flexibility
Flexibility will remain the same for all six months. There is no required intensity or
duration to change among the stretches that will be performed.
Data
Pre-Exercise Testing
The following has not been tested on the client and will be needed for further analysis to
fit client’s needs for progression of weight loss. The testing we will incorporate the skin fold test,
a test designed to help calculate body fat percentage in addition to the test that was already
permitted. Waist and hip length will also be gathered because while it is known that the client’s
ratio is .82, however, the exact measurements is not known for the waist and hip individually.
This allows trainers to determine if the client is overweight. The client’s relative or absolute Vo2
max will also need to be obtained. To prevent risk of physical impairment of client, a doctor will
be needed to administer Vo2 max test. Obtaining this test will allow intensity of aerobic
exercises to be determined. The higher the oxygen consumption, the better the client’s
cardiorespiratory endurance is.
Post-Exercise Testing
Every 3 months the client’s 3rm will need to be tested. The test will not be taken prior to
exercising because the client is a beginner and the client’s repetition maximum will change the
most in the first 3 months of training. A 3rm test will be used instead of a 1rm to avoid risk of
injury due to client’s cardiac issues. The client will also be weighed weekly to be sure that the
goals of losing 1.2 lbs. per week will be met. Every month a skinfold test will be deducted as
well as a hip to ratio measurement to determine how much body fat is decreasing. Client’s Vo2
will be measured every 3 months as well to be sure that the goal of an 8% increase each month is
met.
Conclusion
Client wants to prolong his life by making changes with his exercise. While four hours a
week is not a lot of time and the client hasn’t been regularly exercising in the past, this plan will
allow client to accomplish the set goals. Research has shown that exercise can help prevent
future heart attacks from reoccurring (“Flexibility Exercise (Stretching),” 2018). The trainer
should be prepared if the client may become discouraged or bored and to try to present the
program in a way for the client to become intrigued. The client is known to be a little stubborn
since the client will only do anything within reason, the trainer will need to motivate him to
continue.
Appendix A
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

1 2 intervals of 10 min of Strength 2 intervals of 10 min of Strength 2 intervals of 10 min of Full Rest Full Rest
Light exercise should Sets: 1 Light exercise should Sets: 1 Light exercise should
be be be
completed. Reps: 15 completed. Reps: 15 completed.
Pace: Level 7 Borg's 1rm: 20% Pace: Level 7 Borg's 1rm: 20% Pace: Level 7 Borg's
RPE, Light Level of RPE, Light Level of RPE, Light Level of
Exertion Exercises in Order: Exertion Exercises in Order: Exertion
2 min warm-up Machine Shoulder 2 min warm-up Machine Shoulder 2 min warm-up
press press
10 min walk Level 7 10 min leisurly cycling 10 min walk Level 7
RPE Leg Press Level 7 RPE Leg Press RPE
2 min cool-down Hanging Knee Raise 2 min cool-down Hanging Knee Raise 2 min cool-down
Seated Row Seated Row
Seated Calf Raises Seated Calf Raises
Lat Pull Down Lat Pull Down
Machine Biceps Curl Flexibility
Machine Leg Curl Time: 30 Sec per

Stretch
Flexibility
Type: Static and
Time: 30 Sec per Dynamic
Stretch
Sets: 2 Sets per
Type: Static and stretch
Dynamic
Sets: 2 Sets per Lateral Flexion

stretch
Arm Circles
Lateral Flexion Chest Stretch
Arm Circles Elbow Extension
Chest Stretch Trunk Rotation Stretch
Elbow Extension
Torso Twist
Trunk Rotation Stretch
Seated Hip rotator,
level 1
Torso Twist
Prone quadriceps
Seated Hip rotator,

level 1
Prone quadriceps Seated hamstring
Seated hamstring Seated Calf Stretch
Seated Calf Stretch

2 1 interval of 15 min of Strength 1 interval of 15 min of Strength 1 interval of 15 min of Full Rest Full Rest
Light exercise should Light exercise should Light exercise should
be Sets: 1 be Sets: 1 be
completed. completed. completed.
Reps: 15 Reps: 15
Pace: Level 7 Borg's Pace: Level 7 Borg's Pace: Level 7 Borg's
RPE, Light Level of 1rm: 22% RPE, Light Level of 1rm: 22% RPE, Light Level of
Exertion Exertion Exertion
Exercises in Order: Exercises in Order:
5 min warm-up 5 min warm-up 5 min warm-up
Machine Shoulder Machine Shoulder
15 min walk Level 7 press 15 min leisurly cycling press 15 min walk Level 7
RPE Level 7 RPE RPE
Leg Press Leg Press
5 min cool-down 5 min cool-down 5 min cool-down
Hanging Knee Raise Hanging Knee Raise
Machine Biceps Curl Machine Biceps Curl
Machine Leg Curl Machine Leg Curl
Flexibility Flexibility
Time: 30 Sec per Time: 30 Sec per

Stretch Stretch
Type: Static and Type: Static and

Dynamic Dynamic
Sets: 2 Sets per Sets: 2 Sets per

stretch stretch
Lateral Flexion Lateral Flexion
Arm Circles Arm Circles
Chest Stretch Chest Stretch
Elbow Extension Elbow Extension
Trunk Rotation Stretch Trunk Rotation Stretch

Torso Twist Torso Twist
Seated Hip rotator, Seated Hip rotator,

level 1 level 1
Prone quadriceps Prone quadriceps
Seated hamstring Seated hamstring
Seated Calf Stretch Seated Calf Stretch

3 1 interval of 20 min of Strength 1 interval of 20 min of Strength 1 interval of 20 min of Full Rest Full Rest
Light exercise should Light exercise should Light exercise should
be Sets: 1 be Sets: 1 be
completed. completed. completed.
Reps: 15 Reps: 15
Pace: Level 7 Borg's Pace: Level 7 Borg's Pace: Level 7 Borg's
RPE, Light Level of 1rm: 24% RPE, Light Level of 1rm: 24% RPE, Light Level of
Exertion Exertion Exertion
Exercises in Order: Exercises in Order:
5 min warm-up 5 min warm-up 5 min warm-up
Machine Shoulder Machine Shoulder
20 min walk Level 7 press 20 min leisurly cycling press 20 min walk Level 7
RPE Level 7 RPE RPE
Leg Press Leg Press
5 min cool-down 5 min cool-down 5 min cool-down
Hanging Knee Raise Hanging Knee Raise

Stretch Stretch

Dynamic Dynamic

stretch stretch


level 1 level 1

4 1 intervals of 25 min of Strength 1 intervals of 25 min of Strength 1 intervals of 25 min of Full Rest Full Rest
Light exercise should Sets: 1 Light exercise should Sets: 1 Light exercise should
be be be
completed. Reps: 15 completed. Reps: 15 completed.
Pace: Level 7 Borg's 1rm: 26% Pace: Level 7 Borg's 1rm: 26% Pace: Level 7 Borg's
RPE, Light Level of RPE, Light Level of RPE, Light Level of
Exertion Exercises in Order: Exertion Exercises in Order: Exertion
5 min warm-up Machine Shoulder 5 min warm-up Machine Shoulder 5 min warm-up
press press
25 min walk Level 7 25 min leisurly cycling 25 min walk Level 7
RPE Leg Press Level 7 RPE Leg Press RPE
5 min cool-down Hanging Knee Raise 5 min cool-down Hanging Knee Raise 5 min cool-down

Stretch Stretch

Dynamic Dynamic

stretch stretch


level 1 level 1

Appendix B
Wee
ks 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Mon
ths 1 2 3 4 5 6
Aero
bic
CR
Min/
Day
CR
Days
/We
ek
War
m-
up
Borg
's
RPE
Scal
e
(6-
20)
Vo2

Stre
ngth
Ligh
t
Exer
cise
Days
/We
ek
Sets
Reps
%1
rm
Rest
/min

Flexi
bilit
y
Stati
c-
Day/ 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6
Sec 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s
Dyn
amic
-
Day/ 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6 2/6
Sec 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s 0s
Works Cited:
American College of Sports Medicine,, In Riebe, D., In Ehrman, J. K., In Liguori, G., & In
Magal, M. (2018). ACSM's guidelines for exercise testing and prescription.
Brunet, J., Guérin, E., & Speranzini, N. (2018). An Examination of Exercise-Induced Feeling
States and Their Association With Future Participation in Physical Activity Among Older
Adults. Journal of Aging & Physical Activity, 26(1), 52–60. Retrieved from
http://search.ebscohost.com.cwi.idm.oclc.org/login.aspx?
direct=true&db=s3h&AN=128142588&site=ehost-live&scope=site
Flexibility Exercise (Stretching). (2018). Retrieved from https://www.heart.org/en/healthy-
living/fitness/fitness-basics/flexibility-exercise-stretching
Jacobson, B. H., Smith, D., Fronterhouse, J., Kline, C., & Boolani, A. (2012). Assessment of the
Benefit of Powered Exercises for Muscular Endurance and Functional Capacity in
Elderly Participants. Journal of Physical Activity & Health, 9(7), 1030–1035. Retrieved
from http://search.ebscohost.com.cwi.idm.oclc.org/login.aspx?
Soung Kyun Hong, Dong Geon Lee, & Gyu Chang Lee. (2018). Effect of Aerobic Exercise on
Blood Pressure and Arterial Compliance in Patients with Essential Hypertension. Journal
of Exercise Physiology Online, 21(5), 9–18. Retrieved from
http://cwi.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?
6 Proven Strategies for Weight-Loss Success. (n.d.). (2016). Mayo Clinic, Mayo Foundation for
Medical Education and Research. Retrieved from www.mayoclinic.org/healthy-
lifestyle/weight-loss/in-depth/weight-loss/art-20047752.

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Running Head: Client Training Program for Cardiac Patients 1

Client Training Program for Cardiac Patients

College of Western Idaho

Recommended Actions Prior to Training............................................................................3

Training Plan Reasoning………………………………………………………………………...5

Training Plan Short-Term…………………………………………………………………5

Training Plan Long-Term…………………………………………………………………8

Risk Level: High Risk

to prevent future risk.

but number of times each week is not specified, so it is considered a risk.

Recommended Actions Prior to Training:

activity (ACSM 302).

Client’s goal is simply to live longer. No specific information on what is wanted to be

and achieved (ACSM 222).

previously calculated and has been resulted in an equivalency to 12 kilograms or approximately

26lbs in body weight.

Micro Goal #1:

Micro Goal #2:

Training Plan Reasoning

Training Plan Short-Term

(3 days x 35 min per day).

soreness and overworking the client (ACSM 391).

(posterior). Seated calf stretch: calves.

Training Plan Long-Term

Proven Strategies,” 2016).

is at a total of 66% intensity by month 6.

duration to change among the stretches that will be performed.

cardiorespiratory endurance is.

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Seated Row Seated Row

Seated Calf Raises Seated Calf Raises

Lat Pull Down Lat Pull Down

Machine Biceps Curl Flexibility

Machine Leg Curl Time: 30 Sec per

Sets: 2 Sets per Lateral Flexion

Lateral Flexion Chest Stretch

Arm Circles Elbow Extension

Chest Stretch Trunk Rotation Stretch

Seated Hip rotator,

Prone quadriceps Seated hamstring

Seated hamstring Seated Calf Stretch

Seated Calf Stretch

Seated Row Seated Row

Seated Calf Raises Seated Calf Raises

Lat Pull Down Lat Pull Down

Machine Biceps Curl Machine Biceps Curl

Machine Leg Curl Machine Leg Curl

Time: 30 Sec per Time: 30 Sec per

Type: Static and Type: Static and

Sets: 2 Sets per Sets: 2 Sets per

Lateral Flexion Lateral Flexion

Arm Circles Arm Circles

Chest Stretch Chest Stretch

Elbow Extension Elbow Extension

Trunk Rotation Stretch Trunk Rotation Stretch

Torso Twist Torso Twist

Seated Hip rotator, Seated Hip rotator,

Prone quadriceps Prone quadriceps

Seated hamstring Seated hamstring

Seated Calf Stretch Seated Calf Stretch

Seated Row Seated Row

Seated Calf Raises Seated Calf Raises

Lat Pull Down Lat Pull Down