ACSM Student Case Study

Submitted by Mukesh Marfatia

September 2015 CPT Batch

Submitted on February 27, 2016

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Initial Client Consultation

Profile Medical
• Name : Bhavesh Rupani • Blood Pressure : 138 / 90, RHR : 80 bpm
• Age : 52 • No Cholestrol
• Height : 5.7 • Feels his Muscles are weak, though cardio is
• Weight : 76 kgs fairly good
• Exercise History : No Exercise since last 10 • Weak upper & lower back, though no medical
years, except climbing stairs in office problem
• Has office related stress

Goal Lifestyle

• To control blood Pressure • Is Chief Financial Officer at Axis Capital

• Arrest/lower rate of Muscle atrophy • Climbs up 6 floors regularly in office
• General Fitness to arrest age related • Travels mostly by car
issues • Food habits fairly good – mix of eating at
home and occasional outing

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Initial Client Consultation

Consultation held on Saturday January 10th, 2016

Client agreed to spend 4 days a week for exercises. Each day for 45 minutes to 60 minutes

Additionally Client agreed to spend 15 minutes for 2 days at home for doing basic Yoga
stretching

Client is worried about increase in blood pressure that may ultimately move into
hypertension zone and hence Client also agreed for lifestyle changes to be made.

On discussions, he understands that muscles are getting weaker with increasing age and
exercise will help in partly arresting the same

Has no issues in training in gym and has enrolled for the gym membership for one year.

Is willing to meet a dietician diet planning both from weight loss perspective and additional
protein intake perspective

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Client Screening &
Risk Assessment

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Screening and Risk Assessment
Category Assessment

 Age is 52 and hence a risk factor

 No case Mycardial infarction in parents or first degree relative
 Has smoked earlier during college and initial career years, but stopped smoking
Atherosclerotic about 20 years back
CVD Risk Factors  Life Style is sedentary with only exercise being climbing office staircase (6 floors)
once or twice a week
 BMI stands at 27 in overweight category
 Is bordering hypertension. Before enrollment, his blood pressure was around 138/90,
RHR 80
 LDL is border case around 132, HDL is around 42
 Fasting Blood Sugar 96 and hence not a risk factor

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Screening and Risk Assessment
Category Assessment

 Age is 52 and hence a risk factor

 No case Mycardial infarction in parents or first degree relative
 Has smoked earlier during college and initial career years, but stopped smoking
Atherosclerotic about 20 years back
CVD Risk Factors  Life Style is sedentary with only exercise being climbing office staircase (6 floors)
once or twice a week
 BMI stands at 27 in overweight category
 Is bordering hypertension. Before enrollment, his blood pressure was around 138/90,
RHR 80
 LDL is border case around 132, HDL is around 42
 Fasting Blood Sugar 96 and hence not a risk factor

 No Major Signs of either pain, discomfort in chest, jaw, neck or arms that may indicate
ischemia

Major Signs  No Shortness of breadth or unusual fatigue felt at rest or mild exertion
 Back Pain felt at times, however this is attributed to weak posture and no medical
condition attributed
 There were no other contraindications found during the consultation

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 PAR-Q

Bhavesh Rupani
15/01/2016

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Health Assessment Status
Assess your health status by marking all true statements
History
You have had:
___ a heart attack
___ heart surgery
___ cardiac catheterization
___ coronary angioplasty (PTCA)
___ pacemaker/implantable cardiac
___ defibrillator/rhythm disturbance
___ heart valve disease
___ heart failure
___ heart transplantation
___ congenital heart disease

Symptoms
___ You experience chest discomfort with exertion
___ You experience unreasonable breathlessness
___ You experience dizziness, fainting, or blackouts
___ You experience ankle swelling
___ You experience unpleasant awareness of a forceful
or rapid heart rate
___ You take heart medications
if you marked any of these statements in this
section, consult your physician or other
appropriate health care provider before
engaging in exercise. You may need to use a
facility with a medically qualified staff

Other health issues

___ You have diabetes
___ You have asthma or other lung disease
___ You have burning or cramping sensation in your
___ lower legs when walking short distance
___ You have musculoskeletal problems that limit your
physical activity
___ You have concerns about the safety of exercise
___ You take prescription medications
___ You are pregnant

Cardiovascular risk factors

Yes You are a man ≥45 yr
___ You are a woman ≥55 yr
___ You smoke or quit smoking within the previous 6 months
___ Your blood pressure is ≥140/90 mm Hg
___ You do not know your blood pressure
Border Case
___ You take blood pressure medication
___ Your blood cholesterol level is ≥200 mg dL–1
___ You do not know your cholesterol level
___ You have a close blood relative who had a
heart attack or heart surgery before age
55 (father or brother) or age 65 (mother or sister)
___ You are physically inactive (i.e., you get !30 min of
physical activity on at least 3 d per week)
___ You have a body mass index ≥30 kg m–2
___ You have prediabetes
___ You do not know if you have prediabetes

___ None of the above You should be able to exercise safely

without consulting your physician or other
appropriate health care provider in a self-
guide program or almost any facility that
meets your exercise program needs

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Client Fitness – Test & Assessment
Done at home with help of
spouse who is doctor

Basic Parameters
RHR – 88, HRmax 168
BP – 140 /89
Height – 5.7
Weight – 78
BMI – 27
WHR – 1.0
Waist - 35

• RHR is slightly higher

than earlier stated
• Weight is high, and falls
in overweight category
• Waist size - border case
• Overall Client needs to
reduce weight.
• Chances of high visceral
fat. Needs to be checked
with Bioelectical
Impedance.

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Client Fitness – Test & Assessment
Done at home with help of Carried out at home with
spouse who is doctor sufficient warm up

Basic Parameters Muscular Endurance Test

RHR – 88, HRmax 168 • Push Ups - 4 counts;
BP – 140 /89 Poor, Needs
Height – 5.7 improvement
Weight – 78 • Curl Up – 13 counts;
BMI – 27 Below Average
WHR – 1.02
Waist - 35

• RHR is slightly higher • Muscular Endurance is

than earlier stated very poor.
• Weight is high, and falls • Client had to rest for
in overweight category quite a while after Push
• Waist size - border case Ups and before Curl up
test
• Overall Client needs to
reduce weight. • I suspect poor amount of
lean mass and high fat %
• Chances of high visceral
fat. Needs to be checked • Again Bioelectrical
with Bioelectical Impedance test will
Impedance. indicate amt of lean mass

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Client Fitness – Test & Assessment
Done at home with help of Carried out at home with Test carried out home with
spouse who is doctor sufficient warm up measure tape & yardstick

Basic Parameters Muscular Endurance Test Flexibility Test

RHR – 88, HRmax 168 • Push Ups - 4 counts; YMCA Sit & Reach
BP – 140 /89 Poor, Needs Test
Height – 5.7 improvement • 12 forward reach;
Weight – 78 • Curl Up – 13 counts; below average
BMI – 27 Below Average
WHR – 1.0
Waist - 35

• RHR is slightly higher • Muscular Endurance is • Poor Flexibility

than earlier stated very poor. • This could be due to lack
• Weight is high, and falls • Client had to rest for of stretching for so many
in overweight category quite a while after Push years
• Waist size - border case Ups and before Curl up • Also Client had
test complained about lower
• Overall Client needs to
reduce weight. • I suspect poor amount of and upper back problem
lean mass and high fat % and hence was not
• Chances of high visceral
• Again Bioelectrical attempting maximum
fat. Needs to be checked
Impedance test will stretch
with Bioelectical
Impedance. indicate amt of lean mass

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Client Fitness – Test & Assessment
Done at home with help of Carried out at home with Test carried out home with Test carried out at local
spouse who is doctor sufficient warm up measure tape & yardstick joggers park; track of 350m

Basic Parameters Muscular Endurance Test Flexibility Test Cardio Vascular Test
RHR – 88, HRmax 168 • Push Ups - 4 counts; YMCA Sit & Reach • 1.5 miles Cooper Test
BP – 140 /89 Poor, Needs Test • Completed in 22 mts
Height – 5.7 improvement • 12 inch 25 secs
Weight – 78 • Curl Up – 13 counts; extension; below • VO2max =
BMI – 27 Below Average average 3.5+483/22.41
WHR – 1.0 = 25.05; Poor
Waist - 35

• RHR is slightly higher • Muscular Endurance is • Poor Flexibility • The client could not jog
than earlier stated very poor. • This could be due to lack continuously and did walk
• Weight is high, and falls • Client had to rest for of stretching for so many cum run; particularly in
in overweight category quite a while after Push years later part of the run
• Waist size - border case Ups and before Curl up • Also Client had • However, no untoward
test complained about lower breathing problems was
• Overall Client needs to found and client was
reduce weight. • I suspect poor amount of and upper back problem
lean mass and high fat % and hence was not comfortable post the test
• Chances of high visceral • This reiterated no CVD
• Again Bioelectrical attempting maximum
fat. Needs to be checked related issues
Impedance test will stretch
with Bioelectical
Impedance. indicate amt of lean mass

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Summary Of Consultation and Assessment

Client in highly deconditioned state

There seems to quite a bit of muscle atrophy over years, perhaps stress has added

Cardio Vascular health in poor state, though better than muscle endurance

Flexibility also in poor state

Increasing blood pressures need to be arrested (attempt to arrest)

Diet is more inclined towards carbs, has natural liking for sweets and desserts

Client is not willing/unable to put more than 4 days for exercise training. Hence program
will need to be designed accordingly.

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Exercise Progression
Approach & Plans

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Progression Approach Adopted
1 2
Conditioning Phase
Considering that Client
has not exercised for so
long, initial exercise is
directed at conditioning his
body overall. Hence a
judicious mix of
Resistance, Cardio and
Flexibility is
recommended.
Batch Sept 2015
Endurance Phase
To achieve client’s goal of
avoiding age related
Muscle Atrophy,
endurance based
resistance training is
recommended. Cardio
with more intensity and
stretching with more
frequency.
Student : Mukesh Marfatia
3
Strength & Continuous
Improvement Phase
In this phase vary the
intensity, type of
resistance training to
ensure good body
definition. For cardio
continue to progress to
increased intensity. For
stretching increase
frequency and intensity
Student Case Study
 Progression Approach

Important to get
basic muscle
endurance,
strengthen back,
improve cardio
fitness

• Initial machine based weight

training due to weak lower
Progress

back, hence weak stability.

Though some basic DB based
exercises can be started
• Strengthening ‘core’ through
targeted exercises
• Cardio exercises to be
injected through focused
walks/runs and warms ups

Week 1 – 4 Week 5 - 8 Week 9 - 12

Strength & Continuous

Conditioning Phase Endurance Phase Improvement Phase

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Progression Approach
Important to get
Some visible
results, strengthen
back, improve
cardio fitness
• Initial machine based weight
training due to weak lower
Progress
back, hence weak stability.
Though some basic DB based
exercises can be started
• Strengthening ‘back’ through
targeted exercises
• Cardio exercises to be
injected through focused
walks/runs and warms ups
Week 1 – 4
Conditioning Phase
Batch Sept 2015
Increase in Muscle
Endurance, Up
Cardio Strength,
improve flexibility
• Move to Free Weights exercises
(BB, DB, Cables); activate
stabilizers
• Split Routines between Upper
Body and Lower Body on
different days
• Increase in Intensity and
Volume (weights, reps, sets)
• Increase Cardio intensity
• Increase Stretching intensity,
Frequency
Week 5 - 8 Week 9 - 12
Strength & Continuous
Endurance Phase Improvement Phase
Student : Mukesh Marfatia Student Case Study
 Progression Approach
Important to get
basic muscle
endurance,
strengthen back,
improve cardio
fitness
• Initial machine based weight
training due to weak lower
Progress
back, hence weak stability.
Though some basic DB based
exercises can be started
• Strengthening ‘back’ through
targeted exercises
• Cardio exercises to be
injected through focused
walks/runs and warms ups
Week 1 – 4
Conditioning Phase
Batch Sept 2015
Bring Visible
change in body
definition, feeling
Increase in Muscle of well being
Endurance, Up
Cardio Strength,
• Increase in Intensity (weights)
improve flexibility
• Alternate between Endurance,
stabilizer muscles, Strength
• Move to Free Weights exercises and attempt Hypertrophy for
(BB, DB, Cables); activate larger muscles
stabilizers
• Step up cardio intensity and
• Split Routines between Upper move towards partial HIIT
Body and Lower Body on
• Seek distinct improvement in
different days
ROM through increase in
• Increase in Intensity and stretching intensity
Volume (weights, reps, sets)
• Increase Cardio intensity
• Increase Stretching intensity,
Frequency
Week 5 - 8 Week 9 - 12
Strength & Continuous
Endurance Phase Improvement Phase
Student : Mukesh Marfatia Student Case Study
 Progression Approach Bring Visible
change in body
definition, feeling
Increase in Muscle of well being
Endurance, Up Innovative &
Important to get Variety
Cardio Strength,
basic muscle • Increase in Intensity (weights) through
improve flexibility
endurance, • Alternate between Endurance, periodization
strengthen back,
stabilizer muscles, Strength
improve cardio • Move to Free Weights exercises Life Style
and attempt Hypertrophy for
fitness (BB, DB, Cables); activate changes,
larger muscles more active
stabilizers
• Step up cardio intensity and
• Initial machine based weight • Split Routines between Upper move towards partial HIIT
training due to weak lower Body and Lower Body on
• Seek distinct improvement in Visible
Progress

back, hence weak stability. different days results will

Though some basic DB based
exercises can be started
• Strengthening ‘back’ through
targeted exercises
• Cardio exercises to be
injected through focused
walks/runs and warms ups
ROM through increase in encourage
• Increase in Intensity and stretching intensity
Volume (weights, reps, sets)
• Increase Cardio intensity Changes in
diet to make
• Increase Stretching intensity, it more
Frequency protein rich

Enablers
Week 1Week 1 – 4 cycle)
– 4 (micro Week
Week 5
5 -- 8
8 Week
Week 9
9 -- 12
12

Strength & Continuous

Conditioning Phase Endurance Phase Improvement Phase

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Exercise Training Program
Micro Cycle 1
Week 1 to Week 4

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Summary – Cycle 1 (Week 1 to 4)

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Cardio – Cycle 1 week 1 to 4

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training– Cycle 1 week 1 to 4

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance – Cycle 1 week 1 to 4

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Flexibility – Cycle 1 week 1 to 4

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Exercise Training Program
Micro Cycle 2
Week 5 to Week 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Summary – Cycle 2 Week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Cardio – Cycle 2 week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training– Cycle 2 week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training– Cycle 2 week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training – Cycle 2 week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Flexibility – Cycle 2 week 5 to 8

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Exercise Training Program
Micro Cycle 3
Week 9 to Week 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Summary – Cycle 3 Week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Cardio – Cycle 3 week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training – Cycle 3 week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training– Cycle 3 week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Resistance Training – Cycle 3 week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Flexibility – Cycle 3 week 9 to 12

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Other Exercise Considerations

Client encouraged to do cardio in gym once in a while to workout on elliptical / X-Trainer

machine

Client also encouraged to walk/climb on steep slopes once in a while

Alternate resistance exercises has been recommended to client, to give change from same
routine.

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Conclusion &
Future Plans

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Conclusion

Current Scenario – Post Micro Cycle 1 Re-Tests results

Basic Parameters Muscular Endurance Test Flexibility Test Cardio Vascular Test
RHR – 86, HRmax 168 • Push Ups - 10 YMCA Sit & Reach • 1.5 miles Cooper Test
BP – 136/86 counts; Good Test • Completed in 17 mts
Height – 5.7 • Curl Up – 30 counts; • 15 inch 30 secs
Weight – 76.5 Average extension; • VO2max =
BMI – 26.41 average 3.5+483/17.50
WHR – 1.0 = 31.1; Avg
Waist – 34.5

Highlights
Parameters Changed Lifestyle

• Drop in SBP by 4mm Hg (multiple checks) • Client generally ‘Feeling’ good

• Weight reduced by 1.5kg
• Push ups improved from 4 to 10, Curl up
from 10 to 30
• Flexibility Test improvement of 3 inch
• VO2max improved from 25.05 to 31.1
• Stress levels have reduced significantly
• Client feeling stronger
• Client made diet changes to include more
protein %
• Client is now having less back pain

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Future Plans and Next Steps

Continue to make progress as per plans

Some additional stretching exercises may be required to be introduced

Client being encouraged to spare 20 - 25 minutes for yoga stretching instead of 15 minutes

Client seems to be enjoying more of outdoor jogs, though comfortable in gym too

Over a period of time, the following type of exercises will need to be included

Some Plyometric (even partial) like mountain climbers, Burpees, Squat Thrust, etc

Considering age, few balancing exercises (on Bosu ball or Swiss Ball…) needs to
introduced into the plan

Bhavesh

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 About Trainer

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study

 Trainer Profile – Mukesh Marfatia (age 54)

Has been playing sports since childhood and had reached inter collegiate level in few
sports like TT, Badminton, Soccer and Hockey. Played Giles cricket representing school

At age of 17 learnt Yoga from Kavaliya Dham at Charni Road, Mumbai and have been
regularly practicing Yoga

Since last 30 have been in IT with last 13 years at senior management level working both
in India and abroad with large multinationals. Currently heading a mid sized IT company.

Have been active throughout. Since past 12 years have taken more active interest in
fitness and have been doing regular gym training, swimming and participating in half
marathons (SCMM)

As hobby have reading a lot on exercise science and have acquired very good knowledge.
In future my goal is to take up role in management/marketing of some sports / fitness
institute/academy

Would like to Thank Exercise Science Academy for the excellent course and also to ACSM
for reaching out in India

Batch Sept 2015 Student : Mukesh Marfatia Student Case Study