Case Study: Exercise Management of CHF Patient after Debilitating Fall

Authors

Meghan Brown, tarleton state universityFollow
Jennifer Blevins-McNaughton, Tarleton State UniversityFollow

Abstract

History: A 64-year-old male (160.5 kg) was referred to our cardiopulmonary rehabilitation exercise program in October of 2015. Medical history and initial baseline physical assessments were measured including resting 12-lead ECG, SaO₂- 95 %, HR- 65 bpm, BP- 146/82 mmHg, glucose- 128 mg/dL, weight- 160.5 kg, and the Duke Activity Status Questionnaire and HSQ-SF36® quality of life questionnaire. He was cleared for exercise and given a basic orientation to exercise equipment including Nu-Step® and six different band resistance exercises prescribed at 2 sets of 20 (RPE rating = 13). An exercise prescription for attending the program three days per week was developed for approximately one hour at 2 to 3 METs with intermittent exercise on the Nu-Step® at a 4:1 ratio at 80% of estimated max METs to 20 percent of estimated max METs.

Differential Diagnosis:

1. Hypertension
2. Third degree heart block (Pacemaker)
3. Atrial flutter
4. Type II diabetes
5. Congestive heart failure

Physical Examination and Symptomology: The client was consistently attending the program, tolerating exercise well, increased his workload on the Nu-Step to a level 5, as well as improved his MET capacity up to 3.2 until the 2015 holiday break. He fell while leaving a restaurant and spent two weeks recovering from the injury.

Tests and Results: He declined being admitted to the ER. After his fall the participant went to see his primary care physician for his injury to be examined where he received an x-ray which was negative for fracture. The entire left leg was contused and swollen with excessive swelling at the knee. Once he was cleared to exercise, January 27^th, severe bruising and edema in the left leg continued, and he reported significant knee pain.

Final Management Plan: The participant was placed on the Nu-Step® (1.5 METs) for 15 minutes. He returned to seated resistance exercises with a slow progression into the use of his left leg. He has since worked his way back up to 2.1 METs for 15 minutes.

Recommended Citation

Brown, Meghan and Blevins-McNaughton, Jennifer (2016) "Case Study: Exercise Management of CHF Patient after Debilitating Fall," International Journal of Exercise Science: Conference Proceedings: Vol. 2: Iss. 8, Article 104.
Available at: https://digitalcommons.wku.edu/ijesab/vol2/iss8/104