Roger has been referred to outpatient physical therapy by hi…
Roger has been referred to outpatient physical therapy by his PCP as his PCP felt that before he joins a gym, he should have a complete “fitness evaluation”. Roger, a 50-year-old architect, is a new client who recently decided he should join a gym to get healthy and be more active. He is 5 feet 7 inches and weighs 220 pounds (100 kg). His waist circumference is 40.5 inches, and his hip circumference is 37 inches. Roger is a nonsmoker with 74 BPM HRrest, 132/82 mmHg BP, 200 mg·dL−1 total cholesterol, 38 mg·dL−1 HDL-C, 121 mg·dL−1 LDL-C, 170 mg·dL−1 triglycerides, and 90 mg·dL−1 fasting glucose. His father and mother are in their 70s and are apparently healthy. During additional preactivity screening, Roger had difficulty holding his extended arms directly overhead without arching his back, pushing his head and neck forward, and flexing at his waist when performing a series of overhead squats. He also seemed to become very knock-kneed (genu valgus) during the descent phase of the overhead squat. He stands with a forward head, rounded shoulders, and an anteriorly tilted pelvis. Roger does not currently have back pain; however, he did have some low back and leg pain after both the bike test and the sit-and-reach test, which was alleviated by standing and gently leaning backward. Upon discussing his medical history, Roger reports occasionally taking ibuprofen for low back pain. His physician told him that he has slight degeneration of a disc in his low back and metabolic syndrome. He wants him to get in shape and lose weight before he considers placing Roger on medications. His current activity includes walking his 5-month-old Labrador Retriever for about 2 miles (approximately 40 minutes) daily. In addition, he plays seasonal golf and softball, and he used to play three-on-three basketball (2 years ago), an activity he would like to be able to participate in again. He often feels “tired all over” after walking his dog and hopes that a structured exercise routine that combines endurance training and full-body strength training will help him lose weight and stay healthy, making walking his dog easier, improving his golf game, and enabling him to start playing basketball again. During the first 4 weeks, Roger’s aerobic exercise program should include everything below except: