PHR 101

SP 23: CASE STUDY 4

Lauren is a 52-year-old owner of a website design company. Before starting her company eight years ago, she
used to be very active lifting weights three times a week and cycling on the weekends. She now finds that she
only has time to play pickleball twice a week after work because she typically works 10-12 hours per day.
Lately she has been noticing a dull ache in the center of her right knee after pickleball. Her doctor said her
knee pain will be resolved with strengthening and balancing her vastus medialis and vastus lateralis to improve
patella tracking. Lauren started to notice that her once in-shape, toned body is starting to feel flabby. She is
available after 8pm, 3 times/week. She is currently single, eats at a lot of fast-food places, sits at a computer
for most of the day and talks on the phone with clients, has some low back stiffness at the end of the day and
sleeps 6-7 hours a night but often has a hard time falling asleep at night. She also states she has a hard time
sticking to her exercise programs. Lauren would like you to set her up on a program that she can do a few
times a week and provide nutrition counseling. You notice forward head posture and forward shoulders as well
as tightness in her hamstrings, IT band and gastrocnemius.

The assessment provided you with the following information:

Age HT WT RHR RBP
52 5’7” 200 lbs 75 bpm 120/80 mmHg

Body Composition:
Hip Waist Skinfold – Skinfold – Skinfold –
Circumference Circumference Suprailiac Triceps Thigh
42 in 38 in 32 mm 29 mm 42 mm

Blood Chemistry Profile:

Total cholesterol HDL LDL Triglycerides Fasting Blood Glucose
225 mg/dL 45 mg/dL 115 mg/dL 325 mg/dL 83 mg/dL

Lauren’s goals
• Start working out in the weight room again and manage her knee pain.
• 1 month: Decrease knee pain.
• 4 months: Lose 20 lbs.
• 1 year: Enter local Pickleball tournament - May 2024
 a. Use the Cardiovascular Disease (CVD) Risk Factors and Defining Criteria Table below to identify
all your client’s modifiable and non-modifiable risk factors for cardiovascular disease. Explain to your
client which of their risk factors that are in their control.
MODIFIABLE:
Physical Inactivity
BMI
Waist Circumference
NON-MODIFIABLE:
None

b. Calculate and interpret Body Mass Index (BMI; kg/m2), Waist to Hip Ratio (WHR) and % Body Fat
using the sum of skinfold method (%BF) (show your work).
• 1kg = 2.2 lbs; 1lb = .4535 kg; 1 inch = 2.54 cm; 1m = 100 cm

BMI = kg/m2 Waist to Hip Ratio = Sum of Skinfolds for % Body Fat
Waist measure/hip
measure Site 1 + Site 2 + Site 3 = Sum of
Skinfolds → then use Table to
determine % Body Fat

90.7/2.9 = 31.3 38/42 = 0.9 32 + 29 + 42 = 103

c. Identify your client’s health categories for BMI, WHR, and %BF using the tables at the end of the
case study.
Measurement Score Health Risk Category
Body Mass Index (BMI) 31.3 Kg/m2 Obese
Body Fat % (%BF) 36.9 % BF Obese
Waist to Hip Ratio (WHR) 0.9 At risk

d. Using complete sentences, explain one advantage and one disadvantage of each measurement:
body mass index, body fat percentage using skinfold calipers, and waist to hip ratio. HINT: “Cheap”,
“Expensive/Inexpensive”, “Quick” are not acceptable answers.
 Measurement Advantage Disadvantage
Body Mass Index Anyone can quickly find their BMI if you It can be inaccurate because it doesn’t account for
know your weight and height. muscle mass.

Body Fat % It can give you a very accurate calculation if Needs to be done by someone who knows what
(using skinfold it is done correctly. they are doing.
calipers)
Waist to Hip It can measure fat distribution. Only measures fat around the middle of your body.
Ratio

e. Calculate your client’s estimated target heart ranges for low (40%), moderate (60%), & high
intensity (80%) exercise using the Karvonen Method (show your work).
220 – 52 = 168
Low = 112.2 bpm 168 – 75 = 93 x .4 + 75 = 112.2
Moderate = 130.8 bpm 168 – 75 = 93 x .6 + 75 = 130.8
High = 149.4 bpm 168 – 75 = 93 x .8 + 75 = 149.4

f. In your own word and using complete sentences, explain to your client the general physical
activity guidelines for health.
To meet the general physical guidelines, you must do 150 minutes of moderate intensity activity or 75
minutes of vigorous activity per week. You could do this by playing pickleball with your friends for 30
minutes 5 days a week or you could go on 5 intense 15-minute runs per week.

g. Using complete sentences, explain to your client with three suggestions to improve their nutritional
choices, such as providing healthy choices, grocery shopping, or meal preparation suggestions.

Limits the amount of fast food that you eat in a week.

Prepare meals in advance because then it will be more convenient to eat that instead of fast food.
Buy more vegetables and fruits at the store and buy less sweets.
 h. Create a SMART goal for Lauren’s 4-month goal. Include a FITT exercise prescription for
cardiovascular endurance and muscular strength to help her meet her goal (use table
below).

Description
Specific: Goals are clear, detailed Lose 20lbs in 4 months Reduce knee pain by 1
& unambiguous. Join a pickleball tournament by May month
• What: What do I want to 2024 Lose 20lbs in 4 months
accomplish?
• Why: Specific reasons,
purpose or benefits of
accomplishing the goal.
• Who: Who is involved?
• Where: Identify a location.
• Which: Identify
requirements and
constraints
Measurable: A measurable goal When she has lost 20lbs When she loses 20lbs
will usually answer questions such When she can participate in a When her knee pain in
as: pickleball tournament reduced
• How much?
• How many?
• How will I know when it is
accomplished?
Attainable: An attainable goal will Cardiovascular Endurance exercise Muscular Strength exercise
usually answer the question: prescription: prescription:
• How: How can the goal be
accomplished? F: Go on a 3 mile walk 3-4 times F: Stretch every day for
per week 10 minutes, especially
after walking or working
I: Low intensity out
Work out 3 days per week
T: 45 minutes for
I: Low intensity
T: Walking
T: Stretching = 10min
Workout = 30min

T: Squats, Hamstring
Curls, Calf Raises,
Stretch hamstring
Relevant: A relevant goal must Her goal is to lose 20lbs and to be able Her goal is to lose 20lbs and
represent an objective that the to participate in a pickleball reduce knee pain
goal-setter is willing and able to tournament
work towards. A relevant goal will
usually answer the question:
• Does this seem worthwhile?
 Time Specific: Stresses the 3-4 times per week Stretching every day
importance of giving goals a target Workout 3 days per week
date.
• When?

Use this table to answer question “a”.

** HDL ≥ 60 mg/dl negates another cardiovascular risk factor (ex. If HDL is 60, it could negate the age
risk factor for a female who is 55yo).