Dangerous Dodger Dan

Andrew, Allan, Linda, Erica & Janine

Client Info/Background

Dan is 38 yrs old, married, white, & has 3 kids

Is a Building Construction Foreman Loves cooking, fishing, playing golf He’s 5’4” and weighs 200 lbs Himself, his wife and 3 kids are

overweight He played football, baseball, track and

swimming in high school

Client Info/Background Cont’d Dan has high BP, high LDL Family history of CHD Smokes half a pack of cigarettes a day 10 year old daughter has asthma His father died in his mid 50’s Chronic shoulder injury, back and hip

pain in the morning and right foot pronation

Client Objectives - Nutrition Stop cooking large portion & high fat

meals Change to lower portion sizes Include all food groups in diet Use different, healthier recipes for

cooking See a Dietitian

Client Objectives - Exercise

Exercise more often Move more at work by stretching and

walking more Stretch in the morning every day Maybe go golfing twice a week/walk the

golf course when playing Aqua aerobics/ Flag Football League to

get back to playing sports he did in high school

Try to do 30 minutes of activity a day such as walking, aqua aerobics, etc.

Client Objectives - Injuries See a doctor about your injuries

(shoulder, back pain, foot) Get specific exercises and stretches for

each injury area

Client Objectives - Smoking Long term goal to stop smoking Short term goal to cut down on

smoking and gradually work your to way to quitting

Motivation Factors

All your lifestyle habits are risks for CHD!!! Father died in his 50’s ………do you? You, your wife and your kids are overweight……

this has to change at least for your kids sake Stop smoking for your daughter who has asthma Have injuries looked at and treated Do not ignore pain!!! Your body is telling you

something!! Not getting any younger/ never too late to start Need to Lower LDL, BP, etc.

Behavioral Prescription

Theory of Reasoned Behavior Intentions & Actions = “If I stop smoking

I will be more healthy and attractive which is pleasant”

“If I lose weight I will be more healthy and attractive”

“If I stop smoking, it will help my daughter’s asthma”

Behavioral Prescription Cont’d

Theory of Planned Behavior “I can cut down to two cigarettes a day

at least” “I definitely can quit smoking” “I can eat a piece of fruit or chew gum

instead of having a cigarette”

Behavioral Prescription Cont’d

Self Efficacy Theory “I can stop smoking even if my friends

continue to smoke” “I can stop eating big portions even if

my family doesn’t” “I can definitely exercise for 30 minutes

a day”

Behavior Techniques Must make changes in lifestyle: Nutrition: Lower portions, low fat foods Healthier foods/use all 4 food groups

daily Use different spices, sauces, etc Learn to read food labels Get family involved

Behavior Techniques Exercise: 30 minutes a day (cycling, walking, etc.) Stretch in the morning and throughout

day Weight training to strengthen body and

help injuries Get back into old sports again Involve family and friends Be more active at workplace

Behavior Techniques

Smoking: Set goals of short term and long term Cut down on consumption Use gum, patch, medication, exercise, etc Think of daughter’s asthma

Behavior Techniques Write down list of goals, timeframe, etc. Lose Weight, Lower BP, Lower LDL Stop smoking, lower eating portions,

healthier foods, more balanced diet, be more active, lower stress, help family do the same

Nutritional Prescription

Dan’s Log Book- Day #1Time of Day Meal Location Food/Beverage

8:00am Breakfast Kitchen table 3 eggs; 2 pieces of toast with peanut butter

10:30am Snack Truck Donut; large coffee

1:00pm Lunch Restaurant 3 beef burritos; large fries, large pop

3:30pm Snack Truck Bag of chips; chocolate bar; large coffee

8:00pm Dinner In front of T.V Heaping plate of warmed up stew; 3 biscuits; can of pop

Carbohydrates Carbs spare protein as an energy source so

that it can maintain and repair body tissuse instead of being used up as energy

Carbs are converted to glucose which is the only source of energy to the brain.

Some carbohydrates are high in fiber, which helps prevent constipation and lowers the risk for certain diseases such as cancer, heart disease and diabetes.

CarbohydratesChoose More Often Choose on Occasion Choose Seldom

Whole grain products:Breads, cereals, crackers, pancakes, muffins, bagels, pasta, brown rice, oats, vegetables and fruits, legumes, low fat dairy products

Refined white flour products:Breads, cereals, pancakes, crackers, muffins, bagels, pasta, white potatoes, white rice, fruit juice

Sweets and Snacks:pastries, donuts, candy, cake, pie, cookies, sugared cereals, soft drinks, table sugar, honey, ice cream, sherbert, fruit drinks, potato chips, pretzels, snack crackers

Fats It supplies essential fatty acids needed

by the body Fat carries and transports the fat

soluble vitamins A, D, E, K Fat helps the body use protein and

carbs more efficiently Cholesterol is found in fat. Due to

borderline high Cholesterol levels product of animal origin, should be limited to try and decrease cholesterol levels

Protein It helps to build, repair, and maintain body cells

and tissues like your skin, muscles, organs, blood, and even bones.

Proteins as antibodies protect you from disease-carrying bacteria and viruses.

Meat, fish, poultry, eggs, milk, cheese, yogurt and soybeans provide all nine essential amino acids. For this reason, they are considered high quality or COMPLETE proteins.

Plant sources of protein include legumes (dried beans, peas, and lentils), nuts, and seeds. Grain products such as barley, wheat, millet, rye, as well as many vegetables have smaller amounts of protein. These plant sources are all INCOMPLETE proteins because they do not contain all of the nine essential amino acids that the body needs.

Food GuideFood Group Choose Daily Choose No More Than 3-4

Times a WeekChoose for Special

Occasions Only

Meat and Protein

Lean cuts of beef and pork-- with fat trimmed, poultry without skin, dried beans and peas, lentils, tofu, egg whites, egg substitutes, fish and shellfish, tuna canned with water

Egg yolks, fish sticks, tuna canned in oil, poultry with skin, chicken nuggets, turkey hot dogs or bologna, nuts, peanuts, and peanut butter

Prime grade meats, duck, goose, dark poultry meat, bacon, sausage, bologna, salami, hot dogs, ribs, organ meats, fried meats

Milk and Dairy

Skim milk, 1% milk and buttermilk, nonfat yogurt, nonfat frozen yogurt, fat-free cheese, low fat cottage cheese, soy milk, soy cheese

2% milk, 4% cottage cheese, light cream cheese, light sour cream, low fat yogurt, sherbet, low fat cheese

Whole milk, regular cheese, cream, half-and-half, most non-dairy creamers, real and non-dairy whipped cream, cream cheese, sour cream, ice cream

Food Guide - continuedFruits and

VeggiesFresh, frozen, canned, or

dried fruits and vegetables

Olives and avocados Fruits and vegetables prepared in butter or cream sauce, fried fruits and vegetables, coconut, vegetables with high fat salad dressing

Grains Breads, bagels, pasta, cereals (whole grain products preferred), oats, brown and white rice, baked corn tortillas, low fat crackers, air-popped popcorn, pretzels

Angel food cake, crackers, fat-free cakes and cookies, biscuits, fig bars, oatmeal raisin cookies, pancakes, waffles, packaged mixes

Croissants, pastry, pies, doughnuts, sweet rolls, granola, snack crackers (with saturated fats), grain products prepared with cream, butter, or cheese sauce

Fats and Oils Olives and olive oil, canola oil, peanut oil

Safflower, corn, soybean, sesame, sunflower oils, margarine, mayonnaise, lower fat salad dressings, margarine that does not contain hydrogenated oil

Butter, lard, beef , bacon fat, shortening palm, palm kernel and coconut oils, margarine or shortening made with hydrogenated oil

Portion Control Bread, Grains and Pasta (6-11 servings) 1-ounce slice whole wheat bread = index card ½ bagel = can of tuna ½ cup rice, cereal, or pasta = small Walkman 1 two-ounce muffin = cupcake wrapper 1 small roll = yo-yo 1 four-inch pancake = compact disc 1 two-ounce piece of Italian bread = bar of

soap

Portion Control Fruits and Veggies (2-5 servings of both) 1 medium orange or apple = tennis ball ½ grapefruit = car headlight ¼ cup dried fruit = large egg 1 cup green salad = adult fist ½ cup cooked vegetables or fruit = billiard ball 6 ounces of 100% vegetable or fruit juice = hockey puck 1 small potato = computer mouse 1 broccoli spear = two small beanbags

Protein and Meat (2-3 servings) 3 ounces beef, chicken, pork = small pack of tissues 1 ounce of nuts = ping pong ball ½ cup of cooked dry beans or peas = man’s wallet 1 egg = stick shift knob 2 tbsp. of peanut butter = two tea bags

Portion Control Dairy (2-3 servings) ½ cup non-fat frozen yogurt = child fist 1-1/2 ounces of non-fat cheese = 9-volt battery 1 ounce of cheese = pair of dice

Fats & Oils 1 pat of butter or margarine = Scrabble tile 1 tsp. of butter = tip of thumb to first joint

Snacks and Desserts 1 ounce of chips = medium size handful 1 three-inch piece of cake = small stack of business

cards 1 cup of ice cream = baseball

Summary BMI of 34.3 (Class I Obesity)

60 pound weight loss would be a BMI of 24.0 (within normal range)

Negative Energy Balance Expend more calories than you take

in

Goals Long term goal of 60 pound weight loss Short term goal of 10 lbs in first 2

months An additional 10 lbs per 2 month for 1

year Increase pain free ROM in Shoulder

Referrals Physiotherapist

Shoulder Impingement Pedorthist

Orthotics have been prescribed Physician

Medications for cholesterol & blood pressure(if exercise and diet do not achieve

results)

Referrals- cont Dietitian

- to discuss portion sizes, healthy food choices and tips

Massage Therapist/ Acupuncture - For stress relief and relaxation

- might be a good activity for you and your wife to do together

Exercise Prescription Aerobic exercises

3 – 4 days per week Resistance exercises

2 – 3 days per week 1 – 3 sets 10 – 15 repetitions 8 – 10 exercises

Flexibility Stretches Daily 3 times for 15 – 30 seconds

Exercise Prescription Aerobic exercise

Walking, jogging, cycling, yard work, games with family

3 – 4 days per week with rest days in between Target heart rate 100 – 118 beats per minute

(182*.55) & (182*.65) Moderate level of exercise is 150 calories /day 350 – 500/day or 1000 – 2000 Calories / week

Exercise Prescription Resistance exercises

Strengthen rotator cuff muscles Rhomboids Upper and lower Trapezius Back extensors Abdominals

Exercise Prescription Rotator cuff

External Rotation (3*15-20) Shoulder Extension (3*15-20) Horizontal Abduction (3*15-20)

Rhomboids and Trapezius Seated Rowing (3*12) Lat pull downs (3*12) Lateral dumbbell Raise (3*12)(externally rotated shoulder)

Exercise Prescription Back Extensors

Practice proper posture (All the time) Supine hip lift(3 * 12 holding for 3 seconds) Back extensions on stability ball or

ground/ bed(3 * 12 holding for 3 seconds) Super man’s (3 * 12 on each side holding for 3 seconds)

Exercise Prescription Abdominals

Crunches on stability ball or ground/ bed

(3 * 12) Rotation with stability ball in front(3 * 12 on each side)

Flexibility Shoulder Stretches (3 * 15 – 30 seconds)

Anterior capsule stretch Posterior capsule stretch Medial & lateral capsule stretch

Modified Hip Flexor stretch (3 * 15 – 30 sec) Modified Hamstring stretch (3 * 15 – 30 sec) Wall stretch (3 * 15 – 30 sec)

Workplace Applications

Prepare pre-packed meals from home for lunch Ex. Sandwich, fruits, vegetables, water Bring healthy snacks from homeEx. Apple, Orange, Granola bar, etc Instead of eating every time you feel hungry or bored, try drinking some water first to see if your cravings go away Park your car further away from the building so that you have to walk further

Workplace Applications

Instead of sitting around during your breaks or lunch hour, take a short walk around the workplace

Preoccupy yourself during breaks so that your not tempted to smoke

Stress Management

There are many ways of reducing stress Try and avoid stressful situations at all

times if possible Self-monitor yourself by keeping track of

your portion sizes, amount of physical activity per day and your smoking habits

Self-monitoring allows you to see how well your progress is going and motivates you more

Use mental reinforcements by rewarding yourself with little rewards if you followed your plan for the whole week

Encouragement from the family is a great social reinforcement

Form a contract with the family:- to cut down portion sizes, make less food- to do physical activities as a family- to give encouragement to each other when someone wants to give up

Stress Management

Shaping is another way of reducing stress

If you can’t stop smoking cold turkey, then slowly reduce the habit

Cut portion sizes down slowly as well All changes can be stressful but they

become easier over time so make the changes when your ready

Stress Management

Relapse Prevention Make the program a part of your family

life Go for family walks or plan activities that

will get you active together Make dinner time a family activity too

(having your kids there might help you stay motivated to cook healthy, and at the same time you’ll be teaching them to cook healthy too)

Plan ahead: draw out a weekly schedule, make sure to schedule specific times for exercise and plan for meals ahead of time

Relapse PreventionSmoking Cessation: Always have gum on hand Throw away all cigarettes, ashtrays and

lighters For the first little while after you quit try

to stay away from places you smoked most often

Develop a support network at home and at work; when you get a craving go talk to those people, they can help distract you through the craving

Smoking Cessation continued: Be prepared for cravings, find something

to do that will kept your hands busy Use relaxation techniques instead of

smoking to relieve stress For every time you would have bought a

pack of cigarettes, put that money in a jar and use it to do something fun with your family

References Earle, R.W., & Baechle, T.R. (2003). NSCA’s

Essentials of Personal Training. National Strength & Conditioning Association. Windsor, ON : Canada; Human Kinetics

Sperry, L., Lewis, J., Carlson, J., & Englar-Carlson, M. (2005). Health Promotion and Health Counseling: Effective Counseling and Psychotherapeutic Strategies. Boston, MA. Pearson Education.