Case study: From high to low cardiovascular risk in 12 months
1. History
A 42 years old woman with several years of weight gain due to lifestyle and inactivity has led to a series of physical problems with back and joint pain, difficulty breathing even in simple activities, sometimes experience discomfort in her chest, got swollen leg and occasional dizziness. With the weight gain she is also at risk of social difficulties due to being less mobile and the social stigma that comes with overweight.
She is recommended to come to Paliesius clinic for help to lose weight and get a clear view of her health situation.
2. Clinical profile
A clinical profile is comprised by clinical testing and evaluation from a multidisciplinary team of doctors, cardiologists, psychologist and physiotherapist for a holistic picture of health and function. Read more about testing at Paliesius clinic
Focal health problems were:
- Blood pressure showed hypertension at 145/95.
- Extra/abnormal heartbeats (4-5 extra systoles/min) and increased resting heartrate of HR 92. (Extra heartbeats can be a pre-cursor to cardiovascular problems if excessive).
- Overweight. At 164 cm tall and a weight of 99,7kg she has a body mass index (BMI) of 37,1. (BMI is a way to measure overweight and define degrees of overweight). At 37,1 she is considered clinically obese. High body fat percent and increased visceral fat percent was seen in Body Composition Analysis (BCA). (BCA is used to evaluate the composition of the body, fat, muscle, bone structure and water for a clearer picture)
- Cholesterol with higher than recommended LDL cholesterol on 2.93, and lower than recommended HDL cholesterol of 0,92. Increasing the overall cardiovascular risk. (LDL (low-density lipoprotein), is often referred to as “bad” cholesterol, LDL is important for cell function but to high levels of LDL cholesterol raise your risk for heart disease and stroke. HDL (high-density lipoprotein), or “good” cholesterol, absorbs cholesterol and carries it back to the liver. Higher levels of HDL cholesterol can decrease your risk for heart disease and stroke.)
- Decreased fitness and lower that average values of V02max (oxygen uptake) of 23.5ml/min/kg was seen during Cardiopulmonary exercise testing (CPET).
- Participation. Overweight causes mobility problems and joint pain but is also a big social stigma reducing the ability to be part of activities and social life. The problems to interact in social activities can cause isolation and decreased mental health.
Acute medical issue was a high cardiovascular risk. Read more about cardiovascular risk
3. Treatment goals
- Reduction of cardiovascular risk
- Reduce blood pressure
- Weight reduction
- Increased fitness
- Improve quality of life
- Improve mobility
- Reduce pain
4. Paliesius clinical week
Treatment is based on the clinical profile, exercise testing (CPET), patient goal ,situation and clinical safety. Read more about testing at paliesius clinic
Interventions: Exercise therapy, individualized diet, psychosocial counseling and education. Read more about physical exercise on recipe
Exercise therapy is monitored, adapted and prescribed physical activity.
The health and functional assessment is transformed into an initial recipe for individual physical exercise. The recipe is always individual and based on FITT-VP principal: frequency, intensity, time, type, volume, progression.
During one week at Paliesius mansion the recipe is carried out under guidance of physiotherapist and a doctor while clinically monitoring the physical and mental response for adaptation of the recipe and ensure effectiveness of the treatment. Read more about dosage-response
The diet provided during the program was healthy and individually balanced according to the recipe and activity.
Psychosocial support together with Paliesius clinic phycologist. ‘Psychosocial’ refers to the relationship between the psychological and the social aspects and includes the internal, emotional and thought processes, feelings and reactions as well as the relationships, social values and cultural practices.
Education was provided for increased knowledge about diet, anti-stress and the concept of treatment with physical activity to ensure a lasting result and a lifestyle change.
5. Continued treatment at home
After the program at Paliesius mansion, recommendations with a plan for further actions was provided and plans for follow up. The plan includes a physical exercise recipe, diet recommendations and expected outcome. During this time regular contact with Paliesius clinic was important. Making a lifestyle choice is a long-term commitment and support along the way is vital for a lasting result. Regular visits for follow up was made every 3 months for monitoring of the results and to adapt the recipe for physical exercise following the increase in fitness and monitor risks.
6. Results
Working at home according to the recipe and diet recommendations gave significant results already after 3 months. A decrease in blood pressure from 145/ 95 to 105/75, decreased resting heart rate from 92 to 68 b/min and reduction of swelling. Resulting the cardiovascular risk decreasing from High to Moderate.
After 12 months the results where a cholesterol within norm values, blood pressure within norm values at 120/70. Resting heartrate at 73 which is nearly within what is considered to be an ideal resting heart rate value, a weight-loss of -26,6kg meaning a BMI only 2 point over normal range and a visceral fat area inside a balanced level further decreasing the cardiovascular risk from moderate to low. By a lifestyle change and physical exercise she does not have any increased cardiovascular risk and has only very slight overweight which does not affect her health in any significant way.
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