Sedentary Sally Sarah Azhadi Brian Lannin Heather Lowe

Sedentary Sally Sarah Azhadi Brian Lannin Heather Lowe Katherine Mac. Innes Mike Smit

About Sally 45 year old female Divorced mother of two (12 and 4) Office supervisor = high stress job Post-menopausal Family history of heart disease, stroke and breast cancer Fluctuating body weight Lacto vegetarian Supracondylitis (tennis elbow) Osteoporosis in the spinal vertebrae and long bones of the legs Has relapsed in past attempts

Sally’s Goals Lose weight Improve overall health through diet and exercise Prevent chronic health problems Decrease stress

Recap of Previous Sessions Has been prescribed an exercise routine Has been referred to a registered dietician Workplace assessment was completed Was referred to a physiotherapist but has now finished her last session Addressed injuries

Previous Exercise Routine Using a theraband for office and trips Shoulder press 2 X 10 reps Chess press 2 X 10 reps Biceps 2 X 10 reps Triceps 2 X 10 reps Squats using chair as support 2 X 10 reps Biking 30 minutes 2 times a week Isometric contractions of abs held for 2 X 10 seconds Calf raises 2 X 10 reps

Nutrition Follow Canada’s Food Guide Substituting meat and eggs for soy, nuts, hummus, legumes, beans, etc Has done a food diary and suggestions were made to change some aspects of her diet Asked her in her last session to bring in a new diary to see her progress

Workplace Assessment Workplace has been assessed and the following recommendations have been made: Ergonomic chair Ergonomic keyboard and mouse Stand station to work Has created a lunch group walk club

Physiotherapist Referral Was working in conjunction with the physiotherapist but has completed all the recommended sessions and is now working solely with the kinesiologist.

Previous Injuries - Prescription Supracondylitis Started isometric exercises Progressed to theraband exercises Suggested ice Osteoporosis Increase calcium intake Theraband exercises Biking

The Current Session 6 th Session (End of 2 nd month)

Client Objectives of Current Session Continuing weight loss Increase motivation and prevent relapse Presentation of current food journal Stress management

Behavioural Prescription Motivation Pedometer Lunch group walking club Self-efficacy theory Adding onto the exercise prescription Personal rewards (eg. Sally Day)

Pedometer Prescription A reasonable goal for most people is to increase average daily steps each week by 500 per day until you can easily average 10, 000 per day Week 1 Aim for 3500 steps per day Week 2 Aim for 4000 steps per day Week 3 Aim for 4500 steps per day … Week 14 Aim for 10 000 steps per day

Physical Prescription Change cardiovascular program Change biking to alternate between swimming and biking While son is in swimming lessons, she can do laps and/or aqua aerobics classes Increase strength training Increase reps Internal and external rotation Incorporate theraband into calf raises and squats

Exercise Sets/Reps Modifications Shoulder press Chest press Biceps curls 2 X 15 Increase reps Triceps extensions 2 X 15 Increase reps 2 2 2 Use theraband Use yoga mat Use theraband Squats Calf raises Crunches Internal Rotation External Rotation X X X 15 15 15 10 10

Physical Prescription At home, incorporate weights into squats and calf raises Change over previous theraband exercises to weights Perform crunches with Swiss Ball

Stress Management Try to organize a monthly routine Visit a massage therapist once a month Organize a Sally day bi-weekly Breathing and relaxation techniques implement 5: 1 ratio

Nutritional Prescription Discuss old food diary and look over new food diary

Old Food Diary Monday Tuesday Wednesday Breakfast Pastry and coffee with cream and sugar Apple juice and coffee with cream and sugar Snack Donut and coffee with cream and sugar Donut with caramel macciatto Donut with coffee with cream and sugar Lunch Pre-made sandwiches, muffin and diet pop Veggie pizza with double cheese and diet pop Lick’s veggie burger with lots of mayo with diet pop Snack Apple and water Chocolate éclair and Muffin and coffee with cream and sugar Dinner White pasta with deep fried tofu and cheese Pint of Hagen Daaz therapy Four cheese mac and cheese

New Food Diary Monday Tuesday Wednesday Breakfast Oatmeal with half a grapefruit and coffee with cream Pancakes with a banana and coffee with cream Waffles with strawberry and whip cream and coffee with cream Snack Fruit cup with water Yogurt parfait with granola topping Banana and coffee with cream Lunch Homemade sandwich with fresh cut veggies and V 8 juice Left over whole wheat pasta with alfredo sauce and lemonade Veggie wrap with ranch dressing and orange juice Snack Chocolate granola Mars bar with diet bar and non fat latte pop Latte Dinner Whole wheat pasta with alfredo sauce Spaghetti with ground and spring salad with chickpeas Veggie stir fry with whole grain rice and bean salad

Recommendations Substitute milk for cream in coffee Try to keep it non-fat latte’s Try non-fat milk instead of cream sauce for pasta Try non-fat dressings instead of ranch

Relapse Prevention Techniques Family and friends support network Keep a personal journal that records feelings before and after exercise

Future Projections

1 Year Later Lost 20 pounds Maintained a proper diet Ergonomic aids, exercises, reduced pain associated with supracondylitis and osteoporosis Group network helped reduce stress

Post 1 Year Ex-husband became a drug addict and went to prison Sally took full custody of children Sally was promoted to Regional Manager The added stressors negatively affected Sally, who relapsed; however, she has gone back to the kinesiologist to help her get back on track