Ageing, Metabolic and Musculoskeletal Conditions

A Case Study Your Name Subject and Section Professor’s Name Date Epidemiology Hypertension Hypertension is a significant global health issue affecting an estimated 1.28 billion adults aged 30–79 worldwide. This is also more common in low- to middle-income countries. This expresses the level of inequality today across the continent's regions and brings out the need to enhance health facilities and education (World Health Organization, 2023c). Diabetes Mellitus (DM) The total population suffering from DM has increased year by year from 108 million in 1980 to 422 million in 2014. The incidence of diabetes is rising most rapidly in low- to middle-income countries, reflecting changes in disease patterns consistent with lifestyle and development (World Health Organization, 2023a). Osteoarthritis According to a report, more than 90 million individuals in 2019 had been diagnosed with osteoarthritis (OA), and it had risen by 113% in 2019 from 1990. Most victims are females and individuals above 55 years of age, with approximately 73% of patients being in this age bracket (World Health Organization, 2023c). Patellofemoral Pain Syndrome Patellofemoral Pain Syndrome (PFPS) accounts for 25-40% of all knee-related problems reported in sports medicine practices (Bump & Lewis, 2023). Pathophysiology Hypertension The causes of hypertension can be linked to somatic activity of the renin-angiotensin-aldosterone system, central nervous system impact, and vascular and renal sensitivity. Irvin Page’s idea, known as the Mosaic Theory, showed that angiotensin, when it reacts with plasma, brings about a pressor effect that boosts blood pressure. This theory also consolidates variables such as neural and chemical disruptions, and shifts in caliber and elasticity of blood vessels, all of which lead to hypertension (Harrison et al., 2021). Type II Diabetes Mellitus Type 2 diabetes mellitus (T2DM) is a multifactorial disease with disturbances in multiple metabolic pathways mainly due to insulin resistance and defective insulin secretion. T2DM patients have significant problems in the inadequate insulin release by the pancreatic β-cells in response to increased blood glucose levels caused by genetic and environmental factors of chronic overnutrition, including obesity (Galicia-Garcia et al., 2020). Osteoarthritis OA affect the articular cartilage, synovium, subchondral bone, and the surrounding muscles. Subchondral bone marrow lesions (SBMLs) occurring in > 50 years are signs of mechanical stress and are associated with anatomy alterations (i.e., bone turnover and cartilage loss). The other factors are age, obesity, biomechanics, and physical activity, which determine the development and progression of the disease (Coaccioli et al., 2022). Patellofemoral Pain Syndrome PFPS is the pain at the front of the knee aggravated by flexion, such as during running, climbing upstairs, or squatting. It stems from multiple underlying causes that involve mispositioning of the lower extremity (LE) or the patella, muscle imbalance or overuse, and trauma, with the latter being the most common. Static factors include leg length differences, irregular shape of the foot, short hamstring and hip flexor muscles, and dynamic factors include muscle strength, forces acting on the LE through the ground, and other aspects of a pronated foot. Hip abductor strength is one of the most critical factors in PFPS (Bump & Lewis, 2023). Overview of Philip’s Clinical History Philip, a 49-year-old chef, presents with a clinical history of hypertension, stage I, controlled. This is defined as a systolic blood pressure of 130-139mmHg or a diastolic blood pressure of 80-89mmHg (American Heart Association, 2024); T2DM, and hypertriglyceridemia, which is defined as >10mg/dL in men (Blake, 2021). According to the World Health Organization (2024), his BMI is 45.7 kg/m2, classified as class II obesity. Moreover, his waist size is 115 cm, categorized as a substantially increased risk of metabolic complications (World Health Organization, 2011). Laboratory examinations are within normal limits except that the triglycerides are high, which was >160mg/dL (Blake, 2021). Nevertheless, he has quite an active lifestyle as he walks his dog often but has problems walking up the stairs. Contraindications to Exercise Philip should not engage in any activities that involve the use of the knee during an acute flare of pain or inflammation, as this increases joint damage. Additionally, physical activity should also be avoided if his BP demonstrates malignant hypertension or if there is severe hyperglycemia or hypoglycemia. Also, any new signs of cardiovascular disease, such as chest pain, dyspnea, syncope, and alarm symptoms of stroke, should be taken as severe signs and must be treated as emergency cases. It is also essential for Philip to understand that he should not exercise when he is fatigued or not well due to his obesity and diabetes, especially when the weather is too hot, humid, or freezing. Other Necessary Assessments As an exercise physiology student, the following assessments can be done, and they are essential for formulating a treatment plan. Goniometry of both knees is necessary to establish the extent of restricted motion or left and right-side difference. Next, evaluating the patellar mobility enables the detection of problems related to the patellofemoral joint. The special tests that evaluate PFPS are Clarke's, patellar tilt, and single-leg squat tests. Manual muscle strength tests (MMTs) for LEs will also identify the baseline strength of the skeletal muscles and determine whether any disparity requires correction to prevent falls. Here, one should mainly focus on assessing the knee flexors, extensors, hip flexors, extensors, and abductors. In addition, actual and apparent leg length should be measured as this has been implicated as a cause of PFPS. Moreover, a gait analysis is necessary as it will reveal any abnormalities that might be causing his joint pains or movements that are improper and may worsen the disease (Magee et al., 2011) Exercise Prescription Flexibility Training Before and After Exercise The ACSM FITT recommendations base the prescription of flexing exercises, such as static and dynamic stretches, to be done 2-3 sessions a week to enhance and increase muscular flexibility and joints. Flexibility sessions should hold each stretch for ten to thirty seconds and contain two to four sets for each muscle group. It aids in enhancing the general affinity, minimizes the possibility of getting affected by injury, and, in some cases, it may help optimize aerobic and resistance exercises by stretching the range of motion (Pescatello, 2019). However, based on Iwata et al. (2019), dynamic stretching (DS) has been reported to enhance flexibility and decrease passive stiffness until 90 minutes after stretching. DS resulted in a 7-10% im...