Children Case Study
Subjective
Medical History
Mr. ST, a 16 yr old Caucasian boy, whowas previously diagnosed with juvenile idiopathic arthritis (JIA)at the age of 12, has recently been determined to be in remission.Previously this patient did not respond well to a number ofnonsteroidal anti-inflammatories. After a period of trial anderror, the patient responded well to azathioprine and seems to havebetter control of his disease now. Is has been a concern of theparents and primary care physician that, although this patientseems to be in remission, he has failed to increase his activityand has poor dietary habits, and as such he is beginning to developother potential chronic health issues. Mr. ST’s latest physicalexam and lab work has noted that body weight status is in the 95thpercentile, with elevated resting blood glucose and triglycerides.The parents are concerned that if these poor health indicatorscontinue, their son will have to deal with more than his JIA. Thefamily physician wants the boy to begin a structured exerciseprogram as well as to begin following the DASH diet plan.
Objective and Laboratory Data
Exercise testing was not requested.
Assessment and Plan
Diagnosis
JIA with overweight/obese weightstatus and prediabetes
Exercise Prescription
Mr. ST was referred to ExerciseMedical Clinic to meet with an exercise physiologist. Inconsultation with the child’s parents it was determined that thechild would begin with a programmed exercise routine developed bythe exercise physiologist and would be administered here at theclinic. The patient will come to the clinic 3 d per week for thefirst 4 wk. At week 5 the child will move to completing hisexercise program from home. At week 8 the child will come to theclinic to be assessed on his ability to maintain his at-homeexercise program. If the child is compliant then adjustments willbe made to the program for intensity, duration, frequency, andmode. If the child is struggling then it may be appropriate to havehim exercise in the structured environment for 2 wk to help him getback on track.
Finally, it would be beneficial tohave the child’s parents begin an exercise program as well. Thiswill help them but would also provide positive role models fortheir child. Additionally, the parents and child should be referredto a dietitian to help them with their meal planning and dietplans.
Discussion
A patient such as this, with JIA, isoften in poor physical condition due to the adoption of a sedentarylifestyle, possibly due to the discomfort accompanying the disease.Although drug therapy has improved the quality of life for childrenwith JIA, increasing physical activity may help to enhance itfurther.
Case Study Discussion Questions
- What would your initial exercise prescription look like forthis patient? Include the mode, intensity, and duration (or volume)you would prescribe. Include your rationale for your choices.
- What modifications to your program would you make at week 5when the patient starts a home based exercise program?Explain.
- Assuming the patient is making progress at week 8, how wouldyou progress your program. Explain.
