1. Mucho Mike Presented by: Ben MacPherson, Neil Esarte, Steve Meagher, Kevin McCrae, Jim Warner, and Curtis Cox

2. Meet Mucho Mike…. And Mucho Mutt, the Beagle hound?

3. Mucho Mike - Introduction Mike is a construction worker for a commercial building company He performs various lifting, pushing and pulling activities Mike is always tired after work and never feels that he has the energy to exercise after work

4. Mucho Mike - Introduction This is Mike’s fourth visit to the clinic From prior meetings, Dr. Jimmy Warner has learned that Mike has a history of physical activity, participating in football, as well as power lifting into his 20’s It has been determined that Mike has a poor diet and poor nutritional habits by constantly overeating, often making unhealthy choices

5. Mucho Mike - Introduction Mike’s social support group consists of his girlfriend and his faithful companion Mucho Mutt In the past Mike enjoyed going for mountain bike rides with his girlfriend on the weekend Mucho mutt is 10 pounds over weight and does not get much exercise as he has arthritis in his rear legs

6. Mike’s Health Concerns Some of the health concerns discovered during the interview process include: –High blood pressure of 130/90 –Cholesterol level of 6 –Gained 30 pounds in last 2 years –Has a BMI of 29.4 (borderline between overweight and obese)

7. Prior Injuries He has been diagnosed with a muscle tear in his right erector spinae and a slight disk bulging in his L4/L5 He we prescribed physiotherapy for his back, however was non adherent to the prescribed exercises Continues to experience regular pain in his back Also continues to experience pain from a past injury to his AC joint. Tore the surrounding soft tissue Continues to take pain medication for both injuries

8. Family History Mike has a family history of health problems Intestinal and prostate cancer Coronary heart disease Osteoarthritis on father’s side Alcoholism for his father and uncles

9. Previous Sessions In the first session, Jimmy and Mike built a strong rapport, finding that their personalities mesh well together In the second session brainstorming was done to determine Mike’s goal and a course of action In the third session, core, shoulder, and stretching exercises were prescribed to Mike During the interview sessions, Mike has submitted a nutritional logbook highlighting a typical day, so minor adjustments can be made over the four sessions to his diet

10. Mike’s Thoughts Mike seems to be interested in some aspects of the program, however has difficulty finding time to complete the prescribed exercise program Assessments are based on the Stages of Change Model. Mike is currently between the preparation and action stage

11. Goals Decrease weight by 35 lbs in one year, has recognized that the last 10-15 lbs will be difficult to lose Reduce blood pressure to normal levels (120 / 80) Increase HDL cholesterol levels and decrease LDL levels Rehabilitate shoulder injury so he is able to perform daily tasks without pain Strengthen erector spinae and abdominals

12. Nutritional Logbook – Week 1 Time of DayMealLocationType of Food 7:30amBreakfastHouseTwo pieces of toast with butter, extra large coffee with cream and sugar 10:15amSnackConstruction SiteBag of chips, large coffee (meals on wheels) 12:30amLunchFast Food Burger shop 3 patty burger, large fries with gravy, extra large Coke 2:45pmSnackConstruction SiteChocolate Bar, apple, one pop 6:30pmDinnerHouseTwo large plates of spaghetti and meat sauce with garlic toast 9:00pmSnackIn front of TV3 Budweiser’s

13. Nutritional Logbook – Week 2 Time of DayMealLocationType of Food 7:15amBreakfastHouseTwo eggs, fried ham, large coffee with milk and sugar 10:25amSnackConstruction SiteBag of chips, large orange juice and bottle of water (meals on wheels) 12:30pmLunchFast Food Burger shop Burger, fries, iced tea 2:45pmSnackConstruction SiteTwo granola bars, apple, bottle of water 7:00pmDinnerHouseSteak, fries, salad 8:30pmSnackIn front of TV2 Budweiser

14. Nutritional Logbook – Week 3 Time of DayMealLocationType of Food 7:15amBreakfastHouseCereal with skim milk, apple, juice, medium coffee with milk and a bit of sugar 10:25amSnackConstruction Site3 homemade oatmeal cookies, orange, large apple juice and bottle of water 12:30pmLunchDeli shopSub sandwich, soup, large iced tea 2:45pmSnackConstruction SiteTwo granola bars, apple, and bottle of water 6:45pmDinnerHouseBBQ chicken, baked potato, salad, 2 Budweiser’s 8:30pmSnackIn front of TVApple juice, granola bar

15. Nutritional Suggestions Try consuming more fish, chicken, and turkey on a regular basis: will help to increase HDL levels Consuming fish will increase level of Omega 3 Fatty Acids Choose granola bars which are low in sugar content, avoid chocolate covered, etc. Try for Nature Valley Crunch bars, Mike has said he enjoys these! Needs to include more fruits and vegetables on a daily basis During work should try to consume more water and less juice or coffee Slowly reduce coffee intake Try to prepare weekly lunches as opposed to eating at fast food restaurants Consume more complex carbohydrates: whole wheat bread, legumes, fruits, etc. Remember to follow Canada’s Food Guide as best as possible

16. Canada’s Food Guide

17. Cardiovascular Exercise Need to avoid bike riding as lumbar flexion creates strain on the slightly bulging disc Taking mucho mutt for walks after supper Taking mucho mutt for a swim at the lake and walking in the sand, or walking along side shore, knee deep in water In the winter going public skating with his girlfriend Join a touch football league Prior to performing exercises Mike is to perform at least 5 minutes of cardiovascular activity to ensure his core has warmed up.

18. Prescribed Exercises for Mike Shoulder Exercises using Theraband Upright rows Shoulder shrugs Internal and external rotation of the humerus Front and side deltoid raises

19. Prescribed Exercises for Mike Core strengthening with stability ball Back hyperextensions Crunches Bridge Experienced pain and discomfort with these exercises... However, we’ve got some suggestions for Mike

20. Alternative exercises (in replace of exercise ball) Back extensions on floor Crunches with a rolled towel supporting lower back Supine hip lift If Mike experiences pain with new exercises he needs to call Dr. Warner

21. Frequency 3 sets of each exercise 8-10 reps For the first week Mike was asked to complete 1 full workout Increased to 2 workouts by the second week The third week of program required to complete 3 work outs Recommend 30-45min of aerobic exercise, 3-4 times a week and gradually increase to 5-7 days a week

22. Ergonomic Assessment Lifting techniques for a safer work environment: Avoid extreme lifting in the early morning; try to wait until your body is warmed up While lifting keep back straight and knees bent, load should be close to the body; neck should be straight and not moving. Remember to breathe, DO NOT hold your breath Do not twist body while lifting, Orient your body so you do not have to twist, and while changing direction do so by moving your feet not your upper body Possible reasons for dropping an object while lifting: Loss of balance due to a narrow stance. Use wider stance while lifting and carrying Load is uneven. Make sure the weight is centered; if this is not possible ask for help Load is too heavy. Use more men for the job or acquire a lifting device like a forklift or even a dolly Maneuvering object while carrying may be difficult, make sure path is clear before lifting object When lifting with people communicate on where they are going to move or if they require a break from carrying object When lowering an object bend your back as little as possible lower yourself using your legs

23. Proper Lifting Technique

24. Relapse Prevention Relapse is common; however, it is those who blame themselves and view the relapse as a failure that often fall into a complete relapse Since Mike has performed a great deal of exercise in his past, he must focus intently on exercise, relaxation, even meditation at the end of the day – these things are designed to strengthen his overall coping ability and can help to decrease his urges and cravings Mike and his girlfriend decided to share backrubs at least 5 out of the 7 nights of the week as a means to help Mike relax and utilize his own form of meditation plus he keeps his girlfriend happy because she thoroughly enjoys his backrubs We have tried to get Mike to see the seriousness of the alcoholism history in his family and have used it as a means of scaring him into moderating his alcohol intake. Furthermore, we suggested to him that if he decided to have kids at any point in his life and he kept up his lifestyle without making changes he would unlikely be able to enjoy playing catch, going hiking, or wrestling with his children, or even enjoying bike rides with them.

25. Motivation Factors Need to be concerned about relapse Male side of family has a history of alcoholism Intestinal and prostate cancer, coronary heart disease and osteoarthritis on male side of family Borderline hypertension – if not fixed, could lead to heart attack, even IMPOTENCE Fear of being unable to play with his children if he and his girlfriend decide to have kids His girlfriend is a physically fit figure skating instructor and he admitted in the last session that he felt a sort of pressure from his wife to get in gear and get back in shape Mike did let us know that this pressure from his wife did not bother him and even encouraged him to make this a successful rebound