A physical therapist designs an exercise program for a patient that minimizes the use of isometric work. Which medical condition would MOST necessitate the need for this type of program?

1. Anemia
2. Diabetes mellitus
3. Hemophilia
4. Hypertension

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A physical therapist designs an exercise program for a patient that minimizes the use of isometric work. Which medical condition would MOST necessitate the need for this type of program?

1. Anemia
2. Diabetes mellitus
3. Hemophilia
4. Hypertension

The key to this question is understanding the concept of “isometric work”.

Isometric work is a form of resistance training where working muscles exert force against a static object for a specified period of time without changing length.

Isometric exercise is an alternative to high impact dynamic exercise. It’s able to target specific muscle groups, allowing for focused strength building. Isometric exercise can be used effectively on both large and small muscle groups. It is often employed in the early stages of rehabilitation programs in order to minimize stress on injured muscles or joints.

It’s critically important to make sure that you understand the question that is being asked. The first sentence of the question indicates that the program being designed attempts to minimize the use of isometric work. The question goes on to state which medical condition would MOST necessitate the need for this type of program?

What type of program? A program that minimizes the use of isometric work. Stated differently – Isometric work would be potentially most problematic for which condition.

Failure to interpret the question correctly frequently results in a test taking mistake. This type of mistake is extremely problematic since when it occurs a student’s examination score is no longer reflective of their true abilities.

Let’s explore each of the options.

Option 1 - Anemia
Anemia is a condition in which the number of red blood cells is reduced. Due to the reduction of red blood cells, delivery of oxygen to the tissues is impaired.

Symptoms of anemia include weakness and malaise which would make it challenging for patients to engage in any form of resistance training. However, isometric work has the same inherent risks as other forms of resistance training for patients with anemia.

Option 2 - Diabetes mellitus
Diabetes mellitus is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin.

Again, isometric work has the same inherent risks as other forms of resistance training for patients with diabetes mellitus.

Option 3 - Hemophilia
Hemophilia is a bleeding disorder of genetic etiology. It is a sex-linked autosomal recessive trait. The condition can lead to spontaneous bleeding as well as bleeding following injuries or surgery.

Patients with hemophilia are prone to hemarthrosis, intramuscular hemorrhage, and secondary complications. Once again, isometric work has the same inherent risks as other forms of resistance training for patients with hemophilia.

At this point, we’re hoping that option 4 is incredibly compelling since options 1, 2, and 3 don’t offer anything unique that would make it necessary to minimize the use of isometric work.

Option 4 - Hypertension
Hypertension is a condition in which the force of blood against the artery walls is high.

Let’s explore normal blood pressure and the various levels of hypertension including Elevated, Stage 1, and Stage 2.

Normal blood pressure is defined as systolic pressure less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg.

Elevated blood pressure is defined as systolic blood pressure from 120-129 mm Hg and diastolic blood pressure less than 80 mm Hg.

Stage 1 blood pressure is defined as systolic blood pressure from 130-139 mm Hg or diastolic blood pressure from 80-89 mm Hg.

Stage 2 blood pressure is defined as systolic blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm Hg.

Isometric Work and Blood Pressure
Isometric work can result in sharp increases in blood pressure due to an increase in pressure within the muscle which compresses small blood vessels and prevents oxygen-rich blood from reaching active muscle tissue. Tissue hypoxia causes a rapid rise in both systolic and diastolic blood pressure readings.

The speed and degree of the rise in systolic and diastolic blood pressures is directly related to the intensity and duration of the muscular contraction. Resistance training in patients with hypertension should emphasize low resistance and low repetition isotonic exercise.

The correct answer is Option 4

Let’s explore the all student data:
9% of students selected Option 1, anemia
5% of students selected Option 2, diabetes mellitus
15% of students selected Option 3, hemophilia
71% of students selected Option 4, hypertension, the correct response

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 124, 413-414 from PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

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