VIVA Alexis (68)

Question 1

Explain to the examiner what an appropriate aerobic exercise program for Alexis might look like (FITT) and the considerations you have given to her medical history and medications. (hint: intensity can be described by heart rate, moderate/vigorous, talk test etc). What is meant by “pelvic floor safe” exercises?

Answer 1

F - 2x week on top of her usual walking
I - 6-7/10 RPE (moderate to vig)
T - dancing, swimming, fast-walking, playing with grandchildren
T - 30 minutes plus warm up and cool-down

Considerations - osteopenic, incontinence, low mood, hypertension, painful symptoms from varicose veins, post partum anxiety

Pelvic Floor Safe Exercises mean exercises that strengthen the muscles that support the bladder, uterus, and bowels, helping improve core stability, reduce incontinence, and support recovery after childbirth.

Question 2

Demonstrate and teach an appropriate lower limb compound exercise designed
to target the squat pattern (there are many to choose from so practice and
prepare for many). What would be appropriate loading parameters for this
exercise? What abnormal subjective and objective responses will you need to
watch out for.

Answer 2

• Stand with feet hip-width apart, holding a dumbbell or kettlebell at chest level with both hands.
• Keep your chest lifted and shoulders relaxed, engaging your core.
• Begin by pushing your hips back as if sitting down, allowing knees to travel over your toes.
• Pause briefly at the bottom, then push through your heels to return to standing.
• Breathe in as you squat down, and exhale as you push back up.
• Maintain a controlled, steady pace, focusing on form rather than speed.

F - 2x weekly
I - 4-6/10 RPE (moderate)
T - Resistance
T - 8-12 reps, 2-3 sets, 3 minutes rest

Subjective
* Pelvic heaviness
* Pain in knees, hip or back
* Dizziness and lightheaded
* Incontinence

Objective
* Valgus
* Excessive forward lean or rounding of back
* Breath holding
* Fatigue

Question 3

Demonstrate and teach an appropriate upper limb push or pull exercise (there
are many to choose from so practice and prepare for many). What would be
appropriate loading parameters for this exercise? What abnormal subjective and
objective responses will you need to watch out for.

Answer 3

Seated overhead press (dumbbell)
* sit on bench feet flat on ground hip width apart
* sit up with straight back and core engaged
* bring dumbbells and rest on thighs
* bring dumbbells to shoulder height with palms facing forward, elbows slightly in front of your body
* make sure you feel stable
* breath in, on exhale press dumbbells straight up overhead until your arms are fully extended but not locked
* think about keeping your shoulders down away from your ears when you press
* slowly lower back down into starting position with an inhale
* inhale as you lower and exhale as you press up

F - 2x weekly
I - 4-6/10 RPE (moderate)
T - Resistance
T - 8-12 reps, 2-3 sets, 3 minutes rest

Subjective
* Joint pain
* Shortness of breath/lightheaded

Objective
* Rounded shoulders
* Breath holding
* Signs of struggle

Question 4

Demonstrate and teach an appropriate trunk exercise (there are many to choose
from so practice and prepare for many). What would be appropriate loading
parameters for this exercise? What abnormal subjective and objective responses
will you need to watch out for

Answer 4

Banded trunk rotations

• Anchor a resistance band at about chest height.
• Stand sideways to the anchor point, holding the band with both hands at chest level.
• Position your feet shoulder-width apart and engage your core, standing tall.
• Keeping your arms extended and shoulders relaxed, slowly twist your torso away from the anchor point.
• Use your core to rotate, not just your arms.
• Return to the starting position with control.
• You should feel this in your obliques which are a part of your core stabilisers.

F - 2x weekly
I - 4-6/10 RPE (moderate)
T - Resistance
T - 8-12 reps, 2-3 sets, 3 minutes rest

Subjective
* Joint pain
* Shortness of breath/dizziness
* Back pain

Objective
* Twisting with the hips
* Breath holding
* Fatigue

Question 5

Alexis feels her pelvic issues are a significant barrier for resistance training.
Create a dialogue with Alexis to help her overcome these barriers. (think COM-B
model)

Answer 5

Physiotherapist: “Hi Alexis, I understand you’ve been feeling some pelvic heaviness and other symptoms that can be frustrating and may make you hesitant to engage in resistance training. Let’s chat about how we can work with these concerns so you feel more comfortable and confident to get started.”

Alexis: “Yes, it’s just that every time I think about exercising, I worry about making the symptoms worse. It’s hard to stay motivated.”

Physiotherapist: “That’s completely understandable. Pelvic issues can be a big factor, and it’s good that you’re cautious. Together, we can take steps to strengthen without overloading that area. I’m here to help you find exercises that support your goals while keeping those symptoms in mind.”

Capability:
“To start, let’s focus on a few exercises designed to strengthen your core and lower body that are gentle on the pelvic area. Some, like chair squats or wall push-ups, will help you build strength gradually without putting extra pressure on your pelvic floor.”

Opportunity:
“We can also look at ways to adapt exercises if you experience any discomfort. For example, we can adjust positions or work on breathing techniques that support your core and pelvic floor during movement.”

Motivation:
“One thing to keep in mind is that the strength we build can help reduce these symptoms over time. You’re taking control by supporting the muscles around the area, which can improve your confidence and help you feel more comfortable in your daily activities.”