CASE 6 · AEROBIC EXERCISE · INTERVALS AND MONITORING
How do I build up to a grocery trip?
Sam, 67, wants to walk through the grocery store with fewer rests. His PT has assessed the reduced walking tolerance, reviewed his health history and medications, and established an appropriate exercise and monitoring plan. He takes a beta blocker.
Choose an answer, then check the reasoning. Open the next stage afterward; each update assumes the best-fit plan was followed.
1. Which information should guide the starting intensity?
During a monitored level walk, Sam can talk but not sing, reports moderate effort on the explained exertion scale, and has no concerning symptoms. HR is below a generic age-predicted zone.
A. Increase speed until he enters the generic HR zone.
Check answer
Revisit your choice
A beta blocker can alter the HR response. A generic formula should not override the individualized plan.
Best answer: B. Use the established monitoring plan, effort, symptoms and indicated vital signs; do not chase the generic zone.
The observations help judge demand in context. Medication can make an unadjusted age-based HR target misleading.
Take it with you: Judge effort using the individualized monitoring plan and the person’s response. A generic HR zone is only part of the picture.
B. Use the established monitoring plan, effort, symptoms and indicated vital signs; do not chase the generic zone.
Check answer
Best fit for these findings
The observations help judge demand in context. Medication can make an unadjusted age-based HR target misleading.
Take it with you: Judge effort using the individualized monitoring plan and the person’s response. A generic HR zone is only part of the picture.
C. Use the talk test alone and stop monitoring other responses.
Check answer
Revisit your choice
The talk test is one clue, not clearance or a substitute for monitoring required by his clinical situation.
Best answer: B. Use the established monitoring plan, effort, symptoms and indicated vital signs; do not chase the generic zone.
The observations help judge demand in context. Medication can make an unadjusted age-based HR target misleading.
Take it with you: Judge effort using the individualized monitoring plan and the person’s response. A generic HR zone is only part of the picture.
Stage 2 · Use the new findings
2. Which walking dose fits this starting point?
The supervised trial finds that short walking bouts separated by seated recovery are manageable. Continuous walking for the whole intended shopping trip is not yet manageable.
A. Use planned short walks with rests, selected from the observed response, and build total walking gradually.
Check answer
Best fit for these findings
Intervals provide a workable entry point. Record bout length, total walking, recovery, effort and symptoms; the exact dose is individualized.
Take it with you: Short bouts count as a starting strategy. Build a repeatable amount before adding demands.
B. Use cycling alone until Sam can complete the full shopping trip.
Check answer
Revisit your choice
Cycling may help aerobic capacity, but transfer to walking still needs assessment and suitable walking practice.
Best answer: A. Use planned short walks with rests, selected from the observed response, and build total walking gradually.
Intervals provide a workable entry point. Record bout length, total walking, recovery, effort and symptoms; the exact dose is individualized.
Take it with you: Short bouts count as a starting strategy. Build a repeatable amount before adding demands.
C. Begin with the full trip duration and let exhaustion determine the rest breaks.
Check answer
Revisit your choice
An unmanageable initial duration can overshoot the assessed starting capacity. Plan recovery rather than relying on exhaustion.
Best answer: A. Use planned short walks with rests, selected from the observed response, and build total walking gradually.
Intervals provide a workable entry point. Record bout length, total walking, recovery, effort and symptoms; the exact dose is individualized.
Take it with you: Short bouts count as a starting strategy. Build a repeatable amount before adding demands.
Stage 3 · Review the follow-up
3. What is the most relevant next step?
After several sessions with the interval plan, Sam tolerates more total walking with an acceptable response. A small store trial remains hard because of repeated turns, standing at shelves and carrying items.
A. Increase walking speed only, since total walking has improved.
Check answer
Revisit your choice
Speed may be useful later, but it does not automatically address the newly identified demands.
Best answer: C. Assess those store demands and add suitable route, standing and item-handling practice.
Practice a short aisle-style route with turns and planned shelf stops; introduce a manageable item only if safe with any needed device. Recheck rests, effort and recovery.
Take it with you: The grocery trip includes more than walking straight ahead. Progress the parts Sam still needs.
B. Declare the goal met because the clinic walking time increased.
Check answer
Revisit your choice
A clinic measure is progress, not proof that the shopping goal is met.
Best answer: C. Assess those store demands and add suitable route, standing and item-handling practice.
Practice a short aisle-style route with turns and planned shelf stops; introduce a manageable item only if safe with any needed device. Recheck rests, effort and recovery.
Take it with you: The grocery trip includes more than walking straight ahead. Progress the parts Sam still needs.
C. Assess those store demands and add suitable route, standing and item-handling practice.
Check answer
Best fit for these findings
Practice a short aisle-style route with turns and planned shelf stops; introduce a manageable item only if safe with any needed device. Recheck rests, effort and recovery.
Take it with you: The grocery trip includes more than walking straight ahead. Progress the parts Sam still needs.
New chest discomfort, faintness or unusual severe breathlessness calls for stopping and appropriate assessment—not pushing to complete the planned bout.
Review Chapter 5 · Choose another case
Sources & learning scope
Fictional learning case informed by the Therapeutic Exercise class material and linked chapter. These are reasoned examples, not a complete patient examination or treatment protocol. Dose, guarding and progression require individual assessment; students work within supervision and the established plan of care.
AHA: beta blockers and exercise · CDC: measuring activity intensity
Reviewed October 29, 2026.
