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Someone who has heart disease will have a difficult time participating in a regular exercise program. An unhealthy heart is less efficient and pumps less blood per pump due to the heart muscle thinning and becoming weak (American, 2014). An unhealthy heart will cause an increase in heart rate due to the lack of efficiency. A healthy heart will work more efficiently by pumping more blood per pump, because a healthy heart muscle is thinker and stronger. When the heart is working more efficiently the heart rate decreases.  Heart health will also determine a person oxygen efficiency (American, 2014).

Intermittent claudication is aggravated by exercise and causes pain in the muscles due to a poor supply of blood. This condition is often associated with diabetes. Heart murmurs can be an indication of a cardiovascular disease, and can be life threatening with physical exertion (American, 2014). Unusual fatigue or shortness of breath with daily activities could indicate cardiovascular, pulmonary, or metabolic disease. Ischemia is a burning feeling, tightening, heaviness, or squeezing feeling in the chest, jaw, and upper extremities. Physical stress can aggravate these symptoms (American, 2014).

Case one is high risk due to obesity, inactivity, and intermittent claudication. He also takes medication for high cholesterol, suffers from intermittent claudication, smokes cigarettes, is an overweight male over the age of 45, and is inactive. I would say that he has 5 CVD risk factors, and should have a medical exam, an exercise test, and should exercise in a facility that has easy access to medical staff if needed. The second case has a regular exercise program what she does for thirty minutes a day five days per week. This would be 150 hours of moderate activity per week. She has no known disease, no major sign or symptoms, but her mother died before the age of 65. She is a female over the age of 55, but exercise. She has been doing exercise without any signs or symptoms of being unhealthy. I do not feel that it was necessary for her to have a medical checkup, but she could do an exercise test to see if she is ready to increase her intensity and length of time of exercise. Case three has never participated in a regular exercise program, so even though she is in good health with no signs or symptoms I would suggest a medical exam and exercise test (American, 2014).