A 48-year old man with Parkinson disease who recently lost 35 kg (over a period of 9 months) after initiation of GLP-1RA therapy. He joined your obesity program 6 months ago and now asks your advice on how he can work more on hypertrophy of the upper body. He indicates that he has max 2 to 3 times a week
Training modalities
Key: Dynamic strength training, supplemented with aerobic endurance exercise
Frequency: 2 -> 3 x/week
2-3 sets per muscle group | 2-3 reps in reserve (near failure)
Rest period between sets less important
Volume (i.e. > 10 sets per week per muscle group) is key
Issues after intense training
Problem: Recurrent dizziness and light-headedness when standing up
The patient reports a recent increasing onset of light-headedness occurring primarily when rising from a seated or lying position (e.g., getting up in the morning, standing after watching television, or after meals). Symptoms last for several seconds and improve upon sitting down. No prior history of similar complaints in the past.
What additional questions are useful to establish underlying cause
Medication use
Fluid/salt intake
Other symptoms present?
Complaints in other circumstances | triggers
On further questioning
Significant weight loss (GLP-1 RA) – eating less and very different
More complaints/symptoms in het morning and more frequent with heat
Almost collapsed in the shower last week after training
