Patient Exercise Prescription Project

8002 words (32 pages) Essay

18th May 2020 Physiology Reference this

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1)  The client is a healthy female with a clear medical record and she is currently not on any medication. The client has low-intensity aerobic exercise as part of her current workout routine and for the past 6 months, however, she has not implemented any resistance training in her routine for the past 10 years. As the patient is looking to start a more advanced exercise routine, it is indispensable to check with her doctor for medical clearance should she have any contraindications for high-intensity or high weight exercises. The patient has a history of childbirth, lactation, occasional low back pain, and the feeling of fatigue during current exercising. Though medical clearance is very important before enrolling in any exercise program, listed conditions are not considered contraindications for exercise. Cautions for exercise would be her borderline elevated blood pressure and lower back pain that could be aggravated by certain exercises.  The patient would benefit from further medical investigations if symptoms with either condition worsen.  For example, pelvic floor dysfunction that could be caused by birth/childbearing can lead to lower back pain and can be aggravated by running/heavy lifting exercises.

2) Dear Adi Das, the following are findings from your assessment:

In terms of body shape, your height of 175cm is directly proportional to your weight of 70kg. This gives us a body mass index (BMI) value of 23.5/m2 signifying that you are within the normal ranges of body size and you are not obese or underweight for your age and sexual category. Systolic blood pressure is the pressure in the arteries when blood is ejected out of the heart during contraction of the heart muscle. Your assessment results of the systolic blood pressure measure 118 mmHg, indicating that it is within the normal ranges. Diastolic blood pressure is the blood pressure measured when your heart muscle is between beats and blood is filling the heart chambers. Normal diastolic blood pressure should be less than 80mmHg. Your results show an elevated diastolic blood pressure of 89 mmHg for a non-sedentary young person which classifies you in the pre-hypertensive group. Resting heart rate refers to the number of hearts beats every minute at rest. The normal ranges for a healthy adult fall in between 60-100 bpm which means your heart rate of 67bpm is within the acceptable range. Though, a lower resting heart rate implies a better heart function and cardiovascular fitness.

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The result of your VO2max test which is the maximum rate of oxygen that is used during activity was used to assess your body’s ability to take up and use oxygen and thus your level cardiorespiratory fitness level. The ergometer showed a value of 33mL O2/kg/min, which means that your aerobic fitness is relatively low for your age.

In terms of body composition, your BIA results indicate a 27% body fat. This is the measure of the fitness level of an individual and a high value can indicate a higher risk of morbidity. In your case, it shows your level of fitness to be average. 

The postural assessment indicates that you have a posterior pelvic tilt and a flat back posture. The correct posture is characterized by the ability to maintain an upright and straight position and balance with minimal effort while maintaining an appropriate lumbar, thoracic and cervical curve.  A flat back posture means that your pelvic bone is pushed in and downwards, and your lower back is straight instead of lumbar lordosis, causing you to bend forward; as demonstrated in figure 1. This is likely the cause for your difficulty standing for long periods, and the leaning of your neck and head forward resulting in neck and upper back straining. Flatback posture is the result of muscle imbalances where some muscles are tight pulling on the weaker ones, thus making you adopt this posture. To correct this posture, you will have to engage in exercise that strengthens your core muscles, buttocks, neck and rear shoulder muscles, and back extensors.

Flexibility is the ability of your muscles to bend or lengthen your joints to optimal ranges. You demonstrate a good ROM in the tested joints, except for hip flexion with the leg straight which could be an indication of hamstring tightness, weak hip flexors or nerve mobility issues. The posterior pelvic tilt mentioned before could also be correlated to hamstring tightness denoting that we would want to add hamstring stretching exercises to your program. Hip flexors can be strengthened by certain types of strength training.

Manual Muscle Testing (MMT) assessment was used to analyze your muscular strength. MMT scores for your elbow and knee joints were both 4 out of 5, indicating that you have full ROM against gravity with moderate resistance and normal strength.  However, there is still place for improvement mainly achieved through resistance training with an emphasis on these joints. Strength results indicate your predicted 1RM, which is the maximum load you can handle during 1 repetition in this case for a bench press is 41 kg and leg press is 91 kg. This information will be used to determine the load (intensity) for your resistance training to prevent overload injury.

Figure 1. Spine alignment in a person with flatback vs. an ideal posture

3a) 1-month timeline of exercise prescription for Mrs. Das:

 

Flexibility Exercises for Weeks 1 to 4:

 

Frequency

2-3 times/week – to be done before resistance exercises as a warm-up

Intensity

Each stretch is performed with a slow but steady movement without bouncing or locking of the joints which may result in injury. The client must stretch to point of slight discomfort and stop before the stretch becomes painful.

Time

Total: 10-15 minutes

-          holding each stretch for 20-30 sec before proceeding to the next.

-          the client may repeat 2-3 times targeting the major muscles

-          15-30 sec rest before the second repetition

Type

static or dynamic stretches are recommended (listed in the chart below)

Exercise type

Tempo

Targeted muscles

Bird-dog

4 sets of 10 reps

Glutes, rectus abdominis, and erector spinae

Upward facing dog

4 sets of 10 breaths

No specific muscle group worked. Intervertebral discs decompressed to the opposite direction of lumbar lordosis caused by pregnancy

Cat-cow pose

4 sets of 10 reps

Glutes, rectus abdominis, erector spinae, rhomboids, and lower trapezius

Assisted Hamstring Stretch

3 sets of 10 reps

Hamstrings (requires resistace bands)

Alternating Toe Touches

3 sets of 10 reps

Rectus abdominis, abs, obliques, bicep femoris, hamstrings

Elbow Stretch

4 sets of 20 seconds

Triceps, wrist extensors

Supine Pelvic tilts

3 sets of 10 reps

Rectus abdominis and glutes

*only 4 of the above exercise to be done each time (extra options in case the client loses interest)

Cardiorespiratory Exercises For 4 Weeks:

The client is encouraged to participate in activities that raises her heart rate and engages large muscle groups in a continuous and rhythmic nature e.g. cycling, walking, swimming, jogging or shoveling. Intensity recommendations are 65-90% of maximum heart rate (HRmax). Each workout starts with a warm-up session of 5 minutes or more followed by a moderate-intensity activity, which is intended to make the client sweat and increase her HR, and is completed by a cooldown exercise.

Week 1

Saturday & Wednesday

Type:

Running (low intensity)

 

30 Minutes

1. 10 minutes warm-up – walk

2. 30-minute low-intensity run

3. 10-minute cool down – walk

Intensity:

%VO2max 50, THR40 114bpm +/- 5bpm

Frequency:

2 times per week

 

Week 2

Saturday & Wednesday

Monday

Type

Running

Cycling

 

35 Minutes

1. 5-minute warm-up – walk

2. 30-minute run

3. 10-minute cool down – walk

30 Minutes

1. 5-minute warm up – walk

2. 30-minute cycling

3. 10-minute cool down – walk

Intensity:

%VO2max 5, THR40 114bpm +/- 5bpm

%VO2max 50, THR40 114bpm +/- 5bpm

Frequency:

2 time per week

1 time per week

 

Week 3

Saturday and Sunday

Type:

Moderate to High Intensity Interval Training

 

31.5 Minutes

1. 10-Minute warm-up – Walk

2. 15-Minute moderate-intensity jog

3. 30 seconds of jump rope.

4. 1-minute rest

5. 15-minutes of cycling

6. 10-minute cool down – walk

Intensity:

VO2max % 70, THR 145 bpm +/- 5bpm

Frequency:

2 times per week

 

Week 4

Saturday and Sunday

Type:

HIIT (High Intensity Interval Training)

 

25 Minutes

  1. 5-minute warm up jog
  2. Jump rope for 5 minutes
  3. Burpees for 5 minutes
  4. 30-second rest
  5. Jumping Jacks 5 minutes
  6. 10-minute Jog
  7. 5-minute cool down walk

Intensity:

VO2max % 75, THR 155bpm +/- 5bpm

Frequency:

2 times per week

 

 

Resistance Training For 4 Weeks: Resistance training would help with improving the client’s strength, thus her performance in soccer while elevating her resting metabolism to help her get back in shape. The following resistance program is designed so that the whole body (all muscle groups) are trained in the same session as opposed to training selected muscle groups such as lower body muscle and upper body muscles on different days (month 2 & 3). The Load assigned to each exercise set was estimated using the information provided on the predicted 1RM for bench press and leg press. ACSM guidelines recommend a 40 – 50% 1RM for beginners. The appropriate limb-specific weight load is calculated using the 1RM for chest press and bench press.  The number of repetitions and sets are also adjusted according to the time restriction of the client and it is compensated by increasing the load of the resistance exercise. The client wants to increase her strength and improve her shape while increasing her cardiovascular endurance, thus a moderate load of 8-15 reps would be optimal to enable her goal. In a few exercises, a heavier load with lower reps are used to gradually build muscular force.

Week 1

Monday, Thursday & Saturday

Type

Full body compound (body weight)

 

35 Minutes total

Intensity

Moderate, 30% of 1RM

Frequency

3 time per week

 

Exercise Order

Tempo

Rest

Targeted Muscles

  1. Pushups

3 sets of 10

60 second

chest (pectoralis major), shoulders (deltoid), and elbow extensors (triceps brachii/anconeus).

  1. Pull ups

3 sets of 6

60 second

back (latissimus dorsi, Erector spinae, trapezius, etc.), elbow flexors (biceps brachii, brachialis, brachioradialis, etc.), and scapula stabilizers (rotator cuff muscles & rhomboids).

  1. Squats

3 sets of 16

60 second

quadriceps, and hip extensors (gluteus maximus)

Week 2

Monday, Thursday & Saturday

Type:

Full body compound with weights

 

45 Minutes total

Intensity

Moderate, 40% of 1RM

Frequency

3 time per week

 

Exercise Order

Load 

Tempo

Rest

Targeted Muscles

  1. Barbell Bench Press

65 lb.

3 sets of 12

90 second

Chest (pectoralis major), elbow extensors (triceps brachii/anconeus)

  1. Barbell Military Press

45 lb.

3 sets of 12

60 second

Shoulders (deltoid).

  1. Barbell Row

 

65 lb.

3 sets of 12

90 second

Back (latissimus dorsi, trapezius, erector spinae, etc.), elbow flexors (biceps brachii, brachialis, brachioradialis, etc.), and scapula stabilizers (rotator cuff muscles & rhomboids).

  1. Barbell Deadlift

85 lb.

3 sets of 8

90 second

Muscles of the posterior chain / primarily back muscles (latissimus dorsi, trapezius, erector spinae, etc.), and hamstrings and glutes.

  1. Barbell Squats

85 lb.

3 sets of 12

90 second

quadriceps, and hip extensors (gluteus maximus).

 

Week 3

Monday, Thursday & Saturday

Type

Full body compound with weights & accessory lifts (i.e. isolation of specific muscle groups apart from compound movement)

 

60 Minutes total

Intensity

Moderate, 40% of 1RM

Frequency

3 time per week

 

Exercise Order

Load

Tempo

Rest

Targeted Muscles

  1. Barbell Bench Press

65 lb.

3 sets of 12

90 second

chest (pectoralis major), elbow extensors (triceps brachii/anconeus)

  1. Barbell Military Press

45 lb.

3 sets of 12

60 second

shoulders (deltoid)

  1. Barbell Row

65 lb.

3 sets of 12

90 second

back (latissimus dorsi, trapezius, erector spinae, etc.), elbow flexors (biceps brachii, brachialis, brachioradialis, etc.), and scapula stabilizers (rotator cuff muscles & rhomboids).

  1. Barbell Squats

85 lb.

3 sets of 12

90 second

quadriceps, and hip extensors (gluteus maximus)

  1. Barbell Deadlift

85 lb.

3 sets of 8

90 second

muscles of the posterior chain / primarily back muscles (latissimus dorsi, trapezius, erector spinae, etc.), and hamstrings and glutes.

  1. Dumbbell Biceps Curl

15 lb.

3 sets of 12

60 second

elbow flexors (biceps brachii, brachialis, brachioradialis, etc.)

  1. Dumbbell Triceps Extension

15 lb.

3 sets of 12

60 second

elbow extensors (triceps brachii/anconeus).

 

Week 4

Monday, Thursday & Saturday

Type

Full body compound with increased weight, and accessory lifts (i.e. isolation of specific muscle groups apart from compound movement)

60 Minutes total

Intensity

Moderate, 50% of 1RM

Frequency

3 time per week

 

 

Exercise Order

Load

Tempo

Rest

Targeted Muscles

  1. Barbell Bench Press

80 lb.

3 sets of 8, 10 pushups super set

90 second

chest (pectoralis major), shoulders (deltoid), and elbow extensors (triceps brachii/anconeus).

  1. Dumbbell Shoulder Press

20 lb.

3 sets of 8

60 second

back (latissimus dorsi, Erector spinae, trapezius, etc.), elbow flexors (biceps brachii, brachialis, brachioradialis, etc.), and scapula stabilizers (rotator cuff muscles & rhomboids).

  1. One-Arm Dumbbell Row

25 lb.

3 sets of 8

90 second

back (latissimus dorsi, trapezius, erector spinae, etc.), elbow flexors (biceps brachii, brachialis, brachioradialis, etc.), and scapula stabilizers (rotator cuff muscles & rhomboids).

  1. Barbell Squats

90 lb.

3 sets of 12, followed by 10 curtsy lunges superset

90 second

quadriceps, and hip extensors (gluteus maximus).

  1. Barbell Deadlift

90 lb.

3 sets of 8

90 second

Muscles of the posterior chain / primarily back muscles (latissimus dorsi, trapezius, erector spinae, etc.), and hamstrings and glutes.

  1. Dumbbell Biceps Curl

20 lb.

3 sets of 12

60 second

Elbow flexors (biceps brachii, brachialis, brachioradialis, etc.)

  1. Dumbbell Triceps Extension

20 lb.

3 sets of 12

60 second

elbow extensors (triceps brachii/anconeus).

3B) The cardiorespiratory exercise section includes a warm-up period, a cardiorespiratory phase and a cool-down period. Wagner (2005) argues that warm-ups prepare the body for a transition from rest to physical activity. It serves to stretch muscles, increase flexibility, increase heart rate and circulation. This, therefore, decreases the incidences of both orthopedic injury and ischemic response. The choice of exercises prescribed for this client is based on her level of fitness, the tight schedule, and interests. Most of the aerobic activities prescribed employ large muscles groups and are maintained in continuous and rhythmic motions (Griffin, 2016). Most of these exercises do not require specialized equipment or facility to perform. The client is interested in cycling which is another reason I chose cycling as part of her aerobic exercise. The exercises are also low impact activities, which then decreases the risk of injuries and increases the client’s exercise compliance. According to Farnsworth & Cannon, (2018) aerobics enhance muscular endurance, cardiorespiratory endurance, and flexibility while weight training improves the muscular strength and muscular endurance. I also incorporated HITT into her schedule as it is more effective at building endurance, than endurance training alone. In a study of healthy young and middle ages people, HIIT increased their VO2max levels (a measure of endurance) considerably more than longer, steady-state workouts. HIIT also burns fat, build muscle, improves both your aerobic fitness and your strength, lowers risk of obesity and diabetes by improving the way your body manages insulin.

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The flexibility exercises assigned are important in stretching her back and neck which aids in correcting her flat back posture. They are also quite relaxing and therapeutic which will help the client recover from her other activities. The strength training exercises are inexpensive, easy and are tailored to make use of her body weight hence compliance. The client has a variety of exercises to choose from unlike her normal running, which is a recipe for overtraining and may pose muscular imbalance. This helps in preventing long term repetitive strain of the involved muscles and neglect or weakening of other muscles (Acevedo & Starks, 2016)

4) 1-month schedule for Adi Das

Sunday

Monday

Tues

Wednesday

Thursday

Fri

Saturday

Flexibility

Resistance

REST

Cardio 35-min- running

Flexibility

Resistance

REST

Flexibility

Resistance

Cardio 30-min- running

Flexibility

Resistance

Cardio 30- min cycling

Cardio 35-min- running

Flexibility

Resistance

Flexibility

Resistance

Cardio 35-min-running

Cardio 31.5-min- moderate HIIT

Flexibility

Resistance

Flexibility

Resistance

Flexibility

Resistance

Cardio 31.5-min- moderate HIIT

Cardio 25 min HIIT

Flexibility

Resistance

Flexibility

Resistance

Flexibility

Resistance

Cardio 25 min HIIT

Flexibility Exercises Week 1 to 4:

#1 Alternating Toe Touches – 3 sets of 10 reps

  1. Lay down on your back and hold your arms straight above your head
  2. Raise your left legs and right arm at the same time
  3. Reach across your body and touch your toes. Bring your right arm and left leg back down. Repeat the same motion with left arm and right leg.

#2. Bird-dogs exercise – 4 sets of 10 reps

  1. Put both hands and knees on the floor. Place your arms shoulder width apart, hands directly underneath your shoulders)
  2. Simultaneously raise your right arm and left leg up and line them with the rest of your body. Keep your core tight.

#3. Elbow Stretching – 4 sets of 20 secs

  1. using your left arm push your right arm (at the forearm) down towards your shoulder
  2. add pressure to your elbow joint by trying to let your stretched arm open. Focus on the pressure in your elbow joint

#4. Assisted hamstring stretch – 3 sets of 30 secs

  1. Lie on the floor, extend your legs in front of you, loop the elastic band around your foot.
  2. Raise your leg while pulling the band towards yourself. Keep your knee straight

WEEK 1

3 sets of 10 + 60 sec between sets

Push-ups

  1. Start in a face down prone position with hands beside the shoulders and elbows pointed towards toes
  2. Lift yourself above the ground using only arms

3 sets of 10 + 60 seconds between sets

Pull-ups

  1. Grip a pull up bar with palms facing any direction
  2. Pull your bodyweight using arms and biceps until your chin is slightly above the bar

3 sets of 16 + 60 seconds between sets

Squats

  1.  Stand erect with feet shoulder width apart
  2. Push your hips back and bend knees to 90 degrees

WEEK 2

3 sets of 12 with varying weights + 90 sec between sets

Barbell Bench Press

  1. Lie down flat on the bench and grip the barbell with your hands shoulder width apart
  2. Pull the bar off the holder and extend your arms straight upwards

3 sets of 12 with 45 lb. Barbell + 60 secs between sets

Barbell Military Press

  1. Grip the barbell slightly wider than shoulder width with palms facing forward and up
  2. Push bar straight over your head

3 sets of 12 with 65 lb. Barbell + 90 secs between sets

Barbell Row

  1. Start with feet shoulder width apart and under the barbell
  2. Squat to grip the barbell with an overhand grip and pull the barbell with your forearms towards the chest

3 sets of 8 with varying weights

+ 90 secs between sets

Barbell Deadlift

  1. Start with feet shoulder width apart, squat and bend your back to grab the barbell
  2. Stand up and bring the bar up with you

3 sets of 12 with varying weights + 90 sec between sets

Barbell Squat

  1. Stand erect with shoulders under the barbell and grip the barbell with your hands slightly more than shoulder width apart
  2. Lift the barbell from the rack and push your hips back and bend knees to 90 degrees

WEEK 3

  1. Barbell Bench Press
  2. Barbell Military Press
  3. Barbell Row
  4. Barbell Squat
  5. Dumbbell Biceps Curl
  6. Dumbbell Triceps Extensions
  7. Dumbbell Shoulder Press

3 sets of 12 with varying weights + 60 seconds between sets

Dumbbell Biceps Curl

  1. Start with feet at hip width and knees slightly bent
  2. Grab dumbbell in each hand and alternatively raise each dumbbell to shoulder height

3 sets of 12 with varying weights + 60 seconds between sets

Dumbbell Triceps Extensions

  1. Start with feet shoulder with apart and a single dumbbell. Lift the dumbbell overhead using both hands
  2. Bend elbows and squeeze your triceps to lower dumbbell behind your head

3 sets of 8 with 20 lb. Dumbbells + 60 seconds between sets

Dumbbell Shoulder Press

  1. Start with a dumbbell in each hand shoulder width apart, arms facing upwards and out and slightly lower than shoulder height
  2. Squeeze shoulders and lift dumbbells upwards

WEEK 4

  1. Barbell Bench Press
  2. Dumbbell Shoulder Press
  3. One-Arm Dumbbell Row (demonstrated below)
  4. Barbell Squat
  5. Barbell Deadlift
  6. Dumbbell Biceps Curl
  7. Dumbbell Triceps Extensions

 

3 sets of 8 with 20 lb. Dumbbells + 60 seconds between sets

One-Arm Dumbbell Row

  1. Start by keeping one knee on the exercise bench and bend forward so your back is flat
  2. Lift a dumbbell to the side of your torso in the opposite hand and squeeze your back muscle and bring it to your chest

5) client vision is the most important factor when designing a progression exercise plan. Progression is necessary as the body adapts to the loads and exercise frequencies, and lessening the benefits associated with each exercise. Hence, the client must increase the intensity, frequency interval or the type of the exercises they have been prescribed. However, this must be done in a controlled manner while monitoring the client, should any complications arise, appropriate adjustments must be made.  In the first 4 weeks the progression for aerobic exercises was achieved through increasing the duration of each exercise session by 5 to 10 minutes every 1 to 2 weeks as recommended by ACSM (eq. running time was increased from 30 to 35 minutes with no change in intensity) In week 6 and 8 the duration is furthermore increased to 50 minutes per session while the frequency increases from 2-3day/week to 4 days/week in to increase the client’s oxygen consumption capacity (VO2max) and improve her cardiorespiratory fitness. The intensity is not increased until beginning of week 10, assuming the client is well adapted to the increases in duration of the exercises. In week 10 to 12 the ACSM guidelines recommend an increase of approx. 3-5% HRR every 6th session in exercise intensity. This indicates a value of 125bpm for the THR and increase in VO2max by about 5% from 50% to 55%.     The ACSM generally does not recommend progression in resistance training unless an individual has been training for at least 6 months on a regular basis. The client wishes to build endurance and increase her strength, attained through increasing load and the number of reps per each set while decreasing the rest period between sets. For endurance, the ACSM recommends a load below 70% 1RM, with a high repletion of 10-25 for 2-4 sets and 1 minute of rest between each set. In order to achieve muscular strength, it is recommended that one exercises at 60-70% 1RM, with 8-12 reps of 1-3 sets and 2-3 min rests between each set. The load was increased by 2%-10% of the client recommended 1RM after the client was able to complete two consecutive reps over the recommended reps in the last set for two successive workouts. This means that the client must increase the load by 2-5lbs for smaller muscle groups and 5-10lbs for larger muscle every month at the end of every 4-week period.

6) In terms of other measurements, waist circumference, lean body mass, as well as multiple repetition maximum testing from various joints as part of the assessment would have been helpful in designing an appropriate strength training plan.  1RM testing is not appropriate for a person with little resistance training experience, and may result in serious injury. It is important for the client to be in a stable mental state before committing to a tight regime or somewhat demanding schedule with new exercises. Psychiatric evaluation, one to one consultation with the client, and knowing more about their capacities to respond to changes may help the assessor choose a more appropriate plan for her that does not challenge her mentally, and also incorporate relaxing, and theopoetic exercises in her routine to help her with the transition.  The personal fitness evaluation can be repeated every 2 weeks to monitor the progress of the client. Therefore, the assessor has a better sense of how much they need to add to the exercise time each time for the client to receive the maximum benefit from the exercise and continues improving.

7) Self and Peer Evaluation:

Your name: Donya Eslami-Rezaei

I did this project individually, so I did not have any group members.

Evaluation Criteria

SELF EVALUATION

TEAM-MATE

NAME: N/A

Attends group meetings regularly and arrives on time.

4

N/A

Contributes meaningfully to

group discussions.

4

N/A

Completes group tasks on time.

4

N/A

Prepares work in a quality

manner.

4

N/A

Demonstrates a cooperative and supportive attitude.

4

N/A

Contributes significantly to the success of the project.

4

N/A

TOTALS

24

N/A

Feedback on team dynamics:

  1. How effectively did your group work?

I partnered with a girl from the class to complete this assignment together. We had a brief meeting at the beginning of the term to spilt the work load for background research on the assignment. However, she was not able to continue being part of this assignment, and I had to finish it independently. I believe I kept up with the calendar and tasks very well and followed the instructions very closely.

  1. Were the behaviors of any of your team members particularly valuable or detrimental to the team? Explain.

I completed the entire assignment alone. Even though my partner dropped out midway through the term, and I do not believe that the behavior of my team member was detrimental to this assignment as I was not entirely relying on the other person. I tried to get a few hours of work done every week as planned.

  1. What did you learn about working in a group from this project that you will carry into your next group experiences?

In fact, I learned a lot about working in a group from this project. After hearing the news that my partner was not going to do the assignment anymore, I was very stressed out and overwhelmed. I tried to find another partner, but everyone was already working in groups. Being in this situation taught me a lot about the fact that unfortunate circumstances may happen anytime that we may not have been prepared for. Emailing/ talking to professors and asking for help early on is important in overcoming such situations.

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