lifestyle medicine exam 2

physical activity

any bodily movement produced by skeletal muscle resulting in energy expenditure

exercise

pa that is planned and structured, repetitive body movement done to improve 1 or more components of fitness

physical fitness

a set of attributes that people have or acheive that relates to the ability to preform pa —> health or skill related

benefits of pa for adults and older adults

increase HDL, decrease LDL, decrease risk of chronic disease, increase bone density, decrease bp, increase brain activity, decrease risk of all cause mortality, decrease depression and anxiety

risks associated with exercise

cardiac- screening for disease

musculoskeletal- proper form/technique, stretching and warm-ups, prevent tears strains and fractures

psychological

psychological risks of exercise

compulsive exerciser, exercise addict, exercise bulimia

maladaptive pattern of pa that leads to significant impairment or distress as manifested by 3+ criteria: tolerance, withdrawal, intention, lack of control, time, reduction of other activities, continuing despite issues.

safe pa guidlines

• understand risks, but be confident that pa can be safe for everyone

• choose types of pa that are appropriate for their current fitness lvl

• increase pa gradually overtime to meet guidlines and health goals

• protect self by wearing appropriate gear and equipment

• be under care of health care provider if they have chronic conditions or symptoms

who needs medical clearance?

if they have cv or renal disease medical clearance is recommended

if not currently active vigorous activity is a bad idea

2018 pa guidlines- aerobic

150 min of moderate pa a week or 75 min of vigorous pa, or a combination of both, spread throughout the week. benefit up to 300 min wk of moderate intensity.

2018 pa guidlines- muscle strengthening

2 or more days a week working all major muscle groups, moderate intensity or greater, 1 set 8-12 reps, relative intensity: 1 rep max, weigth, rpe

FITT prescriptions of exercise and pa

Frequency- how much

Intensity- how hard

Time- how long

Type- how

scope of prescription: individual w/out pa- specific certification cannot prescribe specific exercise, use coach approach instead

RPE

scale of relative itensity 1(easy)- 10 (max)

exercise as medicine- application

global health initiative managed by the ACSM to make PA assessment and promotion a standard in clinical care, connecting health care with evidence-based PA resources for PA everywhere and of all abilities

PA and type 2 diabetes

primary and secondary prevention: weight management, increase insulin sensitivity (1st) , improved glycemic control (2nd), improve sleep—> poor sleep associated with t2d and overall quality of life; regular physical activity reduces risk factors and improves outcomes for individuals with type 2 diabetes

Structured interventions combining PA and modest weight loss have been shown to lower T2D risk by 58% in high-risk populations.

walking after meals- prevent blood glucose from spiking, keep insulin lvls stable

PA and CVD

primary prevention- weight management, optimizing coronary artery dilation (blood flow), reducing inflammation/reduce oxidative tissue damage, hemostatic factors: reduce risk for blood clots

secondary prevention- improve HDL, reduce TG, weight management and BP management

limit sedentary time

aerobic pa unkown

pa and obesity

decrease visceral adiposity- preventing weight regain, improve muscle mass/prevent muscle loss that occurs with kcal restriction

a systemic review found that aerobic training produces greater weight loss than resistance training

Observational studies and clinical trials demonstrate that individuals maintain at least 250 min od pa a week are more likely to sustain weight loss

alzheimers disease

a form of dementia, genetic but lifestyle factors can reduce it

prevention- pa, diet, decrease alcohol consumption, basically all pillars

no way to reverse disease

pa and alzheimers

improvement in reaction time, motor function, and cognitive processing speed

the positive impact of long term exercise training by delaying onset of physiological memory loss suggests the effectiveness of exercise as a preventative strategy against age-related memory loss and neurodegeneration

positive results in the delay of brain aging- 1 yr of moderate intensity exercise (40 min/ 3 days wk) increases the size of the hippocampus, increasing spatial memory in healthy healthy older individuals

Resistance training has positive effects on measurements related to the detection of cognitive impairment and executive function, but no effect on working memory measurement.

pa and hypertension

primary prevention- reduce inflimmation and oxidative stress, weight management, decrease arterial stiffness

secondary prevention- reduce vasoconstrict, improvements in how body handles sodium, pa aids in stress management

pa can be and adjunctive treatment for hypertension

pa and stroke

The use of PA as a therapeutic strategy to maximize functional recovery in the rehabilitation of stroke survivors

Observational studies have found an inverse association between PA and stroke risk, with recent reviews estimating that pa is associated with 25-30% risk reduction for stroke

liesure time pa to be productive against ischemic stroke

mediating effect = reduction in bp

pa to reduce stroke recurrence

pt and ot post stroke- balance, mobility, ADL, gait

pa and cholesterol

reduction in total cholesterol considered gold standard in preventativ CV medicine

increased/vigerous intensity structure normally associated with aerobic exercise has better impact on triglycerides and LDL than moderate lvl of pa

HDL is most likely to improve of all in lipid profile (linear relationship)

low to mod intensity resistance training results in greater benefit to lipid profile than high intensity

pa and cancer

hormonal regulation, improve digestion, reduce inflimmation, improve insulin sensitivity

reduce risk of bladder, breast, colon, endometrial, esophegeal, adenocarcinoma, renal, and gastric cancer

pa and anxiety

self efficacy, distraction, anxiety sensitivity, physiological mechanisms

primary, secondary and tertiary prevention

hippocampus and stress regulation

mediating for effect of anxiety and chronic disease risk

evidence for exercise based therapies for anxiety and PTSD

pa and depression

alleviate symptoms of depression

aerobic training program (moderate) efficacious

benefits of exercise may be long lasting- 12 weeks pa intervention, still had same reduction in symptoms at 12 month follow up

no difference between weight lifting and aerobic group among middle aged women population, both affective and reducing symptoms

pa and metabolic syndrom

all the evidence that we talked about obesity, t2d, cholesterol, CVD

aerobic training most effective in prevention and management- energy expenditure

resistance training important for lean mass- important to reduce fat mass amd increrase metabolism

high intensity not typically recommended

the importance of reducing sedentary time overall

dietary guidlines for americans

goal- evidence based advice throughout life, meet nutrient needs, prevent chronic disease, promote health

foundation for- developing health policies and programs, nutrition education; federal, local gov, schools

target audience- policy makers, nutrition educators, and health professionals, update every 5 yrs, USDA and HHS oversee

development process of DGA

identify topics and questions

appoint and advisory committee

review scientific evidence

develop the guidlines

implement

2025-2030 dietary guidlines

The focus- eat real food

2025-2030 dietary guidelines key points

eat the right amount for you

prioritize protein at each meal

consume dairy

eat fruit and vegetable throughout the meal

incorporate healthy fat

focus on whole grain

limit highly processed foods, added sugar, refined carbs

limit alcoholic beverages

clarifications needed for DGAs

visual changes and educational implications

protein: more is not always better

mixed messaging on saturated fats

applying guidlines responsibly

treat guidlines as framework

emphasize evidence based principles

tailor recommendations to cultural traditions

promote practical strategies like meal planning

use visuals as support

diet vs. eating pattern

A diet refers to the specific foods and beverages consumed, whereas an eating pattern encompasses the overall combination and frequency of those foods and drinks over time, reflecting an individual's lifestyle.

cardiovascular disease decrease risk

fruit and vegetable intake

healthful plant based diet (whole grains, F/V, nuts, legumes, oils(unsat fat), tea/coffee

soluble fiber

polyunsaturated fats (lower LDL) omega 3 fats (improve tg)

reduced sodium (improve bp)

cardiovascular disease increase risk

processed meets

unprocessed red meats

added sugars

high sat fat intake

refined carbs

type 2 diabetes decrease risk

diet high in fruit, vegetable, lean meat, whole grains

choosing polyunsaturated fat sources

whole grains/fiber

type 2 diabetes increase risk

processed meats

red meats

sugar sweetened beverages

ADA healthy eating recommendation

Focus on nutrient-dense foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting added sugars and saturated fats.

certain cancers decrease risk

fruit and vegetable intake

whole grains

certain cancer increase risk

processed meats and red meats (carcogenic), alcohol consumption

AICR healthy eating recommendations

foods that are high nutrients in amounts that help you get to and stay at a healthy body weight

a variety of vegetables- green, red, orange, fiber rich legumes

fruits

does not include: red and processed meats, sugary beverages, high processed foods

DASH diet

fruits and vegetables (4-5 cups)

plant and lean proteins (4-4x wk)

low fat dairy (2-3 ups/day)

emphasis on potassium, calcium, and magnesium

decrease intake of- saturated fat, sodium, added sugars

mediterranean diet

high intake- fruit, vegetable, whole grains, beans, lentiles, nuts, olive oil

moderate intake- fish, poultry, cheese/yogurt, wine

little intake- red meat, sweets

MIND diet: mediterranean and dash intervention for neurogenerative delay

whole grains, dark leafy greens, berries, nuts, beans/legumes, vegetables, PUFA

reduce- fish, chicken, cheese

limit- red meat, sweets, fried food, saturated fat

implicit bias

unconcious attitude and stereotype that affect our understanding of patients

becomes a health threat, desire to intervene may decrease

prevent- train providers and bring awareness to bias

FAD diet “quick fix”

signs to be aware of: promising weight loss, eliminating food or groups, severe calorie restriction

obesity

risk factor for many chronic diseases and health problems

modest weight loss can be beneficial when necessary for health and well being

do not focus on weight #

focus on cholesterol (LDL & HDL), energy lvl, feeling mobility and activity is easier

factors that effect weight loss

family history, psychological factors, hormonal (satiety, cortosol, hyperthyroidism), environment, metabolic rate (age, saturation, muscle mass)

talking to clients about weight

encourage health without focusing on weight

emphasis on other positive health outcomes from behavior change, refer to others if needed

intuitive eating

a no diet, mind/body approachthat promotes listening to internal hunger and fullness cues, fostering a healthy relationship with food.

intuitive eating principles

1. reject the diet mentality

2. honor your hunger

3. make peace with food

4. challenge the food police

5. discover the satisfaction factor

6. feel your fullness

7. cope with your emotions with kindness

8. respect your body

9. movement- feel the difference

10. honor your health- gentle nutrition

gentle nutrition

external health knowledge + internal cravings, desires, bodys cues = satisfying our taste and preferences and honoring our health.

5 A’s in coaching

asses, advise, agree, assist, arrange

asses

readiness to change, health history biomarkers

advice

sharing knowledge, see clients level of awareness, share helpful patterns

agree

agree to change, create a plan together

assist

putting plan into action, how to make a change

arrange

arrange time for follow up or other provider

sleep quality

persons satisfaction with all aspects of the sleep experience. important contributor to sleep related health outcomes

sleep duration

amount of time a person sleeps. timing, intensity, and duration regulated by homeostasis and circadian timing.

sleep latency

duration of time from turning the light off to falling asleep , usually < 20 minutes

sleep efficacy

ratio of total sleep time compared to total time in bed. 85% normal >90% very good

wake time after sleep onset

used to determine amount of time a person spends awake from time they fall asleep to time they awaken 5% young adults, 15% older adults