Weigh patients at every yearly visit and if their weight is up, even a little, get them on a daily exercise and weight loss program. It's easier to lose 2 pounds 50 times than 100 pounds once.

Paul D. Thompson, MD

Exercise training is one of the best treatments for claudication. The best results occur when patients walk to intolerable pain, rest, then walk again.¹ We ask patients to buy canes that fold out into chairs, which are called cane chairs. With these devices they always have a seat with them. These chairs can be found on the Web by searching for "cane chair."

Reference

1. Thompson PD. Exercise prescription and proscription for patients with coronary artery disease. Circulation. 2005;112:2354-2363.

Paul D. Thompson, MD

The energy consumed during such activities as walking depends primarily on body weight and the distance that weight is moved. Speed matters because it affects the efficiency of energy utilization, but weight and distance are most important. That is one reason why exercise such as walking is so useful in helping patients lose weight.

Overweight people use more energy walking the same distance than lean people. It is a perfect example of making lemonade from lemons, or using patients’ obesity to increase the energy expenditure of the exercise by having them walk daily.

Paul D. Thompson, MD

The American College of Sports Medicine (ACSM) and the Centers for Disease Control and Prevention (CDC) recommend that people perform moderately vigorous exercise, like brisk walking, for at least 30 minutes on most, if not all, days of the week.¹ More exercise is better, especially for weight control, but this recommendation of 30 minutes daily of brisk walking is a wonderful one for most reasonably healthy patients.

Paul D. Thompson, MD

Reference

1. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407.

Some of the beneficial effects of exercise on serum triglyceride levels, blood pressure, and glucose levels are acute effects of recent exercise. For example, a single vigorous exercise session can lower systolic blood pressure for up to 12 hours. Exercise also lowers triglyceride and glucose levels the day after exertion, possibly because exercise consumes intramuscular energy stores, which must be replaced. Consequently, exercise can be used as primary therapy for these risk factors when they are mild and should be included as adjunctive therapy for severe abnormalities.¹

Paul D. Thompson, MD

Reference

1. Thompson PD, Crouse SF, Goodpaster B, Kelley D, Moyna N, Pescatello L. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33:S438-S445.

Fewer than 50% of obese children older than 6 years “outgrow” their obesity; for older children (10 to 14 years) and adolescents, the likelihood of outgrowing obesity may be just 20% or lower.¹ Medical problems associated with obesity, including diabetes, can also begin during childhood. Screening for diabetes in children at risk should begin when the child is first seen by a physician and should be repeated every 2 years. The screening may include measurement of hemoglobin A_1c, fasting glucose, and 2-hour postprandial glucose.

Pamela Kushner, MA, MD, FAAFP

Reference

1. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869-873.

At every visit of a patient with diabetes who smokes, emphasize how important it is to quit smoking. It is essential for patients to recognize how vital it is for the management of their disease to stop this atherogenic process. Setting a quit date plants the seed that will grow into this realization.

Pamela Kushner, MA, MD, FAAFP

Although the importance of a healthy diet should always be emphasized, dietary measures alone are often not enough to control cholesterol, even in the most compliant patient. The liver actually makes about two thirds of the cholesterol in the body. It is important for patients with diabetes to know that by controlling lipids, they can reduce their risk for cardiovascular complications by 20% to 50%.

Pamela Kushner, MA, MD, FAAFP

Heart disease and stroke account for about 65% of deaths of people with diabetes. However, only one third of people with diabetes are aware of their increased risk for cardiovascular disease.¹ Therefore, I always ask patients with diabetes to tell me how they think the disease affects their risk for atherosclerosis.

Pamela Kushner, MA, MD, FAAFP

Reference

1. American Diabetes Association/American College of Cardiology Diabetic dyslipidemia. Diabetes & Cardiovascular Disease Review. Issue 3. Available at: www.diabetes.org/uedocuments/ADACardioReview3.pdf. Accessed November 14, 2005.

Patients should be encouraged to fill a multi-day pill box with their long-term medications weekly and to place refill orders several days before the last dose (within the range permitted by individual pharmacies). This will avoid emergency lapses in medication availability.

Keith C. Ferdinand, MD, FACC

Clinicians should encourage lifestyle modification as much for emotional well-being as for factor control, since personal stress after a disaster may lead to excessive eating, especially of calorie-rich "comfort food," excessive alcohol intake, and physical inactivity related to intense fatigue or loss of energy in the post-traumatic state.

Keith C. Ferdinand, MD, FACC