Here are some suggestions for long term planning:- Continue monitoring weight and PA levels to prevent regain- Gradually progress PA intensity and duration as tolerated by joints - Consider low impact options like swimming, water aerobics, elliptical- Add strength training 2-3x/week focusing on lower body- Work on mobility and balance exercises to prevent falls- Set new PA and weight goals to stay motivated- Schedule periodic check-ins for medication adjustments as needed- Consider joining a walking/hiking group for social support- Consult orthopedist annually to monitor joint health long term- Transition to lifestyle PA like doubles tennis if joints allow- Maintain regular contact with healthcare team for ongoing support
Obesity ,complication,metabolic syndrome by dr.Tasnim
Similaire à Here are some suggestions for long term planning:- Continue monitoring weight and PA levels to prevent regain- Gradually progress PA intensity and duration as tolerated by joints - Consider low impact options like swimming, water aerobics, elliptical- Add strength training 2-3x/week focusing on lower body- Work on mobility and balance exercises to prevent falls- Set new PA and weight goals to stay motivated- Schedule periodic check-ins for medication adjustments as needed- Consider joining a walking/hiking group for social support- Consult orthopedist annually to monitor joint health long term- Transition to lifestyle PA like doubles tennis if joints allow- Maintain regular contact with healthcare team for ongoing support
Similaire à Here are some suggestions for long term planning:- Continue monitoring weight and PA levels to prevent regain- Gradually progress PA intensity and duration as tolerated by joints - Consider low impact options like swimming, water aerobics, elliptical- Add strength training 2-3x/week focusing on lower body- Work on mobility and balance exercises to prevent falls- Set new PA and weight goals to stay motivated- Schedule periodic check-ins for medication adjustments as needed- Consider joining a walking/hiking group for social support- Consult orthopedist annually to monitor joint health long term- Transition to lifestyle PA like doubles tennis if joints allow- Maintain regular contact with healthcare team for ongoing support (20)
Here are some suggestions for long term planning:- Continue monitoring weight and PA levels to prevent regain- Gradually progress PA intensity and duration as tolerated by joints - Consider low impact options like swimming, water aerobics, elliptical- Add strength training 2-3x/week focusing on lower body- Work on mobility and balance exercises to prevent falls- Set new PA and weight goals to stay motivated- Schedule periodic check-ins for medication adjustments as needed- Consider joining a walking/hiking group for social support- Consult orthopedist annually to monitor joint health long term- Transition to lifestyle PA like doubles tennis if joints allow- Maintain regular contact with healthcare team for ongoing support
1. Deborah Bade Horn DO MPH FASBP
ASBP Board of Trustees, Vice-President
Medical Director, Center for Obesity Medicine & Metabolic Performance
Asst. Professor, University of Texas Medical School
Physical Activity Prescription:
Assessment & treatment
to improve
functional & metabolic capacity.
American Society of Bariatric Physicians®
3. Road Map
“Results Typical”:
Review the Guidelines for Physical Activity
Translate this into success for the patient with obesity
Case Based Application:
Discuss the provider approach & areas for improved
treatment
Creating an individualized PA prescription
Reducing the risks involved with PA
Interactive Delegate Experience
4. 5 Most Common Recommendations for PA
A. Wait until you are at your goal weight. Right
now just focus on your diet
B. Walk 30 minutes per day 5 days per week
C. Take the stairs and Park your car farther away
D. Join a Gym
E. No Pain, No Gain
What’s your PA Rx for a patient with obesity?
5. How Much Physical Activity is Enough?
General Health Benefit
Moderate aerobic exercise
150min/wk (About 30 minutes
5x/wk) + Strength Training
Prevent Weight Gain &
Active Weight Loss
150-250 minutes per week
150-300 minutes per week
Prevention of Wt Regain
200-300 minutes per week
300-420 minutes per week Donnelly J. Am College Sports Med. 2009.
US Health and Human Services. 2008.
9. International Guidelines
Ireland – To avoid gaining
weight…at least 350kcal per
day in PA. 60 min walking.
Canadian – Similar #’s for
“Health benefit” No specific
recs for the Obese population
UK Dept of Health 60-90min/d
to prevent wt regain (2004)
July 2011 rec new guidelines
needed.
Denmark – WHO guidelines
300min/wk for additional
benefit.
Germany – EU guidelines
referenced at 150 min.
Belgium, France, Finland all
refer to CDC website on
search.
Bahrain – Has Strategy, but
no guidelines
India – New Recs
13. Look AHEAD Year 4: Success & Physical Activity
Wadden TA. Obesity. 2011.
4-5 Mets for
60-70min/d
Or
Approx
420min/wk
14. 17 Observational Studies
3.62 kg greater mean wt loss
2.3x greater odds of
unsuccessful wt loss if PA
after surgery
PA repeatedly an
independent predictor of
weight loss
Next Steps
FFM preservation
– (RYGB 31%, BPD 26%,
Band 18% loss of FFM)
Self reported
questionnaires
RCTs needed
Optimal Rx unknown*
Excellent Review: King and
Bond. Exerc Sport Sci Rev., Vol
41(1) 2013
15. Self reported PA 5x from pre-op to post-op
RT3 – non-significant decline in post-op PA
> 150min/wk MVPA compliance: Self report 55%, RT3 5%
16. Physical Activity Recs & Bariatric Surgery
Pre-op
ASMBS: Mild exercise
20min/d, 3-4d/wk
AHA: Low-Moderate intensity
PA at least 20 min/d,
3-4d/wk
Post-op
ASBMS/TOS/AACE:
At least 30 min/d
IOM, HHS, ACSM, IASO: All
agree that 150min/week is
insufficient for the prevention
of weight regain.
250-420min/wk
60-90min/day
ASMBS/ACSM expert panel
assembled to develop specific
pre/post operative recommendations.
http://s3.amazonaws.com/publicASMBS/GuidleliStatesments/guildelines/asbs_bspc.pdfnes
Poirer et al. Circ 2011, Mechanick et al. Obesity 2009
Donnelly Med Sci Sport Ex 2009, IOM 2002
Saris et al Obes Review 2003,
http://www.health..gov/paguidelines/pdf/paguide.pdf
17. Physical Activity / Exercise History
Historical benefit of exercise in their weight loss or weight
maintenance?
Past PA/Exercise participation
Current and favorite PA/Exercise
Previous and current barriers to PA/Exercise
or
18. Basic Physical Activity Rx: FITTE
Frequency
Intensity
Time
Type
Enjoyment
This is NOT the beginning.
This is the End!
20. Readiness Rulers
Why are you a _____
and not at a lower
number?
What would it take to
get you from a ___ to
the next higher
number?
Adapted from Miller, W. R., & Rollnick, S. (2002).
Motivational interviewing: Preparing people for change. Public domain.
31. Patient Profile
66 year old, female
Weight 189.5 kg (416.8)
BMI 59.8
WC 64in
Architect
Single, 1 adult child
Q: Why does the patient want to lose weight?
A: Needs Bilateral Total Knee Replacement
32. Weight & Physical Activity History
Max Weight 192.kg (424lbs)
Onset: >15 yrs ago
Regained 100lbs since last weight loss effort
Repeated rebound weight regain
Eats due to stress, extensive snacking, & eating out
Ongoing struggle with PA & bilateral knee pain 2nd to OA.
Previously a Tennis Pro, preferred activity
No PA at time of admission
Very motivated by need for knee replacements.
Low confidence due to pain.
33. Past Medical History
NIDDM >10 years
Severe Bilateral Knee DJD
Depression/Anxiety
Sitagliptin 100mg
Pioglitazone 45mg
Bupropion-XL 300mg
Diclofenac, gabapentin,
oxycodone, propoxyphene
both combined with
acetaminophen.
Medications
34. Physical Exam
BP 126/68
Ht. = 70in, Wt. = 189.5
kg (416.8 lbs)
BMI = 59.8 WC = 64in
PE within normal limits
except as noted below.
Balance: Unable to
complete tandem gate
Utilizing walker
intermittently
Msktl: Decreased ROM
in shoulders, back, hips,
and knees
R knee: no crepitus,
tenderness or
inflammation
Phys. Therapy – initially
declined by patient
36. Sept 8, 2011
None, Ambulating with walker for long distances.
ADLs only
X
10/10 2/10
The Starting Point…
Patient Described Goals:
– Accelerate Weight Loss
– Improve conditioning in preparation for bilateral TKR
37. CVD Risk Factors
Age
Diabetes
Overweight
Sedentary Lifestyle
Any additional
diagnostic testing
or physical
assessment?
38. Recommendations for Stress Testing Prior to Exercise
Risk Stratification
– Low Risk: Asymptomatic and ≤1 CVD Risk Factor
– Moderate Risk: Asymptomatic and ≥ 2 CVD risk factors
– High Risk: Known cardiovascular, pulmonary or metabolic disease or
major signs of disease
Alternative Guidelines:
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in
Asymptomatic Adults.
Thompson WR, Ed. ACSM’s Guidelines for Exercise Testing & Prescription. 2010.
Greenland P. J Am Coll Cardiol. 2010.
39. Age
• Men ≥ 45 yrs
• Women ≥ 55 yrs
Smoking
• Smoker
• Quit < 6 mo ago
Sedentary
• < 30 min of mod. exercise on
at least 3 d/wk for previous 3
mo.
Obesity
• BMI ≥ 30
• WC > 40in men >35in women
HTN
• Systolic ≥ 140 and/or
• Diastolic ≥ 90
• Antihypertensive Meds
Dyslipidemia
• LDL ≥ 130
• HDL < 40
• Lipid Lowering Meds
PreDM
• Fasting Glucose ≥ 100
• Abnormal IGT
HDL
• ≥ 60
• Negative Risk Factor
Risk Factor Thresholds
Thompson WR, Ed. ACSM’s Guidelines for Exercise Testing & Prescription. 2010.
40. Stress Testing Based on Risk Stratification
Risk
Low Risk
Mod Ex No
Vig Ex No
Intermediate
Risk
Mod Ex No
Vig Ex Yes
High Risk
Mod Ex Yes
Vig Ex Yes
Thompson WR, Ed. ACSM’s Guidelines for Exercise Testing & Prescription. 2010.
41. What are the key components to consider in your
physical activity prescription?
Let’s Write It!
53. Deborah Bade Horn DO MPH FASBP
ASBP Board of Trustees, Vice-President
Medical Director,
UT Center for Obesity Medicine and Metabolic Performance
(COMMP)
Asst. Professor, University of Texas Medical School
debbiebhorn@yahoo.com
American Society of Bariatric Physicians®