Implementing Lifestyle Interventions: The Two Es Eating and Exercise Hour 2

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Implementing Lifestyle Interventions The Two Es
Eating and Exercise(Hour 2)

• Thomas L. Lenz, Pharm.D.
• Michael S. Monaghan, Pharm.D.
• Creighton University
• Eleventh Annual Prairie Health Ventures
• Membership Conference
• May 21, 2008
• Lincoln, Nebraska

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Objectives

• Apply the basic components of nutrition and
  physical activity to sample case patients.
• Construct a wellness plan for a sample case
  patient with hypertension, dyslipidemia, diabetes
  mellitus, obesity, and metabolic syndrome.

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Components of a Patient-Centered Wellness Plan

• Nutrition (Eating Plan)
• Physical Activity
• Weight Control
• Tobacco Cessation (if needed)
• Health Behavior Change Strategies

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Case Patient-Nutrition
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Compare to Guidelines
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Food Diary

• See attached Food Diary for Case Pt LL

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Caloric Intake Analysis(LL average intake 3422
kcal/d)
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Nutritional Goals for Case Patient LL

• Short-Term (First 2 weeks)
• Assess barriers to healthful eating and design
  strategies to overcome
• Decrease caloric intake by 500 kcal/day
• Medium range (2 weeks to 6 months)
• Implement suggested nutritional modifications
• See next slide
• Long-Term (gt6 months)
• Adhere to new eating plan
• Decrease risk for CHD

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Suggested Nutritional Modifications for Case
Patient LL

• ? 500 kcal/d
• ? tot. fat by 10
• ? sat. fat by 3
• ? fast food to 3-4x/wk
• ? alcohol to 1 drink/d
• ? dietary chol. Intake

• ? fruit/veg to 5/d
• ? fiber by 10 gm/d
• ? whole grains
• Try oatmeal or cold cereal for breakfast

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Case Patient-Physical Activity
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Compare to Guidelines

• Moderate intensity aerobic physical activity (ex.
  walking) for a minimum of 30 minutes on 5 days
  each week or vigorous intensity aerobic physical
  activity (ex. jogging) for a minimum of 20
  minutes on 3 days each week.
• LL does not participate in an exercise program
  and has limited activities of daily living
• Traveling salesman
• Average steps/day 2558

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Physical Activity Log

• See attached Physical Activity Log for Case Pt LL

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Physical Activity Goals for Case Patient LL

• Short-Term (4 weeks)
• Increase daily pedometer activity (other than
  exercise) by 25 from baseline
• Goal 3200 steps/d (does not include exercise)
• Begin 10-30 minutes of moderate intensity
  exercise 2-3x/wk initially working to 3-5x/wk
• Long-Term (6 months)
• 30-60 minutes of moderate intensity exercise
  3-5x/wk
• Increase daily pedometer activity (other than
  exercise) by 50 from baseline
• Goal 3840 steps/d (does not include exercise)
• ? risk factors for CHD

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Exercise Program
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Reassessment/Follow-up

• Both nutrition and physical activity
• In general Assess progress every other week for
  the first 4 weeks, then every other month for the
  6 months, then 2-3 times per year thereafter.
• Follow-up should be patient specific

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Questions?