American Journal of Lifestyle Medicine current issue

From the Publisher

Epstein, R. — 2008-07-17

The Risk in Exercise Training

Foster, C., Porcari, J. P., Battista, R. A., Udermann, B., Wright, G., Lucia, A. — 2008-07-17

Although exercise training is unequivocally of benefit relative to the risk of cardiovascular disease, there is a definable risk of complications during exercise training. In younger individuals, the risk is almost exclusively related to the presence of congenital abnormalities, whereas in older (~40 years) individuals, the risk is largely related to atherosclerotic disease. In both groups, the risk of the underlying pathology leading to clinical presentation is increased by higher intensity exercise. In older individuals, preexercise screening is of potential benefit but is not generally well done. Exercise prescription should favor lower intensity exercise during the early weeks of an exercise program. Subjective methods, which do not rely on the results of an exercise test, including the Rating of Perceived Exertion and the Talk Test, are to be recommended because preliminary exercise testing is performed inconsistently. There are inadequate data regarding the spontaneous exercise training intensity in both healthy individuals and patients.

Exercise Nutrition for Adults Older Than 40 Years

Melanson, K. J. — 2008-07-17

In general, nutrient needs do not change much for older individuals who exercise regularly yet moderately for the purposes of chronic disease risk reduction. Overall diets should reflect those recommended by such authorities as the American Dietetic, Heart, and Diabetes Associations, with special attention to ensuring ample protein and antioxidant intakes. Proper timing and amounts of nutrients consumed before physical activity should be practiced, to ensure adequate fueling while minimizing gastrointestinal discomfort. Consuming energy during activities lasting less than 90 minutes is unnecessary if the individual is well fueled before starting. After exercise, consuming a blend of carbohydrate and protein is often advocated for glycogen resynthesis and muscle protein repair, but the importance of this for those not engaging in regular vigorous activity remains to be clarified. Adequate hydration is critical to physical performance and health during exercise, particularly in the heat. Because thirst might not sufficiently reflect fluid needs of older individuals, this matter deserves special attention. Sports drinks are generally not necessary for events lasting less than 60 minutes and may provide unwanted calories, sugars, and sodium for older exercisers. Naturally occurring sources of electrolytes may be preferable.

Exercise for Primary Care

Terre, L. — 2008-07-17

This review discusses physical activity counseling in primary care, including evidence-based perspectives on optimizing the risk-benefit ratio for the majority of patients who are not physically fit.

Do Supplements Benefit Exercise?

Kuczmarski, K. — 2008-07-17

It is a known fact that exercise will have beneficial effects on one's health. Nutritional supplementation is on the rise, resulting in a billion-dollar industry. However, because these medications are not regulated by the Food and Drug Administration, it is difficult for the public to determine what is safe and effective. Health care providers have to be aware of this lack of knowledge and educate their patients on which supplements are beneficial and which may be harmful to their health.

Treatment of Overweight and Obesity in Primary Care Practice: Current Evidence and Future Directions

Simkin-Silverman, L. R., Conroy, M. B., King, W. C. — 2008-07-17

Obesity is commonly encountered in primary care practice. Yet many patients who are overweight or obese are not identified, and those who are do not receive adequate treatment or referral. For many primary care providers, barriers to addressing weight control with patients include lack of time, limited training and resources, patient readiness to change, and inadequate insurance reimbursement. Studies that have evaluated weight control interventions in primary care vary tremendously in design and methodology. Most studies have focused on primary care provider training or practice-level interventions, or they have combined physician and nutrition counseling. Although results from these studies are encouraging, more randomized clinical trials are needed in this area. Future avenues for study include electronic health records, computer-tailored interventions, and translation of efficacious weight control interventions into primary care settings.

Appetite-Related Gut Peptides in Obesity and Binge Eating Disorder

Geliebter, A., Ochner, C. N., Aviram-Friedman, R. — 2008-07-17

The worldwide increase in obesity prevalence is a result of positive energy balance, with energy intake exceeding expenditure. The eating behavior in obesity ranges from mild passive overconsumption to excessive overeating with loss of control observed in binge eating disorder (BED). The signaling systems that underlie appetite control in BED are complex and, at this point, not well understood. The present review highlights the current knowledge of key components of the gut peptide system and examines evidence of defects in signaling that differentiate obese binge eaters from obese non—binge eaters. The signaling network underlying hunger, satiety, and metabolic status includes leptin and insulin from energy stores and cholecystokinin, glucagon-like peptide-1, peptide YY(3-36), and ghrelin from the gastrointestinal tract. Of the many gastrointestinal peptides, ghrelin is the only established appetite-stimulating one, whereas cholecystokinin, glucagon-like peptide-1, and peptide YY(3-36) promote satiety. Adipose tissue provides hormonal signals via leptin and insulin to the brain about energy stores and likely from adiponectin and resistin. Binge eating has been related to a dysfunction in the ghrelin signaling system. Moreover, the larger gastric capacity observed in BED may further reduce satiety signals and contribute to overeating.

A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents

O'Neil, C. E., Nicklas, T. A. — 2008-07-17

Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.

Cardiovascular Risk: Exercise Good Judgment

McInnis, K. — 2008-07-17

Calendar

2008-07-17