ITEMS IN FPM WITH MESH TERM:
Primary Care Interventions to Prevent Low Back Pain in Adults: Recommendation Statement - U.S. Preventive Services Task Force
Exercise is an Effective Intervention in Overweight and Obese Patients - Cochrane for Clinicians
Alpha-glucosidase Inhibitors May Reduce the Risk of Type 2 Diabetes - Cochrane for Clinicians
The Problem With Diet and Exercise Plans - Opinion
ABSTRACT: Few older adults in the United States achieve the minimum recommended amount of physical activity. Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons. In 2008, The U.S. Department of Health and Human Services released guidelines to provide information and guidance on the amount of physical activity recommended to maintain health and fitness. For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance. Generally healthy adults without chronic health conditions do not need to consult with a physician before starting an exercise regimen.
Promoting Physical Activity in Older Adults - Editorials
ABSTRACT: Coronary artery disease is the leading cause of mortality in the United States. In patients who have had a myocardial infarction or revascularization procedure, secondary prevention of coronary artery disease by comprehensive risk factor modification reduces mortality, decreases subsequent cardiac events, and improves quality of life. Options for secondary prevention include medical therapy and surgical revascularization in the form of coronary artery bypass grafting or percutaneous coronary intervention. Medical therapy focuses on comprehensive risk factor modification. Therapeutic lifestyle changes (including weight management, physical activity, tobacco cessation, and dietary modification) improve cardiac risk factors and are universally recommended by evidence-based guidelines. Treatment of hypertension and dyslipidemia reduces morbidity and mortality. Recommendations for persons with diabetes mellitus generally encourage glucose control, but current evidence has not shown reductions in mortality with intensive glucose management. Aspirin, angiotensin-converting enzyme inhibitors, and beta blockers reduce recurrent cardiac events in patients after myocardial infarction. Surgical revascularization by coronary artery bypass grafting is recommended for those with significant left main coronary artery stenosis, significant stenosis of the proximal left anterior descending artery, multivessel coronary disease, or disabling angina. Percutaneous coronary intervention may be considered in select patients with objective evidence of ischemia demonstrated by noninvasive testing.
Pelvic Organ Prolapse - Article
ABSTRACT: Pelvic organ prolapse, or genital prolapse, is the descent of one or more of the pelvic structures (bladder, uterus, vagina) from the normal anatomic location toward or through the vaginal opening. Women of all ages may be affected, although pelvic organ prolapse is more common in older women. The cause is a loss of pelvic support from multiple factors, including direct injury to the levator ani, as well as neurologic injury from stretching of the pudendal nerves that may occur with vaginal childbirth. Previous hysterectomy for pelvic organ prolapse; ethnicity; and an increase in intra-abdominal pressure from chronic coughing, straining with constipation, or repeated heavy lifting may contribute. Most patients with pelvic organ prolapse are asymptomatic. A sense of bulging or protrusion in the vagina is the most specific symptom. Evaluation includes a systematic pelvic examination. Management options for women with symptomatic prolapse include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. Pessary use should be considered before surgery in women who have symptomatic prolapse. Most women can be fitted with a pessary regardless of the stage or site of predominant prolapse. Surgical procedures are obliterative or reconstructive.
ABSTRACT: Dietary factors that influence lipid levels include modification of nutritional components, consumption of specific foods, use of food additives and supplements, and major dietary approaches. The most beneficial changes result from reducing intake of saturated and trans fats; increasing intake of polyunsaturated and monounsaturated fats; fortifying foods with plant stanols or sterols; isocalorically adding tree nuts to the diet; consuming one or two alcoholic drinks per day; and adopting a Portfolio, Mediterranean, low-carbohydrate, or low-fat diet. Smaller but still beneficial effects result from reducing intake of dietary cholesterol, increasing intake of soluble fiber and soy protein, and eating fatty marine fish or taking marine-derived omega-3 fatty acid supplements. Red yeast rice supplements have effects similar to those of statin medications and are better tolerated in some patients. Regular aerobic exercise has beneficial effects on lipid levels, particularly if performed for at least 120 minutes per week. Brief physician counseling will have relatively small effects on unselected patients, so efforts should be concentrated on patients who are motivated and ready to make lifestyle changes.
Weight Loss Maintenance - Article
ABSTRACT: Successful long-term weight loss maintenance can be achieved by various means. A combination of dietary and physical activity interventions, along with one or more behavioral approaches, has proven successful in some persons, as documented by the National Weight Control Registry, but is limited by adherence to a consistent weight loss regimen. Successful approaches to weight loss maintenance include consulting with a physician, nutritionist, or another support source; adhering to a stable diet with a limited variety of food; monitoring weight; eating breakfast; and exercising regularly. Long-term pharmacologic treatments for weight loss maintenance have been studied and were found to have modest success, with some weight regain typically reported. Sibutramine and orlistat are the two medications approved by the U.S. Food and Drug Administration with the potential to help patients achieve long-term weight loss maintenance. Bariatric surgery is another modality for accomplishing successful long-term weight loss maintenance in patients with morbid or complicated obesity. Its success is due in large part to better weight loss outcomes, more successful long-term weight loss maintenance, and remission of comorbid medical conditions.