Log in
HomeClass Notes1,200,000AU40,000

NUTR1023 Lecture Notes - Lecture 4: Metformin, Diabetes Mellitus Type 1, Systematic Review

106 views5 pages
amethystmule965
29 May 2018
School
UQ
Department
Nutrition
Course
NUTR1023
Professor
Michael Leveritt

For unlimited access to Class Notes, a Class+ subscription is required.

Module 2 –lecture 4
1. Watch the video Physical Activity and Cardiovascular Disease
and then read pages 14-16 of the Physical Activity Guidelines
Evidence Report before completing the following activities:
Key component of CVD is atherosclosis; a narrowing of arteries due to the build up of
plaque in the vessel walls due to oxidation within blood.
Risk factors:
- Low HDL
- High LDL
- High triglycerides
- High blood pressure
What types of studies are mostly used as evidence for the benefit of physical activity in
reducing the risk of cardiovascular disease? Describe the strengths and limitations of these
types of studies.
RCT
BENEFITS
- Controls effect of one specific
variable
- Can randomise participants
- Less bias
LIMITATIONS
- Unethical
- Practicality (expenses and time
limitations)
List the biological mechanisms through which physical activity is likely to cause a reduction
in the risk of cardiovascular disease.
- Decrease blood pressure
- Decrease body fat and waste circumference
- Decrease blood glucose
- Decrease triglycerides
- Increase HDL cholesterol
- Increase maximal oxygen consumption
- Increase sleep quality and duration
Physical activity causes a 20-30% reduction in the risk of death
25- 30% reduction in risk of stroke
5% reduction in blood pressure
Explain how the risk of cardiovascular disease changes with increasing amounts of physical
activity.
Dose – response relationship (health benefits around certain physical activity, but can
plateau at other levels).
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-2 of the document.
Unlock all 5 pages and 3 million more documents.

Already have an account? Log in
2. Watch the video Physical Activity and Diabetes and then read
pages 17-20 of the Physical Activity Guidelines Evidence Report
and the Diabetes Prevention study by Knowler et al (2002)
before completing the following activities:
Diabetes effects over 1 million Australians, 85-90% are T2 diabetes (insulin insensitivity)
What types of studies show a benefit of physical activity in reducing the risk of developing
type 2 diabetes? Comment on the strength of this evidence.
Cohort study: risk of T2 diabetes decreases as physical activity increases
- Long term
- Data rich
- Not much info available because T2 diabetes is new in research
RCT: risk also decreased as exercise increased (e.g. diabetes prevention trial had 3000
subjects who had identified risks of developing T2 diabetes. Random allocation to placebo,
metformin (medication to lower BGL) and a lifestyle intervention group). Lifestyle changes
and treatment with metformin both reduced the incidence of diabetes in persons at high
risk. The lifestyle intervention was more effective than metformin.
How much is the risk of diabetes reduced by regular physical activity? Is there a dose-
response relationship between physical activity and a reduced risk of developing type 2
diabetes?
- There is a dose- response relationship, where physical activity is more beneficial
- There is a 58% risk reduction (typically 42%)
Describe the effects of physical activity in the primary, secondary and tertiary prevention of
diabetes. Which do you think is most important?
PRIMARY: Systematic review of 20 primary prevention cohort studies shows: 42% risk
reduction (not 100% clear, but generic healthy lifestyle is beneficial)
Secondary: large scale RCT demonstrated reduction in diabetes incidence among those at
risk: 58% reduced risk (due to lifestyle intervention). Very strong evidence based
Tertiary: There is less clear evidence of the independent effects of physical activity for the
prevention of Type 1 diabetes, other than as a generic healthy lifestyle recommendation.
Most important = primary
Can resistance training be an effective type of exercise for people with type 2 diabetes?
There is some evidence to suggest that resistance training may assist in glucose uptake into
muscles, reducing blood glucose levels (recommendation = 2 sessions per week).
The Diabetes Prevention study by Knowler et al (2002) is considered to be a seminal paper
in nutrition and exercise science. Explain why this study might be considered to be so
influential.
- RCT
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-2 of the document.
Unlock all 5 pages and 3 million more documents.

Already have an account? Log in

Document Summary

Module 2 lecture 4: watch the video (cid:858)physical activity and cardiovascular disease(cid:859) and then read pages 14-16 of the physical activity guidelines. Key component of cvd is atherosclosis; a narrowing of arteries due to the build up of plaque in the vessel walls due to oxidation within blood. Describe the strengths and limitations of these types of studies. List the biological mechanisms through which physical activity is likely to cause a reduction in the risk of cardiovascular disease. Physical activity causes a 20-30% reduction in the risk of death. Explain how the risk of cardiovascular disease changes with increasing amounts of physical activity. Diabetes effects over 1 million australians, 85-90% are t2 diabetes (insulin insensitivity) Cohort study: risk of t2 diabetes decreases as physical activity increases. Not much info available because t2 diabetes is new in research. Rct: risk also decreased as exercise increased (e. g. diabetes prevention trial had 3000 subjects who had identified risks of developing t2 diabetes.

Get access

Grade+
$40 USD/m
Billed monthly
Grade+
Homework Help
Study Guides
Textbook Solutions
Class Notes
Textbook Notes
Booster Class
10 Verified Answers
Class+
$30 USD/m
Billed monthly
Class+
Homework Help
Study Guides
Textbook Solutions
Class Notes
Textbook Notes
Booster Class
7 Verified Answers

Related Documents

NUTR1023 Lecture Notes - Lecture 2: The Strongest, Bone Density, Cardiovascular Disease
redweasel913
KINE 1020 Lecture Notes - Compression Stockings, T Wave, Hypoesthesia
sapphirebuffalo761
NUTR 1010 Lecture Notes - Lecture 12: Monounsaturated Fat, Hypertension, Trans Fat
indigopug433

Related Questions

Medical History:
A 31 yr old man, a two pack per day smoker, presented to the emergency department complaining of sudden-onset, 10/10 crushing substernal chest pain associated with shortness of breath and diaphoresis that began 30 min prior to arrival. He had no previous history of cardiovascular disease.
Physical exam: Height 192 cm, weight 153.8 kg, BMI 41.6 kg · m–2 (class III obesity); blood pressure 178/101 mmHg, pulse 75 beats · min–1, respiratory rate 20 breaths · min–1, temperature 36.7 ∞C; normal heart sounds, lungs clear to auscultation, normal peripheral pulses
Electrocardiogram: Normal sinus rhythm, rate 72 beats · min–1; ST-segment elevation V1-V4
Chest radiograph: Normal Blood work: Elevated cTn and CK-MB; glucose normal; blood lipids: total cholesterol 200 mg · dl–1, HDL-C 45 mg · dl–1, LDL-C 134 mg · dl–1, triglycerides 104 mg · dl–1
Chest CT: No evidence of aortic dissection Echocardiogram: Left ventricular ejection fraction 45%, hypokinesis of the anteroseptal wall, borderline left ventricular enlargement, normal diastolic function, normal cardiac valves

Diagnosis:
Acute anterior wall STEMI.

Treatment:
1. Emergent cardiac catheterization (began 46 min after initial presentation to the hospital): total occlusion of the proximal left anterior descending (LAD) coronary artery, mild diffuse narrowing of the circumflex and right coronary arteries. The LAD occlusion was treated with thrombectomy, percutaneous coronary angioplasty, and placement of a drug-eluding stent, with good result.
2. Medical treatment: Aspirin, heparin, intravenous nitroglycerin, clopidogrel, abciximab, atorvastatin, carvedilol, lisinopril, nicotine patch.
3. Nicotine dependence consultation.
4. Referral to outpatient cardiac rehabilitation. Complications: None Hospital dismissal: Occurred approximately 48 h after admission; appointments made to see primary physician and to begin outpatient cardiac rehabilitation program in 5 d; follow-up blood work, ECG, and cardiology appointment in 8 wk Dismissal medications: Carvedilol, aspirin, clopidogrel, lisinopril, nicotine patch, simvastatin

Outpatient Exercise Test Results (Performed 8 D after Hospital Dismissal)
8.0 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 164 beats · min–1, V.O2peak = 3.04 L · min−1 (20.8 ml ∑ kg−1 ∑ min−1; 47% of expected), no angina reported
Exercise Prescription:
Outpatient cardiac rehabilitation program: Began 5 d after hospital dismissal; initial evaluations included assessments of neuromuscular function (normal), depression (normal), and potential sleep apnea (abnormalBerlin questionnaire, abnormal overnight oximetry resulted in referral for a sleep consultation); meeting with registered dietitian.
Exercise prescription: Goals included weight loss, increased aerobic and muscular fitness; frequency of three supervised sessions per week in cardiac rehabilitation facility plus three or four independent sessions per week (total frequency of six or seven sessions each week); average intensity using target heart rate 130 to 140 beats · min–1 (60-70% heart rate reserve), RPE 12 to 14; high-intensity intervals (to begin 2 wk after starting cardiac rehabilitation) using RPE 17, heart rate <160 beats · min–1; duration initially set at 10 to 15 min (not including warm-up, cool-down, strength training), gradually increasing to 45 to 60 min per session; types of exercise to include outdoor or treadmill walking, elliptical trainer; resistance training (to begin 2 wk after starting cardiac rehabilitation) using free weights and weight machines, initially one set of 8 to 15 slow repetitions, exercises for the major muscle groups, two or three sessions per week; lifestyle or general physical activity including walking short distances during the day, yard work, physical activity at work (return to work as restaurant equipment installer 4 wk after myocardial infarction).

Outcomes from 11 WK of Cardiac Rehabilitation Program
Medication compliance: Excellent (self-report) Exercise training: Frequency six or seven sessions per week (two or three supervised sessions per week); aerobic exercise duration 50 to 60 min per session; aerobic interval training two or three sessions per week (initially treadmill grade walking for 30 s progressing to slow jogging on treadmill for up to 4 min, three to five high-intensity intervals per session); resistance training two or three sessions per week, two or three sets of 8 to 15 repetitions, major muscle groups. Body weight: Stopped eating fast food and desserts, had more fruit, vegetables, poultry, fish; weight loss = 20.8 kg (BMI still excessive, 33.8 kg · m–2). Repeat cardiopulmonary exercise test: 10.5 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 162 beats · min–1, V.O2peak = 4.16 L · min−1 (31.2 ml ∑ kg−1 ∑ min−1; 71% of expected), 37% increase in V.O2peak (L · min−1), no angina reported. Tobacco use: One or two cigarettes daily. Blood pressure: 126/80 mmHg. Blood lipids: Total cholesterol 126 mg · dl–1, HDL-C 33 mg · dl–1, LDL-C 80 mg · dl–1, triglycerides 65 mg · dl–1. Recommendations: Stop smoking; continue medications, exercise program, and heart-healthy eating habits; continue efforts for weight loss; return appointment with cardiac rehabilitation team in 3 mo.

Discussion:
This patient was extremely young and was fortunate to realize the importance of promptly seeking medical attention with the onset of symptoms. His hospital course included standard diagnostic testing for acute myocardial infarction with subsequent timely coronary angiography with PCI of the infarct-related artery. Fortunately he did not develop serious complications and was discharged from the hospital after only 2 d. He enrolled in outpatient cardiac rehabilitation 1 wk after his MI. Of concern, he was markedly obese and may have had obstructive sleep apnea based on his abnormal Berlin questionnaire; he was referred for further evaluation in the Sleep Clinic. His course during rehabilitation was very favorable, and he did not experience post-infarction angina. He was successful in exercise and weight loss and demonstrated a remarkable increase in aerobic capacity. His challenge will be to continue taking his medications, stop smoking completely, eat a healthy diet, maintain his exercise program, and control his other coronary risk factors.

Questions:
1. What were this patient’s coronary risk factors?

2. What clinical tests were used to make the diagnosis of an acute ST-segment elevation anterior wall myocardial infarction?

3. What classes of cardiovascular medications were prescribed for this patient?

4. Compare the two cardiopulmonary exercise tests for this patient. What were the similarities? What were the differences?

5. Review the patient’s exercise prescription and program. Were the established goals achieved? Would you alter the exercise program in any fashion?

6. How effective was the patient in controlling his coronary risk factors by the time he completed 11 wk in the outpatient cardiac rehabilitation program?

7. What is his most important remaining coronary risk factor?

8. What component of the recommendations given to him at the completion of 11 wk of cardiac rehabilitation will potentially help him in sustaining his efforts at secondary prevention?