Syndrome: A New Focus for Lifestyle Modification
disease is still the number one cause of morbidity and
mortality in the United States and much of this burden of disease can
be linked to poor nutrition and a dramatic increase in sedentary
Trainers have the opportunity to do more than just
help people they train become more active. Physical activity should not
only approach to encouraging a healthy and balanced lifestyle. We need
prepared to also help our clients implement lifestyle behavior changes
to stress, family history of coronary heart disease, obesity, smoking,
blood pressure and high cholesterol.
look at what is being called metabolic syndrome will help
you understand why, even though increasing physical activity levels is
overall best thing you can do for any client, there are other ways to
them to a healthier lifestyle. Sometimes you may be able to help them
changes yourself, and sometimes you will need to refer them to another
professional like a doctor or dietician for guidance. Either way,
to help them, or when to turf them to someone who is more knowledgeable
yourself is important. So first lets get familiar with the syndrome and
clinical criteria that the doctor uses to diagnose it. Your goal is
help your client understand and make the necessary changes, so that
progress to cardiovascular disease and the almost certain heart attack
that will be the end result.
disease is still the number one cause of
morbidity and mortality in the
and much of this burden of disease
can be linked to poor nutrition and a dramatic increase in sedentary
lifestyles, leading to overweight and obesity. This increase in weight
an increase in the incidence of type 2 diabetes, and blood pressure and
cholesterol problems, which are all well-established cardiovascular
risk factors. The National Cholesterol Education Program (NCEP) Adult
Panel (ATP) III has updated the recommendations for the evaluation and
management of adults dealing with high cholesterol, renewing its
the importance of lifestyle modifications for improving cardiovascular
The NCEP has coined the term “therapeutic lifestyle
changes” (TLC) to reinforce
both dietary intake and physical activity as crucial components of
control and cardiovascular risk management.
As well as focusing attention on the LDL
called bad cholesterol) levels the NCEP also identified the metabolic
as a secondary target of therapy. The importance of lifestyle
the treatment and prevention of cardiovascular disease has heightened
caused growing awareness of this condition. The metabolic syndrome (also called insulin resistance syndrome
syndrome X) is characterized by decreased tissue sensitivity to the
insulin (pre-diabetes), resulting in a compensatory increase in insulin
secretion. This metabolic disorder predisposes individuals to a cluster
abnormalities that can lead to such problems as type 2 diabetes,
disease, and stroke. According to Daniel Einhorn, MD, who is cochairman
of the American College of Endocrinology (ACE) and the American Association of Clinical
Endocrinologists (AACE) Insulin Resistance Syndrome Task Force and
medical director of the Scripps Whittier Institute for Diabetes in La Jolla,
the prevalence of the syndrome has increased 61% in the last decade. He
that it is crucial for medical professionals to identify patients at
follow these patients closely and counsel them about making lifestyle
to lower the risk of type 2 diabetes and cardiovascular disease.
GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at
least 3 of the following 5 clinical factors
criteria for the metabolic syndrome
>40 in (>102 cm)
>35 in (>88 cm)
>85 mm Hg
or taking antihypertensive medication
mg/dL or diabetes
Source: Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults. Executive
Summary of the Third Report of the National Cholesterol Education
Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III). Bethesda, MD: National Institutes of
Health; 2001. NIH publication 01-3670.
(NHANES III) the Centers for Disease Control and Prevention estimates
that at least 47 million Americans have metabolic syndrome. And, in
2000, more than 97 million adults were considered obese, and more than
half the population is now overweight. This epidemic is not likely to
plateau because childhood obesity is also increasing at an alarming
rate. The explosive increase in the prevalence of obesity observed in
the past decade suggests the current rate of metabolic syndrome is now
likely higher than that estimated by NHANES III.
risk for metabolic syndrome can sharply lower their chances of getting
this disease by adopting a healthy lifestyle (stop smoking, low-fat
diet, weight loss/maintenance and increased physical activity). Diet
and exercise are the cornerstones of treatment in patients with
metabolic syndrome. According to Robert Chilton, MD, (November/
December 2002 issue of Men’s Total Health Digest) without
diet and exercise modifications, most patients will eventually fail and
progress to type 2 diabetes within a decade and experience a heart
attack about 10 years later. Dr. Chilton recommends a diet
reduced in saturated fats (<7%), low in cholesterol (<200
mg/day), high in fiber (20-30gm/day) and reduced in simple sugars.
Weight loss of only 5-7% (less than 15 pounds) can make a big
difference in health markers like cholesterol and blood pressure. A
program that includes exercise daily reaching 85% of heart rate for age
is reported to benefit the patient too. However, Dr. Chilton
says, any exercise is better than none, and a target of 30 minutes
every other day is a reasonable level for most patients.
A study by the
Prevention Program (DPP) found that there was a reduction of 58% in
progression to diabetes when moderate life style changes were made.
These changes were directed towards getting people to lose 8-10 pounds
and becoming more active, mainly by walking briskly for 150 minutes per
week. Other studies have been done by the DPP using a medication called
metformin. It reduced the progression to diabetes by about 30%, but was
not as effective as behavioral interventions and it didn’t
in all groups. The behavioral intervention, on the other hand worked
across the board, regardless of age, body weight, or race and
ethnicity. Another drug called acarbose has also been tested and found
to reduce progression by about 33%. So, there are medications that can
be beneficial, but nothing was as effective overall as the behavioral
intervention used in the DPP. Consideration also needs to be given to
the potential side effects of a medication used to prevent diabetes
compared with lifestyle changes.
MD, who is the director of the diabetes program at the US Centers for
Disease Control and Prevention in Atlanta, the behavioral interventions
used in these studies was quite intense and involved 16 interactions
with individuals during the first year, with a whole series of very
innovative and creative follow-up meetings. The interventions are being
explored further to see if they can be made more practical, more
feasible, and more economically possible. Another point is that, even
within the DPP, a physician did not deliver most of the behavioral
interventions. New recommendations from the CDC will call for involving
trained nurses, dieticians, and other community health workers in the process.
Vincor, about 90% of people with diabetes receive their diabetes care
from the primary care community and there is no reason to anticipate
that things will be any different with pre-diabetes or metabolic
syndrome. He believes the primary care community (internists and family
practice physicians) will play a pivotal role in both the
identification of people with pre-diabetes, as well as the initiation
of therapy. And again he emphasizes, that does not mean that primary
care doctors themselves have to do the counseling and behavioral
he anticipates they will make appropriate referrals to others in their
professional reading this, hopefully you are not asking yourself
“so what?” but are instead seeing an opportunity to
and motivate some of your current clients and to use your knowledge to
help attract future clients. The medical community is good at
diagnosing this syndrome, but not necessarily equipped to provide
patients with the tools to be successful with the lifestyle changes
they recommend. There exists a wonderful opportunity to build a
partnership with physicians in your area. Most physicians will gladly
refer patients to you for help with the all-important exercise and
nutrition portion of the treatment program. In many cases, you have
more knowledge in this area than the physician who has been trained in
tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise
they are not taught this in medical school) medicine. Often
all that you will need to get a referral is for the doctor to be aware
of your existence and to give them an easy way to get the patient to
you. A short introduction letter outlining your qualifications, and
showing your desire to help people make lifestyle changes, is a good
start. A personal visit to your primary care doctor and others in your area is even better. But, be
prepared to take up just a few minutes of their time to introduce
yourself and leave your letter and cards.
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