Fast Five Quiz: Helping Patients With New Year's Resolutions

George D. Harris, MD

Disclosures

December 12, 2018

Individuals who are morbidly obese should be cautious of orthopedic stresses. They may start with non–weight-bearing exercises (eg, swimming, water aerobics, floor exercises). These individuals should avoid high-impact aerobic activities. Emphasize duration as tolerated and exercise frequency (sessions per week). Emphasize premeal exercise, especially exercise in the morning before eating breakfast to mobilize fats (lipolysis).

In elderly individuals, resistance training is both safe and beneficial in improving flexibility and quality of life. Persons with cardiovascular disease are usually asked to refrain from heavy lifting and forceful isometric exercises, but moderate-intensity dynamic strength training is safe and beneficial in persons at low risk.

Individuals with pulmonary disease should engage in low workloads of short duration. Patients should exercise in frequent intervals rather than a longer duration and fewer intervals. Supplemental oxygen may be needed.

In patients with diabetes, monitor blood sugar because hypoglycemia or hyperglycemia can occur in diabetic persons during and after exercise. Consume a meal 1-3 hours before exercising, administer insulin at least 1 hour before exercise, and, if the blood glucose level is greater than 250 mg/dL, check urine for ketones. Supplement energy (caloric) intake every 30 minutes during exercise and maintain adequate fluid replacement. After exercising, monitor the glucose level, increase energy (caloric) intake for 12-24 hours following activity, and anticipate postexercise hypoglycemia; appropriately adjust insulin dosing.

Read more about exercise prescriptions.

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