A personalized diet and exercise Rx.
This diet and exercise plan was cultivated based on a fictitious patient scenario. This assignment was not based on a real person.
B.S. is a 25 y/o man with mild intermittent uncomplicated asthma which is not exercise induced. His only exercise limitation is knee pain with weight bearing exercises due to prior injury. Blood pressure is WNL, LDL is borderline, and BMI is in the obese category. Patient is estimated to be either at or approaching the heavy drinking category (>15 drinks per week). His diet consists of fast food/take-out meals 3x per day with foods high in sugar for dessert. Patient performs moderate exercise intermittently, usually in the form of riding his bike. His primary goal is to achieve weight-loss and “get in better shape” to help his dating life.
People often become overwhelmed with sudden, drastic lifestyles changes which results in failure to achieve their goal. Therefore, Mr. S’s diet and exercise plan will be based on small, gradual modifications that can be sustained. The goal will be to get the patient to see positive results with these small changes will which provide motivation to propel him into further modifications. Recommendations will be tied to lowering his current BMI & LDL and will outline the benefits for protecting against future complications like heart disease of Type 2 Diabetes Mellitus.
Picking exercises that the patient enjoys and is able to do without limitations will likely lead to better compliance. His social history states that he enjoys Latin music so I would encourage a Latin-based exercise class like Zumba or to go out dancing on the weekends at a Latin club at least once per week. He already enjoys riding his bicycle for 3-5 miles on flat terrain, therefore, I would encourage him to slowly increase the intensity and duration of his bike rides as tolerated, along with the frequency. Because of pain from his prior knee injury I would not encourage running. While swimming would be one of the best aerobic exercises for him because it puts little strain on the joint, it could be ineffective if the patient does not have access to a pool, cannot swim, or does not enjoy swimming. The goal would be to find out which exercises the patient will be most compliant with and have him initially perform 150 minutes of moderate activity and 75 minutes of vigorous activity each week. Once the patient has adapted to this routine, I would discuss adding in other components in the future such as muscle strength training, with possible referrals to physical therapy/ortho first to assess the limitations of his knee joint and help him safely strengthen it if warranted. Although his asthma appears to not be exercise induced and is well-controlled, I would still highly encourage the patient to keep his rescue inhaler on him at all times while he begins this new exercise routine.
Because the patient’s diet consists mainly of fast food/take-out, food labels are not present on most of his food’s packaging. Looking up the nutrition info on each company’s website and recording/interpreting the info would be cumbersome. Instead, I would recommend the patient download “MyFitnessPal” which has nutrition and caloric information for most chain restaurants, foods, and grocery store brands. The app works by providing a recommended caloric & nutritional intake for the patient based off of goal body weight, current body weight, and current exercise status. The patient would be able to select his exact order for each restaurant he ate at that day and the app will tell him his exact caloric and nutritional consumption for each individual meal & day with a chart that outlines how close or far off his consumption was to the programmed diet he needs to meet his weight loss goal. This app is helpful because it is convenient and not only accurately assesses caloric intake but other important factors like high sodium consumption, etc. Once the patient has a true understanding of daily nutrition, he can easily identify what areas need improvement. I recommend starting with small changes. For instance, he goes to Dunkin Donuts every morning and get a breakfast sandwich with a large coffee. He might not initially be willing to make meals at home so I can recommend he switches to the sandwich with the highest nutritional value and gets a medium coffee instead of a large to cut back on calories. After he becomes comfortable with this, he could modify it further by alternating his sandwich out for the fruit Dunkin Donut’s sells every other morning. The next phase in his diet plan might include cutting down his alcohol intake by a few beers a week. Again, the positive modifications will be reflected on the app to reinforce these positive changes.
The patient’s goal is to achieve weight loss which will help him reduce his chances of acquiring several chronic conditions such as diabetes and heart disease by placing him in a healthy BMI range. The small breakfast modifications will help decrease his daily salt and cholesterol intake which in-turn help reduce the risk of heart disease. Slowly cutting back on his alcohol will also help save on calories and reduce his risk of heart disease and other future complications. The modest exercise plan of 3.75 hours per week will do the same. This overall plan will likely only show modest initial weight loss, but it was designed to be attainable and sustainable for the patient. After the patient becomes comfortable with each small change, additional modifications will be continually added which will push him more towards his goal and a healthier lifestyle that will reduce his risk of developing several chronic conditions.
-EXERCISE & DIET PRESCRIPTION/PLAN:
-Ride bicycle at modest intensity for 30 minutes 5x per week with heart rate = 97 bpm
-Dance to latin-music for 75 minutes per week with heart rate = 136 bpm
-Increase intensity, duration, and frequency of aerobic exercise as tolerated
-Incorporate muscle strength training for 2+ hours per week in small intervals of 10-15 minutes. Stop exercise if pain occurs in knee joint.
-Substitute current breakfast order at Dunkin for one with higher nutritional value
-After two weeks, do the same modifications for lunch and dinner restaurants
-Reduce alcohol consumption to 10 drinks per week
-Track nutrition and exercise on a health app like “MyFitnessPal” and continue making modifications as indicated based on data from daily intake
-Return in one month to assess weight loss and modify plan