Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based settings.

We have developed, tested, and successfully implemented an affordable, evidence-based, comprehensive cardiovascular disease risk-reduction program for use in primary and secondary prevention settings. The program is administered at hospitals, physician practices, cardiac rehabilitation programs, work sites, shopping malls, and health clubs. The program is also delivered from a call center using the telephone and the Internet. Program staff are guided by a computerized participant management and tracking system. Lifestyle management interventions are based on several behavior change models, primarily social learning theory, the stages of change model, and single concept learning theory. Typically, the program is administered entirely by non-physician healthcare professionals whose services are integrated with the care provided by the participants' physicians. Outcome data have documented the clinical effectiveness of this innovative approach.

Pancreatic polypeptide response to exercise. Effect of alanine and glucose ingestion in carbohydrate-starved athletes.

Human pancreatic polypeptide (hPP) secretion in response to 90 minutes of exercise before and after the ingestion of 50 g glucose or 50 g L-alanine in 33 carbohydrate-starved athletes was examined. There was a very marked increase in plasma hPP concentration with exercise under these circumstances, despite previous reports that the hPP response to exercise is eliminated by training. Glucose and alanine ingestion had no effect on hPP either before or after exercise. This differentiates hPP from other hormones in which secretion is increased by exercise in carbohydrate-depleted subjects.

Post-exercise ketosis in post-prandial exercise: effect of glucose and alanine ingestion in humans.

This study examined ketosis in response to 90 min of running before and after the ingestion of 50 g glucose or 50 g L-alanine in thirty-three athletes. Everyone ran 20 km at 07.30 h and then rested, while fasting, till 16.00 h. There were four test groups: 'glucose-before', 'glucose-after', 'alanine-before' and 'alanine-after' according to whether glucose or alanine was ingested at 07.00 h, or 09.00 h. Controls did not ingest either test substance. The control 3-hydroxybutyrate concentration rose from 0.23 +/- 0.03 mmol/l (S.E. of mean) at 07.00 h to 0.74 +/- 0.27 mmol/l at 12.00 h, and 0.94 +/- 0.33 mmol/l at 16.00 h. Glucose ingestion before or after exercise did not influence post-exercise ketosis significantly, despite high insulin: glucagon ratios, low free fatty acid concentrations and hyperglycaemia. Alanine significantly lowered the 3-hydroxybutyrate levels, especially after exercise (to 0.14 +/- 0.07 mmol/l at 12.00 h; P less than 0.05) despite reversed insulin: glucagon ratios. This suggests that hepatic responsiveness to portal hyperglycaemia and the main hormones of metabolism is altered immediately after exercise, presumably to promote muscle glycogen synthesis in preference to liver glycogen synthesis.

Assessment of a geriatric exercise programme using ambulatory electrocardiography.

The purpose of this study was to assess the efficacy as well as the immediate possible cardiovascular risk of a geriatric exercise programme, administered without prior medical screening or evaluation of the exercise capacity of the participants, in improving cardiorespiratory fitness. Ambulatory electrocardiography performed during exercise on 6 randomly selected male participants in a physiotherapist-controlled geriatric exercise programme revealed heart rates of 72-97/min, values unlikely to produce significant improvements in cardiorespiratory fitness. This low-intensity exercise session did not induce any ischaemic ST-segment displacements, or arrhythmias displaying the generally accepted criteria for premonitory arrhythmias known to precede the development of ventricular fibrillation. However, subsequent stress testing, performed at the lower threshold intensity of exercise needed to elicit a significant physiological training effect, resulted in an adverse cardiac response in 3 subjects, of whom 2 were asymptomatic. We conclude that the geriatric exercise programme under investigation would be unlikely to result in improved cardiorespiratory fitness in the majority of participants, but if such a programme is to be implemented in a safe manner in a geriatric population, prior medical screening including exercise testing is mandatory.