Preventive Cardiovascular Nurses Association

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Reducing Cardiovascular Risk in the Insulin Resistant Patient
Module 3: Lifestyle Interventions: Diet & Exercise
1 CE Credit
Release Date: January 2007
COURSE OVERVIEW:
Lifestyle interventions such as diet, exercise, and weight loss play a critical role in the treatment of Insulin Resistance (IR) and the risk factors associated with Insulin Resistance Syndrome (IRS). These lifestyle modifications, reducing caloric intake, reducing body weight, changing dietary composition, and increasing exercise can have a positive impact on increasing insulin sensitivity (IS) and help in achieving target goals for the risk factors associated with IRS.
PRESENTERS:


 Barbara J. Fletcher, MN, RN, FAAN
Clinical Associate Professor
School of Nursing, College of Health
University of North Florida
Jacksonville, FL





Catherine Christie, PhD, RD, LD/N, FADA
Director of Nutrition Programs and MSH/Dietetic Internship
College of Health
University of North Florida
Jacksonville, FL

PRESENTER BIOS:
Barbara Fletcher is a Clinical Associate Professor of Nursing at the University of North Florida in Jacksonville, and is past president of the Preventive Cardiovascular Nurses Association. As a clinician and researcher in the field of cardiovascular nursing, she has conducted seminal studies on activity for cardiac patients, which evolved into a steady trajectory of scholarly inquiry into exercise behaviors and outcomes for different patient populations. She has led multidisciplinary research projects as a co-principal investigator of federally funded studies addressing cardiovascular risk factors. Barbara has consistently disseminated her expertise and research through over 40 publications in peer-reviewed journals and books, and she has been the lead author on most. Her leadership in the American Heart Association's Council on Cardiovascular Nursing led directly to innovative health policy activities, increased visibility for nursing science, and expanded the scope of nursing’s influence in important patient care and research issues. She is a recipient of numerous nursing awards and is recognized internationally as a leader in cardiovascular nursing.

CE Course Outline

Print slides/handouts (pdf)

Step 1: Take Course
Step 2: Take CE Exam
Step 3: Quick Evaluation
Step 4: Print CE Certificate


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Dr. Catherine Christie is the Director of Nutrition Programs and Director of the MSH/Dietetic Internship Program in the College of Health at the University of North Florida. She is also President of the Florida Dietetic Association and is past chair of the American Dietetic Association Ethics Committee. Dr. Christie is co-author of three books including, Fat is Not Your Fate, I’d Kill for a Cookie, and Eat to Stay Young. A Registered Dietitian and Fellow of the American Dietetic Association, Dr. Christie earned her Ph.D. from Florida State University and served for six years as the Chairman of the Dietetics and Nutrition Council which regulates the nutrition profession in the state of Florida. Dr. Christie is Editor of the Florida Dietetic Association Manual of Medical Nutrition Therapy, and Associate Editor of Nutrition and Well-Being A-Z. She is the recipient of several prestigious awards and certifications including Recognized Young Dietitian, Florida’s Distinguished Dietitian, Florida Dietetic Association President’s Outstanding Service Award, and Certified Nutrition Specialist.

COURSE EDITORS:
Joanna D. Sikkema, MSN, ARNP
Carol M. Mason, ARNP, FAHA

EDUCATIONAL OBJECTIVES:
Upon completion of this program, participants will be able to:
  1. Understand the components that comprise a lifestyle plan for reducing insulin resistance syndrome risk factors
  2. Understand the critical components of traditional and popular-based diets used for treating insulin resistance syndrome
  3. Formulate an exercise plan for decreasing known risk factors in insulin resistance syndrome
AUDIENCE:
The audience for this course consists of nurses and nurse practitioners specializing in cardiovascular disease prevention and management.

PRESENTER DISCLOSURES:
The presenters have no commercial relationships to disclose.

SPONSOR/ACCREDITOR:
This activity is sponsored by the Preventive Cardiovascular Nurses Association (PCNA). PCNA is approved as a provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners (AANP) - provider number 030602. PCNA will provide 1 contact hour of continuing education for this program.

GRANTOR:
This continuing education activity is supported by unrestricted educational grants from KOS Pharmaceuticals and Cholestech Corporation.

COST:
This online educational activity is offered free of charge.

PARTICIPATION IN THE ACTIVITY AND RECEIPT OF CERTIFICATE OF CREDIT:
Complete the online course, online exam, and the evaluation form; and submit your results electronically. Exams will be graded and results displayed instantaneously. Participants who receive a passing score of 80% or higher will receive an electronic, printable certificate of completion following the exam. Participants will have 2 opportunities to successfully complete the exam.

MODULE 3 REFERENCES:

Nutrition Segment
  • The Practical Guide- Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, NIH Publication No. 02-4084, January, 2002.
  • Gaesser, GA and Kratina, K. Eating Well, Living Well, Wheat Foods Council, 2000. (slide #5)
  • Cooper, Z, Fairburn, CG, and Hawker, DM. Cognitive-behavioral treatment of obesity; a clinician’s guide. Guilford Press, New York, NY, 2004:35. (slide #7)
  • Harnack LJ, Jeffery RW, and Boutelle KN. Temporal trends in energy intake in the United States: an ecologic perspective. Am J Clin Nutr 2000: 71(6), 1478-1484.
  • Wansink, B. 2004. Environmental factors that unknowingly increase food intake and consumption volume of unknowing consumers. Annual Review of Nutrition, 24: 455-479.
  • Schwartz, J. and Byrd-Bredbenner, C. Portion-distortion: typical portion sizes selected by young adults. Journal of the American Dietetic Association 2006;106(9):1412-1418.
  • Guthrie, H. Selection and quantification of typical food portions by young adults. J. am Diet. Assoc. 1984;84(12):1440-1444.
  • Johnson Streit, K, Stevens, S, Stevens, VJ and Rossner, J. Food records: a predictor and modifier of weight change in a long-term weight loss program. Journal of the American Dietetic Association 1991; 91(2): 213-214.
  • Executive Summary- Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, NIH Publication No. 01-3670. May, 2001.
  • Cater NB, Grundy SM. Lowering serum cholesterol with plant sterols and stanols. Postgrad Med. 1998: 6-14.
  • Blair SN, Capuzzi DM, Gottlieb SO, Nguyen T, Morgan JM, Cater NB. Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. Am J Cardiol. 2000; 86: 46-52.
  • American Diabetes Association. Nutrition principles and recommendations in diabetes. Diabetes Care 2004; 27; Suppl. 1:S36-S46.
  • Dietary reference intakes for energy, carbohydrates, fiber, fat, protein, and amino acids. National Academy of Sciences, 2002; 7:18-23.
  • Miettinen et al. New England Journal of Medicine,1995
  • Gladding, M. Food Labeling. Florida Manual of Medical Nutrition Therapy, Florida Dietetic Association, 2005; C6.1.
  • Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Eng J Med. 2000; 342: 1392-1398.
  • Gerstein DE, Woodward-Lopez G, Evans AE, Kelsey K, Drenowski A. Clarifying concepts about macronutrients’effects on satiation and satiety. Journal of the American Dietetic Association 2004;104(7):1151-1153.
  • Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER III, Simons-Morton DG, Karanja N., Lin PH, D.A.-S.C.R. Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Eng J Med. 2001; 344: 3-10.
  • Svetkey LP, Sacks FM, Obarzanek E, Vollmer WM, Appel LJ, Lin PH, Karanja NM, Harsha DW, Bray GA, Aickin M, Proschan MA, Windhauser MM, Swain JF, McCarron PB, Rhodes DG, Laws RL. The DASH Diet, sodium intake and blood pressure trial (DASH-sodium): Rationale and design. DASH-Sodium Collaborative Research Group. J Am Diet Assoc. 1999; 99(suppl 8): S96-S104.
  • The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, NIH Publication No. 03-5233. May, 2003.
  • Harris. WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997:65(5 suppl): S1645-1654.
  • Vanschoonbeek K, de Maat MPM. Heemskerk JWM. Fish oil consumption and reduction of arterial disease. J Nutr. 2003; 133:657-660.
  • Von Schacky C., Angerer P, Kothny W. et al. The effect of dietary omega-3 fatty acids on coronary atherosclerosis. A randomized uble-blind, placebo-controlled trial. Ann Intern Med. 1999; 130: 554-562.
  • Dietary Reference intakes for energy, carbohydrates, fiber, fat, protein, and amino acids, National Academy of sciences, 2002; 7:180-23.


Exercise Segment
  • Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Bess HM, et al; Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease; AHA Scientific Statement; Circ. 2003; 107: 3109-3116.
  • Bell DS. Exercise for Patients with Diabetes. Benefits, Risks, Precautions. Post Grad Med (UAB Sch of Med). 1992; 92 (1):183-4, 187-90, 195-8.
  • Kang HS, Gutin B, Barbeau P, et. Al. Physical Training Improves IRS Markers in Obese Adolescents. Med Sci Sports Exerc 2002; 34: 1920-1927.
  • Irwin ML, Ainsworth BE, Mayer-Davis EJ, Addy CL, Pate RR, Durstine JL. Physical Activity and metabolic syndrome in a tri-ethnic sample of women. Obes Res. 2002; 10(10):1020-1037.
  • Sherwin RS, Anderson RM, Buse JB, Chin MH, Eddy D, Fradkin J, et al. Prevention or Delay of Type 2 Diabetes. Diabetes Care. 2004; 27: Supp 1.
  • ACSM (American College of Sports Medicine) Guidelines for Exercise Testing and Prescription. 6th Edition. Franklin BA, Whaley MH, Howley ET, Balady GJ, Grais IM. Lippincott Williams & Wilkins; Philadelphia, 2000: 150.
  • Anderson RE, Wadden TA, Bartlett SJ, et al. Effects of Lifestyle Activity vs Structured Aerobic Exercise in Obese Women. JAMA. 1999; 281: 335-340.
  • Ross R, Dagnone D, Jones P, et al. Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men: A randomized Controlled Trial. Ann Int Med. 2000; 133: 92-103.
  • McKechnie R, Mosca L. Physical Activity and Coronary Heart Disease: Prevention and Effect on Risk Factors. Cardiology in Review. 2003; 11 (1):21-25.
  • Eriksson J, Tuominen J, Valle T, et al. Aerobic Endurance Exercise or Circuit-Type Resistance Training for Individuals with Impaired Glucose Tolerance? Horm Meta Res. 1998: 30: 37-41.
  • Plowman SA & Smith DL; Exercise Physiology for Health, Fitness, and Performance; second edition; Benjamin Cummings; San Francisco 2003: 233.
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