Making Exercise Easier

1. Making Exercise
Easier
Holt Zalneraitis, BS, MD Candidate
Foundations in Healthcare Delivery
Public Health and Prevention
VUMC
08/24/2016

2. Case
• 51 y/o White Female
• PMH
o Coronary artery disease
o Hypertension
o Diabetes mellitus
o Hyperlipidemia
• SH: Non-smoker, rare alcohol use
• FH: Father also had hypertension, sister with end stage
renal disease, hypertension, and diabetes

3. • PE: BP 128/66, HR 102, BMI 51
o CV: Regular rate and rhythm, no murmurs, rubs, or gallops
o Lungs: CTAB, adequate air movement, no wheezes, rhonchi, or rales
o Abdomen: nontender, nondistended, NABS
Labs:
o Total cholesterol 219; HDL 40; Triglycerides 237
• Medications:
o Insulin, Albuterol, Metoprolol, Aspirin, Clopidigrel, Isosorbide dinitrate,
Furosemide, Pravastatin

4. ASCVD Risk Calculation
• Age 51
o HDL 40 (clinic visit, on statin)
o Total Cholesterol 219 (clinic visit, on statin)
o SBP 128 (clinic visit)
o Diabetes and treated for hypertension, no history of smoking
ASCVD RISK: 10 years = 5.7%, Lifetime = 50%

10. ASCVD Risk calculation
Sex (M/F)
Age
(years) BMI (kg/m2)
ASCVD 10 year risk
score
ASCVD Lifetime Risk
Score
1 M 54 30.1 8.7 69
2 M 62 31.2 20.2 N/A
3 M 58 25 7.9 50
4 F 48 29 0.6 39
5 F 58 20 1.5 39
6 M 55 30 4.4 50
7 M 54 25 14.4 50
8 M 75 28 21 N/A
9 M 62 40 8.2 N/A
10 F 51 51 5.7 50
11 F 71 27 13.2 N/A
12 F 69 29 10.1 N/A
13 F 94 21 38.4 N/A
14 M 63 27 22.2 N/A
15 M 51 36 7.6 69
16 M 59 23 3.2 5
17 M 62 33 21.3 N/A
18 M 47 27 5.1 50
19 M 62 27 25.6 N/A
20 F 72 25 23.1 N/A

11. 0
5
10
15
20
25
30
35
Global Average American
Average
Clinic Average
BMI
Comparison of BMI

12. Project: Target Population
Patients who attend the Vanderbilt Heart and Vascular
Institute Clinic, particularly those who are overweight

13. Target of Risk Reduction:
BMI
• Why: While not used in the ASCVD risk calculation,
being overweight puts patients at a high risk of
cardiovascular disease
o Fat, especially intra-abdominal fat, has significant impact on metabolism
o Higher amounts of intra-abdominal fat is correlated with higher blood pressure,
higher blood lipid levels, and higher rates of diabetes
o 58% of diabetes and 21% of ischemic heart disease are attributable to a BMI
above 21

14. Planned Intervention:
Beginner’s Exercise Booklet
• Exercise booklet
• Utilizing a combined effort between cardiologists and exercise specialists,
create a booklet that outlines a beginner’s exercise plan for patients with
cardiovascular disease
• Include daily workouts that meet the Federal Physical Activity Guidelines
• Have different tiers of exercise intensity to limit risk of adverse events in
those with severe cardiovascular disease
• Include easy to follow pictures of each exercise and also be translatable into
other languages

15. Metric to Determine
Improvement
• 1) Average BMI of clinic patient population

16. Time Course Needed
• 1 year
o To assess BMI changes (most patients will have at least one return visit
scheduled and can reassess BMI at that time)

17. Defense
• Many patients are told that exercise is important, but
many do not know where to start
• While nutrition principles are somewhat easier to
discuss in clinic, planning out weekly workouts for
patients is not always feasible
• A easy to read booklet that could be handed out in
clinic would give patients a great way to begin
exercising
• Since many patients seen in clinic currently rarely
exercise, this is a potential area that could
significantly reduce risk