Ralph La Forge
Diplomate, Accreditation Council for Clinical Lipidology North Poston Ct., Durham
Biography
Physiologist and Diplomate of the Accreditation Council for Clinical Lipidology for which is the immediate past president. Immediate past president of the Southeast Lipid Association. Consultant to many health care and accountable care organizations on inaugurating systematic approaches to managing cardiometabolic risk in primary and secondary prevention. Senior consultant to the U.S. Indian and Alaskan Health Service Division of Diabetes Treatment and Prevention. Member of the teaching faculty at the University of North Carolina Chapel Hill Complementary and Integrative Medicine. Former coordinator and faculty of the Duke Lipid Disorder Physician Education Program at Duke University Medical Center, Division of Endocrinology, Metabolism and Nutrition where he is currently consulting faculty.
Abstract
Moderate levels of weekly physical activity (1000-1500 kcal/wk) is most often insufficient to significantly reduce body weight and LDL-cholesterol. Still, those who transition from very little or no daily physical activity to moderate levels, e.g., 120-150 minutes per week, do have clinically meaningful reductions in cardiometabolic risk and this fact is supported by scores of controlled trials. All physical activity is good and can help reduce cardiometabolic risk via biologic mechanisms that are not entirely dependent on body weight or BMI reduction. The immediate cardiometabolic (CMR) effects of physical activity which directly impact CMR risk reduction include AMPK activation, arterial endothelial function, PPAR gamma/delta activation, lipoprotein particle changes, and lipoprotein lipase increases. Recent research demonstrates significant reductions in diabetes risk for those who have prediabetes and/or the metabolic syndrome who increase their physical activity levels but with little or no weight loss. These individuals should be given credit for any and all physical activity principally through objective measures of changes in physical activity. There are practical, economic and effective tools and strategies that can be prescribed in outpatient healthcare settings particularly in endocrine and cardiovascular healthcare settings that can had have been successfully employed. Health care providers have distinct options to better score physical activity outcomes and become more practical in instructing patients on strategies to increase weekly energy expenditure.