Al parecer la empresa norteamericana STAR Analytical Services está trabajando en un sistema software para detectar, a partir del sonido producido por la tos, su causa, ya sea un simple resfriado, gripe, o algo más grave como la EPOC (Enfermedad Pulmonar Obstructiva Crónica).

Según la nota de prensa de la compañía, los últimos 100-250 milisegundos de la tos contienen sonidos distintivos que pueden ayudar a médicos y enfermeras a detectar, a partir de la tos un simple resfriado o algo más serio como la neumonía. Incluso con pocos datos, se puede diferenciar entre una tos involuntaria y la que ocurre en una persona enferma.

Tras el comienzo, la señal sonora de la tos se vuelve progresivamente compleja. Las cuerdas vocales vibran, y la mucosidad en los pulmones, garganta y nariz absorven ciertas longitudes de onda, al mismo tiempo que generan sus propios sonidos. Esto puede indicar la cantidad de fluido retenido en los pulmones de los pacientes.

Fuente: DiscoveryNews

Hay una canción de Amaral que comienza diciendo Domingo por la tarde, me vienes a buscar y vamos a perder el tiempo un rato… Algo tienen las tardes de domingo que llaman al recogimiento, la reflexión y a veces a la nostalgia. Para aprovecharla, os queremos proponer dos lecturas imprescindibles, que han llamado nuestra atención  por distintos motivos:

• La primera, es el último número del Infac, en nuestra jerga habitual el boletín de los vascos, del que somos fieles seguidores. Con el título Seguridad de los tratamientos inhalados en asma y EPOC, este grupo demuestra una vez más su cercanía con el día a día de la práctica clínica en la atención primaria, dedicando sus publicaciones a aquellos temas de más actualidad  o que más controversia generan. Sin duda alguna, controvertida es la seguridad de los inhaladores utilizados en las diversas patologías respiratorias para los que están indicados. Como nos recuerdan en la introducción “El retraso en la publicación de algunos estudios, la información contradictoria o la falta de un posicionamiento de las agencias reguladoras de medicamentos en nuestro medio, han contribuido a generar cierta confusión entre los profesionales sanitarios respecto al balance beneficio/riesgo de fármacos como los beta agonistas de larga duración (BALD o LABA, en la literatura de habla inglesa) en el asma y la EPOC, y los anticolinérgicos y glucocorticoides inhalados en la EPOC”. En relación a los LABA, se hace un amplio recorrido por toda la evidencia disponible, para concluir que el uso de salmeterol y formoterol se asocia a un incremento de eventos graves relacionados con el asma. El riesgo es muy claro en pacientes que no reciben tratamiento de fondo con corticoides inhalados. En pacientes tratados con éstos como tratamiento de fondo, el riesgo se reduce sustancialmente, pero no puede afirmarse que desaparezca. En niños entre 4 y 11 años el riesgo parece ser mayor. El artículo acaba con una tabla (Tabla 1) en la que se resumen las recomendaciones actuales para el uso de los LABA en asma. De ellas, queremos destacar sólo una: en los tratamientos escalonados, los escalones terapéuticos establecidos están para subirlos -cuando sea necesario- y bajarlos -cuando deje de serlo-. Lo primero parece evidente. Y lo segundo, no lo parece tanto, lo que es un sinsentido terapéutico, sobre todo en patologías crónicas y con fármacos tan problemáticos como éstos. (Sobre este tema, recomendamos leer también: Long-Acting Beta2-Agonist and Inhaled Corticosteroid Combination Therapy for Adult Persistent Asthma: Systematic Review of Clinical Outcomes and Economic Evaluation, revisión sistemática recientemente publicada por la CADTH) La segunda parte del boletín está dedicada al tratamiento de la EPOC. Sobre esta patología, ensayos clínicos como el TORCH, INSPIRE y UPLIFT) no han confirmado los posibles riesgos asociados a los LABA y anticolinérgicos, aunque las agencias reguladoras continúan evaluando la seguridad de estos fármacos. En cuanto a los corticoides inhalados, se debe tener en cuenta el posible aumento del riesgo de sufrir una neumonía, junto a los efectos adversos clásicos de este tipo de fármacos. En la tabla 2 del boletín, se resumen las recomendaciones actuales sobre el tratamiento de la EPOC, aunque lo más relevante, desde el punto de vista clínico, es que los fármacos disponibles tienen una eficacia limitada y no están exentos de riesgos, por lo que -teniendo en cuenta la heterogeneidad de esta patología- se deben ofrecer los tratamientos en período de prueba y suspenderse en ausencia de beneficios. (Recomendamos leer también: Combined LABA/ICS may not offer clinically important benefits over LABA alone in COPD, but is associated with serious adverse effects).

• El pasado día 12 el Department of Health del Reino Unido publicaba en su página web un informe titulado Report on the prescribing of anti-psychotic drugs to people with dementia. Este documento fue encargado por el DH en 2008 al Profesor Sube Banerjee, como una revisión independiente sobre el uso de antipsicóticos en Inglaterra, habida cuenta de la creciente preocupación sobre la posible sobreprescripción de estos fármacos, sobre todo en ancianos con demencia. Según Banerjee, los antipsicóticos son actualmente la base del tratamiento de los síntomas psicológicos y conductuales de la demencia. La evidencia que respalda esta práctica clínica es difícil de interpretar pues en muchas ocasiones es contradictoria y contiene importantes lagunas. Todo ello hace que sacar conclusiones para elaborar recomendaciones sea difícil, aunque el autor del informe señala que actualmente la evidencia disponible sólo muestra un efecto positivo limitado sobre el tratamiento de los síntomas y un daño evidente en pacientes con demencia. Por ello, sólo determinados subgrupos de pacientes (por ejemplo, aquellos con síntomas más graves) se beneficiarían de este tratamiento. Algunos datos para la reflexión aportados por el informe, son los siguientes: en Inglaterra, cada año 180.000 personas demenciadas son tratadas con antipsicóticos de las cuales se benefician unas 36.000, mientras que, en el otro extremo, se estima  que estos fármacos producen 1.620 ACV -de los cuales la mitad son graves- y unas 1.800 muertes. Con estos datos, Banerjee concluye que el actual nivel de uso de  los antipsicóticos es un tema de indudable importancia que afecta a la calidad de vida de los ancianos con demencia y tiene un impacto negativo sobre la seguridad del paciente y la efectividad clínica de su tratamiento. El informe concluye con once propuestas cuyo objetivo es reducir el uso de estos fármacos al nivel en el que el beneficio contrarreste los riesgos y que dejaremos que el lector interesado descubra. Antes de terminar hoy, queremos recordar que la polémica sobre el uso de antipsicóticos en pacientes con demencia (sobre todo los denominados atípicos, ya que éstos han dirigido sus objetivos terapéuticos mucho más allá de la esquizofrenia) viene de lejos. Muchas serían las lecturas recomendables sobre este particular, pero tras leer en la lengua de Shakespeare las 63 páginas del informe de Banerjee, vamos a referirnos a una en español: un butlleti groc de 2004, que en un artículo titulado Gasto en medicamentos e innovación terapéutica, afirmaba literalmente “La promoción de los antipsicóticos atípicos, no sólo a través de la visita médica, sino también de congresos, sesiones de “formación continuada” y ampliación de las indicaciones más allá de las permitidas por la ficha técnica, ha inducido a la prescripción de estos fármacos en situaciones en las que no tienen eficacia demostrada o bien no son de primera elección. Es muy probable que las principales víctimas de esta intoxicación masiva inducida por el afán de lucro hayan sido personas de edad avanzada, a veces en situación de aislamiento (por ej., residencias geriátricas). Los escasos recursos disponibles para la atención geriátrica se despilfarran. Es preciso detener este desbarajuste“. Cuando leímos hace ya un lustro este párrafo, pensamos que lo de la intoxicación masiva era un exceso verbal de Laporte. Tras leer el informe de Banerjee, no sólo hemos recordado sus palabras, sino que creemos que a lo peor se quedó corto. Lo del uso indiscriminado de los antipsicóticos en ancianos con demencia, no puede esperar más. Otros países han comenzado a tomárselo en serio, mientras aquí nos conformamos con un triste visado de recetas. ¿Esto es todo lo que podemos hacer? Pensamos que no, que podemos -debemos- hacer mucho más. Por ejemplo, comenzar a replantearnos la estrategia farmacoterapéutica seguida hasta ahora en los pacientes más débiles. A partir de ahí, lo demás vendrá sobrevenido. Si no lo hacemos, seguirá resonando la canción de Amaral en nuestra cabeza y  su endiablado soniquete que nos recuerda que importará quién pierde o gana si nunca nos jugamos nada. Feliz tarde de domingo a todos.

Jade Teta ND, CSCS

This post is a little more technical than usual and is geared mainly towards the science junkies and personal trainers who want to understand mechanisms to apply to their own training and that of their clients.  Lately we have been getting questions about the post-exercise elevation in calorie usage called EPOC (excess post-exercise oxygen consumption). People are fascinated by this subject and want to know how it works. Others are skeptical of EPOC and feel its impact is marginal. This post reveals the inside scoop on EPOC, why it is important and why it falls short in detailing the full power of higher intensity exercise for fat loss.

First a brief review of EPOC. EPOC used to be called oxygen debt, which is a much better term to describe what it is. When you exercise at higher intensities, usually defined as greater than 55% Vo2 max for untrained individuals and 75% Vo2 max for trained persons (72% MHR and 85% MHR respectively. Based on equation= %MHR=.64X%Vo2+37), you will quickly begin to dip into your anaerobic energy systems. When this happens there is no longer a direct relationship between oxygen consumed and energy used.  In other words, using respiratory exchange ratios (CO2 vs O2) to determine fat vs. carbohydrate use becomes difficult.  To make up for this discrepancy, researchers use EPOC.  Once the body begins recovery after intense exertion, it will compensate by increasing oxygen consumption to make up for the “deficit” created during exercise. We all know what this feels like.  If you walk up a flight of steps, you experience and acute example of EPOC.  In this scenerio you will breathe harder after reaching the top of the stairs than you did while you are walking up.  This is a micro-example of the EPOC effect. By waiting until recovered from intense exercise to again to capture CO2 and O2 (carbon dioxide and oxygen) researchers can extrapolate the energy expenditure during the period of time during exercise that was lost. However, this is being shown to be only partially true.

This is where confusion about EPOC comes in.  The metabolic effect of exercise, also called the after-burn, is more than just EPOC.  EPOC is an important part, but it is not the whole story. We will get to that in a minute, but first lets define how big of an impact EPOC can have.  Some experts say that EPOC is normally 15% of total calories burned in a workout.  So if you burned 100 calories in your workout, the EPOC effect would be 15 calories for a grand total of 115 calories.  This leads many people to say that EPOC is insignificant and provides no real advantage.  However, it is impossible to make such a statement about EPOC because it is impacted by so many variables.  EPOC depends on the type of exercise done (cardio, intervals, weights), the weight and body composition of the person doing the exercise (the heavier the person the greater the EPOC), the gender (men have a greater EPOC then women), glycogen reserves (more glycogen reserves = less EPOC), the order of exercise (cardio before weights = increased EPOC), workout timing (2 short bouts of exercise in the same day have greater EPOC than 1 long one) exercise intensity (higher intensity = greater EPOC), exercise duration (longer workouts = greater EPOC), and training status (trained individuals have less EPOC compared to untrained). There are other factors as well, but you get the point. There are many ways to raise EPOC. If you look at low intensity aerobic exercise you will see EPOC magnitudes that are low and dont last long.  Ironically, this is where most of the insignificant claims about EPOC come from. However, if you look at interval training and resistance training exercise you will see EPOC values that are larger and last much longer.

How Long does it last and how significant is it?

There are several studies that challenge the notion that EPOC is insignificant.  One of the most important was published in  2002 in the European Journal of Applied Physiology. In this study Schuenke et. al. showed a circuit resistance training program utilizing heavy weights, short rest periods and lasting only thirty-one minutes was able to generate an EPOC that persisted for 48 hours (1). The results showed that metabolism 24 hours and 48 hours after the exercise session was increased by 21% and 19% respectively. The researchers point out that for a typical 180-pound individual “This equates to 773 calories expended post exercise”. This is far from insignificant and greatly exceeds the 15% number many researchers quote for EPOC.  Similar findings have been shown in women using a similar resistance training protocol. In women the elevation in metabolic rate lasted 16 hours (2). Women likely have a lower response due to lower muscle mass and decreased levels of testosterone.Similar findings have been seen with interval training as well with significant EPOC values lasting up to 24 hours (3-4).

Metabolic Effect’s after-burn is more than just EPOC

While the EPOC effect can be significant as demonstrated above, it does not explain the complete impact of a metabolic workout because standard methods for calculating energy use are ineffective. This is an important point and requires some explanation. When exercise researchers calculate energy use from a workout, they cannot measure it directly so they use respiration to indirectly measure the amount of energy burned as well as the type of fuel (sugar or fat).  The ratio of carbon dioxide to oxygen, called the respiratory exchange ratio or RER in research studies, is used by researchers to make these calculations.  This works very nicely at low intensity exercise done at steady state. However, once the exercise intensity goes above the anaerobic threshold, the Co2 and O2 measurements can no longer predict calorie use or substrate metabolism.

Dr. Christopher Scott of the University of Southern Maine is an expert in the full contribution of energy from both anaerobic metabolism, aerobic exercise and EPOC. Where as many people use EPOC to extrapolate the anaerobic energy use during exercise, Dr. Scott has shown this approach leaves 30-70% of the actual calories burned uncounted (5-9).  Dr. Scott emphasizes that to fully account for calories burned during intense exercise three components must be measured: calories burned aerobically during exercise, calories burned aerobically after exercise (EPOC), and anaerobic calories burned from exercise (5-9). The latter point is not insignificant and requires a measures of blood lactic acid to quantify. It is this anaerobic measurement through lactic acid that is left out in calorie calculations of intense exercise. EPOC and the anaerobic lactic acid measurements for exercise are considered separate by Dr Scott. While I understand this discussion is getting very technical, it is important to understand these issues to fully understand Metabolic Effect.

The major take home message in regards to the metabolic after-burn of intense exercise is this, EPOC is not only more significant than we may think, but it cannot fully explain the metabolic advantage of metabolic conditioning.  A full 30% or more of calories burned during intense exercise will be neglected if only EPOC is used to measure the after-burn of exercise. If EPOC  is also left out of the calculation, as some researchers are still doing, over 90% of calories burned during a higher intensity metabolic conditioning workout will be neglected and uncounted. This explains why so many practitioners of metabolic exercise see such a drastic change in their body’s compared to standard exercise programs.

How can you generate the greatest metabolic effect?

Using this new understanding of exercise and following what the research says, there are 4 reliable ways to stimulate the maximum caloric burn both during and after the exercise session. We call these the “Bs” and the “Hs”, breathless, burning, heavy and heat. Each workout should work to genrate all four of these components.

1. Get Breathless- you have to be panting for breath in order to reap the full benefits of a metabolic workout.  If you can talk, you are not doing metabolic conditioning. This aspect correlates with the degree of EPOC and anaerobic calorie burn. It is important to minimize pacing yourself which is why we have developed a system of exercise we call rest-based training that allows each exerciser to generate the correct intensity required for their unique metabolism to reap the rewards…hence the ME acronym.

2. You need to get Burning- You have to get to the point of “metabolic failure”.  Metabolic failure is a term I use to describe the need to stop exercise because of an intense burn in the muscles, not necessarily because the weight is too heavy to lift.  This is directly related to the lactate generation in a workout and how much growth hormone and testosterone you will generate from the workout (more a HGH determining factor than a testosterone one).  What many people are unaware of is that lactic acid acts like a hormone and may actually cause/contribute to the release of HGH and testosterone (10-14). In other words the degree of burn in your muscles is directly correlated to the proper hormone response for increased muscle building and fat burning.

3. You need to lift heavy- if you are not incorporating heavy weighted movements into your workout you are missing a key component of the after-burn.  In the 2002 research by Schuenke the weights used were very heavy (a 10 rep max) and the exercises were full body movements.  Heavy barbell squats, explosive power cleans, and maximal dead lifts or similar full body exercises are key to the metabolic effect.  If you don’t have access to heavy weights, then you need to use body-weight exercises and explosive movements that come close to mimicking the same effect (single leg squats, pull-ups, push-ups, explosive jumps, and other plyometrics).  This one is all about the type IIb muscle fibers.  Heavy weights trigger HGH and testosterone (more testosterone than HGH).  This is what I call “mechanical failure”.  As opposed to metabolic failure, this is when the weight just gets to heavy to overcome gravity and go no longer be lifted.

4. You need to generate heat- the final parameter is heat. One of the biggest contributors to EPOC and anaerobic energy use is heat. If you are not sweating, your body is not getting hot enough.  As a matter of fact, I use the ability to sweat as a biofeedback tool into how sensitive the body is to its catecholamine response.  If your not sweating in a workout, you are missing out on this heat effect and the after-burn will suffer.

References:

1. Schuenke, et. al. Effect of an acute period of resistance exercise on excess post-exercise oxygen consumption: Implicationsfor body mass management European Journal of Applied Physiology. 2002;86:411-417.
2. Osterberg, et. al. Effect of acute resistance exercise on postexercise oxygen consumption and resting metabolic rate in young women. International Journal of Sport Nutrition and Exercise Metabolism. 2000;10(1):71-81.
3. Tremblay, et. al. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994;43:814-818
4. Treuth, et. al. Effects of exercise intensity on 24-h energy expenditure and substrate oxidation. Medicine and Science in Sport and Exercise. 1996;28:1138-1143
5. Scott, et. al. Misconceptions about aerobic and anaerobic energy expenditure. Journal of the International Society of Sports Nutrition. 2005;2:32-37.
6. Scott et. al. Estimating total energy expenditure for brief bouts of exercise with acute recovery.  Applied Physiology Nutrition and Metabolism. 2006;31:144-149.
7. Scott, et. al. Contribution of blood lactate to the interpretation of total energy expenditure for weight lifting. Journal of Strength and Conditioning Research. 2006;20:21-28.
8. Scott et. al. Contributions of Anaerobic Energy Expenditure to Whole-body Thermogenesis. Nutrition and Metabolism. 2005;2:14.
9. Scott, et. al. Direct and indirect calorimetry of lactate oxidation: implications for whole-body energy expenditure. Journal of Sports Science. 2005;23:15-19.
10. Turner ET AL. (1995). Effect of graded epinephrine infusion on blood lactate response to exercise. J Appl Physiol,79(4):1206-11.
11. Takahashi ET AL.(1995). Relationship among blood lactate and plasma catecholamine levels during exercise in acute hypoxia. Applied Human Sci,14(1):49-53.
12. Kaiser ET AL. (1983). Effects of acute beta-adrenergic blockade on blood and muscle lactate concentration during submaximal exercise. International Journal Sports Med, 4(4):275-7.
13. Godfrey Et. Al. The role of lactate in the exercise-induced human growth hormone response: evidence from McArdle disease. British Journal of Sports Medicine. July 2009;43(7):521-525.
14. Lin Et. Al. Stimulatory effect of lactate on testosterone production by rat leydig cells. Journal of Cellular Biochemistry. June 2001;83(1):147-154.

Algunas veces me encuentro con enlaces interesantes que no dan para escribir una entrada larga en el blog, como la publicación de un artículo, o la actualización de una guía de práctica clínica. Muchos de estos enlaces me llegan vía twitter y los retransmito por el mismo medio, pero soy consciente de que mucha gente aún no utiliza esta herramienta por lo que si no están atentos a la barra lateral de este blog es probable que no lo lean. Por esta razón he decidido hacer una recopilación heterogénea de algunos de ellos:

• American Journal of Gastroenterology Guidelines for Colorectal Cancer Screening 2008: This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5–10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).
• Why can’t you tickle yourself? PubMed abstract
• Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax 2009;64:863-868
• El abordaje multidisciplinar de la esquizofrenia en Centros de Salud Mental. GuíaSalud id: 443.
• Centro de Recursos del CEADAC: Coincidiendo con el Día Nacional del Daño Cerebral, el Centro de Referencia Estatal de Atención al Daño Cerebral os invita a la presentación del Centro de Recursos del CEADAC el lunes 26 de Octubre a las 12:30 h en el Salón de Actos del centro (Sala Polivalente). Se ruega confirmación de asistencia al evento.
• Primer mapa de la incidencia de la tuberculosis: Martín, R, Monleón-Getino, T. A graphical study of tuberculosis incidence and trends in the WHO’s European region (1980-2006). Eur J Epidemiol. 2009;24(7):381–387.
• Manifiesto del Bibliotecario 2.0 (vía Universo Abierto). Imprescindible su lectura.
• How to add Medline Plus and UpToDate search boxes to your website: Medline - UpToDate Patient Search (vía Clinical Cases and Images – Blog)
• LigerCat: herramienta de búsqueda, muy útil para reforzar nuestras búsquedas en PubMed.
• Visible Human Server: recurso interactivo y gratuito, creado por la Escuela Politécnica Federal de Lausanne, para aprender anatomía humana (vía USALbiomédica)

El gobierno ha presentado hoy la Estrategia nacional de EPOC del Sistema Nacional de Salud. El objetivo, mejorar el diagnóstico precoz y el tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC), que provoca más de 17.500 muertes al año, y cuyos pacientes no son conscientes hasta ya que los primeros síntomas se manifiestan con la enfermedad muy avanzada.

Los primeros síntomas (disnea, tos y expectoración) aparecen cuando la enfermedad ya está muy avanzada. Según los expertos, esta circunstancia determina que el 73% de quienes tienen EPOC no lo sepa hasta que es demasiado tarde. Por ello, el nuevo documento también especifica los cuidados paliativos a enfermos terminales de EPOC, la formación de `profesionales y la apertura de nuevas líneas de investigación en este campo.

Datos que cortan la respiración

Según la OMS, en 2007 un total de 210 millones de personas en todo el mundo sufrían EPOC. En 2005, tres millones de personas fallecieron en el mundo por esta causa, lo que supuso el 5% de las muertes registradas ese año.

Según sus estimaciones, en 2030 la EPOC será la causante del 7,8% de todas las muertes y del 27% de las muertes relacionadas con el tabaco, sólo superada por el cáncer (33%) y por las enfermedades cardiovasculares (29%).

En España, en 2005 la EPOC fue la quinta causa de muerte entre los varones, con una tasa anual de 61 muertes por 100.000 habitantes, y la séptima para las mujeres, con una tasa anual de 20 muertes por 100.000 habitantes. Según el Centro Nacional de Epidemiología, en 2005 murieron en España 17.571 personas a causa de la EPOC.

El gasto total asociado a la EPOC equivale al 0,2% del Producto Interior Bruto español.

Fuente: SINC

That’s it! A keyboard you can control with your brain.
This is my new little project using the emotiv epoc. The idea is born from a request on the emotiv forum, when someone asked if a paralized child would have been able to type using the epoc. I thought I could give myself a try with this.

The layout of the keyboard is “stolen” from a psp keyboard appeared for the first time in Gran Turismo, if I’m not wrong and then brought to popularity by the psp homebrew comunity.
My application, called mindKeyboard allows you to select one of 9 quares each with 4 letters in the four sides; once you select the desired square you can select the desired letter in that square.

You can get a video of it in action here
The source code is available from git or in zipped package
The binary distribution is on sourceforge too.

Hope someone will enjoy the application =)

Foto: Routers

La mitad de los fumadores de edad avanzada desarrolla una enfermedad obstructiva pulmonar crónica (Epoc), según pone de relieve un estudio realizado por un consorcio internacional en el que han participado el Centro de Investigación en Epidemiología Ambiental (Creal), el Instituto Municipal de Investigación Médica (Imim-Hospital del Mar) y el Hospital Clínic de Barcelona.

La investigación, publicada en el boletín médico ‘The Lancet’, ha permitido la elaboración de un índice de riesgo para calcular la mortalidad de pacientes con Epoc, cuyo uso permitirá a los médicos evaluar de forma más objetiva la gravedad de la enfermedad en cada caso, así como desarrollar tratamientos ajustados a cada persona.

El índice, que podría ser utilizado en los Centros de Atención Primaria (CAP), donde se trata a la mayoría de pacientes con Epoc, tiene en cuenta factores como la edad del paciente, su nivel de disnea –dificultad de respirar–, y predice la posibilidad de que muera en los próximos tres años.

La Epoc se encuentra entre las cinco causas principales de muerte en el mundo, ya que causa unos tres millones de fallecimientos anuales. La enfermedad llega a afectar a la mitad de los fumadores a lo largo de su vida, y se estima que en España mueren más de 18.000 personas al año por esta dolencia.

Unos 60 hombres de cada 100.000 mueren en España por esta razón, así como 17 de cada 100.000 mujeres, si bien estas cifras aumentan cada año debido a que España es uno de los países que tienen un mayor índice de tabaquismo entre adolescentes y en mujeres.

La Epoc se produce por la inflamación de los pulmones y en el resto del organismo produce ahogo, junto con una insuficiencia respiratoria progresiva, lo que representa uno de los principales problemas de los pacientes en su vida cotidiana.

Hasta el momento la mayoría de los pacientes recibían un tratamiento similar, fruto de la evaluación tradicional de la enfermedad, basada solo en la función pulmonar y que no predecía con precisión las condiciones clínicas ni la evolución progresiva de la enfermedad.

El uso del nuevo índice, “sencillo y práctico”, indica explícitamente el riesgo de muerte de un paciente concreto y contribuye a identificar cuáles podrían beneficiarse de un tratamiento más completo, que además del abandono del tabaquismo o del uso de fármacos por inhalación, puede incluir otros métodos no farmacológicos como la rehabilitación pulmonar y el ejercicio físico regular.

La investigación es el resultado de la colaboración entre investigadores de Suiza, Países Bajos, Estados Unidos y España, y ha sido posible por el análisis de datos de 232 pacientes suizos y 342 españoles tratados de esta patología en siete hospitales de Catalunya, uno del País Vasco y otro de Baleares.

Fuente: EuropaPress. El 50% de los fumadores sufrirá una enfermedad obstructiva pulmonar

Estaba terminando de subir una página con datos sobre la Enfermedad Pulmonar Obstructiva Crónica (EPOC) cuando me aparece un comentario para considerar. Sin consultar a quién lo hizo voy a citarlo ya que viene “como anillo al dedo”.

“Estoy buscando alternativas para dejar de fumar. llevo una adicción de mas de 30 años.. me cuesta y caigo en mucha tristeza.. gracias”

Fuí un fumador de 1 cajilla diaria durante 40 años, lo dejé por cortos períodos varias veces pero solamente después de que se me diagnosticó el tumor de cuerda vocal que mencionaba antes  (hablando del alóe) pude dejarlo y ya hace más de 3 años.

Mi compañera, otra fumadora de muchos años, se propuso dejarlo pero necesitó de ayuda profesional, asistió (y a veces aún asiste) a un grupo “antitabaquismo” dirigido por una neumóloga, en el que mediante charlas informativas y de apoyo y la administración de goma de mascar especial (con nicotina) logró dejarlo y ya hace más de 3 años. Otros pacientes necesitaron recurrir además a medicamentos ansiolíticos.

Por otra parte quiero comentarles de una familia conocida en la que, 2 varones de unos 60 años fallecieron hace meses por tumores de pulmón y un tercer hermano tiene enfisema pulmonar y un EPOC grado 4 (con serias dificultades para respirar, aún sin hacer ejercicios). En el vecindario veo pasar caminando casi todos los días a otro vecino de unos 56 a 58 años, que tiene que detener su marcha cada 30 o 40 metros para recuperar el aliento (la causa, un EPOC debido al tabaco). Tiene una discapacidad casi total.

Que más decir, dejar de fumar SE PUEDE, de lo contrario un elevado porcentaje de fumadores muere por cáncer de pulmón, con un sufrimiento horrible y muchos de los que se salvan de esta enfermedad desarrollan EPOC después de los 50 años y si no toman medidas también pueden morir ASFIXIADOS lentamente o por complicaciones infecciosas.

Algunos datos sobre plantas medicinales útiles las encuentran en una página de Adicciones.

What were we talking about?

Today I came across this beauty on www.tmuscle.com.  I’m a huge fan of Tmuscle and it’s sister company Biotest (supplements). They consistently have the best training information and supplements you can find.  Today’s article on complexes was no exception.

Coach Dan John had a great explanation of complexes: ” A complex is a series of exercises performed back to back where you finish the reps of one lift before moving on to the next lift. The bar only leaves your hands or touches the floor after all the lifts are completed.”

The structure of complexes makes them very conducive to metabolic conditioning.  By performing three to five exercises back-to-back with the same load, you can elicit a huge conditioning response.  Complexes are a great alternative to traditional cardio (treadmill, bike, stairmaster, etc…) if you want to lose body fat and maintain muscle.

Coach Robert dos Remedios summed up complexes perfectly: ” cardio strength training.”

#mce_temp_url#

In Part 1, we looked at why the TIME magazine article entitled “Exercise Can’t Make You Thin” may not have been entirely true. In the first part, I addressed why interval training exercises were far superior to steady state cardio exercises such as jogging, swimming or cycling.

In this article, I will elaborate on the many benefits provided by weight resistance exercises for weight loss.

Weight resistance training are exercises which stress your muscles against heavy loads. These loads can be dumbbells or even your own bodyweight. Resistance exercises that utilize your own body weight include push-ups, squats or even pull-ups.

Resistance exercises build your muscle mass. While this may excite most men, it should not frighten women away. Men tend to build bulky large muscles. Women on the other hand can never build bulky muscles. Women build muscles that are dense and compact.

The hulking women with bowling ball sized biceps that you would have seen in magazines are on steroids. A woman on a normal weight resistance exercise regime will find it extremely difficult to build any biceps at all. I would love to meet any woman out there who can build large muscles without taking steroids. I will pay you for your secret formula as I have been trying to do this for years.

Instead of building bulking muscles, these exercise are able to sculpt and shape a woman’s body as if a master sculptor was sculpting the statue of a Greek goddess. For ladies needing more information on weight resistance training, please read “Women & Weight Resistance Training“.

Courtesy of SXC.hu

Why are weight resistance exercises so effective for losing weight. Its mainly due to the vast amounts of energy required to build and maintain muscles. In the scientific world, this energy to build and sustain muscle mass is known as Excess Post Exercise Oxygen Consumption or EPOC for short. It can be scientifically defined as the “recovery of the metabolic rate back to pre-exercise-levels”. It can take several minutes for light exercise and several hours for resistance or interval training type exercises.

In layman’s terms, it means that you continue burning calories at an increased rate after an interval or resistance training workout. This is what raises your metabolic rate. It literally means continuing to burn fat while you paint your nails (ladies), watch TV or even as you gobble down your dinner. Its some times also called the “afterburn” effect.

TIME Magazine should have referred to the study conducted by Schuenke in 2002 published in Eur J Appl Physiol. The study looked at the effects of weight training on EPOC. The exercises only took a total of 31 minutes. The researchers found that EPOC was elevated for 38 hours post workout. It could have possibly been longer but this is when the researchers stopped measuring. It means that after 31 minutes of exercise, the metabolic rate remained elevated for a whopping 38 hours.

In other words, that is 38 hours of continuous fat burn for 31 minutes of work. Isn’t this the best way to lose weight? Spend 31 minutes on exercise and enjoy a continuous 38 hours of fat burning?

Exercise definitely works for weight loss but it’s not just any exercise. It must be the correct exercises. The correct exercises for correct weight loss are interval training and weight resistance training irrespective of your gender. The studies referred to in the TIME magazine article were focused on cardio type exercises which are proven to be ineffective for long term weight loss.

For more information, please read “Why Resistance Training is More Effective that Jogging/Swimming for Sculpting Your Body“.

Tags: TIME Magazine, afterburn, afterburn effect, cardio, EPOC, exercise, interval exercises, interval training, steady state cardio, weight resistance exercises, TIME Magazine article on weight loss

I’ve found today that I can post on this blog even from my iPhone, I’ve just installed an application and here I am to try it!

Yes, because I use iPhone since last year, before official import in Italy (a 2G iPhone from US) and I’ve just replaced it with a new 16 GB iPhone 3Gs.

I love mobile devices, I’ve always loved them and I started using mobile internet in 1999 (och… is 10 years now…) with my Psion Revo connected via IR to my cellular phone. I went even further when, after having replaced the Revo with a Ericsson MC218 (Psion 5mx clone, what a wonderful object!), I connected to my home phone line using a 33.6k US Robotics Sportser using a null modem cable: I cannot say I surfed the web fast but it was funny…

Both these devices used the Symbian “Epoc” OS that started the Symbian adventure, today one of the most used OS on smartphone.

After that, I jumped to Palm OS buying a Palm Tungsten T2, a real tank, metal body and long battery life.

Now I’m in love with iPhone, a real Unix machine in my pocket (I love Unix-like OS’s, we’ll find the time to talk about that…), let’s see how this app work.

See you at next post!

Andrea

Post From My iPhone 3Gs

Which is the fastest way to lose body fat: doing cardio training or weight training?

Long-distance runners are skinny and have little body-fat. Sprinters are big with muscle, and have little body-fat. Long-distance runners do very little weight training; sprinters do a lot of weight training.

What is best for your goals?

We might intuit that just doing cardio training will be the fastest way to lose body-fat. It appears so – in cardio you are constantly moving, and often for long periods of time. When weight-training, you move much less: generally just a part of your body at each time. And with rest periods between movements.

And we know that movement equals calories burned, which leads on to fat-loss. And this is true. But measuring movement is not actually the way to understand calories burned. The best way to work out calories burned is by check your oxygen consumption.

So if in a 30 minute workout your oxygen consumption doing cardio is the same as lifting weight, you will be close to having burned the same number of calories. Essentially regardless of the activity you have been doing.

But in practice it doesn’t quite work like that. All things being equal, your oxygen consumption in 30 minutes of cardio will be greater than that in 30 minute of weight training.

An example:

Consider an 80 kg male performing 30 minutes of weight training. Let’s say he is having minimal rest between sets, and his heart rate is elevated the whole time. He might expend 250 calories doing this.

The same guy would expend 400 calories running at 10 km/hr on the treadmill.

Check out this calculator to work out calories used for any physical activity for your specific height, weight and age.

So clearly for straight-out calories used you are better off on the treadmill than lifting weights (all things being equal). Don’t forget – and many do – that you are still burning calories when lifting weights.

How can you make weight-lifting burn more calories?

Make sure you run out of breath while you do it. Is it possible to get puffed lifting weights? Yes – I for one insist on it. What happens at the end of my last couple of sets of lifting – when I reach highest intensity – is that my body feels like it’s out of oxygen. I actually have a little trouble getting oxygen in, and I’m blowing out a lot. It’s what I’m used to now, and I like the challenge.

I like to limit my rest periods and make sure I'm puffing by the end

But there is more to it…

Whilst movement, and length of time in movement, is a factor in calories burned, there are other factors of importance. These factors are:

ONE  How fit you are to begin with

As you get fitter, you body adapts in many physiological ways. One improvement that takes place as you get fitter is that your heart rate lowers during a workout for a given oxygen consumption. You stronger heart can now cope easier with the rate of oxygen consumption, and so can manage it by pumping fewer times per minute. What then might happen is that you feel that you can exercise harder. When you push yourself harder , you elevate your (now stronger) heart rate to pre-adaption levels, and so increase your rate of oxygen consumption and therefore expenditure of calories.

So we could say that you can lose weight faster as you learn to keep elevating your heart rate even as you get fit. And this will apply whether you are doing cardio or weight training.

TWO  Excess Post Exercise Oxygen Consumption (EPOC)

Research suggests that Excess Post Exercise Oxygen Consumption (EPOC) is greater after weight training than after aerobic exercise.  Again, because you are using more oxygen, you are burning more calories.

It is not clear how long EPOC actually lasts for.  Some bodybuilding literature suggests you get this effect for up to 24 hours. Recent research suggests that 60 minutes or less is a much more accurate estimate. I’m quite sure that I can feel this EPOC thing after a weight training. To me, it feels like I am ever-so-slightly short of breath for about 20 minutes after finishing. I guess extra amounts of oxygen are required by my muscles while they immediately recover from their work.

EPOC is real, but it doesn’t really help the case of doing weights over cardio for burning calories. Increased EPOC post-weight-training is understood to only burn about 20 to 30 calories. It’s fairly negligible.

THREE  Long-term – muscle counts

Metabolic rate is the rate at which the body burns calories. We’ve been talking above about burning calories while exercising. And that is obvious. But the body burns calories just to exist: even when still much energy is being used to perform automatic bodily functions.

Which is where muscle comes in. Having muscle boosts your basal – or stationary – metabolic rate. Think of it as muscles being ‘hungry’ for energy just to continue to exist. Studies have shown that regular weight training can increase basal metabolic rate by around 15%. Other studies suggest for every 1 kg (2.2 lb) of muscle you have, your body burns around 100 extra calories per day.

So over time, you are in a much better position to keep losing weight, or keep the weight off, if you have grown yourself some extra muscle. So weight training becomes a very useful form of exercise if your timeframe is a little longer.

FOUR  More is not always more

To wrap this up, there are a couple of real interesting studies that have been done comparing different types of cardio training, and the affects they have on oxygen consumption and therefore calories expended. Reference: Making Sense of Calorie-burning Claims.
By Robert A. Robergs, Ph.D., and Len Kravitz, Ph.D.

In the above study, tests were set up with a healthy and fit female exercising in three different ways: a stationary bike; the same bike with arm ergometrics (like on a cross-trainer); with arm ergometrics only.

So essentially, they tested the result of exercising your legs only, arms and legs, and arms only.

The highest heart rate was recorded for the combination arms and legs exercising, which makes sense as more muscles are being used. But peak (maximum recorded) oxygen consumption was actually higher in legs-only exercising, even though fewer muscles are being used.

So  using arms and legs felt like harder work, and produced an increased heart rate for the volume of oxygen used.  Cycling-only resulted in a lower heart rate, and that meant that a higher intensity – or higher level of oxygen consumption – could be maintained.

Cycling is an activity where large oxygen exchange occurs at a heartrate that can be maintained for a long time

The study found  that by involving less movement and focusing on only the larger muscles of the lower body, a higher intensity can be created at a given heartrate. And this higher intensity represents more oxygen used and more calories expended.

The end result? My favourite go-to statement about losing weight and getting in shape – it’s the intensity that really initiates the process of burning calories. Whether weight training or cardio  training.

So what to do? Cardio or weights to help lose body fat?

It depends on your goals. If you want to lose weight fast NOW, go for cardio. And make it intense cardio. 20 minutes is enough. But make sure it’s HIIT training. You do want to get to a point during your training where you are using maximum possible oxygen.

If you want to lose weight over the medium to long term (if you have 6 weeks or more), be sure to use cardio and weight training. I recommend alternating weights and cardio. You should only need to do each bodypart once per week in weight training. Again, I would rely on the higher intensity HIIT cardio training.

Of course, incorporating the weights is a massive benefit long-term when looking to continue losing weight, or to help keep it off.

Where does this leave our runner types? I will always prescribe the training style of the short distance athlete. I like the leanness, the muscles, the speed, and the fitness. And producing that physique allows a variety of weight and cardio training.

Check this now

Next time you are working out, check both your breathing rate and your heart rate. Imagine that the greater volume of air you are breathing, the more calories you are burning. Monitor your heart rate too, because keeping your heart rate from getting too high will allow you to stay at that level of exertion for longer.

And the longer you can maintain a large volume of oxygen exchange, the more calories you can burn per workout.

Monitor your breathing (and rest when you run out)

Christopher R. Mohr, PhD, RD
Meal Plans101

Whether it is business lunches or quick stops at fast food restaurants with the kids, knowing how to make the best decisions to forgo sabotaging the diet is important. This is also crucial for athletes who are regularly traveling and need to be fueled with “high octane” foods. Use these handy rules to help make the best decisions at various restaurants.

General Tips:

1. Order off the menu and focus in on these 4 words when ordering:

Steamed
Broiled
Baked
Grilled

Never go to the restaurant hungry

Eat a piece of fruit
Try a yogurt
Eat a granola bar
Have some cottage cheese and fruit

Ask for what you want; as a paying customer, restaurants will cater to your needs (within reason).

Do not cook foods in butter
Limit the amount of oil used in cooking
Replace refined carbohydrate, high fat foods (fries, potato salad, etc) with an extra order of steamed vegetables

Call ahead to find out what foods are offered so you can plan ahead

Figure out calories and fat grams of foods you may eat
Know what foods fit the bill for health options

Avoid pre-dinner cocktails and bar snacks
Fast Food Restaurant Tips

Fast food restaurants permeate nearly every corner of the road; from Italian to Chinese, burgers to subs, there is no limit on what you can find. Here are some general tips when trying to make the best decisions if faced with a “fast food dilemma.”

Chinese Food

Order steamed options (or ask for your favorite item steamed).
Most Chinese restaurants now offer brown rice too, rather than the more traditional white rice.
Avoid the fried noodles they often put on the table before the meal.

“Hamburger” Restaurant (McDonalds, Burger King, Wendy’s, In and Out, etc)

Most now offer grilled chicken salads. Choose this vs. a triple artery clogging bacon cheeseburger.
If craving a hamburger, order a plain burger or cheeseburger; leave the hefty burgers for the next person in line.
Try a grilled chicken sandwich sans mayonnaise or “special” sauce.
Leave the fries behind.

Italian Food

Split your meal with someone; portions here are at least double what they need to be.
Try grilled or broiled fish.
Avoid creamy sauces on pasta dishes; instead opt for marinara, which is much lower in fat and calories.
Limit consumption of bread on the table that’s commonly doused with olive oil or covered in butter and opt for a healthy tossed salad, with olive and balsamic vinegar on the side.

Steak Restaurants (Outback Steakhouse, Ruby Tuesday, etc)

Avoid the “prime” cuts of beef (e.g., prime rib) and opt for the loin or the round (sirloin, top round, eye round, etc).
Ideally order grilled or broiled seafood

Sub Shops (Subway, Quiznos, Blimpie, etc)
Order the grilled chicken or turkey breast options.
If possible, choose the whole grain breads.
Leave off the bacon, cheese sauce, and mayonnaise; instead try mustard, vinegar.

About the Author:

Dr. Chris Mohr RD, PhD is a health nutrition consultant to a number of media outlets and corporations including Discovery Health Channel, Clif Bar, Waterfront Media, and Fit Fuel. He has authored and co-authored several textbooks and textbook chapters, including consulting with LL Cool J on “LL Cool J’s Platinum Workout” (Rodale Press, 2006).  He is also co-creator of Meal Plans 101 nutrition software. For more information on how you can utilize Chris’s expertise go to Meal Plans101

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We all know training is a big part of getting into shape and gaining better health, but even more important is nutrition. This is usually the missing link that keeps individuals from reaching their goal. It takes both training and nutrition to effectively reach your goals, but by fine tuning your nutrition program, you will reach your goals more quickly.

I sat down with Dr. Chris Mohr of Meal Plans 101 to let him explain just how easy it is to reach your nutritional goals.

He and Jayson Hunter, RD, CSCS have designed a piece of nutritional software along with that makes it absolutely simple to create simple, yet effective meal plans.

Question 1:

How important is having a meal plan to follow in regards to nutrition compliance?

It’s just as important as having driving directions if you don’t know where you’re going. Having a nutrition plan is the map to get you where you want to go. Or, for the more technologically sounds folks, the meal plan is the GPS system for improving compliance. I don’t know how to get to Fargo North Dakota—but if I had to drive there, I would pull out a map and write my directions. The same is true for nutrition—most folks know what they need to do to lose fat or gain muscle, but they don’t have the specific directions to get there.
Question 2:

What do you think are the biggest barriers to following a good nutrition program?

First is not planning. Like I described above, you need to plan the best way to reach your destination—in this case, the destination may be fat loss or gaining lean body mass. Meal Plans 101 does the planning for you. If you fail to plan, plan to fail. Why struggle any longer; use the properly designed tools to help you reach your goals.

Second, is watching your portions. Oatmeal is fantastic for you, but sitting down every day to 2-3 cups of oatmeal per meal might be a bit much. Wouldn’t it be nice, though, to know just how much a portion size should actually be? We did that research for you, and it’s all in the software.
Question 3:

Do you have to be a nutrition expert to know how to eat healthy? How hard is it to create an effective meal plan that will allow someone to lose fat or gain muscle?

Nutrition experts are of course beneficial—I’d be knocking myself and Jayson down if I didn’t think they were. But we can’t be there with every single person who wants a simple meal plan put together for them and, quite frankly, it isn’t cheap to work with us individually. This software isn’t meant to replace the advice of a qualified nutrition professional, what it’s meant to do is provide you with science based tools, such as specific formulas (they are behind the scenes, so you don’t have to get involved with them) to tell you how many calories to eat for your goals, along with providing you the ability to choose your food preferences, so you don’t have a cookie cutter program, but instead a unique, proprietary meal plan that fits YOU!

Question 4:

You have mentioned your software. What is it exactly and how can it make the lives of my readers easier?

Simply put—it allows folks to plug in specific values they get from clients or from themselves and it will spit out your specific nutritional needs to achieve those goals. It will then give you the breakdown of just how much of each food group you should be eating, but you are able to customize it to your food choices!! It’s takes just a few minutes to get the grasp of this and then it’s just another tool to help you reach your health and physical goals,
Question 5:

One last question. How important is it to adjust your carbohydrates when it comes to weight loss?

This is the million dollar question. Some research supports a modified carbohydrate diet for successful weight loss, while others suggest a lower fat nutrition plan. The key is nutrient quality and the answer is probably somewhere in the middle. The right types of carbohydrates are excellent. Similarly, healthy fats are crucial, so drastically restricting one or another is not the best way to go about it, in my opinion. And that’s why you have the ability to choose both in the food options under each category.

Chris, thank you for your time today–if you feel your nutrition is the missing link, then check out Meal plans 101 to find out just how easy it is to get your nutrition on track. Don’t leave your nutrition to chance or else you may very well be wasting all that hard work you put in at the gym.

Meal Plans 101 Home Page

Ready to Order Meal Plans 101

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By: Jayson Hunter RD, CSCS
http://vur.me/s/MealPlans101

1. Eat 4-6 small meals day a day instead of the usual 2-3 large meals. Eating frequently will help regulate and boost your metabolism to burn more calories.

2. Consume whole foods that are high in fiber and low in sugar such as lean protein (lean beef, chicken, fish, and whey protein), fruits & vegetables (oranges, apples, strawberries, blueberries, broccoli, peppers, asparagus, carrots, nuts (almonds, cashews, & walnuts), and whole grains.

3. Eat low-glycemic carbohydrates such as vegetables, whole-wheat products and oatmeal instead of refined processed carbohydrates which usually come in a box or a bag.

4. Recommend consuming 25-35 grams of fiber per day. Since the average diet contains only 14 grams we could all use more fiber. Fiber will help satisfy hunger pangs as well as control insulin and blood sugar levels which tend to promote fat storage when they are elevated.

5. Eat some type of lean protein at each meal. Protein helps to satisfy hunger and provide the necessary building blocks to maintain lean body mass while losing body fat.

6. Consume adequate amounts of healthy fat foods such as olive oil, walnuts, almonds, Omega-3 fortified eggs or other Omega-3 products. Healthy fats are great antioxidants as well as help with brain function and many other essentials processes that take place in the body on a daily basis. Essential Fatty acids also help prevent certain diseases.

7. Recommend eating 5-10 servings of fruit and vegetables a day to meet your micronutrient needs. Vegetables also contain a good amount of fiber and help to control appetites and curb hunger.

8. Consume Green Tea or Water instead of calorie filled drinks such as soft drinks. Green Tea has many health benefits and should be drinking 1ml of non-caffeinated fluid for every calorie that you consume. This works out between (8-12) 8oz glasses of Green Tea or Water a day.

9. Balance your fat intake for the day. 1/3 should come from saturated fats, 1/3 from monounsaturated fats, and 1/3 from polyunsaturated fats.

10. If you want to start building habits then you need to follow a plan. Habits are formed by repetitively following a prescribed plan. Therefore map out your meals every day and follow them. If you follow your plan everyday for 2-3 weeks you will form habits that become part of your daily routine and you won’t even notice it. How do you think bad habits are formed? By repetitively doing something over and over again.

11. Include what I call “Superfoods” into your meal plan on a daily basis. These include but not entirely lean meat, salmon, low fat plain yogurt, tomatoes, spinach, mixed berries, whole oats, mixed nuts, olive oil, flax seeds(or flax meal), green tea, and various beans. These are just some of the “Superfoods” who should be incorporating into your daily meal plans.

12. Keep total fat intake under 30% for the day. This can be accomplished by not adding too many extra fats such as butter, sour cream, mayonnaise, etc. This doesn’t mean you have to completely eliminate these items, but do not eat them as a regular food item every day.

13. EXERCISE!! You can lose weight by just following a nutrition plan on its own but very few succeed at it and it takes much longer than when you eat properly as well as exercise. I am not talking about just getting on a treadmill for 30 minutes every other day. Though you can lose weight this way it is not the most efficient use of your time nor maximizing the ability to burn calories. The most effective way to lose fat is by strength training or some type of interval training utilizing strength training and cardiovascular exercises. A properly designed program can burn more overall calories in 20 minutes than 20 minutes on a treadmill. Also, the X factor in all this is that you will burn more calories per minute hours after you finished strength training because of the EPOC effect. Static exercise on a treadmill doesn’t produce this X factor.

14. Record what you eat and drink. You will be amazed at what you consume and not even realize you did it until you right it down and reflect back on the day. Keeping a food log is critical to your success because if modifications need to be made you need something to be able to evaluate and analyze. If changes aren’t happening like you had hoped the answer can usually be found in the food and or exercise journal.

15. Follow the 90% rule. If you can follow your plan 90% of the time then that is enough to have success with weight loss. If you find yourself breaking the rules more than 90% of the time then the chance of being successful with weight loss is not as likely. Your chances of failing increase significantly. Lose the all or nothing attitude and just take one day at a time. Reflect on your day before you go to bed at night and instead of getting down on yourself because you weren’t perfect just set goals to accomplish next day that would eliminate those errors.

About the Author:

Jayson Hunter, RD, CSCS, is a registered dietitian and fitness professional with more than 10 years of experience. He has worked with 1000’s of individuals in achieving their ideal body and has been published in numerous magazines. He is also co-creator of Meal Plans 101 nutrition software. For more information on how you can utilize Jayson’s expertise go to http://vur.me/s/MealPlans101

Es sabido que las guardias en la planta de trauma o son muy buenas o muy malas. Pareciera que los traumas se focalizaran demasiado en técnicas quirúrgicas y se olvidan de la medicina interna por lo que algunos pacientes pueden evolucionar de forma fatal. Muchos ancianos que se operan las caderas son pluripatologicos, plurimedicados, plurietc, etc,etc. Cuando no se les medica con su tratamiento habitual y se les llena de sueros o transfusiones vienen los problemas.
Acude el que está de guardia al llamado de la enfermera porque el paciente no orina o está con disnea o con palpitaciones o dolor torácico, etc, etc. Se mira la historia y mayúscula es la sorpresa cuando su historia consta de un informe quirúrgico y un pre-operatorio en la que en una linea figura Fibrilacion auricular o EPOC sin que conste por ningun lado alguna información más. Los evolutivos tampoco son útiles ya que son de una linea en la que consta “herida operatoria en buen estado…”. Con esto no quiero decir que los traumas sean malos. Afortunadamente hay traumas que si hacen bien las cosas y que están al pie del cañón con el médico de guardia y el paciente sin desentenderse del asunto. Desde aquí mi reconocimiento para todos ellos.

Tampoco podemos dejar de mencionar sus habilidades raidologicas.
No hace mucho llegó a la UPA un anciano de 86 años con tres dias de dolor e inflamación en el codo izquierdo que no habia mejorado con ibuprofeno y que cada vez estaba peor y con un dia de fiebre. Al verlo estaba tan hinchdo, indurado y eritematoso que me impresionó una celulitis vs artritis infecciosa. Le pedí una analítica con un leve incremento en la PCR sin leucocitosis y una radiografia de codo que el radiologo informó como osteoporosis. Ya le iba a dar de alta con anitbióticos cuando el Dr Cabello, internista de mi servicio, pasaba por allí, le conté el caso y me dijo que les mostrara la radiografía a los traumas. Grande fue mi sorpresa cuando el trauma me dijo que era una fractura impactada de cabeza de radio. El paciente habia estado cargando una puerta de madera pesada y había sentido un tirón en un momento dado que no le había dado importancia pero que seguramente era la causa de su fractura.

Moraleja: Radiografias de huesos a los traumas. Los radiólogos tambien se equivocan. No todos los traumatólogos son malos.