Easy to Make Easy to Eat Mexican Casserole

By Barbara Day, M.S., R.D., C.N.

This casserole is easy to fix. You can change the bean type if you want or use canned or frozen corn. You can use cooked chicken breast for lower calories and fat or use combination of chicken breast and dark meat.

Nutritional Information Per Serving:  389 calories, 31 grams protein, 8 grams of fat, 43 grams of CHO, 12 grams of fiber,  1058 mg sodium.

Preparation Time:  20 minutes Cook Time: 30 minutes

Serves:  8


  • 1 tablespoon olive oil
  • 1 cup chopped yellow onion
  • 1 green bell pepper, cut into 1/4 –inch pieces
  • 1 pound of shredded cooked chicken breast*
  • One 15 ½ – ounce black beans, drained and rinsed
  • One 15 ½ -ounce can red kidney beans drained & rinsed
  • One 15 ½ ounce can corn kernels, drained or 2 cups of frozen corn
  • 2 cups chunky salsa
  • ¼ cup chopped cilantro
  • Juice of 1 lime
  • Salt & ground black pepper to taste
  • ½ cup shredded low fat Monterey Jack Cheese
  • ½ cup shredded low fat cheddar cheese
  • 1 ½ cup baked tortilla chips


Preheat the oven to 350 degrees and no-stick cooking spray in 13 X 9-inch baking dish. Heat olive oil in a small skillet and sauté the onion & bell pepper until tender. Remove from heat. Combine chicken, kidney & black beans, corn, salsa, cilantro, lime juice, salt and pepper in a bowl.  Add in the sautéed onion & bell pepper. Place half the mixture evenly in the baking dish. Combine the Monterey Jack & Cheddar cheeses and sprinkle half over the mixture.  Cover the remaining half of the chicken & bean mixture & sprinkle the remaining cheese over the top.  Bake for 30 minutes and let stand for 5 minutes before serving.  Serve with a handful of crushed tortilla chips.

Shopping List

  • Olive oil
  • 1 yellow onion
  • 1 green bell pepper
  • 1 pound of chicken breast
  • One 15 ½ – ounce black beans
  • One 15 ½ -ounce can red kidney beans
  • One 15 ½ ounce can corn kernels or frozen corn
  • Chunky salsa
  • Chopped cilantro
  • 1 lime
  • Shredded low fat Monterey Jack Cheese
  • Shredded low fat cheddar cheese
  • Baked tortilla chips

*Can use cooked rotisserie chicken or poached chicken (see recipe below).

How to Poach Chicken

To poach boneless, skinless chicken breasts, place them in a large pot or skillet and add 1-2 cups of water or chicken broth. Bring to a boil, reduce heat, cover, and cook for 9-14 minutes until chicken reaches 160 degrees F. about 15 minutes.

You can also poach in the oven. Place chicken in a single layer in a roasting pan. You can add lemon slices, peppercorns, or any other spices or herbs. Bring 4 cups of water to a boil and immediately pour over chicken. Cover and bake at 400 degrees F for 20-35 minutes, checking for an internal temperature of 160 degrees F.


Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHEALTHWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 11 grandchildren.    





What is Cardiopulmonary Exercise Stress Testing?

By Bob Hobbs, APRN, MBA

With Healthcare reform focusing on more preventative services we wanted to discuss a diagnostics/screening test that has been around for years.  The stress test was developed in 1928 and has been used since 1929 to help diagnose and screen patients with various heart related problems.  It has evolved into a cardiac investigative test.  Technological improvements over the years have led to the decrease in costs of performing this test which makes it available to more facilities.  Patients are being screened now at the primary care level.  In this article we will discuss the basics of a cardiopulmonary exercise stress test (CPET), discuss how the results of the test are used, and which patients should be asking their provider more about this test.

What is the CPET Stress Test?

While there are several types of stress tests that are performed such as a Dobutamine or Adenosine Stress Test (chemical stress test for those patients unable to exercise), stress echocardiogram, and nuclear stress test, we will focus on the treadmill or bicycle exercise stress test.

This test measures your cardiovascular, pulmonary and metabolic systems simultaneously.  The test will start with a breathing study to determine your resting lung function, followed by a resting EKG to determine a baseline reading of your heart rhythm.  As the name suggests there is exercise involved with this test, you will start walking on a treadmill or ride a stationary bike with a gradual increase in resistance until you reach your target heart rate (based on age and gender) or until you feel it is necessary to stop.  Most patients will reach their target heart rate in about 7-10 minutes.  During the test your blood pressure, oxygen level, breathing rate, heart rate, and EKG will be monitored.  Once the exercise portion of the test is complete, a breathing test and resting EKG will be performed again.

How are the results used from the stress test?

Your health care provider uses the results of the CPET stress test in several ways:

  • As a preventative screening tool to establish a baseline of your cardiac condition, help develop a safe exercise program, and to determine the likelihood of heart disease or further testing.
  • As a diagnostic tool to determine abnormal heart rhythms during exercise, to determine if there is adequate blood flow to your hear during increased levels of activities, to evaluate effectiveness of heart medications, and to assess benefits of procedures performed on the heart.  In addition, it helps determine if the patient has any abnormal pulmonary function and can help determine if the patient has asthma or related pulmonary diseases.

The CPET can help your provider determine whether your symptoms are due to a medical problem (such as heart or lung disease) or due to poor fitness.  This test helps to determine the proper course of treatment, whether it be prescription of medication, referral to cardiac or pulmonary specialists, exercise prescription or monitoring changes of your condition.

Who is a candidate for the stress test?

Typically, patients who has a history of any of the following:

  • A family history of heart disease
  • Shortness of breath
  • Fatigue
  • Obesity
  • Sleep Apnea
  • Chest pain
  • Congestive Heart Failure
  • Diabetes
  • Hypothyroidism
  • Starting an exercise program

While some of these health issues are very apparent, such as chest pain, for the patient to seek immediate assistance with follow up testing, screening patients who have been sedentary and are starting an exercise program, particularly middle aged men, can help prevent that “heart attack waiting to happen.”  If you have current health issues such as diabetes, hypothyroidism, sleep apnea, obesity, fatigue, or shortness of breath then speak with your primary care provider about having a screening test performed.  In addition, if you are starting an exercise program or have had a family history of heart disease you may want to speak with your primary care provider about scheduling a cardiopulmonary exercise stress test.  As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure.”

Where can I have it performed?

Several outpatient centers, cardiologists’ offices, and some primary care offices can perform this test.  This test does require a health care providers order and requires supervision by the provider.  Since this is a preventive screening test it is covered by health insurance.

Image from: www.junipermed.com

Bob Hobbs, APRN is a nurse practitioner for Louisville Lifestyle Medicine, a primary care office in northeastern Louisville.  Bob has over 15 years experience helping patients with their health and fitness needs.  Bob is an avid triathlete and has completed over 50 triathlons, including three Ironman triathlons.  You can reach Bob by email at bob@louisvillelifestylemedicine.com and get further information at www.louisvillelifestylemedicine.com.


ACSM experts examine what’s hot, and what’s not, in the health-and-fitness industry

Zumba® is in and Pilates is out, according to more than 2,600 fitness professionals who completed an American College of Sports Medicine survey of the top fitness trends for 2012. The survey results were released today in the “Worldwide Survey of Fitness Trends for 2012” article published in the November/December issue of ACSM’s Health & Fitness Journal®.

Zumba (and other dance workouts) and outdoor activities both made their debuts in the top 20 this year. Zumba and other dance workouts ranked ninth, and outdoor activities ranked 14th.

“Zumba and other dance workouts first appeared on the list of potential trends in 2010, but this is the first year Zumba has made the top 20,” said Walter R. Thompson, Ph.D., FACSM, the lead author of the survey. “While Zumba has experienced a rapid surge in popularity in the past year, future surveys will indicate if Zumba is truly a trend or simply a fad.”

Educated and experienced fitness professionals claimed the top spot in 2012 for the fifth consecutive year. Outcome measurements and clinical integration/medical fitness both dropped out of the top 20 this year. Outcome measurements, a way to quantify progress in clubs and wellness programs, had a five-year run in the top 20 and ranked 13th in 2011. Clinical integration/medical fitness, perhaps tied to last year’s national health care reform, only appeared in the top 20 in 2011 and claimed 18th place. Pilates, which first dropped out of the top 20 for 2011, remained off the list for 2012.

“The U.S. Department of Labor’s Bureau of Labor Statistics is predicting that jobs for fitness workers will increase much faster than other occupations,” said Thompson, an exercise physiologist at Georgia State University, a Fellow of ACSM and a spokesperson for the ACSM American Fitness IndexTM. “Educated and experienced fitness professionals – such as those with professional certifications – will have the best chances to get new jobs in an increasingly competitive field.”

The survey, now in its sixth year, was completed by 2,620 health and fitness professionals worldwide (many certified by ACSM) and was designed to reveal trends in various fitness environments. Thirty-seven potential trends were given as choices, and the top 20 were ranked and published by ACSM.

The top ten fitness trends predicted for 2012 are:

1. Educated and experienced fitness professionals. Given the large number of organizations offering health and fitness certifications, it’s important that consumers choose professionals certified through programs that are accredited by the National Commission for Certifying Agencies (NCCA), such as those offered by ACSM.

2. Strength training. Strength training remains a central emphasis for many health clubs. Incorporating strength training is an essential part of a complete physical activity program for all physical activity levels and genders.

3. Fitness programs for older adults. As the baby boom generation ages into retirement, some of these people have more discretionary money than their younger counterparts. Therefore, many health and fitness professionals are taking the time to create age-appropriate fitness programs to keep older adults healthy and active.

4. Exercise and weight loss. In addition to nutrition, exercise is a key component of a proper weight loss program. Health and fitness professionals who provide weight loss programs are increasingly incorporating regular exercise and caloric restriction for better weight control in their clients.

5. Children and obesity. With childhood obesity growing at an alarming rate, health and fitness professionals see the epidemic as an opportunity to create programs tailored to overweight and obese children. Solving the problem of childhood obesity will have an impact on the health care industry today and for years to come.

6. Personal training. More and more students are majoring in kinesiology, which indicates that students are preparing themselves for careers in allied health fields such as personal training. Education, training and proper credentialing for personal trainers have become increasingly important to the health and fitness facilities that employ them.

7. Core training. Distinct from strength training, core training specifically emphasizes conditioning of the middle-body muscles, including the pelvis, lower back, hips and abdomen – all of which provide needed support for the spine.

8. Group personal training. In challenging economic times, many personal trainers are offering group training options. Training two or three people at once makes economic sense for both the trainer and the clients.

9. Zumba and other dance workouts. A workout that requires energy and enthusiasm, Zumba combines Latin rhythms with interval-type exercise and resistance training.

10. Functional fitness. This is a trend toward using strength training to improve balance and ease of daily living. Functional fitness and special fitness programs for older adults are closely related.

Image from: www.smashgyms.com

da Vinci® Surgical System Makes Heart Procedures Less Invasive for Patients at Jewish Hospital

By Sebastian Pagni, M.D.

As breakthroughs in minimally invasive surgery continue, I am pleased that we are now able to give many patients the option of having robotically-assisted surgery for common cardiothoracic conditions such as heart valve disorders, arrhythmias and coronary heart disease.

At Jewish Hospital, the da Vinci® Surgical System for minimally invasive surgical procedures is also used for urology, gynecology and bariatric surgeries. da Vinci heart procedures are the most recent to develop because of the complex nature of these surgeries.  Jewish Hospital is the only hospital in the metro Louisville region performing minimally invasive heart procedures.

The da Vinci is a robotically-assisted surgical system that uses small incisions to introduce miniaturized instruments and a high-definition camera, enabling surgeons to view magnified, high-resolution images of the surgical site.  At the same time, robotic and computer technologies translate the surgeon’s hand movements into precise micro-movements of the da Vinci instruments, required to repair intra-cardiac structures.

The da Vinci instruments are more flexible and operate much more like the human hand than previous minimally-invasive surgical systems. It allows us to perform incredibly precise surgical procedures, such as mitral and tricuspid leaking valves, using small incisions.

da Vinci surgery is an effective, least invasive treatment option for some cardiothoracic procedures and there are many potential benefits for the patient including:

  • Reduced risk of infection
  • Less blood loss and need for blood transfusions
  • Shorter hospital stay
  • Less pain and scarring
  • Faster recovery and return to normal activities
  • Greater cosmetic and patient satisfaction

 Traditional “open heart” surgery usually involves an 8-10-inch incision, splitting the patient’s breastbone and spreading the ribs with a retractor. Recovery after the surgery is longer and often painful due to healing of the large chest wound.  Patients are usually not allowed to drive for several weeks and must avoid heavy lifting for three months following an open-heart surgery.

With da Vinci’s minimally invasive techniques, small incisions can be made between the ribs to perform valve repairs to the heart or removal of cardiac masses and closing “holes” by using thoracoscopy – the insertion of a miniaturized video camera between the ribs.

Patients undergoing da Vinci robotic heart surgery usually have just three tiny instrument incisions less than one centimeter in size and a small working port incision (3cm).  In most cases, patients have far fewer restrictions on activities, and are up and active much sooner.  Using this robotic approach, recovery typically requires a 3-4 day stay in the hospital and a return to normal activity in about two weeks. In an open heart surgery, the recovery is about 6-8 weeks. For patients who qualify, this innovative new approach is certainly a welcome option.

In addition, some studies have indicated that minimally invasive surgery can help increase survival after surgery, which allows treatment parameters to include patients who may not normally be considered candidates for surgery because they were not strong enough to undergo a traditional open-heart procedure.

For more information about da Vinci cardiothoracic surgery at Jewish Hospital, visit www.jhsmh.org or call 502-583-8383.

Image from: www.biomed.brown.edu

Sebastian Pagni, M.D. is a Cardiothoracic Surgeon, University Cardiothoracic Surgical Associates/Jewish Hospital/University of Louisville.


Hurry-Up Salmon with Sautéed Peppers

By Barbara Day, M.S., R.D., C.N.

This recipe is very easy & quick.  It’s high in vitamin C, potassium, folic acid and vitamin A.  Add a green vegetable like spinach or snap peas and you have a very colorful meal plus it’s loaded with vitamins, minerals and phytochemicals.

Nutritional Information Per Serving:  381 calories, 34 grams protein,  12 grams of fat, 36 grams of CHO,  7 grams dietary fiber, 287 mg sodium.

Preparation Time: 15 minutes Cook Time: 15 minutes  

Serves:  4


  • 1 cup whole wheat couscous
  • 1 ½ teaspoon oil
  • 4 skinless salmon fillets (5 oz, each)
  • ¼ tsp salt
  • 1/8 tsp pepper
  • 2 limes (1 cut into wedges)
  • 3 small peppers (red, orange, yellow or green), thinly sliced
  • 1 medium onion, finely chopped
  • 1/8 tsp salt
  • ½ cup packed fresh basil leaves


Prepare couscous as directed.  In a non-stick skillet, heat ½ teaspoon oil on medium.  Sprinkle salt and pepper on salmon.  Cook 8 to 10 minutes in skillet until opaque throughout and flakes turning once.  Transfer to serving plates. Grate lime peel over fish. Wipe fat from skillet before heating 1 teaspoon of oil to sauté peppers and onions. Add 3 tbsp water to mix and 1/8 tsp of salt. Cover and cook for 5 minutes. Uncover and cook for additional 3 minutes until vegetables are tender but crisp.  Stir in basil and cook until wilted. Add 1 tbsp of freshly squeezed lime into pepper mixture. Spoon couscous onto serving plate with salmon.  Add pepper mixture over the couscous.

Shopping List

  • whole wheat couscous
  • oil
  • 4 skinless salmon fillets (5 oz, each)
  • 2 limes
  • 3 small peppers (red, orange, yellow or green)
  • 1 medium onion
  • fresh basil leaves

Image from: www.discusscooking.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHEALTHWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 11 grandchildren.    



Do You Have Restless Legs Syndrome or are You Just Fidgeting?

By Jennifer Wider, MD

Society for Women’s Health Research

We’ve all experienced abnormal sensations in our legs at one time or another, but for as many as 10 percent of the US population, restless legs syndrome (RLS) is a daily occurrence. Characterized by throbbing, pulling, tingling, itching, and crawling sensations, RLS is a neurological disorder that produces unpleasant physical sensations in the extremities and an urge to counteract that sensation by movement.

RLS occurs in both men and women, but according to statistics from the National Institutes of Health, “the incidence is about twice as high in women.” The prevalence of RLS in the general population is higher than most people realize.

“The condition is more prevalent among women,” said Bjorn Backe, MD, PhD, Professor of Maternity Care in Trondheim, Norway who has studied RLS among pregnant women. “Pregnancy is an important cause of RLS, but the etiology, that is the mechanism through which pregnancy leads to RLS, remains completely unknown.”

In fact, the cause of RLS can be elusive in the general population as well. The primary form occurs for unknown reasons, but according to research studies there may be an underlying genetic factor to the disease.

The secondary form of RLS is the result of a medical condition or side effect from a medication (most often antidepressants, anticonvulsants, and beta blockers). Conditions linked to secondary RLS include: iron-deficiency anemia, peripheral neuropathy (damage to the nerves of the extremities, often due to diabetes), thyroid conditions, kidney failure, vitamin deficiencies, fibromyalgia and varicose veins.

“Varicose veins are an often overlooked and potentially curable cause of restless legs syndrome,” said Erez Salik, MD, Co-director of the Greenwich Vein Center in Greenwich, Conn. “For these patients, treating the varicosities can significantly improve the RLS-related symptoms.”

Many patients suffer from the symptoms of RLS without realizing anything is wrong. According to David Rye, MD, PhD, Professor of Neurology at Emory University, “the clinical diagnosis is based on four essential criteria.”

These include:

  • A strong urge to move your legs. Often, but not always, this urge occurs in conjunction with unpleasant feelings in your legs. When the disorder is severe, you may also have the urge to move your arms.
  • Symptoms that begin or get worse when you’re inactive. The urge to move increases when you’re sitting still or lying down and resting.
  • Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
  • Symptoms that start or get worse in the evening or at night.

“There are supportive criteria as well,” said Rye, “which include a first-degree family member, periodic leg movements in sleep (present in >90% of subjects); and a good response to medications that mimic the brain chemical dopamine.”

To diagnose RLS, doctors often focus on the patient’s description of symptoms to ensure they meet the four essential criteria. A neurological and physical exam is often performed and a thorough history should be taken, including: personal and family history, current medications, and sleep habits. Lab tests are frequently performed to rule out other conditions and identify potential vitamin and mineral deficiencies, which may initially present as RLS.

Treatment can vary from person to person and often focuses on relieving the symptoms that a patient is experiencing. If an underlying condition or medication side effect is responsible, then these issues need to be addressed foremost. Supplements to correct deficiencies can help alleviate symptoms for some patients, and in others a variety of medications including dopaminergic medications, benzodiazepines, opioids and anti-convulsants can help treat this uncomfortable disease.

There is some evidence that RLS may be related to abnormalities in neurotransmitters, or brain chemicals including dopamine, which help control gross motor movement. Research is still being conducted to further examine this relationship.

With more research and greater attention, a cure for RLS may be discovered, allowing millions of restless women to rest easy.


Desautels A, Turecki G, Montplaisir J, et al. Identification of a major susceptibility locus for restless legs syndrome on chromosome 12q.Am J Hum Genet. 2001;69:1266-1270).

“Restless Legs Syndrome Fact Sheet,” NINDS. Publication date September 2010.

Image from: www.sleepdisordersguide.com

Jennifer Wider, M.D.,is a medical advisor for the Society for Women’s Health Research (SWHR)www.swhr.org, a national non-profit organization based in Washington D.C., widely recognized as the thought leader in research on sex differences and dedicated to improving women’s health through advocacy, education, and research.

Dr. Wider is a graduate of Princeton University and received her medical degree in 1999 from the Mount Sinai School of Medicine in New York City. She is frequently published in newspapers, magazines, and websites and has been a guest on the Today Show, CBS News, Fox News, Good Day New York, and a variety of cable channels. Dr. Wider hosts “Paging Dr. Wider,” a weekly segment on Sirius satellite radio for the Cosmopolitan magazine channel.

Dr. Wider is a past managing editor of the health channel at iVillage.com. She writes a monthly news service article for SWHR and is the author of the consumer health booklet “Just the Facts: What Women Need to Know about Sex Differences in Health” and the book “The Doctor’s Complete College Girls’ Health Guide: From Sex to Drugs to the Freshman Fifteen.”


Quick Chicken Veggie Creole

By Barbara Day, M.S., R.D., C.N.

 This is an easy-to-fix recipe that is loaded with dietary fiber, vitamins B1, B2, pantothenic acid, copper, iron, magnesium and manganese. The recipe is also a good source of vitamins A, B3, B6,  and C and minerals and electrolytes such as potassium, phosphorus and selenium.

Nutritional Information Per Serving: 370 calories, 17 grams protein, 15 grams of fat,  44 grams of CHO, 4 grams of fiber, 620 mg sodium.

Preparation Time:  10 minutes Cook Time: 15 minutes

Serves:  4


  • 4 boneless chicken breast tenders, cut into 1” strips (12 oz)
  • 1 can (14 oz) low sodium diced tomatoes
  • 1 cup low sodium chili sauce
  • 1 ½ cup green peppers chopped
  • 1 ½ cup celery, chopped
  • ¼ cup onion, chopped
  • 2 cloves of garlic, minced
  • 1 tbsp fresh basil or 1 tsp of dried basil
  • 1 tbsp fresh parsley  or 1 tsp of dried parsley
  • ¼ tsp crushed red pepper
  • ¼ tsp salt


Spray a deep skillet with non-stick cooking spray. Preheat the pan over high heat. Cook chicken in a hot skillet for 3 to 5 minutes or until no longer pink.  Reduce heat. Add the rest of the ingredients. Bring to a boil. Reduce heat and cover simmering about 10 minutes. Serve over brown rice, whole wheat couscous or whole wheat pasta.

Shopping List

  • 4 boneless chicken breast tenders (12 oz)
  • 1 can (14 oz) low sodium diced tomatoes
  • low sodium chili sauce
  • green peppers
  • celery
  • onion
  • 2 cloves of garlic
  • fresh basil
  • fresh parsley
  • crushed red pepper

Image from: www.tasteofhome.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHEALTHWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 11 grandchildren.    






Study finds energy expenditure persists for 14 hours after high-intensity workout

INDIANAPOLIS – When it comes to lasting calorie burn, vigorous-intensity exercise could be the gift that keeps on giving. Research published today by the American College of Sports Medicine reports that a 45-minute bout of vigorous exercise can boost a person’s energy expenditure for up to 14 hours.

Researchers with Appalachian State University and the University of North Carolina at Chapel Hill examined energy expenditure among ten healthy, male participants during two nonconsecutive sessions of 24 hours in the metabolic chamber. During the first session, participants were mostly inactive, but they stood and stretched for two minutes every hour. They could also perform everyday tasks, such as washing their hands and brushing their teeth, as needed. During the second session, participants followed the same routine, but they cycled vigorously (defined as 73 percent maximal oxygen uptake) for 45 minutes at 11 a.m.

“We found that 45 minutes of vigorous exercise caused 190 additional calories to be burned later in the day while the participant was at rest,” said David Nieman, Ph.D., lead investigator of the study. “The calories burned after exercise represent a 37 percent increase in net energy expended compared to no exercise, and these findings may have implications for people trying to lose or manage their weight.”

The increased calorie burn lasted for an average of 14.2 hours after exercise and included the first 3.5 hours of sleep. Participants maintained energy balance during both sessions, so they consumed snacks on exercise day that replaced the calories they burned during exercise.

The study, “A 45-Minute Vigorous Exercise Bout Increases Metabolic Rate for 14 Hours,” is the first to use a metabolic chamber to analyze energy expenditure after a vigorous workout. Metabolic chambers look like normal rooms – with modern amenities such as a bed, sofa, laptop, toilet and sink – but they are highly controlled and capable of measuring energy expenditure through indirect calorimetry. While other studies have used the metabolic chamber to measure energy expenditure after moderate-intensity exercise, Nieman and his team are the first to study the effects of vigorous exercise.

The study was published in the September 2011 issue of Medicine & Science in Sports & Exercise®, ACSM’s official scientific journal.

Image from: www.spinningtranism.com

Women & Heart Disease: Management Strategies

By Chandhiran Rangaswamy, M.D.

Conditions afflicting the blood vessels of the heart, also known as coronary artery disease or ischemic heart disease, currently affect 16.3 million Americans. Approximately 1.3 million new and recurrent cases occur annually, and a little over 40 percent of these involve women.
Although the mortality rate from coronary artery disease has declined by 34 percent over the last 10 years, ischemic heart disease remains the leading single cause of death in the United States and is responsible for one of every 4.8 deaths. Women in particular seem more vulnerable to the consequences of coronary artery disease. Recent statistics suggest that 1 in 3 women has some form of cardiovascular disease and that women represent 52.6 percent of all cardiovascular deaths. In fact, women are almost twice as likely to die from cardiovascular disease as from all forms of cancer combined. Moreover, 23 percent of women age 40 and older who have an initial heart attack die within one year compared to 18 percent of men. In part because women have heart attacks at older ages than men, they are more likely to die from them within a few weeks.
Like any muscle, the heart needs a constant supply of oxygen and nutrients to carry on its vital function. These nutrients are carried by the blood in the coronary arteries. Coronary artery disease most commonly occurs when cholesterol accumulates within the wall of the coronary arteries. This process, termed atherosclerosis, leads to the formation of cholesterol plaque that can gradually cause narrowing of the coronary arteries, thus decreasing the supply of oxygen to the heart. If not enough oxygen-carrying blood reaches the heart, the heart may respond with pain called angina. Under certain circumstances a cholesterol plaque may rupture and lead to the formation of an occlusive blood clot that completely cuts off the supply of oxygen-carrying blood to the heart, thus resulting in a heart attack.
The classic presentation of a heart attack involves chest pressure that may radiate to the neck or to the left arm. However, many people (especially women) do not experience these classic symptoms. Some may experience indigestion discomfort, which may be naturally attributed to acid reflux. Others may only experience sharp pains or even shortness of breath, which may unknowingly be attributed to other medical conditions. Women, and particularly diabetic women, are more likely to develop non-classical symptoms of a heart attack. Consequently, they are less likely to see a doctor for further evaluation and treatment, and when they do see a doctor, they are more likely to present later in the course of their symptoms. This may partially explain the increased cardiovascular mortality rate observed in women.
The diagnosis of a heart attack is typically made by specific blood tests as well as characteristic electrocardiographic (EKG) changes. Once a heart attack has been diagnosed, time is of the essence in treatment; the adage that “time is muscle” is particularly important in this situation since the earlier that treatment can be initiated the greater the amount of heart muscle that can be saved. The cornerstone of therapy is aspirin, which may reduce the risk of dying from a heart attack by up to 35 percent. Most hospitals across the United States will additionally treat heart attacks with clot-busting medications, called thrombolytics, to break up the causative blood clot in an effort to restore blood flow to the heart. Until recently, this was the primary modality of therapy at most centers. Unfortunately, thrombolytic therapy is not always successful and in some cases may increase the risk of major bleeding complications. Many hospitals now have the capability to treat heart attacks with angioplasty, also referred to as percutaneous coronary intervention (PCI).
Angioplasty first involves performing a diagnostic heart catheterization, a non-surgical and minimally invasive procedure intended to visualize the coronary arteries and localize the blockage responsible for the heart attack. Once the blockage has been identified, a small guiding wire is carefully positioned in the affected artery to serve as a “rail” onto which a balloon can be loaded and subsequently advanced to the site of the blockage. The balloon is then inflated to a high pressure, thus pushing the blockage aside and restoring blood flow through the artery. In most situations, the procedure is completed by deploying a stent at the original site of the blockage. A stent is a metal scaffold that helps keep the artery open and reduces the risk of re-narrowing of the coronary artery compared to balloon angioplasty alone. Although current stents are permanently incorporated into the coronary artery, newer bioresorbable stents are under development that will allow angioplasty to be performed without leaving permanent evidence of the procedure. Performed promptly, angioplasty can improve survival from a heart attack beyond that attributable to thrombolytic therapy.
The mainstay of treatment after a heart attack focuses on risk factor modification to reduce the risk of recurrent events. The principal targets of therapy include high blood pressure, high cholesterol, diabetes mellitus, smoking cessation, weight loss and exercise. Guidelines have been established by the American College of Cardiology and the American Heart Association with respect to target goals. With strict adherence to the guidelines, the risk of recurrent events can be reduced by up to 65 to 70 percent. Overall, vigilance is the key to successful outcomes.

Chandhiran Rangaswamy, M.D., F.A.C.C., is with Louisville Heart Specialists, The Physician Group at Jewish Hospital & St. Mary’s HealthCare. He earned an undergraduate degree from Speed Scientific School at the University of Louisville and his medical degree from the U of L School of Medicine. He completed his training in internal medicine at the Cleveland Clinic Foundation and received additional specialty training in general and interventional cardiology at the University of Michigan. Dr. Rangaswamy is a full-time faculty member at U of L. He is board certified in internal medicine, cardiovascular disease and interventional cardiology. He is a member of the American Heart Association and a Fellow of the American College of Cardiology. He can be contacted at 502-581-1951.