Exercise Script

PT: Jose Garcia, 68yr old man

PMH: HTN-148/88 mm/Hg, on BP Medications, high cholesterol, arthritis in both knees, Overweight- BMI: 40.3, waist circumference: 45″ , Pre-diabetic- FBG:120mg/dL

SH: Retired taxi driver for 3 years, largely sedentary, has a lot of time on his hands, smokes half a pack of cigarettes a day, wife prepares many of his meals otherwise eats out with friends/alone, used to enjoy playing handball and riding a bike

Meals consumed often: eggs, pancakes, buttered roll from coffee shop, sandwich, Dominican food, steak and fried plantains, rice and beans, meat and fish, likes dessert (pastries, flan), very fond of chicharrones (fried pork skins)

Goal: Lose weight + avoid Type 2 Diabetes

Nutrition/ Diet recommendations for: weight loss and prevention of Type 2 Diabetes – stress portion control and healthy alternatives *encourage PT to ask his wife to incorporate these changes as she is the meal maker on many occasions

BREAKFAST

  • *Encourage PT to try some tomatoes as a side with his eggs. If PT enjoys scrambled eggs, encourage scrambled eggs with some veggies inside such as onions, peppers, spinach, kale etc.
  • *Recommend swapping pancakes with whole grain oatmeal with fresh berries and REAL maple syrup (where maple syrup is the only ingredient – not Aunt Jemima) on a few occasions.
  • Recommend PT to try pumpernickel bread with butter or any bread with visible grain/seeds instead of usual buttered roll from coffee shop. If PT is really motivated and willing to explore, encourage swapping butter with mashed avocado as butter alternative.

LUNCH

  • Recommend PT to fill sandwich with veggies on top such as fresh cut tomatoes, arugula, mixed greens, pickles, sliced cucumbers, chives, or any veggie of choice. Can be topped with sprinkle of salt and pepper and/or drizzle of extra virgin olive oil.
  • Suggest swapping steak for chicken when eating meals at his favorite Dominican restaurant.
  • Recommend PT to explore other similar cuisines with his friends that are more veggie based such as Mexican veggie burritos or Mediterranean.

DINNER

  • *Recommend PT to ask his wife to add a side of home-made salsa to his meals of rice and beans. Also, recommend using Brown rice or Basmati Rice which have a low glycemic index and will be very beneficial to keep his insulin from spiking.
  • *Recommend adding veggies into the pan or on the side with the meat/fish such as broccoli, mushrooms, carrots, asparagus, onions, peppers, spinach, peas or snow peas that also have a low glycemic index.

DESSERT/SNACK

  • Recommend PT have a bowl of berries or fruit of choice with his custard.
  • Encourage PT to try having a fruit a day as a dessert- any just to start habit.
  • Recommend trying seaweed as alternative to fried pork skin and/or trying pistachios as a snack.

Exercise Recommendations: start with low intensity exercises due to low exercise tolerance – combats both pre-diabetic state and obesity

  • Take a walk around the block two times before going to get his breakfast from the local coffee shop.
  • Encourage PT to take a second walk around the block doing two laps after dinner before evening.
  • If accessible, use a stationary bike for 5-10 minutes a day at low intensity 2-3 times a week.
  • As exercise tolerance increases and knee pain is not a hindrance, encourage use of regular bike out doors in a park and counsel PT on important of use of safety equipment, most importantly helmet.

Other Lifestyle Recommendations: Assess PT’s readiness for smoking cessation

  • If PT expresses readiness and desire, advise PT on the specific risks continuation of smoking will have on his health and provide the health benefits of smoking cessation.
  • Provide information on Pharmacotherapy which can aid in the transition process, support group resources and come up with a plan together.
  • Schedule a follow up appointment.