A case for exercise

Did you miss me?  Various things have kept me away from the blog for a while, but I thought I’d come back with a case.

You have a 58 year old white male patient who you’ve seen 4-5 times in your continuity clinic.  He has diabetes (uncontrolled, with HbA1c 9.5%), HTN (typically reads low 150s/90s in clinic), and hyperlipidemia (guess what?  He refuses medicines).  Oh, and his BMI is 36.

You’ve been harping on the miraculous benefits of diet and exercise all this time, and he’s finally decided to give it a try. He tells you that he’s joined Crossfit and is ready to start exercising, once you give the OK.

He wants to know:

  1. Don’t I need to have a stress test or something?  My dad got one every year before his last heart attack.
  2. How much exercise should I doing?  WHAT should I be doing? Can I just jump right in on the Workout of the Day?
What do you think? How would you answer him? If you aren’t sure what to say, vent about your patients like this (in a HIPAA compliant way, of course), or strategize how to get patients to exercise in the first place.  Or just tell me hello- let me know you are out there.  Any comments are appreciated.  And stay tuned,  some resolution and some more questions to come later this week.
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