Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

3 March 2015 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Both low intensity and high intensity workouts effective for weight loss

Higher intensity workouts associated with improved glucose levels

Patients at risk for diabetes or heart disease may want to choose their workout intensity based on health goals, according to an article being published in Annals of Internal Medicine.

Exercise has been shown to reduce obesity and related glucose tolerance, but whether increasing exercise intensity improves outcomes has not been determined. Researchers studied 300 abdominally obese adults to determine the separate effects of exercise amount and intensity on abdominal obesity and glucose tolerance. Participants were randomly assigned to perform either short, high intensity workouts or long, lower intensity workouts five times a week. All participants were instructed to eat a healthy diet during the study but did not reduce their caloric intake. After 24 weeks, all participants experienced similar reductions in waist circumference, but only participants in the high intensity exercise group experienced reduction in two-hour glucose levels.

According to lead study author, Robert Ross, PhD, of the School of Kinesiology and Health Studies at Queen’s University in Kingston, Ontario, the results show a clear benefit to higher intensity workouts for those who wish to reduce glucose levels. For those who may think that high intensity workouts are too difficult, Dr. Ross has good news. “Higher intensity can be achieved simply by increasing the incline while walking on a treadmill or walking at a brisker pace,” he said. “Participants were surprised by how easy it was for them to attain a high intensity exercise level.”

2. American College of Physicians releases new guidelines for preventing and treating bedsores

Nutritional supplementation with protein or amino acids shown to reduce wound size

The American College of Physicians makes recommendations for preventing and treating bedsores, also called pressure ulcers, in two evidence-based clinical guidelines being published in Annals of Internal Medicine. Bedsores commonly occur in people with limited mobility, such as those in hospitals or long-term care settings.

Preventing Bedsores
ACP recommends that physicians perform an assessment to identify patients who are at risk of developing bedsores. For patients who are at increased risk, ACP recommends that physicians choose an advanced static mattress (a mattress made of foam or gel that does not move when a person lies on it) or an advanced static overlay (a material such as sheepskin or a pad filled with air, water, gel, or foam that is secured to the top of a bed mattress), which are associated with a lower risk of bedsores compared to standard hospital mattresses. Advanced static mattresses and overlays are also less expensive than alternating air or low-air-loss mattresses and they can be used as part of multicomponent approach to bedsore prevention. Because the evidence does not show a clear benefit for prevention, ACP recommends against using alternating air mattresses and alternating air overlays for patients who are at increased risk of developing bedsores. Also known as dynamic mattresses and overlays, these devices can alter the level of support by adjusting the level of air or fluid.

Treating Bedsores
ACP recommends that physicians use protein or amino acid supplementation and hydrocolloid or foam dressings in patients with bedsores to reduce wound size. Protein supplementation was assessed in conjunction with standard therapies such as dressings or support surfaces. The evidence showed that hydrocolloid dressings are better than gauze dressings for reducing wound size and resulted in similar complete wound healing as foam dressings. ACP also recommends that physicians use electrical stimulation as adjunctive therapy in patients with pressure ulcers to accelerate wound healing.

3. Adults with HIV twice as likely to smoke and less likely to quit than general population

Adults with HIV are more likely to smoke and less likely to quit than the general adult population, according to an article being published in Annals of Internal Medicine. For adults with HIV, cigarette smoking is associated with higher rates of both HIV-related and non-HIV-related illness and death. Responses from 4,217 adults with HIV who participated in the Medical Monitoring Project and 27,731 U.S. adults who participated in the National Health Interview Survey in 2009 were analyzed to compare the prevalence of current cigarette smoking and smoking cessation between the two populations. The surveys showed that adults with HIV were nearly twice as likely to smoke than adults in the general population and less likely to quit. Similar to the general population, HIV-positive adults were significantly more likely to smoke if they had experienced homelessness, incarceration, or poverty in the last year. They were also more likely to smoke if they experienced substance abuse, binge drinking, depression, or a lack of HIV viral suppression. The authors suggest that smoking cessation should be a routine component of HIV care programs and clinical visits.