There's been quite a number of publications looking at exercise benefits for diabetes and obesity. The evidence points to benefits of a faster pace for a shorter amount of time. for example, sprinting for 6 seconds followed by a 1 minute rest, repeated 10 times, 5 days a week for 2 weeks,can improve exercise capacity in sedentary people by 10%. that's only 10 minutes of actual exercise time!
Another study starts with 5 min warm-up; then an 8 second sprint follwed by 12 second rest repeated 60 times; then 5 min cool-down. Leg muscles get a little bigger and belly fat gets smaller. Insulin sensitivity improves. Including the warm-up and cool-down that is 18 minutes of actual exercise and 12 minutes of resting in a half hour. This exercise schedule is more effective for weight loss and reducing waist measurement than a steady exercise for 45 minutes.
There are a couple things to keep in mind when starting a high-intensity interval program. First, don't over-exert yourself at the start, especially if you are not exercising much or have been exercising at a leisurely pace. Take a couple of weeks to build up to the high intensity and complete duration. Second, don't try this on a treadmill. The machine isn't designed to speed up and slow down at such a rapid rate. An eliptical trainer or bicycle can be set at high resistance; you simply speed up and slow down on your own. Of course you can do this while running/walking. I suppose that interval body-weight squats or jump-rope would also be suitable. The key is to use your 'big' muscles, that is your leg muscles.High intensity intervals on a keyboard, joystick or TV remote won't get you the results that have been published.
Check your smart phone store or Ipad app store to download a free app to keep time for you. Search 'HIIT or 'high intensity intervals' to find the appropriate timer.
Wednesday, October 10, 2012
Wednesday, October 3, 2012
Struggling with the insurance approach
I'm frustrated with the mess that the insurance approach to health care makes for both patients and providers. I have 'contracts' with many insurance companies. Each has their own approach to determine what they will pay me for an office visit. Medicare clearly calculates how a price is determined. It still leaves a huge gap since I am paid by volume as well as time. I can see twice as many patients and still meet the criteria for a specific payment. I don't want to herd patients through my office but quality time is reimbursed poorly.
I really don't know how private insurance companies decide the reimbursement rate. The reimbursement range is wide; the best-paying company reimburses 25% more for an office visit compared to the lowest-paying company, for the same level of care. the lower-paying insurance companies (and Medicare) say I need to be 'more efficient', which ends up meaning see more patients and spending less time with each patient.
I understand sales and volume discounts for mass-produced items and companies trying to increase business. I understand that a service-based business may offer a new customer discount or other sales promotion to increase business. Neither of these conditions apply to my medical practice. If I refuse to rush patients through my office and the insurance companies (and Medicare) refuse to pay adequately for the time I spend with patients, I have 2 basic choices. First, I drop the contracts that pay poorly. Those patients either see another physician who is on their plan or they pay me directly. My second choice is to leave clinical medicine and get a job with a medically-oriented business. I have spoken to many physicians who have chosen one or the other, and they have been helpful understanding the risks, benefits and compromises of each. It is a choice that I will ponder leisurely until I am compelled to make a change.
I really don't know how private insurance companies decide the reimbursement rate. The reimbursement range is wide; the best-paying company reimburses 25% more for an office visit compared to the lowest-paying company, for the same level of care. the lower-paying insurance companies (and Medicare) say I need to be 'more efficient', which ends up meaning see more patients and spending less time with each patient.
I understand sales and volume discounts for mass-produced items and companies trying to increase business. I understand that a service-based business may offer a new customer discount or other sales promotion to increase business. Neither of these conditions apply to my medical practice. If I refuse to rush patients through my office and the insurance companies (and Medicare) refuse to pay adequately for the time I spend with patients, I have 2 basic choices. First, I drop the contracts that pay poorly. Those patients either see another physician who is on their plan or they pay me directly. My second choice is to leave clinical medicine and get a job with a medically-oriented business. I have spoken to many physicians who have chosen one or the other, and they have been helpful understanding the risks, benefits and compromises of each. It is a choice that I will ponder leisurely until I am compelled to make a change.
New location for Renown Diabetes Center
The Renown Diabetes Center is at a new address: 850 Mill Street, #100. All of the excellent staff is working at the new location. The phone number is the same, (775) 982-5073. The fax numbers have changed. The prescription fax line is now (775) 982-3959 and the general fax line is (775) 982-3958.
The location is easy to find. Take the Mill Street exit off of US 395 and head west (towards downtown). The building is one door past the corner of Mill and Kirman, on the left. If you know where Dish Cafe is, we are right across the street.
The location is easy to find. Take the Mill Street exit off of US 395 and head west (towards downtown). The building is one door past the corner of Mill and Kirman, on the left. If you know where Dish Cafe is, we are right across the street.
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