June 2012 JMSMA

June 2012

VOL. LIII No. 6

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June 2012 JOURNAL MSMA 169

JUNE 2012 VOLUME 53 NUMBER 6

Special article Southern Remedy’s Healthy Living Fitness Program 171Josie Bidwell, MSN, CNP and Richard D. deShazo, MD

inStructionS for authorS 211

about the cover: Garden Girl – Martin M. Pomphrey, Jr., MD, who serves on the MSMA Committee on Publications, photographed his granddaughter at about age six in the main garden at his home in Mayhew, Mississippi. Caroline’s other interests include dancing, basketball, soccer, and piano. She has even tried her hand at songwriting. Dr. Pomphrey says she is a rabid Auburn fan except when she attends Mississippi State games. Her grandfather enjoys teasing her by shouting “Roll Tide” when Auburn is playing Alabama. Dr. Pomphrey is a semi-retired orthopaedic surgeon sub-specializing in sports medicine who practiced with Oktibbeha County Hospital (OCH) Bone and Joint Clinic in Starkville. r

Journal of the Mississippi state Medical association (issn 0026-6396) is owned and published monthly by the Mississippi State Medical Association, founded 1856, located at 408 West Parkway Place, Ridgeland, Mississippi 39158-2548. (ISSN# 0026-6396 as mandated by section E211.10, Domestic Mail Manual). Periodicals postage paid at Jackson, MS and at additional mailing offices. correspondence: Journal MSMA, Managing editor, Karen a. evers, p.o. Box 2548, ridgeland, Ms 39158-2548, ph.: (601) 853-6733, fax: (601)853-6746, www.MsMaonline.com. suBscription rate: $83.00 per annum; $96.00 per annum for foreign subscriptions; $7.00 per copy, $10.00 per foreign copy, as available. advertising rates: furnished on request. cristen hemmins, hemmins hall, inc. advertising, p.o. Box 1112, oxford, Mississippi 38655, ph: (662) 236-1700, fax: (662) 236-7011, email: [email protected] postMaster: send address changes to Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS 39158-2548. The views expressed in this publication reflect the opinions of the authors and do not necessarily state the opinions or policies of the Mississippi State Medical Association.

copyright© 2012 Mississippi state Medical association.

official publication of the MsMa since 1959

Lucius M. Lampton, MDEditor

D. Stanley Hartness, MDRichard D. deShazo, MD

AssociAtE Editors

Karen A. EversMAnAging Editor

PublicAtions coMMittEE

Dwalia S. South, MD chair

Philip T. Merideth, MD, JDMartin M. Pomphrey, MD

Leslie E. England, MD, Ex-OfficioMyron W. Lockey, MD, Ex-Officio

and the editors

thE AssociAtion

Steven L. Demetropoulos, MDpresident

James A. Rish, MDpresident-elect

J. Clay Hays, Jr., MDsecretary-treasurer

Lee Giffin, MD speaker

Geri Lee Weiland, MD vice speaker

Charmain Kanosky executive director

2012June

VOL. LIII No. 6

As physicians around the state await “with bated

breath and whispering humbleness” (to borrow

Shakespeare’s phrase) the U.S. Supreme Court

decision on PPACA, I am reminded that whatever is decided,

we must continue to fight for our patients and our profession.

Physicians have a primary obligation to our patients, that’s what

our oath says, not to the federal government, not to hospitals,

and not to insurance companies. We must always be first and

foremost patient advocates. Yes, we have other responsibilities,

but they are all secondary to our primary duty, which is to that

one patient sitting in front of us, trusting his or her life to us.

There is no doubt fundamental and exponential change is on hand for our

profession and our patients. Hopefully, as physicians, we can shape and influence

that change in a manner which preserves the patient/physician relationship. My

continued on next page


From The Editor

170 JOURNAL MSMA June 2012

Journal Editorial Advisory Board

From the Editor

170 JOURNAL MSMA JUNE 2012

R. Scott Anderson, MD, FACRChair, Journal Editorial Advisory BoardRadiation Oncologist and Medical Director, Anderson Regional Cancer Center, Meridian

Diane K. Beebe, MDProfessor and Chair, Department of Family Medicine,University of MS Medical Center, Jackson

Claude D. Brunson, MDSenior Advisor to the Vice Chancellor for External Affairs,University of Mississippi Medical Center, Jackson

Jeffrey D. Carron, MD, FAAP, FACS Associate Professor, Department of Otolaryngology & Communicative Sciences,University of Mississippi Medical Center, Jackson Gordon (Mike) Castleberry, MDUrologist, Starkville Urology Clinic

Mary Currier, MD, MPH State Health OfficerMississippi State Department of Health, Jackson

Thomas E. Dobbs, MD, MPHHealth Officer, District VII/VIIIMississippi State Department of Health, Hattiesburg

Sharon Douglas, MD Chair, AMA Council on Ethical & Judicial Affairs Professor of Medicine and Associate Dean for V A Education, University of Mississippi School of Medicine, Associate Chief of Staff for Education and Ethics, G.V. Montgomery VA Medical Center, Jackson

Daniel P. Edney, MD Executive Committee Member, National Disaster Life Support Education Consortium,InternistThe Street Clinic, Vicksburg

Owen B. Evans, MDProfessor of Pediatrics and NeurologyUniversity of Mississippi Medical Center, Jackson

Maxie L. Gordon, MD Assistant Professor, Department of Psychiatry and Human Behavior, Director of the Adult Inpatient Psychiatry Unit and Medical Student Education,University of Mississippi Medical Center, Jackson

Scott Hambleton, MDMedical DirectorMississippi Professionals Health Program, Ridgeland

John Edward Hill, MD, FAAFPResidency Program DirectorNorth Mississippi Medical Center, Tupelo

John D. Isaacs, Jr., MDInfertility Specialist,Mississippi Fertility Institute at Women’s Specialty Center, Jackson

Kent A Kirchner, MDChief of StaffG.V. Montgomery VA Medical Center, Jackson

Brett C. Lampton, MD Internist/HospitalistBaptist Memorial Hospital, Oxford

Philip L. Levin, MDPresident, Gulf Coast Writers Association Emergency Medicine Physician, Gulfport William Lineaweaver, MD, FACSEditor, Annals of Plastic SurgeryMedical DirectorJMS Burn and Reconstruction Center, Brandon

John F. Lucas,III, MD SurgeonGreenwood Leflore Hospital

Gailen D. Marshall, Jr., MD, PhD, FACPProfessor of Medicine and Pediatrics, Vice Chair for Research,Director, Division of Clinical Immunology and Allergy,Chief, Laboratory of Behavioral Immunology ResearchThe University of Mississippi Medical Center, Jackson

Alan R. Moore, MDClinical NeurophysiologistMuscle and Nerve, Jackson

Paul “Hal” Moore Jr., MD, FACR RadiologistSinging River Radiology Group, Pascagoula

Jason G. Murphy, MD Surgeon Surgical Clinic Associates, Jackson

Ann Myers, MDRheumatologist Mississippi Arthritis Clinic, Jackson

Jimmy L. Stewart, Jr., MD Program Director, Combined Internal Medicine/Pediatrics Residency Program, Associate Professor of Medicine and PediatricsUniversity of Mississippi Medical Center, Jackson

Samuel Calvin Thigpen, MDHematology-Oncology Fellow, Department of MedicineUniversity of Mississippi Medical Center, Jackson

Thad F. Waites, MD, FACCClinical Cardiologist, Hattiesburg Clinic

Chris E. Wiggins, MDOrthopaedic SurgeonBienville Orthopaedic Specialists, Pascagoula

John E. Wilkaitis, MD, MBA, CPE, MS Chief Medical Officer Brentwood Behavioral Healthcare, Flowood


continued from previous page

other “favorite” past AMA president (besides my friend and

hero Dr. Edward Hill) is the eternally bow-tied Dr. Daniel

“Stormy” Johnson of Louisiana. I always enjoy his comments

on the floor of the AMA House of Delegates, and I especially

enjoyed his reflection last year that the end result of health

system reform must place “the patient in the driver’s seat, but

the physician riding shotgun!” And he’s right, that’s what must

evolve in this ongoing health system reform mess: the patient in

the driver’s seat, but our profession riding shotgun, watching out

for the patient’s best interests.

I call your attention to the special article in this issue

on Southern Remedy’s Healthy Living fitness program for

Mississippi. As patient advocates, we must empower our patients

to heal themselves and contribute to their own wellness through

preventive measures and healthy lifestyles. Southern Remedy’s

programs on diet and fitness can help physicians create a

healthier Mississippi (and that healthier Mississippi begins in

our local towns and cities!).

Immediate MSMA Past President Dr. Tom Joiner commented

in his official address in early June that one of the ways component

societies can step up and take on active leadership roles in their

communities is through such projects as Southern Remedy’s

Healthy Living programs. He advised component societies to

coordinate with their alliances introducing this program to their

communities, churches, and schools. He noted that this “would

make a great difference in our fight against obesity and its co-

morbidities.” Dr. Joiner is right, and component societies should

seize this opportunity to promote Southern Remedy’s diet and

exercise guides to encourage healthy lifestyles at the local level.

Reflecting the best evidence at hand and created with the

leadership of our Associate Editor Dr. Rick deShazo, the fitness

program published in this issue is intended for individuals who

don’t have a regular exercise program and desire to initiate one

to complement calorie restriction and weight control. (See the

December 2011 JMSMA for a copy of the first component in this

series which focused on weight, calorie, and portion control.)

This issue’s fitness program will help our patients battle not

only obesity, but also other chronic illnesses directly related to

a sedentary lifestyle. Here is another weapon for Mississippi’s

physicians in our daily battles for the health of our patients.

— Lucius “Luke” Lampton, MD, Editor


HealtHy living

Program

• Special article •

Program

[In the December 2011 issue of JMSMA, the first component of a new weight, calorie and portion control program was published. That program, Southern Remedy’s Healthy Living, offered materials for use with adult and pediatric patients, including training materials for office staff and lay personnel to use in teaching the program. With this issue, we offer the companion piece, the Fitness Prescription. Data on weight management now suggest that the combination of calorie and portion control with moderate aerobic exercise produces better weight loss results and lower levels of recidivism.

The Fitness Prescription offers aerobic exercise information for adults at all fitness levels, beginning with an aerobic program to optimize weight control. It also offers a flexibility and resistance component. Flexibility and resistance exercises have been demonstrated to decrease falls and osteoporosis and slow the rate of muscle mass associated with aging.

We hope you will consider training your office staff to share these materials with your patients as well as taking them into community settings, such as churches and civic organizations. They will be updated from time to time, on the internet. To the best of our knowledge represent these recommendations reflect the best evidence at hand. All of these materials are available at www.southernremedy.org for reproduction in your office or use by commercial printers, if you wish. If you wish to co-brand your own practice, hospital or other sponsoring organization with the principle sponsor, Mississippi Public Broadcasting, you are welcome to do.

If you would like a CD of Southern Remedy’s Healthy Living to take to a printer, we will provide you a CD and copyright release (required by professional printers) by mail. Please email your request to [email protected]. You will need to include your name, contact number, and mailing address.]—Richard D. deShazo, MD, Associate Editor

172 JOURNAL MSMA June 20122 SouthernRemedyHealthyLivingProgram

Healthy Living Fitness Program

Physical Activity3 Improvesbloodpressure

3 Improvescholesterollevels(byraisingthegoodandloweringthebad)

3 Improvesbloodsugarlevels

3 Improvesbonedensity

3 Increasesstrengthandflexibility

3 Promoteswell-beingandhappiness

3 Decreasesriskoffalls

Let’s Get Physical Southern Remedy, a health initiative of Mississippi Public Broadcasting, has developed Southern Remedy’s Healthy Living. This program includes Southern Remedy’s Food Challenge, Healthy Living Plates for Adults and Children, and the Fitness Prescription. Although calorie control with good nutrition is the most important thing you can do for weight control, physical activity assists in calorie balance and has additional health benefits.

No matter what your age or fitness level, there are easy to use fitness suggestions for you right here. The payoff is big and worth your effort! Please see the chart on the left to get started

AreYouReadyToGetFit?

NotSure? ForSure!

SeePage2ProblemSolutionChart

Notregularlyactive*,overtheageof45years

formenor55yearsforwomen,orwithmedicalproblems

Notregularlyactive*,undertheageof45yearsformenor55yearsforwomen,

withnomedicalproblems

Alreadyactive**butreadyformore

Speaktoyourhealthcareproviderfirst.Youmayneedevaluation

priortostartingafitnessprogram.

SouthernRemedyBeginnerFitness

Program:Walking

SouthernRemedyAdvanced

FitnessProgram:Walking/Jogging

*Notregularlyactive=lessthan150minutesofphysicalactivityperweek**Alreadyactive=150minutesormoreofphysicalactivityperweek

SouthernRemedyAdvanced

FitnessProgram

SouthernRemedyFlexibilityand

ResistanceProgram

Southern Remedy

Fitness Navigation

Chart

SouthernRemedyFlexibilityand

ResistanceProgram

- Try- - Try- - Try-

Healthy Living Booklet.AP.indd 2 6/11/12 9:49 AM

See Page 173

June 2012 JOURNAL MSMA 173SouthernRemedyHealthyLivingProgram 3


• Review the benefits of physical activity provided in this material.• Think about how these benefits will improve your health and well-being.• Fill in the blank below: ________________________ keeps me from being physically active (or as active as I would like to be).

Did you say:3 Lack of time, motivation, support, knowledge, or facilities?3 Current disease, disability, fear of injury?3 Past failure?

You are not alone! These are some of the most common reasons that people are not physically active. The information in this toolkit will address all of these issues and help you establish a physical activity plan just for you!

Lack of timeSolution: Starting with as little as 10 minutes of physical activity per day can have positive health benefits.

Lack of motivation/supportSolution: Physical activity has many great health benefits. Try to find a friend, co-worker, or family member who is physically active. Exercising together is a great way to stay motivated. Get jump-started with a quick and easy change. (Keep reading for tips!)

Lack of knowLedge and faciLitiesSolution: Being physically active doesn’t require a gym membership or a personal trainer. This toolkit will give you easy and inexpensive ways to get active.

current disease/disabiLity or fear of injurySolution: Being physically active is an important part of becoming and staying healthy. In most cases, light to moderate intensity activity is safe for everyone. Speak with your healthcare provider before beginning a new program if you are concerned. Don’t forget to warm up and cool down with each workout.

past faiLuresSolution: To be successful, you need realistic goals. Our program walks you through each step of the activity and gives you clear goals for each week or month. See Losing Focus: Don’t Give Up! on page 4 for more tips.

1. Take the stairs instead of the escalator or elevator.

2. Park in the back of the lot at the grocery store, mall, or work, and walk to the entrance.

3. Take a trip to the mall to “window shop.”

4. March in place during commercial breaks on television.

Get Jump-Started! Quick and Easy Changes

Not Sure?

Problem & Solution




1Know Your Limitsthe “talk test” is an easy way to judge the intensity of your activity.

Lightno noticeable changes in breathing. you can carry on a full conversation or even sing.

moderateBreathing effort increases without being out of breath. you can have a conversation but not sing.

vigorousBreathing is deep and rapid. you can’t say more than a few words without pausing for breath.

2Pick Your Activitythe Southern Remedy Fitness Prescription is designed as a walking/jogging program. other activities can be substituted, just remember to match up the intensity using the “talk test.”

Swimming Bicycling Dancing

For Sure!get fit

match up the intensity using the “

Swimming Bicycling Dancing




3333Losing Focus: Don’t Give Up!We all have habits that we have developed over the years that are hard to change. many of these habits are triggered by particular situations. For example, we all have bad days at work that just make us want to crawl in bed or relax in front of the tv. What about when you are sick? the last thing you want to do is exercise. then, you quickly find yourself back in the cycle of inactivity. the best way to deal with a situation like this is to be prepared.

We generally recommend physical activity at least 5 days per week. Don’t schedule the days you “will not excercise.” instead plan to be active every day. then, if something comes up that keeps you from being active, it won’t derail all your efforts. When you do slip up, don’t beat yourself up. Use the following system, or one you develop on your own, to figure out why you slipped and how not to do it again.

don’t beat yourself up!SteP 1 stop and think • identify thoughts or actions that are causing you to lose focus• think of strategies to combat these thoughts or actions.

SteP 2 don’t panic! • one slip up does not equal failure!

SteP 3 modify your fitness program• review the reasons you started a fitness program.• modify your fitness goals if needed.• think of fun, new activities to energize you.

SteP 4 act immediateLy• Don’t blame yourself! everyone will have slip-ups.• Start back on your fitness program as soon as possible.

SteP 5 seek heLp • Don’t be shy! ask for help and encouragement from family, friends, or co-workers.

Warning Signsexercise is usually a safe and beneficial activity. However, there are certain warning signs you should never ignore if they happen during exercise. you should contact your healthcare provider immediately if these occur.

• Dizziness, nausea, clammy skin• Hot, flushed, dry skin (you have stopped sweating)• Chest pain, arm tingling, jaw pain, or sudden shortness of breath

avoid exercising during the hottest

part of the day.

Drink plenty of fluids.

remember to always warm-up and cool-down.

Don’t do toomuch too quick

!Drink plenty

of fluids.

remember to always warm-up and cool-down.

Don’t do toomuch too quick

To help prevent problems



Beginner Fitness ProgramWe recommend a warm-up and cool-down activity each time you exercise.

We SuggeSt

week 4

week 1

ReADY To WoRKoUTBeginner Fitness Program

week 2

week 3

60 minutes weekly

Light intensity walking* for a total of 20 minutes per day (may be done in two 10 minute bursts), 3 days per week

75 minutes weekly

Continue light intensity walking.* Increase to 25 minutes per day, 3 days per week

90 minutes weekly

Continue light intensity walking.* Increase to 30 minutes per day, 3 days per week

120 minutes weekly

Continue light intensity walking.* for 30 minuties per day, increase to 4 days per week

Light


Week 1

Slow, easy walking pace for a few

minutes before and after activity.

Week 2-7

Slow, easy walking pace for 5


Week 8 and beyond

Slow, easy walking pace for 5-10




week 5 & 6

week 7

week 8 maintenance

120 minutes weekly

Increase to moderate intensity walking* for 30 minutes per day, 4 days per week

135 minutes weekly

Continue moderate intensity walking* for 30 minutes per day, 4 days per week. Add another day of moderate intensity walking for 15 minutes.

150 minutes weekly

Continue moderate intensity walking.* Increase to 30 minutes per day, 5 days per week

150 minutes weekly

Continue moderate intensity walking* for 30 minutes per day, 5 days per week

Suggestion

If at any point you don’t feel ready to move to the next stage, spend another week in your current stage. This does not equal failure.

*SeeKnow your limit forexerciseintensityinpage2

Moderate




Know Your Limitsthe “talk test” is an easy way to judge the intensity of your activity.




once the Beginner Fitness Program is complete, please choose one of the following three options:

Continue moderate intensity walking for a total of 30 minutes daily for 5 days per week.

Continue on to the advanced Fitness Program (more walking/jogging) for added health benefits!

Continue on the Flexibility and resistance training Program (stretching and weights) for added health benefits!

123




week Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

1 minutes

intensity

2minutes

intensity

3minutes

intensity

4minutes

intensity

5minutes

intensity

6minutes

intensity

7minutes

intensity

8minutes

intensity

weekly Total

minutes

intensity

Keep Track of Your Progress Use this form to write down the amount and intensity of the exercise you are doing. You can compare your weekly total to the total weekly time goals provided in the program. If you don’t meet the designated goal, refer back to Losing Focus: Don’t Give Up!




Congratulations!If you have made it to this portion of the Fitness Prescription, you have either completed the Beginner Fitness Program, Advanced Fitness Program, or both! This is a wonderful accomplishment, and you should be very proud of yourself!

Now is a great time to reward yourself. Don’t choose food rewards. Instead think of things that will be a treat but also keep you on the road to continued health. Some great choices are:

• new exerciSe cloTheS

• a greaT pair of aThleTic ShoeS

• a maSSage




SourcesAmerica On the Move Foundation. (2008). 100 ways to add 2,000 steps. Retrieved November 8, 2011 from http://www.americaonthemove.org

Brownell, K.D. (1994). The LEARN Program for Weight Control (6th edition). Dallas, TX: American Health Publishing Company.

Bushman, B. (Ed.). (2011). American College of Sports Medicine’s Complete guide to fitness and health: Physical activity and nutrition guidelines for every age. Champaign, IL: Human Kinetics.

Centers for Disease Control and Prevention. (2011). Measuring physical activity intensity. Retrieved December 30, 2011, from http://www.cdc.gov/physicalactivity/everyone/measuring/index.html

Centers for Disease Control and Prevention. (2011). Overcoming barriers to physical activity. Retrieved November 8, 2011 from www.cdc.gov/physicalactivity/everyone/getactive/barriers.html

Mayo Foundation for Medical Education and Research. (2011). Barriers to fitness: Overcoming common challenges. Retrieved November 8, 2011, from http://www.mayoclinic.com/health/fitness/SMOOO85_D

Mayo Foundation for Medical Education and Research. (2011). Heat and exericise: Keeping cool in hot weather. Retrieved from http://www.mayoclinic.com/health/exercise/HQ00316

Thompson, W.R., Gordon, N.F., & Pescatello, L.S. (Eds.). (2010). American College of Sports Medicine’s Guidelines for exercise testing and prescription (8th ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.

United States Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved from: http://www.health.gov/paguidelines



Advanced Fitness ProgramWe recommend a warm-up and cool-down activity each time you exercise. We suggest using a comfortable walking pace for 5-10 minutes before and after each activity.

week 5

week 1 & 2

week 3

week 4

200 minutes weekly

Moderate intensity walking* for a total of 40 minutes per day, 5 days per week.

225 minutes weekly

Continue moderate intensity walking.* Increase to 45 minutes per day, 5 days per week

250 minutes weekly(moderate)Continue moderate intensity walking.* Increase to 50 minutes per day, 5 days per week.

-or- 125 minutes weekly (vigorous)Begin vigorous intensity jogging* for 25 minutes per day, 5 days per week

275 minutes weekly(moderate) Continue moderate intensity walking.* Increase to 55 minutes per day, 5 days per week.

-or- 135 minutes weekly(vigorous)Continue vigorous intensity jogging.* Increase to 27 minutes per day, 5 days per week

ReADY To WoRKoUTadvanced Fitness Program




Tipsif at any point you don’t feel ready to move to the next stage, spend another week in your current stage. this does not equal failure.

week 6

maintenance

300 minutes weekly(moderate)Continue moderate intensity walking.* Increase 60 minutes per day, 5 days per week.

-or- 150 minutes weekly(vigorous)Continue vigorous intensity jogging.* Increase 30 minutes per day, 5 days per week

300 minutes weekly(moderate)Continue moderate intensity walking.* for 60 minutes per day, 5 days per week.

-or- 150 minutes weekly(vigorous)Continue vigorous intensity jogging* for 30 minutes per day, 5 days per week

-or- 200 minutes weekly(moderate) plUS

50 minutes weekly(vigorous)Combine moderate* and vigorous* activities on alternate days of the week.

*SeeKnow your limits forexerciseintensityonpage2




Know Your Limitsthe “talk test” is an easy way to judge the intensity of your activity.




Extra Tipsonce the advanced Fitness Program is complete, please choose one of the following two options:

1. Continue the maintenance stage of the advanced Fitness Program.

2. Continue on the Flexibility and resistance training Program (stretching and weights) for added health benefits!


See page 179 to track your progress.



Flexibility and Resistance Training Program

whaT iS iT?flexibility Training involves stretching exercises to improve joint and muscle function.

Stretching can be an important part of a complete physical activity program when combined with aerobic exercises (walking or jogging) and anaerobic exercises (lifting weights).

resistance Training is the use of weights and/ormachines to increase muscle strength and endurance.

If you have a history of heart disease or high blood pressure, you should speak with your healthcare provider priorto starting a resistance training program.

STepS of the flexibility and resistance Training programWARm UP 5 minutes of walking at a comfortable pace.WoRKoUT Resistance ExercisesCooL DoWn Flexibility Exercises

equipmentNo gym membership? No worries. These exercises use only your own body, dumbbells, steps, and chair. Dumbbells are available at most sporting goods stores. Don’t have those either? Make your own.

For Dumbbells use: 15oz soup cans, 16-20oz water bottles or half-gallon plastic milk jugs filled halfway with water (for heavier weights)

Remember to always start with the lowest weight that is comfortable for you before moving up.

make Your ownDumbbells

15 oz soup can

16-20 oz water bottle

half-gallon milk jug




Advanced Beginner(1-2 months)

number of repetitions:8 - 12 (one set)number of Sets: 1exercises: CHAIR SQUATSBEGINNER SEATED PRESS-UPADvANCED BEGINNER CURL-UPMODIFIED KNEE PUSH-UPCALF RAISESDUMBBELL ROWSTEP-UPMODIFIED PRONE PLANK

workout stage

Beginner(1-2 months)

number of repetitions:8 - 12 (one set)number of Sets: 1exercises: WALL SITTINGBEGINNER CURL-UPKNEELING HIP EXTENSIONSIDE-LYING LEG RAISESMODIFIED INCLINE PUSH-UPCALF RAISES

Intermediate(usually lasts 3-6 months but may take up to 1 year)

number of repetitions:8 - 12 (one set)number of Sets: 1exercises: SQUATSPUSH-UPCURL-UPSEATED PRESS-UPSTEP-UPCALF RAISESBICEPS CURLDUMBBELL ROWSPRONE AND SIDE PLANKS

workout workout stageIntermediate

expertContact a fitness professional at your local YMCA or gym. You can also make an appointment with a physical therapist.

Resistance Training Program




Wall SittingStand 1-2 feet away from a wall and place your back against the wall. Slide your body down the wall until your knees form a 90 degree angle. Hold this position for 20-30 seconds and return to the starting position. This is one repetition. Only 6-8 repetitions of this exercise are required to equal one set.

Resistance Exercises

Wall SittingStand 1-2 feet away from a wall and place your back against the wall. Slide your body down the wall until your knees form a 90 degree angle. Hold this position for 20-30 seconds and return to the starting position. This is one repetition. Only 6-8 repetitions of this exercise are required to equal one set.

modified Incline Push-Upa. Standing a few feet from the wall, place your palms on the wall at shoulder height, slightly wider than your shoulders. b. Bend your elbows until your face almost touches the wall. Your back should stay straight. Hold this position briefly and then return to the starting position. This is one repetition.

Too Easy? Try using your kitchen counter instead of a wall. This increases the incline and makes you work harder. Too Easy? Try using your kitchen counter instead of a wall. This increases the incline and makes you work harder.

Chair SquatStand with your back facing a chair and your hands held out in front of you. Keeping your back straight, sit down in the chair. Return to the starting position. This is one repetition.

SquatStand with your knees and feet shoulder width apart and your arms held out in front of you. Lean slightly forward at the hips and bend your knees until they are parallel to the floor. Hold this position briefly and then shand back up. This is one repetition.

a

b




Push-Upa. Place your toes and hands on the floor, with your hands placed slightly wider than your shoulders. Keep your back and arms straight. b. Bend your elbows and slowly lower your chest towards the floor. Stop when you are 3-4 inches from the floor or your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.


modified Knee Push-Upa. Get down on your knees and hands with your hands slightly wider than your shoulders. Lift your feet off the floor and cross your ankles. b. Bend your elbows and slowly lower your chest towards the floor. Stop when you are 3-4 inches from the floor or your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.


Get down on your knees and hands with your hands slightly

your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.

Beginner Curl-Upa. While lying flat on your back, bend your knees and hips to 90 degrees and place your arms by your sides. Lift your shoulders and upper back off the floor. b. Hold this position briefly and then return your back to the floor. This is one repetition.

Beginner

While lying flat on your back, bend your knees and

Hold

a

a. hands placed slightly wider than your shoulders. Keep your back and arms straight. and slowly lower your chest towards the floor. Stop when you are 3-4 inches from the floor or your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.

b

a

b

a

b

20 SouthernRemedyHealthyLivingProgram




Kneeling Hip extensiona. Place your palms and knees on the floor in the crawl position. b. Lift and straighten your right leg until it is parallel with the floor. Keep your shoulders and hips level. Hold this position briefly and return your right knee to the floor. Repeat with the left leg. This is one repetition.


Advanced Beginner Curl-Upa. While lying flat on your back, bend your knees and hips to 90 degrees and cross your arms over your chest. b. Lift your shoulders and upper back off the floor. Hold this position briefly and then return your back to the floor. This is one repetition.

Curl-Upa. While lying flat on your back, bend your knees and hips to 90 degrees and place your hands behind your head. a. Lift your shoulders and upper back off the floor. Do not pull on your neck. Hold this position briefly and then return your back to the floor. This is one repetition.

Advanced Beginner Curl-Upa. While lying flat on your back, bend your knees and hips to 90 degrees and cross your arms over your chest. and upper back off the floor. Hold this position briefly and then return your back to the floor. This is one repetition.

Kneeling Hip extensiona. Place your palms and knees on the floor in the crawl position. b. Lift and straighten your right leg until it is parallel with the floor. Keep your shoulders and hips level. Hold this position briefly and return your right knee to the floor. Repeat with the left leg. This is one repetition.

and upper back off the floor. Hold this position briefly and then return your back to the floor. This is one repetition.

a

b

a

b

aWhile lying flat on your back, bend your knees and

hips to 90 degrees and place your hands behind your Lift your shoulders and upper back off the floor.

Do not pull on your neck. Hold this position briefly and then return your back to the floor. This is one repetition.

b

SouthernRemedyHealthyLivingProgram 21




b


Side-Lying Leg Raisesa. Lie on your right side with your right leg slightly bent and your left leg straight. Place your right arm under your head and your left arm, palm down in front of your chest for balance. b. While keeping your abdominal muscles tight, lift your left leg until it is level with the hip. Hold this position briefly and then return to the starting position. This is one repetition. Remember repeat on the other leg.

Calf Raisesa. Place the balls of your feet on a step with your heels hanging off the back of the step. Use a handrail to help maintain your balance. b. Raise your heels until you are standing on your tip-toes. Hold this position briefly and then return to the starting position. This is one repetition.


Lie on your right side with your right leg slightly bent and your left leg straight. Place your right arm under your head and your left arm,

b

leg straight. Place your right arm under your head and your left arm, While keeping your

abdominal muscles tight, lift your left leg until it is level with the hip. Hold this position briefly and then return to the starting position. This

Lie on your right side with your right leg slightly bent and your left

Calf Raisesa. Place the balls of your feet on a step with your heels hanging off the back of the step. Use a handrail to help maintain your balance. your heels until you are standing on your tip-toes. Hold this position briefly and then return to the starting position. This is one repetition.

Beginner Seated Press-Upa. Face forward while sitting in a chair. Place your palms flat on the chair bottom beside your thighs. b. Push downward with your palms to lift your buttocks off the chair. Leave your feet on the floor but do not use your feet to aid in lifting. Hold briefly and return to the starting position. This is one repetition.

Seated Press-UpFace forward while sitting in a chair. Place your palms flat on

Push downward with your palms to lift your buttocks off the chair. Leave your feet on the floor but do not use your feet to aid in lifting. Hold briefly and

a

a

b

a

b




Step-Upa. Stand and face a step approximately 6-15 inches in height. (The higher the step, the harder the exercise). Place your right foot completely on the step. b. Transfer your weight to the heel of your foot and press down into the step while straightening your leg. Touch your left toe to the step but do not put your weight on this foot. Return to starting position. This is one repetition.


Seated Press-UpFace forward while sitting in a chair. Place your palms flat on the chair bottom beside your thighs. Lift your feet slightly off the floor. Push downward with your palms to lift your buttocks off the chair. Hold briefly and return to the starting position. This is one repetition.

Dumbbell Rowa. Standing on the left side of a bench, put your right knee and palm of your right hand on the bench surface. Your back and arm should be straight. Extend your left arm straight down and hold your dumbbell with your left hand. b. Pull your dumbbell upwards by bending your elbow and shoulder. Lower your left hand back

a b

straight. Extend your left arm straight down and hold your dumbbell with your left hand. elbow and shoulder. Lower your left hand back

b

a





Biceps Curla. Stand upright with your feet shoulder width apart. Your arms should be by your side and you should hold a dumbbell in each hand with palm side of hand facing out. b. Bend your elbows and bring your hands upward toward your shoulders. Straighten your elbows and return your hands to your side. This is one repetition.

modified Prone PlankLay face down on the floor. Rise up on your forearms and your knees. Your back and neck should remain straight. Continue to breath normally. Hold for 10-20 seconds. This is one repetition. Only 5-8 repetitions are required of this exercise to equal one set.

Biceps CurlStand upright with your feet shoulder width apart.

Your arms should be by your side and you should hold a dumbbell in each hand with palm side of hand facing

Bend your elbows and bring your hands upward toward your shoulders. Straighten your elbows and return your hands to your side. This is one repetition.

modified

Prone PlankLay face down on the floor. Rise up on your forearms and your toes. Your back and neck should remain straight. Continue to breath normally. Hold for 20-30 seconds. This is one repetition. toes. Your back and neck should remain straight. Continue to breath normally. Hold for 20-30 seconds. This is one repetition.

Side PlankLay on your side with your legs straight. Your weight should be supported on your bottom arm. Use your abdominal muscles to keep your hip in line with your shoulders. Hold for 20-30 seconds. This is one repetition. Only 4-6 repititions are required for prone and side planks to equal one set

Side Plank

a

b




Stretches for FlexibilityGood Stretches Stretching works best when done for at least 10 minutes, 2-3 days per week. Stretching has the most benefit when performed after your fitness or resistance exercises when your muscles are already warmed up. Stretches should be held for 15-60 seconds and repeated 4 times. You should never stretch to the point of pain.

neckforward flexion: Face forward and move your head forward like you are placing your chin on your chest. You should feel this stretch in the back of your neck and upper back.

eck

Stretching has the most benefit when performed after your fitness or resistance exercises when your muscles are already warmed up. Stretches should be held for 15-60 seconds and repeated 4 times. You should never stretch to the point of pain.

lateral flexion: Face forward and move your head to the side like you are placing your ear on your shoulder. Repeat with both sides of the neck. You should feel this stretch on the opposite side of your neck.

retraction: Sit upright in a chair and rest your arms by your sides. Pick a spot on the wall to focus on and keep your head level. Keep your back against the chair and extend your neck by sticking your chin out. You should feel this stretch behind your ears and down your neck.

ShoulderArms across chest: Face forward, straighten your right arm, and move it across your chest. Hold your right arm with your left hand and use gentle pressure on your right arm. Repeat with the left arm. You should feel this stretch in your shoulder.

ShoulderArms across chest: Face forward, straighten your right arm, and move it across your chest. Hold your right arm with your left hand and use gentle pressure on your right arm. Repeat with the left arm. You should feel this stretch in your shoulder.

UpperBackUpper Back: Crisscross your arms over the front of your upper chest, point your elbows forward, and give a gentle squeeze. This is just like giving yourself a hug. You should feel this stretch in the middle of your upper back between your shoulder blades.




Hips Butterfly stretch: Sit on the floor, bend your knees, and touch the soles of your feet together. Lean slightly forward and use your elbows to gently press down on your knees. You should feel this stretch in your upper thighs.

TricepsElbow behind the head: Face forward, lift your right arm straight up, bend at the elbow and reach for your left shoulder. You can support your right arm with your left hand. Repeat on the left side. You should feel this stretch in your triceps (underside of the top part of your arm).

Butterfly stretch: Sit on the floor, bend your knees, and touch the

Hips

Lower BackLower Back: Lie flat on your back with your legs straight out in front of you and your heels on the floor. Pull your right knee up toward your chest. You can keep your other leg straight or bend it. Repeat with the other leg. You should feel this stretch in your lower back. Do not perform this stretch if you have osteoporosis.

Chest StretchChest Stretch: Face forward, straighten your arms, and raise them up to your sides and slightly toward your back. Make sure to keep your shoulders relaxed and your arms slightly lower than your shoulders. You should feel this stretch across your upper chest.

Stretches for Flexibility

BicepsWall Stretch: Touch the wall with your right palm and forearm and slowly turn your body away from the wall. Repeat on the left side. You should feel this stretch in your bicep muscle (top part of your upper arm) and across your upper chest.




Kneeling Hip Flexor Stretcha. Kneeling Hip Flexor Stretch: Place your left foot and right knee on the floor. Both of your legs should now form a 90 degree angle. b. Shift your weight forward to your left knee. Repeat on the right side. You should feel this stretch on the inside of your hip.

Stretches for Flexibility

Kneeling Hip Flexor Stretch

Kneeling Hip Flexor Stretch: Place your left foot and right knee on the floor. Both of your legs should now form a 90 degree angle.

Shift your weight forward to your left knee. Repeat on the right side. You should feel this stretch on the inside of your hip.

a

b

HamstringSeated Hamstring Stretch: Sit on the floor with both legs straight out in front of you. Place your hands on your thighs and slowly move your hands toward your feet. Keep your chest lifted up. You should feel the most stretch in your hamstring (back of your thighs) and some stretch in your calves.

CalvesStanding Calf Step Stretch: While standing straight on a step, move your right foot slightly backward. Your heel should be off the edge of the step. Lower your right heel slowly to stretch your calf. Repeat on the left side. Remember to use a handrail to keep yourself steady. You should feel this stretch in your calves (back of your lower leg).

QuadricepsStanding Quadriceps Stretch: While standing, bend your left knee toward your buttocks. Hold your left ankle with your right hand and gently pull back on your thigh. You may use a chair or the wall for support. Repeat with the right leg. You should feel this stretch in your front thigh.




Bad StretchesSome stretches put unnecessary strain on your muscles and joints. For this reason, there are some stretches you should avoid or only use under the direction of a physical therapist.

Hyperextension of the backHyperextension of the back

Standing Toe Touch

Hurdler Stretch



Healthy Living Youth Fitness

Physical activity is a very important part of overall health, especially in children. regular physical activity improves the function of the heart and lungs, strengthens muscles, makes bones stronger, decreases body fat, and improves mood. the results are healthier children and adolescents who will grow into healthy adults.

How often and how much of each? endurance activities should make up the largest portion of the 60 minutes of daily exercise. muscle-strengthening or bone-strengthening activities should be included in the 60 minutes of daily exercise for three days of each week.

SOUTHERN REMEDY HEALTHY LIvING

yoUTh fiTneSS rxNote to PareNts

Physical activity is a very important part of overall health, especially in children.

rxxs




the goals How much activity is enough? the best evidence suggests that children and adolescents 6-17 years of age need 60 minutes of physical activity every day.

60Minutes Activity

606060HOW MUCH ACTIvITY IS ENOUGH?

What Kind of activity is Best?there are 3 kinds of activity: endurance, muscle-strengthening, bone-strengthening. each is important in its own way.

How often and How much of each?endurance activities should make up the largest portion of the 60 minutes of daily exercise. muscle-strengthening or bone-strengthening activities should be included in the 60 minutes of daily exercise for three days of each week.



Children (6-12 years of age)

Bicycle ridingrunningSoccerBasketballSwimmingactive games(suchasfreezetag)

Adolescents (13-17 years of age)

Bicycle ridinglawn mowing (push)Baseball/SoftballSoccerBasketballSwimmingrunning


climbing monkey barsplaying tug of warSit-upsclimbing rope


push-upspull-upsSit-upsclimbing rock wall


playing hopscotchJumping ropehopping/skipping


Jumping roperunningTennisVolleyball

REPRESENTATIvE EXERCISE for chilDren anD aDoleScenTS


endurance

muscle-strengthening

Bone-strengthening




less Than 60 minutes Every dayChildren should increase their physical activity

gradually over time. If your child is active for 60

minutes per day but not EvERY day, increase the

number of days that he or she is active. If your

child is active EvERY day but not for at least 60

minutes, increase the time he or she is active.

Remember that short bursts (10 minutes) count!

Add them up to reach the goal!!

Choose the arrow that represents your child or adolescent’s present physical activity level to move forward.

60Minutes606060

less than

physical activity




60 minutes Every dayDo even more! In general, children

should not be inactive for more than

2 hours at a time when awake.

more than 60 minutes Every dayContinue current physical activity routine!

more than

60Minutes606060

60Minutes606060

physical activity

physical activity




Sample Weekly exerciSe program

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Endurance (40 minutes)

Muscle-strengthening (20 minutes)


Bone-strengthening (20 minutes)










- or - any of the Bone

and Muscle strengthening

Safety First• remember to use appropriate safety gear during physical

activity (bicycle helmets, elbow pads, knee pads)• never swim alone.• avoid obvious dangers such as allowing children to ride

on all terrain vehicles.

STOP

WEEKLY EXERCISE PROGRAM




SourcesAmerica On the Move Foundation. (2008). 100 ways to add 2,000 steps. Retrieved November 8, 2011 from http://www.americaonthemove.org

Brownell, K.D. (1994). The LEARN Program for Weight Control (6th edition). Dallas, TX: American Health Publishing Company.

Bushman, B. (Ed.). (2011). American College of Sports Medicine’s Complete guide to fitness and health: Physical activity and nutrition guidelines for every age. Champaign, IL: Human Kinetics.

Centers for Disease Control and Prevention. (2011). Measuring physical activity intensity. Retrieved December 30, 2011, from http://www.cdc.gov/physicalactivity/everyone/measuring/index.html

Centers for Disease Control and Prevention. (2011). Overcoming barriers to physical activity. Retrieved November 8, 2011 from www.cdc.gov/physicalactivity/everyone/getactive/barriers.html

Mayo Foundation for Medical Education and Research. (2011). Barriers to fitness: Overcoming common challenges. Retrieved November 8, 2011, from http://www.mayoclinic.com/health/fitness/SMOOO85_D

Mayo Foundation for Medical Education and Research. (2011). Heat and exericise: Keeping cool in hot weather. Retrieved from http://www.mayoclinic.com/health/exercise/HQ00316

Thompson, W.R., Gordon, N.F., & Pescatello, L.S. (Eds.). (2010). American College of Sports Medicine’s Guidelines for exercise testing and prescription (8th ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins.

United States Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved from: http://www.health.gov/paguidelines


204 JOURNAL MSMA June 201236 Southern Remedy Healthy Living Program

AcknowledgementsMany individuals played important roles in the production of Southern Remedy Healthy Living.

Debbie Minor, PharmD, Olivia Henry, PhD,RD, and I worked with Leigh Wright, BA, on the original

version, and Josie Bidwell, CNP, led the effort on the Fitness Prescription component. The Healthy

Living plate was adapted from the USDA’s Choose My Plate program. Southern Remedy Healthy

Living is a work in progress. It will be updated on the MPB website www.southernremedy.org.

We anticipate others will come along to help.

A superb committee of medical experts contributed at many levels and reviewed the final product.

MD; Paula Stubbs, PT; Lindsey Tillman, PharmD; Mark Weber, PT. We would also like to thank

Monica Watkins, administrative assistant III at UMMC and Christy Chamblee, graphic designer;

Margaret McPhillips, public relations director; Nancy Perkins, marketing & development; and

Jenny Wilburn, executive producer with MPB.

Scientific data strongly suggests that any weight management and fitness program is more

successful when implemented with a group. We strongly encourage the use of the materials

in small groups to include church, civic, and at-work groups. For instance, hosting weigh-ins at

regular intervals with prizes for success are effective and fun. The body immediately releases

gastrointestinal hormones after weight reduction, which increase appetite and tend to decrease

interest in physical activity. It is a constant fight to overcome these hormones, which stay

elevated for many months after weight loss. Doing this as a group and making sure the exercise

component is always a part of the calorie restriction are key.

All of us wish you success in moving toward a more healthy lifestyle. Remember, a little effort

goes a long way!

Richard D. deShazo, MDProfessor of Medicine and Pediatrics University of Mississippi Medical Center


These include: Hillary Freeman, PharmD; Lissa Kay, PharmD; Yana Nikitina RN, MD; Faiza Qureshi,


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Express your opinion in the JMSMA

through a letter to the editor

or guest editorial. The Journal MSMA

welcomes letters to the editor. Letters for

publication should be less than 300 words. Guest

editorials or comments may be longer, with an

average of 600 words All letters are subject to editing

for length and clarity. If you are writing in response to

a particular article, please mention the headline and

issue date in your letter. Also include your contact

information. While we do not publish street addresses,

e-mail addresses or telephone numbers, we do verify

authorship, as well as try to clear up ambiguities, to

protect our letter-writers. You can submit your letter

via email to KEvers@MSMA online.com or mail to

the Journal office at MSMA headquarters: P.O. Box

2548, Ridgeland, MS 39158-2548.


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June 2012 JOURNAL MSMA 21128 JOURNAL MSMA January 2012

• InstructIons for Authors •The Journal of the Mississippi State Medical Association

(JMSMA) welcomes material for publication submitted inaccordance with the following guidelines. Address allcorrespondence to the Editor, Journal of the Mississippi StateMedical Association, P.O. Box 2548, Ridgeland, MS, 39158-2548. Contact Karen Evers, managing editor, with any questionsconcerning these guidelines: (601)853-6733, ext. 323.

Style: Articles should be consistent with JAMA/ JMSMAstyle. Please refer to explanations in the AMA Manual of Style:A Guide for Authors and Editors. 10th ed. New York, NY:Oxford University Press; 2007. JAMA and JMSMA style differsfrom APA style. JAMA: http://jama.ama-assn.org/misc/ifora.dtlQuick reference quide:http://www.docstyles.com/amastat.htmAny manuscript that does not conform to the AMA Manual ofStyle, 10th edition will be returned for revision.

ManuScriptS should be of an appropriate length due to thepolicy of the Journal to feature concise but complete articles.(Some subjects may necessitate exception to this policy and willbe reviewed and published at the Editor’s discretion.) Thelanguage and vocabulary of the manuscript should beunderstandable and not beyond the comprehension of thegeneral readership of the Journal. The Journal attempts to avoidthe use of medical jargon and abbreviations. All abbreviations,especially of laboratory and diagnostic procedures, must beidentified in the text. Manuscripts must be typed, double-spacedwith adequate margins. (This applies to all manuscript elementsincluding text, references, legends, footnotes, etc.) the originaland one duplicate hard copy should be submitted. inaddition, the Journal also requires manuscripts in the formstated above be supplied in Windows OS-compatible digitalformat. you may email digital files as attachments [email protected] or supply them on a portablememory storage medium. All graphic images should beincluded as individual separate files in TIFF, PDF or EPSformat. Please identify the word processing program used andthe file name. Pages should be numbered. An accompanyingcover letter should designate one author as correspondent andinclude his/her address and telephone number. Manuscripts arereceived with the explicit understanding that they have not beenpreviously published and are not under consideration by anyother publication. Manuscripts are subject to editorial revisionsas deemed necessary by the editors and to such modifications asto bring them into conformity with Journal style. The authorsclearly bear the full responsibility for all statements made andthe veracity of the work reported therein.

revieWing prOceSS: Each manuscript is received by themanaging editor, and reviewed by the Editor and/or AssociateEditor and/or other members of the MSMA Committee onPublications and its review board. The acceptability of amanuscript is determined by such factors as the quality of themanuscript, perceived interest to Journal readers, and usefulnessor importance to physicians. Authors are notified upon theacceptance or rejection of their manuscript. Accepted

manuscripts become the property of the Journal and may not bepublished elsewhere, in part or in whole, without permissionfrom the Journal MSMA.

title page should carry [1] the title of the manuscript,which should be concise but informative; [2] full name of eachauthor, with highest academic degree(s), listed in descendingorder of magnitude of contribution (only the names of those whohave contributed materially to the preparation of the manuscriptshould be included); [3] a one- to two-sentence biographicaldescription for each author which should include specialty,practice location, academic appointments, primary hospitalaffiliation, or other credits; [4] name and address of author towhom requests for reprints should be addressed, or a statementthat reprints will not be available.

abStract, if included, should be on the second page andconsist of no more than 150 words. It is designed to acquaintthe potential reader with the essence of the text and should befactual and informative rather than descriptive. The abstractshould be intelligible when divorced from the article, devoid ofundefined abbreviations. The abstract should contain: [1] a briefstatement of the manuscript’s purpose; [2] the approach used;[3] the material studied; [4] the results obtained. Emphasize newand important aspects of the study or observations. The abstractmay be graphically boxed and printed as part of the publishedmanuscript.

Key WOrdS should follow the abstract and be identified assuch. Provide three to five key words or short phrases that willassist indexers in cross indexing your article. Use terms from theMedical Subject Heading list from Index Medicus when possible.Available at: http://www.nlm.nih.gov/mesh/authors. html.

SubheadS are strongly encouraged. They should provideguidance for the reader and serve to break the typographicmonotony of the text. The format is flexible but subheadsordinarily include: Methods and Materials, Case Reports,Symptoms, Examination, Treatment and Technique, Results,Discussion, and Summary.

referenceS must be double spaced on a separate sheet ofpaper and limited to a reasonable number. They will be criticallyexamined at the time of review and must be kept to a minimum.You may find it helpful to use the PubMed Single CitationMatcher available online at: http://www.ncbi.nlm.nih. gov/entrez/query/static/citmatch.html to find PubMed citations. Allreferences must be cited in the text and the list should bearranged in order of citation, not alphabetically. Referencenumbers should appear in superscript at the end of a sentenceoutside the period unless the text cited is in the middle of thesentence in which case the numeral should appear in superscriptat the right end of the word or the phrase being cited. Noparenthesis or brackets should surround the reference numbers.Personal communications and unpublished data should not beincluded in references, but should be incorporated in the text.

212 JOURNAL MSMA June 2012 January 2012 JOURNAL MSMA 29

References must conform to proper style to be eligible for review.Contact managing editor Karen Evers for an easy-to-followguide with examples of how to use JMSMA/ JAMA referencecitation format. The following form should be followed:

Journals: [1] author(s). Use the surname followed by initialwithout punctuation. The names of all authors should be givenunless there are more than three, in which case the names ofthe first three authors are used, followed by “et al.” [2] titleof article. Capitalize only the first letter of the first word. [3]name of Journal. Abbreviate and italicize, according to thelisting in the current Index Medicus available online athttp://www.nlm.nih.gov/bsd/aim.html. [4] year ofpublication; [5] volume number: Do not include issuenumber or month except in the case of a supplement or whenpagination is not consecutive throughout the volume. [6]inclusive page numbers. Do not omit digits. Do not includespaces between digits of the year, volume and page numbers.

example: Bora LI, Dannem FJ, Stanford W, et al. A guideline forblood use during surgery. Am J Clin Pathol. 1979;71:680-692.

books: [1] author(s). Use the surname followed by initialswithout punctuation. The names of all authors should begiven unless there are more than three, in which case thenames of the first three authors are used followed by “et al.”[2] title. Italicize title and capitalize the first and last wordand each word that is not an article, preposition, orconjunction, of less than four letters. [3] edition number,[4] editor’s name. [5] place of publication, [6] publisher,[7] year, [8] inclusive page numbers. Do not omit digits.

example: DeGole EL, Spann E, Hurst RA Jr, et al. BedsideExamination, in Cardiovascular Medicine, ed 2, Smith JT (ed).New York, NY: McGraw Hill Co; 1986:23-27.

figureS require high resolution digital scans to beprovided. Printed copies should also be submitted in duplicatein an envelope (paper clips should not be used on illustrationssince the indentation they make may show on reproduction).Legends should be typed, double-spaced on a separate sheet ofpaper. Photographic material should be high-contrast glossyprints. Patients must be unrecognizable in photographs unlessspecific written consent has been obtained, in which case a copyof the authorization should accompany the manuscript. Allillustrations should be referred to in the body of the text. Omitillustrations which do not increase understanding of text.illustrations must be limited to a reasonable number. (Fourillustrations should be adequate for a manuscript of 4 to 5 typedpages.) The following information should be typed on a label andaffixed to the back of each illustration: figure number, title ofmanuscript, name of senior author, and arrow indicating top.

tableS should be self-explanatory and should supplement,not duplicate, the text. The brief descriptive title, usually written asa phrase rather than a sentence, appears above to distinguish thetable from other data displays in the article. Data should be alignedhorizontally not to exceed 6.5". Tables should be numbered andsupplied on individual pages separate from manuscript body text

with placement indicated within. See Section 4 of the "AMAManual of Style" for specific Figure and Table components andproper presentation of data.

acKnOWledgMentS are the author’s prerogative; however,acknowledgment of technicians and other remuneratedpersonnel for carrying out routine operations or of residentphysicians who merely care for patients as part of their hospitalduties is discouraged. More acceptable acknowledgementsinclude those of intellectual or professional participation. Therecognition of assistance should be stated as simply as possible,without effusiveness or superlatives.

SubMiSSiOnS tO JMSMA Scientific SerieStop 10 facts you need to Know Series

The purpose of this series of articles is to providereferenced information on clinical management of medicalconditions in a concise fashion. The submissions should bedirected toward practitioners who do not have specialty trainingon the specific topic as a matter of general information. Theauthor of the best submission for each year will receive a prize.guidelines: 1) Articles should consist of 10 numberedparagraphs. Each of the paragraphs will begin with a fact thatphysicians need to know and a brief explanation of why. Factswill be referenced for each of the 10 points. 2) Suggestedorganization of manuscript is Introduction, Point 1, Point 2, etc.,Conclusion, and References. 3) Articles will be about 3 pages(about 700 words) in length written at a level that can be easilyunderstood by a practicing physician of any specialty. 4) Areference supporting the fact offered should be provided for eachof the 10 points. Citations should not be review articles. 5) Ifthere are specialty society guidelines in the area being discussed,the essential features of the recommendations should be includedin the official guidelines cited in the references.

uptodate SeriesThe purpose of this series of articles is to provide brief

reviews on topics of general interest to the practicing physiciansof Mississippi in areas where recent developments in diagnosisor treatment have occurred. guidelines: 1) Articles should bepractical and useful to physicians in office or hospital practice.2) Suggested organization of manuscripts is Introduction,Diagnosis, Recent developments, Conclusion, and References. 3)Articles will be about 6 pages (1500 words) or so in length writtenat a level that can be easily understood by a practicing physicianof any specialty. 4) Only include those references useful tophysicians who desire further information in the area. Five to eightreferences that will be useful to those who desire furtherinformation should be included. 5) Figures are great as are “call-outs,” i.e., boxes with key points to remember emphasizing the“take home” messages. 6) If there are specialty society guidelineson the topic, the essential features of the recommendations shouldbe summarized in the text and the official guidelines should becited in the references.

galley prOOf - The principal author will receive a PDFvia email to review. It is the author's responsibility to proof andapprove it. Corrections should be clearly marked and returnedpromptly. If you desire reprints, inquire about prices to order. r

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Documents

June 2012 JMSMA