Muhammad Firdaus, MD, FACP, Section of Endocrinology, Department of Medicine, University of Oklahoma Health Sciences Center; Veterans Affairs Medical Center, Oklahoma City, OK, USA.
Timothy J Lyons, MD, FRCP, Section of Endocrinology, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

The metabolic syndrome, though controversial due to lack of a uniform pathophysiological mechanism, is a useful clinical tool for identifying persons at risk for diabetes and cardiovascular disease. It indicates the cumulative cardiometabolic risk exerted by abdominal obesity, hyperglycemia, high triglyceride, low high density lipoprotein cholesterol (HDL-C), and high blood pressure. Lifestyle factors, high calorie intake, and less physical activity have been implicated in the causation of the metabolic syndrome, and thus older adults are at particular risk for the development of this syndrome. Current evidence indicates that the components of the metabolic syndrome can be targeted with lifestyle interventions to prevent the complications of diabetes and cardiovascular disease. This paper reviews various diagnostic criteria, etiological factors, and lifestyle interventions to combat the metabolic syndrome in order to prevent diabetes and cardiovascular disease in older adults.
Key words: metabolic syndrome, prevention, lifestyle modification, diet, physical activity.

Kristine E. Pringle, Ph.D., Health Care Consultant, First Health Services Corporation/PAPACE, Harrisburg, PA, USA.
Frank M. Ahern, Ph.D., Senior Research Associate, Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA.
Debra A. Heller, Ph.D., Senior Health Care Consultant, First Health Services Corporation/PA-PACE, Harrisburg, PA, USA.

Many medications have the potential to interact with alcohol, and older patients may be at greater risk of experiencing adverse effects due to issues of comorbidity and polypharmacy. Even small amounts of alcohol consumed by an older person who is taking multiple medications can have serious consequences. A retrospective analysis linked prescription claim records with self-reported alcohol use. Results showed that 77% of older adults used at least one alcohol-interactive medication, and 19% of alcohol-interactive drug users reported concomitant alcohol use. Because many individuals are unaware of the risks posed by alcohol and medications, it is important for clinicians to warn patients about potential interactions.
Keywords: older adults, alcohol, prescription drug use, alcohol-drug interactions, concomitant use of alcohol and prescription drugs.

Marie D.Westby, BSc(PT), PhD Candidate, Mary Pack Arthritis Program,Vancouver Coastal Health, School of Rehabilitation Sciences, University of British Columbia,Vancouver, BC.
Linda Li, BSc(PT), PhD, Harold Robinson/Arthritis Society Chair, Assistant Professor, School of Rehabilitation Sciences, University of British Columbia,Vancouver, BC.

Physiotherapy aims to prevent physical impairment and restore functional ability through the use of exercise, education, and physical modalities. While there is solid evidence supporting physical activities in the management of arthritis, inactivity continues to be a problem among both younger and older patients with arthritis as compared to the general population. Current evidence supports the effectiveness and safety of moderate- to highintensity aerobic and strengthening exercises for osteoarthritis and stable rheumatoid arthritis. Participation in recreational activities does not replace the need for therapeutic exercises. Physicians and health professionals should be equipped with strategies to overcome barriers and facilitate treatment adherence when prescribing exercise.
Keywords: osteoarthritis, rheumatoid arthritis, physical therapy, exercise, physical activity.

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of Elderly, Toronto, ON.

Diabetes is a common disease in the elderly. While pharmacological management is important, the need for and benefits of non-phamacological therapy should not be underestimated in this population. Such therapy includes nutrition therapy, physical activity, smoking cessation and diabetic education. This article reviews, in detail, current recommendations for nutrition therapy and physical activity in elderly patients with Type 2 diabetes, including specific recommendations for all types of food groups and specific recommendations for pre-exercise evaluation.
Key words: elderly, diabetes mellitus Type 2, nutrition therapy, diet, physical activity, exercise.

Nat Jackson

The benefits of physical activity are well known throughout the health care profession. Exercise has found its way into programs for patients with conditions such as heart disease, and it is becoming part of standard care. Studies have now begun to look at whether or not the success of programs which include exercise can also be realized with cancer patients. This form of care seems to have met with success.^1,2,3,4

It now appears that rehabilitation has been defined as the process by which a person is restored to an optimal physiological, psychological, social and vocational status.² In the case of cancer patients, rehabilitation can be a challenge due to the significant side-effects of cancer treatment: fatigue, weakness, impaired nutritional status, difficulty sleeping and nausea. The patient often sees a decrease in normal physical performance, and the resumption of regular activities after therapy is often delayed. New studies have shown that including exercise within the rehabilitation program reduces the above-mentioned side effects, and even shortens the length of stay in the hospital following treatment.¹ In one study, patients who participated in an exercise program during high-dose chemotherapy were discharged, on average, sooner than patients in a control group.