medicine and health

ScienceDaily (Oct. 22, 2012) — Exercising regularly in old age may better protect against brain shrinkage than engaging in mental or social activities, according to a new study published in the October 23, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology. Research suggests that brain shrinkage may lead to problems with memory and thinking.

"People in their seventies who participated in more physical exercise, including walking several times a week, had less brain shrinkage and other signs of aging in the brain than those who were less physically active," said study author Alan J. Gow, PhD, with the University of Edinburgh in Scotland. "On the other hand, our study showed no real benefit to participating in mentally and socially stimulating activities on brain size, as seen on MRI scans, over the three-year time frame." Researchers looked at medical records of 638 people from Scotland born in 1936. The participants were given MRI scans at 73 years old.

The group gave details about their exercise habits, ranging from moving only in connection with necessary household chores to keeping fit with heavy exercise or participating in competitive sports several times per week. They also reported their participation in social and mentally stimulating activities.

The study found that after three years, people who participated in more physical activity experienced less brain shrinkage than those who exercised minimally.

"Our results show that regularly exercising in old age is potentially important to protecting the brain as we age," said Gow.

The study was supported by Research Into Aging, the Age UK-funded Disconnected Mind Project and the United Kingdom's Medical Research Council.

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The above story is reprinted from materials provided by American Academy of Neurology (AAN).
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Journal Reference:

A. J. Gow, M. E. Bastin, S. Munoz Maniega, M. C. Valdes Hernandez, Z. Morris, C. Murray, N. A. Royle, J. M. Starr, I. J. Deary, J. M. Wardlaw. Neuroprotective lifestyles and the aging brain: Activity, atrophy, and white matter integrity. Neurology, 2012; 79 (17): 1802 DOI: 10.1212/WNL.0b013e3182703fd2

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Exercise and complete decongestive therapy best ways to manage lymphedema, expert says

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ScienceDaily (Oct. 22, 2012) — Nearly 40 percent of breast cancer survivors suffer from lymphedema, a chronic condition that causes body limbs to swell from fluid buildup, as a result of lymph node removal and radiation therapy. A cure for lymphedema does not exist, so individuals with the condition must find ways to manage the symptoms throughout their lifetimes. Now, a team of researchers and clinicians working with a University of Missouri lymphedema expert has found that full-body exercise and complete decongestive therapy (CDT) are the best ways for patients to minimize their symptoms and maintain their quality of life.

"There's a sense of empowerment -- of autonomy -- that comes from meeting the challenge of living with lymphedema," said Jane Armer, an MU nursing professor. "Some breast cancer survivors say that they've become a new person after cancer because they met a challenge, and they like the stronger person they've become. The challenge of lymphedema is similar. It's something that is pervasive in every part of life. It takes problem solving and persistence to manage the condition without letting it interfere with their goals."

Armer and her colleagues reviewed published research about lymphedema self-management in order to determine which practices were most effective in managing the condition. The researchers found that full-body exercise, such as weight lifting and stretching, was likely to be effective in minimizing lymphedema symptoms. In addition, the researchers concluded that complete decongestive therapy (CDT), a comprehensive treatment approach that incorporates skin care, exercise, manual lymphatic drainage and bandaging of swollen limbs, also helps patients effectively manage the condition.

"Previous research suggests that, the earlier the interventions, the better the outcomes," Armer said. "If patients can learn how to successfully manage the condition early on, then they can continue those processes throughout their lives, and their outcomes will be better than those of individuals who resist participating in self-care."

Armer is a professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center. The literature review, "Self-Management of Lymphedema," recently published in Nursing Research, was led by nurse colleagues, Sheila Ridner, professor at Vanderbilt University School of Nursing, and Mei Fu, associate professor at New York University College of Nursing and MU nursing alumna. The review is the fifth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). Another literature review, "A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema From 2004 to 2011," was published by the American Academy of Physical Medicine and Rehabilitation earlier this year. This review was led by expert lymphedema clinicians and educators, Bonnie Lasinski, Long Island, N.Y.; Kathryn Thrift, Dallas; and DeCourcy Squire, Atlanta.

As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006.

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The above story is reprinted from materials provided by University of Missouri-Columbia.
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Journal Reference:

Sheila H. Ridner, Mei R. Fu, Ausanee Wanchai, Bob R. Stewart, Jane M. Armer, Janice N. Cormier. Self-Management of Lymphedema. Nursing Research, 2012; 61 (4): 291 DOI: 10.1097/NNR.0b013e31824f82b2

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Exercise the body to keep the brain healthy, study suggests

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ScienceDaily (Oct. 22, 2012) — People who exercise later in life may better protect their brain from age-related changes than those who do not, a study suggests.

Researchers found that people over 70 who took regular exercise showed less brain shrinkage over a three-year period than those who did little exercise.

Psychologists and Neuroimaging experts, based at the University of Edinburgh, did not find there to be any benefit to brain health for older people from participation in social or mentally stimulating activities.

Greater brain shrinkage is linked to problems with memory and thinking and the researchers say their findings suggest that exercise is potentially one important pathway to maintaining a healthy brain both in terms of size and reducing damage.

The researchers also examined the brain's white matter - the wiring that transmits messages round the brain. They found that people over 70 who were more physically active had fewer 'damaged' areas - visible as abnormal areas on scanning - in the white matter than those who did little exercise.

Additionally, the researchers from the University of Edinburgh found that the over-70s taking regular exercise had more grey matter - the parts of the brain with nerve cell bodies.

The Edinburgh team used MRI scans to measure the volume of brain tissue and the volume and health of the brain's white matter in almost 700 people.

They studied levels of physical activity which ranged from moving only for necessary housework to more strenuous forms of exercise such as keep-fit or taking part in competitive sports.

Scientists also recorded whether or not the participants - all aged over 70 - took part in mentally stimulating activities such reading and participating in social groups.

Dr Alan Gow of the University of Edinburgh's Centre for Cognitive Ageing and Cognitive Epidemiology who led the research, said: "Our results suggest that to maintain brain health, physical activity may be more beneficial than choosing more sedentary activities. We are excited by the next stages of this research as we seek to understand more about what might underlie the effect, but in the meantime, increasing physical activity - even a short walk each day - can only be encouraged."

Professor James Goodwin, Head of Research at Age UK who fund the Disconnected Mind research project, said: "This research is exciting as it provides vital clues as to what impacts the way our brain ages and how we could tackle mental decline. If we can establish definitively that exercise provides protection against mental decline, it could open the door to exercise programmes tailored to the needs of people as they age.

"We already know that exercise is important in reducing our risk of some illnesses that come with ageing, such as cardiovascular disease and cancer. This research reemphasises that it really is never too late to benefit from exercise, so whether it's a brisk walk to the shops, gardening or competing in a fun run it is crucial that, those of us who can, get active as we grow older."

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Exercise May Delay Early Aging of People With Diabetes

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FRIDAY, Oct. 19 (HealthDay News) -- Regular exercise may slow the premature aging of the cardiovascular system that occurs in people with type 2 diabetes, according to new research.

A healthy adult loses about 10 percent of fitness with each decade of life after age 40 or 50, but research shows that fitness levels in people with type 2 diabetes are about 20 percent lower than in healthy adults.

This accelerated loss of fitness increases the risk of early disability and death, said Amy Huebschmann, of the University of Colorado School of Medicine, and colleagues.

"Not only do these patients have more trouble with exercise ... but also with activities of daily living, such as a simple stroll to the corner store," the researchers said in an American Physiological Society news release.

The investigators confirmed other research, however, that has found that regular exercise can slow premature cardiovascular aging in diabetes patients. The findings suggest that their fitness levels can improve by as much as 40 percent after 12 to 20 weeks of exercise training.

"In other words, these defects are not necessarily permanent," Huebschmann said. "They can be improved, which is great news."

Regular exercise, however, does not restore diabetes patients' fitness levels to those of healthy adults, according to the findings. The research was presented last week at an exercise conference in Colorado sponsored by the American Physiological Society, the American College of Sports Medicine and the Canadian Society for Exercise Physiology. Data and conclusions presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal

Although exercise can benefit diabetes patients, it may be difficult for them to achieve the recommended 150 minutes per week of moderate exercise. Huebschmann and her colleagues are working on ways to help diabetes patients reach their exercise goals.

"Type 2 diabetes has a significant negative impact on health, but that impact can be improved with as simple an intervention as regular brisk walking or other physical activity that most people with diabetes can do," Huebschmann said.

More than 8 percent of the U.S. population has diabetes, mostly type 2, according to the U.S. Centers for Disease Control and Prevention. With type 2 diabetes, the body can't properly process glucose, the main type of sugar in the blood.

Sunday, October 21, 2012

Health Tip: Encourage Your Family to Exercise

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(HealthDay News) -- Having the will to exercise can be challenging when you're the only family member who would rather be active than watching TV.

The American Council on Exercise offers these suggestions to spare children from a "couch potato" lifestyle:

Exercise lowers the risks of type 2 diabetes, being overweight, and heart attack and stroke.Exercise improves energy levels, increasing one's desire for activities such as camping, biking and hiking.Exercise helps improve brain health, which leads to better critical thinking, concentration and learning.Exercise fosters a healthier, more positive body image.Exercise promotes a healthier family culture of physical activity.

Friday, October 19, 2012

Efforts to establish exercise as a vital sign prove valid, experts say

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ScienceDaily (Oct. 17, 2012) — Kaiser Permanente has created a new electronic Exercise Vital Sign initiative to systematically record patients' physical activity in their electronic health records. The new feature is successfully compiling accurate and valuable information that can help clinicians better treat and counsel patients about their lifestyles, according to a Kaiser Permanente study published in the journal Medicine & Science in Sports & Exercise.

The study examined the electronic health records of 1,793,385 Kaiser Permanente Southern California patients ages 18 and older from April 2010 to March 2011 and found that 86 percent of all eligible patients had an exercise vital sign in their record. Of those patients who had an exercise record, one-third were meeting national guidelines for physical activity, and two-thirds were not meeting guidelines. Of those not meeting guidelines, one-third were not exercising at all.

"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said study lead author Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and health care utilization, cost and chronic disease that has not been previously available."

Kaiser Permanente is one of the first -- and largest -- health care organizations to implement an Exercise Vital Sign in patient health records. The initiative was launched in the organization's Southern California region in 2009 and has since been implemented in several of Kaiser Permanente's regions. As part of these efforts, patients are asked about their exercise habits during routine outpatient visits and their responses are included in their electronic medical record, along with other traditional vital signs such as blood pressure, pulse and temperature.

The U.S. Department of Health and Human Services recommends that Americans engage in at least 150 minutes per week of moderate-to-vigorous intensity physical activity, such as brisk walking, to receive maximal health benefits. The guidelines state that regular physical activity reduces the risk of many adverse health outcomes.

The Exercise Vital Sign is part of Exercise is Medicine ®, a multi-organizational initiative coordinated by the American College of Sports Medicine and the American Medical Association to encourage primary-care physicians and other health care providers to include exercise when designing treatment plans for patients.

"Given that health care providers have contact with the majority of Americans, they have a unique opportunity to encourage physical activity among their patients through an assessment and brief counseling," said Coleman. "Future studies will examine if adding a physical activity assessment during clinic visits actually leads to higher rates of physician counseling and eventually increases the rates of physical activity in our patients."

Researchers validated the findings of the study by comparing exercise levels reported by the Kaiser Permanente Southern California adult patients with those reported in U.S. population surveys. The researchers also examined the ability of these reports to discriminate between groups of patients with differing demographics and health status. The patient reports of physical activity were lower than national surveys, but followed similar patterns to those reported in the scientific literature: Members who were older, female, obese, belonging to a racial or ethnic minority, or had more chronic health conditions were more likely to be inactive.

This study and the Exercise Vital Sign initiative are parts of ongoing efforts at Kaiser Permanente to conduct research on and highlight the health benefits of physical activity. Kaiser Permanente partners with several other organizations on Every Body Walk!, a public awareness campaign about the health benefits of walking. Kaiser Permanente also works to increase public awareness of the prevalence and effects of obesity in the United States. Earlier this year, Kaiser Permanente partnered with HBO (Home Box Office), the Institute of Medicine, the National Institutes of Health, the Centers for Disease Control and Prevention and the Michael & Susan Dell Foundation to launch one of the most ambitious public education campaigns addressing America's obesity epidemic to date, including the documentary series The Weight of the Nation on HBO.

Kaiser Permanente can conduct transformational health research in part because it has the largest private electronic health system in the world. The organization's integrated model and electronic health record system, Kaiser Permanente HealthConnect®, securely connect 9 million people, 611 medical offices, and 37 hospitals, linking patients with their health care teams, their personal health information, and the latest medical knowledge. It also connects Kaiser Permanente's researcher scientists to one of the most extensive collections of longitudinal and medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.

Funding for this research was provided by the Southern California Permanente Medical Group.

Other authors of the paper include: Eunis Ngor, MS, Kristi Reynolds, PhD, MPH, Virginia P. Quinn, PhD, Corinna Koebnick, PhD, and Deborah Rohm Young, PhD, of the Department of Research & Evaluation, Kaiser Permanente Southern California; Barbara Sternfield, PhD, of the Division of Research, Kaiser Permanente Northern California; and Robert E. Sallis, MD, of the Department of Family Medicine Fontana Medical Center, Kaiser Permanente Southern California.

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Journal Reference:

Coleman, Karen J.; Ngor, Eunis; Reynolds, Kristi; Quinn, Virginia P.; Koebnick, Corinna; Young, Deborah Rohm; Sternfeld, Barbara; Sallis, Robert E. Initial Validation of an Exercise "Vital Sign " in Electronic Medical Records. Medicine & Science in Sports & Exercise, 2012 DOI: 10.1249/MSS.0b013e3182630ec1

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Thursday, October 18, 2012

Diet, Exercise May Boost 'Good' Cholesterol, Study Suggests

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THURSDAY, Oct. 11 (HealthDay News) -- For overweight people with diabetes, intensive exercise and dieting not only aids weight loss, it can also help train their fat cells to produce a hormone believed to boost production of "good" cholesterol, according to a new study.

And this so-called "good" cholesterol, or HDL cholesterol, has been linked to positive effects for cardiovascular health.

The new study, from researchers at The Methodist Hospital in Houston, included data on overweight and obese people with type 2 diabetes who were taking part in a multicenter clinical trial examining how increased physical activity and reduced calorie intake affected their risk for cardiovascular disease.

The participants were randomly assigned to either an intensive diet and exercise program (the "lifestyle intervention" group) or a program that offered only diabetes support and education and no lifestyle changes (the "control" group).

After one year, the lifestyle intervention group had achieved significant improvements in a measure of total fat called "adiposity," fitness, blood sugar levels and fat levels, the investigators found.

In addition, while levels of "bad" LDL cholesterol did not change, levels of the fat hormone adiponectin and HDL cholesterol did increase: Total adiponectin produced by fat cells increased about 12 percent and HDL cholesterol increased nearly 10 percent in the people who made lifestyle changes, compared to those in the control group, the research showed.

It's well established that adiponectin plays a role in fat burning and sugar storage. This study suggests that the hormone also encourages the liver to produce HDL cholesterol, the study authors pointed out in a hospital news release.

"What we're learning is that even overweight people who are physically active and eating a healthy diet are getting benefits from the lifestyle change," principal investigator Dr. Christie Ballantyne, director of the Center for Cardiovascular Disease Prevention, part of the Methodist DeBakey Heart and Vascular Center at The Methodist Hospital in Houston, said in the news release.

"When you exercise and diet, you're improving the function of your adipose tissue, your heart and vascular systems, and even muscle performance. You're getting a lot of benefits that you may not see by just looking at the weight on a scale," he added.

The study was released online in advance of publication in an upcoming print issue of the Journal of Lipid Research.