Strength training improves vascular function in young black men

Dec. 21, 2012 — Six weeks of weight training can significantly improve blood markers of cardiovascular health in young African-American men, researchers report in the Journal of Human Hypertension.

The researchers measured blood markers associated with inflammation, immune response or the remodeling of arteries that normally occur after tissue damage, infection or other types of stress. They found that levels of two of these markers dropped significantly in African-American men but not in Caucasian men after six weeks of resistance training.

"This suggests that resistance exercise training is more beneficial in young African-American men than in Caucasian men of the same age," said Bo Fernhall, the dean of the College of Applied Health Sciences at the University of Illinois at Chicago. Fernhall led the study as a professor in the department of kinesiology and community health at the Urbana-Champaign campus. The 14 African-American and 18 Caucasian study subjects were matched for body mass index, cardiovascular fitness and age. None had previously been trained in endurance or resistance exercise.

African-Americans are known to have higher rates of cardiovascular disease than Caucasians, Fernhall said. In particular, "hypertension, stroke and kidney disease are much, much higher in the African-American population," he said.

Some of these problems start young.

"Higher blood pressures in African-American children have been shown as young as 8 to 10 years of age," Fernhall said. "So there's obviously something going on that predisposes the African-American population to end stage disease, hypertension and stroke and the more debilitating diseases later on in life."

A previous study led by Fernhall and his doctoral student Kevin Heffernan (an author on the new paper as well) found that resistance training reduced levels of C-reactive protein (CRP) in the blood of African-American, but not Caucasian, men. This protein is a reliable marker of systemic inflammation. Levels of CRP rise after injury or infection, and chronically elevated levels are sometimes associated with heart disease and cancer.

The new study looked at other markers that could signal trouble in the arteries: MMPs, which help remodel blood vessels after injury or infection; and 8-isoprostane, a marker of oxidative stress involving chemically charged ions or molecules called reactive oxygen species. Both markers went down in the African-Americans, but not the Caucasians, after resistance training. The researchers were surprised to see that initial levels of MMP-9 were lower in African-Americans before the weight training.

"It may be that MMP-9 has a different effect on the vasculature of African-Americans than it does on Caucasians," said Illinois doctoral student Marc Cook, who conducted the new analysis. "We don't know."

The decrease in MMP-9 was significantly correlated with the increase in muscle strength in the African-American men, Cook said. He sees the reduction in MMP-9s and 8-isoprostane as a positive outcome in the African-American men.

Previous studies showed that "aerobic exercise actually reduces oxidative stress, and reduces iosprostane," Cook said. "But nobody had a clue about resistance training."

Cook said he now knows what to say to African-American men who ask him why they should exercise.

"If you don't like cardiovascular exercise, if you don't like running on a treadmill, if you can't play basketball or you're not good at it, you can lift weights and improve your health, especially when it comes to high blood pressure, which happens to run in our family," he said. "If you just want to lift weights and you do it on a regular basis, you could improve your function."

"The overall goal of our departmental research here at the U. of I. is to explore the use of exercise as adjunct therapy for disease, while providing a public health message and evidence about how exercise is beneficial, even at an early age," said Illinois kinesiology and community health professor Jeffrey Woods, a co-author on the study.

This work was partially funded through the National Institutes of Health and the American Heart Association.

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M D Cook, K S Heffernan, S Ranadive, J A Woods, B Fernhall. Effect of resistance training on biomarkers of vascular function and oxidative stress in young African-American and Caucasian men. Journal of Human Hypertension, 2012; DOI: 10.1038/jhh.2012.48

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Scientific explanation to why people perform better after receiving a compliment

Nov. 9, 2012 — Japanese scientists have found scientific proof that people doing exercises appear to perform better when another person compliments them. The research was carried out by a group lead by National Institute for Physiological Sciences Professor Norihiro Sadato, Graduate University for Advanced Studies graduate student Sho Sugawara, Nagoya Institute of Technology Tenure-Track Associate Professor Satoshi Tanaka, and in collaboration with Research Center for Advanced Science and Technology Associate Professor Katsumi Watanabe.

The team had previously discovered that the same area of the brain, the striatum, is activated when a person is rewarded a compliment or cash. Their latest research could suggest that when the striatum is activated, it seems to encourage the person to perform better during exercises.

Forty-eight adults recruited for the study were asked to learn and perform a specific finger pattern (pushing keys on a keyboard in a particular sequence as fast as possible in 30 seconds). Once participants had learned the finger exercise, they were separated into three groups. One group included an evaluator who would compliment participants individually, another group involved individuals who would watch another participant receive a compliment, and the third group involved individuals who evaluated their own performance on a graph. When the participants were asked to repeat the finger exercise the next day, the group of participants who received direct compliments from an evaluator performed better than participants from the other groups. It indicates that receiving a compliment after exercising stimulates the individual to perform better afterwards.

According to Professor Sadato, "To the brain, receiving a compliment is as much a social reward as being rewarded money. We've been able to find scientific proof that a person performs better when they receive a social reward after completing an exercise.There seems to be scientific validity behind the message 'praise to encourage improvement'. Complimenting someone could become an easy and effective strategy to use in the classroom and during rehabilitation."

This research was funded by the Japanese Ministry of Education, Culture, Sports, Science and Technology's Sciences Research Grant (KAKENHI).

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Sho K. Sugawara, Satoshi Tanaka, Shuntaro Okazaki, Katsumi Watanabe, Norihiro Sadato. Social Rewards Enhance Offline Improvements in Motor Skill. PLoS ONE, 2012; 7 (11): e48174 DOI: 10.1371/journal.pone.0048174

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Obese children more vulnerable to food advertising

Nov. 30, 2012 — Rates of childhood obesity have tripled in the past 30 years, and food marketing has been implicated as one factor contributing to this trend. Every year, companies spend more than $10 billion in the US marketing their food and beverages to children; 98% of the food products advertised to children on television are high in fat, sugar, or sodium. In a new study scheduled for publication in The Journal of Pediatrics, researchers used neuroimaging to study the effects of food logos on obese and healthy weight children.

Amanda S. Bruce, PhD, and colleagues from the University of Missouri-Kansas City and the University of Kansas Medical Center assessed 10 healthy weight and 10 obese children, ages 10-14 years, using both self-reported measures of self-control and functional magnetic resonance imaging, which uses blood flow as a measure of brain activity. Dr. Bruce states, “We were interested in how brain responses to food logos would differ between obese and healthy weight children.” The children were shown 60 food logos and 60 nonfood logos, and functional magnetic resonance imaging scans indicated which sections of the brain reacted to the familiar logos being shown.

Obese children showed greater activation in some reward regions of the brain than healthy weight children when shown the food logos. Healthy weight children showed greater brain activation in regions of the brain associated with self-control, when shown food versus nonfood logos. Overall, healthy weight children self-reported more self-control than the obese children. This adds to the body of research showing that in certain situations, healthy weight individuals experience greater activation of control regions of the brain than obese individuals.

“This study provides preliminary evidence that obese children may be more vulnerable to the effects of food advertising. One of the keys to improving health-related decision-making may be found in the ability to improve self-control,” notes Dr. Bruce. Self-control training may be a beneficial addition to obesity and behavioral health interventions, and may lead to greater success in weight loss.

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Amanda S. Bruce et al. Brain Responses to Food Logos in Obese and Healthy Weight Children. Journal of Pediatrics, 2012 (in press) DOI: 10.1016/j.jpeds.2012.10.003

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Intensive weight-loss intervention linked with increased chance of partial remission from diabetes

Dec. 18, 2012 — Among overweight adults, participation in an intensive lifestyle intervention (that included counseling sessions and targets to reduce caloric intake and increase physical activity) was associated with a greater likelihood of partial remission of type 2 diabetes; however, the absolute remission rates were modest, according to a study in the December 19 issue of JAMA.

"Diabetes traditionally has been considered a progressive, incurable condition wherein the best case scenario after diagnosis is tight metabolic and risk factor management to forestall vascular and neuropathic complications," according to background information in the article. Some bariatric surgery studies have suggested that many diabetes cases among obese patients can be resolved. "Patients diagnosed as having type 2 diabetes frequently ask their physicians whether their condition is reversible, and some physicians may provide hopeful advice that lifestyle change can normalize glucose levels," the authors write. "However, the rate of remission of type 2 diabetes that may be achieved using non-surgical approaches has not been reported."

Edward W. Gregg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to examine the association of an intensive lifestyle intervention with frequency of partial and complete remission of type 2 diabetes. The study consisted of an ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE). The study included 4,503 U.S. adults with body mass index of 25 or higher and type 2 diabetes.

Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n = 2,241); or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n = 2,262). The ILI aimed to reduce total caloric intake to 1,200 to 1,800 calories a day through reductions in total and saturated fat intake and by increasing physical activity levels to a goal of 175 minutes/week. Liquid meal replacements were provided to assist dietary goals.

Participants in the ILI group lost significantly more weight than DSE participants at year 1 (-8.6 percent vs. -0.7 percent) and at year 4 (-4.7 percent vs. -0.8 percent) and had greater increases in fitness at both year 1 (20.6 percent vs. 5.3 percent) and year 4 (4.9 percent vs. -1.5 percent). The researchers found that the prevalence of complete remission (i.e., glucose normalization without medication) was more common in the ILI group than in the DSE group across all years of the study. However, the absolute prevalence was low, ranging from 1.3 percent for ILI vs. 0.1 percent for DSE in year 1; to 0.7 percent for ILI vs. 0.2 percent for DSE in year 4.

Additional analyses indicated that ILI participants were significantly more likely to experience any remission (partial or complete), with a prevalence of 11.5 percent during the first year, decreasing to 7.3 percent during year 4, compared with 2.0 percent in the DSE group at both time points. Rates of any remission were notably higher (15 percent -- 21 percent) among persons with substantial weight loss or fitness change, shorter duration of extant diabetes, or a lower HbA1c level (a measure of blood glucose) at entry and those not using insulin.

"The ILI group was significantly more likely to have continuous, sustained remission, as 9.2 percent experienced at least a 2-year remission (vs. for DSE, 1.7 percent) at some point during follow-up, 6.4 percent had at least a 3-year remission (vs. DSE, 1.3 percent), and 3.5 percent had a continuous 4-year remission (vs. DSE, 0.5 percent). The results from the complete case analyses were similar," the authors write.

"The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented. These analyses of more than 4,500 overweight adults with type 2 diabetes confirm that complete remission associated with an intensive life-style intervention, when defined by glucose normalization without need for drugs, is rare. However, partial remission, defined as a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes."

Editorial: A Look Ahead at the Future of Diabetes Prevention and Treatment

David E. Arterburn, M.D., M.P.H., of the Group Health Research Institute, Seattle, and Patrick J. O'Connor, M.D., M.A., M.P.H., of the HealthPartners Institute for Education and Research, Minneapolis, write in an accompanying editorial that "evidence-based and cost-effective diabetes prevention strategies should be more broadly applied using the full range of available technologies and incentives."

"But that is not enough. Research, education, and policy efforts need to be focused further upstream, toward primary prevention: reducing incident obesity in children, adolescents, and adults, especially among those with a family history of obesity or diabetes. Prevention of diabetes and obesity should be a rallying cry for all clinicians who care about the health of the nation."

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Journal References:

Gregg EW, Chen H, Wagenknecht LE, et al. Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes. JAMA., 2012; 308 (23): 2489-2496 DOI: 10.1001/jama.2012.67929Arterburn DE, O’Connor PJ. A Look Ahead at the Future of Diabetes Prevention and Treatment. JAMA., 2012; 308 (23): 2517-2518 DOI: 10.1001/jama.2012.144749

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Five reasons why New Year's resolutions to diet and exercise might be unhealthy

Dec. 19, 2012 — Year after year, one of the most popular New Year's resolutions is to eat healthy and lose weight. But as resolutions and health regimens are about to be in full swing, many might find that instead of feeling good they are feeling worse. And the reason might be due to the one thing that should be helping: exercise.

"Not only can new workout routines be difficult for those with asthma, but several allergens can be found lurking in health clubs making this healthy activity bothersome for the more than 40 million Americans that suffer from allergies," said allergist Richard Weber, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI). "By understanding what triggers symptoms, those with allergies and asthma will be able to feel good and remain active."

To help those with New Year's resolutions succeed, ACAAI has identified the five most common allergy and asthma exercise ailments, with tips on how to overcome them.

• Over Stepping your Boundaries - If you're experiencing shortness of breath, wheezing, coughing, chest tightness and unusual fatigue you might have exercise-induced bronchoconstriction (EIB). The condition affects about 10 percent of Americans. Find relief by using your allergist prescribed inhaler before you begin your workout routine. Breathing through your nose, rather than your mouth, can also help.

• Think Before you Eat - Whether you've signed up for a dieting meal plan or are opting for foods with less calories, be sure to always read nutrition labels before you consume new items. Many products contain hidden food allergens, such as milk, wheat and egg. Energy bars can also be loaded with allergens, including soy and nuts, that affect certain people.

• Choose Equipment Wisely - While most exercise machines won't cause you to sneeze or wheeze, rubber mats, medicine balls and some rubber coated free weights might. Latex can often be found in these items, causing those with latex allergies to develop a rash or hives. Also beware of disinfectant wipes and sprays used to clean gym equipment. They can contain volatile organic compounds (VOCs) which can spur an asthma attack or cause skin irritation.

• Explore the Great Indoors - If you're allergic to pollen, grass and other environmental factors, hit the ground running indoors. Not a fan of treadmills and indoor tracks? Take your allergy medication and avoid running outdoors during mid-day and afternoon hours when pollen counts may be highest. Be sure to change your clothes and shower immediately after finishing your workout to remove any particles that might have fallen onto your clothes and hair.

• Opt for Comfort over Fashion - If your workout leaves you itchy and you've ruled out other gym culprits, your clothing might be the setback. Synthetic materials used in everything from shirts to socks could be irritating your skin. ACAAI recommends checking clothing labels and opting for Lycra (spandex) which is higher quality and less likely to irritate your skin. Garments made of natural products can also help. If you have a latex allergy, be wary of athletic shoes and elastic waistbands.

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Mobile app boosts weight loss by 15 pounds

Dec. 10, 2012 — Using a mobile app that tracks eating and activity helped people lose an average of 15 pounds and keep it off for at least a year, according to a new Northwestern Medicine study.

But the technology only aided weight loss when its users also attended regular classes about nutrition and exercise. The app alone didn't help.

"The app is important because it helps people regulate their behavior, which is really hard to do," said Bonnie Spring, lead investigator of the study and a professor of preventive medicine at Northwestern University Feinberg School of Medicine. "Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment."

"The 'widget' is critical but it is not magical by itself," Spring added. "People need all the tools at their disposal."

The study will be published Dec. 10 in Archives of Internal Medicine.

This is the first study to show that technology added to an existing program of weight loss classes can produce sustained weight loss. Spring believes the weight loss app is the first proven to be effective in a published randomized clinical trial. Commercially available apps are not usually evidence based or tested for effectiveness in rigorously designed research, she noted.

In addition, the Northwestern technology is based on validated behavior change techniques including self-monitoring, goal setting, feedback and social support.

The study included 69 overweight and obese adults who were an average age of 58 and primarily men. All participants were offered health education classes on nutrition, exercise and behavior change twice monthly during the first six months and once monthly for the remainder of the year.

Each participant received weekly calorie goals based on his current weight and weekly activity goals based on his current level of activity. Participants receiving treatment as usual recorded their eating and activity on paper. Those in the experimental treatment used the mobile device to transmit their data to a behavioral coach, who monitored their information and provided scheduled telephone coaching for 10 to 15 minutes about twice monthly.

People who used the mobile phone technology and attended 80 percent of the health education sessions lost 15 pounds and maintained the loss for one year. The average weight loss for the mobile phone group -- including those who did not attend the education sessions -- was 8.6 pounds. The control group -- which received the education sessions but no mobile app -- did not lose weight.

The time people spent interacting with the remote coaches was minimal.

"The coaches' most important role was being in the wings," Spring said. "The patients know the coaches are hovering and supportively holding them accountable. They know somebody is watching and caring and that's what makes a difference."

The participants, who were older, did not have prior experience with mobile phone technology and easily mastered the technology. "Some people think older people won't use technology interventions, but that isn't so," Spring said.

One big challenge in treating obesity is the need to provide intensive behavioral treatment in a health care system where physicians don't have the time and training to do it.

"This approach empowers patients to help themselves on a day-to-day basis," Spring said. "We can help people lose meaningful amounts of weight and keep it off. To do that we need to engage them in tracking their own eating and activity, learn how that governs weight, and take advantage of social support."

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Journal Reference:

Bonnie Spring et al. Integrating Technology Into Standard Weight Loss TreatmentA Randomized Controlled Trial. Archives of Internal Medicine, 2012 DOI: 10.1001/jamainternmed.2013.1221

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Olympians live longer than general population ... But cyclists no survival advantage over golfers

Dec. 13, 2012 — Olympic medallists live longer than the general population, regardless of country of origin, medal won, or type of sport played, finds a study in the Christmas issue published on bmj.com today.

A second study comparing athletes who trained at different physical intensities, found that those from high or moderate intensity sports have no added survival benefit over athletes from low intensity sports. But those who engage in disciplines with high levels of physical contact, such as boxing, rugby and ice hockey, are at an increased risk of death in later life, the data show.

An accompanying editorial adds that everyone could enjoy the "survival advantage" of elite athletes by just meeting physical activity guidelines.

In the first study, researchers compared life expectancy among 15,174 Olympic athletes who won medals between 1896 and 2010 with general population groups matched by country, sex, and age.

All medallists lived an average of 2.8 years longer -- a significant survival advantage over the general population in eight out of the nine country groups studied.

Gold, silver and bronze medallists enjoyed roughly the same survival advantage, as did medallists in both endurance and mixed sports. Medallists in power sports had a smaller, but still significant, advantage over the general population.

The authors say that, although their study was not designed to determine why Olympic athletes live longer, "possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come from international sporting glory."

In the second study, researchers measured the effect of high intensity exercise on mortality later in life among former Olympic athletes.

They tracked 9,889 athletes with a known age at death, who took part in at least one Olympic Games between 1896 and 1936. Together they represented 43 disciplines requiring different levels of exercise intensity and physical contact.

After adjusting for sex, year of birth and nationality, they found that athletes from sports with high cardiovascular intensity (such as cycling and rowing) or moderate cardiovascular intensity (such as gymnastics and tennis) had similar mortality rates compared with athletes from low cardiovascular intensity sports, such as golf or cricket.

However, the researchers did find an 11% increased risk of mortality among athletes from disciplines with a high risk of body collision and with high levels of physical contact, such as boxing, rugby and ice hockey, compared with other athletes. They suggest this reflects the impact of repeated collisions and injuries over time.

In an accompanying editorial, two public health experts point out that people who do at least 150 minutes a week of moderate to vigorous intensity physical activity also have a survival advantage compared with the inactive general population. Estimates range from just under a year to several years.

But they argue that, compared with the successes that have been achieved in tobacco control, "our inability to improve physical activity is a public health failure, and it is not yet taken seriously enough by many in government and in the medical establishment."

"Although the evidence points to a small survival effect of being an Olympian, careful reflection suggests that similar health benefits and longevity could be achieved by all of us through regular physical activity. We could and should all award ourselves that personal gold medal," they conclude.

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The above story is reprinted from materials provided by BMJ-British Medical Journal.

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Journal References:

P. M. Clarke, S. J. Walter, A. Hayen, W. J. Mallon, J. Heijmans, D. M. Studdert. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. BMJ, 2012; 345 (dec13 8): e8308 DOI: 10.1136/bmj.e8308R. Zwiers, F. W. A. Zantvoord, F. M. Engelaer, D. van Bodegom, F. J. G. van der Ouderaa, R. G. J. Westendorp. Mortality in former Olympic athletes: retrospective cohort analysis. BMJ, 2012; 345 (dec13 8): e7456 DOI: 10.1136/bmj.e7456A. E. Bauman, S. N. Blair. Everyone could enjoy the 'survival advantage' of elite athletes. BMJ, 2012; 345 (dec13 8): e8338 DOI: 10.1136/bmj.e8338

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Daily steps add up for midlife women's health

Nov. 21, 2012 — Moving 6,000 or more steps a day -- no matter how -- adds up to a healthier life for midlife women. That level of physical activity decreases the risk of diabetes and metabolic syndrome (a diabetes precursor and a risk for cardiovascular disease), showed a study published online this month in Menopause, the journal of the North American Menopause Society.

Although other studies have shown the value of structured exercise in lowering health risks such as diabetes, high blood pressure, and heart disease, this study has shown that habitual physical activity -- whether it comes from exercising or just activities of daily living -- has the power to improve women's health.

In Passo Fundo, Brazil, 292 women who were 45 to 72 years old wore pedometers and recorded their daily steps. They also had health checks such as cholesterol and blood sugar and waist and hip measurement (to gauge abdominal obesity, which is a risk for diabetes and cardiovascular disease). Women who took 6,000 or more steps per day were considered active and those who took fewer inactive.

The active women were much less likely than the inactive ones to be obese and have metabolic syndrome or frank diabetes, whether or not they had gone through menopause-when these risks usually go up-and whether or not they were using hormone therapy.

For midlife women, it looks like the journey to health begins with 6,000 steps.

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The above story is reprinted from materials provided by The North American Menopause Society (NAMS), via EurekAlert!, a service of AAAS.

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Veronica Colpani, Karen Oppermann and Poli Mara Spritzer. Association between habitual physical activity and lower cardiovascular risk in premenopausal, perimenopausal, and postmenopausal women: a population-based study. Menopause, 2012

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Exercise can extend your life by as much as five years

Dec. 11, 2012 — Adults who include at least 150 minutes of physical activity in their routines each week live longer than those who don't, finds a new study in the American Journal of Preventive Medicine. Promoting the years of life that can be gained from moderate activity may be a better motivator to get Americans moving, said study author Ian Janssen, Ph.D., of Queen's University in Ontario, Canada.

Janssen and his team used data from the National Health and Nutrition Examination Survey, the National Health Interview Study mortality linkage, and U.S. Life Tables to estimate and compare the life expectancy at each age for adults who were inactive, somewhat-active and active. "Active" was defined as doing at least 150 minutes of moderate activity per week.

They found that men at age 20 were estimated to gain as much as 2.4 years of life from moderate activity. Women at age 20 gained about 3 additional years from engaging in moderate activity. The biggest benefit from physical activity was seen in non-Hispanic black women, who gained as many as 5.5 potential years of life.

Janssen hopes the positive message of the study can help health officials better relay the importance of exercise to the public.

"Research has shown that the health messages that have the greatest effect on changing people's behaviors need to be easy to understand, specific to the individual, and be phrased in a gained-framed and positive manner," he explained.

"The messages on longevity gains associated with physical activity that were developed in this paper meet all three of those characteristics," Janssen added. "That is, people will understand what it means if you tell them they will live 2½ years longer if they become active."

Sara Bleich, Ph.D., assistant professor of Health Policy at the Johns Hopkins Bloomberg School of Public Health, said presenting the issue as "years of life gained" versus "years of life loss" raises the classic issue of the carrot or the stick, that is, when it comes to behavior change, do people prefer to be rewarded or penalized?

"For healthy behavior changes such as dieting or smoking, rewards have been shown to effectively motivate behavior change," she continued. "From the current research, it is unclear whether rewards or penalties are more effective at motivating behavior change, but it is clear that rewards do work."

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Journal Reference:

Ian Janssen, Valerie Carson, I-Min Lee, Peter T. Katzmarzyk, Steven N. Blair. Years of life gained due to leisure-time physical activity in the U.S.. American Journal of Preventive Medicine, 2013 DOI: 10.1016/j.amepre.2012.09.056

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Aerobic exercise boosts brain power, review finds

Dec. 13, 2012 — The physical benefits of regular exercise and remaining physically active, especially as we age, are well documented. However, it appears that it is not only the body which benefits from exercise, but the mind too. The evidence for this is published in a new review by Hayley Guiney and Liana Machado from the University of Otago, New Zealand, which focuses on the importance of physical activity in keeping and potentially improving cognitive function throughout life. Their review is published online in the Springer publication Psychonomic Bulletin & Review.

A certain amount of mental deterioration is expected with advancing age. However, this may not necessarily have to be the case as particular aspects of cognitive function such as task switching, selective attention and working memory among others, all appear to benefit from aerobic exercise. Studies in older adults reviewed by the authors consistently found that fitter individuals scored better in mental tests than their unfit peers. In addition, intervention studies found scores in mental tests improved in participants who were assigned to an aerobic exercise regimen compared to those assigned to stretch and tone classes.

Interestingly, these results were not replicated in children or young adults. The one area where physical fitness or regular exercise was found to have an effect on cognitive function in these age groups was for memory tasks. Both the updating of working memory and the volume of information which could be held was better in fitter individuals or those put on an aerobic exercise regime. The authors comment that despite physical fitness not affecting all areas of cognitive function in younger people, evidence is mounting that just because they are in their prime developmentally does not mean that they cannot benefit from regular exercise.

In older generations, the evidence for improvement in cognitive function is insurmountable. The types of tests of cognitive function reviewed here are important in showing that exercise may attenuate age-related decline for specific tasks. For example, it has been found to positively affect mental tasks relating to activities such as driving, an activity where age is often seen as a limiting factor.

The authors conclude that engagement in exercise can provide a simple means for people to optimize their cognitive function. They add that more research into the effects of exercise on young adults and children is required. However, they say that "the indications reported thus far -- that regular exercise can benefit brains even when they are in their prime developmentally -- warrant more rigorous investigation, particularly in the context of society becoming increasingly sedentary."

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Hayley Guiney, Liana Machado. Benefits of regular aerobic exercise for executive functioning in healthy populations. Psychonomic Bulletin & Review, 2012; DOI: 10.3758/s13423-012-0345-4

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Aerobic exercise trumps resistance training for weight and fat loss

Dec. 15, 2012 — Aerobic training is the best mode of exercise for burning fat, according to Duke researchers who compared aerobic training, resistance training, and a combination of the two.

The study, which appears Dec. 15, 2012, in the Journal of Applied Physiology, is the largest randomized trial to analyze changes in body composition from the three modes of exercise in overweight or obese adults without diabetes.

Aerobic exercise -- including walking, running, and swimming -- has been proven to be an effective way to lose weight. However, recent guidelines have suggested that resistance training, which includes weight lifting to build and maintain muscle mass, may also help with weight loss by increasing a person's resting metabolic rate. Research has demonstrated health benefits for resistance training, such as improving glucose control, but studies on the effects of resistance training on fat mass have been inconclusive.

"Given that approximately two-thirds of adults in the United States are overweight due to excess body fat, we want to offer clear, evidence-based exercise recommendations that will truly help people lose weight and body fat," said Leslie H. Willis, MS, an exercise physiologist at Duke Medicine and the study's lead author.

Researchers enrolled 234 overweight or obese adults in the study. Participants were randomly assigned to one of three exercise training groups: resistance training (three days per week of weight lifting, three sets per day, 8-12 repetitions per set), aerobic training (approximately 12 miles per week), or aerobic plus resistance training (three days a week, three set per day, 8-12 repetitions per set for resistance training, plus approximately 12 miles per week of aerobic exercise).

The exercise sessions were supervised in order to accurately measure adherence among participants. Data from 119 people who completed the study and had complete body composition data were analyzed to determine the effectiveness of each exercise regimen.

The groups assigned to aerobic training and aerobic plus resistance training lost more weight than those who did just resistance training. The resistance training group actually gained weight due to an increase in lean body mass.

Aerobic exercise was also a more efficient method of exercise for losing body fat. The aerobic exercise group spent an average of 133 minutes a week training and lost weight, while the resistance training group spent approximately 180 minutes exercising a week without shedding pounds.

The combination exercise group, while requiring double the time commitment, provided a mixed result. The regimen helped participants lose weight and fat mass, but did not significantly reduce body mass nor fat mass over aerobic training alone. This group did notice the largest decrease in waist circumference, which may be attributed to the amount of time participants spent exercising.

Resting metabolic rate, which determines how many calories are burned while at rest, was not directly measured in this study. While theories suggest that resistance training can improve resting metabolic rates and therefore aid in weight loss, in this study, resistance training did not significantly decrease fat mass nor body weight irrespective of any change in resting metabolic rate that might have occurred.

"No one type of exercise will be best for every health benefit," Willis added. "However, it might be time to reconsider the conventional wisdom that resistance training alone can induce changes in body mass or fat mass due to an increase in metabolism, as our study found no change."

Duke researchers added that exercise recommendations are age-specific. For older adults experiencing muscle atrophy, studies have found resistance training to be beneficial. However, younger, healthy adults or those looking to lose weight would see better results doing aerobic training.

"Balancing time commitments against health benefits, our study suggests that aerobic exercise is the best option for reducing fat mass and body mass," said Cris A. Slentz, PhD, a Duke exercise physiologist and study co-author. "It's not that resistance training isn't good for you; it's just not very good at burning fat."

In addition to Willis and Slentz, Duke study authors include Lori A. Bateman, Lucy W. Piner, Connie W. Bales, and William E. Kraus. East Carolina University study authors include A. Tamlyn Shields and Joseph A. Houmard.

The study was funded with a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health (2R01-HL057354).

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L. H. Willis, C. A. Slentz, L. A. Bateman, A. T. Shields, L. W. Piner, C. W. Bales, J. A. Houmard, W. E. Kraus. Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. Journal of Applied Physiology, 2012; 113 (12): 1831 DOI: 10.1152/japplphysiol.01370.2011

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Hair practices may be barrier to physical activity for some African-American women

Dec. 17, 2012 — A study that surveyed 103 African-American women suggests that nearly 40 percent of the women reported avoiding exercise at times because of their hair, according to a report published Online First by Archives of Dermatology, a JAMA Network publication.

Regular physical activity (PA) is associated with a decreased risk for obesity, but African-American women have been among the least likely to meet some of the targeted PA goals. Sufficient physical activity has been defined as moderate-intensity aerobic PA for at least 150 minutes per week or vigorous-intensity aerobic PA for at least 75 minutes per week. Hair care and hairstyle maintenance can be costly for African-American women and because of the relative infrequency of hair washing needed to maintain many common hairstyles they may opt to avoid exercise and the associated sweating, according to the study background.

Rebecca R. Hall, M.D., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues surveyed African-American women about their hair care practices and PA to characterize the relationship of hairstyle maintenance with exercise. The average age of the 103 women surveyed was about 42 years.

"Hair maintenance in African-American women in this study limited their participation in PA with more than half of the women exercising less than 75 minutes/week and 26.2 percent reporting 0 minutes of exercise per week," the authors note.

Most of the women (62.1 percent) wore their hair in a relaxed (chemically straightened) style and most of the women washed their hair every one to two weeks (81.6 percent).

Hair concerns caused 35.9 percent of the women surveyed to avoid swimming and water activities, while 29.1 percent avoided aerobic and gym activities. Women with normal scalps (not dry or oily) were significantly more like to participate in aerobic/gym activities than those with scalp complaints. Women who exercised less because of hair concerns were 2.9 times less likely to exercise more than 150 minutes per week, according to study results.

"Effective strategies to promote PA in African-American women, known to disproportionately have obesity and associated sedentary diseases, must include addressing dermatologic barriers to PA with strategies that address hairstyle maintenance. The high percentage of African-American women with baseline scalp complaints suggests that dermatologists need to consider these symptoms when providing care for African-American women," the authors conclude.

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Rebecca R. Hall. Hair Care Practices as a Barrier to Physical Activity in African American WomenHair Practices and PA in African American Women. Archives of Dermatology, 2012; DOI: 10.1001/jamadermatol.2013.1946

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Kids need at least seven minutes a day of 'vigorous' physical activity, but most aren't getting that

Nov. 9, 2012 — Children need a minimum of seven minutes a day of vigorous physical activity, demonstrates recently published findings by University of Alberta medical researchers and their colleagues across Canada.

"If you watch late-night television, or look in the backs of magazines, you'll see magical ads saying you need just 10 minutes a day or five minutes a day of exercise to stay fit. And for those of us in the medical field, we just rolled our eyes at that. But surprisingly, they may actually be right and that's what this research shows," says co-principal investigator Richard Lewanczuk, a researcher with the Faculty of Medicine & Dentistry at the U of A.

"Our research showed children don't need a lot of intense physical activity to get the health benefits of exercise -- seven minutes or more of vigorous physical activity was all that was required. But the seven minutes had to be intense to prevent weight gain, obesity and its adverse health consequences. And most kids weren't getting that."

Lewanczuk worked on this study with Jonathan McGavock, his co-principal investigator, and former post-doctoral fellow, who now works with the Manitoba Institute of Child Health. They collaborated with Black Gold Regional Schools in Leduc and surrounding communities just south of Edmonton, as well as researchers from the University of Manitoba, Queen's University, the University of Newcastle, and U of A researchers from the Faculty of Medicine & Dentistry, the School of Public Health, Physical Education and Recreation, and Agricultural, Life and Environmental Sciences. The team's findings were recently published in the peer-reviewed journal Archives of Pediatrics & Adolescent Medicine.

More than 600 children, between the ages of nine to 17 from Leduc and surrounding areas, wore monitors that tracked their physical activity levels for seven days. These children also had their weight, waist circumference and blood pressure regularly monitored.

Researchers reviewed the data collected through the Healthy Hearts program via Black Gold Regional Schools and determined the children spent almost 70 per cent of their time doing sedentary activities; nearly 23 per cent was devoted to light physical activity; almost seven per cent to moderate physical activity and 0.6 per cent to vigorous physical activity.

Overall, boys were less sedentary than girls. And the more vigorous the physical activity, the less apt the children were to be overweight. Children who were overweight had improved fitness levels and shrinking waist lines when they increased the amount of time spent doing vigorous activities.

Lewanczuk said the team made some other notable findings including the following: there weren't the expected health benefits from doing only mild or moderate activity even if the time spent doing this type of activity increased. What seemed to be critical was taking part in intense physical activity. For kids who took part in vigorous physical activity that lasted longer than seven minutes, their health benefits were significantly better. And the whole notion of being overweight but fit? The team's data didn't support that finding in children. If children were overweight, they were also unhealthy, Lewanczuk says.

"This research tells us that a brisk walk isn't good enough," says Lewanczuk, a professor in the Department of Medicine who has been studying this topic for eight years. "Kids have to get out and do a high-intensity activity in addition to maintaining a background of mild to moderate activity. There's a strong correlation between obesity, fitness and activity. Activity and fitness is linked to a reduction in obesity and good health outcomes."

Getting young children to make vigorous physical activity part of their daily routines is important, especially considering activity levels in the teenage years drop right off, Lewanczuk says. And previously published research from the same group of children shows kids are more active at school than they are at home.

"Quite often the activity levels on evenings or weekends would be almost flat," he says. "We made the presumption that kids were just sitting in front of a screen the whole time."

Lewanczuk hopes the research findings will help schools decide what type of mandatory physical activity is needed.

He praised the school district involved in the study, noting the research wouldn't have been possible without its support.

Paul Wozny with Black Gold Regional Schools said physical activity is always worthwhile and noted that increased moderate to intense activity was closely associated with lower weights from year to year. He said the Healthy Hearts project has truly created "a school and community culture where regular physical activity and healthy nutrition are seen as essential ingredients for students' health, wellness and life-long learning. Everyone is involved -- students, their parents, teachers, staff, researchers and the community as a whole.

"We are always striving to improve, so we regularly review the research results to help us fine tune and develop future activity and wellness programming at all of our school communities. Black Gold Regional Schools' Health Hearts project has received both national and international recognition as a world-leading school and community initiative dedicated to the improvement of student cardiovascular health through regular physical activity and multi-stakeholder support."

The primary funders of the research were: the Canadian Diabetes Association and the Alberta Centre for Child, Family and Community Research.

"The Canadian Diabetes Association is proud to be a leading supporter of diabetes research in Canada, investing more than $7 million annually in diabetes research," said Janet Hux, chief scientific advisor for the Canadian Diabetes Association. "The Association encourages Canadians to pursue healthy lifestyles in order to prevent and manage diabetes. Dr. Lewanczuk's work provides important new insights that may make enhanced activity more feasible for children and youth."

The Alberta Centre for Child, Family and Community Research added: "Having this kind of evidence should make it easier for parents, schools and daycare programs to do activities with children that will help develop lifelong healthy attitudes towards exercise and activity," stated Alberta Centre for Child, Family and Community Research President and CEO, Robyn Blackadar.

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Jacqueline Hay. Physical Activity Intensity and Cardiometabolic Risk in YouthPA Intensity and Cardiometabolic Risk in Youth. Archives of Pediatrics & Adolescent Medicine, 2012; : 1 DOI: 10.1001/archpediatrics.2012.1028

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Leisure-time physical activity extends life expectancy as much as 4.5 years

Nov. 6, 2012 — Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to a study by a team of researchers led by the National Cancer Institute (NCI), part of the National Institutes of Health. The study, which found that people who engaged in leisure-time physical activity had life expectancy gains of as much as 4.5 years, appeared Nov. 6, 2012, in PLoS Medicine.

In order to determine the number of years of life gained from leisure-time physical activity in adulthood, which translates directly to an increase in life expectancy, researchers examined data on more than 650,000 adults. These people, mostly age 40 and older, took part in one of six population-based studies that were designed to evaluate various aspects of cancer risk.

The U.S. Department of Health and Human Services, the parent agency of NIH, recommends that adults ages 18 to 64 engage in regular aerobic physical activity for 2.5 hours at moderate intensity -- or 1.25 hours at vigorous intensity -- each week. Moderate activities are those during which a person could talk but not sing. Vigorous activities are those during which a person could say only a few words without stopping for breath.

After accounting for other factors that could affect life expectancy, the researchers found that life expectancy was 3.4 years longer for people who reported they got the recommend level of physical activity. People who reported leisure-time physical activity at twice the recommended level gained 4.2 years of life. In general, more physical activity corresponded to longer life expectancy.

The researchers even saw benefit at low levels of activity. For example, people who said they got half of the recommended amount of physical activity still added 1.8 years to their life.

"Our findings highlight the important contribution that leisure-time physical activity in adulthood can make to longevity," said study author Steven Moore, Ph.D., of NCI's Division of Cancer Epidemiology and Genetics, and lead author of the study. "Regular exercise extended the lives in every group that we examined in our study -- normal weight, overweight, or obese."

The researchers found that the association between physical activity and life expectancy was similar between men and women, and blacks gained more years of life expectancy than whites. The relationship between life expectancy and physical activity was stronger among those with a history of cancer or heart disease than among people with no history of cancer or heart disease.

The researchers also examined how life expectancy changed with the combination of both activity and obesity. Obesity was associated with a shorter life expectancy, but physical activity helped to mitigate some of the harm. People who were obese and inactive had a life expectancy that was between five to seven years shorter (depending on their level of obesity) than people who were normal weight and moderately active.

Physical activity has been shown to help maintain a healthy body weight, maintain healthy bones, muscles and joints, promote psychological well-being, and reduce the risk of certain diseases, including some cancers.

"We must not underestimate how important physical activity is for health -- even modest amounts can add years to our life," said I-Min Lee, M.D., Sc.D. , professor of Medicine, Harvard Medical School, Cambridge, Mass., and senior author on the study.

This work was supported by NCI's Division of Cancer Epidemiology and Genetics under intramural project number ZIACP010196 and by NCI's Division of Cancer Control and Population Sciences under grants CA105069 and CA047988. Additional support was received from two other parts of the NIH, the National Institute on Aging (AG18033), and the National Heart, Lung, Blood Institute (HL043851 and HL080467).

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Steven C. Moore, Alpa V. Patel, Charles E. Matthews, Amy Berrington de Gonzalez, Yikyung Park, Hormuzd A. Katki, Martha S. Linet, Elisabete Weiderpass, Kala Visvanathan, Kathy J. Helzlsouer, Michael Thun, Susan M. Gapstur, Patricia Hartge, I-Min Lee. Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. PLoS Medicine, 2012; 9 (11): e1001335 DOI: 10.1371/journal.pmed.1001335

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Why are kids in asthma hotspots in NYC more likely to visit the ER? Exercise may be a factor

Dec. 17, 2012 — Asthmatic children in New York City neighborhoods with high rates of asthma make many more visits to the emergency room (ER) than those who live in other parts of the city. While socioeconomic factors such as lack of adequate preventive care are part of the equation (high-asthma neighborhoods tend to be lower income), new research points to a possible biological basis for the disparity. Asthmatic children living in asthma hotspots were twice as likely to experience a common symptom known as exercise-induced wheeze than were those in neighborhoods with lower asthma rates.

Results by researchers at Columbia University Medical Center and Dartmouth-Hitchcock Medical Center appear online in Pediatrics, the journal of the American Academy of Pediatrics.

The study enrolled 195 middle-income children with asthma, ages 7 and 8, living throughout New York City -- in areas with varying asthma prevalence. The children were given a clinical evaluation, and their caregivers completed a health survey that included whether they had experienced exercise-induced wheeze one or more times in the past year.

Overall, 43% of the children had experienced exercise-induced wheeze. Those living in asthma hotspots were twice as likely to have experienced symptoms after exercise and more likely to have visited their doctor in a hurry or an ER because of breathing problems, even after adjusting for neighborhood, income, and other factors.

"Exercise-induced wheeze is very uncomfortable for children. It can present rapidly after beginning any strenuous activity and lead quickly to respiratory symptoms, so it is not surprising that it is a factor in ER visits," said lead author Timothy Mainardi, MD, past fellow at Columbia University Medical Center and currently in practice at Hudson Allergy.

Dr. Mainardi and his colleagues found that one-third of the children experiencing exercise-induced wheeze had not used an inhaler prior to exercising. "The good news," he said, "is that these symptoms are preventable. Parents should talk with their doctor so they can be ready with a plan, including the use of appropriate medication such as a bronchodilator inhaler prior to exercise."

Addressing neighborhood disparities in asthma-related ER visits has been a public health priority for many years. A 2002 report by the New York City Department of Health and Mental Hygiene found that ER visits for asthma were up to 20 times more common in low-income neighborhoods than elsewhere. Since then, asthma-related ER visits have declined, although a gap between higher and lower income neighborhoods remains.

To help explain these differences, the Columbia researchers first looked to see if asthma was more severe in low-income, high-asthma neighborhoods. It was not. "Lung function, airway inflammation, allergy to common asthma triggers, and symptom frequency were similar no matter where the child lived," said senior author Matthew Perzanowski, PhD, associate professor of environmental health sciences at Columbia's Mailman School of Public Health. By process of elimination, the researchers focused on one particular manifestation of the disease: rapid airway constriction brought on by exercise.

Exactly why asthma hotspots have higher rates of this symptom remains a mystery. While inadequate use of a bronchodilator inhaler prior to exercise was part of the story, it didn't fully explain the findings. Allergens and air pollution related to fossil fuel burning were not found to be factors. Neither were differences in physical activity, obesity, or neighborhood conditions such as the number of parks.

"Exercise-induced symptoms," said Dr. Perzanowski, "may identify a distinct population of asthmatics with causes for their exacerbations yet to be determined. The important lesson is that with greater awareness and treatment, we can hope to prevent those unscheduled visits to the doctor and trips to the ER."

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Timothy R. Mainardi, Robert B. Mellins, Rachel L. Miller, Luis M. Acosta, Alexandra Cornell, Lori Hoepner, James W. Quinn, Beizhan Yan, Steven N. Chillrud, Omar E. Olmedo, Frederica P. Perera, Inge F. Goldstein, Andrew G. Rundle, Judith S. Jacobson, and Matthew S. Perzanowski. Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence. Pediatrics, December 17, 2012 DOI: 10.1542/peds.2012-1072

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Novel role for protein linked to obesity and development of type 2 diabetes identified

Dec. 17, 2012 — Researchers at UT Southwestern Medical Center have taken another step toward better understanding the metabolic functions of obesity and its connection to type 2 diabetes.

Dr. Philipp Scherer, Director of the Touchstone Center for Diabetes Research at UT Southwestern, led a group of researchers in a recent multicenter study published in Nature Medicine that successfully identified ways to manipulate the protein mitoNEET. This is the first time the protein has been effectively altered to expand fat tissue in a way that allows subjects -- in this case, mice -- to remain metabolically healthy.

MitoNEET is a key component of a cell's mitochondrion, which serves as the cell's energy powerhouse. When the levels of MitoNEET protein were elevated inside the fat cells of rodents, more fat was stored in the adipose tissue, thereby keeping toxic lipids away from other types of cells. This sequestration resulted in extremely obese yet metabolically healthy mice that displayed no signs of type 2 diabetes. In contrast, when MitoNEET levels were decreased, the mice became lean but unhealthy, and developed pre-diabetic conditions such as failure to metabolize glucose properly.

"The manipulation of mitochondrial activity in fat tissue is a very powerful approach to control how much excess energy we store in our bodies and where we store it. We have heretofore underestimated the importance of mitochondrial pathways in our fat cells and their influence on how we manage our weight," said Dr. Scherer, senior author of the three-year study and Professor of Internal Medicine and Cell Biology at UTSW.

The body stores fat in the white adipose tissue, and, ideally, individuals burn any excess calories through exercise and a healthy diet. The current research findings suggest that manipulating components of mitochondria in fat cells can be an effective way to funnel excess calories into "good" locations. This storage then thwarts their negative effect on other internal organs like the liver in which excess fat accumulation is toxic.

The obese mice in this study weighed 120 to 130 grams (4.23 to 4.58 ounces), whereas a normal adult mouse weighs 25 to 30 grams (.88 to 1.06 ounces). This difference is the equivalent of a 150-pound person increasing his or her weight to 700 pounds.

The researchers were careful to clarify that the findings were not meant to encourage obesity, even though the obese mice were considered metabolically healthy. The study instead provides a clearer understanding of the mitochondrion's importance to the metabolic dysfunction -- that is characteristic of obese patients and those with type 2 diabetes.

"These results taught us a great deal about how fat cells sense, store, and burn energy," said Dr. Christine Kusminski, a postdoctoral researcher in Internal Medicine who served as the study's first author. "By learning more about the underlying mechanisms, we hope to develop ways to target these pathways for future drug development."

The researchers now hope to translate these findings into a clinical setting. The staff of the Touchstone Center is devoted to the study of cells and tissues that either contribute to or are affected by diabetes and related diseases, including the physiology of adipose tissue.

Other UT Southwestern researchers involved in the study were Dr. William L. Holland, Instructor in Internal Medicine; Dr. Kai Sun, Assistant Instructor in Internal Medicine; Dr. Jiyoung Park, Assistant Instructor in Internal Medicine; and Stephen B. Spurgin, a medical student. Scientists from the Albert Einstein College of Medicine, the University of Utah School of Medicine, and Merck Research Laboratories also contributed.

The investigation was funded by support from the National Institutes of Health, the American Heart Association, and fellowships from the Juvenile Diabetes Research Foundation and the Department of Defense.

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Christine M Kusminski, William L Holland, Kai Sun, Jiyoung Park, Stephen B Spurgin, Ying Lin, G Roger Askew, Judith A Simcox, Don A McClain, Cai Li, Philipp E Scherer. MitoNEET-driven alterations in adipocyte mitochondrial activity reveal a crucial adaptive process that preserves insulin sensitivity in obesity. Nature Medicine, 2012; 18 (10): 1539 DOI: 10.1038/nm.2899

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Maintaining weight loss as important as losing it for older women

Dec. 10, 2012 — When you're postmenopausal and overweight, losing weight is a good thing, but gaining back just a few pounds may actually be detrimental to your cardiovascular health.

New research from Wake Forest Baptist Medical Center found that gaining weight back after intentional weight loss is associated with negative long-term effects on some cardiometabolic (CM) risk factors in postmenopausal women.

In this paper, published online by the Journal of Gerontology: Medical Sciences, lead authors Daniel Beavers, Ph.D., and Kristen Beavers, Ph.D., wanted to look at how weight regain affects health risk in these women. The researchers looked specifically at CM risk factors -- a cluster of risk factors that are indicators of a person's overall risk for type 2 diabetes and cardiovascular disease. They include blood pressure, HDL and LDL cholesterol, triglycerides, fasting glucose and insulin.

"In this group of women, weight loss and maintaining that loss offers the most health benefit, but therein lies the problem," Daniel Beavers said. "For most people, weight regain after intentional weight loss is an expected occurrence, and the long-term health ramifications of weight regain in older adults are not well understood."

Specifically, the researchers looked at how CM risk factors change in the year following significant, intentional weight loss and whether these changes are affected by weight regain.

"What we found was that all CM risk factors are improved with weight loss, which is not surprising, but most regressed back to their baseline values 12 months later, especially for women who were classified as 'regainers,'" Kristen Beavers said. "For women who had regained weight in the year after their weight loss, several risk factors were actually worse than before they lost the weight."

For the study, sponsored by the National Institute on Aging, the researchers evaluated 112 obese, postmenopausal women averaging 58 years of age, through a five-month weight loss intervention and a subsequent 12 month non-intervention period. Body weight/composition and CM risk factors were analyzed before and after the weight loss intervention and at six and 12 months after the intervention. During the intervention, women lost a significant amount of weight, an average of 25 pounds, and 80 women returned for at least one followup measurement. Weight regain status was based on whether a participant regained at least four pounds during the follow-up period. Two-thirds of the women fell into this category and, on average, regained approximately 70 percent of lost weight.

Beavers said these study results highlight the need for future research to better identify barriers to long-term weight loss success and develop effective strategies to promote the maintenance of weight loss in this population. These new findings build on previously published data from Wake Forest Baptist's gerontology research group that found when postmenopausal women lose weight and gain it back, they regain it mostly in the form of fat, rather than muscle.

"Our data suggest that for postmenopausal women, even partial weight regain following intentional weight loss is associated with increased cardiometabolic risk. Conversely, maintenance of or continued weight loss is associated with sustained improvement in the cardiometabolic profile," Kristen Beavers said. "The take away message for overweight, older women is to approach weight loss as a permanent lifestyle change, with weight maintenance just as important as weight loss."

This work was supported by the NIH (R01-AG/DK20583, R01-HL093713 and F32-AG039186), Wake Forest University Claude D Pepper Older Americans Independence Center (P30- AG21332), and Wake Forest University General Clinical Research Center (M01-RR07122). Co-authors are: Barbara Nicklas, Ph.D., and Mary F. Lyles, M.D., of Wake Forest Baptist.

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D. P. Beavers, K. M. Beavers, M. F. Lyles, B. J. Nicklas. Cardiometabolic Risk After Weight Loss and Subsequent Weight Regain in Overweight and Obese Postmenopausal Women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2012; DOI: 10.1093/gerona/gls236

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Easy, at-home exercise program can help cancer patients

Dec. 13, 2012 — It has been known for some time that exercise is important for cancer patients, but few studies have looked at the practicality of exercise programs and whether even a minimal workout can help. Exercise can reduce cancer-related fatigue, improve sleep, boost a sense of wellness, and reduce the recurrence of certain types of tumors. A Mayo Clinic study published in the Journal of Pain and Symptom Management found that a brief, at-home exercise program -- dubbed the Rapid, Easy, Strength Training program, or REST, -- was sufficient to increase cancer patients' mobility and reduce fatigue.

"We talk a lot about how important it is for cancer patients to exercise, but until now, nobody has questioned whether less may be more for patients negotiating the demands of cancer treatment," says lead author Andrea Cheville, M.D., of the Mayo Clinic Department of Physical Medicine and Rehabilitation. "This was the first trial to investigate what's feasible and helpful for patients with limited time and energy."

An interdisciplinary team of Mayo Clinic researchers developed an at-home exercise regimen, involving a pedometer-based walking program and a series of gentle resistance movements -- lifts and curls using a resistance band -- that can be done standing or seated. The workout takes only a few minutes a day, with minimal cost to patients.

In a randomized, controlled study of 66 adults with stage IV lung or colorectal cancer, researchers found that patients who exercised at least four times a week for two months showed improved mobility, had less fatigue and slept better when compared with those who didn't exercise. Though other measures such as pain were unaffected, the study suggests that the exercises can address several important disabling effects of disease and that even patients with late-stage cancer are able to perform the brief regimens.

The exercise program and study have significant implications for cancer care, Dr. Cheville says. Other studies have suggested that cancer-related exercise programs may impose financial burdens; patients can learn the REST regimen in a single physical therapy session. A muscle-building exercise regimen may help patients at all stages of cancer treatment.

"Muscles may atrophy during cancer care," Dr. Cheville adds. "Our regimen preserves muscle mass so that if patients develop complications from cancer or treatment, or require hospitalization, they have the reserves necessary to ensure that their bodies heal."

The study was funded by the National Institutes of Health; grant number KL2 RR024151-01. Other authors include Jenny Kollasch, Justin Vandenberg, Tiffany Shen, Axel Grothey, M.D., and Jeffrey Basford, M.D., Ph.D., all of Mayo Clinic, and Gail Gamble, M.D., of the Rehabilitation Institute of Chicago.

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Planning meals help people with diabetes enjoy the holidays

Nov. 15, 2012 — A figurative mine field of savory dishes and desserts await many this holiday season, from pumpkin pies topped with whipped cream, green bean and mushroom casseroles, pork tamales, cranberries and cornbread dressing to fruit salads and oven-roasted turkey.

Harris Health System experts warn that while most will indulge in these tasty foods and some will gain weight, people with diabetes will need a plan to stay healthy.

Dr. Ashok Balasubramanyam, chief, Endocrinology, Harris Health Ben Taub Hospital, and Talar L. Glover, MS, RN, director, Diabetes Service Line and Patient Education, Harris Health System, say the strategy for people with diabetes is simple -- portion control, planning sensible meals and getting regular exercise.

"The rules for taking care of diabetes on a daily basis are straightforward," says Balasubramanyam, also a professor, Baylor College of Medicine. "Eat right, exercise, take your medicines and check your blood sugar. But following this every day, all the time, is hard. Everyone knows the rules, but the practice is difficult because you have to do it year-round for every meal, including holidays."

Symptoms of diabetes:

• Blurry vision

• Excessive thirst

• Fatigue

• Frequent urination

• Hunger

• Weight loss

Complications from diabetes:

• Heart disease

• Stroke

• High blood pressure

• Blindness

• Kidney disease

• Amputation of limbs

While people with diabetes face a challenge to stay healthy, they can still enjoy the abundance of tasty foods available during the holidays.

"There's nothing that you need to avoid eating," Glover says. "A small serving of pecan pie is fine, but don't overdo it. If you're going to have pecan pie, then you can't have cranberries and cornbread dressing and gravy and mashed potatoes and macaroni and cheese."

Because temptation is at every table, people with diabetes can't afford to indulge on a whim.

"You can't skip a meal to 'save up' to eat a big lunch or dinner if you've got diabetes," Glover adds. "You've got to know what's on the menu and try to spread your eating throughout the day. Don't try to eat it all in one sitting."

Normal fasting blood sugar ranges are between 70 and 99. However, even people who don't have diabetes may feel the effects of temporary high sugar levels. While tryptophan in turkey is usually blamed for post-holiday meal sleepiness, the real culprits are overeating and increases in sugar levels. A good way to avoid this is to take a walk or plan a physical activity after meals.

Balasubramanyam warns people with diabetes against upping prescribed medicine doses to compensate for food indiscretions. Because of the danger of potential side effects, any change in dosage should be carefully monitored by a physician. Only patients taking insulin who know how to adjust doses based on carbohydrate counting and "correction" factors should even consider adjusting insulin doses to cover overeating during the holidays, he adds.

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Low fat diet helps drop pounds, study suggests

Dec. 6, 2012 — Exchanging fatty foods for lower fat alternatives will help people shift around three-and-a-half pounds -- without any other form of dieting. People taking part in trials also saw their waist-lines become slimmer, and levels of bad cholesterol decrease. The results demonstrate that weight loss can happen without actively trying to lose weight beyond simply choosing foods lower in fat.

The report was commissioned by the World Health Organisation (WHO) Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health following a request to update their guidelines on total fat intake. The results will be crucial in making global recommendations.

The research is particularly important because being overweight or obese increases the risk of many cancers, coronary heart disease and stroke. Reductions in total fat were also associated with small but statistically significant reductions in cholesterols and blood pressure, suggesting a beneficial effect on other major cardiovascular risk factors.

The systematic review included results from 33 randomised controlled trials, in North America, Europe and New Zealand, involving 73,589 men, women and children.

Those taking part had varying states of health. Comparisons were made between those eating less fat than usual (intervention group) and those eating their usual amount of fat (control group). The effect on weight and waist line was measured after at least six months.

The results show that eating less fat reduces body weight by 1.6kg, BMI by 0.56kg/m² and waist circumference by 0.5cm. All these effects were in trials in which weight loss was not the intended outcome, suggesting that they occur in people with normal diets. The weight loss happened quickly and was maintained over at least seven years.

The research was led by Dr Lee Hooper from UEA's Norwich Medical School. She said: "The weight reduction that we found when people ate less fat was remarkably consistent -- we saw it in almost every trial. Those who cut down more on fat, lost more weight.

"The effect isn't dramatic, like going on a diet. The research specifically looked at people who were cutting down on fat, but didn't aim to lose weight -- so they were continuing to consume a normal amount of food. What surprised us was that they did lose weight, their BMI decreased and their waists became slimmer. On top of this, they kept their weight down over at least seven years. There isn't a specific goal, the more fat you cut down, the more your weight falls.

"We didn't consider different types of fat in this study," said Dr Hooper. "But cutting down on saturated fat reduces our risk of heart disease and strokes, so the healthiest way to cut down on fat is to cut down on saturated fats.

"This means having low fat milk and yogurt, cutting down on butter and cheese, and cutting the fat off meat. Most importantly have fruit instead of fatty snacks like biscuits, cake and crisps. And remember, this isn't a diet, so don't take it to extremes, but work out a way of eating that you can stick to permanently.

"Keeping healthy is not just about fat and weight -- but cutting down on fat, especially saturated fat, is a great start. Being physically active, not smoking, drinking alcohol in moderation, eating plenty of fruit and vegetables, and drinking plenty of fluid also help to keep us healthy. We just need to get in the habit of doing these things," she added.

Co-author Prof Carolyn Summerbell, from Durham University, said: "A healthy diet is a way of eating that people can sustain over time. That's the trick, to find a comfortable way to eat that you can stick to for life which helps you maintain your weight. Cutting down on fat will help.

"Doing exercise and being physically active is good for maintaining weight and also has other health benefits, but it's not a replacement for a healthy diet."

The small amount of data available for children in the same analysis confirmed a relationship between total fat intake and subsequent weight change. Further trials are needed to examine the effect of reducing fat intake on body weight in developing countries as well as in children.

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The above story is reprinted from materials provided by University of East Anglia, via EurekAlert!, a service of AAAS.

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Journal Reference:

L. Hooper, A. Abdelhamid, H. J. Moore, W. Douthwaite, C. M. Skeaff, C. D. Summerbell. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ, 2012; 345 (dec06 1): e7666 DOI: 10.1136/bmj.e7666

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Low muscle strength in adolescence linked to increased risk of early death

Nov. 20, 2012 — Low muscle strength in adolescence is strongly associated with a greater risk of early death from several major causes, suggests a large study published on the British Medical Journal website.

The effect is similar to well established risk factors for early death like being overweight or having high blood pressure, leading the authors to call for young people, particularly those with very low strength, to engage in regular physical activity to boost their muscular fitness.

High body mass index (BMI) and high blood pressure at a young age are known risk factors for premature death, but whether muscular strength in childhood or adolescence can predict mortality is unclear.

So a team of researchers, led by Professor Finn Rasmussen at the Karolinska Institutet in Sweden, tracked more than one million Swedish male adolescents aged 16 to 19 years over a period of 24 years.

Participants underwent three reliable muscular strength tests at the start of the study (knee extension strength, handgrip strength and elbow flexion strength). BMI and blood pressure were also measured. Premature death was defined as death before age 55 years.

During the follow-up period, 26,145 participants (2.3% of the group) died. Suicide was the most common cause of death (22.3%) compared with cardiovascular diseases (7.8%) or cancer (14.9%).

High muscular strength was associated with a 20-35% lower risk of early death from any cause and also from cardiovascular diseases, independently of BMI or blood pressure. No association was seen with cancer deaths.

Stronger adolescents also had a 20-30% lower risk of early death from suicide and were up to 65% less likely to have any psychiatric diagnosis, such as schizophrenia and mood disorders. These results suggest that physically weaker individuals might be more mentally vulnerable, say the authors.

In contrast, male adolescents with the lowest level of muscular strength showed the greatest all-cause mortality and also the greatest mortality in cardiovascular disease and suicide before age 55 years.

Death rates from any cause (per 100,000 person years) ranged between 122.3 and 86.9 for weakest and strongest adolescents respectively. Rates for cardiovascular diseases were 9.5 and 5.6 and for suicide were 24.6 and 16.9.

The authors say that low muscular strength in adolescents "is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases." The effect sizes of these associations "are similar to classic risk factors such as body mass index and blood pressure," they add.

They suggest that muscular strength tests, in particular handgrip strength, could be assessed with good reliability in almost any place, including clinical settings, schools and workplaces.

They also support the need for regular physical activity in childhood and adolescence, saying: "People at increased risk of long term mortality, because of lower muscular strength, should be encouraged to engage in exercise programmes and other forms of physical activity."

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Journal Reference:

F. B. Ortega, K. Silventoinen, P. Tynelius, F. Rasmussen. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ, 2012; 345 (nov20 3): e7279 DOI: 10.1136/bmj.e7279

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