Laurie Barclay, MD

September 27, 2010 —Home-based exercises may protect high-risk elderly women from hip fractures, according to the results of a population-based, randomized controlled exercise trial reported in the September 27 issue of the Archives of Internal Medicine.

"Long-term evidence from randomized trials of the effectiveness of exercise in preventing disability and fall-related fractures in elderly people has been lacking," write Raija Korpelainen, PhD, from University of Oulo in Oulo, Finland, and colleagues. "Fall-related fractures are associated with long-term pain, functional impairment, and increased risks of institutionalization and death in elderly women. Hip fractures place the greatest demands on resources and have the greatest effect on patients because they are associated with high mortality rates and increased morbidity."

From April 1 through April 30, 2001, a total of 160 women aged 70 to 73 years with osteopenia were enrolled in a long-term follow-up extension of an exercise trial. Women in the exercise group had attended supervised balance, leg strength, and impact training sessions once a week for a 6-month period from October to March each year from 1998 to 2001.

Extended follow-up took place from May 1, 2001, through December 31, 2005, with mean total time in observation of 7.1 years. The main study endpoints were femoral neck bone mineral density, postural sway, and leg strength; secondary endpoints were hospital-treated fractures and measures of functional ability. Evaluators blinded to study group measured these endpoints each year.

The exercise group had significantly better outcomes than the control group in postural sway (group x time interaction, P = .005), walking speed (group x time interaction, P < .001), and Frenchay Activities Index score (group x time interaction, P = .001). However, both groups had similar decreases in bone mineral density across time.

During extended follow-up, women in the exercise group had an incidence rate of fractures 0.05 per 1000 person-years vs 0.08 per 1000 person-years among women in the control group (Poisson incidence rate ratio, 0.68; 95% confidence interval [CI], 0.34 – 1.32). None of the women in the exercise group had hip fractures vs 5 in the control group. There was 1 death in the exercise group and 8 deaths in the control group (Poisson incidence rate ratio, 0.11; 95% CI, 0.01 – 0.85).

"Mainly home-based exercises followed by voluntary home training seem to have a long-term effect on balance and gait and may even protect high-risk elderly women from hip fractures," the study authors write.

Limitations of this study include participation rate of approximately three quarters of originally eligible women, lack of generalizability to very ill or institutionalized elderly patients, and incomplete information on falls and physical activity during the postintervention period.

"Life-long physical activity was associated with reduced risk of fractures," the study authors conclude. "Furthermore, mortality was significantly lower in the exercise group than in the control group during the extended follow-up period. Regular daily physical activity should be recommended to elderly women with osteopenia."

The Finnish Ministry of Education, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Miina Sillanpää Foundation, the Research Foundation of Orion Corporation, and the Northern Ostrobothnia District Hospital supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1548-1556.

Obesity at Age 20 Linked to Early Death

If this isn’t a wake up call, I don’t know what is!!!!

July 15, 2010 — Men who are obese at age 20 are twice as likely to die young, according to new research presented at the International Congress on Obesity in Stockholm, Sweden.

As it stands, more than two-thirds of U.S. adults aged 20 and older are overweight or obese, according to the National Institutes of Health in Bethesda, MD.

"Entering adult life as obese leads to a life-long doubling of the risk of dying prematurely," study researcher Esther Zimmermann, PhD, of the Institute of Preventive Medicine in Copenhagen University Hospital in Denmark, tells WebMD in an email. "The best advice is to avoid beginning adult life as obese [because] if you enter adult life as obese, the majority will remain obese as adults."

Zimmerman and colleagues tracked about 5,500 Swedish men from age 20 to age 80 and found that the 1,930 men who were obese when they were 20 were twice as likely to die at any given age than were their counterparts who were not obese at age 20. Starting at age 55, men who were obese at 20 died an average of eight years earlier than their counterparts who were not obese at age 20.

What’s more, their chance of dying early increased by 10% for each body mass index (BMI) unit above 25. BMI takes height and weight into account to measure body fat. If your BMI is greater than 25, you are considered overweight. If it is over 30, you are considered obese.

Study participants completed follow-up surveys at age 35 and 46. More than 70% of men who were obese at age 20 remained so during these follow-up exams. By contrast, just 4% of men who were not obese at age 20 went on to become obese, the study showed. Researchers adjusted for other factors known to affect mortality such as smoking status.

"Entering adult life as obese had a life-long effect on mortality," she says. The next step is to study why those individuals who were obese at age 20 died earlier, she says.

Second Opinion

This game plan makes sense to Randall Urban, MD, professor and chair of internal medicine at the University of Texas Medical Branch in Galveston.

"This is a valuable study, and I think the results raise a lot of questions such as why are people who are obese at age 20 are dying sooner," he says. "We need to break down why they did worse and see how many people develop diabetes or heart disease," he says. Obesity is a major risk factor for diabetes and heart disease.

"This is a fascinating beginning and we really need to dig down further in this group to understand why they are dying earlier," he says.

Such information will help shape more effective prevention strategies. "Obesity is a marker that there will be problems down the road," he says. "In broad strokes, we can say that if obese people change their lifestyle, they will do better, but there may be more to it than this."

George L. Blackburn, MD, PhD, the S. Daniel Abraham Associate Professor of Nutrition and associate director of nutrition at Harvard Medical School in Boston, tells WebMD that this new information may help individuals grasp the consequences of obesity.

"In this day and age, everyone wants to live as long as they can, and we really haven’t had the [mortality] card to play before," he says.

"This is another wake-up call," he tells WebMD. "On top of all the problems that the obese have, obesity doubles your risk of death if you are obese at age 20."

Importantly, Blackburn adds, "it is never too late to make healthy changes," he says.

SOURCES:

International Congress on Obesity in Stockholm, Sweden, July 11-15, 2010.

Esther Zimmermann, PhD, Institute of Preventive Medicine, Copenhagen University Hospital, Denmark.

Randall Urban, MD, professor and chair, internal medicine, University of Texas Medical Branch, Galveston.

George L. Blackburn, MD, PhD, S. Daniel Abraham Associate Professor of Nutrition; associate director of nutrition, Harvard Medical School, Boston.

National Institutes of Health: "Statistics Related to Overweight and Obesity."

Surgeon General Urges Exercise for Optimal Health

Regina M. Benjamin, MD, MBA

Editor’s Note:

The following commentary from US Surgeon General Regina Benjamin, MD, MBA, is a collaboration between the US Department of Health and Human Services (HHS), the American College of Sports Medicine (ACSM), and Medscape.

As Surgeon General, my priorities focus on wellness and prevention. Earlier this year, I released my paper, The Surgeon General’s Vision for a Healthy and Fit Nation [2010].

There is, perhaps, no more serious challenges to the nation’s health and well-being than those posed by obesity and overweight. Since 1980, obesity rates have doubled in adults and more than tripled in children, and the problem is even worse among black, Hispanic, and Native American children. We see the sobering impact of these numbers in the high rates of chronic diseases, such as diabetes, heart disease, and other chronic illnesses, that are starting to affect our children more and more.

A few months ago, a study from The University of North Carolina [at Chapel Hill] School of Medicine reported that obese children as young as age 3 show signs of an inflammatory response that has been linked to heart disease later in life. I was pleased to join the First Lady for the launch of her Let’s Move! campaign to solve the problem of childhood obesity within 1 generation.

Both my Vision for a Healthy and Fit Nation and the First Lady’s Let’s Move! campaign take a comprehensive approach that engages families and communities, as well as the public and private sectors. My Vision for a Healthy and Fit Nation is an attempt to change the national conversation from a negative one about obesity and illness to a positive conversation about being healthy and being fit. I want to encourage Americans to eat more nutritiously, exercise regularly, and maintain healthier lifestyles.

That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient’s interaction with a health clinician. Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action:

• Policy makers are asked to change policies to support physical activity as a major component of health.
• Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction.
• Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being.
• Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity.

As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward — something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each day and live their lives to the fullest — without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.

Physical Activity Should Be Encouraged Into Advanced Old Age

September 16, 2009 — Physical activity should be encouraged into advanced old age, according to the results of a prospective cohort study reported in the September 14 issue of the Archives of Internal Medicine.

"Recommendations encouraging physical activity set no upper age limit, yet evidence supporting the benefits of PA [physical activity] among the very old is sparse," write Jochanan Stessman, MD, from Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel, and colleagues. "We examined the effects of continuing, increasing, or decreasing PA levels on survival, function, and health status among the very old."

Using data from the Jerusalem Longitudinal Cohort Study performed from 1990 through 2008, the investigators evaluated mortality from ages 70 to 88 years and health, comorbidity, and functional status at ages 70, 78, and 85 years among a representative sample of 1861 people born in 1920 and 1921. Follow-up for all-cause mortality was 17,109 person-years.

At age 70 years, 8-year mortality rate was 15.2% among physically active participants vs 27.2% among sedentary participants (P < .001). At age 78 years, 8-year mortality rate was 26.1% vs 40.8% (P < .001), and at age 85 years, 3-year mortality rate was 6.8% vs 24.4% (P < .001).

When mortality risk factors were adjusted for using Cox proportional-hazards models, lower mortality rate was associated with physical activity level at ages 70 years (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.38 – 0.96), 78 years (HR, 0.69; 95% CI, 0.48 – 0.98), and 85 years (HR, 0.42; 95% CI, 0.25 – 0.68). Starting physical activity between ages 70 and 78 years was associated with a significant survival benefit (P = .04), and this was also true for starting physical activity between ages 78 and 85 years (P < .001).

Compared with being sedentary, participating in greater levels of physical activity did not show a dose-dependent association with mortality rate. Physical activity level at age 78 years predicted independence for performing activities of daily living at age 85 years (odds ratio, 1.92; 95% CI, 1.11 – 3.33).

"Among the very old, not only continuing but also initiating PA was associated with better survival and function," the study authors write. "This finding supports the encouragement of physical activity into advanced old age."

Limitations of this study include attrition at follow-up, self-reported data on physical activity, limited generalizability to other cultures, and lack of data on energy expenditure.

"Despite the increasing likelihood of comorbidity, frailty, dependence, and ever-shortening life expectancy, remaining and even starting to be physically active increases the likelihood of living longer and staying functionally independent," the study authors conclude. "The clinical ramifications are far reaching. As this rapidly growing sector of the population assumes a prominent position in preventive and public health measures, our findings clearly support the continued encouragement of physical activity, even among the oldest old."

The Jerusalem Longitudinal Study has received funds from the Ministry of Labor and Social Affairs of the State of Israel; ESHEL, the Association for the Planning and Development of Services for the Aged in Israel; the National Insurance Institute; and various private, charitable donors. The study authors have disclosed no relevant financial relationships.

Authors and Disclosures

Journalist

Laurie Barclay, MD

freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

I hate being injured!

I know that is probably a rhetorical statement for most of us, yet how many of you right now are sitting in front of your computer with some sort of neck/shoulder/low back/knee injury shaking your head because you hurt yourself doing some mundane household chore? By my guess, probably quite a bit of you.

In my experience as a trainer, I’ve come across hundreds of people with all sorts of injuries. I myself have experienced more injuries than I would care to fess up to, so my knowledge on the subject is quite extensive. For my clients, it’s a pain in the neck (no pun intended) when they come to me complaining about some ailing injury and tell me they need to “take it easy today” because of it. Then they would rather mask the pain with medication then try and get to the base of the problem.

For most of us, the reason we experience so much neck/shoulder/low back/knee pain is because of imbalance and lack of flexibility. I know that I struggle to remember to stretch when I’m done working out, and usually pay for it the next few days with extremely stiff and sore muscles, so I can imagine a thorough stretching routine might not be in the cards for you either.

Most of this pain we experience, though, is due to an imbalance of our muscles. To give you a quick anatomy lesson, each muscle in your body has a yin to its yang, so to speak. Your biceps, which act as a pulling muscle, has the triceps, a pushing muscle, as its counterpart, your quadriceps have your hamstrings, and so forth. Most people have a problem training only those muscles they see in the mirror (especially guys on this one). Everyone wants a stronger “core” and a six pack and do a million crunches a day, yet fail to realize that your lower back is also part of that core and failure to train it causes imbalance. Your abdominals get tighter as a result of the exercise, and because your lower back is weaker, it “gives” so to speak and pulls it out alignment.

To correct this, you need to train what is called your “posterior chain”.

This is a group of muscles that runs from the base of your skull into the back of your knees. It includes your trapezius, erector spinae, glutes, and hamstrings, to name a few. Each of these muscles overlaps one another and works to straighten your posture and move your hips. So for those of you with neck problems, is probably due to the fact you shrug your shoulders all day and they tend to pitch forward, causing your trapezius to become tight. When the muscle is stretched, it wants to go back to “normal” and tries to correct itself, causing a “stiff neck”. Or for those of you with a bad lower back, its probably due to the fact you have weak glutes, so when you bend over to pick something up, instead of using your hips, you arch your back causing the muscles to “pull” past their comfort zone. Better yet, those with knee problems probably experience pain because they never train their hamstrings, causing extreme tightness around that knee joint (where most of your thigh muscles insert) and pulling everything out of whack, to put it in technical terms.

But don’t worry, there is a solution. Here is a list of exercises that should be a staple in your workout routine.

1) Squats – Place the bar across your trapezius. Take a wider-than-shoulder width stance, break at the hips first, bend your knees until your thighs are parallel to the ground, and then return to a standing position. Make sure your heels stay planted. You do NOT want to come up on your toes during this exercise. Repeat several times over…

2) Deadlifts – My favorite! Place a bar on the floor in front of you. Take a shoulder width stance and bend down, keeping your butt down and your back straight, grab the bar just outside of your legs. Using your LEGS to start the motion, pull the bar straight up as you go to a standing position. Return the bar slowly to the floor keeping a good posture.

3) Good mornings – Same position as a squat, but this time you want to keep your knees “soft” (not locked out but not bent). Break at your hips again, you want to slowly bend forward in a bowing motion, keeping your head and chest up. Try and get your body almost parallel to the floor, and then using your hips stand yourself back up.

4) Hamstring curls – Think bicep curls for your legs (and being that your hamstrings are technically biceps, that shouldn’t be hard). Any gym will have a hamstring curl machine, pick a moderate weight and make sure you’re going through the full range of motion.

5) Shrugs. Take any barbell or pair of dumbbells. Pretend someone is asking you “who stole the cookie from the cookie Jar?” and pull your shoulders up to your ears as if to say “I dunno…” Repeat.

By doing these few exercises, and stretching out your low back/hamstrings on a regular basis, not only can you alleviate any nagging pain you might have, but you will also prevent future injuries from occurring. Get on it!

-The Wellness Guru

Weight Loss Should Improve OSA in Obese Patients With Type 2 Diabetes CME

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

October 6, 2009 — Weight loss should result in significant and clinically relevant improvements in obstructive sleep apnea (OSA) among obese patients with type 2 diabetes, according to the results of a multicenter randomized study published in the September 28 issue of the Archives of Internal Medicine.

"The belief that weight loss improves…OSA has limited empirical support," write Gary D. Foster, PhD, from the Center for Obesity Research and Education, Temple University in Philadelphia, Pennsylvania, and colleagues from the Sleep AHEAD Research Group of the Look AHEAD Research Group. "The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period."

The study sample consisted of 264 participants with type 2 diabetes who were randomly assigned to either an intensive lifestyle intervention (behavioral weight loss program developed specifically for obese patients with type 2 diabetes) or to a diabetes support and education group (3 group sessions discussing effective diabetes management). Mean age was 61.2 ± 6.5 years, mean weight was 102.4 ± 18.3 kg, mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 36.7 ± 5.7 kg/m², and mean apnea-hypopnea index (AHI) was 23.2 ± 16.5 events per hour.

Compared with participants in the support and education group, participants in the intensive lifestyle group lost more weight at 1 year (10.8 kg vs 0.6 kg; P < .001) and had a relative adjusted decrease in AHI of 9.7 ± 2.0 events per hour (P < .001). Total remission of OSA at 1 year occurred in more than 3 times as many participants in the intensive lifestyle group vs the support and education group, and the prevalence of severe OSA in the intensive lifestyle group was half that in the support and education group. The factors most predictive of changes in AHI at 1 year were initial AHI and weight loss (P < .01), with the greatest reductions in AHI occurring in participants with weight loss of at least 10 kg.

"Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes," the study authors write. "The greatest benefit was observed in men, in participants with more severe OSA at baseline, and in participants who lost the most weight."

Limitations of this study include lack of generalizability to younger patients, to patients without type 2 diabetes, or to patients with milder degrees of OSA. In addition, future research should address the mechanical, metabolic, and hormonal mechanisms underlying these improvements in OSA.

"The significant increase in AHI over 1 year in participants who were weight stable suggests that OSA is a rapidly progressing syndrome that will worsen without treatment in middle-aged obese adults with type 2 diabetes," the study authors conclude.

The National Institutes of Health (NIH) National Heart, Lung, and Blood Institute supported Sleep AHEAD. The NIH National Institute of Diabetes and Digestive and Kidney Diseases supported Look AHEAD. One of the study authors (Dr. Sanders) has disclosed various financial relationships with Philips-Respironics, Cephalon, and Sanofi-Aventis.

Arch Intern Med. 2009;169:1619-1626. Abstract

Clinical Context

Weight loss is frequently recommended to improve OSA in obese patients; however, this recommendation has limited empiric support. Existing studies evaluating the effects of weight loss in patients with OSA are limited by the small sample size (N = 8 – 26 participants), short duration (≤ 6 months), predominantly male samples (90%), and lack of patients in comparison groups who do not lose weight. More data are needed to help understand the expected benefits of weight loss in the management of OSA.

The purpose of this 4-center study was to assess the effects of weight loss on OSA in obese patients with type 2 diabetes during a 1-year period.

Study Highlights

• This randomized controlled study included 264 participants with type 2 diabetes and a mean (SD) age of 61.2 (6.5) years, weight of 102.4 (18.3) kg, body mass index of 36.7 (5.7) kg/m², and an AHI of 23.2 (16.5) events per hour.
• As part of the Look AHEAD study, the participants were randomly assigned to either a behavioral weight loss program developed specifically for obese patients with type 2 diabetes (intensive lifestyle intervention) or 3 group sessions related to effective diabetes management (diabetes support and education).
• Patients were excluded if they had previous surgical or current medical treatments of OSA.
• The intensive lifestyle participants were prescribed portion-controlled diets, with prescribed energy intake of 1200 to 1500 kcal/day if the patients weighed less than 113.6 kg or 1500 to 1800 kcal/day if the patients weighed 113.6 kg or more, with 30% less calories from fat. The recommended physical activity was 175 minutes per week of moderate-intensity activity.
• The support and education participants attended group sessions focused on diet, physical activity, and social support for effective diabetes management.
• Of the 264 study participants, 38.7% had mild OSA, 35.2% had moderate OSA, and 26.1% had severe OSA.
• Results demonstrated that the intensive lifestyle participants lost more weight at 1 year vs the support and education participants (10.8 kg vs 0.6 kg; P < .001). They also experienced greater reductions in waist and neck circumferences vs the support and education participants.
• Overall, OSA among the intensive lifestyle participants improved, whereas OSA worsened among the support and education participants.
• Among the intensive lifestyle participants, the AHI decreased from 22.9 (18.0) to 18.3 (15.3) (P < .001 within the group), whereas among the support and education participants, the AHI increased from 23.5 (15.0) to 28.3 (20.7) (P < .01 within the group).
• Relative to the support and education group, the intensive lifestyle intervention was associated with an adjusted (SE) decrease in AHI of 9.7 (2.0) events per hour (P < .001).
• At 1 year, more than 3 times as many participants in the intensive lifestyle group vs the support and education group had total remission of their OSA, and the prevalence of severe OSA among intensive lifestyle participants was half that of the support and education group.
• More than twice as many intensive lifestyle participants vs the support and education participants demonstrated improvement in their OSA category (eg, severe to moderate, moderate to mild, and mild to none) at 1 year.
• There were significant treatment interactions with both sex (P < .02) and baseline AHI (P < .001). Intensive lifestyle was more effective in reducing the AHI in men vs women and was more effective in participants with higher levels of baseline AHI vs those with lower levels of baseline AHI.
• Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year (P < .01).
• Participants with a weight loss of 10 kg or more had the greatest reductions in AHI, specifically 11.3 events per hour.
• Limitations of this study were that the results were not generalizable to younger patients, to patients without type 2 diabetes, or to patients with milder degrees of OSA.

Clinical Implications

• Current studies evaluating the effects of weight loss in patients with OSA are limited by the small sample size, short duration, predominantly male samples, and lack of patients in the comparison groups who do not lose weight.
• Weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes.

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Today, I want to address an important part of the family lifestyle. In our ever-busy lives, we often take for granted not only OUR health, but the health of our families as well. I mean think about it, if you can find excuses NOT to go to the gym and exercise, are you really going to find the motivation to encourage others to? I didn’t think so…

Doing things as a family creates family unity. A big part about health and wellness is “balance” and no I don’t mean standing on one foot. I mean dedicating your time and efforts to various aspects of your life, be it relations, finances, education, spirituality, fitness, etc. So many of us are caught up in the day-to-day melee that is life that we often overlook and neglect certain areas of our lives. This neglect leads to deterioration of relationships and can have an awful affect on our health and well-being.

For those of you who have kids, this article is especially important to you. I am currently working on a research grant studying childhood obesity. 1 in 4 kids today is either overweight or obese! 1 in 4!! Kids are developing chronic diseases that are USUALLY found in older adults…high cholesterol, high blood pressure, diabetes, asthma, and the list goes on. Part of the reason is the crap we’re feeding kids these days, but that is another story for another time. The other BIG part of it is the lack of physical activity kids are getting. Video games have become a replacement for going outside and playing tag; NBA Street Hoops has replaced REAL basketball…come on now, people!

To tie everything together, here are a few suggestions for this time of year to do something active for the whole family. For instance, it’s Fall…and the leaves are well, “falling”. Go outside and rake leaves together, not only will you be getting exercise (especially if you have a big yard), but you’ll be doing things together as a family and possibly even (brace yourself) strike up a conversation! You can also go for walks together, play touch football in your newly-raked backyard, and if the kids are insistent on playing video games, get the Nintendo Wii and play Wii Fitness. If you don’t have kids, get a couples membership at a gym or health club, join exercise classes there, hire a trainer and do group fitness, or just grab two elliptical machines side by side and get on there with your spouse and chat about your day (in between the heavy breathing you should be experiencing if you’re doing it right, by the way).

The take away message is this: Spend time as a family being active and being healthy. I know that other things might be on the forefront of your mind right now, like bills, jobs, etc…but you need to take time and focus on the most important part of your lifestyle, your family. You’ll have more focus, more energy, and less stress by striving for balance in life. Focusing on your family is step 1 of the process.

-The Wellness Guru

From Medscape Medical News

Guidelines Address Physical Activity for Individuals 6 Years and Older CME/CE

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD

Authors and Disclosures

CME/CE Released: 10/09/2008; Valid for credit through 10/09/2009

CME/CE Information

Authors and Disclosures

Laurie Barclay, MD
Laurie Barclay, MD is a freelance reviewer and writer for Medscape.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
Brande Nicole Martin is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Laurie E. Scudder, MS, NP-C
Nurse Planner, Medscape; Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC;  Curriculum Coordinator, Nurse Practitioner Alternatives, Inc., Ellicott City; Nurse Practitioner,  Baltimore City School-Based Health Centers, Baltimore, Maryland
Disclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.

Laurie Barclay, MD
Laurie Barclay, MD, is a freelance reviewer and writer for Medscape.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Learning Objectives

Upon completion of this activity, participants will be able to:

1. Describe health benefits linked with regular physical activity.
2. Describe specific recommendations regarding physical activity applicable to children and adolescents, adults, older adults, and those with disabilities or who are pregnant.

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October 9, 2008 — The US Department of Health and Human Services (HHS) has issued guidelines regarding the types and amounts of physical activity that provide substantial health benefits for physical activity for individuals 6 years and older. These 2008 Physical Activity Guidelines for Americans are posted online at the HHS Web site. Although primarily targeting policymakers and health professionals, the information in these guidelines may also be useful to interested members of the lay public.

"Along with President Bush, I believe that physical activity should be an essential component of any comprehensive disease prevention and health promotion strategy for Americans," HHS Secretary Michael O. Leavitt writes in a letter introducing the guidelines. "We know that sedentary behavior contributes to a host of chronic diseases, and regular physical activity is an important component of an overall healthy lifestyle. There is strong evidence that physically active people have better health-related physical fitness and are at lower risk of developing many disabling medical conditions than inactive people."

Regular physical activity each week, sustained for months and years, can produce long-term health benefits. Strong evidence links regular physical activity with a lower risk for early death, heart disease, stroke, type 2 diabetes, hypertension, hyperlipidemia, metabolic syndrome, colon and breast cancers, and depression. Regular physical activity also promotes prevention of weight gain, weight loss when combined with diet, better cardiorespiratory and muscular fitness, fall prevention, and better cognitive function in older adults.

The 2008 Physical Activity Guidelines were designed to complement the Dietary Guidelines for Americans, which were developed by HHS and the US Department of Agriculture. When used together, these guidelines may help promote good health and reduce the risk for chronic diseases by emphasizing the importance of being physically active and eating a healthy diet.

When writing the guidelines, HHS primarily used a report from an appointed external scientific advisory committee (the Physical Activity Guidelines Advisory Committee) as well as comments from the public and government agencies.

Major research findings on the health benefits of physical activity, gathered by the Physical Activity Guidelines Advisory Committee after a review of the literature and other available evidence, are as follows:

• Regular physical activity lowers the risk for many adverse health outcomes.
• Although some physical activity is better than none, higher intensity, greater frequency, and/or longer duration of physical activity provide additional benefits for most health outcomes.
• At least 150 minutes per week of moderate-intensity physical activity, such as brisk walking, is needed for most health benefits, but more physical activity provides additional benefits.
• Aerobic (endurance) and muscle-strengthening (resistance) physical activity both promote better health.
• In every studied racial and ethnic group, and in children and adolescents, young and middle-aged adults, and older adults, physical activity is linked to health benefits.
• People with disabilities also receive health benefits from physical activity.
• The benefits provided by physical activity far outweigh the risk for harms.

Key guidelines for physical activity for children and adolescents are as follows:

• Children and adolescents should engage in at least 1 hour of physical activity daily, preferably in physical activities that are appropriate for their age, that are enjoyable, and that offer variety.
• Most of this activity should be either moderate- or vigorous-intensity aerobic physical activity.
• Vigorous-intensity physical activity, muscle-strengthening physical activity, and bone-strengthening physical activity should each be performed at least 3 days per week.

Key guidelines for physical activity for adults, including older adults, are as follows:

• All adults should avoid inactivity. Participation in any amount of physical activity is associated with some health benefits relative to no physical activity.
• At least 150 minutes per week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity offers substantial health benefits.
• Aerobic activity should preferably be spread throughout the week and performed in episodes of at least 10 minutes.
• Aerobic physical activity of 300 minutes per week of moderate intensity, or 150 minutes per week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity, is associated with additional and more extensive health benefits.
• Engaging in physical activity beyond this amount provides additional health benefits.
• Muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups should be performed on 2 or more days per week for additional health benefits.

Additional guidelines specific to older adults are as follows:

• When chronic conditions prevent older adults from doing 150 minutes of moderate-intensity aerobic activity per week, they should be as physically active as their abilities and conditions allow. They should understand whether and how their conditions affect their ability to do regular physical activity safely.
• Older adults at risk of falling should do exercises that maintain or improve balance.
• Older adults should determine their level of effort for physical activity relative to their fitness level.

Adults, children, and adolescents with disabilities should follow the guidelines for their age group if possible, or if not, they should be as physically active as their abilities allow, with guidance from their healthcare provider. They should avoid inactivity.

Healthy pregnant and postpartum women who are not already engaged in vigorous-intensity physical activity should get at least 2 hours and 30 minutes of moderate-intensity aerobic activity per week, preferably spread throughout the week. Those who regularly engage in vigorous-intensity aerobic activity or in high amounts of activity can continue with this regimen, provided that their condition remains unchanged and that they consult with their healthcare provider regarding their activity level throughout their pregnancy.

US Dept of Health and Human Services. 2008 Physical Activity Guidelines for Americans.

Published online October 7, 2008.

http://www.health.gov/paguidelines/guidelines/default.aspx

Clinical Context

Regular physical activity each week, sustained for months and years, is linked to long-term health benefits, including reduced risks for early death, heart disease, stroke, type 2 diabetes, hypertension, hyperlipidemia, metabolic syndrome, colon and breast cancers, and depression. Evidence is also strong that regular physical activity is associated with prevention of weight gain, weight loss when combined with diet, better cardiorespiratory and muscular fitness, fall prevention, and better cognitive function in older adults.

The HHS designed these Physical Activity Guidelines for Americans to be used together with Dietary Guidelines for Americans, which were developed by HHS and the US Department of Agriculture. When used together, these recommendations may provide health benefits and lower the risk for chronic diseases by highlighting the importance of being physically active and eating a healthy diet.

Study Highlights

• Health benefits of physical activity are as follows:
  • Regular physical activity reduces the risk for many adverse health outcomes.
  • Some physical activity is better than none. Greater intensity, higher frequency, and/or longer duration of physical activity offer additional benefits for most health outcomes.
  • Moderate-intensity physical activity, such as brisk walking, at least 150 minutes per week is needed for most health benefits. More physical activity offers additional benefits.
  • Aerobic (endurance) and muscle-strengthening (resistance) physical activity both promote better health.
  • Physical activity is linked to health benefits in every studied racial and ethnic group; in children and adolescents; in young, middle-aged, and older adults; and in people with disabilities.
  • The benefits provided by physical activity far outweigh the risk for harms.
• Key guidelines for physical activity are as follows:
  • Children and adolescents should engage in 1 or more hours of physical activities daily, preferably those that are age appropriate, enjoyable, and that offer variety. Most of this activity should be moderate- or vigorous-intensity aerobic physical activity, with vigorous-intensity physical activity, muscle-strengthening physical activity, and bone-strengthening physical activity each to be performed 3 or more days per week.
  • All adults should avoid inactivity; some physical activity is better than none.
  • In adults, at least 150 minutes per week of moderate-intensity, 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of both, offers substantial health benefits.
  • Aerobic activity should preferably be spread throughout the week, in episodes of at least 10 minutes. Additional, more extensive health benefits are offered by 300 or more minutes per week of moderate intensity, 150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of both. More of this activity is even better.
  • Moderate- or high-intensity muscle-strengthening activities that involve all major muscle groups should be performed on 2 or more days per week for additional health benefits.
  • Older adults should follow the adult guidelines whenever possible, or they should be as physically active as their abilities and conditions allow, while observing safety precautions.
  • Older adults at risk of falling should do exercises that maintain or improve balance.
  • Adults, children, and adolescents with disabilities should follow guidelines for their age group if possible. If not, they should be as physically active as their abilities allow, with guidance from their healthcare provider.
• Healthy pregnant and postpartum women not already engaged in vigorous-intensity physical activity should get 2.5 or more hours of moderate-intensity aerobic activity per week, preferably spread throughout the week. Those already engaged in such activity can continue their usual activity levels, provided that their condition remains unchanged and that they consult with their healthcare provider.

Pearls for Practice

• The HHS 2008 Physical Activity Guidelines for Americans describe the numerous health benefits of regular physical activity in reducing the risk for many adverse health outcomes in every age, racial, and ethnic group studied. Some physical activity is better than none, but greater intensity, higher frequency, and/or longer duration of physical activity offer additional benefits for most health outcomes.
• Key guidelines for physical activity are that children and adolescents should engage in 1 or more hours of physical activities daily, mostly moderate- or vigorous-intensity aerobic physical activity, with vigorous-intensity physical activity, muscle-strengthening physical activity, and bone-strengthening physical activity each performed 3 or more days per week. In adults, at least 150 minutes per week of moderate-intensity, 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of both, offers substantial health benefits.

Getting in shape is a tough step to take. You have to make changes in your life. For a lot of people it isn’t the act of eating right that’s so hard, or the vigorous workouts, it’s the change. This is completely understandable.

Change, especially that which you need to last a lifetime, has to happen slowly. Take little steps in the right direction. Don’t feel overwhelmed by it. There are quite a few things that you can do to help with this change, and they are easier than you think.

Getting healthy isn’t necessarily simple, but, losing fat can be simplified. It’s calories in, calories out. If you’re able to increase your daily activity level a little bit at a time you’ll be much more likely to shed that weight in a shorter amount of time.

Seems like a huge change in your daily lifestyle…it doesn’t have to be.

Remember, think small. You’ll grow from there.

These little things that I mean are as easy as taking the stairs at work. If you’re an elevator lover you are missing out on hundreds of calories to burn each day. The average person works on the second floor of their building. Assuming you leave for lunch, you’re going up and down 2 flights of stairs twice each day! that’s a lot of added steps to your day, for not much effort.

Now everyone is probably thinking “What’s so new about this? We already know we should do that.” Ok, but how many of you do? How many of you really make the commitment to choose to walk the stairs everyday and create one more consistent thing towards health in your life? It’s self reflection time. Can you do these things on your own?

If you can Great!! Keep at it. Try to add one more healthy thing each week. Gradually you will be feeling healthier and looking better.

If you can’t, that’s ok too. You shouldn’t feel lost, or ashamed. Everyone needs some level of accountability, and that’s different for each person. That’s why there’s help out there, and it’s closer than you think.

If you’re doing great and these blogs are enough keep at it. If you need more, contact me. Success Doesn’t have to be for the fortunate few, but it is reserved for those who seize an opportunity when they are presented with it. Will you let this pass you by?