j’s blog

Vigorous Activity Cuts Arthritis Disabilities

Inactivity Nearly Doubles Loss of Physical Function Among Seniors With Arthritis

By Miranda Hitti
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, April 07, 2005

April 7, 2005 — Older adults with arthritis who do their best to get regular, vigorous physical activityarthritis who do their best to get regular, vigorous physical activity have an advantage over those who are sedentary.

“Lack of regular, vigorous physical activity … almost doubled the odds of functional decline after controlling for all risk factors,” says a study in April’s issue of Arthritis & Rheumatism.

If everyone in the study had gotten enough activity, decline in physical function could have been as much as 32% lower, the researchers estimate.

“Older persons with chronic conditions need to be encouraged to participate in physical activities, regardless of their current capabilities,” they write.

Arthritis and other rheumatic conditions are the leading causes of disability in the U.S., says the study. Nearly 60% of U.S. adults aged 65 and older have arthritis, and 10% of them say their daily activities are limited, the researchers note.

Trouble With Daily Life

Arthritis can be painful, and that may understandably make some patients want to avoid physical activity.patients want to avoid physical activity. But the new study says that’s not always a great idea.

More than 5,700 people with arthritis participated. All were at least 65 years old.

At the study’s start, nearly one in five said their physical function was limited, and some 13% had trouble with activities of daily life. Almost 6% said they had trouble with two or more activities, while twice as many reported problems with three or more daily tasks.

Men, Whites More Active

Many participants said they weren’t very active, but women and minorities were more likely to fall into that category.

Women were more likely than men to say they had a hard time with daily activities.

About 68% of women said they didn’t get regular, vigorous activity, compared to 57% of men. Among minorities of either sex, the rates were 73% for blacks, 70% for Hispanics, and 63% for whites or people of other races.

After two years, 14% of at-risk participants reported declines in physical function. That included 15% of all women in the study, 18% of Hispanics, and nearly 19% of black participants.

After evaluating various potentially unhealthy behaviors, the researchers found that lack of regular, vigorous physical activity nearly doubled the risk of functional decline. Almost two-thirds of the participants did not get regular physical activity.

More Problems 2 Years Later

The biggest predictor of limitations in daily activities was lack of regular vigorous physical activity. A decline in mental skills also predicted physical limitations in daily activity.

“Function declined less frequently in persons who engaged in regular, vigorous physical activity, regardless of their baseline ability,” write the researchers, who included Dorothy Dunlop, PhD, of Northwestern University’s medical school.

In other words, being as active as possible was beneficial. Health care providers can help design a plan to do that safely.

Lack of regular physical activity is a potentially modifiable risk factor which could substantially reduce functional decline and health care cost, they conclude.

SOURCES: Dunlop, D. Arthritis & Rheumatism, April 2005; vol 52: pp 1274-1282. News release, John Wiley & Sons, Inc.

Mediterranean Diet Linked to Longer Life

Researchers Recommend Diet Low in Meat and Dairy, High in Fruits and Veggies

By Salynn Boyles
WebMD Medical News Reviewed By Michael Smith, MD
on Thursday, April 07, 2005

April 7, 2005 — There is more evidence that eating like a villager on the Isle of Crete can help you live longer.

A study examining eating patterns in nine European countries found that people who ate a traditional Mediterranean diet lived longerpeople who ate a traditional Mediterranean diet lived longer than those who didn’t.

Researchers say a healthy man of 60 who follows the diet, which is rich in fruits and vegetables and low in meat and dairy, can expect to live a year longer than a man of the same age who doesn’t follow the diet.

“A year may not sound like much to some people,” study researcher Dimitrios Trichopoulos, MD, PhD, tells WebMD. “But I’m in my mid 60s, and it sounds pretty good to me.”

Living to 100

Physiologist Ancel Keys was both the world’s best-known champion of the Mediterranean diet and its best advertisement.

Keys was the first to notice, more than half a century ago, that heart disease was rare in Mediterranean areas like Greece and southern Italy, where olive oilolive oil and red winered wine were dietary staples and people ate plenty of fruits and vegetables.

Keys died late last year at the age of 100, still active and doing nutrition research until the last few years of his life.

In an interview with WebMD in 2000, he lamented the fact that the typical meat, cheese, and pasta-heavy dishes Americans encounter in Italian restaurants have little in common with traditional Mediterranean fare.

“The Mediterranean diet was nearly vegetarian, with fish and very little meat, and was rich in green vegetables,” he said, adding that something got lost in the translation from Italy to the U.S. “They may call it Italian, but it’s very different from the food we studied.”

Eating Mediterranean

The newly published study involved more than 74,000 healthy men and women aged 60 and older living in Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and the United Kingdom.

Study participants were asked about their diets, medical and smoking histories, exercise patterns, and other relevant health information. Researchers measured how closely they stuck to a Mediterranean-style diet using a special scale developed by the researchers. The findings are reported in the April 8 issue of the British Medical Journal.

Eating a Mediterranean diet was linked to a longer life. The largest association was seen in Greece and southern Italy, where people stuck more closely to the diet.

Mediterranean Diet: More Than Olive Oil

Trichopoulos says there is no single component of the Mediterranean diet that holds the key to longer life. Though the mantra of Mediterranean eating could be “olive oil good, saturated fats bad,” there is more to it than that.there is more to it than that.

“In this case, the total is better than the sum of the parts,” he says. “You can’t point to one thing and say that is what does it.”

People who follow traditional Mediterranean diets:

* Eat mostly plant foods, including fruits, vegetables, beans, whole grains, and nuts.
* Eat fish often but eat other animal-based foods such as red meat, poultry, and dairy sparingly.
* Drink alcohol in moderation — no more than one drink a day for women and no more than two drinks a day for men. While many believe that red wine offers health advantages over other forms of alcohol, Trichopoulos says that is still not clear. One drink equals 1.5 ounces of liquor (whiskey, gin, vodka, etc.), 5 ounces of wine, or 12 ounces of beer.
* Don’t limit fat consumption, as long as fats are derived from plants, not animals, and are not overly refined. Trichopoulos says olive oil is the best fat, but canola and soybean oils are also good.

Going to Extremes

Trichopoulos says the current mania for low-carbohydrate eating in the U.S. incorporates some elements of Mediterranean eating but not others.

“Americans tend to go to extremes when it comes to eating, and right now they hate carbohydrates and love protein,” he says. “Lowering carbohydrates is probably a good thing, but too much meat-based protein is not.”

Nutrition researcher Alice Lichtenstein, DSc, is a strong proponent of Mediterranean eating. But she worries that people will lose sight of the fact that there is more to good health than what you eat.

“Two-thirds of Americans are overweight or obese,” she says. “If everyone adopted this diet but did not change anything else, it is unlikely that they would reap the benefits.”

In other words, getting regular exercise and limiting calories, no matter what form they come in, is just as important as following a particular diet.

“There is no simple fix,” she says. “You really have to think about the whole package. Not just what you are eating, but how much you are eating and whether you are moving. There are no shortcuts to good health.”

SOURCES: Trichopoulos, A. British Medical Journal, April 8, 2005; online edition. Dimitrios Trichopoulos, department of epidemiology, Harvard School of Public Health, Boston. Alice Lichtenstein, DSc, senior scientist and director, Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center of Aging, Tufts University, Boston. WebMD Feature: “Setting the Recipe Straight: Forget Pasta if You Want Real Mediterranean Food.”

|| DukeMedNews || Exercise, Stress Management Show Physiological Benefits for Heart Patients

DURHAM, N.C. — Behavior modification techniques such as exercise and stress management can not only reduce the levels of depression and distress in heart patients, but can also improve physiological markers of cardiovascular health, according to the results of a randomized controlled trial conducted by Duke University Medical Center researchers.

According to the research team, this may be the first randomized trial to demonstrate that a non-pharmaceutical approach can have positive effects on such physiological determinants of cardiovascular health as blood flow to heart, the responsiveness of the lining of blood vessels and the ability of the cardiovascular system to regulate surges in blood pressure.

“While studies have shown that psychosocial factors such as depression, stress and anxiety place heart patients at a much greater risk of suffering future cardiac events or dying, few have looked at the effects of modifying psychosocial factors,” said Duke medical psychologist James Blumenthal, Ph.D., lead author of a study appearing in the April 6, 2005 issue of the Journal of the American Medical Association. The trial was supported by a $4.3 million grant from the National Institutes of Health.

“Our results suggest that exercise and stress management training offer considerable promise for patients with heart disease by not only improving psychosocial functioning and reactions to mental and physical stressors, but also by modifying important bio-markers of risk that may translate into improved clinical outcomes,” he said.

The Duke trial enrolled 134 patients with stable heart disease and randomized them to one of three groups – exercise, stress management or standard medical therapy. Patients randomized to the exercise group participated in 35 minutes of supervised aerobic exercise training three times a week for 16 weeks. Those in the stress management arm received 16 weekly 1.5-hour classes designed to help patients recognize the sources of stress in their everyday lives and to teach them strategies to respond more adaptively to those stresses.

Patients enrolled had stable heart disease, meaning they did not experience chest pain while at rest, and exhibited evidence of myocardial ischemia, or reduced blood flow to the heart, during exercise. All participants underwent a battery of psychological and physiological testing before randomization, which was repeated four months later.

One of the physiological markers studied was the endothelium, which forms the inner lining of the blood vessels and controls how the vessels reacted to changes in blood flow and pressure. The researchers took ultrasound images of the brachial artery of the arm before and after a tourniquet was applied and released to determine how the vessels responded. Healthy arteries will dilate to accommodate the increased blood flow, while diseased arteries are less responsive, the researchers said.

In these tests of flow-mediated dilation, patients who received the behavioral treatments displayed nearly a 25 percent improvement when compared to those patients who only received usual medical care.

“To our knowledge, this is the first study to show that stress management might reduce cardiovascular risk in part through beneficial effects on vascular endothelial function,” Blumenthal said. “This is a level of improvement is comparable to that achieved in drug trials. For that reason, these findings add additional support for the use of non-pharmaceutical approaches to treating patients with heart disease.”

The researchers also found that patients who received exercise training or stress management had improved baroreflex sensitivity, a phenomenon by which receptors located along the walls of blood vessels respond to changes in blood pressure. These receptors are connected to the heart by nerves, which carry the message to pump faster or slower in response to pressure changes.

“This finding is important because past studies have demonstrated that abnormally low baroreflex sensitivity has been shown to be associated with worse outcomes for patients with heart disease–improvement may produce clinical benefits,” Blumenthal said.

Additionally, the researchers measured changes in the left ventricle — the pumping chamber of the heart — during periods of both mental and physical stress. The research team used radionuclide imaging tests to identify wall motion abnormalities (WMAs). These WMAs, or areas of abnormal contractions of the left ventricle, are known indicators of ischemia.

“While there was no difference in WMA scores between the three groups during mental stress testing, among the subgroup of patients who had mental stress-induced WMAs before treatment, those in the exercise and stress management groups had lower WMA scores after treatment compared to patients in usual care.”

Other findings, which were expected, showed that patients in the exercise group had the largest improvements in such measures as exercise duration and aerobic capacity. For the psychosocial tests, the researchers found that exercise and stress management had reduced general distress and depression compared to usual care controls.

Future studies are planned to determine if stress management and exercise together have an even greater positive effect on these markers of cardiovascular health. The researchers also said further investigation is needed to reveal the biological mechanisms behind the improvements seen.