February 28, 2018
A new study suggests any physical movement by people aged over 70 increases their life span.
Updated 20 February
Light physical activity of any kind can significantly reduce an older person's risk of death, according to new research.
Current advice recommends accumulating at least 150 minutes a week of moderate to vigorous physical activity in bouts lasing 10 or more minutes.
For many older adults this can be unachievable, say researchers.
New research has shown that for those aged 70 and over, any movement can increase their life span.
Published in the British Journal of Sports Medicine, an observational study of more than 1,000 men aged 71 to 92 found there was a 15 per cent reduction in all-cause mortality risk for every thousand steps a day, no matter the intensity, .
Emmanuel Stamatakis, Associate Professor of Exercise, Health, and Physical Activity at the University of Sydney, says for this particular demographic the study refutes the idea that activity must be done it at least 10 minute bouts.
"Importantly this showed that it did not matter how participants accumulated their physical activity," Professor Stamatakis said.
"The key public health message from this study is that any movement in this age group matters," he told AAP.
Researchers at University College London tracked the activity levels of more than 1,181 men from the British Regional Heart Study through the use of wearable monitors for five years.
The average age of the men was 78 and all were without pre-existing cardiovascular disease.
The researchers concluded "all activities" of light intensity and upwards was associated with a reduction in overall mortality risk.
Each 30 minute increase in light physical activity per day was associated with a 17 per cent reduction in mortality, the study found.
The more vigorous the exercise the more substantial the reduction in mortality risk.
While high intensity exercise is not realistic for many older people, one thousand steps per day should is achievable for pretty much everyone with the exception of those with serious functional limitations, says Prof Stamatakis.
"It doesn't have to be in long bouts of 10 minutes or more, any movement seems to matter, any steps we are making seem to make a difference, including light intensity," he said.
October 5, 2017
Exercise Prevents Mobility Problems, and the More the Better
Less than an extra hour a week of moderate exercise (walking) can make a big difference in helping older adults stay mobile and reduce their risk of developing major mobility problems, researchers report in the journal PLoS ONE, online August 18.
It is well known that exercise prevents or improves hip fractures, heart disease and diabetes. This study was designed to tell us if exercise could prevent the onset of physical disability in older adults who were at risk for becoming disabled and if the amount of exercise performed made a difference.
According to this study of 1,635 men and women who enrolled in The Lifestyle Interventions and Independence for Elders (LIFE) Study in 2010 and 2011, between ages 70 and 89, the answer is YES.
Improvements were seen in all the 70-to-90-year-olds who added some physical activity to their weekly routines over about two years, and those who got more exercise saw greater changes. The greatest benefit was seen in those people who increased their exercise approximately 50 minutes per week over two years.
Moderate-intensity exercise (walking) is generally safe for most people. “Walking was part of our intervention and almost all older people, even those with mobility problems, can begin a walking program” according to the researcher, Roger Fielding of Tufts University in Boston.
He recommends starting slowly, with about five minutes per session and building up over time. “Try to walk most days of the week but at least five,” he said, adding that people should inform their physician that they are starting to exercise but don’t necessarily need to wait for their physician’s okay.
October 1, 2015
The numbers game: Count up the nutrients, not the calories
Is your diet calorie-dense, or nutrient-dense? As a society, the answer is definitely calorie-dense. Overall, we eat few nutrient-dense vegetables and fruits but a lot of calorie-dense refined grains, fats and sweets — in other words, foods that have more calories per bite. And most people don’t need more calories.
Can a food be both calorie-dense and nutrient-dense? Not really. Research has found that calorie-dense foods tend to also be nutrient-poor, while nutrient-dense foods tend to be lower in calories.
Nutrient-dense foods are high in the nutrients we need more of for good health, like fiber, vitamins and minerals, and low in those we need less of, like salt, sugar and unhealthful fats.
Nonstarchy vegetables have the highest nutrient-density, followed closely by fruit. Next are legumes (beans and lentils), nuts and seeds, then eggs. After that, you have meat and poultry, milk and dairy and grains. Not all foods within a group rank the same: For example, whole grains, plain yogurt and lean meats are more nutrient-dense than refined grains, sweetened yogurt and fatty cuts of meat.
Because nutrient-dense foods contain lots of nutrients with relatively few calories, they are good for your health as well as your waistline. If you want to reduce the calorie density of your meals, lowering fat is one way to do it (fat has nine calories per gram, carbs and protein have four), but this isn’t necessarily the best road to health, because some fats (nuts and seeds, avocados, olives and olive oil) have health benefits.
Rather than simply subtracting fat, add more vegetables and fruits. Vegetables and fruits are tops for nutrient-density because they are full of fiber and water. Fiber gives us only two calories per gram, because we don’t fully digest it.
Water has zero calories, but it adds satisfying weight and volume to food. According to research by Barbara Rolls, Ph.D., author of the “Volumetrics” books, people decide how much of a food to eat based on portion size, not calories.
When you reduce your calories per bite by choosing nutrient-dense foods, especially nonstarchy veggies (greens, broccoli, cauliflower, peppers, asparagus, etc.) it’s easier to eat enough nutritious food to satisfy hunger while still lowering calories. Consider this: 1 cup of chopped broccoli has 31 calories and 1 cup of brown rice has 216 calories.
When doing the traditional protein plus starch plus veggie, fill half your plate with veggies. Including a cooked nonstarchy veggie and a green salad is an easy way to do this.
Add more veggies to soups, stews and meat-based pasta sauces.
Add chopped or shredded vegetables to scrambled eggs.
Lighten burgers and meatloaf with the addition of finely chopped mushrooms (which have a “meaty” flavor of their own).
Eat more broth-based soups and moist casseroles with lots of vegetables. Both the veggies and the added water or broth help fill you up on fewer calories.
Swap veggies for some of your starches and grains. Buy a spiralizer, and embrace the zoodle (zucchini noodle). Make stir-fries with tons of veggies and a healthy portion of protein (beef, chicken, fish, tofu or tempeh), and skip the rice.
Toss your favorite sandwich fixings on top of salad greens, instead of between two slices of bread.
Use fruit for snacks. Have an apple and a small handful of nuts rather than just a large handful of nuts.
Carrie Dennett, MPH, RDN, CD is a registered dietitian nutritionist at Menu for Change and Nutrition By Carrie. Her blog is nutritionbycarrie.com and her website is carriedennett.com. Reach her at
March 17, 2015
Studies on Sleep and Weight Loss
There have been many studies on the association between sleep and weight loss. Here are a few examples:
In one study, participants decreased the amount of calories they consumed for two weeks and got either 5.5 hours or 8.5 hours of sleep per night. By the end of the study, those who got more sleep each night lost more body fat than those who got less.
In another study, 123 overweight or obese adults went on a calorie-restricted diet for 17 weeks. Similar to the first study, the amount of sleep was linked to how much weight they lost by the end of the study.
In a third study, women who slept 5 hours per night were 32% more likely to experience major weight gain (an increase of 33 pounds or more) and 15% more likely to become obese over the course of the 16-year study, compared to those who slept 7 hours a night. And, those women who slept 6 hours per night were still 12% more likely to experience major weight gain, and 6% more likely to become obese, compared to women who slept 7 hours a night.
How Does Sleep Deprivation Impact Weight Loss?
The connection between sleep and weight loss is twofold. First, when you are sleep deprived, your metabolism is slower, and second, you tend to eat more.
Getting adequate sleep appears to play an important role in one’s metabolic rate; that is, the amount of calories you burn while resting. In fact in the last study cited above, the women who were getting less sleep didn’t appear to be eating any more than the women who were getting more sleep, yet they gained significantly more weight!
A second connection between sleep and weight loss is that sleep deprived people may tend to eat more. A study recently presented at the American Heart Association showed that those who were permitted to get only 2/3 of their normal amount of sleep a night ate greater than 500 more calories per day than those who were able to get a full night’s sleep.
This urge to eat more when we are sleep deprived has a lot to do with our hormones. When you are sleep deprived, you have more ghrelin, a hormone that tells you when to eat. Sleep deprived people also have less leptin, which is a hormone that tells you to stop eating.
February 26, 2015
Study: NSAID Use After MI Has Very High Risks and should be avoided with all heart disease
A JAMA study raises specific concerns about the safety of nonsteroidal anti-inflammatory drugs among people who’ve had a recent myocardial infarction.
Using data from national registries, Danish researchers studied over 60,000 people with a first MI, one third of whom received a prescription for an NSAID following discharge. Overall, NSAID users had double the rate of bleeding events as nonusers. In particular, people taking standard dual antiplatelet therapy with aspirin and clopidogrel had 3.3 bleeding events per 100 person-years; the addition of an NSAID increased this risk to 7.6 events per 100 person-years. Increased bleeding risks were found even when NSAIDs were used for 3 days or fewer.
In addition, the rate of cardiovascular events was increased by the addition of an NSAID to other drugs.
The authors note that NSAID use in people with established heart disease remains common, despite guidelines discouraging this practice.
Editorialists conclude that for now, “practitioners would do well to advise patients with cardiovascular disease against all NSAID use (except low-dose aspirin), especially patients with a recent acute coronary syndrome.”
NOTE: NSAIDs include aspirin, Advil, Motrin, ibuprofen, Aleve, naproxen, Voltaren, etc
February 10, 2015
Where Dietary-Fat Guidelines Went Wrong
· Alice Park @aliceparkny, Feb. 9, 2015
A new review argues that there was no evidence to support the low-fat message that has been the mantra for good health since the 1970s
A little fat may not be harmful, while too much of it can be unhealthy, and even fatal. But in the latest review of studies that investigated the link between dietary fat and causes of death, researchers say the guidelines got it all wrong. In fact, recommendations to reduce the amount of fat we eat every day should never have been made.
Reporting in the journal OpenHeart, Zoe Harcombe, a researcher and Ph.D. candidate at University of the West of Scotland, and her colleagues say that the data decision makers had in 1977, when the first U.S. guidelines on dietary fat were made, did not provide any support for the idea that eating less fat would translate to fewer cases of heart disease, or that it would save lives.
“The bottom line is that there wasn’t evidence for those guidelines to be introduced,” she says. “One of the most important things that should have underpinned the guidelines is sound nutritional knowledge, and that was distinctly lacking.”
When the recommendations were made, in the 1970s, heart disease claimed more U.S. lives than any other cause of death (and has retained that distinction for most of the ensuing years), so public-health and government officials were eager to get on the low-fat bandwagon. National guidelines, endorsed by health experts and expected to be followed by physicians in doctors’ offices around the country, sent word to the American public — trim fat to about 30% of your total daily calories, and cut saturated fat, from red meat and dairy products like milk, egg and cheese, in particular down to no more than 10% of total calories.
The problem, as Harcombe notes in her study, is that advice was “arbitrary. The 30% wasn’t tested, let alone proven,” she says. In fact, some data even contradicted the idea that the fat we took in from food had anything at all to do with the artery-clogging plaques that caused heart disease. In one study, men who were fed copious amounts of high-fat foods (butter, eggs, portions of cream and the like) did not show higher levels of blood cholesterol, suggesting that the fat from food had little to do with the cholesterol circulating in the body and produced by the liver. In fact, says Judith Wylie-Rosett, a professor of epidemiology and population health at Albert Einstein College of Medicine and a spokesperson for the American Heart Association (AHA), roughly a third of the cholesterol from food becomes part of the circulating cholesterol that can potentially build up in heart vessels — “not a major driver,” she says.
That’s why the AHA, among other groups, has gradually revised its guidelines and moved away from the strict guidance to lower fat intake. Instead, they focus on the types of fats in our foods, and on the diet as a whole. For example, Harcombe argues that the focus on fat, and on cholesterol and saturated fat in particular, has had a boomerang effect on the health of Americans. When we cut the fat, we replaced it with carbohydrates, which are broken down by the body into sugars and into a different form of fat, triglycerides, which may actually do more harm to the heart than cholesterol from animal products like red meat and dairy.
So the AHA, while still urging people to be aware of how much saturated fat they eat, are not as focused on limiting total fat intake. “The message is still to use lean meats and fish, but the emphasis is not so much on total fat,” says Wylie-Rosett.
Harcombe would argue that even that doesn’t go far enough, according to her results. In her analysis of six trials in which people were randomly assigned to eat higher or lower amounts of dietary fat, she found no difference in heart attacks and mortality rates among the two groups. “What we are saying is that dietary interventions did not provide the evidence that dietary fat is associated with heart disease outcomes,” she says.
Does that mean a diet of daily steak and eggs won’t harm the heart? Harcombe admits that she also doesn’t have evidence for that position, but says that her findings do expose the shortcomings of current recommendations and the need for more rigorous studies. Given the current state of knowledge, she says “We are not doing our best by the consumer at the moment.” Wylie-Rosett agrees. “We don’t need to restrict fat to below 30% of daily calories, but do we want to allow up to 70%? We don’t know.”
Harcombe’s own solution to the confusion is to stick with the basics. “It’s one message, in three words — eat real food,” she says. The less adulterated and processed your diet is, the more nutrients and healthy fats, proteins and carbohydrates your body will get, and the less you’ll have to worry about meeting specific guidelines or advice that may or may not be based on a solid body of evidence.
January 20, 2015
Lack of Exercise More Deadly Than Obesity, Study Suggests
Just a 20-minute brisk walk each day can lower odds of early death, researchers add
By Steven Reinberg
WEDNESDAY, Jan. 14, 2015 (HealthDay News) -- Being sedentary may be twice as deadly as being obese, a new study suggests.
However, even a little exercise -- a brisk 20-minute walk each day, for example -- is enough to reduce the risk of an early death by as much as 30 percent, the British researchers added.
"Efforts to encourage small increases in physical activity in inactive individuals likely have significant health benefits," said lead author Ulf Ekelund, a senior investigator scientist in the Medical Research Council Epidemiology Unit at the University of Cambridge.
The risk reduction was seen in normal weight, overweight and obese people, Ekelund said. "We estimated that eradicating physical inactivity in the population would reduce the number of deaths twice as much as if obesity was eradicated," he said.
December 24, 2014
"Sugar is definitely the worst thing in the world."
-- RD Catherine Taylor, as quoted by U.S. News and World Report. In this article they review research showing sugar, not saturated fat, is what is wrong with our diet. By Anna Medaris Miller, Staff Writer |Dec. 23, 2014
December 15, 2014
Published in Cephalalgia. 2014 Dec 4.
Objectively measured physical activity in women with and without migraine.
AIM: The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine in women with and without migraine.
METHODS: Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA
RESULTS: Women with Migraine spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p=0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls
CONCLUSIONS: Women with migraine spent nearly 1.5 hours/day less in Physical Activity compared to women without migraines.
NOTE: This is just one of many studies indicating that exercise is part of the solution for migraines. For more information on preventing migraines see our Migraine Prevention guidelines in the Education section or schedule an appointment to discuss your migraines.
December 12, 2014
Juice Consumption Increases Blood Pressure
Is It Time To Give Up Drinking Juice For Good?
No matter how much vitamin C it may have or which "superfruit" it's supposedly made from, fruit juice isn't healthy. Fruit juices deliver a wallop of sugar without the blood-sugar-stabilizing fiber needed to digest it, which is found in whole fruit.
Now, add another strike against juice: A recently announced study from the Swinburne University of Technology in Australia found that drinking a glass of fruit juice every day is associated with high blood pressure.
The central systolic blood pressure of daily drinkers was 4 points higher than non juice drinkers. [NOTE: THIS MAY NOT SEEM LIKE A LARGE INCREASE, BUT IT IS EQUIVALENT TO ABOUT HALF OF THE DECREASE IN BLOOD PRESSURE ASSOCIATED WITH THE USE OF ONE OF THE MOST POPULAR BLOOD PRESSURE DRUGS] Why does fruit elevate blood pressure? Fruit juice consumption contributes excessive sugar, a known trigger of blood pressure spikes. It has the same effect as drinking soda.
So is it time to swear off juice for good? Or does the drink still have any nutritional merit?
"In all honesty, I really don't recommend drinking juice,"
says nutritionist Stefanie Sacks.
December 11, 2014
Sugar Hurts Heart Health More Than Salt, Mostly With Heart Disease And Blood Pressure
Dec 10, 2014 06:30 PM By Justin Caba@jcaba33
Sugar is more detrimental to high blood pressure than salt. John Watson, CC by 2.0
The American Heart Association calls a healthy diet and lifestyle "your best weapons to fight cardiovascular disease," especially when it comes to high blood pressure, heart disease’s most detrimental risk factor. A recent paper featured in the British Medical Journal (BMJ) suggests that dietary guidelines for treating hypertension and subsequent cardiovascular disease should focus on reducing the amount of added sugars, primarily fructose, consumed by people at risk for heart disease.
"Sugar may be much more meaningfully related to blood pressure than sodium, as suggested by a greater magnitude of effect with dietary manipulation," the study’s research team said in a statement. "Compelling evidence from basic science, population studies, and clinical trials implicates sugars, and particularly the monosaccharide fructose, as playing a major role in the development of hypertension (high blood pressure)."
James DiNicolantonio from the Department of Preventive Cardiology at Saint Luke's Mid America Heart Institute in Kansas City and Sean Lucan from the Department of Family and Social Medicine at Albert Einstein College of Medicine, Montefiore Medical Center in the Bronx called the dietary approach of cutting salt intake to lower high blood pressure “debatable.” They argue that restricting salt intake leads to a relatively small drop in blood pressure readings. Some research even suggests that between 3 and 6 grams of salt per day is optimal for health, while less than 3 grams of salt can be harmful.
DiNicolantonio and Lucan suggests that dietary guidelines target sugar, high fructose corn syrup in particular. High fructose corn syrup is the most common sweetener used in processed food and drink, such as sugary fruit juice and soda. A diet consisting of daily added sugar intake that adds up to a quarter of total daily calories can triple a person’s heart disease risk compared to people who consume less than 10 percent. Consuming over 74 grams of fructose a day can also lead to a 77 percent higher risk of blood pressure above 160/110 mm Hg.
"Moreover, evidence suggests that sugars in general, and fructose in particular, may contribute to overall cardiovascular risk through a variety of mechanisms. Worldwide, sugar sweetened beverage consumption has been implicated in 180,000 deaths a year," researchers explained.
According to a report issued by the Centers for Disease Control and Prevention, around 16 percent of children and adolescents’ total caloric intake comes from added sugars. Over 40 percent of calories from added sugar come from sugar-laden beverages, like soda. DiNicolantonio and Lucan noted that naturally occurring sugar found in fruit and vegetables have no harmful effect on our health.
"Just as most dietary sodium does not come from the salt shaker, most dietary sugar does not come from the sugar bowl; reducing consumption of added sugars by limiting processed foods containing it, made by corporations, would be a good place to start," the research team added. "The evidence is clear that even moderate doses of added sugar for short durations may cause substantial harm."
Source: DiNicolantonio J, Lucan S. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. BMJ. 2014.
For more information on sugar and pain see our Diet module in the Education section.
December 8, 2014
Vitamin D Deficiency Ups Odds of Asthma Exacerbation
Cohort study shows increased odds of exacerbation, even after adjustment for confounders
FRIDAY, Dec. 5, 2014 (HealthDay News) -- Vitamin D deficiency is associated with increased odds of asthma exacerbations, according to a study published in the December issue of Allergy.
December 3, 2014
"As the weather turns darker and we head into winter, be aware that, without natural exposure to sunlight on bare skin, vitamin D deficiency is a real issue."
-- RD Ginger Hultin, writing in Food & Nutrition magazine online's Stone Soup blog
Vitamin D deficiency can cause chronic pain and depression. For more information about Vitamin D and pain go to our Vitamins and Minerals module in the Education section.
November 8, 2014
Have a Minute? Then You Have Time for a Workout
By Carl Engelking | November 6, 2014 3:04 pm
Leave it to science to invalidate the excuse that there’s just not enough time in the day for a workout. In May, the New York Times published a story about the scientifically proven 7-minute workout routine to stay fit. But who has seven minutes? Now, scientists have discovered that just one minute of all-out, high-intensity exercise three times a week can markedly improve muscle and heart health in overweight individuals.
Researchers from McMaster University in Ontario, Canada recruited 14 men and women who were overweight, but in good health, to test the expedited fitness regimen. All the participants regularly exercised two or fewer times per week, and were far from reaching the recommended 150 minutes of weekly moderate exercise.
Researchers recorded participants’ baseline health information and took blood and muscle samples. Then, they put participants on a 6-week training regimen. During the training period, researchers individually customized each person’s diet using a mathematical formula to calculate their required calories — roughly 2,600 calories for men and 1,800 calories for women.
Participants returned to the lab three times a week for a supervised training session. Each workout consisted of 3 sets of all-out cycling against resistance for 20 seconds separated by 2 minutes of low intensity cycling. Each session also included a 2-minute warm-up and a 3-minute cool-down. Therefore, the weekly regimen involved a total of 3 minutes of all-out pedaling, and an ultimate time commitment of 30 minutes per week if you include warm-ups and cool-downs.
It turns out that just 1 minute of intense exercise three times a week for 6 weeks was potent enough to induce physiological changes in the bodies of 14 overweight people, based on measurements following their workouts.
Blood pressure and blood glucose readings for both men and women improved. Their bodies’ maximal oxygen uptake (VO2 max) — one of the best measures of cardiovascular fitness — also increased by 12 percent. Researchers published their findings Monday in the online journal PLOS One.
Researchers write that their study “provides further evidence of the potential for very brief, intense bursts of exercise to elicit physiological adaptations that are associated with improved health status in a time-efficient manner.” In other words: busy people, your cover is blown.
November 6, 2014
Smoking linked to increased risk of chronic back pain
People who smoke are much more likely to develop chronic back pain than those who do not smoke. These are the findings of a new study by researchers from Northwestern University in Evanston, IL.
Researchers found that people who smoke may be much more likely to develop chronic back pain, as the habit reduces their resilience to it.
This is not the first study to link smoking to chronic pain. But according to the research team, led by Bogdan Petre of the Feinberg School of Medicine at Northwestern, it is the first study to suggest that smoking interferes with a brain circuit associated with pain, making smokers more prone to chronic back pain.
Back pain is one of the most common medical problems in the US, estimated to affect 8 out of 10 Americans at some point in their lives. According to the American Chiropractic Association, back pain is the main reason for missed days at work and the second most common reason for doctor's visits.
This latest study, published in the journal Human Brain Mapping, suggests that smokers could reduce their risk of developing chronic back pain by quitting the habit.
To reach their findings, the researchers analyzed 160 participants who had recently developed subacute back pain, defined as back pain lasting 4-12 weeks. They also assessed 32 participants with chronic back pain - defined as having back pain for 5 years or more - and 35 participants with no back pain.
On five separate occasions over a 1-year period, all participants completed questionnaires that gathered information about their smoking status and other health conditions. They also underwent magnetic resonance imaging (MRI) brain scans.
The brain scans, the researchers say, were used to assess activity between two brain regions - the nucleus accumbens and the medial prefrontal cortex. Both of these regions play a role in addictive behavior and motivated learning.
Smoking increases brain activity that reduces resilience to chronic back pain
Petre and his team found that the connection between these two brain regions plays a crucial role in chronic pain development. They explain that the stronger the connection between them, the less resilient an individual is to chronic pain.
Smoking appears to affect this connection. The researchers found that compared with nonsmoking participants, those who smoked had a stronger connection between the nucleus accumbens and the medial prefrontal cortex, increasing their risk of chronic back pain. The team calculated that smokers are three times more likely to develop chronic back pain than nonsmokers.
"But we saw a dramatic drop in this circuit's activity in smokers who - of their own will - quit smoking during the study," explains Petre. "So when they stopped smoking, their vulnerability to chronic pain also decreased."
Commenting on their findings, the researchers say:
"We conclude that smoking increases risk of transitioning to chronic back pain, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning."
The team points out that smoking participants who managed their chronic back pain with medication - such as anti-inflammatory drugs - did experience some pain reduction, but that these medications did not alter brain circuitry.
As such, they suggest that smokers could reduce their risk of chronic back pain by engaging in smoking cessation programs or other behavioral interventions that may help them quit the habit.
Because the team's findings show that smoking affects brain circuitry linked to chronic pain, they suggest that there may be a link between addiction and chronic pain in general.
October 15, 2014************************
Ibuprofen outperforms morphine for fracture pain in children
Ibuprofen was as effective as oral morphine in relieving the pain of children and teens with fractures and was linked to fewer severe adverse reactions, Canadian researchers wrote in the journal CMAJ. Morphine was associated with side effects such as nausea, vomiting and drowsiness.
Medical News Today (10/27)
Study estimates persistent pain incidence at 19% of U.S. adults
Wednesday October 29, 2014
About 39 million people in the U.S., or 19%, have persistent pain, and the incidence varies according to age and gender, according to a recent study.
For the study, researchers at the Washington State University College of Nursing in Spokane defined persistent pain as frequent or constant pain lasting longer than three months. Their research goals were to:
• Identify groups at higher risk for persistent pain.
• Identify body sites, chronic conditions and disabilities associated with persistent pain.
• Assess the relationship between persistent pain and anxiety, depression and fatigue.
• Describe the individual experience of persistent pain.
Researchers used data from the 2010 Quality of Life Supplement of the National Health Interview Survey to calculate the prevalence of persistent pain. They also calculated persistent pain based on risk group, chronic condition and disability status.
Findings were published in the October issue of The Journal of Pain, the peer-reviewed publication of the American Pain Society.
Results of the analysis showed about 19% of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. The age group at highest risk of persistent pain was adults ages 60-69, findings showed. Women also had a slightly higher risk of persistent pain than men.
Persistent pain was more common in adults who were overweight (18.2%) or obese (25.3%), compared with those at a healthy weight (14.6%). Those who had been hospitalized one or more times in the previous year also were at higher risk for persistent pain (35.5%) than those who had not been hospitalized during that time (17.3%), the study found.
Persistent pain also correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue, the researchers found. Their analysis found 45.3% of adults who reported daily feelings of anxiety also reported persistent pain, as did 56.8% of those with depression and 63.7% of those with fatigue.
The study also found persistent pain was closely linked to disability, with adults who could not work because of disability at the highest risk of reporting persistent pain (60.6%). About half of the adults who were limited in type or amount of work reported persistent pain, findings showed.
In 2011, the Institute of Medicine reported about 100 million Americans have chronic pain. Study authors said the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in definitions of persistent pain.
In the 2010 NHIS, about 60% of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42% of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.
From a public health perspective, the difference is significant, researchers wrote in the study. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.
“From a public health planning perspective, persistent pain can be thought of as an indicator of unmet need for pain management in the general population, as well as an obvious risk factor for disability, depression and dependency,” the authors wrote.
Curcumin as Effective as Ibuprofen (Advil) in Reducing Pain and Improving Function in Patients with Knee Osteoarthritis
Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;9:451-458.
Knee osteoarthritis (OA) is a major cause of pain, disability, and diminished quality of life, especially among the elderly. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for OA pain relief; unfortunately, some patients cannot use NSAIDs because of adverse effects. Curcumin, a substance found in the spice turmeric (Curcuma longa syn. C. domestica), has been shown to inhibit the joint inflammatory process. In an earlier study, these authors evaluated the efficacy of 2,000 mg daily of turmeric extracts compared with 800 mg daily of ibuprofen in 107 patients with knee OA for 6 weeks.1 Noting some limitations of that study, the authors conducted this multicenter, double-blind, randomized, controlled trial using a lower dosage of curcumin extract and a therapeutic dose of ibuprofen for a shorter duration to determine its efficacy and safety in pain reduction and functional improvement compared with the daily use of ibuprofen.
From July 2010 to March 2012, the authors recruited patients with knee OA from 8 tertiary hospitals throughout Thailand. The patients, aged 50 years and older, had to meet the American Rheumatism Association criteria for primary knee OA, with a numerical rating of knee pain of 5 or greater out of 10.
Upon enrollment, the patients received a knee x-ray and were randomly assigned to receive either 1,200 mg daily of ibuprofen (n=182) or 1,500 mg daily of curcumin extract (n=185). Both medications were manufactured by the Department of Pharmacy at Siriraj Hospital in Bangkok, Thailand. Grounded powder from dried rhizomes of turmeric was extracted with ethanol and then evaporated to obtain ethanol extract as a semisolid containing oleoresin and curcuminoids. Removing the oleoresin yielded a total curcuminoids content between 75% and 85%. Each curcumin capsule contained 250 mg curcuminoids. The patients took 2 capsules after meals 3 times daily for 4 weeks and did not use other medications, except for tramadol for severe pain.
Outcomes, evaluated at baseline and at the end of weeks 2 and 4, were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Thai version, and a 6-minute walk distance. Three WOMAC subscales (pain, stiffness, and function) ranged from 0 to 10. The authors designed the study as a noninferiority trial assuming a significant difference of ±0.5 point in WOMAC pain score after treatment.
Of 524 patients with knee OA screened, 367 were recruited; of the initial patients enrolled, 160 in the ibuprofen and 171 in the curcumin groups completed the study. Baseline characteristics among the patients were similar. Nearly 60% had unilateral knee OA; few patients (7%) used walking aids; and roughly one-third used knee support and took pain medications. At baseline, the WOMAC scores, which were higher than 5 out of 10, were similar in the 2 groups. The 6-minute walk distance was 304 meters (997 feet) in the ibuprofen group and 310 meters (1,017 feet) in the curcumin group.
The authors report that WOMAC scores decreased significantly in both groups from baseline to the end of the study (P<0.001); however, no significant between-group differences were observed. A noninferiority test revealed that the mean difference (95% confidence interval) in the curcumin group of the WOMAC total (P=0.010), WOMAC pain (P=0.018), and WOMAC function (P=0.010) subscales at week 4 adjusted by week 0 was within 0.5 point, showing similar improvements with both treatments. There was also a similar improvement in the 6-minute walk distance at week 4 in both groups.
Treatment compliance was similar in both groups. Two patients in the ibuprofen group and 5 in the curcumin group used tramadol; the difference was not significant. Overall, no between-group differences were observed in the number of patients reporting adverse events. The rate of abdominal pain and distension, however, was significantly lower in the curcumin group compared with the ibuprofen group (P=0.046). Most patients (96% of the ibuprofen group and 97% of the curcumin group) were satisfied with the treatment, and two-thirds considered themselves as improved.
The authors conclude that the curcumin extract was as efficacious as ibuprofen in reducing pain and improving function in patients with knee OA. Furthermore, although the safety profile was similar between the 2 groups, fewer gastrointestinal complaints were reported in the curcumin group.
1Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, Wattanamongkonsil L, Thamlikitkul V. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009;15(8):891-897.
Ginger Comparable to Sumatriptan (Imitrex) but Better Tolerated for the Treatment of Migraine
Maghbooli M, Golipour F, Moghimi Esfandabadi A, Yousefi M. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014;28(3):412-415.
Migraine headaches are chronic and can occur several times per month. Patient satisfaction with therapy varies, and many patients turn to alternative therapies. Ginger (Zingiber officinale) has a good safety record. The purpose of this randomized, double-blind, controlled study was to evaluate the efficacy of ginger powder on migraine without aura and compare it to standard sumatriptan treatment. Sumatriptan is a synthetic pharmaceutical used to treat migraine.
Patients (n=100, aged ≥ 18 years) with migraine without aura as confirmed with the International Headache Society Classification (ICHD-II) participated in this study conducted at the Neurology Clinic of Zanjan Vali-e-Asr Hospital; Zanjan, Iran. Other inclusion criteria were a high school diploma or higher, and headache frequency of 2-10 days/month. Exclusion criteria were a history of biliary calculus or peptic ulcer disease, allergic reaction, hemorrhagic diathesis or using anticoagulants, history of ischemic heart disease or Prinzmetal's angina, pregnancy or lactation, and headache following head trauma. Patients randomly received either 250 mg ginger powdered rhizome (Zintoma; Goldaru Pharmaceutical; Isfahan, Iran) or 50 mg sumatriptan (Imegraz®; Razak Laboratories; Tehran, Iran), and were instructed to take 1 tablet upon headache onset. The study duration was 1 month. All patients were instructed to continue their previous maintenance therapeutic regimens. At each migraine attack, patients filled out a questionnaire recording the time of headache onset, headache severity (rated on a visual analog scale), timing of drug intake, and self-assessments following 30, 60, 90, 120 min, and 24 h.
On average, patients in both groups had had migraine attacks for approximately 7 years. Prior to the study, patients in the sumatriptan group had migraine attacks a mean of 5.8 times per month, and patients in the ginger group had migraine attacks a mean of 4.9 times per month. During the study, the frequency of migraine attacks was 4.6 times per month for both groups. The headache severity 2 hours after treatment was similar between the groups with 44% of both groups headache free. At 2 hours, both groups had a similar and significant reduction in headache severity compared to the onset of headache (P < 0.0001 for both). Headache relief, defined as ≥90% decrease in headache severity, occurred in 70% of sumatriptan-treated and 64% of ginger-treated patients at 2 h following treatment. The greatest reduction in headache severity was at 30 minutes, followed by 1 h; the time course was similar in both groups. High treatment satisfaction was similar between groups (86% vs. 88%). Eighty-eight percent of the sumatriptan group and 72% of the ginger group reported that they wanted to continue the treatment (P=0.139).
Patients (20%) in the sumatriptan group reported adverse events (AEs) of dizziness, sedation, vertigo, and heartburn. Patients (4%) in the ginger group reported AEs of dyspepsia (indigestion). Significantly more sumatriptan-treated patients had AEs (P=0.028).
The authors conclude that ginger had similar efficacy as sumatriptan but was better tolerated for the treatment of migraine without aura. They recommend ginger treatment of migraine for patients who are not responsive to other medications or who prefer to use herbal therapies. Taken in conjunction with evidence from other studies, the authors anticipate "that increasing the total amount of ginger intake per attack can greatly enhance migraine relief rate."
Extremely Short–Duration High-Intensity Training Substantially Improves the Physical Function and Self-Reported Health Status of Elderly Adults
Simon B. Adamson MbR, Ross Lorimer PhD, James N. Cobley PhD and John A. Babraj PhD
Article first published online: 12 JUL 2014
NEWSER) – Not feeling up for a half-hour on the bike? Can't find the time to jog or walk a few miles? Good news out of Abertay University in Scotland, where researchers put 12 retired people to the test. Coming in twice a week for six weeks, the volunteers, all over age 60, were instructed to bike for 6-second bursts of high intensity on an exercise bike, then rest for at least one minute. The bursts gradually increased until, by the end of the trial, they were doing 10 of them per session, for a full minute of total exercise, reports the Daily Mail. The result? A 9% reduction in blood pressure, an increased ability to get oxygen to their muscles, and an easier go at day-to-day activities like walking the dog, the BBC reports.
"The broad message is that you're never too old, too frail, too ill to benefit from exercise, as long as it's carefully chosen," the honorary secretary of the British Geriatrics Society says, adding that he'd like to see the research done on people in their 80s and 90s. The researchers say that this is the first time this type of high-intensity training has been studied in seniors, and they're already planning larger trials. Perhaps counterintuitively, these bursts of effort could be safer for the heart than a reduced yet prolonged strain, one researcher explains. (Meanwhile, check out how running for just minutes a day might help, too.)
Short bursts of power walking 'helps diabetics': It lowers blood sugar, say scientists
Diabetics are usually advised to avoid high-intensity exercise and walk
Scientists have found interval training had greater health benefits
Alternating fast and slow walking led to better control of blood sugar levels
By JENNY HOPE
PUBLISHED: 19:12 EST, 4 August 2014 | UPDATED: 10:38 EST, 5 August 2014+2
Scientists found interval walking training led to better control of blood sugar levels
Short bursts of fast walking could hold the key to managing diabetes, according to a study.
Researchers found that patients who alternated between three minutes of rapid walking and three minutes of slow walking over an hour had better control of blood sugar levels than those who walked at a constant pace.
Traditionally, those with diabetes have been advised to stick to walking at a moderate pace and avoid high-intensity exercise in case it causes injury and discourages them from keeping active.
But scientists from Copenhagen University found interval walking training – or alternating between fast and slow walking – had greater health benefits and led to better control of blood sugar levels, a key marker for type 2 diabetes.
The research is published in Diabetologia, the journal of the European Association for the Study of Diabetes.
The Danish study involved patients aged between 57 and 61 who had type 2 diabetes and were receiving a variety of medications except insulin. Eight were randomly assigned to a control group, 12 to a continuous walking training group and 12 to an interval walking training (IWT) group.
The two walking groups were instructed to train for one hour, five times a week, during the four-month study period.
Their activity was tracked using a heart rate monitor and a training computer that included an accelerometer to measure their speed and movement.
IWT consisted of walking quickly for three minutes then slowly for three minutes, and repeating this throughout the session. The aim was to achieve 70 per cent of peak energy expenditure during fast walking and 40 per cent during slow walking.
Those in the continuous-walking group walked at the same moderate speed throughout each session.
The aim was to achieve 55 per cent of peak energy expenditure. Improved blood sugar control was found only in the IWT group, resulting in lowered glucose levels after exercise and probably caused by increased insulin sensitivity. No changes occurred in the continuous walking group or the control group.
In a previous study from the same research team led by Dr Thomas Solomon, interval walkers lost an average of half a stone in weight, while the weight of continuous walkers did not change.
Traditionally, those with diabetes have been advised to stick to walking at a moderate pace and avoid high-intensity exercise in case it causes injury and discourages them from keeping active
The weight loss was thought to be caused by ‘post-exercise oxygen consumption’ – a phenomenon by which the body burns more fat after intensive exercise.
The researchers said: ‘Whether these beneficial effects of IWT continue and result in better health outcomes in the long term must be determined in order to justify the clinical utility of interval training for people with type 2 diabetes.’
Dr Richard Elliott, of the charity Diabetes UK, said: ‘This small study builds on previous evidence to suggest that interval training, involving alternating periods of high and low intensity exercise, might help people with type 2 diabetes to manage their blood glucose levels.
‘It found that interval training seemed to be linked to improvements in insulin sensitivity around the body. Further research is needed to find out if this form of exercise yields greater long-term health benefits … and of course it might not be suitable for everyone with the condition.’
Risk of death from heart disease was lower in regular runners
July 28, 2014 / Author: Sean Kinney / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh
(dailyRx News) With so many options for exercise, it can be tough to choose one that will fit into your schedule and provide the maximum health benefits. Taking up running might be one of your best bets.
Running in your free time may reduce the risk of death in general and cut down on the risk of death from cardiovascular complications like heart disease and stroke, new research suggests.
Researchers from the University of Iowa found that, regardless of how far, fast or often they ran, runners were significantly less likely than others to die from any cause.
"Take up running as a healthy leisure activity."
The research was conducted by Duck-chul Lee, PhD, assistant professor in the Iowa State University Kinesiology Department in Ames, and colleagues.
Dr. Lee and team set out to analyze the link between running, death in general and death specifically from cardiovascular disease.
The researchers studied 55,137 adults between ages 18 and 100 during a 15-year period. Participants answered questions about running habits.
During the 15-year study period, 3,413 participants died. Of those, 1,217 of the deaths were linked to cardiovascular disease. In that group, 24 percent reported running as part of their exercise.
Runners had a 30 percent lower risk of death from death by any cause, according to the study, and a 45 percent lower risk of death from heart disease or stroke.
Dr. Lee and associates also found that runners lived an average of three years longer than non-runners.
The results were consistent regardless of personal factors like sex and age, and exercise measurements including distance, speed and frequency.
The researchers found that people who ran for six years or longer had a 29 percent lower risk of death from any cause and a 50 percent lower risk of death from heart disease or stroke.
"Since time is one of the strongest barriers to participate in physical activity, the study may motivate more people to start running and continue to run as an attainable health goal for mortality benefits," Dr. Lee said in a prepared statement. "Running may be a better exercise option than more moderate intensity exercises for healthy but sedentary people since it produces similar, if not greater, mortality benefits in five to 10 minutes compared to the 15 to 20 minutes per day of moderate intensity activity that many find too time consuming."
The study was published online July 28 in the peer-reviewed Journal of the American College of Cardiology.
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