It's Never Too Late to Get Healthy

Even starting in middle age reduces risk of heart disease and death, study shows

By Steven Reinberg
HealthDay Reporter

THURSDAY, June 28 (HealthDay News) -- Adopting a heart-healthy lifestyle makes a difference, even if the change doesn't come until middle age.

In fact, people who eat right and exercise more can substantially reduce their risk for cardiovascular disease and death even if they're in their 50s or 60s, researchers from the Medical University of South Carolina report.

Consuming at least five fruits and vegetables daily, exercising at least 2.5 hours per week, maintaining a healthy weight and not smoking can lessen your chances of heart trouble by 35 percent, and your risk of dying by 40 percent, compared to people with less healthy lifestyles, according to the report in the July issue of the American Journal of Medicine.

"We call this the turning-back-the-clock study," said lead researcher Dr. Dana E. King. "We want to emphasize that it's not too late change, and the benefits of a healthy lifestyle don't accrue only to people who have been doing this all along, but you can make changes in your 50s and 60s and have a healthier longer life because of it."

King said his team wanted to test if, once you reach middle age, it's too late to adopt healthy habits and improve your health. "We found that it's not too late," he said. "The benefits were dramatic and immediate, even at age 65."

"Some people in middle age don't change, because they think the damage is done," King said. "In fact, in this study, the chances of dying or having a heart attack were reduced by a third after just four years of living a healthy lifestyle."

In the study, King's team collected data on 15,792 men and women aged 45 to 64 who took part in the Atherosclerosis Risk in Communities Study.

The researchers found that during four years of follow-up, the benefit of switching to a healthy lifestyle after age 45 became apparent. In addition, the benefit happened even with modest changes in health habits.

Moreover, a healthy lifestyle was beneficial when compared with people with three or fewer healthy habits, not just compared to people with no healthy habits or only one of the healthy habits, King's group found. While people with only three healthy habits had lower mortality, they did not reduce their risk for cardiovascular disease.

Unfortunately, only 8.5 percent of people in the study practiced these four healthy behaviors, and only 8.4 percent adopted these lifestyle changes after age 45.

King noted that men, blacks, those without a college education, those with lower income, or those with a history of high blood pressure or diabetes were all less likely to adopt a healthy lifestyle past age 45.

One expert noted that living healthy reduces your risk of other diseases, too.

"Most experts agree that a health-promoting lifestyle -- eating well, being active, not smoking -- can cut overall risk of heart disease by 80 percent, cancer risk by 60 percent, and diabetes risk by 90 percent," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

King and his colleagues show that it may never be too late to start over, Katz said. "Healthy living is the most powerful medicine of all. It requires no prescription, and all of the side effects are beneficial, too. It can, admittedly, be tough at times to get there from here, but it's well worth it, and anytime is a good time to start."

Another expert agreed.

"These are very encouraging results," said Alice H. Lichtenstein, director of the Cardiovascular Nutrition Lab and Gershoff Professor of Nutrition at the USDA Human Nutrition Research Center at Tufts University.

"They confirm that adopting heart-healthy behaviors, regardless of age, can lead to clear benefits," Lichtenstein said. "Additionally, by identifying individuals who are more likely to adopt heart-healthy behaviors and who is not, more targeted programs to help the more unlikely ones to change can be developed."

More information

For more information on healthy living, visit the American Heart Association.

SOURCES: Dana E. King, M.D., Medical University of South Carolina, Charleston; David Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Alice H. Lichtenstein, D.Sc., director, Cardiovascular Nutrition Lab, Gershoff Professor of Nutrition, USDA Human Nutrition Research Center, Tufts University, Boston, and vice chairwoman, nutrition committee, American Heart Association; July 2007, American Journal of Medicine

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Exercise: The best medicine

By Sally Squires/ The Lean Plate Club

“Walk two miles and call me in the morning.”
That’s what doctors could soon prescribe if the new leaders of two major medical groups have their way.
“We’re trying to get every physician to prescribe exercise,” says Robert Sallis, a California physician who recently became president of the American College of Sports Medicine. “Physicians have a moral responsibility to inform patients of the danger of inactivity and the health benefits of being more active.”
That’s also the message from the new head of the American Medical Association.
“We are in lockstep with them on that concept,” says incoming AMA President Ronald M. Davis, who is also the director of the Henry Ford Health System’s Center for Health Promotion and Disease Prevention in Detroit. “We need to get doctors to prescribe exercise more and we need to get patients to follow that advice.”

More than half of Americans fail to get the 30 minutes of physical activity recommended daily to provide health benefits, according to the Centers for Disease Control and Prevention.
So many Americans are inactive that some experts have coined a new term for it: sedentary death syndrome. The condition helps cut short an estimated 250,000 lives annually, according to Frank Booth, professor of physiology at the University of Missouri. Research suggests that people who are sedentary spend about $1,500 more annually on medical bills than do their more active counterparts.
“There are also studies to show that they miss more work and are not as productive,” says Sallis. Research shows that regular physical activity improves health by cutting the risk of heart disease, stroke, colon cancer, diabetes and high blood pressure. Even brief bouts of activity several times a day can help control weight and relieve arthritis, anxiety and depression.
“Exercise is medicine,” Sallis says. “We know that it works very well. We just don’t have the proper way to administer it.”
That’s where the doctors come in. Sallis is leading the charge to get doctors and other health professionals to ask every patient at every office visit about their exercise habits.
It isn’t just activity that doctors are being asked to encourage. Harvard Medical School and the Culinary Institute of America recently teamed up to teach physicians to cook more healthfully for their own personal consumption.
The theory is that by teaching doctors how to cook, they may be more likely to encourage their patients to do the same. Harvard also is considering establishing teaching kitchens in hospitals. The goal would be to take patients who have recently been diagnosed with diabetes, heart disease or other nutritionally related conditions, and show them how to make healthier meals.

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Fitness level predicts heart problems

By Amy Norton

NEW YORK (Reuters Health) - Cardiovascular fitness may predict the odds of a future heart attack in men and women with no apparent signs of heart disease, a large study suggests.

Researchers found that of more than 26,000 adults with no symptoms of heart disease, those who showed the greatest endurance on exercise tests had the lowest risk of suffering a heart attack or stroke over the next 10 years.

Men with the highest fitness levels were 31 percent less likely than their least-fit counterparts to have a non-fatal heart attack or stroke, or to require an invasive procedure for heart artery blockages. The risk for men with moderate fitness levels fell between the highest and lowest fitness groups.

A similar pattern emerged among women, the study authors report in the American Journal of Epidemiology.

By now, most people may have heard the familiar advice to get 30 minutes of moderate exercise each day for the sake of their health. The new findings underscore how important fitness -- and, therefore, regular exercise -- is in heart health, according to Dr. Xuemei Sui, the study's lead author.

Other findings in this same study group, she told Reuters Health, have shown "again and again" the benefits of boosting fitness through exercise.

This includes not only a lower risk of death from cardiovascular disease, but also a lower likelihood of premature death from a range of causes, noted Sui, a research associate at the University of South Carolina in Columbia.

The current findings are based on 20,728 men and 5,909 women who had no symptoms of heart disease when they entered the study, somewhere between 1971 and 2001. At that time, they underwent a treadmill test to gauge their fitness levels, had physical exams and completed questionnaires on their lifestyle habits.

They were then followed for an average of 10 years, during which time 1,512 men and 159 women had a non-fatal heart attack or stroke, or underwent an artery-clearing procedure.

Sui's team found that, even when several other factors were accounted for -- such as age, smoking and weight -- higher fitness levels seemed to protect against heart problems.

The findings, according to the researchers, argue for the value of more routine exercise testing of people with no symptoms of heart disease. Those test results, they say, could be used along with traditional risk factor assessment -- like measuring blood pressure and cholesterol -- to help predict a person's odds of heart trouble down the road.

Right now, however, it's not standard practice for people without heart disease symptoms to undergo exercise testing. The test is generally reserved for people who have symptoms, such as chest pain, or a high risk of heart disease, Sui noted.

SOURCE: American Journal of Epidemiology, June 15, 2007.

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Health costs of aging workers imperil state

Study cites trends in population, obesity, medical expenses

By Jeffrey Krasner

An aging workforce, combined with the growing obesity epidemic and the high cost of medical care, could result in an epidemic of preventable illness that might cripple the region's economy, according to a study being released this morning by the New England Health Care Institute and the Boston Foundation.

Wendy Everett , president of the not-for-profit healthcare institute which seeks to improve patient care, said population and cost trends could conspire to make the Boston area the first in the United States to be severely affected by the intersection of demographics and disease. She warned that unless action is taken quickly, within the next eight years companies and municipalities will be hit with rising healthcare costs that make today's annual double-digit increases seem modest by comparison.

"The message of the report is, here we are in paradise, with the best teaching hospitals and physicians and the lowest number of uninsured of any state in the country, and a creative and ambitious health reform program, but if we don't act now our economy is going to be dead in the water," Everett said.

Massachusetts residents have already been coping with hefty annual insurance-premium increases. For the past seven years, premiums have increased an average of 10 percent annually.

But the report highlights some little-noticed population trends that could precipitate a financial crisis.

For instance, its authors say the high cost of living is forcing many residents ages 34 to 44 to leave the state. As a result, the state's workforce is getting older while population growth stagnates. Older workers, and immigrants -- who account for many of the state's new workers -- are more vulnerable to developing chronic illnesses, including obesity, which has led to increases in conditions such as heart disease and high blood pressure. The incidence of adult obesity in Massachusetts doubled from 10 percent 1990 to 20 percent in 2005, according to the Department of Public Health.

"Obesity is the elephant in the room," said Everett. "We are getting fatter and fatter, and that's one of the root causes of chronic illness."

The rise of such preventable conditions will greatly increase treatments costs, driving up healthcare premiums and making it more difficult for local companies to compete with those in less expensive states.

The report also predicts the start of a vicious cycle that could put the Boston area at a greater disadvantage than many other parts of the country: As chronic diseases become more prevalent, state government will have to divert money and other resources from preventive programs to those that treat existing conditions.

"We should view this as a call to action," said Andrew Dreyfus , executive vice president of healthcare services at Blue Cross Blue Shield of Massachusetts, the state's largest health insurer, who has been briefed on the report.

"We need to work now to significantly improve our public health and prevention programs in the state. We need to do a lot in the physician's office, in the workplace, and in the hospital to intervene earlier with people suffering from chronic illness."

Dr. JudyAnn Bigby , secretary of health and human services, downplayed the report's finding, saying some of the apparent increase in chronic disease might be attributable to a rise in the earlier diagnosis of conditions.

"I don't see anything in this report that hasn't been known," she said. "The report makes very clear that Massachusetts is one of the healthiest states in the nation."

The report was funded by the Boston Foundation, a community charity that last year made grants of $70 million to nonprofit organizations. Its title, "The Boston Paradox," refers to the irony that an area with some of the country's top medical research and academic institutions could experience such a serious increase in preventable illness.

Despite the report's grim predictions, Boston now ranks high in measures of public health. For example, in 2004 the life expectancy for someone born in Massachusetts was 79.5 years, well above the US average of 77.9 years, according to the Organisation for Economic Cooperation and Development.

But such statistics are not reason for complacency, according to the report's authors.

"It is now imperative for Greater Boston to become as innovative in public health as we have been in medical technologies," said Paul S. Grogan , chief executive of the Boston Foundation, in an introduction to the report. The foundation is also funding a second study, to be completed in December, that will focus on regulation, legislation, and action strategies that it says could help.

Others involved in state healthcare issues say they are optimistic about finding ways to head off the healthcare problems predicted by the report.

"I don't think this is written in stone yet," said Rick Lord , chief executive of Associated Industries of Massachusetts. "There are opportunities for employers and insurers to prevent this from developing."

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Women's midlife weight key to future diabetes risk

NEW YORK (Reuters Health) - People carrying excess weight who aim to ward off diabetes should try to lose the pounds before they reach middle age, Australian researchers suggest.

A woman's body mass index (BMI) in her late 40s was the strongest predictor of her risk of developing diabetes over the next eight years, Dr. Gita D. Mishra of the University of Queensland and her colleagues found.

On the other hand, there was no link between weight change in subsequent years and the likelihood of becoming diabetic.

While excess weight is understood to boost the risk of developing type 2 diabetes, the effects of shorter-term weight gain or loss are not as clear, Mishra and her team note in the journal Diabetes Care. To investigate, the researchers followed 7,239 women for 8 years. Study participants were 45 to 50 years old when the study began, and they completed surveys on their health at the study's outset in 1996 and in 1998, 2001 and 2004.

Those with BMIs of 25 or greater, indicating they were overweight or obese, in 1996 were at the highest risk of developing type 2 diabetes by 2004, the researchers found. Very obese women with BMIs of 35 or above were 12 times more likely than their normal-weight peers to become diabetic.

Weight gain or loss during the course of the study had no influence on a woman's risk of developing diabetes, while physical activity only reduced risk for the most active women.

"Because women's risk of developing type 2 diabetes in midlife is more closely related to their initial BMI (when aged 45-50 years) than to subsequent short-term weight-change, public health initiatives should target the prevention of weight gain before and during early adulthood," the researchers conclude.

They note that only small changes in physical activity and calorie intake are needed to stop from becoming overweight or obese, and that it is particularly important to "inspire people" to make those changes while they are young adults.

SOURCE: Diabetes Care, June 2007.

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Exercise plus good food can halve breast cancer deaths

Eating healthily and taking regular exercise can slash a breast cancer
victim's risk of dying, according to scientists.

They found that walking briskly for half an hour and eating five portions of
fruit and vegetables a day halved the chances of dying from the disease,
even if a woman was obese.

In the first study to look at the impact of both diet and physical activity
on breast cancer survival, a team from the University of California at San
Diego studied 1,490 women with an average age of 50.

The women, who had all undergone primary therapy for early-stage breast
cancer, were taking part in the Women's Healthy Eating and Living study,
looking at the effects of lifestyle on health.

The researchers found that women who were both physically active and had a
healthy diet were much more likely to survive for between five and 11 years
than the rest of the group.

Only around 7 per cent of the 'healthyliving' women died within 11 years -
about half that seen for the others taking part in the study.

Dr John Pierce, from the university's Moores Cancer Centre, said: "We
demonstrate in this study of breast cancer survivors that even if a woman is
overweight, if she eats at least five servings of vegetables and fruits a
day and walks briskly for 30 minutes, six days a week, her risk of death
from her disease goes down by 50 per cent. The key is that you must do
both."

The findings are published in the latest issue of the Journal of Clinical
Oncology.

Because of the strength of the findings, the scientists now want to see if
taking steps to change diet and physical activity affects breast cancer
survival.

They suggest that a healthy lifestyle should be routinely prescribed as part
of breast cancer treatment.

The findings were welcomed by cancer charities yesterday.

Dr Sarah Cant of Breakthrough Breast Cancer said: "This initial study is
encouraging - breast cancer patients tell us that they would like more
information about beneficial lifestyle changes can make, and we look forward
to further research in this

"We also know that regular exercise helps to reduce the risk of developing
breast cancer, so Breakthrough Breast Cancer encourages all women to lead a
healthy lifestyle, which includes taking regular exercise and eating a
balanced diet."

Liz Caroll, head of clinical services at Breast Cancer Care, said: "More and
more evidence is emerging clearly pointing to the potential benefits
exercise and a healthy diet may have in improving breast cancer survival
rates.

"It is important to stress that regular exercise and a healthy diet are
always beneficial in maintaining good health."

Henry Scowcroft of Cancer Research UK, said: "The results of this study add
to mounting evidence that adopting a healthy lifestyle might also play a
role in cancer survival, as well as helping to prevent the disease.

"It is really interesting that the effects observed in this study only
occurred when the women both exercised and ate healthily.

"We still need to find out more about exactly how lifestyle changes can
influence breast cancer survival.

"What we do know is that maintaining a healthy bodyweight, eating sensibly
and taking regular exercise is the key to a healthy life, as it can help
reduce your risk of several types of cancer, as well as many other disease

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Many Americans do maintain weight loss

By Amy Norton

NEW YORK (Reuters Health) - Though dieters often see their weight "yo-yo," a new national survey suggests that many Americans do fairly well at keeping the pounds off.

Government researchers found that of 1,310 U.S. adults who'd ever lost a substantial amount of weight, the majority had managed to keep at least some of the weight off.

Overall, 59 percent were still close to their weight of a year before -- which in all cases was at least 10 percent lower than their heaviest all-time weight. Another 8 percent weighed less than they did a year earlier.

However, one third of the subjects had regained a significant amount of weight over the year, the researchers report in the American Journal of Preventive Medicine.

Lost pounds are notorious for finding their way back again. So it's "encouraging" to see that so many people in this study were keeping their weight stable, lead study author Dr. Edward Weiss told Reuters Health.

Still, weight maintenance remains a "challenge" in a culture that encourages sitting and eating, according to Weiss and his colleagues at the Centers for Disease Control and Prevention in Atlanta.

Several past studies have shown that overweight people in clinical weight-loss programs regain the weight when the program ends. Individuals treated with lifestyle modification, like calorie-cutting and exercise, generally regain about one third of their lost weight over the next year. By the fifth year, they've regained most of the weight, on average.

But much of the research on weight regain has focused on people in clinical weight-loss programs. To get a better idea of how the average American fares, Weiss's team used data from a federal health survey that questioned a nationally representative sample of U.S. adults.

The researchers focused on 1,310 men and women who, 1 year before the survey, weighed at least 10 percent less than their all-time high. They then compared respondents' current weight with their weight 1 year earlier.

While relatively few people kept losing weight over the year, the study found, a majority managed to stay within 5 percent of their weight from the year before.

Exercise seemed to be one of the factors that separated the regainers from the maintainers. The odds of weight regain were twice as high among sedentary men and women than among those who met public health recommendations for exercise -- moderate physical activity for at least 30 minutes a day on most, and preferably all, days of the week.

The risk also climbed in tandem with the number of hours survey respondents spent in front of the TV or computer each day.

Exercise, Weiss said, has consistently been associated with long-term weight-loss maintenance. So staying active after the pounds are off may be one key to keeping them off.

But he pointed out that exercise has to be accompanied by continuing calorie control.

It's also important for people to focus on more than the number on the scale, according to the researcher. Even if the weight loss is not as substantial as you'd like, eating well and exercising will bring significant health benefits, like lower risks of diabetes and heart disease.

SOURCE: American Journal of Preventive Medicine, July 2007.

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Study spots gaps in Americans' diet, health IQ

NEW YORK (Reuters) -- Ninety percent of Americans say breakfast is an important part of a healthy diet, but just 49 percent manage to eat breakfast every day, a new survey shows.

And only 11 percent know the amount of calories they should consume daily to maintain a healthy weight, according to the International Food Information Council Foundation's second annual Food & Health Survey. "The only good thing is more people tried to guess than last year," Susan Borra, the president of the Washington, DC-based IFIC Foundation, told Reuters.

IFIC commissioned a survey of 1,000 U.S. adults, this March to better understand people's beliefs and behaviors regarding healthy eating. The survey identified a number of "diet disconnects" between what people intend to do and their actual habits, according to Borra and her team.

Among the most striking "disconnects," Borra said, concerned knowledge about good and bad fats. While current guidelines recommend people consume more polyunsaturated fats, found in fish and some whole grain foods, and monounsaturated fats, found in nuts, avocados and vegetable oils, she noted, 42 percent of those surveyed said they were trying to eat fewer polyunsaturated fats and 38 percent reported trying to cut down on monounsaturated fats.

However, 70 percent of people said they were trying to cut down on saturated fat, more than last year's 57 percent. Saturated fats are found in meats, dairy foods, and coconut and palm oils, among other sources, and have been tied to an increased risk off heart disease and stroke.

While 84 percent said they were physically active at least once a week for health benefits, only 44 percent said they "balanced diet and physical activity" for weight management. "That concept of calories in, calories out isn't quite making the consumer radar screen," Borra said. "That's another big disconnect."

And while most people surveyed knew about the benefits of functional foods; for example, 80 percent knew such foods could benefit the heart, just 42 percent actually ate such heart-healthy foods.

"Consumers are interested in health, they want to have a healthy lifestyle, but they're just having a tremendous difficulty achieving it," Borra said, adding that people's "hectic, crazy lifestyles" and the confusing mix of information out there don't help matters.

Borra recommends people stick to good sources of information on diet and health, such as IFIC's Web site; the federal government's mypyramid.gov; the American Dietetic Association; and the American Heart Association .

She also urges people to make incremental changes in their lifestyle habits, rather than trying to do everything all at once, and recommends IFIC's "Your Personal Path to Health: Steps to a Healthier You" as a good source for identifying ways to make these small changes.

"If you just make a couple of small steps a day, you're doing a lot to achieving a healthy lifestyle in the long run," Borra said.

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