Big biceps, trim waist mean longer life for men

By Anne Harding

NEW YORK (Reuters Health) - The size of an aging man's belly and the bulk of his biceps provide a more accurate picture of his mortality risk than body mass index (BMI) alone, UK researchers have shown.

Among 4,107 men aged 60 to 79, those with a waist circumference less than 102 centimeters (40 inches) and above-average muscle mass in their upper arms were the least likely to die over a six-year period, Dr. S. Goya Wannamethee of Royal Free and University College Medical School in London and colleagues found.

BMI, on the other hand, was only linked to mortality among very thin men, who were at increased risk of dying.

"In older men especially, we should not just be measuring weight but also their waist circumference and their muscle mass as measured by mid-arm muscle circumference," Wannamethee told Reuters Health.

As people age they typically lose muscle mass and gain belly fat, Wannamethee and colleagues note in a report in the American Journal of Clinical Nutrition. These changes mean BMI may not provide an accurate picture of obesity and overweight in older people.

The researchers set out to determine whether belly fat and muscle mass might be more precise predictors of mortality by making several measurements of body composition in 4,107 men, 713 of whom died during the study's six-year follow-up period.

A man's risk of dying during the study dropped as his muscle mass rose, while both BMI and waist circumference alone showed little relationship to mortality.

Combining muscle mass and waist size provided the most accurate gauge of death risk. Men with waist circumferences greater than 102 cm and above-average muscle mass were 36 percent more likely to die than those with smaller waists and bigger-than-average muscles, while those with big bellies and small muscles were at 55 percent greater mortality risk.

The findings underscore the importance of life-long fitness, Wannamethee noted. Men who have avoided obesity, particularly in the abdominal area, while keeping their muscle mass "are likely to enjoy longer, and almost certainly healthier lives," the researcher said.

"A combination of a prudent diet (low calorie, low saturated fat, and low alcohol) and regular moderate physical activity is required to achieve these ends," Wannamethee added.

"The key message is 'keep active' all the way to the end."

SOURCE: American Journal of Clinical Nutrition,

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Move to celebrate Diabetes Day

Structured exercise is better than physical activity to fight diabetes

Technogym supported a large Randomized Control Trail aimed to evaluate if
prescribed and controlled exercise is better than standard physical
activity. The study involved 600 patients with type 2 diabetes and metabolic
syndrome randomized into an exercise group (300 patients) and a control
group (the remaining 300) doing standard physical activity.

The exercise group followed in 23 Centers a specific training program
prescribed by a team of endocrinologist and Technogym exercise
physiologists. The training was managed with Wellness System, the Technogym
Software Solution for exercise control and evaluation, ideal to share data
between patient, Wellness Centers and doctors.

Preliminary results show that structured exercise is definitely better than
standard physical activity in controlling the main metabolic parameters (eg.
Hb1c and lipid profile) and in improving physical performance as expressed
in V02 max and maximal strength.

The benefits of physical activity are already well-known and supported in
literature, thus diabetic patients generally received the recommendation to
carry an active lifestyle, for example walking 150 minute per week at a
low-moderate intensity – just few doctors would send them to a club for a
specific training program.

Dr. Zanuso – Technogym Exercise Physiologist said that "This study
represents the first large randomized clinical study that supports the
importance of exercising at a controlled intensity with supervision of
trained professionals teaming up with doctors demonstrating that Wellness
Clubs can provide a very good medicine for diabetic patients".

Consistently with its strong commitment on special populations Technogym
developed a Metabolic Fitness Project aimed to raise doctors awareness on
effectiveness of exercise to treat diabetic patients and to create metabolic
exercise specialists within the Clubs.

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Exercise on the Brain

By SANDRA AAMODT and SAM WANG

FEELING a little less mentally quick than you did a few years ago? Maybe you are among the many people who do “brain exercises” like sudoku to slow the cognitive decline associated with aging. We’ve got a better suggestion.

Computer programs to improve brain performance are a booming business. In the United States, consumers are expected to spend $80 million this year on brain exercise products, up from $2 million in 2005. Advertising for these products often emphasizes the claim that they are designed by scientists or based on scientific research. To be charitable, we might call them inspired by science — not to be confused with actually proven by science.

Environmental enrichment does improve mental function in laboratory animals. Rodents and monkeys that get playmates or toys learn to complete a variety of tasks more easily, at all ages. They also have larger brains, larger brain cells and more synaptic connections than animals raised alone in standard cages. But here’s the rub: standard laboratory environments are tremendously boring. Lab animals rarely need to search for food or avoid predators. In contrast, most of us get plenty of everyday stimulation in activities like finding a new address, socializing with friends or navigating the treacherous currents of office politics. Animal enrichment research may be telling us something important not about the positive effects of stimulation, but about reversing the negative effects of deprivation.

Another line of evidence cited by marketers comes from studies of elderly people who improve certain skills by practicing a challenging computer-based task. Although most programs work to some extent, the gains tend to be specific to the trained task.

That is, practice can certainly make people better at sudoku puzzles or help them remember lists more accurately. The improvement can even last for years. Similarly, people tend to retain skills and knowledge they learned thoroughly when they were younger. Unless the activities span a broad spectrum of abilities, though, there seems to be no benefit to general mental fitness.

For people whose work is unstimulating, having mentally challenging hobbies, like learning a new language or playing bridge, can help maintain cognitive performance. But the belief that any single brain exercise program late in life can act as a quick fix for general mental function is almost entirely faith-based.

One form of training, however, has been shown to maintain and improve brain health — physical exercise. In humans, exercise improves what scientists call “executive function,” the set of abilities that allows you to select behavior that’s appropriate to the situation, inhibit inappropriate behavior and focus on the job at hand in spite of distractions. Executive function includes basic functions like processing speed, response speed and working memory, the type used to remember a house number while walking from the car to a party.

Executive function starts to decline when people reach their 70s. But elderly people who have been athletic all their lives have much better executive function than sedentary people of the same age. This relationship might occur because people who are healthier tend to be more active, but that’s not the whole story. When inactive people get more exercise, even starting in their 70s, their executive function improves, as shown in a recent meta-analysis of 18 studies. One effective training program involves just 30 to 60 minutes of fast walking several times a week.

Exercise is also strongly associated with a reduced risk of dementia late in life. People who exercise regularly in middle age are one-third as likely to get Alzheimer’s disease in their 70s as those who did not exercise. Even people who begin exercising in their 60s have their risk reduced by half.

How might exercise help the brain? In people, fitness training slows the age-related shrinkage of the frontal cortex, which is important for executive function. In rodents, exercise increases the number of capillaries in the brain, which should improve blood flow, and therefore the availability of energy, to neurons. Exercise may also help the brain by improving cardiovascular health, preventing heart attacks and strokes that can cause brain damage. Finally, exercise causes the release of growth factors, proteins that increase the number of connections between neurons, and the birth of neurons in the hippocampus, a brain region important for memory. Any of these effects might improve cognitive performance, though it’s not known which ones are most important.

So instead of spending money on computer games or puzzles to improve your brain’s health, invest in a gym membership. Or just turn off the computer and go for a brisk walk.

Sandra Aamodt is the editor in chief of Nature Neuroscience. Sam Wang is an associate professor of molecular biology and neuroscience at Princeton. They are the authors of the forthcoming “Welcome to Your Brain: Why You Lose Your Car Keys but Never Forget How to Drive and Other Puzzles of Everyday Life.”

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Regular Exercise Helps Fight Heart Failure

It stimulates tissue repair better than drugs, study finds

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Nov. 7 (HealthDay News) -- Exercise boosts the number of progenitor cells in people with heart failure, and those cells in turn repair and rebuild weakened muscle and blood vessels, researchers report.

According to two studies that were to be presented Wednesday at the American Heart Association annual meeting in Orlando, Fla., that response can dramatically enhance patients' ability to move and work out.

"Both studies point to the beneficial effect of exercise on patients with heart failure," said Dr. Sidney Smith, past president of the American Heart Association and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine.

"These observations provide some understanding into the mechanisms which [make exercise helpful]," Smith said.

More than 5 million people in the United States have heart failure, a condition that affects the heart's ability to pump blood throughout the body.

However, researchers are beginning to understand that heart failure woes come not only from this pumping disorder but from changes in the legs and other parts of the body.

"The muscle of the leg starts to shrink, so there is less muscle mass," explained Dr. Axel Linke, a co-author on both studies and assistant professor of medicine at the University of Leipzig in Germany. "The endothelium and the vessels supplying blood to the muscles deteriorate, so they are less flexible, elasticity is reduced," he said. The endothelium is a layer of cells that lines blood vessels.

However, exercise opens up the vessels and improves their flexibility and elasticity.

In the first study, investigators looked at whether exercise training could activate progenitor cells -- immature cells that can divide into other cells and help repair tissue.

Fifty men with moderate-to-severe heart failure were randomized to receive either six months of exercise training under the supervision of a physician, or to be sent to a control group that remained inactive.

Exercise consisted of riding a stationary bicycle at least 30 minutes a day (usually in two sessions).

At the end of six months, biopsies of the patients' thigh quadriceps revealed that the number of progenitor cells in the exercise group increased by 109 percent, progenitor cells turning into muscle cells increased by 166 percent, and progenitor cells actively dividing to form new cells and repair damage to the muscle increased sixfold.

For the second study, 37 men with severe heart failure were randomly assigned to receive three months of exercise or to remain inactive.

The exercisers experienced dramatic changes: Circulating progenitor cells increased 47 percent, progenitor cells beginning to mature into endothelial cells increased almost 200 percent, and the density of capillaries in skeletal tissue increased 17 percent. There were no changes in the control group.

When they began, the exercising patients had peak oxygen uptake in the range of other patients needing heart transplants. But regular exercise was linked to an average 35 percent increase in exercise capacity, giving the men about 75 percent of the capacity seen in healthy people of the same age.

"Your heart is like an engine with six cylinders, and when we started the exercise program in those patients, about 3.5 cylinders were just not working," Linke explained. "After three to six months of exercise training, two of the cylinders started working again."

"It's a tremendous improvement, and no medication is able to do it," he noted.

But patients with heart failure should only embark on an exercise regimen under the supervision of a physician, Linke added.

"We recommend exercise once a day for up to 20 minutes five days a week for patients with heart failure, but clearly an exercise program should be initiated in in-hospital conditions or an outpatient setting, because you never know how an individual patient might react to initiation of a training program," he explained.

More information

For more on exercise and fitness, head to the American Heart Association.

SOURCES: Axel Linke, M.D., assistant professor, medicine, University of Leipzig, Germany; Sidney Smith, M.D., past president, American Heart Association, and director, Center for Cardiovascular Science and Medicine, University of North Carolina School of Medicine, Chapel Hill; Nov. 7, 2007, presentations, American Heart Association annual meeting, Orlando, Fla.

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Advocates of "exercise prescriptions" received a huge boost with the unveiling of "Exercise is Medicine"

Advocates of "exercise prescriptions" received a huge boost with the
unveiling of "Exercise is Medicine," a joint initiative of the American
Medical Association (AMA) and the American College of Sports Medicine
(ACSM).


Exercise is Medicine has several goals that recognize the importance of
physical activity:


1. Create broad awareness that exercise is indeed medicine.


2. Make "level of physical activity" a standard vital sign question in
each patient visit.


3. Help physicians and other healthcare providers to become consistently
effective in counsel–ing and referring patients as to their physical
activity needs.


4. Lead to policy changes in public and private sectors that support
physical activity counseling and referrals in clinical settings.


5. Produce an expectation among the public and patients that their
healthcare providers should and will ask about and prescribe exercise.


6. Appropriately encourage physicians and other healthcare providers to
be physically active themselves.


At a news conference held at the National Press Club, Robert E. Sallis,
M.D., ACSM President, expressed his hope that Exercise is Medicine will
"merge the fitness industry with the health-care industry."


"We already advise against smoking; recommending exercise should be no
different," added Dr. Sallis. "Physicians can support the program by
prescribing exercise and offering patients basic educational materials.
Exercise can have tremendous health benefits for patients."


"If we had a pill that contained all of the benefits of exercise, it would
be the most widely prescribed drug in the world," noted Ronald M. Davis,
M.D., AMA President.


Other speakers at the news conference included Melissa Johnson, Executive
Director, President’s Council on Physical Fitness & Sports, and Jake
Steinfeld, Chairman of the California Governor's Council on Physical Fitness
and Sports. A luncheon following the press conference was highlighted by
encouraging and supportive comments from Rear Admiral Steven K. Galson,
M.D., M.P.H., Acting Surgeon General.


IHRSA is very proud to be an official supporter of Exercise is Medicine. We
look forward to providing you with updates on the progress of Exercise is
Medicine throughout the year. In the meantime, if you have any questions
about the initiative, please do not hesitate to contact IHRSA or visit the
website: exerciseismedicine.org.

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