Take Care of Your Heart Before and After Problems

Healthy blood pressure and weight can help avoid heart failure; rehab can aid recovery

By Steven Reinberg
HealthDay Reporter

MONDAY, Sept. 24 (HealthDay News) -- People need to take care of their heart both before and after heart trouble starts, two new studies suggest.

In the first study, researchers said that to avoid heart failure when you're 70 or 80, you must begin by keeping your blood pressure and weight under control when you're 50.

"We tested the hypothesis that higher levels of blood pressure and body mass index (BMI) in midlife would be powerful determinants of heart failure risk in later life, and that the risk posed by preceding measurements would remain even after accounting for these risk factors measured later in life," said lead researcher Dr. Ramachandran S. Vasan.

"This is exactly what we found," added Vasan, a senior investigator with the Framingham Heart Study and a professor of medicine at Boston University School of Medicine.

An increase of about 20 mm Hg in systolic blood pressure at age 50 was associated with a 36 percent higher risk of heart failure up to 20 years later. Every 2.2 pound increase in BMI (a ratio of weight to height) at age 50 was associated with a 6 percent increase in the risk of heart failure, Vasan said.

"The study highlights the importance of maintaining an ideal BMI and blood pressure over the life course of individuals," Vasan said.

For the study, Vasan's team collected data on 3,362 people who were part of the Framingham Heart Study who had routine examinations between 1969 and 1994. During follow-up, 518 people developed heart failure.

"The prevention of heart failure should begin early in life and should include screening for elevated blood pressure and BMI," Vasan said. "Failure to identify or treat such modifiable risk factors in early and mid-adulthood may result in the loss of opportunities to reduce the incidence of heart failure in later life."

The findings are published in the November issue of the journal Hypertension.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that keeping both your weight and blood pressure down will help you avoid the ravages of heart failure.

"The lifetime risk for developing heart failure in both men and women is one in five," said Fonarow. "However, heart failure can be prevented, and there are a number of modifiable risk factors for heart failure, including hypertension, obesity, and diabetes.

"Maintaining a healthy blood pressure and body weight is essential to reduce the risk of heart failure," he said.

The second study found that fewer than 20 percent of patients seek cardiac rehabilitation after a heart attack or coronary bypass surgery.

"It has been shown by many trials that cardiac rehabilitation reduced the risk for new coronary events, re-hospitalization and mortality. The main advantage of cardiac rehabilitation is to reduce mortality," said study leader Dr. Jose A. Suaya, a lecturer and scientist at the Brandeis University Schneider Institutes for Health Policy, Heller School, in Waltham, Mass.

Cardiac rehabilitation also improves functional capacity, Suaya said. "Patients can walk more without pain and improve their quality of life," he said.

For the study, Suaya's group collected data on 267,427 men and women, 65 and older, who had survived a heart attack or bypass surgery. The data were drawn from 1997 Medicare claims records.

In the year after hospital discharge, only 18.7 percent of the patients had at least one session of cardiac rehabilitation. Patients who underwent bypass surgery were more likely to seek rehabilitation -- 31 percent -- compared with heart attack patients -- 13.9 percent.

More men had cardiac rehabilitation (22.1 percent) than women (14.3 percent). Age also played a role -- patients 75 to 85 were less likely to go for rehabilitation, the researchers found.

In addition, patients with other medical conditions, such as diabetes, a previous stroke, congestive heart failure or cancer, were significantly less likely to seek cardiac rehabilitation, Suaya's group found.

The study results are published in the Oct. 9 issue of the journal Circulation.

There are many reasons why patients don't seek rehabilitation, the researchers said.

"Many doctors may be reluctant to refer patients to cardiac rehabilitation," said study co-author Donald S. Shepard, a research professor at Brandeis' Heller School. "In addition, patients may not know or ask about it."

Shepard also noted that many medical institutions don't promote the service, which typically includes exercise and advice on diet. "It's not glamorous and, from the data we have, it is not very profitable," he said.

It may also be difficult for people to get to rehabilitation centers, Shepard said. "One of the findings in the study was that the closer you are, the more likely you are to use the service," he said. "Travel time and travel expense are things that reduce the use of the service."

Fonarow said "more needs to be done to ensure that eligible patients are effectively enrolled in supervised cardiac rehabilitation. The American Heart Association's 'Get With The Guidelines Program' is one example of a highly successful initiative to improve referral to cardiac rehabilitation after hospitalization for cardiovascular event or surgery."

More information

For more on heart health, visit the American Heart Association.

SOURCES: Ramachandran S. Vasan, M.D., senior investigator of the Framingham Heart Study, professor of medicine, Boston University School of Medicine; Jose A. Suaya, M.D., Ph.D., lecturer and scientist, the Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass; Donald S. Shepard, Ph.D., research professor at the Heller School for Social Policy and Management, Brandeis University, Waltham, Mass.; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; early release, November 2007, Hypertension; Oct. 9, 2007, Circulation

Read more!

Childhood Obesity Epidemic a Long-Term Challenge

It may take decades to reverse the health threats, experts say

By Karen Pallarito
HealthDay Reporter

THURSDAY, Sept. 20 (HealthDay News) -- In the 1980s and '90s, Americans tried to control their weight by watching their cholesterol by cutting dietary fat and substituting carbohydrates. They paid little mind to total calories and physical activity. And guess what happened to their waistlines -- and their children's?

"It was just an end run around the issue of health maintenance," said Dr. Henry C. McGill Jr., senior scientist emeritus at the Southwest Foundation for Biomedical Research in San Antonio, Texas. "And, of course, it crept over into kids, especially kids subjected to all of the advertising and offerings of high-density caloric food -- opportunities to avoid physical activity, attractions to television viewing and net surfing."

Today, more than one in three children and adolescents in the United States -- some 25 million kids -- are overweight or obese, according to the Robert Wood Johnson Foundation, which recently announced an unprecedented effort to reverse the childhood obesity epidemic by 2015. The Princeton, N.J.-based philanthropy said it plans to spend at least $500 million over the next five years on public health efforts focusing on kids and families in underserved communities.

It's the foundation's largest commitment ever. While the foundation has spent roughly as much in the area of tobacco over the years, "we never made the scale of that commitment up-front and public like we have with this," said Dr. James S. Marks, senior vice president and director of the foundation's health group.

"If we don't deal with children," he added, "this could be the first generation that will live sicker and die younger than its parents."

Scientists, physicians and public health advocates know that efforts to prevent obesity must start in childhood, because the problem leads to increased risk of coronary heart disease and other health hazards in adulthood. In fact, there's substantial evidence that obesity and related diseases, including diabetes and hypertension, can begin to exact damage during the teenage years.

In one landmark study, a group of researchers from across the United States analyzed post-mortem blood samples and evaluated atherosclerosis in coronary artery and aorta specimens from roughly 3,000 15- to 34-year-old men and women who died from causes such as accidents, homicide or suicide. One of the surprising results of the study, according to McGill, was that an elevated blood sugar -- as measured by levels of "glycohemoglobin" -- was associated in the late 20s and early 30s with about an 8-fold increase in advanced lesions in the coronary arteries. "It was a whopper of an effect," he said.

In another study, published in the Journal of the American Medical Association, researchers documented a significant upward shift over the past 16 years in blood pressure levels of children and teens aged 8 to 18. Lead author Paul Muntner, an epidemiologist at Tulane University School of Medicine, and colleagues said the increase in blood pressure levels is partially due to the increased prevalence of overweight in the United States.

And British researchers recently reported that children who are overweight at age 11 continue to have weight problems through their teenage years. Rates of overweight and obesity were highest among girls and children from lower socioeconomic backgrounds. The authors said the study highlights the need to target efforts to prevent obesity in the early years.

But even as more money and manpower are devoted to obesity prevention, McGill said it may take many years to erase the epidemic. And, he added, it will take action on many different fronts, from educating children and physicians to improving the health-care financing system to include more preventive medicine.

"It was 1964 when the first U.S. Surgeon General's report came out, and just now, there's talk about the tide turning on cigarette smoking," he observed. "Obesity's perhaps going to take that long to get the tide turned."

More information

For more on childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Henry C. McGill Jr., M.D., senior scientist emeritus, Southwest Foundation for Biomedical Research, San Antonio, Texas; James S. Marks, M.D., M.P.H., senior vice president, director, health group, Robert Wood Johnson Foundation, Princeton, N.J.; Feb. 24, 1999, May 5, 2004, and April 25, 2005, Journal of the American Medical Association; May 5, 2006, British Medical Journal

Read more!

Physical Fitness Improves Asthma Management In Children

Children with asthma who improve their physical fitness are likely to experience beneficial effects on disease control and quality of life, according to a study published recently in Medicine & Science in Sports & Exercise , the official journal of the American College of Sports Medicine (ACSM). The results show aerobic training to be effective in improving cardiopulmonary fitness and decreasing daily use of inhaled steroids in asthmatic children, outcomes that should have positive implications for disease management in a group that tends to have lower cardiorespiratory fitness than their healthy counterparts.

"Children who experience breathing restrictions caused by asthma sometimes fear inducing breathlessness by exercise, which can cause physical deconditioning over time," said Celso Carvalho, Ph.D., an author on the study. "This is where we often see patients with asthma having lower fitness levels. Physical training, properly supervised, is not only a possibility for this group, but also a management strategy for their symptoms."

The study enrolled 38 children with moderate-to-severe persistent asthma, randomly assigned to either a training group or a control group. Exercise performance and exercise-induced bronchoconstriction was evaluated 16 weeks apart, while daily doses of inhaled steroids and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores also were recorded.

Asthmatic children, even with moderate to severe disease, showed significant improvements in their aerobic capacity after the training program and a reduction in exercise induced-bronchoconstriction, which induces breathlessness and is a characteristic response to exercise present in most patients. Daily doses of inhaled steroids were reduced in trained patients by 52 percent, but remained unchanged or increased in the control (untrained) group. When compared to controls, these children also reported a significant improvement in health-related quality of life.

The authors emphasize that training should be supervised and performed in children properly medicated, and the actual impact of physical training on clinical indicators of disease control is unknown. While these data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease, additional research is warranted to discover the contribution of exercise on asthma symptoms and its manifestations.

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Medicine & Science in Sports & Exercise is the official journal of the American College of Sports Medicine, and is available from Lippincott Williams & Wilkins at 1-800-638-6423.

American College of Sports Medicine

Read more!

Aerobic, Weight Training Combo Best Against Diabetes

Exercise is always good, but combining two approaches brings better results, study finds

By Kathleen Doheny
HealthDay Reporter

MONDAY, Sept. 17 (HealthDay News) -- Most people know that exercise can help beat type 2 diabetes, but one type of fitness regimen might work best, a new study shows.

Specifically, workouts that combine aerobic and resistance training exercises appear better at controlling blood sugar than either type of activity alone, researchers say.

The finding is new, because "most other studies have looked at just one kind of exercise, either aerobic or resistance," noted lead researcher Dr. Ronald J. Sigal, an associate professor of medicine and cardiac sciences at the University of Calgary, in Alberta, Canada.

The study is published in the Sept. 18 issue of the Annals of Internal Medicine.

As part of their research, Sigal's team evaluated 251 adults, ages 39 to 70, all with type 2 diabetes and not regular exercisers at the start of the study.

The participants were assigned to one of four groups: those who did 45 minutes of aerobic training three times a week, those who did 45 minutes of resistance (i.e., weight) training three times a week, those who did 45 minutes each of both forms of exercise three times a week, and those who did no exercise at all.

The aerobic group worked out on a treadmill or a bike at the gym; memberships were provided. The resistance group also worked out at the gym, with memberships provided, doing seven different exercises on weight machines.

Sigal's team evaluated changes in A1c values -- a measurement reflecting blood sugar concentrations -- over the previous two to three months. A1c is expressed as a percentage. A decline of 1.0 percent in A1c value would be linked to a 15 percent to 20 percent decrease in risk of heart attack or stroke, the researchers explained, and a 25 percent to 40 percent decline in risk of complications linked to diabetes, such as eye disease or kidney disease.

As expected, blood sugar control improved in all the exercise groups. In those who did either aerobic or resistance, the A1c value declined by about 0.5 percent compared to the non-exercisers. Those who did both kinds of exercise had double that level of success, with their A1c value dropping by 0.97 percent compared to the non-exercising group. Non-exercisers experienced no change in their A1c values over the 26-week study.

The bottom line: "There is additional value to doing both resistance and aerobic exercise," according to Sigal.

He said the decrease of nearly one percent of A1c seen in the study "translates to a 15 to 20 percent reduction in risk of heart attack or stroke and a 25 to 40 percent reduced risk of other complications, such as retinopathy," an eye problem related to diabetes.

How does physical activity fight type 2 diabetes, the most common and obesity-linked form of the disease? According to Sigal, "exercise decreases insulin resistance. It makes the transport of glucose [blood sugar] more efficient."

Another expert said the study adds gives new information for people hoping to beat back diabetes.

"Basically, aerobic and resistance training both do very well, and the combination does even better," said Cathy Nonas, director of physical activity and nutrition for the New York City Department of Health and Mental Hygiene and a registered dietitian and certified diabetes educator.

But she said couch potatoes often need to ease into exercise to maintain a fitness regimen over time.

The study participants built up to their 45-minute fitness sessions, Nonas noted, and the combination group ended up doing about 4.5 hours of exercise a week -- an amount some might find daunting.

"I would never talk about 4.5 hours a week to someone who doesn't exercise at all," Nonas said. Rather, she encourages physical activity in any amount to start. "Anything you do is good," she said. Then, she encourages people to slowly build up their time.

"I think this is a very uplifting study," she added. "It says whatever you do will have an effect, and the more you do, the better the effect."

More information

To learn more about the benefits of exercise for diabetes, visit the American Diabetes Association.

SOURCES: Ronald J. Sigal, M.D., associate professor, medicine and cardiac sciences, University of Calgary, Alberta, Canada; Cathy Nonas, R.D., director, physical activity and nutrition, New York City Department of Health and Mental Hygiene, and certified diabetes educator; Sept. 18, 2007, Annals of Internal Medicine

Read more!

Lifestyle disease deaths may double by 2015, WHO warns

SEOUL (AFP) — World deaths from "lifestyle" diseases will double by 2015 unless all-out efforts are taken to combat them, the World Health Organization (WHO) warned Friday.

It said about 17 million people die prematurely each year as a result of the global epidemic of largely preventable chronic diseases -- the leading cause of death in the world today.

High on the list are cardiovascular diseases -- mainly heart disease and stroke -- cancer, chronic respiratory diseases, diabetes and obesity.

"Unless national interventions are urgently taken to reduce the prevalence of chronic diseases, 36 million people will die of these diseases by 2015, nearly half of them before they turn 70," said Shigeru Omi, director of the WHO regional committee for the Western Pacific.

The committee Friday was winding up a five-day meeting in the southern South Korean island of Jeju.

In 2005 the WHO set a global goal of reducing the projected trend of chronic disease death rates by two percent each year until 2015.

The vast majority of cases are caused by a small number of known and preventable risk factors. Three of the most important are unhealthy diet, physical inactivity and tobacco use, the WHO said.

Omi called for a "whole-of-society" approach to prevention. "All sectors, from government to private enterprises, civil society and communities, will have to work together," he said.

Regional health ministers urged national leaders to be role models for healthy lifestyles, including encouraging people to eat nutritious local food.

The ministers also called for better strategies to reduce non-communicable diseases.

Strengthening health services that are under pressure from the growing burden of non-communicable diseases is also part of the "whole-of-society" approach, the WHO said.

In line with this, regional health leaders will meet in Singapore in November to identify solutions.

Read more!

Exercise may generate new blood vessels

By MARIA CHENG, AP Medical Writer

VIENNA, Austria - Having a bad heart doesn't mean you can skip exercise, doctors said Wednesday. In fact, it may even help your heart to repair itself. Research presented at the European Society of Cardiology meeting showed that exercise sparks the creation of new heart vessels.

In a small study of 37 people at Leipzig University in Germany, Dr. Robert Hollriegel found that people with serious heart failure who rode a bike for up to 30 minutes a day for four months produced new stem cells in their bones.

They also had more small blood vessels in their muscles. Those who didn't exercise had no change in their vessels or muscles.

Most patients with heart failure are over 70 years old, and some can barely walk a few steps without stopping for rest. Doctors think that even these patients would benefit from light exercise such as walking or cycling. To ensure that patients will be able to handle a certain level of physical activity, doctors conduct a test first to determine their maximum limits and to ensure they would not be exceeded. Some exercise regimens also are supervised by health professionals.

"We're not talking about patients with acute heart problems," said Dr. John Cleland, a heart failure specialist at the University of Hull in Britain who is spokesman for the European Society of Cardiology. Cleland was not involved in Hollriegel's research.

"This is to prevent people from getting into a cycle of deterioration where they're afraid to exercise and they just avoid any activity that leaves them out of breath," he said.

Physical activity strains the heart's arteries and muscles by sending 10 times the normal amount of blood to the muscles being used. Stem cells then are dispatched to relieve this stress and may repair any damaged parts. If you continue to exercise, these stem cells help the body adapt to the stress, by building new blood vessels and strengthening muscles. But to maintain such benefits, you must exercise regularly.

Cleland said that people with heart failure should exercise to a state where they're breathless at least once a day. Pushing the limits of their heart's capabilities should help make it stronger.

"People think that if they have heart failure, then they're at the end of the road and they can't exercise," said Dr. Freek Verheugt, a cardiologist at the University of Nymegen in the Netherlands. "But this study shows that exercise can work to produce new blood vessels, even in patients with serious heart disease."

Because no drugs exist to produce new stem cells, exercise may be the only method for some patients to rebuild their hearts.

"We are not saying that patients should run marathons, but there is no other way to augment your arteries," said Dr. Francois Carre of Rennes University Hospital in France. "Patients have to exercise if they want that."

Previous studies have shown that people who do physical therapy after a heart attack live longer than those who don't. Experimental studies in rats have also suggested that exercise can even be more effective than statins, drugs that are commonly used to treat heart disease.

Though doctors routinely recommend that patients exercise, it is not an actual treatment. Carre thinks that should change. "We need to write patients prescriptions to exercise the same way we write prescriptions for drugs," he said.

"People have been trying for years to create a polypill to treat many different parts of heart disease," Carre said. "But that already exists. It's exercise."

Read more!

B.C. kids will be required to exercise

VANCOUVER -- School children in B.C. will be required to do 30 minutes of exercise a day starting next September, Education Minister Shirley Bond announced yesterday.

"This is not about mandatory P.E., this is about daily physical activity," said Bond after making the first-day-of-school announcement in Vancouver.

Students will be able to sweat out their mandatory minutes either during or outside of school hours, said Bond, so walking to school, extracurricular sports and classroom calisthenics will all be on the list of acceptable activities.

"This is not adding to a student's curricular course load, but in fact (high school students) already are required to do 80 minutes of physical activity (per week) to graduate. We are going to increase that to 150 (minutes for all students)."

Bond said her ministry will take the next year to write the fine print of the policy, so she doesn't know yet how students' activity levels will be recorded or monitored. But come next fall, she said, schools will have to offer at least 30 minutes of physical activity programs each day, whether during class or recess.

Bond also announced the provincial government is about to fast-track its two-year-old promise to remove junk food from schools by 2009. The ban on unhealthy snacks will be implemented in elementary schools this January and in middle and secondary schools by September 2008.

Statistics Canada says one in four B.C. children and youth is obese or overweight.

Health Canada recommends children and youth do at least 30 minutes of moderate to vigorous physical exercise per day, which could be anything from brisk walking, skating, and bike riding to running, weight training, and team sports.

Read more!