Older Adults with Heart Disease Can Become More Independent and Heart Healthy with Physical Activity

Improving physical activity among older adults with heart disease benefits their heart health, independence and quality of life, according to a new American Heart Association scientific statement published in the American Heart Association journal Circulation.

Physical activity helps reduce heart disease symptoms for patients with heart failure, heart attacks and stroke, and it also helps to improve the age-related erosions of strength, balance, and reduces frailty that particularly affect older heart patients. It is important part of care for the growing population of older adults with heart disease.

“Many healthcare providers are focused only on the medical management of diseases, such as heart failure, heart attacks, valvular heart disease and strokes, without directly focusing on helping patients maximize their physical function,” said Daniel E. Forman, M.D., the geriatric cardiologist who chaired the American Heart Association panel that drafted the new statement.

“Yet, after a heart attack or other cardiac event, most patients also want to regain physical capacity and confidence to maintain their independence and quality of life, such as the ability to lift a grocery bag and to carry it to their car,” Forman said.

Aerobic fitness is a measure of how well the body transports oxygen during sustained exercise, which tends to decline with age. Older adults with heart disease are at added risk for frailty — unintentional weight loss, exhaustion, slowness while walking and low levels of physical activity – which often limits their ability to return to an active and independent life after a cardiac event, such as a heart attack, even if their heart disease was treated with the correct medications and procedures.

“Emphasizing physical function as a fundamental part of therapy can improve older patients’ quality of life and their ability to carry out activities of daily living. Patients in their 70s, 80s and older can benefit,” said Forman, a professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System in Pennsylvania.

Cardiac rehabilitation is one crucial tool for helping elderly heart patients restore and maintain function. These programs provide exercise counseling and training to promote heart health, manage stress and depression, and educate people on proper nutrition, tobacco cessation and other topics. It is especially important in helping older adults gain confidence and stamina after an illness and hospitalization. But nationally, only about one-third or fewer of eligible, elderly, cardiac patients get such care.

“Cardiac rehabilitation is not prescribed often enough,” Forman said. “When treating cardiac patients in their 70s, 80s and 90s, healthcare providers often stress medications and procedures without considering the importance of getting patients back on their feet, which is exactly what cardiac rehabilitation programs are designed to do.”

Even without a formal cardiac rehabilitation program, keeping patients’ personal goals in mind, doctors can tailor physical activity advice to help them improve their physical function and remain independent, according to the statement. Daily walking has been linked to better health. Resistance and balance training can reduce the risk for falls. Tai chi and yoga combine strength, aerobic and balance elements. Even encouraging patients to do more chores around the house can be helpful, Forman said.

Medicines that are staples in cardiology can ironically complicate the picture of how well patients function in daily life. For example, cholesterol-lowering drugs can sometimes cause muscle pain, anti-ischemic drugs may cause fatigue and blood pressure drugs may cause dehydration, dizziness and falls, Forman said.

“By the time they’re 75, about half of cardiac patients are taking more than 10 medications, and they can have cumulative effects that are uncertain and which can be debilitating,” Forman said. “We really have to talk to patients and weigh the benefits versus the risk of each medication, especially if they seem to be contributing to a lower level of physical function.”

The new statement details an array of methods for healthcare providers to measure factors related to functional status in older patients to help improve their quality of life and ability to remain independent. Capabilities should be assessed as part of every regular physical exam to track where people are and to detect sudden declines. It is also vital to assess functional benchmarks after medical procedures or hospitalizations, which can cause a loss of muscle mass and a functional setback, he said.

The issue is growing in importance as the number of Americans age 65 or older is expected to double between 2010 and 2050, ultimately accounting for one-fourth of the U.S. population, the statement noted.

Source: American Heart Association


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Weight-Bearing Exercises Promote Bone Formation in Men

RoseAnn Sorce wrote . . . . . .

“People may be physically active, and many times people know they need to exercise to prevent obesity, heart disease or diabetes,” Hinton said. “However, you also really need to do specific exercises to protect your bone health.”

In the study, men 25- to 60-years-old who had low-bone mass were split into two groups. One group performed resistance training exercises such as lunges and squats using free weights. The other group performed various types of jumps, such as single-leg and double-leg jumps. After 12 months of performing the exercises, Hinton then compared the levels of bone proteins and hormones in the blood.

“We saw a decrease in the level of sclerostin in both of these exercise interventions in men,” Hinton said. “When sclerostin is expressed at high levels, it has a negative impact on bone formation. In both resistance and jump training, the level of sclerostin in the bone goes down, which triggers bone formation.”

The other significant change Hinton observed was an increase in the hormone IGF-1. Unlike sclerostin, IGF-1 triggers bone growth. The decrease of harmful sclerostin levels and the increase in beneficial IGF-1 levels confirmed Hinton’s prior research that found both resistance training and jump training have beneficial effects on bone growth.

To increase bone mass and prevent osteoporosis, Hinton recommends exercising specifically to target bone health. While exercises such as swimming and cycling are beneficial to overall health, these activities do not strengthen the skeleton. Hinton suggests also doing exercise targeted for bone health, such as resistance training and jump training.

The study was published in Bone.

Source: University of Missouri


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Playing Pokémon Go May Help People Reach 10,000 Daily Steps Goal

Playing the popular smartphone game Pokémon Go may increase people’s daily steps, especially among young adults with low physical activity levels or those who are overweight or obese, according to research presented at the American Heart Association’s Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions.

In Pokémon Go, a location-based augmented reality game, players move around a physical location capturing animated creatures on smartphones and other mobile devices. Pokémon Go has generated a great deal of interest since it was released in July 2016, but few studies have examined whether playing the game can increase an individual’s level of physical activity.

“We wanted to determine if Pokémon Go can provide an enjoyable way to engage people in regular physical activity,” said Hanzhang Xu, a graduate student at Duke University School of Nursing in Durham, North Carolina. “Our findings suggest that active-play games, such as Pokémon Go, may encourage people who live sedentary lifestyles, who otherwise may not participate in traditional forms of exercise, to increase their physical activity.”

The researchers recruited 167 iPhone users who had played Pokémon Go in July 2016 and asked them to provide screenshots of their daily steps reported by the iPhone Health app between June 15 and July 31, 2016. Before playing Pokémon Go, participants walked an average of 5,678 steps. This number increased to 7,654 after playing the game, an average increase of 1,976 steps each day.

They also found:

Participants were twice as likely to reach 10,000 daily steps after playing Pokémon Go than they were before playing the game.

The percentage of days in which the 10,000-daily step goal was reached increased from 15.3 percent before playing Pokémon Go to 27.5 percent after playing the game.

Participants who had low activity levels before playing Pokémon Go or who were overweight or obese appear to benefit most from the game.

Participants with the lowest physical activity level at baseline walked nearly 3,000 additional steps each day after playing Pokémon Go. Participants who were overweight or obese also walked approximately 3,000 additional steps per day.

Although the researchers found a significant increase in physical activity after playing Pokémon Go, Ms. Xu said the initial interest may decline over time.

Ms. Xu said that while the average increase of nearly 2,000 additional steps per day may seem small, previous studies show this increase lowers the risk of having a heart attack or stroke by 8 percent in high-risk individuals. Mobile games incorporating physical activity into the gameplay may provide an alternative way to promote physical activity in people who are attracted to the game.

“Considering the low level of physical activity in the United States, doing some physical activity is always better than sitting on the couch,” she said. “While current physical activity guidelines recommend activity such as running or swimming to promote health and fitness, it should be noted that the best form of physical activity is the one that people will do. We think our study could have implications for the design of other digital health interventions that encourage people to exercise more.”

Source: American Hear Association


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Can Combined Exercise and Nutritional Intervention Improve Muscle Mass and Function?

A study of the combined effect of exercise and nutrition intervention on muscle mass and function in seniors finds that exercise has a positive impact, with some possible additive effect of dietary supplementation.

Although progressive muscle loss is a natural part of ageing, sarcopenia is generally identified when muscle mass and muscle function falls below defined thresholds. Sarcopenia’s impact can be enormous as it affects mobility, balance, risk of falls and fractures, and overall ability to perform tasks of daily living. Given the ageing of populations worldwide, public health and clinical recommendations to prevent and manage sarcopenia are urgently needed.

The new systematic review ‘Nutrition and Physical Activity in the Prevention and Treatment of Sarcopenia’ summarizes the results of randomized controlled trials (RCTs) assessing the effect of interventions combining physical activity and dietary supplements on muscle mass and muscle function in subjects aged 60 years and older.

Following up on a previous study, the new study looked at a total of 37 RCTs. The studies were heterogeneous both in terms of protocols for physical exercise and in regard to dietary supplementation. The various supplements used included proteins, essential amino acids, creatine, β-hydroxy-β-methylbuthyrate, vitamin D, multi-nutrients and others.

Professor René Rizzoli, Emeritus Professor of Medicine at University Hospitals of Geneva, stated: “

Previous trials have shown that physical activity, and primarily resistance training interventions, have a positive impact on muscle strength and physical performance. Other studies have suggested that certain dietary supplements play a role in muscle mass or function. However, more needs to be learned about the synergistic effects of these two interventions.”

The review concluded that:

  • In 79% of the studies, muscle mass increased with exercise and an additional effect of nutrition was found in 23.5% of the RCTs.
  • Muscle strength increased in 82.8% of the studies following exercise intervention and dietary supplementation showed additional benefits in a small number of studies (22,8%).
  • The majority of studies showed an increase of physical performance following exercise intervention (92.8%) and interaction with nutrition supplementation was found in 14.3% of these studies.

Physical exercise was found to have a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older. The greatest effect of exercise intervention, of any type, was observed on physical performance (gait speed, chair rising test, balance, SPPB test, etc.). Based on the included studies, mainly performed in well-nourished subjects, the combined effect of dietary supplementation on muscle function was less than expected.

Professor Elaine Dennison, Professor of Musculoskeletal Epidemiology and Honorary Consultant in Rheumatology within Medicine at the University of Southampton, noted:

Among the challenges in carrying out this study was the great heterogeneity in the RCTs, including in the exercise protocols and in the dosage of supplementation, all of which contributes to the variable findings between studies. Nevertheless, the results of the systematic review show the overwhelming positive impact of exercise interventions. One should also bear in mind that the majority of studies included in this systematic review looked at primarily healthy older subjects. It is likely that populations with nutritional or physical deficiencies would benefit more from nutritional interventions than well-nourished populations.”

The study authors point to a need for more well-designed studies assessing the impact of a combined exercise intervention and dietary intervention in frail and sarcopenic populations, and in populations suffering from nutritional deficiency or at risk of malnutrition. Furthermore, future studies should include rigorous documentation of the subjects’ baseline exercise levels and nutritional status prior to the implementation of intervention regimens.

Source: International Osteoporosis Foundation


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Three Yoga Moves that Can Give Relief to Your Back Pain

Sally Wadyka wrote

New guidelines released last week by the American College of Physicians (ACP) suggest that trying yoga for back pain is a good move.

The guidelines recommend opting for nondrug remedies first. The evidence that yoga offers a benefit is as strong as for other nonmedical treatments, such as chiropractic, massage, and tai chi, according to Richard Deyo, M.D., M.P.H. Deyo is the Kaiser Permanente Professor of Evidence-Based Family Medicine at Oregon Health and Science University and author of a review study of nondrug therapies for back pain, which was part of the research used to set the new guidelines.

And in a new, nationally representative survey from the Consumer Reports National Research Center of more than 3,500 adults, yoga (and tai chi, or the like) was helpful to almost 90 percent of the back-pain suffers who tried it. In comparison, 75 percent of people who saw a physical therapist and 64 percent who saw a primary care doctor said the advice or treatment they received gave them relief.

Further evidence of the potential benefits of yoga for back pain were found in a recent review of 12 studies by researchers at the University of Maryland School of Medicine’s Center for Integrative Medicine. Compared with those who didn’t exercise, those who did yoga saw small to moderate improvements in back function.

Do’s and Don’ts of Yoga for Back Pain

It’s important to note that all of the positive research on yoga focused on people with chronic back pain.

“I suspect that truly acute back pain is the wrong time to begin a yoga program,” Deyo says. “But a mild regimen in the subacute phase [pain lasting up to 12 weeks]—that focuses on relaxation, stretching and maintaining joint range of motion—may make sense.”

The tricky part is finding the right type of yoga for back pain, one that will help rather than potentially cause more pain. “The yoga interventions we studied in our review were designed to treat low back pain, and the classes were taught by experienced teachers,” says L. Susan Wieland, M.P.H, Ph.D., an assistant professor at the University of Maryland’s medical school.

She suggests getting your doctor’s okay before starting a yoga program and seeking out knowledgeable teachers. (Check out the Yoga Alliance or the International Association of Yoga Therapists for instructors with advanced levels of training.)

Look for classes with words like “gentle,” “relaxation,” or “restorative” in their title, and steer clear of those that have words like “power” or “Ashtanga”—two styles that are more vigorous—in their description.

During class, don’t be afraid to skip some postures or ask the teacher for modifications. “If something doesn’t feel intuitively good, don’t do it,” says Larry Payne, Ph.D., founder of the Samata Yoga Center in Los Angeles.

Three Back-Friendly Postures to Try

According to Payne, sitting too much is the biggest enemy. “That position causes people to round forward, which leads to low back pain,” he says. “Yoga postures that make the back arch more help to reinstate the natural lumbar curve.”

Low back pain also tends to affect one side more than the other, so moves that address both sides of the back separately can be helpful in restoring balance.

Here are three that Payne suggests making part of your daily routine:

Knee to Chest (see picture on top)

To help tune your back before you even get out of bed, lie with one leg extended, bend the other leg, and gently pull that knee into your chest. Breathing slowly through your nose, hold for five breaths, then repeat on the other side.

Cobra

Lie on your stomach, hands on the floor with fingertips near your armpits. As you inhale to a count of five, slowly press your chest forward and up, extending your elbows only as far as you comfortably can (the straighter your arms, the more your back will arch). Hold for a moment, then lower down as you exhale to a count of five. Start with six to eight repetitions and work up to 12 to 15.

Warrior One

Stand facing forward, legs extended so that your right foot is on the ground in front of you, left foot behind you. As you inhale, bend your front knee (your right knee should end up directly above your right ankle) and move your arms overhead. Move in and out of the pose three times and on the third time, stay in the lunge with arms overhead, back slightly arched and hold for five breaths. Repeat the sequence on the other side.

“I think the most important thing is to start slowly, expect that some of the techniques will be challenging at first and maybe cause some temporary increase in pain,” says Roger Chou, M.D., a professor of medicine at the Oregon Health and Science University School of Medicine, and lead author of the review of nondrug therapies that was used to set the ACP guidelines. “As with most movement-based therapies, once people get through the first six to eight weeks, a lot of the initial soreness goes away and they start to feel better. So don’t give up on it too quickly.”

Source: Consumer Report


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