Among Older Women, 10,000 Steps Per Day Not Needed for Lower Mortality

In the world of step goals and activity trackers, the number 10,000 can sound like a magic one. Many wearable devices that track the number of steps a person takes each day come pre-programmed with a daily goal of 10,000 steps. But while a large body of evidence shows that physical activity is good for a person’s health and longevity, few studies have examined how many steps a day are associated with good health, particularly long-term health outcomes. A new study led by investigators from Brigham and Women’s Hospital sought to address this knowledge gap by examining outcomes over an average of more than four years for older women in the Women’s Health Study who had measured their steps for a full week. The team reports that, among older women, taking as few as 4,400 steps per day was significantly associated with lower risk of death compared to taking 2,700 steps per day. Risk of death continued to decrease with more steps taken but leveled off at around 7,500 steps per day — less than the 10,000 steps default goal in many wearables. The team’s results are presented today at the American College of Sports Medicine Annual Meeting and published simultaneously in JAMA Internal Medicine.

“Taking 10,000 steps a day can sound daunting. But we find that even a modest increase in steps taken is tied to significantly lower mortality in older women,” said I-Min Lee, MBBS, ScD, an epidemiologist in the Division of Preventive Medicine at the Brigham. “Our study adds to a growing understanding of the importance of physical activity for health, clarifies the number of steps related to lower mortality and amplifies the message: Step more — even a little more is helpful.”

According to previous studies, the average number of steps taken by people in the U.S. is between 4,000 and 5,000 per day. The origin of the 10,000-step goal is unclear but may trace back to 1965, when a Japanese company began marketing a pedometer called Manpo-kei, which translates to “10,000 steps meter” in Japanese.

To conduct their study, Lee and colleagues included participants from the Women’s Health Study, a randomized trial originally conducted to evaluate risk of cardiovascular disease and cancer among women taking low-dose aspirin and vitamin E. When the original trial ended, participants were invited to participate in a long-term observational study. For the present study of steps and health, almost 18,000 women were asked to wear an ActiGraph GT3X+ accelerometer device — a research grade wearable — on their hips for seven consecutive days during all waking hours. The team analyzed 16,741 of the women who were compliant with wearing the device; their average age was 72.

Participants were followed for an average of more than four years, during which time 504 women died. Participants in the bottom 25 percent of steps walked (average of 2,700 steps per day) were at greatest risk of death, with 275 women dying. Those who walked modestly more (average of 4,400 per day) were at 41 percent lower risk of death. Risk of death continued to decrease with more steps walked, up to 7,500 steps per day, after which risk leveled off. The team also found that for women who walked the same number of steps per day, the intensity — how fast or slow they walked — was not associated with risk of death.

Due to the observational nature of the study, the authors cannot definitively separate cause from correlation (that is, to differentiate between “do more steps lower mortality?” or “do women in better health step more?”). However, the team did take several measures to try to ensure that the association observed was more likely causal than not, such as excluding women with heart disease, cancer, diabetes and less than excellent or good self-rated health and excluding the first year of follow-up data. The findings also are supported by previous experiments showing physical activity causes beneficial changes in short-term markers of health e.g., blood pressure, insulin/glucose levels, lipid profile, inflammation, and more.

The Women’s Health Study included primarily older, white women, and further studies will be needed in younger and diverse populations to determine if the findings are applicable to other groups, especially those who may, on average, take more steps. Other outcomes — such as quality of life and risk of specific diseases — were not assessed, but will be addressed in future studies.

“Of course, no single study stands alone. But our work continues to make the case for the importance of physical activity,” said Lee. “Clearly, even a modest number of steps was related to lower mortality rate among these older women. We hope these findings provide encouragement for individuals for whom 10,000 steps a day may seem unattainable.”

Source: Science Daily


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Diet Drinks May be Associated with Strokes Among Post-menopausal Women

Among post-menopausal women, drinking multiple diet drinks daily was associated with an increase in the risk of having a stroke caused by a blocked artery, especially small arteries, according to research published in Stroke, a journal of the American Heart Association.

This is one of the first studies to look at the association between drinking artificially sweetened beverages and the risk of specific types of stroke in a large, racially diverse group of post-menopausal women. While this study identifies an association between diet drinks and stroke, it does not prove cause and effect because it was an observational study based on self-reported information about diet drink consumption.

Compared with women who consumed diet drinks less than once a week or not at all, women who consumed two or more artificially sweetened beverages per day were:

  • 23 percent more likely to have a stroke;
  • 31 percent more likely to have a clot-caused (ischemic) stroke;
  • 29 percent more likely to develop heart disease (fatal or non-fatal heart attack); and
  • 16 percent more likely to die from any cause.

Researchers found risks were higher for certain women. Heavy intake of diet drinks, defined as two or more times daily, more than doubled stroke risk in:

  • women without previous heart disease or diabetes, who were 2.44 times as likely to have a common type of stroke caused by blockage of one of the very small arteries within the brain;
  • obese women without previous heart disease or diabetes, who were 2.03 times as likely to have a clot-caused stroke; and
  • African-American women without previous heart disease or diabetes, who were 3.93 times as likely to have a clot-caused stroke.

“Many well-meaning people, especially those who are overweight or obese, drink low-calorie sweetened drinks to cut calories in their diet. Our research and other observational studies have shown that artificially sweetened beverages may not be harmless and high consumption is associated with a higher risk of stroke and heart disease,” said Yasmin Mossavar-Rahmani, Ph.D., lead author of the study and associate professor of clinical epidemiology and population health at the Albert Einstein College of Medicine in the Bronx, New York.

Researchers analyzed data on 81,714 postmenopausal women (age 50-79 years at the start) participating in the Women’s Health Initiative study that tracked health outcomes for an average of 11.9 years after they enrolled between 1993 and 1998. At their three-year evaluation, the women reported how often in the previous three months they had consumed diet drinks such as low calorie, artificially sweetened colas, sodas and fruit drinks. The data collected did not include information about the specific artificial sweetener the drinks contained.

The results were obtained after adjusting for various stroke risk factors such as age, high blood pressure, and smoking. These results in postmenopausal women may not be generalizable to men or younger women. The study is also limited by having only the women’s self-report of diet drink intake.

“We don’t know specifically what types of artificially sweetened beverages they were consuming, so we don’t know which artificial sweeteners may be harmful and which may be harmless,” Mossavar-Rahmani said.

The American Heart Association recently published a science advisory that found there was inadequate scientific research to conclude that low-calorie sweetened beverages do – or do not – alter risk factors for heart disease and stroke in young children, teens or adults. The Association recognizes diet drinks may help replace high calorie, sugary beverages, but recommends water (plain, carbonated and unsweetened flavored) as the best choice for a no calorie drink.

“Unfortunately, current research simply does not provide enough evidence to distinguish between the effects of different low-calorie sweeteners on heart and brain health. This study adds to the evidence that limiting use of diet beverages is the most prudent thing to do for your health,” said Rachel K. Johnson, Ph.D., R.D., professor of nutrition emeritus, University of Vermont and the chair of the writing group for the American Heart Association’s science advisory, Low-Calorie Sweetened Beverages and Cardiometabolic Health.

“The American Heart Association suggests water as the best choice for a no-calorie beverage. However, for some adults, diet drinks with low calorie sweeteners may be helpful as they transition to adopting water as their primary drink. Since long-term clinical trial data are not available on the effects of low-calorie sweetened drinks and cardiovascular health, given their lack of nutritional value, it may be prudent to limit their prolonged use” said Johnson.

Source: American Heart Association


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Could Diet Sodas Raise an Older Woman’s Stroke Risk? . . . . .

Weight Loss Linked to Lower Breast Cancer Risk for Postmenopausal Women

In a study of postmenopausal women, participants who lost weight had a lower risk of developing invasive breast cancer than those who maintained or gained weight. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that weight loss may help lower postmenopausal women’s breast cancer risk.

In a study of postmenopausal women, participants who lost weight had a lower risk of developing invasive breast cancer than those who maintained or gained weight. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings suggest that weight loss may help lower postmenopausal women’s breast cancer risk.

Although obesity has been strongly related to breast cancer risk, studies examining whether weight loss might reduce postmenopausal women’s risk have provided mixed results. To examine the issue, Rowan Chlebowski, MD, PhD, of the City of Hope National Medical Center in Duarte, California, and his colleagues analyzed information on 61,335 women participating in the World Health Initiative Observational Study who had no prior breast cancer and had normal mammogram results. The women’s body weight, height, and body mass index were assessed at the start of the study and again 3 years later.

During an average follow-up of 11.4 years, there were 3,061 new cases of invasive breast cancer diagnosed. Women with weight loss ≥5 percent had a 12 percent lower breast cancer risk compared with stable weight women, with no interaction by body mass index. Weight gain of ≥5 percent was not associated with risk of breast cancer overall but was associated with a 54 percent higher incidence of triple negative breast cancer.

“Our study indicates that moderate, relatively short-term weight reduction was associated with a statistically significant reduction in breast cancer risk for postmenopausal women,” said Dr. Chlebowski. “These are observational results, but they are also supported by randomized clinical trial evidence from the Women’s Health Initiative Dietary Modification trial where, in a randomized clinical trial setting, adopting a low-fat dietary pattern that was associated with a similar magnitude of weight loss resulted in a significant improvement in breast cancer overall survival. These findings, taken together, provide strong correlative evidence that a modest weight loss program can impact breast cancer.”

October is Breast Cancer Awareness Month.

Source: Wiley


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When ‘Good’ Cholesterol Is Bad for Older Women

Amy Norton wrote . . . . . . .

HDL cholesterol may be known as the “good” kind, but a new study suggests high levels of it are not always a good thing for women after menopause.

The study, of nearly 1,400 postmenopausal women, found that those with higher HDL levels were more likely to show “plaques” in their carotid arteries. Those arteries supply blood to the brain, and plaque buildup there signals an increased risk of both stroke and heart disease.

The study did not look at women’s rates of heart attack or stroke. But experts said the findings add to evidence that when it comes to HDL, there can be too much of a good thing.

“We used to think, the higher the better,” said Dr. Karol Watson, director of the Women’s Heart Health Program at the University of California, Los Angeles. “But we’ve been re-thinking HDL in recent years.”

Watson, who was not connected to the study, is also a member of the American College of Cardiology’s Prevention of Cardiovascular Diseases Section Leadership Council.

She said “everyone agrees” that low HDL — below 40 mg/dL — is bad.

But studies have also found that very high HDL is linked to trouble, too. For example, a 2016 study of over 630,000 people found that women and men with very high HDL — above 90 mg/dL — were more likely to die (of non-cardiovascular causes) during the study period than those whose HDL was in the middle of the pack.

HDL is known as the “good” cholesterol because it does positive things, including clearing fat from the arteries and ushering it to the liver to be removed.

But, Watson said, research suggests that HDL function can go awry when its environment is not ideal — such as when a person is obese or has diabetes or other health conditions causing chronic inflammation in the blood vessels.

“HDL seems to be like a chameleon, changing based on its surroundings,” Watson explained.

That general idea may explain what was seen in this study, according to lead researcher Samar El Khoudary, an associate professor at the University of Pittsburgh’s School of Public Health.

During the menopause transition, she said, women see a sharp drop in estrogen, a heart-protecting hormone. They also go through changes in body fat distribution, blood fats and other metabolic processes; that might lead to chronic inflammation that could alter the quality of HDL particles.

So a higher HDL level is “not necessarily cardio-protective,” El Khoudary said. But, she added, it’s not necessarily bad, either.

It’s important to look at the whole picture, she said. If, for example, a woman is normal weight, exercises, and does not have heart risk factors like high LDL cholesterol (the “bad” kind) or diabetes, a high HDL is “probably not something to worry about,” El Khoudary said.

Watson agreed. On the other hand, she said, a high HDL level should not make women or their doctors complacent.

“Never ignore a high LDL level just because the HDL is high,” Watson said.

The bottom line, according to El Khoudary, is that women should pay even more attention to maintaining a healthy lifestyle as they go through menopause.

On the research end, she said, doctors need more precise measures of HDL function — not just HDL cholesterol level.

El Khoudary’s team also measured the study participants’ levels of HDL “particles” — which carry HDL cholesterol through the blood.

Overall, women with a greater number of “small” HDL particles had a lower risk of plaque buildup. Meanwhile, “large” particles showed a more complicated relationship: When women were just past menopause, those particles were tied to a heightened risk of artery narrowing. But among relatively older women, high numbers of large particles were linked to healthier-looking arteries.

If that all sounds complicated, that’s because it is.

For now, Watson said, no one knows whether measuring HDL particles is useful. “Until we understand more, we can’t do anything with that information,” she said.

How high is “too high” when it comes to HDL? There is no known cutoff, Watson said. In general, she added, there seems to be an HDL “sweet spot” of around 60 to less than 80 mg/dL.

But again, Watson said, you have to look at the whole person: If someone has risk factors for heart disease, a higher HDL number may be misleading.

El Khoudary recently received funding from the U.S. National Institute on Aging to expand on this research.

The findings were published online in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Source: HealthDay


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Pilates for Older Women

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