More Docs Are Asking Patients to Exercise

Physicians are getting better at advising adults to exercise.

Photo courtesy National Cancer Institute/Bill Branson

In 2010, 32.4% of adults in the United States who had seen a physician or other health care professional in the past year had received a recommendation to begin or continue to do exercise or physical activity, up from 22.6% in 2000. At each time point, women were more likely than men to have been advised to exercise.

The findings, published this month as a National Center for Health Statistics Data Brief, come from the National Health Interview Surveys conducted in 2000, 2005, and 2010.

Between 2000 and 2010 the percentage of patients aged 85 and older who received a “get fit” recommendation from a physician nearly doubled from 15.3% to 28.9%. The percentage of patients aged 18-24 years receiving such a recommendation also increased during the same time period, but to a lesser extent (from 10.4% to 16.1%).

The report also found that the percentage of adults with hypertension, cardiovascular disease, cancer, and diabetes who received exercise advice from a physician increased between 2000 and 2010.

“Trends over the past 10 years suggest that the medical community is increasing its efforts to recommend participation in exercise and other physical activity that research has shown to be associated with substantial health benefits,” the report states. “Still, the prevalence of receiving this advice remains well below one-half of U.S. adults and varies substantially across population subgroups.” 

 — Doug Brunk (on Twitter@dougbrunk)

Photo courtesy National Cancer Institute Visuals Online

What Fuels the Athlete With Type 1 Diabetes?

A phenomenon that was virtually impossible just a couple of decades ago is now becoming increasingly commonplace: Athletes with type 1 diabetes are not only competing at elite levels in just about every sport, but in many cases are actually beating nondiabetic competitors. Gary Hall Jr. won three Olympic Gold medals in swimming after his diagnosis in 1999. Natalie Strand, an anesthesiologist, won the TV extreme-sport reality show Amazing Race with her partner last December. And bicycle racers Team Type 1 won the Race Across America in 2009 and 2010.

Of course, exercise is encouraged for people with both type 1 and type 2 diabetes as a way of improving glycemic control, cardiovascular health, and quality of life. But in competitive sports, milliseconds count and physical perturbations of any kind can mean the difference between winning and losing. With type 1 diabetes, aerobic exercise can result in hypoglycemia, while anaerobic exercise can cause glucose levels to rise. Many sports involve a combination of the two. The athlete with type 1 diabetes must perform frequent glucose checks and eat or take insulin as needed to maintain normal or near-normal glucose, while at the same time performing the athletic feat itself. It seems nearly impossible, yet they do it … with the help of both new technology and devoted health care professionals.

“I take each athlete, learn their sport and find solutions,” said Dr. Anne Peters, the endocrinologist who managed Gary Hall Jr.’s diabetes regimen during the Olympics and is now doing the same for professional racecar driver Charlie Kimball. “Each athlete is unique and requires individualized care.”

Javier Megias of Team Type 1 checks his blood sugar while warming up for a time trial at a race in Italy. Photo courtesy of Team Type 1

New research is aimed at understanding the physiology of these athletes better in order to improve that care. Team Type 1, sponsored by Sanofi, is funding a study in which data are being collected on about 10 bike racers with and 10 without type 1 diabetes. The athletes are being evaluated before, during, and after races using continuous glucose monitors and devices placed on the bicycles that measure variables such as power, heart rate, energy expenditure, speed, and altitude. Data on the athletes’ diet, insulin doses, and other variables are also being collected in a total of five major cycling events, each of which includes 4-8 individual races. “Bottom line, it’s a lot of data,” said Team Type 1 director of research Dr. Juan Frias.

Interestingly, blood glucose values of up to 200 mg/dL – far above “normal” – have been recorded in the nondiabetic riders during very intense portions of races. This “stress hormone” effect had been seen previously in the lab and in some hospitalized patients, but has not been well documented in field-based, real-world studies of healthy people. “Ultimately we hope that this feasibility study will provide data that will help us begin to better understand the optimal glucose concentrations needed to maximize athletic performance, Dr. Frias said.

Findings from the TT1 study will likely be announced at scientific conferences during 2012 and ultimately published, he told me.

Another research project, led by Nate Heintzman, Ph.D., of the University of California, San Diego, is studying athletes who are part of Insulindependence, an organization that promotes physical fitness and sport for people with type 1 diabetes. One of Insulindependence’s recreation-specific clubs, Triabetes, trains people with type diabetes to compete in triathalons. The UCSD-supported project, called the Diabetes Management Integrated Technology Research Initiative (DMITRI), is looking at many of the same variables as in the TT1 study, but is also collecting other data, including behavioral and cognitive information and biospecimens for DNA sequencing.

Insulindependence Captains starting their track workout at UCSD in June. Every person in this photo has type 1 diabetes. Courtesy of Nate Heintzman, Ph.D.

“The idea is to use emerging wireless and device technology as well as genetics and genomics to understand more about the personalized basis of blood glucose management. I think we’ll uncover trends to help tailor therapeutic regimens, and also develop technology on a personal level,” Dr. Heintzman said.

The DMITRI project began in June, and data will begin to emerge in the coming months. In the meantime, if you’re a health care provider or person with diabetes interested in learning more, Dr. Peters recommends Sheri Colberg-Ochs Ph.D.’s Diabetic Athlete’s Handbook. And if you’re seeking inspiration, you can follow Team Type 1 founder and CEO Phil Southerland’s efforts to enter the team in the 2012 Tour de France, professional cycling’s most elite event.

Bottom line, according to Dr. Peters, “The truly gifted athletes I have known seem to be born with an ability that compels them to compete, diabetes or not.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

To Get the Teen Away from the Screen, Get a Dog

The physical and psychological health benefits of dog ownership for adults are well known, but data from a new study suggest that Mom isn’t always the one on dog-care duty.

photo by Heidi Splete

In a study published in the March issue of the American Journal of Preventive Medicine, John Sirard, Ph.D., of the University of Virginia and colleagues surveyed 618 teen/parent pairs in Minneapolis about their physical activity levels and how many, if any, dogs they had at home. The teens wore accelerometers to track their physical activity levels for 1 week.

The researchers found that teens with dogs were more active, even after controlling for the usual suspects of gender, race, and socioeconomic status. Both measures of activity – accelerometer counts per minute and the average daily minutes of “moderate to vigorous physical activity” – were significantly greater in teens who had dogs.

But here’s the interesting twist: According to the researchers, “dog walking behavior and active play with the family dog were not assessed in the current study and need to be studied further.”

Although having a dog doesn’t guarantee an increase in activity, the findings suggest that even teens who don’t walk the dog will likely get up off the sofa to let the dog out, and in, and back out. . . even if they don’t put down their phones.

Of course, the study was limited by the use of a homogenous sample, but it is the first to address the impact of dog ownership on activity in teens.

Bonus: A dog gives parents and teens something to talk about, too.

–Heidi Splete (on twitter @hsplete)

Not Just Surviving: More Cancer Doctors Tune in To Patients’ Post-Treatment Lives

The 2010 Breast Cancer Symposium, held last week in National Harbor, Md., dedicated an entire session to survivorship. The specific topics included sexuality, survivorship in older patients, management of osteonecrosis of the jaw, and physical activity, diet, and weight.  

courtesy of flickr user N!els (creative commons)

This is encouraging. It seems like more doctors are paying increasing attention to the quality of cancer patients’ lives after their treatments are over. Dr. Michael Krychman of Newport Beach, Calif., emphasized the importance of individualizing sexual problems in cancer survivors. The decrease in estrogen after cancer treatment can cause a range of sexual problems for which there are a range of solutions even at the most basic level, such as choosing the right lubricant for vaginal dryness, he said.

 

 

The physical activity talk stood out in light of recent guidelines issued by the American College of Sports Medicine (ACSM). Dr. Rachel Ballard-Barbash of the National Cancer Institute mentioned the guidelines and emphasized the value of a variety of types of exercise—cardiovascular activity, resistance training, and flexibility—for cancer survivors.

My colleague Kerri Wachter (@knwachter on Twitter), covered the ACSM’s June meeting, and blogged about how the recommendations said that there’s no reason why cancer patients can’t get out and do whatever exercise feels good to them. Kerri also conducted a video interview with Kathryn Schmitz, Ph.D., of the University of Pennsylvania, lead author on the ACSM guidelines.

Dr. Ballard-Barbash said that even though studies of exercise interventions for cancer patients haven’t shown significant weight loss, they have shown improvements in cardiovascular fitness and physical function. And let’s not underestimate the psychological benefits of exercise in general, and the comfort and joy of returning to a favorite activity in particular.

–Heidi Splete (@hsplete on twitter)

Getting Kids HEALTHY

Thank God – or school administrators, or Dr. Gary Foster, or kids who just want to have fun – thank anyone you want… but there’s finally some good news about childhood obesity. It came on June 27, at the annual meeting of the American Diabetes Association. 

The Move It Kids demonstrate fun fitness. By Flickr user nutrition educator.

 The results of the three-year HEALTHY Study are in, and while they might not be exactly what researchers hoped for, they’re plenty good. A three-pronged middle school program that improved food in schools, jacked up gym classes, and made it “cool” to be healthy, helped husky 6th-graders slim down by the time they were headed off to high school.  

Technically, the study didn’t succeed – that is, it did not meet the primary endpoint of decreasing the prevalence of a combination of overweight and obesity at target schools more than control schools. But by the end of the intervention, HEALTHY schools did have fewer kids with extremely high waist circumference, and fewer with a body mass index above the 95th percentile.  

The program seemed to work best in the kids who were already overweight or obese as 6th-graders. They were 21% less likely to be overweight or obese in 8th grade than students at the control schools. And they had a trend – though not a significant difference toward a greater reduction in the BMI z-score  by grade eight.  

Perhaps the best news in the study was its “failed” primary endpoint: By the end of the study both intervention and control schools saw significant decreases of 4% in the prevalence of kids who were overweight or obese. It’s not entirely clear why, but at a press briefing, Dr. Foster, a Temple University endocrinologist, suggested a few possibilities.  

The control schools had the same enrollment procedure as the intervention schools: All the 6th-graders had a health screening that included weight, blood pressure, a lipid panel, and insulin and fasting glucose levels. All the parents got a “health report card” describing their child’s status and suggesting a doctor visit if indicated. That might have been enough to stimulate some family changes that helped children shed pounds.  

Just as likely, he suggested, are societal trends. Maybe word of the looming avalanche of obesity-related diabetes, cancers, and cardiovascular disasters has finally penetrated the cacophony of advertisements suggesting that kids can live off the “Children’s Menu” diet – chicken fingers, french fries, and a soda.  

Whatever the reason, I’m thrilled: Last year, my son wanted to celebrate  his 13th birthday by taking some buddies to a theme park . Two of them — one “husky” and one frankly huge —  couldn’t take the strain of walking around a slightly hilly park on a warm late-April day. The bigger one ended up in the nurse’s station for 4 hours with a splitting headache and an upset stomach.  

It was a lesson learned for my son, though. He has moderated his own diet noticeably since then, referring several times to how sad it was that his lifelong, overweight friend couldn’t keep up, even in the race to have fun. 

— Michele G. Sullivan (on Twitter @MGsullivan)

   

Is There Anything Exercise Can’t Help?

From the International Stroke Conference in San Antonio

Image courtesy of Flickr user Josiah MacKenzie (CC)

If you hate to get off the sofa, here’s some more news about exercise that you probably don’t want to hear.

Transient ischemic attack (TIA) is often considered a warning. By some estimates, more than half of those with a TIA will have a stoke within the next 5 years.  TIA shares a number of risk factors with cardiac disease, among them hypertension, smoking, diabetes, and cholesterol.  What’s bad for the heart must be bad for the brain too, right?

Right.  And now there is increasing evidence that what’s good for the heart must be good for the brain too.

A small study presented at the meeting showed that patients with a TIA benefit from the same type of exercise rehabilitation program that cardiac patients go through following an MI.  Fourteen post-TIA patients participated in a 6-week rehabilitation program.  Patients attended three 1.5-hour sessions per week.  Sessions included a warm-up, timed aerobic exercise, resistence training, and a cool-down.  Intensity progressed with patient tolerance.

The researchers measured changes in blood pressure, gait speed, and endurance.  At the end of 6 weeks, systolic blood pressure was decreased by 8.71 mm Hg and diastolic blood pressure was decreased by 7.18 mm.  While the results were not statistically significant, study author Marieke Van Puymbroeck of Indiana University noted these decreases in blood pressure were clinically meaningful. Previous work has shown that a 5 mm Hg decrease in systolic translates to a 14% decrease in stroke risk, while a 5 mm Hg decrease in diastolic blood pressure translates to an impressive 42% decrease.

While the findings need to be validated in a larger study that controls for changes in medication, it looks like there’s another reason to lace up those trainers.

— Kerri Wachter (on Twitter @knwachter)