Fitness in Mid-life Leads to Less Illness in Later Life

Woman with DumbbellsAt doctor/patient visits, physicians stress the importance of developing and following a healthy lifestyle. That healthy lifestyle includes eating correctly and in moderation, controlling your weight, going for periodic benchmarking checkups and getting regular and consistent exercise. An untold number of research studies have supported these recommendations.  Medpage, the online medical journal of the University Of Pennsylvania School Of Medicine printed two reviews of studies which confirm the findings.

Ambrish Pandey, MD, of the prestigious University of Texas Southwestern Medical Center in Dallas, Texas with his colleagues presented data that links fitness in your fifties with a reduced risk of cardiovascular heart failure in later life.  They looked at 9,050 men and women with an average age of 48 and followed them for a period of eight years. They evaluated their fitness at entry into the study and eight years later. They followed patients for 60,635 patient years.  

Their findings were quite simple. Those people who exercised regularly and improved their fitness over time had less heart disease and heart failure. They proved that your risk of cardiovascular disease in your sixties and seventies was modifiable based on your fitness level and effort to improve it and sustain it.

Susan Lakoski, MD, of the University of Vermont in Burlington looked at fitness in men in their fifties and concluded that “physical fitness reduces the risk of lung and colorectal cancer”.  She pointed out that if fit men developed cancer they tended to have a higher survival rate than unfit men. Interestingly, her study suggested that weight was NOT the issue.  Overweight men who were fit did well, while unfit lean men did not do as well.

It is refreshing to have data to back up the recommendations we make to our patients – find some form of exercise they enjoy and keep doing it, frequently and repeatedly if you wish to have fewer health issues to deal with as you age.

Evaluation of Blood in the Urine (Hematuria)

Speciman BottlesI recently had a long discussion with a diabetic patient about the drug Actos. This very effective and relatively safe diabetic drug has now been implicated as increasing the risk of bladder cancer. While the FDA has not removed the drug from the market, it has been removed from the market in Germany.  My patient wondered if he could continue using Actos but send his urine off for testing and evaluation regularly to detect any indication bladder cancer early. I said I preferred switching medications. 

Chance would have it that the April 11, 2013 edition of Journal Watch addressed the question indirectly.  They looked at whether or not it was safe to send urine off for cytology to look for cancerous cells in the evaluation of blood in the urine. Urine cytology, like the Pap smear, looks at cells in the urine from the bladder and tries to diagnose bladder abnormalities and cancers by identifying abnormal cells. The traditional evaluation of blood in the urine includes doing x-ray and imaging studies as well as performing an invasive procedure called a cystoscope (under anesthesia a fiber optic device is inserted into the bladder through the urethra and advanced into the upper collecting tracts.).

In a study performed in the United Kingdom at a teaching hospital, researchers reviewed the records of patients with blood in the urine. Sixty-five percent of the patients had visible bleeding while 35% had only microscopic bleeding. They all underwent imaging of the upper tract, cystoscopy and urine cytology.

A full evaluation of imaging, cystoscopy and cytology was performed on 2,507 patients. Fourteen percent of the patients were ultimately diagnosed with transitional cell cancers of the bladder. The sensitivity and specificity of abnormal cytology were 45% and 89% making cytology not “good enough” to serve as a first line test for patients with unexplained blood in the urine. More than half the patients with bladder cancers had negative cytology and about 105 of patients with negative cytology had bladder cancers.

The study supports the recommendations of the American Urologic Association’s guidelines that recommend against using urine cytology in the initial evaluation of patients with microhematuria.