Fitness Lowers Your Risk of Dementia

Over the years I have read and passed on to my patients the benefits of exercise on quality of life and healthy aging. This hypothesis was supported by a recent publication in the journal “Primary Care” by Peter Lin, MD, CCFP. Dr Lin and colleagues followed a group of woman aged 38 to 60 years for 44 years to determine the relationship between fitness and development of dementia. They chose to follow 191 women from a group of 1462 patients and selected a balanced number of patients in each age group up to age 60. They performed a physical fitness test on the women in 1968 and then grouped them into high fitness category, intermediate fitness category and low fitness category based on their performance in the physical fitness test. The women then received neuropsychiatric evaluations in 1974, 1980, 1992, 2000, 2005 and 2009.

The patients within the high fitness group showed an 88% reduction in dementia rate compared to those with medium fitness. Those in the lowest fitness group had a 41% increase d risk of dementia compared to the medium fitness group. Those patients in the high fitness group who developed dementia showed symptoms 9.5 years later on average than the patients in the medium fitness group.

The message for young adults is simple. Stay fit at a high level doing something you enjoy and you may reduce your risk of developing dementia by up to 90%.

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Extreme Exercise Tied to Gut Damage

I was out doing my morning two mile trot on an unseasonably cool late spring morning in South Florida. The crispness of the day, coupled with unexplained lack of my normal warm up aches and pains made me particularly frisky. I had walked the dog for a few miles slowly, then engaged in my normal pre-run stretching routine and felt unusually energetic and fluid. I was enjoying the outdoors and weather, while listening to music on my play list and struggling to stay within the parameters of speed, pace, and target heart rate appropriate for a 67 year old man. The inner competitor within me was screaming, “You feel great, go for it.” Moderation and common sense are always the great traits to keep exercising and not injured. The inner stupid competitor in me said pick up the pace. I did pick up the pace. I completed my course far quicker than usual. I performed my cool down and stretching routine and was feeling pretty cocky about doing more than I should when I heard that rumble in my gut and saw the distention begin. The distention was followed by cramps, gas and profuse uncomfortable loose stools for several hours. My gut was sore and my appetite was gone.

I mention this after reading an article review in MedPage Today about a publication in the journal Alimentary Pharmacology and Therapeutics published by Ricardo J.S. Costa, M.D., of Monash University in Victoria, Australia. He and his colleagues showed that exercise intensity was a main regulator of gastric emptying rate. Higher intensity meant causing more disturbances in gastric motility. High intensity exercise at a rate you are not used to for a period of time longer than you usually exercise leads to gut problems including all the issues I experienced. Low to moderate physical activity was found to be beneficial especially to patients, like myself, suffering over the years from irritable bowel syndrome.

The researchers found that ultra- endurance athletes competing in hot ambient temperatures running in multi stage continuous 24 hour marathons were far more likely to develop exercise associated GI symptoms than individuals running a less intense half marathon. The results are fairly clear for us non ultra-endurance athletes. There is great wisdom in regular moderate exercise to keep your effort within the parameters your physician and trainer recommend based on your age and physical training. Even if it’s a cool crisp day and you feel that extra surge of adrenaline and competitiveness, moderation is best for your health and your gut. I hope the competitor in me remembers that the next time the urge to push the limit pops up.

Benefits of Exercise on Blood Pressure and Prevention of Atrial Fibrillation

Senior Citizens, exercise v2Junxiu Liu, MD, of the University of South Carolina published an article in the September 15 , 2014 edition of the Journal of the American College of Cardiology showing that exercise and improving fitness levels prevented an age related expected rise in patient systolic blood pressure. His study followed 14,000 men for 35 years. Sedentary men started to see their systolic blood pressure rise at about age 46. Men who were fit delayed this rise in blood pressure until they were 54 years of age. The effect on the diastolic blood pressure was even more pronounced when looking at fitness levels. Men with low fitness ratings elevated their diastolic blood pressure to above 80 by age 42. Those men with a high fitness level did not see the rise in diastolic BP until they were beyond age 90. His research suggests that “highly fit men are likely to reach abnormal BP readings a decade later or more than sedentary men.

In an unrelated study published in the same issue, researchers in Texas found that regular aerobic exercise prevented the hearts left ventricle or main pumping chamber from developing stiffness. The stiff ness of the ventricle contributes too many common cardiovascular conditions effecting older patients. They found that low levels of casual lifelong exercise such as four (4) sessions of 30 minutes per week throughout adult hood was sufficient to keep the ventricle from stiffening.

Marco Perez, MD of Stanford University looked at exercise levels in women and the development of the heart arrhythmia atrial fibrillation. He found that sedentary women were much more likely to develop this pathologic arrhythmia than women who exercised regularly. Obesity and being overweight is a risk factor that increases your chances of atrial fibrillation. Regular exercise by obese women reduced this risk by about nine percent (9%).

The message is very clear that keeping moving and being active improves your blood pressure control and reduces your risk of developing many cardiovascular related problems. My advice is find some activity you enjoy doing and make sure you try it several times per week to gain the natural benefits the exercise provides.

Extreme Intensity Exercise Good for the Ego But Maybe Not for the Heart

ExerciseHealth experts have encouraged regular moderate level exercise for adults 5-7 days a week lasting 30 – 60 minutes per session to stay heart healthy.  We talk about walking 15 – 20 minute miles while being able to comfortably carry on a conversation as your suggested goal. We all see other adults appearing far more fit and aggressive working out daily at a much quicker and much more strenuous pace. Experts have always wondered if they are healthier and if they fare better?

Two articles addressing this issue appear in the journal Heart. Researcher Ute Mons, MA, of the German Cancer Research Institute found that men with known stable coronary artery disease who exercised strenuously daily had more than a two fold increase in cardiovascular mortality compared to men with CAD who exercised 2 -4 times per week at a moderate level. The study was the first of its kind to look at different levels of exercise and frequencies of exercise. Certainly more research is now required to verify these findings in studies which do not rely on patient self reporting of how often, how hard and how long you work out. It is also critical to remember that this study was conducted on individuals known to have heart disease.  The message to them should be clear to exercise moderately for the most benefit and least risk. The study says nothing about the benefits or risks of individuals without cardiovascular disease who exercise moderately versus strenuously.

In another related article men at age 30 who reported exercising 5 or more hours a week had an increased risk of developing the arrhythmia atrial fibrillation as compared to those who exercised more modestly. While these were both excellent preliminary works requiring further study, they both point toward moderation once again as the healthiest and best lifestyle path.

New Diet Drugs Not Being Used

Diet DrugsA joint survey was conducted by the online medical news service MedPage Today, Everyday Health and The Daily Meal to evaluate physicians’ methods of treating obesity. They surveyed almost 1000 providers and found that the newer drugs such as Qsymia (phentermine/topiramate) are only being used by about 6% and Belviq (lorcaserin) in only 3.3%. Several of the survey respondents cited the high cost of the medications as barriers to use. One provider noted that “middle class (patients) and below cannot afford “these medications so he prescribes generic phentermine 37.5 mg one half tablet each morning with generic topiramate 25 mg twice a day with similar effectiveness.

Fat absorption blockers such as orlistat in it’s over the counter form “Alli” or its prescription form xenical were popular with over 20 % of respondents using those products. Generic phentermine was used alone by 16%. Other medications frequently mentioned included metformin the diabetic drug, and victoza another diabetic drug not yet approved for weight loss therapy.

The majority of the respondents prescribe diet and exercise to begin with. Weight Watchers is their favorite commercial diet with over 75% of those surveyed noting that it works steadily and safely. The South Beach Diet was the clear runner up. When the Atkins Diet was mentioned there was concern and controversy.

In our local clinical practice we are asked frequently about medication to lose weight. The survey did not look at the average age of the patients the respondents treated and their associated medical issues. Locally we have many elderly individuals using multiple medications for heart disease, elevated lipids, diabetes, heart rhythm control and other complex problems. It is much more difficult to find any oral medications for weight loss that do not adversely react with their prescribed medicines or that are not contraindicated due to their underlying medical problems.

New Knees and Hips Cut Heart Risk

Heart DiseaseAt the annual meeting of the American Academy of Orthopedics in New Orleans, Bheeshma Ravi, M.D., an orthopedics resident at the University of Toronto, reported that patients who underwent knee and hip replacements were able to dramatically reduce their risk of a heart attack or stroke over a seven year period. He followed 153 patients who were high risk for cardiovascular disease and noted the major risk reduction.

Some of the improvement in risks were assumed to be due to the increased mobility and increased activity the recipients were able to enjoy. The increased physical activity improves cardiac health. While physical activity is one explanation, the reduction in pain, stress, use of painkillers and inflammation is another set of potential reasons. With pain comes use of more nonsteroidal anti-inflammatory medications which have been implicated in the development of acute heart attacks.

In our medical practice we often see senior citizens who are healthy enough to undergo a joint replacement but are too fearful to proceed with the surgery. This particular study provides additional evidence that replacing the inflamed joint and resuming activity is the correct choice to make.

Walking Reduces Stroke Risk

Walking signBarbara Jefferis, PhD, of University College London UK presented data in the journal Stroke that indicated that older men who added a long walk to their daily routine significantly reduced their risk of having a stroke.  The association was independent of activity level or walking pace. Men who walked 8 – 14 hours per week had about a one third lower risk of stroke compared to men who walked no more than three hours per week or at all. The risk was about 2/3 lower for men who walked more than 22 hours per week.  Walking is recognized to be the predominant form of physical activity in older adults and its impact in reducing stroke risk is important to understand.

The study looked at 3,435 men followed over a ten year period.  The lead researcher said there is no reason to believe that the protective effect does not apply to women as well.

This is one of several studies published over the last few months that extol the benefits of modest age related exercise to preserve function and independence.  We have seen the benefits of an after dinner walk on blood sugar levels documented in recent studies. In a recent British Medical Journal article (BMJ 2013, 347:f5555) researchers reviewing 60 research trials conclude that exercise benefits patients with arthritis rather than being sedentary. We have seen other studies linking seniors with active leisure activity life style exhibiting improved cognitive function compared to seniors with a more sedentary leisure life style.

From a doctor’s perspective the advice is simple. Find something you enjoy doing that is active and aerobic such as walking, running, cycling, swimming, dancing, roller skating or roller blading and engage in this activity regularly to protect your health and independence.