Aerobic Training Helps Blood Pressure Medications Do Their Job

We are always looking for ways to stay healthy with less medicine.  Miguel Ramirez-Jiminez, PhD of the  University of Castilla-La Mancha, Toledo, Spain presented a paper to the American College of Sports Medicine recently week and addressed this topic.

His group looked at 36 obese and overweight adults who normally did less than 120-minutes of physical activity per week. Ages ranged from 53 – 65 years with 22% postmenopausal women. They had all been taking blood pressure medications for at least eight years and all met the criteria for having the metabolic syndrome which includes hypertension, elevated blood glucose, elevated triglycerides and a large waist.

The group was randomly divided into a placebo group whose medication was stopped or a trial group who continued their antihypertensive medications for the next three days. All participants then underwent 24-hour ambulatory blood pressure monitoring. All the participants were then entered into a four-month cycling program three times a week. 

After completing the four months of cycling training the placebo group again did not receive their medications for three days while the trial group did.  Twenty-four-hour ambulatory blood pressure was then checked in both groups.

The group exercising plus taking their medications saw an average drop in blood pressure of 3-5 mm Hg in addition to the 5mm Hg noted just from the medication’s pre-exercise training. When the exercise program stopped, the extra drop in blood pressure additionally dropped. There is a phenomenon known as “post exercise hypotension” that can reduce your blood pressure for up to 24 hours after training. This is the reason experts advise 3-5 exercise sessions per week.  

The study also revealed that if you exercise aggressively, and hope to permanently stop your blood pressure medications, your pressure usually rises above acceptable levels.  Exercise is not a substitute for prescribed blood pressure medicines. The article can be found at www.medscape.com  

Caffeine Before Exercise Helps You Burn Fat

Researchers at the University of Granada have published a research article in the Journal of the International Society of Sports Nutrition showing that drinking a caffeinated beverage 30-minutes before exercising in the afternoon is the best way to burn fat. Morning exercise with caffeine, or without, was less productive at burning fat than afternoon exercise. Fifteen men, with an average age 32, each completed an aerobic exercise test four times with seven days in between testing. On the days tested, they were given either a caffeine dose equivalent to a strong cup of coffee or a placebo. They then rested for 30-minutes and then completed the aerobic exercise. Their meals were standardized on test days. Researchers measured the participants for fat oxidation, maximum oxygen uptake and exercise intensity.

Caffeine increased fat oxidation by 10.7 % in the morning and 29% in the afternoon. Caffeine increased exercise intensity by 11% in the morning and 13% in the afternoon. Maximum oxygen uptake was higher in the afternoon.

Recent literature has shown the benefit of tea in lowering systolic blood pressure. I think I might try a stiff cup of tea 30-minutes before my after-work exercise regimens. Come to think of it, Ii will try some coffee prior to my weekend morning workouts as well.

Keep Moving for Cardiovascular Benefits

We keep extolling the benefits and virtues of regular exercise and fitness. Some research studies have documented the intensity and duration of exercise programs with cardiovascular events and mortality. Those who do more and are fitter apparently do much better which surprises few of us.

It comes down to the “which came first the chicken or egg “question?  Are people genetically able to exercise at a high level living longer and healthier because they exercise at a high intensity and duration or vice versa?

It is quite comforting to read the recent study in JAMA by Andrea LaCroix, PhD, MPH and colleagues from the University of California, San Diego that shows the benefits of even modest movement and exercise.  The study was conducted under the umbrella of the Women’s Health Initiative and put pedometers and accelerometers on women to measure activity during waking hours.  Light physical activity was defined as less than 3 metabolic equivalents (Walking one mile in about 22 minutes expends about 3 Metabolic Equivalents of Activity).  They noted that for each hour per day increment in light activity there was a 14% lower risk of Coronary Heart Disease and 8% lower risk of cardiovascular disease.

The researchers evaluated 5,861 women with a mean age of 78.5 years. Average follow-up spanned 3.5 years with study members having 570 cardiovascular disease events and 143 coronary heart disease events. The study group was diverse with there being 48.8% Caucasian women, 33.5 % Black women and 17.6% Hispanic women.

The study’s results and message was clear. Keep moving. Even modest exercise is beneficial in reducing heart attack and stroke risk.

Statins May Reduce Your Energy Level

Beatrice A. Golomb, MD, PhD. of the University of California San Diego and colleagues discussed the results of their ongoing studies in the Archives of Internal Medicine online edition regarding cholesterol lowering drugs Simvastatin and Pravastatin and recipients’ perception of their energy level. Their research suggested that Simvastatin might leave its users, especially women, feeling tired and drained after exertion.  The scores hinted that almost 40% of women felt more tired and fatigued during physical activity on Simvastatin than without the lipid-lowering drug.

The trial included 1,016 men and women with low-density lipoprotein (LDL) cholesterol screened at 115- 19- mg/dL who were randomized to receive 20 mg Simvastatin, 40 mg Pravastatin, or placebo each day for 6 months. These patients did not have documented heart disease, cardiovascular disease or diabetes.

There was a worsening of perceived energy level and exertion related fatigue in 4 of 10 women on Simvastatin. The effect was much less, and not significant, with Pravastatin or placebo.   In a recent review of statins and adverse effects in the Cleveland Clinic Journal of Medicine, the authors pointed out that muscles performing work required  fats and lipids as a source of fuel and energy to work successfully. They hypothesized the possibility that the goals of cardiology to reduce lipid levels to prevent cardiovascular disease to extremely low levels may create an environment in working muscles where the lipid levels are too low to generate the fuel or energy needed to perform the exercise and work needed to be done.

Clearly, further research needs to be done.  We must remember all these participants DID NOT have vascular disease and this is a primary prevention study to prevent them from developing cardiovascular disease.  Might there be other methods to achieve this?  Is Simvastatin the only statin to cause this type of problem or will the other statins do the same?  Is this a problem of the particular generic brand of Simvastatin used or is it an across the board effect of Simvastatin?  All these questions require additional research to obtain the answers that we need.

Alzheimer’s Disease – Recent Data

Researcher’s gathered in Paris, France this month to present their data on new developments with Alzheimer’s disease.  In reviewing the meeting’s material, it is clear that much of what is “new” is old.

In the past we were taught that patients placed on medications for Alzheimer’s Disease would derive a benefit about 50% of the time. This benefit would last for six to twelve months.

One of the world’s authorities on this topic is Susan Rountree, M.D. of Baylor College of Medicine in Houston.  She has followed 641 patients since the late 1980’s.  In 2008 she reported that patients treated with medicines such as donepezil (Aricept) and rivastigmine (Exelon) survived about three years longer than patients who did not take these medications.  She re-analyzed that data, updated it and came to the conclusion that “using anti-dementia drugs doesn’t seem to prolong survival.”   She did however recommend continuing their use because her data showed that patients taking them had improved cognition and ability to function.

At the Paris event there was material presented that was not surprising but needs the legitimacy of a well planned study to turn theory into scientific evidence and fact.

The study showing that military personnel who suffered traumatic brain injuries during the Vietnam War were more likely to develop dementia has great implications for today’s veterans fighting in Iraq and Afghanistan where brain injuries are on the rise.  It will clearly help us as well in terms of long-term planning for the development of dementia in private citizens suffering from traumatic brain injuries.  It was not surprising either when certain medications were cited as being more likely to contribute to the development of Alzheimer’s Disease. This year’s culprits seem to be anticholinergic drugs which make a patient’s mouth dry and cause constipation.

What was not surprising were the studies that showed that elderly individuals who engaged in regular and vigorous physical exercise were less likely to develop cognitive impairment.  Those patients who get regular and vigorous exercise who show signs of cognitive problems declined at a slower rate than those who don’t.

While much of the material discussed confirmed the fact that healthy lifestyle is the best defense against this disease; there was also much hopeful discussion of research which is untangling the relationship between brain chemicals, development of plaques in the brain and its relationship to Alzheimer’s. On an encouraging note, we are much closer to early detection and therapeutic intervention than we were a decade ago.

Reducing Triglyceride Levels

The American Heart Association along with Michael Miller, M.D., director for the Center for Preventive Cardiology at the University of Maryland – School of Medicine in Baltimore, just released data and recommendations that diet and lifestyle changes alone should be sufficient to reduce elevated triglyceride levels.

The researchers analyzed more than 500 international studies conducted over the last 30 years for the purpose of updating doctors on the role of triglycerides in the evaluation and management of cardiovascular disease risks. The study confirmed that triglycerides are not directly atherogenic but are instead a marker of cardiovascular disease risk.  High triglycerides are commonly seen in diabetes mellitus, chronic kidney disease and certain disorders associated with HIV disease. Alcohol and obesity plus inactivity all contribute to elevated levels with TG levels rising markedly in this country since the mid 1970’s in concert with the obesity epidemic we are now seeing.

Triglycerides are checked on a fasting blood test of optimally 12 hours with the upper limit of normal set at 150mg/dl. Newer recommendations will reduce the level to 100 mg/dl.  If your triglycerides are elevated the study made the following suggestions to lower them to appropriate levels:

  1. Limit your sugar intake to less than 5% of calories consumed with no more than 100 calories per day from sugar for women and no more than 150 calories per day from sugar for men.
  2. Limit Fructose from naturally occurring foods and processed foods to less than 50 -100 grams per day
  3. Limit saturated fats to less than 7% of total calories
  4. Limit trans-fat to less than 1% of total calories.

Elevated triglycerides, especially above 500 mg/dl, are associated with an increased risk of pancreatitis. For individuals with TG levels this high we recommend complete abstinence from alcohol.

Exercise is necessary to lose weight and lower triglyceride levels as well. Physical activity of a moderate level such as brisk walking for at least 150 minutes per week (2.5 hours) can lower your triglycerides another 20-30%.

If lifestyle changes including diet modifications and aggressive exercise do not bring you to target levels we suggest the addition of marine based omega 3 products. Also, eat fleshy cold water fish!

A combination of dietary changes, moderate regular exercise and weight reduction is all that is needed to control most problems with triglycerides.  Referrals to registered dietitians can be very helpful in assisting you with the dietary changes required to be successful.