From The Desk Of Clarence Bass

“The message from this is if you have a genetic predisposition for some things, you can change your lifestyle and contribute to better health.”
 Gil Atzmon, geneticist Albert Einstein College of Medicine, Bronx, New York (Los Angeles Times, September 2, 2010) 

“Only exercise improves [arterial] function and slows the progression of [heart] disease… [Standard patient care] is only a local palliative therapy,
while exercise training has an impact on the underlying disease in the entire coronary tree.”
Dr. Rainer Hambrecht, HerzzentrumBremen, Germany (HeartWire, August 30, 2010)

Change Your Lifestyle, Change Your Life

The vast majority of people don’t tap into the power of active living.

Most Americans Don’t Get Daily Exercise, USA Today and other news outlets across the country reported last month. Ninety five percent of Americans over 20 are inactive most days. That’s shocking. 95%!

Most American adults report sedentary activities such as eating and drinking and watching television/movies, or light activities such as washing, dressing and grooming, and driving a car, truck or motorcycle. But only 5 percent do some type of vigorous physical activity on any given day. (American Time Use Survey, American Journal of Preventive Medicine, October, 2010.)

America would be a happier and healthier country if more of us would exercise on a regular basis.

The opportunity for improvement is stunning.

Walking regularly would make a huge difference in the lives of the roughly 225 million sedentary adults. Walking briskly or uphill a couple of times a week and pumping iron 30 minutes twice a week would be even better.

In the last few months alone, a flood of new evidence has been reported on the power of exercise.

Exercise Overcomes Fat Genes

Scientists have known for sometime that a single gene called FTO (stands for fat and obesity) predisposes people to obesity. In the last three years, however, more DNA variants have been linked to obesity. “The more [gene] variants you carry, the more likely you are to be obese,” said Ruth J. F. Loos, program leader at Cambridge University’s Medical Research Council Epidemiology Unit.

Loos is the senior author of a study to determine the extent to which genetic susceptibility may be overcome by physical activity. It’s a powerful study with several significant variables. (PLoS Medicine, August 31, 2010.)  

Loos and her team examined the effect of 12 genes associated with a high risk of obesity; the study included 20,430 people in the United Kingdom. They calculated a genetic predisposition score for each participant ranging from 0 to 24, representing the number of obesity-related genes inherited. Most of the scores were between 10 and 13. They also queried the subjects about their level of physical activity. 

They determined that each genetic variant carried a 16 percent increased risk of obesity. For participants who were physically active at least one hour a day, however, the risk was only 10 percent per variant. That’s a reduction of 40 percent.

In terms of actual weight gain, that translated to 1.3 pounds for each variant in inactive subjects. In people who exercised, the weight gain was only 0.8 pounds, again a difference of about 40 percent. 

That’s big. It means we can do something about genetic predisposition. It’s not destiny. It’s a tendency that can be overcome or mitigated by lifestyle change.

A combination of diet and exercise would, no doubt, increase the lifestyle advantage.

Exercise Restores Heart Function

We have long known that exercise reduces the risk of heart disease. We now have substantial evidence that it can also reverse the damage of heart disease. (European Society of Cardiology Congress, Stockholm, Sweden, August 30, 2010) 

Dr. Brage Amundsen (Norwegian University of Science and Technology) told the Cardiology Congress what his group is learning about the use of exercise to improve peak oxygen consumption in heart-failure patients.

They compared interval training and continuous exercise in 200 patients.

Preliminary results showed that interval training improved peak oxygen consumption by a much larger margin than continuous training. Specifically, “the interval-training group exhibited reverse left ventricular remodeling…and improved in left ventricular ejection fraction.” In other words, their heart muscle grew stronger and pumped oxygenated blood to their body more forcefully. (There were more signs of improvement, but that’s the one easiest to understand.)

“It’s not that hard and anybody can do it,” Dr. Amundsen told the conference. The interval protocol was 4-minutes of brisk walking on a treadmill, with 3-minutes of active rest. The work intervals were at 90% to 95% of peak heart rate and rest periods were at 50-70%. They did four reps for a total of 28 minutes. The continuous-training group walked at 70-75% of heart rate peak for 47 minutes.

Another physician (Rainer Rauramaa, Institute of Exercise Medicine, Finland) presented research indicating that regular moderate-intensity exercise ought to be a “cornerstone” in the treatment of hypertension. (Exercise makes arteries more flexible.) He pointed out that the antihypertensive benefits of exercise can be achieved even without weight reduction.

What about the role of strength training? In a separate presentation, Dr. Francois Carre (Hospital Pontchaillou, Rennes, France) described research showing that cardiovascular-disease patients benefit from strengthening large muscles in addition to aerobic exercise. (Strong muscles help the heart pump blood throughout the body.) He told the gathering that “well-done” resistance training should be encouraged; the benefits far outweigh the risks. “The physician must evaluate the individual risk, propose an individual program, and give a good education to the patients,” he said.

Finally—and perhaps most telling—Dr. Rainer Hambrecht (HerzzentrumBremen, Germany) told the conference that “only exercise improves [arterial] function and slows the progression of [heart] disease… [Standard patient care] is only a local palliative therapy, while exercise training has an impact on the underlying disease in the entire coronary tree,” Hambrecht said. “I would be happy if I could convince everybody with coronary artery disease to participate in a moderate exercise program,” he added.

Stay Mentally Sharp

A new analysis of data collected in the renowned Framingham Study indicates that moderate to heavy physical activity reduces the risk of dementia by 45 percent.

“A reduced risk of dementia may be one of the additional health benefits that can be derived from maintaining at least moderate physical activity,” lead author Zaldy Tan, MD, MPH, from the Brigham and Women’s Hospital, VA Boston, and Harvard Medical School, told the International Conference on Alzheimer’s Disease 2010 in Honolulu, Hawaii.

 “Interestingly, while there are many potentially modifiable risk factors that have been linked with Alzheimer’s disease and dementia, physical activity seems to be one that is fairly consistent in being shown to be related to the risk of dementia,” Tan said. A recent review showed that 20 of 24 population-based studies showed a link between physical activity and risk of cognitive decline. 

“What we found is that participants who spent at least one hour per day in moderate or heavy physical activity had a 45% lower risk of developing dementia,” Dr. Tan told the conference. Physical activity would likely take years to reveal its effect, Tan noted, “so the fact that we’ve followed [the participants] for over 20 years…suggests that long-term physical activity actually works.” 

“I’m perfectly comfortable with [exercise] being one of our primary recommendations,” William Thies, PhD, chief medical and scientific officer of the National Alzheimer’s Association, said. The strength of Dr. Tan’s paper is that “it comes from a really big, really good, historically dependable study.”

Again, exercise is the nearest thing we have to a sure fire answer to a potentially devastating health problem.

Never Too Late

Previous studies have shown a direct relationship between fitness and longevity. The more fit you are the longer you’re likely to live.

Age makes little difference, according to new study. Moreover, you don’t have to spend all day in the gym. (Wait until you hear what can be accomplished.)

It’s never too late to receive a survival benefit from physical activity, Dr. Peter Kokkinos (Georgetown School of Medicine, Washington DC) told HeartWire.

His team tested 5314 males—aged 65 to 92 years—on a treadmill for peak exercise capacity in METs or metabolic equivalents. (One MET is defined as the oxygen uptake at rest.) “Most health benefits are evident at fitness levels of greater than 5 METs,” Kokkinos explained.

The study found that each MET increase in exercise capacity carries with it a 12% reduction in the risk of death. Those able to achieve a MET level over 5 had a 38% lower risk of death. The fittest, those with a capacity over 9 METs, had a 61% lower mortality risk. 

Kokkinos says there was no difference in the effect of exercise capacity on mortality in older patients; 70-year-olds benefited the same as younger patients. No matter what the age, unfit individuals who improved their exercise capacity to above 5 METs had a 38% lower risk of death.

And, it’s not that hard. Kokkinos stressed that 20 to 40 minutes of brisk daily exercise will move capacity over 5 METs. One patient, a 90-year-old man, returned for follow-up with an exercise capacity of 12 METs, all from daily walking, Kokkinos told HeartWire. 

(The new study was published online August 9, 2010, in Circulation.)

Fight Back

You don’t need a treadmill to gauge your future prospects. You don’t even have to go to the gym. Your capacity to do everyday tasks is a strong indicator of vitality—and for some a wake-up call.

British researchers did a systematic review of studies examining the relationship between ability to do physical tasks of everyday living—grip strength, walking speed, chair rising, and standing balance times—and mortality. Their results are reported in the September 9, 2010, British Medical Journal.

In every measure, those who performed less well were found to be at a higher risk of all cause mortality. For example, comparing the weakest with the strongest quarter in grip strength (14 studies, 53,475 participants) the risk was 67% higher. For walking speed (5 studies, 14,692 participants) the margin was 187%. For chair-rise time it was 96%.

Standing balance has not been measured and categorized like the other tasks, but all five studies found evidence that poor performance in standing balance tests was associated with higher mortality rates. 

“This review shows the value of objective physical capacity as predictors of subsequent mortality in older community dwelling populations,” the study concluded. “Grip strength measured at younger ages also predicted mortality, but whether walking speed, chair rise time, and standing balance performance are associated with mortality in younger [people] remains to be seen.”

These measures provide tools for doctors to identify people at risk. Importantly, all of these tasks improve with practice. If you or someone you love are/is falling behind, do something about it. Better yet, work on gripping, walking, rising, and balancing before they begin to go south. Fight back. Help yourself.

In a well known study at Tufts University wheel-chair bound oldsters, some in their 90s, became mobile again after a short period of strength training; see Biomarkers 15 Years Later: http://www.cbass.com/Biomarkers.htm

Exercise works. It’ll work for you.

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