Friday, January 25, 2008

Largest Study to Date Shows Simple Walking Will Reduce Mortality. What Is The Problem Then?

I read a quote today from Dr Peter Kokkinos (Veterans Affairs [VA] Medical Center, Washington, DC), and it spawned too many thoughts. I realize how important exercise is to all of us. As a Registered Nurse, I'm also painfully aware of individual limitations toward health maintenance. I recognize the burden on Healthcare. We know beyond a doubt that exercise will reduce mortality. What is the problem then?

Here's the quote: "People are people, and we all get caught up in the excuse, 'I can't exercise I don't have time,'" Kokkinos commented. "But everyone needs to get involved to get this nation going again, because we are the fattest nation, the most sedentary nation in the world. And we need to do something about it." (1)

Dr. Kokkinos also states: "For God's sake, if we could walk on the moon we can certainly walk on earth."

These comments stem from research that included male Veterans who were enrolled in a study designed to measure the incidence of overall mortality as it relates to exercise. It is one of the largest studies ever done.

The results have proven that you can reduce your risk of death from overall causes by 70% by improving your exercise capability. Even moderate fitness yielded a 50% drop in mortality.

I agree with Dr. Kokkinos, and I appreciate the study, but I feel like this really is difficult for too many people. I'd like to see a study that actually targets resolutions to this lack of overall fitness.

Black veterans, white veterans, veterans with heart disease, and those with no heart disease were included in the study. No one socioeconomic group was targeted. The outcome remained the same for everyone - exercise will help you live longer.

Walking just thirty minutes a day would do the trick. Here are some limitations as I see them:

Mall walking means you have to get up pretty early; something than takes away from family time and other personal obligations. Yes, it's a free, viable alternative for winter months, but think about how many people work very long hours. The same limitations regarding family time apply to walking in the evening. Also, during the winter months it's too dark to walk safely. In many parts of the country it's too cold or just impossible due to snowfall and ice.

Too many people don't have space in the home for exercise equipment. Maybe they can't afford this sort of purchase.

Other forms of home exercise may require other expense and space: a computer, training DVD's, or monthly online subscriptions. At the very least, even Fit TV requires Cable.

I suppose you can stand in the room and march in place, but only the truly motivated will do this, bringing us back to square one.

For many, the options are truly limited. No, not everyone can simply walk thirty minutes a day.

Perhaps this is a by-product of capitalism. We have encouraged the work sector to sit in front of computers, allowed employers to remain unconcerned about the health of their employees, and permitted laws requiring mandatory overtime. In many states, an employee can be "fired at will". Many people work long hours, even seven days a week. Fatigue, stress and financial concerns, compounded by increased fatigue and worry stemming from frantic attempts to fit in daily exercise doesn't seem like a good recipe for success.

We have become cogs in the wheel, focused on work and productivity; allowing our own health and well being to be sacrificed. We have lost our substance. The day has to arrive when health takes precedence over money. It's not JUST an individual response to action; initiatives for health should involve changes in employee/employer relationships, legislation and obsession with productivity on the part of Corporate America. Can we never settle for "comfortable" profits?

I realize there are many large corporations who include employee wellness in their structure. On the flipside, I know of one small company that has even removed employee pay lunches, squeezing every sixty seconds possible from their employees. The same company cut employee lunch breaks to twenty minutes, both of these changes applicable to temporary employees.

We need to treat the entire dilemma regarding good health by taking this issue to a higher level for examination and resolution. How about some powerful advocacy in the workplace? Perhaps we could base our economy on individual empowerment rather than control.

That's my opinion, what is yours? Does your workplace provide incentives toward exercise? Can you break away from other obligations to fit in some exercise? Please leave a comment.


Surprising Study Shows Possible Harmful Effects of Calcium Supplements

In a surprising study, researchers have discovered that Calcium supplementation in elderly women may actually increase the risk of heart attack and related vascular disease such as stroke, sudden death, angina and "other chest pain".

The study was initiated in order to see what effect Calcium supplementation really has on improving bone density. The researchers, Dr Mark J Bolland (University of Auckland, New Zealand) and colleagues, expected findings that have previously been published - heart attack prevention. Instead, they found "robust" information indicating that Calcium supplements might increase a woman's chance of heart attack.

There's no way to make absolute sense of the study just yet however, and women are advised to continue Calcium supplements unless medically advised to do otherwise. More studies are recommended to refine and clarify this information.

Issues regarding this study include the following:

The study remains unequivocal, though carefully studied, according to experts.

Initial Vitamin D serum levels were not measured - a factor that may play a role in the current study outcomes.

Vitamin D, combined with Calcium for supplementation was not studied.

The women included in this study were "quite old" compared to previous studies which included women in their 50's. Previous studies have been done in the UK and Australia in the younger age group.

According to senior author, Dr Ian R Reid (University of Auckland, New Zealand, 1Gm of very soluble Calcium was used in the study, "and our study is a bit longer than some of the others, so that may also explain why we've got a more powerful effect."

The combination of high dose calcium with rapid entry into the blood stream(solubility) may contribute to calcium formation in the artery walls, leading to the results of increased vascular disease seen with this particular study.

Here is the information women can take from this study:

High doses of Calcium supplements may lead to increased risk of cardiovascular disease in postmenopausal women. We should anticipate and monitor future studies.

Improvement in bone density was evident with Calcium supplementation of 1Gm/day, but caution should be exercised if you have a history of cardiovascular disease, but you should speak with your doctor first.

Women in New Zealand are presently being advised not to use Calcium supplements if they are elderly and have heart disease.

Lower doses on Calcium (500mg) do not show benefits for bone loss but it is a safer approach if you do take Calcium for other benefits (blood pressure and cholesterol).

If you already have osteoporosis, do not rely on Calcium supplements for treatment.

No one has jumped on the bandwagon to say that Calcium supplements should be completely disregarded, but these findings are noteworthy.

Dr Erin D Michos (Johns Hopkins University, Baltimore, MD), who was not involved with this new study expresses his opinion to Heartwire: "This is a thought-provoking study, although not definitive, but further work should be done." Dr. Michos co-wrote articles regarding Vitamin D and Calcium supplements last year for the Women's Health Initiative (WHI).

This sort of research emphasizes to me how important it is for women to maintain awareness. It's only through education that we can make informed decisions about our own health management.

It's also a good time to again emphasize the necessity of exercise for bone loss and cardiovascular disease prevention. We have many options to protect our own health without relying on supplements and medications that may cause deleterious effects and expense.

There has been a huge initiative from the healthcare sector toward emphasizing the value of exercise and nutrition. So many health problems are related to inactivity and poor dietary choices. It seems so simple, but it's a problem that seems to defy solution when you look the obesity "epidemic" and statistics related to diabetes and heart disease.

I feel certain that each and every practicing physician would welcome the opportunity to successfully drive this message to their patients.

Ref: BMJ January 15, 2008

Why Should I be Physically Active?