‘Weekend warrior’ physical activity helps protect against more than 260 diseases

Busy with work and other obligations, some people concentrate their moderate-to-vigorous exercise in one or two days of the week or weekend. A study led by investigators at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, has found that this “weekend warrior” pattern of exercise is associated with lower risk of developing 264 future diseases and was just as effective at decreasing risk as more evenly distributed exercise activity. Results are published in Circulation.

“Physical activity is known to affect risk of many diseases,” said co-senior author Shaan Khurshid, MD, MPH, a faculty member in the Demoulas Center for Cardiac Arrhythmias at Massachusetts General Hospital. “Here, we show the potential benefits of weekend warrior activity for risk not only of cardiovascular diseases, as we’ve shown in the past, but also future diseases spanning the whole spectrum, ranging from conditions like chronic kidney disease to mood disorders and beyond.”

Guidelines recommend at least 150 minutes of moderate-to-vigorous physical activity per week for overall health. Among people who meet these recommendations, however, do those who exercise 20–30 minutes most days of the week experience benefits over those who go 5 or 6 days between longer exercise sessions?

Khurshid, along with co-senior author Patrick Ellinor, MD, PhD, the acting chief of Cardiology and the co-director of the Corrigan Minehan Heart Center at Massachusetts General Hospital, and their colleagues analyzed information on 89,573 individuals in the prospective UK Biobank study who wore wrist accelerometers that recorded their total physical activity and time spent at different exercise intensities over one week. Participants’ physical activity patterns were categorized as weekend warrior, regular, or inactive, using the guideline-based threshold of 150 minutes per week of moderate-to-vigorous physical activity.

The team then looked for associations between physical activity patterns and incidence of 678 conditions across 16 types of diseases, including mental health, digestive, neurological, and other categories.

The investigators’ analyses revealed that weekend warrior and regular physical activity patterns were each associated with substantially lower risks of over 200 diseases compared with inactivity. Associations were strongest for cardiometabolic conditions such as hypertension (23% and 28% lower risks over a median of 6 years with weekend warrior and regular exercise, respectively) and diabetes (43% and 46% lower risks, respectively). However, associations also spanned all disease categories tested.

“Our findings were consistent across many different definitions of weekend warrior activity, as well as other thresholds used to categorize people as active,” said Khurshid.

The results suggest that physical activity is broadly beneficial for lowering the risk of future diseases, especially cardiometabolic conditions. “Because there appears to be similar benefits for weekend warrior versus regular activity, it may be the total volume of activity, rather than the pattern, that matters most,” said Khurshid. “Future interventions testing the effectiveness of concentrated activity to improve public health are warranted, and patients should be encouraged to engage in guideline-adherent physical activity using any pattern that may work best for them.”

Patients expect antibiotics for common symptoms

 

Lack of knowledge about antibiotic risks 

Background and Goal: Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use, contributing to antibiotic resistance and other health risks. This study examined the prevalence of and factors that influence patient antibiotic expectations for common symptoms.

Study Approach: This study surveyed 564 primary care patients in Texas between January 2020 and June 2021 across public and private clinics. The survey assessed patients’ expectations for antibiotics when experiencing five common symptoms—diarrhea, sore throat, cold/flu, sinus infections, and bronchitis—and their knowledge of the risks associated with antibiotic use. Researchers also examined how health literacy affected these expectations.

Main Results: Over 93% of the patients surveyed expected antibiotics for at least one of the five common symptoms. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu compared to those in private clinics. Higher expectations for receiving antibiotics for diarrhea and cold/flu symptoms was linked to lack of knowledge about the potential risks of antibiotics. Patients with lower education levels and inadequate health literacy were more likely to expect antibiotics for diarrhea.

Why It Matters: To reduce unnecessary antibiotic use, future efforts should educate patients on when antibiotics are truly needed and emphasize potential risks.

MIND diet lowers the risk of memory problems later in life

 People whose diet more closely resembles the MIND diet may have a lower risk of cognitive impairment, according to a study published in the September 18, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. Results were similar for Black and white participants. These results do not prove that the MIND diet prevents cognitive impairment, they only show an association.

The MIND diet is a combination of the Mediterranean and DASH diets. It includes green leafy vegetables like spinach, kale and collard greens along with other vegetables. It recommends whole grains, olive oil, poultry, fish, beans and nuts. It prioritizes berries over other fruits and recommends one or more servings of fish per week.

“With the number of people with dementia increasing with the aging population, it’s critical to find changes that we can make to delay or slow down the development of cognitive problems,” said study author Russell P. Sawyer, MD, of the University of Cincinnati in Ohio and member of the American Academy of Neurology. “We were especially interested to see whether diet affects the risk of cognitive impairment in both Black and white study participants.”

The study involved 14,145 people with an average age of 64. Of participants, 70% were white and 30% were Black. They were followed for an average of 10 years.

Participants filled out a questionnaire on their diet over the past year. Researchers looked at how closely the foods people were eating matched the MIND diet.

One point was given for each of the following: three or more daily servings of whole grains; six or more weekly servings of green leafy vegetables; one or more daily servings of other vegetables; two or more weekly servings of berries; one or more weekly servings of fish; two or more weekly servings of poultry; three weekly servings of beans; five daily servings of nuts; four or fewer weekly servings of red meat; one or fewer weekly servings of fast or fried foods; one or more weekly servings of olive oil; and one or fewer tablespoons of butter or margarine daily; five or fewer weekly servings of pastries and sweets; and one glass per day of wine. The total points possible was 12.

Researchers then divided participants into three groups. The low group had an average diet score of five, the middle group had an average score of seven and the high group had an average score of nine.

Thinking and memory skills were measured at the beginning and end of the study.

During the study, cognitive impairment developed in 532 people, or 12% of 4,456 people in the low diet group; in 617 people, or 11% of 5,602 people in the middle group; and in 402 people, or 10% of the 4,086 people in the high group.

After adjusting for factors such as age, high blood pressure and diabetes, researchers found people in the high group had a 4% decreased risk of cognitive impairment compared to those in the low group.

When looking at male and female participants, researchers found a 6% decreased risk of cognitive impairment for female participants who most closely followed the diet but no decreased risk for male participants.

Researchers also looked at how quickly people’s thinking skills declined as they developed problems. They found that people who more closely followed the MIND diet declined more slowly than those who did not, and that association was stronger in Black participants than in white participants.

“These findings warrant further study, especially to examine these varying impacts among men and women and Black and white people, but it’s exciting to consider that people could make some simple changes to their diet and potentially reduce or delay their risk of cognitive issues,” said Sawyer.

A limitation of the study was it included only older Black and white people so results may not be the same for other populations.

Cutting out sugar and starch is as effective for IBS as current recommendationsS

Symptoms for patients with the gastrointestinal disease IBS improved as much by eating less sugar and starch as for those who followed FODMAP – the diet currently recommended to patients. The results, presented in a new study from Lund University in Sweden, also show that weight loss is greater and sugar cravings are reduced among those who follow the starch and sucrose-reduced diet.

Bodil Ohlsson is a professor at Lund University and consultant at Skåne University Hospital. Her choice to investigate the role of sugars and starches in IBS is linked to a geneticist’s discovery: a genetic variation that hinders the breakdown of sugars and starches in the gut is overrepresented among IBS patients.

“‘Let’s try giving these patients less sugar and starch,’ we thought,” says Bodil Ohlsson.

A few years ago, she led a study involving 105 people with IBS. For four weeks, they ate significantly less sugar and starch, known as the starch and sucrose-reduced diet (SSRD). In addition to sweet treats, highly processed food – “ready meals” – were also to be avoided. The results of that study showed that the SSRD diet greatly reduced IBS symptoms. The most common symptoms of IBS are recurring pain and tightness in the abdomen, and diarrhoea and/or constipation. 

The current study, now published in the scientific journal Nutrients, addresses a question that no other research has previously: how does SSRD compare to the current dietary recommendation for IBS, the FODMAP diet? FODMAP is a stricter, more regulated diet where lists of foods that are allowed/not allowed must be consistently followed. This diet also excludes gluten and lactose.

“We launched this study in 2022 to compare SSRD and Low FODMAP. One hundred and fifty-five patients diagnosed with IBS were included and randomly allocated to follow either SSRD or Low FODMAP for four weeks. They were not allowed to have been on a diet at the start of the trial, but rather ate ‘everything’,” says Bodil Ohlsson.

Participants in both groups had to follow the basic principles of each diet. But they chose how often or regularly they ate. In both groups, regardless of diet, IBS symptoms improved in 75-80 per cent of the patients, which according to Bodil Ohlsson “was even better than we expected”. In addition, weight loss after four weeks was greater in the SSRD group. Sugar cravings also decreased the most in this group, which is positive, as IBS patients weigh more on average than healthy people, says Bodil Ohlsson.

“We wouldn’t really even call SSRD a diet. It’s how everyone should eat, not just those with IBS. And unlike Low FODMAP, SSRD is easy to understand and easier to follow. You can eat everything when you are invited to dinner, just less of certain things. If you rest your stomach for the rest of the week, you can indulge a little one day!” says Bodil Ohlsson.

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Blackcurrant supplementing mitigates postmenopausal bone loss

 As we age, our bones lose density and become more fragile, putting us in danger of breaks and fractures.

This is especially a concern among post-menopausal women who generally have much greater losses in bone density than men in their age group.

Ock Chun, professor of nutritional sciences in UConn’s College of Agriculture, Health and Natural Resources (CAHNR), has been working with blackcurrant, a tart berry, for years, investigating its potential to ameliorate a host of conditions including postmenopausal bone loss and osteoporosis.

Chun previously led a study showing that in mice, blackcurrant supplements helped prevent bone density loss post-menopause. This study showed that the best time for intervention was in the transition between pre- and post-menopause before bone loss has significantly progressed.

With these findings in hand, Chun and her team wanted to see if they would translate to a human population.

They recently published their findings demonstrating blackcurrant’s protective effects against bone density loss in the Journal of Nutritional Biochemistry.

The group includes nutritional sciences graduate student Briana Nosal, who is the first author on the paper, kinesiology post-doctoral researcher Staci Thornton, and Elaine Choung-Hee Lee, professor of kinesiology, as well as researchers from UConn Health and the Jackson Laboratory for Genomic Medicine.

Forty peri- and early post-menopausal participants between the ages of 45 and 60 took capsules of blackcurrant powder daily for six months. Participants were randomly assigned to either take one capsule, two capsules, or a placebo. Each capsule was 392 milligrams.

The researchers found that the supplements prevented the loss of whole-body bone mineral density. The group that took two capsules actually showed overall increases in bone mineral density at the end of the six-month trial period.

The researchers looked at changes to the gut microbiome and immune system, which interact to play a key role in bone metabolism.

They found that the blackcurrant supplements decreased levels of proteins called interleukin-1 beta and RANKL. Interleukin-1 beta stimulates the expression of RANKL which causes bone resorption and thus a decrease in bone density.

“The reduction in RANKL is important because that can cause shifts toward excessive bone resorption, so we’d want to see a decrease in that,” Nosal says.

This study showed that the decrease in RANKL was directly correlated with an increase in whole body bone density after six months.

Taking the supplements also increased a bacteria found in the gut microbiome called Ruminococcus 2. This led the researchers to infer that it could be one of the bacteria driving the protective effects blackcurrant has on bones.

“It’s all related, and there’s a lot of research showing the gut can regulate various systems in the body,” Nosal says.

These bacteria help degrade polysaccharides and fibers. This is a key function to transform the foods we eat into available energy for our bodies to use.

The researchers identified a total of four proteins that had increased expression in the group that took two supplement capsules. These could serve as potential biomarkers for the changes they observed to bone density to allow researchers or medical professionals to quickly and easily assess if the blackcurrant supplementation is benefitting bone density.

This study is especially important for peri- and early post-menopausal women who have or are at risk of developing osteoporosis. While medications for osteoporosis do exist, compliance is low due to side effects.

If blackcurrant supplements can improve bone density without the same side effects, it could prove an effective alternative for this population.

“This study shows that blackcurrant may be a potential dietary strategy to help in preventing post-menopausal osteoporosis,” Nosal says.

As the group continues to study the relationship between blackcurrant and its benefits on the body, they will complete additional studies seeking to better understand why exactly they are seeing these results.

“[We want to learn] how all our findings connect to each other,” Nosal says. “Conducting that multi-faceted research will really paint the picture of how everything works, the different mechanisms, and what we can do for next steps.”

Moderate coffee and caffeine consumption: lower risk of developing cardiometabolic diseases

 Consuming moderate amounts of coffee and caffeine regularly may offer a protective effect against developing multiple cardiometabolic diseases, including type 2 diabetes, coronary heart disease and stroke, according to new research published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Researchers found that regular coffee or caffeine intake, especially at moderate levels, was associated with a lower risk of new-onset cardiometabolic multimorbidity (CM), which refers to the coexistence of at least two cardiometabolic diseases.

The prevalence of individuals with multiple cardiometabolic diseases, or CM, is becoming an increasing public health concern as populations age around the world, notes the study.

Coffee and caffeine consumption could play an important protective role in almost all phases of CM development, researchers found.

“Consuming three cups of coffee, or 200-300 mg caffeine, per day might help to reduce the risk of developing cardiometabolic multimorbidity in individuals without any cardiometabolic disease,” said the study’s lead author Chaofu Ke, M.D., Ph.D., of the Department of Epidemiology and Biostatistics, School of Public Health at Suzhou Medical College of Soochow University, in Suzhou, China.

The study found that compared with non-consumers or consumers of less than 100mg caffeine per day, consumers of moderate amount of coffee (3 drinks per day) or caffeine (200-300 mg per day) had a 48.1% or 40.7% reduced risk for new-onset CM.

Ke and his colleagues based their findings on data from the UK Biobank, a large and detailed longitudinal dietary study with over 500,000 participants aged 37-73 years. The study excluded individuals who had ambiguous information on caffeine intake. The resulting pool of participants included a total of 172,315 individuals who were free of any cardiometabolic diseases at baseline for the analyses of caffeine, and a corresponding 188,091 individuals for the analyses of coffee and tea consumption.

The participants’ cardiometabolic diseases outcomes were identified from self-reported medical conditions, primary care data, linked inpatient hospital data and death registry records linked to the UK Biobank.

Coffee and caffeine intake at all levels were inversely associated with the risk of new-onset CM in participants without cardiometabolic diseases. Those who reported moderate coffee or caffeine intake had the lowest risk, the study found. Moderate coffee or caffeine intake was inversely associated with almost all developmental stages of CM.

“The findings highlight that promoting moderate amounts of coffee or caffeine intake as a dietary habit to healthy people might have far-reaching benefits for the prevention of CM,” Ke said.

Addressing a Research Gap

Numerous epidemiological studies have revealed the protective effects of coffee, tea and caffeine consumption on morbidity of single cardiometabolic diseases. However, the potential effects of these beverages on the development of CM were largely unknown.

The authors reviewed the available research on this topic and found people with single cardiometabolic disease may have a two-fold higher all-cause mortality risk than those free of any cardiometabolic diseases. By contrast, the researchers found individuals with CM may have an almost 4 to 7 times higher risk of all-cause mortality. The researchers also noted that CM may present higher risks of loss of physical function and mental stress than those with single diseases.

Other study authors include: Xujia Lu, Guochen Li, Luying Wu, Liping Shao, Yulong Fan, and Chen-Wei Pan of Soochow University; Xiaohong Zhu of Suzhou Centers for Disease Control and Prevention in Suzhou, China; Ying Wu of the Southern Medical University in Guangzhou, China; and Yan Borné of Lund University in Malmö, Sweden.

The National Natural Science Foundation of China, the Project of MOE Key Laboratory of Geriatric Diseases and Immunology, and the Research on Key Technologies for the Prevention and Control of Major Diseases and Infectious Diseases in Suzhou funded the study.

The manuscript, “Habitual Coffee, Tea and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity,” was published online, ahead print.

Replacing ultra-processed foods in diet reduces type 2 diabetes risk

Peer-Reviewed Publication

People who eat more ultra-processed foods (UPF) are at increased risk of developing type 2 diabetes, but this risk can be lowered by consuming less processed foods instead, finds a new study led by researchers at UCL.

The study, published in The Lancet Regional Health – Europe in collaboration with experts at the University of Cambridge and Imperial College London, investigated the relationship between the degree of food processing and type 2 diabetes risk, including which kinds of UPF were most high-risk.

The team analysed UPF intake and health outcomes for 311,892 individuals from eight European countries over 10.9 years on average, during which time 14,236 people developed type 2 diabetes.

They found that every 10% increase in the amount of ultra-processed foods in a person’s diet is linked with a 17% increase in type 2 diabetes risk, but this risk can be lowered by consuming less-processed foods instead.

The highest risk UPF groups were savoury snacks, animal-based products such as processed meats, ready meals, and sugar-sweetened and artificially-sweetened beverages, suggesting that particular attention should be paid to these foods to help tackle ill-health.

The degree of processing in foods is most often assessed using the Nova classification, which divides foods into four groups: unprocessed or minimally processed foods (MPF) such as eggs, milk, and fruit; processed culinary ingredients (PCI) such as salt, butter and oil; processed foods (PF) like tinned fish, beer and cheese; and ultra-processed foods such as ready-to-eat/heat mixed dishes, savoury snacks, sweets and desserts.

The exact causes of the link between UPF and type 2 diabetes are unconfirmed, though several factors are thought to be at play including overconsumption and weight gain. In a previous study, backed up by new analysis in this study, increased body fat accounted for around half the association.

Samuel Dicken, first author of the study from UCL Division of Medicine, said: “We know that ultra-processed foods are associated with a higher risk of certain diseases such as type 2 diabetes. As expected, our findings confirm this link and show that every 10% increase in the diet from UPF increases the risk of developing type 2 diabetes considerably.

“Most studies to date only consider UPF as a whole, but we also suspect that there may be different risks associated with different types of UPF, and the risks of other processing groups have not been well researched. Our analysis goes a step further than previous studies, by looking at all four processing groups in the Nova classification to gauge the impact on type 2 diabetes risk when we substitute UPF with less processed foods, as well as looking at nine UPF subgroups.

“The good news is that replacing UPF with less processed foods was associated with a reduced type 2 diabetes risk.”

In the study, researchers from UCL analysed data from the EPIC study, which has investigated the relationship between diet, lifestyle, and environmental factors, and the incidence of chronic diseases in more than half a million Europeans over time.

Additional analysis on the data was performed to separate UPF into nine subgroups1 in order to better understand how level of processing affects type 2 diabetes risk.

Alongside analysing how eating UPF affected a person’s risk of developing type 2 diabetes, the researchers performed substitution modelling on the data to see how, theoretically, replacing one Nova food group with another would affect type 2 diabetes risk.

The results showed that substituting 10% of UPF in the diet with 10% of MPF/PCI reduced type 2 diabetes risk by 14%.

Substituting 10% of UPF in the diet with 10% of PF reduced diabetes risk by 18%. The authors say this may be down to the fact that 30-50% of PF intake in this study came from beer and wine, which have been associated with a lower risk of type 2 diabetes in a previous EPIC study. PF also includes salted nuts, artisanal breads, and preserved fruits and vegetables.

Analysis of the nine UPF subgroups showed that savoury snacks, animal-based products, ready meals, and sugar-sweetened and artificially-sweetened beverages were associated with higher incidence of type 2 diabetes.

High proportions of these less healthy foods contributed to overall type 2 diabetes risk. In the top 25% of UPF consumers, where UPF made up 23.5% of their total diet, sweetened beverages alone accounted for nearly 40% of their UPF intake and 9% of their diet overall.

However, UPF breads, biscuits and breakfast cereals, sweets and desserts, and plant-based alternatives were associated with lower incidence of type 2 diabetes.

Professor Rachel Batterham, senior author of the study from UCL Division of Medicine, said: “The UPF subgroup analysis in this study has been revealing and confirms that not all foods categorised as UPF are alike in terms of the health risks associated with them.

“Breads and cereals, for example, are a staple of many people’s diets. Based on our results, I think we should treat them differently to savoury snacks or sugary drinks in terms of the dietary advice we provide.”

The authors say that, due to the observational nature of the study, it can only measure associations rather than causal effects.

The UCL team are currently conducting a trial to assess the impact of UPF versus MPF diets meeting healthy diet guidance, which will further clarify the results of this study. The results of this trial are expected to be published in 2025.

In 2023, the UK Scientific Advisory Committee on Nutrition (SACN) reviewed the available scientific evidence on UPFs and published a report stating that increased consumption of processed foods, particularly UPFs, was associated with an increased risk of health issues such as obesity, chronic diseases like type 2 diabetes, and depression. The report also highlighted the need for additional research to understand the cause of these associations.

Professor Marc Gunter, an author of the study from Imperial College London and one of the coordinators of the EPIC study, said: “The findings from this study add to the growing body of research that links consumption of UPF with higher risk of certain chronic diseases including obesity, cardiometabolic diseases and some cancers. While such a study cannot determine causal relationships, it does suggest that reducing consumption of some UPF and replacing them with unprocessed, whole foods, might lower risk of type 2 diabetes. Further research to understand mechanisms and potential causal pathways is now needed.” 

Light pollution a new Alzheimer’s risk factor

Outdoor light at night could be a significant risk factor in Alzheimer’s disease, according to new research from Rush.

While light pollution is associated with increased risk of some disorders and diseases, this is the first time it had been associated with Alzheimer’s disease.

The study was conducted at Rush University System for Health and published in Frontiers in Neuroscience.

“Our research shows that there is an association in the U.S. between Alzheimer’s disease prevalence and exposure to light at night, particularly in those under the age of 65,” said lead investigator, Robin Voigt-Zuwala, PhD, an associate professor at Rush. “Nightly light pollution — a modifiable environmental factor — may influence risk for Alzheimer’s.”

High U.S. light levels
While legislation in some states aims to reduce light pollution, levels of nighttime light remain high in many parts of the country.

In studying light pollution maps, researchers looked at the lower 48 states and incorporated medical data associated with Alzheimer’s disease risk factors and divided the groups by light intensity. In the five groups, they found that light intensity was correlated with Alzheimer’s disease prevalence even when some well-established disease factors were not.

While the cause is unknown, higher nighttime light intensity was associated with a greater Alzheimer’s disease prevalence than any other risk factor examined in the study for those under the age of 65, suggesting that younger people may be more sensitive to the effects of light exposure at night.

“Certain genes can influence early-onset Alzheimer’s, and these same genes may cause increased vulnerability to the effects of nighttime light exposure,” Voigt-Zuwala explained. “Additionally, younger people are more likely to live in urban areas and have lifestyles that may increase exposure to light at night.”

Reducing light exposure
Exposure to light influences the body’s natural sleep-wake pattern, which is called a circadian rhythm. Exposure to light at night can disrupt a person’s circadian rhythm, which can promote inflammation and make a person less resilient and more prone to disease. Researchers did not examine light inside the home at night or how it might impact health.

Voigt-Zuwala said, “The good news is that simple changes can be made with minimal effort to reduce exposure to light at night — adding black out curtains or sleeping with an eye mask.”

The research results are limited to a subset of the population and further testing is needed to better understand the connection between evening outdoor light and Alzheimer’s disease.

Laughter may be as effective as drops for dry eyes

 

Researchers suggest this could be a first treatment for relieving symptoms of dry eye disease

Laughter may be as effective as eye drops in improving symptoms of dry eye disease, finds a clinical trial from China published by The BMJ today

The researchers suggest that laughter exercise could be an initial treatment for relieving symptoms of dry eye disease.

Dry eye disease (DED) is a chronic condition estimated to affect around 360 million individuals worldwide. Common symptoms include uncomfortable, red, scratchy or irritated eyes.

Evidence suggests that laughter therapy alleviates depression, anxiety, stress, and chronic pain, while strengthening immune function and is recognised as a beneficial complementary and add-on treatment for various chronic conditions, including mental health disorders, cancer, and diabetes. But whether laughter therapy has a beneficial effect on dry eye disease is still unknown.

To explore this further, researchers from China and the UK set out to assess the effectiveness and safety of laughter exercise in patients with symptoms of dry eye disease.

Their findings are based on 283 participants aged 18-45 years (average age 29; 74% female) who were assessed for dry eye disease using the ocular surface disease index (OSDI) score and randomly assigned to receive laughter exercise or 0.1% sodium hyaluronic acid eye drops four times a day for eight weeks. 

Participants with existing eye conditions, injury, infection or allergy, and those who had recently used contact lenses or any dry eye disease treatment were excluded.

The laughter exercise group watched an instructional video and were asked to vocalise and repeat the phrases “Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah” 30 times per five minute session using a face recognition mobile app to standardise the exercise and enhance facial movements.

The eye drop (control) group applied 0.1% sodium hyaluronic acid eye drops to both eyes four times a day for eight weeks, tracking their usage frequency via the same app. 

Both treatments were stopped at eight weeks and any change in eye surface discomfort scores were measured at weeks 10 and 12.

The average OSDI score at eight weeks was 10.5 points lower (indicating less discomfort) in the laughter exercise group and 8.83 lower in the control group, with a mean difference of −1.45 points, suggesting that laughter exercise was no less effective than eye drops.

Laughter exercise also showed significant improvements in non-invasive tear break up time (time taken for the first dry spot to appear on the cornea after a blink), meibomian gland function (oil glands that help prevent tears from evaporating too quickly), and mental health scores. No adverse events were noted in either study group.

The authors acknowledge some limitations that may have influenced the results, but say the findings suggest that laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in improving dry eye disease symptoms and clinical signs. 

“As a safe, environmentally friendly, and low cost intervention, laughter exercise could serve as a first-line, home based treatment for people with symptomatic dry eye disease and limited corneal staining,” they add.

Long-term exercisers have 'healthier' belly fat

People with obesity who are long-time exercisers have healthier belly fat tissue and can store fat there more effectively than nonexercisers with obesity, according to a new study from a team of researchers at the University of Michigan.

 

The research team also grew fat tissue in the lab from cells collected from both exercisers and nonexercisers, and cells from the exercisers developed into a tissue that stored fat more effectively.  

 

"Our findings indicate that in addition to being a means to expend calories, exercising regularly for several months to years seems to modify your fat tissue in ways that allows you to store your body fat more healthfully if or when you do experience some weight gain––as nearly everyone does as we get older," said principal investigator Jeffrey Horowitz, professor of movement science at the U-M School of Kinesiology.

 

Researchers wanted to see the effects of years of regular exercise on fat tissue, but it's very difficult to design a study to track this long term. Instead, they compared two groups of adults with obesity: 16 people who reported exercising at least four times a week for at least two years—the average was 11 years; and 16 people who'd never exercised regularly but matched in other things like body fat mass, weight and sex. The team took samples of belly fat tissue just under the skin from both groups. 

 

They found that the exercisers had distinct structural and biological characteristics in their fat tissue that increased the capacity to store fat there. The nonexercisers did not have those characteristics. Specifically, the exercisers had more blood vessels,  mitochondria and beneficial proteins, and less of a type of collagen that can interfere with metabolism and fewer cells that cause inflammation.

 

This matters because the healthiest place to store fat is the fat tissue just under the skin where the samples were taken, called subcutaneous adipose tissue. Increasing the capacity to store fat here through exercise reduces the need to store fat in unhealthy places, like in the fat tissue around the organs or in the organs themselves.  

 

"Compared with our previous study in which we examined the effects of three months of training on fat tissue, we generally see these differences are more robust in people who exercise regularly for years versus those who don't exercise," Horowitz said.

 

It's important to note that increasing the capacity to store fat does not equate to gaining fat, which requires overeating. 

 

"What it means is that if or when people experience weight gain, this excess fat will be stored more 'healthfully' in this area under the skin, rather than in the fat tissue around their organs (visceral fat) or an accumulation of fat in organs themselves, like the liver or heart."

 

One disease caused by unhealthy fat accumulation that's getting more attention in the U.S. and elsewhere is nonalcoholic fatty liver disease, which occurs most often in people with overweight or obesity. Excess fat builds up in the liver and can cause diseases like cirrhosis (seen most often with alcoholism) or cancer.

 

Horowitz said it's important to perform long-term studies to track people as they start and maintain an exercise program for several years to see how their fat tissue changes—even if they don't change the amount of fat tissue they have. It's also important to know if there is a type or intensity of exercise that achieves a better response in modifying fat tissue. 

 

In follow-up studies the team will also examine whether the fat tissue grown from exercisers and nonexercisers functions differently, and if there are other health-related differences that may translate to the health of the tissue and the person the cells came from.

 

Games, puzzles and reading can slow cognitive decline in the elderly

The aging process can lead to diminished cognitive functioning for older adults. In addition, about 10 percent of people previously diagnosed with mild cognitive impairment develop Alzheimer’s disease or other forms of dementia every year.

Although a few studies have found that activities such as putting together jigsaw puzzles can protect against cognitive aging, the benefits of these activities in preventing or postponing cognitive decline are still largely unknown.

Now, findings from a new study from the Texas A&M University School of Public Health suggest that older people with mild cognitive impairment who engage in high levels of activities such as word games and hobbies have better memory, working memory, attention and processing speed than those who do not.

“Today, nearly six million people in the United States have dementia, and this number is projected to grow to about 14 million by 2060—with minority populations affected the most,” said Dr. Junhyoung “Paul” Kim, an associate professor of health behavior at Texas A&M. “We sought to help fill the gap in our understanding of cognitive decline.”

For the study, published in the Journal of Cognitive Enhancement, Kim, along with researchers from the University of Southern Mississippi and Indiana University, analyzed data on 5,932 people who were at least 50 years old in 2012, had mild cognitive impairment and were part of the Health and Retirement Study (HRS) from 2012 to 2020.

The HRS collects data through self-reported paper-and-pencil surveys and in-depth phone interviews. For this study, the researchers analyzed the answers to seven questions about how often participants engaged in cognitively stimulating activities such as reading, game playing and hobbies. Next, they divided the participation levels in the categories of low, mid and high based on criteria used in previous studies and conducted repeated-measured multivariate analysis of covariance.

“In short, the high-level participation group consistently exhibited higher cognitive function levels during the study period and maintained a similar level of cognitive functions compared to the other groups,” Kim said.

Those in the high-level category had higher levels of memory, working memory, and attention and processing speed than those in the mid- and low-level groups. In addition, those in the mid-level category had higher levels of working memory and attention and processing speed than those in the low-level participation group.

“We also found significant differences in all three cognitive functions between years with a declining slope, but the differences between 2014 and the other years of the data set that were examined were not significant,” Kim said.

Kim and the others are hopeful that these findings will lead health care providers to recommend that older people with mild cognitive impairment play games, read or engage in similarly stimulating activities at least three to four times a week.

“In addition, we hope that barriers to doing this, such as inadequate caregiver support and financial constraints, could be overcome through stronger public care services and community support networks,” Kim said

High-intensity interval training is more beneficial for older women

 

 than moderate exercise or resistance training alone

HIIT combined with muscle strength exercises was the most efficacious in terms of reducing blood pressure and arterial stiffness, the main risk factors for cardiovascular disease.

 

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The study involved 92 socioeconomically vulnerable elderly women living in Bauru

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Credit: Emmanuel Ciolac/UNESP

A study involving 92 socioeconomically vulnerable elderly women compared the efficacy of different low-cost community-based exercise programs to improve and/or maintain cardiovascular and functional parameters, such as waist circumference, blood pressure, and above all arterial stiffness, a risk factor for atherosclerosis.

An article describing the results is published in the European Journal of Preventive Cardiology. The main conclusion is that high-intensity interval training (HIIT) combined with resistance training (RT) to build muscle strength was the option most beneficial to the women’s health.

In HIIT, short periods of intense or explosive anaerobic exercise alternate with brief recovery periods. It involves whole-body exercises performed in the shortest time possible. It has been used for decades by high-performance athletes and has become a craze in recent years, mainly because sessions are short and no equipment is needed.

The other protocols tested were RT alone, and moderate-intensity aerobic training combined with RT. The study was conducted in Brazil with FAPESP’s support at São Paulo State University’s School of Sciences (FC-UNESP) in Bauru.

The volunteers performed the exercise programs twice a week for nine months at four neighborhood community centers run by an NGO. Clinical status, anthropometric measurements and specific health parameters (cardiovascular, functional, mobility etc.) were assessed before the first session (baseline), at the end of the nine-month intervention, and three months after that. 

HIIT combined with RT and moderate-intensity aerobic training combined with RT were equally efficacious in terms of reducing waist circumference (by 3.3 cm on average). This benefit persisted after the end of the training period. However, only HIIT combined with RT effectively lowered systolic blood pressure (7.9 mmHg) and reduced arterial stiffness (0.69 m/s), which remained so three months after the end of the training period. 

All three programs were efficacious in terms of improved functional performance (handgrip, flexibility, lower limb strength and mobility), but only HIIT combined with RT at least partially maintained the improvements after the intervention.

“The lack of improvement in cardiovascular parameters for the groups that performed RT alone or moderate-intensity aerobic training combined with RT suggests that HIIT was responsible for the improvement in blood pressure and arterial stiffness. The superiority of HIIT may have been due, at least to some extent, to the need for constant adjustment of blood vessels during interval training,” Emmanuel Ciolac, a professor at FC-UNESP and last author of the article, told Agência FAPESP.

During HIIT, heart rate and stroke volume (the volume of blood pumped out of the heart during each systolic contraction) increase, Ciolac explained. The rise is normally proportional to the intensity of the exercise. Arteries and smaller blood vessels expand to receive the augmented blood flow (vasodilation), contracting again while the body recovers and the blood flow decreases.

“Our hypothesis is that the primary mechanism behind the improvement in arterial stiffness is associated with this constant adjustment of blood vessels and the increase or decrease in production of vasodilatory substances during bursts of exercise alternating with recovery,” he said.

Public policy

The researchers believe that the findings of the study showing the benefits of an affordable exercise program will contribute significantly to the wellbeing of low-income older women, who are a high-risk group for cardiovascular diseases, and to the formulation of public policy relating to the prevention of those diseases.

“We expected HIIT combined with RT to assure more cardiovascular benefits, since for the last ten years we’ve conducted similar studies of other high-risk groups [people with obesity and diabetes, for example], and the combination has always proved beneficial to cardiovascular and metabolic parameters. What surprised us was that the improvement in arterial stiffness persisted even three months after the end of the training period. The training can be said to have slowed vascular aging in these women,” Ciolac said.

Arterial stiffness tends to increase the risk of cardiovascular disease. “A reduction of 7 mmHg in systolic pressure is very substantial and considerably lowers the risk of having a heart attack or stroke. Arterial stiffness is the main marker of vascular aging and a very important variable in abnormally high systolic pressure,” he explained.

Previous studies by his group showed that HIIT has no risks for people with high blood pressure, obesity or diabetes, or indeed for clinical populations in general. “The protocol requires a prior assessment to confirm the absence of contraindications, such as a high risk of heart attack, for example. Generally speaking, it’s very safe,” Ciolac stressed.

Off-label prescriptions

 A new study from King’s College London shows that off-label prescriptions of a common antidepressant doesn’t help breathlessness in patients with respiratory disease – and may cause side effects.

Researchers warn prescribing medicines for a use which it has not been licensed could make things worse, even though the prescriber was trying to help.

The findings, presented at the ERS Congress in Vienna and published today in The Lancet Respiratory Medicine, show the desperate need for options to treat the symptoms of severe breathlessness, as there are no drugs licensed for this in the UK or most countries.

The severe breathlessness caused by chronic respiratory diseases greatly impacts patient’s quality of life. As well as creating substantial clinical challenges and health care costs. Most patients with diseases like this have few options to help with their symptoms.

Ahead of the trial, researchers surveyed doctors in respiratory and palliative medicine and found doctors were often using off-label prescribing – where a clinician prescribes a medicine for use in a different way than that stated in its licence. Various off-label prescriptions were being used, including common anti-anxiety and anti-depressant drugs like benzodiazepines and SSRIs.

Mirtazapine, a common antidepressant, was one of the types of drugs being prescribed. Case series and early studies showed it had potential. However, in this international trial, the first large-scale study to be done, researchers found that mirtazapine does not improve breathlessness in patients with respiratory disease compared with placebo. They also found that patients receiving mirtazapine had slightly more side effects and needed more care from hospitals and family members.

Chronic respiratory diseases affect 454.6 million people worldwide, with numbers predicted to increase with an aging population. Over 217 million people globally have Chronic Obstructive Pulmonary Disease (COPD) or Interstitial Lung Disease (ILD), both of which can cause severe breathlessness as they progress.

Off-label use can be as safe as on-label use if based on good evidence. It is often used when symptoms can't be controlled with licenced medicines, particularly in serious illnesses. This is common in severe breathlessness care, making proper evaluation of medicines vital. Off-label prescribing doesn't mean a doctor is making a mistake; it often happens when there are no other options to manage symptoms like breathlessness.

First author Professor Irene Higginson, King’s College London said: “Breathlessness is a widespread issue in palliative care as a symptom of respiratory diseases, heart disease and some cancers. When severe, it’s distressing for patients, as well as their caregivers, family and friends.  It diminishes people’s quality of life and often leads to considerable health and social care use, including driving emergency hospital admissions.

“Despite being a widespread issue we still don’t have effective treatments available. As such, many doctors turn to off-label prescribing, trying to help their patients.

“Our earlier survey found that 19% of respiratory and 11% of palliative physicians frequently recommend antidepressants for severe breathlessness in COPD, so these medicines are already being used off-label. This new trial concludes that mirtazapine is not recommended for the treatment of breathlessness, that the use of unlicensed medicines should be approached with caution and that it’s crucial to subject medicines in palliative care to rigorous trials.

“We need further research into potential therapies for severe breathlessness. In the meantime, we recommend clinicians use early identification and non-pharmacological approaches, such as those offered from breathlessness support services, to treat the symptom.”

The paper is published in The Lancet Respiratory Medicine on September 9th 2024.

Targeted vitamin D supplementation = better cardiometabolic health

 

A latest systematic review and meta-analysis conducted by scientists from institutions across China and the United States has uncovered promising insights into how vitamin D supplementation can significantly impact cardiometabolic health. The study, which was published in Engineering, has implications for tailored therapeutic strategies targeting cardiovascular diseases and related risks.

The comprehensive review analyzed 99 randomized controlled trials (RCTs) involving a total of 17 656 participants. The analysis revealed that vitamin D supplementation, with a median dose of 3320 International Units (IU) per day, was associated with favorable effects on various cardiometabolic risk factors, including reductions in systolic and diastolic blood pressure, total cholesterol, fasting blood glucose, hemoglobin A1C, and fasting blood insulin.

Significantly, the researchers discovered that the benefits of vitamin D supplementation were most pronounced in specific groups: non-Western populations, individuals with baseline 25-hydroxyvitamin D levels below 15.0 ng·mL−1, those with a body mass index (BMI) below 30 kg·m−2, and older individuals aged 50 years or above.

This research underscores the need for personalized vitamin D intervention strategies, taking into account individual characteristics such as ethnocultural background, age, BMI, and baseline vitamin D levels. The findings highlight the potential of longer intervention durations (three months or more) and higher doses to optimize cardiometabolic health outcomes in specific populations.

These findings could lead to significant advancements in preventive medicine and nutritional sciences, potentially leading to the development of more effective public health strategies. By tailoring vitamin D supplementation based on individual characteristics, healthcare providers may improve intervention efficacy and reduce the prevalence of cardiometabolic diseases.

The authors suggest that future research should focus on elucidating the mechanisms behind these observed effects and the potential benefits of vitamin D supplementation on chronic diseases such as cardiovascular diseases. Additionally, studies exploring the long-term effects and potential risks associated with high-dose supplementation are warranted.

This landmark study not only provides new insights into the benefits of vitamin D supplementation for cardiometabolic health but also emphasizes the importance of personalized medicine in optimizing these effects. As cardiovascular diseases remain a leading cause of mortality globally, the findings from this meta-analysis offer a glimmer of hope for more targeted and effective preventive strategies.

The paper “Modifiers of the Effects of Vitamin D Supplementation on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis,” authored by Peng An, Sitong Wan, Langrun Wang, Tiancheng Xu, Teng Xu, Yonghui Wang, Jin Liu, Keji Li, Xifan Wang, Jingjing He, Simin Liu. Full text of the open access paper: https://doi.org/10.1016/j.eng.2024.07.010.

Low-impact yoga and exercise found to help older women manage urinary incontinence

 

Peer-Reviewed Publication

Stanford Medicine

Older women struggling with urinary incontinence can benefit from regular, low-impact exercise, with yoga as well as stretching and strengthening showing benefits in a new study published Aug. 27 in Annals of Internal Medicine.

The research, led by scientists at Stanford Medicine and the University of California, San Francisco, is part of a larger effort to identify low-risk, low-cost ways to treat one of the most common health problems women face as they age.

After 12 weeks of a low-impact yoga program, study participants had about 65% fewer episodes of incontinence. Women in a control group doing stretching and strengthening exercises experienced a similar benefit over the same time period. The benefits are on par with the effects of medications used to address incontinence, the researchers said.

“Our study was testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” said the study’s senior author, Leslee Subak, MD, chair of obstetrics and gynecology at Stanford Medicine. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor and accessible wherever you live.” Because the trial was conducted partly during the COVID-19 pandemic, many participants received their yoga or exercise instruction via online meetings, exercising in their own homes, she noted.

The study’s lead author is Alison Huang, MD, professor of medicine, urology, and epidemiology and biostatistics at UCSF.

Urinary incontinence, which affects more than half of middle-aged women and up to 80% of 80-year-olds, can lead to a variety of other problems, from social isolation to bone fractures caused by falls. But there is help.

“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Subak, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor III. “Or we hear folklore about this being normal when you get older. In fact, it’s very common but it’s not inevitable, and we have very effective ways of treating it.”

Addressing a common problem

Incontinence deserves good treatment because of the many ways it interferes with people’s lives.

“It takes away independence,” Subak said. “My patients will say, ‘I can’t stay with my kids or grandkids because I’m afraid I’ll wet the bed, and I can’t talk about it; it’s too embarrassing.’”

Patients may avoid activities that could boost their well-being, such as exercising and seeing friends. They are more likely to be admitted to a nursing home and to suffer certain serious medical problems such as hip fractures.

“Incontinence and overactive bladder are among the biggest risk factors for falls and fractures among older women,” Subak said. “You’re rushing to the bathroom at night — with the lights off — tripping and falling, and breaking a hip.”

Some factors that contribute to risk for incontinence can’t be changed, such as aging or having had children. But others are modifiable.

“A lot of my research has focused on weight loss and physical activity, which in fact are effective treatments,” Subak said. She became interested in studying yoga as a treatment after some of her patients told her it helped them.

Being active helps

The study compared two 12-week exercise programs: 121 participants were randomly assigned to yoga, and 119 to a physical conditioning control group. The participants were women with urinary incontinence that caused symptoms at least once a day. They were 45 to 90 years old, with a mean age of 62.

In the yoga program, participants learned 16 hatha yoga poses intended to strengthen the pelvic floor, via two 90-minute sessions per week. The pelvic floor consists of the muscles that form the base of the pelvis and hold its organs — including the bladder and urethra — in place. Participants were also asked to practice yoga for at least one hour per week outside of class and to maintain a practice log.

Participants in the control group spent an equal amount of time in exercise classes, but their classes focused on nonspecific stretching and strengthening exercises that did not engage the pelvic floor. They were also asked to practice for an additional hour per week and keep a practice log.

The study began with in-person classes, then transitioned to a videoconference format when the COVID-19 pandemic lockdowns began.

Participants recorded when they leaked urine and classified whether each episode was urgency incontinence, when an overactive bladder causes a person to feel the need to urinate more often than usual, or stress incontinence, in response to pressure in the abdomen, such as from coughing or sneezing. They also answered standard questionnaires about their bladder function.

At the beginning of the study, the participants had an average of 3.4 episodes of urinary incontinence per day, including 1.9 urgency-type episodes and 1.4 stress-type episodes.

By the end of the 12-week programs, participants in the yoga group were experiencing 2.3 fewer episodes of incontinence per day, on average. Those in the physical conditioning group were experiencing 1.9 fewer episodes per day.

The two treatments are about equally effective, with both approaches reducing episodes of incontinence by around 60%, and the benefits from both treatments are meaningful, Subak said.  Patients who would like to try these approaches can search for low-impact Iyengar yoga or low-impact exercise classes in their communities or online, she said, adding that instructors should be able to adapt the activity to participants’ physical limitations.

“I’m impressed that exercise did so well and impressed that yoga did so well,” Subak said. “One of the take-home messages from this study is ‘Be active!’”

Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, she noted.

If a patient asked whether yoga could help with incontinence, “I would say that I think it’s a great idea to try it if you’re interested,” Subak said. “It’s very low risk, and there’s potential for benefit not only for incontinence but also for your general well-being.”