Intermittent fasting is effective for weight loss and improves cardiovascular health in people with obesity

 

A team of scientists led by the University of Granada (UGR), the Public University of Navarra (UPNA) and the CIBER has shown that intermittent fasting (reducing the number of hours of intake and extending the hours of fasting each day) is an effective method for losing weight and improves cardiovascular health in people with obesity problems.

Their work, published in the prestigious journal Nature Medicine, reveals that eating the last meal before 5pm and then not eating dinner at night is a safe and effective strategy for reducing subcutaneous abdominal fat, i.e. the fat just under the skin, especially after periods of excess such as Christmas.

In Spain, the prevalence of overweight and obesity reaches 70% in men and 50% in women, which is associated with multiple metabolic disorders such as type 2 diabetes and exponentially increases the risk of developing cardiovascular diseases, hypertension and certain types of cancer. This alarming weight gain in the population not only impacts people’s quality of life, but also represents a major challenge for the public health system. Scientific research is working hard to implement effective yet simple strategies to treat this problem, which is now considered a disease.

Calorie restriction diets help weight loss and improve cardiovascular health. However, they are not easy to maintain in the long term and often lead to most people eventually dropping out of treatment and thus regaining lost weight, or even gaining more than their starting weight.

Faced with the difficulties of maintaining adherence to traditional calorie restriction, new nutritional strategies are emerging. One of these is intermittent fasting, which consists of alternating periods of eating with periods of fasting ranging from hours to days. One type of intermittent fasting that has gained popularity in recent years is that which reduces the number of hours of intake and extends the hours of fasting each day. This is known as time-restricted eating. Normally, in Spain, people have their first breakfast at 7-8 a.m. and dinner at 21-22 p.m., so they have a 12-14 hour window of intake. In this type of intermittent fasting, the intake window is reduced from 12-14 hours to 6-8 hours, and people fast for 16-18 hours. This nutritional strategy helps to maintain a daily cycle of eating and fasting, which stabilises our body’s biological rhythms. We know that eating irregularly or at night disrupts these rhythms and increases the risk of obesity, cardiovascular disease and type 2 diabetes.

The research group PROFITH CTS-977 of the Department of Physical Education and Sports, Faculty of Sports Sciences and the Sport and Health University Research Institute (iMUDS) led by Dr. Jonatan Ruiz, in collaboration with ibs.Granada, the University Hospital Clínico San Cecilio and the University Hospital Virgen de las Nieves of Granada, as well as the research group led by Dr. Idoia Labayen of the University of Granada, in collaboration with Dr. Idoia Labayen of the University of Granada and the University Hospital Virgen de las Nieves of Granada. Idoia Labayen from the Public University of Navarra and the University Hospital of Navarra, together with the CIBER on Obesity (CIBEROBN) and the CIBER on Frailty and Healthy Ageing (CIBERFES) have investigated the effects of a 12-week intervention with three different fasting strategies: early fasting (intake sale: approximately 9:00-17:00), late fasting (approximately 14:00-22:00), and self-selected fasting, where people could select the time slot in which they wanted to eat, and did so on average between 12am and 8pm.

Study with 197 participants

In addition, all people participating in the study also received the standard treatment, which consisted of a nutrition education programme on Mediterranean diet and healthy lifestyles. In this randomised, controlled, multicentre trial, conducted in Granada (southern Spain) and Pamplona (northern Spain) and one of the largest to date, a total of 197 people (50% women) aged 30-60 years participated. Participants were randomly assigned to one of the following groups: treatment as usual (49 participants), early fasting (49 participants), late fasting (52 participants), or self-selected fasting (47 participants).

This study was part of the doctoral thesis of Manuel Dote-Montero, who is currently a postdoctoral fellow at the prestigious National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in the United States.

Manuel Dote-Montero, together with Antonio Clavero Jimeno, a predoctoral researcher at the UGR, and Elisa Merchán Ramírez, a postdoctoral researcher at the UGR, led this study in Granada, and indicate that it is unclear whether the timing of the intake window – early, late or self-selected – may have a different effect on weight loss, visceral fat (i.e. fat surrounding organs in the abdominal area) or overall cardiovascular health in people who are overweight or obese.

The results of the study, published in the prestigious journal Nature Medicine, reveal that intermittent fasting showed no additional benefits over a nutrition education programme in reducing visceral fat. However, the fasting groups, regardless of the timing of intake, achieved greater weight loss, on average 3-4 kg, compared to the usual treatment group who continued with their intake window of at least 12 hours. Notably, the early fasting group reduced abdominal subcutaneous fat, i.e. the fat just under the skin, to a greater extent.

The study also assessed fasting and 24-hour glucose levels using a continuous glucose monitor worn by participants for 14 days before and at the end of the intervention. The results show that the early fasting group significantly improved fasting glucose levels and overnight glucose compared to the other groups.

Regulating glucose

These findings suggest that early fasting may be especially beneficial in optimising glucose regulation, which may help prevent diabetes and improve metabolic health. By not eating at night allows the body more time to digest and process nutrients, better regulation of blood glucose is facilitated, thus reducing the risk of developing sugar problems and other metabolic disorders, says Dr Labayen, principal investigator of the study in Pamplona and member of CIBEROBN together with Dr Jonatan Ruiz and Dr Manuel Muñoz (CIBERFES).

The researchers stress that all the fasting groups had a high adherence rate and no serious adverse events were recorded. Intermittent fasting is therefore presented as a safe and promising strategy for managing body weight and improving cardiovascular health in people who are overweight or obese. This information could be crucial for improving the efficacy of nutritional interventions in such populations.

Regular physical activity before cancer diagnosis may lower progression and death risks

 

Even relatively low levels of physical activity may be advantageous, findings show

Regular physical activity before a cancer diagnosis may lower the risks of both disease progression and death, suggests research published online in the British Journal of Sports Medicine.

And even relatively low levels of physical activity may be advantageous, the findings indicate.

There is compelling evidence that physical activity has a key part to play in lowering the risk of death from cancer, but the evidence isn’t as conclusive for its role in disease progression, explain the researchers.

To explore this further, they analysed anonymised data from the Discovery Health Medical Scheme (DHMS), linked to the Vitality health promotion programme. The DHMS is the largest open medical plan in South Africa, covering approximately 2.8 million beneficiaries.

All Vitality programme participants are rewarded for adopting healthy lifestyle behaviours, earning points for physical activity, recorded by activity trackers, logged gym attendance, or registered participation in organised fitness activities.

Activity type, frequency, duration and intensity are recorded and translated into weekly minutes of exercise.

In all, 28,248 Vitality programme members with stage 1 cancers, and comprehensive physical activity data for the year preceding diagnosis, were included in the study, which spanned the period 2007 to 2022.  

Breast and prostate cancers were the most common cancers, comprising 44% of the study total. 

The length of time between initial diagnosis and disease progression, death, or exit from the study ranged from 1 month to nearly 13 years. 

Cancer didn’t progress in nearly two thirds of the total sample (65.5%), but in just over a third (34.5%) it did. And while 81% survived, 19% died before the end of the study. The average time to death was 20 months and the average time to progression was 7 months. 

Levels of physical activity in the year before diagnosis were categorised as none recorded (17,457; 62% of participants); low, equal to 60 or fewer weekly minutes (3722;13%); and moderate to high, equal to 60 or more weekly minutes of moderate intensity physical activity (7069; 25%).

After accounting for potentially influential factors, including age at diagnosis, sex, economic and social position, and co-existing conditions, rates of cancer progression and death from any cause were lower among those who were physically active in the year preceding their diagnosis.

The odds of disease progression were 16% lower for those who had engaged in low levels of physical activity in the preceding year than among those who hadn’t recorded any physical activity, while the odds for those who had engaged in moderate to high levels were 27% lower.

Similarly, the odds of death from any cause were 33% lower among those who had engaged in low levels of physical activity compared with those who hadn’t recorded any, and 47% lower for those who had managed moderate to high levels.

Two years on from diagnosis, the likelihood of no disease progression among those with no recorded physical activity in the year before diagnosis was 74%, compared with 78% and 80%, respectively, for those achieving low and moderate to high levels of physical activity. 

While the likelihood of disease progression increased as time went on, it was still lower for those who had clocked up some level of physical activity in the year preceding their diagnosis.

After 3 years, the likelihood of no disease progression was 71%, 75%, and 78%, respectively, for none, low, and moderate to high levels of physical activity. And after 5 years, it was 66%, 70%, and 73%, respectively.

Similar patterns were evident for death from any cause. Two years after diagnosis, the probability of survival among those with no documented physical activity in the year preceding diagnosis was 91% compared with 94% and 95%, respectively, among those who had recorded low and moderate to high levels.

The equivalent probabilities of survival 3 years after diagnosis were 88%, 92%, and 94%, respectively, and 84%, 90%, and 91%, respectively, after 5 years. 

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that they weren’t able to account for other potentially influential factors, such as smoking and alcohol consumption, while the data on weight (BMI) were incomplete.

But there are several plausible biological explanations for the findings, they suggest, chief among which is the way in which physical activity strengthens immunity by increasing numbers of natural killer cells, lymphocytes, neutrophils and eosinophils.

Physical activity may also lower the progression risk of hormone sensitive cancers, such as breast and prostate cancers, by regulating oestrogen and testosterone levels, they add.

“Physical activity may be considered to confer substantial benefits in terms of progression and overall mortality to those diagnosed with cancer,” they write. 

“In a world where cancer continues to be a significant public health burden, the promotion of physical activity can yield important benefits regarding the progression of cancer as well as its prevention and management,” they conclude.

Basking too long in a sauna without adequate hydration may risk heat stroke

Basking too long in a sauna may put bathers at risk of heat stroke, particularly if they haven’t drunk enough water beforehand, warn doctors in the journal BMJ Case Reports, after treating a woman whose condition required admission to hospital.

Although relatively rare, heat stroke can be life threatening, even in the absence of various underlying risk factors, such as heart, lung, or neurological disease, and heavy drinking or taking a cocktail of prescription meds, they point out.

Heat stroke is defined as a sharp increase in core body temperature above 40°C that is associated with acutely impaired brain function, and ‘non-exertional’ heat stroke results from prolonged exposure to high environmental temperatures, explain the authors.

They treated a woman in her early 70s who had been found unconscious in her local gym’s sauna, where she had been doing stretching exercises for around 45 minutes.

Her core body temperature was 42°C—normal temperature is 36.4°C—her blood pressure was extremely low, and her heart rate was extremely high. She had a seizure after her arrival in emergency care.

She had previously been diagnosed with type 1 diabetes and an underactive thyroid, but she wasn’t a smoker or heavy drinker, and was a regular gym goer, so had few risk factors, point out the authors.

She was rapidly cooled with wet towels and a fan and given intravenous fluids and blood products to stabilise her. 

Blood tests revealed malfunctioning kidneys and liver, evidence of a minor heart attack, and muscle tissue breakdown (rhabdomyolysis). 

She regained consciousness within 2 hours of reaching normal core temperature but was confused and drowsy for 2 days. By day 3 this had resolved and she had no further seizures during her inpatient stay, which lasted 12 days.

After 26 days she had more or less fully recovered, except for some mild fatigue and mild liver function disturbance.

This is just one case report after prolonged sauna use, and as far as the authors are aware, only 9 other similar cases have been reported. But 3 of those people died as a result.

“The prognosis of heat stroke varies according to patient factors, particularly extremes of age,” explain the authors. “Classical heat stroke in elderly people carries a mortality rate of  [more than] 50%, and this increases further with each additional organ dysfunction. 

“Heat-related deaths spike during heat waves, as has been observed in multiple large international datasets. Deaths from heat stroke are expected to rise as global temperatures continue to increase," they add.

“Once heat stroke has occurred, the key determinate of outcome is how rapidly a patient is cooled, as the time spent with elevated core body temperature is correlated to the degree of cellular damage,” they emphasise.

The woman in question comments: “My experience has emphasised the dangers of saunas and how important it is to be fully hydrated on entering a sauna, and for them to be regularly checked by staff. As a regular sauna user, I never suffered any issues and, on reflection, I believe I had not drunk enough water.”

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Morning coffee may protect the heart better than all-day coffee drinking

 People who drink coffee in the morning have a lower risk of dying from cardiovascular disease and a lower overall mortality risk compared to all-day coffee drinkers, according to research published in the European Heart Journal [1] today (Wednesday).

 

The research was led by Dr Lu Qi, HCA Regents Distinguished Chair and Professor at the Celia Scott Weatherhead School of Public Health and Tropical Medicine at Tulane University, New Orleans, USA. He said: “Research so far suggests that drinking coffee doesn’t raise the risk of cardiovascular disease, and it seems to lower the risk of some chronic diseases, such as type 2 diabetes. Given the effects that caffeine has on our bodies, we wanted to see if the time of day when you drink coffee has any impact on heart health.”

 

The study included 40,725 adults taking part in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. As part of this study, participants were asked about all the food and drink they consumed on at least one day, including whether they drank coffee, how much and when. It also included a sub-group of 1,463 people who were asked to complete a detailed food and drink diary for a full week.

 

Researchers were able to link this information with records of deaths and cause of death over a period of nine to ten years.

 

Around 36% of people in the study were morning coffee drinkers (they primarily drank coffee before midday), 16% of people drank coffee throughout the day (morning, afternoon and evening) and 48% were not coffee drinkers.

 

Compared with people who did not drink coffee, morning coffee drinkers were 16% less likely to die of any cause and 31% less likely to die of cardiovascular disease. However, there was no reduction in risk for all-day coffee drinkers compared to non-coffee drinkers.

 

Morning coffee drinkers benefitted from the lower risks whether they were moderate drinkers (two to three cups) or heavy drinkers (more than three cups). Light morning drinkers (one cup or less) benefitted from a smaller decrease in risk.

 

Dr Qi said: “This is the first study testing coffee drinking timing patterns and health outcomes. Our findings indicate that it’s not just whether you drink coffee or how much you drink, but the time of day when you drink coffee that’s important. We don’t typically give advice about timing in our dietary guidance, but perhaps we should be thinking about this in the future.

 

“This study doesn’t tell us why drinking coffee in the morning reduces the risk of death from cardiovascular disease. A possible explanation is that consuming coffee in the afternoon or evening may disrupt circadian rhythms and levels of hormones such as melatonin. This, in turn, leads to changes in cardiovascular risk factors such as inflammation and blood pressure.

 

“Further studies are needed to validate our findings in other populations, and we need clinical trials to test the potential impact of changing the time of day when people drink coffee.”

 

In an accompanying editorial [2] Professor Thomas F. Lüscher from Royal Brompton and Harefield Hospitals, London, UK said: “In their study published in this issue of the European Heart Journal, Wang et al analysed the time of the day when coffee is consumed in 40 725 adults from the NHANES and of 1463 adults from the Women’s and Men’s Lifestyle Validation Study.

 

“During a median follow-up of almost a decade, and after adjustment for caffeinated and decaffeinated coffee intake, the amounts of cups per day, sleep hours, and other confounders, the morning-type, rather than the all-day-type pattern, was significantly associated with lower risks of all-cause mortality with a hazard ratio of 0.84 and of cardiovascular mortality of even 0.69 as compared with non-coffee drinkers.

 

“Why would time of the day matter? In the morning hours there is commonly a marked increase in sympathetic activity as we wake up and get out of bed, an effect that fades away during the day and reaches its lowest level during sleep. Thus, it is possible, as the authors point out, that coffee drinking in the afternoon or evening disrupts the circadian rhythm of sympathetic activity. Indeed, many all-day drinkers suffer from sleep disturbances. In this context, it is of interest that coffee seems to suppress melatonin, an important sleep-inducing mediator in the brain.

 

“Overall, we must accept the now substantial evidence that coffee drinking, particularly in the morning hours, is likely to be healthy. Thus, drink your coffee, but do so in the morning!”

Mediterranean diet changes gut bacteria, boosting memory and cognition

 

A new Tulane University study suggests the Mediterranean diet's brain-boosting benefits may work by changing the balance of bacteria in the gut.

In a study published in Gut Microbes Reports, researchers at Tulane University School of Medicine found that subjects following a Mediterranean diet developed distinctly different gut bacteria patterns compared to those eating a typical Western diet. These bacterial changes correlated with better memory and cognitive performance.

"We've known that what we eat affects brain function, but this study explores how that could be happening," said lead author Rebecca Solch-Ottaiano, PhD, neurology research instructor at Tulane’s Clinical Neuroscience Research Center. “Our findings suggest that dietary choices can influence cognitive performance by reshaping the gut microbiome."

The study found that rats fed a Mediterranean-style diet rich in olive oil, fish and fiber over 14 weeks showed increases in four beneficial types of gut bacteria and decreases in five others compared to rats eating a Western diet high in saturated fats. These bacterial changes were linked to improved performance on maze challenges designed to test memory and learning.

Specifically, higher levels of bacteria such as Candidatus Saccharimonas were associated with better cognitive performance, while increased levels of other bacteria, such as Bifidobacterium, correlated with poorer memory function.

The Mediterranean diet group also showed better cognitive flexibility — the ability to adapt to new information — and improved working memory compared to the Western diet group. They maintained lower levels of "bad" LDL cholesterol.

This study is the first to assess the effects of the Mediterranean on microbiota and cognitive function outcomes relative to the Western diet in a rodent model. The researchers used young rats approximately equivalent in age to 18-year-old humans to model the effects of diet during a critical developmental period. The diets were based on human consumption and used ingredients reflecting the complexity of human diets. The Mediterranean diet (MeDi) showed clear benefits for cognitive flexibility, memory, and gut health, suggesting potential parallels in young adults whose brains and bodies are still maturing.

“Our findings suggest that the Mediterranean diet or its biological effects could be harnessed to improve scholastic performance in adolescents, or work performance in young adults,” said corresponding author Dr. Demetrius M. Maraganore, Herbert J. Harvey, Jr. Chair of Neurosciences. “While these findings are based on animal models, they echo human studies linking the Mediterranean diet to improved memory and reduced dementia risk.”

The researchers emphasize that larger human studies are needed to confirm these effects and better understand the complex relationship between diet, gut bacteria, and brain function in young people.

For those interested in following a Mediterranean eating pattern, key components include:
- Olive oil as the primary fat source
- Abundant vegetables, fruits and whole grains
- Fish and lean proteins
- Limited red meat and saturated fats
- High fiber intake from various plant sources

Loneliness linked to higher risk of heart disease and stroke and susceptibility to infection

Interactions with friends and family may keep us healthy because they boost our immune system and reduce our risk of diseases such as heart disease, stroke and type 2 diabetes, new research suggests.

Researchers from the UK and China drew this conclusion after studying proteins from blood samples taken from over 42,000 adults recruited to the UK Biobank. Their findings are published today in the journal Nature Human Behaviour.

Social relationships play an important role in our wellbeing. Evidence increasingly demonstrates that both social isolation and loneliness are linked to poorer health and an early death. Despite this evidence, however, the underlying mechanisms through which social relationships impact health remain elusive.

One way to explore biological mechanisms is to look at proteins circulating in the blood. Proteins are molecules produced by our genes and are essential for helping our bodies function properly. They can also serve as useful drug targets, allowing researchers to develop new treatments to tackle diseases.

A team led by scientists at the University of Cambridge, UK, and Fudan University, China, examined the ‘proteomes’ – the suite of proteins – in blood samples donated by over 42,000 adults aged 40-69 years who are taking part in the UK Biobank. This allowed them to see which proteins were present in higher levels among people who were socially isolated or lonely, and how these proteins were connected to poorer health.

The team calculated social isolation and loneliness scores for individuals. Social isolation is an objective measure based on, for example, whether someone lives alone, how frequently they have contact with others socially, and whether they take part in social activities. Loneliness, on the other hand, is a subjective measure based on whether an individual feels lonely.

When they analysed the proteomes and adjusted for factors such as age, sex and socioeconomic background, the team found 175 proteins associated with social isolation and 26 proteins associated with loneliness (though there was substantial overlap, with approximately 85% of the proteins associated with loneliness being shared with social isolation). Many of these proteins are produced in response to inflammation, viral infection and as part of our immune responses, as well as having been linked to cardiovascular disease, type 2 diabetes, stroke, and early death.

The team then used a statistical technique known as Mendelian randomization to explore the causal relationship between social isolation and loneliness on the one hand, and proteins on the other. Using this approach, they identified five proteins whose abundance was caused by loneliness.

Dr Chun Shen from the Department of Clinical Neurosciences at the University of Cambridge and the Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, said: “We know that social isolation and loneliness are linked to poorer health, but we’ve never understood why. Our work has highlighted a number of proteins that appear to play a key role in this relationship, with levels of some proteins in particular increasing as a direct consequence of loneliness.

Professor Jianfeng Feng from the University of Warwick said: "There are more than 100,000 proteins and many of their variants in the human body. AI and high throughput proteomics can help us pinpoint some key proteins in prevention, diagnosis, treatment and prognosis in many human diseases and revolutionise the traditional view of human health.

"The proteins we’ve identified give us clues to the biology underpinning poor health among people who are socially isolated or lonely, highlighting why social relationships play such an important part in keeping us healthy.”

One of the proteins produced in higher levels as a result of loneliness was ADM. Previous studies have shown that this protein plays a role in responding to stress and in regulating stress hormones and social hormones such as oxytocin – the so-called ‘love hormone’ – which can reduce stress and improve mood.

The team found a strong association between ADM and the volume of the insula, a brain hub for interoception, our ability to sense what's happening inside our body – the greater the ADM levels, the smaller the volume of this region. Higher ADM levels were also linked to lower volume of the left caudate, a region involved in emotional, reward, and social processes. In addition, higher levels of ADM were linked to increased risk of early death.

Another of the proteins, ASGR1, is associated with higher cholesterol and an increased risk of cardiovascular disease, while other identified proteins play roles in the development of insulin resistance, atherosclerosis (‘furring’ of the arteries) and cancer progression, for example.

Professor Barbara Sahakian from the Department of Psychiatry at the University of Cambridge said: “These findings drive home the importance of social contact in keeping us well. More and more people of all ages are reporting feeling lonely. That’s why the World Health Organization has described social isolation and loneliness as a ‘global public health concern’. We need to find ways to tackle this growing problem and keep people connected to help them stay healthy.”

Physical activity reduces chronic disease risk

 

University of Iowa researchers are recommending all patients be surveyed about their physical activity levels, after a new study underscores the link between physical activity and chronic disease.

The study, led by Lucas Carr, associate professor in the Department of Health and Human Physiology, examined responses from more than 7,000 patients at University of Iowa Health Care Medical Center who noted their level of physical activity in a questionnaire. 

From patients’ answers to the questionnaire, the researchers found that those who reported the highest level of physical activity — meaning they exercised moderately to vigorously at least 150 minutes per week — were at statistically significant lower risk of having 19 chronic conditions, including cardiovascular disease, cancer, respiratory disease, and diabetes.

The findings further suggest patients who are least active — meaning they reported little to no exercise in a given week — are at increased risk to develop a chronic disease.

Based on those results, the Iowa researchers also recommend health care systems provide information on health and wellness services for physically inactive patients who are at most risk.

“In our health care environment, there's no easy pathway for a doctor to be reimbursed for helping patients become more physically active,” says Carr, the study’s corresponding author. “And so, for these patients, many of whom report insufficient activity, we need options to easily connect them with supportive services like exercise prescriptions and/or community health specialists.”

Most hospitals in the United States do not ask patients about their physical activity, and no hospital system in the Midwest has done so, according to the researchers. In this study, Carr partnered with Britt Marcussen, a family medicine physician in UI Health Care, to offer the questionnaire to patients visiting for annual wellness exam appointments. The study period was from November 2017 to December 2022.

The Exercise Vital Sign survey, as the questionnaire is called, asked patients two questions that they answered on a tablet:

• “On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?” (0-7 days) 
• “On average, how many minutes do you engage in exercise at this level?” 

Carr and his team propose making the survey available to all patients.

“This two-question survey typically takes fewer than 30 seconds for a patient to complete, so it doesn’t interfere with their visit. But it can tell us a whole lot about that patient’s overall health,” Carr says.

The researchers also compared results from patients who completed the surveys with more than 33,000 patients who weren’t offered the survey in other areas of the hospital. The researchers found patients who took the survey were younger and in better health than the patient population who weren’t given the questionnaire, based on analyzing all patients’ electronic medical records. 

While the link between physical activity and reduced risk of chronic disease has been known, the researchers say the study underscores the value of surveying patients about their physical activity levels.

“We believe this finding is a result of those patients who take the time to come in for annual wellness exams also are taking more time to engage in healthy behaviors, such as being physically active,” Carr says.

In a related study, published this month in the Journal of Physical Activity and Health, Carr’s team found that when healthcare providers billed for providing exercise counseling to patients, those invoices were reimbursed by insurance providers nearly 95 percent of the time. 

“Our findings suggest the recommended physical activity billing codes are reimbursed at a high rate when providers submit them for reimbursement, which reinforces the idea to make physical activity surveys and counseling services available,” Carr says.

Cole Chapman, assistant professor in the College of Pharmacy, is the first author on the study. Chapman, who joined the Pharmacy faculty in 2019 after earning bachelor’s and doctoral degrees at Iowa, collected and analyzed the data from the patients’ electronic medical records.