Exercise linked to reduced risk of several cancers

“I love any article that says I can do something to decrease the risk of cancer. The researchers pooled data from 12 prospective US and European cohorts (baseline 1987-2004). They used self-reported exercise level in Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults.” Bill Chesnut, MD

(Return to New Health News, https://billchesnutmd.com/new-health-news/)
Exercise linked to reduced risk of several cancers

ABC World News Tonight (5/16, story 11, 0:25, Muir) reported, “The National Cancer Institute confirms that moderate exercise, all the way up to intense exercise, lowers the risk of” cancer “in many forms.”

The Los Angeles Times (5/16, Healy) reports that the research, published in JAMA Internal Medicine, suggests “exercise is a powerful cancer-preventive.” Investigators found that “physical activity worked to drive down rates of a broad array of cancers even among smokers, former smokers, and the overweight and obese.”

US News & World Report (5/16, Esposito) reports that investigators “analyzed data from participants in 12 US and European study groups who self-reported their physical activity between 1987 and 2004.” The researchers “looked at the incidence of 26 kinds of cancer occurring in the study follow-up period, which lasted 11 years on average.” The data indicated that “overall, a higher level of activity was tied to a 7 percent lower risk of developing any type of cancer.”

TIME (5/16, Park) reports that “the reduced risk was especially striking for 13 types of cancers.” Individuals “who were more active had on average a 20% lower risk of cancers of the esophagus, lung, kidney, stomach, endometrium and others compared with people who were less active.” Meanwhile, “the reduction was slightly lower for colon, bladder, and breast cancers.”

AMA News 5.17.16

A morning meal may lead to more exercise.

“The research about breakfast is so good if you eat the right breakfast that it is hard to find good negative articles. Add to breakfast doing several one minute strengthening exercises at the beginning of the day and a better day is guaranteed.” Bill Chesnut, MD
Breakfast bonus! A morning meal may lead to more exercise.

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Cleveland Clinic Wellness newsletter_March 13, 2016
“One thing leads to another” is more than a catchy song from an ’80s band (okay, we’ll give it to you: Pet Shop Boys). It’s a fact of life — and health. And sometimes the connections surprise you. Case in point: a compelling benefit of breakfast. No, your morning meal does not lead to immortality or hundred-dollar bills falling from the sky (sorry!), but research suggests that if you’re trying to be more active, eating breakfast may help. In a randomized, clinical trial studying people with obesity, researchers found that those who ate breakfast were more physically active during the day than those who fasted until lunch. Earlier research found similar benefits in people of normal weight. That’s a big deal, given the marked disadvantages of being sedentary. The study didn’t track what people ate, but that matters, too, of course. (In a nutshell, skip the sweet stuff and stripped carbs, and aim for whole foods, including protein.) You’ll probably notice more spring in your step! The possibilities are endless, and staying active is one of the pillars of good health.


Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

“ This research is a heads-up for hard working people. If you must, want to or just enjoy working more than 45 hours a week, counteract the risk factor by exercise, good consistent diet habits, stress control, good interpersonal relationships, mindfulness, good sleep habits and a regular lifestyle, not having wild variations in your weeks. This risk applies to most physicians in patient care; it is unavoidable. Their skills and knowledge are so needed, they have a strong reason to work excessively.” Bill Chesnut, MD.

Working long hours may be linked to higher risk of heart disease, study suggests

The New York Times (3/10, Bakalar) “Well” blog reports that research suggests “the more hours you work, the greater your risk for heart disease.” Investigators “found that for each additional hour of work per week over ten years, there was a 1 percent increase in the risk for heart disease.” The findings were published in the Journal of Occupational and Environmental Medicine. _________________Ama 3.10.1

Journal of Occupational & Environmental Medicine: ____March 2016 – Volume 58 – Issue 3 – p 221–226


Dose–Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics                 Conway, Sadie H. PhD; Pompeii, Lisa A. PhD; Roberts, Robert E. PhD; Follis, Jack L. PhD; Gimeno, David PhD

Objectives: The aim of this study was to examine the presence of a dose–response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers.

Methods: A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose–response relationship of work hours with CVD.

Results: A dose–response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%.

Conclusion: Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.


Exercise may slow mental decline by ten years.

“The Journal of the American Academy of Neurology reports a wonderful piece of news from the University of Miami. This long-term study of 876 participants found exercise can slow cognitive decline in older people by ten years. Keeping better brain function for years by exercising is a great cost/benefits ratio. In the eyes of an orthopedic surgeon, this finding is true and those who exercise have fewer painful bone fractures in the last decade. Major fractures in the elderly commonly prevent the injured to cover to the pre-injury quality of life. “  Bill Chesnut, MD

Study: Exercise may slow mental decline by ten years. MIAMI, March 25 (UPI) –.

Exercise can slow cognitive decline in older people by ten years, researchers at the University of Miami found in a recent study. People who reported little to no physical activity in the study saw a greater decline in brain aging than those who were active, the researchers report in the new study, published in the Journal of the American Academy of Neurology. A study released earlier this year by Boston University found increased blood flow resulting from physical activity protected brain volume, which also protects its ability to function properly. Physical activity is an attractive option to reduce the burden of cognitive impairment in public health because it is low cost and doesn’t interfere with medications, Dr. Clinton Wright, an associate professor of neurology at the University of Miami, said in a press release. For the study, researchers recruited 876 participants with an average age of 71, assessing their cognition in the Northern Manhattan Study based on processing speed, semantic memory, episodic memory and executive function, with 90 percent of participants reporting light exercise, and 10 percent reporting moderate to heavy levels of exercise. The participants were then assessed seven years later with the same tests, and again five years after that. Overall, the researchers report people without signs of cognitive impairment who exercised the least when the study started showed a more significant decline in brain function equivalent to about 10 years of aging. The number of people over the age of 65 in the United States is on the rise, meaning the public health burden of thinking and memory problems will likely grow, Wright said. Our study showed that for older people, getting regular exercise may be protective, helping them keep their cognitive abilities longer. .


Lifting Weights As You Age Cuts Your Risk Of Death By 46%

“Lifting weights is essential for bone health. Lifting weights have been shown to be at least as effective as taking Fosamax. From menopause to age 65 women without hormone replacement lose 25 percent of their bone mass.  I lift every day, and you should do. (Do I sound like your mother?).”     Bill Chesnut, MD.

To go back to New Health News: https://billchesnutmd.com/new-health-news

Lifting Weights As You Age Cuts Your Risk Of Death By 46%.   Discover the science of how strength training keeps you young.                     Men’s Health by  ALI EAVESWednesday, March 23, 2016.

The secret to a longer life may be a barbell: Strength training as you age reduces your risk of death, according to a new study from Penn State College of Medicine.

Researchers surveyed people age 65 or older about their exercise habits and then tracked them for 15 years. Nearly a third of the study participants died during that period.

Less than 10 percent of the subjects strength is trained, but those select few were 46 percent less likely to die during the study than everyone else.

Sure, you could say that older folks who lift must be in better health to begin with. But even after adjusting for BMI, chronic conditions like diabetes and hypertension, and habits like total physical activity, drinking, and smoking, lifting was linked to a 19 percent reduced risk of death.

Strength training can keep you active and independent in your golden years, says study author Jennifer Kraschnewski, M.D. Not only does it strengthen your muscles, resulting in better stamina and balance, but it also increases your bone density.

Make sleep #1 at night and be #1 all day!

“Creating and maintaining a healthy sleep pattern is deliberate. It involves several important steps including decreasing stimulation in the evening, increasing exercising in the day and learning to concentrate on the act of falling asleep.” Bill Chesnut, MD

To return to New Health News: https://billchesnutmd.com/new-health-news

Make sleep #1 at night and be #1 all day!    Cleveland Clinic Wellness newsletter_ March 7, 2016.   Sleep and technology go together like oil and water. And by oil, we mean the midnight oil that’s far too easy to burn when you get caught up in texting your BFF, catching up on social media, and other online pursuits. Numerous studies show that staying e-connected interferes with sleep. And new research shows that the reverse is true, too: Sleeping badly may make you more likely to check Facebook compulsively the next day. Can you say vicious cycle? The explanation has to do with a lack of focus.

Sleep and technology go together like oil and water. And by oil, we mean the midnight oil that’s far too easy to burn when you get caught up in texting your BFF, catching up on social media, and other online pursuits. Numerous studies show that staying e-connected interferes with sleep. And new research shows that the reverse is true, too: Sleeping badly may make you more likely to check Facebook compulsively the next day. Can you say vicious cycle? The explanation has to do with a lack of focus.

When you don’t sleep well, you tend to be more distracted and distractible. And what are social media and the Internet in general if not distraction’s dream come true! By prioritizing your sleep at night, you’ll improve your focus and productivity by day.

Start by getting back to basics: For starters, keep a consistent bedtime and wake time, avoid screens for an hour prior to bedtime, avoid caffeine in the afternoon and evening, and keep your room a sleep haven. Create a relaxing bedtime routine that includes dimming the lights (or switching to red wavelength lights only), keeping the temperature of your room cool, taking a bath or shower, meditating, doing gentle stretching, and…turning off your devices. To avoid temptation, keep them out of the bedroom. They’ll be there in the morning, we promise!

Return to New Health News, https://billchesnutmd.com/new-health-news

Higher percent of body fat may be linked to higher risk of dying early

“This important article studies the body fat percentage and not the BMI index. This is more specific research than articles using the BMI to determine results. Men with highest body fat percent had a 60 percent higher risk of mortality. A warning here for the wise.” Bill Chesnut, MD

To return to New Health News: https://billchesnutmd.com/new-health-news

Higher percent of body fat may be linked to higher risk of dying early, study suggests

The AP (3/7, Neergaard) reports that research published in Annals of Internal Medicine suggests that “a higher percent of body fat, independent of” a “person’s BMI,” may be “linked to reduced survival.”

STAT (3/7, Anyaegbunam) reports that investigators “examined the medical charts and X-rays of people…who had gotten osteoporosis screenings between 1999 and 2013.”

TIME (3/7, Park) reports that when the researchers “looked at how body fat correlated with early death,” they “found that people with the lowest BMI had a 44% to 45% higher risk of dying early – likely because they were malnourished or otherwise ill – than those with more average BMI.” Individuals “with the highest body fat composition, regardless of their BMI, also had the highest risk of dying early – women with more body fat showed a 19% increased risk of early death while men had a 60% higher risk of mortality.”

The Los Angeles Times (3/7, Healy) reports on the study, and also reports on a separate study published in the Annals of Internal Medicine, which “found that in a group of more than 1.5 million Swedish military recruits, men who had poor physical fitness at age 18 were three times more likely to develop Type 2 diabetes in midlife than were those who had been highly fit on the cusp of adulthood.” AMA News.

Return to New Health News, https://billchesnutmd.com/new-health-news

In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty

In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial.

To return to New Health News: https://billchesnutmd.com/new-health-news

BACKGROUND: The availability of less resource-intensive alternatives to home visits for rehabilitation following orthopaedic surgeries is important, given the increasing need for home care services and the shortage of health resources. The goal of this trial was to determine whether an in-home telerehabilitation program is not clinically inferior to a face-to-face home visit approach (standard care) after hospital discharge of patients following a total knee arthroplasty.

METHODS: Two hundred and five patients who had a total knee arthroplasty were randomized before hospital discharge to the telerehabilitation group or the face-to-face home visit group. Both groups received the same rehabilitation intervention for two months after hospital discharge. Patients were evaluated at baseline (before total knee arthroplasty), immediately after the rehabilitation intervention (two months after discharge), and two months later (four months after discharge). The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the last follow-up evaluation. Secondary outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, functional and strength tests, and knee range of motion. The noninferiority margin was set at 9% for the WOMAC.

RESULTS: The demographic and clinical characteristics of the two groups of patients were similar at baseline. At the last follow-up evaluation, the mean differences between the groups with regard to the WOMAC gains, adjusted for baseline values, were near zero (for 182 patients in the per-protocol analysis): -1.6% (95% confidence interval [CI]: -5.6%, 2.3%) for the total score, -1.6% (95% CI: -5.9%, 2.8%) for pain, -0.7% (95% CI: -6.8%, 5.4%) for stiffness, and -1.8% (95% CI: -5.9%, 2.3%) for function. The confidence intervals were all within the predetermined zone of noninferiority. The secondary outcomes had similar results, as did the intention-to-treat analysis, which was conducted afterward for 198 patients.

CONCLUSIONS: Our results demonstrated the noninferiority of in-home telerehabilitation and support its use as an effective alternative to face-to-face service delivery after hospital discharge of patients following a total knee arthroplasty.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Menopausal hot flashes decrease with evercise.

“Exercise during menopause to stay cool is a good idea for many reasons. Without hormone replacement, menopausal women lose 25% of their total bone mass by age 60. That is a strong reason for exercise, calcium, checking your Vit D level to be sure you are around 50 ng/dl and staying current on available safe hormone replacement. Talk to a medical provider who has interest and is current in hormone replacement therapy. “ Bill Chesnut, MD.
Keep your cool during menopause — with exercise!____Cleveland Clinic Wellness newsletter March 2, 2016.
Call it a paradox, but getting sweaty can help you stay cool as a cucumber — in more ways than one! Not only can regular exercise help you manage stress, but in addition, if you’re going through menopause, it can help keep you cool literally. In a large population study, physically active women experienced fewer hot flashes and other uncomfortable symptoms than their more sedentary counterparts. And because “the change” is sometimes accompanied by weight gain, menopausal women may be especially responsive to the effects of exercise. One study showed that light exercise, such as casual walking and yard work, improved the body composition of menopausal women more than that of premenopausal women. (Take that, twentysomethings!) If you’re planning to start an exercise routine from scratch, clear it with your doctor, and choose your inspirational slogans carefully. To avoid injury or burnout, think “slow and steady” rather than “just do it.” Start with a 10-minute walk once a day, and increase by a couple of minutes every few weeks, with a goal of 30 minutes daily. And remember to include moves for balance, flexibility, and resistance, all valuable aspects of your health and fitness.
Cleveland Clinic Wellness Newsletter_ March 2, 2016

Why Exercise Can Help Make You Happier

“The value of exercise as a treatment has been increasing documented in the last three decades. This information is timely because of the increasing rate of injury by using prescription opioid pain medications. Controlling depression decreases pain.” Bill Chesnut, MD

Why Exercise Can Help Make You Happier   by Mladen Golubic, M.D., Ph. D. Cleveland Clinic Wellness newsletter 2.24.16

Lifestyle factors — like food choices, physical activity and stress — have a profound effect on your mood and strongly influence whether or not you may develop anxiety and depression. Here’s a fact you may not know: Depression is projected to be a leading social and economic burden worldwide by 2020, second only to coronary artery disease! In fact, about 10 percent of the U.S. population suffers from depression at any point in time. Why so much depression? It is suspected that continuously increasing levels of stress are contributing to the rapid rise in depression. Increased stress hormones not only damage nerve cells, but also prevent growth of new ones in parts of the brain responsible for positive mood states. While there are effective treatments for depression, for example psychotherapy and antidepressant medications, only about a third of depression sufferers actually receive these treatments. What can be done for the remaining two-thirds? A lot.

Physical activity has been identified as an effective alternative treatment, either alone or in combination with standard therapies. In fact, the American Psychiatric Association now includes exercise in their treatment recommendations. It’s easy to understand why: Data from randomized clinical trials provide solid evidence about the benefits of both aerobic (walking, running, biking) and resistance (strength) training for those afflicted with depression. The recommended amount? Three to five exercise sessions per week, of 45 to 60 minutes each. Here’s more great news: People with depressive symptoms may experience improvements within four weeks of starting an exercise routine. And if that’s not enough to convince you of the mental health benefits of exercise, consider this: While stress decreases the growth of new nerve cells that can boost your mood, exercise does the opposite. Exercise grows the brain!

While there is no doubt about the effectiveness of exercise in reducing symptoms of depression, it does take real effort to begin and maintain an exercise routine. To be successful, find an exercise that you love to do. Many people enjoy walking, which has several health benefits if you reach 10,000 steps a day. If you begin to lose interest in your routine, change it up. Take a new fitness class, start dancing, begin a yoga practice or take bike rides with friends or family. And if you’re pressed for time, you may want to look into short, high-intensity workouts that do not require any equipment but use only body weight. They can be performed anywhere and can be done in as little as seven minutes a day. But high-intensity workouts are not for everyone, so please discuss this idea with your doctor before attempting it on your own. Even if your exercise frequency, intensity and duration are below the current recommendation, do not despair. Engaging in at least some physical activity may still be beneficial for patients with depression, according to the authors of the report.

If you’re not suffering from depression, you should know that exercise has numerous other health benefits, too. Regular physical activity can lower your blood pressure, improve your cholesterol profile, help control blood sugar, and reduce your risk of heart disease, diabetes and common cancers. And of course, it will help you achieve or maintain a healthy weight. What medication can do all that? Yes, you’re right. None. Such a pill does not exist and probably will not for generations to come. If it is ever created, it won’t be cheap. Exercise is free and readily available. So just do it.



Mindfulness training focused on stress reduction may benefit people with chronic low back pain

“Low back pain is increasingly seen as a chronic condition that requires multimodal approach. Combining exercise, massage, topical modalities like heat or an electrical stimulator, anti-inflammatories, acetaminophen helps most people. There is a condition of hypersensitivity to pain that is now being documented by testing. This makes the pain worse. Exercises make the pain better if properly done and daily. This is another tool to add, mindfulness training, which helped lower low back pain levels. The first two paragraphs are from Medscape. The second article below is from the Journal of American Medical Association Internal Medicine for the details and more comment” Bill Chesnut, MD

Mindfulness training focused on stress reduction may benefit people with chronic low back pain

Reuters (2/23, Doyle) reports that in a 282-patient study, an eight-week program of mindfulness training focused on reducing stress may benefit people with chronic low back pain. The findings were published online Feb. 22 in JAMA Internal Medicine.

According to Medscape (2/23, Garcia), an accompanying editorial observed, “Attention to underlying mechanisms of behavioral change (i.e., how or why the treatment leads to change) will be key, as will efforts directed at identifying what treatment components and/or specific combinations might be particularly influential in treatment outcomes.”


The Editorial referenced   above  by Medscape: Why We Need Nonpharmacologic Approaches to Manage Chronic Low Back Pain in Older Adults

M. Carrington Reid, MD, PhD1; Anthony D. Ong, PhD2; Charles R. Henderson Jr, MS2 JAMA Intern Med. Published online February 22, 2016. doi:10.1001/jamainternmed.2015.8348

Chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older, and is associated with substantial disability and costs.1,2 Management of chronic pain in older adults is complicated by age-related physiologic changes, competing comorbidities that limit treatment choices, and numerous patient (eg, fear of deleterious effects of medications) and physician (eg, lack of training) barriers. One of the most significant barriers to effective management, however, is a limited evidence base to guide treatment decisions. Recent reviews have documented the paucity of high-quality randomized clinical trials in the field.1,2 Shortcomings include study durations of 12 weeks or less, a lack of study population diversity, and enrollment of young-old study populations without major comorbidities. Studies focused on nonpharmacologic interventions are particularly needed, given that many barriers exist regarding the use of pharmacologic treatments in this target population. Studies further document that older adults with chronic pain are receptive to nonpharmacologic therapies3,4; many already use nondrug treatments and cite concerns about adverse drug effects and the use of too many medications as reasons.4 In this issue of JAMA Internal Medicine, Morone and colleagues5 begin to address this important knowledge gap by presenting data from a well-conducted randomized clinical trial that evaluated the effects of a mindfulness meditation intervention among older adults with chronic low back pain.


Low levels of midlife fitness may be associated with smaller brain tissue volume later

“Great study of 1,583 participants without dementia using brain scans and fitness tests. Note this:  “observed that participants who had an especially high heart rate and blood pressure during the most vigorous exercise had notably smaller brain volumes 20 years later“. Bill Chesnut, MD

Low levels of midlife fitness may be associated with smaller brain tissue volume later

Reuters (2/10, Rapaport) reports that people who are not physically fit in midlife have an increased chance of having lower brain tissue volume in late life, compared to people who take part in regular exercise during their middle years, the findings of a study published online Feb. 10 in Neurology suggest.

TIME (2/10, Sifferlin) reports that investigators “looked at 1,583 men and women who didn’t have dementia or heart disease,” all of whom “worked out on a treadmill to assess their fitness levels.” Two decades later, study participant underwent “another treadmill fitness test and had brain scans.”

Newsweek (2/10, Firger) reports that “smaller brain volume” was found to correlate “with lower levels of physical fitness.” In addition, investigators “observed that participants who had an especially high heart rate and blood pressure during the most vigorous exercise had notably smaller brain volumes” 20 years later. While the study did not “measure rates of cognitive decline” in participants, “a decrease in brain volume is a strong indicator of declining function.”


Exercise combined with education is a reasonable approach to preventing episodes of low back pain.

“Common low back pain is responsive to strengthening exercise and education. Exercise combined with  education should be tried first if everything indicates the back pain is common lumbago and not a symptom of some different diagnosis.” Bill Chesnut, MD

 Study: Is exercise combined with education a reasonable approach to preventing episodes of LBP?

JAMA Intern Med. 2016 Jan 11:1-10. doi: 10.1001/jamainternmed.2015.7431. [Epub ahead of print]

Prevention of Low Back Pain: A Systematic Review and Meta-analysis.

Steffens D1Maher CG2Pereira LS3Stevens ML2Oliveira VC3Chapple M4Teixeira-Salmela LF3Hancock MJ4.


OBJECTIVE: To investigate the effectiveness of interventions for prevention of LBP.

DATA SOURCES: MEDLINE, EMBASE, Physiotherapy Evidence Database Scale, and Cochrane Central Register of Controlled Trials from inception to November 22, 2014.

STUDY SELECTION: Randomized clinical trials of prevention strategies for nonspecific LBP.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The Physiotherapy Evidence Database Scale was used to evaluate the risk-of-bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to describe the quality of evidence.

MAIN OUTCOMES AND MEASURES: The primary outcome measure was an episode of LBP, and the secondary outcome measure was an episode of sick leave associated with LBP. We calculated relative risks (RRs) and 95% CIs using random-effects models.

RESULTS: The literature search identified 6133 potentially eligible studies; of these, 23 published reports (on 21 different randomized clinical trials including 30 850 unique participants) met the inclusion criteria. With results presented as RRs (95% CIs), there was moderate-quality evidence that exercise combined with education reduces the risk of an episode of LBP (0.55 [0.41-0.74]) and low-quality evidence of no effect on sick leave (0.74 [0.44-1.26]). Low- to very low-quality evidence suggested that exercise alone may reduce the risk of both an LBP episode (0.65 [0.50-0.86]) and use of sick leave (0.22 [0.06-0.76]). For education alone, there was moderate- to very low-quality evidence of no effect on LBP (1.03 [0.83-1.27]) or sick leave (0.87 [0.47-1.60]). There was low- to very low-quality evidence that back belts do not reduce the risk of LBP episodes (1.01 [0.71-1.44]) or sick leave (0.87 [0.47-1.60]). There was low-quality evidence of no protective effect of shoe insoles on LBP (1.01 [0.74-1.40]).

CONCLUSION AND RELEVANCE: The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP. Other interventions, including education alone, back belts, and shoe insoles, do not appear to prevent LBP. Whether education, training, or ergonomic adjustments prevent sick leave is uncertain because the quality of evidence is low.

PMID: 26752509




Sedentary behavior may dramatically increase risk of developing T2D

“Beware of sitting all day; diabetes may come to stay.” Bill Chesnut, MD

Sedentary behavior may dramatically increase risk of developing T2D, study says.

CNN (2/2, Christensen) reports that “even an extra 40 minutes of couch potato behavior will dramatically increase” the risk of developing type 2 diabetes (T2D).

HealthDay (2/2, Reinberg) reports that “each extra hour in a sedentary position – whether working on the computer or lounging in the recliner – seems to increase” the “odds of type 2 diabetes by 22 percent, the study authors” said in a study published online Feb. 2 in Diabetologia. That risk remained even if people exercised, researchers found after collecting “data on nearly 2,500 adults, average age 60.”

AMA newsletter 2.3.16.

Study examines impact of early physical therapy for lower-back pain

“This is an example of the media not saying what the study demonstrated. Fortunately, they linked to the original publication in JAMA, October 13, 2015. There you find that PT was not so good, but a little good.” Bill Chesnut, MD

Study examines impact of early physical therapy for lower-back pain

The NPR (10/14, Shallcross) “Shots” blog reports that a study published Oct. 13 in the Journal of the American Medical Association examines “the impact of early physical therapy” for lower-back pain. Researchers “looked at more than 200 patients with lower-back pain to see whether physical therapy sessions would make a difference if they started the sessions soon after they began having pain” instead of waiting a few weeks to see if people could recover on their own.

HealthDay (10/14, Reinberg) points out that “early physical therapy produced a modest improvement in the study participants’ ability to function after three months, compared with no physical therapy” at all. At the one-year mark, however, “no significant difference in function was found between the two groups.”


If you read the entire abstract, http://jama.jamanetwork.com/article.aspx?articleid=2456165&utm_source=BHClistID&utm_medium=BulletinHealthCare&utm_term=101415&utm_content=MorningRounds&utm_campaign=BHCMessageID the conclusions are different than the media reported.

Conclusions and Relevance. Among adults with recent-onset LBP, early physical therapy resulted in statistically significant improvement in disability, but the improvement was modest and did not achieve the minimum clinically important difference compared with usual care.

Trial Registration  clinicaltrials.gov Identifier: NCT01726803



Teens see lasting health benefits from bariatric surgery

“This study is good news that decreasing obesity by surgery in teenagers clears type 2 diabetes in 95%, return to normal kidney function in 86%, remission of pre-diabetes in 76%, correction of hypertension in 74% and a return of cholesterol to normal in 66%. That adds more pressure to develop effective treatments for obesity to be used in the young and to continue to use bariatric surgery until we have a less invasive equally effective treatment. Yahoo.” Bill Chesnut, MD

 Teens see lasting health benefits from bariatric surgery, study suggests

 The AP (11/7, Tanner) reported, “The largest, longest study of teen obesity surgery shows huge weight loss and health gains can last at least three years.”

Stat (11/7, Samuel) reported that in the study, which was published in the New England Journal of Medicine, adolescents “received one of two common bariatric surgeries – Roux-en-Y gastric bypass or sleeve gastrectomy – and were followed for three years after the procedure.” Teenagers “who received either surgery showed significant improvements in both their weight and quality of life at the end of the study period.”

MedPage Today (11/7, Brown) reported that the teens not only lost weight, but 95 percent of patients who had type 2 diabetes at the start of the study experienced a remission of the disease. What’s more, “emission of abnormal kidney function occurred in 86% of patients (95% CI 72%-100%), remission of prediabetes in 76% (95% CI 56%-97%), remission of elevated blood pressure in 74% (95% CI 64%-84%), and remission of dyslipidemia in 66% (95% CI 57%-74%).”


MRI Reveals Weight Loss Protects Knees

“This important article includes beautiful MRI images of knee arthritis. I cannot reproduce them here. You can see some of these in HealthImaging, http://www.healthimaging.com/topics/advanced-visualization/rsna-weight-loss-markedly-slows-knee-damage

This text is relevant without the pictures. This type of research will stand the test of time. The point is for obese patients to lose weight knowing that it can help their knee arthritis. Don’t jump to the conclusion that you should go directly to total knee replacement.

This report adds to the importance of medicine developing an effective treatment for those who are obese; more many our current methods don’t work.” Bill Chesnut, MD

MRI Reveals Weight Loss Protects Knees

CHICAGO — Obese people who lose a substantial amount of weight can significantly slow the degeneration of their knee cartilage, according to a new MRI study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Alexandra Gersing, M.D.

Obesity is a major risk factor for osteoarthritis, a degenerative joint disease that affects more than a third of adults over the age of 60, according to the Centers for Disease Control and Prevention. The knee joint is a common site of osteoarthritis, and in many people the condition progresses until total knee replacement becomes necessary. Aging baby boomers and a rise in obesity have contributed to an increased prevalence of knee osteoarthritis.

“Degenerative joint disease is a major cause of pain and disability in our population, and obesity is a significant risk factor,” said the study’s lead author, Alexandra Gersing, M.D., from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “Once cartilage is lost in osteoarthritis, the disease cannot be reversed.”

Dr. Gersing and colleagues recently investigated the association between different degrees of weight loss and the progression of knee cartilage degeneration in 506 overweight and obese patients from the Osteoarthritis Initiative, a nationwide research study focused on the prevention and treatment of knee osteoarthritis. The patients either had mild to moderate osteoarthritis or risk factors for the disease. They were divided into three groups: a control group who did not lose weight, a second group who lost a little weight, and a third group who lost more than 10 percent of their body weight. The researchers then used MRI to quantify knee osteoarthritis.

“Through T2 relaxation time measurements from MRI, we can see changes in cartilage quality at a very early stage, even before it breaks down,” Dr. Gersing said.

When the researchers analyzed differences in the quality of cartilage among the three groups over a four-year time span, they found evidence that weight loss has a protective effect against cartilage degeneration and that a larger amount of weight loss is more beneficial.

“Cartilage degenerated a lot slower in the group that lost more than 10 percent of their body weight, especially in the weight-bearing regions of the knee,” Dr. Gersing said. “However, those with 5 to 10 percent weight loss had almost no difference in cartilage degeneration compared to those who didn’t lose weight.”

Substantial weight loss not only slows knee joint degeneration—it also reduces the risk of developing osteoarthritis, Dr. Gersing said. Along with moderate exercise, weight loss is one of the primary interventions against the disease.

“It’s most helpful if these lifestyle interventions take place as early as possible,” Dr. Gersing said.



Figure 1. Cartilage T2 maps indicating worsening cartilage quality (red) after 48 months in an obese patient without weight loss (top row) compared to a patient with >10% weight loss (bottom row) in which only little cartilage degeneration is found.

Figure 2. Knee joint of patient without weight loss (A) showing severe cartilage defects after 48 months, whereas in the knee joint of a patient with a substantial amount of weight loss (B), cartilage remains intact.

Higher fitness linked to reduced morbidity after first heart attack

“Yeah for this news. The study is of 2,000 women and men. Keep exercising! Stay strong every day.” Bill Chesnut, MD

Higher fitness linked to reduced morbidity after first heart attack, research suggests.

CBS News (2/1, Marcus) reports that research suggests “getting regular exercise not only reduces a person’s risk of heart disease, it can increase the chance of survival if a heart attack does happen, compared to people who aren’t in very good shape.”

TIME (2/1, Park) reports that investigators “studied the electronic health records of more than 2,000 men and women who took a treadmill test as a way to measure how fit they were.” Individuals “with the highest fitness scores were 40% less likely to die after their first heart attack than those with lower fitness scores.” The researchers also found that “a third of the people with the lowest fitness died within a year of their first heart attack.” The findings were published in Mayo Clinic Proceedings.


AMA newsletter 2.3.16.


Fidgeting may mitigate negative effects of prolonged sitting, study suggests

I don’t believe that this study of 13,000 women over 12 years proves anything except you need to pay attention when you read medical publications. Look askance. Apply common sense. The “fidgeting” behavior is self-reported; there is the weakness. If you don’t fidget I don’t recommend beginning perennial fidgeting for this study conclusion.” Bill Chesnut, MD

 Fidgeting may mitigate negative effects of prolonged sitting, study suggests

ABC World News (9/23, story 9, 0:15, Muir, 5.84M) reported that a new study about fidgeting found that it “may actually counteract the negative effects of sitting behind a desk all day.” Researchers theorize fidgeting “jolts your metabolism.”

The Chicago Tribune (9/23) reports that the study, published online in American Journal of Preventive Medicine, used data from the United Kingdom Women’s Cohort Study, following 12,778 women age 37 to 78 over a 12-year period. The women were divided into three groups based on self-assessments of their fidgeting habits: low, middle, or high. Among the women who did not fidget, the researchers “found that women who sat for seven or more hours daily had a 30 percent increased risk of dying from any cause,” compared to those who sat less than five hours a day. Meanwhile, “middle or high fidgeters saw no increased risk.”

AMA 9.24.15

Study suggests exercise prevents lower back pain

“This study and another elsewhere posted are finding that exercise is essential for the common variety of low back pain, lumbago. This summary in the AMA Wire does not point out that this may not be true in patients with actual nerve impingement causing back pain and sciatica pain.” Bill Chesnut, MD

Study suggests exercise prevents lower back pain

The NPR (1/12, Bichell) “Shots” blog reports that a study published in JAMA Internal Medicine analyzed 21 studies of treatment methods for lower back pain, “involving over 30,000 people in total.” The findings show that “back belts and show insoles didn’t seem to offer a benefit,” and that any kind of exercise “reduced the risk of repeated lower-back pain in the year following an episode between 25 and 40 percent.” In a corresponding editorial, Dr. Tim Carey at the University of North Carolina at Chapel Hill writes that healthcare providers don’t prescribe exercise enough, pointing out that “fewer than half of patients participate in an exercise program, even if they have long-term back pain.” Carey discovered that passive treatments, like ultrasound or orthotic insoles, were far more common. The discrepancy may be because of the health industry’s focus on “sellable products, and exercise isn’t one.”

TIME (1/12, Sifferlin) adds that about 80 percent of people will experience lower back pain at some point in their life. While exercise was found to be effective, “the researchers say it’s unclear whether these effects would last beyond a year.” The study authors write, “This finding raises the important issue that, for exercise to remain protective against future [lower back pain], it is likely that ongoing exercise is required.”



7 Million People in US Walking on Artificial Knees or Hips

“This is an editorial comment in the Journal of Bone and Joint Surgery, Sept 11, 2015. The full scientific article is in that issue and too technical to post here. It is a significant contribution to human productivity and secondarily quality of life if the patient takes advantage of the regained function.” Bill Chesnut, MD

7 Million People in US Walking on Artificial Knees or Hips

We know that more than 1 million total hip and total knee replacements are performed each year in the US. But how many people are actually walking around right now with such prostheses?

That’s the question Kremers et al. answer in the September 2, 2015 edition of The Journal of Bone & Joint Surgery. Using the so-called “counting method” to combine historical incidence data, these Mayo Clinic authors concluded that about 7 million US residents (slightly more than 2% ) were living with a hip or knee replacement in 2010.

Prevalence of hip replacement was 0.83%, while that of knee replacement was 1.52%. Not surprisingly, prevalence increased with age (5.26% for total hip and 10.38% for total knee at 80 years of age), but the authors also found a shift toward younger people having the procedure.

These prevalence stats for hip and knee replacement are similar to those for stroke (6.8 million) and myocardial infarction (7.6 million), underscoring just how common these orthopaedic procedures are. Even in the unlikely event that the annual incidence of these joint replacements remains steady rather than rises, the authors estimate that 11 million people will be living with artificial hips or knees in 2030.

According to Kremers et al., among the many implications of these findings is “a need for the medical profession and the policy makers to recognize and address the lifelong needs of this population,” including the development of evidence-based protocols for follow-up care and radiographic assessments.

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The Best Bodyweight Exercises for Travelers

“This is an excellent post from the Cleveland Clinic in the last three months. My personal favorites are Move1, the high knees, and the bird dog plank, Move 6. I do that one on the toes, not the knees. I like doing this every day with the intention to do them twice a day,  in addition to being in the gym. I say this to “benchmark,” encouraging  you to a higher and more frequent simple exercise program. The author has good pictures I recommend at their site, http://www.clevelandclinicwellness.com/DailyDose/archive/2015/07/03/The-Best-Bodyweight-Exercises-for-Travelers.aspx ” Bill Chesnut, MD

The Best Bodyweight Exercises for Travelers

by Ryan Sidak, B.S. Exercise Science

From business travel to family getaways to European vacations, we live in a culture that’s on the go — often! But all that moving from place-to-place doesn’t mean you have to stop exercising. All you need is your body — some of the best “equipment” available! I’ve outlined here a bodyweight circuit routine with six of my favorite moves and simple instructions you can pull up on your phone — no matter where you are. Even better: It won’t take hours out of your busy schedule to stay fit. You can adjust the circuit to the amount of time you have available. Happy travels!
Move 1: High Knees

Stand upright with good posture and raise your right knee up toward your chest as high as you can. Return your right foot to the ground and repeat with the left foot and leg. To crank up the intensity, increase the pace so that you are running in place with high knees.

Move 2: Squats
Begin with your feet slightly wider than shoulder-width apart and toes pointing forward. Lower your hips while also pushing them back. Stand back up pressing through your heels. If you have difficulty with squats, stand in front of a bench or chair and simply sit down into the chair all the way before standing back up.
Move 3: Mountain Climbers

Make sure that your chair is heavy enough to hold you, or to further secure it, push it up against a wall or desk. Begin in a push-up position with your hands under your shoulders and a straight line from the top of your head to your heels. Raise one knee as close to your chest as you can and return to the starting positing. Repeat with opposite leg. To make this move more difficult, remove the chair or bench and place your hands on the ground. Complete one knee raise with the left foot and the right foot for a full rep.
Move 4: Glute Bridge

Lie in your back with knees bent and feet on the ground, toes pointed toward the ceiling. Press through your heels to raise your hips so that your body forms a straight line from shoulders to knees. Hold for 3 to 5 seconds squeezing your glutes as hard as possible.

Move 5: Plank

With your hands or elbows under your shoulders, create a straight line from head to heel. Squeeze your glutes and brace your stomach (think about flexing as if someone was about to punch you in the stomach) — and breathe. If this move feels too challenging for you, try a plank position from your knees.

Move 6: Bird Dog

Begin on your hands and knees with a flat back. Simultaneously raise your right hand and left leg. Straighten both and hold 3 to 5 seconds. Return to starting position and raise your left hand and right leg (opposite sides).



Exercise may help reduce injuries from falls in older men

Exercise may help reduce injuries from falls in older men

 “The British Medical Journal is a distinguished peer reviewed publication. This investigation is based on 1,600 men. They found that men aged 70-89 can lower their risk of a serious fall by 38% by exercise. If these “working out” men fall, they have a 53% lower risk of fall-related fractures. These men have a 59% lower rate of fall injuries requiring hospitalization.

I personally find going to a gym daily is the best way to stay strong when you retire.” Bill Chesnut, MD.

 The New Haven (CT) Register (2/3, Stannard) reported that research published in the BMJ (British Medical Journal) suggests exercise may help reduce “injuries from falls in older men, but not in women.”

HealthDay (2/4, Preidt) reports that the research “included more than 1,600 inactive women and men, aged 70 to 89, randomly assigned to either a long-term, moderate exercise regimen or to a health education program.” Investigators found that “compared to those in the health education group, men in the workout group had a 38 percent lower risk of serious fall injuries, a 53 percent lower risk of fall-related fractures, and a 59 percent lower rate of fall injuries requiring hospitalization.” However, “the exercise program did not appear to reduce women’s risk of serious fall injuries.”

AMA newsletter, February, 2016.


3 simple ways to help prevent falls among older patients.

“This is important information for any families with older members. Balance declines at age 65. Field sobriety tests are different for drivers >65 years of age I heard on the radio.” Bill Chesnut, MD

 Three simple ways to help prevent falls among older patients  AMA newswire_9/22/2015, 3:30 PM

Fall-related injuries among older Americans are rising as the people age 65 and older become a larger percentage of the population. In 2013, 2.5 million older Americans were treated in emergency departments for injuries from falls, resulting in $34 billion in direct medical costs. Fortunately, several opportunities are available to help physicians prevent falls among their patients.

With National Falls Prevention Awareness Day Wednesday, sponsored by the National Council on Aging, it’s a good time to work with your patients to minimize their risk of falling. Here are three things you can do:

  1. 1.Screen patients by asking if they have fallen in the past year, feel unsteady or worry about falling.
  2. Review patients’ medications and stop, switch or reduce the dose of drugs that increase the risk for falls.
  3. Recommend daily Vitamin D with calcium. (The American Academy of Orthopedic Surgeons recommends that everyone > 65 years or who had a fracture falling from standing height have a bone density test and blood tests for hypovitaminosis D. Bill Chesnut, MD)

Resources to help

The Centers for Disease Control and Prevention (CDC) recently launched its STEADI (Stopping Elderly Accidents, Deaths and Injuries) initiative for health care professionals in association with the 2015 White House Conference on Aging. Rooted in established clinical guidelines and scientifically tested interventions, STEADI helps physicians address fall risk, identify modifiable risk factors and provide effective interventions for patients.


How to Regain Age-Related Standing Imbalance

How to Regain Age-Related Standing Imbalance in 60 seconds a day

Do the 60 sec plank exercise and for 30 sec hold one’s leg up behind you, as straight as you can, and off to that side. Feel it work the lateral chest muscle.

Repeat using the other leg to strengthen that hip and side.

It works quicker than you would think. Use a stopwatch. Start every day on the floor. Expect you may only be able to do only 10-15 seconds at first. That will change over the months.

It feels so good to feel firm and youthful in your gait. Really good.

Bill Chesnut, MD

February 4, 2016.