Exercise: The Best Medicine, By Sally Squires/ The Lean Plate Club

“Walk two miles and call me in the morning.”

That’s what doctors could soon prescribe if the new leaders of two major medical groups have their way.

“We’re trying to get every physician to prescribe exercise,” says Robert Sallis, a California physician who recently became president of the American College of Sports Medicine. “Physicians have a moral responsibility to inform patients of the danger of inactivity and the health benefits of being more active.”

That’s also the message from the new head of the American Medical Association.

“We are in lockstep with them on that concept,” says incoming AMA President Ronald M. Davis, who is also the director of the Henry Ford Health System’s Center for Health Promotion and Disease Prevention in Detroit. “We need to get doctors to prescribe exercise more and we need to get patients to follow that advice.”

More than half of Americans fail to get the 30 minutes of physical activity recommended daily to provide health benefits, according to the Centers for Disease Control and Prevention.

So many Americans are inactive that some experts have coined a new term for it: sedentary death syndrome. The condition helps cut short an estimated 250,000 lives annually, according to Frank Booth, professor of physiology at the University of Missouri. Research suggests that people who are sedentary spend about $1,500 more annually on medical bills than do their more active counterparts.

“There are also studies to show that they miss more work and are not as productive,” says Sallis. Research shows that regular physical activity improves health by cutting the risk of heart disease, stroke, colon cancer, diabetes and high blood pressure. Even brief bouts of activity several times a day can help control weight and relieve arthritis, anxiety and depression.

“Exercise is medicine,” Sallis says. “We know that it works very well. We just don’t have the proper way to administer it.”

That’s where the doctors come in. Sallis is leading the charge to get doctors and other health professionals to ask every patient at every office visit about their exercise habits.

It isn’t just activity that doctors are being asked to encourage. Harvard Medical School and the Culinary Institute of America recently teamed up to teach physicians to cook more healthfully for their own personal consumption.

The theory is that by teaching doctors how to cook, they may be more likely to encourage their patients to do the same. Harvard also is considering establishing teaching kitchens in hospitals. The goal would be to take patients who have recently been diagnosed with diabetes, heart disease or other nutritionally related conditions, and show them how to make healthier meals.

Girls Protected By Hormones During Adolescence, Study Suggests

HealthDay News, by Ed Edelson (Apr. 21, 2008) — The first signs that men are at higher risk of heart disease than women appear during the adolescent years, according a new study that tracked boys and girls through their teens.

This is not what we would have predicted," said Dr. Antoinette Moran, chief of pediatric endocrinology and diabetes at the University of Minnesota Children's Hospital, and lead author of the report in the April 22 issue of Circulation. "Because boys lose fat and gain muscle in adolescence, while girls add body fat.

At the start, 11-year-old boys and girls were similar in body composition, blood pressure and blood levels of lipids (fats). As expected, the percentage of body fat decreased in the boys and increased in the girls over the adolescent years.

Yet the study of the 507 Minneapolis school children found that between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increased in the boys and dropped in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, went down in boys but rose in girls.

Blood pressure increased in both, but significantly more in boys. And insulin resistance, a marker of cardiovascular risk, which was lower in boys at age 11, rose until the 19-year-old men were more resistant than the women.

But excess weight is of major importance in both sexes, Moran said. "Being overweight or obese can cancel out these relationships and cause increased cardiovascular risk for males and females," she said. "Any protection that the young women had was wiped out by obesity.

A recent study found that more than a third of children and adolescents in the United States are overweight or obese.

The study points toward the importance of hormonal factors in cardiovascular disease risk, Moran explained. "We knew that women had extra protection from cardiovascular disease, and we knew it disappeared after menopause," she said. "This adds further weight to the role of hormones by looking at the other end of the age spectrum.

One possible lesson of the study is that it is never too early to start protective measures against heart disease, said Dr. Stephen R. Daniels, chairman of the department of pediatrics at the University of Colorado.

Studies have used autopsies of young people who died in accidents to show that by the late teens, the kind of lesions we know cause heart attacks and strokes are in the process of developing," Daniels said. "So, in some ways, our best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early.

Fighting obesity in the years before adulthood is essential, he said. "Some changes that occur may be due to what is built into the difference between the sexes," he said. "But if you add overweight and obesity, you can increase risk through that mechanism.

More information
Facts about childhood obesity are available from the U.S. Surgeon General.

Source: Antoinette Moran, M.D., chief, pediatric endocrinology and diabetes, University of Minnesota Children's Hospital, Milwaukee; Stephen R. Daniels, M.D., chairman, pediatrics, University of Colorado, Denver; April 22, 2008, Circulation

How Exercise Changes Structure And Function Of Heart

ScienceDaily (Apr. 23, 2008) — For the first time researchers are beginning to understand exactly how various forms of exercise impact the heart. Massachusetts General Hospital (MGH) investigators, in collaboration with the Harvard University Health Services, have found that 90 days of vigorous athletic training produces significant changes in cardiac structure and function and that the type of change varies with the type of exercise performed.

"Most of what we know about cardiac changes in athletes and other physically active people comes from 'snapshots,' taken at one specific point in time. What we did in this first-of-a-kind study was to follow athletes over several months to determine how the training process actually causes change to occur," says Aaron Baggish, MD, a fellow in the MGH Cardiology Division and lead author of the study.

To investigate how exercise affects the heart over time, the MGH researchers enrolled two groups of Harvard University student athletes at the beginning of the fall 2006 semester. One group was comprised of endurance athletes -- 20 male and 20 female rowers -- and the other, strength athletes -- 35 male football players. Student athletes were studied while participating their normal team training, with emphasis on how the heart adapts to a typical season of competitive athletics.

Echocardiography studies -- ultrasound examination of the heart's structure and function -- were taken at the beginning and end of the 90-day study period. Participants followed the normal training regimens developed by their coaches and trainers, and weekly training activity was recorded. Endurance training included one- to three-hour sessions of on-water practice or use of indoor rowing equipment. The strength athletes took part in skill-focused drills, exercises designed to improve muscle strength and reaction time, and supervised weight training. Participants also were questioned confidentially about the use of steroids, and any who reported such use were excluded from the study.

At the end of the 90-day study period, both groups had significant overall increases in the size of their hearts. For endurance athletes, the left and right ventricles -- the chambers that send blood into the aorta and to the lungs, respectively -- expanded. In contrast, the heart muscle of the strength athletes tended to thicken, a phenomenon that appeared to be confined to the left ventricle. The most significant functional differences related to the relaxation of the heart muscle between beats -- which increased in the endurance athletes but decreased in strength athletes, while still remaining within normal ranges.

"We were quite surprised by both the magnitude of changes over a relatively short period and by how great the differences were between the two groups of athletes," Baggish says. "The functional differences raise questions about the potential impact of long-term training, which should be followed up in future studies."

While this study looks at young athletes with healthy hearts, the information it provides may someday benefit heart disease patients. "The take-home message is that, just as not all heart disease is equal, not all exercise prescriptions are equal," Baggish explains. "This should start us thinking about whether we should tailor the type of exercise patients should do to their specific type of heart disease. The concept will need to be studied in heart disease patients before we can make any definitive recommendations."

Their study appears in the April Journal of Applied Physiology. Baggish and senior author Malissa J. Wood, MD, of MGH Cardiology note that collaboration with the Harvard University Medical Services, led by Francis Wang, MD, was instrumental in the success of this study. Additional co-authors of the report are Rory Weiner, MD, Jason Elinoff, Francois Tournoux, Michael Picard, MD, and Adolph Hutter, MD, MGH Cardiology; and Arthur Boland, MD, Harvard University Health Services.

Adapted from materials provided by Massachusetts General Hospital.