Sacubitril/Valsartan Reduces Physical and Social Limitations in Heart Failure Patients

MedicalResearch.com Interview with:
Dr. Alvin Chandra  MD first author  and
Dr. Scott David Solomon M.D.
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In general, the quality of life of heart failure with reduced ejection fraction patients is quite impaired, and  similar to that of patients on dialysis.

PARADIGM-HF was the largest trial of heart failure patients and showed that sacubitril/valsartan was superior to the gold-standard enalapril in reducing cardiovascular death, heart failure hospitalization and all-cause mortality. In addition, patients on sacubitril/valsartan, when compared to enalapril, showed significant improvement in overall quality of life.

In this study we looked in more detail at the individual components of “quality of life” and found that in virtually all domains and activities, patients who were randomized to sacubitril/valsartan reported improvement in their limitations  compared to those who were randomized to enalapril. These activities included jogging, doing hobbies, and household chores, with the largest improvement seen in  sexual activities limitations.

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Every Minute Counts! Short Bursts of Physical Activity Reduces Mortality

MedicalResearch.com Interview with:

Pedro F. Saint-Maurice, Ph.D. Postdoctoral Fellow Metabolic Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer Institute, NIH, HHS Rockville, MD 20850

Dr. Saint-Maurice

Pedro F. Saint-Maurice, Ph.D.
Postdoctoral Fellow
Metabolic Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH, HHS
Rockville, MD 20850

MedicalResearch.com: What is the background for this study?

 Response: The 2008 Physical Activity Guidelines for Americans recommends adults do 150 minutes/week of moderate intensity physical activity (PA) in increments of at least 10 minutes at a time. However, there is limited epidemiologic evidence supporting the use of the 10-minute increment and whether shorter increments (for instance walking up the stairs) can also be beneficial for health in adults. We looked at accelerometer-measured physical activity in roughly 5,000 adults (40 and older) representative of the US population and followed them prospectively (over 7 years) to determine whether physical activity accumulated in 10-minute increments, but also accumulated in shorter bursts, were associated with lower risk of death (mortality data came from the National Death Index). Continue reading

Sustaining Physical Activity With Age Decreases All-Cause Mortality Risk

MedicalResearch.com Interview with:
“physical-activity-120112-M-2021D-019” by MilitaryHealth is licensed under CC BY 2.0
Trine Moholdt, PhD
Research Fellow
Department of Circulation and Medical Imaging | Exercise, Cardiometabolic Health and Reproduction
Norwegian University of Science and Technology

MedicalResearch.com: What is the background for this study?  

Response: Although obese individuals have an increased risk of cardiovascular disease, evidence from many observational studies shows that in those who already have cardiovascular disease, being overweight or obese is associated with lower risk of mortality compared to their normal weight counterparts.

This phenomenon is often called the “obesity paradox”. Recently we observed that in individuals who have a high physical activity level, there is no such obesity paradox and body mass index did not associate with survival time in those who with high physical activity (Moholdt et al, American Journal of Medicine, 2017).  Continue reading

Chronic Disease Linked To Increased Risk of Cancer and Cancer Death

MedicalResearch.com Interview with:

Dr. Xifeng Wu, MD PhD Department Chair, Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences Director, Center for Translational and Public Health Genomics Professor, Department of Epidemiology Division of Cancer Prevention and Population Sciences The University of Texas MD Anderson Cancer Center, Houston, Texas

Dr. Xifeng Wu

Xifeng Wu MD PhD
Prevention and Population Sciences
MD Anderson Center

MedicalResearch.com: What is the background for this study?

Response: Previous studies have shown that certain chronic diseases may predispose to cancer. These studies generally assessed chronic diseases or disease markers individually. As chronic diseases are typically clustered, it is necessary to study them simultaneously to elucidate their independent and joint impact on cancer risk. Therefore, we investigated the independent and joint effect of several common chronic diseases or disease markers on cancer and life span in a large prospective cohort. Also, we compared the contribution of chronic diseases or disease markers to cancer risk with that of lifestyle factors. We further assessed whether physical activity could attenuate the cancer risk associated with chronic diseases or disease markers. We hope the results of this study can contribute to evidence-based recommendations for future cancer prevention strategies.

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Doing Something Is Better Than Nothing: Even Light Physical Activity Improves Health

MedicalResearch.com Interview with:

Michael J. LaMonte, PhD, MPH Research Associate Professor Department of Epidemiology and Environmental Health Co-Director, MPH Program (epidemiology) School of Public Health and Health Professions Women’s Health Initiative Clinic University at Buffalo – SUNY 

Dr. LaMonte

Michael J. LaMonte, PhD, MPH
Research Associate Professor
Department of Epidemiology and Environmental Health
Co-Director, MPH Program (epidemiology)
School of Public Health and Health Professions
Women’s Health Initiative Clinic
University at Buffalo – SUNY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current national public health guidelines recommend 150 minutes of moderate to vigorous physical activity a week for adults. The guidelines recommend persons 65 and older follow the adult guidelines to the degree their abilities and conditions allow. Some people, because of age or illness or deconditioning, are not able to do more strenuous activity. Current guidelines do not specifically encourage light activity because the evidence base to support such a recommendation has been lacking.

Results from the Objective Physical Activity and Cardiovascular Health (OPACH) Study, an ancillary study to the U.S. Women’s Health Initiative, recently published in the Journal of the American Geriatrics Society showed women ages 65-99 who engaged in regular light intensity physical activities had a reduction in the risk of mortality. The 6,000 women in the OPACH study wore an activity-measuring device called an accelerometer on their hip for seven days while going about their daily activities and were then followed for up to four and a half years.  Results showed that just 30 additional minutes of light physical activity per day lowered mortality risk by 12 percent while 30 additional minutes of moderate activity, such as brisk walking or bicycling at a leisurely pace, exhibited a 39 percent lower risk. 

The finding for lower mortality risk associated with light intensity activity truly is remarkable. We anticipated seeing mortality benefit associated with regular moderate-to-vigorous intensity activity, as supported by current public health guidelines. But, observing significantly lower mortality among women who were active at levels only slightly higher than what defines being sedentary was such a novel finding with important relevance to population health.

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Wearable Device Study Confirms Moderate-to-Vigorous Physical Activity Linked To Decreased Mortality

MedicalResearch.com Interview with:

I-Min Lee, MD, ScD Professor of Medicine, Harvard Medical School Professor of Epidemiology, Harvard T.H. Chan School of Public Health Brigham and Women's Hospital Boston, MA 02215

Dr. Lee

I-Min Lee, MD, ScD
Professor of Medicine, Harvard Medical School
Professor of Epidemiology, Harvard T.H. Chan School of Public Health
Brigham and Women’s Hospital
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The fact that physical activity lowers the risk of premature mortality is not a new fact – we have many studies showing this.  However, previous studies have primarily relied on self-reported physical activity, and self-reports tend to be imprecise.  Based on these self-report studies, we know that physical activity is associated with a 20-30% reduction in mortality rates.  And, these self-report studies also have focused on moderate-to-vigorous intensity physical activity, since they are more reliably reported than lighter intensity activity.  We have little information on whether light-intensity activities (e.g., light household chores, very slow walking such as when strolling and window shopping) are associated with lower mortality rates.

We now have “wearables” – devices that can more precisely measure physical activity at low (as well as higher) intensities, and sedentary behavior.  The present study, conducted between 2011 and 2015, investigated a large cohort of older women (n=16,741; mean age, 72 years)  who were asked to wear these devices for a week – thus, providing detailed physical activity and sedentary behavior measures.  During an average follow-up of about two-and-a-half years, 207 women died.  The study confirmed that physical activity is related to lower mortality rates.

What is new and important is how strong this association is when we have more precise measures of physical activity – the most active women had a 60-70% reduction in mortality rates, compared with the least active, during the study.  For context, non-smokers have about a 50% risk reduction, compared to smokers, which is why patients (and doctors) should pay attention to being physically active.

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Very High Exercise Levels Linked To Increase in Coronary Artery Calcification

MedicalResearch.com Interview with:

Deepika Laddu PhD Assistant Professor Department of Physical Therapy College of Applied Health Sciences The University of Illinois at Chicago Chicago, IL 60612

Dr. Laddu

Deepika Laddu PhD
Assistant Professor
Department of Physical Therapy
College of Applied Health Sciences
The University of Illinois at Chicago
Chicago, IL 60612 

MedicalResearch.com: What is the background for this study?

Response: Recent findings in population-based cohort studies on cumulative exercise dose have caused some controversy and debate showing U-shaped trends of association between physical activity and disease risk. Our objective was to better understand this association between physical activity and cardiovascular disease risk from young adulthood to middle age.

Given that engagement in physical activity is a continuously evolving behavior throughout life, this study looked at the physical activity trajectories of 3,175 black and white participants in the multicenter, community-based, longitudinal cohort CARDIA study who reported physical activity patterns over 25 years (from 1985 through 2011), and assessed the presence of coronary artery calcification, or CAC, among participants. Unique to this study is the evaluation of long-term exercise patterns from young adulthood into middle age in CARDIA participants. Based on the trajectories (or patterns of change) of physical activity over 25 years, participants were categorized into three distinct trajectory groups: trajectory group one was defined as exercising below the national guidelines (less than 150 minutes a week), group two as meeting the national guidelines for exercise (150 minutes a week), and group three as exercising three-times the national guidelines (more than 450 minutes a week).

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Physical Activity In Decline For Most Kids By School Age

MedicalResearch.com Interview with:
Professor John J Reilly
University of Strathclyde Glasgow
Physical Activity for Health Group
Scotland, UK 

MedicalResearch.com: What is the background for this study?

Response: There is Concern that levels of physical activity among modern children are typically very low, well below the amounts recommended for their physical & mental health, well-being, and academic attainment.

It has been assumed for many years that physical activity levels begin to become a problem at adolescence, and this adolescent decline in activity is especially marked in girls.

MedicalResearch.com: What are the main findings?

1. Physical activity- in our sample of 545 individuals studies at ages seven, nine, 12, and 15 using activity monitors for six to seven days at each time point- was already low and was in decline from age seven, well before adolescence.

2. The physical activity decline was not especially marked at adolescence, or in girls.

3. In a minority of boys (19% of boys) and girls (12% of girls) physical activity was maintained at a relatively high level from age seven to 15 years. these are interesting exceptions to the general pattern.

MedicalResearch.com: What should readers take away from your report?

Response: We should no longer see girls,or adolescents, as the only high risk groups for low physical activity; the entire population is at high risk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Efforts to promote or maintain physical activity need to start well before adolescence, and should not just focus on girls. Physical activity seems to be in decline in most children by the time they start school. We need to address more research and policy effort at lifestyles of younger children of both sexes.

We also need to direct more research effort at the interesting minority in both sexes who maintained a relatively high physical activity from age seven to 15 years. We don’t know why they were different to the rest – for example, were they more engaged in sport ? – and understanding why and how they differed from the rest of the population would help us develop strategies for preventing the age-related decline in physical activity in future.

There are no conflicts of interest to declare. The work was funded by the UK MRC and the Scottish Government Chief Scientist Office.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Farooq MA, Parkinson KN, Adamson AJ, et al

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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paul.gallagher@strath.ac.uk

 

Physical Activity Not Enough To Ward Off Weight Gain

MedicalResearch.com Interview with:

Lara Dugas, PhD, MPH, FTOS Public Health Sciences Loyola University Chica

Dr. Lara Dugas

Lara Dugas, PhD, MPH, FTOS
Public Health Sciences
Loyola University Chicago

MedicalResearch.com: What is the background for this study?

Response: Our NIH-funded study is led by Dr. Amy Luke, Public Health Sciences, Loyola University Chicago, and is titled “Modeling the Epidemiologic Transition study” or METS. It was initiated in 2010, and 2,500 young African-origin adults were recruited from 5 countries, spanning the Human Development Index (HDI), a WHO index used to rank countries according to 4 tiers of development. The 5 countries include the US, Seychelles, Jamaica, South Africa, and Ghana. Within each country 500 young adults, 25-45 yrs., and 50% male, were recruited and followed prospectively for 3 years. Each year, contactable participants completed a health screening, body composition, wore an activity monitor for 7 days, and told researchers everything they had eaten in the preceding 24hrs. Our main research questions we were trying to answer were to understand the impact of diet and physical activity on the development of obesity, and cardiovascular disease in young adults. It was important to have countries spanning the HDI, with differences in both country-level dietary intake and physical activity levels.

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Physical Activity Linked to Improved Survival from Metastatic Colon Cancer

MedicalResearch.com Interview with:

Brendan John Guercio, M.D. Clinical Fellow in Medicine (EXT) Brigham and Women's Hospital

Dr. Brendan Guercio

Brendan John Guercio, M.D.
Clinical Fellow in Medicine (EXT)
Brigham and Women’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sedentary lifestyle is a known risk factor for the development of colon cancer and has been associated with increased disease recurrence and mortality in patients with early stage colorectal cancer. This is the first study to our knowledge to show an association between increased physical activity (i.e. non-sedentary lifestyle) and improved survival and progression-free survival in patients with metastatic colorectal cancer.

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