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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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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Relatively Brief Physical Activity Can Offset Adverse Effects of Prolonged Sitting

MedicalResearch.com Interview with:

Ulf Ekelund, PhD FACSM Professor Department of Sports Medicine Norwegian School of Sport Sciences

Prof. Ulf Ekelund

Ulf Ekelund, PhD FACSM
Professor
Department of Sports Medicine
Norwegian School of Sport Sciences 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is known that long sitting hours may be detrimental to health and previous studies have suggested associations between sitting time and all-cause mortality.However, it is not known whether physical activity can eliminate the increased risk of death associated with long sitting time.

We found that at least one hour of physical activity every day appear to offset the increased risk associated with more than eight hours of sitting. We also found that those who were physically inactive and sat for less than 4 hours every day were at greater risk compared with those who were physically active and sat for more than 8 hours providing further evidence on the benefits of physical activity.

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Pandemic of Global Physical Inactivity Costs Lives and Money

MedicalResearch.com Interview with:

Ding Ding (Melody), Ph.D., MPH NHMRC Early Career Senior Research Fellow/Sydney University Postdoctoral Research Fellow Prevention Research Collaboration Sydney School of Public Health The University of Sydney

Dr. Melody Ding

Ding Ding (Melody), Ph.D., MPH
NHMRC Early Career Senior Research Fellow
Sydney University Postdoctoral Research Fellow
Prevention Research Collaboration
Sydney School of Public Health
The University of Sydney

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

Response: Understanding the true burden of a pandemic is indispensable for informed decision making. After decades of research, we now have established knowledge about how physical inactivity contributes to pre-mature deaths and chronic diseases, but the economic burden of physical inactivity remains unquantified at the global level. Through estimating the economic burden of physical inactivity for the first time, we hope to create a business case for investing in cost-effective actions to promote physical activity at the global levels.

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Physical Activity Important For Brain Health At Any Age

MedicalResearch.com Interview with:
Tina Hoang MSPH
Staff Research Associate
Northern California Institute for Research and Education,
Veterans Affairs Medical Center
Dr. Kristine Yaffe MD
Professor of Psychiatry, Neurology, and Epidemiology
University of California
San Francisco, CA  94121

Medical Research: What is the background for this study? What are the main findings?

Response: We assessed physical activity and TV watching in young adults over 25 years to see if there was an association with cognitive function in middle age.  Most previous studies have only considered this association in older adults. We found that both low physical activity and high TV watching over time were associated with worse cognitive function.

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Even Low Dose Physical Activity Helpful In Reducing Mortality

Dr David Hupin CHU Saint-Etienne, Hôpital Nord Service de Physiologie Clinique et de l'Exercice, Centre VISAS Cedex 2, FranceMedicalResearch.com Interview with:
Dr David Hupin

CHU Saint-Etienne, Hôpital Nord
Service de Physiologie Clinique et de l’Exercice, Centre VISAS Cedex 2, France

Medical Research: What is the background for this study?

Dr. Hupin: Today, over 95% of the world’s population has health problems, according to the Global Burden of Disease Study published recently in The Lancet. The proportion of healthy years lost due to disease rapidly increased with age. There is no medical treatment that can influence as many diseases in a positive manner as can physical activity. It is well established that regular physical activity is an efficient strategy for successful aging. The 2008 Physical Activity guidelines for Americans recommend a minimum of 150 min of moderate-intensity (>3 MET) or 75 min of vigorous-intensity (≥6 MET) physical activity per week or an equivalent combination of moderate and vigorous physical activity (MVPA). A Metabolic Equivalent or MET is a unit useful for describing the energy expenditure of a specific physical activity. However, less than 50% of older adults are able to achieve the current recommendations of physical activity. Thus, the prescription of physical activity for older adults needs to be clarified, i.e., what “dose” of physical activity is required.

Medical Research: What is the design of your study?

Dr. Hupin: Within the dynamic Department of Clinical and Exercise Physiology of University Hospital of St-Etienne, we conducted a systematic review and meta-analysis. Out of at total of 835 relevant studies, nine were suitable for analysis. These involved a total of 122, 417 participants, monitored for an average of around 10 years, during which time 18,122 died.

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Combining Acceleration and Skin Temperature Can Improve Accuracy of Physical Activity Monitors

Dr. Shang-Ming Zhou Senior Lecturer in Statistical Modelling and Analytics for Epidemiology and Public Health, Public Health Informatics Group, Health Information Research Unit (HIRU), UKCRC DECIPHer (Development and Evaluation of Complex Interventions for Public Health Improvement) Centre, College of Medicine, Swansea University, Swansea, MedicalResearch.com Interview with:
Dr. Shang-Ming Zhou
Senior Lecturer in Statistical Modelling and Analytics for Epidemiology and Public Health,
Public Health Informatics Group,
Health Information Research Unit (HIRU),
UKCRC DECIPHer (Development and Evaluation of Complex Interventions for Public Health Improvement) Centre,
College of Medicine, Swansea University, Swansea, UK

Medical Research: What is the background for this study? What are the main findings?

Response: In medical and sport science research, body-worn accelerometers are widely used to provide objective measurements of physical activity. However, accelerometers collect data continuously even during periods of nonwear (i.e. periods when participants may not be wearing their monitor, such as during sleeping). It is important to distinguish time of sedentary behaviours (eg. watching television) from time of nonwear. The clinical consequence of misclassification of accelerometer wear and nonwear would overestimate or underestimate physical activity level, and mislead the interpretation of the relationship between physical activity and health outcomes. Automated estimation of accelerometer wear and nonwear time events is particularly desired by large cohort studies, but algorithms for this purpose are not yet standardized and their accuracy needs to be established. This study presents a robust method of classifying wear and nonwear time events under free living conditions for triaxial accelerometers which combines acceleration and surface skin temperature data.

The new findings are: Either acceleration data or skin temperature data alone is inadequate to accurately predict wear and nonwear events in some scenarios under a free living condition; This study provides a simple and efficient algorithm on use of short time periods of consecutive data blocks for accurately predicting triaxial accelerometer wear and nonwear events; Combining both types of acceleration and skin temperature data can significantly improve the accuracy of accelerometer wear and nonwear events classification in monitoring physical activity. Continue reading