Meet the Active Couch Potato

2012-04-06

Can someone exercise and still be a couch potato? That peculiarly modern question motivated a new study from Finland in which a group of healthy, physically active volunteers donned special shorts that measure muscular activity in the legs. The volunteers then went about their daily lives.

All were diligent exercisers. Some ran. Others lifted weights or played soccer. A few Nordic-walked. On one day during the study, they worked out as usual. On another, they did not exercise.

Throughout, the shorts measured how much they actually moved.

A growing body of science suggests that prolonged inactivity, a practice known more familiarly as sitting a lot, is both widespread and unhealthy. In a representative study published last month in The Archives of Internal Medicine, Australian researchers compared medical records and lifestyle questionnaires for more than 220,0000 Australian adults 45 and older.

They found that the more hours the men and women sat every day, the greater their chance of dying prematurely. Those people who sat more than eight hours a day — which other studies have found is about the amount that a typical American sits — had a 15 percent greater risk of dying during the study’s three-year follow-up period than people who sat for fewer than four hours a day.

That increased risk held true in the Australian study even if the people sitting eight hours a day spent at least part of that day exercising.

But that study and many others examining sitting and health have relied on self-reported measures of physical activity, like questionnaires. A few have used accelerometers to determine how many steps people were taking during the day.

No one, though, had directly studied people’s muscular activity during sitting and exercising, outside the artificial environment of an exercise physiology lab, until the Finnish researchers came up with the idea of embedding flexible electrodes into shorts fabric.

And measurement of muscle activity matters. In earlier studies with animals whose legs were immobilized with casts or traction devices, physiologists noticed swift, dramatic and deleterious changes in the levels of certain enzymes in cells throughout the animals’ bodies that affect fat metabolism and blood sugar regulation. The researchers concluded that the lack of muscular contractions in the animals’ legs had caused a chain of biological reactions that led to the alterations in enzyme production.

In the current Finnish study, after volunteers donned the shorts, the electrodes began constantly tracking contractile activity in the quadriceps and hamstring muscles, two of the largest sets of muscles in the body. The volunteers also completed detailed logs about their activities during the days of the study.

The researchers had hypothesized that they would see considerably less muscular inactivity over all on the days the volunteers exercised, says Taija Juutinen Finni, a professor of kinesiology at the University of Jyvaskyla in Finland, who led the study.

But the results did not turn out that way. There was, in fact, virtually no difference in how much time people spent being couch potatoes on the days when they exercised compared with days when they did not. On nonexercise days, about 72 percent of volunteers’ waking time, or about nine hours, was spent sitting.

When they formally exercised, volunteers used about 13 percent more energy over all than on days they didn’t exercise. But they still sat 68 percent of the time.

Surprisingly, how much people exercised or what kind of exercise they chose did not change sitting time. Whether volunteers worked out for less than an hour or for more than 90 minutes, they spent an equivalent amount of time the rest of the day being mostly torpid physically.

It seems that after exercising, the study authors concluded, people “substitute either lighter and/or sedentary activities.”

David W. Dunstan, a professor at the Baker IDI Heart and Diabetes Institute in Australia, who has studied inactivity and wrote an editorial to accompany the new Australian paper, says he found the study fascinating. By measuring muscular inactivity using electromyography, he says, “the measurement is getting closer to the heart of the sitting problem, that being a problem of muscular disuse.”

Dr. Finni agrees. Although she and her colleagues did not look directly at the downstream biochemical effects of the inactivity, she says, their results suggest that normal exercise, which fills so few hours of even active people’s days, “may not be enough in terms of health.”

Of course, exercise remains valuable, she and Dr. Dunstan are both quick to add. It reduces risks for cardiovascular disease and other conditions and burns calories.

But exercise paired with otherwise unalloyed sitting should be avoided, Dr. Dunstan says. “It is important the general public become more conscious about what they do in their nonexercise time,” he says. Almost everybody, he says, “should look for opportunities to reduce their daily sitting time and move more, more often, throughout the day.”

Shisha pipes: Is smoking them really harmless?

The sweet smelling tobacco is gaining in popularity, but most people who smoke it in cafes are unaware of the potential risks.
You might call it shisha in Egypt and Sudan, nargile in Turkey and Syria or hookah in India. Some are made from clay, others from ornately carved metals or plastics. But the principle is same – these water-pipes allow you to smoke flavoured tobacco as it is bubbled through water. Maybe you know it simply as hubble-bubble.

Sharing a water-pipe is thought to be harmless, relaxing fun. They are now enjoying something of a resurgence in popularity in India and the Middle East, where they are said to have originated. In the Middle East the trend has extended to teenagers and women, many of whom do not smoke cigarettes.

This shisha cafe culture has also extended to Europe, Brazil and the United States. If I run home from my office in London, I pass a street filled with cafes where groups of people sit outside engulfed in clouds of honey-scented smoke. In the United States many hookah cafes have opened in college towns and a recent study found that as many as a fifth of American students have tried it. In many countries these pipes are seen as safe enough to be exempt from legislation on smoking in public places.

But the idea that these pipes are harmless is a myth.

Smoke on the water

One of the main misconceptions is that the risks of tobacco are minimised because it is purified as it passes through the water. But this ignores the complete source of the smoke that enters your mouth.

The tobacco burns in a small dish on top of the main body of the water-pipe. You inhale through a mouthpiece connected by a pipe to a reservoir of water at the bottom. As you breathe in smoke is drawn from the burning tobacco and bubbles through the water and up into your mouth. The tobacco is sweetened with glycerine, which can make it damp, so charcoal is added to keep the tobacco burning. This means the smoke inhaled derives from charcoal too, and charcoal contains several toxic substances, including carbon monoxide, heavy metals and tar.

Some water-pipes are sold with mouthpieces containing cotton filters or a plastic mesh. This does result in smaller bubbles, but a report by the World Health Organisation says there is no evidence that these mouthpieces reduce the harm.

Unknown risk

But surely the water cools the smoke, making it less dangerous than a cigarette? It is true that this might make an individual puff less harmful, but this does not factor in the quantity of puffs. A typical water-pipe session lasts for at least 20 minutes, often for an hour. So instead of taking 8-12 puffs of a single cigarette a person is inhaling 50-200 puffs in a session. This, in effect, makes it more like chain smoking. In an hour-long session a person can inhale the equivalent of 100 to 200 times the smoke from a single cigarette, which may come as a surprise to most people. A survey carried out this year by the British Heart Foundation found that 84% of respondents thought the amount of smoke inhaled was equivalent to 10 cigarettes or fewer.

In a study in Florida, USA, customers’ carbon monoxide levels were tested as they left bars that allowed the smoking either of cigarettes or hookah pipes. The people leaving the bars that had water-pipes had triple the levels of carbon monoxide in their bodies. Some reported feeling high, which the authors say could have been the early stages of carbon monoxide poisoning.

But what do we know about any long-term consequences? Here, the science is incomplete, as long-term studies of the kind conducted on cigarette tobacco have not been carried out. Researchers admit the evidence is scant, but suggest that smokers of water-pipes could be at long-term risk for nicotine dependence, cardiovascular disease and even cancer. Professor Hani Najm, Head of Cardiac Surgery at National Guard Health Affairs in Saudi Arabia told me in an interview that he fears that water-pipe smoking could result in an escalation in heart disease in the Gulf States.

So bear in mind one thing. Whether you call it shisha, nargile or hubble bubble, it might smell nice, but it is not as harmless as you might think.

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Study: Mammograms May Overdiagnose Some Early Breast Cancers

For years, women have been urged to get screened for breast cancer because the earlier it’s found, the better. Now researchers are reporting more evidence suggesting that’s not always the case.

A study in Norway estimates that between 15 and 25 percent of breast cancers found by mammograms wouldn’t have caused any problems during a woman’s lifetime, but these tumors were being treated anyway. Once detected, early tumors are surgically removed and sometimes treated with radiation or chemotherapy because there’s no certain way to figure out which ones may be dangerous and which are harmless.

“When you look for cancer early and you look really hard, you find forms that are ultimately never going to bother the patient,” said Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, who was not part of the research. “It’s a side effect of early diagnosis.”

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The study is the latest to explore overdiagnosis from routine mammograms — finding tumors that grow so slowly or not at all and that would not have caused symptoms or death. Previous estimates of the problem have varied.

The researchers took advantage of the staggered decade-long introduction of a screening program in Norway, starting in 1996. That allowed them to compare the number of breast cancers in counties where screening was offered with those in areas that didn’t yet have the program. Their analysis also included a decade before mammograms were offered.

They estimated that for every 2,500 women offered screening, one death from breast cancer will be prevented but six to 10 women will be overdiagnosed and treated.

Study leader Dr. Mette Kalager and other experts said women need to be better informed about the possibility that mammograms can pick up cancers that will never be life-threatening when they consider getting screened. The dilemma is that doctors don’t have a good way of telling which won’t be dangerous.

“Once you’ve decided to undergo mammography screening, you also have to deal with the consequences that you might be overdiagnosed,” said Kalager, a breast surgeon at Norway’s Telemark Hospital and a visiting scientist at Harvard School of Public Health. “By then, I think, it’s too late. You have to get treated.”

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Kalager and her colleagues looked only at invasive breast cancer. The study did not include DCIS, or ductal carcinoma in situ — an earlier stage cancer confined to a milk duct.

Under the Norway program, screening was offered every two years to women ages 50 to 69.

Researchers analyzed nearly 40,000 breast cancer cases, including 7,793 that were detected after routine screening began. They estimated that between 1,169 and 1,948 of those women were overdiagnosed and got treatment they didn’t need.

Their findings appear in Tuesday’s Annals of Internal Medicine.

The problem of overdiagnosis has been long recognized with prostate cancer. Darthmouth’s Welch said it’s also a problem in thyroid and lung cancer, a childhood tumor called neuroblastoma and even melanoma. He considers breast cancer screening a close call.

“The truth is that we’ve exaggerated the benefits of screening and we’ve ignored the harms,” he said. “I think we’re headed to a place where we realize we need to give women a more balanced message: Mammography helps some people but it leads others to be treated unnecessarily.”

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An editorial published with the study said overdiagnosis probably occurs more often in the United States because American women often start annual screening at an earlier age and radiologists in the U.S. are more likely to report suspicious findings than those in Europe.

Radiologists could help by raising the threshold for noting abnormalities, wrote Dr. Joann Elmore of the University of Washington School of Medicine and Dr. Suzanne Fletcher of Harvard Medical School.

A “watch-and-wait” approach has been suggested instead of an immediate biopsy, but the editorial writers acknowledge that could be a “tough sell” for some women and radiologists alike.

They said most women aren’t aware of the possibility of overdiagnosis.

“We have an ethical responsibility to alert women to this phenomenon,” they wrote.

Read more: http://healthland.time.com/2012/04/02/study-finds-some-early-breast-cancer-overdiagnosed/#ixzz1r3vMcTZs

Will living alone make you depressed?

2012-03-26

(Health.com) — It’s long been known that elderly people are more prone to depression and other mental-health problems if they live on their own. New research suggests the same pattern may also be found in younger, working-age adults.

In a study of nearly 3,500 men and women ages 30 to 65, researchers in Finland found that people who lived alone were more likely that their peers to receive a prescription for antidepressant drugs. One quarter of people living alone filled an antidepressant prescription during the seven-year study, compared to just 16% of those who lived with spouses, family, or roommates.

“Living alone may be considered a mental-health risk factor,” says lead author Laura Pulkki-Råback, Ph.D., a lecturer at the University of Helsinki’s Institute of Behavioral Sciences. The study was published today in the journal BMC Public Health.

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