Overweight vs. Lifespan
Dr. Gabe Mirkin’s Fitness and Health e-Zine
January 13, 2013
Being Overweight Does Not Prolong Lives
A recent meta-analysis of a hundred large studies showed that being a little bit overweight offers slight protection (a six percent decrease) from premature death (Journal of the American Medical Association, January 2, 2013). This study has been widely reported in the media, with headlines such as “Our Imaginary Weight Problem”. Instead of being told that overweight is beneficial, people should continue to hear that excess weight shortens lives, particularly if their fat is stored in the belly.
WHY THE REPORT IS FLAWED: People with wasting diseases usually lose weight long before they die. All chronic diseases that shorten lives have a tendency to make people lose weight. Heart diseases, cancers, late stages of diabetes, kidney failure, arthritis, and even aging itself, usually cause weight loss before death (J Cachexia Sarcopenia Muscle, 2012;3(1):1-4). Weight loss that precedes death can last as long as 10 to 20 years, so it is impossible to correct epidemiological studies for this effect. As people with wasting diseases approach death, their rate of weight loss increases dramatically. Sicker people, and those closer to death, lose weight faster than people with wasting diseases whose immunities are successfully holding their diseases at bay. It is true that people who have diseases that will eventually kill
them may live longer as long as they do not lose weight.
EVEN A LITTLE BIT OF FAT IN YOUR BELLY CAN KILL YOU. Not all fat is harmful. Fat stored on your hips and upper legs protects you from disease. It does not turn on your immunity or cause inflammation; and it helps to prevent diabetes and heart attacks. However, fat located inside your belly and around your
organs:
* turns on your immunity to cause inflammation that leads to cancers, heart attacks, strokes, diabetes, inflammatory types of arthritis and so forth; and
* blocks insulin receptors to raise blood sugar levels, leading to diabetes that can damage every cell in your body.
This large study should not make you believe that being overweight is beneficial. You should maintain a healthful weight and try to lose any excess fat that you have in your belly. Belly fat is harmful and shortens lives.
from Dr. Mirkin dot com
Exercise for Parkinson’s Patients
(With adept application, many human interventions may be crossed over to non-human animal functional rehab 
)
Becky G. Farley, PhD, PT, MS, knows that exercise is about more than fitness-it is a physiological tool that encourages the body’s own endogenous brain repair mechanisms.
“Exercise promotes brain health and, thereby, may protect the remaining ‘viable’ dopamine neurons, called neuroprotection,” she said.
It also optimizes brain function through activity-dependent plasticity mechanisms that can restore function to damaged pathways, normalize interference from inefficient signaling and increase reliance on undamaged systems.
In July 2010, Dr. Farley founded NeuroFit NetWorks, a non-profit program dedicated to developing and expanding access to research-based exercise programming that is proactive, optimizes brain health/function, and changes the lives of individuals living with a neurodegenerative disease.
Exercise, she said, may at the very least slow motor deterioration in patients with Parkinson’s disease, and, if started early enough, may be able to modify disease progression.
Research, Advocacy & Education
While at the University of Arizona, Dept. of Physiology, Dr. Farley researched muscle activation mechanisms that underlie one of the primary symptoms in patients with Parkinson’s disease. This research led to the development of an exercise program called LSVT BIG™ to target bradykinesia (a slowness of movement) and an NIH-funded randomized clinical trial.
After training more than 5,000 physical and occupational therapists around the world in how to instruct people with Parkinson’s disease in LSVT BIG™ methods, Dr. Farley realized that basic and clinical science research about exercise and Parkinson’s disease is not being translated to real-world application.
“For example, continuous access to proactive neuroplasticity-principled programs that have been shown in animals to slow disease progression.are not available,” she explained. “As it stands now, patients with Parkinson’s disease rarely go to therapy, and when they do, it is usually only after they lose function and start to fall. And those that do go are rarely seen by PD-exercise experts.”
Even if they do find therapists that understand Parkinson’s disease, most patients are not implementing approaches that adhere to the principles of practice that are required to promote learning and plasticity. Instead, outdated guidelines are implemented that promote using strategies or working on secondary impairments like weakness and flexibility.
“No doubt these things help make life better for patients with Parkinson’s disease, but they don’t target the problems that got them to that level of disability. So, ultimately nothing is changed,” said Dr. Farley.
NeuroFit NetWorks plans to change that. The non-profit is advocating for translation of this research now. They have started a national Parkinson Exercise Revolution to help people get better and stay better with exercise. Dr. Farley is conducting training workshops nationally for therapists and fitness professionals to become Parkinson’s disease exercise experts and to work together in their local communities to implement early intervention and continuous access to PD-specific exercise for life.
A model neuro-fitness center in Tucson, AZ, is currently being developed to show how rehab can be accessible and integrated with community fitness programming to optimize learning and function.
“This is the infrastructure that we think offers promise to delay disease onset, slow disease progression, restore motor function, and increase longevity and quality of life for people with neurodegenerative or neurological conditions, and for those individuals at risk for these conditions,” Dr. Farley noted.
It will take advocacy; education of the medical, fitness community and lay public; and working with health care systems to change existing paradigms, demonstrate health care cost savings, and document slowing of motor deterioration.
Research-Based Exercise Programs
All exercise programs at NeuroFit NetWorks are implemented within the context of the Exercise4BrainChange™ (E4BC) model that requires therapists and fitness professionals to incorporate instructions, feedback, and research techniques that promote four essential learning constructs: prepare, activate, reflect, motivate.
These constructs can accommodate multiple exercise approaches and be customized to address a disease’s specific physical/cognitive/emotional deficits. The depth of the content can be modified to allow for a system of communication with a similar language across a variety of therapeutic disciplines and exercise professionals. This is the first time that these essential principles have been described in a manner that can help clinicians implement these concepts immediately with their patients.
“We believe to effect disease modification, proactive models of health care continuums must embrace research-based exercise approaches that are guided by the essential principles of learning and neuroplasticity,” said Dr. Farley. “We call these essential elements “Exercise4BrainChange™ principles” and we have developed a model that integrates all these elements in a way that can promote optimal brain function and skill acquisition.”
Every staff member has undergone training to learn about Parkinson’ disease and exercise and how to modify their instruction/programming to make it PD-specific and optimize the potential for learning and plasticity.
The following programs are offered at the Parkinson Wellness Recovery (PWR!) Gym:
Rehabilitation – 1:1 Exercise4BrainChange. This is where an individual comes to the gym to get a ‘PWR! PLAN.’ They work one-on-one with a therapist that is a PD-exercise expert who educates them about the research on exercise and helps them develop a proactive PD-specific “Use It Or Lose It” program that includes ongoing coaching and tune-ups for life.
Other 1:1 rehabilitation treatments address and target specific problems, such as freezing or postural instability, to “use it and improve it.”
“We integrate research techniques to target bradykinesia/rigidity/coordination/postural instability/posture, such as the training of activated large amplitude whole-body movements; focused practice on axial rotation and extension exercises; paced, rhythmical movements to augmented sensory proprioceptive feedback; rhythmical; treadmill activities for endurance, coordination for gait and balance, and more,” Dr. Farley explained. Clients are progressively challenged to work harder than then self-select. Language and cognitive activities are integrated to increase difficulty, and emotional deficits are targeted through empowerment/education/affirmations to retrain their emotional brain about what they CAN do.
Community – Group E4BC Programming. This program offers PWR! MOVES; PWR! Circuit and specialty classes (agility, strengthening, stretching) that target PD-specific symptoms; and cardio programs for brain health and to prepare the brain to learn! (mobilize neurotransmitters, cell survival and growth factors, boost the immune system, reduce inflammation).
Other enrichment programming to optimize brain health and restoration includes nutrition, stress reduction, brain fitness, and other social or general group exercise activities (drumming, dance, tai chi, etc.).
Retraining the Brain
It is not enough to simply exercise when one has a neurodegenerative disease, noted Dr. Farley.
“It is important to target the anticipated and existing problems with intensive, repetitive practice while receiving certain types of feedback to help you learn and pay attention to critical aspects of the practice,” she explained.
It is also vital that a person is ready to learn and able to manage stress, anxiety and fear to optimize the conditions for learning. That’s why NeuroFit NetWorks has specially trained therapists and fitness professionals that understand how to implement programming to optimize brain health and function for people with different types of conditions.
“Our movements and ability to learn new skills requires active engagement. So, dysfunction in emotional or cognitive systems that interferes with planning, intrinsic motivation, self-monitoring, confidence, etc., interferes with learning,” explained Dr. Farley.
The cognitive deficits in Parkinson’s disease are in the area of executive functioning and attention. These cognitive components are essential for the planning and production of complex whole-body movements; ability to adapt movements/postures to changes in the environment, and automaticity (ability to divide or focus attention for multitasking).
In addition, the loss of dopamine contributes to emotional dysfunction, such as loss of motivation, self-efficacy, anxiety, fear and learned helplessness.
“Evidence suggests that physical exercise improves not only the sensorimotor deficits, but cognitive and emotional deficits as well,” Dr. Farley stated.
She noted that NeuroFit NetWorks is helping people with Parkinson’s disease get better and stay better with exercise, enrichment, education and empowerment.
“We want to have the infrastructure in place when the definitive research emerges that exercise that begins early and is continuous in nature slows disease progression,” she said. “It requires that we advocate for change to existing rehab/health care paradigms that don’t ever see people with Parkinson’s disease until they start to fall; years after the diagnosis.”
A window of opportunity has been lost to begin proactive and disease modifying exercise programs founded in research, said Dr. Farley. It will be years before clinical trials demonstrate the best exercise and the best dosage.
“In the meantime, we are going to implement the best of the best and incorporate new information as it becomes available,” she concluded. “There are studies showing that exercise augments the response to Parkinson’s disease medications in the short term and long term, yet people are rarely empowered after they are diagnosed, and so instead they go home and withdraw.”
Bone Strength – From MedlinePlus
Exercise, lifestyle, and your bones
Osteoporosis is a disease that causes bones to become brittle and more likely to fracture (break). With osteoporosis, the bones lose density. Bone density is the amount of bone tissue that is in your bone.
Exercise plays a key role in preserving bone density as you age.
Why Exercise?
Make exercise a regular part of your life. It will help keep your bones strong and lower your risk of osteoporosis and fractures as you get older.
Before you begin an exercise program, talk with your doctor if you are older, have not been active for a while, have diabetes, heart disease, lung disease, or any other health condition.
How Much and What Type of Exercise?
To build up bone density, the exercise must make your muscles pull on your bones. These are called weight-bearing exercises. Some of them are:
Brisk walks, jogging, playing tennis, dancing, or other weight-bearing activities such as aerobics and other sports
Careful weight training, using weight machines or free weights
Weight bearing exercises also:
Increase bone density even in young people
Help preserve bone density in women who are approaching menopause
To protect your bones, do weight bearing exercises 3 or more days a week for a total of over 90 minutes a week.
If you are older, do not do high-impact aerobics, such as step aerobics. This type of exercise may increase your risk of fractures.
Low-impact exercises like yoga and tai chi do not help your bone density very much. But they can improve your balance and lower your risk of falling and breaking a bone. And, even though they are good for your heart, swimming and biking do not increase bone density.
Other Lifestyle Changes to Help Your Bones
If you smoke, quit. Also limit how much alcohol you drink. Too much alcohol can damage your bones and raise your risk of falling and breaking a bone.
If you do not get enough calcium, or if your body does not absorb enough calcium from the foods you eat,your body may not make enough new bone. Talk with your health care provider about calcium and your bones.
Vitamin D helps your body absorb enough calcium.
Ask your health care provider if you should take a vitamin D supplement.
You may need more vitamin D during the winter or if you need to avoid sun exposure to prevent skin cancer.
Ask your health care provider about how much sun is safe for you.
Alternate Names
Osteoporosis – exercise; Low bone density – exercise
References
Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16.
National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington,DC: National Osteoporosis Foundation; 2010.
Update Date: 5/17/2012
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones.
J Bone Miner Res. 2011; 26(12):2851-9 (ISSN: 1523-4681)
Shah K; Armamento-Villareal R; Parimi N; Chode S; Sinacore DR; Hilton TN; Napoli N; Qualls C; Villareal DT
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO, USA.
Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30 kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p < 0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p < 0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p < 0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p = 0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p = 0.001). Multivariate analyses revealed that changes in lean body mass (β = 0.33), serum osteocalcin (β = -0.24), and one-repetition maximum (1-RM) strength (β = 0.23) were independent predictors of changes in hip BMD (all p < 0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.
Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial.
Source
School of Nursing, Oregon Health & Science University, Portland, OR 97239, USA. wintersk@ohsu.edu
Erratum in
- Breast Cancer Res Treat. 2011 Jun;127(2):457.
Abstract
Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥ 50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm²) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover-serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. -2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (-49.9 vs. -32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.”
A comment from me, Deborah: I know of medical doctors, specialists, oncologists…who are ceasing to prescribe the pharmaceuticals that were developed to be used for osteoporosis and osteopenia yet have turned out to be destructive in the long run, and instead they are recommending weight-bearing exercise to improve bone density. Specific exercise under controlled circumstances is proved to be beneficial for healing of bone after surgery as well.
Exercise and Bone Mass in Adults
Sports Med. 2009; 39(6):439-68 (ISSN: 0112-1642)
Guadalupe-Grau A; Fuentes T; Guerra B; Calbet JA
Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain.
There is a substantial body of evidence indicating that exercise prior to the pubertal growth spurt stimulates bone growth and skeletal muscle hypertrophy to a greater degree than observed during growth in non-physically active children. Bone mass can be increased by some exercise programmes in adults and the elderly, and attenuate the losses in bone mass associated with aging. This review provides an overview of cross-sectional and longitudinal studies performed to date involving training and bone measurements.
Cross-sectional studies show in general that exercise modalities requiring high forces and/or generating high impacts have the greatest osteogenic potential. Several training methods have been used to improve bone mineral density (BMD) and content in prospective studies. Not all exercise modalities have shown positive effects on bone mass. For example, unloaded exercise such as swimming has no impact on bone mass, while walking or running has limited positive effects. It is not clear which training method is superior for bone stimulation in adults, although scientific evidence points to a combination of high-impact (i.e. jumping) and weight-lifting exercises. Exercise involving high impacts, even a relatively small amount, appears to be the most efficient for enhancing bone mass, except in postmenopausal women.
Several types of resistance exercise have been tested also with positive results, especially when the intensity of the exercise is high and the speed of movement elevated. A handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used.
Studies performed in older adults show only mild increases, maintenance or just attenuation of BMD losses in postmenopausal women, but net changes in BMD relative to control subjects who are losing bone mass are beneficial in decreasing fracture risk. Older men have been less studied than women, and although it seems that men may respond better than their female counterparts, the experimental evidence for a dimorphism based on sex in the osteogenic response to exercise in the elderly is weak. A randomized longitudinal study of the effects of exercise on bone mass in elderly men and women is still lacking. It remains to be determined if elderly females need a different exercise protocol compared with men of similar age.
Impact and resistance exercise should be advocated for the prevention of osteoporosis. For those with osteoporosis, weight-bearing exercise in general, and resistance exercise in particular, as tolerated, along with exercise targeted to improve balance, mobility and posture, should be recommended to reduce the likelihood of falling and its associated morbidity and mortality. Additional randomized controlled trials are needed to determine the most efficient training loads depending on age, sex, current bone mass and training history for improvement of bone mass.
Lack of Exercise, Not Aging, Causes Weakness and Loss of Muscle in Older People
Aging does not cause you to lose muscles. Loss of muscle is caused by lack of exercise. You can preserve both muscle size and strength by continuing to exercise as long as you live. Here are MRIs of the legs of 40- and 70-year-old triathletes, and a 70-year-old non-exerciser:
http://www.drmirkin.com/public/ezine030412.html
The dark spots are muscle, the light spots are fat. Which legs would you like to have?
Forty competitive athletes, aged 40-81, who trained four to five times a week, had the same size muscles, the same absence of fat around their muscles, and close to the same strength as much younger athletes (The Physician and Sportsmedicine, September 2011).
Many of the diseases and debilitating conditions associated with aging are caused by lack of exercise. “Exercise decreases body fat and obesity, increases muscle strength, improves balance, gait, and mobility, decreases likelihood of falling, improves psychological health, reduces arthritis pain, and heart
attacks, osteoporosis, cancer, and diabetes.”
After age 40, the average person loses more than eight percent of muscle size per decade. This loss increases to 15 percent per decade after age 75 years. Older people who lose muscles are four times more likely be disabled, have difficulty walking, and need walkers and other mechanical devices to help
them walk (Am J Epidemiol, 1998; 147(8):755-763).
From Deb:
This post was taken from Dr. Mirkin’s eZine on health and fitness.The primary benefit my practice brings to animals, human or otherwise, is the knowledge of how to develop and encourage the right types of movement to improve health. In short. 🙂
The primary attribute that YOU bring is follow-through, compliance. Thank you.
Fast Walking and Jogging Halve Development of Heart Disease and Stroke Risk Factors, Research Indicates
The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.
This has been proved in different studies in different ways for different reasons, mostly related to sport science and training, for many years. Don’t think you don’t have enough time to exercise 🙂
Keep in mind, though, that it’s very slow walks that bring about the benefits at the beginning of rehab, as per my homework instructions!
ScienceDaily (Oct. 8, 2012) — Daily activities, such as fast walking and jogging, can curb the development of risk factors for heart disease and stroke by as much as 50 per cent, whereas an hour’s daily walk makes little difference, indicates research published in the online journal BMJ Open.
The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.
Genes, diet, and lack of exercise are thought to be implicated in the development of the syndrome, which is conducive to inflammation and blood thickening.
The authors base their findings on more than 10,000 Danish adults, between the ages of 21 and 98, who were initially assessed in 1991-94 and then monitored for up to 10 years. All the participants were quizzed on the amount of physical activity they did, which was categorised according to intensity and duration.
At the initial assessment, around one in five (20.7%) women and just over one in four (27.3%) men had metabolic syndrome. Prevalence was closely linked to physical activity level.
Among the women, almost one in three of those who had a sedentary lifestyle had the syndrome whereas only one in 10 of those who were very physically active had it. Among men, the equivalent proportions were just under 37% and just under 14%
Of the remaining 6,088 participants without metabolic syndrome, just under two thirds (3,992) completed the fourth and final survey and assessment, by which point one in seven (15.4%; 585) had developed it.
Again, the prevalence was higher among those leading a sedentary lifestyle, with almost one in five (19.4%) affected compared with around one in nine (11.8%) of those who were very physically active.
It was not only the amount of exercise, but also the intensity which helped curb the likelihood of developing the syndrome.
After taking account of factors likely to influence the results, fast walking speed halved the risk, while jogging cut the risk by 40 per cent. But going for an hour’s walk every day made no difference.
“Our results confirm the role of physical activity in reducing [metabolic syndrome] risk and suggest that intensity rather than volume of physical activity is important,” conclude the authors.
