EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 24, 2003
To contact Jennifer S. Brach, Ph.D., P.T., G.C.S., call Jocelyn Uhl 412/624-2607.

PHYSICAL ACTIVITY IN LATER YEARS HELPS WOMEN PRESERVE FUNCTIONAL ABILITIES

CHICAGO—Women who are consistently physically active in their later years function better and have fewer problems with performing basic daily activities, according to an article in the November 24 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, in older adults the ability to function normally is related to physical activity; and people who are more active have fewer physical limitations than inactive individuals. However, the association between levels of physical activity and functional status over a long period of time has not been established.

Jennifer S. Brach, Ph.D., P.T., G.C.S., of the University of Pittsburgh, and colleagues examined the long-term association between physical activity and functional status in 229 postmenopausal, white women (average age, 74 years) over a 14-year period (1985-1999). Physical activity was assessed in 1985, 1995 and 1999 using a physical activity questionnaire and physical activity monitors (pedometer, or step counter, and an activity monitor worn on the hip). Functional status was assessed in 1999 using questionnaires about difficulties performing activities of daily living (eating, dressing, bathing, mobility, etc.).

The researchers found that physical activity in 1985 was predictive of walking speed in 1999. They also found that the consistency of physical activity from 1985 to 1995 was related to functional status in 1999. Women who were always active had the best functional status and women who were always inactive had the worst functional status. When the researchers assessed participants' difficulty with activities of daily living, they found:

• 17 of 45 women (37.8 percent) who were always active had problems with daily activities
• 24 of 60 women (40 percent) who were inconsistently active had problems with daily activities
• 39 of 66 women (59.1 percent) who were always inactive had problems with daily activities

"We demonstrate the importance of an active lifestyle to functional status in older upper socioeconomic class white women. We have shown, in a relatively healthy sample, the importance of physical activity in maintaining physical function," the authors write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 24, 2003
To contact Steven E. Nissen, M.D., call Alicia Sokol 216/445-9661.

PATIENTS WHO BEGIN CHOLESTEROL-LOWERING DRUG THERAPY IN THE HOSPITAL CONTINUE TAKING THEIR MEDICATION LONGER

CHICAGO—Starting patients on cholesterol-lowering drugs in the hospital instead of after they go home may increase the likelihood that they will continue taking their medications longer, according to an article in the November 24 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Despite data demonstrating the health benefits of lipid-lowering drugs (drugs that lower cholesterol levels) in patients with heart disease, these medicines remain underused, according to information in the article. Because lipid-lowering agents can improve cardiovascular health, strategies to increase their use are needed, the article states. Lipid-lowering therapy can be started when a patient is either in the hospital, or in an outpatient setting; it has been suggested that initiating therapy in the hospital may increase the probability that the patient adheres to the regimen for longer periods of time than if initiated outside the hospital.

Steven E. Nissen, M.D., of the Cleveland Clinic Foundation, and colleagues examined the relationship between when lipid-lowering therapy is initiated (during a hospital stay, or in an outpatient setting) and its long-term use.

The researchers used data from patients at 69 centers from the United States and Canada that participated in the Evaluation in PTCA to Improve Long-term Outcome With Abcix-imab GP IIb/IIIa Blockade (EPILOG) trial. The EPILOG trail involved patients hospitalized for treatment for heart disease who were randomized to receive placebo or lipid-lowering drugs. The patients were older than 21 years and were not taking lipid-lowering drugs when hospitalized. One hundred and seventy-five patients were discharged taking lipid-lowering therapy and 1,951 were discharged without lipid-lowering therapy.

The researchers found that after six months, 134 patients (77 percent) who started taking lipid-lowering agents before hospital discharge continued taking therapy compared with 494 (25 percent) of those discharged without lipid-lowering therapy, and who had these drugs prescribed by their doctors later.

"We found that initiation of lipid-lowering agents before discharge was the most important independent predictor of their use at follow-up," the authors write. "In fact, patients in whom lipid-lowering therapy was initiated before discharge were nearly three times as likely to be taking these agents six months later."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 24, 2003
To contact Teresa M. Damush, Ph.D., call Mary Hardin 317/274-7722.

SELF-MANAGEMENT PROGRAM IMPROVES PHYSICAL FUNCTION AND HEALTH STATUS FOR PATIENTS WITH ACUTE LOW BACK PAIN

CHICAGO—A self-management program consisting of group classes, exercise sheet handouts and telephone follow-up may help inner-city patients with acute low back pain manage their pain and improve function, according to an article in the November 24 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, low back pain is highly prevalent in the United States and is extremely costly in terms of health care expenditures, lost wages and disability. Acute low back pain is defined as symptoms lasting less than three months, accounts for more than 90 percent of all back pain and nearly half of the associated cost. A recently conducted national survey indicated that compared to whites, African American men and women in the United States reported losing more workdays for greater lengths of time because of low back pain.

Teresa M. Damush, Ph.D., of Indiana University, Indianapolis, and colleagues developed a self-management program for poor, urban, primary care patients with acute low back pain that focuses on boosting confidence in order to increase the patient's motivation to incorporate suggestions for improving low back pain into their daily activities. According to the authors, programs that emphasize increasing patient confidence are consistently successful at improving and maintaining health outcomes and reducing health care use among patients with various chronic conditions.

The researchers conducted a randomized, controlled trial comparing their self-management program with usual care among 211 patients who visited a physician for acute low back pain. Patients were enrolled at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital.

Patients in the self-management program attended three group sessions that emphasized treatment recommendations, behavioral changes, increased self-efficacy (confidence), and reducing negative thoughts and behaviors. They received handouts outlining exercise regimens and body mechanics. Patients who missed classes were provided with an audiotape of the class, a tape cassette player, and the accompanying handouts. Patients received follow-up telephone calls at 4, 6, and 8 weeks after the first class to reinforce the class sessions and to mark progress and address any issues or concerns. Subsequently, patients received follow-up calls once a month. Patients in the usual care group did not receive these interventions, and were advised by their physicians. Based on the physician's judgment they could get referrals to occupational or physical therapy, or other interventions such as medication or back exercise sheets.

Interviewers assessed back pain, health status, self-efficacy, and time spent in physical activity at the beginning of the study, at four months, and at 12 months.

The researchers found that after 12 months, patients in the self-management group had significantly better scores on a questionnaire assessing disability than those in the usual care group. These patients also had better mental functioning, were better able to manage their back pain, were more physically active and were less fearful of reinjuring their backs at 12 months.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, NOVEMBER 24, 2003
To contact Philip Greenland, M.D., call Elizabeth Crown at 312/503-8928.
To contact June K. Robinson, M.D., call Stephen Davidow at 708/216-3200.

NEW EDITORS FOR THE ARCHIVES OF INTERNAL MEDICINE AND THE ARCHIVES OF DERMATOLOGY

CHICAGO—Beginning January 1, 2004, Philip Greenland, M.D., of Northwestern University Feinberg School of Medicine, Chicago, will be the new editor of The Archives of Internal Medicine, and June K. Robinson, M.D., of Loyola University Medical Center, Maywood, Ill., will be the new editor for The Archives of Dermatology.

Dr. Greenland, 55, earned his bachelor degree from Williams College, Williamstown, Mass., and received his medical degree from the University of Rochester School of Medicine and Dentistry, Rochester, N.Y. Dr. Greenland completed his residency in internal medicine at Strong Memorial Hospital, Rochester, New York, and completed a cardiology fellowship at the University of Minnesota Hospital, Minneapolis.

Since 1991, Dr. Greenland has been the Harry W. Dingman Professor of Cardiology and chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine.