JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 14, 2005)
PHYSICAL ACTIVITY IMPROVES LIFE EXPECTANCY AND CARDIOVASCULAR HEALTH
PRESCRIBED WALKING CAN IMPROVE PHYSICAL FITNESS
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 14, 2005)
SUPPORT SYSTEM HELPS OVERCOME BARRIERS FOR NURSING HOME RESIDENTS IN NEED OF CATARACT SURGERY
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 14, 2005)
SPECIAL ONLINE PUBLICATION — MEASURING TWO BIOMARKERS MAY PROVIDE IMPORTANT ADDITIONAL INFORMATION FOR PATIENTS AT RISK FOR RECURRENT ISCHEMIC STROKE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 14, 2005
Media Advisory: To contact Oscar H. Franco, M.D., Ph.D., email o.francoduran{at}erasmusmc.nl.
PHYSICAL ACTIVITY IMPROVES LIFE EXPECTANCY AND CARDIOVASCULAR HEALTH
CHICAGO—People age 50 and older who engage in moderate or high levels of physical activity live longer and have less cardiovascular disease, according to a study in the November 14 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
There is a large amount of evidence to support the beneficial effect of physical activity in the prevention of cardiovascular disease. However, it remains unclear whether physical activity levels have a significant effect on life expectancy or on time spent with and without cardiovascular disease, according to background information in the article.
Oscar H. Franco, M.D., Ph.D., of Erasmus M.C. University Medical Center Rotterdam, the Netherlands, and colleagues calculated the effects of different levels of physical activity on life expectancy and years lived with and without cardiovascular disease among people age 50 and older. They used data from the Framingham Heart Study, a cohort study that has followed 5,209 residents of Framingham, Mass., over the past 46 years. The researchers calculated the effects of low, moderate, or high levels of physical activity, adjusted for age, sex, smoking, and coexistent diseases - including cancer, arthritis, diabetes, left ventricular hypertrophy (enlargement of the left pumping chamber of the heart), ankle edema, and pulmonary disease.
The authors report that total life expectancy increased proportionally with higher levels of physical activity.
"Moderate and high physical activity levels led to 1.3 and 3.7 years more in total life expectancy, and 1.1 and 3.2 more years lived without cardiovascular disease, respectively, for men aged 50 years or older compared with those who maintained a low physical activity level," they write. "For women the differences were 1.5 and 3.5 years in total life expectancy, and 1.3 and 3.3 more years lived free of cardiovascular disease, respectively."
"This study shows that higher levels of physical activity not only prolong total life expectancy but also life expectancy free of cardiovascular disease at age 50 years," they continue. "This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular disease-free life expectancy at higher levels are more than twice as large."
The authors point out that their study results underline current recommendations for physical activity, which call for even moderate levels of activity to enjoy the benefits of a healthier and longer life.
"The role that physical activity plays in cardiovascular risk management should be emphasized to achieve a worldwide implementation of an active pattern of life," they conclude. "Our study suggests that following an active lifestyle is an effective way to achieve healthy aging."
(Arch Intern Med. 2005;165:2355-2360. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants to all authors from the Netherlands Organization for Scientific Research. Co-author Anna Peeters, Ph.D., was partly funded as a VicHealth Public Health Research Fellow.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 14, 2005
Media Advisory: To contact corresponding author Michael G. Perri, Ph.D., call Melanie Fridl Ross at 352-273-5812 or 352-690-7051. To contact editorial co-author Steven N. Blair, P.E.D., call Sarah Grohmann at 972-560-3236.
PRESCRIBED WALKING CAN IMPROVE PHYSICAL FITNESS
CHICAGO—Exercise counseling with a prescription for walking at either hard intensity or high frequency produces improvements in cardiorespiratory fitness, according to a study in the November 14 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
The health benefits of regular physical activity have been well established. But most U.S. adults are not sufficiently active regularly, and 26 percent are not active at all, according to background information in the article. The exercise prescription needed to improve cardiovascular disease risk factors in free-living sedentary adults remains unclear.
Glen E. Duncan, Ph.D., R.C.E.P.S.M., of the University of Washington, Seattle, and colleagues conducted a randomized trial to examine the effects of exercise counseling prescriptions, varied in intensity and frequency. A total of 492 sedentary adults (177 men, 315 women) were randomized to one of four exercise counseling conditions, or to a physician advice comparison group. The duration of exercise (30 minutes) and type of exercise (walking) were the same in the four counseling groups, while exercise intensity and frequency was manipulated to form four prescriptions:
- Moderate intensity (ModI)-low frequency (LowF)
- Moderate intensity-high frequency (HiF)
- Hard intensity (HardI)-low frequency
- Hard intensity-high frequency
Intensity was defined by percentage of maximal heart rate (HR) reserve - 45-55 percent for ModI, and 65-75 percent for HardI. LowF was defined as three to four sessions per week, while HiF was five to seven sessions per week. Comparison group participants received physician advice and written materials regarding recommended levels of exercise for health. The researchers measured changes in cardiorespiratory fitness (maximum oxygen consumption), high-density lipoprotein cholesterol (HDL-C), and the ratio of total cholesterol to HDL-C.
"At six months, the HardI-HiF, HardI-low frequency, and moderate intensity-HiF conditions demonstrated significant increases in maximum oxygen consumption, but only the HardI-HiF condition showed significant improvements in HDL-C level, total cholesterol-HDL-C ratio, and maximum oxygen consumption, compared with physician advice" the authors write.
"At 24 months, the increases in maximum oxygen consumption remained significantly higher than baseline in the HardI-HiF, HardI-low frequency, and moderate intensity-HiF conditions and in the HardI-HiF group compared with physician advice, but no significant effects on HDL-C or total cholesterol-HDL-C ratio were observed," they continue.
"The findings demonstrate that significant improvements in cardiorespiratory fitness can be achieved and maintained over 24 months via exercise counseling with a prescription for walking 30 minutes per day, either at a ModI five to seven days per week, or at a HardI three to four days per week," the authors conclude. "Additional benefits, including larger changes in fitness and increases in HDL-C level, may be achieved by prescribing either more exercise or the combination of HardI plus HiF exercise."
(Arch Intern Med. 2005;165:2362-2369. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a Polar Research Award to Dr. Duncan from the American College of Sports Medicine Foundation, Indianapolis, Ind., and Polar Research; by a grant from the National Institutes of Health, Bethesda, Md., to co-author Michael G. Perri, Ph.D.; and by a grant from the General Clinical Research Center, National Institutes of Health. Dr. Duncan received an American Heart Association/Florida-Puerto Rico Affiliate Postdoctoral Fellowship.
EDITORIAL: HOW MUCH AND WHAT TYPE OF PHYSICAL ACTIVITY IS ENOUGH?
In an accompanying editorial, Steven N. Blair, P.E.D., and Michael J. LaMonte, Ph.D., of the Cooper Institute, Dallas, write that the findings of Duncan and colleagues carry important public health and clinical implications.
"In summary, Duncan et al have demonstrated that various combinations of exercise frequency and intensity, yielding a modest total physical activity dose, can be effective in increasing aerobic power," they write. "Individuals who choose to exercise at a higher intensity (65-75 percent of maximal HR reserve) can make significant improvements in their fitness by walking for 30 minutes three or four days per week. Likewise, persons who prefer a lower intensity of 45 to 55 percent can obtain similar benefits by walking for 30 minutes five to seven days per week."
"The findings reported by Duncan et al are further evidence of the opportunity that practitioners have in counseling their patients on a health behavior that has critical importance for primary and secondary disease prevention," they conclude.
(Arch Intern Med. 2005;165:2324-2325. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The current work of Drs. Blair and LaMonte on topics relevant to this editorial is supported in part by grants from the National Institutes of Health, Bethesda, Md.; equipment grants from Life Fitness, Schiller Park, Ill.; and support from Nancy Ann and Ray L. Hunt through the Communities Foundation of Texas, Dallas.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 14, 2005
Media Advisory: To contact David S. Friedman, M.D., M.P.H., call John Lazarou at 410-502-8902.
SUPPORT SYSTEM HELPS OVERCOME BARRIERS FOR NURSING HOME RESIDENTS IN NEED OF CATARACT SURGERY
CHICAGO—Although nursing home residents with vision-impairing cataract face significant obstacles to obtaining surgical services, a support system that facilitates scheduling surgery and getting the patient to and from the hospital increases cataract surgery rates, according to a study in the November issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
Cataract removal is the most commonly performed operation among the Medicare population. More than 1.5 million procedures were performed in 1998. Surgery is highly successful in restoring good vision, and more than 95 percent of patients achieve 20/40 or better vision, according to background information in the article.
David S. Friedman, M.D., M.P.H., and colleagues at The Johns Hopkins University, Baltimore, conducted a study to determine whether individuals receiving assistance in scheduling cataract evaluation and attending cataract surgery were more likely to undergo cataract surgery than those receiving routine care. The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) project is a randomized clinical trial studying the effect of a comprehensive vision restoration-rehabilitation program-including the provision of cataract surgery services when needed. Twenty-eight nursing homes in the Eastern Shore area of Maryland and Delaware were matched in pairs by size and payment type. Nursing homes within each pair were randomized to usual care or targeted intervention. Eligible residents in both groups underwent visual acuity screening, and those with visual impairment underwent a full ophthalmologic examination. In the intervention group, the project staff facilitated access to new eyeglasses, cataract surgery, or low-vision care, if these services were indicated.
The authors report 31 percent of residents in intervention homes who needed cataract removal underwent surgery, compared with only two percent in usual-care facilities.
"Without a program to assist residents in identifying a surgeon, making it to the appointment, and getting to the hospital for surgery, only two (two percent) of 99 identified by an ophthalmologist as having decreased vision due to cataract received surgery," they write.
"In contrast, an intensive effort to support residents in the process led to one third (24 of 77 persons) being scheduled for surgery, all but two of whom had the surgery," they continue.
Residents with cataract-regardless of nursing home assignment-tended to be older, were more likely to be black, had lower scores on a test for cognitive impairment, and had longer length of stay in the nursing home.
The authors point out that this project highlights the many barriers to providing cataract surgery services to institutionalized, cognitively impaired elderly residents of nursing homes. "Not only is testing vision in these residents more difficult than in community-dwelling individuals, but once residents are identified as having a cataract as the primary cause of vision loss, multiple obstacles prevent them from undergoing cataract surgery," they write.
"If it is found that cataract surgery improves the quality of life of frail nursing home residents, then it will be essential to establish programs to remove barriers to access cataract surgery services," the authors conclude.
(Arch Ophthalmol. 2005;123:1581-1587. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the National Institute on Aging, National Institutes of Health, Bethesda, Md. Co-author Sheila K. West, Ph.D., is a Research to Prevent Blindness Senior Scientific Investigator. Dr. Friedman is the recipient of the Research to Prevent Blindness Robert E. McCormick Scholarship and the American Geriatrics Society Dennis Jahnigen Scholars Award.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 14, 2005
Media Advisory: To contact Duncan J. Campbell, M.D., Ph.D., email: dcampbell{at}svi.edu.au.
MEASURING TWO BIOMARKERS MAY PROVIDE IMPORTANT ADDITIONAL INFORMATION FOR PATIENTS AT RISK FOR RECURRENT ISCHEMIC STROKE
CHICAGO—Measurement of two biomarker levels in stroke survivors may provide predictive information for recurrent ischemic stroke beyond traditional risk factors, according to a study published online today by the Archives of Neurology, one of the JAMA/Archives journals. The study will be published in the January print edition of the journal.
The two biomarkers are soluble vascular cell adhesion molecule 1 (sVCAM-1) and N-terminal pro-B-type natruiretic peptide (NT-proBNP). These biomarkers along with C-reactive protein, homocysteine, renin (an enzyme from the kidneys that affects blood pressure) and lipids and lipoprotein particle concentration and size were measured in 252 participants with cerebrovascular disease, a sub-group, of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). These participants had experienced ischemic stroke during the follow-up period of the study and were matched to control patients who did not have a stroke. PROGRESS was a placebo-controlled trial of a perindopril erbumine-based, blood pressure-lowering regimen (a medication) that reduced ischemic stroke risk by 24 percent among individuals with previous stroke or transient ischemic attack. Ischemic stroke is the most common kind of stroke caused by an interruption of blood flowing to the brain.
In background information provided by the researchers they write "patients with stroke or transient ischemic attack are at high risk of another stroke, and there is need for improved strategies to predict recurrent stroke." Stroke is a leading cause of death and disablement, with a risk of 21 percent for people 55 years of age or older.
Duncan J. Campbell, M.D., Ph.D., from St. Vincent's Institute of Medical Research, Fitzroy, Australia, and colleagues analyzed the findings. "Patients in the highest quarters [highest 25 percent of values] for both sVCAM-1 and NT-proBNP levels had 3.6 times the risk of recurrent ischemic stroke compared with patients in the lowest quarters for both biologic markers," the researchers found. "Level of sVCAM-1 was similarly predictive of ischemic stroke in patients allocated to placebo and perindopril-based (blood pressure lowering) therapy. Baseline plasma levels of C-reactive protein, homocysteine, renin, and lipids and lipoprotein particle concentration and size did not predict recurrent ischemic stroke risk."
In conclusion the authors write, "Characterization of the mechanisms of ischemic stroke pathogenesis associated with increased sVCAM-1 level may lead to development of therapies that provide benefits additional to those provided by angiotensin-converting enzyme inhibitor-based (ACE-inhibitors), blood pressure lowering therapies."
(Arch Neurol. 2006;63:1-6. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see Archives of Neurology study for funding information and authors' financial disclosures.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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