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Parentgiving Newsletter - August 4, 2009

Inside this Edition:
Senior Strength. Three important studies show the value of health-oriented lifestyle habits, mostly centered on maintaining, or if necessary developing, muscle density and strength. A fourth points out how that can be achieved.
It is never too late to start making lifestyle choices that improve health as they ward off illness.
The adage “you are what you eat” is only the beginning. “You” are also what you drink, what exercise you do and what you smoke. If you still have any doubt that your lifestyle choices influence your health at any age, two exhaustive studies by Harvard researchers, published in the July 22/29 2009 issue of the Journal of the American Medical Association, should erase it and set you and your loved ones on a healthier path. Together they show that lifestyle choices can reduce lifetime risk of developing heart failure, one of the life-threatening conditions that accounts for a large percentage of hospital readmissions, and hypertension, a risk factor for many other diseases.

In the heart failure study based on data from the Physicians’ Health Study I, researchers evaluated findings from about 20,900 men who were followed for over 20 years, starting at an average age of 54. They found that the risk of heart failure could be cut in half by following 6 key health habits that had to do with body weight, smoking, exercise, alcohol intake, eating breakfast cereals and eating fruits and vegetables. Men who did not adhere to any of the six lifestyle factors had the highest risk of developing heart failure in their lifetime, 21.2 percent; men who followed four or more desirable lifestyle factors had a risk of only 10.1 percent.

In the hypertension study, researchers looked at the link between lifestyle factors and the risk of developing hypertension in 83,882 women ages 27 to 44 years old at the start of the second Nurses' Health Study who did not have hypertension, cardiovascular disease, diabetes or cancer and who had normal blood pressure readings of 120/80 mm; they were followed for 14 years through 2005.

The lifestyle factors associated with a reduced risk of hypertension were maintaining a body-mass index (BMI), which measures the ratio of your weight to your height, of less than 25, exercising vigorously for 30 minutes a day, following the Dietary Approaches to Stop Hypertension (DASH) diet, having a modest alcohol intake, low usage of non-narcotic analgesics (less than once per week) and taking 400 micrograms a day or more of supplemental folic acid. Women who followed all of these positive lifestyle factors had about an 80 percent lower risk of developing high blood pressure. On the flip side, not adhering to any one of them led to an increased risk, with a BMI over 25 by itself being the most powerful predictor of hypertension and increasing the risk by 40 percent compared to those with a BMI of less than 25.
The 6 Healthy Habits
  • Maintain a normal body weight—if you’re not there already, lose weight gradually. Aim for a BMI under 25.
  • Don’t smoke—if you’re not there already, work with your doctor to develop a quit plan; there are many ways to get help, from support groups to nicotine replacement choices to prescription drugs.
  • Exercise regularly—if you’re not there already, start with a simple plan of walking for 10 minutes, up to three times a day; include strength training (see below) to build or maintain muscle.
  • Lower your alcohol intake—if you’re not there already, cut down to one drink max for women per day, two for men.
  • Eat whole-grain breakfast cereals—if you’re not there already, try old fashioned oats or a bran or puffed rice dry cereal.
  • Eat fruits and vegetables—if you’re not there already, eat 2 cups of fruits and 2-1/2 cups of vegetables per day. Take out a measuring cup and you’ll be surprised at how low this volume is, making getting these minimums easy to do. A single piece of whole fruit, like an apple, orange, pear or banana, is 1 cup right there.
Whole grains, fruits and vegetables are hallmarks of the DASH diet that also stresses lowfat or fatfree dairy, nuts, legumes, little salt and less red meat. Talk with your doctor about folic acid, calcium, vitamin D and any other supplements that might be appropriate for you.
People with better muscle density seem to stay healthier and ward off hospitalizations.
Older adults who have less strength, poor physical function and low muscle density are at higher risk of being hospitalized compared to adults with more strength and better function. That's the finding of a new study in the Journal of the American Geriatric Society. The study also found that muscle density, a measure of how much fat compared to lean tissue there is in the muscle, is a more accurate gauge of a person's risk of hospitalization than muscle mass or size. In understandable terms, the relative risk for hospitalizations was 50% higher for those with poor walking or less dense muscle mass.

"Our research suggests that we need to re-think the way we define sarcopenia or age-related muscle loss," says Peggy Cawthon, PhD, MPH, a scientist with the California Pacific Medical Center Research Institute and the lead author of the study. "Many definitions of sarcopenia today tend to focus on lean mass or muscle size—our study shows that is looking at the wrong factors. We found that muscle strength or performance were much better ways of measuring function."

One in five Americans over the age of 65 suffers from sarcopenia. The researchers followed 3,011 healthy, non-disabled adults between the ages of 70 and 80 for an average of almost five years. They measured their physical function in a number of ways including walking speed, their ability to stand up from a chair repeatedly, the strength of their grip and their leg strength. By the end of the study more than 55 percent of the participants had experienced one or more hospitalizations. Those most likely to end up in the hospital were the adults who scored lowest on the measures of physical function; this held true after allowing for age, medical conditions, lean mass or muscle size. They also found that adults with the least dense thigh muscles, namely those with a higher proportion of fat in their thighs, were also at a higher risk of hospitalization compared to adults with more dense thighs.

"The findings are particularly important because they suggest that interventions, such as physical exercise, that improve physical function could help keep more vulnerable seniors out of the hospital," says Cawthon. Good news because numerous studies show that even short stays in the hospital are associated with a greater future risk of functional decline and disability.

"Most methods of measuring muscle mass or density rely on complex imaging procedures, such as using quantitative computed tomography (QCT). Those are time consuming and expensive," says Cawthon. "However, we found that much simpler methods, such as measuring walking speed, are much easier and cheaper to do, and are even more accurate in determining a person's risk of future hospitalization. This gives us the ability to screen larger groups of people and help those at risk with some simple interventions, such as physical exercise."
Frailty, one sign of which is a lack of muscle, can precipitate a downward spiral.

Frail older adults are at increased risk of serious problems including becoming disabled, falling and losing their independence. Just what is frailty? Through the work of Linda P. Fried, MD, MPH, dean and DeLamar Professor of Public Health at the Columbia University Mailman School of Public Health and colleagues at Johns Hopkins University, frailty has been defined as a distinct medical syndrome, recognized when a critical group of symptoms and signs emerge, specifically three or more of the following: low strength, low energy, slowed motor performance, low physical activity or unintentional weight loss. (Separately, frailty can also be a result of having many chronic diseases.) A new study by Dr. Fried shows that many of these weak points need to be addressed at the same time to see improvement and, if not, the cumulative effect could have a serious downward spiral.

"We found that the likelihood of frailty increases in relationship to the number of abnormal physiological systems, and the number of abnormal systems was strongly predictive of the likelihood of frailty, whereas the individual systems were not," says Dr. Fried. "It further suggests that therapeutic replacement of any one deficient system, such as testosterone, estrogen or growth hormone, is unlikely to ameliorate or prevent frailty, unless it improves multiple physiologic systems. This may explain the public health

import of remaining physically active as we get older, since activity improves many aspects of biology and health."
"This research provides evidence of the interaction of a number of factors that contribute to frailty in older people," said Richard Suzman, PhD, director of the Division of Behavioral and Social Research at the National Institute on Aging, which funded the research. "It emphasizes the importance of considering frailty holistically."

Staying Physically Active: How Progressive Resistance Training Helps
This specific approach to strength training can help reverse the trend of muscle density loss that leads to so many negative health outcomes.

While physical activity in general has huge advantages for maintaining a healthy weight and muscle density, as well as lowering the risk of a variety of diseases, one type of exercise in particular, progressive resistance training (PRT) builds the muscle that can prevent frailty and keep seniors in their best possible shape.

Strength training uses weights, lightweight resistance bands of various tensions or weight training machines to work muscles; with PRT, you progressively increase the weight or tension—the resistance—as you build up your strength. To determine the value of PRT, researchers Chiung-ju Liu, PhD, OTR, of Indiana University in Indianapolis, and Nancy K. Latham, PhD, PT, of Boston University, reviewed a large number of studies that looked at the effects of PRT on seniors—121 trials involving 6,700 participants. Writing in The Cochrane Database of Systematic Reviews, they concluded that PRT is effective for improving functioning, strength and the ability to perform certain daily activities, like getting out of a chair. In a few of the studies they analyzed, the positive effects also included a lessening of pain for some osteoarthritis patients.

Care does need to be taken for the elder who is already experiencing frailty or another disability, but working with a physical therapist to design a program is a smart way to start. To avoid strains and injury from improperly exercising, beginners should also exercise under a PT or fitness trainer’s supervision. The great thing about progressive resistance is that you can often begin at a very low weight, yet progress indefinitely.


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A round-up of articles and studies impacting the lives of seniors
Fighting Senior Depression," by Virginia Diaz (Tampa Tribune, July 30, 2009).
"Democrats Push Health Care Plan While Issuing Assurances on Medicare" by Robert Pear and David M. Herszenhorn (New York Times, Jul. 29, 2009).
"Dozens arrested in Medicare fraud busts across US" by Kelli Kennedy (Associated Press via Google News, Jul. 29, 2009).
"LSUHSC (Louisiana State University Health Sciences Center) Contributes To Research Revealing Targets To Reduce Racial Disparity In Prostate Cancer Deaths" (LSUHSC news release via Eurekalert [American
Association for the Advancement of Science], Jul. 29, 2009).
"Credit Card Debt Rises Faster For Those 65 And Older" by Kathy Chu (USA Today [McLean, Virginia], July 28, 2009).
"Latest Republican health care idea: scare the elderly," by Marlene Phillips (Phoenix [Arizona] Liberal Examiner, Jul. 28, 2009).
"Bipartisan group eyes Medicare savings" by David Espo and Erica Werner (Associated Press via Google News, Jul. 28, 2009).
"Many Prostate Cancers Don't Need Radical Therapy"  (Reuters Health, Jul. 28, 2009).
"The new retirement plan: Just keep working" by John W. Schoen (MSNBC, July 28, 2009).
"Older Diabetics Should Avoid Dementia Meds" (Atlanta Journal Constitution, July 28, 2009).
"Low Blood Count Ups Death Risk In Elderly People" (Reuters Health, July 27, 2009).