Whole grains stave off pre-diabetes

Posted on December 21, 2012 by Stone Hearth News

Consumption of whole grain reduces risk of deteriorating glucose tolerance, including progression to prediabetes

First published December 12, 2012, doi: 10.3945/​ajcn.112.045583 Am J Clin NutrDecember 2012 ajcn.112.045583

Tina Wirström, Agneta Hilding, Harvest F Gu, Claes-Göran Östenson, and Anneli Björklund

From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Abstract

Background: High whole-grain intake has been reportedly associated with reduced risk of developing type 2 diabetes (T2D), which is an effect possibly subject to genetic effect modification. Confirmation in prospective studies and investigations on the impact on prediabetes is needed.

Objectives: In a prospective population-based study, we investigated whether a higher intake of whole grain protects against the development of prediabetes and T2D and tested for modulation by polymorphisms of the TCF7L2 gene.

Design: We examined the 8–10-y incidence of prediabetes (impaired glucose tolerance, impaired fasting glucose, or the combination of both) and T2D in relation to the intake of whole grain. Baseline data were available for 3180 women and 2297 men aged 35–56 y.

Results: A higher intake of whole grain (>59.1 compared with

Conclusions: A higher intake of whole grain is associated with decreased risk of deteriorating glucose tolerance including progression from normal glucose tolerance to prediabetes by mechanisms likely tied to effects on insulin sensitivity. Effect modifications by TCF7L2 genetic polymorphisms are supported.

Received June 26, 2012.
Accepted October 24, 2012.

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Exercise adherence in heart failure patients study

Posted on December 21, 2012 by Stone Hearth News

Newswise — The University of Nebraska Medical Center College of Nursing Lincoln Division has received a $3.36 million grant to study long-term adherence to exercise in heart failure patients. Funding comes from the National Institutes of Health.

As the population ages, heart failure will become an even bigger problem in the United States. Heart failure causes weakening of the heart and affects the heart’s ability to pump enough blood to meet the body’s needs.

Though the disease is chronic, progressive and incurable, medications and lifestyle change can help people live longer with more active lives. Regular exercise helps patients tolerate more activity, reduce fatigue and improve their mood.

The 5-year clinical research study, which will begin in November, be conducted at Bryan Heart in Lincoln and in Detroit at Wayne State University and Henry Ford Health System. The study will enroll 256 participants.

“Twenty years ago we would have said you shouldn’t exercise, but now we know that exercise is safe and beneficial,” said Bunny Pozehl, Ph.D., UNMC College of Nursing professor and principal investigator of the study. “The biggest problem is getting patients to adhere to exercise. There have been no studies to date focusing on this problem.”

Two groups of randomized patients will be studied. Each group will receive access to an exercise facility to learn how to exercise and what symptoms to watch for. One group will receive educational group sessions and support for adherence from an exercise coach.

“One of the barriers for our patients is they get short of breath, tire more easily, and they’re afraid to initiate exercise on their own,” Dr. Pozehl said. “They fear that exercise will stress their failing heart too much. What they don’t realize is exercise is beneficial and will actually help them feel better and have more energy.”

Dr. Pozehl, a nurse practitioner who’s worked with the heart failure clinic at Bryan Heart for 17 years, said some of the common exercise barriers to heart failure patients are the cost of exercise programs and the fear that exercise may cause complications. Structured, supervised exercise programs for heart failure patients currently aren’t reimbursed by most insurance companies and Medicare.

Rheumatoid arthritis, aggressive, early treatment reduces risk of disability

For rheumatoid arthritis, aggressive, early treatment reduces risk of disability

Posted on December 21, 2012 by Stone Hearth News

ROCHESTER, Minn. — A generation ago, rheumatoid arthritis almost always led to disfigured joints and severe disability. Today, this disease still causes joint damage, discomfort and disability. But the risk of disability can be dramatically reduced when drugs that modify the immune system are started soon after the disease begins, according to the December issue of Mayo Clinic Health Letter.

Rheumatoid arthritis occurs when the immune system attacks joint linings (synovial membranes) that protect and lubricate the joints. The joint linings become inflamed and feel warm, painful and swollen. Muscle aches and fatigue may also occur. The onset can be sudden or subtle, involving swelling in only one or two joints.

When joint swelling occurs and lasts more than two weeks, it’s important to see a physician. Persistent inflammation can lead to changes that damage cartilage, bone, tendons and ligaments. Medications can slow or stop this destructive process.

Aggressive drug treatment for rheumatoid arthritis starts as soon as possible. With several choices for medication, doctors increase dosages of drugs used — or add or take away drugs from the mix — until remission or very low disease activity is achieved. The intensity of early treatment improves the odds of remission. The longer the active disease persists, the less likely it will respond to drug therapy.

Exercise will very likely be part of the treatment plan, too. Older adults with rheumatoid arthritis — especially those newly diagnosed — are at risk of muscle weakness caused by the disease. A physical therapist can design an exercise program to strengthen muscles, increase exercise capacity and avoid joint irritations. Without safe exercise, a decline to disability can occur quickly, sometimes within weeks.

It’s not entirely known what causes rheumatoid arthritis, but there’s a strong genetic component that makes certain people more susceptible to triggering factors, such as a viral infection. While it can occur at any age, the peak age of onset is 56.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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Rotator cuff treatment

Rotator cuff treatment update, as well as a new method

Posted on December 14, 2012 by Stone Hearth News

Management of degenerative rotator cuff tears: a review and treatment strategy

Nicholas D Clement, Yuan X Nie and Julie M McBirnie

Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:48 doi:10.1186/1758-2555-4-48

Published: 14 December 2012

Abstract (provisional)

The aim of this review was to present an over view of degenerative rotator cuff tears and a suggested management protocol based upon current evidence.

Degenerative rotator cuff tears are common and are a major cause of pain and shoulder dysfunction.

The management of these tears is controversial, as to whether they should be managed non-operatively or operatively.

In addition when operative intervention is undertaken, there is question as to what technique of repair should be used.

This review describes the epidemiology and natural history of degenerative rotator cuff tears.

The management options, and the evidence to support these, are reviewed.

We also present our preferred management protocol and method, if applicable, for surgical fixation of degenerative rotator cuff tears.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement

Effect of leisure time physical activity on severe knee or hip osteoarthritis leading to total joint replacement: a population-based prospective cohort study

Posted on December 15, 2012 by Stone Hearth News

Eva Ageberg^1,2,7*, Gunnar Engström^3,4,Maria Gerhardsson de Verdier³, Jan Rollof³, Ewa M Roos⁵ and L S Lohmander^1,5,6

• * Corresponding author: Eva Agebergeva.ageberg@med.lu.se

Author Affiliations

¹ Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden

² Department of Health Sciences, Lund University, Lund, Sweden

³ AstraZeneca R&D, Lund, Molndal, Sweden

⁴ Epidemiology Research Group, Clinical Sciences, Malmö, Lund University, Lund, Sweden

⁵ Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

⁶ Department of Orthopedics and Traumatology, University of Southern Denmark, Odense, Denmark

⁷ Department of Health Sciences, Lund University, PO Box 157, SE-221 00, Lund, Sweden

For all author emails, please log on.

BMC Musculoskeletal Disorders 2012, 13:73 doi:10.1186/1471-2474-13-73
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2474/13/73

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Studies on leisure time physical activity as risk factor or protective factor for knee or hip osteoarthritis (OA) show divergent results. Longitudinal prospective studies are needed to clarify the association of physical activity with future OA. The aim was to explore in a prospective population-based cohort study the influence of leisure time physical activity on severe knee or hip OA, defined as knee or hip replacement due to OA.

Methods

Leisure time physical activity was reported by 28320 participants (mean age 58 years (SD 7.6), 60% women) at baseline. An overall leisure time physical activity score, taking both duration and intensity of physical activities into account, was created. The most commonly reported activities were also used for analysis. The incidence of knee or hip replacement due to OA over 11 years was monitored by linkage with the Swedish hospital discharge register. Cox’s proportional hazards model (crude and adjusted for potential confounding factors) was used to assess the incidence of total joint replacement, or osteotomy (knee), in separate analyses of leisure time physical activity.

Results

There was no significant overall association between leisure time physical activity and risk for knee or hip replacement due to OA over the 11-year observation time. For women only, the adjusted RR (95% CI) for hip replacement was 0.66 (0.48, 0.89) (fourth vs. first quartile), indicating a lower risk of hip replacement in those with the highest compared with the lowest physical activity. The most commonly reported activities were walking, bicycling, using stairs, and gardening. Walking was associated with a lower risk of hip replacement (adjusted RR 0.76 (95% CI 0.61, 0.94), specifically for women (adjusted RR 0.75 (95% CI 0.57, 0.98)).

Conclusions

In this population-based study of middle-aged men and women, leisure time physical activity showed no consistent overall relationship with incidence of severe knee or hip OA, defined as joint replacement due to OA, over 11 years. For women, higher leisure time physical activity may have a protective role for the incidence of hip replacement. Walking may have a protective role for hip replacement, specifically for women.

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