Posts tagged disease risk
Hip Strength Shown To Have Protective Effect Against Worsening Of Knee Arthritis
knee-arthritis-hip-strengthening-progression

Knee arthritis will affect many older adults limiting their ability to participate in their daily, occupational, and recreational activities. Lost independence and function is one of the most common concerns among patients with knee arthritis who are treated in our Boulder Physical Therapy practice. In addition to manual therapy to the involved joints, exercise remains the gold standard of conservative treatment for this condition. Specifically strength training has been shown to both reduce knee pain and improve function and independence among older adults. New research suggests this form of exercise may also prevent progression of arthritis.

Chang and colleagues examined the association between hip abductor strength on both cartilage injury progression and patient function in patients with knee arthritis (Osteoarthritis and Cartilage. 2019). They enrolled 275 knee in 164 patients with knee arthritis. All patients were given baseline strength and functional assessments, as well as, x rays of their knees. Authors reported patients who had greater hip abduction strength at baseline demonstrated reduced progression of their arthritis at 2 year follow up. In addition, these stronger individuals had a reduced risk of disability and an improved functional level at 5 year follow up. Authors reported these findings provide support for the important role of hip strengthening in modifying the disease progression of arthritis.

Can push ups help determine future heart disease events?
push-up-testing-heart-disease-risk

Heart disease remains the number one killer of both women and men in our country. Although the causes of heart disease are multifactorial in nature a significant percentage of known risk factors are modifiable. Abstaining from smoking, weight loss, nutrition, and exercise remain some of the most powerful ways to reduce your individual risk for heart disease including heart attack and stroke. Unfortunately, only a small percentage of Americans reach minimum national standards for weekly exercise. As our country becomes more sedentary and obese heart disease will continue to be a major health problem. Consistent with any disease, emphasis is often placed on prevention of heart disease as a more effective and less costly option for tackling heart disease. A recent study identified a functional test that can be used to help identify those at risk of future heart disease.

Researchers in the Journal of the American Medical Association reported on a retrospective analysis of heart disease events and push up ability (Yang et al. JAMA Network Open. 2019). Authors reviewed the cardiac history, anthrometric measurements, and functional testing of over 1100 participants. During the 10 year follow up 37 cardiovascular disease outcomes were reported. Authors reported a lower push up capacity was associated with an increased risk of cardiovascular disease events. Participants who could perform > 40 push ups were at a significantly lower risk of cardiovascular risk compared to those who were unable to perform 10 reps. Further studies are needed to confirm these findings and determine if this relationship is present in other patient populations.

If I Am Active At Work Do I Still Need to Exercise?
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Studies reported the United States lost 1/3 of all manufacturing positions between 1999 and 2010. Many of these individuals have not returned to their prior manufacturing jobs and may have started more sedentary occupations. While prior U.S. generations relied upon their work to provide daily activity, more recent generations must actively pursue aerobic and strength training exercise to receive the incredible health benefits associated with consistent exercise. Individuals who continue to work in active jobs such as construction, shipping, or manufacturing often believe their jobs provide all the activity they need, but new research questions the ability for these occupational activity to meet each individual’s exercise requirements.

A review article in the British Journal of Sports Medicine discussed the available research on occupational activity and health benefits, as well as, made arguments as to why workers with more active occupations should exercise (Holtermann et al. 2018). Previous research in this area has shown occupational activity does not improve an individual’s health. Further, many studies have shown these individuals have poor health and an increased risk of cardiovascular disease and early death.

Individuals in jobs with higher occupational activity often perform repetitive, low load movements with periods of heavy lifting and/or abnormal postures. This is in contrast to the shorter duration, higher intensity body movements associated with physical activity and exercise. Specifically, authors report aerobic capacity utlization of 30-35% and 60-80% between occupational activity and exercise, respectively, These lower aerobic intensities do not meet the minimal aerobic levels required for cardiovascular health benefits.

Aerobically trained individuals demonstrate decreased resting heart rate and blood pressure measurements compared to their sedentary peers. Conversely, research shows individuals involved in occupational active jobs demonstrate increased inflammation, heart rate, and blood pressure in the 24 hours following their shifts. If sustained, elevations in heart rate and blood pressure have been shown to be independent risk factors for the development of cardiovascular disease. These increases may be explained in part due to the lack of adequate recovery following occupational activities. Resistance training participants take 1-2 days off between sessions while this category of workers often perform job duties longer hours over consecutive days within the work week. Based on these aforementioned factors, workers in these jobs are encouraged to meet the same weekly exercise goals as the general population.

One Strength Session Per Week Reduces Cardiovascular Disease Risk
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Aerobic exercise has long been known to reduce an active individuals risk of chronic mental, emotional, and physical diseases. The majority of the publicity regarding the benefits of aerobic exercise has been related to the prevention of cardiovascular diseases and premature death due to these diagnoses. Government and professional medical organizations recommend 120-150 minutes of moderate exercise per week. These minutes should be at least 10 minutes in duration to receive the cardiovascular benefits of exercise. Interesting new research on strength training is being conducted on the benefits of this mode of exercise on the prevention of chronic disease and premature death.

Authors in the journal Medicine and Science in Sport and Exercise conducted an examination of the relationship of strength training, independent of aerobic exercise, and the development of cardiovascular disease (Liu et al. 2018). Authors included 12,591 participants who self reported their resistance training and disease status over a 16 year period. They reported a 40-70% disease risk reduction for all cardiovascular events with weekly resistance training frequencies of 1-3 sessions per week. No additional benefits were found with strength training frequencies of greater than 4 session per week. Interestingly, one session of up to 60 minutes of strength training was associated with decreased disease risk and early death independent of aerobic exercise participation. A patient’s body mass index (BMI) was found to significantly impact the impact of resistance training benefits.

This study supports the importance of strength training for cardiovascular health and wellness.

Lack Of Exercise Shown To Be Greatest Risk Factor For Premature Death
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Exercise remains one of the most powerful interventions to improve your mental, emotional, and physical health. Specifically, aerobic exercise, when performed consistent with medical experts prescriptions, has been shown to effectively treat 26 chronic conditions and diagnoses. Despite the clinically and cost effective benefits of aerobic exercise 80% of Americans to not reach the CDC’s recommendations of 2.5 hours of moderate exercise or 75 minutes of vigorous exercise. This sedentary behavior not only contributes to our countries 40% obesity rate, but also put these Americans at risk for serious health conditions and premature death. A new study shows this sedentary behavior may be more dangerous than high blood pressure or diabetes.

A new article published in the Journal of the American Medical Association followed 122,000 participants over an 8 year period (Mandsager et al. 2018). At the beginning of the study, participants were given a symptom limited treadmill test to determine their cardiovascular fitness. They were then placed into percentiles based on their performance and then followed to determine their how their aerobic performance impacted their development of chronic disease and premature death.

As expected, the authors found participants levels of cardiovascular fitness were inversely associated with life expectancy. Thus, fitter patients had the lowest risk of death without any upper limits to this benefit. Authors reported the most sedentary participants. were had a 500% higher risk of death compared to the most fit peers. Participants who exercise inconsistently, not meeting CDC guidelines, were still at close to 400% greater risk of early death compared to those who do exercise regularly. Amazingly, sedentary behavior was found to have a worse prognosis than high blood pressure, smoking, or being a diabetic (type II).

Increased Medical Risks of Chronic Pain and Mental Health Disorders Found After Elective Hip Surgery
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Inherent risks, such as infection and blood clots, are associated with orthopedic surgeries and should be considered in decision making between surgical and conservative treatments for musculoskeletal diagnoses. In addition to these inherent risks, patients should also consider other hidden or less common risks after surgery including increased healthcare costs (office visits, additional surgeries, hospitalization) and changes in disability after surgery. A recent study examined additional risks found in patients who elected for arthroscopic hip surgery.

Rhon and colleagues followed 1870 patients treated in the military health system up to 2 years after elective arthroscopic hip surgery to determine their subsequent healthcare utilization (Br J Sp Med. 2018). Specifically, the authors assessed for seven co morbidities (mental health, chronic pain, substance abuse, cardiovascular disoders, metabolic syndrome, systemic arthropathy, and sleep disorders) associated with poor outcomes in the management of musculoskeletal disorders. The incidence of these seven co morbidities at 1 and 2 year follow up was compared to each patient’s pre operative status. Authors reported a statistically significant increase in all seven co morbidities following the surgical procedure. Specifically, authors found significant increases in the following

Chronic Pain - 166%

Systemic Arthropathy - 132%

Sleep Disorders - 111%

Metabolic Syndrome - 86%

Mental Health Disorders - 84%

Cardiovascular Disorders - 71%

Authors concluded, “major clinical co morbidities increased substantially after elective hip surgery compared to preoperative status”.

Previous studies have not shown significant differences in outcomes between Physical Therapy and arthroscopic hip surgery. Thus, patient’s must consider surgical risks in their decision making.