The Blog

By Denise Cook and Ann Kostin-McGill

In September, Blue Cross Blue Shield of Michigan and Michigan Recreation and Park Association announced an innovative partnership to promote walking as a viable form of exercise and recreation. While each organization has a long existing walking program with its own target market, they have a shared value of health and well-being for Michigan residents.

WalkingWorks® is a noncompetitive national walking program developed by the Blue Cross and Blue Shield Association and promoted at the state level by BCBSM. The objective is to encourage people to take advantage of an activity readily available to virtually anybody and at anytime; it’s also designed to assist employers in developing opportunities for employees to commit to brisk walks during approved work breaks. The philosophy is that a person does not have to spend a lot of money to realize the many health benefits walking has to offer.

Walk Michigan! is a noncompetitive statewide walking program created by MRPA. Given the same objective as BCBSM, Walk Michigan! offers opportunities for community residents to utilize local park and recreation walking trails throughout the state. The philosophy is that in addition to important health benefits there are also significant social benefits, from meeting new community members and participating in a family activity to bonding with a pet that has been alone all day.
The partnership promotes WalkingWorks and Walk Michigan! simultaneously by combining resources and implementing a per market program model throughout the state. BCBSM has committed to a $50,000 sponsorship to support the expansion of both programs, making them available to Michigan communities throughout the state. MRPA brings to the table a strong organizational infrastructure to administer the marketing campaign. The potential outcomes for all stakeholders are astounding. BCBSM and MRPA are joining forces with six regional park and recreation organizations, up to one hundred local park and recreation agencies and forty Michigan corporations.

One of the features of this program model is the coordination of efforts between local P & R agencies and select Michigan companies to create walking opportunities for employees and their families before, during and after work. This both encourages walking and introduces walkers to area parks and recreation facilities they may not have previously considered. Beyond this program, the potential for long-term relationships and further collaboration between P & R agencies and Michigan companies is exciting.

Michigan faces serious challenges when it comes to the overall health of its residents. A recent economic study by Altarum, a nonprofit research institute, compared the health of Michigan’s work force to benchmark states that compete with Michigan for new corporations and jobs. The study found that the health of Michigan’s work force could hinder its ability to compete. The study ranked Michigan:
• Highest in death rates from heart disease
• Second-highest in rates of obesity and diabetes
• Sixth-highest in number of smokers
• Highest prescription drug use.

Physical inactivity alone is responsible for the majority of preventable diseases and results in the annual loss of about twenty days per worker. The Michigan Chamber of Commerce reported that member organizations complained that the high cost of health insurance was the greatest threat to their profitability and they wanted help.

Worksites are one of the best places to reach the majority of Michigan’s adult citizens to encourage them to lead a healthy lifestyle. Participating in a walking routine is a step in the right direction. According to the Mayo Foundation for Medical Education and Research, brisk walking on a regular basis can reduce your risk of a heart attack, decrease your chances of developing diabetes, help control your weight, improve your muscle tone and promote your overall sense of wellness.

This, in essence, is the inspiration for this combined effort kicking off on Thursday, May 22, from 11:30 a.m. to 1:30 p.m. on the lawn of the State Capitol. Chris Holman steps up to emcee with special appearances by BCBSM health and fitness advocate Ernie Harwell, and BCBSM walking advocate Jodi Davis. Ernie is a former Detroit Tigers announcer and National Radio Hall of Famer, and Jodi is an amazing woman from southwest Michigan who lost 162 pounds in 16 months and changed her life with the help of walking. Everyone is invited to join Ernie and Jodi as they lead Michigan in taking the first step in the right direction for this year’s program.

By Justin Grinnell

I am fresh off a fantastic trip to Chicago where I attended a Perform Better 3-Day Functional Training Summit at the McCormick Center. This event brought together some of the best trainers in the world. I was included in the event as one of the top trainers in the Midwest and was excited to learn about all the new trends and scientific research findings.

And why wouldn’t I? Some of these trainers had a clientele base that consisted of NFL and Olympic athletes, yet still managed to relate to the everyday athlete. I was impressed. I was excited to see such great presentations, but so overwhelmed with the massive amounts of information. What would I do with all of this information? What types of methods do I take back to The Michigan Athletic Club to show my clients? What is right and what is wrong? Do I take it slow, or just start changing all of my training methods right away?

I have been a trainer for six years—since I was a sophomore in college. I’ve changed my training philosophies more than 10 times since then. I could easily change it again with the techniques and philosophies I learned at this event. But is that OK? Should I stick with the same methods if they work? Or, do I continue to change as time goes on and scientific and practical evidence makes things more clear?

These are questions I ask myself everyday as I train 40-50 clients a week, along with the many other teams and Boot Camps that I have each week.

One thing I can tell you for sure is that I am committed to providing my clients and teams with the best training possible. I pride myself on continuing my education by attending conferences and classes to keep up my certifications, as well as reading for at least 30-60 minutes a day so I can keep up on all the latest and greatest trends, and educate myself about the not so great exercise and nutrition information.

When I talk with people I understand their frustrations. Here are some of my most asked questions:

• “What is the best way to lose weight?”
• “Do I perform more cardio or lift more weights?”
• “Is core training the way to go?”
• “Yoga or Pilates?”
• “Joint stability or joint mobility?”
• “What are the best foods to eat?”
• “High carbs or low carbs?”
• “High protein or low protein?”
• “What do I do Justin? Please help!”

Well, with this column I am here to set the records straight. I have great confidence that I will provide the best and most up to date information on all aspects of exercise, nutrition, and overall health and wellness. This is my passion, and I will continue to relay the best possible advice to my clients and to the general public. I do not marry myself to one Dogma. I keep a very open mind when it comes to these complex topics, so you can be sure you will not be receiving any biased information. I am going to keep it real.

I would like to thank Healthy & Fit Magazine Publisher Tim Kissman for giving me such a great opportunity. I am very excited to write for such a great publication, and I look forward to presenting the readers with the most up to date and information possible.

Check back often for new columns and workout tips. You won’t be disappointed!

by Gary Riggs
mailto: eeyorekidding2@hotmail.com

Kettlebells are finding their way into the mainstream of American fitness. No doubt you’ve seen them featured in “Healthy & Fit Magazine” over the past year, as well as various other publications. And if you didn’t blink, you may have seen Sylvester Stallone snatch a kettlebell over his head, in “Rocky Balboa”. And now, Lansing, kettlebells can be found at select local gyms, or a sporting goods store, near you!

“So what is a kettlebell, and why should I get one?” you may be asking.

A kettlebell is typically described as a cast-iron ball with a suitcase handle on top. It’s been around for at least a couple hundred years–most popularly in Russia. But in the days before the plate-loaded barbell became popular over here, from the 1920’s onward, the kettlebell was a staple in most American and western European gyms, too. Its survival may owe itself to 70-plus years of Soviet isolation from the rest of the world, during which time the kettlebell seems to have become the preferred fitness tool of Russian military and proletarian fitness enthusiasts alike.

“So popular were kettlebells in Tsarist Russia that any strong man or weightlifter was referred to as a ‘girevik’, or ‘a kettlebell man’,” writes “Evil Russian” Pavel Tsatsouline, who re-introduced the kettlebell to the West, in 2002. In his modern classic, “The Russian Kettlebell Challenge”, Pavel cites numerous benefits of this versatile iron weight–for both muscular strength and cardiovascular fitness:

“Girevoy sport delivers unparalleled cardio benefits. That is one reason kettlebells are very popular with the Russian Navy; there is nowhere to run aboard a man-of-war but who needs to if there is a kettlebell around?…High rep C&J’s and snatches with K-bells kick the fighting man’s system into warp drive….” (I can personally vouch for this: after returning from DALMAC just after Labor Day, my schedule precluded any further riding. Throughout the fall and winter months, I maintained my normal weight with mostly swings and snatches. Finally, on the first nice day in April, I was out on my bike again and logged 40 miles–it was as if I’d never been away!) For the same reason, the kettlebell has been adopted by U.S. military personnel in Afghanistan and Iraq, where jogging through the streets of Baghdad or Kabul just doesn’t seem like a good idea.

It’s also become popular with woman trainees, who want to burn fat and build muscle tone without bulking up. And for the deconditioned client in general, who just wants to get into shape without learning all the rocket science of isolating muscle groups, intimidating and confusing machinery, the kettlebell is simplicity itself.

Take the swing for instance, a deceptively simple drill that forms the basis of nearly every exercise in the KB repertoire: using the momentum of your body, it almost seems to carry you through the movement. Yet you’ll have worked your hips, inner thighs, glutes, hamstrings, back and shoulders, in addition to getting a good cardio workout–all without the “dishonor of aerobics”.

Of course, you could perform the same drill with a dumbbell. But the kettlebell handle is 9-10 inches above the floor, and easier to grip. And its weight displacement gives it a whole ‘nother dynamic (Bill Pullum used to load one end of his DBs with slightly more weight to replicate this effect, but now you don’t have to!).

So where can you get a kettlebell of your very own?

Kettlebells are now locally available (Hallelujah!) from MC Sports and Dicks Sporting Goods. They’re manufactured by Go Fit, and come included with an introductory DVD by Iron Core maiden, Sarah Lurie. Weights range from between 10-25 pounds in five pound increments–the recommended starting weight for the average woman is 20 pounds. Dick’s offers a 35-pounder for the average male trainee. But if you’re a little more advanced, and can bench over 200 pounds, you may be ready for the 45-pounder (Iron Core makes one; ask at Dick’s if they can order it).

If you’re still not sure, and would like to road test a kettlebell, Justin Grinnell would be happy to oblige. His Boot Camp at the Michigan Athletic Club incorporates KBs into its routine. Give him a call at 364-8888.

U-M study finds shorter sleep duration for 9- to 12-year-old kids is associated with increased risk for being overweight

Ann Arbor, Mich. - Diets high in fat and sugar may not be the only things contributing to American children’s expanding waistlines. Research findings from the University of Michigan C.S. Mott Children’s Hospital suggest that kids who aren’t getting enough sleep also may be at an increased risk for being overweight.

In a study exploring the relationship between sleep duration and overweight risk for third-grade and sixth-grade children, researchers found that children who got less shut-eye - fewer than 9 hours each day - were at an increased risk of being overweight, regardless of their gender, race, socioeconomic status, or quality of the home environment.
These findings reveal that sixth graders with shorter nightly sleep durations were more likely to be overweight. And third-grade students who got fewer hours of sleep, regardless of their body mass index, or BMI, were more likely to become overweight in sixth grade. Results from this study appear in the November issue of the journal Pediatrics.

“Many children aren’t getting enough sleep, and that lack of sleep may not only be making them moody or preventing them from being alert and ready to learn at school, it may also be leading to a higher risk of being overweight,” says study lead author Julie C. Lumeng, M.D., assistant research scientist at the U-M Center for Human Growth and Development.

“This study suggests that an increased risk for overweight is yet another potential consequence of short sleep duration, providing an additional reason to ensure that children are receiving adequate sleep, primarily through enforcing an age-appropriate bed time.”

Already, research has demonstrated that among adults, even modest reductions in sleep duration are associated with significant increases in obesity risk. Other studies conducted in Japan and England also offer evidence of a link between shorter sleep duration and overweight risk in children. Those studies with children, however, are limited by racial and socioeconomic homogeneity, says Lumeng, assistant professor in the Department of Pediatrics and Communicable Diseases at C.S. Mott Children’s Hospital.

Since U.S. children’s risk for overweight varies by race and socioeconomic status, Lumeng and her colleagues wanted to examine sleep duration and overweight risk for children independent of those factors.

The researchers reviewed data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development on reported sleep problems, sleep duration and BMI for 785 elementary school children, ages 9 to 12. Among those studied, 50 percent were male, 81 percent were white, and 18 percent were overweight in sixth grade.

The researchers found that overweight sixth-grade children slept fewer hours than children who were not overweight. Boys made up the majority of overweight sixth-grade children.

Boys, too, were reported to sleep fewer hours, while girls were found to have more sleep problems. Sleep problems, however, were not associated with a child being a risk for overweight.

Most promising, these study results show that for every additional hour of sleep in sixth grade, a child was 20 percent less likely to be overweight in sixth grade; every additional hour of sleep in third grade resulted in a 40 percent decrease in the child’s risk of being overweight in sixth grade.

“Sleep may have a behavior impact on children,” says Lumeng. “In other words, children who are better rested may have more energy to get more exercise. For example, they may be more likely to go out and play, as opposed to lying on the couch watching TV. It also is possible that when children are tired, they may be more irritable or moody, and may use food to regulate their mood.”

Even more important, Lumeng says, is emerging research that shows a connection between sleep disruption and the hormones that regulate fat storage, appetite and glucose metabolism. Short sleep duration alters carbohydrate metabolism, and leads to impaired glucose tolerance, which can affect a person’s weight. Circadian rhythms, too, affect the body’s leptin, glucose and insulin levels.

“So weight gain may not be a result of sleep’s effect on behavior, but rather sleep’s effect on hormone secretion in the body, specifically, leptin and grehlin,” says Lumeng, who notes that sleep and leptin secretion in children is an important area for future research.
Bottom line: If families are struggling to get their children to go to sleep at a reasonable hour, they should seek help from their health care provider, Lumeng advises. Revising school start times may also provide a solution to increasing the amount of sleep a child gets each day.

The National Sleep Foundation recommends these basic daily sleep requirements for children, adolescents, pre-teens and teens:
. Preschoolers: 11-13 hours
. Elementary school students: 10-12 hours
. Pre-teens: 9 - 11 hours
. Teens: 8 ½ - 9 hours

In addition to Lumeng, co-authors from the U-M Center for Human Growth and Development are Deepak Somashekar, B.S., and Niko Kaciroti, Ph.D.; Danielle Appugliese, MPH, with the Data Coordinating Center, Boston University; and Robert F. Corwyn, Ph.D., and Robert H. Bradley, Ph.D., with the Center for Applied Studies in Education, University of Arkansas.

The study was supported by the American Heart Association Fellow-to-Faculty Transition Award, and the American Heart Association Midwest Affiliate Grant-in-Aid.

If you’re one of the millions of Americans who will travel abroad this summer, make sure your plans include a trip to the doctor, says H. Thomas Johnson, M.D., a Saint Louis University family physician.

Ideally, Johnson says, travelers should make an appointment six months before traveling to the most exotic locations because some vaccines, such as hepatitis A and B, require six months to receive both the first dose and booster.

However, if you do not have six months, Johnson still recommends getting the first vaccine as it will provide some protection.

For travelers visiting more mainstream destinations, such as the tourist areas of Mexico, Johnson still recommends checking in with your doctor.

“Your doctor can tell you about any necessary precautions or recommended vaccines,” explained Johnson, who is an expert in travel medicine. “He or she can also prescribe important medications, such as an antibiotic to bring with you in case you develop traveler’s diarrhea or a patch to prevent sea sickness.”

The key to successful travel, Johnson says, is planning ahead. He recommends these five tips for a healthy and safe vacation.

Pack smart: Make sure to bring plenty of your regular medications, both prescribed and over-the-counter, in your carry-on luggage. However, controlled substances must be in their original pharmacy container and over-the-counter liquid medications must meet the TSA guidelines, which require that liquids be in three ounce or smaller containers and fit in one quart-size clear plastic bag. In addition to your regular medications, don’t forget the basics: pain relievers, medicine for nausea and heart burn, bandages, antibacterial ointment and antibacterial hand wipes.

Enjoy the sun, safely: Nothing ruins a vacation like getting a sun burn on the first day. Using a sunscreen with a minimum of a 30 SPF is especially important when visiting tropical destinations. However, even if you will not be tanning on a beach, you can still get burnt while sight-seeing or driving in a car, so make sure to apply sunscreen every day.

Keep the bugs away: Bug spray with 30 to 50 percent DEET is especially important if you are traveling to places where malaria is present. In addition, if you will be sleeping outdoors or in huts, bring a mosquito net.

Be cautious about what you eat and drink: Anyone traveling to Mexico has heard the warning to not drink the water. But Johnson cautions that just avoiding the water is not enough. In addition to water and ice, the general rule of thumb is if it’s not pealed, boiled or cooked, avoid it. This includes fresh vegetables and fruits, as well as undercooked meats and raw fish. Be particularly careful when purchasing food and drinks from street vendors and make sure the seal is not broken on bottled water.

Bring your personal health information: Think of it as insurance – you hope you don’t need it, but if something goes wrong, it can be a real life-saver. Having medical information, such as all prescription and over-the-counter medications you are currently taking, chronic conditions and vaccine information, will help the physician treating you if you have a medical emergency. Store the information in your suitcase, on a USB drive or on a small card in your wallet, but make sure someone knows where the information is stored in case you are unconscious.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease

Worried about your cholesterol? You may want to schedule a few appointments with a registered dietitian, to get some sound advice about how to shape up your eating habits, according to a new national study led by University of Michigan Health System researchers.

Not only are you likely to lower your cholesterol levels, you may be able to avoid having to take cholesterol medication, or having to increase your dose if you’re already taking one. And you’ll probably lose weight in the process, which also helps your heart.

The new results, published in the February issue of the Journal of the American Dietetic Association, are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians at 24 sites in 11 states.

In the group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before they changed or added medication, 44.6 percent either reduced their levels of “bad” cholesterol by at least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient’s life.

All of the R.D.s in the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association’s 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, the ADA has updated the clinical guideline based on new research, which means that patients who see an R.D. today may have even more success.

The study was funded by the ADA and its Clinical Nutrition Management Dietetic Practice Group, and based on a framework developed for a pilot project carried out in Michigan by the Michigan Dietetic Association and led by U-M cardiovascular dietitians.

“Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely,” says lead author Kathy Rhodes, Ph.D., R.D., manager of Nutrition Services with the U-M Cardiovascular Medicine program at Domino’s Farms and the U-M Cardiovascular Center. “But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the best evidence.”

Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing “healthy” fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.

Called the Lipid Management Nutrition Outcomes Project or LMNOP, the national study was launched by Rhodes and her U-M colleagues Melvyn Rubenfire, M.D., and Martha Weintraub, MPH, R.D., after the successful completion of the Michigan-wide pilot project. Rubenfire, Weintraub and Christina Biesemeier, M.S., R.D., FADA, of Vanderbilt University are co-authors of the new study.

The study gives us an important “real world” picture of what happens when R.D.s try to implement evidence-based nutrition guidelines in daily practice, Rhodes notes.

Some commercial health insurance plans are beginning to cover appointments with registered dietitians, but many still do not. Only dietitian visits for diabetes or kidney disease are covered by Medicare. It is important for people to check their specific health insurance plan to see whether nutrition is covered, Rhodes says. But even if individuals need to pay for the appointments out of their own pocket, they may find that an R.D.’s advice will pay off in the long run, she says.

To get uniform data, the researchers brought lead R.D.s from each state to U-M for training on the cholesterol and nutrition guidelines, and on the data collection practices used in the study. R.D.s at Veterans Affairs hospitals got their training by phone conferencing. R.D.s then returned to their own practices, trained their colleagues and implemented the ADA guidelines.

The study included only patients between the ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status. Neither the R.D.s nor their patients were paid to participate in the study.

The “real world” aspect of this study included the disappointing finding that many patients dropped out of nutrition counseling after one or two visits, when three or four sessions with an R.D. is recommended to make and sustain truly effective changes in eating habits. Lack of insurance coverage was a major factor in this dropout rate.

Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn’t have any change in their medication status, the impact of the R.D. counseling became apparent in the first year after the initial visit.

“Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient’s knowledge of ‘cardioprotective foods’ and assist them in individualizing the guidelines to fit their preferences and lifestyle,” says Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased the number of days each week on which they exercised for 30 minutes or more.

“Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R.D., their care team may not allow enough time to see how effective diet is before they add additional treatment,” says Rhodes. “We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too.”

To learn more about how eating habits can influence cholesterol levels, or to find an R.D., visit the ADA’s web site at www.eatright.org. For more on U-M Cardiovascular Medicine and its nutrition services, visit www.med.umich.edu/cvc/prevention. Reference: JADA, Vol. 108, No. 2, Feb. 2008.

As the warm-weather months approach, many families will be making vacation plans for their spring and summer breaks. And while these trips can be fun, they can also be stressful—especially when it comes to dealing with unexpected health issues.

But Stephen Park, M.D., assistant professor of pediatrics and communicable diseases at the University of Michigan C.S. Mott Children’s Hospital, says that parents can alleviate this stress by preparing for health situations before they take off on their next family getaway.

“We as parents pay a lot of attention to things like packing toys and packing clothes, but sometimes we don’t pay as much attention to preparing for potential or anticipated health issues,” explains Park.

He offers these health tips for families planning their next trip:

Create a travel kit.

“One of the first things I think we can do as parents is to take along the essentials. You can develop a travel health kit that you can use not only to travel, but to have around the house and use for local travel,” says Park.

The kit should include medicines that a child takes regularly as well as preparatory medicines for sudden ailments, such as congestion or a rash. Park recommends packing a fever reducer, an antihistamine, bandages and a topical antibiotic ointment. He does not generally recommend packing an anti-diarrhea medicine for “travelers’ diarrhea,” which is often associated with traveling overseas. Instead, he suggests consulting your regular physician to learn about antibiotics that treat bacterial infections that can cause diarrhea.

Park also encourages parents to consider various factors of the vacation, such as the destination’s climate, as they pack their health kit. Going somewhere sunny? Bring plenty of sunscreen, as well as aloe vera to relieve the pain of sunburns. And don’t forget the insect repellent, netting and poison ivy treatments if you anticipate spending much time outdoors.

Prepare for your mode of transportation. Sometimes the traveling itself can cause the most headaches for parents. One main problem with air travel is that children’s ears are particularly sensitive to changes in barometric pressure. Park recommends feeding a small child during take-off and landing to generate a suck and swallow motion that will help alleviate ear pain. Older children can chew gum or blow bubbles for relief. He also advises sitting in the middle of the plane over the wings if a child is prone to motion sickness.

Traveling by car instead? Park says that the best way to avoid motion sickness is through prevention. Discourage your children from reading in the car or looking down, and tell them to focus their eyes on a point in front of them if they begin to feel ill.

Research. As you make your travel plans, find out the location of the closest urgent care center, night-time care center and emergency room. Park notes that many hotels coordinate with local health care providers, and some resorts offer health care services on site or within a complex nearby. And be sure to bring the phone number of your regular physician with you in case you need any medical questions answered by phone, he advises.

Be patient. Traveling throws off normal routines, which can often leave a child—as well as a parent—a bit grumpy. Park says parents should mentally prepare themselves for the fact that children may act out as they transition to traveling.

“One of the biggest concerns of parents when they are traveling with children is not so much about health, but about behavior,” he explains. “Parents need to relax as much as possible and plan ahead. Anticipate that children may be a little off while traveling, so be patient with routines.”

With your plans made and your health travel kit in tow, you are on your way to a trip that will be a bit less stressful, Park says.

“Traveling with children can be some of the most fun a family can have in growing as a family and spending that time together to see the world around us,” says Park. “By preparing a first aid kit, addressing health needs in advance and having a plan in case you need to seek health care services while you’re away, some pressure is taken off and a family can just have a great time.”

Individuals who are physically active during their leisure time appear to be biologically younger than those with sedentary lifestyles, according to a report in the January 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Regular exercisers have lower rates of cardiovascular disease, type 2 diabetes, cancer, high blood pressure, obesity and osteoporosis, according to background information in the article. “A sedentary lifestyle increases the propensity to aging-related disease and premature death,” the authors write. “Inactivity may diminish life expectancy not only by predisposing to aging-related diseases but also because it may influence the aging process itself.”

Lynn F. Cherkas, Ph.D., of King’s College London, and colleagues studied 2,401 white twins, administering questionnaires on physical activity level, smoking habits and socioeconomic status. The participants also provided a blood sample from which DNA was extracted. The researchers examined the length of telomeres—repeated sequences at the end of chromosomes—in the twins’ white blood cells (leukocytes). Leukocyte telomeres progressively shorten over time and may serve as a marker of biological age.

Telomere length decreased with age, with an average loss of 21 nucleotides (structural units) per year. Men and women who were less physically active in their leisure time had shorter leukocyte telomeres than those who were more active. “Such a relationship between leukocyte telomere length and physical activity level remained significant after adjustment for body mass index, smoking, socioeconomic status and physical activity at work,” the authors write. “The mean difference in leukocyte telomere length between the most active [who performed an average of 199 minutes of physical activity per week] and least active [16 minutes of physical activity per week] subjects was 200 nucleotides, which means that the most active subjects had telomeres the same length as sedentary individuals up to 10 years younger, on average.” A sub-analysis comparing pairs in which twins had different levels of physical activity showed similar results.

Oxidative stress—damage caused to cells by exposure to oxygen—and inflammation are likely mechanisms by which sedentary lifestyles shorten telomeres, the authors suggest. In addition, perceived stress levels have been linked to telomere length. Physical activity may reduce psychological stress, thus mitigating its effect on telomeres and the aging process.

“The U.S. guidelines recommend that 30 minutes of moderate-intensity physical activity at least five days a week can have significant health benefits,” the authors write. “Our results underscore the vital importance of these guidelines. They show that adults who partake in regular physical activity are biologically younger than sedentary individuals. This conclusion provides a powerful message that could be used by clinicians to promote the potential anti-aging effect of regular exercise.”

Editor’s Note: This study was supported in part by a grant from the Welcome Trust, grants from the National Institutes of Health and a grant from The Healthcare Foundation of New Jersey. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

by Dr. Divyakant B. Gandhi

The heart performs two primary functions in the body. The right side of the heart collects deoxygenated blood from the body and pumps it into the lungs, that purify, filter, and oxygenate the blood. The left side of the heart, then, collects the blood from the lungs and pumps it throughout the body to maintain its oxygen, nutritional and metabolic requirements. These functions are carried out by well-designed and synchronous actions of the top and bottom chambers of the heart, along with careful and coordinated actions of the valves of the heart. Overall, this is maintained by the electrical system of the heart, which was discussed in detail in the October 2007 issue of Healthy& Fit Magazine. Any failure of the cyclical function of the heart at any level results in a condition which may lead to congestive heart failure (CHF).

As one can imagine, a lot of conditions could lead to heart failure. In order to simplify the understanding of various causes of CHF, the medical community has proposed a number of classifications—none of which encompass all known causes of CHF. Therefore, in order to understand this, the utilization of multiple classifications is necessary but may often lead to confusion and conflicting opinions regarding management strategy of various conditions.

Broadly speaking, the causes of CHF include:

• Hypertension and Coronary Artery Disease - commonest in the older population, accounting for about 75% of cases within that age group.
• Diseases of the Heart Valves – Aortic Stenosis and Regurgitation and Mitral Stenosis and Regurgitation. The latter was discussed in the November 2007 issue of Healthy & Fit Magazine.
• Cardiomyopathy – heterogeneous group of diseases of the heart muscle associated with mechanical or electrical dysfunction causing dilation and/or thickening of the lower chambers of the heart. This may be:
• Primary – predominantly confined to the heart muscle, either genetic or

Acquired;
• Secondary - involving the heart muscle as a part of generalized multiorgan disorders.
• Pericarditis – inflammation, along with fibrosis, of the membrane covering the heart causing restriction of the movement of the heart.
• Arrhythmia
• Atrial Fibrillation - usually rapid and irregular heartbeat (October 2007 Issue of Healthy & Fit Magazine)
• Ventricular Arrhythmias – (i.e. Ventricular Tachycardia) Bradycardia – slower-than-normal heart rate (i.e. complete heart block)
• Tachycardia – any type of persistent, rapid heartbeat

The symptoms of CHF that one may experience are varied and not always apparent. Due to the fact that CHF is usually slow to develop, people in the very early stages of this disease may not notice any symptoms at all; while others will dismiss their symptoms as being age-related. Still, many individuals will have obvious and persistent symptoms such as:

• Shortness of breath, especially with physical activities or exercise
• Orthopnea – difficulty breathing unless sitting up straight or standing erect
• Swelling of the feet and legs
• Lack of energy or general feeling of tiredness or lethargy
• Swollen or tender abdomen, loss of appetite
• Cough with “frothy” sputum
• Increased urination at night
• Confusion, impaired memory

The statistics reported by The American Heart Association exemplify the scope of the problem that our healthcare system faces. Individuals over the age of 40 have a 1 in 5 chance of developing CHF. At the present time, 5 million people in the United States suffer from Congestive Heart Failure—with 550,000 new cases being diagnosed each year, thus, accounting for a significant financial burden on America’s healthcare system.

Fortunately, a team approach to the management of this debilitating condition could improve the quality of life and longevity for these patients. Diagnosis of the cause of this condition is the pillar on which the entire treatment is based. As can be concluded from the multitude of causes of this condition, a large number of tests may be necessary in order to diagnose the problem.

These tests may include a Chest X-ray, EKG, Echocardiogram, Stress Tests, Nuclear Studies, MRI, CT Angiogram and Cardiac Catheterization. Laboratory blood tests are necessary and include blood count, kidney function tests, electrolytes studies, hormonal studies, and genetic testing.

The goals of treatment for CHF are improvement in quality of life, avoid occurrences of acute episodes of decompensation and hospitalization and improved length of survival. This goal also includes the reduction in the likelihood of irregular heartbeats and sudden death syndromes.

The use of medications is the mainstay of treatment for CHF in a large proportion of patients. A large number of medications are available, and multiple regimens may be necessary to ensure optimal response. These options should be carefully monitored by the healthcare provider, including doctors and nurse practitioners. More importantly, lifestyle changes including dietary restrictions, weight loss, smoking and alcohol cessation, are the pillars of successful long-term management of this debilitating condition.

Certain conditions causing CHF have surgical treatment options, and these will be discussed in detail in the February issue of Healthy & Fit Magazine.

A single dose of buckwheat honey before bedtime provided the greatest relief from cough and sleep difficulty compared with no treatment and an over-the-counter cough medicine in children with upper respiratory tract infections, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

“Cough is the reason for nearly 3 percent of all outpatient visits in the United States, more than any other symptom, and it most commonly occurs in conjunction with an upper respiratory tract infection,” the authors write as background information in the article. Cough is usually more bothersome at night because it disrupts sleep. Although unsupported by the American Academy of Pediatrics or the American College of Chest Physicians, dextromethorphan is the most commonly used over-the-counter remedy for children’s cough. “In many cultures, alternative remedies such as honey are used to treat upper respiratory tract infection symptoms including cough.”

Ian M. Paul, M.D., M.Sc., and colleagues at Penn State College of Medicine, Hershey, conducted a study involving 105 children age 2 to 18 with upper respiratory tract infections who were sick for seven days or less and experienced symptoms during the night. Thirty-five children were randomly assigned to receive an age-appropriate dose of honey, 33 to receive dextromethorphan and 37 to receive no treatment for one night within 30 minutes of bedtime. The children’s parents were asked to complete a survey assessing their child’s cough and sleep difficulty the night before their assigned treatment and then again the night after treatment.

Honey was found to yield the greatest improvement followed by dextromethorphan, while no treatment showed the least improvement in cough frequency, cough severity, cough bothersome to child, child’s sleep and parent’s sleep. “In paired comparisons, honey was significantly superior to no treatment for cough frequency and the combined score, but dextromethorphan was not better than no treatment for any outcome,” the authors write. “Comparison of honey with dextromethorphan revealed no significant differences.”

“While our findings and the absence of contemporary studies supporting the use of dextromethorphan continue to question its effectiveness for the treatment of cough associated with upper respiratory tract infections, we have now provided evidence supporting honey, which is generally regarded as safe for children older than 1 year, as an alternative,” the authors conclude. “While additional studies to confirm our findings should be encouraged, each clinician should consider the findings for honey, the absence of such published findings for dextromethorphan and the potential for adverse effects and cumulative costs associated with the use of dextromethorphan when recommending treatments for families.”