Tag Archives: prevention

Holidays are a great time to obtain a family medical history

Healthcare professionals have known for a long time that common diseases (like heart disease, cancer, and diabetes) as well as some rare diseases (like hemophilia, cystic fibrosis, and sickle cell anemia) can run in families. If one generation of a family has high blood pressure, it is not unusual for the next generation to have similarly high blood pressure. Tracing the illnesses suffered by your parents, grandparents, and other blood relatives can help your doctor predict the disorders to which you may be at risk and take action to keep you and your family healthy.

To help focus attention on the importance of family history, the Surgeon General has launched a national public health campaign called the Surgeon General’s Family History Initiative, to encourage all American families to learn more about their family health history.

A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family’s health history.

Because family health history is such a powerful screening tool, the Surgeon General has created a new computerized tool to help make it fun and easy for anyone to create a sophisticated portrait of their family’s health.

The “My Family Health Portrait” tool is a Web-enabled program that runs on any computer that is connected to the Web and running an up-to-date version of any major Internet browser. The new version of the tool offers numerous advantages over previous versions, which had to be downloaded to the user’s computer.

The Web-based tool helps users organize family history information and then print it out for presentation to their family doctor. In addition, the tool helps users save their family history information to their own computer and even share family history information with other family members. You can access the My Family Health Portrait Web tool here.

Each year since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Learning about their family’s health history may help ensure a longer, healthier future together.

ABC News interviewed NIH Director Dr. Francis Collins yesterday and he advised all of us to learn about their families’ medical histories during the holidays. Collins said, “There is a tool that the Surgeon General has put together which is freely available on the Web to allow people to collect their own family medical history, and then present it to their physicians in a way that can start a conversation. This would be the single most important thing to do as far as assessing your genetic risks for future illness. DNA tests can help with that in many situations, but it’s always good to start with the family history.”

The Formula for Good Health = 0, 5, 10, 30, 150

An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:

  • 0 = no cigarettes or tobacco products
  • 5 = five servings of fruits and vegetables per day
  • 10 = ten minutes of silence, relaxation, prayer, or meditation per day
  • 30 = keep your BMI (body mass index) below 30
  • 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)

The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:

It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?

Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.

But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.

There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.

Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.

Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.

There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.

The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)

The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.

Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)

In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.

Address correspondence to Colin Kopes-Kerr, MD, at cpkerr@nni.com. Reprints are not available from the author.

Author disclosure: Nothing to disclose.

REFERENCES

  1. Stampfer  MJ, Hu  FB, Manson  JE, et al.  Primary prevention of coronary heart disease in women through diet and lifestyle.  N Engl J Med.  2000;343(1):16–22. View here
  2. Hu  FB, Manson  JE, Stampfer  MJ, et al.  Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.  N Engl J Med.  2001;345(11):790–797. View here
  3. Forman  JP, Stampfer  MJ, Curhan  GC.  Diet and lifestyle risk factors associated with incident hypertension in women.  JAMA.  2009;302(4):401–411. View here
  4. Knowler  WC, Barrett-Connor  E, Fowler  SE, et al.; Diabetes Prevention Program Research Group.  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med.  2002;346(6):393–403. View here
  5. Knoops  KT, de Groot  LC, Kromhout  D, et al.  Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.  JAMA.  2004;292(12):1433–1439. View here
  6. Yusuf  S, Hawken  S, Ounpuu  S, et al.; INTERHEART Study Investigators.  Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study.  Lancet.  2004;364(9438):937–952. View here
  7. Rosengren  A, Hawken  S, Ounpuu  S, et al.; INTERHEART Investigators.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.  Lancet.  2004;364(9438):953–962. View here
  8. Chiuve  SE, McCullough  ML, Sacks  FM, et al.  Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications.  Circulation.  2006;114(2):160–167. View here
  9. Chiuve  SE, Rexrode  KM, Spiegelman  D, et al.  Primary prevention of stroke by healthy lifestyle.  Circulation.  2008;118(9):947–954. View here
  10. Kurth  T, Moore  SC, Gaziano  JM, et al.  Healthy lifestyle and the risk of stroke in women.  Arch Intern Med.  2006;166(13):1403–1409. View here
  11. King  DE, Mainous  AG  III, Geesey  ME.  Turning back the clock: adopting a healthy lifestyle in middle age.  Am J Med.  2007;120(7):598–603. View here
  12. Khaw  KT, Wareham  N, Bingham  S, et al.  Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70].  PLoS Med.  2008;5(1):e12. View here
  13. Ford  ES, Bergmann  MM, Kröger  J, et al.  Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study.  Arch Intern Med.  2009;169(15):1355–1362. View here
  14. Lee  CD, Sui  X, Blair  SN.  Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men.  Arch Intern Med.  2009;169(22):2096–2101. View here
  15. Djoussé  L, Driver  JA, Gaziano  JM.  Relation between modifiable lifestyle factors and lifetime risk of heart failure.  JAMA.  2009;302(4):394–400. View here
  16. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
  17. Dialogue Partner. View here
  18. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here

Pre-Run Stretch May Hurt Endurance

Runners who stretch before a run expended more energy and run shorter distances, according to a new study. Here are the details from WebMD:

Some runners swear by their pre-run stretch as a sure-fire way to run better and stronger and reduce their risk of injury in the process.

But according to a new study, distance runners who stretch before a run may not perform as well and may spend more energy than runners who skip the stretch.

”Overall, I don’t think it’s worth it to stretch before a run,” researcher Jacob M. Wilson, PhD, assistant professor of exercise science and sport studies at the University of Tampa, tells WebMD. “After a run, if someone is trying to work on flexibility, that’s fine.”

Although his study was done only on male runners who were young and highly trained, Wilson speculates that the findings would apply to recreational runners and to female runners as well.

The study was published in the Journal of Strength and Conditioning Research.

Stretching Before a Run: The Study

Wilson evaluated 10 runners, all men, who were on average 25 years old. They were in good shape with a low percent of body fat — just under 7%, on average.

All runners participated in a 60-minute treadmill run on two different days separated by at least one week. One time, they stretched for 16 minutes before running and the other time they just sat quietly for the same time period.

The pre-run stretches were static — stretching a muscle to the maximum length and holding it — and included all the major muscle groups of the lower body.

After the stretching or the sitting, the runners did a 30-minute warm-up run, then a 30-minute performance run. Each time, the runners were told to run as far as possible during the performance part, but they couldn’t see distance or speed on the treadmill display panel.

Without stretching, the runners averaged 6 kilometers or 3.7 miles in the half-hour performance run, Wilson tells WebMD. With stretching, they averaged 5.8 km or 3.6 miles, a difference of 3.4%.While the difference seems small, it could add up during a competitive event.

“One of the reasons why stretching impairs performance is it probably causes muscle damage,” Wilson says, referring to tiny, micro tears.

Previous research by others has looked at stretching and the effects on sprinting or vertical jumping, Wilson says. “Ninety percent have found declines in performance.”

He says that “ours is one of the first to look at stretching and endurance performance, and we saw decrements.”

Stretching also resulted in a higher number of calories burned. When runners stretched before they ran, they burned 425 calories, on average, during the warm-up run. When they didn’t stretch, they burned 405 calories, on average.

Stretching and Performance

Whether to stretch before running or not is ”an individual choice,” says Ryan Lamppa, a spokesman for Running USA, which promotes the growth of the U.S. running industry. He has coached distance runners and is a runner.

“I know runners of all abilities,” he says. “Some stretch on a regular basis and some don’t. Many, like me, stretch after a run, when the muscles are warm and supple.”

“This study reinforces what I’ve heard in the sport at the top end: ‘You don’t see a cheetah stretch before the cat goes after [its] prey.'”

“This [study] is looking at a very select group of people,” says Cathy Fieseler, MD, member of the board of directors of the American Medical Athletic Association and a veteran marathoner and ultra-distance runner. A doctor in Tyler, Texas, she notes that the men studied had a low level of body fat and were regular runners. She says the finding that the pre-run stretch affected performance in high-level athletes is plausible, but she is not sure if the findings would apply to recreational or older runners.

She wonders, too, if the 16-minute stretching period made the runners more tired than the pre-run session of simply sitting, and if that may have affected performance.

The research is clear, she says, on another aspect of stretching. “There’s no study that says a pre-run stretch reduces the risk of injury.”

Her advice for endurance runners? She usually doesn’t recommend a pre-run stretch, but she does see the value of warming up. She tells runners: “Start off easy, do a mile or two. If you are sweating, your muscles are warmed up. Then you can pick up the pace.”

”The biggest thing is to start out slow.”

Prevention may not cut healthcare costs

Bloomberg News is reporting that while both Democrats and Republicans are asserting in the healthcare debate that “prevention saves money.” However, “economists and policy analysts who study the issue have a different message: Sorry, it doesn’t work that way.” Continue reading

Health Myth #10: Preventive Medicine Saves Money

According to a column by Charles Krauthammer, MD, “Obama (touts) prevention as amazingly dual-purpose: ‘It saves lives. It also saves money.’ Reform proponents repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.” Can this be true?

More Information: Continue reading