Tai chi improves pain in arthritis sufferers

The results of a new analysis have provided good evidence to suggest that Tai Chi is beneficial for arthritis. Specifically, it was shown to decrease pain with trends towards improving overall physical health, level of tension and satisfaction with health status.

Musculoskeletal pain, such as that experienced by people with arthritis, places a severe burden on the patient and community and is recognized as an international health priority. Exercise therapy including such as strengthening, stretching and aerobic programs, have been shown to be effective for arthritic pain. Tai Chi, is a form of exercise that is regularly practiced in China to improve overall health and well-being. It is usually preformed in a group but is also practiced individually at one’s leisure, which differs from traditional exercise therapy approaches used in the clinic.

Recently, a new study examined the effectiveness of Tai Chi in decreasing pain and disability and improving physical function and quality of life in people with chronic musculoskeletal pain. The study is published in the June issue of Arthritis Care & Research. Led by Amanda Hall of The George Institute in Sydney, Australia, researchers conducted a systematic review and meta-analysis. They analyzed seven eligible randomized controlled trials that used Tai Chi as the main intervention for patients with musculoskeletal pain. The results demonstrate that Tai Chi improves pain and disability in patients suffering arthritis.

The authors state, “The fact that Tai Chi is inexpensive, convenient, and enjoyable and conveys other psychological and social benefits supports the use this type of intervention for pain conditions such as arthritis.”

“It is of importance to note that the results reported in this systematic review are indicative of the effect of Tai Chi versus minimal intervention (usual health care or health education) or wait list control,” the authors note. Establishing the specific effects of Tai Chi would require a placebo-controlled trial, which has not yet been undertaken.

Exercise more, not less, to ease aching back

People with lower back pain are better off exercising more, not less, according to a University of Alberta study.

The study followed 240 men and women with chronic lower-back pain and showed that those who exercised four days a week had a better quality of life, 28% less pain and 36% less disability, while those who hit the gym only two or three days a week did not show the same level of change.

“While it could be assumed that someone with back pain should not be exercising frequently, our findings show that working with weights four days a week provides the greatest amount of pain relief and quality of life,” said Robert Kell, lead author of the study and an assistant professor of exercise physiology at the University of Alberta, Augustana Campus.

About 80% of North Americans suffer from lower back pain.

In the study, groups of 60 men and women with chronically sore lower backs each exercised with weights in two, three or four-day weekly programs, or not at all. Their progress was measured over 16 weeks.

The level of pain decreased by 28% in programs that included exercise four days a week, by 18% three days a week and by 14% two days a week. The quality of life, defined as general physical and mental well-being, rose by 28%, 22% and 16% respectively.

BPA found to leach from polycarbonate bottles into humans

Attention parents, athletes, and everyone using plastic bottles. Let the debate about the dangers of bisphenol A (BPA) and whether or not it leaches finally come to an end.

A new study from Harvard School of Public Health (HSPH) researchers found that participants who drank for a week from polycarbonate bottles - the popular, hard-plastic used in drinking bottles and baby bottles - showed a two-thirds increase in their urine of the chemical BPA. Exposure to BPA, used in the manufacture of polycarbonate and other plastics, has been shown to interfere with reproductive development in animals and has been linked with cardiovascular disease and diabetes in humans. The study is the first to show that drinking from polycarbonate bottles increased the level of urinary BPA, and thus suggests that drinking containers made with BPA release the chemical into the liquid that people drink in sufficient amounts to increase the level of BPA excreted in human urine.

The study appears on the website of the journal Environmental Health Perspectives and is freely available at http://www.ehponline.org/members/2009/0900604/0900604.pdf.

In addition to polycarbonate bottles, which are refillable and a popular container among students, campers and others and are also used as baby bottles, BPA is also found in dentistry composites and sealants and in the lining of aluminum food and beverage cans. In bottles, polycarbonate can be identified by the recycling number 7. Numerous studies have shown that it acts as an endocrine-disruptor in animals, including early onset of sexual maturation, altered development and tissue organization of the mammary gland and decreased sperm production in offspring. It may be most harmful in the stages of early development.

“We found that drinking cold liquids from polycarbonate bottles for just one week increased urinary BPA levels by more than two-thirds. If you heat those bottles, as is the case with baby bottles, we would expect the levels to be considerably higher. This would be of concern since infants may be particularly susceptible to BPA’s endocrine-disrupting potential,” said Karin B. Michels, associate professor of epidemiology at HSPH and Harvard Medical School and senior author of the study.

The researchers, led by first author Jenny Carwile, a doctoral student in the department of epidemiology at HSPH, and Michels, recruited Harvard College students for the study in April 2008. The 77 participants began the study with a seven-day “washout” phase in which they drank all cold beverages from stainless steel bottles in order to minimize BPA exposure. Participants provided urine samples during the washout period. They were then given two polycarbonate bottles and asked to drink all cold beverages from the bottles during the next week; urine samples were also provided during that time.

The results showed that the participants’ urinary BPA concentrations increased 69% after drinking from the polycarbonate bottles. (The study authors noted that BPA concentrations in the college population were similar to those reported for the U.S. general population.) Previous studies had found that BPA could leach from polycarbonate bottles into their contents; this study is the first to show a corresponding increase in urinary BPA concentrations in humans.

One of the study’s strengths, the authors note, is that the students drank from the bottles in a normal use setting. Additionally, the students did not wash their bottles in dishwashers nor put hot liquids in them; heating has been shown to increase the leaching of BPA from polycarbonate, so BPA levels might have been higher had students drunk hot liquids from the bottles.

Canada banned the use of BPA in polycarbonate baby bottles in 2008 and some polycarbonate bottle manufacturers have voluntarily eliminated BPA from their products. With increasing evidence of the potential harmful effects of BPA in humans, the authors believe further research is needed on the effect of BPA on infants and on reproductive disorders and on breast cancer in adults.

“This study is coming at an important time because many states are deciding whether to ban the use of BPA in baby bottles and sippy cups. While previous studies have demonstrated that BPA is linked to adverse health effects, this study fills in a missing piece of the puzzle—whether or not polycarbonate plastic bottles are an important contributor to the amount of BPA in the body,” said Carwile.

Patients with chronic pain may need more vitamin D

A new study by the Mayo Clinic shows a correlation between inadequate vitamin D levels and the amount of narcotic medication taken by patients who have chronic pain. This correlation is an important finding as researchers discover new ways to treat chronic pain. According to the Centers for Disease Control and Prevention, chronic pain is the leading cause of disability in the United States. These patients often end up taking narcotic-type pain medication such as morphine, fentanyl or oxycodone.

This study found that patients who required narcotic pain medication, and who also had inadequate levels of vitamin D, were taking much higher doses of pain medication — nearly twice as much — as those who had adequate levels. Similarly, these patients self-reported worse physical functioning and worse overall health perception. In addition, a correlation was noted between increasing body mass index (a measure of obesity) and decreasing levels of vitamin D.

“This is an important finding as we continue to investigate the causes of chronic pain,” says Michael Turner, M.D., a physical medicine and rehabilitation physician at Mayo Clinic and lead author of the study. “Vitamin D is known to promote both bone and muscle strength. Conversely, deficiency is an under-recognized source of diffuse pain and impaired neuromuscular functioning. By recognizing it, physicians can significantly improve their patients’ pain, function and quality of life.”

Researchers retrospectively studied 267 chronic pain patients admitted to the Mayo Comprehensive Pain Rehabilitation Center in Rochester from February to December 2006. Vitamin D levels at the time of admission were compared to other parameters such as the amount and duration of narcotic pain medication usage; self-reported levels of pain, emotional distress, physical functioning and health perception; and demographic information such as gender, age, diagnosis and body mass index.

This study has important implications for both chronic pain patients and physicians. “Though preliminary, these results suggest that patients who suffer from chronic, diffuse pain and are on narcotics should consider getting their vitamin D levels checked. Inadequate levels may play a role in creating or sustaining their pain,” says Dr. Turner.

“Physicians who care for patients with chronic, diffuse pain that seems musculoskeletal — and involves many areas of tenderness to palpation — should strongly consider checking a vitamin D level,” he says. “For example, many patients who have been labeled with fibromyalgia are, in fact, suffering from symptomatic vitamin D inadequacy. Vigilance is especially required when risk factors are present such as obesity, darker pigmented skin or limited exposure to sunlight.”

Assessment and treatment are relatively simple and inexpensive. Levels can be assessed by a simple blood test (25-hydroxyvitamin D [25(OH)D]). Under the guidance of a physician, an appropriate repletion regimen can then be devised. Because it is a natural substance and not a drug, vitamin D is readily available and inexpensive.

In addition to the benefits of strong muscles and bones, emerging research demonstrates that vitamin D plays important roles in the immune system, helps fight inflammation and helps fights certain types of cancer.

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 3,300 physicians, scientists and researchers and 46,000 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year.

Benefits of exercise on quitting smoking

Research from the University of Exeter reveals for the first time, that changes in brain activity, triggered by physical exercise, may help reduce cigarette cravings. The study shows how exercise changes the way the brain processes information among smokers, thereby reducing their cravings for nicotine. For the first time, researchers used functional Magnetic Resonance Imaging (fMRI) to investigate how the brain processes images of cigarettes after exercise.

The study adds weight to a growing body of evidence that exercise can help manage addiction to nicotine and other substances. It backs up previous studies, which have shown that just one short burst of moderate exercise can significantly reduce smokers’ nicotine cravings.

Ten regular smokers were asked to cycle at a moderate pace for ten minutes, after 15 hours of abstinence from nicotine. They were then given an fMRI scan while they viewed a series of 60 images. Some visuals featured cigarettes and would normally induce cravings in a smoker. On a second occasion, the same group was given an fMRI scan and shown the same series of images without having undertaken exercise. They were also asked to report on their cravings for nicotine during both phases of the study.

The brain images captured by the fMRI show a difference between the two conditions. After no exercise the smokers showed heightened activity in response to the images in areas of the brain associated with reward-processing and visual attention. After exercise the same areas of activation were not observed, which reflected a kind of ‘default mode’ in the brain. The smokers also reported lower cravings for cigarettes after exercise compared with when they had been inactive.

The researchers do not know exactly what caused the difference in brain activity following exercise. One suggestion is that completing exercise raises mood (possibly through increases in dopamine) which reduces the salience or importance of wanting a cigarette. Another possibility is that exercise causes a shift in blood flow to areas of the brain less involved in anticipation of reward and pleasure generated by smoking images.

Previous research by the University of Exeter has suggested that exercise can reduce nicotine cravings. Results from a series of studies show that smokers report reduced cigarette cravings after exercising. This study showed that exercise can reduce cravings when smokers are faced with images that have been previously shown to cause lapses in smokers trying to quit. This is the first time that anyone has investigated brain activity during this process.

Kate Janse Van Rensburg, a PhD student at the University of Exeter, lead author on the paper, says, “Our findings add to a growing body of evidence suggesting that exercise can help people give up smoking. This strengthens the argument that moderate exercise could be a viable alternative to many of the pharmaceutical products, such as nicotine patches, for people who want to give up smoking. A ten or fifteen minute walk, jog or cycle when times get tough could help a smoker kick the habit. There are of course many other benefits from a more active lifestyle including better fitness, weight loss and improved mood.”

Vigorous exercise may help prevent vision loss

There’s another reason to dust off those running shoes. Vigorous exercise may help prevent vision loss, according to a pair of studies from the U.S. Department of Energy’s Lawrence Berkeley National Laboratory. The studies tracked approximately 41,000 runners for more than seven years, and found that running reduced the risk of both cataracts and age-related macular degeneration.

The research, which is among the first to suggest that vigorous exercise may help prevent vision loss, offers hope for people seeking to fend off the onset of eye disease.

“In addition to obtaining regular eye exams, people can take a more active role in preserving their vision,” says Paul Williams, an epidemiologist in Berkeley Lab’s Life Sciences Division who conducted the research. “The studies suggest that people can perhaps lessen their risk for these diseases by taking part in a fitness regimen that includes vigorous exercise.”

A cataract, which is a cloudy opacity of the eye lens, is the leading cause of blindness. More than one-half of people in the U.S. over the age of 65 suffer from some form of cataracts. Age-related macular degeneration, which is damage to the retina, is the leading cause of irreversible vision loss in older white Americans, affecting 28 percent of people aged 75 and older.

The diseases have several known risk factors, such as sunlight exposure and diabetes in the case of cataracts, but few interventions. Now, it appears that vigorous cardiovascular exercise may be one way to derail the diseases.

To conduct the research, Williams analyzed data collected in the National Runners’ Health Study, which he established in 1991 to determine the health benefits of running.

In this case, he followed approximately 29,000 male runners and 12,000 female runners for more than seven years. Of these people, 733 men reported being diagnosed with cataracts on a questionnaire filled out at the end of the study. Too few women reported cataracts to track.

Men who ran more than 5.7 miles per day had a 35% lower risk of developing cataracts than men who ran less than 1.4 miles per day. The study also analyzed men’s 10-kilometer race performances, which is a good indicator of overall fitness. The fittest men boasted one-half the risk of developing cataracts compared to the least-fit men.

A second study found that running appeared to reduce the risk of age-related macular degeneration. In the study, 152 men and women reported being diagnosed with the disease. Compared to people who ran less than 1.2 miles per day, people who averaged between 1.2 and 2.4 miles per day had a 19% lower risk for the disease, and people who ran more than 2.4 miles per day had between 42% and 54% lower risk of the disease.

“These findings are compelling because of the large size of the study, and the fact that we are looking at something that is fairly well defined: vigorous exercise, as opposed to more moderate exercise,” says Williams.

Most of the runners in the study exceeded the current public health recommendations for physical activity, which is at least 30 minutes of moderate-intensity activities such as brisk walking five days a week, or smaller doses of more vigorous exercise such as running. It is unclear whether people might also lower their risk for cataracts and age-related macular degeneration by walking.

“We know there are important health benefits to walking, including lowering heart disease risk,” says Williams. “It is quite likely that the studies’ results might apply to a lesser extent to smaller doses of more moderate exercise.”

Williams also adds that further research is needed to explore why there is a link between vigorous exercise and a decreased risk for eye disease.

“We know some of the physiological benefits of exercise, and we know about the physiological background of these diseases, so we need to better understand where there’s an overlap,” says Williams.

Omega-3s ease depression related to menopause

Omega-3s ease psychological distress and depressive symptoms often suffered by menopausal and perimenopausal women, according to researchers at Université Laval’s Faculty of Medicine. Their study, published in the February issue of The American Journal of Clinical Nutrition, presents the first evidence that omega-3 supplements are effective for treating common menopause-related mental health problems.

Dr. Michel Lucas and colleagues recruited 120 women age 40 to 55 and divided them into two groups. Women in the first group took three gel capsules containing a total of one gram of EPA, an omega-3 fatty acid of marine origin, every day for eight weeks. Those in the second group followed the same protocol, but took gel capsules containing sunflower oil without EPA.

Test results before and after the eight-week period indicate that omega-3s significantly improved the condition of women suffering symptoms of psychological distress and mild depression. “The differences we observed between the two groups are noteworthy,” commented Dr Lucas, “especially considering that omega-3s have very few side effects and are beneficial to cardiovascular health.” However, no positive effect was observed among a small group of women with more severe depressive symptoms.

Women with hot flashes also noted that their condition improved after consuming omega-3s. At baseline, the number of daily hot flashes was 2.8 and dropped by an average of 1.6 in the group taking omega-3s and by 0.5 in the control group. The change that can be attributed to the use of omega-3s, i.e. a decrease of 1.1 hot flashes per day, is equivalent to results obtained with hormone therapy and antidepressants. Details of these results were published in the November 20, 2008 online edition of the journal Menopause.

Many women suffer from depressive symptoms during menopause and perimenopause. Some take antidepressants for relief even though their effectiveness is controversial. Mistrust of hormone therapy and antidepressants leads certain women to turn to alternative methods whose effectiveness has not yet been scientifically demonstrated. This study by Université Laval researchers corrects this situation with regard to marine-sourced omega-3s.