Exercise

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Hi All,

The following are pdf-available and not in Medline (yet for JAMA).

The first paper was from an obscure journal, but mentioned CR,

so it is included here, since the paper was about exercise.

Importance of Physical Activity,

Nutrition, and Social Support for Optimal Aging

JOYCE L. McREYNOLDS, BA, RN; EILEEN K. ROSSEN

Nurse specialist 18 (4), 2004, 201-26

...consistent optimal nutrition. In addition, clinical and epi-

demiological

studies in humans have found that dietary

restriction, reduction in food intake, and consumption of a

low-calorie diet (1600–2000 cal per day) may maximize

life spans and positively affect antiaging and disease pre-vention.

7 Furthermore, caloric restriction has been found

to decrease the risk of the most prominent age-related dis-eases

in humans, including cardiovascular disease, dia-betes,

and cancers; may delay age-related functional

deficits in the brain; reduce the risk of major neurodegen-erative

disorders including Alzheimer's and Parkinson's;

and may promote successful brain aging in humans.7...

And from the JAMA, September issue not in Medline comes:

The first is a synopsis of the paper of interest from " THIS WEEK IN

JAMA " .

Inactivity and Obesity as Health Risks in Women

JAMA, September 8, 2004—Vol 292, No. 10 1243

THIS WEEK IN JAMA

...Physical inactivity and obesity are closely linked established

risk factors for cardiovascular

disease (CVD) and type 2 diabetes; however, the relative contribution

of each alone is

not clear. Wessel and colleagues examined the relationship of obesity

and physical fit-ness

to CVD in women being evaluated for suspected myocardial ischemia.

They found

that women with higher self-reported physical fitness scores had a

less adverse CVD

profile than women with lower scores, whereas measures of obesity

were not indepen-dently

associated with CVD risk. In a second article, Weinstein and

colleagues examined

the association of physical activity and body mass index (BMI) with

incident type 2 dia-betes

in women. They found both BMI and physical inactivity to be

independent predic-tors

of incident diabetes, but the magnitude of risk from BMI was much

greater. In an

editorial, Blair and Church emphasize the benefits of increased

physical activity to dimin-ish

disease risks and improve health. ...

SEE PAGES 1179 AND 1188 AND EDITORIAL ON PAGE 1232

The second is the editorial for the two papers.

EDITORIAL

The Fitness, Obesity, and Health Equation

Is Physical Activity the Common Denominator?

1232-1234

...In summary, the majority of studies show that regular

physical activity has health benefits at any weight, and for

those who want or need to lose weight, physical activity is

a critical component of long-term weight management. Con-sequently,

physical activity promotion should be a founda-tion

of clinical therapy and public health policy, whether

to promote health or weight control. The medical commu-nity

needs to lead in communicating the importance of physi-cal

activity for health and weight maintenance. Just as weight

is addressed in some manner at nearly every physician visit,

so should attention be given to recommending the accu-mulation

of 30 minutes a day of moderate intensity physi-cal

activity at least 5 days of the week. This can be obtained

through brisk walking, bicycling, swimming, or activities

of daily life such as housework or gardening.

And, here are the two papers creating all the excitement.

R. Wessel, et al., and C. Noel Bairey Merz

Relationship of Physical Fitness vs Body Mass Index With

Coronary Artery Disease and Cardiovascular Events in Women

JAMA. 2004;292:1179-1187

Context Individual contributions of obesity and physical fitness

(physical activity and

functional capacity) to risk of coronary heart disease in women

remain unclear.

Objective To investigate the relationships of measures of obesity

(body mass index

[bMI], waist circumference, waist-hip ratio, and waist-height ratio)

and physical fit-ness

(self-reported Duke Activity Status Index [DASI] and Postmenopausal

Estrogen-Progestin

Intervention questionnaire [PEPI-Q] scores) with coronary artery

disease (CAD)

risk factors, angiographic CAD, and adverse cardiovascular (CV)

events in women evalu-ated

for suspected myocardial ischemia.

Design, Setting, and Participants The National Heart, Lung, and Blood

Institute–

sponsored Women's Ischemia Syndrome Evaluation (WISE) is a

multicenter prospec-tive

cohort study. From 1996-2000, 936 women were enrolled at 4 US

academic medi-cal

centers at the time of clinically indicated coronary angiography and

then assessed

(mean follow-up, 3.9 [sD, 1.8] years) for adverse outcomes.

Main Outcome Measures Prevalence of obstructive CAD (any angiographic

ste-nosis

50%) and incidence of adverse CV events (all-cause death or

hospitalization

for nonfatal myocardial infarction, stroke, congestive heart failure,

unstable angina,

or other vascular events) during follow-up.

Results Of 906 women (mean age, 58 [sD, 12] years) with complete

data, 19% were

of nonwhite race, 76% were overweight (BMI 25), 70% had low

functional capacity

(DASI scores 25, equivalent to 7 metabolic equivalents [METs]), and

39% had ob-structive

CAD. During follow-up, 337 (38%) women had a first adverse event, 118

(13%)

had a major adverse event, and 68 (8%) died. Overweight women were

more likely

than normal weight women to have CAD risk factors, but neither BMI

nor abdominal

obesity measures were significantly associated with obstructive CAD

or adverse CV events

after adjusting for other risk factors (P=.05 to .88). Conversely,

women with lower DASI

scores were significantly more likely to have CAD risk factors and

obstructive CAD (44%

vs 26%, P.001) at baseline, and each 1-MET increase in DASI score

was indepen-dently

associated with an 8% (hazard ratio, 0.92; 95% confidence interval,

0.85-0.99;

P=.02) decrease in risk of major adverse CV events during follow-up.

Conclusions Among women undergoing coronary angiography for suspected

is-chemia,

higher self-reported physical fitness scores were independently

associated with

fewer CAD risk factors, less angiographic CAD, and lower risk for

adverse CV events.

Measures of obesity were not independently associated with these

outcomes.

Amy R. Weinstein, et al and J. Gaziano, MD

Relationship of Physical Activity vs Body Mass Index With Type 2

Diabetes in Women

JAMA. 2004;292:1188-1194

Context Physical inactivity and body mass index (BMI) are

established independent

risk factors in the development of type 2 diabetes; however, their

comparative impor-tance

and joint relationship with diabetes are unclear.

Objective To examine the relative contributions and joint association

of physical ac-tivity

and BMI with diabetes.

Design, Setting, and Participants Prospective cohort study of 37878

women free

of cardiovascular disease, cancer, and diabetes with 6.9 years of

mean follow-up. Weight,

height, and recreational activities were reported at study entry.

Normal weight was

defined as a BMI of less than 25; overweight, 25 to less than 30; and

obese, 30 or

higher. Active was defined as expending more than 1000 kcal on

recreational activi-ties

per week.

Main Outcome Measure Incident type 2 diabetes, defined as a new self-

reported

diagnosis of diabetes.

Results During the follow-up, 1361 cases of incident diabetes

occurred. Individually,

BMI and physical activity were significant predictors of incident

diabetes. Compared with

normal-weight individuals, the multivariate-adjusted hazard ratio

(HR) was 3.22 (95%

confidence interval [CI], 2.69-3.87) for overweight individuals and

9.09 (95% CI, 7.62-

10.8) for obese individuals. For overall activity (kilocalories

expended per week), com-pared

with the least active first quartile, the multivariate-adjusted HRs

were 0.91 (95%

CI, 0.79-1.06) for the second quartile, 0.86 (95% CI, 0.74-1.01) for

the third, and 0.82

(95% CI, 0.70-0.97) for the fourth (P for trend=.01). In the combined

analyses, over-weight

and obese participants, whether active or inactive, had significantly

elevated risks,

compared with normal-weight active individuals. The multivariate-

adjusted HRs were 1.15

(95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-

5.15) for over-weight

active, 4.16 (95% CI, 3.05-5.66) for overweight inactive, 11.5 (95%

CI, 8.34-

15.9) for obese active, and 11.8 (95% CI, 8.75-16.0) for obese

inactive participants.

Conclusions Although BMI and physical inactivity are independent

predictors of in-cident

diabetes, the magnitude of the association with BMI was greater than

with physi-cal

activity in combined analyses. These findings underscore the critical

importance of

adiposity as a determinant of diabetes.

Cheers, Al Pater.