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Good News for Exercise, But Not Prostate Cancer Screening

Friday, October 29, 2010 // Uncategorized

4/2/2009 9:34:26 PM

OK.  I’m compulsive about exercise.  I no longer obsess over it.  Here are 3 recent articles that demonstrate,yet again, the benefits of exercise.

First, from the BMJ (British Medical Journal) is an article which details how four healthy behaviors reduce stroke risk in “older people”.  Their definition of “older people” was 40-79 years of age.

Healthy Behaviors Associated with Halving of Stroke Risk
Four behaviors combined — exercise, not smoking, healthy eating, and moderate drinking — are associated with a significant drop in stroke risk among older people, according to a BMJ study.
U.K. researchers ascertained the health behaviors of a cohort of some 20,000 adults aged 40 to 79. The group was then followed for an average of 11 years.
Over that period, those not engaging in any of four specific healthy behaviors had more than twice the risk for stroke as those engaging in all four — exercising regularly (or having a nonsedentary occupation), not smoking, eating five or more portions of fruits and vegetables daily, and drinking moderately. (The risk for stroke increased linearly with increasing numbers of unhealthy behaviors.)
An editorialist comments that modifying lifestyle behaviors “across a population has a greater potential for overall reduction in stroke than modifying more powerful risk factors (such as carotid stenosis and atrial fibrillation) in a smaller number of people.”
BMJ article (Free)eople” was 40-79 years of age.

The second study which was from Australia involved promoting physical activity in “mid to older adults ages 50-79. It showed that increasing physical activity can lower blood pressure.

OBJECTIVE: To evaluate three strategies for promoting physical activity (PA) in a primary care setting. METHOD: Data were collected between 2002 and 2004 from 136 patients attending two general practices in Brisbane, Australia. Inactive patients (50-70 years) were randomly allocated to one of three hierarchical intervention groups: the general practitioner (GP) group received `brief` advice; the GP+ES group also received behavior change advice from an exercise scientist (ES); and the GP+ES+P group also received a pedometer. Self-reported PA and its determinants were measured at baseline and weeks 12 and 24. Cardio-respiratory variables were measured at baseline and week 12.
RESULTS: Overall, mean PA time increased by 84 and 128 min/week at weeks 12 and 24 (p<.01) with no significant group differences. Small improvements in blood pressure and post-exercise heart rate were observed. At week 24, the GP+ES+P group were more likely to report meeting PA guidelines than the GP group (OR=2.39 95% CI: 1.01, 5.64).
CONCLUSION: PA levels can be increased in mid- to older-age adults, either by brief advice from motivated GPs alone, or from collaboration between GPs and ESs. The most intense intervention (GP+ES+P) showed the most promising results.

Finally, again from the BMJ:

Never Too Late to Get Active
Middle-aged men who increase their physical activity level may see a survival advantage over the long term, BMJ reports.
Swedish researchers surveyed some 2200 men at age 50 and then followed them for about 35 years, during which four additional interviews were conducted.
Overall, mortality was lowest among the most active men. In adjusted analyses, men who increased their activity level from low/moderate to high between the ages of 50 and 60 saw a drop in mortality after 10 years’ follow-up, thereby achieving survival similar to that among men were highly active from the start. (Before 10 years, no survival advantage was observed.)
The long-term benefit of increased activity was on par with that of quitting smoking during the same period.
BMJ article (Free)

And finally:

A good screening test reduces mortality.

Prostate Cancer Screening Controversy Not Dead Yet
Two ongoing prostate cancer studies, together comprising a quarter-million men, report discrepant results on the benefits of screening in the New England Journal of Medicine.
A U.S.-centered trial found a higher incidence of prostate cancer among those randomized to annual screening (with either PSA or digital rectal exam) than those randomized to usual care (which could include screening). During the trial’s 7-year follow-up, however, prostate-cancer death rates were roughly the same between groups.
On the other hand, European investigators report that men randomized to screening, although suffering a higher incidence of prostate cancer than controls, showed a significantly lowerrate of prostate cancer death.
An editorialist finds that screening offers “at best a modest effect” on mortality. He concludes that “a shared decision-making approach to PSA screening, as recommended by most guidelines, seems more appropriate than ever.”
And in Journal Watch General Medicine, Allan Brett offers this: “Healthcare policy makers also need to ask boldly whether the PSA screening juggernaut — with all the time, energy, and resources consumed by screening and its sequelae — is appropriate in an era of unsustainable growth in healthcare spending.”
NEJMarticle on screening in the U.S. (Free)
NEJMarticle on screening in Europe (Free)

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