Saturday, 2nd December 2023

Recent advances Part 1

If you read my blogs from the first published in June 2019 you will find, I hope, a logical series of articles. They take you through some of the facts about exercise and fitness and describe the various conditions which may be prevented and/or treated by increasing physical activity.

From this week I will be reporting on recent advances and new information about exercise – its benefits and less commonly its side effects.

Running versus Medication for Depression.
A paper presented at the European College of Neuropsychopharmacology Congress compared the effects of running with standard antidepressant medication (The MOTAR Study). 141 adults were offered the choice of 16 weeks of escitilopram tablets or supervised running training – 2 or 3 sessions of 45 minutes/week. Remission of depression was achieved by 45% in the drug group and 43% in the running group ie no difference in outcome. In addition, the running group derived a number of other health benefits including weight loss and reduction in blood pressure. However adherence to the chosen treatment was far higher in the drug group – 82% versus 52%.
This was not a randomised study so the two options ere not properly compared. The study did, however, indicate that it would be entirely reasonable to offer the running option before medication to those might take it up.

Physical fitness and long-term mortality after cardiac surgery
A paper in the Journal of Clinical Medicine evaluates the association between cardio-respiratory fitness (CRF) and long-term survival following coronary artery bypass grafting (CABG). The study included 14,550 US Veterans who underwent CABG at least six months after their CRF had been measured by treadmill testing. By ten years after surgery, 6,502 (43%) had died.
The preoperative fitness was divided into five categories – Least-Fit, Low-Fit, Moderate-Fit, Fit and High-Fit. Mortality was found to be inversely related to CRF across the full range of fitness. Compared with the Least-Fit group, the mortality risk was 22% lower in the Low-Fit, 31% lower in the Moderate-Fit, 52% lower in the Fit, and 66% lower in the High-Fit groups. The authors concluded that every effort should be made to get individuals as fit as possible before undergoing such surgery.

Obesity and cancer
A report from Cancer Research UK (CRUK) estimates that 21 million adults (36% of the population) in the UK will be obese by 2040 and that obesity will surpass smoking as the biggest cause of cancer. This percentage is the “tipping point” when the number of the obese adults overtakes the number who are of healthy weight. The tipping point is likely to be met sooner in England and Northern Ireland but not in Wales and Scotland. Sadly the accompanying comment discusses banning junk food but nothing about exercise!

Sedentary lifestyle and daily exercise.
An article in the British Journal of Sports Medicine reports on the exercise habits and sedentary time in some 12,000 subjects aged 50 or more. Remaining sedentary for more than 12 hours daily was linked to a higher risk of death than being sedentary for 8 hours, but increasing exercise narrowed the gap. The increased mortality risk from too much sitting about was offset by taking the amount of exercise recommended by the Department of Health – that is 150 minutes weekly of moderate to vigorous physical activity.  So, if you sit about for more than 12 hours a day you will come to no harm if you follow the recommendations.

Preventing Type 2 Diabetes (T2DM) with exercise
It has been established for several years that losing weight can cure T2DM. The study by Lean et al in 2018 found that 86% of their diabetic group were cured if they lost 15kg or more. The main intervention was dietary and the potential role of exercise was not studied. A research letter in Internal Medicine reports a randomised trial of one years treatment with vigorous exercise, moderate exercise or no exercise in 220 obese, non-diabetic adults. After ten years follow-up, the rate of T2DM found to be about halved in the two exercise groups compared to the no exercise group. The long term weight change showed no difference between the groups. As with so many other conditions, the combination of diet and exercise is the most effective lifestyle intervention for T2DM and likely to be hugely more beneficial than medication.

I would be very grateful to hear from you, my readers, what they think of this new form for my Blog.



8 responses to “Recent advances Part 1”

  1. James Willis says:

    Excellent summary – very helpful. Thank you.
    Any comments on the piece in this week’s New Scientist reporting research that suggests the optimum body mass index for older (>65) people is between 25 and 39 – a bit more than previously recommended? Mine is 28 – yay!

    • James Willis says:

      I MISS-TYPED THAT – the figure should be 25-30 !!! No facility to edit I’m afraid,

      • Hugh Bethell says:

        Thanks James and my apologies for taking so long to reply.
        The answer is, of course, very complicated – as are the answers to so many simple questions! There are many variables – age at which BMI is measured, waist to height ratio, smoking status, outcomes to be predicted etc. The figure for predicting OA knee or hip will be higher than that for predicting cardio-respiratory fitness. For longevity, the most recent figure which comes to mind is that produced by the Global BMI Mortality Collaboration (2016) which found the lowest mortality for a BMI between 20.0 and 25.0.
        Personally I think that any figure below 30 is perfectly acceptable. The mischief starts and increases exponentially above that level.

  2. Ian Campbell says:

    Yes, very interesting – and encouraging.

  3. Richard Crook says:

    Thank you for your Blog. As someone none medically trained, but interested in keeping fit & health matters, I find the information you provide in an easy to understand format, very interesting & useful.
    A question I have for you – does exercise have any effect on cholesterol levels. That is assuming it’s a problem anyway.
    Re -Dr. Malcom Kendrick “The Great Cholesterol Con”.

    • Hugh Bethell says:

      Thanks Richard – and apologies for taking so long to reply. The answer is not straightforward and there is surprisingly little research-based information on the subject. Broadly, a high fitness level is associated with lower total cholesterol levels and higher levels of the all important ratio of HDL-cholesterol to total cholesterol. How big a part this plays in the overall benefits of regular exercise is uncertain – though I believe that it does play some part.
      If you want a longer answer do let me know and I will send you an extract from my recent book!

  4. Nicky Barton says:

    Dear Dr. Bethell,
    I always look forward to your blogs. Not only informative, they encourage me to persist in my exercise regime. After 10 years caring for my mother and father, my health had deteriorated and my motivation was at an all time low! The new format looks good and is easy to read.
    Thank you so much for all your efforts to help us improve our own health outcomes.
    Best wishes,

    • Hugh Bethell says:

      Many thanks Nicky and my apologies for taking so long to reply -I hope that your health rapidly improves!
      Very best wishes

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