Vindicated...Just saying.

Moderate Coffee Consumption and Mortality: Good News

Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Park S-Y et al. Ann Intern Med 2017 Jul 11. Two studies confirm an association between coffee intake and lower risk for death in diverse populations. Coffee contains antioxidants and other bioactive compounds that may have positive effects (e.g., reduced insulin resistance). Prior studies have suggested the protective effects of coffee; however, concerns over predominantly white U.S. participants as well as different coffee preparations from country to country have raised questions about the generalizability of these findings. Now, in two large cohort studies (one U.S., one European), researchers prospectively evaluated the effects of coffee intake in >700,000 participants (mean follow-up, 16 years). The U.S. cohort included minorities (e.g., black, Latino, Asian American) as well as whites, while the European cohort included 10 different countries. Each study adjusted for known and potential confounders. Both cohorts showed significant inverse associations between amount of coffee consumed and mortality. U.S. coffee drinkers who consumed ≥2 cups daily attained almost 20% relative risk reduction (RRR) in mortality compared with those drinking no coffee; European coffee drinkers of ≥2 cups daily exhibited RRRs of 7% to 10% (women) and 12% to 14% (men). Coffee-associated lower mortality was seen across all U.S. ethnic minorities and European countries; among nonsmokers, former smokers, and current smokers; and for caffeinated or decaffeinated coffee.

Comment These studies provide support that moderate coffee intake (2–5 cups daily) is safe and associated with reduced risk for death, probably in a dose-dependent fashion. If you're still debating the health benefits of coffee for your patients, you may want to do it over a cup of joe. From the NEJM Journal Watch Nutrition/Obesity, July 27, 2017

Diabetes and SMBG

From the NEJM Journal Watch June 29, 2017. General consensus of the study is that SMBG is less than ideally effective in glycemic control and quality of life. It seems to me that result is not a measure of the effectiveness but of the ineffectiveness of not doing so. It would be a little more helpful to do a study of those who actually maintain the practice.

That said, any personal trainer following standard established guidelines will insist that you monitor you blood sugar as a requisite for training. Hypoglycemia is common with diabetics who begin an effective exercise program and may occur up to 24 after an exercise session. Hypoglycemia, frightening at best, can be fatal. I require all those who have been diagnosed as diabetic or pre-diabetic to SMBG and carry some form of glucose recovery (e.g., glucose tablets, fruit juice, a fast acting carb).

Is Glucose Self-Monitoring Worthwhile in Non–Insulin-Treated Diabetes?

Bruce Soloway, MD reviewing Young LA et al. JAMA Intern Med 2017 Jun 10.

1. Bruce Soloway, MD

In a study with limitations, self-monitoring did not improve outcomes.

1. Bruce Soloway, MD

Most non–insulin-treated patients with type 2 diabetes perform self-monitoring of blood glucose (SMBG), but whether this practice improves glycemic control or quality of life is unclear. Researchers in North Carolina randomized 450 non–insulin-treated type 2 diabetics (glycosylated hemoglobin [HbA_1c] level, 6.5%−9.5% within 6 months preceding randomization) to no SMBG, once-daily SMBG, or once-daily SMBG plus automated algorithm-derived messages designed to educate and motivate patients. Primary care providers received reports of SMBG data and continued routine management of their patients' diabetes. HbA_1c and health-related quality of life were measured at baseline and 1 year later. Otherwise, the study team did not contact the patients or clinicians; interim HbA_1c values were retrieved from patients' electronic medical records.

Among patients randomized to SMBG, adherence to daily testing decreased from about 90% at baseline to about 55% at 1 year, with less-frequent testing in patients who received automated messages than in those who did not. Mean HbA_1c was significantly lower in both SMBG groups than in the no-SMBG group (mean difference, −0.33%) at 6 months. However, at 1 year, groups did not differ significantly in HbA_1c levels or health-related quality of life.

Comment

Without consistent reinforcement, adherence to SMBG eroded rapidly; the authors suggest that this might have contributed to the disappearance of SMBG's early effect on HbA_1c. In my experience, SMBG can be helpful for some non−insulin-treated patients, by providing daily reinforcement of lifestyle choices that enhance glycemic control. More rigorous studies could help us identify those patients with type 2 diabetes for whom SMBG might add measurable value.

Overcoming the Postural Effects of Prolonged Sitting

I am doing something I rarely do; i.e. posting an article verbatim. The article comes from the Journal of Physical Therapy Science reporting a study done on the corrective benefits of exercise to overcome the effects of postural deviations caused primarily by prolonged sitting. In short, for those who are unlikely to read the article, it says,  yes! careers and/or hobbies and habits that include prolonged sitting has a sinister downside. Not only does it lend itself to significantly increase risk of heart disease but it also leads to chronic pain; especially in the neck, shoulders and back. The result of the study? Regular exercise (sometimes corrective exercise is needed) can help reverse the postural deviations of prolonged sitting that cause pain and consequently significantly relieve pain.

J Phys Ther Sci. 2015 Jun; 27(6): 1791–1794.

Published online 2015 Jun 30. doi:  10.1589/jpts.27.1791

PMCID: PMC4499985

Effect of an exercise program for posture correction on musculoskeletal pain

DeokJu Kim,¹ MiLim Cho,² YunHee Park,³ and YeongAe Yang^4,*

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Abstract

[Purpose] The present study investigated the effect of an exercise program for posture correction on musculoskeletal pain. [Subjects] Between September 2, 2013 and November 3, 2013, an exercise program was performed in 88 students from S University in K city (male students, n = 34; female students, n = 54). [Methods] The exercise program for posture correction was performed for 20 minutes per session, 3 times a week for 8 weeks. Pain levels were measured using a pain scale, and pain levels before and after the exercise program were compared. [Results] Overall, pain levels of the participants were lower after the exercise program than before the program, and significant differences in pain levels were noted in the shoulders, middle back, and lower back. [Conclusion] In conclusion, shoulder pain, mid back pain, and low back pain were relieved with the exercise program for posture correction. Therefore, the findings of this study can be used to improve the work efficiency of students as well as people engaged in sedentary work.

INTRODUCTION

Presently, working with a computer has become common, as computers are being widely use in homes and workplaces, and the working time in a sedentary posture is increasing¹⁾. Especially, children and teenagers are spending a lot of time seated at a desk or working with a computer because of excessive learning activities at private educational institutes, group private lessons, or home learning. Generally, posture is defined as the relative disposition of the body parts in relation to the physical position, such as standing, lying down, and sitting. Correct posture involves a straight spine, which maintains the natural curve of the spine in the human body²⁾. Correct posture minimizes the strain on the human body by maintaining balance of the muscles and skeleton. This balanced musculoskeletal state protects the supporting structures in the body and prevents damage or progressive deformation in all positions, including standing, lying down, and sitting. Additionally, correct posture implies not inclining the body forward, backward, left, or right³⁾.

Therefore, the importance of correct posture should be emphasized, and maintaining correct sitting posture is especially important because the strain on the back is greater in a sitting posture than a standing or lying down posture, although some differences may be present between postures⁴⁾. Working with a computer requires maintaining a seated posture for a long time, and therefore, it is very difficult to maintain correct posture⁵⁾. People tend to change their posture according to habits, such as slouching and crossing the legs, and they maintain a bad posture regardless of their recognition of incorrect posture and desire to maintain correct posture. If incorrect postures become a habit at an early age, individuals maintaining those postures may adapt and consider them comfortable, and this can cause strain on the spine, pelvis, muscles, tendons, joints, bones, and discs, which can lead to fatigue and deformation⁶⁾. Thus, incorrect habits, such as excessive use of computers, use of desks and chairs without proper height, lack of health care education, lack of exercise, carrying heavy school bags, and inappropriate postures when studying or watching television, affect the shape of muscles, deform the skeleton, and cause abnormal development, which prohibit the maintenance of correct posture⁷⁾.

Incorrect posture has many negative effects on the spine. For example, joint imbalance limits the movement of the tendons and muscles and makes normal exercise and movement difficult. Additionally, incorrect posture can cause pain⁸⁾. Moreover, such a posture indicates an incomplete relationship among body parts, and it creates inefficient balance owing to stress on the supporting structures of the body and prevents proper functioning of the structures of the body. This can cause problems in appearance as well as pain and physical disability⁹⁾. Therefore, correct posture is essential for maintaining balance of the body, proper arrangement of supporting structures, and effective functioning of the body; therefore, to say that correct posture is a prerequisite of a healthy life is not an exaggeration¹⁰⁾. However, not enough systematic programs for posture correction are available to the public.

Therefore, the present study aimed to present a method for efficiently working in a seated posture by investigating the changes of musculoskeletal pain in students after participating in an exercise program for posture correction.

SUBJECTS AND METHODS

The present study included 88 (34 males and 54 females) students from S university located in K city. The mean ages of the male and female participants were 23.4 and 21.1 years, respectively. The purpose and procedures of the research were fully explained to the participants, and demographic data were collected from participants who agreed to participate in the study. Information on the pain level was collected using a questionnaire. All research materials were sent to the Committee of Science Research of Inje University for approval.

The initial evaluation and postprogram evaluation of pain were performed using the visual analog scale; each participant marked pain levels in the neck, shoulders, middle back, lower back, and pelvis on a 10-point scale. After explaining the pain scale, the participants indicated their current pain level by choosing a number from 0 (no pain at all) to 10 (unbearable pain), which were displayed along a horizontal line. This scale is widely used in clinical settings as it is known to best reflect the pain level and has been utilized as an important tool to assess the effectiveness of pain treatment¹¹⁾. Between September 2, 2013 and November 3, 2013, an exercise program for posture correction was performed for 20 minutes per session, 3 times a week for 8 weeks. The exercise program was based on the program presented in the study by Park and Park⁸⁾. The exercise program in the first week mainly included stretching, while the program from the second week to the eighth week included activities for correcting bad posture and straightening body shape, which can help improve concentration and be continued after the study

The collected data were analyzed using SPSS for Windows, version 18.0. Frequency analysis was performed to investigate the general characteristics of the participants. The independent t-test and paired t-test were performed to evaluate pain in relation to the general characteristics of the participants and to compare pain levels before and after the program, respectively. For verifying statistical significance, the significance level was set at α = 0.05.

RESULTS

Pain levels according to the general characteristics of the participants are presented. Pain levels in the neck, shoulders, middle back, lower back, and pelvis were recorded using the pain scale. In terms of gender, female participants had higher pain levels compared to those in male participants. In terms of sitting time, participants with an average sitting time of 4–6 hours per day had the highest pain levels. Additionally, in terms of sitting habits, participants with a slouching habit had the highest pain levels. Participants who did not exercise regularly had higher pain levels compared to those in participants who exercised regularly.

Comparisons of pain levels before and after the exercise program are presented in Table 4. Pain levels in the neck, shoulders, middle back, lower back, and pelvis ranged from 0 to 10 on the pain scale. Additionally, pain levels in the shoulders (p = 0.000), middle back (p = 0.049), and lower back (p = 0.002) were significantly different between before and after the exercise program (p < 0.05).

DISCUSSION

The present study investigated the effect of an exercise program for posture correction on musculoskeletal pain in 88 students from S university located in K city.

The results showed that pain levels were higher in female participants than in male participants. This result is similar to that reported in previous studies, which showed higher pain levels in the neck and shoulders in female office workers than in male office workers¹²⁾. These higher pain levels in female individuals than in male individuals may have several causes. First, physical phenomena, including menstruation, may contribute to higher pain levels in the lower back in female individuals. Second, physically, female individuals may have weaker bodies compared to those of male individuals. Third, the sensitivity to pain may be greater in female individuals than in male individuals. Additionally, the muscle strength is lower in female individuals than in male individuals; therefore, female individuals have a higher risk of posture imbalance. To reduce such risk, the increase of muscle strength and flexibility through regular overload exercise is necessary¹³⁾.

In the present study, the exercise program reduced pain levels in the participants, and this result is identical to that reported in a previous study, which showed that an exercise program including yoga and stretching reduced pain levels in the lower back in high school students¹⁴⁾. Additionally, in another study, pain levels in the neck and shoulders in participants significantly reduced after 4 weeks of performing stretching exercises compared to those before the exercise program⁷⁾. In a study by Jung and Chae, which was limited to the cervical region, the pain level on the pain scale significantly decreased by 38.8% after 8 weeks of stretching compared to that before stretching¹⁵⁾. Another study investigated the effect of isometric exercise on back pain, and reported a significant decrease in back pain after the exercise program (improvement in walking ability, ability to sit on a hard chair, and reduction in handicap), and the study reported that performance of gymnastics and stretching exercise in a standing position corrected posture, decreased the pain level, and resulted in a tendency to improve quality of life¹⁶⁾. The results of the above-mentioned studies show that steady exercise corrects posture, which improves the balance of the body, and relaxes the whole body, which relieves musculoskeletal pain. Therefore, the development and introduction of suitable exercise programs will contribute to the physical and mental health of society.

This study has some limitations. The study included only students, and it may be difficult to generalize the results to other individuals owing to the age of the participants, their area of residence, and other such factors. Additionally, the participants may have not maintained an accurate posture during the exercise program. Further studies with a large number of participants of different ages from diverse backgrounds and regions are required. Additionally, conducting exercise programs in groups on a regular basis may help individuals exercise regularly and maintain correct posture.

Although this study had some limitations, the results obtained from investigating the effect of an exercise program for posture correction on musculoskeletal pain can be used as a basis for the improvement of learning efficiency and health in students and workers.

REFERENCES

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8. Park MJ, Park JS: [Effect of a posture training program on cobb angle and knowledge of posture of elementary school students]. Taehan Kanho Hakhoe Chi, 2003, 33: 643–650. [PubMed]

9. Anderson CA, Harvey RJ: Discriminating between problems in living: a examination of measure of depression, loneliness, shyness, and social anxiety. J Soc Clin Psychol, 1988, 6: 482–491.

10. Moon JH, Lee JS, Kang MJ, et al. : Effects of rehabilitation program in adolescent scoliosis. Ann Rehab Med, 1996, 20: 424–432.

11. Jung CY, Kim EJ, Hwang MS: The research of pain and functional disability assessment scales for knee joint disease. J Korean Acupu Moxibu Med Soc, 2010, 27: 123–142.

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Articles from Journal of Physical Therapy Science are provided here courtesy of Society of Physical Therapy Science

I Have Fallen and I Can't Get Up

Exercise and Balance

We are all aware that balance and recovery when balance is lost is a major concern in the health of older adults. Falls among older adults are frequent; so much so that they provide sufficient concern for a very effective advertising campaing; i.e. “Help I’ve fallen and I can’t get up.”

Most are far less aware that falls can be mitigated, if not completely prevented, with regular physical activity and strength training.

Balance is controlled by the cerebellum that acts in response to the information it receives from sensors throughout the body. When we think of balance, or compromised balance, the first thing to come to mind is the middle/inner ear, the vestibular system that sends signals to the eye and the muscles in the body that keep us upright. But what happens in the dark when you can’t see? How do you manage to get dressed in the dark? And what happens when you lose your balance?

Without getting overly technical, throughout the body we have proprioceptors, golgi tendon organs that despond to tension on the tendons and muscle spindles that respond to the speed of muscle shortening/lengthening or muscle stretch. By sensing tension and stretch, these specialized neural organs send information to the brain about where our bodies/body parts are in space as well as a sense of the relative position of body parts to one another. The brain then sends information back to the muscles get back into neutral alignment. That is a simplified explanation but sufficient. And that explains how, without constantly watching our hands, we get food to our mouths rather than our ears or over our shoulders. If you have ever watched a child learning to eat or walk, you realize that not only do these organs and the muscles they send signals to control have to be trained but having been trained the muscles that control balance must be strong enough to respond with sufficient force to maintain balance and recover lost balance. We have all seen toddlers who clearly realize they are losing balance but do not have the muscle strength or control to regain it.

When children are learning to walk, they are developing the neural pathways to and from these organs and the brain and to and from the brain to the muscles so that we can walk about with consciously our every movement to assure the legs and feet or doing what they should be doing.

However, just as these pathways can be developed, they can become deconditioned from lack of use.  And  we can not only lose proprioceptive sense, when they have warned us we are falling, we can lose the strength to react with sufficient force to correct our body position and avoid a fall.

Regular physical exercise, exercises that require us to stabilize our bodies while performing them, exercises that challenge different body positions and multi-joint exercises are crucial to maintaining a healthy balance system and providing the strength to recover balance when it is lost. Regular physical activity and strength training is a crucial part of maintaining independence as we age.

If you have an opportunity to learn a few balance training exercises, take advantage of that opportunity. Life is much better in an upright position.

What if my LDL is very low?

SUMMARY AND COMMENT | LIPID MANAGEMENT February 23, 2017 Are Very Low LDL Cholesterol Levels Safe? Kirsten E. Fleischmann, MD, MPH Reviewing  Everett BM., J Am Coll Cardiol 2017 Feb 7; 69:483 Cataracts and adverse neurocognitive events might be more common with very low LDL cholesterol levels.

The proprotein convertase subtilisin-kexin type 9 (PCSK-9) inhibitors (evolocumab [Repatha] and alirocumab [Praluent]) are potent lipid-lowering agents that can result in very low levels of LDL cholesterol. But can LDL cholesterol be driven so low that adverse events ensue? In two meta-analyses, researchers explore this possibility. In an industry-sponsored analysis, data from 14 trials in which alirocumab was added to background lipid-lowering therapy were pooled. Treatment duration ranged from 8 to 104 weeks. Among 3340 alirocumab patients, 25% had two consecutive LDL cholesterol measurements <25 0.8="" 9="" achieved="" adverse="" alirocumab="" analyses="" analysis="" and="" any="" as="" at="" baseline="" but="" cataract="" cataracts="" cholesterol="" complications="" control="" diabetes="" different="" dl.="" dl="" effects="" event="" events="" for="" groups.="" higher="" in="" incidence="" incident="" its="" ldl="" levels="" low="" mg="" neurocognitive="" neurological="" not="" of="" or="" overall="" p="" patients="" presented.="" propensity-adjusted="" propensity="" rates="" reported="" significantly="" similar="" specific="" such="" than="" the="" those="" very="" vs.="" was="" were="" with="" without=""> A second meta-analysis, which was limited to studies with at least 6 months of follow-up, also showed no significant difference in serious adverse events; however, subgroup analysis of the larger outcome studies suggested excess incidence of neurocognitive adverse events in the very low cholesterol group (odds ratio, 2.85), although the overall incidence was low (<1 p=""> Comment In the first analysis, very low LDL cholesterol levels weren't associated with excess adverse events, except for a higher incidence of cataracts. (This finding has biological plausibility — an editorialist reminds us that the lens of the eye synthesizes cholesterol for structure and clarity.) The second analysis suggests excess neurocognitive adverse events in subgroup analysis only, but a low incidence overall, and authors note that the type and severity of these adverse events are unknown. Although these results are generally reassuring, longer-term monitoring and structured assessment of neurocognitive adverse events will be needed before the safety of very low LDL cholesterol levels with PCSK-9 inhibitors can be assessed fully.