Regular exercise can keep lifestyle diseases away

April 5, 2015

Apr 5: Cardiovascular disease, diabetes, and osteoporosis - Indians are facing an unhealthy future burdened with a slew of lifestyle diseases. But instead of expensive medication and therapy, the cure lies in making exercise a compulsory part of everyday life, health experts say.

"Indians are increasingly leading a sedentary and machine-dependent life, which may seem comfortable but has extremely adverse effects on health," T.S. Kler, Head of the Department Cardiology, Fortis Escorts Heart Institute and Research Centre said.

Regular exerciseKler said with increasingly hectic lifestyles, most Indians in urban areas nowadays do not walk to the neighbourhood store but rather order groceries on phone for home delivery or drive down.

"We do not climb stairs any more, with lifts being omnipresent. Riding bicycles to work or to school is not cool in urban areas any more. Forget adults, this conditioning begins with children who prefer to stay indoors watching television or playing video games rather than spending time in the playground," he added.

"We all know that cardiovascular diseases are today a major health concern in India. They are the single largest leading cause of deaths in the country, and relatively younger people are today afflicted by coronary artery disease," the noted cardiologist said.

Various surveys done in India have shown that the incidence of coronary heart disease is 8-10 percent in urban areas and 5-6 percent in rural areas.

Kler said regular exercise can help prevent risk factors for cardiovascular diseases such as hypertension and type II diabetes. It also keeps the weight in check.

"Incidences of coronary artery disease can be reduced substantially if the entire Indian population religiously takes to physical exercise. Even 30 minutes of moderate exercise daily can be immensely beneficial. We need a national focus on this less-talked about subject," Kler said.

According to Rajeev K. Sharma, senior consultant orthopedics and joint replacement surgery, Indraprastha Apollo Hospital: "Adequate levels of physical activity decreases the risk of a hip or vertebral fracture and helps control weight. In fact, exercise is very crucial for maintaining good bone health, besides adequate intake of calcium."

"WHO estimates that globally, one in four adults is not active enough while more than 80 percent of the world's adolescent population is insufficiently physically active. This is a dreadful scenario as all these inactive people are making themselves vulnerable to several health issues," he said.

Osteoporosis-related injuries such as vertebrae fractures not only cause pain but also degrade the quality of life, curtail movement and increase dependence. Since the bone is a living tissue, it becomes stronger when subjected to exercise, Sharma said, adding that loss of bone mineral density that begins during the 30s can be curtailed by exercising regularly.

"People who exercise are found to have greater peak bone mass as compared to people who do not exercise."

According to the International Osteoporosis Foundation, the malaise annually causes more than 8.9 million fractures around the globe.

"Though exercising can, to a large extent, help in building strong bones, there is a general lack of an exercise culture in India. This needs to change. Schools, colleges and other institutions should take the lead in nurturing an exercising culture."

Harvinder Singh Chhabra, medical director and chief of spine services at Indian Spinal Injuries Centre, Vasant Kunj, said Indians generally do not realize the importance of exercising unless hit by an ailment.

"Many patients start walking regularly after back pain or osteoarthritis has already set in their bodies. We tell them they could have delayed it by being active all their lives," he added.

According to Chhabra, in the West, there is a lot of focus on physical activity and people are moving away from sedentary ways of life. "They are junking television and going for cycling, running, or adventure sports such as rock climbing. This shift is yet to take place in India."

To make exercise a national culture, apart from awareness, many enabling policy measures are also needed.

"In urban areas, several environmental factors discourage people from leading more active lives even if they want to. Lack of public spaces such as parks and grounds, safety issues on the roads, pollution and irksome traffic do not allow many people to step out of homes to run or walk. This needs to change," he said.

The latter half of the 20th century has brought substantial progress in disease control due to expansion of health infrastructure. With food and nutritional consumption also improving for a vast majority of population, life expectancy in India has gone up over the years. Experts say that deaths due to communicable diseases have decreased while those from non-communicable diseases (NCDs) have risen.

NCDs at present account for 53 percent of all deaths and 44 percent of disability adjusted life-years lost. Projections indicate a further increase to 67 percent of all deaths by 2030. Cardiovascular disease is the major contributor to this burden, attributable to 52 percent of NCD-associated deaths and 29 percent of total deaths.

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Agencies
June 11,2020

The World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus said that more research needs to be done to better understand the extent to which COVID-19 is being spread by people who don't show symptoms.

"Since early February, we have said that asymptomatic people can transmit COVID-19, but that we need more research to establish the extent of asymptomatic transmission," the WHO chief said at a virtual press conference from Geneva on Wednesday, Xinhua news agency reported.

"That research is ongoing, and we're seeing more and more research being done," he added.

Saying that the world has been achieving a lot in knowing the new virus, the WHO chief told reporters that "there's still a lot we don't

"WHO's advice will continue to evolve as new information becomes available," he said.

Tedros stressed that the most critical way to stop transmission is to find, isolate and test people with symptoms, and trace and quarantine their contacts.

"Many countries have succeeded in suppressing transmission and controlling the virus doing exactly this," Tedros said.

Meanwhile, Michael Ryan, executive director of WHO Health Emergencies Program, said Wednesday that the COVID-19 pandemic is still evolving.

"If we look at the numbers... this pandemic is still evolving. It is growing in many parts of the world," he said. "We have deep concerns that health systems of some countries are struggling, under a huge strain and require our support, our help and our solidarity."

He said "each and every country has a different combination of risks and opportunities, and it's really down to national authorities to carefully consider where they are in the pandemic."

In Europe, the risk issue now are about travels and the opening of the schools, around risk management, mass gathering, surveillance and contact tracing, said the WHO official.

In Southeast Asian countries, where to a great extent transmissions have been under control, governments are more concerned about the re-emergence of clusters, while in South America, the issue of PPE for health workers has not gone away, said Ryan.

As regards Africa, Ryan said the death rates have been very low in the past week, but the health system can be overwhelmed, as it would have to cope with other diseases such as malaria.

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Agencies
January 26,2020

High-protein diets may help people lose weight and build muscle, but there is a downside to it --a greater heart attack risk. Researchers now report that high-protein diets boost artery-clogging plaque.

The research in mice showed that high-protein diets spur unstable plaque -- the kind most prone to rupturing and causing blocked arteries.

More plaque buildup in the arteries, particularly if it's unstable, increases the risk of heart attack.

"There are clear weight-loss benefits to high-protein diets, which has boosted their popularity in recent years," said senior author Babak Razani, associate professor at Washington University School of Medicine in St. Louis, Missouri.

"But animal studies and some large epidemiological studies in people have linked high dietary protein to cardiovascular problems. We decided to take a look at whether there is truly a causal link between high dietary protein and poorer cardiovascular health," Razani added.

The researchers studied mice who were fed a high-fat diet to deliberately induce atherosclerosis, or plaque buildup in the arteries.

Some of the mice received a high-fat diet that was also high in protein. And others were fed a high-fat, low-protein diet for comparison.

The mice on the high-fat, high-protein diet developed worse atherosclerosis -- about 30 per cent more plaque in the arteries -- than mice on the high-fat, normal-protein diet, despite the fact that the mice eating more protein did not gain weight, unlike the mice on the high-fat, normal-protein diet.

"A couple of a scoop of protein powder in a milkshake or smoothie adds something like 40 grams of protein -- almost equivalent to the daily recommended intake," Razani said.

"To see if protein has an effect on cardiovascular health, we tripled the amount of protein that the mice receive in the high-fat, high-protein diet -- keeping the fat constant. Protein went from 15 per cent to 46 per cent of calories for these mice".

Plaque contains a mix of fat, cholesterol, calcium deposits and dead cells. Past work by Razani's team and other groups has shown that immune cells called macrophages work to clean up plaque in the arteries.

But the environment inside plaque can overwhelm these cells, and when such cells die, they make the problem worse, contributing to plaque buildup and increasing plaque complexity.

"In mice on the high-protein diet, their plaques were a macrophage graveyard," Razani informed.

To understand how high dietary protein might increase plaque complexity, Razani and his colleagues also studied the path protein takes after it has been digested -- broken down into its original building blocks, called amino acids.

"This study is not the first to show a telltale increase in plaque with high-protein diets, but it offers a deeper understanding of the impact of high protein with the detailed analysis of the plaques," said Razani.

"This work not only defines the critical processes underlying the cardiovascular risks of dietary protein but also lays the groundwork for targeting these pathways in treating heart disease," he added.

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Dr G K Sudhakar Reddy
August 4,2020

Being overweight or obese is now recognised as a serious cause of ill health and disability. There is a significant positive association between orthopaedic disorders and the level of obesity causing pain, deformity and difficulty in walking.

Excess body weight accumulation increases pressure on joints, particularly the hips, knees and ankles.

Here are a few type of  arthritis:

Osteoarthritis

It is a condition of damage/ wear and tear of the joint lining or cartilage. Obesity triggers this by loading excessive weight on the weight bearing joints like the knee and the hip. 

Knee Osteoarthritis

This is the most common arthritis especially in the Indian subcontinent.

While walking, an individual exerts 3 to 6 times pressure that of the body weight on the weight-bearing knee joint, which means in an obese with excess body weight, larger forces are exerted, which lead to higher risk of deterioration of cartilage.

In addition, there are excessive fat tissues that produce hormones and other factors that affect the joint cartilage metabolism and cause inflammation of the joints giving rise to joint pathology.  Leptin is one of the hormones causing knee osteoarthritis. 

Hip osteoarthritis

The force exerted across the hip is 3 times that of body weight. Hip osteoarthritis is caused by factors such as joint injury, increasing age and being overweight.    

Hand osteoarthritis

The observation that obese individual has a higher risk in having hand osteoarthritis has led to a hypothesis that the metabolic effect produced by fat tissue is the underlying factor. 

Osteoporosis

It is a progressive bone condition of decrease in bone mass and density (Bone Mineral Density or BMD) which can lead to an increased risk of fracture. Recent research suggests that obesity may accelerate bone loss. It is the amount of muscle mass which is seen in an active person, which accounts for bone strengthening effects and not due to the fat seen in a heavy person.

Low back pain

Low back pain from degenerative disc disease of the lumbar spine is one of the most disabling conditions in the community and overweight and obesity have the strongest association with seeking care for low back pain.

Managing Hip and Knee Osteoarthritis

Life style changes

If one is overweight, try to lose weight by doing more physical activity and eating a healthier diet. Regular exercise keeps you active and mobile and builds up muscle, thereby strengthening the joints and can improve symptoms. 

Pain Killers

Painkillers help with pain and stiffness for short term. They don’t affect the arthritis itself and won’t repair the damage to your joint. Creams and gels can be applied directly onto painful joints.

Nutritional Supplements

Glucosamine and chondroitin are nutritional supplements. Animal studies have found that glucosamine can both delay the breakdown of and repair damaged cartilage. However, there is insufficient evidence to support the use of glucosamine in humans and one can expect only a mild-to-moderate reduction in pain

Joint injections

If pain from osteoarthritis is severe joint steroid injections are injected into the joints that can reduces swelling and pain. The injections can start working within a day or so and may improve pain for several weeks or months. 

Hyaluronic acid injections, which help to lubricate your knee joint also give short term relief. In early stages. Stem cell treatment or cartilage regeneration procedures are being tried in young people with small defects, however it is still experimental and lacks long term evidence.

Surgery

May be recommended if you have severe pain or mobility problems.

Arthroscopy

If one has frequent painful locking/stiffening episodes especially in the knee joint, an operation to wash out loose fragments of bone and other tissue as joint can be performed by a minimally invasive key hole procedure called Arthroscopy.

Arthrodesis

If hip or knee replacement is not suitable, especially in young people who do heavy manual work, one can consider an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

In young, active people in whom a knee joint replacement would fail due to excessive use one can consider an operation called an osteotomy. This involves adding or removing a small section of bone either above or below your knee joint.  This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually as you grow old

Joint replacement surgery

Joint replacement therapy is most commonly carried out to replace hip and knee joints. It involves replacing a damaged, worn or diseased joint with an artificial joint made of special plastics and metal.

For most people, a replacement hip or knee will last for at least 20 years, especially if it is cared for properly and not put under too much strain.

Dr G K Sudhakar Reddy is a Sr Consultant Orthopaedic Surgeon at Citizens Speciality Hospitals, Hyderabad

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