Health for life

Home aerobic program as effective as clinical therapy in treating lower back pain, finds TAU researcher

Lower back pain is a common complaint, and treatment often requires many hours of physical therapy over multiple weekly clinic visits — a costly commitment. Now Dr. Michal Katz-Leurer of Tel Aviv Universitys Stanley Steyer School of Health Professions at the Sackler Faculty of Medicine says that a simple aerobic walking program is as effective in alleviating lower back pain as muscle strengthening programs that require specialized equipment in rehabilitation clinics. The program includes walking two to three times a week for a period of 20 to 40 minutes.

Dr. Katz-Leurer and her colleague Ilana Shnayderman, a graduate student at the Department of Physical Therapy and a practicing physiotherapist at Maccabi Health Care, say that their treatment option fits easily into a daily routine and allows those with back pain to be more responsible for their own health.

Their study was published in the journal Clinical Rehabilitation.

According to Dr. Katz-Leurer, research has shown that when people walk actively, abdominal and back muscles work in much the same way as when they complete exercises that target these areas. And unlike muscle strengthening programs, which often call for specific equipment and can involve exercises that require expert supervision, walking is a simple activity that can be done alone.

For the study, the researchers recruited 52 patients with lower back pain to participate in a randomized control trial. Through questionnaires, they were initially assessed for pain levels, feelings of disability, and avoidance of daily activities, as well as muscle and walking endurance.

Then, half of the participants completed a typical clinic-based muscle strengthening program, with two to three exercise sessions a week for six weeks. The other half completed a six-week aerobic walking program, walking two to three times weekly. Participants started with 20 minutes of walking, then progressed to 40 minutes as their endurance improved.

Results showed that both groups improved significantly in all areas of assessment, demonstrating that the walking program was "as effective as treatment that could have been received in the clinic," says Dr. Katz-Leurer.

The path to a healthier lifestyle

Dr. Katz-Leurer says that the walking program has the additional advantage of encouraging patients to follow a healthier lifestyle overall. In terms of physical fitness, those in the walking group were able to walk an average of 0.05 miles farther during a six-minute walking test at the end of the program compared to the pre-program assessments.

She also notes that that regularly active people are less likely to suffer typical aches and pains over their lifetime. Walking, a low-impact activity, also lowers blood pressure, boosts brain and immune system functioning, and reduces stress, she says.

Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control.

Corresponding author Janet L. Stanford, Ph.D., co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease.

Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week.

They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately.

First study to assess the link between tea and prostate cancer outcomes

Regarding tea consumption, the researchers did not find an associated reduction of prostate cancer recurrence and/or progression. The study also did not draw any conclusions regarding the impact of tea drinking on prostate-specific death.

“To our knowledge, our study is the first to investigate the potential association between tea consumption and prostate cancer outcomes,” the authors wrote. “It is important to note, however, that few patients in our cohort were regular tea drinkers and the highest category of tea consumption was one or more cups per day. The association should be investigated in future studies that have access to larger populations with higher levels of tea consumption.”

The population-based study involved 1,001 prostate cancer survivors, aged 35-74 years old at the time of diagnosis between 2002-2005, who were residents of King County, Wash. Participants answered questions regarding their diet and beverage consumption two years prior to prostate cancer diagnosis using a validated food frequency questionnaire, and were interviewed about demographic and lifestyle information, family history of cancer, medication use and prostate cancer screening history.

The researchers followed up with patients more than five years after diagnosis to ascertain whether the prostate cancer had recurred and/or progressed. Those who were still living, willing to be contacted and had been diagnosed with non-metastatic cancer were included in the follow-up effort.

Of the original 1,001 patients in the cohort, 630 answered questions regarding coffee intake, fit the follow-up criteria and were included in the final analysis. Of those, 61 percent of the men consumed at least one cup of coffee per day and 12 percent consumed the highest amount: four or more cups per day.

The study also evaluated daily coffee consumption in relation to prostate cancer-specific death in 894 patients using data from the initial food frequency questionnaire. After the median follow-up period of eight-and-a-half years, 125 of the men had died, including 38 specifically from prostate cancer. Daily coffee consumption was not associated with prostate cancer-specific mortality or other-cause mortality, but with few deaths these analyses were limited.

“Our study differs from previous ones because we used a composite definition of prostate cancer recurrence/progression,” said first author Milan Geybels, a doctoral student at Maastricht University in the Netherlands who was a graduate student in Stanford’s Prostate Studies group at Fred Hutch when the study was conducted. “We used detailed information on follow-up prostate-specific antigen levels, use of secondary treatment for prostate cancer and data from scans and biopsies to assess occurrence of metastases and cause-specific mortality during follow up. Using these detailed data, we could determine whether a patient had evidence of prostate cancer recurrence or progression.”

The results are consistent with findings from Harvard’s Health Professionals Follow-up Study, which found that men who drank six or more cups of coffee per day had a 60 percent decreased risk of metastatic/lethal prostate cancer as compared to coffee abstainers.

Phytochemicals in coffee have anti-inflammatory and antioxidant effects

Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism. These naturally occurring compounds include:

Caffeine, which has properties that inhibit cell growth and encourage apoptosis, or programmed cell death. Previous studies have found that caffeine consumption may reduce the risk of several cancer types, including basal-cell carcinoma, glioma (a cancer of the brain and central nervous system) and ovarian cancer.
Diterpenes cafestol and kahweol, which may inhibit cancer growth.
Chlorogenic acid, which, along with caffeic acid, can inhibit DNA methylation, a biochemical process involved in the development and progression of many cancer types.
Additional studies needed to confirm whether coffee can prevent cancer recurrence

The researchers emphasize that coffee or specific coffee components cannot be recommended for secondary prevention of prostate cancer before the preventive effect has been demonstrated in a randomized clinical trial. Further, there’s ongoing debate about which components in coffee are anti-carcinogenic, and additional large, prospective studies are needed to confirm whether coffee intake is beneficial for secondary prevention.

Coffee drinking may even be problematic for some men, Geybels said.

“Although coffee is a commonly consumed beverage, we have to point out that increasing one’s coffee intake may be harmful for some men. For instance, men with hypertension may be vulnerable to the adverse effects of caffeine in coffee. Or, specific components in coffee may raise serum cholesterol levels, posing a possible threat to coronary health. Patients who have questions or concerns about their coffee intake should discuss them with their general practitioner,” he said.

The investigators also noted limits to their study, which included a lack of data on how coffee consumption might have changed following diagnosis, whether the coffee that participants consumed was caffeinated or decaffeinated, and how the coffee was prepared (espresso, boiled or filtered), a factor that may affect the bioactive properties of the brew.

Eating an apple a day might in fact help keep the cardiologist away, new research suggests.

In a study of healthy, middle-aged adults, consumption of one apple a day for four weeks lowered by 40 percent blood levels of a substance linked to hardening of the arteries.

Taking capsules containing polyphenols, a type of antioxidant found in apples, had a similar, but not as large, effect.

The study, funded by an apple industry group, found that the apples lowered blood levels of oxidized LDL -- low-density lipoprotein, the "bad" cholesterol. When LDL cholesterol interacts with free radicals to become oxidized, the cholesterol is more likely to promote inflammation and can cause tissue damage.

"When LDL becomes oxidized, it takes on a form that begins atherosclerosis, or hardening of the arteries," said lead researcher Robert DiSilvestro, professor of human nutrition at Ohio State University and a researcher at the universitys Ohio Agricultural Research and Development Center. "We got a tremendous effect against LDL being oxidized with just one apple a day for four weeks.”

The difference was similar to that found between people with normal coronary arteries versus those with coronary artery disease, he said.

The study is published online in the Journal of Functional Foods and will appear in a future print edition.

DiSilvestro described daily apple consumption as significantly more effective at lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.

“Not all antioxidants are created equal when it comes to this particular effect,” he said.

DiSilvestro first became interested in studying the health effects of eating an apple a day after reading a Turkish study that found such a regimen increased the amount of a specific antioxidant enzyme in the body.

In the end, his team didnt find the same effect on the enzyme, but was surprised at the considerable influence the apples had on oxidized LDL.

For the study, the researchers recruited nonsmoking healthy adults between the ages of 40 and 60 who had a history of eating apples less than twice a month and who didnt take supplements containing polyphenols or other plant-based concentrates.

In all, 16 participants ate a large Red or Golden Delicious apple purchased at a Columbus-area grocery store daily for four weeks; 17 took capsules containing 194 milligrams of polyphenols a day for four weeks; and 18 took a placebo containing no polyphenols. The researchers found no effect on oxidized LDLs in those taking the placebo.

“We got a tremendous effect against LDL being oxidized with just one apple a day for four weeks.”

"We think the polyphenols account for a lot of the effect from apples, but we did try to isolate just the polyphenols, using about what youd get from an apple a day," DiSilvestro said. "We found the polyphenol extract did register a measurable effect, but not as strong as the straight apple. That could either be because there are other things in the apple that could contribute to the effect, or, in some cases, these bioactive compounds seem to get absorbed better when theyre consumed in foods."

Still, DiSilvestro said polyphenol extracts could be useful in some situations, "perhaps in higher doses than we used in the study, or for people who just never eat apples."

The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health, DiSilvestro said. He hopes to follow up on that finding in a future study.

Hugging a health insurer

Its an old conservative joke, but what is the one key difference between health insurers and terrorists? 

Answer: liberals only occasionally attack terrorists.

For the latest example of the continuing disdain for health insurers, check out this rather typical July 5 Washington Post article "Is this the end of health insurers?" After extolling one enlightened companys decision to self-insure its workers*, writer Sarah Kliff points out that hospitals can cut out the insurer middle man and offer the same service. The result, says the article, will be the wiser use of the premium dollars, lower costs and fewer coverage denials.

While the physician Disease Management Care Blog agrees that the health insurers have only themselves to blame for their bad reputation, it doesnt think that these companies are going to go away anytime soon.  Its not because, under Obamacare, U.S. citizens are now required to buy their product at any price.  Its not because they control hundreds of billions of dollars.  And its not because theyve had the ear of the political class for years.

The contrarian DMCB thinks theyll continue to stick around because they perform a two useful public services:

1. Keeping Providers From Going Belly Up: There have been too many examples of hospitals and physician organizations being unable to collect todays premium dollars and hold them as a promise to pay for tomorrows sickness.  Whether its not charging enough or being unable to say no, providers are vulnerable to running out of cash and being unable to cover their insureds health care bills.  The DMCB says its better to insulate hospitals and doctors from the perils of the underwriting cycle.  Insurers do that.

2. Keeping Providers From Going to the Dark Side: Assuming a hospital or physician organization can hold the dollars, pay for all that health care and end the year in the black, theres a good chance that theyll do it by ultimately employing the same tactics used by many mainstream insurers: denials of services based on determinations of "medical necessity."

*As an aside, self-insured companies dont always act in the their employees best interest.  Look at this infamous example and note that Cigna only "administered" the insurance plan on behalf of a self insured organization.

Were all aware of the past criticisms of "disease management." According to the critics, these for-profit vendors were in collusion with commercial insurers, relying robo-calls to blanket unsuspecting patients with dubious advice. Their claims of "outcomes" were based on flawed research that was never intended to be science; it was really intended to market their wares.  

But suppose the Disease Management Care Blog alerted you to:

1. A company that had developed a patient registry to identify at-risk patients who had not received an evidence-based care recommendation? Software created mailings to those patients that not only informed them of the recommendation but offered them a toll-free number to call if there were questions. Patients who remained non-compliant were then called by coordinators, who made three attempts to contact the patient and assist in any scheduling needs. If necessary, a nurse was available to telephonically engage patients and develop alternative care options.

If you think that sounds like typical vendor-driven telephonic disease management, youd be right.  Youd also be describing an approach to care that was studied by Group Health Cooperative using their electronic record, medical assistants and nurses.  When it was applied to colon cancer screening, a randomized study revealed each additional level of support progressively resulted in statistically significant screening rates.

Or how about.......

2. A major insurer that decided to use its claims data to identify its own "best practices" without waiting for any published evidence-based studies?  Since "strict experimental conditions cannot always be met," shortcuts like time-series analyses" and "propensity score approaches" will be used to "blur" the lines between feedback and evaluation, as well as the lines between provider and insurer?

If you think that sounds like an commercial insurer muscling into health care delivery while using quasi-experimental research shortcuts, youd be right.  Youd also be describing how Medicares Innovation Center is borrowing from the disease management industrys approach.  Its all here.

Lastly, theres......

3. A major insurer that decided to NOT to pay primary care sites enough fee-for-service or capitation, preventing them from hiring nurses who could provide coordinated care.  The insurer instead hired its own nurses and "embedded" them in the primary care sites while linking additional monthly payments of approximately $5 to pay-for-performance metrics.

If you think that sounds like a step away from the usual Patient Centered Medical Home, youd be wrong.  In this instance, having the embedded nurses did not get in the way of the sites achieving PPC-PCMH recognition. Whats more, compared to usual care in a prospective randomized study that was underwritten by the medical-home fans at the Commonwealth Fund, the embedded nurse approach resulted in better hypertension care, breast cancer screening and fewer emergency room visits.

Alas, disease management: to paraphrase The Bard, a rose still smells as sweet by any other name, especially if its used by Group Health, CMS and the Commonwealth Fund.

Living in the moment is something most of us struggle with, and its only becoming more difficult with modern technology. No matter where we are physically, its becoming increasingly easy to be elsewhere mentally. Step into any crowded public place... there are people talking on the phone, listening to music, playing games on their iPads, updating their Facebook statuses. Our bodies may be present, but our minds certainly are not.

Im just as guilty as anyone else. Any time I find myself with nothing to immediately occupy my mind, my first instinct is to take out my phone... check Facebook, check email, check Instagram, play Candy Crush. At times, Ill even do this when Im with people. Not proud of it. If I have a long walk ahead of me and no one to talk to, Ill call a family member... god forbid I have nothing to do for 15 minutes. Thankfully, my affliction hasnt yet advanced to the point of walking around in public with headphones on. If I ever get to that point, please punch me in the genitals. Ill thank you later.


But I cant help but wonder... what are we missing out on? We all walk by hundreds, if not thousands of people each day. We sit next to them on the subway. We see them in the grocery store. Yet we dont say hello. Our minds are off in another world. Our own little world is comfortable thats for sure... we stick to the people we like, the things we know... its easy and comforting. Were smitten by that. But, as Im understanding more and more, closing ourselves off like this misses the bigger picture. Every time we choose to be absent, we pass up a chance to enhance our personal relationships, or to meet someone special who could have an impact on our lives. How do we know what we dont know if we dont even know what were missing? (What???.)

Approach life with a positive attitude. Any interaction with another person is a chance to brighten their day and yours. A smile is contagious; give a little happy and youll get a lot more in return. Recently Ive gotten to know some of my coworkers a little more... people Ive known for months, but perhaps didnt dig deep enough and really get to know them. Its amazing how far a positive attitude can go in getting people to open up. It turns out, I work with some pretty amazing people. Now, I could have chosen to keep to myself, but I would have completely missed out on what they have to offer. Ask questions. Ask how people are doing, whats going on in their lives, even if you think you already know. And most importantly, listen to what they have to say. You may be surprised where that takes you.

Do good things for good people. The other day I helped two of my friends move into their new apartment. It was a long, long day, with hours and hours of driving, carrying heavy shit up three flights of stairs... just exhausting. No one likes moving. But to be honest, I couldnt think of a better way to spend my Saturday than to spend some quality time with people I really care about, helping them start a new life together. Sure it was hard work, and I could have fallen down three flights of stairs together with a giant armoire, but these are the experiences that build character and cultivate relationships. Go into it knowing this and I promise you youll find it worthwhile, and not just in hindsight. We even found this gem, thanks to craigslist... its all about the memories (even if these happen to be someone elses).


Talk to strangers. This past weekend at work (Whole Foods), I was in the break room eating my breakfast. Normally I just ignore the people I dont know and mess around on my phone, but on this day, a coworker from the seafood department asked about my Botticello Farms t-shirt. Its my grandfathers brothers farm, I guess my great uncle, grand uncle, if either one of those is a thing. Anyway, it turns out this guy knows all of the Botticellos, all of my distant relatives that Ive never really gotten to know. Hes like my long lost cousin. Ive worked with him since last Winter, and I had no idea. What else am I missing out on by ignoring those around me?

Say yes more. Last weekend, I made dinner with my friend Amanda. Jambalaya with cauliflower rice and a side salad from my garden. Delicious and amazing. But a dinner like that is pretty status quo for us. After dinner, Amanda, her sister, and her sisters friend wanted to hang out and uh, eat sandwiches (How I Met Your Mother erence). Normally I would say no; its not something I like to do often. But I decided to partake because I dont always get to hang out with Amanda as much as Id like. In the end, it turned into one of the most fun, hilarious nights Ive had in a long time, and were all a little closer now because of it.


Life is what you make of it... you get out what you put in. Be present more. Forget about whats going on in the intrawebs, or in your social media world, or on your cell phone, and be mentally where you are physically. Stop and smell the roses. Cultivate relationships. Spark up a conversation with a stranger. Learn something new. Smile. Appreciate the moment. 

This is a reminder for everyone, myself included... theres only one moment and its right now. Your life is right in front of you. Dont miss it.