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Does heart disease or another chronic illness have you anxiety-ridden? Starting an exercise program may help calm your nerves, according to a review of published studies.

The authors of the review say they found “solid evidence” that exercise can curb anxiety in patients dealing with a chronic illness, such as heart and circulatory problems, fibromyalgia, arthritis and other pain conditions, mental health problems, cancer, as well as the breathing disorder

COPD.

Anxiety is common among people who are dealing with a chronic illness, yet it often goes unrecognized or untreated by doctors who may view it as an “unimportant response to a chronic illness,” Matthew P. Herring and colleagues from the University of Georgia in Athens note in the Archives of Internal Medicine. Yet, anxiety can have a negative impact on treatment, in part because anxious patients may be less apt to stick to their prescribed treatment regimen, they point out.

Anti-anxiety drugs can ease anxiety, but exercise is a good option for those who want a non-drug approach, Herring and colleagues found.

They searched the medical literature for relevant studies that tested the effects of exercise (versus no exercise) in sedentary adults with a chronic illness. The people included in the 40 selected studies were 50 years old on average, and 59 percent were women. Those assigned to exercise worked out three times per week for an average of 16 weeks, for an average of 42 minutes per session.

The types of exercises performed varied considerably, but that didn’t matter. Exercise reduced anxiety symptoms by approximately 20 percent, compared with no exercise.

“Even though the majority of these patient groups did not have extremely elevated anxiety symptom scores at the beginning of exercise training, anxiety symptoms were still reduced,” Herring noted in an email to Reuters Health.

Multiple sclerosis was the only illness for which exercise seemed to do little to curb anxiety.

The benefits of exercise on anxiety were similar whether or not the exercise regimen met recommendations for moderate or vigorous physical activity.

Exercise programs lasting between 3 and 12 weeks resulted in larger anxiety symptom reductions than programs longer than 12 weeks, while exercise sessions greater than 30 minutes elicited larger anxiety reductions compared to sessions less than 30 minutes. According to Herring, patients were more likely to stick with shorter duration exercise programs “which might account for larger anxiety reductions compared to longer program durations.” To put it another way, he said, “better participation rates likely will result in greater anxiety reductions.”

Although the role of exercise in alleviating depression symptoms has been well studied, the impact of exercise training on anxiety symptoms has received comparatively little attention, Herring told Reuters Health.

“The findings of our review add to the growing body of evidence that physical activities such as walking or weight lifting may be low-cost, effective treatments to help alleviate anxiety symptoms among patients.”

Exercise “may be especially useful” for patients with chronic illnesses who prefer non-drug approaches to dealing with anxiety, Herring and colleagues note in their report.

SOURCE: Archives of Internal Medicine

Diabetes and its complications — such as strokes and heart disease — will place an enormous financial burden on poorer countries in years to come, researchers warned in a report published Tuesday.

“Diabetes is moving from being a disease of developed countries to a disease in developing countries like India and China, and this could put pressure on healthcare systems through rising healthcare costs,” said Philip Clarke, associate professor at University of Sydney’s School of Public Health.

Clarke and his colleagues examined records of 11,140 patients with severe diabetes in 20 countries, including the complications they suffered, money spent and length of hospital stays; and they found diabetes hit healthcare costs more severely in poorer countries.

“Patients in Asia and Eastern Europe had higher incidence of some events (eg. stroke) than patients in established market economies, lower rates of hospitalization and longer lengths of stay,” according to the report.

While average per capita spending on healthcare in China was around $216 (international dollars) a year, health expenditure for a diabetic who ends up with stroke would be 10 times more, or $2,166, according to the study, which was published in the latest issue of PLoS Medicine.

International dollar is the equivalent of the US dollar but adjusted for purchasing power across countries.

“We know there are efficient ways of reducing these rates of complications. If you can stop people having strokes through blood pressure control, you can clearly reduce these patients’ healthcare costs,” Clarke told Reuters by telephone.

Nearly 250 million people worldwide have diabetes and this number is increasing, with three quarters of all people with diabetes living in the developing world.

The 20 countries involved in the study are China, India, Malaysia, the Philippines, the Czech Republic, Estonia, Hungary, Lithuania, Poland, Russia, Slovakia, Australia, Canada, France, Germany, Ireland, Italy, the Netherlands, New Zealand and Britain.

Assessing whether you are in poor, moderate or ideal cardiovascular health takes just seconds, thanks to a new American Heart Association measure of health factors and behaviors.

The seven-point checklist is part of a heart association program designed to improve U.S. cardiovascular health by 20 percent and reduce deaths from cardiovascular disease and stroke by 20 percent.

The program for children and adults, published online Jan. 20 in Circulation, includes well-known recommendations on diet, exercise, smoking and other risk factors, but there’s more, said Dr. Clyde W. Yancy, medical director of the Baylor Heart and Vascular Institute and president of the heart association.

“Collectively, when these health factors and healthy behaviors are found in aggregate in one person, the effect on markers of health and healthy outcome are remarkable,” Yancy said. “Your chance for meaningful longevity with good quality of life is substantially increased.”

The U.S. death rate from heart attack, stroke and other cardiovascular conditions has been reduced by 35 percent, with half of that improvement because of better preventive measures, Yancy said.

“By packaging these seven components together, it is possible to see a further 20 percent reduction in deaths from heart attack and stroke and also improve cardiovascular health,” he said.

In a recent survey, 39 percent of Americans said they had ideal heart health, yet 54 percent of those folks said they had been told by a health professional that they had at least one risk factor for heart disease and/or needed to make a lifestyle change. This suggests that many people don’t connect lifestyle behaviors like inactivity and poor diet with cardiovascular disease, the association said.

For adults, the seven goals for achieving ideal cardiovascular health are:
Never smoked or quit more than a year ago.
Body mass index, a measure based on weight and height, less than 25.
Physical exercise — at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity each week.
At least four key components of a healthy diet, such as fewer calories, more fruits and vegetables, and oily fish, such as salmon, four times a week.
Total cholesterol lower than 200.
Blood pressure below 120/80.
Fasting blood sugar below 100.

Cardiovascular health is graded as poor, intermediate or ideal depending on how an individual scores in the seven areas, dubbed “Life’s Simple 7.”

“This strategy of seven simple steps makes it a lifestyle-worthy approach,” Yancy said.

The goals and assessment chart can be accessed online at www.heart.org/MyLifeCheck. The Web site also tells how to improve your status and track your progress toward better health.

“What’s exciting about this is that the American Heart Association is dedicated not only to preventing the ravages of heart disease but also to promoting cardiovascular health in general,” said Dr. Donald M. Lloyd-Jones, associate professor of medicine and chair of preventive medicine at Northwestern University Feinberg School of Medicine, and lead author of the scientific statement.

“Very strong scientific evidence shows us that the package of all seven is the fountain of youth for your life,” Lloyd-Jones added.

Is any one factor more important than the others?

“Since we’re talking about not just heart disease but also stroke, heart failure and peripheral arterial disease, much of what is driving cardiovascular disease today is obesity,” Lloyd-Jones stated.

SOURCES: Clyde W. Yancy, M.D., medical director, Baylor Heart and Vascular Institute, Dallas, and president, American Heart Association; Donald M. Lloyd-Jones, M.D., associate professor, medicine, and chair, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago;

The U.S. Food and Drug Administration today approved the HeartMate II, a continuous-flow, left ventricular assist system as a support for severe heart failure patients who are not acceptable candidates for heart transplantation.

The HeartMate II is already FDA-approved for use in patients awaiting further, perhaps more complex treatment, such as transplants.

Heart assist devices are surgically implanted mechanical pumps that help the heart’s ventricle pump blood to the rest of the body. HeartMate II consists of a small, lightweight blood pump implanted in a patient’s chest just below the heart. An electrical cable that powers the blood pump passes through the patient’s skin to an external controller worn around the patient’s waist.

A physician designates the pump’s speed based upon clinical need. The device is designed to sound an alarm upon malfunction or other potentially drastic changes that could impact the pump’s operation.

“The approval of HeartMate II provides an option for heart failure patients who cannot receive a transplant,” said Jeffrey Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health. “Its smaller size and mobility should allow more patients, including women and men of smaller stature, access to treatment.”

In a randomized clinical study of 200 participants at 38 centers, 46 percent of 134 participants with the HeartMate II were still living after two years with no disabling stroke or need for a reoperation for device replacement or repair compared with 11 percent of 66 participants in the control group. In addition, data collected in a separate registry of smaller stature women and men indicated that the device worked well in this specific population.

As a condition of the FDA’s approval, the company will conduct a post-approval study to further evaluate the device’s performance. The data will be recorded in the Interagency Registry of Mechanical Assisted Circulatory Support (INTERMACS) and made available when the post-approval study is concluded. The INTERMACS is a clinical outcomes registry managed by the FDA, the National Heart, Lung and Blood Institute at the National Institutes of Health, the Centers for Medicare & Medicaid Services and participating hospitals and companies.

HeartMate II is manufactured by Thoratec Corp. based in Pleasanton, Calif.

Women who take high-dose vitamin C supplements may be increasing their risk of age-related cataracts, hint findings of a Swedish study.

Among nearly 24,600 adult women followed for more than 8 years, those who reported regular or occasional vitamin C supplementation of about 1000 milligrams per serving were about 25 percent more likely than those who did not take supplements to have age-related cataracts removed.

Women who took extra vitamin C for 10 years or longer; or in combination with being 65 years and older, or taking hormone replacement or corticosteroid medications had even greater risk, researchers found.

However, in the American Journal of Clinical Nutrition, Alicja Wolk, of the Karolinska Institutet in Stockholm, and colleagues caution that the apparent association between vitamin C and cataract risk does not involve vitamin C obtained from fruits and vegetables.

Rather, their study assessed cataract risk related to the high-dose vitamin C supplements common in Sweden. Their findings, the researchers note, support results from some previous studies.

Overall, 59 percent of the 49 to 83 year old otherwise healthy women said they used some sort of dietary supplement. Of these 5 percent said they only took vitamin C supplements and 9 percent said they took only multivitamins that contained about 60 milligrams of vitamin C.

Of the 1,225 women who took only vitamin C supplements, 143 (nearly 13 percent) had cataracts removed during the study period.

By comparison, cataracts were removed in 878 of 9,974 women who did not use any supplements (roughly 9 percent) and in 252 of 2,259 multivitamin-only users (about 11 percent).

The higher cataract risk among the supplement users versus non-users remained evident in analyses that allowed for age by 5-year increments, waist girth, education, smoking, alcohol drinking habits, and use of medications such as hormone replacement therapy.

Wolk and colleagues call for further research to confirm their findings, particularly among older women on hormone replacement therapy or using steroids, as well as investigations into mechanisms that may fuel the association.

While physicians and surgeons are getting better at treating heart attacks and other cardiovascular problems, too many Americans are ignoring the basic rules for preventing them, according to new statistics from the American Heart Association.

Topping the list: too little exercise, too much weight.

In fact, 59 percent of adults surveyed last year reported no activity vigorous enough to prompt sweating and a significant increase in breathing or heart rate, according to the update. The findings are published online Dec. 17 in the journal Circulation.

“The things people need to focus on are our weight and our waist,” said Dr. Donald M. Lloyd-Jones, chair of the heart association’s statistics committee. “Those are driving a lot of other risk factors, such as cholesterol and diabetes.”

Tackling inactivity and overweight will be key to turning heart health statistics around said Lloyd-Jones, who is also chairman of the department of preventive medicine and staff cardiologist at Northwestern University Feinberg School of Medicine.

The American diet also demands more attention, he said. “There is just too much availability of very calorie-dense food,” he said. “We’re not doing anything to burn off those extra pounds.”

Data from 2003-2006 shows that 11.3 percent of children and teenagers were at or above the 97th percentile in body mass index for their age. That’s ominous, because oerweight teens have a 70 percent chance of becoming overweight adults, the report notes.

Preventive measures should be emphasized for younger people, Lloyd-Jones said. “We need to be thinking about this as a life-long problem, not just when you turn 50,” he said.

Cholesterol control is ignored by many who would benefit from it most, according to the Heart Disease and Stroke Statistics 2010 update. Fewer than half the Americans with symptomatic heart disease are receiving treatment to lower their blood levels of fats, and only a third of people getting treatment are achieving the target levels of LDL cholesterol, the “bad kind” that clogs arteries.

“Everything is coming together in the worst way — obesity, inactivity, smoking,” said Dr. Clyde W. Yancy, heart association president and medical director of the Baylor Heart and Vascular Institute in Dallas. “In our younger group, instead of seeing improvement, it is getting worse.”

One relatively bright spot is better control of high blood pressure, a major cardiovascular risk factor, Lloyd-Jones said. “In the last few years, we have taken a bump up, and that gives us reason to hope, especially in prevention of heart failure,” he said.

Other findings:
Death rates from cardiovascular disease declined about 30 percent between 1996 and 2006, as treatments improved.
In 2006, 7.2 million in-hospital cardiovascular procedures were performed, a 33 percent increase over the 1996 level.
The cost of treating cardiovascular disease is expected to rise 5.8 percent in 2010, to $503.2 billion, a figure that lends real urgency to prevention efforts, Lloyd-Jones said.

“So we are spending half a trillion dollars on cardiovascular disease,” Yancy said. “And we recognize that, as in our younger population the incidence of sedentary life style, obesity and smoking are going up, that expenditure will continue to rise.”

By 2020, the association hopes for a 20 percent improvement in the cardiovascular health of all Americans and a 20 percent reduction in deaths from cardiovascular diseases and stroke.

Human embryonic stem cell lines currently used for research come mostly from white donors, a new report finds.

That could mean that nonwhites will benefit less from any medical breakthroughs that emerge from that research down the line, experts say.

Blacks could be especially affected. In fact, none of the most widely used stem cell lines studied showed any traces of recent African ancestry, the team reported online in a Dec. 16 letter in the New England Journal of Medicine.

To increase the diversity of embryonic stem cell lines, the researchers urge increased efforts to include stem cells from other populations.

“We have examined the population ancestry of a large collection of human embryonic stem cell lines that are commonly used in research,” said study co-author Noah Rosenberg, an associate professor in the department of human genetics at the University of Michigan, Ann Arbor.

“Most of these lines appear to derive from European or Middle Eastern populations,” he added. Only two of the lines were linked to East Asians, and “none of these lines derive from populations with recent African ancestry,” the researchers wrote.

Included in the embryonic stem cell lines Rosenberg’s team examined are about 10 of the 20 embryonic stem cell lines recently approved by the U.S. National Institutes of Health for federally funded research.

This suggests that most of the research being done in this area is being done on a very small slice of the human population, Rosenberg noted.

The importance of stem cell lineage remains uncertain, he added. “We don’t yet know the extent to which the ancestry of embryonic stem cell lines will affect the ultimate utility of therapies and drugs developed using stem cell research,” he said.

However, to ensure that new stem cell-derived therapies or drugs will work in a wide range of people, there needs to be an effort to include embryonic stem cell lines from blacks, Asians and other populations.

“New efforts to derive and disseminate additional stem cell lines need to focus on underrepresented populations,” Rosenberg said.

Dr. Camillo Ricordi, scientific director of the Diabetes Research Institute and Cell Transplant Center at the University of Miami Miller School of Medicine, called the lack of diversity in stem cell lines “something that should be corrected as new cell lines are being produced.

Ricordi noted that they have started the Florida stem cell bank to add diversity, because right now 85 percent of the cell lines are from whites.

Diversity in stem cell lines is essential, Ricordi believes. “If you are developing therapies for everyone, you cannot leave out anyone of African descent or others,” he said.

Another expert noted the timing of the study was critical.

“It’s a very well-done study with irrefutable findings,” said Dr. Diane Krause, a professor in the departments of laboratory medicine, pathology and cell biology at Yale University School of Medicine. “The timing of this study is important because, with the increased use of inducible pluripotent cell lines from adult donors, it is important to remember that the diseases we are working to cure are often found in patients with specific genetic backgrounds.”

A protein switch called TAK1 helps prevent liver damage, including inflammation, fibrosis and cancer, according to a team of scientists from the United States and Japan.

Learning more about how TAK1 works could improve understanding about the development of liver disease and cancer, and lead to new therapies, the researchers noted in their report, released online the week of Dec. 14 in advance of publication in an upcoming print issue of the Proceedings of the National Academy of Sciences.

“TAK1 appears to be a master regulator of liver function,” study co-leader Dr. David A. Brenner, a professor of medicine and dean at the University of California San Diego School of Medicine, said in a university news release.

It was already known that TAK1 activates two proteins that play a role in immunity, inflammation, programmed cell death and cancer. But it wasn’t clear whether TAK1 promotes or prevents liver cancer.

To investigate this question, Brenner and colleagues created mice with liver cells that lacked TAK1 and found that the mice had a high rate of liver cell death. To compensate, the rodents’ livers produced too many cells, resulting in liver damage that led to liver cancer, the researchers found

Young children of working parents may watch even more television every day than previous reports have found, especially kids in home-based day-care settings, a new study finds.

Researchers from Seattle Children’s Hospital and the University of Washington surveyed day-care directors to find out how much television viewing was available and then added on the estimated two or three hours a day of home viewing done by many preschoolers.

“If you add the TV from day-care setting to home viewing, you get about five hours a day,” said lead researcher Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute and a professor of pediatrics at the University of Washington School of Medicine.

At home-based day care centers, the preschool-age children watched more — 2.4 hours a day on average — compared to 0.4 hours in center-based settings. The differences were less significant with toddlers and infants in home care who viewed 1.6 hours and 0.2 hours, respectively, compared with 0.1 hours for toddlers and none for infants in the centers.

The results, Christakis said, are surprising and somewhat alarming. “When you consider preschool kids are only awake for 12 hours a day, they are spending almost half their waking hours in front of the TV,” he said.

The study was published online Nov. 23 in advance of publication in the December issue of Pediatrics.

For the study, the researchers interviewed directors of 168 licensed child-care programs in four states, Florida, Massachusetts, Michigan and Washington. They asked the directors how many hours of television were usually watched. In all, the directors of 94 home-based programs and 74 center-based programs participated.

Those in home-based programs watched, on average, double the amount viewed in center-based programs.

“A lot of home-based day care programs are using a lot of ’screen time’,” Christakis said, noting that many prior studies of TV viewing time rely on parent reports of home viewing and don’t ask about day-care viewing time.

The researchers did not ask specifics about the content of the program. “No doubt some is educational,” Christakis said. “But it really doesn’t matter. Even the best educational program is no substitute for real, live human interaction.”

His advice? “Parents should make a point of inquiring how much time the television is on “when searching for day care or with their current arrangement.”

And, he said, if there is too much television viewing at day care, parents can adjust downward the TV time at home. He cites the recommendation from the American Academy of Pediatrics, suggesting no TV for the first two years and a daily limit of one to two hours for older children. Less than that is even better, Christakis said.

The findings don’t surprise David Bickham, a research scientist at the Center on Media and Child Health at Children’s Hospital Boston and an instructor of pediatrics at Harvard Medical School. “I think it’s an important study,” he said, agreeing that researchers often overlook TV time in day-care settings.

”I do think they have touched on something unique here that is very important,” Bickham said. While TV can be educational, Bickham suspects that at day care, television is “often used as a way to fill the time.”

The message on this is clear, Bickham and Christakis agreed. “Parents need to go and talk to their day-care center and find out what is going on with media use,” Bickham said.

When shopping for day care, parents may want to ask about the director’s educational background, the findings suggest. In home-based programs in which the director had a two- or four-year college degree, TV was watched less than in those centers where the directors did not have a college background, Christakis found.

Too much screen time, especially at day care, may mean that preschoolers miss out on opportunities to interact, socialize and learn language and other skills, both Bickham and Christakis said.