Long-term physical activity on prescription intervention for patients with insufficient physical activity level—a randomized controlled trial

Background: Physical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare
professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized
controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with
insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.
Methods: We included 190 patients, 27–77 years, physically inactive with metabolic risk factors where the patients
were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to
either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care
centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA
recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group
received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and
health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.
Results: At the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level
and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over
2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental
health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups.

Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis

Background: Alzheimer’s disease (AD), as the most common cause of dementia, brings huge economic burden for
patients and social health care systems, which motivates researchers to study multiple protective factors, among
which physical activity and exercise have been proven to be both effective and economically feasible.
Methods: A systematic literature search was performed for eligible studies published up to November 1st 2018 on
three international databases (PubMed, Cochrane Library, and Embase) and two Chinese databases (Wanfang Data,
China National Knowledge Infrastructure). All analyses were conducted using Stata 14.0. Due to heterogeneity
between studies, a random-effects model was used for this meta-analysis. Meta-analysis was used to explore if
physical activity and exercise can exert positive effects on cognition of elderly with AD and subgroup analyses were
conducted to find out if there are dose-response effects.
Results: A total of 13 randomized controlled trials were included with a sample size of 673 subjects diagnosed with
AD. Intervention groups showed a statistically significant improvement in cognition of included subjects measured
by the MMSE score (SMD = 1.12 CI:0.66~1.59) compared to the control groups. Subgroup analyses showed different
amounts of physical activity and exercise can generate different effects.
Conclusions: As one of few meta-analyses comparing different quantities of physical activity and exercise
interventions for AD in details, our study suggests that physical activity and exercise can improve cognition of older
adults with AD. While the concomitant effects on cognition functions of high frequency interventions was not
greater than that of low frequency interventions, the threshold remains to be settled. However, more RCTs with
rigorous study design are needed to support our findings.
Keywords: Physical activity, Exercise, Alzheimer’s disease, cognition, Meta-analysis, Elderly, Older adults

Loneliness and cognitive function in the older adult: a systematic review

Background: Loneliness is a significant concern among the elderly, particularly in societies with rapid growth
in aging populations. Loneliness may influence cognitive function, but the exact nature of the association
between loneliness and cognitive function is poorly understood. The purpose of this systematic review was to
synthesize current findings on the association between loneliness and cognitive function in older adults.
Method: A comprehensive, electronic review of the literature was performed. Criteria for inclusion were
original quantitative or qualitative research, report written in English, human participants with a mean age
60 years, and published from January 2000 through July 2013. The total number of studies included in this
systematic review was ten.
Results: Main findings from the ten studies largely indicate that loneliness is significantly and negatively
correlated with cognitive function, specifically in domains of global cognitive function or general cognitive
ability, intelligence quotient (IQ), processing speed, immediate recall, and delayed recall. However, some
initial correlations were not significant after controlling for a wide range of demographic and psychosocial risk
factors thought to influence loneliness.
Conclusions: Greater loneliness is associated with lower cognitive function. Although preliminary evidence is
promising, additional studies are necessary to determine the causality and biological mechanisms underlying
the relationship between loneliness and cognitive function. Findings should be verified in culturally diverse
populations in different ages and settings using biobehavioral approaches.

Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study

Background The health benefi ts of leisure-time physical activity are well known, but whether less exercise than the
recommended 150 min a week can have life expectancy benefi ts is unclear. We assessed the health benefi ts of a range
of volumes of physical activity in a Taiwanese population.
Methods In this prospective cohort study, 416 175 individuals (199 265 men and 216 910 women) participated in a
standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8·05 years
(SD 4·21). On the basis of the amount of weekly exercise indicated in a self-administered questionnaire, participants
were placed into one of fi ve categories of exercise volumes: inactive, or low, medium, high, or very high activity. We
calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life
expectancy for every group.
Findings Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an
average of 92 min per week (95% CI 71–112) or 15 min a day (SD 1·8), had a 14% reduced risk of all-cause mortality
(0·86, 0·81–0·91), and had a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum
amount of 15 min a day further reduced all-cause mortality by 4% (95% CI 2·5–7·0) and all-cancer mortality by 1%
(0·3–4·5). These benefi ts were applicable to all age groups and both sexes, and to those with cardiovascular disease
risks. Individuals who were inactive had a 17% (HR 1·17, 95% CI 1·10–1·24) increased risk of mortality compared with
individuals in the low-volume group.
Interpretation 15 min a day or 90 min a week of moderate-intensity exercise might be of benefi t, even for individuals
at risk of cardiovascular disease.
Funding Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health
Research Institutes.

Lifestyle and Mental Health

Mental health professionals have significantly underesti-
mated the importance of lifestyle factors (a) as contributors

to and treatments for multiple psychopathologies, (b) for
fostering individual and social well-being, and (c) for

preserving and optimizing cognitive function. Conse-
quently, therapeutic lifestyle changes (TLCs) are underuti-
lized despite considerable evidence of their effectiveness in

both clinical and normal populations. TLCs are sometimes
as effective as either psychotherapy or pharmacotherapy
and can offer significant therapeutic advantages. Important
TLCs include exercise, nutrition and diet, time in nature,

relationships, recreation, relaxation and stress manage-
ment, religious or spiritual involvement, and service to

others. This article reviews research on their effects and
effectiveness; the principles, advantages, and challenges
involved in implementing them; and the forces (economic,
institutional, and professional) hindering their use. Where
possible, therapeutic recommendations are distilled into

easily communicable principles, because such ease of com-
munication strongly influences whether therapists recom-
mend and patients adopt interventions. Finally, the article

explores the many implications of contemporary lifestyles
and TLCs for individuals, society, and health professionals.
In the 21st century, therapeutic lifestyles may need to be a
central focus of mental, medical, and public health.
Keywords: lifestyle, therapeutic lifestyle changes, mental
health, psychopathology, cognitive capacities

Intensive lifestyle changes and health reform

Health reform is moving forward in high gear in the USA.
President Barack Obama said recently, “We’re going to
achieve comprehensive health reform. Not in fi ve years;
not in ten years; but by the end of this year.”
The director of the White House Offi ce of Health
Reform is Nancy-Ann DeParle, health-policy advisor to
President Obama and former Administrator of Medicare
under President Clinton. Two Senate committees are
taking the lead in health reform: the Senate Finance
Committee, chaired by Senator Max Baucus, and the
Senate Committee on Health, Education, Labor and
Pensions (HELP), chaired by Senator Edward Kennedy.
In the Finance Committee, Senator Ron Wyden is
focusing on issues related to prevention, integrative
medicine, and public health; his counterpart in the HELP
committee is Senator Tom Harkin.

Increased telomerase activity and comprehensive lifestyle changes: a pilot study

Telomeres are protective DNA–protein complexes at the end of linear chromosomes that promote
chromosomal stability. Telomere shortness in human beings is emerging as a prognostic marker of disease risk,
progression, and premature mortality in many types of cancer, including breast, prostate, colorectal, bladder, head
and neck, lung, and renal cell. Telomere shortening is counteracted by the cellular enzyme telomerase. Lifestyle
factors known to promote cancer and cardiovascular disease might also adversely aff ect telomerase function. However,
previous studies have not addressed whether improvements in nutrition and lifestyle are associated with increases in
telomerase activity. We aimed to assess whether 3 months of intensive lifestyle changes increased telomerase activity
in peripheral blood mononuclear cells (PBMC).

Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention

Epidemiological and prospective studies indicate that comprehensive
lifestyle changes may modify the progression of prostate cancer.
However, the molecular mechanisms by which improvements in diet
and lifestyle might affect the prostate microenvironment are poorly
understood. We conducted a pilot study to examine changes in
prostate gene expression in a unique population of men with low-risk
prostate cancer who declined immediate surgery, hormonal therapy,
or radiation and participated in an intensive nutrition and lifestyle
intervention while undergoing careful surveillance for tumor pro-
gression. Consistent with previous studies, significant improvements
in weight, abdominal obesity, blood pressure, and lipid profile were
observed (all P < 0.05), and surveillance of low-risk patients was safe. Gene expression profiles were obtained from 30 participants, pairing RNA samples from control prostate needle biopsy taken before intervention to RNA from the same patient’s 3-month postinterven- tion biopsy. Quantitative real-time PCR was used to validate array observations for selected transcripts. Two-class paired analysis of global gene expression using significance analysis of microarrays detected 48 up-regulated and 453 down-regulated transcripts after the intervention. Pathway analysis identified significant modulation of biological processes that have critical roles in tumorigenesis, including protein metabolism and modification, intracellular protein traffic, and protein phosphorylation (all P < 0.05). Intensive nutrition and lifestyle changes may modulate gene expression in the prostate. Understanding the prostate molecular response to comprehensive lifestyle changes may strengthen efforts to develop effective preven- tion and treatment. Larger clinical trials are warranted to confirm the results of this pilot study.

Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of ≤40% or N40% in the Multicenter Lifestyle Demonstration Project

Background: Lifestyle changes are recommended for coronary heart disease (CHD) patients at risk for heart failure (HF) [ACC/AHA stage B;
left ventricular ejection fraction (LVEF)V40%]. However, it is not clear whether changes in lifestyle are feasible and beneficial in these patients.
Aim: To investigate the feasibility of intensive lifestyle changes for CHD patients at risk for HF.
Methods: We compared 50 patients (18% female) with angiographically documented LVEF≤40% (mean = 33.4 ± 7.3; range: 15–40%) to 186
patients (18% female) with LVEFN40% (mean = 58.2 ± 9.6; range: 42–87%), who were participants in the Multicenter Lifestyle
Demonstration Project (MLDP). All were non-smoking CHD patients. The MLDP was a community-based, insurance-sponsored
intervention (low-fat, plant-based diet; exercise; stress management) implemented at 8 sites in the US. Coronary risk factors, lifestyle and
quality of life (SF-36) were assessed at baseline, 3 and 12 months.
Results: Regardless of LVEF, patients showed significant improvements (all pb.05) in lifestyle behaviours, body weight, body fat, blood
pressure, resting heart rate, total and LDL-cholesterol, exercise capacity, and quality of life by 3 months; most improvements were maintained
over 12 months.
Conclusion: CHD patients at risk for heart failure with an LVEFV40%, can make changes in lifestyle to achieve similar medical and
psychosocial benefit to patients with an LVEFN40%.
© 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

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