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Getting into shape pre-surgery to aid recovery for older patients – study

Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

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Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

A study published by researchers in the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences showed that short term ‘prehabilitation’ strength exercises, undertaken pre-surgery, are insufficient to prevent muscle loss.

In the study, the researchers asked a group of older adults to perform four sessions of weight lifting exercise over one week. The participants did the exercises using only one leg, while the other leg did no exercise at all.

After completing the prehabilitation, the participants underwent five days of bed-rest – a typical length of stay in hospital for an older patient. Although the researchers expected to find that the leg which had undergone the exercise would experience less muscle loss than the other leg, in fact they found muscle loss was about the same in both legs.

The team’s detailed analysis showed that, while short-term exercise prehabilitation does enhance the body’s muscle-building processes, thigh muscle-wasting was about 3-4 per cent in both legs – roughly equivalent to what older adults would typically lose over 3-5 years of ageing.

The researchers recommend that one approach to protect older muscle from wasting during hospitalisation is to perform longer-term strength exercise prehabilitation beforehand.

Dr Leigh Breen, the study’s corresponding author, says: “Although short-term prehabilitation offers a cost-effective and easy-to-implement strategy, it does not prevent muscle wasting among older adults undergoing bed-rest. This muscle loss may be extremely hard to recover from and can lead to long-term health and disease complications.”

The team recommend that prehabilitation exercise programmes should also incorporate aerobic exercise alongside strength training to protect cardiovascular health, and a protein rich diet to increase muscle mass levels in a way that will effectively cancel out the muscle loss that is experienced during bed-rest

They also recommend that, where appropriate and safe, hospitalised older patients should aim to get back on their feet and mobile again as quickly as possible. Post-surgery exercise and dietary strategies will also be important to ensure a return to full health and lower the risk of future health complications.

Dr Benoit Smeuninx, now at Monash University in Australia, is lead author on the paper. He says: “Our study reinforces the need for more research into the benefits of longer term training programmes prior to surgery. In the same was as an athlete would train before a race or a competition, exercise training before hospitalisation is likely to be highly beneficial to older adults undergoing elective surgeries.”

The work was completed in collaboration with colleagues within the Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, which is a partnership between the University of Birmingham and the University of Nottingham. The work was funded by the Biotechnology and Biological Sciences Research Council.

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Want to be robust at 40-plus? Meeting minimum exercise guidelines won’t cut it

5 hours of moderate activity a week may be required to avoid midlife hypertension, UCSF-led study shows.

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Young adults must step up their exercise routines to reduce their chances of developing high blood pressure or hypertension – a condition that may lead to heart attack and stroke, as well as dementia in later life.

Current guidelines indicate that adults should have a minimum of two-and-a-half hours of moderate intensity exercise each week, but a new study led by UCSF Benioff Children’s Hospitals reveals that boosting exercise to as much as five hours a week may protect against hypertension in midlife – particularly if it is sustained in one’s thirties, forties and fifties.

In the study publishing in American Journal of Preventive Medicine on April 15, researchers followed approximately 5,000 adults ages 18 to 30 for 30 years. The participants were asked about their exercise habits, medical history, smoking status and alcohol use. Blood pressure and weight were monitored, together with cholesterol and triglycerides.

Hypertension was noted if blood pressure was 130 over 80 mmHg, the threshold established in 2017 by the American College of Cardiology/American Heart Association.

The 5,115 participants had been enrolled by the Coronary Artery Risk Development in Young Adults (CARDIA) study and came from urban sites in Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Approximately half the participants were Black (51.6 percent) and the remainder were White. Just under half (45.5 percent) were men.

Fitness Levels Fall Fast for Black Men Leading to More Hypertension

Among the four groups, who were categorized by race and gender, Black men were found to be the most active in early adulthood, exercising slightly more than White men and significantly more than Black women and White women. But by the time Black men reached age 60, exercise intake had slumped from a peak of approximately 560 exercise units to around 300 units, the equivalent to the minimum of two-and-a-half hours a week of moderate intensity exercise recommended by the U.S. Department of Health and Human Services. This was substantially less exercise than White men (approximately 430 units) and slightly more than White women (approximately 320 units). Of the four groups, Black women had the least exercise throughout the study period and saw declines over time to approximately 200 units.

“Although Black male youth may have high engagement in sports, socio-economic factors, neighborhood environments, and work or family responsibilities may prevent continued engagement in physical activity through adulthood,” said first author Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine. Additionally, Black men reported the highest rates of smoking, which may preclude physical activity over time, he noted.

Physical activity for White men declined in their twenties and thirties and stabilized at around age 40. For White women, physical activity hovered around 380 exercise units, dipping in their thirties and remaining constant to age 60.

Rates of hypertension mirrored this declining physical activity. Approximately 80-to-90 percent of Black men and women had hypertension by age 60, compared with just below 70 percent for White men and 50 percent for White women.

“Results from randomized controlled trials and observational studies have shown that exercise lowers blood pressure, suggesting that it may be important to focus on exercise as a way to lower blood pressure in all adults as they approach middle age,” said senior author Kirsten Bibbins-Domingo, MD, PhD, of the UCSF Department of Epidemiology and Biostatistics.

“Teenagers and those in their early twenties may be physically active but these patterns change with age. Our study suggests that maintaining physical activity during young adulthood – at higher levels than previously recommended – may be particularly important.”

More Exercise from Youth to Midlife Offers Best Protection Against Hypertension

When researchers looked at the 17.9 percent of participants who had moderate exercise for at least five hours a week during early adulthood – double the recommended minimum – they found that the likelihood of developing hypertension was 18 percent lower than for those who exercised less than five hours a week. The likelihood was even lower for the 11.7 percent of participants who maintained their exercise habits until age 60.

Patients should be asked about physical activity in the same way as they are routinely checked for blood pressure, glucose and lipid profiles, obesity and smoking, Nagata said, and intervention programs should be held at schools, colleges, churches, workplaces and community organizations. Black women have high rates of obesity and smoking, and low rates of physical activity, he said, and should be an important group for targeted intervention.

“Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity,” Nagata said. “This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce and parenthood, and leisure time is eroded.”

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Childhood diet and exercise creates healthier, less anxious adults

Though diet and exercise are consistently recommended as ways to promote health, this study is the first to examine the long-lasting, combined effects of both factors when they are experienced early in life.

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Exercise and a healthy diet in childhood leads to adults with bigger brains and lower levels of anxiety, according to new UC Riverside research in mice.

Though diet and exercise are consistently recommended as ways to promote health, this study is the first to examine the long-lasting, combined effects of both factors when they are experienced early in life.

“Any time you go to the doctor with concerns about your weight, almost without fail, they recommend you exercise and eat less,” said study lead and UCR physiology doctoral student Marcell Cadney. “That’s why it’s surprising most studies only look at diet or exercise separately. In this study, we wanted to include both.”

The researchers determined that early-life exercise generally reduced anxious behaviors in adults. It also led to an increase in adult muscle and brain mass. When fed “Western” style diets high in fat and sugar, the mice not only became fatter, but also grew into adults that preferred unhealthy foods.

These findings have recently been published in the journal Physiology and Behavior. To obtain them, the researchers divided the young mice into four groups — those with access to exercise, those without access, those fed a standard, healthy diet and those who ate a Western diet.

Mice started on their diets immediately after weaning, and continued on them for three weeks, until they reached sexual maturity. After an additional eight weeks of “washout,” during which all mice were housed without wheels and on the healthy diet, the researchers did behavioral analysis, measured aerobic capacity, and levels of several different hormones.

One of those they measured, leptin, is produced by fat cells. It helps control body weight by increasing energy expenditure and signaling that less food is required. Early-life exercise increased adult leptin levels as well as fat mass in adult mice, regardless of the diet they ate.

Previously, the research team found that eating too much fat and sugar as a child can alter the microbiome for life, even if they later eat healthier. Going forward, the team plans to investigate whether fat or sugar is more responsible for the negative effects they measured in Western-diet-fed mice.

Together, both studies offer critical opportunities for health interventions in childhood habits.

“Our findings may be relevant for understanding the potential effects of activity reductions and dietary changes associated with obesity,” said UCR evolutionary physiologist Theodore Garland.

In other words, getting a jump start on health in the early years of life is extremely important, and interventions may be even more critical in the wake of the pandemic.

“During the COVID-19 lockdowns, particularly in the early months, kids got very little exercise. For many without access to a park or a backyard, school was their only source of physical activity,” Cadney said. “It is important we find solutions for these kids, possibly including extra attention as they grow into adults.”

Given that exercise was also shown to reduce adult anxiety, Cadney believes children who face these challenges may face unique physical and mental health issues as they become adults in the coming decade.

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Exercise in mid-life won’t improve cognitive function in women

For middle-aged women, exercise has many health benefits, but it may not help maintain cognitive function over the long term, according to a new UCLA Health study.

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For middle-aged women, exercise has many health benefits, but it may not help maintain cognitive function over the long term, according to a new UCLA Health study. The study observed a diverse group of roughly 1,700 women over a 21-year period starting when the women’s average age was 45. In the study, women’s cognitive ability was tested in three key areas: cognitive processing speed (how fast the mind works); verbal memory (the ability to recall a story that they heard); and working memory (the ability to manipulate information).

The study was published in JAMA Network Open, and is one of the first to explore the longitudinal cognitive effects of physical activity in middle-aged women. The study found that over the 21 years, women’s cognitive processing speed declined by a total of 8%, or about 0.4% per year, and that verbal and working memory declined more slowly, dropping by 4% and 3%, respectively. After adjusting for other risk factors for cognitive aging, researchers found no association between physical activity and cognitive performance over time in the three cognitive areas tested.

“Our study showed that in midlife, women’s usual, self-selected exercise activity was not sufficient to slow cognitive aging,” said Gail Greendale, corresponding author of the study and professor of medicine and obstetrics and gynecology at the David Geffen School of Medicine at UCLA and research director of the Iris Cantor-UCLA Women’s Center.

However, Greendale points out that the study does not tell us whether increasing physical activity to higher levels might help preserve cognitive function. “We need more research on how to prevent cognitive aging during middle age — we just don’t know what works,” she said.

“In the meantime, the benefits of physical activity are great. While we work to figure out whether exercise is good for your brain, it’s important that we strive to maximize physical activity throughout the life span.”

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