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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.”

Fitness

Study finds moderate-vigorous physical activity is the most efficient at improving fitness

Dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

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In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.

“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

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Fitness

Tips to avoid common running injuries

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

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Whether training for a marathon or preparing for your first community race, being knocked off course with pain can be hard to handle mentally and physically.

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

Injury prevention is critical. Here are some safety tips from Dr. Joshua Blomgren, a 15-time Chicago Marathon team physician and sports medicine physician, Midwest Orthopaedics at Rush:

Don’t over-train

Don’t increase weekly mileage or intensity by more than 10 percent each week. Build up slowly and let a good training schedule determine how much you run.

Invest in good shoes

Go to a specialty running shop to be properly fitted for running shoes and/or orthotics. Replace them every 350-500 miles. Incorrect shoes can affect your gait, leading to injuries in your feet, legs, knees, or hips.

Choose the best running surface

Look for running surfaces that absorb shock. Opt for asphalt over concrete. Find grass or dirt trails, especially for higher mileage. Avoid uneven surfaces and seek paths with slow curves.

Stretch!

Training causes tight muscles, leading to strain and changes in your gait. Commit to a stretching program. Just 5 -10 minutes after each workout can make a big difference.

Strengthen muscles

Runners have tight hip flexors because their quads are overtrained. Strengthen your hamstrings and glutes to reduce chance of injury and abductors, adductors, and core to create stability.

Watch out for heel striking

Heel striking occurs when your feet land in front of you and your heel hits the ground first. This is common among new runners but can lead to injuries such as shin splints, stress fractures, and joint pain. Land mid-sole with your foot directly underneath your body.

Prioritize posture

Good form means staying upright and keeping your shoulders back and relaxed. Work core exercises into your training and do posture checks every so often. Hold your head right above your shoulders and hips.

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Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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