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Young adults face higher risk of severe disease from infections than school-age children

New research suggests children aged 5-14 years are most resilient to infectious diseases, and immune aging may start in young adults, with implications for drug and vaccine design.

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The first systematic review of how the severity of infectious diseases changes with age suggests that the human immune system might start to lose the ability to protect against infections earlier than previously thought, according to new research published in Scientific Data.

Led by the London School of Hygiene & Tropical Medicine, the study analysed data of 32 different infectious diseases, 19 viral and 13 bacterial, looking for patterns in severity at different ages using case fatality and hospitalisation rates.

The severity of most infectious diseases was found to be at its lowest in school-age children (5-14 years old). Strikingly, the severity was higher among young adults in their 20s than among school-age children for many diseases, including polio, measles, HIV, tuberculosis, typhoid and meningococcal meningitis.

Some infections show a slower rise of severity with age after childhood – including COVID-19, SARS, plague and hepatitis A and B – but for most infections this rise begins well before old age. Dengue was the only infection that was most severe in school-age children.

These findings suggest that ‘immune aging’ may start much earlier than previously thought, with the rise in severity of many infectious diseases after childhood apparent by the age of 20 years. The researchers say these results could have major implications for understanding of resilience to infection, optimal vaccine scheduling, drug design and health protection policies over the life course.

Professor Judith Glynn, lead author from the London School of Hygiene & Tropical Medicine, said: “We know infants are particularly vulnerable to infectious diseases due to their immature immune system, and the elderly are vulnerable due to immune deterioration. Surprisingly little is known about how the response to infection changes between these age extremes. The finding that ‘immune aging’ could begin as early as young adults could be a catalyst for much needed new approaches to how drugs and vaccines are designed and scheduled, although this resilience to infection could be attributable to other aspects outside of immune function.”

To reveal these patterns of disease severity in different age groups, the researchers collated more than 140 datasets with information on disease severity for over 30 different bacterial and viral infections. These included studies from the pre-antibiotic and pre-vaccine era, to understand natural responses to infection.

They found that, while most diseases have the lowest severity in school-age children, for many the severity increased in young adults. Severity was higher by the age of 20 years for polio, typhoid, tuberculosis, measles, smallpox, chickenpox, HIV, infectious mononucleosis and yellow fever.

Infectious diseases that showed increased severity from age 20 years onwards included Ebola, meningococcal meningitis, cholera, scarlet fever and Lassa fever. Some had a slower rise in severity after childhood, including seasonal flu, brucellosis and hepatitis B acute infection where severe disease was more common from 30 years old.

For SARS, COVID-19, MERS-CoV and hepatitis A disease severity increased from age 40 years. COVID-19 and SARS appear to have more extreme variation in severity by age than other infections, with predominantly very mild disease in children, and high case fatality rates in the elderly.

Professor Glynn added: “Extraordinarily, information on responses to infections by age has never previously been brought together for a wide range of infections, and the reasons for variation in severity outside the extremes of age have hardly been explored. Our results suggest peak immune response is reached during school-age, and then starts to drop off much earlier than currently thought, from as early as 15 years old in some cases. We also see age patterns in the immune responses to some vaccines, in how the body handles some persistent viral infections, and in immune markers, that together support our interpretation.”

While adolescents and adults may be exposed to higher doses of the infectious agent, which increases the risk of infection, the relationship with disease severity is less consistent, and infectious dose cannot explain the continued rise in severity throughout adulthood.

Co-morbidities also tend to increase with age, but are generally low in young adults, so are unlikely to explain the increase in severity.

Further research is required into the mechanisms of immune aging, and how school-age children are better able to resist infections, in order to inform new approaches to drug or vaccine design. Understanding the different resilience of children and adults to infections should guide policies, including vaccine schedules and the role of school closures.

The researchers acknowledge the limitations of this study. Many reports relied on clinical diagnoses or were based on surveillance data or were limited to hospitalised patients. It was not possible to carry out a formal systematic review because finding sufficiently detailed age-specific information for different diseases is not straightforward. Few studies have been done to look at the effect of age on disease outcomes, so the researchers collated information from many different types of study. To ensure unbiased reporting, all identified studies with sufficient information were included in the review, whatever age-pattern they showed.

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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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