Exercise Medicine: key to a NCD-free life

by Carol Aloysius

When schools re-open for the new academic year in 2014, we are likely to see school children across the country starting their day with ten minutes of physical exercise prior to their usual morning lessons.

This decision made by the Education Minister follows rising concerns on mounting non communicable diseases (NCD) in the country, which health officials believe begin in childhood and are rooted in the sedentary lifestyles we follow as children, subsequently compounded by unhealthy habits we adopt such as smoking, drinking alcohol and drug addiction. According to them, lack of a proper program of exercise under professional advice is the reason why non communicable diseases such as cardiac illnesses, diabetes, hypertension and stroke have proliferated and have now overtaken communicable diseases in our country.

Currently promoting this concept and determined to put sports medicine with a focus on exercise medicine on top priority is Sports and Exercise Physician , Institute of Sports Medicine, Ministry of Sports, Dr Daminda Attanayake, who believes that exercise medicine has been long neglected in this country.

The Sunday Observer met her at her ‘Home away from Home’ as she fondly refers to the Ministry of Sports where she says she works almost 20 hours a day, combining her career with her role as a mother and wife.

Excerpts…

Question: Sports Medicine is a relatively new field in Sri Lanka. What does it involve?

Answer: Sports Medicine is a field that covers several areas - from physiotherapy, biomechanics, to sports physiology, sports psychology, sports nutrition and exercise medicine among other areas.

Q. Of these fields, what is your particular interest?

A. My personal interest is in Exercise Medicine.

Q. Why?

A. This is a field that has not been given much importance in this country upto now, although this is not the case of most other countries in the rest of the world - e.g. in Europe and in the West, where Sports Medicine is usually combined with Exercise Medicine on a routine basis.

Q. If it has been a component in Sports Medicine since the beginning, why was Exercise Medicine not given the same role as other components that come under this category?

A. For answers we need to go back to the past. In the days of our grandparents, we did not have the hi-tech gadgets designed to make our work easier and quicker, as we now do e.g. blenders, washing machines, electric coconut scrapers, ‘instant’ foods, floor polishers, tractors, dish washers and the like.

Our grandparents did all the work themselves without these modern aid gadgets.

They scraped coconut, pounded flour, swept their gardens, washed loads of soiled clothes, ground their spices, and tilled their fields with ploughs instead of tractors which do this work today.

They did not have cars. They walked to school, to the market, to the Pola, to the post office breathing in clean pure air. Today, the environment has become polluted, people have become lazy and even children have adopted sedentary life styles preferring to sit in front of the TV or their computers rather than playing outside.

This is what has caused the current explosion of non communicable disease both here and in other Asian countries. Added to that we have changed our healthy diets to eating ‘instant’ foods dripping with sugar, starch and cholesterol. So now Sports Medicine has become important.

Q. Have you any statistics on the adverse impacts these so called technological advances had on our people?

A. According to the Health Bulletin, in 2004 there were 50.9 percent of deaths from NCD’s . In 2008 within the space of four years it had increased to 65 percent. So as you can see, NCDs are now a huge problem in our region. So much so, that the Health Ministry declared 2012 as the Year of NCD!

Q. As you said, the main causes for this steep rise in NCD’s were: 1) leading an inactive life 2) tobacco smoking 3) alcohol consumption 4) Dietary imbalances.

Let’s talk about the first, since Exercise Medicine is your forte. Using this approach, what can be done do to resolve this problem?

A. People must be encouraged to be active either by engaging in physical activities or getting involved in a structured exercise program. This can not only prevent them from developing NCD, it can delay the onset of these diseases and control them as well if they already have some non communicable disease.

Q. Examples?

A. If you have hypertension, improving cardio respiratory fitness can control your blood pressure. It can also prevent the onset of this disease in those who have not got high blood pressure.

Q. Does that include other NCDs?

A. Yes, most NCDs benefit from cardio respiratory fitness exercises.

Q. What are the other components for physical fitness?

A. There are five physical fitness components in all: (1) Cardio respiratory fitness (2) Body composition i.e. the relative amount of muscle, fat and bone (3) Muscular strength (4) Muscular endurance (5) Flexibility. All these factors will have to take into account diseases we already have and the time that can be allocated by us for exercise, as well as the type of exercise we prefer. It is by using these factors that a professional fitness trainer should evaluate and prescribe the exercises for each person.

Q. What happens if the personal trainer does not take these factors into consideration?

A. In that case the person undergoing the training could either drop out half way for various reasons such as the time factor or lack of interest in the exercises prescribed and so, will not be able to follow the exercise program properly. Without a baseline testing the exercise program can’t be evaluated properly so that the benefits are visible. You can only measure any exercise program if you can evaluate a person at the very beginning of the program and see the visible benefits later.

Q. Does this include people with NCDs as well, or just normal healthy persons?

A. It includes everyone. For instance, if a patient with arthritis does a baseline test medically at the beginning of his exercise regime, he will be able to measure his progress by measuring the range of his movements.

Q. So when should one start on a fitness exercise program?

A. The earlier the better - ideally in childhood and continuing life long. Even if you are 80 years and you can still do some kind of exercise, you will get some benefit from it.

Q. Who are those most at risk from not exercising?

A. In Sri Lanka, obesity which also results from lack of exercise, is the main reason for NCDs. I’m told that 25 percent of obesity is among women as against 19 percent in men.

So women are more at risk. Others include those who have passed their 40s and 50s when they have been leading active lives and then slow down, thus losing their health benefits from an active life.

Q. Coming to school children, why do you think that exercise is so important for them?

A. School children are now doing less and less physical activity. They don’t walk to school since they travel by bus, train or car. They don’t engage in extra curricular activities or only in a limited number of such activities mostly in my opinion, because their parents are over protective and don’t want them to get injured. So we need to talk and create awareness about the importance of exercise for parents.

Q. What about school gyms? Do you think that they are well equipped to encourage children to take to sports in a big way?

A: Abroad every gym needs to display a certificate and have a professional trainer. Well equipped gyms have to have equipment that have the five key components for exercise fitness. I also wish to emphasise that we should not only look at professional athletes but at professional sports, because now we see many people doing sports not just to compete but as a recreation e.g. walking and jogging.

Q. What do you currently do at the Ministry?

A. At the Sports Ministry where I have been for the past seven years, I look after mainly national level athletes. That’s my job. But privately, I practise Exercise Medicine. I advocate exercise for all ailments and diseases irrespective of age and gender. And I repeat - any age even if they are in their eighties and nineties!

Q. Have you a message for the public in general?

A. I recommend 20-30 minutes of physical exercise daily at least three times a week for everyone. If you can include the five health components I mentioned earlier, the benefits will be much more.

I also wish to add, that if you want to start an exercise program it does not have to be in a gym. You can do your exercises even inside your home and at any time. Nor do you need any sophisticated gadgets or instruments. Age is not a barrier either. Anyone at any age, will benefit from exercise.

But physical activity alone is not enough. If you drink, smoke and don’t have a balanced diet you will not reap the fullest benefits.

Bacteria can recycle broken DNA

Bacteria put broken DNA on a scrapheap. Bacteria can then recycle small as well as large pieces of old DNA from this and include it in their own genome. This discovery may have major consequences - both in connection with resistance to antibiotics in hospitals and in our perception of the evolution of life itself.

Our surroundings contain large amounts of strongly fragmented and damaged DNA, which is being degraded. Some of it may be thousands of years old. Laboratory experiments with microbes and various kinds of DNA have shown that bacteria take up very short and damaged DNA from the environment and passively integrate it in their own genome. Furthermore this mechanism has also been shown to work with a modern bacteria's uptake of 43.000 years old mammoth DNA.

The results are published now in the scientific journal Proceedings of the National Academy of Sciences USA (PNAS). The discovery of this second-hand use of old or fragmented DNA may have major future consequences. Postdoc Søren Overballe-Petersen from the Centre for GeoGenetics at the Natural History Museum of Denmark is first author on the paper and he says about the findings:

It is well-known that bacteria can take up long intact pieces of DNA but so far the assumption has been that short DNA fragments were biologically inactive. Now we have shown that this assumption was wrong. As long as you have just a tiny amount of DNA left over there is a possibility that bacteria can re-use the DNA.

One consequence of this is in hospitals that have persistent problems with antibiotic resistance. In some cases they will have to start considering how to eliminate DNA remnants. So far focus has been on killing living pathogen bacteria but this is no longer enough in the cases where other bacteria afterwards can use the DNA fragments which contain the antibiotic resistance.

The research group's results reveal that the large reservoir of fragments and damaged DNA in the surroundings preserve the potential to change the bacteria's genomes even after thousands of years.

This is the first time a process has been described which allows cells to acquire genetic sequences from a long gone past. We call this phenomenon Anachronistic Evolution - or Second-hand Evolution. Professor Eske Wellesley from the Centre for GeoGenetics at the Natural History Museum of Denmark is the leader of the project. He says:

That DNA from dead organisms drives the evolution of living cells is in contradiction with common belief of what drives the evolution of life itself.

Furthermore old DNA is not limited to only returning microbes to earlier states.

Damaged DNA can also create new combinations of already functional sequences. You can compare it to a bunch of bacteria which poke around a trash pile looking for fragments they can use. Occasionally they hit some ‘second-hand gold’, which they can use right away. At other times they run the risk of cutting themselves up. It goes both ways.

This discovery has a number of consequences partially because there is a potential risk for people when pathogen bacteria or multi-resistant bacteria exchange small fragments of ‘dangerous’ DNA e.g. at hospitals, in biological waste and in waste water.

In the grand perspective the bacteria's uptake of short DNA represents a fundamental evolutionary process that only needs a growing cell consuming DNA pieces.

A process that possibly is a kind of original type of gene-transfer or DNA-sharing between bacteria. The results show how genetic evolution can happen in jerks in small units.

The meaning of this is great for our understanding of how micro-organisms have exchanged genes through the history of life. The new results also support the theories about gene-transfer as a decisive factor in life's early evolution. Søren Overballe-Petersen explains:

This is one of the most exciting perspectives of our discovery. Computer simulations have shown that even early bacteria on Earth had the ability to share DNA - but it was hard to see how it could happen.

Now we suggest how the first bacteria exchanged DNA. It is not even a mechanism developed to this specific purpose but rather as a common process, which is a consequence of living and dying.

- MNT

Glaucoma risk high for long-term oral contraceptive users

Research has found that women who have taken oral contraceptives for three or more years are twice as likely to suffer from glaucoma, one of the leading causes of blindness which affects nearly 60 million worldwide. The researchers caution gynecologists and ophthalmologists to be aware of the fact that oral contraceptives might play a role in glaucomatous diseases, and inform patients to have their eyes screened for glaucoma if they also have other risk factors.

The study - conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China - is the first to establish an increased risk of glaucoma in women who have used oral contraceptives for three or more years.

The researchers utilised 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES), administered by the Centres for Disease Control, which included 3,406 female participants aged 40 years or older from across the United States who completed the survey's vision and reproductive health questionnaire and underwent eye exams. It found that females who had used oral contraceptives, no matter which kind, for longer than three years are 2.05 times more likely to also report that they have the diagnosis of glaucoma.

Although the results of the study do not speak directly to the causative effect of oral contraceptives on the development of glaucoma, it indicates that long-term use of oral contraceptives might be a potential risk factor for glaucoma, and may be considered as part of the risk profile for a patient together with other existing risk factors.

These include factors such as African American- ethnicity, family history of glaucoma, history of increased eye pressure or existing visual field defects. Previous studies in the field have shown that oestrogen may play a significant role in the pathogenesis of glaucoma.

- MNT

Risky heart rhythm may be identified via small vessel changes in eye, kidney

People with damage in the small blood vessels of the retina and kidneys are at increased risk to develop the most common type of abnormal heart rhythm, according to research presented at the American Heart Association's Scientific Sessions 2013.

Atrial fibrillation the risk of stroke and causes heart-related chest pain or heart failure in some people.

Researchers in the Atherosclerosis Risk in Communities Study (ARIC) followed 10,009 middle-aged people for an average 13.6 years. Atrial fibrillation developed at a rate of: - 5.7 incidences per 1,000 person-years in those with no retina or kidney changes. - 8.9 incidences per 1,000 person-years in those with signs of small vessel damage in the retina, such as micro-bleeds or micro-aneurysms.

- 16.8 incidences per 1,000 person-years in those with signs of vessel damage in the kidneys, allowing tiny amounts of protein to be released into their urine (micro-albuminuria).

- 24.4 incidences per 1,000 person-years in those with both retinopathy and micro-albuminuria.

Though reasons for the association are unclear, changes in other vascular beds may serve as a representation of coronary micro-vascular changes and the observed association may be mediated via inflammation, endothelial dysfunction, autonomic dysfunction, and electro-mechanical remodelling, the researchers said.

- Medicalxpress