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I'm Not Overweight. But Am I Fit?
Tweet Share on Facebook May 20, 2009 Comment (1)I have a normal body weight, eat modestly, exercise a little, and feel healthy. How do I know that I am fit?
The best and safest way to determine the fitness of the cardiovascular system is to be evaluated by treadmill or bicycle stress testing with EKG monitoring in a physician's office. In the past, being physically fit was described as there being an absence of disease. Over the years, that definition has changed to imply adequate cardiovascular fitness. In a clinical setting, we determine cardiovascular fitness by treadmill stress testing.In addition, our studies have shown that in predicting future coronary events, these three measurements from treadmill stress tests are very important:
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How Can Older People Get Active?
Tweet Share on Facebook May 20, 2009 Comment (3)I'm an older adult, and I've heard (and heard) the message that I should have a regular exercise program, but I've just never gotten into it. How do I seriously get started? And what should I hope to accomplish?
Exercise can be used in three general ways: (1) rest and relaxation, (2) muscle building and body shaping, and (3) cardiovascular/pulmonary conditioning. For older people, I would recommend focusing on Nos. 1 and 3. Consider the known benefits of exercise when you are contemplating starting into a program. The most common reason people continue exercising is that it "makes them feel good." Studies show that regular exercisers are less depressed and less hypochondriacal, have an improved self-image, have a more positive attitude toward life, and have fewer somatic [physical] complaints. -
How Can You Build Bone Mass?
Tweet Share on Facebook May 19, 2009 Comment (6)My 88-year-old mother has been taking glucosamine and chondroitin twice a day for joint pain, along with vitamin D once a day, but her doctor says that her bone mass is worse than when she began treatment. Does she have other options?
To my knowledge, no studies have documented adverse side effects from these two substances. And most other treatments for joints, such as aspirin, nonsteroidal anti-inflammatory agents, and even Tylenol, have their own associated risks. The most important initial test for your mother would be to check her level of vitamin D3 and administer 2,ooo to 4,000 international units of vitamin D3 a day. Vitamin D increases calcium absorption from the intestines and stimulates osteoblasts to make new bone in the bone marrow. -
Why Isn't There a Gardasil for Men?
Tweet Share on Facebook May 18, 2009 Comment (19)Why was the vaccine against the cancer-causing, sexually transmitted HPV virus not approved for men at the same time it was for women? Is there any reason to think that men and women would react to it differently?
Interesting question. First, a little background.Gardasil is a genetically engineered vaccine to immunize girls and women ages 9 to 26 against four types of human papillomavirus (HPV). HPV is the name given to a family of viruses, many of which can be transmitted from one partner to another through sexual activity. HPV may represent the most frequent sexually transmitted infection in the United States. It is estimated that over 6 million people become infected by a sexually related form of HPV every year. Some estimates suggest that over half of all sexually active males and females become infected at one point or another in their lifetimes.
Certain types of HPV can sometimes evade the body's immune system and, when they do, establish a state of persistent infection. That in turn may cause certain cancers. Indeed, this is now recognized as the major cause of cervical cancer and related conditions, and vaccines that immunize people against HPV could make a dramatic impact against these diseases.
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Is Occasional Marijuana Use Bad for Adolescents?
Tweet Share on Facebook May 15, 2009 Comment (43)There is a big push to legalize or at least decriminalize recreational marijuana use, in part because it is so widely used among young people. What is your advice to young people who are occasional pot users? And, as a pediatrician, do you discuss an adolescent's pot use with Mom and Dad?
At the Children's Hospital in Boston, we are very fortunate to have the Center for Adolescent Substance Abuse Research. CeASAR expert Dr. Sharon Levy gave me this advice:We recommend that young people avoid use of marijuana entirely. While marijuana does not cause severe withdrawal symptoms seen with other drugs, the syndrome of marijuana dependence is well described in the medical literature, is every bit as powerful as addiction to other drugs, and causes great harm to young people. Marijuana addiction is characterized by lack of motivation, poor functioning in school and at work, disruption in family relationships and friendships, and loss of control over how much is used and how often. Several large scientific studies have shown those who use marijuana during adolescence are at much greater risk of developing depression and schizophrenia, and adolescents who become addicted to marijuana have poorer outcomes relative to education, career, and family goals than their siblings. Unfortunately, because of slow and insidious onset, symptoms are often not recognized. Recent research has demonstrated that, as with alcohol, adolescents who begin using marijuana early are much more likely to develop an addiction than fully mature adults. Parents should not permit their adolescent children to use marijuana—in the end, the messages they give have a greater impact on their children's behavior than the law. They should see the laws prohibiting marijuana use as a means to support them rather than an end in itself.
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Do Antidepressants Strengthen the Immune System?
Tweet Share on Facebook May 15, 2009 Comment (12)
Treating depression with medicines like antidepressants can help both your mood and your immune system. Depression can fuel inflammation, and data from several studies suggest that antidepressants may dampen inflammation. Drugs that treat depression may have other positive benefits that indirectly help inflammation as well; when people are depressed their sleep is poorer, they tend to eat high-fat diets, they exercise less, and they smoke and drink more—behaviors that can promote inflammation. Inflammation is associated with many age-related diseases, including heart disease and stroke, so treating depression may be one way to help heal the body as well. -
Do Statins Reduce Cholesterol Deposits in Arteries?
Tweet Share on Facebook May 15, 2009 Comment (7)
There is evidence that statins can reduce the amount of cholesterol plaque in the arteries in some patients. In 2006, we published a study showing that high doses of a powerful statin could reduce plaques in about two thirds of patients. In this study, we treated people to reach very low levels of LDL, the "bad" cholesterol, and were able to increase HDL, "good" cholesterol, by 14.7 percent. However, such an aggressive regimen is not for everybody, so please talk to your doctor. -
Is Exercise Possible if I'm in Chronic Pain?
Tweet Share on Facebook May 5, 2009 Comment (3)
One of my colleagues at Duke Integrative Medicine, Sam Moon, M.D., M.P.H., in the Department of Community and Family Medicine, Division of Occupational and Environmental Medicine, is an expert in integrative approaches to pain and healthful lifestyles. Here is what he has to say:Chronic pain frequently produces 'collateral' harm, including the many adverse effects of physical inactivity, such as decreased vigor, muscle weakness, worsening obesity, low mood, and so on. It is human and natural to withdraw a bit and 'nurse' one's pain with rest. This is good early on. Chronically, this natural instinct becomes part of the problem. Exercise (physical activity) is but one small slice of a full, long-term pain management plan, and that 'slice' is as crucial as it is highly individual, complex, and tricky. Success is finding combinations of activity that are safe, beneficial, fun, sustainable over seasons, and 'elastic' (i.e., their intensity and duration can be scaled up and down easily). If this goal becomes a struggle, you should seek a professional 'integrative exercise prescription.'
