Health and Fitness

At the Stanford Women’s Health Forum held in May, experts from throughout the School of Medicine presented on a range of topics affecting young, middle-age and senior women. A number of the talks, including the keynote delivered by Susan Love, MD, were posted today on the Stanford Center for Health Research on Women & Sex Differences in Medicine Facebook page.

In the above video, Stanford nutrition researcher Christopher Gardner, PhD, and endocrinologist Sun Kim, MD, discuss diet, weight control and why it’s so hard to shed those extra pounds. As Kim explains during her presentation, modern society has created the “perfect storm” for obesity.  She discusses how to overcome environment and genetics to manage your weight.

Following Kim’s talk, Gardner offers an overview of recent research comparing high-protein, low-carbohydrate and low-fat diets.  He also talks about how individuals’ insulin sensitivity or insulin resistance may affect their weight loss success on the various diets. “The disservice that we’ve been doing to people is looking for the magic diet, and there isn’t one. There are lots of ways to do this,” he tells forum attendees.

Previously: At Stanford event, cancer advocate Susan Love talks about “a future with no breast cancer”, Breast cancer advocate Susan Love to deliver keynote at Stanford Women’s Health Forum, To meet weight loss goals, start exercise and healthy eating programs at the same time and How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals

A short survey that asks patients to assess their walking ability could be helpful in predicting a person’s risk of cardiovascular disease, as well as mortality risks from any cause. That’s according to a Stanford study recently published online in the journal Circulation.

The Walking Impairment Questionnaire, also known as the WIQ, is currently used to predict risks of peripheral artery disease, a narrowing of the arteries that causes limited circulation to the limbs. The authors of this new study wanted to see if the WIQ, which can be filled out by patients while waiting for their doctor appointments, might be helpful in predicting other health risks.

“A 70-year-old patient’s ability to walk six minutes is a great predictor of cardiovascular risks,” said Kevin Nead, a Stanford medical student and the first author of the study. “But most people are seen in 15-minute doctor visits. They’re not going to be doing a walking test.” Perhaps, he reasoned, a subjective test like this 17-question survey could be used instead.

Nead and his colleagues, who examined questionnaire results from more than 1,700 patients, found that the use of the WIQ alone successfully predicted cardiovascular outcomes. In addition, when the survey was used in conjunction with other common clinical tests such as blood pressure measurements and blood tests, it significantly improved the ability to predict mortality not just from cardiovascular disease but from any cause.

“In an era of increasing expense for medical costs, this work suggests that the WIQ, an extremely simple and economical tool, may significantly improve our ability to prognosticate risk,” Nead told me.

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I’ll admit that I often use the excuse of not having enough time to work out. Between the demands of work and raising two small kids, sometimes it really is difficult to drag myself to the gym. That’s why this piece on Well this morning grabbed my attention – a high-intensity workout in just seven minutes, and one that’s backed by science! Blogger Gretchen Reynolds writes:

…Sometimes you just want someone to lay out guidelines for how to put the newest fitness research into practice.

An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal does just that. In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.

“There’s very good evidence” that high-intensity interval training provides “many of the fitness benefits of prolonged endurance training but in much less time,” says Chris Jordan, the director of exercise physiology at the Human Performance Institute in Orlando, Fla., and co-author of the new article.

I’m ready to give this a try. If all I need are seven minutes, a chair and wall, then there’s really no room for excuses anymore.

Previously: Fitness research: A year in review, Is fitness level more important than body weight in boosting heart health, Study shows physically fit older adults have fewer age-related changes in their brains, Exercise may be effective in treating depression, Exercise may protect aging brain from memory loss following infection, injury, How physical activity influences health and Study shows how physical activity benefits seniors’ hearts
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With bathing suit season just around the corner, many of us are thinking more and more about how to shed a few extra pounds before hitting the beach or pool this summer. New research from Stanford shows that to successfully slim down, a dual approach – addressing both improving eating habits and increasing physical activity – is most effective.

In a study involving 200 people, Abby King, PhD, and colleagues divided participants into four groups: one made changes to diet and exercise at the same time, another adopted healthier eating habits without altering their fitness routine, a third increased their physical activity level before changing their diet, and a comparison group didn’t make any changes to their eating or exercising habits but were given instruction on stress-management techniques. Individuals’ progress was tracked for a year.

My colleague discussed the researchers’ findings in a release:

Despite the challenge of making multiple changes to their already-busy routines at once, those who began changing diet and exercise habits at the same time were most likely to meet national guidelines for exercise — 150 minutes per week — and nutrition — five to nine servings of fruit and vegetables daily, and keeping calories from saturated fats at 10 percent or less of their total intake.

Those who started with exercise first did a good job of meeting both the exercise and diet goals, though not quite as good as those who focused on diet and exercise simultaneously.

The participants who started with diet first did a good job meeting the dietary goals but didn’t meet their exercise goals. King, who also is a senior researcher at the Stanford Prevention Research Center, speculates this is because changing diet and introducing exercise both have unique challenges. “With dietary habits, you have no choice; you have to eat,” she said. “You don’t have to find extra time to eat because it’s already in your schedule. So the focus is more on substituting the right kinds of food to eat.”

Previously: What type of smartphone apps are effective for promoting healthy habits among older adults?, Computer-generated phone calls shown to help inactive adults get – and keep – moving, Eat a carrot and exercise – or your iBird dies and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
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While debating what to order for lunch last week, my brother explained that he was participating in a Biggest Loser-style contest with a group of co-workers and the winner received a sizable cash prize. As he described the competition, I took note of how he focused on strategies for beating other contestants, his weight-loss progress and odds at winning, rather than feeling deprived of his favorite foods or complaining about having to exercise more. The experience seemed to have given him a positive outlook on dieting and even motivated him to keep the weight off. When I mentioned that he only had to “be good” for a few more months and could go back to indulging afterwards, he said “No, I wouldn’t want to ruin my hard work.”

So I was interested to read about new research showing that weight-loss programs involving group competitions for financial prizes motivate people to shed more pounds than those offering individual rewards. Reuters reports:

Researchers compared two incentive scenarios. Under one, employees got $100 for each month they met the goal of dropping at least one pound per week. Under the second scenario, $500 was set aside each month for a group of five co-workers and the ones who met their goal got to split the prize.

“People may be more motivated to achieve a particular goal when a particular resource that had been allocated for them is given to someone else if they don’t achieve their goal,” said Dr. Jeffrey Kullgren, the study’s lead author from the University of Michigan Medical School and the Ann Arbor VA Healthcare System.

In the randomly controlled trial, participants offered individual incentives lost 3.7 pounds, on average, compared to 10.6 pounds among those with group-based incentives. The findings were published online today in the Annals of Internal Medicine.

Previously: The trouble with the current calorie-counting system, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, Can a food-tracking app help promote healthy eating habits?, Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
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Many of us, myself included, can’t fathom the idea of exercising without listening to a carefully curated playlist. But what is it exactly about music that motivates us to run further, cycle harder and pump more iron?

An article today in Scientific American sheds some light on the psychology of music and exercise and offers insights into what types of tunes are best suited to working out. Ferris Jabr writes:

In the last 10 years the body of research on workout music has swelled considerably, helping psychologists refine their ideas about why exercise and music are such an effective pairing for so many people as well as how music changes the body and mind during physical exertion. Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it. In a 2012 review of the research, Costas Karageorghis of Brunel University in London, one of the world’s leading experts on the psychology of exercise music, wrote that one could think of music as “a type of legal performance-enhancing drug.”

Selecting the most effective workout music is not as simple as queuing up a series of fast, high-energy songs. One should also consider the memories, emotions and associations that different songs evoke. For some people, the extent to which they identify with the singer’s emotional state and viewpoint determines how motivated they feel. And, in some cases, the rhythms of the underlying melody may not be as important as the cadence of the lyrics. In recent years some researchers and companies have experimented with new ways to motivate exercisers through their ears, such as a smartphone app that guides the listener’s escape from zombies in a postapocalyptic world and a device that selects songs based on a runner’s heart rate.

The full story is worth a read and is sure to energize you for today’s post-work run or gym session.

Previously: Study shows regular physical activity, even modest amounts, can add years to your life, Study shows short, daily jogs boost longevity and How physical activity influences health
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As previously reported here, Stanford researcher Abby King, PhD, and colleagues have been testing different smartphone apps to determine what type of framework best promotes exercise and eating healthy among older adults.

All three apps in her study used the accelerometer in participants’ smartphone and a custom program to monitor how active individuals were during the day. The analytic version used goal-setting and feedback to motivate users. The social comparison design utilized support and competition among a group to encourage participants to meet goals. And the third one, the game-style app, promoted attachment to an avatar, a digital bird, that thrived or languished depending on the healthy habits of its “owner.”

In a talk at last fall’s Stanford Medicine X conference, King shared results from her research and discussed which types of apps were most effective in improving healthy behaviors. The video, which was just posted online, offers some interesting evidence on how mobile device apps can change users’ behavior quicker than traditional methods.

Previously: Computer-generated phone calls shown to help inactive adults get – and keep – moving, Eat a carrot and exercise – or your iBird dies, Research shows remote weight loss interventions equally effective as face-to-face coaching programs and Monitoring patient wellness from a distance

“Hello, Mrs. Jones. Your goal last time we talked was to do 30 minutes per day of brisk walking five days per week. Were you able to reach this goal?”

In 2007, Stanford researchers showed in a study of 218 older, inactive adults that computer-generated phone calls appeared to be an effective, low-cost way to encourage sedentary adults to exercise. In the trial, those participants in both the group called by trained health educators and the group called by a computer asking questions like the one above and delivering an interactive, individualized program wound up completing a regular 150-minute per week exercise program.

Now Abby King, PhD, and colleagues have found that the increases in regular physical activity seen during the year-long study were maintained in a subsequent six-month follow-up period – regardless of whether the participants had received human or automated advisor-initiated telephone contacts during those first 12 months. In looking at the trajectory of physical activity change over 18 months, the researchers also saw that the greatest physical activity increases for participants occurred during the first six months of intervention.

I recently discussed these findings with King, who told me that while advice and support is often important in maintaining healthy behaviors, “it doesn’t necessarily have to be delivered in person or by a human at all.” Below King talks more about the study, which appears online in the journal Health Psychology.

How significant is it that participants in the study – regardless of the intervention they received – were able to maintain their healthy habits? Were you surprised by what you found?

Given that participants in such programs tend to decrease their physical activity levels when instructor-initiated support ends, it is quite encouraging to see that both groups were able to “step up” and take charge of their programs during the maintenance period. Both groups received specific information from their physical activity advisors on how to do this during the initial program.

Your results also show the importance of the first six months of programming in establishing sustained physical activity change. How critical is this? Has this been shown in other studies, as well?

This study substantiates the observation seen in some of our prior studies as well as in those of others in the field that the initial six months of programming is a “critical period” for establishing the types of behavioral habits and skills necessary for continued behavioral success.

In your paper you and your co-authors call these automated technologies “attractive intervention tools” because of their reach, availability and cost. Can you explain how they might be beneficial in less-developed countries, where trained health educators are not in large supply?

The growing pervasiveness of mobile phones worldwide, particularly in less-developed countries, sets the stage for a “paradigm shift” with respect to how evidence-based health promotion programs can reach individuals regardless of where they live. Tele-health and the use of automated communication technologies allow for the types of “borderless health promotion” that can potentially make a substantive difference in the health promotion field worldwide.

What are your next steps? Are you conducting/planning more work in this area?

Based on this study, my group is currently collaborating with Dr. Marcia Stefanick here at Stanford and her colleagues in developing an automated tele-health physical activity coaching program specifically for older women. We have initially piloted the automated program with a group of older women here in the Bay Area, and were quite encouraged by the initial results from that effort. The goal is to be able to reach thousands of older women across the country with an easy to use automated tele-health program that is personalized to their needs and preferences.

Previously: Eat a carrot and exercise – or your iBird dies, Research shows remote weight loss interventions equally effective as face-to-face coaching programs and Monitoring patient wellness from a distance
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I quite like this entry on the U.S. News & World Report blog eat + run today; in it a New York dietician (and mom) candidly discusses the pressure of those in her field to “remain a model of good health and fitness,” admits that she’s a few pounds over her ideal weight (“I may still squeeze into the same size-28 jeans as before [I had kids], but I sure don’t look as good in them”), and describes the recent changes she’s made to get in better shape. And, because it includes a term that is (sadly) so familiar to many of us moms, I especially love her headline.

Previously: How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals

In case you haven’t seen it, the New York Times’ Well blog quotes Stanford childhood obesity expert Thomas Robinson, MD, in a piece on how to help your kids filter the barrage of pro-junk food messages they get from food advertisements.

As the story describes, Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital, has done extensive research on children’s responses to food advertising and branding. I’m particularly fond of the study where young children tasted pairs of identical foods in different wrappers and said which they liked better. Regardless of the food tested (hamburgers, baby carrots, french fries, milk, whatever), kids said food in a McDonald’s wrapper was yummier than food in a plain wrapper.

Food advertising targeted to kids has become so pervasive – it’s not just on TV but also all over social media, Well reports – that Robinson says parents should do more than just say “no” when their children ask for junk food:

“Respond, ‘Well, why do you want that? Where did you hear about it?’ ” said Dr. Robinson. And if the answer is that the child saw it on TV or on the Internet, “Say, ‘Well, they want you to want it, they’re trying to sell you that.’ And then have a discussion.”

And what about my aspirations of nurturing young cynics? Though teaching critical viewing skills does enhance children’s awareness, Dr. Robinson told me that relying too much on notions of media literacy can actually play into the hands of the advertisers.

“That takes the responsibility away from them and puts it on the kids to be educated consumers,” he said.

If you’re wondering how to help your kids deal with the barrage of messages they get from food ads, the entire entry is well worth reading.

Previously: Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids, How food advertising and parents’ influence affect children’s nutritional choices and The First Amendment and marketing junk food to kids
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