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Contact: Will Sansom, 210-567-2579, sansom@uthscsa.edu

On this Diabetes Alert Day, March 28, 2023, we present a conversation with Carolina Solis-Herrera, MD. Solis is chief of endocrinology in the Joe R. and Teresa Lozano Long School of Medicine, which is part of The University of Texas Health Science Center at San Antonio. She speaks about both diabetes and obesity, which she treats in patients at the UT Health Physicians diabetes, obesity and metabolic health practice.

Q: Dr. Solis-Herrera, what is one of the newer medications for type 2 diabetes and obesity?

A: Thank you for the opportunity to talk about this important topic. Semaglutide is one of the medications we have at our disposal to treat patients with these conditions. In addition to treating diabetes, one of its additional effects is that you lose weight because it curbs your appetite.

The following has not been addressed often in the media, and it is very important for the public to know. Some clinics are announcing semaglutide for $25 in social media. It is not clear the formulation or the dose the patients will be receiving, which creates safety concerns. We advise patients to see their physicians to be prescribed any medication.

Q: What class of drug is semaglutide, doctor?

A: It is a GLP1-receptor agonist and is what we call a second-generation drug for diabetes and obesity. Currently, more medications are in the pipeline for treating these conditions.

Q: Do you think people underestimate the risks of obesity?

A: It is very important for the public to know that, just like diabetes, obesity is a chronic inflammatory disease that needs to be addressed immediately with lifestyle intervention and FDA-approved medications. Obesity is as important as high blood pressure, high cholesterol and diabetes, and has just as many complications that if untreated increase the risk of heart attacks, strokes, increased blood pressure and diabetes. It also decreases life span. It is very important, if you are overweight or obese, to seek medical attention.

Obesity can affect every organ, from your brain and lungs to your heart and kidneys, among many other organs. Obesity is associated with and increases your risk of multiple cancers including colon, liver and pancreatic cancer, and it seems to also possibly be associated with dementia.

The obesity pandemic needs to be treated as an emergency. According to a recent study, for the first time in our lives weve noticed life expectancy in America starting to go down. After a century of increasing life span, in 2020 the average longevity dropped 1.8 years and in 2021, it fell another 0.9 years. That is the biggest two-year decrease since the 1920s.

The drop is even greater in minority populations, including Hispanics and Blacks, and it is in part because of diabetes and obesity.

Q: You dont have to be diabetic to be obese, right?

A: Correct. However, patients with obesity may have insulin resistance, which might later translate into type 2 diabetes. Inversely, about 70% of patients with diabetes are overweight or obese. As you gain weight you become more insulin-resistant, and this is how both pandemics of diabetes and obesity go hand in hand.

Obesity and diabetes are associated with the potential development of fatty liver, fatty kidney, fatty pancreas and fatty heart as fatty acids continue depositing in different organs. We usually only talk about fatty liver, but damage in the other organs is also devastating.

About 80% of patients with diabetes have fatty liver. The American Diabetes Association recommends that 100% of patients with diabetes get screened for it. Why? Because a percentage of these patients will develop liver cirrhosis and end-stage liver disease and will need a liver transplant.

Q: And they are at risk for liver cancer.

A: Yes, obesity and fatty liver may increase the risk for hepatocellular carcinoma. Therefore, screening for fatty liver is so important. The best treatment for fatty liver is weight loss. When patients lose weight and improve their glucose control, we are also treating the fatty liver.

Q: New drugs help patients lose weight, but what about lap bands and gastric bypass to treat obesity?

A: Bariatric surgery certainly has a place in the management of obesity. First, not every patient is a candidate for a GLP1-receptor agonist such as semaglutide. If they have a history of severe pancreatitis or they cannot tolerate the medication, we will need to use other resources to help them lose weight.

Oral medications that we call first-generation obesity drugs, which came before semaglutide, may help patients lose about 5% to 8% of their body weight, which is still very good. As you lose more weight, there are better outcomes in your diabetes control and the complications of obesity.

Our goal is to help patients lose about 10% to 15% of their body weight. Their sugar will get better, their fatty liver will get better and their overall health will significantly improve. Blood pressure will get significantly better. They will be able to cut down on their medications.

Patients who have a body mass index over 40 and other comorbidities, and go through a specialty assessment, could be good candidates for bariatric surgery. This type of surgery will help them lose a significant amount of weight, with the goal of improving their health and life span. However, they need to start with changes in lifestyle and, if possible, anti-obesity medication.

It is important for all patients to be treated in a multidisciplinary way, meaning they receive a continuum of care encompassing proper nutrition, behavioral therapy, medications and, if indicated, bariatric surgery. Following a bariatric procedure, they need follow up, because after surgery, the body might have some vitamin deficiencies and also might regain some of the weight.

This is why obesity is a medical condition that requires long-term follow-up. It is just like high blood pressure. The day that you remove the medication, your blood pressure goes up. For obesity, the day that you remove the medication, the weight comes back, and if you already have comorbidities, they come back as well. Education of primary care providers and patients is greatly needed in this area.

Q: That is an important message for the public. These and other medical conditions need continuous education and action every day, not only on Diabetes Alert Day, correct?

A: Yes. Remember, we are in a part of the United States where type 2 diabetes prevalence is among the worst in the country. About one in six people (16%) in San Antonio have it and many of them dont even know it. In the Rio Grande Valley, it is closer to one in five people. The public needs information about diabetes and obesity to help communities stay healthy.

Q: Hemoglobin A1C, the three-month test for diabetes, is interesting to people. You can be lulled into thinking you are OK because your HbA1C looks good, right?

A: Yes, because you can have a lot of highs and lows in your sugars and HbA1C, which is an average of your sugar values over time, will not reflect it. This is where continuous glucose monitoring, or CGM, is important. CGM is a service that we provide here at the UT Health Physicians diabetes, obesity and metabolic health practice.

CGM can show you if the patient is having significant episodes of low or high sugars, and we are able to adjust medications accordingly. The device is the size of a quarter or a penny depending on the brand. It feels like a little shot as it is attached. Patients wear it for two weeks, then return. We download the report, and its a great teaching tool for the patients and physicians. The device also has alarms, which are a great advantage for patient safety. If a significant low or high are present, alarms will alert you to check your sugar, and take action before there are any negative outcomes such as severe hypoglycemia (low blood sugar).

CGM devices represent a technological advance that improves outcomes in patients, decreases hospitalizations and likely saves lives.

Q: Thank you for this timely discussion, Dr. Solis-Herrera.

Diabetes | UT Health San Antonio Appointments: 210-450-9050

The University of Texas Health Science Center at San Antonio(UT Health San Antonio), is one of the countrys leading health science universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated more than 41,100 alumni who are leading change, advancing their fields and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways We make lives better, visitUTHealthSA.org.

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Reverse dieting is a nutritional strategy that involves gradually increasing calorie intake after a period of dieting or calorie restriction in order to prevent weight gain and maintain a healthy body composition. This approach is based on the principle that the body adapts to lower calorie intake by slowing down its metabolism, so increasing calorie intake gradually can help the body adjust and prevent rebound weight gain.

Reverse dieting typically involves adding small amounts of calories back into your diet each week, while monitoring your weight and body composition to ensure that you are not gaining too much fat. The goal is to slowly increase your calorie intake to a level that allows you to maintain your weight without gaining any excess fat.

Reverse dieting can be helpful for several reasons:

Its important to note that reverse dieting is not a quick fix or a magic solution for weight loss or weight maintenance. It requires patience, discipline, and careful monitoring to ensure that you are increasing your calorie intake in a healthy and sustainable way. If you are considering reverse dieting, its a good idea to consult with a registered dietitian or nutritionist to help you develop a safe and effective plan.

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Chris Martin was recently interviewed on the Conan OBrien Needs A Friend podcast where he revealed that he doesn't eat dinner anymore and stops eating altogether at 4pm. He then went on to say that it wasn't a nutritionist whose advice he was following but that of Rock God Bruce Springsteen.

'I was lucky enough to go over there for lunch the day after we played Philadelphia last year,' said Martin. 'I was on a really strict diet anyway. But, I was like 'Bruce looks even more in shape than me.' And Patti [Bruce's wife] said, 'he's only eating one meal a day' so I was like, well, there we go, that's my next challenge.'

He's not the only one in Hollywood, or the only one in his family, sharing their eating (or perhaps, lack of eating) habits. Last week Martin's former partner, Gwyneth Paltrow caused a stir on social media, admitting she also employs an intermittent fasting regimen. Paltrow revealed on the Art of Being Well podcast she feasts upon a hearty diet of 'bone broth for lunch a lot of the days. Then for dinner I try to eat according to paleo, so lots of vegetables.'

Needless to say, we're not convinced, but let's weigh up the facts on fasting.

Intermittent fasting (IF) has gained popularity with other celebrities such as Mark Wahlberg and Hugh Jackman touting its benefits. But what is it?

Intermittent fasting is an eating method where you simply limit the hours in which you eat. Some versions of intermittent fasting include:

Whilst research is limited, there have been some benefits found by adopting the IF eating method, including:

Despite this, when compared with calorie restriction, a 2022 study found IF to be no more effective. The study published in the New England Journal of Medicine included 139 participants with obesity and assigned them to time restricted eating (intermittent fasting) with calorie restriction or daily calorie restriction alone. The results found that changes in weight were not significantly different between the two groups at the assessment 12 months later. It concluded that 'among patients with obesity, a regimen of time-restricted eating was not more beneficial with regard to reduction in body weight, body fat, or metabolic risk factors than daily calorie restriction.'

According to research by the American Journal of Lifestyle Medicine, one of the most important factors that dictate long term weight loss success is adherence. As with any diet, it's important the body is being fed with the nutrients it needs. Depriving the body of certain foods needs to be done under the guidance of a professional to ensure it's done safely and helps you achieve what set out to without harming yourself in the process.

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Here's Why Chris Martin's One-Meal-a-Day Diet Isn't Such a Great Idea - Men's Health UK

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EXCLUSIVE: The upcoming second season of HBOs House of the Dragon will consist of eight episodes, two fewer than Season 1 of the Critics Choice Award-winning Game of Thrones prequel. It is part of a long-term plan for the show, which includes HBO mulling a green light for a third season, I have learned.

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The news comes as production is about to begin on Season 2 in the UK for a likely summer 2024 premiere.

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In what is a relatively common practice, HBO did not reveal the episode order in the Season 2 renewal announcement last summer. I hear the initial plan was for another 10-episode arc, which eventually changed, leading to some script rewrites. Given the leadership change at HBOs parent company, some pointed at Warner Bros. Discovery leaderships focus on cost-cutting. An HBO spokesperson, who confirmed to Deadline that Season 2 will contain 8 episodes, stressed that the episode count trim was story-driven.

It has been reported that House of the Dragons creative team had envisioned the series running for three or four seasons. I hear executive producer-showrunner Ryan Condal, working with author/executive producer George R.R. Martin, took a step back as Season 2 was being put together to take a big-picture view of the series, which follows MartinsFire & Blood, and figure out the overall narrative flow, including how to break up the stories season-to-season and what battles to include and when.

Story continues

As part of that, I hear Season 3 has been mapped out and might be greenlighted, with HBO seriously considering committing to moving ahead with scripts, casting and a production plan as the network too is trying to think long-term instead of season-to-season.

With a portion of the plot originally intended for Season 2, including a major battle, moving to Season 3, I hear it is now more likely that the series would run for four seasons, but that has not been determined as Condal and Martin continue to go back-and-forth on the number of seasons (three or four) that would be optimal to tell the full story, sources said.

In an October blog post, Martin spoke of the fact that HBO series like The Sopranos used to get 13 episodes a season, which had changed to 10 by the time Game of Thrones came along. The Emmy-winning fantasy juggernaut produced six 10-episode seasons, leading into the final 13-episode chapter that was split into two. This is more than the eight-episode seasons of Amazons LOTR: The Rings of Power, he noted.

RELATED: House Of The Dragon Premiere Photo Gallery

I am thrilled that we still have 10 hours every season to tell our tale, Martin said about House of the Dragon. I hope that will continue to be true. It is going to take four full seasons of 10 episodes each to do justice to the Dance of the Dragons, from start to finish.

House of the Dragon is set 172 years before the events ofGame of Thronesand tells the story of House Targaryen.

Warner Bros. Discoverys new regime embraced the series last summer, supporting the $200M production with the biggest marketing campaign in HBOs history, which reached 130M people in the U.S.by company estimates.

It led to a big ratings splash for the series August 21 premiere, which was followed by a Season 2 renewal a few days later.

House of the Dragon stars Paddy Considine, Matt Smith, Olivia Cooke, Emma DArcy, Steve Toussaint, Eve Best, Fabien Frankel, Sonoya Mizuno and Rhys Ifans.

Condal and Martin executive produce with Sara Hess, Vince Gerardis, Season 2 director Alan Taylor and Season 1 director/co-showrunner Miguel Sapochnik.

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Regardless of the diet you choose to adhere to, experts note that the main driver of weight loss is via a caloric deficit (in which you burn more calories than you consume). This is why a high protein diet seems to produce such favorable changes in body compositionthere is evidence to suggest that higher protein diets may indeed promote a loss of body fat through mechanisms related to the thermic effect of feeding (the amount of energy it takes to digest and process the food you eat), as well as promoting better satiety.

With that in mind, there are many expert-backed eating patterns that can promote weight loss for men. Here are a few of the top recommendations.

Julie Miller Jones, Ph.D., a board-certified nutritionist and scientific advisor for the U.S. Food and Drug Administration and the Joint Institute of Food Safety and Nutrition for the University of Maryland, recommends the Dietary Approaches to Stop Hypertension (DASH) Diet for men interested in weight loss.

Originally developed by the National Heart, Lung and Blood Institute to help lower blood pressure, the DASH Diet provides general guidelines of how many servings from each food group you should aim for each day. In particular, the diet emphasizes fruits, vegetables, whole grains, low-fat dairy products, vegetable oils, fish and poultry. While calorie counting is not required with this eating plan, it doest limit daily sodium intake to 2,300 milligrams or less. It also recommends limiting foods high in saturated fats, tropical oils and sugar-sweetened beverages.

As Dr. Miller Jones points out, the DASH diet is not overly restrictive and can be followed long-term. I always say that you should never go on a diet that you cannot live with for the rest of your life, she says. There are no forbidden foods, just foods that you should choose infrequently, and the DASH diet supports this mantra.

While the DASH diet is famous for its heart health benefitssuch as lower blood pressure and LDL cholesterolit can be effective for weight loss, too, as it encourages nutrient-dense whole foods and physical activity. According to one review of 13 studies, a low-calorie DASH diet was found to be more effective for weight loss and fat loss than other low-calorie diets.

Joan Salge Blake, a registered dietitian and nutrition professor at Boston University, recommends both the DASH Diet and Mediterranean diet as her top choices for weight loss for men. Both are backed by research and have been shown to reduce the risk of heart disease, the leading cause of death among Americans, especially men, says Salge Blake.

The Mediterranean diet, in particular, includes ample amounts of fruits, vegetables, whole grains, fish and legumes, along with plenty of heart-healthy fats, such as olive oil. While no foods are excluded from the diet completely, red meat and sweets should be limited.

One 2020 study found that greater adherence to the Mediterranean diet was associated with two times greater likelihood of weight loss maintenance. Researchers note that this may be attributed to the increased intake of fiber and protein on the Mediterranean diet, both of which can increase feelings of fullness and satiety.

In addition to promoting weight loss, the Mediterranean diet has also been linked to a variety of other health benefits, including a reduced risk of high blood pressure, metabolic syndrome and type 2 diabetes. As Salge Blake points out, it may also help protect against heart disease, which accounts for about one out of four male deaths in the U.S., according to the CDC.

Intermittent fasting is a popular dietary practice that has been associated with a number of health benefits. The general idea of intermittent fasting is to cycle between periods of eating and fasting within an allotted period of time, and one of the most common variations is 16/8 fasting, which involves fasting for 16 hours and limiting food intake to an eight-hour window each day.

According to Chicago-based registered dietitian, Amber Dixon, This helps to reduce insulin levels, which can help with fat loss. Dixon also notes that fasting can force the body into ketosis, a metabolic state in which the body burns fat for fuel instead of sugar.

Interestingly, one review of 27 studies found that intermittent fasting could be as effective as a calorie-restricted diet when it comes to weight loss, with studies reporting an average weight loss of up to 13% of body weight with no serious side effects.

I recommend a whole food, plant-based diet for men for weight loss, says Dana Ellis Hunnes, Ph.D., a senior clinical dietitian at UCLA Health. Plant-based diets are high in fiber, fruits and vegetables, which are anti-inflammatory, are satiating and fuel your muscles and brain. While there are different iterations of plant-based diets, they all emphasize nutritious plant foods while limiting animal products, such as meat, eggs and dairy, as well as refined and processed foods.

For weight management in particular, research suggests that plant-based diets can help prevent overweight and obesity, improve diet quality and promote weight loss.

In addition to supporting weight loss, Dr. Ellis Hunnes also notes that plant-based diets can promote muscle growth, reduce inflammation and provide a wealth of essential vitamins and minerals. Furthermore, additional research suggests that plant-based diets may protect against chronic conditions like heart disease, cancer and type 2 diabetes.

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Heading out the door? Read this article on the new Outside+ app available now on iOS devices for members! Download the app.

When people say, You cant outrun a bad diet, I smile and nod. Its perfectly true, in a holistic sense. Exercise and diet are two different things, with separate effects on your health and performance. You cant automatically compensate for deficiencies in one area by being extra good at the other, any more than donating to charity makes it OK to embezzle at work.

Still, theres a little voice in my head that asks: Well, how far were you planning to run? It may be true that youd have to jog three or four miles to burn the calories in a single McDonalds Happy Meal, but some people run a lot farther than four miles. The question of how many calories a person can burn in a given day is an interesting scientific one, with some researchers arguing that our ability to get food through the digestive tract is actually the fundamental limitation on feats of sustained human endurance.

Thats why a new study in the International Journal of Sports Physiology and Performance, from a team led by Brent Ruby of the University of Montana along with colleagues from the University of Wisconsin, caught my eye. Ruby and his colleagues collected a bunch of data from a competitor in the Mudslinger Oregon 24, a mountain-bike race in Oregon that involves racking up as many 11-mile loops as you can in 24 hours. The most interesting detail: they fed their subject a dose of very expensive doubly labeled watera mix that contains water molecules with either an uncommon isotope of hydrogen or an uncommon isotope of oxygenthat enables them to calculate with very high accuracy how many calories he burned over the course of his 24-hour ordeal.

The subject, a 41-year-old male, managed to complete a very impressive total of 238 miles. The course, for context, includes dominantly soft-dirt, single-track, and loose-gravel fire roads with occasional large rocks that required periodic rider dismount. In the process, he also climbed a total of over 25,000 feet, not too far from Everesting. He started out with an average heart rate of 162 beats per minute for the first three laps, but had dropped to 113 for the last three laps, with an overall average of 134. He wasnt messing around.

His total energy expenditure during the event was 9,775 calories. In round numbers, thats roughly quadruple the typical energy expenditure of an adult male whos living a normal life rather than biking all day and night. Its a lotbut its not unprecedented. Earlier studies have tended to focus on extreme examples like polar explorers and Grand Tour riders. A 2019 study, for example, found that seven riders in the Giro dItalia averaged 7,719 calories per day for 24 straight days.

An earlier paper by Ruby and his colleagues found that Ironman triathletes burned just over 9,000 calories, and that ten Western States 100-mile finishers averaged a total expenditure of 16,310 calories while finishing in 26.8 hours. That works out to a little over 14,000 calories per 24-hour period. Again, thats just an average: some of the subjects were several thousand calories higher. Those who run 100-mile races are not exactly typical shmoes, but Ruby is careful to point out that these werent the people winning the race. The title of that paper is Extreme endurance and the metabolic range of sustained activity is uniquely available for every human not just the elite few.

Of course, you cant go on burning that much fuel indefinitely. Thats the point Herman Pontzer and John Speakman make about the alimentary limit on sustained endurance: you simply cant eat (and digest) that much. In this case, Rubys 24-hour cyclist managed to shovel down 5,616 calories, a little over half of what he burned. Most of that was in the form of carbohydrate, which he managed to consume at a rate of 58 grams per hour. Thats impressively close to the traditional guidance for marathoners of 60 grams per hour (though more recent research has pushed the target up to 90 or even 120 grams per hour). Given how much trouble most people have stomaching that amount of carbohydrate, its hard to imagine the cyclist doubling his intake over an entire day.

One other detail enabled by the doubly labeled water measurement: his total water turnover was 17.2 liters (about 4.5 gallons). He drank 13.3 liters (3.5 gallons), and lost about seven pounds from start to finish. That weight loss came entirely in the first half of the race, which was during the daytime in temperatures that climbed as high as 92 degrees Fahrenheit with 84 percent humidity. During the night, it dropped to 37 degrees with 17 percent humidity, so its not surprising his fluid loss stabilized.

We dont get any information about how the cyclist made his fuel and hydration decisions, but its interesting how closely his rate of fluid consumption (the darker line in the graph below) matches the air temperature (the lighter line) over the course of the race. Its what youd expect to see if someone was drinking according to thirst:

When it was hot, he drank a lot; when it was cool and he was presumably sweating less, he drank less. Given that some of the seven pounds he lost would be the result of burning fuel stores rather than losing fluids, its likely that he got his hydration pretty close to perfect.

Ruby is probably most famousor infamousfor a study he ran back in 2015 that compared McDonalds fast food with products from Gatorade, Cliff, Power Bar, and other sports nutrition companies. They all worked equally well for restocking glycogen after a 90-minute bike ride and fueling a subsequent 20K time trial. Calories, in this view, are calories (or at least carbs are carbs). As I said at the top, I dont think thats true in the long term: theres more to health than burning as many calories as you consume. Still, its not a bad place to startand Rubys data offers a reminder that, with sufficient fitness and motivation, were capable of burning a staggering number of calories.

For more Sweat Science, join me on Twitter and Facebook, sign up for the email newsletter, and check out my book Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.

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UNMs Exercise Science program will keep working out, and onward.

The Commission on Accreditation of Allied Health Education Programs (CAAHEP) has awarded initial accreditation to the College of Education & Human Sciencess (COEHS) Exercise Science program, including its Strength and Conditioning add-on.

CAAHEP accreditation requires a tough, in-depth evaluation, meaning the Exercise Science program has metincredibly high standards, including continuous quality improvement in theeducation of health-related professions.

Exercise Science Associate Professor Fabiano Amorim says all standards were not only met, but hit maximum scoring. That does not mean, he says, that COEHS will stop striving for a perfect education standard.

This is a significant achievement for the ES program and proof of the hard work and dedication of the faculty, staff, and students, Amorim said."I would like to thank the entire faculty, staff, and students for their hard work and dedication in achieving this significant milestone. I would also like to thank the Associate Provost, Dean, and Department Chair for their continued support of the program."

COEHS Interim Dean Kristopher Goodrich says this accreditation will also give back to New Mexico.

This new accreditation for the Exercise Science program in the college acknowledges the truly excellent preparation and training that allied healthcare professionals receive here, Goodrich said. New Mexicans benefit from the graduates of exercise science who go on to careers in athletic training, health education, physical therapy, and other allied health careers.

The accreditation standards are established by CAAHEP as well as theAmerican College of Sports Medicine, American Council on Exercise, American Kinesiotherapy Association, American Red Cross, National Academy of Sports Medicine, and National Council on Strength & Fitness.

We believe that the accreditation will bring benefits to our program, including increased recognition and prestige for future students and the community in general, and enhanced opportunities for our students, Amorim said.

The next evaluation of the program is scheduled to occur no later than 2028. In the meantime, students, faculty and staff can be confident this program is at the top of its game.

Check out ongoing research and initiatives from the Exercise Science Program in the Department of Health, Exercise & Sports Sciences.

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UNM's Exercise Science program receives distinguished accreditation - UNM Newsroom

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Physical exercise may improve the motor symptoms and quality of life for patients with Parkinson's disease (PD), new research shows.

A systematic review of 156 clinical trials involving 8000 patients with PD, showed dancing and aquatic exercise, in particular, were most likely to improve motor symptoms, while swimming, endurance training, and mind-body training were most likely to benefit quality of life (QoL).

Moritz Ernst

"For most types of exercise we studied, we observed positive effects on both the severity of motor signs and quality of life. These results highlight the importance of exercise in general, as they suggest people with Parkinson's disease can benefit from a variety of exercises," study investigator Moritz Ernst, MSc, deputy head of the working group on evidence-based medicine at the University Hospital Cologne in Cologne, Germany, told Medscape Medical News.

"Clinicians and people with PD may have several options of exercise programs to choose from when establishing an individual training routine," he added, emphasizing that overall those with PD should seek professional advice, including assessment of motor and nonmotor symptoms, to develop a training agenda based on their individual needs.

The study was published online earlier this year in the Cochrane Database of Systematic Reviews.

The investigators analyzed data from randomized, controlled trials comparing different types of exercise and no exercise and the subsequent effect on PD symptoms.

Exercise included dance, strength-resistance training, mind-body training such ad tai chi and yoga, water-based training, resistance training, gait/balance/functional training, and endurance training.

The average age of study participants ranged from 60 to 74 years, and most of the studies included patients with mild to moderate PD. The mean length of the various interventions was 12 weeks.

When the researchers examined the effect of exercise on motor symptoms, they found that dance (P = .88), aqua-based training (P = .69), and gait/balance/functional training (P = .67) were most likely to reduce symptom severity.

Aqua-based training (P = .95), endurance training (P = .77), and mind-body training (P = .75) were most were most likely to benefit QoL, although the investigators caution that these findings were at risk of bias because quality of life was self-reported.

The investigators note other study limitations including the fact that most of the studies included in the review had small sample sizes and their study only included patients with mild-to-moderate vs severe PD.

Ernst said that future research should include larger samples, report intent-to-treat analyses, and involve participants with more advanced forms of PD who may also have cognitive difficulties.

"We should be giving our patients, no matter where they are in their disease stage, a 'prescription' to exercise," Mitra Afshari, MD, MPH, told Medscape Medical News.

Dr Mitra Afshari

Afshari, who was not involved in the study, but leads her own research on PD and exercise as the site principal investigator on the NIH-funded SPARX3 Study in Parkinson's Disease and Exercise at Rush University in Chicago, Illinois, said that based on her experience caring for PD patients at all disease stages noted that "patients who have been physically active their whole lives and can maintain that activity despite their diagnosis fare the best."

However, she added, those who initiate physical exercise after diagnosis can also do very well and reap benefits, including improved motor symptoms.

The study was funded by University Hospital of Cologne, Faculty of Medicine and University Hospital, University of Cologne, Germany, and the German Ministry of Education and Research. The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online January 5, 2023. Abstract

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Heart failure occurs when the heart can no longer pump blood and oxygen around the body. The condition represents around 8.5% of heart disease deaths in the United States.

Heart failure with preserved ejection fraction (HFpEF) causes around half of heart failure cases in the U.S. It happens when the hearts left ventricle stiffens, increasing pressure inside the heart.

Studies show that exercise improves physical and cardiac function in patients with HFpEF and may lead to better outcomes than medication.

Understanding more about how exercise could benefit those with heart failure could help physicians improve treatment plans for the condition.

Recently, researchers reviewed recent studies investigating the impact of supervised exercise therapy on those with chronic, stable HFpEF.

They found that supervised exercise therapy improves exercise capacity and quality of life among patients with heart HFpEF.

Currently in the United States, 1 in 2 Americans has diabetes or prediabetes and 3 in 4 are overweight or obese, said Dr. Melody H. Hermel, a cardiologist at United Medical Doctors in La Jolla, CA, not involved in the study, in an interview with Medical News Today.

To truly combat the comorbid conditions patients face, we need to combine traditional medication and procedures with nutrition, exercise, stress management, and preventative care to best address patients underlying risk factors and truly get at the heart of the matter, Dr. Hermel added.

Dr. Vandana Sachdev, a senior research clinician and the director of the Echocardiography Laboratory in the Division of Intramural Research at the National Heart, Lung, and Blood Institute (NHLBI), first author of the study, said in a press release:

Future work is needed to improve referral of appropriate patients to supervised exercise programs, and better strategies to improve long-term adherence to exercise training is needed. Hybrid programs combining supervised and home-based training may also be beneficial. Further, implementation efforts will need to include coverage by Medicare and other insurers.

The study was published in Circulation.

For the study, the researchers analyzed results from 11 randomized controlled trials investigating supervised exercise therapy on HFpEF outcomes.

The studies included over 700 participants, mostly aged between 60 and 70 years old. Participants engaged in various activities, including walking, Greek dancing, and high intensity training three times per week for 1-8 months.

Supervised exercise training also improved quality of life scores on the 21-point Minnesota Living with Heart Failure questionnaire by 4-9 points.

Exercising helps improve the hearts pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle, said Dr. Sachdev.

Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have HFpEF than most medications, she added.

Supervised exercise allows people to have their blood pressure, heart rate, breathing capacity observed when they are recovering from an illness or a procedure and there is uncertainty about their basic skills in exercise, ability to perform exercise or their ability to increase the intensity of exercise or to perform some types of exercise correctly, Dr. Charlie Porter, Cardio-oncologist at The University of Kansas Health System, not involved in the study, told MNT.

The benefits of exercise cannot be duplicated by medication or procedures. Regular exercise of 2.5 hours weekly or that equivalent increases life expectancy, reduces the incidence of heart disease complications, and has been linked to reduced risk for some cancers, such as colon. Improved sense of well-being or quality of life is consistently demonstrated in studies of sustained safe exercise, he added.

Increasing evidence indicates that resistance exercise is helpful in some neurologic disorders. Early signals suggest that resistance exercise may improve decline in cognitive function over time. There is no other intervention that can provide this array of established and probable benefits. There are no other interventions that can offer this array of established or probable benefits, he noted.

There are so many benefits to supervised exercise for many people, but there may be particular benefits for people who also have diabetes, are overweight or depressed, Dr. Martha Abshire Saylor, Ph.D., assistant professor at the Johns Hopkins School of Nursing, not involved in the study, told MNT.

Starting a supervised exercise program may have social support benefits, including encouragement and accountability for participation, but also will help with physiologic benefits like reducing inflammation and lipid levels, Dr. Saylor added.

Dr. Saylor cautioned, however, that supervision is key as vigorous physical activity can trigger acute cardiovascular events in those who are unfit, inactive, or with coronary artery disease.

Dr. Hermel added:

Supervised exercise programs such as cardiac rehab have demonstrated significant benefit for patients with recent heart attack or another acute coronary syndrome, chronic stable angina, congestive heart failure, pulmonary hypertension, after stent placement, coronary artery bypass surgery, heart valve surgery or cardiac transplant.

MNT also spoke to Dr. Yu-Ming Ni, a cardiologist of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study. Dr. Ni noted that the biggest obstacle to successful use of supervised exercise programs is adherence to exercise sessions.

Unlike in clinical trials, patients in real life are less likely to come to exercise sessions, and are not always committed to staying for the entire hour of exercise. Thus, patients who stand to gain the most from supervised exercise programs are those who are motivated to attend, he said.

When asked about limitations to the findings, Dr. Mirza Baig, a cardiologist with Memorial Hermann in Houston, Texas, not involved in the study, noted that the different studies included in the analyses had different selection criteria and endpoints.

Dr. Robert Segal, board certified cardiologist and founder of Manhattan Cardiology, Medical Offices of Manhattan, and co-founder of LabFinder, not involved in the study, also told MNT:

Women, low socioeconomic status, minority racial and ethnic groups were small percentages of the demographic that were studied. Most of the studies dont specify which type of heart failure (HFpEF vs Heart Failure With Reduced Ejection Fraction [HFrEF]) they are analyzing. The studies are short-term studies, a year or less. There were also issues with adherence to the exercise programs.

Dr. Adedapo Iluyomade, a preventive cardiologist at Baptist Health Miami Cardiac & Vascular Institute, also not involved in the study, told MNT:

There are several evidence gaps that need to be addressed, including the optimal exercise modalities, strategies to increase long-term adherence, and the use of exercise therapy for patients recently hospitalized with acute, decompensated heart failure.

Further research is needed to determine the potential effects of exercise-based therapies on hospitalization, death, cardiovascular events, and healthcare expenditures, as well as in the prevention of HFpEF in patients with multiple risk factors, Dr. Illuyomade noted.

This statement makes it clear that it is time for Medicare and Health plans to support the provision of supervised exercise programs to patients with HFpEF. The body of knowledge cited in this report indicates that further delays in expanding access to this important component of care is unwarranted, noted Dr. Porter.

Dr. Ni added:

Physicians should recommend supervised exercise programs to patients with heart failure with preserved fractions who are willing to attend regularly. If not qualified by insurance, physicians should recommend home exercise for patients with heart failure, as there are certainly enough benefits from exercise to justify routinely recommending it.

Patients with heart failure should take advantage of exercise programs covered by insurance to improve exercise capacity and quality of life.

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Heart failure: Study finds exercise therapy safe and helps recovery - Medical News Today

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Staying fit as you age can be quite the challenge. Between the loss of muscle mass, strength, mobility, and testosterone, aging can catch up to men quickly after they reach 50. Additionally, poor exercise programs can lead to back pain and other lingering issues that you begin to notice as you age. The good news is that there are plenty of great exercises for men to stay fit after 50. In fact, you can actually reverse some effects of aging through resistance training and regular exercise.

The following are my top eight exercises for men to stay fit after 50. Perform three sets of eight to 12 repetitions per exercise one to two times per week. When combined with a good diet and healthy lifestyle, this workout program can help you age gracefully, stay in great shape, and maintain independence after hitting 50.

As with any new exercise routine, it's always a smart idea to check in with a certified fitness or medical professional to see what movements receive the green light for you to safely perform at your age and stage of life. Exercising should not be a painful experience, so if you ever experience any sort of pain, you should immediately stop and reevaluate again with a professional.

Keep reading to learn all about the best exercises for men to stay fit after 50, and for more workout inspiration, check out 7 Best Exercises for Men to Gain Muscle Without Equipment.

I recommend squats for virtually every client capable of performing them. You don't have to use a barbell squat, either. Choose a squat method that challenges you but remains doable. This can mean doing box squats with just your body weight, adding a kettlebell to perform a goblet squat, or going heavier with barbell squats.

Regardless of which squat variation you choose, keep your knees in line with your toes, avoid letting your torso fall forward, and aim to get your thighs parallel to the floor.

Keeping your upper body strong and maintaining the range of motion in your shoulders is vital for overall fitness and day-to-day strength. Choose overhand, neutral, or reverse grip pull-ups. If you cannot perform pull-ups with your body weight, you can perform negative pull-ups by jumping to the top of the bar and slowly lowering yourself.

RELATED: The Ultimate Muscle-Building Workout Every Man Over 40 Should Try

Pushups are a great exercise for several reasons. First off, they work your chest and shoulder muscles in a coordinated and functional way. And second, the core stability required to avoid letting your hips sag to the ground means you get the added benefits of core training in the same exercise.

You can make pushups easier by placing your hands on an elevated surface. Conversely, you can increase the difficulty by elevating your feet or moving your hands closer together.

Some variation of a deadlift is a must when it comes to staying fit. Standard barbell deadlifts and Romanian deadlifts are both popular options. You can also use dumbbells or kettlebells as your resistance.

To perform a standard deadlift, begin with your knees and hips bent and your chest at a 40 to a 45-degree angle relative to the floor. Drive through the floor with both feet to lift the weight until your hips and knees are locked out.

For Romanian deadlifts, begin with a slight bend in the knees, then hinge forward at the waist to reach the barbell. Romanian deadlift variations hit the hamstrings and glutes more, while standard deadlifts shift more load to the quads.

RELATED: 5 Exercises for Men To Increase Testosterone

Overhead pressing is a must for maintaining upper body strength and mobility. Everything from reaching for tools to screwing in lightbulbs requires you to be able to reach overhead and exert some force.

You can use barbells, dumbbells, or kettlebells to overhead press. When pressing, do not allow your shoulders to shrug, and always press the weight to full lockout.

Rows are movements that involve horizontal pulling and hit the major muscle groups in your upper back and biceps. My favorite rowing exercise is the bent-over single-arm dumbbell row. You can perform the same lift with a kettlebell. Additionally, you can perform bent-over barbell rows to hit both sides at once.

Regardless of your rowing exercise choice, avoid letting your shoulders shrug, and focus on "squeezing" your shoulder blades together as you finish the row.

RELATED: The 4 Best Quad Exercises for Men To Build Muscle & Strength

Lunges are an excellent functional exercise for your lower body. They mimic the standard gait and help improve balance, coordination, and athleticism alongside strength and muscle building. I prefer dumbbell lunges with the dumbbells held at your side. You can perform kettlebell lunges as well, or even rack a barbell across your upper back.6254a4d1642c605c54bf1cab17d50f1e

When lunging, take a deep step forward, and then lower your back knee toward the ground as you bend your front leg. Push through the floor to either step back to the starting position if lunging in place, or take your next step with the opposite leg if performing walking lunges.

Incorporating some form of rotational core exercise is important to keep your core strong and your spine healthy as you age. I like standing cable rotations if the equipment is available. However, Russian twists, medicine ball twists, or resistance band rotations are also great options.

Whichever twist variation you choose, do not round your spine when rotating. Begin in a neutral spine position, and rotate through your hips and torso to perform each rotation. Repeat on both sides.

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