Features To Search For When Selecting Healthcare

By Loris F. Andres

There is a vast number of factors that consumers need to review when selecting healthcare. Before these individual commit to plans, they must make sure that these are affordable in a senses. More importantly, people also need to ensure that policies are adequate for taking care of their preventative car needs and any emergency health concerns that might develop.

Many people are now receiving a basic and free form of healthcare through the government. This takes a lot of stress out of the equation as it helps to make basic medical care a lot more accessible to numerous individuals. If a person wants to obtain a comprehensive level of protection, however, this plan will need to be supplemented through the use of a secondary policy.

It is first important to consider the different factors that might make a person unqualified to receive coverage. For instance, those with severe and existing health issues may need to suffice with the coverage that they have received from governmental policies. Private insurance companies may not be willing to accept the financial risks of covering these individuals.

There are, however, certain companies that are willing to accept consumers who have preexisting ailments. This additional cover might be a bit more costly, but it is definitely far less expensive than the alternative of not having a supplemental plan. These entities may make it necessary for prospective policyholders to pass health examinations, however, in order to gauge the severity of their illnesses and the level of treatment that will be required.

Being able to access specialized care is a top concern for consumer when selecting a supplemental plan. This is a major benefit in having supplementary insurance. It allows people to see medical specialists when they have not been able to receive successful treatments or diagnoses from more conventional doctors. Thus, consumers should check for access to providers that offer their preferred forms of treatment including naturopaths and chiropractors among many others.

How much money people need to pay in addition to their coverage premiums is a vital consideration to make as well. Thus, people should learn what their co-payments might be because if they are too high, it might make it difficult to access treatments or schedule visits when necessary. This is also true of the prescriptions that a person receives. These should be accessible at reasonable prices.

These are just a few of the considerations that people will have to make when selecting supplemental healthcare. Given the complexity of this task it is often best to conduct this process with the assistance of a qualified agent. Consumers can find and screen these entities by using various online platforms.

Regular Jogging Shows Dramatic Increase in Life Expectancy

Undertaking regular jogging increases the life expectancy of men by 6.2 years and women by 5.6 years, reveals the latest data from the Copenhagen City Heart study presented at the EuroPRevent2012 meeting. Reviewing the evidence of whether jogging is healthy or hazardous, Peter Schnohr told delegates that the study's most recent analysis (unpublished) shows that between one and two-and-a-half hours of jogging per week at a "slow or average" pace delivers optimum benefits for longevity.


The EuroPRevent2012 meeting, held 3 May to 5 May 2012, in Dublin, Ireland, was organised by the European Association for Cardiovascular Prevention and Rehabilitation (EACPR), a registered branch of the European Society of Cardiology (ESC).

"The results of our research allow us to definitively answer the question of whether jogging is good for your health," said Schnohr, who is chief cardiologist of the Copenhagen City Heart Study, speaking in the "Assessing prognosis: a glimpse of the future" symposium. "We can say with certainty that regular jogging increases longevity. The good news is that you don't actually need to do that much to reap the benefits."

The debate over jogging first kicked off in the 1970s when middle aged men took an interest in the past-time. "After a few men died while out on a run, various newspapers suggested that jogging might be too strenuous for ordinary middle aged people," recalled Schnohr.

The Copenhagen City Heart study, which started 1976, is a prospective cardiovascular population study of around 20,000 men and women aged between 20 to 93 years. The study, which made use of the Copenhagen Population Register, set out to increase knowledge about prevention of cardiovascular disease and stroke. Since then the study, which has resulted in publication of over 750 papers, has expanded to include other diseases such as heart failure, pulmonary diseases, allergy, epilepsy, dementia, sleep-apnea and genetics. The investigators have explored the associations for longevity with different forms of exercise and other factors. For the jogging sub study, the mortality of 1,116 male joggers and 762 female joggers was compared to the non joggers in the main study population. All participants were asked to answer questions about the amount of time they spent jogging each week, and to rate their own perceptions of pace (defined as slow, average, and fast). "With participants having such a wide age span we felt that a subjective scale of intensity was the most appropriate approach," explained Schnohr, who is based at Bispebjerg University Hospital, Copenhagen.

The first data was collected between 1976 to 1978, the second from 1981 to 1983, the third from 1991 to 1994, and the fourth from 2001 to 2003. For the analysis participants from all the different data collections were followed using a unique personal identification number in the Danish Central Person Register. "These numbers have been key to the success of the study since they've allowed us to trace participants wherever they go," said Schnohr.   Results show that in the follow-up period involving a maximum of 35 years, 10,158 deaths were registered among the non-joggers and 122 deaths among the joggers. Analysis showed that risk of death was reduced by 44% for male joggers (age-adjusted hazard ratio 0.56) and 44% for female joggers (age-adjusted hazard ratio 0.56).

Furthermore the data showed jogging produced an age adjusted survival benefit of 6.2 years in men and 5.6 years in women. Further analysis exploring the amounts of exercise undertaken by joggers in the study has revealed a U-shaped curve for the relationship between the time spent exercising and mortality. The investigators found that between one hour and two and a half hours a week, undertaken over two to three sessions, delivered the optimum benefits, especially when performed at a slow or average pace. "The relationship appears much like alcohol intakes. Mortality is lower in people reporting moderate jogging, than in non-joggers or those undertaking extreme levels of exercise," said Schnohr.

The ideal pace can be achieved by striving to feel a little breathless. "You should aim to feel a little breathless, but not very breathless," he advised.

Jogging, said Schnohr, delivers multiple health benefits. It improves oxygen uptake, increases insulin sensitivity, improves lipid profiles (raising HDL and lowering triglycerides), lowers blood pressure, reduces platelet aggregation, increases fibrinolytic activity, improves cardiac function, bone density, immune function, reduces inflammation markers, prevents obesity, and improves psychological function. "The improved psychological wellbeing may be down to fact that people have more social interactions when they're out jogging," said Schnohr.

Artificial Heart With Norwegian Sensor

France is going to test an artificial heart on patients. The heart will contain a Norwegian pressure sensor.

The French company Carmat will now proceed with full-scale testing on patients. It could save the lives of people who have been waiting many years for a heart transplant.

Made in Norway
The Norwegian company MEMSCAP is supplying the pressure sensor that will be used in the artificial heart, and SINTEF is responsible for its 'innards'. Sigurd Moe at SINTEF ICT explains that they have been working with MEMSCAP for the last ten years. "We develop the processes and design of the tiny silicon chips that go into the pressure sensors, and MEMSCAP assembles and packages them in a way that makes them completely stable. Our MiNaLab also produces the tailored pressure element. Until now, these sensors have been used as altimeters in planes, and the same type will now be used in the heart."

From space to human hearts
"Reliability is key here," says Jan Hallenstvedt at MEMSCAP. "In environments such as planes and the human heart, you want to know that the sensor will be up to scratch and will not fail." The MEMSCAP sensors have gained an excellent reputation internationally as extremely stable and reliable, and it was a major boost to their marketing when NASA decided to use the Norwegian sensor installed in the rover on its Curiosity spacecraft, which landed on Mars in 2012. Hallenstvedt says that they have been supplying sensors to Carmat for many years, and that it has been a long road leading to the results they have now achieved. "Two years ago, Carmat carried out tests on animals with great success, and has since conducted tests on some patients. But it was not until the spring of this year that they were granted approval, and announced publicly that they would be starting full scale medical testing. So this summer, we sent several hundred sensors to the Continent," he says.

Diabetic diet

The diet frequently recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar.

Patients may be encouraged to reduce their intake of carbohydrates that have a high glycemic index.

However, in cases of hypoglycemia, they are advised to have food or drink that can raise blood glucose quickly, followed by a long-acting carbohydrate (such as rye bread) to prevent risk of further hypoglycaemia.

For people with diabetes, healthy eating is not simply a matter of "what one eats", but also when one eats.

Aerobic exercise

In physical exercise, aerobic exercise is complementary to anaerobic exercise.

Aerobic literally means "with oxygen", and refers to the use of oxygen in muscles' energy-generating process.

Aerobic exercise includes any type of exercise, typically those performed at moderate levels of intensity for extended periods of time, that maintains an increased heart rate.

In such exercise, oxygen is used to "burn" fats and glucose in order to produce adenosine triphosphate, the basic energy carrier for all cells.

Initially during aerobic exercise, glycogen is broken down to produce glucose, but in its absence, fat metabolism is initiated instead.

The latter is a slow process, and is accompanied by a decline in performance level.

The switch to fat as fuel is a major cause of what marathon runners call "hitting the wall." There are various types of aerobic exercise.

In general, aerobic exercise is one performed at a moderately high level of intensity over a long period of time.

For example, running a long distance at a moderate pace is an aerobic exercise, but sprinting is not.

Playing singles tennis, with near-continuous motion, is generally considered aerobic activity, while golf or doubles tennis, with their more frequent breaks, may not be.

An Apple a Day Keeps the Doctor Away

Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the UK -- similar to giving statins to everyone over 50 years who is not already taking them -- according to a study in the Christmas edition of The BMJ.

The researchers conclude that the 150 year old public health message: "An apple a day keeps the doctor away" is able to match more widespread use of modern medicine, and is likely to have fewer side effects. The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.

In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease. As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.

Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population. They analysed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.

The researchers assumed a 70% compliance rate and that overall calorie intake remained constant.

They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.

They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70% of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.

However, side-effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.

Additional modelling showed a further 3% reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.

"This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK," say the authors.

"This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets," they conclude.

Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: "The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: "An apple a day keeps the doctor away." It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.

While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit."

Building a Better Malaria Vaccine: Mixing the Right Cocktail

A safe and effective malaria vaccine is high on the wish list of most people concerned with global health. Results published on December 26 inPLOS Pathogens suggest how a leading vaccine candidate could be vastly improved.

The study, led by Sheetij Dutta, from the Walter Reed Army Institute of Research, USA, and colleagues, focused on a protein called AMA1 needed by thePlasmodium falciparum parasite to invade blood cells and cause disease. Study results suggest that a cocktail of AMA1 proteins from only a few different strains can overcome major limitations of an earlier designed version of AMA1-based vaccines.

The challenge with the malaria parasite in general and its AMA1 surface protein in particular is that both exist as multiple strains. Using AMA1 in a vaccine readies the human immune system for subsequent encounters with the parasite, but when such a vaccine was previously tested in humans, it was effective mostly against one particular P. falciparum strain. To explore the potential for a more broadly protective vaccine, the scientists tested different cocktails of AMA1 from different parasite strains for their ability to elicit a diverse range of antibodies that are active in parasite inhibition assays. They confirmed that a cocktail of AMA1 proteins from three different parasite strains was better than one or two, and one they call Quadvax, which contained AMA1 proteins derived from four different strains, led to an antibody response that was broader than the sum of strain-specific antibodies elicited by the four individual strains. Moreover, Quadvax-elicited antibodies inhibited a range of parasites, including many strains that were different from those in the Quadvax mix. In different laboratory tests, Quadvax-induced antibodies inhibited the growth of 26 different parasite strains, and the scientists suggest that "the combination of four AMA1 variants in Quadvax may be sufficient to overcome global AMA1 diversity."

Besides varying a lot from strain to strain, AMA1 also contains less variable (conserved) exposed parts (so-called epitopes) on its surface. The researchers found that vaccination with Quadvax yielded not only antibodies against the variable epitopes, but also against more conserved epitopes of the AMA1 protein. Such antibodies were not seen when using individual strains for immunization, but Quadvax appeared to enhance the immunogenicity -- the ability to provoke an antibody response -- of these conserved parts of the protein. Since the epitopes are identical across strains, the resulting antibodies are broadly active rather than strain-specific.

The scientists conclude "we had set out to study broadening of antibody responses achieved by mixing AMA1 proteins and were surprised and delighted to find not only greater variety of strain-specific antibodies but also increased antibodies against conserved epitopes were induced by the Quadvax. Perhaps even more exciting, when mixed, combinations of these antibodies were synergistic in their broad inhibition of many parasite strains. Novel conserved epitopes described here can be targets for further improvement of the vaccine. Most importantly, our data strongly supports continued efforts to develop a blood stage vaccine against malaria."

In spite of the extreme variability, a vaccine containing only a few diverse AMA1 strains, the scientists hope, could provide universal coverage by redirecting the immune response towards conserved epitopes. The next steps will be to test human-use formulations of Quadvax in primate models and in a human blood-stage challenge model.

Longer Life Linked To Specific Foods In Mediterranean Diet

Some food groups in the Mediterranean diet are more important than others in promoting health and longer life according to new research published on the British Medical Journalwebsite.

However, the study also claims, that following a Mediterranean diet high in fish, seafood and cereals and low in dairy products were not indicators of longevity.

While several studies have concluded that the Mediterranean diet improves chances of living longer, this is the first to investigate the importance of individual components of the diet.

Professor Dimitrios Trichopoulos at the Harvard School of Public Health explains that they have surveyed over 23,000 men and women who were participants in the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Participants were given dietary and lifestyle questionnaires when they enrolled onto the study and they were subsequently followed up for around 8.5 years with interviews. Their diets were rated from 0 to 10 based on the level of conformity to a traditional Mediterranean diet.

As part of the interview process, participants were also asked about their smoking status, levels of physical activity and whether they had ever been diagnosed with cancer, diabetes and heart disease.

The authors maintain that when high intake of vegetables, low intake of meat or moderate alcohol intake were excluded from the rating system, the benefits of following a Mediterranean diet were substantially reduced. They also note that there are clear benefits in combining several of the key components, for example high consumption of vegetables and olive oil.

Professor Trichopoulou, lead author of the study, concludes that the main reasons why the Mediterranean diet can lead to living longer are moderate consumption of ethanol (mostly in the form of wine during meals, as traditionally done in the Mediterranean countries), low consumption of meat and meat products, and high consumption of vegetables, fruits and nuts, olive oil and legumes.

Massage After Exercise Myth Busted

A Queen’s University research team has blown open the myth that massage after exercise improves circulation to the muscle and assists in the removal of lactic acid and other waste products.
“This dispels a common belief in the general public about the way in which massage is beneficial,” says Kinesiology and Health Studies professor Michael Tschakovsky. “It also dispels that belief among people in the physical therapy profession. All the physical therapy professionals that I have talked to, when asked what massage does, answer that it improves muscle blood flow and helps get rid of lactic acid. Ours is the first study to challenge this and rigorously test its validity.”

The belief that massage aids in the removal of lactic acid from muscle tissue is so pervasive it is even listed on the Canadian Sports Massage Therapists website as one of the benefits of massage, despite there being absolutely no scientific research to back this up.

Kinesiology MSc candidate Vicky Wiltshire and Dr. Tschakovsky set out to discover if this untested hypothesis was true, and their results show that massage actually impairs blood flow to the muscle after exercise, and that it therefore also impairs the removal of lactic acid from muscle after exercise.

This study will be presented at the annual American College of Sports Medicine conference in Seattle, Washington May 27-30, 2009

Five healthy behaviors lower dementia risk, study shows

A 35-year study from the UK cites five lifestyle behaviors that have been shown to reduce the risk of cognitive decline, and researchers say these healthy habits are more beneficial than medical treatments or preventative procedures.

The study, published in the journal PLOS One, was led by Prof. Peter Elwood of Cardiff University's School of Medicine.

He and his team analyzed data from the Caerphilly Cohort Study, which recorded healthy behaviors in 2,235 men aged 45-49 from 1979 to 2004, in Caerphilly, UK. During this period, diabetes, vascular disease, cancer and death were recorded, along with a 2004 check for cognitive state.

After assessing the data, the researchers identified the following five healthy behaviors as being essential for the best chance of living a disease-free life:
Doing regular exercise
Not smoking
Keeping a low bodyweight
Following a healthy diet
Having a low alcohol intake.

The study shows that the individuals who adhered to four or five of these behaviors had a 60% decline in dementia and cognitive decline, and there were 70% fewer cases of diabetes, heart disease and stroke, compared with individuals who followed none of the behaviors.

As far as reducing the dementia risk, the team notes that exercise was the strongest factor.
Number of healthy lifestyle followers still low

Researchers found that exercise was the strongest factor in reducing the risk of dementia.

Though the Caerphilly Cohort Study had many goals, one of the most important ones was to look at the relationship between healthy lifestyles and chronic diseases, as well as to monitor changes in the adoption of healthy behaviors.

"The size of reduction in the instance of disease owing to these simple healthy steps has really amazed us and is of enormous importance in an aging population," says Prof. Elwood.

"What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health," he adds.

However, evidence from the study shows that the number of people who follow a consistently healthy lifestyle is very low.

Prof. Elwood notes that although the number of individuals who smoke has decreased from the start of the study, the number of those who are following the healthy behaviors "has not changed."

He adds that if the men from the study had been told to add one extra healthy behavior 35 years ago and only half of them adhered to this instruction, then there would have been:
A 13% reduction in dementia
A 12% drop in diabetes
A 6% reduction in vascular disease, and
A 5% reduction in deaths.

Dr. Doug Brown, director of research and development at the Alzheimer's Society, says:


"We have known for some time that what is good for your heart is also good for your head, and this study provides more evidence to show that healthy living could significantly reduce the chances of developing dementia."

He adds that large, long-term studies like this latest one are expensive and complicated, but he says they are "essential to understand how dementia can be prevented."

As a result, he calls for commitment to greater funding of such studies at the G8 Summittaking place December 11th in London.

Researchers in Canada recently released a study suggesting that exercise is beneficial for dementia patients, citing improvements in cognitive functioning and their ability to perform daily activities.

ype 2 diabetics 'have better glucose control' with exercise game

Exercise video games are used by many people worldwide to adopt a regular exercise routine, help with weight loss or to simply play with friends. But new research suggests the popular games could help people with type 2 diabetes to improve control of their glucose levels.

Type 2 diabetes occurs when cells in the body that produce insulin are unable to make enough, or when the insulin that is produced does not work effectively - known as insulin resistance.

The condition is more common in those aged over 40, and obesity has long been known as a risk factor for the development of type 2 diabetes.

But previous research has shown that this risk can be reduced through adopting regular physical activity and a healthy diet.

Therefore, researchers from Germany decided to conduct a randomized control trial in order to improve levels of physical activity of 220 people aged between 50 and 75 who suffered from diabetes.

A fun game with health benefits? Researchers say the Wii Fit Plus exercise game could help individuals with type 2 diabetes have better control over their glucose levels.

Of the participants, 120 were randomized to use the Wii Fit Plusexercise game from Nintendo as the primary form of physical activity for a period of 12 weeks, while the other 100 subjects received routine care. The routine care patients were then given the exercise game to use after the initial 12-week period.


The Wii exercise game involves the use of a Nintendo Wii console with a hand-held control and a Wii balance board, which participants stand on during exercise. Both the hand-held control and balance board records a player's movements.

At the beginning and end of the 12 weeks, participants had their weight, blood pressure and glucose levels measured following an 8-hour fasting period.
Exercise game 'beneficial for glucose monitoring'

Results of the study, published in the journal BMC Endocrine Disorders, revealed that the group using the Wii Fit Plus exercise game had better control of their glucose levels, compared with the group who received routine care, and they also experienced a reduction in glycated hemoglobin - signaling a decrease in elevated blood glucose.


Furthermore, the exercise game group also showed a reduction in weight, compared with the routine care group, and demonstrated an increase in overall quality of life. The number of patients suffering from depression also reduced.

On monitoring the routine care patients once they were given the Wii exercise game, it was found that they demonstrated similar results to the group who used the game initially.


Commenting on the findings, Prof. Stephan Martin, of the West German Centre for Diabetes and Heath and senior author of the study, says:


"Given the positive attitudes of the participants and the limited restrictions for gaming at home, exercise games may potentially be used in a home setting as a tool to reduce inactive behavior in people with Type 2 diabetes."

The researchers note that the completion rate in the study was only 67%, but they point out that this rate is similar to other studies looking at physical activity in older individuals.

They say their findings suggest that in the future, exercise games should be created specifically for individuals with type 2 diabetes. Through these, they say glucose control should be optimized and performed exercises should be transferrable online in order to increase adherence.

Previous research has revealed other potential benefits of the Wii. Earlier this year, Medical News Today reported on a study suggesting that playing the Wii could help doctors to become better surgeons, while other research suggests that playing the Wii Fit could help patients with chronic obstructive pulmonary disease (COPD) to breathe better.

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Sports concussions and chronic traumatic encephalopathy

It's been widely reported that football and other contact sports increase the risk of a debilitating neurological condition called chronic traumatic encephalopathy (CTE).


But in the journal Neuropsychology Review,researchers are reporting only limited evidence showing a link between sports concussions and an increased risk of late-life cognitive and neuropsychiatric impairments.


Loyola University Medical Center clinical neuropsychologist Christopher Randolph, PhD, is a co-author of the paper. First author is Stella Karantzoulis, PhD, of New York University School of Medicine.


CTE is believed to be the cause of behavioral symptoms including irritability, anger, aggression, depression and suicidality; and cognitive symptoms including impaired learning, memory, language, information-processing speed and executive functioning. CTE is said to be linked to concussions and characterized by the buildup of abnormal substances in the brain called tau proteins.


But so far there is only limited evidence to support this CTE theory, Karantzoulis and Randolph write. These are among the limitations of the evidence: 

• So far CTE cases have been reported following the autopsies of athletes' brains that were donated from families concerned about the players' cognitive and behavioral symptoms before dying. But such non-random "samples of convenience" can bias findings because the samples may not be representative of the entire population of retired players. 
• The largest epidemiological study of retired NFL athletes, which included 3,439 players, found that suicide rates were actually substantially lower among these athletes than among the general population. "Given that suicidality is described as a key feature of CTE, this finding is difficult to reconcile with the high rates of CTE that have been speculated to occur in these retired athletes . . . ," Karantzoulis and Randolph write. "It is likely that there are a diverse set of risk factors for suicidality (e.g. life stress, financial difficulty, depression, chronic pain, drug abuse) in retired athletes . . ." 
• Two previous studies, including one by Randolph and colleagues, examined symptoms of retired NFL players who had mild cognitive impairment, a precursor to Alzheimer's disease. In both studies, symptoms seen in the retired players were virtually the same as those observed in non-athletes diagnosed with mild cognitive impairment. These findings cast doubt on the notion that CTE is a novel condition unique to athletes who have experienced concussions. 
• The presence of abnormal tau proteins in the brain may not be a reliable indicator of CTE. For example, various case studies have found that between 20 percent and 50 percent of subjects who had abnormal tau deposits nevertheless did not have any symptoms. "Older persons without dementia can accumulate Alzheimer's disease pathology (including tau deposition) without any associated cognitive or clinical symptoms," Karantzoulis and Randolph write. "The actual clinical significance of 'abnormal' tau deposition in the brains of retired athletes therefore remains unclear." 

The authors detail how CTE originally was identified in 1928 as "punch drunk" syndrome in boxers. There is a striking parallel between the controversy over CTE today and punch drunk syndrome decades ago. In 1965, for example, a skeptic argued that punch drunk syndrome symptoms seen in boxers could have been due to alcoholism and venereal diseases, which were common in boxers at the time.


"One cannot deny that boxing and other contact sports can potentially result in some type of injury to the brain," Karantzoulis and Randolph write. "There currently are no carefully controlled data, however, to indicate a definitive association between sport-related concussion and increased risk for late-life cognitive and neuropsychiatric impairment of any form."


The authors say more rigorous and definitive studies are needed than the case reports and samples of convenience that have been done to date.

Goals affect feelings of pride and shame after success and failure

When the St. Louis Cardinals lost the World Series, just how much shame did the players feel? According to researchers at Penn State and Australia's Central Queensland University, a person's goals at the outset of a competence-based task, such as a sporting event, can influence how much shame or pride he or she feels upon completion of the task.

"Our research suggests that when your goal is to outperform others, your feelings of pride will be amplified when you succeed," said Amanda Rebar, postdoctoral researcher, Central Queensland University, "but when your goal is to avoid being outperformed by others, your feelings of shame will be amplified when you fail."

The research team -- which included David Conroy, professor of kinesiology, Penn State -- recruited 58 undergraduate students to complete 24 rounds of the video game Tetris. The participants were instructed to earn as many points as possible. Before each round, one of four different criteria for earning a point was presented onscreen, the goal of which was to elicit different achievement goals among the participants. Immediately following each round, the researchers provided the participants with bogus feedback and the participants rated their shame and pride.

"Our results suggest that a person's motivation and purpose regarding a task -- whether that task is a video game, a race or an academic exam -- impacts the amount of pride or shame he or she will experience in response to success or failure," Conroy said. "And the amount of pride or shame a person feels can influence whether he or she will persist in the task or drop out."

The results appeared in the November 2013 issue of the journal Sport, Exercise and Performance Psychology. According to the researchers, it isn't necessarily a bad thing for people to focus on their performances relative to others.

"Pride is known to invoke a boost of confidence, persistence, and problem-solving ability, which can help people perform at their best," Rebar said.

But shame, on the other hand, can cause problems.

"If a baseball player is the first to strike out in a game, his shame may cause him to become distracted or to worry too much about his precise movements, both of which can hurt his performance," she said.

"Our advice is for people to focus on what they can achieve rather than on what they can lose," Conroy said. "It may be particularly helpful if coaches and teachers understand these results so they can help influence their athletes' and students' achievement goals so as to minimize feelings that can hurt performance."

Recognition memory in young adults predicted by aerobic fitness and hormones

Researchers at Boston University School of Medicine (BUSM) have found further evidence that exercise may be beneficial for brain health and cognition. The findings, which are currently available online in Behavioural Brain Research, suggest that certain hormones, which are increased during exercise, may help improve memory.

Hormones called growth factors are thought to mediate the relationship between exercise and brain health. The hippocampus, a region of the brain crucial for learning and memory, is thought to be uniquely affected by these hormones.

The growth factors brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), have been implicated in the link between exercise and hippocampal function. BDNF, for example, acts on the nervous system to help regulate communication between existing brain cells (neurons) and stimulate the growth and maturation of new hippocampal neurons and blood vessels.

In this study, the researchers recruited healthy young adults, in whom they measured blood hormone levels together with performance on a recognition memory task and aerobic fitness. The researchers were thus able to correlate the blood hormone levels with aerobic fitness, and subsequently whether there was any effect on memory function.

According to the researchers, BDNF and aerobic fitness predicted memory in an interactive manner, suggesting that at low fitness BDNF levels negatively predicted expected memory accuracy. Conversely, at high fitness resting BDNF levels positively predicted recognition memory. There also was a strong association between IGF-1 and aerobic fitness; however there was no complementary link between IGF-1 and memory function.

"We will be continuing this line of research by testing if memory improves following an exercise training program in both young and geriatric adults, and by adding brain imaging techniques," explained Karin Schon, PhD, assistant professor of anatomy and neurobiology at BUSM, who served as the study's principal investigator.

Study investigates the role of the motor system in conceptualization

Is it true, as some scientists believe, that to understand words like "spike" (in the volleyball sense) the brain has to "mentally" retrace the sequence of motor commands that accomplish the action? According to a study just published as a cover story in the December issue of Brain Research and conducted with the participation of scientists from SISSA, the International School for Advanced Studies of Trieste, the high-level motor expertise of subjects (in the case at hand of the volleyball players who responded to instructions to perform volleyball-specific actions) modulates the involvement of the brain motor areas in understanding the actions. The effect of experience is a novelty that challenges some recent hypotheses, making the theoretical picture more complex.

According to theories of embodied cognition, conceptual representations are construed based on the brain's sensory and motor experience and, when we need to understand or recognise a concept, apparently our brain will subconsciously mime that experience. In practice, to understand the word "drink" our brain implicitly activates the motor processes involved in drinking. But is that really how it works? "According to our studies, the involvement of the motor system is not so direct or obvious but depends on several variables: the context, the experience and the feasibility/unfeasibility of the actions," explains Barbara Tomasino.

Tomasino, a former SISSA student now at the IRCSS "E. Medea-La Nostra Famiglia" in San Vito al Tagliamento, is the first author of this study which was conducted together with, amongst others, Raffaella Rumiati, the coordinator of the PhD course in Neuroscience at SISSA.

Tomasino, Rumiati and colleagues used "expert" subjects from the motor point of view, namely professional volleyball players. "The idea of using expert subjects is interesting because it allows us to see if the degree of mastery of the act has an effect on performance in understanding. In fact, supporters of embodied theories state that motor activation is always present and there should be no difference", explains Rumiati, differences which were nonetheless identified.

More in detail ...
The subjects (two groups: one of volleyball players and one of non-experts) had to read silently sentences describing acts in the form of commands. The cue could be an action that was either possible -"go block" - or impossible - "do a forearm dig during a leap" in volleyball. The sentences could also be positive - "do..." - or negative - "don't do..."-. Even on the basis of a previous behavioural study the research team supposed that the motor system is activated by positive but not by negative orders.

"In the present study we used functional magnetic resonance imaging to observe the activity of the brain during performance of the task. In particular, we monitored the activity of the motor areas and the changes in the way these "speak", or rather connect functionally, to the cognitive areas", explains Rumiati. "One of the interesting things we found is an inhibition of motor activity in expert subjects in response to a positive but impossible command".

By contrast, in non-expert subjects the motor activity had a non-specific character, without the differences observed in experts. "Overall this indicates that there is a modulating effect of the interaction between the possible/impossible cue and the positive or negative command", comments Tomasino. "It's as if the volleyball players' experience gave rise to a sort of motor alphabet that affects they way they perform the task", says Rumiati, "an alphabet that is instead absent in non-experts. This suggests that the assumption of embodied theories, that is, the constant intervention of the motor system, is not always true but is modulated by contextual factors, such as the subject's experience".

A skiing trip can give you a valuable boost in pleasure and well-being

Are you contemplating a skiing holiday?

The all-out pleasure and enjoyment you experience on a pair of skis or a snowboard is positively priceless to enhance your overall happiness. This is true even if you only get to go out on the slopes once in a blue moon, says Hyun-Woo Lee and colleagues from Yonsei University in the Republic of Korea, in an article published in Springer's journalApplied Research in Quality of Life.

Lee and his team conducted a survey of 279 visitors at three major ski resorts in South Korea. The happiness and satisfaction of skiers and snowboarders were determined by assessing their sense of pleasure, their level of flow or engagement in the activity, and the sense of involvement and satisfaction they subjectively reported after venturing out on the snow. Of the sample, 126 (45.2 percent) participants skied, 112 (40.1 percent) were snowboarders and 41 (14.7 percent) participated in both activities. Respondents spent on average four and a half days at a resort, while more than 90 percent visited ski resorts fewer than five times in a season.

The results of the survey indicate that sport participation indeed has a positive effect on satisfaction, and that such rich experiences enhance happiness. This can in turn lead to positive affirmations outside of sports that can have an impact on one's health and well-being. The manner in which participants engaged in the activity (known as flow) had the greatest direct impact on satisfaction, followed by involvement.

Flow or engagement is the manner in which you lose yourself in an activity, and are almost oblivious of all else around you. The experience itself, such as skiing, is so enjoyable that people will do it even at a great cost, for the sake of doing it. Involvement relates to having a sense of meaning and purpose in life: how you are able to be part of something larger than yourself. Being deeply involved in an enjoyable physical activity can enhance a person's positive outlook on life. Together, the research model demonstrated how such elements are interrelated in influencing a person's subjective well-being.

Lee noted that even one-off or fewer skiing outings had a positive effect on participants. Interestingly, skiers showed a higher level of pleasure and involvement in their sport than snowboarders did.

The findings are in line with the thinking of positive psychology that physical activity such as participating in sports helps people and communities to flourish. Previous research highlighted its benefits in preventing mental illness, in enhancing positive thinking and in buffering people against the stresses of life.

"Adult playfulness can influence people's happiness, while activities and socially convening around a sporting activity such as skiing have positive psychological outcomes and contribute to overall well-being," Lee believes. "This is also true for people who only casually participate in sports." Lee advised that people who organize sporting activities should attempt to build group solidarity and greater involvement so that people can grow emotionally, socially and creatively.

Degenerative tendon disease in athletes improved by PRP therapy

Ultrasound-guided delivery of platelet-rich plasma (PRP) improves functionality and reduces recovery time in athletes with degenerative disease in their tendons, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

PRP therapy is a recent development in which blood is collected from the patient and then spun in a centrifuge to separate the PRP from other blood components. The PRP is then injected under ultrasound guidance into the target area, where it stimulates cellular growth and healing.

The therapy has grown popular among professional athletes from a variety of sports, who are looking to avoid surgery or prolonged recovery periods. Tiger Woods, Peyton Manning, Kobe Bryant and Rafael Nadal are just a few sports superstars who are reported to have undergone PRP therapy in recent years.

"PRP enables regeneration of the tendons and reduction of pain thanks to its regenerative and anti-inflammatory properties," said study author Alice La Marra, M.D., radiology resident at the University of L'Aquila in L'Aquila, Italy.

Dr. La Marra and colleagues recently evaluated PRP in 50 athletes who had degenerative tendinosis in the Achilles tendon, which connects the calf muscle to the heel bone, and 30 who had tendinosis in the patellar tendon, which connects the kneecap to the shin bone. Tendinosis is common in athletes and is caused by a repeating cycle of damage and repair. The Achilles and patellar tendons are common sites of tendinosis.

The patients underwent ultrasound-guided PRP every 21 days for a total of three treatments.MRI was performed before the procedures and 30 days and one year after the last treatment. The researchers used standard measures of functionality and pain to determine the severity of the tendinosis.

Patients with tendinosis of the Achilles tendon saw an overall improvement of 80 percent in pain and 53 percent in functionality after the PRP treatment. Those patients who had tendinosis in the patellar tendon saw a 75 percent improvement in pain and a 50 percent improvement in functionality.

The signal intensity on MRI, which provides a measure of tissue integrity, normalized in 90 percent of the PRP patients.

"Our study showed that in patients who underwent PRP treatments, there was an improvement of functionality, a decrease in pain and a normalization of the signal intensity seen on MRI," Dr. La Marra said. "Therefore, our experience proves that PRP infiltration may be a good therapeutic alternative for the treatment of Achilles and patellar tendinopathy in athletes."

Current treatment for degenerative diseases of these tendons is based on the severity of the lesion and the age and activity level of the person, Dr. La Marra said. Common treatment options include physical therapy, corticosteroids and surgery.

"Our study showed that PRP is the better option. Compared to the other therapies, it allows a faster and more efficient recovery," she said.

In addition, Dr. La Marra pointed out that the use of corticosteroids is risky for professional athletes, as it can result in failed drug tests.

"Considering the results obtained in recent years, we hope that the use of PRP in tendinosis becomes routine for patients who practice sports activities, even at a competitive level," she said.

In night games circadian timing may give edge to West Coast NFL teams

A new analysis of National Football League results suggests that the body's natural circadian timing gives a performance advantage to West Coast teams when they play East Coast teams at night.

"Over the past 40 years, even after accounting for the quality of the teams, West Coast NFL teams have had a significant athletic performance advantage over East Coast teams when playing games starting after 8 p.m. Eastern time," said lead author and board-certified sleep medicine physician Dr. Roger S. Smith. "Both the power and the persistent nature of this sleep-related athletic advantage were surprising."

The study by Harvard and Stanford researchers analyzed all NFL games from 1970 to 2011 that started after 8 p.m. EST and involved East Coast versus West Coast teams. There were 106 games that met inclusion criteria. An additional 293 daytime games involving the same match-ups were analyzed as a control group.

Data analysis showed a strong advantage for West Coast teams even after adjusting for the Las Vegas point spread, which takes into account factors such as the quality of the teams, injuries, and home-field advantage. During night games the West Coast teams beat the point spread in 66 percent of the games, and did so by an average of 5.26 points. For daytime games there was no significant advantage for West or East Coast teams.

"This study is a reminder that the body has an intricate timing system that regulates both sleep and aspects of human performance," said American Academy of Sleep Medicine President Dr. M. Safwan Badr. "We function best when we maintain a daily routine that promotes healthy sleep, which is critical for daytime alertness, performance and public safety."

The results are published in the December issue of the journal SLEEP.

According to the authors, biological rhythms can determine specific times at which peak performance is likely to occur. Previous studies have shown that elements of athletic performance peak in the late afternoon based on intrinsic circadian factors. Therefore, these night games may provide West Coast teams with an athletic advantage by allowing their players to compete at a body clock time that is closer to their athletic peak than their opponents.

"Applying principles of sleep physiology to competitive sports has the clear potential to yield a significant and natural athletic performance advantage," said Smith. "So if you are an athlete looking for a natural performance advantage, or if you just want to improve your health, talk with your doctor about your sleep."

Exercising in free time may keep blood pressure healthy

A new study finds that exercising during leisure time is linked to a lower risk for high blood pressure in people who do not do much exercise.

Researchers came to this conclusion after carrying out a meta-analysis that pooled results from 13 studies examining links between exercise and blood pressure.

They found people who did more than 4 hours per week of exercise in their leisure time, as opposed to work time, had a 19% lower risk of high blood pressure, compared with people who did not do much exercise at all.

Writing about their work online this week in the American Heart Association journalHypertension, the researchers also found no solid link between physical exertion at work and lower risk of high blood pressure.

The American Heart Association defines high blood pressure as having readings at or above 140 mm of mercury for the upper number or 90 or more for the bottom number.

This definition puts around 78 million US adults in the high blood pressure category.

High blood pressure typically has no symptoms and remains undetected and untreated in many people.

Co-author Dr. Bo Xi, a lecturer at the Shandong University School of Public Health in Jinan, China, says current health guidelines that urge people to exercise more for the benefit of their health do not distinguish between physical activity at work and for leisure, but "given the new findings, perhaps they should."

The team pooled data covering nearly 137,000 people in the US, Europe and East Asia who had healthy blood pressure on enrollment to their particular study.

Over a follow-up period ranging from 2 to 45 years, more than 15,600 of the participants developed high blood pressure.

The team found exercising more than 4 hours per week in leisure time was tied to a 19% lower risk for developing high blood pressure, compared with exercising less than 1 hour per week.

The researchers also detected a "dose-response" relationship between recreational physical activity and blood pressure: the more people exercised in their leisure time, the less likely they were to develop high blood pressure.

Even people who only did between 1 and 3 hours per week of leisure-time physical activity had an 11% lower risk of high blood pressure, they found.

However, they found "no significant association" between work-related physical activity and lower risk for high blood pressure.
Leisure exercise different than work-related activity

While the findings may suggest the more recreational exercise you do, the more you protect yourself from developing high blood pressure, Dr. Xi points out they do not prove it. The link may not even be causal.

People who exercise in their leisure time may just have healthier lifestyles, says Dr. Xi.



However, co-author Wei Ma, associate professor at the Shandong University School of Public Health, says high blood pressure is a risk factor for cardiovascular and kidney disease, so it is important to prevent and control it, and nevertheless recommends:

"To try to lower your risk of high blood pressure, you should exercise more in your leisure time."

While the team did not examine the reasons behind their findings, Prof. Ma points out that physical activity at work is different to leisure time exercise.

Work-related activity, such as in farming or industry, may involve heavy lifting, standing for long periods and doing repetitive work.

But leisure time exercise may affect high blood pressure in a number of ways, such as helping retain a healthy weight, improve insuling sensitivity and reduce resistance to flow in blood vessels, Ma adds.

Funds for the study came from the Independent Innovation Foundation of Shandong University, the Research Fund for the Doctoral Program of Higher Education of China and the Foundation for Outstanding Young Scientists in Shandong Province.

Another US study reported earlier this year found that breaking a sweat reduces stroke risk. Those findings revealed that physically inactive people have a 20% higher risk of stroke or TIA (transient ischemic attack or mini-stroke), compared with those who exercise enough to break a sweat four or more times a week.

Huge increase in emergency room visits for pediatric concussions

Researchers report a skyrocketing increase in the number of visits to the emergency department for kids with sports-related traumatic brain injuries (TBI), such as concussions.

The study, conducted by emergency physicians at Cincinnati Children's Hospital Medical Center, shows that emergency visits for sports-related TBI increased 92 percent between 2002 and 2011.

The number of children and teens admitted to the hospital with the same diagnosis also increased. That increase was proportionate to the increase in emergency department visits - about 10 percent. Patients admitted during the later years of the time period had less severe injuries and stayed in the hospital shorter amounts of time.

"More people are seeking care for TBI in the emergency department, and proportionately more are being admitted for observation," says Holly Hanson, MD, an emergency medicine fellow at Cincinnati Children's and lead author of the study. "Here in Cincinnati, we anticipate more children will be seeing their primary care physician or going to the Cincinnati Children's TBI clinic, due to the passage of recent Ohio legislation mandating medical clearance to return to play."

The study of emergency department trends in sports-related TBI is published online in the journal Pediatrics.

The researchers studied more than 3,800 children and teens who came to Cincinnati Children's with a sports-related TBI between 2002 and 2011. Of these patients, 372 were admitted.

Injury severity, however, decreased from 7.8 to 4.8, based on an established medical score to measure trauma severity. Length of stay changed little but trended downward. Skiing, sledding, inline skating and skateboarding had the highest admission rates for patients who visited the emergency department.

Their research did not concentrate on why more children and teens with less severe injuries were admitted to the hospital during this time period. They speculate that emergency physicians may be ordering fewer CT scans and observing patients in the hospital, or perhaps that athletes are getting bigger and stronger, causing more head injuries needing longer periods of observation.

The Centers for Diseases Control and Prevention has called TBI an "invisible epidemic" because these injuries are often profound but not readily apparent to the public. TBI is responsible for approximately 630,000 emergency visits, more than 67,000 hospitalizations, and 6,100 deaths in children and teens each year. Medical evaluations for sports-related TBI increased 62 percent between 2001 and 2009, according to previous studies.

The benefits of strength training as physical exercise in older seniors

After doing specific training for 12 weeks, people over the age of 90 improved their strength, power and muscle mass. This was reflected in an increase in their walking speed, a greater capacity to get out of their chairs, an improvement in their balance, a significant reduction in the incidence of falls and a significant improvement in muscle power and mass in the lower limbs. These are some of the outcomes of the study recently published in the journal Age of the American Ageing Association and which was led by Mikel Izquierdo-Redín, Professor of Physiotherapy at the NUP/UPNA-Public University of Navarre.

24 people between 91 and 96 participated in the research, eleven of them in the experimental group and 13 in the control group. Two days a week over a 12-week period they did multicomponent training: a programme of various exercises designed specifically for them and which combined strength training and balance improving exercises. As Mikel Izquierdo explained, "the training raised their functional capacity, lowered the risk of falls, and improved muscle power. In addition to the significant increases in the physical capacity of frail elderly people, the study has shown that power training can be perfectly applied to the elderly with frailty."

With ageing, the functional capacity of the neuromuscular, cardiovascular and respiratory system progressively starts to diminish, and this leads to an increased risk of frailty. Physical inactivity is one of the fundamental factors that contributes to the loss of muscular mass and functional capacity, a key aspect in frailty.

"From a practical point of view," says Prof Izquierdo, "the results of the study point to the importance of implementing exercise programmes in patients of this type, exercises to develop muscle power, balance and walking." In his view, "it would be beneficial to apply exercises of this type among vulnerable elderly people to prevent the impact of ageing, improve their wellbeing and help them to adapt to the society in which they live."

The piece of research which has been echoed by the American Ageing Association is entitled: "Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians".

Physical inactivity after cardiac surgery linked with substantially higher risk of depression

New research indicates that inactive patients following cardiac surgery have a substantially higher risk of depression and that the number of patients suffering from depression after cardiac surgery is as high as 40%. Investigators recommend that cardiac patients should be assessed for depression and level of physical activity and remain as active as they safely can after surgery to minimize post-operative depression. The results were published in the December issue of the Canadian Journal of Cardiology.

Major depressive disorder is an independent risk factor for the development of coronary artery disease (CAD) and increases the risk of cardiac events and premature death. Prevalence estimates of depression among patients with CAD requiring cardiac surgery ranges from 23% and 47%, which is higher than the general CAD population, including those who have had a heart attack, and is nearly twice as common as in the general population without cardiac disease. Approximately half of patients suffering from depression before cardiac surgery remain depressed one year after surgery, and an additional 20% of patients who undergo coronary artery bypass grafting experience new or elevated depressive symptoms after surgery. Moderate to severe depression after cardiac surgery increases the risk of further cardiac complications.

Evidence describing the change in physical activity status before and after cardiac surgery, and whether physical activity status is associated with depressive symptoms following surgery, is limited. Investigators from the University of Manitoba therefore sought to define who is at risk for depression after surgery, whether all patients experience similar mood changes, how and when physical activity changes, and how this affects depression after surgery. They conducted the Impact of Physical Activity on Depression After Cardiac Surgery (IPAD-CS) study to assess 436 patients who were undergoing elective cardiac surgery or awaiting in-hospital cardiac surgery requiring cardiopulmonary bypass in 2010-2011. Patients were assessed for short-term depression and physical activity behavior before surgery, at hospital discharge, and three and six months after surgery. Patients were categorized as "depression naïve," "at risk," or "depressed" before surgery and as physically "inactive" or "active" based on their activities over the preceding seven days.

Results show that physical inactivity was an independent risk factor for increased depressive symptoms before surgery and that inactive patients had double the risk of experiencing depressive symptoms preoperatively. Preoperative depression and postoperative stressful events were the strongest associations after surgery. Physical inactivity was associated with preoperative depression and new depression six months after surgery. Strikingly, the investigators found that 58% of the "at-risk" group progressed to clinical depression after surgery compared to 28% in the "naive" group, and that 23% remained depressed after six months. Furthermore, stressful events (e.g., death in family, divorce, living alone) became significantly associated with depression at three and six months after surgery, suggesting that factors predisposing patients with cardiac disease to elevated symptoms of depression are not fixed and vary over time.

A subgroup of patients who were not depressed at baseline ("naive" plus "at-risk" subgroups), but who became depressed by the three- or six-month follow-up, demonstrated a significant decrease in physical activity from baseline to six-month follow-up compared to those who remained free from depression.

One caveat the investigators point out is whether reduced physical activity increased depressive symptoms or, conversely, if depression resulted in sedentary behavior.

Antidepressant medications remain the mainstay of current depression treatment strategies. However, their use is controversial in patients with coronary artery disease. Previous studies have shown that exercise as a treatment among patients with coronary artery disease is as effective as antidepressants for reducing depressive symptoms. However, it is not yet known if physical activity has a similar effect in patients undergoing cardiac surgery who already have depression.

"Depression in the patient undergoing cardiac surgery appears complex," says lead investigators Rakesh C. Arora, MD, PhD (Faculty of Medicine, Department of Surgery, University of Manitoba, Winnipeg) and Todd Duhamel, PhD (Faculty of Kinesiology and Recreational Management, University of Manitoba, Winnipeg). "We have identified that although seven independent factors are associated with depression before and after cardiac surgery, different mood responses in different subsets of patients exist. Furthermore, patients 'at risk' for depression represent a new high-risk subset. Preoperative physical inactivity independently poses a two-fold risk for depression before surgery and is associated with the development of new depression postoperatively.

"These findings justify more detailed assessments of depression and physical activity before, during, and after surgery, and the need for assisted bio-psycho-social support in patients undergoing cardiac surgery," they conclude.

Tips For Keeping Your New Year's

The New Year is quickly creeping up on us. Do you have a New Year’s Resolution? Well, if you’re like most Americans (88 percent in 2001 according to a General Nutrition Centers poll), you have at least one resolution. And, if you are like the majority of these promise-makers, your resolution is probably related to health and fitness. In 2001 (according to GNC), 55 percent promised to eat healthier, 50 percent resolved to exercise more, and 38 percent wanted to lose weight.

While resolutions are well-intentioned, unfortunately most people fail at keeping them. With all the hype surrounding these promises, it’s easy to get caught up in them without really taking them seriously.

We live in a throw-away society and even our resolutions, I’m afraid, are not immune. However, especially for promises that include improving our health it’s in our best interest to not take them lightly.

So, what’s the secret to successful resolutions? While you can’t wave a magic wand and make your resolution come true, there are some easy steps to take to make it easier to fulfill your promise to yourself.

• Choose an obtainable goal. Resolving to look like a super model is not realistic for the majority of us, but promising to include daily physical activity in our lives is very possible.

• Avoid choosing a resolution that you’ve been unsuccessful at achieving year after year. This will only set you up for failure, frustration and disappointment. If you are still tempted to make a promise that you’ve made before, then try altering it. For example, instead of stating that you are going to lose 30 pounds, try promising to eat healthier and increase your weekly exercise.

• Create a game plan. At the beginning of January, write a comprehensive plan. All successful businesses start with a business plan that describes their mission and specifics on how they will achieve it. Write your own personal plan and you’ll be more likely to succeed as well.

• Break it down and make it less intimidating. Rather than one BIG end goal, dissect it into smaller pieces. Set several smaller goals to achieve throughout the year that will help you to reach the ultimate goal. Then even if you aren’t able to reach your final goal, you will have many smaller, but still significant, achievements along the way. For example, if your goal is to complete a 10K race, your smaller goals could be running a 5K in less than 30 minutes, adding upper and lower body strength training to increase your muscular endurance, and running 2 miles with a personal best completion time.

• Ask friends and family members to help you so you have someone to be accountable to. Just be sure to set limits so that this doesn’t backfire and become more irritating than helpful. For example, if you resolve to be more positive ask them to gently remind you when you start talking negatively.
Reward yourself with each milestone. If you’ve stuck with your resolution for 2 months, treat yourself to something special. But, be careful of your reward type. If you’ve lost 5 pounds, don’t give yourself a piece of cake as an award. Instead, treat yourself to a something non-food related, like a professional massage.
• Don’t go it alone! Get professional assistance. Everyone needs help and sometimes a friend just isn’t enough. Sometimes you need the help of a trained professional. Don’t feel that seeking help is a way of copping out. Especially when it comes to fitness, research studies have shown that assistance from a fitness professional greatly improves peoples success rate.

• Limit your number of promises. You’ll spread yourself too thin trying to make multiple changes in your life. This will just lead to failure of all of the resolutions.

On average only about 20% of us keep our New Year’s resolutions. Unfortunately, some of the biggest failures are found in fitness resolutions. But don’t let the statistics get you down. By following the tips above you’ll be better equipped to fall into the successful 20% category. If you need professional help with a fitness-related resolution, visit www.workoutsforyou.com for help.

Written by Lynn Bode, owner of WorkoutsForYou.com. Workouts For You provides affordable online exercise programs to help you lose weight, tone-up, build muscles, increase stamina and more.