Health News
UF researchers find lack of physical fitness
poses weighty problems for
heart health
GAINESVILLE, Fla. - Women who are fat yet fit appear less likely to suffer a heart attack or die than those who are slender but slothful, University of Florida researchers report today in the Journal of the American Medical Association.
But don't view the news as a reason to soothe a snack attack with fatty favorites or to pile on a second hefty portion at mealtime - it's best to aim for trim and in shape, says cardiologist Timothy R. Wessel, M.D., an investigator at UF's Health Science Center and the report's lead author. Still, the study suggests body weight may not be as crucial as regularly pounding the pavement with a brisk walk, staking out a spot at the gym or simply doing household chores.
"Our study accepts the fact that obesity is a cardiovascular risk factor," Wessel said. "It is and has been shown to be so in multiple studies. But what this study suggests is that simply modifying weight without modifying your physical fitness level is not addressing a perhaps more important risk condition for cardiovascular events; that is, poor physical fitness."
The researchers say their results clearly emphasize the need to assess an individual's activity level as a routine part of the medical exam. A 12-item questionnaire used in the study to assess the women's perceived level of fitness is a powerful tool that easily could be adopted by physicians to identify patients prone to future problems, said Carl J. Pepine, M.D., chief of cardiovascular medicine at UF's College of Medicine and the paper's senior author.
"It's amazing that a simple 12-item questionnaire predicted adverse outcome as well as it did," Pepine said. "I believe that the real implications from the project are that this may be a tool to incorporate into our routine evaluation of patients."
The findings come as experts note a staggering two-thirds of U.S. adults are overweight and more than a third are obese. Obesity heightens the risk of heart-related problems, in part because it is associated with the development of artery-clogging fat deposits and malfunctioning blood vessels. But the UF study is important because it shows that a patient's own perceived physical activity level alone appears to predict heart disease risk, even after accounting for weight, traditional cardiovascular risk factors and body measurements, such as body mass index, waist circumference or waist-to-hip ratio, Pepine said.
"There's no doubt that increasing levels of obesity are associated with many potential medical problems over time, not the least of which are cardiovascular disease, diabetes and hypertension. The latter conditions can lead to serious heart disease," he said. "But it seems from this research that at least women may be able to negate some of the adverse effects of obesity and being overweight by increasing their levels of fitness."
UF researchers studied about 900 middle-aged women who wereenrolled in the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation, or WISE.
All had symptoms suggestive of reduced blood flow to the heart. WISE seeks to define the prevalence, extent, severity and complexity of heart disease in women and also aims to find ways to better predict it.
About 41 percent of study participants were obese, defined as a body mass index greater than or equal to 30; all told, three-quarters were overweight. A little more than half had high blood pressure or high cholesterol. Two-thirds had no evidence of obstructed arteries on coronary angiograms.
The women completed a questionnaire that assessed measures of fitness, including whether they participated in light sports, could climb a flight of stairs, carry groceries up stairs or run a short distance. Results are designed to express the questionnaire findings in terms of the standard exercise treadmill test performance commonly used to gauge heart health.
"In the study we used the term physically fit not to describe trained Olympic athletes but to correspond to the day-to-day activities many of us do," Wessel said.
The UF researchers found that lower fitness levels were associated with a higher-than-expected rate of heart attack, stroke, hospitalization and death during follow-up. Overall, about half the study participants developed heart-related adverse events. Of those, about 28 percent of the women classified as obese yet fit experienced heart problems, just slightly more than the 24 percent of women who were lean and fit. In contrast, a startling 43 percent of those who were lean but unfit developed events, comparable to the 42 percent of those who were obese and unfit who also fared poorly.
"The suggestion is that it's actually better to be in shape even if you are obese. If you were out of shape, being thin did not offer protection," Wessel said. "Just being at a lower body mass index or some other measure of obesity is not as important as better fitness or having higher activity or exercise capacity."
However, many popular approaches to tackling obesity, such as diets, focus on weight loss alone and fail to stress efforts to improve physical fitness, he said.
"It's alarming to see recent weight loss trends that involve following a diet plan and don't emphasize changing physical activity or fitness at all," said Wessel, adding that the American Heart Association recommends women participate in at least 30 minutes of moderate exercise every day. "Too many people just diet and don't do more exercise.
"To practitioners we'd say that assessing a patient's level of physical fitness or functional capacity should be at least as important as assessing their weight status, and that these simple self-reported questionnaires could be easily used as part of a cardiovascular risk stratification program," he added. "For the general public, the bottom-line message is it's not enough to just focus on weight without making the lifestyle modifications that increase physical fitness. Just being on the Atkins diet and losing 20 pounds does not mean you've decreased your risk of a cardiovascular event."
In an accompanying editorial, Steven N. Blair, P.E.D., and Tim S. Church, M.D., M.P.H., Ph.D., of the Cooper Institute in Dallas, wrote that the findings "provide a timely opportunity to examine an ongoing debate and offer a resolution."
"In essence, physical activity is the common denominator for the clinical treatment of low fitness and excess weight, making the 'fitness vs. fatness' debate largely academic," they wrote. "Thus, physicians, researchers, and policymakers should spend less energy debating the relative health importance of fitness and obesity and more time focusing on how to get sedentary individuals to become active." |
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Group forms to test new cancer drugs
in children
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By Melanie Fridl Ross
University of Florida physicians have partnered with eight other academic medical centers to form a national consortium aimed at testing new cancer therapies in children who fail to respond to traditional treatments.
The Pediatric Oncology Experimental Therapeutics Investigators Consortium, or POETIC, launched its first clinical trial Monday, when doctors gave an investigational anticancer drug to an 11-year-old North Central Florida boy who has battled bone cancer for the past three years.
"The importance of the consortium is that there haven't been a lot of opportunities for children with cancer to access drugs in the earliest stages of development," said Stephen P. Hunger, M.D., chief of the division of pediatric hematology/oncology at UF's College of Medicine. "There is nowhere else in the state of Florida where such trials are available. This gives patients throughout Florida and elsewhere in the Southeast opportunities that didn't exist otherwise. This particular trial is the first of a number of trials the consortium will conduct."
Each year, an estimated 12,000 patients under the age of 20 are diagnosed with cancer in the United States, Hunger said. Of those, about 20 percent do not respond to first- and second-line therapies, he said.
During the past 25 years, many major breakthroughs in the treatment of childhood cancer have arisen out of the collaborative efforts of research groups across the United States. UF, for example, is one of the statistical centers for the international Children's Oncology Group, a federally supported consortium that pools resources to design, conduct and analyze studies of pediatric cancer therapies worldwide. Clinicians worldwide funnel their data to statisticians at UF and the other COG statistical and data centers who analyze findings and monitor research initiatives.
Most COG studies focus on research protocols to test established, widely available chemotherapy drugs. In contrast, POETIC focuses on newer agents being tested in people for the first time, Hunger said. In addition to the UF Shands Cancer Center, other members of POETIC are Johns Hopkins University, Memorial Sloan-Kettering Cancer Center, M.D. Anderson Cancer Center, Emory University, the University of Colorado Health Sciences Center, Vanderbilt University, the University of Arizona and Phoenix Children's Hospital. Together researchers at these institutions will lead phase 1 and phase 2 trials of cancer drugs that target the underlying biologic mechanisms of various malignancies in children.
A phase 1 trial seeks in part to determine the safety and pharmacologic effects of escalating doses of a drug in the first stages of development. A phase 2 trial establishes whether a drug works for its proposed purpose and evaluates doses, adverse effects and drug metabolism. POETIC trials also include detailed studies to determine if the drug being tested is working as predicted from preclinical studies.
The consortium is in the process of developing a half-dozen other trials slated to open in the coming year, Hunger said. The goal will be to have four trials open at any given moment so there's always something available for a family to consider, he said.
For the study that began this week, researchers will enroll about two-dozen children with various forms of recurrent cancer who have not responded to other therapies. They will test an intravenous drug called 17-AAG, supplied by the National Cancer Institute.
On Monday, a patient of Hunger's was the first study participant to receive the drug. The young NASCAR fan, who likes to ride his all-terrain vehicle and watch the television show "Unsolved Mysteries," was diagnosed in October 2001 with a form of bone cancer known as osteosarcoma after experiencing pain in his left arm. His name is being withheld due to patient privacy concerns.
The patient was treated at Shands at UF with conventional chemotherapy and surgery to remove the bone tumor and replace the upper part of the arm bone. However, the cancer spread to his lungs about three months after he finished chemotherapy, eventually forcing doctors to remove his left lung and a large portion of his right lung. Since then, several treatments have been tried, but the cancer has continued to grow. Then his family heard about the current study and returned to Shands at UF for the first treatment.
"This study gives us hope," his mother said. "We're glad there's something else we can try."
His father said the family is getting desperate.
"It's at the point now where we've got to try other things, even if it means an experimental drug with no history, really, to see if it was going to help him," he said.
The family discovered the study after searching for alternatives on the computer and calling hospitals across the country. They said they were relieved to learn they could enroll in the trial yet stay close to home.
"That's what everybody should do, too - never give up," the boy's mother said. "Because there may be a doctor who says there's no more, but you can always find more. And that's what I would like other parentsto know." |
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