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Exercise is Medicine

Health care systems in the public and private sectors in South Africa find it difficult to keep up with the ever rising cost of health care. In fact, public health services are facing serious challenges to provide adequate services on many levels1. This article will propagate a way for medical practitioners, healthcare funders and the public to improve health and most likely decrease the cost of healthcare. It has been proved unequivocally that regular exercise is good for peoples health, that it improves quality of life, prevents disease often better than pharmacological agents do, as proved by leading epidemiologists2,3. It is for this reason that Dr Robert Sallis, general practitioner and task team leader of Exercise in Medicine in the United States, asked the question:

What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly.4

In fact, my contention is that if such medication was presented in tablet form and not prescribed, malpractice would certainly have been considered. Should healthcare providers and funders not be in a frenzy trying to make this medication available to as many people as possible? Added the fact that it is free, makes this a revolutionary, not to be missed opportunity to affect millions of lives for the better.

THE EVIDENCE

In a recently published longitudinal study on attributable factors for death of all causes among 40 842 men and 12943 women, it was shown that low cardiorespiratory fitness was more detrimental to health in terms of mortality than obesity, cigarette smoking, hypertension, hyperlipidaemia and diabetes5. In fact, low fitness carries a higher risk of mortality than obesity, hyperlipidaemia and diabetes put together! (Figure 1). It has also been shown that life expectancy is significantly higher in physically fit persons. Figure 2 demonstrates that the life expectancy of a physically fit 80-year old is similar to that of an unfit 60-year old person6! Quality of life also improves with increased physical fitness. In a study by Valiyeva et al among 6462 adults it was found that physical inactivity was the second most important risk for admission to a nursing home (or loss of independence) second only to cigarette smoking and a significantly higher risk than obesity, hypertension, high cholesterol and diabetes7.

In a presentation on the benefits of regular exercise, the Exercise is Medicine movement reported from scientific reports that regular physical activity at the correct intensity4:

  • Reduces the risk of heart disease by 40%.
  • Lowers the risk of stroke by 27%.
  • Reduces the incidence of diabetes by almost 50%.
  • Reduces the incidence of high blood pressure by almost 50%.
  • Can reduce mortality and the risk of recurrent breast cancer by almost 50%.
  • Can lower the risk of colon cancer by over 60%.
  • Can reduce the risk of developing of Alzheimers disease by one-third.
  • Can decrease depression as effectively as Prozac or behavioral therapy.
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    Tendon research has come a long way. So far, in fact, that 120 tendon-interested clinicians and scientists met in Ume, north Sweden, in October 2010 at a conference called Neuronal and non-neuronal pathways in the tendon pathology continuum. The novel data, vigorous exchanges and the generation of new ideas for study highlighted the buzz in this field. The stories of challenging clinical cases underscored the urgency for improvements in diagnosis and in treatment.  

Subgroups, stages and algorithms

One of the issues arising from all this research is that the days are well gone when tendinopathy was an overarching diagnosis. Subgroups of tendinopathies, different stages of presentation, and risk factors that vary between sexes, ages and activities mean that the diagnosis must be more specific than just tendinopathy.

This is most clearly described by Professor Alfredson who raises the concept of plantaris being the root of some failed Achilles tendinopathy treatments. Although he suggests a surgical solution (he is a surgeon!) there are conservative approaches that may work if applied in the early stages. As he suggests that compression of the plantaris against the Achilles may be a key aetiology, then reducing compression similar to the approach taken with insertional Achilles tendon problems can help.1 It may also explain why heel raises help some people with Achilles tendinopathy and yet do not seem to help others.

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Deflating the Genomic Bubble

Soccer is the sport of the future

in America and it always will

be. This oft-quoted epithet poking

fun at the promise of the beautiful game

in the United States can seem uncomfortably

apt when applied to genomic medicine. Its

now been 10 years since humans deciphered

the digital code that defines us as a species.

Although it may be hard to overestimate the

significance of that achievement, it is easy to

misconstrue its meaning and promise. People

argue about whether mapping the human

genome was worth the investment (13). With

global funding for genomics approaching $3

billion/year (4), some wonder what became

of all the genomic medicine we were promised

(5). It thus seems an appropriate time to

take stock of whence the real benefi ts from

genomic research may come and how best to

attain a future in which genomics improves

human health.

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Task may be too ambitious

HEALTH Minister Aaron Motsoaledi has a far better relationship with the private sector than his much-lampooned predecessor, the result of a greater willingness to engage and negotiate rather than confront and dictate. Yet he is not having much more luck in achieving the government's goal of regulating private healthcare prices. Partly, that is because such meddling in the market is devilishly complicated, even when motivated by the best of intentions. Unintended - and, more often than not, undesirable - consequences are virtually guaranteed, demanding new interventions that invariably also have unpredictable consequences. As the Department of Health has now discovered on several occasions, the courts do not subscribe to the philosophy that the end justifies the means. Mainly, however, the state's lack of regulatory success seems to be a function of its inability to intervene in a manner that makes sense to anyone else, is administratively and procedurally fair, and can be backed up by solid research.

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The Influence of Intervertebral Disc Shape on the Pathway of Posterior/Posterolateral Partial Herniation
Thursday, 20 May 2010 07:38

Joseph K. Lee, MD

Introduction

Intervertebral disc (IVD) herniations are commonly diagnosed on imaging studies. IVD herniations occur most commonly in the posterolateral direction. The consequences and effects of inherent IVD structure, however, have not been well delineated in the role of IVD herniations.

Yates JP, Giangregorio L, McGill SM
Spine .2010;35:734-739

Summary

Dr. Yates and colleagues sought to identify the role that the size and morphology of intervertebral discs play in the evolution of a disc herniation. Twenty-two porcine cervical spine specimens were placed under compressive loads and subsequently under repetitive flexion-extension cycles. A radioopaque contrast/custom blue dye mixture was injected into the discs through the anterior annulus fibrosus and subsequently evaluated via serially computed tomographic (CT) imaging, contrast-enhanced plain films.

IVD shapes ranged from ovoid to kidney-shaped (limaon) discs. In total, 81.8% (18/22) specimens were found to have posterior or posterolateral disc herniations, 17 of which were considered to have only a partial IVD herniation on imaging, which was confirmed by gross anatomic dissection. V angles, as shown in Figure 1 were developed by the investigators to quantify the different IVD shapes.

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