May 6th, 2011

Table of Contents:

Research and Practical Health Care (Introduction to special issue)

Exercise Cuts Older Adult Health Costs (Insurance implications)

Listen to the Quiet Protein (Cancer research)

Narrow Arrow Escape (A medical story for pet lovers)

Research and Practical Health Care

by American Senior Fitness Association

The great universities of the world produce important research findings and provide practical medical care as well. Below are three current news releases from the University of Florida that demonstrate such centers’ value — and that will be of great interest to those involved in older adult health and fitness.

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Exercise Cuts Older Adult Health Costs

by American Senior Fitness Association

While most senior health-fitness professionals already advocate insurance coverage of structured physical exercise programming for older adults, the following news release strongly reinforces that position:

Structured exercise and physical activity programs should be covered by insurance as a way to promote health and reduce health care costs, especially among high health-risk populations such as those who have diabetes.

So says Marco Pahor, M.D., director of the University of Florida Institute on Aging, in an editorial Wednesday, May 4, in the Journal of the American Medical Association. Pahor’s paper accompanies an analysis of multiple clinical trials that examined the effect of exercise and physical activity on the control of blood glucose levels.

“Cumulative work over the past few decades provides solid evidence for public policymakers to consider structured physical activity and exercise programs as worthy of insurance reimbursement,” Pahor said.

A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. People who take part in programs that contain both aerobic and resistance training are likely to get the greatest benefit, compared with people who do only resistance exercises.

The study that Pahor’s editorial accompanied, conducted by Daniel Umpierre, M.Sc., of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues, compared the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes.

Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

“People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

Various studies, including the UF Institute on Aging Lifestyle Interventions and Independence for Elders, or LIFE study, are aimed at answering those questions through randomized controlled trials that can provide data about the efficacy and cost-effectiveness of structured activity programs with respect to a range of health outcomes. Funded by the National Institute on Aging, the LIFE study is the largest of its kind to examine physical activity and health education as a way to prevent mobility disability among older adults, and accounts for the largest federal award to the University of Florida.

The institute will break ground on May 26 for a 40,000-square-foot complex within UF’s new $45 million, 120,000-square-foot Clinical and Translational Research Building, which will serve as headquarters for this research and others aimed at speeding scientific discoveries to patients.

“There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.

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Listen to the Quiet Protein

by American Senior Fitness Association

As noted in the article below, lung cancer strikes both cigarette smokers and nonsmokers. For new hope in the fight against this form of cancer, read on:

When a movie character says, “It’s too quiet,” that’s usually a sign something bad may happen.

Now, University of Florida researchers have discovered that when variations of a certain protein in our cells are too quiet, it may add to the risk that someone will develop lung cancer. When scientists restored the protein to its normal, active self, its cancer-inhibiting properties reappeared.

These discoveries, published in two reports in the online version of Oncogene, provide evidence that drugs can potentially suppress tumor growth by restoring cellular processes rather than inhibiting cancer-causing genes known as oncogenes.

“It’s a well-accepted fact that you can inhibit things, particularly oncogenes,
that drive cancer. Oncogenes are the cancer’s gas pedal,” said principal investigator David Reisman, M.D., Ph.D., a UF associate professor of medicine and a member of the UF Shands Cancer Center. “What we’ve done is demonstrate the feasibility of reconstituting the cancer brake.”

The protein, known as Brahma, or BRM, is involved in the regulation of cellular functions like gene expression, DNA repair, cell adhesion and telling cells whether to divide and grow or stop dividing and die. Other studies have found
“silenced” BRM is present in 10 to 20 percent of all solid tumors. Reisman knew from his own research in mouse models that silencing the BRM gene alone did not cause tumor growth, but when carcinogens were introduced, 10 times as many tumors appeared compared with mice with normal BRM expression.

“The gene was not a tumor suppressor in the classical definition but a tumor susceptibility gene, and when the expression is lost, it primes you to other events that potentiate the development of tumors, such as tobacco carcinogens,” Reisman said.

More people die of lung cancer every year than of cancers of the breast, colon, prostate or lymphoma combined, according to the National Cancer Institute. However, only 10 percent of smokers develop lung cancer and as many as 15 percent of those diagnosed with lung cancer have never smoked.

Reisman’s work suggests the presence of two variations within the BRM gene — known as polymorphisms — could potentially be biomarkers for lung cancer and assist doctors in identifying individuals at higher risk, which could lead to more cost-effective screening practices and lifesaving early detection.

Study investigators sequenced the genes of 160 people and learned that roughly 20 percent carry the gene variants. With collaborator Geoffrey Liu, M.D., a research scientist at the Ontario Cancer Institute at the University of Toronto,
the team then verified the presence of the silenced BRM variants in human lung tumors.

Reisman and Lui also conducted case control studies on 1,199 people who were
matched for age, gender and smoking history but in whom 484 individuals had lung cancer and 715 were healthy and cancer free.

“We found these polymorphic sites were greatly enriched in the population that had developed lung cancer,” Reisman said. “The chance that you would develop lung cancer if you had both polymorphic sites was 220 percent higher. Our analysis demonstrated those odds to be independent of smoking history, sex, race and cancer type.”

Reisman’s team also studied whether it would be possible to restore the normal expression of the BRM protein. Certain compounds, called histone deacetylase — or HDAC — inhibitors, had been demonstrated by other researchers to reactivate the BRM gene, but did not restore the normal, cancer-suppressing function of the BRM protein.

By introducing the healthy protein alongside the reactivated gene, the researchers were able to stop the growth of cancer cells. That makes the process a potential target for drug therapies to use in suppressing many tumor types.

“We know there are a lot of genes that are silenced in cancer, and it’s believed that gene silencing is necessary in order for the cancer to grow and thrive. This research demonstrates — and is really the first example of — an approach that’s led to the reactivation of a specific tumor-suppressing gene,” said Aubrey Thompson, Ph.D., a professor of cancer biology at Mayo Clinic Comprehensive Cancer Center in Jacksonville, Fla., who was not involved in the research.

“That’s a really big deal,” he said. “It’s an approach that is widely applicable to a lot of genes and a lot of different types of cancer. I think it’s going to be met with a great deal of enthusiasm and interest from researchers in human cancer therapy.”

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Narrow Arrow Escape

by American Senior Fitness Association

It’s no secret among senior fitness professionals that many older adult exercise participants are devoted pet lovers. Some older individuals care for their own furry friends, some financially support animal rescue organizations, and others volunteer their time and energy. Therefore, you may wish to share the following inspirational story with your clients:

Yes, Virginia: There really is a cat with nine lives, and he owes all of them to a concerned citizen, veterinarians from Ocala and the University of Florida, a generous benefactor — and a whole lot of luck.

After an arrow penetrated the chest of a stray cat in Marion County in mid-March, a concerned citizen from Dunnellon contacted Sheltering Hands, a local cat rescue group, for help. The citizen and her neighbors knew the cat to be friendly with children, not feral, but did not know who owned him.

“Law enforcement authorities and Marion County Animal Services had been contacted early on, but were unable to trap the cat because the width of the arrow would not allow him to enter a standard trap,” said Dr. Kathleen Fleck, a veterinarian who works part time with Brick City Cat Hospital in Ocala and volunteers with Sheltering Hands. “By this time, he was too scared to come to anyone willingly. He wandered the neighborhood this way for nearly a week.”

The Dunnellon newspaper even ran a small article about his predicament, and at that point, the concerned citizen contacted Sheltering Hands.

“One of our dedicated volunteers obtained access to a very large dog trap and spent two days coaxing him into it,” Fleck said. “When he arrived at Brick City Cat Hospital, he was quite septic and it was determined that without immediate surgery to remove the arrow from his chest, he would surely die.”

Fleck said a benefactor, who wishes to remain anonymous, stepped forward to assist with the cost of transporting the cat — now known as “Arrow” — to the UF Small Animal Hospital. The trip proved to be quite dramatic.

“He tried twice to go into respiratory arrest and had to be on oxygen support in the back seat of my truck with my technician doing the bagging (to supply oxygen) during the entire 45-minute trip,” Fleck recalled.

Arrow arrived at UF the morning of March 12 in critical condition, requiring
ventilation with oxygen through an endotracheal tube.

“Fluid and air were drained off his chest, and he then received fluids and medications to stabilize his blood pressure,” said Dr. Jordan Nickell, an intern with the UF Small Animal Hospital’s emergency service.

A CT scan revealed that the arrow had passed right through his chest between his
heart and diaphragm, fortunately missing the cat’s major blood vessels and many other vital structures, UF veterinarians said.

Dr. Stanley Kim and Dr. Laura Cuddy performed surgery to remove the arrow and treat the severe infection in the cat’s chest. Parts of Arrow’s lung lobes were removed because of damage from the injury, and the cat remained hospitalized under Cuddy’s care for another week while infected fluid was drained from his chest and he received antibiotics and pain medications.

Arrow’s condition improved and he was discharged from UF on March 18 to a volunteer, who transported him back to Fleck.

“So far, the story is very positive,” Fleck said. “Arrow remains in my foster care under Sheltering Hands and now is weighing in at about 10 pounds. Initially, he weighed less than 8 pounds. He really has had no problems beyond
the normal healing process.”

Fleck said Arrow stayed on antibiotics for six weeks, and that other than treatment for internal parasites and vaccines, he has not needed additional treatment.

“Except for his funky body Mohawk haircut, it would be difficult to appreciate how extensive his injuries were,” Fleck said. “He is a total lover and I am
hoping he is able to find a perfect forever home in the near future.”

She added that Sheltering Hands was taking applications from prospective owners, and would be selecting Arrow’s new owner very carefully.

“We want to do our best to make sure he never has to fight for his life again,” she said. “Thanks to the UF emergency team’s excellent response, Arrow is with us today.”

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