For Seniors, Activity Helps Mind as Well as Muscle

SPECIAL TO THE TIMES

Staying physically active may help older adults think on their feet nearly as well as they did when they were young.

The ability to choose quickly among several possible actions, called executive control function, normally seems to decline with age. Executive control requires more processing by the brain than automatic activities that are done with little if any conscious thought, such as stepping on the gas when the red light turns green. When the red light turns green and then a person steps out into the intersection, the driver has to both stop the automatic action--stepping on the gas--and do something different--slam on the brakes. That's when executive control comes into play.

After dividing 24 older adults into groups according to their usual level of physical activity, the researchers tested their executive control functions while monitoring the electrical activity in their brains. The same tests were done on eight young adults.

The highly active older men and women were able to process information nearly as quickly as the younger adults. But those in the low and moderately active groups lagged behind, says Charles H. Hillman, professor of kinesiology at the University of Illinois at Urbana-Champaign. He presented his findings recently at the annual meeting of the American College of Sports Medicine.

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Strand of Colored Beads Tracks Cycle, Simplifies Birth Control

There are only about six days a month--five days before ovulation and 24 hours after ovulation--when a woman is likely to become pregnant. But figuring out when these days occur involves complicated calculations or meticulous observations and charting. Now researchers have figured out when a couple should avoid unprotected sex and have devised an easier way to keep count of the days.

It's called the Standard Days Method, and a study of more than 450 women has shown it to be as effective as barrier methods of birth control for women who have regular monthly menstrual cycles. The method was developed using a computerized model that applied the variability of ovulation and the probability of pregnancy to data on more than 7,000 menstrual cycles of women around the world. Using their results, the researchers then devised a simple system using a strand of colored beads that allows women to easily see when they are fertile and whether their cycles are the right length to use this method.

The researchers recruited women in Peru, Bolivia and the Philippines to test CycleBeads for at least 13 cycles in a study funded by the U.S. Agency for International Development. The pregnancy rate was 4.8%, which compares well with the diaphragm (6%) and the male condom (3%).

Victoria H. Jennings, director of the Institute for Reproductive Health at Georgetown University Medical Center in Washington, D.C., says CycleBeads are already being used on a wider scale in the countries where they were tested. She expects that CycleBeads will be available soon through family planning clinics in the U.S. and on the Internet.

Contraception 65 (2002), 333-338

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How Exercise Helps the Heart: Reduced Inflammation May Be Key

Researchers may have identified a key reason why being physically active helps the heart: It appears to subdue chronic inflammation, which has been linked to atherosclerosis.

By studying the levels of several indicators of inflammation in the blood, Emory University researchers in Atlanta found that people who exercised most were less likely to have elevated signs of inflammation than those who rarely performed any physical activity. Among 3,500 middle-aged and older Americans, those who exercised 22 or more times a month were 37% less likely to have elevated levels of C-reactive protein (CRP) than those who were physically active only three or fewer times a month. C-reactive protein is not routinely tested as cholesterol is, but experts agree that that a high level is an important sign of increased risk of heart disease.

The white blood cell count of those who exercised often was 41% less likely to be elevated, and they were 23% less likely to have an elevated level of fibrinogen, a component of blood. These are also indicators of inflammation.

One of the limitations of the study is that participants were asked only how often they exercised, not for how long. "It may be that exercising longer but less frequently has the same anti-inflammatory effect as exercising frequently but for short time periods," says Jerome L. Abramson, postdoctoral fellow in the division of cardiology at Emory University School of Medicine.

Archives of Internal Medicine (June 10, 2002), 162: 1286-1292

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Updated Guidelines for Diagnosis of Carpal Tunnel Syndrome

Despite the proliferation of high-tech imaging tests, the gold standard laboratory study to confirm the diagnosis of carpal tunnel syndrome remains the classic nerve conduction tests. Such tests can be done by a specially trained physician in less than half an hour and are far less expensive than, say, an MRI scan. Now, in response to improvements in the techniques, three medical organizations have agreed on updated guidelines for these tests.

The guidelines--from the American Assn. of Electrodiagnostic Medicine, the American Academy of Neurology and the American Academy of Physical Medicine and Rehabilitation--were published this month in three medical specialty journals. Carpal tunnel syndrome produces discomfort of the hand and wrist because of pressure on the nerves at the base of the palm.

"Nerve conduction studies measure the electrical patterns in nerves ... just as an EKG measures the electrical patterns of the heart," says Dr. Charles K. Jablecki, clinical professor of neuroscience at UC San Diego Medical Center.

Jablecki, a coauthor of the revised guidelines, says that by performing the new tests, the physician will be able to accurately confirm carpal tunnel syndrome in 85% of the people who have it, which is a 10% to 15% improvement in sensitivity over the tests recommended in the previous guidelines.

A detailed history and physical exam by a physician is still done before any laboratory tests, but according to Jablecki, "The consensus of several medical specialties is that electrodiagnosis should be done before carpal tunnel surgery."

Neurology 58: 1589-1592

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'Skin Sparing' Surgery Technique Minimizes Breast Cancer Scars

Back in the mid-1980s, a few plastic surgeons reasoned that removing only the breast tissue in a mastectomy and leaving the envelope of skin intact might enable them to immediately reconstruct a more natural-looking breast than traditional mastectomy operations allowed. The concern was local recurrence: Would the cancer be more likely to come back?

According to a long-term evaluation of 105 women operated on by the first surgeon to do a skin-sparing mastectomy, the rate of recurrence in the breast was 3.8%, which is comparable to other techniques. The average follow-up time of the current study was eight years and four months.

The skin-sparing procedure is now being done at hospitals across the U.S. The operation involves removing the breast tissue, biopsy scar, nipple and areola, usually through an incision around the areola. The reconstruction is done using muscle taken from another part of the woman's body or a synthetic implant. When the circular incision is closed and the nipple later re-created, there is little if any visible scarring and the breast has a natural shape.

San Francisco plastic surgeon Bryant A. Toth says the low recurrence rate means that a mastectomy doesn't have to be a mutilating procedure. The operation is limited to women with early-stage breast cancer or women at very high risk of breast cancer who choose to have a preventive mastectomy.

European Journal of Plastic Surgery

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