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Walking

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Walking improves bone health and brain volume

By David Dunaief, M.D.

Dr. David Dunaief

What does it take to get Americans off the sofa? We know that exercise is good for our long-term physical and mental health, but it’s still elusive for the majority of us. It’s just too tempting to let the next episode of our new favorite series autoplay or to answer those last 12 emails.

As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” I once heard that the couch is as bad as the worst deep-fried food. It perpetuates inactivity. Even sleeping burns more calories than sitting watching TV, for example.

I think part of the problem might be that we don’t know what type of exercise is best and how long and frequently to do it. 

I have good news. There is an easy way to get tremendous benefit with very little time involved. You don’t need expensive equipment, and you don’t have to join a gym. You can sharpen your wits with your feet.

Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best. 

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. 

Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Participants who had an increase in brain tissue volume also had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier?

In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

This is a terrific strategy to get you off the couch or away from your computer. Set an alarm for specific points throughout the day and use that as a prompt to get up and walk, even if it’s only for 15 minutes. The miles will add up quickly. In addition to the mental acuity benefits, this may also help with your psychological health, giving you a mental break from endless Zoom calls and your eyes a break from endless screens.

If you ratchet up the exercise to running, a study showed that mood also improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. Sadly, if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles. 

So, remember, use your feet to keep your mind sharp and yourself even-tempered. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References: 

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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High blood pressure can be lowered in part by exercise. METRO photo
Collaborate with your physician on lifestyle changes that improve risks

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension, also known as high blood pressure, is commanding a lot of attention in the U.S, where it’s pervasive, affecting approximately 45 percent of adults over 18 (1). Over the last decade, new and extended studies have given us better clarity about treatments, stratifying approaches to ensure the best outcomes for patients.

Since 2017, hypertension severity has been categorized into three stages, each with its recommended treatment regimen. One of the most interesting shifts with this recategorization was the recategorization of what we used to call “prehypertension” into what we now call “elevated” blood pressure and “hypertension stage 1.” 

Elevated blood pressure is defined as systolic blood pressure (the top number) of 120-129 mmHg and diastolic blood pressure (the bottom number) of less than 80 mmHg, while Stage 1 includes systolic blood pressure of 130-139 mmHg or diastolic blood pressure of 80-89 mmHg (2). A simple chart of all levels can be found on The American Heart Association’s website at www.heart.org.

The consequences of both prehypertension and hypertension are significant, even though there are often no symptoms. For example, they increase the risk of cardiovascular disease and heart attack dramatically.

In an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (3). This is why it’s crucial to treat it in these early stages, even before it reaches the more severe levels of hypertension.

Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (4).

This can have a dramatic impact on quality of life.

Treating elevated blood pressure

In my view, it would be foolish not to treat elevated blood pressure. Updated recommendations for treatment, according to the Joint National Commission (JNC) 8, the association responsible for guidelines on the treatment of hypertension, are lifestyle modifications (5).

Lifestyle changes include a Mediterranean-type diet or the DASH (Dietary Approaches to Stop Hypertension) diet. It’s important to focus on fruits, vegetables, reduction in sodium to a maximum of 1500 mg (2/3 of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis) (6). Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (7). Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.

The danger in treating elevated blood pressure comes only when medication is used, due to side effects. For example, the Trial of Preventing Hypertension (TROPHY), suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (8)(9). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Still, the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, the makers of the drug. 

In an editorial, Jay I. Meltze, M.D., a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (10). 

Elevated blood pressure is an asymptomatic disorder that has been shown to respond well to lifestyle changes — why create symptoms with medication? Therefore, I don’t recommend treating elevated blood pressure patients with medication. Thankfully, the JNC8 agrees.

Treating Stage 1 hypertension

For those with Stage 1 hypertension, but with a low 10-year risk of cardiovascular events, these same lifestyle modifications should be implemented for three-to-six months. At this point, a reassessment of risk and blood pressure should determine whether the patient should continue with lifestyle changes or needs to be treated with medications (11). It’s important to note that risk should be assessed by your physician. I am encouraged that the role of lifestyle modifications in controlling hypertension has been recognized. When patients and physicians collaborate on a lifestyle approach that drives improvements, the side effects are only better overall health.

References: 

 (1) cdc.gov. (2) heart.org. (3) Stroke 2005; 36: 1859–1863. (4) Hypertension 2006;47:410-414. (5) Am Fam Physician. 2014 Oct 1;90(7):503-504. (6) J Am Coll Cardiol. 2018 May, 71 (19) 2176–2198. (7) Archives of Internal Medicine 2001;161:589-593. (8) N Engl J Med. 2006;354:1685-1697. (9) J Am Soc Hypertens. Jan-Feb 2008;2(1):39-43. (10) Am J Hypertens. 2006;19:1098-1100. (11) Hypertension. 2021 Jun;77(6):e58-e67.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Metro photo
Moderate exercise is better for weight maintenance than weight loss

By David Dunaief, M.D.

Dr. David Dunaief

It’s that time of year again, when exercise product commercials flood the airways. If you have “lose weight” on your list of 2022 resolutions, it’s helpful to consider what the research tells us about the relationship between exercise and weight loss.

Unfortunately, exercise without dietary changes may not actually help many people lose weight, no matter what the intensity or the duration (1). If it does help, it may only modestly reduce fat mass and weight for the majority of people. However, it may be helpful with weight maintenance.

Ultimately, it may be more important to reconsider what you are eating than to succumb to the rationalization that you can eat with abandon and work it off later.

Don’t give up on exercise just yet, though. There is good news: Exercise does have benefits for a wide range of conditions, including chronic kidney disease, cognitive decline, diabetes, cardiovascular disease, osteoporosis, fatigue, insomnia and depression.

Exercise may not result in weight loss

The well-known weight-loss paradigm is that when more calories are burned than consumed, we will tip the scale in favor of weight loss. The greater the negative balance with exercise, the greater the loss. However, study results say otherwise. They show that in premenopausal women there was neither weight nor fat loss from exercise (2). This involved 81 women over a short duration (12 weeks). All of the women were overweight to obese, although there was great variability in weight.

However, more than two-thirds of the women gained a mean of 1 kilogram, or 2.2 pounds, of fat mass by the end of the study. There were a few who gained 10 pounds of predominantly fat. A fair amount of variability was seen among the participants, ranging from significant weight loss to substantial weight gain. These women were told to exercise at the American College of Sports Medicine’s optimal level of intensity (3). This is to walk 30 minutes on a treadmill three times a week at 70 percent VO2max — maximum oxygen consumption during exercise — or, in other words, a moderately intense pace. 

The good news is that the women were in better aerobic shape by the end of the study. Also, women who had lost weight at the four-week mark were more likely to continue to do so by the end of the study.

Other studies have shown modest weight loss. For instance, in a meta-analysis involving 14 randomized controlled trials, results showed that there was a disappointing amount of weight loss with exercise alone (4). In six months, patients lost a mean of 1.6 kilograms, or 3.5 pounds, and at 12 months, participants lost 1.7 kilograms, or about 3.75 pounds.

Exercise and weight maintenance

However, exercise may be valuable in weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (5). When exercise was added to diet, women were able to maintain 30 percent more weight loss than with diet alone after a year in a prospective study (6).

Exercise and disease

Walking the dog several times a week is a good moderate exercise. METRO Photo

As just one example of exercise’s impact on disease, let’s look at chronic kidney disease (CKD), which affects 15 percent of adults in the United States, according to the Centers for Disease Control and Prevention (7).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD, stages 3 to 5 (8). Yes, this includes stage 3, which most likely is asymptomatic. There was a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death when walkers were compared to non-walkers.

Walking had an impressive impact, and results were based on a dose-response curve. In other words, the more frequently patients walked during the week, the better the probability of preventing complications. Those who walked between one and two times per week had 17 and 19 percent reductions in death and kidney replacement therapy, respectively, while those who walked at least seven times per week saw 44 and 59 percent reductions in death and kidney replacement. These are substantial results. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

Therefore, while there are many benefits to exercise, food choices will have a greater impact on our weight and body composition. 

However, exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

So, by all means, exercise, but also focus on consuming nutrient-dense foods instead of calorically dense foods that you may not be able to exercise away.

References:

(1) uptodate.com. (2) J Strength Cond Res. 2015 Feb;29(2):297-304. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) Obesity (Silver Spring). 2010;18(1):167. (6) Int J Obes Relat Metab Disord. 1997;21(10):941. (7) cdc.gov. (8) Clin J Am Soc Nephrol. 2014 Jul;9(7):1183-1189.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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Walking may reduce the need for dialysis. METRO photo
Simple lifestyle changes can have an impact

By David Dunaief, M.D.

Dr. David Dunaief

On the heels of National Kidney Month in March, let’s look more closely at strategies for reducing chronic kidney disease (CKD). Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk.

CKD is tricky because, similar to high blood pressure and dyslipidemia (high cholesterol), it tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms in moderate stages such as fatigue, malaise and loss of appetite.

What are the CKD stages?

CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. Stage 5 is end-stage renal disease, or kidney failure.

Who should be screened?

According to the U.S. Preventive Services Task Force and the American College of Physicians, those who are at highest risk should be screened including, as I mentioned above, patients with diabetes or hypertension (1)(2). 

In an interview on Medscape.com, “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives to advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential screening candidates (3). This broadens the asymptomatic population that may benefit from screening.

Slowing CKD progression

Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

How much exercise?

Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent respectively (4). And although some don’t like formal exercise programs, most people agree that walking is enticing.

The most prevalent form of exercise in this study was walking. Even more intriguing, the results are based on a dose-response curve. In other words, those who walked more often saw greater results. So, the participants who walked one-to-two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. There were 6,363 participants for an average duration of 1.3 years.

How much protein to consume?

When it comes to CKD, more protein is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials) of Cochrane database studies, results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (5). According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant.

Sodium: How much is too much?

Good news! In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg was shown to be beneficial, something all of us can achieve.

Medications have a place

We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, responsible for blood pressure and water balance (7). Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, this result, including both participants and dropouts, is probably close to what will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.

While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.

References:

(1) uspreventiveservicestaskforce.org (2) aafp.org. (3) Medscape.com. (4) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2009;(3):CD001892. (6) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (7) J Am Coll Cardiol. 2014;63(7):650-658.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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METRO photo
A good pace and mindset may improve your outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Medical professionals (including me!) often press you to exercise. This sage advice seems simple enough; however, the type, intensity level and frequency of exercise may not be well-defined. For instance, any type of walking is beneficial, right? Well, as one study that quantifies walking pace notes that some types of walking are better than others.

We know exercise is beneficial for prevention and treatment of chronic disease. But another very important aspect of exercise is the impact it has on specific diseases, such as diabetes and osteoarthritis. Also, certain supplements and drugs may decrease the beneficial effects of exercise. They are not necessarily the ones you think. They include resveratrol and nonsteroidal anti-inflammatory drugs (such as ibuprofen). Let’s look at the evidence.

Walk with a spring in your step

While pedometers give a sense of how many steps you take on a daily basis, this number isn’t all that’s important. Intensity, rather than quantity or distance, may be the primary indicator of walking’s benefit.

In the National Walkers’ Health Study, results showed that those who walk with more pace are more likely to decrease their mortality from all causes and to increase their longevity (1). This is one of the first studies to quantify specific speed and its impact. In the study, there were four groups. The fastest group was almost jogging, walking at a mean pace of less than 13.5 minutes per mile, while the slowest group was walking at a pace of 17 minutes or more per mile.

The slowest walkers had a higher probability of dying, especially from dementia and heart disease. Those in the slowest group stratified even further: those whose pace equaled 24-minute miles or greater had twice the risk of death, compared to those who walked with greater speed.

However, the most intriguing aspect of the study was that there were big differences in mortality reduction in the second slowest category compared to the slowest, which might only be separated by a minute-per-mile pace. So, don’t fret: you don’t have to be a speedwalker to realize significant benefit.

Align your mind and body

The mind also plays a significant role in exercise. The results of one study note that a positive mindset while exercising makes a big difference in the exercise’s impact (2). Researchers created two groups. The first was told to find four positive phrases, chosen by the participants, to motivate them while on a stationary bike and repeat these phrases consistently for the next two weeks while exercising.

Members of the group who repeated these motivating phrases consistently throughout each workout were able to increase their stamina for intensive exercise after only two weeks, while the same could not be said for the control group, which did not use reinforcing phrases.

‘Longevity’ supplement may negate exercise benefits

Resveratrol is a substance that is thought to provide increased longevity through proteins called Sirtuin 1. So how could it negate some benefit from exercise? Well it turns out that we need acute inflammation to achieve some exercise benefits, and resveratrol has anti-inflammatory effects. Acute inflammation is short-term inflammation and is different from chronic inflammation, the basis for many diseases.

In a small randomized controlled study, treatment group participants were given 250 mg supplements of resveratrol and saw significantly less benefit from aerobic exercise over an eight-week period, compared to those who were in the control group (3). Participants in the control group had improvements in both cholesterol and blood pressure that were not seen in the treatment group. This was a small study of short duration, although it was well-designed.

Impact on diabetes complications

The majority of Type 2 diabetes patients suffer from cardiovascular disease. The good news is that exercise may improve outcomes. In a prospective (forward-looking) observational study, results show that diabetes patients who exercise less frequently, once or twice a week for 30 minutes, are at a higher risk of developing cardiovascular disease and almost a 70 percent greater risk of dying from it than those who exercised at least three times a week for 30 minutes each session. In addition, those who exercised only twice a week had an almost 50 percent increased risk of all-cause mortality (4).

The study followed more than 15,000 men and women with a mean age of 60 for five years. The authors stressed the importance of exercise and its role in reducing diabetes complications.

Calculate your fitness age

You can calculate your fitness age without the use of a treadmill, according to the HUNT study (5). An online calculator utilizes basic parameters – age, gender, height, weight, waist circumference and frequency and intensity of exercise – to help you judge where you stand with exercise health. This calculator can be found at www.ntnu.edu/cerg/vo2max. Your results may surprise you.

Even in winter, you can walk and talk yourself to improved health by increasing your intensity while repeating positive phrases that help you overcome premature exhaustion. Exercise can also have a significant impact on complications of chronic diseases, such as cardiovascular disease and resulting death with diabetes. As a bonus, getting outside during the day may also help you avoid the effects of the “winter blues.”

References:

(1) PLoS One. 2013;8:e81098. (2) Med Sci Sports Exerc. 2013 Oct. 10. (3) J Physiol Online. 2013 July 22. (4) Eur J Prev Cardiol Online. 2013 Nov. 13. (5) Med Sci Sports Exerc. 2011;43:2024-2030.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

There are some compelling studies that show exercise’s powerful effects in altering our genes. Recent studies show its impact on specific diseases. Exercise has effects on diabetes and a host of other chronic diseases, including kidney stones, osteoarthritis, cardiovascular disease and breast, colorectal and endometrial cancers (1).

There are also studies on simple ways to motivate yourself during exercise. One showed that those who repeat positive mantras like “feels good” while exercising were able to persist in their exercise routines for longer periods (2).

Why is this so important and why am I harping on exercise during the holidays? Because we are too sedentary, and this is the time of the year when we are inclined to overeat. According to data from the 2015-2016 National Health & Nutrition Examination Survey, we spend 6.4 hours a day sedentary (3). And this percentage is trending up.

Exercise and your genes

While you may be waiting for gene therapy to cure our chronic illnesses, it turns out that exercise may have a significant impact on our genes.

No waiting required; this is here and now.

Photo from Pixabay

In a study, results showed that thousands upon thousands of genes in fat cells were affected when participants exercised (4). The study involved sedentary men and asked them to exercise twice a week at a one-hour spin class. According to the researchers, the genes impacted were those involved most likely in storing fat and in risk for subsequent diabetes and obesity development. Participants’ gene expression was altered by DNA methylation, the addition of a methyl group made up of a carbon and hydrogens. These participants also improved their biometrics, reducing fat and subsequently shrinking their waist circumferences, and improved their cholesterol and blood-pressure indices.

The effect is referred to as epigenetics, where lifestyle modifications can ultimately lead to changes in gene expression, turning them on and off. This has been shown with dietary changes, but this is one of the first studies to show that exercise also has significant impacts on our genes. It took only six months to see these numerous gene changes with modest amounts of cardiovascular exercise.

If this was not enough, another study showed substantial gene changes in muscle cells after one workout on a stationary bike (5).

Exercise versus drug therapy

We don’t think of exercise as being a drug, but what if it had similar benefits to certain drugs in cardiovascular diseases and mortality risk? A meta-analysis — a group of 57 studies that involved drugs and exercise — showed that exercise potentially has equivalent effects to statins in terms of mortality with secondary prevention of coronary heart disease (6).

This means that, in patients who already have heart disease, both statins and exercise reduce the risk of mortality by similar amounts. The same was true with prediabetes and the use of metformin vs. exercise. It didn’t matter which one was used, the drug or the lifestyle change.

Don’t change your medication without consulting your physician.

Kidney stones and exercise

Anyone who has tried to pass a kidney stone knows it can be an excruciating experience. Most of the treatment revolves around pain medication, fluids and waiting for the stone to pass. However, the best way to treat kidney stones is to prevent them. In the Women’s Health Initiative Observational Study, exercise reduced the risk of kidney stones by as much as 31 percent (7).

Even better, the intensity of the exercise was irrelevant to its beneficial effect. What mattered more was exercise quantity. One hour of jogging or three hours of walking got the top results. But lesser amounts of exercise also saw substantial reductions. This study involved 84,000 postmenopausal women, the population most likely to suffer from kidney stones.

Sex as exercise

We have heard that sex may be thought of as exercise, but is this myth or is there actual evidence? Try to keep a straight face. Well, it turns out this may be true. In a study published in the PLoS One journal, researchers found that young healthy couples exert 6 METs — metabolic energy, or the amount of oxygen consumed per kilogram per minute — during sexual activity (8).

How does this compare to other activities? Well, we exert about 1 MET while sitting and 8.5 METs while jogging. Sexual activity falls between walking and jogging, in terms of the energy utilized, and thus may be qualified as moderate activity. Men and women burned slightly less than half as many calories with sex as with jogging, burning a mean of 85 calories over about 25 minutes. Who says exercise can’t be fun?

I can’t stress the importance of exercise enough. It not only influences the way you feel, but also may influence gene expression and, ultimately, affects the development and prevention of disease. In certain circumstances, it may be as powerful as drugs and, in combination, may pack a powerful punch. Therefore, make exercise a priority — part of the fabric of your life. It may already be impacting the fabric of your body: your genes.

References:

(1) JAMA. 2009;301(19):2024. (2) Med Sci Sports Exerc. 2013 Oct 10. (3) JAMA Netw Open. 2019;2(7):e197597. (4) PLoS Genet. 2013 Jun;9(6):e1003572. (5) Cell Metab. 2012 Mar 7;15(3):405-11. (6) BMJ 2013; 347. (7) JASN online 2013, Dec. 12. (8) PLoS One 8(10): e79342.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Officials from Shoreham Village, Suffolk County and utility companies look at plans for the North Shore Rail Trail, which will stretch from Wading River to Mount Sinai. Photo from Anker’s office

Work is picking up once again on the North Shore Rail Trail project, also known as Rails to Trails. Plans are for a 10-mile bike and walking path along LIPA-owned right of ways from Wading River to Mount Sinai.

Workers have done grading and the subbase for the North Shore Rail Trail. Plans are to pour asphalt starting from Mount Sinai. Photo by Kyle Barr

Suffolk County Legislator Sarah Anker (D-Mount Sinai) said Medford-based DF Stone Contracting, which was tapped for the Rail Trail project, has finished grading and creating the subbase layer on the path from Crystal Brook Hollow Road in Mount Sinai to Sound Beach Boulevard in Miller Place. Workers are still laying the subbase layer heading further east.

Though there was a period during the pandemic when work stopped for about a month in order to create a safety plan for the project, the company should be ready to start laying down asphalt some time in October. That part of the project will run from Crystal Brook Hollow Road up to Sound Beach Boulevard and should be finished by the end of the year, the legislator said. 

Though the project may have to break for the winter, the hope is to have the entire path open to the public by summer of fall 2021.

“It’s literally moving along,” Anker said.

The $8.82 million trail is being funded through federal and state grants, along with Suffolk County funds. Despite major financial difficulties that Suffolk County faces due to COVID-19 and the subsequent business shutdowns, Anker said the funding for the trail is definitively set. 

If anything, she said the ongoing pandemic has made even more of a case for the trail.

“The pandemic has made people understand how important it is to have outdoor recreational locations,” she said.

This week Anker and officials from the Village of Shoreham, including Mayor Brian Vail, former mayor Ed Weiss met with officials from Verizon, Altice and PSEG Long Island to discuss the trails path. Plans are to go across the old stone bridge that arches across Woodville Road. To make the path accessible, workers would need to run the electrical lines under the bridge instead of over it. The bridge would also need new guardrails and fencing, particularly fencing that curves inward so people on the bridge can’t throw items over and onto cars passing underneath.

There are some more spots along the trail that present challenges. One is a power substation at the corner of Apricot Road and King Road in Rocky Point, where Anker said the path will need to snake around the substation rather than through it. Another is along Echo Avenue in Sound Beach, a relatively highly trafficked road where the path would need to cross. The legislator said she and the county Department of Public Works would need to work with the New York State Department of Transportation in order to make such a place safe to cross.

This article has been amended to correct the ownership of the right-of-ways on the North Shore as well as how far workers have added the subbase layer on the trail.

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Walking helps strengthen your joints, bones and muscles. METRO photo
Walking’s benefits extend beyond physical fitness

By David Dunaief, M.D.

Dr. David Dunaief

There is great emphasis on exercise in medicine and in society. We have heard it is good for us ever since we were children in gym class striving for the presidential fitness award.

The average reaction, unfortunately, is an aversion to exercise. As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” The result of this is a nation of couch potatoes. I once heard that the couch is the worst deep-fried food. It perpetuates inactivity, especially when watching TV. Even sleeping burns more calories.

I think part of the problem, generally, is that we don’t know what type of exercise is best and how long and frequently to do it. These days, for many who depend on gyms, dance studios and other exercise-related facilities for exercise are struggling to find meaningful substitutes.

Well, guess what? There is an easy way to get tremendous benefit with very little time involved. You don’t need expensive equipment, and you don’t have to join a gym. You can sharpen your wits with your feet.

Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away.

Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Those participants who had an increase in brain tissue volume had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier?

In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

This is a terrific strategy to get you off the couch or away from your computer, another hazard for many of us working or schooling from home. Set an alarm for specific points throughout the day and use that as a prompt to get up and walk, even if only for 15 minutes. The miles will add up quickly.

In addition to the mental acuity benefits, this may also help with your psychological health, giving you a mental break from endless Zoom calls and your eyes a break from endless screens.

If you ratchet up the exercise to running, a study showed that mood also improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. The movie “WALL-E” even did a spoof on this, projecting a future where people lived in their movable recliners. The result was a human skeletal structure that had receded over the generations from lack of use. Although it was tongue-in-cheek, it wasn’t too far from the truth; if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

So, remember, use your feet to keep your mind sharp. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References:

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Being active is the magic pill for a healthy life. Stock photo
Inactivity may increase mortality and disease risk

By David Dunaief, M.D.

Dr. David Dunaief

With the advent of summer weather, with its heat and humidity, who wants to think about exercise? Instead, it’s tempting to lounge by the pool or even inside with air conditioning.

First, let me delineate between exercise and inactivity; they are not complete opposites. When we consider exercise, studies tend to focus on moderate to intense activity. However, light activity and being sedentary, or inactive, tend to get clumped together. But there are differences between light activity and inactivity.

Light activity may involve cooking, writing and strolling (1). Inactivity involves sitting, as in watching TV or in front of a computer screen. Inactivity utilizes between 1 and 1.5 metabolic equivalent units — better known as METS — a way of measuring energy. Light activity, however, requires greater than 1.5 METS. Thus, in order to avoid inactivity, we don’t have to exercise in the dreaded heat. We need to increase our movement.

What are the potential costs of inactivity? According to the World Health Organization, over 3 million people die annually from inactivity. This ranks inactivity in the top five of potential underlying mortality causes (2).

How much time do we spend inactive? In an observational study of over 7,000 women with a mean age of 71 years old, 9.7 waking hours were spent inactive or sedentary. These women wore an accelerometer to measure movements. Interestingly, as body mass index and age increased, the amount of time spent sedentary also increased (3).

Inactivity may increase the risk of mortality and plays a role in increasing risks for diseases such as heart disease, diabetes and fibromyalgia. It can also increase the risk of disability in older adults.

Surprisingly, inactivity may be worse for us than smoking and obesity. For example, there can be a doubling of the risk for diabetes in those who sit for long periods of time, compared to those who sit the least (4).

Let’s look at the evidence.

Does exercise overcome inactivity?

We tend to think that exercise trumps all; if you exercise, you can eat what you want and, by definition, you’re not sedentary. Right? Not exactly. Diet is important, and you can still be sedentary, even if you exercise. In a meta-analysis — a group of 47 studies — results show that there is an increased risk of all-cause mortality with inactivity, even in those who exercised (5). In other words, even if you exercise, you can’t sit for the rest of the day. The risk for all-cause mortality was 24 percent overall.

However, those who exercised saw a blunted effect with all-cause mortality, making it significantly lower than those who were inactive and did very little exercise: 16 percent versus 46 percent increased risk of all-cause mortality. So, it isn’t that exercise is not important, it just may not be enough to reduce the risk of all-cause mortality if you are inactive for a significant part of the rest of the day.

Worse than obesity?

Obesity is a massive problem in this country; it has been declared a disease, itself, and it also contributes to other chronic diseases. But would you believe that inactivity has more of an impact than even obesity? In an observational study, using data from the EPIC trial, inactivity might be responsible for two times as many premature deaths as obesity (6). This was a study involving 330,000 men and women.

Interestingly, the researchers created an index that combined occupational activity with recreational activity. They found that the greatest reduction in premature deaths (in the range of 16 to 30 percent) was between two groups, the normal weight and moderately inactive group versus the normal weight and completely inactive group. The latter was defined as those having a desk job with no additional physical activity. To go from the completely inactive to moderately inactive, all it took, according to the study, was 20 minutes of brisk walking on a daily basis.

So what have we learned about inactivity? If you are inactive, increasing your activity to be moderately inactive by briskly walking for 20 minutes a day may reduce your risk of premature death significantly. Even if you exercise the recommended 150 minutes a week, but are inactive the rest of the day, you may still be at risk for cardiovascular disease. You can potentially further reduce your risk of cardiovascular disease by increasing your activity with small additions throughout the day.

The underlying message is that we need to consciously move throughout the day, whether at work with a walk during lunch or at home with recreational activity. Those with desk jobs need to be most attuned to opportunities to increase activity. Simply setting a timer and standing or walking every 30 to 45 minutes may increase your activity levels and possibly reduce your risk.

References:

(1) Exerc Sport Sci Rev. 2008;36(4):173-178. (2) WHO report: https://bit.ly/1z7TBAF. (3) JAMA. 2013;310(23):2562-2563. (4) Diabetologia 2012; 55:2895-2905. (5) Ann Intern Med. 2015;162:123-132, 146-147. (6) Am J Clin Nutr. online Jan. 24, 2015.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.   

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Norhtport village residents packed the Jan. 29 public hearing regarding The Northport Hotel. Photo by David Luces

By David Luces

Northport residents came out in support of the business a local hotel could bring but raised concerns about the traffic that may come with it.  

Northport village held a hearing Jan. 29 on business owners Kevin O’Neill and Richard Dolce’s, of the John W. Engeman Theater,  proposal to construct a hotel-restaurant, The Northport Hotel, at 225 Main St. The much-anticipated project drew a large crowd to the American Legion Hall, which was packed to standing room only. 

Christopher Modelewski, an attorney representing O’Neill and Dolce, presented an updated site rendering of the hotel at the village public hearing Jan. 29. The rendering included changes they made to the site as a result of concerns raised by the planning board and area professionals. 

Study:  Northport has parking spots, if you walk

Northport residents voiced their concerns about a lack of parking along Main Street at a Jan. 29 public hearing on a proposed hotel and restaurant. Yet, a study released in December 2018 determined there are plenty of spots if people are willing to walk.

The Village of Northport hired Old Bethpage-based Level G Associates LLC to perform a paid parking study of Northport. Their survey, which took place from August to October 2018, concluded the village’s 615 parking spaces are sufficient, with a slight exception of summer evenings.

Northport’s central business district has a total 195 metered slots and 420 free spaces between Main Street and its side municipal lots, according to the study.  Nearly half of these spots are divided between streetside metered parking on Main Street, and the two free lots adjacent to the village’s waterfront parks.

On a typical weekday, from 10 a.m. to 2 p.m., Level G Associates found 60 percent of Main Street metered spots were taken and Main Street lots were full as well. However, the study cited roughly 100 available spaces in the waterside lots and Lot 7, located off Woodside Avenue by the American Legion hall.

“These are normal/healthy parking patterns for an active [central business district],” the report reads.

On Friday and Saturday evenings, Level G Associates found most metered parking spots and lots on Main Street were full. However, the study found “ample available parking” in the free waterside and Woodside Avenue lots that “are within reasonable walking distance for downtown employees or visitors.”

The only time traffic experts found an issue with the village’s parking was on summer nights, from 5 to 9 p.m. The study found the village’s parking is 95 percent full, often due to concerts and special event attendance, and could be improved through the addition of 72 spaces.

Tom Kehoe, deputy mayor of Northport, said the village board is being proactive in trying to address parking demands and congestion concerns.

“The evaluation provided us with some suggestions that we may consider,” he said.

Some suggestions include re-striping of  waterfront municipal lots could add 30 spaces, expanding the free lot by the American Legion to add 35 spots and development of a parking management plan. Other ideas given by Level G Associates are just not feasible, according to Kehoe such as leasing the parking lot used by the St. Philip Neri Church and Parish Center on Prospect Avenue.

Kehoe also said he has suggested moving the village’s Highway Department out of the Woodside Avenue lot to provide more spaces.

“It is a public safety issue,” the deputy mayor said. “You have the theater close by, snow plows are in there — that lot can get very busy.”

Kehoe said Northport residents are fortunate to live in a place where people want to visit and spend money, but in turn that causes more of a demand for parking. The village’s town board plans to continue the process of making these changes between now and the upcoming summer.

When the building plans were first presented to the village’s planning board in May 2017, O’Neill sought to construct a 24-room hotel and a 200-seat restaurant. Recent changes have  reduced the size of the restaurant to 124 seats with an additional 50 seats in the lobby and
bar area. 

Despite these changes, Northport residents continued to express concern about accessibility and how it could exacerbate parking issues in the village.

Tom Mele, of Northport, said he is for the creation of the hotel but argues it is off base to think that there isn’t an accessibility and parking problem in the village.

“If you [O’Neill] love this town as much as you say you do, you would find a way to work with the village board,” Mele said. “Work with them to decrease the traffic on Main Street and if that means downsizing the venue downstairs to accommodate the people, I don’t think it’s too much to ask for.”

Northport property owner Frank Cavagnaro expressed similar sentiments saying that the planning board shouldn’t accept the site plans as is. He viewed the parking issue as his main concern.

“You’re gonna come in and try to stuff five pounds of bologna in a 1-pound bag — it’s not going to fit,” Cavagnaro said. “Parking in the village is terrible, it’s going to kill the village.”

The  Village of Northport commissioned a parking study by Old Bethpage-based Level G Associates, released in December 2018, that found that during a typical weekday the downtown area “exhibited normal and healthy parking patterns.” While approximately 60 percent of Main Street metered spots were taken and the free Main Street lots were full, the study found 100 free spaces available during peak times in the in the municipal lots. 

Still, Cavagnaro presented a possible compromise to the village board. 

“Consider a smaller restaurant, to get him started with the option if we find more parking, for him [O’Neill] to come back to the board,” Cavagnaro said. 

Modelewski also cited a traffic impact study performed by Walter Dunn, a professional engineer and founder of Dunn Engineering Associates, and Tom Mazzola, former traffic and safety director for the Town of Huntington. The study found that the hotel would have a benign impact on the traffic in the area.  

O’Neill said under the proposed plans there would be no parking on Woodside Avenue and no right turn out of the two parking lots so traffic does not go into residential areas. 

“We will have the ability to take, between the theater and the hotel-restaurant operation,  roughly 150 cars off [the] street,” O’Neill said. “The village has 609 [parking] spots, for anybody in the industry that’s a seismic shift in the dynamics in how much parking is being provided.”

Residents were also concerned about the possibility of delivery trucks unloading on Main Street, which is not permitted under Northport village law according to Modelewski. 

“Tractor trailers and box cars double park behind cars — that’s unlawful,” the hotel’s attorney said. “There’s a reason why the law isn’t being enforced — it’s because it’s the only way businesses can function.”

Modelewski said O’Neill will work with the suppliers to use only box cars. 

Northport resident Alex Edwards-Bourdrez said the proposed hotel would fit the town beautifully. 

“I understand that there can be all these of glitches [in the process] but I would ask for all of us to rise up together in support of this,” Edwards-Bourdrez said. “We have all the brains in here to put the pieces together in a way that they won’t fall apart, it won’t choke the village — I don’t believe it will.”

Edwards-Bourdrez also touched on the issue of parking. 

“Nobody that goes into New York City or a bigger town worries about walking 5 to 10 minutes to where they are going,” he said. “There is parking, you just sometimes can’t park right next to where you want to go. We have to make these concessions for us to grow as a village.” 

The village’s parking study found that on a typical weekend, defined as Friday and Saturday evenings, there is ample available parking “within reasonable walking distance for downtown employees or visitors.”

Lenny Olijnyk, of Northport, said everybody was against the theater until O’Neill took over and renovated it in 2007. He argued that the hotel would increase the village’s commercial tax base. 

“Maybe we can clean up the streets a little bit, the sidewalks will get fixed,” Olijnyk said. “You have to think about that. The village wants to grow, my grandkids are going to live here. There has to be revenue for the village.”

O’Neill felt strongly in order for his theater business and others to strive they must work together in a positive way. 

“It’s just not sitting up here trying to make money, there’s more to it,” he said. “I don’t believe in sucking the community dry where we do business.” 

 

 

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