Johns Hopkins researchers present new healthcare tips from American Heart Association Meeting

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Personalized Text Messages Can Boost Physical Activity

Linking digital activity trackers to smartphones and periodically pinging users with personalized texts that urge them to walk more can significantly increase physical activity levels and spark healthy behavior changes, according to findings of a pilot study conducted at Johns Hopkins.

The findings, presented Nov. 9 at the annual American Heart Association meeting, are also published simultaneously in the Journal of the American Heart Association.

The idea that tracking physical activity can motivate people to get more of it is hardly novel, researchers say, but their study disputes the notion that awareness alone is enough to get or keep people moving.

Instead, they report, personalized text messages that encourage people to go just a bit farther or congratulate them for having done so make the real difference. Indeed, in their study of 48 individuals, those receiving text nudges were twice as likely to walk farther and reach a preset goal of 10,000 steps daily.

“Think of these messages as digital check-ins from your physician, gently but persistently reminding you to fit more exercise into your day,” says lead investigator Seth Martin, M.D., M.H.S., a preventive cardiologist and assistant professor of medicine at the Johns Hopkins University School of Medicine. “The strategy appears to work.”

Researchers caution that the study followed people only for a few short weeks, so it remains unclear whether the observed change in activity levels will persist over time. To answer that question, investigators are conducting a long-term follow-up of participants involved in the original trial.

The trial involved 48 men and women, ages 18 to 69, followed over a month at the preventive cardiology clinic at Johns Hopkins, all of whom reported low levels of physical activity to their physicians. Using a relatively cheap activity tracker, researchers measured participants’ normal, or baseline, daily physical activity levels during week one. During the following two weeks, a third of the participants — the control group — had their activity levels tracked but could not view data showing how much they moved. The remaining two-thirds of participants could freely view their daily activity levels, including total step count and aerobic activity levels on their smartphones.

Subdividing the latter group further, half of participants also received automated but personalized text messages bearing the names of their cardiologists three times a day. The other half received no such messages but could assess their daily report if they wanted to.

The messages detailed a patient’s current activity “balance,” with the number of steps taken and number needed to reach the 10,000-steps-a-day goal. The timing of texts was also customized to each patient’s wake, lunch and dinner time.

People who were on track to reach or surpass the 10,000-step mark received congratulatory messages such as “Jon, you are on track to have a VERY ACTIVE day! Outstanding! We might as well call you LeBron James!”

Those who remained well below received encouraging or booster messages such as “Jane, giving someone a call tonight? Consider walking while you talk. Your exercise prescription for tonight is 3,878 steps.”

Those who received text messages took, on average, 2,534 more steps per day, compared with people who didn’t get texts nudging them to move more and an average 3,376 more than patients in the control group. Overall, 81 percent of those in the text-message group reached their 10,000-steps-a-day goal, compared with 44 percent of people in the other two groups.

People in the text-message group increased their total activity time by 21 minutes a day, on average, and aerobic time by 13 minutes on average, compared with the other two groups.

“Our results suggest that harnessing smart technology into clinical efforts could catalyze behavioral changes that have the potential to reduce disease risk and shape health,” says senior study investigator Michael Blaha, M.D., M.P.H. “If sustained long term, the clinical impact of such changes could be rather dramatic.”

Clinicians and public health experts recommend that people should get a minimum of 30 minutes of physical activity a day at least three times a week to minimize their risk of cardiovascular disease. More than half of Americans falls short of these recommendations.

The work was supported by the PJ Schafer Cardiovascular Research Fund and by the National Institutes of Health grant T32HL07024.

Vitamin D Deficiency Linked to Erectile Dysfunction

Vitamin D deficiency has recently emerged as a risk factor in conditions ranging from diabetes to hypertension and heart disease. Now the findings of a study by Johns Hopkins researchers suggest low levels of the “sunshine” vitamin may also fuel erectile dysfunction (ED).

The results, scheduled for presentation Nov. 10 at the annual meeting of the American Heart Association in Orlando, Fla., revealed greater prevalence of impotence among men with vitamin D deficiency.

The investigators caution that their findings are observational and that further research is needed to determine whether, in fact, low vitamin D levels can cause or directly contribute to ED. However, they note that if their results are affirmed in subsequent studies, vitamin D deficiency may become a clinical marker and a possible therapeutic target for ED.

“Vitamin D deficiency is easy to screen for and simple to correct with lifestyle changes that include exercise, dietary changes, vitamin supplementation and modest sunlight exposure,” says lead investigator Erin Michos, M.D. M.H.S., a preventive cardiologist and associate professor of medicine at the Johns Hopkins University School of Medicine.

“Checking vitamin D levels may turn out to be a useful tool to gauge ED risk,” Michos adds. “The most relevant clinical question then becomes whether correcting the deficiency could reduce risk and help restore erectile function.”

Both ED and vitamin D deficiency are individual markers of heightened cardiovascular risk so researchers say the new findings underscore the systemwide effects that vitamin D has on vascular function throughout the body, including vessels that feed cardiac and genital tissues.

The findings are based on analysis of records of more than 3,400 men ages 20 and older participating in a national Health and Nutrition Examination Survey between 2001 and 2004. None of them had overt heart disease, 30 percent were vitamin D deficient and 16 percent reported symptoms of erectile dysfunction. Vitamin D deficiency, defined as vitamin D levels below 20 nanograms per milliliter of blood, was present in 35 percent of men with ED, compared with 29 percent without ED.

Vitamin D deficient men were 32 percent more likely to have ED than men with adequate vitamin D levels, even after investigators accounted for other factors commonly known to lead to impotence, including certain medications, alcohol use, smoking, diabetes, inflammation and high blood pressure.

ED — defined as the inability to achieve or maintain erection for satisfactory sexual intercourse — affects about 40 percent of men older than 40 and 70 percent of those over 70, researchers say. Vitamin D deficiency affects as many as 40 percent of adult Americans, according to the Centers for Disease Control and Prevention.

Risk factors for vitamin D deficiency include being obese or overweight, limited outdoor activity, having darker skin and suffering from certain from inflammatory conditions, such as diabetes and inflammatory bowel disease. The Institute of Medicine recommends cumulative daily vitamin D intake of 600 international units for adults between 18 and 70 years of age, and 800 international units for those over 80.

Vitamin D supplementation is typically reserved only for those with documented deficiency, defined as blood levels below 20 ng/ml.

Other investigators involved in the research included Youssef Farag, Eliseo Guallar, Di Zhao, Rita Kalyani, Seth Martin and Kevin Billups of Johns Hopkins and Pamela Lutsey of the University of Minnesota.

Study Suggests Starting Exercise Later in Life Reduces Heart Failure Risk

Even modest increases in activity offered some protection

The heart-protective benefits of regular, long-term exercise are well known: Those who engage in physical activity repeatedly and regularly over the years slash their risk of atherosclerotic heart disease and heart failure.

But a new study led by researchers at Johns Hopkins shows that even reformed couch potatoes who get moving later in life can also reduce their risk of heart failure. Those who added modest amounts of exercise but did not reach recommended levels also reaped some, albeit smaller, benefits.

“Our findings suggest that when it comes to exercise and heart failure, the better-later-than-never axiom rings particularly true, and that even small boosts in activity can cut risk,” says senior investigator Chiadi Ndumele, M.D., M.H.S., a preventive cardiologist and assistant professor of medicine at the Johns Hopkins University School of Medicine.

In their presentation of the results on Nov. 8 at the annual meeting of the American Heart Association in Orlando, Fla., the researchers made it clear that those who met or exceeded current recommendations for physical activity had the lowest risk of heart failure. But those who shifted from sedentary to a more active lifestyle also reduced their risk. So did those who added some exercise to their weekly routines but did not quite get the recommended 150 minutes of moderate or 75 minutes of vigorous exercise per week put forth by the American Heart Association and the American College of Cardiology.

For the study, researchers analyzed exercise routines of some 11,000 men and women, between the ages of 45 and 64, followed over 20years as part of the Atherosclerosis Risk in Communities (ARIC) study, a federally funded, ongoing long-term project designed to track risk factors for heart disease among Americans as they age. Participants’ activity levels were assessed on two consecutive visits over six years. Although none of the study participants had overt heart disease at the initiation of the study, some developed heart failure over time.

People who met or exceeded exercise recommendations at both visits were, overall, 33 percent less likely to develop heart failure than chronically sedentary people. Those who consistently got modest exercise — defined as fewer than 149 minutes of moderate or fewer than 74 minutes of vigorous physical activity a week had a 20 percent lower risk of heart failure. However, sedentary people who increased their exercise to recommended levels at some point during the study, reduced their risk by 22 percent. Those who were sedentary at the beginning of the study, clocking in zero minutes of exercise a week, but subsequently increased their activity to about 30 minutes of walking four times a week decreased their heart failure risk by 12 percent.

“Many people get discouraged if they don’t have the time or ability to exercise vigorously, but our findings demonstrate that every little bit of movement matters and that picking up exercise later in life is decidedly better than not moving at all,” says first author Roberta Florido, M.D., a cardiology fellow at the Johns Hopkins University School of Medicine.

Heart failure, estimated to affect some 5 million Americans and 23 million people worldwide, is a condition marked by the progressive stiffening, weakening or enlargement of the heart muscle and its gradual loss of blood-pumping ability.

Co-investigators on the research included Lucia Kwak, Mariana Lazo-Elizondo, Vijay Nambi, Haitham Ahmed, Sheila Hegde, Gary Gerstenblith, Roger Blumenthal, Christie Ballantyne, Elizabeth Selvin, Aaron Folsom and Josef Coresh.

No Evidence of Statin Harm to Memory Among Acute Coronary Syndrome Patient.

A Johns Hopkins-led study of people treated with statins for acute coronary syndrome has found no evidence of harm to memory and cognition from the drugs’ short-term use.

The results, presented Nov. 8 at the American Heart Association meeting, are based on analysis of outcomes among more than 1,500 men and women, between ages 50 to 72, treated for acute coronary syndrome (ACS), a condition that encompasses several types of heart attack. Most of the patients (92 percent) were prescribed statins or other cholesterol-lowering medications at discharge, and followed for one year after they left the hospital.

To gauge the effects of statins on learning and memory, investigators measured cognitive function among patients receiving statins and those who did not. Mild cognitive impairment is common among people with heart disease due to compromised blood and oxygen supply to the brain, researchers say, and the condition is often exacerbated during a heart attack.

During four consecutive telephone calls at one, three, six and 12 months following hospital discharge, participants answered a series of questions designed to assess their cognitive performance and reported any symptoms suggestive of failing memory.

Overall, the researchers say they found similar gains in cognitive performance following the acute coronary episodes in patients receiving cholesterol-lowering therapy and in those receiving none. For example, at one month, patients receiving statins experienced cognitive gains of 1 point on a scale of 0 to 41, compared to 1.6 among those not receiving treatment — a statistically insignificant difference, the researchers say. In other words, the team says, cognitive scores improved at about the same rate whether they took statins or not.

“Our results cast further doubt on the notion that statins interfere with memory and should provide some reassuring news to ACS patients who take these medications and to the clinicians who treat them,” says study first author Brett Wanamaker, M.D., an internal medicine resident at the Johns Hopkins University School of Medicine.

The researchers caution that their study only followed patients for one year and longer follow-up studies are needed to conclusively assess the long-term effects of statin use on memory.

Statins are well known to cause muscle pain and damage in some people, and have also been linked to a small increase in the risk for type 2 diabetes. But the idea that they can also harm memory has recently come under serious doubt by scientists who say observations of the memory loss in statin-takers are more likely because people who start any new drugs are more alert to — and aware of — coincidental changes in cognition.

“Our observations fall in line with a number of other studies that have failed to find a link between statins and memory loss,” says senior investigator Seth Martin, M.D., M.H.S., a preventive cardiologist and assistant professor of medicine at the Johns Hopkins University School of Medicine.

Roger Blumenthal of Johns Hopkins was co-investigator on the study. Other participating institutions included Vanderbilt University and the University of Massachusetts.



The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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