Every year, over two thirds of U.S. current smokers express a desire to permanently quit. Yet despite this broad desire, only about 40% actually try to quit in any given year and of this 40% who attempt to quit less than 10% are ultimately successful in abstaining from cigarettes for more than six months even with the most effective of treatment options. In fact according to research findings it takes the average smoker up to ten attempts to finally kick the habit permanently.
People who attempt to quit on their own without any medical assistance are the least successful with low single digit success rates. Those who combine long-term counseling with nicotine replacement therapy tend to be the most successful with between 8-17% success rates although some of these reported success rates seem dubious because many rely primarily on self-reported abstinence confirmation versus chemical verification.
Pharmaceutical companies pour many millions of dollars into research each year to find new drugs to boost success rates but so far no major breakthrough. Alarmingly though, a number of the newer pharmaceuticals prescribed by doctors for smoking cessation (anti-depressants) have received Food and Drug Administration warnings for some pretty scary side effects. Meanwhile many other companies tout all manner of other products or services to aid in boosting cessation rates ranging from hypnosis to acupuncture to electronic cigarettes (but with little success in moving the needle).
It is a reminder of how addictive nicotine can be and of how challenging it can be to eliminate a long-term habit.
So what’s a smoker to do?
Well, a simple answer that might just double your odds of success and produce positive side effects versus negative ones is…exercise. Seems hard to believe doesn’t it? Not much research has been done on combining exercise with smoking cessation but the research that has been done has shown some promise. Why is exercise a possible valuable addition to a smoking cessation program? According to the exercise researchers, exercise has been shown in other research to improve mood, assist in weight loss and reduce cravings – all three big-time cigarette smoking withdrawal symptoms.
As a case in point, a new study was published online ahead of print last month in the journal Nicotine & Tobacco Research that demonstrated that study subjects undergoing a 12-week resistance training program (weight lifting) boosted abstinence at 3-month and 6-month follow-up checkpoints by 100% over study subjects who did not exercise during the study. Both the control and resistance training groups received one 15-20 minute smoking cessation counseling session and both groups received nicotine patches during the study period so the only differentiating variable between the two groups was the resistance training program. The absolute abstinence success rate for the resistance training group was 15-16% at both the 3-month and 6-month follow-up checkpoints compared to 8% at both time intervals for the control group. These abstinence results were determined by both self-reported questionnaires and by chemical analysis of each subject’s carbon monoxide levels. [1]
The 12-week resistance training program followed by the exercise group was described the researchers as follows, “Participants engaged in two 60-min RT sessions/week for 12 weeks. The full-body routine (ACSM, 2009b), involved 10 exercises, with set intensity and volume adjusted every 3 weeks. For the first 3 weeks, participants completed one set (10 repetitions) of each exercise at 65%–75% of their estimat¬ed maximal strength. From weeks 4–12, participants complet¬ed two sets per exercise. Weight was systematically increased by a researcher to match gains in strength and maintain inten¬sity at weeks 7–10. Researchers monitored exercise for safety, interactions were minimized, and smoking was not discussed. Participants exercised alone and could attend up to three ses¬sions/week to make up for one missed session in the prior week, with no more than one session/day. All were asked not to engage in RT beyond the supervised sessions or change their other exercise.”
To be fair, the study population was small (25 total subjects) and only 50% of the subjects participated all the way through to the 6-month follow-up checkpoint. So one might argue the success rates of both approaches were actually lower if all subjects were tracked the full way through. That said, those engaged in a resistance training program who did make it all the way through this novel study (novel because it examined resistance training versus aerobic training in conjunction with smoking cessation) did achieve higher abstinence, greater weight loss and lower body fat measurements than the control group.
Other studies probing the addition of an exercise component to a smoking cessation program have also shown promise. In one such 2010 study, researchers found 34% of women participating in the study who participated in a 150 minute per week moderate intensity aerobic exercise program achieved chemically verified abstinence at 6-month follow-up compared to 20% for the control group. In this study, both groups also received one smoking cessation counseling session and nicotine patches for the duration of the study. [2]
In yet another 2010 study examining the effect of either high-intensity (running) or moderate intensity (walking) aerobic exercise on craving to smoke, researchers reported, “Significant group x time interactions were identified, demonstrating significant reductions in craving items after the walking and running conditions compared with the passive control. No significant differences in craving reductions were found between walking and running conditions. Post hoc comparisons found that running condition cravings to smoke scores were reduced for a longer duration post-treatment than post-walking condition scores. The decline in cortisol concentration was attenuated in the running group only. Vigorous exercise has a similar effect to moderate exercise in terms of the magnitude of craving reduction. However, performing bouts of moderate-intensity exercise may be a better recommendation for reducing cravings.” [3]
It therefore seems that adding an exercise program (resistance training and/or aerobic training) to a smoking cessation attempt is worthy of your consideration. Not only might exercise improve your odds of kicking the habit permanently, it has also been shown to notably improve heart rate variability (a risk factor in cardiovascular disease), reduce the risk of lung cancer, and reduce chronic shortness of breath – even among smokers who continue to light up!
For smokers interested in experimenting with an exercise program but who aren’t sure where to start or what specific exercises to do, we have three suggestions for your consideration. First, consider asking your doctor to recommend a specific exercise program. Alternatively, consider visiting a local fitness center and ask to speak to a certified fitness instructor. Associations such as the American College of Sports Medicine create recommended exercise protocols for different health conditions and a fitness instructor should be able to help construct one appropriate for you. They will likely charge for their services but most provide an initial consultation free of charge.
If neither of those options appeals to you, I created the Breathe Better for Life guidebook and companion CD-ROM to assist people with poor respiratory health (smokers and people with lung disease) access the principles and practices of the respiratory medical treatment pulmonary rehabilitation. This treatment option combines aerobic exercise, resistance training, breathing technique training, airway clearing technique training and guidance on other respiratory related topics.
In the Breathe Better for Life guide/CD, I developed an exercise program based on guidelines established by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine to assist people with poor respiratory health start and maintain an aerobic and resistance training program if they cannot access such a program elsewhere. The CD provides narrated, pictorial step-by-step instructions for the specific resistance training exercises in addition to many other valuable education elements geared to help improve one’s ability to breathe. Click here to learn more about Breathe Better for Life.
Regardless of what exercise program you choose, it is always advisable to review the program prior to starting with your physician to ensure it is appropriate for your particular health status.
[1] Ciccolo JT, et al. Resistance Training as an Aid to Standard Smoking Cessation Treatment: A Pilot Study. Nicotine & Tobacco Research. April 18, 2011 [Epub ahead of print].
[2] Williams DM, et al. Moderate intensity exercise as an adjunct to standard smoking cessation treatment for women: a pilot study. Psychol Addict Behav. 2010 June:; 24(2): 349-354.
[3] Scerbo F, et al. Effects of exercise on cravings to smoke: the role of exercise intensity and cortisol. J Sports Sci. 2010 Jan;28(1):11-9.
Wednesday, May 18, 2011
Friday, May 6, 2011
Antioxidants for oxidative stress in COPD patients revisited
Regular readers of our Breathe Better for Life e-letters and Breathe Better Blog are well aware we are strong advocates of antioxidants for people with chronic shortness of breath. Our perspective - we view antioxidants as an excellent addition to a regular exercise program, a Mediterranean-style diet and smoking cessation to reduce inflammation and oxidative stress.
We do not believe that antioxidants will cure, reverse lung disease or improve lung function. However, there is substantial and growing evidence that oxidative stress (an imbalance in damaging pro-oxidant molecules known as free radicals and protective anti-oxidant molecules) is a key contributing factor to the sensation of breathlessness and that most COPD patients are significantly deficient in antioxidants compared to those without persistent shortness of breath.
We are not alone in this belief as a new research paper echoes many of our sentiments. This research review article, published in the journal Current Drug Targets, examines the role of oxidative stress in COPD and the potential of antioxidants as a supportive therapy. In fairness to the review authors, they acknowledge that while antioxidant therapy seems a key area for further exploration there are conflicting study results on the effectiveness of antioxidants for COPD patients. Further, they acknowledge there are few definitive guidelines regarding the optimum human daily dosages for the most promising antioxidants. [1]
Still we’re concerned that it will be decades before enough researchers and practitioners determine these criteria to their own satisfaction. Meanwhile, millions of COPD patients will not learn of the potential benefits that have already been reported in peer reviewed published research for over the past decade.
So, we thought it would be helpful to share some snippets of this research review paper so that readers have access to the emerging potential of antioxidants as a supporting therapy to other traditional COPD treatments.
First, some observations about oxidative stress and COPD offered in the paper’s introduction, “The lung is the organ with the highest exposure to ambient air in the entire human architecture. Due to its large surface area and blood supply, the lung is susceptible to oxidative injury in the form of myriads of reactive oxygen species (ROS) and free radicals. ROS may be produced endogenously by metabolic reactions or have exogenous origins, such as air pollutants or cigarette smoke. Airborne pollutants may result in direct lung damage as well as in activation of inflammatory responses in the lungs. Tobacco smoke is a mixture of over 4700 chemical compounds, including high concentrations of oxidants. Inflammatory cells recruited in airspaces become activated and generate ROS in response to appropriate stimuli.”
“Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease which is characterized by an abnormal inflammatory response of the lungs to external stimuli, the most common being tobacco smoke. This abnormal inflammatory response is attributed to many underlying pathophysiologic mechanisms and one of the most important is the imbalance of oxidative stress and antioxidant defenses.”
For a layman’s understanding of the above process, we recommend readers check out our War of the Worlds in Your Lungs article.
Regarding antioxidants, the review authors explain, “In order to provide defense against the oxidative burden, the lungs produce various endogenous agents called antioxidants. The antioxidant species help the lungs ward off the deleterious consequences of a wide variety of oxidants/reactive oxygen species and reactive nitrogen species, either of endogenous or environmental origin. The major nonenzymatic antioxidants of the lungs are glutathione, vitamins C and E, beta-carotene, uric acid, whereas the major enzymatic antioxidants are superoxide dismutases, catalases and peroxidases. These antioxidants are the first lines of defense against oxidants and usually act at a gross level.”
As a side note, the most powerful of these antioxidants is glutathione. That said the human body does not absorb glutathione well when administered directly. Our bodies are much better at producing our own glutathione when we are provided precursors of the antioxidant. The most effective precursor in assisting the body’s production of glutathione is N-Acetyl Cysteine (NAC).
“Oxidative stress is intimately associated with the progression and the development of exacerbations in COPD. A rational approach for the treatment of COPD would therefore be to consider antioxidant intervention not only aiming to neutralize the increased oxidative stress and the subsequent inflammatory response, but also in an attempt to identify the source of oxidants and overwhelm their generation. This can be achieved through two approaches, either by increasing the endogenous antioxidant enzyme defences or by enhancing the non-enzymatic defences through dietary or pharmacological means. To date, however, most clinical trials of antioxidants for COPD have yielded conflicting or disappointing results.”
Despite these conflicting and disappointing results, however, the study authors conclude, “There is now solid evidence for the role of oxidative stress in the development and evolution of COPD. Several biomarkers of oxidative stress have been evaluated by invasive and non-invasive means in patients with COPD. However, further standardization of methods is imperative for the application of such biomarkers in clinical practice. An effective wide-spectrum antioxidant therapy with bioavailability is urgently needed to control the local and systemic oxidative burst in COPD. In that direction, several antioxidant agents have been evaluated as potential candidates for the management of COPD. However, despite some encouraging results, clinical trials so far have failed to elaborately define the type of antioxidant, the regimen and the time period of treatment that may improve clinically meaningful outcomes in patients with COPD. This may be largely due to the incomplete understanding of the pathophysiology of COPD and the differences within COPD phenotypes. Moreover, some of the antioxidants may not reach the correct cellular/tissue compartment where the oxidative damage is taking place. Well-designed clinical trials investigating the potential role of new antioxidants and combinations of antioxidants with existing anti-inflammatory agents may provide new insights in COPD management."
So the takeaway – not enough evidence yet to satisfy researchers and practitioners regarding efficacy and not enough clear guidance on dosages, but clearly an area that will receive great attention in the future due to the unambiguous connection between shortness of breath, inflammation and oxidative stress.
By the way, the antioxidants with most encouraging study results highlighted by the authors:
• N-Acetyl Cysteine
• Resveratrol
• Curcumin
• Vitamin C
• Vitamin E
• Beta Carotene
Attentive readers will note the above mentioned antioxidants, with the exception of Beta Carotene, are key ingredients of our Resplenish anti-oxidant respiratory support dietary supplement. We’ve further bolstered the formula with other antioxidants that have recently demonstrated promising results in respiratory health studies (including Vitamin D, Quercetin, Coenzyme Q10 and Baicalin). If you are interested to learn more about Resplenish, click here.
Whether our Resplenish supplement is of interest to you or not, we recommend you consider bolstering your daily diet with an antioxidant rich dietary supplement and antioxidant rich foods. While it’s true there is no “gold-standard” when it comes to antioxidant dosages for respiratory health it is also true and undeniable that the primary weapons at the disposal of physicians to combat oxidative stress are the natural agents our bodies already use and/or produce – antioxidants.
[1] Loukides S, et al. Oxidative Stress in Patients with COPD. Current Drug Targets. 2011; 12: 469-477.
We do not believe that antioxidants will cure, reverse lung disease or improve lung function. However, there is substantial and growing evidence that oxidative stress (an imbalance in damaging pro-oxidant molecules known as free radicals and protective anti-oxidant molecules) is a key contributing factor to the sensation of breathlessness and that most COPD patients are significantly deficient in antioxidants compared to those without persistent shortness of breath.
We are not alone in this belief as a new research paper echoes many of our sentiments. This research review article, published in the journal Current Drug Targets, examines the role of oxidative stress in COPD and the potential of antioxidants as a supportive therapy. In fairness to the review authors, they acknowledge that while antioxidant therapy seems a key area for further exploration there are conflicting study results on the effectiveness of antioxidants for COPD patients. Further, they acknowledge there are few definitive guidelines regarding the optimum human daily dosages for the most promising antioxidants. [1]
Still we’re concerned that it will be decades before enough researchers and practitioners determine these criteria to their own satisfaction. Meanwhile, millions of COPD patients will not learn of the potential benefits that have already been reported in peer reviewed published research for over the past decade.
So, we thought it would be helpful to share some snippets of this research review paper so that readers have access to the emerging potential of antioxidants as a supporting therapy to other traditional COPD treatments.
First, some observations about oxidative stress and COPD offered in the paper’s introduction, “The lung is the organ with the highest exposure to ambient air in the entire human architecture. Due to its large surface area and blood supply, the lung is susceptible to oxidative injury in the form of myriads of reactive oxygen species (ROS) and free radicals. ROS may be produced endogenously by metabolic reactions or have exogenous origins, such as air pollutants or cigarette smoke. Airborne pollutants may result in direct lung damage as well as in activation of inflammatory responses in the lungs. Tobacco smoke is a mixture of over 4700 chemical compounds, including high concentrations of oxidants. Inflammatory cells recruited in airspaces become activated and generate ROS in response to appropriate stimuli.”
“Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease which is characterized by an abnormal inflammatory response of the lungs to external stimuli, the most common being tobacco smoke. This abnormal inflammatory response is attributed to many underlying pathophysiologic mechanisms and one of the most important is the imbalance of oxidative stress and antioxidant defenses.”
For a layman’s understanding of the above process, we recommend readers check out our War of the Worlds in Your Lungs article.
Regarding antioxidants, the review authors explain, “In order to provide defense against the oxidative burden, the lungs produce various endogenous agents called antioxidants. The antioxidant species help the lungs ward off the deleterious consequences of a wide variety of oxidants/reactive oxygen species and reactive nitrogen species, either of endogenous or environmental origin. The major nonenzymatic antioxidants of the lungs are glutathione, vitamins C and E, beta-carotene, uric acid, whereas the major enzymatic antioxidants are superoxide dismutases, catalases and peroxidases. These antioxidants are the first lines of defense against oxidants and usually act at a gross level.”
As a side note, the most powerful of these antioxidants is glutathione. That said the human body does not absorb glutathione well when administered directly. Our bodies are much better at producing our own glutathione when we are provided precursors of the antioxidant. The most effective precursor in assisting the body’s production of glutathione is N-Acetyl Cysteine (NAC).
“Oxidative stress is intimately associated with the progression and the development of exacerbations in COPD. A rational approach for the treatment of COPD would therefore be to consider antioxidant intervention not only aiming to neutralize the increased oxidative stress and the subsequent inflammatory response, but also in an attempt to identify the source of oxidants and overwhelm their generation. This can be achieved through two approaches, either by increasing the endogenous antioxidant enzyme defences or by enhancing the non-enzymatic defences through dietary or pharmacological means. To date, however, most clinical trials of antioxidants for COPD have yielded conflicting or disappointing results.”
Despite these conflicting and disappointing results, however, the study authors conclude, “There is now solid evidence for the role of oxidative stress in the development and evolution of COPD. Several biomarkers of oxidative stress have been evaluated by invasive and non-invasive means in patients with COPD. However, further standardization of methods is imperative for the application of such biomarkers in clinical practice. An effective wide-spectrum antioxidant therapy with bioavailability is urgently needed to control the local and systemic oxidative burst in COPD. In that direction, several antioxidant agents have been evaluated as potential candidates for the management of COPD. However, despite some encouraging results, clinical trials so far have failed to elaborately define the type of antioxidant, the regimen and the time period of treatment that may improve clinically meaningful outcomes in patients with COPD. This may be largely due to the incomplete understanding of the pathophysiology of COPD and the differences within COPD phenotypes. Moreover, some of the antioxidants may not reach the correct cellular/tissue compartment where the oxidative damage is taking place. Well-designed clinical trials investigating the potential role of new antioxidants and combinations of antioxidants with existing anti-inflammatory agents may provide new insights in COPD management."
So the takeaway – not enough evidence yet to satisfy researchers and practitioners regarding efficacy and not enough clear guidance on dosages, but clearly an area that will receive great attention in the future due to the unambiguous connection between shortness of breath, inflammation and oxidative stress.
By the way, the antioxidants with most encouraging study results highlighted by the authors:
• N-Acetyl Cysteine
• Resveratrol
• Curcumin
• Vitamin C
• Vitamin E
• Beta Carotene
Attentive readers will note the above mentioned antioxidants, with the exception of Beta Carotene, are key ingredients of our Resplenish anti-oxidant respiratory support dietary supplement. We’ve further bolstered the formula with other antioxidants that have recently demonstrated promising results in respiratory health studies (including Vitamin D, Quercetin, Coenzyme Q10 and Baicalin). If you are interested to learn more about Resplenish, click here.
Whether our Resplenish supplement is of interest to you or not, we recommend you consider bolstering your daily diet with an antioxidant rich dietary supplement and antioxidant rich foods. While it’s true there is no “gold-standard” when it comes to antioxidant dosages for respiratory health it is also true and undeniable that the primary weapons at the disposal of physicians to combat oxidative stress are the natural agents our bodies already use and/or produce – antioxidants.
[1] Loukides S, et al. Oxidative Stress in Patients with COPD. Current Drug Targets. 2011; 12: 469-477.
Tuesday, March 22, 2011
Exercise reduces shortness of breath and improves heart rate variability in COPD patients
When we think of respiratory health we often concentrate our thoughts on the lungs and the act of breathing. However, respiratory health also encompasses the heart and our circulatory vessels that pump blood carrying oxygen inhaled through the lungs to all parts of our bodies.
Often the impact of chronic shortness of breath therefore is not just seen in lung function tests but in tests to evaluate the efficiency/health of the heart and circulatory system. One such measure is called heart rate variability (HRV). In simple terms, HRV is the amount of time between heartbeats. In general, if there is a large gap in time between heartbeats the HRV is considered to be good. On the flip side, if there is a short gap in time between heartbeats, the HRV is considered bad.
When physicians evaluate HRV, they are most interested to see whether a person’s heartbeats are getting closer together or farther apart. When they are getting closer together, physicians become concerned as this indicates the heart is working harder than it did before. Poor HRV (meaning shorter and shorter gaps of time between heartbeats) is a significant predictor of cardiovascular events such as heart attacks and strokes.
For COPD patients, heart rate variability tends to be poor which makes sense given that the lungs have to work harder to breathe which places greater stress on the heart and therefore the heart has to beat faster/more often in order to help the rest of body perform normal every day functions. As a result, COPD patients experience a greater incidence of cardiovascular events compared to non-COPD populations.
Exercise has been shown in previous studies in non-COPD populations to improve HRV (meaning exercise helps the heart slow down or said another way it helps the heart beat less frequently). Exercise has also been shown in previous studies to reduce COPD patient shortness of breath. So a group of Brazilian researchers recently decided to evaluate whether exercise could also help COPD patients specifically improve heart rate variability. [1]
The study authors described the purpose of their research project as follows,” Nowadays, exercise training is a well-recognized method to treat symptomatic patients with COPD. Its objective is to improve impaired disease outcomes such as exercise capacity, functional status, health-related quality of life and peripheral muscle force, as well as physical activity in daily life. However, little is known about the effects of exercise training programs on HRV changes in patients with COPD.”
In their study, the research team divided 40 COPD patients into two groups. One group of 20 patients participated in a high intensity exercise program patterned on principles and practices of the COPD treatment pulmonary rehabilitation (high intensity group). The other group of 20 patients engaged in a low intensity exercise program that did not push patients as much as a traditional rehab program does (low intensity group). The researchers desired to see whether either program made a notable difference in heart rate variability and whether one level of intensity was more effective in improving HRV than the other.
The study team discovered that the high intensity exercise group experienced a notable mean improvement in heart rate variability (24% on one particular measure known as the SDNN index, and 27% on another measure known as the rMSDD) while the low intensity group saw their HRV worsen between 12-13% on these same two measures. This led the researchers to conclude that high intensity exercise (ala similar to the intensities practiced in pulmonary rehabilitation programs) not only reduce shortness of breath symptoms but also improves heart rate variability. In the researchers own words, “The present study showed that a 12-week high-intensity exercise training program including endurance and strengthening exercises was able to improve HRV outcomes such as the rMSSD and SDNN variables, whereas a low-intensity program of similar duration was not.”
So what did the two different exercise programs entail? According to the study authors, “In the HI group, circuit training including cycling, walking and strength training was performed based on a protocol previously described. For ergometry cycling, the training intensity was set at 60% of the initial maximal work rate; for treadmill walking, at 75% of the average walking speed during the baseline 6-min walking test (6MWT); and for strength training, at 70% of the baseline 1 repetition maximum test (1RM). Increase in work rates and/or duration was assured on a weekly basis, guided by a predetermined schedule and driven by the patients’ perception of their symptoms (Borg-symptom scores). In the LI group, patients progressively performed 5 different sets of exercises including breathing exercises, strengthening of the abdominal muscles (crunches) and calisthenics. Each set consisted of 12 different exercises which were repeated 15 times each. Every 7 sessions, patients began a new set of exercises with an increment on the intensity. Close supervision was provided during both training protocols, which were attended three times per week, for 12 weeks, with 1-h training sessions.”
As we have discussed in many previous articles, exercise is incredibly beneficial to COPD patients and those who otherwise suffer from chronic shortness of breath regardless of disease severity. We have many times recommended COPD patients seek entry to a pulmonary rehabilitation program in their local area if their pulmonologist will provide a referral.
For those people who cannot access a pulmonary rehab program (and unfortunately that’s about 99% of COPD patients and nearly 100% of an expanded audience of people who suffer from chronic shortness of breath but do not carry a COPD diagnosis), we created our Breathe Better for Life guidebook and CD-ROM, www.breathebetterforlife.com, to put the principles and practices of pulmonary rehabilitation directly in your hands. In the guide we created a 12 week exercise program patterned after the guidelines of the American Thoracic Society, the European Respiratory Society and the American College of Sports Medicine for those with poor respiratory health. Our accompanying CD-ROM provides narrated, pictorial step-by-step instructions for the various strength training, stretching and breathing exercises recommended in the guidebook.
Regardless of what exercise program you follow, it is vitally important for COPD patients to start and maintain an exercise program for the long haul. Many research studies have proven the benefits of a regular exercise program for COPD patients (reduced shortness of breath, fewer hospitalizations, improved quality of life, and improved physical strength and stamina to name a few). This study’s results seem to indicate that following a pulmonary rehabilitation style exercise program can also improve heart rate variability and in so doing lessen the potential for a cardiovascular event.
[1] Camillo CA, et al. Improvement of heart rate variability after exercise training and its predictors in COPD. Respiratory Medicine. 2011 February 20 [Epub ahead of print]
Often the impact of chronic shortness of breath therefore is not just seen in lung function tests but in tests to evaluate the efficiency/health of the heart and circulatory system. One such measure is called heart rate variability (HRV). In simple terms, HRV is the amount of time between heartbeats. In general, if there is a large gap in time between heartbeats the HRV is considered to be good. On the flip side, if there is a short gap in time between heartbeats, the HRV is considered bad.
When physicians evaluate HRV, they are most interested to see whether a person’s heartbeats are getting closer together or farther apart. When they are getting closer together, physicians become concerned as this indicates the heart is working harder than it did before. Poor HRV (meaning shorter and shorter gaps of time between heartbeats) is a significant predictor of cardiovascular events such as heart attacks and strokes.
For COPD patients, heart rate variability tends to be poor which makes sense given that the lungs have to work harder to breathe which places greater stress on the heart and therefore the heart has to beat faster/more often in order to help the rest of body perform normal every day functions. As a result, COPD patients experience a greater incidence of cardiovascular events compared to non-COPD populations.
Exercise has been shown in previous studies in non-COPD populations to improve HRV (meaning exercise helps the heart slow down or said another way it helps the heart beat less frequently). Exercise has also been shown in previous studies to reduce COPD patient shortness of breath. So a group of Brazilian researchers recently decided to evaluate whether exercise could also help COPD patients specifically improve heart rate variability. [1]
The study authors described the purpose of their research project as follows,” Nowadays, exercise training is a well-recognized method to treat symptomatic patients with COPD. Its objective is to improve impaired disease outcomes such as exercise capacity, functional status, health-related quality of life and peripheral muscle force, as well as physical activity in daily life. However, little is known about the effects of exercise training programs on HRV changes in patients with COPD.”
In their study, the research team divided 40 COPD patients into two groups. One group of 20 patients participated in a high intensity exercise program patterned on principles and practices of the COPD treatment pulmonary rehabilitation (high intensity group). The other group of 20 patients engaged in a low intensity exercise program that did not push patients as much as a traditional rehab program does (low intensity group). The researchers desired to see whether either program made a notable difference in heart rate variability and whether one level of intensity was more effective in improving HRV than the other.
The study team discovered that the high intensity exercise group experienced a notable mean improvement in heart rate variability (24% on one particular measure known as the SDNN index, and 27% on another measure known as the rMSDD) while the low intensity group saw their HRV worsen between 12-13% on these same two measures. This led the researchers to conclude that high intensity exercise (ala similar to the intensities practiced in pulmonary rehabilitation programs) not only reduce shortness of breath symptoms but also improves heart rate variability. In the researchers own words, “The present study showed that a 12-week high-intensity exercise training program including endurance and strengthening exercises was able to improve HRV outcomes such as the rMSSD and SDNN variables, whereas a low-intensity program of similar duration was not.”
So what did the two different exercise programs entail? According to the study authors, “In the HI group, circuit training including cycling, walking and strength training was performed based on a protocol previously described. For ergometry cycling, the training intensity was set at 60% of the initial maximal work rate; for treadmill walking, at 75% of the average walking speed during the baseline 6-min walking test (6MWT); and for strength training, at 70% of the baseline 1 repetition maximum test (1RM). Increase in work rates and/or duration was assured on a weekly basis, guided by a predetermined schedule and driven by the patients’ perception of their symptoms (Borg-symptom scores). In the LI group, patients progressively performed 5 different sets of exercises including breathing exercises, strengthening of the abdominal muscles (crunches) and calisthenics. Each set consisted of 12 different exercises which were repeated 15 times each. Every 7 sessions, patients began a new set of exercises with an increment on the intensity. Close supervision was provided during both training protocols, which were attended three times per week, for 12 weeks, with 1-h training sessions.”
As we have discussed in many previous articles, exercise is incredibly beneficial to COPD patients and those who otherwise suffer from chronic shortness of breath regardless of disease severity. We have many times recommended COPD patients seek entry to a pulmonary rehabilitation program in their local area if their pulmonologist will provide a referral.
For those people who cannot access a pulmonary rehab program (and unfortunately that’s about 99% of COPD patients and nearly 100% of an expanded audience of people who suffer from chronic shortness of breath but do not carry a COPD diagnosis), we created our Breathe Better for Life guidebook and CD-ROM, www.breathebetterforlife.com, to put the principles and practices of pulmonary rehabilitation directly in your hands. In the guide we created a 12 week exercise program patterned after the guidelines of the American Thoracic Society, the European Respiratory Society and the American College of Sports Medicine for those with poor respiratory health. Our accompanying CD-ROM provides narrated, pictorial step-by-step instructions for the various strength training, stretching and breathing exercises recommended in the guidebook.
Regardless of what exercise program you follow, it is vitally important for COPD patients to start and maintain an exercise program for the long haul. Many research studies have proven the benefits of a regular exercise program for COPD patients (reduced shortness of breath, fewer hospitalizations, improved quality of life, and improved physical strength and stamina to name a few). This study’s results seem to indicate that following a pulmonary rehabilitation style exercise program can also improve heart rate variability and in so doing lessen the potential for a cardiovascular event.
[1] Camillo CA, et al. Improvement of heart rate variability after exercise training and its predictors in COPD. Respiratory Medicine. 2011 February 20 [Epub ahead of print]
Thursday, March 17, 2011
Breathing exercises significantly reduce fatigue intensity in COPD patients
In January 2011, a group of Iranian researchers reported that COPD patients who engaged in a regimen of three breathing technique exercises four times a day over a ten day period experienced an average 27% reduction in fatigue intensity. By comparison, the control group in the study (COPD patients who received no breathing technique exercises) reported only a 4% improvement in self-perceived fatigue. [1]
In introducing their study findings, the researchers set the stage by noting, “Two significant symptoms of COPD frequently complained by the patients are dyspnea (shortness of breath) and fatigue. Any patient who feels tired for more than 1 month is considered as affected by chronic fatigue. Chronic fatigue is important and common sensation in patients with COPD that interferes with the quality of life but (is) almost neglected. As the disease advances, hard breathing followed by dyspnea and increasing limitation of the patient’s ability to perform daily activities are worsened, and even for doing simple work during the day, the patient gets out of breath and is affected with early fatigue…
Respiratory exercises such as lip-pursing (pursed-lips breathing) or diaphragm respiration (diaphragmatic breathing), are considered as a part of pulmonary rehabilitation programs, which could lead to an improvement in gas exchange, exercise tolerance and quality of life. The goal of respiratory exercises in patients with COPD is for the patients to replace their ineffective respiratory techniques with effective ones and to discharge the lungs from secretions through deep respiratory exercises and effective coughing.”
In other words, the study team speculated that employing breathing techniques that help re-train COPD patients to breathe more deeply and at a slower speed would reduce the sensation of fatigue and enable the patients to participate in more activities and thereby enjoy a higher quality of life.
A total of 60 COPD patients participated in the study (30 in the breathing exercise group and 30 in the control group). Both groups completed a “fatigue severity scale” survey upon enrollment. Then the breathing exercise group received instruction in three respiratory exercise techniques (pursed-lips breathing, diaphragmatic breathing and “effective coughing” – the technique for effective coughing was not identified in the study but was most likely the Huff Cough technique taught in many pulmonary rehab progams).
The COPD patients in the breathing exercise group received instruction and supervision of the proper breathing and coughing techniques and then were asked to practice these techniques 4 times a day for 10 consecutive days. The control group did not receive the breathing/coughing training and were not instructed to utilize such techniques over the same 10 day period. After the 10 day study period, both groups again completed the fatigue survey and the researchers compared the pre- and post- results within and across each group.
For such a short duration of breathing/coughing technique training, the breathing exercise group recorded significant improvements. For example, at the outset of the study 27 of the 30 COPD patients indicated their fatigue was “severe” (the highest level on the survey), while 3 rated their fatigue as “moderate”. At the end of the study, only 16 reported their fatigue as severe (a 41% drop in the number of COPD patients who considered their fatigue severe), 11 indicated their fatigue was moderate, and 3 reported their fatigue as mild. On average, the breathing exercise group demonstrated a 27% improvement in perceived fatigue.
The control group barely moved in their fatigue perceptions. At the outset of the study, 27 of the 30 COPD patients reported their fatigue as severe. At the end of the study, 26 still perceived their fatigue intensity as severe.
These are pretty remarkable findings especially considering the study did NOT involve the core regimen of physical exercise typically offered in a pulmonary rehabilitation program. The only element of pulmonary rehab used in the study was the training and application of breathing and coughing techniques.
The study authors concluded, “Results of the present research showed a reduction in the fatigue intensity among COPD patients under interference as well as a meaningful reverse relationship between the fatigue intensity and the rate of respiratory exercises. In other words, the higher the rate of respiratory exercise applied, the less the fatigue intensity among the samples under interference. The present research also showed that it was the change of respiratory pattern that caused the reduction of fatigue intensity in COPD patients. Patients with COPD have a shallow, fast and insufficient breathing. Through exercises, this type of respiration has improved to diaphragm respiration in which the breathing speed is reduced leading to an increase of alembic aeration. By lip-pursing respiration also, the breathing depth is increased in patients.
Training of respiratory exercises through face to face procedure while implementing treatment procedures may have significant effects on controlling and improving the symptoms, raising the level of awareness and finally, upgrading their quality of life.”
If you are unfamiliar with pursed-lips breathing, diaphragmatic breathing or the huff cough techniques, consider making an appointment with your pulmonologist or respiratory therapist to learn and practice the techniques. For those interested there is a brief overview of these techniques on our Resplenish dietary supplement web site that you can view by clicking here. In addition, our Breathe Better for Life CD-ROM which accompanies our Breathe Better for Life guidebook contains narrated, pictorial, step-by-step instructions of these techniques. To learn more about Breathe Better for Life, visit www.breathebetterforlife.com.
[1] Zakerimoghadam M, et al. The Effect of Breathing Exercises on The Fatigue Levels of Patients with Chronic Obstructive Pulmonary Disease. Acta Medica Indonesia. January 2011: 43(1); 29-33.
In introducing their study findings, the researchers set the stage by noting, “Two significant symptoms of COPD frequently complained by the patients are dyspnea (shortness of breath) and fatigue. Any patient who feels tired for more than 1 month is considered as affected by chronic fatigue. Chronic fatigue is important and common sensation in patients with COPD that interferes with the quality of life but (is) almost neglected. As the disease advances, hard breathing followed by dyspnea and increasing limitation of the patient’s ability to perform daily activities are worsened, and even for doing simple work during the day, the patient gets out of breath and is affected with early fatigue…
Respiratory exercises such as lip-pursing (pursed-lips breathing) or diaphragm respiration (diaphragmatic breathing), are considered as a part of pulmonary rehabilitation programs, which could lead to an improvement in gas exchange, exercise tolerance and quality of life. The goal of respiratory exercises in patients with COPD is for the patients to replace their ineffective respiratory techniques with effective ones and to discharge the lungs from secretions through deep respiratory exercises and effective coughing.”
In other words, the study team speculated that employing breathing techniques that help re-train COPD patients to breathe more deeply and at a slower speed would reduce the sensation of fatigue and enable the patients to participate in more activities and thereby enjoy a higher quality of life.
A total of 60 COPD patients participated in the study (30 in the breathing exercise group and 30 in the control group). Both groups completed a “fatigue severity scale” survey upon enrollment. Then the breathing exercise group received instruction in three respiratory exercise techniques (pursed-lips breathing, diaphragmatic breathing and “effective coughing” – the technique for effective coughing was not identified in the study but was most likely the Huff Cough technique taught in many pulmonary rehab progams).
The COPD patients in the breathing exercise group received instruction and supervision of the proper breathing and coughing techniques and then were asked to practice these techniques 4 times a day for 10 consecutive days. The control group did not receive the breathing/coughing training and were not instructed to utilize such techniques over the same 10 day period. After the 10 day study period, both groups again completed the fatigue survey and the researchers compared the pre- and post- results within and across each group.
For such a short duration of breathing/coughing technique training, the breathing exercise group recorded significant improvements. For example, at the outset of the study 27 of the 30 COPD patients indicated their fatigue was “severe” (the highest level on the survey), while 3 rated their fatigue as “moderate”. At the end of the study, only 16 reported their fatigue as severe (a 41% drop in the number of COPD patients who considered their fatigue severe), 11 indicated their fatigue was moderate, and 3 reported their fatigue as mild. On average, the breathing exercise group demonstrated a 27% improvement in perceived fatigue.
The control group barely moved in their fatigue perceptions. At the outset of the study, 27 of the 30 COPD patients reported their fatigue as severe. At the end of the study, 26 still perceived their fatigue intensity as severe.
These are pretty remarkable findings especially considering the study did NOT involve the core regimen of physical exercise typically offered in a pulmonary rehabilitation program. The only element of pulmonary rehab used in the study was the training and application of breathing and coughing techniques.
The study authors concluded, “Results of the present research showed a reduction in the fatigue intensity among COPD patients under interference as well as a meaningful reverse relationship between the fatigue intensity and the rate of respiratory exercises. In other words, the higher the rate of respiratory exercise applied, the less the fatigue intensity among the samples under interference. The present research also showed that it was the change of respiratory pattern that caused the reduction of fatigue intensity in COPD patients. Patients with COPD have a shallow, fast and insufficient breathing. Through exercises, this type of respiration has improved to diaphragm respiration in which the breathing speed is reduced leading to an increase of alembic aeration. By lip-pursing respiration also, the breathing depth is increased in patients.
Training of respiratory exercises through face to face procedure while implementing treatment procedures may have significant effects on controlling and improving the symptoms, raising the level of awareness and finally, upgrading their quality of life.”
If you are unfamiliar with pursed-lips breathing, diaphragmatic breathing or the huff cough techniques, consider making an appointment with your pulmonologist or respiratory therapist to learn and practice the techniques. For those interested there is a brief overview of these techniques on our Resplenish dietary supplement web site that you can view by clicking here. In addition, our Breathe Better for Life CD-ROM which accompanies our Breathe Better for Life guidebook contains narrated, pictorial, step-by-step instructions of these techniques. To learn more about Breathe Better for Life, visit www.breathebetterforlife.com.
[1] Zakerimoghadam M, et al. The Effect of Breathing Exercises on The Fatigue Levels of Patients with Chronic Obstructive Pulmonary Disease. Acta Medica Indonesia. January 2011: 43(1); 29-33.
Sunday, February 27, 2011
COPD and sleep quality
Breathing difficulties can notably degrade one’s ability to enjoy a good night’s sleep and, according to a new study, poor sleep quality is a significant contributor to COPD patients’ reporting of low quality of life. [1]
As a case in point, the new study found that 74% of the 180 COPD patients enrolled in the research program reported incurring at least one sleep-disturbing respiratory symptom 3 times a week or more. The most common respiratory symptoms cited by study participants included:
• Coughing
• Wheezing
• Snoring
• Sleep apnea events
• Can’t breathe at night
• Chest pains
These symptoms affected the self-reported average amount of time it took study participants to fall asleep (30 minutes), the amount of time they slept each night (5 hours) and the percentage of patients that awoke during the night (78%) for one reason or another. If the study population is representative of the general COPD population (and there is no reason to think otherwise) then sleep quality is a huge problem for people with respiratory conditions.
To assess whether sleeping difficulties affect COPD patients overall self-reported quality of life, the researchers had the study participants complete three different quality of life surveys (a common respiratory health survey, a sleep specific health survey, and a general health survey) from which the study team conducted a statistical comparison of the correlations.
They discovered a particularly strong correlation between low reported quality of life on the respiratory health survey (St. George’s Respiratory Questionnaire) and poor sleep quality as determined by the sleep specific survey (Pittsburgh Sleep Quality Index).
Ironically, the researchers reported that only about 7% of the enrolled COPD patients indicated they felt excessively sleepy during the day (i.e. difficulty in staying awake) despite the significant percentage of sleep disturbances and quality of life correlation. With that said the researchers concluded, “Patients with COPD have poor HrQOL (self-reported quality of life) and a high prevalence of disturbed sleep. This was correlated with indices of disturbed sleep. Few patients reported daytime sleepiness in spite of severe sleep disturbances. Studies in COPD incorporating HrQOL as an outcome should take sleep quality into account.”
We previously wrote an article for COPD patients and smokers detailing strategies for improving chances for a good night’s sleep. To read that article, click here.
[1] Scharf SM, et al. Sleep quality predicts quality of life in chronic obstructive pulmonary disease International Journal of Chronic Obstructive Pulmonary Disease. 2011:6 1–12
As a case in point, the new study found that 74% of the 180 COPD patients enrolled in the research program reported incurring at least one sleep-disturbing respiratory symptom 3 times a week or more. The most common respiratory symptoms cited by study participants included:
• Coughing
• Wheezing
• Snoring
• Sleep apnea events
• Can’t breathe at night
• Chest pains
These symptoms affected the self-reported average amount of time it took study participants to fall asleep (30 minutes), the amount of time they slept each night (5 hours) and the percentage of patients that awoke during the night (78%) for one reason or another. If the study population is representative of the general COPD population (and there is no reason to think otherwise) then sleep quality is a huge problem for people with respiratory conditions.
To assess whether sleeping difficulties affect COPD patients overall self-reported quality of life, the researchers had the study participants complete three different quality of life surveys (a common respiratory health survey, a sleep specific health survey, and a general health survey) from which the study team conducted a statistical comparison of the correlations.
They discovered a particularly strong correlation between low reported quality of life on the respiratory health survey (St. George’s Respiratory Questionnaire) and poor sleep quality as determined by the sleep specific survey (Pittsburgh Sleep Quality Index).
Ironically, the researchers reported that only about 7% of the enrolled COPD patients indicated they felt excessively sleepy during the day (i.e. difficulty in staying awake) despite the significant percentage of sleep disturbances and quality of life correlation. With that said the researchers concluded, “Patients with COPD have poor HrQOL (self-reported quality of life) and a high prevalence of disturbed sleep. This was correlated with indices of disturbed sleep. Few patients reported daytime sleepiness in spite of severe sleep disturbances. Studies in COPD incorporating HrQOL as an outcome should take sleep quality into account.”
We previously wrote an article for COPD patients and smokers detailing strategies for improving chances for a good night’s sleep. To read that article, click here.
[1] Scharf SM, et al. Sleep quality predicts quality of life in chronic obstructive pulmonary disease International Journal of Chronic Obstructive Pulmonary Disease. 2011:6 1–12
Monday, February 21, 2011
Tai chi improves respiratory function in COPD patients
A new study published online ahead of print last month in the journal Complementary Therapies in Medicine demonstrated that a 3-month tai chi qigong program improved respiratory function and activity capacity in COPD patients participating in the study. [1]
As we’ve written in many previous articles, regular physical activity is crucially important for COPD patients to reduce shortness of breath and improve quality of life. While we’ve previously discussed tai chi as one form of physical activity that has shown promise for improving quality of life among COPD patients (click here for our most recent previous tai chi article), this is the first study to demonstrate tai chi’s impact on respiratory function.
Tai chi, according to the study authors, “…is a combination of exercise and meditation. It consists of a series of slow movements and deep breathing that helps to promote circulation of ‘‘Qi’’ (vital energy) in the meridians, regulate functions of the internal organs, and improve physiological functions. The slow, controlled graceful movements of TCQ, which integrates mental concentration and deep breathing, is believed to improve circulation and breathing. Deep breathing draws the breath down into the “tantien” (the main energy center of the body) placing less pressure on lungs and increasing lung capacity.”
The design of the study was as follows: the one hundred and fifty eight COPD patients who completed the 3-month research program were divided into three groups (a tai chi group, a walking group, and a control group). The China based researchers collected baseline measurements at the outset of the program including lung function (spirometry), exercise capacity (distance walked in 6 minutes), and self-reported dyspnea (shortness of breath) among other diagnostic tests. At 6 weeks into the study, the researchers again recorded measurements on these tests. Finally, at the end of the 3-month study, the COPD patients completed one more battery of these diagnostic evaluations. The researchers then compared the results of the baseline, 6-week and 3-month readings to assess whether there had been any significant improvements or declines since the outset of the study.
The tai chi group (60 COPD patients) practiced 13 movement forms of tai chi qigong twice a week for one hour each group session over the 3-month period. The sessions were held at an outpatient hospital center and led by a qualified tai chi instructor. Additionally, patients were asked to practice tai chi on their own at home one further hour each day during the study and were given a tai chi DVD to help facilitate their at-home practice.
The walking group (50 patients) was asked to walk for one hour daily during the study. In addition, during their one hour sessions the walking group COPD patients were also asked to practice two breathing techniques (pursed lips breathing and diaphragmatic breathing).
The control group received no instruction on breathing techniques and was not requested to engage in exercise during the course of the study (48 patients).
The results of the study showed significant improvement (7%) in forced vital capacity (a measure of respiratory function) in the tai chi group while the control group experienced a 4% decline in the same measure. The walking group showed a 4% improvement in FVC.
With regard to exercise capacity, the tai chi group exhibited an 11% jump in distance walked in 6 minutes while the control group and walking group’s distance walked rose only 2%.
The study authors concluded, “TCQ did contribute noticeable improvement in health outcomes with respect to lung functions and activity tolerance. Due to reduced physical abilities, people with COPD may not be able to carry out exercises at high-intensity levels. Despite the fact that much of the evidence pertaining to the physiological benefit of exercise is based on conventional physical exercise, such as walking, jogging, swimming and cycling, the role of other complementary and alternative modes of exercise also deserves attention. TCQ has been selected in this study because it has a number of potential advantages for health promotion among people with chronic illnesses. Studies have shown that practicing TCQ in a supportive atmosphere can foster feelings of self-efficacy. Through continuous practice, the subjects gradually developed mastery, which may have the effect of increasing their confidence in disease management and treatment compliance. In addition, through the TCQ program, subjects could increase their abilities to be more independent in terms of self-care and decrease their feelings of physical dysfunction due to the disease. TCQ was also well tolerated and enjoyed by the subjects. This might be the reason for the higher compliance rate and less attrition due to ‘‘no interest to continue’’ in the TCQ group (n = 2) than in the exercise (n = 10) and the control groups (n = 11).”
Regarding the authors’ final point, it has been shown in previous respiratory health studies that COPD patients participating in tai chi programs tend to stick with the programs for longer periods of time than other forms of conventional exercise. This current study seems to echo those findings.
If you are interested in trying a tai chi class, most fitness and community centers offer group classes for all levels of skill (beginner, intermediate, expert) and the movements can be adapted so that people with limited mobility/poor balance can participate while seated in a chair. Alternatively, there are many tai chi DVDs available through retail and online stores that you can use to practice at home. These DVDs also come in beginner, intermediate and expert versions and there are a few that are geared for practicing tai chi while seated. We’ve selected a sampling of the top selling beginner DVD’s from amazon.com on our Breathe Better Marketplace site for those who are interested.
[1] Chan AWK, et al. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single blind, randomized controlled trial. Complementary Therapies in Medicine (2011) 19, 3—11.
As we’ve written in many previous articles, regular physical activity is crucially important for COPD patients to reduce shortness of breath and improve quality of life. While we’ve previously discussed tai chi as one form of physical activity that has shown promise for improving quality of life among COPD patients (click here for our most recent previous tai chi article), this is the first study to demonstrate tai chi’s impact on respiratory function.
Tai chi, according to the study authors, “…is a combination of exercise and meditation. It consists of a series of slow movements and deep breathing that helps to promote circulation of ‘‘Qi’’ (vital energy) in the meridians, regulate functions of the internal organs, and improve physiological functions. The slow, controlled graceful movements of TCQ, which integrates mental concentration and deep breathing, is believed to improve circulation and breathing. Deep breathing draws the breath down into the “tantien” (the main energy center of the body) placing less pressure on lungs and increasing lung capacity.”
The design of the study was as follows: the one hundred and fifty eight COPD patients who completed the 3-month research program were divided into three groups (a tai chi group, a walking group, and a control group). The China based researchers collected baseline measurements at the outset of the program including lung function (spirometry), exercise capacity (distance walked in 6 minutes), and self-reported dyspnea (shortness of breath) among other diagnostic tests. At 6 weeks into the study, the researchers again recorded measurements on these tests. Finally, at the end of the 3-month study, the COPD patients completed one more battery of these diagnostic evaluations. The researchers then compared the results of the baseline, 6-week and 3-month readings to assess whether there had been any significant improvements or declines since the outset of the study.
The tai chi group (60 COPD patients) practiced 13 movement forms of tai chi qigong twice a week for one hour each group session over the 3-month period. The sessions were held at an outpatient hospital center and led by a qualified tai chi instructor. Additionally, patients were asked to practice tai chi on their own at home one further hour each day during the study and were given a tai chi DVD to help facilitate their at-home practice.
The walking group (50 patients) was asked to walk for one hour daily during the study. In addition, during their one hour sessions the walking group COPD patients were also asked to practice two breathing techniques (pursed lips breathing and diaphragmatic breathing).
The control group received no instruction on breathing techniques and was not requested to engage in exercise during the course of the study (48 patients).
The results of the study showed significant improvement (7%) in forced vital capacity (a measure of respiratory function) in the tai chi group while the control group experienced a 4% decline in the same measure. The walking group showed a 4% improvement in FVC.
With regard to exercise capacity, the tai chi group exhibited an 11% jump in distance walked in 6 minutes while the control group and walking group’s distance walked rose only 2%.
The study authors concluded, “TCQ did contribute noticeable improvement in health outcomes with respect to lung functions and activity tolerance. Due to reduced physical abilities, people with COPD may not be able to carry out exercises at high-intensity levels. Despite the fact that much of the evidence pertaining to the physiological benefit of exercise is based on conventional physical exercise, such as walking, jogging, swimming and cycling, the role of other complementary and alternative modes of exercise also deserves attention. TCQ has been selected in this study because it has a number of potential advantages for health promotion among people with chronic illnesses. Studies have shown that practicing TCQ in a supportive atmosphere can foster feelings of self-efficacy. Through continuous practice, the subjects gradually developed mastery, which may have the effect of increasing their confidence in disease management and treatment compliance. In addition, through the TCQ program, subjects could increase their abilities to be more independent in terms of self-care and decrease their feelings of physical dysfunction due to the disease. TCQ was also well tolerated and enjoyed by the subjects. This might be the reason for the higher compliance rate and less attrition due to ‘‘no interest to continue’’ in the TCQ group (n = 2) than in the exercise (n = 10) and the control groups (n = 11).”
Regarding the authors’ final point, it has been shown in previous respiratory health studies that COPD patients participating in tai chi programs tend to stick with the programs for longer periods of time than other forms of conventional exercise. This current study seems to echo those findings.
If you are interested in trying a tai chi class, most fitness and community centers offer group classes for all levels of skill (beginner, intermediate, expert) and the movements can be adapted so that people with limited mobility/poor balance can participate while seated in a chair. Alternatively, there are many tai chi DVDs available through retail and online stores that you can use to practice at home. These DVDs also come in beginner, intermediate and expert versions and there are a few that are geared for practicing tai chi while seated. We’ve selected a sampling of the top selling beginner DVD’s from amazon.com on our Breathe Better Marketplace site for those who are interested.
[1] Chan AWK, et al. Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single blind, randomized controlled trial. Complementary Therapies in Medicine (2011) 19, 3—11.
Thursday, February 17, 2011
Pulmonary rehabilitation effective even for severe COPD patients
One of the most valuable steps anyone who suffers from chronic shortness of breath can undertake is to engage in a regular program of physical activity (including those diagnosed with chronic obstructive pulmonary disease or COPD).
Often the biggest challenge to become more physically active among those with pronounced breathing difficulties is a poor level of conditioning. Shortness of breath often leads people to rest more (meaning sitting or lying for larger segments of the day). The trend towards a more sedentary existence weakens muscles, bones, and the body’s cardiovascular function.
To help COPD patients “kick start” a physical activity program, pulmonology professionals can prescribe a treatment option known as pulmonary rehabilitation. In these programs, respiratory therapists and physicians first assess the baseline physical condition of each patient and then they design a somewhat customized 8-12 week exercise program that includes aerobic exercise (typically walking on a treadmill, riding a stationary cycle, or utilizing a device known as a cycle ergonometer) and strength training (weight lifting). Patients typically visit an outpatient rehab center 2-3 days per week for the 1 hour exercise sessions, and at various points along the way the therapists increase the duration and/or intensity of the exercise to help patients build back strength and endurance. Most rehab programs also include counseling and education sessions regarding breathing techniques, nutrition, smoking cessation, proper use of medications and social support.
Sounds great, right? Well, it is. Literally thousands of studies have been conducted on the effectiveness of pulmonary rehabilitation in reducing COPD patient shortness of breath, improving physical conditioning (strength and endurance), reducing exacerbations (shortness of breath attacks), shortening hospital stays and reducing overall health care costs. You’d think pulmonary rehab would be offered to every COPD patient…but it isn’t. In fact, only 1-2% of COPD patients are admitted to pulmonary rehab programs each year for a variety of reasons (none of them compelling).
At particular disadvantage are COPD patients considered “severe” cases. You see, there is a bit of a goldilocks mentality when it comes to doling out access to pulmonary rehab. If you have mild COPD (Stage I), you are unlikely to be admitted. If you have very severe COPD (Stage IV), you are also unlikely to be admitted. Why? Because Medicare and insurance companies will only reimburse rehab clinics for moderate to severe COPD patients (Stage II and III). And hospitals are not in the business of offering services for which they do not get paid.
Further, there is somewhat of an unspoken bias against admitting severe and very severe patients to begin with among pulmonology professionals. There seems to be an undercurrent that offering pulmonary rehab to severe patients is a waste of resources since their condition is unlikely to improve.
But research studies counter such notions. For example, a recent Nigerian study designed a 6-week pulmonary rehab program for 42 severe/very severe COPD patients. In particular, the study team desired to see whether the program would boost both the physical condition of patients as well as improve quality of life. [1]
Their results were remarkable in that the 6 week program (2 visits weekly for 2 ½ hours each session) delivered clinically significant improvements in distance walked on a timed test (21% improvement). Further, quality of life ratings for dyspnea (perceived shortness of breath), fatigue, emotional support and mastery all improved above the clinically significant threshold established in past research studies. Further still, the percentage of study participants acknowledging depression (40%) and anxiety (32%) both fell to 27% by the end of the study. More remarkable is the fact that the vast majority of these improvements were maintained 4 months after the 6 week program ended.
The study authors concluded, “This study has shown that a successful outpatient based rehabilitation programme is feasible and possible in patients with very severe COPD. Significant improvements can be achieved in shuttle walking distance, quality of life and psychological measurements, and the improvement is maintained for at least three more months without further intervention.”
If you are a COPD patient, we highly recommend you speak to your pulmonologist about gaining entry to a pulmonary rehab program in your area. If they won’t refer you, if you get rejected for admission, or there is no program in your area, we suggest you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM.
We devised a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and the European Respiratory Society. We then augmented these guidelines with the exercise protocol recommended by the American College of Sports Medicine for those with chronic respiratory conditions. The guide and the CD were reviewed and edited by prominent respiratory care professionals, and both resources cover elements of a pulmonary rehab program that go beyond exercise (breathing techniques, airway clearing techniques, nutrition, proper use of inhaler medications, and other topics). To learn more about Breathe Better for Life, visit www.breathebetterforlife.com.
If you decide to follow our exercise program please consult your physician first to ensure the program is appropriate for your particular situation. While we did create two different programs based on condition severity (with different starting points, intensities, durations), it is important to include your doctor in your plans to begin an exercise program.
[1] Ige OM, et al. Outpatient Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease. Indian J Chest Dis Allied Sci. 2010 Oct-Dec; 52(4)
Often the biggest challenge to become more physically active among those with pronounced breathing difficulties is a poor level of conditioning. Shortness of breath often leads people to rest more (meaning sitting or lying for larger segments of the day). The trend towards a more sedentary existence weakens muscles, bones, and the body’s cardiovascular function.
To help COPD patients “kick start” a physical activity program, pulmonology professionals can prescribe a treatment option known as pulmonary rehabilitation. In these programs, respiratory therapists and physicians first assess the baseline physical condition of each patient and then they design a somewhat customized 8-12 week exercise program that includes aerobic exercise (typically walking on a treadmill, riding a stationary cycle, or utilizing a device known as a cycle ergonometer) and strength training (weight lifting). Patients typically visit an outpatient rehab center 2-3 days per week for the 1 hour exercise sessions, and at various points along the way the therapists increase the duration and/or intensity of the exercise to help patients build back strength and endurance. Most rehab programs also include counseling and education sessions regarding breathing techniques, nutrition, smoking cessation, proper use of medications and social support.
Sounds great, right? Well, it is. Literally thousands of studies have been conducted on the effectiveness of pulmonary rehabilitation in reducing COPD patient shortness of breath, improving physical conditioning (strength and endurance), reducing exacerbations (shortness of breath attacks), shortening hospital stays and reducing overall health care costs. You’d think pulmonary rehab would be offered to every COPD patient…but it isn’t. In fact, only 1-2% of COPD patients are admitted to pulmonary rehab programs each year for a variety of reasons (none of them compelling).
At particular disadvantage are COPD patients considered “severe” cases. You see, there is a bit of a goldilocks mentality when it comes to doling out access to pulmonary rehab. If you have mild COPD (Stage I), you are unlikely to be admitted. If you have very severe COPD (Stage IV), you are also unlikely to be admitted. Why? Because Medicare and insurance companies will only reimburse rehab clinics for moderate to severe COPD patients (Stage II and III). And hospitals are not in the business of offering services for which they do not get paid.
Further, there is somewhat of an unspoken bias against admitting severe and very severe patients to begin with among pulmonology professionals. There seems to be an undercurrent that offering pulmonary rehab to severe patients is a waste of resources since their condition is unlikely to improve.
But research studies counter such notions. For example, a recent Nigerian study designed a 6-week pulmonary rehab program for 42 severe/very severe COPD patients. In particular, the study team desired to see whether the program would boost both the physical condition of patients as well as improve quality of life. [1]
Their results were remarkable in that the 6 week program (2 visits weekly for 2 ½ hours each session) delivered clinically significant improvements in distance walked on a timed test (21% improvement). Further, quality of life ratings for dyspnea (perceived shortness of breath), fatigue, emotional support and mastery all improved above the clinically significant threshold established in past research studies. Further still, the percentage of study participants acknowledging depression (40%) and anxiety (32%) both fell to 27% by the end of the study. More remarkable is the fact that the vast majority of these improvements were maintained 4 months after the 6 week program ended.
The study authors concluded, “This study has shown that a successful outpatient based rehabilitation programme is feasible and possible in patients with very severe COPD. Significant improvements can be achieved in shuttle walking distance, quality of life and psychological measurements, and the improvement is maintained for at least three more months without further intervention.”
If you are a COPD patient, we highly recommend you speak to your pulmonologist about gaining entry to a pulmonary rehab program in your area. If they won’t refer you, if you get rejected for admission, or there is no program in your area, we suggest you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM.
We devised a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and the European Respiratory Society. We then augmented these guidelines with the exercise protocol recommended by the American College of Sports Medicine for those with chronic respiratory conditions. The guide and the CD were reviewed and edited by prominent respiratory care professionals, and both resources cover elements of a pulmonary rehab program that go beyond exercise (breathing techniques, airway clearing techniques, nutrition, proper use of inhaler medications, and other topics). To learn more about Breathe Better for Life, visit www.breathebetterforlife.com.
If you decide to follow our exercise program please consult your physician first to ensure the program is appropriate for your particular situation. While we did create two different programs based on condition severity (with different starting points, intensities, durations), it is important to include your doctor in your plans to begin an exercise program.
[1] Ige OM, et al. Outpatient Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease. Indian J Chest Dis Allied Sci. 2010 Oct-Dec; 52(4)
Friday, February 11, 2011
Incorrect use of inhalers common among COPD patients
Bronchodilators are common treatment options prescribed by physicians treating patients suffering from chronic shortness of breath. Despite their widespread use, however, a significant percentage of COPD patients do not use their inhalers properly. The result of the misuse is inhalation of either too-little or too-much medication. In either case, patients can become frustrated with the effectiveness and/or side effects of the medications.
This widespread misuse is somewhat understandable given that there are different types of inhalers which carry different usage instructions (dry powder inhalers, metered dose inhalers) and some incorporate nebulizers while others don’t. Further, despite the best efforts of respiratory care professionals, many patients report they do not receive adequate instruction on how to use them properly.
As a case in point, a new study abstract published online ahead of print in the Journal of General Internal Medicine, examined the inhaler use of 40 COPD and 60 asthma patients who had been hospitalized due to their conditions at one of two Chicago area hospitals. The researchers discovered that 86% of the study subjects were improperly using metered dose inhalers while 71% were misusing Diskus brand dry powder inhalers. [1]
The study authors cited two main reasons for the poor rate of correct usage – difficulty with vision, and low health literacy. 43% of the COPD patients in the study had vision worse than 20/50 in both eyes. 61% of COPD patients in the study scored “less-than-adequate” health literacy on a test called The Short Test of Functional Health Literacy in Adults (S-TOFHLA for short).
After administering the vision and health literacy tests, the researchers taught patients the correct methods for using the inhalers (and presumably practiced with them). At the end of the study 100% of the participants correctly used their inhalers. The research team concluded the abstract by acknowledging, “Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.”
If you think you might be using your inhaler improperly, the simplest of solutions is to visit your physician/pulmonologist/respiratory therapist and ask them to demonstrate the proper technique. Practice it in front of them to ensure you’ve got it down right and in future office visits, every now and then ask them to evaluate your inhaler technique.
Here is a brief excerpt from our Breathe Better for Life guidebook regarding proper use of metered dose inhalers:
“Many COPD medications need to be inhaled deeply into the lungs. Most people, over 90%, misuse their inhalers. To help you do this effectively, you will most likely need to use a metered-dose inhaler (MDI). If you have an MDI without a spacer, you need to shake the inhaler to prime it. Remove the cap and exhale deeply. Hold the inhaler one to two inches from your mouth (do NOT put it in your mouth). Press down to discharge the medication as you breathe in as deeply as you can. One depression (spray) per breath. Close your mouth and hold your breath for 5–10 seconds (ideally). Then exhale slowly.
If your MDI has a spacer, you want to shake the inhaler to prime it, then attach the spacer. Exhale deeply, then put the spacer between your teeth and seal your lips around it. With your chin up, pump one puff into the spacer. Slowly inhale through your mouth for three to four seconds. (Too rapid of an inhalation will likely result in less medication getting to the lungs, where it is absorbed and utilized by the airways.)
Remove the spacer from your mouth, and with your mouth closed, hold your breath for 10 seconds (ideally). Then exhale slowly. If you take a second puff, wait at least 30 seconds before doing so.”
If you’d like a more robust explanation and demonstration of the proper use of inhalers, our Breathe Better for Life companion CD-ROM includes easy-to-understand pictorial, narrated, step-by-step instructions on the proper use of metered dose inhalers, dry powder inhalers and nebulizers. As many of you know the Breathe Better for Life guidebook and CD-ROM also contains specific exercise, nutrition, breathing technique and airway clearing technique recommendations and demonstrations. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Press VG, et al. Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD. J Gen Intern Med. 2011 Jan 20 [Epub ahead of print]
This widespread misuse is somewhat understandable given that there are different types of inhalers which carry different usage instructions (dry powder inhalers, metered dose inhalers) and some incorporate nebulizers while others don’t. Further, despite the best efforts of respiratory care professionals, many patients report they do not receive adequate instruction on how to use them properly.
As a case in point, a new study abstract published online ahead of print in the Journal of General Internal Medicine, examined the inhaler use of 40 COPD and 60 asthma patients who had been hospitalized due to their conditions at one of two Chicago area hospitals. The researchers discovered that 86% of the study subjects were improperly using metered dose inhalers while 71% were misusing Diskus brand dry powder inhalers. [1]
The study authors cited two main reasons for the poor rate of correct usage – difficulty with vision, and low health literacy. 43% of the COPD patients in the study had vision worse than 20/50 in both eyes. 61% of COPD patients in the study scored “less-than-adequate” health literacy on a test called The Short Test of Functional Health Literacy in Adults (S-TOFHLA for short).
After administering the vision and health literacy tests, the researchers taught patients the correct methods for using the inhalers (and presumably practiced with them). At the end of the study 100% of the participants correctly used their inhalers. The research team concluded the abstract by acknowledging, “Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.”
If you think you might be using your inhaler improperly, the simplest of solutions is to visit your physician/pulmonologist/respiratory therapist and ask them to demonstrate the proper technique. Practice it in front of them to ensure you’ve got it down right and in future office visits, every now and then ask them to evaluate your inhaler technique.
Here is a brief excerpt from our Breathe Better for Life guidebook regarding proper use of metered dose inhalers:
“Many COPD medications need to be inhaled deeply into the lungs. Most people, over 90%, misuse their inhalers. To help you do this effectively, you will most likely need to use a metered-dose inhaler (MDI). If you have an MDI without a spacer, you need to shake the inhaler to prime it. Remove the cap and exhale deeply. Hold the inhaler one to two inches from your mouth (do NOT put it in your mouth). Press down to discharge the medication as you breathe in as deeply as you can. One depression (spray) per breath. Close your mouth and hold your breath for 5–10 seconds (ideally). Then exhale slowly.
If your MDI has a spacer, you want to shake the inhaler to prime it, then attach the spacer. Exhale deeply, then put the spacer between your teeth and seal your lips around it. With your chin up, pump one puff into the spacer. Slowly inhale through your mouth for three to four seconds. (Too rapid of an inhalation will likely result in less medication getting to the lungs, where it is absorbed and utilized by the airways.)
Remove the spacer from your mouth, and with your mouth closed, hold your breath for 10 seconds (ideally). Then exhale slowly. If you take a second puff, wait at least 30 seconds before doing so.”
If you’d like a more robust explanation and demonstration of the proper use of inhalers, our Breathe Better for Life companion CD-ROM includes easy-to-understand pictorial, narrated, step-by-step instructions on the proper use of metered dose inhalers, dry powder inhalers and nebulizers. As many of you know the Breathe Better for Life guidebook and CD-ROM also contains specific exercise, nutrition, breathing technique and airway clearing technique recommendations and demonstrations. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Press VG, et al. Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD. J Gen Intern Med. 2011 Jan 20 [Epub ahead of print]
Tuesday, February 8, 2011
Vitamin E supplementation reduces risk of lung disease by 10% among women in new study
A new study published online ahead of print in the respiratory journal Thorax showed that healthy women who consumed 600 IU of vitamin E every other day had a 10% lower risk of developing lung disease. [1]
The study examined the past health records of nearly 40,00 women who enrolled in a large, ongoing health study called the Women’s Health Study. The researchers split the 40,000 women into two groups of roughly 20,000 – those who consumed 600 IU of vitamin E every other day, and those who received a placebo (100 mg of aspirin every other day). The mean age, weight, smoking status, alcohol use, multivitamin use and other health factors between the two groups were largely the same (a purposeful selection by the researchers to eliminate variables that might skew the study results).
During 10 years of follow up from study enrollment, 760 women receiving vitamin E were diagnosed with lung disease. By way of comparison, 846 of the study participants receiving the placebo were diagnosed with a chronic respiratory condition. From this data, the study authors concluded that those receiving vitamin E had a 10% lower risk of developing lung disease.
As an aside, the researchers pointed out that the strongest contributing health factor in developing lung disease among the study participants was cigarette smoking. Smokers in the study had 4.2 higher odds of developing lung disease than non-smokers. This is not a novel finding as other studies have produced similar results but we offer it as a reminder of the strong correlation between cigarette smoking and lung disease.
In addressing the implications of the lower lung disease risk from consumption of vitamin E, the study authors did not speculate on the mechanisms involved but did relate the findings of other vitamin E/COPD studies, “Observational studies investigating the association of dietary intake and pulmonary function consistently report that higher intake of nutrients with antioxidant properties is associated with better pulmonary outcomes, but causal inferences are limited by concerns about confounding and other biases. Studies comparing patients with COPD with healthy individuals report lower plasma and peripheral skeletal muscle vitamin E (alpha-tocopherol) concentrations in patients and a lower risk of death from respiratory disease with higher serum alpha-tocopherol concentration, but whether nutrition contributed to the onset of COPD is less clear.”
In other words, even though previous studies have hinted at vitamin E’s potential value for people who already have lung disease, there is not yet overwhelming, definitive evidence of its effectiveness. Further, the Thorax study was conducted on healthy women not COPD patients and therefore one cannot necessarily extend vitamin E’s benefits to those who already have respiratory disease.
With that in mind, however, there is a strong and growing body of evidence linking depressed levels of antioxidants (including vitamin E) with oxidative stress and inflammation in humans and laboratory animals with diagnosed respiratory conditions. And many of these studies demonstrate the power of boosting antioxidant blood levels in lowering oxidative stress and inflammation (whether through diet or dietary supplements). For additional articles we've written on antioxidants for healthy respiratory function, type in the keyword "antioxidant" in the search box in the left hand column of this page.
The dosage level consumed by the women in the Thorax study, 600 IU every other day, is well within the tolerable upper daily limits as reported by the National Institutes of Health Office of Dietary Supplements. For more information about vitamin E and potential counter-indications, click here to visit the aforementioned NIH information page on vitamin E. Please also consult your physician to determine whether adding vitamin E to your daily regimen is appropriate.
[1] Agler AH, et al. Randomized vitamin E supplementation and risk of chronic lung disease in the Women’s Health Study. Thorax. 2011 January 21. [Epub ahead of print]
The study examined the past health records of nearly 40,00 women who enrolled in a large, ongoing health study called the Women’s Health Study. The researchers split the 40,000 women into two groups of roughly 20,000 – those who consumed 600 IU of vitamin E every other day, and those who received a placebo (100 mg of aspirin every other day). The mean age, weight, smoking status, alcohol use, multivitamin use and other health factors between the two groups were largely the same (a purposeful selection by the researchers to eliminate variables that might skew the study results).
During 10 years of follow up from study enrollment, 760 women receiving vitamin E were diagnosed with lung disease. By way of comparison, 846 of the study participants receiving the placebo were diagnosed with a chronic respiratory condition. From this data, the study authors concluded that those receiving vitamin E had a 10% lower risk of developing lung disease.
As an aside, the researchers pointed out that the strongest contributing health factor in developing lung disease among the study participants was cigarette smoking. Smokers in the study had 4.2 higher odds of developing lung disease than non-smokers. This is not a novel finding as other studies have produced similar results but we offer it as a reminder of the strong correlation between cigarette smoking and lung disease.
In addressing the implications of the lower lung disease risk from consumption of vitamin E, the study authors did not speculate on the mechanisms involved but did relate the findings of other vitamin E/COPD studies, “Observational studies investigating the association of dietary intake and pulmonary function consistently report that higher intake of nutrients with antioxidant properties is associated with better pulmonary outcomes, but causal inferences are limited by concerns about confounding and other biases. Studies comparing patients with COPD with healthy individuals report lower plasma and peripheral skeletal muscle vitamin E (alpha-tocopherol) concentrations in patients and a lower risk of death from respiratory disease with higher serum alpha-tocopherol concentration, but whether nutrition contributed to the onset of COPD is less clear.”
In other words, even though previous studies have hinted at vitamin E’s potential value for people who already have lung disease, there is not yet overwhelming, definitive evidence of its effectiveness. Further, the Thorax study was conducted on healthy women not COPD patients and therefore one cannot necessarily extend vitamin E’s benefits to those who already have respiratory disease.
With that in mind, however, there is a strong and growing body of evidence linking depressed levels of antioxidants (including vitamin E) with oxidative stress and inflammation in humans and laboratory animals with diagnosed respiratory conditions. And many of these studies demonstrate the power of boosting antioxidant blood levels in lowering oxidative stress and inflammation (whether through diet or dietary supplements). For additional articles we've written on antioxidants for healthy respiratory function, type in the keyword "antioxidant" in the search box in the left hand column of this page.
The dosage level consumed by the women in the Thorax study, 600 IU every other day, is well within the tolerable upper daily limits as reported by the National Institutes of Health Office of Dietary Supplements. For more information about vitamin E and potential counter-indications, click here to visit the aforementioned NIH information page on vitamin E. Please also consult your physician to determine whether adding vitamin E to your daily regimen is appropriate.
[1] Agler AH, et al. Randomized vitamin E supplementation and risk of chronic lung disease in the Women’s Health Study. Thorax. 2011 January 21. [Epub ahead of print]
Friday, February 4, 2011
Physical activity level best predictor of mortality in COPD patients
The official journal of the American College of Chest Physicians, Chest, just published an abstract of a new study evaluating a range of potential predictors of mortality among COPD patients. Though the contents of the full study are embargoed until the article has gone to press, the abstract provides some interesting insights worth sharing.
First, as regular readers of our blog and e-letters well know, we are strong proponents for daily physical activity among COPD patients and anyone who suffers from chronic shortness of breath. We favor an exercise program based on the principles and practices of the COPD treatment pulmonary rehabilitation but acknowledge that even a simple walking program can confer conditioning benefits for smokers and those with respiratory conditions.
Many previous respiratory health studies have clearly and unambiguously demonstrated that regular physical activity reduces shortness of breath symptoms, increases cardiovascular conditioning, heightens muscle strength, improves self-reported quality of life, reduces hospital admissions and reduces severe shortness of breath attacks known as exacerbations.
When physicians act to address shortness of breath symptoms they typically favor smoking cessation, inhaler-based medications and antibiotics. These are reasonable and prudent treatment options. Smoking cessation confers significant health benefits in both the short and long run but a minority of smokers achieves successful permanent smoking cessation. Inhaler-based bronchodilators, steroids, and antibiotics offer short-term relief of immediate shortness of breath symptoms but their track record in conferring long term health benefits are spotty at best.
Regular physical activity, on the other hand, can deliver both short-term and long-term benefits provided one begins and maintains a regular program of activity. Previous studies have shown that COPD patients who are the most active (whether they exercise the most or simply are up and walking/moving around more frequently) report the highest quality of life, demonstrate the best exercise capacity and record the lowest sensations of breathlessness compared to those who are the least active.
In the new Chest study abstract, the researchers offered one more compelling reason to become more physically active – COPD patients in their study who were the most active reported the best survival rates over the four year follow up period after study enrollment. In fact, of all the diagnostic measures evaluated by the study team, the level of physical activity was considered the strongest predictor of patients likely to survive. [1]
According to the abstract, the Germany based researchers enrolled 170 stable COPD patients in their study. At the outset, they conducted a battery of diagnostic tests on the patients and recorded their respective readings. Tests included evaluations of respiratory function, cardiovascular function, body mass index, nutrition status, blood levels of inflammation markers, exercise capacity and levels of physical activity.
Forty-eight months after enrolling the patients and conducting the diagnostic tests, the researchers followed up with the patients to determine which were still alive and which had passed away (26 of the 170 patients died during the four year follow up period, roughly 15%).
The researchers then compared the mean diagnostic readings for the survivors and non-survivors and determined that among all the diagnostic measures, physical activity level was the measure with the highest inverse correlation between the two groups (meaning the people who did not survive the four year follow up period had recorded the lowest levels of physical activity in the diagnostic tests).
In fact, the study abstract mentioned that each 8-10% increase in physical activity level was associated with approximately 50% lower risk of death! Pretty compelling reason to get up off the couch and get moving, wouldn’t you say?!
Note: Physical activity level (PAL) in the study was measured by attaching a device to patients called a multisensory armband which records energy expenditure from movement over a defined period of time (typically a number of days). The World Health Organization has established that PAL levels between 1.7 and 2.0 are indicative of moderately active adults based on data accumulated over time utilizing this device and associated energy expenditure/metabolism calculations. Those considered sedentary or inactive have PAL levels between 1.4 and 1.7. In the Chest abstract, each .14 increase in PAL yielded 54% lower hazard ratio of death, hence our approximation of 8-10% movement in PAL (.14/1.7 or .14/1.4).
If you are a COPD patient and spend most of the day sitting or lying down, it is strongly worth your while to consider becoming more active (standing, walking, exercising). Not only will doing so improve how you feel and breathe each and every day, it may also help extend your life!
We realize getting started on a physical activity program may feel daunting. For those of you who feel that way, you are likely concerned about your balance, potential shortness of breath episodes, and lack of current energy. All are reasonable concerns but none of these issues will go away by simply sitting or lying down. They will only get worse.
To address these concerns, respiratory care professionals offer a treatment option known as pulmonary rehabilitation which assists COPD patients get started on a regular exercise program by starting slow and gradually increasing the intensity and duration of exercise for each patient based on their respective individual starting conditioning levels. These programs are highly effective and we strongly recommend you ask your pulmonologist for a referral to a program in your area.
One thing to keep in mind, however. Entry into these programs can be challenging. There are not enough pulmonary rehab programs around the country to serve all the COPD patients who could benefit from the treatment. Further, Medicare and insurance reimbursement only applies to Stage II and Stage III COPD patients in most cases (moderate to severe COPD), and the programs only last 8-12 weeks.
If you can’t gain entry into a pulmonary rehab program in your area, we recommend you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM. We have created an at-home (or fitness center) exercise program based on pulmonary rehabilitation guidelines published by the American Thoracic Society and European Respiratory Society. We augmented these guidelines by incorporating exercise recommendations for people with chronic respiratory problems from the American College of Sports Medicine. Whether you follow our program or simply use the guide as a resource to discuss structuring an exercise program with your physician, we believe Breathe Better for Life provides excellent education for COPD patients and smokers on exercise, nutrition, breathing technique and airway clearing techniques to improve how you breathe and live. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Waschki B, et al. Physical activity is the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease: a prospective cohort study. Chest. 2011 Jan 27 [Epub ahead of print].
First, as regular readers of our blog and e-letters well know, we are strong proponents for daily physical activity among COPD patients and anyone who suffers from chronic shortness of breath. We favor an exercise program based on the principles and practices of the COPD treatment pulmonary rehabilitation but acknowledge that even a simple walking program can confer conditioning benefits for smokers and those with respiratory conditions.
Many previous respiratory health studies have clearly and unambiguously demonstrated that regular physical activity reduces shortness of breath symptoms, increases cardiovascular conditioning, heightens muscle strength, improves self-reported quality of life, reduces hospital admissions and reduces severe shortness of breath attacks known as exacerbations.
When physicians act to address shortness of breath symptoms they typically favor smoking cessation, inhaler-based medications and antibiotics. These are reasonable and prudent treatment options. Smoking cessation confers significant health benefits in both the short and long run but a minority of smokers achieves successful permanent smoking cessation. Inhaler-based bronchodilators, steroids, and antibiotics offer short-term relief of immediate shortness of breath symptoms but their track record in conferring long term health benefits are spotty at best.
Regular physical activity, on the other hand, can deliver both short-term and long-term benefits provided one begins and maintains a regular program of activity. Previous studies have shown that COPD patients who are the most active (whether they exercise the most or simply are up and walking/moving around more frequently) report the highest quality of life, demonstrate the best exercise capacity and record the lowest sensations of breathlessness compared to those who are the least active.
In the new Chest study abstract, the researchers offered one more compelling reason to become more physically active – COPD patients in their study who were the most active reported the best survival rates over the four year follow up period after study enrollment. In fact, of all the diagnostic measures evaluated by the study team, the level of physical activity was considered the strongest predictor of patients likely to survive. [1]
According to the abstract, the Germany based researchers enrolled 170 stable COPD patients in their study. At the outset, they conducted a battery of diagnostic tests on the patients and recorded their respective readings. Tests included evaluations of respiratory function, cardiovascular function, body mass index, nutrition status, blood levels of inflammation markers, exercise capacity and levels of physical activity.
Forty-eight months after enrolling the patients and conducting the diagnostic tests, the researchers followed up with the patients to determine which were still alive and which had passed away (26 of the 170 patients died during the four year follow up period, roughly 15%).
The researchers then compared the mean diagnostic readings for the survivors and non-survivors and determined that among all the diagnostic measures, physical activity level was the measure with the highest inverse correlation between the two groups (meaning the people who did not survive the four year follow up period had recorded the lowest levels of physical activity in the diagnostic tests).
In fact, the study abstract mentioned that each 8-10% increase in physical activity level was associated with approximately 50% lower risk of death! Pretty compelling reason to get up off the couch and get moving, wouldn’t you say?!
Note: Physical activity level (PAL) in the study was measured by attaching a device to patients called a multisensory armband which records energy expenditure from movement over a defined period of time (typically a number of days). The World Health Organization has established that PAL levels between 1.7 and 2.0 are indicative of moderately active adults based on data accumulated over time utilizing this device and associated energy expenditure/metabolism calculations. Those considered sedentary or inactive have PAL levels between 1.4 and 1.7. In the Chest abstract, each .14 increase in PAL yielded 54% lower hazard ratio of death, hence our approximation of 8-10% movement in PAL (.14/1.7 or .14/1.4).
If you are a COPD patient and spend most of the day sitting or lying down, it is strongly worth your while to consider becoming more active (standing, walking, exercising). Not only will doing so improve how you feel and breathe each and every day, it may also help extend your life!
We realize getting started on a physical activity program may feel daunting. For those of you who feel that way, you are likely concerned about your balance, potential shortness of breath episodes, and lack of current energy. All are reasonable concerns but none of these issues will go away by simply sitting or lying down. They will only get worse.
To address these concerns, respiratory care professionals offer a treatment option known as pulmonary rehabilitation which assists COPD patients get started on a regular exercise program by starting slow and gradually increasing the intensity and duration of exercise for each patient based on their respective individual starting conditioning levels. These programs are highly effective and we strongly recommend you ask your pulmonologist for a referral to a program in your area.
One thing to keep in mind, however. Entry into these programs can be challenging. There are not enough pulmonary rehab programs around the country to serve all the COPD patients who could benefit from the treatment. Further, Medicare and insurance reimbursement only applies to Stage II and Stage III COPD patients in most cases (moderate to severe COPD), and the programs only last 8-12 weeks.
If you can’t gain entry into a pulmonary rehab program in your area, we recommend you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM. We have created an at-home (or fitness center) exercise program based on pulmonary rehabilitation guidelines published by the American Thoracic Society and European Respiratory Society. We augmented these guidelines by incorporating exercise recommendations for people with chronic respiratory problems from the American College of Sports Medicine. Whether you follow our program or simply use the guide as a resource to discuss structuring an exercise program with your physician, we believe Breathe Better for Life provides excellent education for COPD patients and smokers on exercise, nutrition, breathing technique and airway clearing techniques to improve how you breathe and live. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Waschki B, et al. Physical activity is the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease: a prospective cohort study. Chest. 2011 Jan 27 [Epub ahead of print].
Wednesday, February 2, 2011
New study shows N-acetylcysteine’s effect on oxidative stress from cigarette smoke
Each puff of cigarette smoke contains massive numbers of molecules known as free radicals that damage the lining of the airways and allow the toxic chemicals present in cigarette smoke to enter lung tissues. Over time, these toxins damage the tissue’s immune response to invading bacteria and fungi. This results in inflammation of lung tissue, and inflammation is believed to be a prime cause for chronic shortness of breath.
Normally, the body has a supply of neutralizing molecules known as antioxidants that bond to free radicals and essentially render them harmless. Antioxidants are in foods we eat (primarily fruits and vegetables) and can also be consumed in the form of dietary supplements.
But in the vast majority of cigarette smokers, the body’s supply of antioxidants is severely depressed for two reasons. On one hand, the significant counts of free radicals inhaled in cigarette smoke are far larger than even the healthiest of eater’s consumption of antioxidant rich foods. On the other hand, previous research has shown that the average smoker’s diet is low in antioxidant-rich food to begin with. The combination of these two factors (too many free radicals and too few antioxidants) leads to a condition known as oxidative stress.
Respiratory researchers have increasingly turned their attention to the impact of supplementing antioxidants in smokers and those with chronic shortness of breath to see if they can reduce oxidative stress and inflammation (and thereby contribute to improving shortness of breath symptoms).
We have previously written a number of articles regarding a number of recent studies regarding antioxidants that have shown promise in reducing oxidative stress and inflammation among those exposed to cigarette smoke and those with respiratory health conditions, including COPD. One such antioxidant is n-acetylcysteine (often referred to as NAC). NAC has been studied extensively for its anti-inflammatory properties and has also shown effectiveness in boosting exercise tolerance among COPD patients participating in a pulmonary rehabilitation exercise program.
A new research paper published this month online ahead of print in the journal International Immunopharmacology showed further evidence of NAC’s ability to significantly reduce oxidative stress and inflammation due to exposure to cigarette smoke. [1]
In the study, lung tissue from four groups of laboratory mice were examined for differences in oxidative stress and inflammation markers (proteins and white blood cells known to be present in high numbers as a result of oxidative stress and inflammation).
A control group of mice lung tissue received a normal diet and was not exposed to nicotine, NAC or another antioxidant compound known as eugenol. A cigarette group received exposure to nicotine in addition to a normal diet. Another group received nicotine and eugenol and the final group received nicotine and NAC.
The researchers then examined the four groups’ lung tissue counts of cytokines (proteins) and macrophages (white blood cells) to evaluate the relative influence of nicotine, eugenol and NAC.
First, they discovered that nicotine dramatically increased the number of cytokines and macrophages compared to the control group (approximately 3 fold increase), proving once again the impact of the chemicals in cigarette smoke in generating oxidative stress and inflammation.
Further the researchers reported dramatic decreases in the same oxidative stress and inflammation markers in lung tissue treated with nicotine and either NAC or eugenol (the relative performance between NAC and eugenol was about the same). In fact, the study results showed that NAC (and eugenol) lowered the counts of cytokines and macrophages to nearly the same level as the control group, implying that NAC and eugenol effectively negated the impact of nicotine in the mice lung tissue samples.
The researchers concluded, “…we have also demonstrated that, the importance of eugenol and N-acetylcysteine to exert a new anti-inflammatory [effect] to combat against nicotine-induced immune disorder, as our results clearly established that, co-treatment of eugenol or N-acetylcysteine with nicotine can diminish the nicotine-induced enhanced Th1 cytokines (TNF-α and IL-12) release and in mRNA level, as well as, boost up the Th2 (IL-10 and TGF-β) cytokine release and mRNA level up to more or less control level . In summary, our study has enhanced our understanding of the molecular steps leading to nicotine induced weaken of immune functions by murine [mouse] macrophages, and provided additional rationale for the application of anti-inflammatory therapeutic approaches by eugenol and N-acetylcysteine for different inflammatory [condition] prevention and treatment during nicotine-induced toxicity.”
Respiratory health care professionals will caution that these results may or may not translate to humans exposed to nicotine/cigarette smoke. However, there have been promising live human studies involving NAC therapy as an effective treatment option for chronic inflammation and therefore we believe NAC is worth your consideration.
NAC is an amino acid that helps the body produce glutathione – the most abundant antioxidant found in the human body (including lung tissues). NAC is widely available as a stand-alone dietary supplement or in combination with other antioxidant ingredients. As an aside, NAC is the lead ingredient in our respiratory support antioxidant-rich dietary supplement, Resplenish at a daily dosage of 1200mg. To learn more about Resplenish, please visit www.resplenish.com.
Normally, the body has a supply of neutralizing molecules known as antioxidants that bond to free radicals and essentially render them harmless. Antioxidants are in foods we eat (primarily fruits and vegetables) and can also be consumed in the form of dietary supplements.
But in the vast majority of cigarette smokers, the body’s supply of antioxidants is severely depressed for two reasons. On one hand, the significant counts of free radicals inhaled in cigarette smoke are far larger than even the healthiest of eater’s consumption of antioxidant rich foods. On the other hand, previous research has shown that the average smoker’s diet is low in antioxidant-rich food to begin with. The combination of these two factors (too many free radicals and too few antioxidants) leads to a condition known as oxidative stress.
Respiratory researchers have increasingly turned their attention to the impact of supplementing antioxidants in smokers and those with chronic shortness of breath to see if they can reduce oxidative stress and inflammation (and thereby contribute to improving shortness of breath symptoms).
We have previously written a number of articles regarding a number of recent studies regarding antioxidants that have shown promise in reducing oxidative stress and inflammation among those exposed to cigarette smoke and those with respiratory health conditions, including COPD. One such antioxidant is n-acetylcysteine (often referred to as NAC). NAC has been studied extensively for its anti-inflammatory properties and has also shown effectiveness in boosting exercise tolerance among COPD patients participating in a pulmonary rehabilitation exercise program.
A new research paper published this month online ahead of print in the journal International Immunopharmacology showed further evidence of NAC’s ability to significantly reduce oxidative stress and inflammation due to exposure to cigarette smoke. [1]
In the study, lung tissue from four groups of laboratory mice were examined for differences in oxidative stress and inflammation markers (proteins and white blood cells known to be present in high numbers as a result of oxidative stress and inflammation).
A control group of mice lung tissue received a normal diet and was not exposed to nicotine, NAC or another antioxidant compound known as eugenol. A cigarette group received exposure to nicotine in addition to a normal diet. Another group received nicotine and eugenol and the final group received nicotine and NAC.
The researchers then examined the four groups’ lung tissue counts of cytokines (proteins) and macrophages (white blood cells) to evaluate the relative influence of nicotine, eugenol and NAC.
First, they discovered that nicotine dramatically increased the number of cytokines and macrophages compared to the control group (approximately 3 fold increase), proving once again the impact of the chemicals in cigarette smoke in generating oxidative stress and inflammation.
Further the researchers reported dramatic decreases in the same oxidative stress and inflammation markers in lung tissue treated with nicotine and either NAC or eugenol (the relative performance between NAC and eugenol was about the same). In fact, the study results showed that NAC (and eugenol) lowered the counts of cytokines and macrophages to nearly the same level as the control group, implying that NAC and eugenol effectively negated the impact of nicotine in the mice lung tissue samples.
The researchers concluded, “…we have also demonstrated that, the importance of eugenol and N-acetylcysteine to exert a new anti-inflammatory [effect] to combat against nicotine-induced immune disorder, as our results clearly established that, co-treatment of eugenol or N-acetylcysteine with nicotine can diminish the nicotine-induced enhanced Th1 cytokines (TNF-α and IL-12) release and in mRNA level, as well as, boost up the Th2 (IL-10 and TGF-β) cytokine release and mRNA level up to more or less control level . In summary, our study has enhanced our understanding of the molecular steps leading to nicotine induced weaken of immune functions by murine [mouse] macrophages, and provided additional rationale for the application of anti-inflammatory therapeutic approaches by eugenol and N-acetylcysteine for different inflammatory [condition] prevention and treatment during nicotine-induced toxicity.”
Respiratory health care professionals will caution that these results may or may not translate to humans exposed to nicotine/cigarette smoke. However, there have been promising live human studies involving NAC therapy as an effective treatment option for chronic inflammation and therefore we believe NAC is worth your consideration.
NAC is an amino acid that helps the body produce glutathione – the most abundant antioxidant found in the human body (including lung tissues). NAC is widely available as a stand-alone dietary supplement or in combination with other antioxidant ingredients. As an aside, NAC is the lead ingredient in our respiratory support antioxidant-rich dietary supplement, Resplenish at a daily dosage of 1200mg. To learn more about Resplenish, please visit www.resplenish.com.
[1] Kar Mahapatra S, et al. Alteration of immune function and Th1/Th2 cytokine balance in nicotine-induced murine macrophages: Immunomodulatory role of eugenol and N-acetylcysteine. Int Immunopharmacol. 2011 Jan 13 [Epub ahead of print].
Thursday, January 27, 2011
Gold Kiwi – Powerful Fruit for a Healthy Heart
So you know the old adage – “an apple a day helps keep the doctor away”, right? Well, when it comes to heart health it appears the better option is gold kiwi fruit by a long-shot, so says a new study published this month in the journal Biological and Pharmaceutical Bulletin.
In their study, the Japanese research team examined seven fruits that are known to have high antioxidant content: gold kiwi, green kiwi, navel orange, mandarin orange, white grapefruit, ruby grapefruit, and apple (the researchers did not specify the apple type tested). ¹
In particular, the study team desired to know which of the fruits had the highest concentration of polyphenols (powerful antioxidants that offset the effects of molecules known as free radicals), which were most effective in reducing lipid oxidation (the process whereby fatty acids are turned into free radicals that damage cells), and which were most effective in eliminating free ranging hydrogen peroxide (another type of free radical produced as a byproduct of the body’s process to create and use energy at the cellular level).
People with high levels of unhealthy lipids (LDL cholesterol) in their blood serum (oxidized LDL in particular) are considered at high risk for cardiovascular conditions such as atherosclerosis, heart attacks, strokes and other maladies. By reducing the amount of oxidized lipids and the number of other free radicals in blood serum, physicians believe people can significantly reduce their risk of heart disease. A common way to reduce free radicals and oxidized lipids is to consume more antioxidant rich food, hence the interest of the researchers in these fruits.
The short takeaway – gold kiwi crushed the competing fruits on all measures. In fact, apples came in dead last on every measure!
For example, to assess polyphenol content, the researchers cut equal weight pieces of each fruit flesh and blended in a mixer for about 30 seconds. The blended fruit juices were then processed through a centrifuge for 10 minutes and subsequently strained through a filter. The strained juice was centrifuged again – this time for one hour - and then samples were taken of the remaining, centrifuged juice.
Using this method, the researchers found that gold kiwi’s polyphenols content was approximately 1.04 milligrams per milliliter, green kiwi was second with 0.85 mg/ml, navel oranges were third at 0.80 mg/ml, while apples were dead last at 0.13 mg/ml!
To assess the antioxidant properties of these polyphenols, the researchers then mixed a 1% concentration of the fruit juice solutions with lipids from egg yolk and then irradiated the mixture for various time intervals (irradiation via UV rays causes the lipids to oxidize). After irradiation, the study team examined the counts of oxidized lipid molecules remaining in the respective fruit juice mixtures. They found gold kiwi and navel orange both inhibited oxidation of 60% of the lipids. Again, apples were dead last at 23%.
To further evaluate the antioxidant properties of the various fruits, the researchers mixed a 5% concentration of the fruit juice solutions with hydrogen peroxide and let the mixture sit for two hours. Then the researchers measured the amount of hydrogen peroxide eliminated by the fruit juices. Once again, gold kiwi significantly outperformed the other fruits, eliminating over 60% of the hydrogen peroxide. No other fruit achieved greater than 30% elimination and apples again lagged the field at less than 10%.
The study authors concluded, “Therefore, we propose the novel possibility that daily consumption of kiwi fruit is effective on decrease of oxidative stress and further prevention of disease by excessive oxidation…All these indicators showed the highest activity for gold kiwi, demonstrating that gold kiwi has strong anti-oxidant effects. Overall, green kiwi had lower anti-oxidant effects than gold kiwi, but had stronger effects than the other fruits.”
So, if you’d like to add an easy, tasty and heart healthy fruit to your daily diet, consider gold kiwi. It’s a little more challenging to find in a retail grocery store (and a little more expensive to buy) so you may need to look for it in a specialty/gourmet food store.
According to the prime producer of gold kiwi fruit, a New Zealand company called Zespri, the biggest difference between the green and gold kiwi is taste, “ While green kiwifruit has a tangier, more tart flavor, gold kiwifruit is mellow and tropical, a mixture of mango, melon and citrus flavors. People who find green kiwifruit too tart usually love gold. As for other differences, the color is gold, instead of green, and it is tear-drop shaped, with a smooth skin and a crown on the top. Finally, while you might need to wait a few days for green to ripen, gold kiwifruit is always ready to eat.” ²
(Article by Kevin P. Donoghue originally published on January 13, 2011 for Peak Health Advocate, www.peakhealthadvocate.com)
¹ Iwasawa H, et al. Anti-oxidant Effects of Kiwi Fruit in Vitro and in Vivo. Biol Pharm Bull. 2011;34(1):128-34.
² Zespri Kiwifruit North America web site, http://www.zesprikiwi.com/faqs.htm, accessed January 12, 2011.
In their study, the Japanese research team examined seven fruits that are known to have high antioxidant content: gold kiwi, green kiwi, navel orange, mandarin orange, white grapefruit, ruby grapefruit, and apple (the researchers did not specify the apple type tested). ¹
In particular, the study team desired to know which of the fruits had the highest concentration of polyphenols (powerful antioxidants that offset the effects of molecules known as free radicals), which were most effective in reducing lipid oxidation (the process whereby fatty acids are turned into free radicals that damage cells), and which were most effective in eliminating free ranging hydrogen peroxide (another type of free radical produced as a byproduct of the body’s process to create and use energy at the cellular level).
People with high levels of unhealthy lipids (LDL cholesterol) in their blood serum (oxidized LDL in particular) are considered at high risk for cardiovascular conditions such as atherosclerosis, heart attacks, strokes and other maladies. By reducing the amount of oxidized lipids and the number of other free radicals in blood serum, physicians believe people can significantly reduce their risk of heart disease. A common way to reduce free radicals and oxidized lipids is to consume more antioxidant rich food, hence the interest of the researchers in these fruits.
The short takeaway – gold kiwi crushed the competing fruits on all measures. In fact, apples came in dead last on every measure!
For example, to assess polyphenol content, the researchers cut equal weight pieces of each fruit flesh and blended in a mixer for about 30 seconds. The blended fruit juices were then processed through a centrifuge for 10 minutes and subsequently strained through a filter. The strained juice was centrifuged again – this time for one hour - and then samples were taken of the remaining, centrifuged juice.
Using this method, the researchers found that gold kiwi’s polyphenols content was approximately 1.04 milligrams per milliliter, green kiwi was second with 0.85 mg/ml, navel oranges were third at 0.80 mg/ml, while apples were dead last at 0.13 mg/ml!
To assess the antioxidant properties of these polyphenols, the researchers then mixed a 1% concentration of the fruit juice solutions with lipids from egg yolk and then irradiated the mixture for various time intervals (irradiation via UV rays causes the lipids to oxidize). After irradiation, the study team examined the counts of oxidized lipid molecules remaining in the respective fruit juice mixtures. They found gold kiwi and navel orange both inhibited oxidation of 60% of the lipids. Again, apples were dead last at 23%.
To further evaluate the antioxidant properties of the various fruits, the researchers mixed a 5% concentration of the fruit juice solutions with hydrogen peroxide and let the mixture sit for two hours. Then the researchers measured the amount of hydrogen peroxide eliminated by the fruit juices. Once again, gold kiwi significantly outperformed the other fruits, eliminating over 60% of the hydrogen peroxide. No other fruit achieved greater than 30% elimination and apples again lagged the field at less than 10%.
The study authors concluded, “Therefore, we propose the novel possibility that daily consumption of kiwi fruit is effective on decrease of oxidative stress and further prevention of disease by excessive oxidation…All these indicators showed the highest activity for gold kiwi, demonstrating that gold kiwi has strong anti-oxidant effects. Overall, green kiwi had lower anti-oxidant effects than gold kiwi, but had stronger effects than the other fruits.”
So, if you’d like to add an easy, tasty and heart healthy fruit to your daily diet, consider gold kiwi. It’s a little more challenging to find in a retail grocery store (and a little more expensive to buy) so you may need to look for it in a specialty/gourmet food store.
According to the prime producer of gold kiwi fruit, a New Zealand company called Zespri, the biggest difference between the green and gold kiwi is taste, “ While green kiwifruit has a tangier, more tart flavor, gold kiwifruit is mellow and tropical, a mixture of mango, melon and citrus flavors. People who find green kiwifruit too tart usually love gold. As for other differences, the color is gold, instead of green, and it is tear-drop shaped, with a smooth skin and a crown on the top. Finally, while you might need to wait a few days for green to ripen, gold kiwifruit is always ready to eat.” ²
(Article by Kevin P. Donoghue originally published on January 13, 2011 for Peak Health Advocate, www.peakhealthadvocate.com)
¹ Iwasawa H, et al. Anti-oxidant Effects of Kiwi Fruit in Vitro and in Vivo. Biol Pharm Bull. 2011;34(1):128-34.
² Zespri Kiwifruit North America web site, http://www.zesprikiwi.com/faqs.htm, accessed January 12, 2011.
Monday, January 24, 2011
Pulmonary rehabilitation increases exercise capacity and reduces shortness of breath
This month, a new study published in the journal Archives of Physical Medicine and Rehabilitation, clearly demonstrated again the physical gains achieved by COPD patients participating in a pulmonary rehabilitation program.
As regular readers of our articles can attest, we believe strongly in the COPD treatment, pulmonary rehabilitation, and its proven ability to reduce shortness of breath, improve physical endurance and strength, as well as its impact in improving COPD patient quality of daily living. Still, it remains an under-prescribed treatment by physicians and an underutilized resource by COPD patients.
As further evidence of pulmonary rehab’s effectiveness, a group of Dutch researchers examined the impact of a 12 week pulmonary rehab program in 18 moderate-to-severe COPD patients. They discovered the 12 week program of aerobic exercise and strength training improved cycling endurance of the study participants by 160% and walking distance achieved in a 6-minute timed test improved by 14%. In addition, at the end of the program, self-reported dyspnea (shortness of breath) during the activities tested had declined by 9-17%. [1]
The study was intended to assess whether conditioning tests traditionally used to validate pulmonary rehab’s effectiveness are better measures than observed improvements in training performance. In other words, is a comparison of 6 minute walk test distances recorded at the beginning and end of a rehab program a better way to determine whether COPD patients derived benefit from the program versus measuring increases in how much weight a patient could lift or how much more resistance a patient could withstand during cycling.
The researchers ultimately concluded that the traditional conditioning tests are better measurements of COPD patient improvement, but to us the value of the study was in reaffirming the benefits of pulmonary rehab in general – regardless of measurement preference.
The pulmonary rehab program in the study involved 1.5 hour exercise sessions, 3 days per week over a 12 week period. The exercises included in each session (with intermittent rest breaks) included:
• 20 minutes of interval cycling (alternating sessions of heavy and light intensity cycling),
• 5 minutes of unsupported arm dumbbell lifting exercises (2.5 minutes for each arm)
• 5 minute sit/walk slalom course designed to simulate everyday sit/walk activities at home
• 6-12 minutes of endurance walking exercise on a treadmill
• Additional strength resistance training of abdominal, shoulder, and leg muscle groups
Prior to beginning the rehab program, and again following the last rehab session, the researchers had the study participants perform three conditioning tests (constant work-rate cycling, 6-minute walk test and maximal incremental cycling). To determine the rehab program’s effectiveness, researchers evaluated the pre- and post- rehab conditioning test results of the study subjects. They also assessed improvements in the amount of weight lifted in the arm exercise and resistance load achieved during the interval cycling from the beginning of the program to the end.
While the patients did see significant improvements in amount of weight lifted, number of repetitions performed, and resistance load achieved during interval cycling, the researchers found the traditional conditioning tests to be a better gauge of the pulmonary rehabilitation program’s impact.
The study authors concluded, “Indeed, in the current study, exercise duration and walking distance during submaximal exercise tests (constant workrate cycling, 6-min walk test) increased by 160% and 14%, respectively, and both of these have been reported to be of clinical relevance…The current study also included the training activities in the evaluation. During the 12 weeks of training, all patients were able to perform training activities with higher loads and weight for a longer duration, and with a trend toward less dyspnea and fatigue.”
Pulmonary rehabilitation works and if you are a COPD patient interested in improving how you feel, you owe it to yourself to discuss pulmonary rehabilitation with your pulmonologist. If you can’t gain entry to a rehab program in your area (or if one is not offered), we recommend asking your doctor to recommend an exercise program appropriate for your particular circumstance.
Alternatively, we have created a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and European Respiratory Society that is available in our Breathe Better for Life guidebook, www.breathebetterforlife.com. Our program also incorporates guidelines established by the American College of Sports Medicine for those with chronic respiratory conditions.
As regular readers of our articles can attest, we believe strongly in the COPD treatment, pulmonary rehabilitation, and its proven ability to reduce shortness of breath, improve physical endurance and strength, as well as its impact in improving COPD patient quality of daily living. Still, it remains an under-prescribed treatment by physicians and an underutilized resource by COPD patients.
As further evidence of pulmonary rehab’s effectiveness, a group of Dutch researchers examined the impact of a 12 week pulmonary rehab program in 18 moderate-to-severe COPD patients. They discovered the 12 week program of aerobic exercise and strength training improved cycling endurance of the study participants by 160% and walking distance achieved in a 6-minute timed test improved by 14%. In addition, at the end of the program, self-reported dyspnea (shortness of breath) during the activities tested had declined by 9-17%. [1]
The study was intended to assess whether conditioning tests traditionally used to validate pulmonary rehab’s effectiveness are better measures than observed improvements in training performance. In other words, is a comparison of 6 minute walk test distances recorded at the beginning and end of a rehab program a better way to determine whether COPD patients derived benefit from the program versus measuring increases in how much weight a patient could lift or how much more resistance a patient could withstand during cycling.
The researchers ultimately concluded that the traditional conditioning tests are better measurements of COPD patient improvement, but to us the value of the study was in reaffirming the benefits of pulmonary rehab in general – regardless of measurement preference.
The pulmonary rehab program in the study involved 1.5 hour exercise sessions, 3 days per week over a 12 week period. The exercises included in each session (with intermittent rest breaks) included:
• 20 minutes of interval cycling (alternating sessions of heavy and light intensity cycling),
• 5 minutes of unsupported arm dumbbell lifting exercises (2.5 minutes for each arm)
• 5 minute sit/walk slalom course designed to simulate everyday sit/walk activities at home
• 6-12 minutes of endurance walking exercise on a treadmill
• Additional strength resistance training of abdominal, shoulder, and leg muscle groups
Prior to beginning the rehab program, and again following the last rehab session, the researchers had the study participants perform three conditioning tests (constant work-rate cycling, 6-minute walk test and maximal incremental cycling). To determine the rehab program’s effectiveness, researchers evaluated the pre- and post- rehab conditioning test results of the study subjects. They also assessed improvements in the amount of weight lifted in the arm exercise and resistance load achieved during the interval cycling from the beginning of the program to the end.
While the patients did see significant improvements in amount of weight lifted, number of repetitions performed, and resistance load achieved during interval cycling, the researchers found the traditional conditioning tests to be a better gauge of the pulmonary rehabilitation program’s impact.
The study authors concluded, “Indeed, in the current study, exercise duration and walking distance during submaximal exercise tests (constant workrate cycling, 6-min walk test) increased by 160% and 14%, respectively, and both of these have been reported to be of clinical relevance…The current study also included the training activities in the evaluation. During the 12 weeks of training, all patients were able to perform training activities with higher loads and weight for a longer duration, and with a trend toward less dyspnea and fatigue.”
Pulmonary rehabilitation works and if you are a COPD patient interested in improving how you feel, you owe it to yourself to discuss pulmonary rehabilitation with your pulmonologist. If you can’t gain entry to a rehab program in your area (or if one is not offered), we recommend asking your doctor to recommend an exercise program appropriate for your particular circumstance.
Alternatively, we have created a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and European Respiratory Society that is available in our Breathe Better for Life guidebook, www.breathebetterforlife.com. Our program also incorporates guidelines established by the American College of Sports Medicine for those with chronic respiratory conditions.
[1] Hanneke A, et al. Exercises Commonly Used in Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Cardiopulmonary Responses and Effect Over Time. Arch Phys Med Rehabil. 2011;92:111-117.
Friday, January 21, 2011
Skipping breakfast is bad medicine for smokers
In researching an article about the dangers of skipping breakfast we wrote recently for a different publication, we came across a 2009 study that examined the breakfast eating habits of current smokers. Though the research is not hot off the presses, we thought the results were worth sharing with you knowing that many of you are active smokers. The most startling finding in the study - current smokers who regularly omitted a morning meal were 4.7 times more likely to develop diabetes than current smokers who ate breakfast every day. ¹
The Japan-based research team also found that 63% of current smokers in their study regularly skipped breakfast, evidently echoing previous studies that have shown a strong correlation between smokers and breakfast skipping tendencies.
In other studies, skipping breakfast has been shown to increase fasting lipids (fats in the blood stream), elevate blood sugar, and impair insulin control. All of these impacts are considered contributing factors in the development of diabetes. The researchers in this study speculated that smoking seems to accelerate these effects of breakfast skipping leading to a pronounced increase in the odds of developing diabetes.
How strong is the influence of breakfast skipping combined with smoking in the risk of developing diabetes? Well, the results of this study indicated that smokers who regularly ate breakfast had the same, low odds of developing diabetes as never smokers who regularly ate breakfast. But when compared with smokers who never or rarely eat breakfast, the odds ratio of developing diabetes were 4.7 times higher than both groups of regular breakfast consumers.
In addition to diabetes risk, there are a host of other studies that have been published over the past few years that highlight other significant health risks associated with eschewing a morning meal including increased risk for cardiovascular disease and obesity. Further, a number of previously reported papers have shown strong correlations between breakfast skipping and poor mental focus, poor sleep quality and persistent fatigue.
In fact, in the Japanese smoker/breakfast skipping study, the paper’s authors also noted that smokers who skipped breakfast were more than 2 times likely than regular breakfast eaters (both smokers and non-smokers) to report poor sleep quality.
If you are interested in adding a morning meal to your daily routine, a number of breakfast-oriented studies have determined the healthiest choice is ready-to-eat cereal made from whole grains combined with low-fat milk. For those wishing to spice it up a bit, add a piece of fruit into the mix.
Cereals made with whole grains typically have a higher fiber content, lower glycemic index value (glycemic index is a measure applied by dieticians to assess the blood sugar raising effects of various foods), and less harmful fats/oils. Before you start to groan imagining eating tasteless, coarse cereals, check out this list of healthy and unhealthy cereal choices developed by Dr. Diane Mirkin.
If you can’t see your way chomping on bran flakes to start your day, at least try to avoid breakfast foods that have been shown to possess a high glycemic index. High glycemic index foods are strongly correlated with obesity, diabetes, high blood pressure and other cardiovascular risk factors. Some of the biggest breakfast offenders on this list include doughnuts, waffles, bagels, and toast made from white bread.
However, this study points out smokers would be well served to add a regular meal to begin the day (regardless of breakfast food choice) so as to avoid the risk of adding insult to injury by compounding the respiratory effects of smoking by increasing the odds of contracting diabetes.
¹ Nishiyama M, et al. The Combined Unhealthy Behaviors of Breakfast Skipping and Smoking Are Associated with the Prevalence of Diabetes Mellitus. Tokohu J. Exp. Med. 2009;218:259-264.
...
The Japan-based research team also found that 63% of current smokers in their study regularly skipped breakfast, evidently echoing previous studies that have shown a strong correlation between smokers and breakfast skipping tendencies.
In other studies, skipping breakfast has been shown to increase fasting lipids (fats in the blood stream), elevate blood sugar, and impair insulin control. All of these impacts are considered contributing factors in the development of diabetes. The researchers in this study speculated that smoking seems to accelerate these effects of breakfast skipping leading to a pronounced increase in the odds of developing diabetes.
How strong is the influence of breakfast skipping combined with smoking in the risk of developing diabetes? Well, the results of this study indicated that smokers who regularly ate breakfast had the same, low odds of developing diabetes as never smokers who regularly ate breakfast. But when compared with smokers who never or rarely eat breakfast, the odds ratio of developing diabetes were 4.7 times higher than both groups of regular breakfast consumers.
In addition to diabetes risk, there are a host of other studies that have been published over the past few years that highlight other significant health risks associated with eschewing a morning meal including increased risk for cardiovascular disease and obesity. Further, a number of previously reported papers have shown strong correlations between breakfast skipping and poor mental focus, poor sleep quality and persistent fatigue.
In fact, in the Japanese smoker/breakfast skipping study, the paper’s authors also noted that smokers who skipped breakfast were more than 2 times likely than regular breakfast eaters (both smokers and non-smokers) to report poor sleep quality.
If you are interested in adding a morning meal to your daily routine, a number of breakfast-oriented studies have determined the healthiest choice is ready-to-eat cereal made from whole grains combined with low-fat milk. For those wishing to spice it up a bit, add a piece of fruit into the mix.
Cereals made with whole grains typically have a higher fiber content, lower glycemic index value (glycemic index is a measure applied by dieticians to assess the blood sugar raising effects of various foods), and less harmful fats/oils. Before you start to groan imagining eating tasteless, coarse cereals, check out this list of healthy and unhealthy cereal choices developed by Dr. Diane Mirkin.
If you can’t see your way chomping on bran flakes to start your day, at least try to avoid breakfast foods that have been shown to possess a high glycemic index. High glycemic index foods are strongly correlated with obesity, diabetes, high blood pressure and other cardiovascular risk factors. Some of the biggest breakfast offenders on this list include doughnuts, waffles, bagels, and toast made from white bread.
However, this study points out smokers would be well served to add a regular meal to begin the day (regardless of breakfast food choice) so as to avoid the risk of adding insult to injury by compounding the respiratory effects of smoking by increasing the odds of contracting diabetes.
¹ Nishiyama M, et al. The Combined Unhealthy Behaviors of Breakfast Skipping and Smoking Are Associated with the Prevalence of Diabetes Mellitus. Tokohu J. Exp. Med. 2009;218:259-264.
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Monday, January 17, 2011
Mate tea reduces inflammation caused by cigarette smoke
On many occasions we have written about the power of antioxidants in reducing oxidative stress and inflammation among smokers and those with respiratory conditions such as COPD. We’ve discussed studies examining dietary antioxidant supplements, foods with high antioxidant content, and even cigarettes laced with antioxidants. Now comes a new study about an antioxidant rich beverage, Mate tea, and its ability to reduce inflammation caused by cigarette smoke. (1)
Mate tea is a beverage made by brewing the dried leaves and twigs of the herb yerba mate. Once steeped, it can be served hot or cold and is a popular beverage in many Latin American and Arabian countries. Yerba mate is known to be a rich source of an antioxidant form called xanthines. Interestingly, caffeine is considered one of the more powerful xanthines.
The research article, published online ahead of print in the journal Experimental Lung Research, investigated supplementing Mate tea to cigarette smoke-exposed laboratory mice. The researchers divided 60 laboratory mice into four groups. The control group received no exposure to cigarette smoke and Mate tea. A second group received the Mate tea but no cigarette smoke. A third group was exposed to cigarette smoke but received no Mate tea. The last group was exposed to both cigarette smoke and Mate tea.
The groups exposed to cigarette smoke received the equivalent of 12 cigarettes a day over a 60 day period. The groups receiving Mate tea received 500 milligrams per kilogram of body weight daily over the same 60 day period. At the end of the study, the mice were euthanized, their lungs removed and analyzed. The researchers evaluated both statistical measures of inflammation (counting certain white blood cells known to be present in high numbers in inflamed lung tissue), and observational differences in lung tissue samples examined under a microscope.
They found dramatic differences in both evaluation sets. For example, counts of inflammation related white blood cells known neutrophils were measured at 8.7 squared millimeters in the control group while the cigarette smoke exposed group measured 71 (a huge difference and a clear indication of the impact of cigarette smoke’s ability to inflame lung tissue). By comparison, the neutrophil count in cigarette smoke exposed mice who also received Mate tea was only 27. In other words, while the cigarette/Mate group showed some inflammation, it was significantly lower than the mice exposed to cigarette smoke only (61% lower). Similar results were found for other inflammation related white blood cell types measured by the study team.
When looking at samples of lung tissue under a microscope, the researchers found significantly enlarged air spaces in the cigarette smoke exposed mice in comparison to the control group (enlarged air spaces are indicative of emphysema and are a by-product of persistent inflammation). On average, the volume density of the air spaces in the cigarette group was 16% higher than the control. By comparison, the volume density of the cigarette/Mate group was only 6% higher than the control group. Again, this shows that the antioxidant properties of Mate tea were effective in reducing inflammation associated with cigarette smoke.
The researchers concluded, “This study examined Mate tea in response to CS (cigarette smoke) exposure in the mouse. The protection observed, by both histological and biochemical analyses, leads us to suggest that Mate tea provides beneficial effects against lung damage caused by CS exposure in the mouse. In the CS+Mate group, few alterations to the alveolar spaces were observed, elastic fibers were preserved, and there were fewer macrophages and neutrophils recruited to alveoli compared to the CS group... Our results point to Mate tea as a nutritional antioxidant against lung injury in mice exposed chronically to CS and support efforts to investigate the beneficial effects of Mate tea on CS related lung injury in other animal models and humans.”
While many pulmonology professionals will be reluctant to recommend consuming Mate tea to COPD patients and smokers based on a mouse study, we think it is of value to share the study results with you. In the pursuit of better breathing, it is clear that regular consumption of antioxidants by any means possible is beneficial to those who smoke and have respiratory conditions. And certainly, there is no harm in adding a cup of Mate tea to your daily routine.
If you don’t think Mate is your cup of tea (sorry for the bad pun) to receive antioxidants, we recommend you either consider adding an antioxidant-rich multi-nutrient such as our Resplenish dietary supplement, www.resplenish.com, and/or adding antioxidant rich foods to your daily diet – an excellent choice is gold kiwi (check out our new article on gold kiwi in our e-letter Breathe Better for Life News). For other articles we’ve written regarding inflammation, oxidative stress, and antioxidants studied by respiratory health researchers, visit our Breathe Better Blog.
(1) Lanzetti M, et al. Mate tea ameliorates emphysema in cigarette smoke-exposed mice. Experimental Lung Research. 2011 Jan 6. [Epub ahead of print].
Mate tea is a beverage made by brewing the dried leaves and twigs of the herb yerba mate. Once steeped, it can be served hot or cold and is a popular beverage in many Latin American and Arabian countries. Yerba mate is known to be a rich source of an antioxidant form called xanthines. Interestingly, caffeine is considered one of the more powerful xanthines.
The research article, published online ahead of print in the journal Experimental Lung Research, investigated supplementing Mate tea to cigarette smoke-exposed laboratory mice. The researchers divided 60 laboratory mice into four groups. The control group received no exposure to cigarette smoke and Mate tea. A second group received the Mate tea but no cigarette smoke. A third group was exposed to cigarette smoke but received no Mate tea. The last group was exposed to both cigarette smoke and Mate tea.
The groups exposed to cigarette smoke received the equivalent of 12 cigarettes a day over a 60 day period. The groups receiving Mate tea received 500 milligrams per kilogram of body weight daily over the same 60 day period. At the end of the study, the mice were euthanized, their lungs removed and analyzed. The researchers evaluated both statistical measures of inflammation (counting certain white blood cells known to be present in high numbers in inflamed lung tissue), and observational differences in lung tissue samples examined under a microscope.
They found dramatic differences in both evaluation sets. For example, counts of inflammation related white blood cells known neutrophils were measured at 8.7 squared millimeters in the control group while the cigarette smoke exposed group measured 71 (a huge difference and a clear indication of the impact of cigarette smoke’s ability to inflame lung tissue). By comparison, the neutrophil count in cigarette smoke exposed mice who also received Mate tea was only 27. In other words, while the cigarette/Mate group showed some inflammation, it was significantly lower than the mice exposed to cigarette smoke only (61% lower). Similar results were found for other inflammation related white blood cell types measured by the study team.
When looking at samples of lung tissue under a microscope, the researchers found significantly enlarged air spaces in the cigarette smoke exposed mice in comparison to the control group (enlarged air spaces are indicative of emphysema and are a by-product of persistent inflammation). On average, the volume density of the air spaces in the cigarette group was 16% higher than the control. By comparison, the volume density of the cigarette/Mate group was only 6% higher than the control group. Again, this shows that the antioxidant properties of Mate tea were effective in reducing inflammation associated with cigarette smoke.
The researchers concluded, “This study examined Mate tea in response to CS (cigarette smoke) exposure in the mouse. The protection observed, by both histological and biochemical analyses, leads us to suggest that Mate tea provides beneficial effects against lung damage caused by CS exposure in the mouse. In the CS+Mate group, few alterations to the alveolar spaces were observed, elastic fibers were preserved, and there were fewer macrophages and neutrophils recruited to alveoli compared to the CS group... Our results point to Mate tea as a nutritional antioxidant against lung injury in mice exposed chronically to CS and support efforts to investigate the beneficial effects of Mate tea on CS related lung injury in other animal models and humans.”
While many pulmonology professionals will be reluctant to recommend consuming Mate tea to COPD patients and smokers based on a mouse study, we think it is of value to share the study results with you. In the pursuit of better breathing, it is clear that regular consumption of antioxidants by any means possible is beneficial to those who smoke and have respiratory conditions. And certainly, there is no harm in adding a cup of Mate tea to your daily routine.
If you don’t think Mate is your cup of tea (sorry for the bad pun) to receive antioxidants, we recommend you either consider adding an antioxidant-rich multi-nutrient such as our Resplenish dietary supplement, www.resplenish.com, and/or adding antioxidant rich foods to your daily diet – an excellent choice is gold kiwi (check out our new article on gold kiwi in our e-letter Breathe Better for Life News). For other articles we’ve written regarding inflammation, oxidative stress, and antioxidants studied by respiratory health researchers, visit our Breathe Better Blog.
(1) Lanzetti M, et al. Mate tea ameliorates emphysema in cigarette smoke-exposed mice. Experimental Lung Research. 2011 Jan 6. [Epub ahead of print].
Wednesday, December 29, 2010
Calcium deficiency and COPD
A new Japanese research study published in the Asia Pacific Journal of Clinical Nutrition points to dietary calcium deficiency as a risk factor for developing COPD. In particular, their research findings showed that study subjects who consumed the most dietary calcium had a 35% lower risk of developing COPD than those who consumed the least amount of calcium-rich food.
The goal of the study was to determine if there were correlations between the dietary consumption of certain key minerals and prevalence of COPD. To assess these correlations, the researchers analyzed the dietary habits of 278 Japanese COPD patients and 340 healthy Japanese adults. The researchers surveyed the study participants regarding their eating habits and then used standard nutritional content tables to calculate the mineral content of the foods consumed by study participants. (Hirayama F, et al. Dietary intake of six minerals in relation to the risk of chronic obstructive pulmonary disease. Asia Pac J Clin Nutr. 2010;19(4):572-7)
Of the six minerals examined, only two showed correlations between low mineral levels and high prevalence of COPD – calcium and iron. Of the two, calcium was the most pronounced.
Calcium deficiency is also a known contributor to the development of osteoporosis. We’ve previously written about the high incidence of osteoporosis among COPD patients (estimated to exist in 50-65% of COPD patients). In those previous articles we’ve highlighted the root causes as a combination of sedentary lifestyle, Vitamin D deficiency (from lack of exposure to direct sunlight), and prolonged exposure to cigarette smoke. Click here and here to read these previous articles. It is likely therefore that calcium deficiency plays a role in the development of osteoporosis among COPD patients as well.
Foods that are naturally rich in calcium content include certain fish such as salmon, tuna, sardines and mackerel. Additionally, soy beans and other soy based products (such as tofu) contain high levels of calcium. Dairy products such as milk, cheese, egg yolks, and yogurt are also good sources of calcium.
The goal of the study was to determine if there were correlations between the dietary consumption of certain key minerals and prevalence of COPD. To assess these correlations, the researchers analyzed the dietary habits of 278 Japanese COPD patients and 340 healthy Japanese adults. The researchers surveyed the study participants regarding their eating habits and then used standard nutritional content tables to calculate the mineral content of the foods consumed by study participants. (Hirayama F, et al. Dietary intake of six minerals in relation to the risk of chronic obstructive pulmonary disease. Asia Pac J Clin Nutr. 2010;19(4):572-7)
Of the six minerals examined, only two showed correlations between low mineral levels and high prevalence of COPD – calcium and iron. Of the two, calcium was the most pronounced.
Calcium deficiency is also a known contributor to the development of osteoporosis. We’ve previously written about the high incidence of osteoporosis among COPD patients (estimated to exist in 50-65% of COPD patients). In those previous articles we’ve highlighted the root causes as a combination of sedentary lifestyle, Vitamin D deficiency (from lack of exposure to direct sunlight), and prolonged exposure to cigarette smoke. Click here and here to read these previous articles. It is likely therefore that calcium deficiency plays a role in the development of osteoporosis among COPD patients as well.
Foods that are naturally rich in calcium content include certain fish such as salmon, tuna, sardines and mackerel. Additionally, soy beans and other soy based products (such as tofu) contain high levels of calcium. Dairy products such as milk, cheese, egg yolks, and yogurt are also good sources of calcium.
Tuesday, December 28, 2010
New study shows acai berry helpful for smokers
A novel study published online ahead of print in the journal Food and Chemical Toxicology explored injecting the extract of a potent antioxidant known as acai berry into cigarettes that were in turn inhaled by laboratory mice. The researchers discovered that the acai berry treated cigarettes produced far less inflammation in mice receiving the antioxidant compared to mice exposed to cigarette smoke alone.
The purpose of the study was to determine whether providing a powerful antioxidant along with cigarette smoke would lessen the likelihood of lung tissue damage and associated inflammation. The researchers chose acai berry extract (specifically the extract of the acai berry stone [seed]) because previous research studies involving plant-based antioxidants known as proanthocyanidins have shown similar anti-inflammatory effects.
In this study, the researchers divided the 60 mice in the study into three groups. One group, the control group, received neither exposure to cigarette smoke or acai berry extract. A second group, the cigarette group, was exposed to cigarette smoke from 12 cigarettes daily over a 60 day period. The third group, the acai group, was exposed to cigarette smoke in the same manner as the cigarette group but received the cigarette smoke from cigarettes injected with the acai berry extract. (de Moura RS, et al. Addition of acai (Euterpe oleracea) to cigarettes has a protective effects against emphysema in mice. Food Chem Toxicol. 2010 Dec 10. [Epub ahead of print])
At the end of the 60 day period, all mice were euthanized and lung tissue samples were extracted. The researchers viewed lung tissue samples via microscope to assess the size of alveolar spaces between the three groups (in emphysema, alveolar spaces enlarge). In addition, the lung tissue was analyzed for counts of proteins and white blood cells that are known to be present in large numbers in inflamed airway tissue.
The study team discovered that the cigarette group had 38% greater alteration to alveolar tissue in comparison to the control group. The acai group had 25% lower alteration compared to the cigarette group (meaning the acai group’s lung tissue samples showed less alteration than the cigarette group but more alteration in comparison with the control group).
When analyzing the inflammation markers, researchers found 400% more leukocytes in the cigarette group compared to the control group. The acai group had 65% fewer leukocytes than the cigarette group (again showing the acai group lessened the impact of cigarette smoke). Similar findings were found for other markers such as macrophages and neutrophils.
The study team concluded, “This study demonstrated for the first time that adding a hydro-alcoholic extract of acai stone to cigarettes significantly reduced pulmonary inflammation, oxidative stress, and CS-induced emphysema in mice… Because lung damage induced by CS is mainly due to inflammation and oxidative stress, it seems likely that acai’s anti-inflammatory and antioxidant properties underlie these protective effects…The present study demonstrated that acai extract in cigarettes has a preventive action; that is, the harmful effects of CS can be significantly reduced when the smoke also contains antioxidant compounds.”
Now, what to make of this finding? First, it is unlikely you will find acai-injected cigarettes offered by cigarette companies any time soon. The medical community will object vociferously to such additives because they fear such additives will give consumers the false impression that adding antioxidants to cigarettes reduces their negative health effects.
Second, the study results echo those of other recent studies on different antioxidant ingredients. There is a clear, growing body of evidence in pulmonology research that antioxidant supplementation (whether through consumption of antioxidant rich foods or from dietary supplements) confers significant anti-inflammatory benefits in smokers and people with COPD.
Currently, there is no consensus view as to what antioxidants are most appropriate for smokers and people with lung disease. Further, there is no consensus among researchers as to the appropriate human dosage levels to achieve significant inflammation reduction (most recent studies have been conducted on either human tissue samples or laboratory animals).
That said, the antioxidants that have received the most attention from pulmonology researchers over the past few years include Vitamin D, Vitamin A, Vitamin C, Vitamin E, N acetyl cysteine, reseveratrol, curcumin, quercetin, Chinese skull cap (baicalin), and now acai berry.
As an aside, all of the above antioxidants, with the exception of acai berry, are included in our respiratory support dietary supplement, Resplenish. To learn more about Resplenish, visit www.resplenish.com.
For more information about acai berry, click here for a WebMD.com summary.
For a sampling of dietary supplements that include acai berry, visit our Breathe Better Marketplace hosted by amazon.com.
The purpose of the study was to determine whether providing a powerful antioxidant along with cigarette smoke would lessen the likelihood of lung tissue damage and associated inflammation. The researchers chose acai berry extract (specifically the extract of the acai berry stone [seed]) because previous research studies involving plant-based antioxidants known as proanthocyanidins have shown similar anti-inflammatory effects.
In this study, the researchers divided the 60 mice in the study into three groups. One group, the control group, received neither exposure to cigarette smoke or acai berry extract. A second group, the cigarette group, was exposed to cigarette smoke from 12 cigarettes daily over a 60 day period. The third group, the acai group, was exposed to cigarette smoke in the same manner as the cigarette group but received the cigarette smoke from cigarettes injected with the acai berry extract. (de Moura RS, et al. Addition of acai (Euterpe oleracea) to cigarettes has a protective effects against emphysema in mice. Food Chem Toxicol. 2010 Dec 10. [Epub ahead of print])
At the end of the 60 day period, all mice were euthanized and lung tissue samples were extracted. The researchers viewed lung tissue samples via microscope to assess the size of alveolar spaces between the three groups (in emphysema, alveolar spaces enlarge). In addition, the lung tissue was analyzed for counts of proteins and white blood cells that are known to be present in large numbers in inflamed airway tissue.
The study team discovered that the cigarette group had 38% greater alteration to alveolar tissue in comparison to the control group. The acai group had 25% lower alteration compared to the cigarette group (meaning the acai group’s lung tissue samples showed less alteration than the cigarette group but more alteration in comparison with the control group).
When analyzing the inflammation markers, researchers found 400% more leukocytes in the cigarette group compared to the control group. The acai group had 65% fewer leukocytes than the cigarette group (again showing the acai group lessened the impact of cigarette smoke). Similar findings were found for other markers such as macrophages and neutrophils.
The study team concluded, “This study demonstrated for the first time that adding a hydro-alcoholic extract of acai stone to cigarettes significantly reduced pulmonary inflammation, oxidative stress, and CS-induced emphysema in mice… Because lung damage induced by CS is mainly due to inflammation and oxidative stress, it seems likely that acai’s anti-inflammatory and antioxidant properties underlie these protective effects…The present study demonstrated that acai extract in cigarettes has a preventive action; that is, the harmful effects of CS can be significantly reduced when the smoke also contains antioxidant compounds.”
Now, what to make of this finding? First, it is unlikely you will find acai-injected cigarettes offered by cigarette companies any time soon. The medical community will object vociferously to such additives because they fear such additives will give consumers the false impression that adding antioxidants to cigarettes reduces their negative health effects.
Second, the study results echo those of other recent studies on different antioxidant ingredients. There is a clear, growing body of evidence in pulmonology research that antioxidant supplementation (whether through consumption of antioxidant rich foods or from dietary supplements) confers significant anti-inflammatory benefits in smokers and people with COPD.
Currently, there is no consensus view as to what antioxidants are most appropriate for smokers and people with lung disease. Further, there is no consensus among researchers as to the appropriate human dosage levels to achieve significant inflammation reduction (most recent studies have been conducted on either human tissue samples or laboratory animals).
That said, the antioxidants that have received the most attention from pulmonology researchers over the past few years include Vitamin D, Vitamin A, Vitamin C, Vitamin E, N acetyl cysteine, reseveratrol, curcumin, quercetin, Chinese skull cap (baicalin), and now acai berry.
As an aside, all of the above antioxidants, with the exception of acai berry, are included in our respiratory support dietary supplement, Resplenish. To learn more about Resplenish, visit www.resplenish.com.
For more information about acai berry, click here for a WebMD.com summary.
For a sampling of dietary supplements that include acai berry, visit our Breathe Better Marketplace hosted by amazon.com.
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