Title: Physical Activity and Public Health in Older Adults: Recommendation From the American College of Sports Medicine and the American Heart Association
Date Posted: 9/26/2007
Author(s): Nelson ME, Rejeski WJ, Blair SN, et al.
Citation: Circulation. 2007;116:1094-1105.
Perspective: The following are 10 points to remember about this recommendation on physical activity and public health in older adults:
1. Benefits of regular physical activity include reductions in the risk of diabetes, hypertension, cardiovascular disease (including stroke), dyslipidemia, obesity, anxiety, and depression. Physical activity is a component of clinical practice guidelines for coronary heart disease, hypertension, peripheral vascular disease, diabetes, obesity, and hyperlipidemia. Currently, older Americans are the least fit of any age group. In a study of Medicare enrollees, an estimated 14% of the men and 23% of the women were not able to walk 2-3 blocks. This age group is the fastest growing demographic segment in the United States, and has significant medical expenditures. Therefore, increasing physical activity among older adults has significant public health implications.
2. Physical activity recommendations for older adults pertain to all adults ages 65 or older, and to those ages 50-64 years with clinically significant chronic conditions and/or functional limitations. Recommendations are similar to those for adults under 65 years of age; however, intensity recommendations have been adapted to accommodate a wide range of aerobic fitness levels.
3. Physical activity recommendations include a minimum of 30 minutes/day of moderate intensity activity 5 days per week or a minimum of 20 minutes/day of vigorous activity 3 days/week. Moderate intensity activity can be completed in 10-minute intervals throughout the day. On a 10-point scale, moderate intensity is a 5-6 of perceived effort, whereas vigorous activity is a 7-8.
4. The intensity level for older adults is relative to the individual’s aerobic fitness and thus varies by person. These amounts of aerobic activity recommended should be in addition to routine daily activities such as cooking or shopping.
5. If conditions or baseline fitness do not permit the patient to achieve minimum levels of recommended physical activity, older adults should maintain regular physical activity consistent with their abilities and avoid sedentary behavior.
6. Benefits of physical activity appear to have a dose-response relationship, such that reductions in the risk of cardiovascular disease have been observed with as little as 45-75 minutes per week of walking.
7. Muscle strengthening activities are recommended at least 2 times per week and should include 8-10 exercises, which involve major muscle groups (with 10-15 repetitions). For those older adults at increased risk for falls, flexibility and balances exercises should be incorporated into these activities.
8. Physical activity has been observed to reduce risk of falls (and fall injuries) by as much a 35%-40%. Several studies have noted balance exercises to be an effective component of fall prevention.
9. An activity plan for an older adult should tailor recommendations to the person’s abilities and conditions and should include a stepwise plan for gradual increases in physical activity to achieve recommended levels of physical activity.
10. The majority of older Americans should be physically active. Both individual and community interventions are needed to support current recommendations for older adults, particularly in light of the growing number of older men and women residing in the United States.
Elizabeth A. Jackson, M.D., F.A.C.C.
Showing posts with label Guidelines. Show all posts
Showing posts with label Guidelines. Show all posts
Monday, October 1, 2007
Wednesday, September 5, 2007
Prevention of infective endocarditis: new US Guidelines
Prevention of infective endocarditis: new US Guidelines bring major changes for at-risk patients
Infective endocarditis (IE) is a life-threatening disease associated with a high mortality rate. To avoid its severe complications, several recommendations have been published during the past 20 years about the best use of antimicrobial prophylaxis to prevent IE in patients who undergo a dental, gastrointestinal (GI) or genitourinary (GU) tract procedures. However, efficacy of such prophylaxis has been questioned and several authorities have suggested that guidelines need to be revised and simplified.
The new American guidelines for prevention of infective endocarditis
The main changes in the updated American recommendations are as follows:
1. IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE.
2. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.
3. Prophylaxis is not recommended based solely on an increased lifetime risk of acquiring IE.
4. Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.
A considerable change for patients with cardiac disease
These represent a considerable change and limitation in the current use of endocarditis prophylaxis for Americans with cardiac disease; for instance:
• patients at risk: only those with the highest risk of adverse outcome in case of IE are considered for prophylaxis, including prosthetic cardiac valves, previous endocarditis, unrepaired congenital heart disease, and cardiac transplants who develop cardiac valvulopathy.
Most patients with valvular heart disease are no longer considered candidates for antibiotic prophylaxis;
• the dental procedures for which IE prophylaxis is recommended: all procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa are considered at risk and need prophylaxis when performed in at-risk patients;
• the GU or GI tract procedures: antibiotic prophylaxis is no longer recommended in these procedures
Limits to applying American guidelines in Europe
Before applying the American guidelines in Europe, we need to consider their limitations.
First, the new guidelines are not based on randomised studies.
Second, such radical modifications may be difficult to accept and understand by both patients and practitioners, and much effort will be required to explain them carefully, particularly so that patients understand the shift from focus on dental procedures towards a greater access to dental care and oral health for those with cardiac disease associated with the worst outcome after IE.
Third, these guidelines probably will be followed by a reduction in the number of antibiotic prescriptions for preventing IE in the USA. It will be important to monitor the consequences on the epidemiologic profile of IE in the USA.
Finally, prospective placebo-controlled double-blinded studied of antibiotic prophylaxis of IE in patients at risk of IE remain necessary, as well as additional prospective case-control studies.The ESC is developing a new version of the 2004 IE guidelines. These will focus on prevention, diagnosis and treatment of IE and are expected by 2009.
Infective endocarditis (IE) is a life-threatening disease associated with a high mortality rate. To avoid its severe complications, several recommendations have been published during the past 20 years about the best use of antimicrobial prophylaxis to prevent IE in patients who undergo a dental, gastrointestinal (GI) or genitourinary (GU) tract procedures. However, efficacy of such prophylaxis has been questioned and several authorities have suggested that guidelines need to be revised and simplified.
The new American guidelines for prevention of infective endocarditis
The main changes in the updated American recommendations are as follows:
1. IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE.
2. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.
3. Prophylaxis is not recommended based solely on an increased lifetime risk of acquiring IE.
4. Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.
A considerable change for patients with cardiac disease
These represent a considerable change and limitation in the current use of endocarditis prophylaxis for Americans with cardiac disease; for instance:
• patients at risk: only those with the highest risk of adverse outcome in case of IE are considered for prophylaxis, including prosthetic cardiac valves, previous endocarditis, unrepaired congenital heart disease, and cardiac transplants who develop cardiac valvulopathy.
Most patients with valvular heart disease are no longer considered candidates for antibiotic prophylaxis;
• the dental procedures for which IE prophylaxis is recommended: all procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa are considered at risk and need prophylaxis when performed in at-risk patients;
• the GU or GI tract procedures: antibiotic prophylaxis is no longer recommended in these procedures
Limits to applying American guidelines in Europe
Before applying the American guidelines in Europe, we need to consider their limitations.
First, the new guidelines are not based on randomised studies.
Second, such radical modifications may be difficult to accept and understand by both patients and practitioners, and much effort will be required to explain them carefully, particularly so that patients understand the shift from focus on dental procedures towards a greater access to dental care and oral health for those with cardiac disease associated with the worst outcome after IE.
Third, these guidelines probably will be followed by a reduction in the number of antibiotic prescriptions for preventing IE in the USA. It will be important to monitor the consequences on the epidemiologic profile of IE in the USA.
Finally, prospective placebo-controlled double-blinded studied of antibiotic prophylaxis of IE in patients at risk of IE remain necessary, as well as additional prospective case-control studies.The ESC is developing a new version of the 2004 IE guidelines. These will focus on prevention, diagnosis and treatment of IE and are expected by 2009.
Thursday, August 30, 2007
New guidelines for cardiac pacing and cardiac resynchronization therapy
ESC publishes new guidelines for cardiac pacing and cardiac resynchronization therapy
August 30, 2007
Michael O'Riordan
Sophia Antipolis, France - On the eve of the European Society of Cardiology (ESC) 2007 Congress, which begins Sunday in Vienna, Austria, the ESC, in partnership with the European Heart Rhythm Association, has released new guidelines for cardiac pacing and cardiac resynchronization therapy (CRT) [1].
The guidelines, now published online in the European Heart Journal, aim to provide an up-to-date specialists' view of the European field and specifically address the issue of permanent pacing in bradyarrhythmias, syncope, and other conditions like hypertrophic obstructive cardiomyopathy and the use of ventricular resynchronization as an adjunct therapy in patients with heart failure.
The new guidelines, by Dr Panos Vardas (Heraklion University Hospital, Greece) and other experts, focus on the use on the appropriate use of pacemakers with various arrhythmias, including sinus node disease, atrioventricular and intraventricular conduction disturbances, pacing disturbances related to AMI, and reflex syncope, among others, and provide recommendations for clinical indications for pacing and the choice of pacing mode.
In addition, the expert panel comments on the rationale for CRT in heart-failure patients, highlights the newest evidence, and makes recommendations according to the different clinical and technical characteristics of the single patient.
"Thanks to important developments in technology and advances in the essential knowledge that we now have concerning the physiology of the paced beat, patients with sinus-node dysfunction and atrioventricular conduction system defects can now be given high-quality therapy," Vardas, chair of the new ESC guidelines, commented in an press release. "These and other developments over the past few years have advanced electrical stimulation further into the realm of ventricular resynchronization as an adjunctive therapy for patients with drug-refractory heart failure and ventricular conduction delay."
The ESC guidelines also highlight the main objectives, structure, and function of a pacemaker clinic and provide recommendations for predischarge assessment of long-term follow-up methodology. The full document, which will soon be published as a pocket-sized version and be available as a personal digital assistant download, is available at the ESC website.
Source:
Vardas PE, Auricchio A, Blanc JJ, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2007; DOI:10.1093/eurheart/ehm305. Available at: http://eurheartj.oxfordjournals.org.
Related links:
Guidelines for cardiac pacing and cardiac resynchronization therapy.
In CRT, ventricular size responds more to biventricular than to LV-only pacing [HeartWire > Heart failure; Apr 13, 2007]
Atrial fib: No reason to avoid resynchronization therapy for heart failure [HeartWire > Heart failure; Mar 20, 2007]
CRT patient-selection criteria: Studies question QRS duration, support tissue-Doppler imaging [HeartWire > Heart failure; Dec 22, 2006]
COMPANION and DEFINITE published: CRT, ICD for HF on threshold of new era [HeartWire > Heart failure; May 19, 2004]
August 30, 2007
Michael O'Riordan
Sophia Antipolis, France - On the eve of the European Society of Cardiology (ESC) 2007 Congress, which begins Sunday in Vienna, Austria, the ESC, in partnership with the European Heart Rhythm Association, has released new guidelines for cardiac pacing and cardiac resynchronization therapy (CRT) [1].
The guidelines, now published online in the European Heart Journal, aim to provide an up-to-date specialists' view of the European field and specifically address the issue of permanent pacing in bradyarrhythmias, syncope, and other conditions like hypertrophic obstructive cardiomyopathy and the use of ventricular resynchronization as an adjunct therapy in patients with heart failure.
The new guidelines, by Dr Panos Vardas (Heraklion University Hospital, Greece) and other experts, focus on the use on the appropriate use of pacemakers with various arrhythmias, including sinus node disease, atrioventricular and intraventricular conduction disturbances, pacing disturbances related to AMI, and reflex syncope, among others, and provide recommendations for clinical indications for pacing and the choice of pacing mode.
In addition, the expert panel comments on the rationale for CRT in heart-failure patients, highlights the newest evidence, and makes recommendations according to the different clinical and technical characteristics of the single patient.
"Thanks to important developments in technology and advances in the essential knowledge that we now have concerning the physiology of the paced beat, patients with sinus-node dysfunction and atrioventricular conduction system defects can now be given high-quality therapy," Vardas, chair of the new ESC guidelines, commented in an press release. "These and other developments over the past few years have advanced electrical stimulation further into the realm of ventricular resynchronization as an adjunctive therapy for patients with drug-refractory heart failure and ventricular conduction delay."
The ESC guidelines also highlight the main objectives, structure, and function of a pacemaker clinic and provide recommendations for predischarge assessment of long-term follow-up methodology. The full document, which will soon be published as a pocket-sized version and be available as a personal digital assistant download, is available at the ESC website.
Source:
Vardas PE, Auricchio A, Blanc JJ, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2007; DOI:10.1093/eurheart/ehm305. Available at: http://eurheartj.oxfordjournals.org.
Related links:
Guidelines for cardiac pacing and cardiac resynchronization therapy.
In CRT, ventricular size responds more to biventricular than to LV-only pacing [HeartWire > Heart failure; Apr 13, 2007]
Atrial fib: No reason to avoid resynchronization therapy for heart failure [HeartWire > Heart failure; Mar 20, 2007]
CRT patient-selection criteria: Studies question QRS duration, support tissue-Doppler imaging [HeartWire > Heart failure; Dec 22, 2006]
COMPANION and DEFINITE published: CRT, ICD for HF on threshold of new era [HeartWire > Heart failure; May 19, 2004]
Saturday, August 4, 2007
STUDY CONFIRMS THAT GUIDELINES FOR TREATMENT AND CARE OF HEART ATTACK PATIENTS ARE SAVING LIVES
STUDY CONFIRMS THAT GUIDELINES FOR TREATMENT AND CARE OF HEART ATTACK PATIENTS ARE SAVING LIVES
Evidence-based guidelines for the treatment of heart attacks are saving significant numbers of lives.
That’s the gratifying conclusion of an international study, which sought to ascertain whether the creation and promulgation of guidelines was actually resulting in improved outcomes for patients.
The study was conducted from 1999 to 2006. Called the Global Registry of Acute Coronary Events, it examined 44,372 heart attack patients in 113 hospitals in the United States of America, Canada and 12 other countries in Europe and South America.
Deaths, cardiogenic shock and congestive heart failure or pulmonary oedema all declined.
Myocardial infarctions more than 24 hours after hospitalization also declined, as did those within six months of discharge.
In patients with ST-segment elevation myocardial infarction, hospital deaths declined by 18%, congestive heart failure and pulmonary oedema by 9% and cardiogenic shock by 24%.
Angioplasties increased by 37%. Treatment with beta blockers increased by 11%, with statins by 48% and with ACE inhibitors by 22%.
“This is good news for patients and for the use of evidence-based guidelines for hospital care,” said World Heart Federation Scientific Advisory Board Chairman Sidney Smith. “It confirms that we now have treatment strategies that contribute to reducing the burden of cardiovascular disease worldwide.”
Until the study, it was largely unknown whether the promulgation of guidelines was having a significant impact on patient care.
“That’s why the study is so tremendously important,” Dr Smith said. “Not only does it validate the guidelines but it shows clear cut reductions in cardiovascular events at the international level.”
Guidelines for the treatment of heart attacks were developed in the early 1990s by the American Heart Association and the American College of Cardiology, Dr Smith said. In 2001, the American Heart Association began a major effort to encourage their use. Other societies, notably the European Society of Cardiology, have been active in the same area.
In 2004, the World Heart Federation identified 10 principles that countries should follow for the formulation of national and regional guidelines. The principles include that governments and national heart societies and foundations should collaborate to develop population-appropriate guidelines targeting risk factors and emphasizing prevention.
Since 2005, the World Heart Federation has been participating in a study in China to determine whether there are gaps between the country’s guidelines and actual clinical treatment of patients with acute coronary syndromes. If such gaps are confirmed to exist, the next step will be to develop interventions for closing them.
China is the world’s most populous country. The study is being carried out at 63 hospitals with at least two from each province and autonomous region. Collaborators include the Beijing Institute of Heart, Lung and Blood Vessel Diseases, the Chinese Society of Cardiology and the China National Healthy Heart Programme.
Evidence-based guidelines for the treatment of heart attacks are saving significant numbers of lives.
That’s the gratifying conclusion of an international study, which sought to ascertain whether the creation and promulgation of guidelines was actually resulting in improved outcomes for patients.
The study was conducted from 1999 to 2006. Called the Global Registry of Acute Coronary Events, it examined 44,372 heart attack patients in 113 hospitals in the United States of America, Canada and 12 other countries in Europe and South America.
Deaths, cardiogenic shock and congestive heart failure or pulmonary oedema all declined.
Myocardial infarctions more than 24 hours after hospitalization also declined, as did those within six months of discharge.
In patients with ST-segment elevation myocardial infarction, hospital deaths declined by 18%, congestive heart failure and pulmonary oedema by 9% and cardiogenic shock by 24%.
Angioplasties increased by 37%. Treatment with beta blockers increased by 11%, with statins by 48% and with ACE inhibitors by 22%.
“This is good news for patients and for the use of evidence-based guidelines for hospital care,” said World Heart Federation Scientific Advisory Board Chairman Sidney Smith. “It confirms that we now have treatment strategies that contribute to reducing the burden of cardiovascular disease worldwide.”
Until the study, it was largely unknown whether the promulgation of guidelines was having a significant impact on patient care.
“That’s why the study is so tremendously important,” Dr Smith said. “Not only does it validate the guidelines but it shows clear cut reductions in cardiovascular events at the international level.”
Guidelines for the treatment of heart attacks were developed in the early 1990s by the American Heart Association and the American College of Cardiology, Dr Smith said. In 2001, the American Heart Association began a major effort to encourage their use. Other societies, notably the European Society of Cardiology, have been active in the same area.
In 2004, the World Heart Federation identified 10 principles that countries should follow for the formulation of national and regional guidelines. The principles include that governments and national heart societies and foundations should collaborate to develop population-appropriate guidelines targeting risk factors and emphasizing prevention.
Since 2005, the World Heart Federation has been participating in a study in China to determine whether there are gaps between the country’s guidelines and actual clinical treatment of patients with acute coronary syndromes. If such gaps are confirmed to exist, the next step will be to develop interventions for closing them.
China is the world’s most populous country. The study is being carried out at 63 hospitals with at least two from each province and autonomous region. Collaborators include the Beijing Institute of Heart, Lung and Blood Vessel Diseases, the Chinese Society of Cardiology and the China National Healthy Heart Programme.
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