The Elephant in the room

[Jolt]

While I don't think this has anything to do with politics, I can already hear the people screaming that this would be "too much big government." Sorry, but I just saw the news tape of the protest in DC yesterday. I would like to ask those people what they would do if they lost their job and then got sick...

And the kicker is that a lot of the stuff being discussed here doesn't even have to (and often shouldn't) be done by the government! Sure, things like changing the infrastructure and agricultural policies will require government intervention, but incentives for healthy habits can be provided by employers and insurance companies. Education about exercise (including safe cycling), healthy eating and as Medianox said, about what good health is and how the body works can be carried out by other organizations and individual health workers (I happen to be a nurse as well, and working on becoming a nurse practitioner). For example, churches could (and some do) have parish nurses whose role includes educating and providing information about health topics; I am trying to work on getting something like that started in my church since we have a good number of nurses. Cyclists in a community could get together and do a presentation on utility cycling and road safety in a place like a YMCA or community center. Grassroots activities have a lot of potential to help this situation.

[shootingstar]

And the kicker is that a lot of the stuff being discussed here doesn't even have to (and often shouldn't) be done by the government! Sure, things like changing the infrastructure and agricultural policies will require government intervention, but incentives for healthy habits can be provided by employers and insurance companies. Education about exercise (including safe cycling), healthy eating and as Medianox said, about what good health is and how the body works can be carried out by other organizations and individual health workers (I happen to be a nurse as well, and working on becoming a nurse practitioner).

Designing communities with neighbourhoods, transportation infrastructure and services that encourage more use of non-car transportation should be encouraged...as one piece of the whole big solution.

Nothing wrong with incentives by employers and other organizations to encourage healthy habits and lifestyles, but...real long lasting change also must begin early in life and at home, with parents/at home where eating habit, activities and diet have a profound influence on children's foundational health ...for their future.

It is hard work and patience here that demands serious dedication and consistency by parents and other adults to provide to children reasonably healthy food day after day, week after week, year after year and finds ways to encourage them to eat it.

[Crankin]

I read that article (the one about angioplasty), and while I really do agree that for the majority of people with these symptoms, lifestyle changes would probably eliminate the need for angioplasty, it doesn't apply to everyone. My DH was dealt the card of horrible genetics and despite the fact he was a already a fit cyclist who ate well, he still had 2 80% blockages. It's true that if he had started cycling 10 years earlier and had started medication before he did (about a year before the surgery), maybe they would not have developed. But, he was not inactive, was not overweight, and ate better than most people.
I guess I just don't want people to think that lifestyle changes is the whole thing...

[Trek420]

I agree. Where is the jersey that says "eat right, exercise, die anyway"

Working with the disabled community I'm made aware every day that I am only temporarily able bodied. Often I hear this "I never thought this would happen to me, I was active, working, suddenly I had ________ ".

My feeling is do what I can do, take care of what I have control over. Even with injury/illness focussing on wellness can help.

For years I banged my head on the walls of doctors offices asking why I hurt so much. Finally a diagnosis, severe arthtritis Again I staged a hissy fit. Simply knowing was not enough. I wanted it to hurt less and still be able to stay active.

Several appointments later the orthopedic surgeon for both the 49'ers and the Raiders told me "there's no pill, no surgical option. You have this choice:

change your lifestyle to fit your knee (he meant go sedentary)
change your joints to fit your lifestyle (build the muscles around the knee)"

He suggested cycling ..... here I am For me I don't so much focus on wellness to live to be 116, it's about being able to open the peanut butter jar in my 80's, being able to just keep doing what I want to, need to do as long as I can. It's about quality of life.

[tulip]

I'm happy to live in an economically-disadvantaged part of the city that really has wonderful grass-roots efforts to improve the educational and nutritional outlook for kids. The Neighborhood Resource Center has a community garden and a kitchen, where kids grow their own food and then learn to cook it. They also have chickens for eggs. Kids had no clue where food came from, and they are so into the gardening and cooking.

I agree that Home Ec should be taught in schools again, too. And yes, people taking responsibility for their health will go a long way in improving society in general, and the health care issue as well.

[Reesha]

They should be teaching life skills in general! Basic cooking skills, balancing check books, paying bills on time, understanding basic financial stuff. People stumble out into the real world these days barely equipped to survive.

[roadie gal]

For Jolt: Here's the article. It's from one of my subscribed sites, so I have to post it this way. Sorry it's so long.

BTW, I never meant to imply that exercise is the total answer. Some people have crappy genetics (myself included). Some people need emergent intervention. My point was that they had to stop the study because they couldn't find participants for the exercise group.


September 8, 2009 (Barcelona, Spain) - Investigators for the multicenter PET study were keen to build on the surprising findings from their pilot trial: that 12 months of exercise training was just as good as PCI for myocardial perfusion and symptom relief in patients with stable angina and even better in terms of preventing cardiovascular events. Those hopes, however, were dashed when the multicenter PET study ground to a halt due to a lack of enthusiasm among patients and enrolling centers.

But in new findings presented by Dr Rainer Hambrecht (Klinikum Links der Weser, Bremen, Germany) at the European Congress of Cardiology 2009 Congress, combined data from the PET pilot study and the aborted PET multicenter trial suggest that regular exercise training is superior to PCI at preventing subsequent cardiovascular events.

The original PET study [1] randomized 102 patients to either exercise or PCI and reexamined patients after 12 months using coronary angiography, technetium-99m scintigraphy, and ergospirometry, as well as a range of clinical end points. Results, which were published in Circulation in 2004, showed clear and comparable improvements in symptoms and myocardial perfusion from baseline with both treatment strategies, and a trend toward better event-free survival in the training group at both 12 and 48 months.

"Our expectation was that exercise training would not be inferior to PCI; however, what we saw after 12 months was a clear, significant improvement in exercise over PCI in patients with stable CAD," Hambrecht told heartwire .

Exercise benefits

Inspired by the PET pilot, Hambrecht et al launched the PET multicenter trial at four hospitals in Germany, Austria, Switzerland, and Romania. By design, patients were randomized either to PCI or to two weeks of a supervised exercise training program every day, made up of five short periods of exercise daily. Patients were then given bicycles at home and asked to exercise on them every day, plus attend a supervised exercise program one or two times per week. The bikes, Hambrecht told heartwire , were equipped with sensors that monitored the amount and duration of exercise and ensured that it was actually the study participant--and not another family member--who was using the equipment.

But according to Hambrecht, the trial had major problems recruiting and was halted with just over 100 of the original 400 patients it had hoped to enroll. The study had plenty of funding; enrollment problems lay with both the recruiting centers and the patients themselves, he said. "There was some reluctance among the centers to join us in performing this study and also difficulties recruiting patients for the study" and explaining the randomization process. "If you get the stent you are free of symptoms within a few minutes, [whereas] in the training group, you have to work a lot, for several months, to reduce the angina threshold."

As with the pilot study, there were striking improvements with both PCI and exercise training in angina class and improvements in event-free survival that were nonsignificantly better for the training patients.

However, when the patients from both the multicenter and pilot studies were combined for a total of 202 patients with two-year follow-up, investigators achieved the statistical significance not met in the multicenter trial, Hambrecht reported. In a pooled analysis of event-free survival, 21 events occurred in the training group as opposed to 32 events in the PCI group (p=0.039). The differences speak to the direct benefits of exercise on the cardiovascular system globally, as opposed to the palliative, more localized benefits of PCI. Whereas both strategies improve myocardial perfusion, angina threshold, and exercise capacity, only exercise improves endothelial function and slows disease progression, he noted. Moreover, he stressed, improvements in both arms were seen on top of optimal medical therapy.

Forces work against exercise

In an interview with heartwire , Hambrecht acknowledged that there are multiple forces working against a scenario in which regular exercise is prescribed instead of stenting. For one, patients are not motivated to take responsibility for improving their own cardiovascular health--even if it means better event-free survival. For another, encouraging exercising is financially less appealing for hospitals, Hambrecht observed: "That was my feeling, that hospitals were reluctant to participate in this study, because they derive revenue from PCI procedures."

Hambrecht believes his data support calls to take the time between the diagnostic angiogram and the revascularization procedure to discuss the options with the patient, rather than stenting every patient.

"We have enough evidence from several studies, including COURAGE and our PET studies, comparing PCI vs more conservative strategies, and the data are quite convincing that PCI is not superior" in stable angina, he concluded.

[Trek420]

I'm just going to stumble in here and ask "who's they"? Parents? Teachers? Both? The entire village that it takes?

We ask a lot of our teachers: teach the kid to read who's been babysat by the TV and not read to, teach morals, values, calculus, French literature ..... I've been stumbling in the real world for decades, tons of schooling, raised in the wild by a pack of teachers and I've found I have lots to learn still.

So I'll just ask this question for the group: In a society/culture that does not reward or teach a healthy lifestyle or healthier choices how did you learn? Was it in the home, in the kitchen? Classes? Community? A little of both?

[mayanorange]

And the kicker is that a lot of the stuff being discussed here doesn't even have to (and often shouldn't) be done by the government! Sure, things like changing the infrastructure and agricultural policies will require government intervention, but incentives for healthy habits can be provided by employers and insurance companies.

This is one of the reasons I switched insurance to Fallon- they reimburse $400/yr for my hubby and I to do pretty much any organized fitness- not just gyms. They cover town sports, the Y, even our fave indoor cycling classes! I think it's great. Hopefully people will be encouraged to actually use it and maybe other companies will follow suit.

[Trek420]

This is one of the reasons I switched insurance to Fallon- they reimburse $400/yr for my hubby and I to do pretty much any organized fitness- not just gyms. They cover town sports, the Y, even our fave indoor cycling classes! I think it's great. Hopefully people will be encouraged to actually use it and maybe other companies will follow suit.

Not health insurance but this is one reason I switched from AAA to Better World for roadside assistance which pained me for sentimental reasons.

I've used AAA since I learned to drive . BW gives a public transit discount because we use that most often, they have a bike assistance option (not signed up for that yet) and they lobby FOR cycling.

I get a low mileage discount on my auto insurance. By being car-light (not car free) I drive far less than the national average.