Science In Brief

Chiropractic Litterature Review

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   The Journal of the American College of Cardiology has published a study which sheds some new light on physical exercise and longevity. Despite decades of popular wisdom on the subject, the truth is that we don't know nearly as much as we should about if, or to what degree, runners accrue any benefit in terms of increased life span. Oh sure, we all assume that folks who exercise regularly live longer, but what's actually known on the subject isn't quite so certain..

The authors looked at the dose-response relationship between running and both cardiovascular and "all cause" mortality. The study followed 55,000 + adults, ages 18-100 years, over a period of 15 years. Runners demonstrated a 30 percent lower risk of "all cause" mortality and a 45 percent reduction in cardiovascular death as compared to non runners. This equated to approximately 3 years of increased life expectancy on average for runners as opposed to non runners. So far so good. But wait, it gets even better!

As it turns out, benefits of running were basically the same across all the quintiles in terms of "running time, distance, frequency, amount, and speed". Even participants who ran less than 6 miles or 51 minutes WEEKLY, experienced nearly identical benefits to those in the upper quintiles of participation.

The authors conclude that "Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease." Good news indeed for those of us who thought we had to put in hours on the treadmill to get any benefit.

Author: Mark R. Payne DC

Reference: Duck-chul Lee, PhD∗; Russell R. Pate, PhD; Carl J. Lavie, MD; Xuemei Sui, MD, PhD; Timothy S. Church, MD, PhD§; Steven N. Blair, PED Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk∗ Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, Iowa  Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina   Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana 
Department of Preventive Medicine Research, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana   Department of Exercise Science and Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058

Link To Abstract:

  http://content.onlinejacc.org/article.aspx?articleID=1891600 

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In the News - July 23, 2014

Risk factors for underlying pathology in LBP patients.

The July issue of the Journal of Emergency Medicine has a new article of interest to every D.C. The study was designed as a review of records on 329 patients, ages 16 and older who presented in the E.R. with non traumatic LBP. The authors excluded patients presenting with obvious kidney pain (renal colic) and/or a prior history of kidney stones.

They looked at the outcomes on the patients and compared them with 56 possible "predictor variables" to determine if identifiable risk factors could be determined for serious, underlying pathology. Of the 329 patients, 6.7% (N=22) were ultimately shown to have serious underlying pathology. Example of the underlying problems encountered included compression fractures, malignancies, disc prolapses requiring surgery, retroperitoneal bleeds, osteomyelitis, epidural abscess, cauda equina syndroms, and leaking aortic aneurysms. One patient died.

The high risk factors which were identified were:

  1. Anticoagulant use.
  2. Decreased sensation on physical examination.
  3. Pain at night.
  4. Pain that persists despite appropriate treatment.

A simple awareness of these four basic risk factors appears to provide a very high rate of predictability in detecting patients who are likely to require additional medical attention.

Author: Mark R. Payne DC

Reference: Thiruganasambandamoorthy V1, Turko E2, Ansell D3, Vaidyanathan A4, Wells GA5, Stiell IG1. Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients. J Emerg Med. 2014 Jul;47(1):1-11. doi: 10.1016/j.jemermed.2013.08.140. Epub 2014 Apr 13.

Link To Abstract: http://www.ncbi.nlm.nih.gov/pubmed/24725822

Acknowledgment: Special thanks to David Graber DC, DACBSP, (Mountain Lakes NJ) for suggesting this article.

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Use of prescription NSAIDS has been linked to increased incidence of atrial fibrillation (AFIB). The study from the April British Medical Journal followed 8423 elderly patients and compared the incidence of AFIB (as confirmed by ECG) with known use of prescription NSAIDS (as documented by prescription records). Additionally, there appeared to be some evidence of increased risk being associated with higher doses although the authors do point out the effect didn't reach statistical significance in this study. The mean age was 68.5 yrs and participants were followed for a mean period of 12.9 years. During the study, 857 individuals developed AFIB. Current and recent NSAID use (out to 30 days) were both associated with significantly increased risk as compared to participants who never used NSAIDS. The statistical analysis used accounted for age, sex, and other potential confounding factors.

This study appears to support a relationship between NSAID use and increased risk of AFIB as had been found in previous studies.

Reference: Krijthe BP1, Heeringa J, Hofman A, Franco OH, Stricker BH.
Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study. BMJ Open. 2014 Apr 8;4(4):e004059.

Link To Full Text:
http://bmjopen.bmj.com/content/4/4/e004059.long

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A new study in the journal HEART finds increased risk of cardiovascular events among inactive patients. No surprise there. But this study, the second one to come out recently with similar findings, also finds an increased risk of death among patients who participated in daily, "strenuous" activity.

Lead author Ute Mons of the German Cancer Research Center writes that "Both inactive and daily-active patients had increased hazards of mortality compared with the reference group of patients who were active two to four times per week, but with the hazards being highest in the inactive-patient group." (emphasis ours)

Every study has some inherent problems and this one is no different. Although the authors adjusted their data to account for both pre existing "co-morbid conditions and for self-reported poor health", they note that "Because patients with poorer health are less likely to engage in strenuous physical activity, reverse causation bias could have led to an overestimation of the hazards in the inactive patient group and to an underestimation in the most physically active." (emphasis ours. )

For now it appears that while inactive patients are still at the highest risk, patients who exercise more than 2-4 times weekly also appear to be at substantially increased risk of death from both cardiovascular events and "all cause" mortality. Doctors take heed...more isn't necessarily better.

Reference: Mons Y, Hahmann H, Brenner H. A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements. Heart 2014; DOI:10.1136/heartjnl-2013-305242.

Link To Abstract:
http://heart.bmj.com/content/early/2014/03/18/heartjnl-2013-305242.abstract

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A new article casts doubt on the advisability of underwater childbirth. The practice of laboring and ultimately delivering while the mother is immersed has been a fad practice for a number of years. Proponents of the practice claim immersion during first stage of labor shortens labor time and reduces pain and subsequent need for anesthesia however, objective data supporting any real benefits appears to be thin. That aside, the new opinion paper, written in conjunction with the American Academy of Pediatrics concludes that immersion during the labor process is probably safe, and is not likely to interfere with the normal care of the mother and child during labor since both fetal and maternal monitoring can still take place.

Immersion during second stage labor (actual delivery of the child) however, is strongly condemned. Possible problems which may be caused or complicated by underwater delivery have been cited in a previous study by Pinette and Wilson and include fresh water drowning, waterborne infectious diseases, cord ruptures with neonatal hemorrhage, infant hypoxia, and death. There have been reports in the literature of babies drowning, or almost drowning during the procedure. And while proponents of water birthing will no doubt argue its safety, and even given that the actual rate of complications may be very low, the best that can be said is that there doesn't appear to be any strong evidence of benefit to what MIGHT end up being a risky procedure with potentially dire consequences.

Author's Comments: Although not new, water birthing has been getting a fair amount of attention recently, with a couple of high profile celebrities choosing the procedure. In fact, water births were fairly popular over 34 years ago when my own son was born at home. Alternative health care providers and the home birthing community have been the most vocal proponents of water labor and delivery. And while I can understand why a mother interested in natural childbirth might gravitate toward almost anything that would ease her pain during labor, I can't for the life of me understand how anyone can consider underwater delivery of the child to be a "natural" experience.

Marine mammals excepted, I am unable to come up with a single example of a mammal giving birth to its' young underwater. As chiropractors I think it's almost second nature for us to be constantly on the lookout for natural health care alternatives, but there comes a point at which common-sense must prevail. The only thing truly "natural" is for newborn infants to begin breathing air immediately after leaving the birth canal.

Author: Mark R Payne DC

Link To Full Text: http://pediatrics.aappublications.org/content/133/4/758.long

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