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February 20, 2009
NIH Podcast Episode #0078
Balintfy: Welcome to the 78th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode, we continue our three part series on the importance of physical activity. In this discussion of the Physical Activity Guidelines for Americans, we look at the importance of physical activity for adults, even cancer survivors. But first, two reports from the National Heart Lung and Blood Institute: one on a new website explaining children’s medical research, the other on how some key medical data now includes asthma. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
NIH Expands Open-Access Dataset of Genetic and Clinical Data to Include Asthma
Balintfy: In 2007, the National Heart, Lung, and Blood Institute initiated SHARe, or SNP Health Association Resource. SHARe is a Web-based dataset which provides qualified researchers with free access to a wealth of data from multiple large population-based studies, starting with the Framingham Heart Study. Now the NHLBI has expanded its collection of genetic and clinical data to include information collected from three asthma research networks as well.
Kiley: And those are the Childhood Asthma Management Program, the Childhood Asthma Research and Education Network, and the Asthma Clinical Research Network.
Balintfy: Dr. James Kiley, Director of the Division of Lung Diseases at NHLBI says this new expansion of the project, is called SHARP.
Kiley: SHARP will allow the broad research communality to relate genetic variations to clinical and laboratory results. And the hope here is that will enable future discoveries of the links between the genes and health for asthma and other airway diseases.
Balintfy: SHARP includes data on 2,332 people with asthma and 805 families whose DNA was tested for 1 million genetic variations. In addition, clinical data gathered during asthma clinical trials, such as lung function, allergy status, and respiratory symptoms are included in the database. Dr. Kiley adds that the project was designed to accelerate knowledge and help researchers pursue an agenda around the goal of personalized healthcare.
Kiley: The ways in which we prevent diagnose and treat health problems could be tailored to an individual’s genetic makeup and we think that asthma represents a very good opportunity to pursue that type of agenda.
Balintfy: For more information about asthma and SHARP, visit www.nhlbi.nih.gov.(TRANSITIONAL MUSIC)
NHLBI Launches Web Site for Parents on Medical Research Studies for Kids
Balintfy: Many efforts are being made to provide proper clinical research for children, to find the best treatments, drugs, and devices for them. Research in children has helped to save lives and improve health. But how is clinical research handled when it comes to children? A new National Heart Lung and Blood Institute website offers parents and health care providers an insider’s guide to children’s medical research. Wally Akinso has the details about the website.
Akinso: The website, Children and Clinical studies, combines information about how clinical studies in youth are conducted with award-winning video of children, parents, and healthcare providers discussing the rewards and challenges of participating in research. Ms. Victoria Pemberton, a Clinical Trials specialist at the NHLBI, talks about the purpose of the website.
Pemberton: The site was developed because we realized that parents, families, even health care professionals in many ways did not understand what it meant to be in a clinical trial, especially for a child to participate in clinical research.
Akinso: In June 2008, the main 10 minute video earned three Telly Awards, including a sliver in education, which is the highest award. The Tellys honor outstanding local, regional, and cable TV commercials and programs; film and video productions; web ads, videos and films. Ms. Pemberton points out some of the features that the website offers.
Pemberton: I think that the website combines a couple of features. We try to put in very simple language — the website is at an average sixth grade reading level. So then even older children might be able to get on it and understand it. The second component, there are graphics there. And I think the graphics help to explain some of the more technical things. We’ve tried to put on definitions — where definitions are required. And the fourth thing, are the videos clips. And I think the video clips are a big draw because parents like seeing other people like themselves in situations similar to their own. Talking about their struggles, their decision, how did they make a decision to participate or not participate. I think parents are reassured by some of the things that they hear there.
Akinso: The Web site describes why research in children is important, how studies are conducted, and what measures are taken to protect participants’ safety and privacy. Dr. Gail Pearson, an NHLBI pediatric cardiologist, believes that this website will serve as some sort of educational tool for the public when it comes to clinical research.
Akinso: In general, many members of the public aren’t really quite sure what research is or what it means be in clinical research. And I think this is an important message that NHLBI and NIH can get out generally to educate the public not so much about results of specific studies but in this case about the importance of research in children— the safeguards that are available and just the nuts and bolts of the process.
Akinso: Ms. Pemberton hopes that this new resource will help parents and others learn more about how clinical studies are conducted in children.
Pemberton: So we’d like to educate the public, health care professionals. We’d like to get the word out to trainees, people who are in medical school, nursing school, those who are interested in research. So I think that’s pretty much the world.
Akinso: If you would like to check out the website, visit www.childrenandclinicalstudies/nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up next, part two of our series on the Physical Activity Guidelines for Americans. We’ll be right back.(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Physical Activity Guidelines for Americans – Part 2 of 3
Balintfy: In our last episode we talked with Acting Surgeon General, Dr. Steven Galson and Dr. Bill Haskell, from Stanford University. They gave a good overview of the Physical Activity Guidelines for Americans. To get more details, this episode we talk to Dr. Richard Troiano, a Capt. in the Public Health Service, and an epidemiologist at the National Cancer Institute, and Dr. Ashley Wilder Smith, in the Outcomes Research Branch, also at NCI.
Dr. Troiano: I think, frequently we do a big scientific review, we write a report, and it sort of stops there. There’s a big, thick book that goes on a shelf, and not much happens.
Balintfy: That’s Dr. Troiano. He coordinated the effort to create these guidelines. He says that a lot of focus was put on not just reviewing the science, but also getting the word out about the physical activity guidelines. And not just what they are, but to help motivate people to action.
Dr. Troiano: We still did make our big, thick book. The advisory committee report, which is a terrific resource for researchers, it’s the most up-to-date review of the science, it’s over 650 pages. That’s available for that audience. The actual physical activity guidelines, which are targeted toward policymakers and health professionals, are available. And then, I think, an innovation is that we have a consumer booklet that is aimed at adults, to help them be motivated to do physical activity. So rather than laying out all the numbers, and all the rationale, it sort of meets people where they are. You now, there’s a section on if you’re trying to get started, there’s a section on if you’re doing a little activity but you want to do more, there’s a section on if you’re meeting the guidelines and you’re looking for ways to help maintain that activity. And that — all of these documents are available from the Web site, www.health.gov/paguidelines, and they can be downloaded or read on-screen there.
Balintfy: So if you’re not a researcher or policy maker, the publication to look for is “Be Active Your Way: A Guide for Adults.” And the key is to get started.
Dr. Smith: Start Low and Go Slow.
Balintfy: That’s Dr. Ashley Wilder Smith. She helped write the actual guidelines. And as Dr. Troiano mentioned, she explains that there are different sections for people with different levels of existing activity:
Dr. Smith: One of the things that we discussed at length was the importance of having a variety of activities that were available to people. So what we’ve done in the guidelines is actually describe a number of scenarios, different kinds of ideas that people can have in terms of integrating a new physical activity program. So that can be, depending upon where you start, both your fitness level as well as what your exercise has been historically, whether you’re inactive, whether you’re somewhat active, whether you’re highly active, and also depending on your health goals and your fitness and physical activity goals. So for inactive adults — we have a number of scenarios for folks who are just starting to think about walking, let’s say, a little bit more to the bus stop and on their way to work, rather than taking their car, and maybe that’s a 10-minute walk, and doing that a couple of times a week. And then as they get used to it, increasing that to 15, 20, and 30 minutes per day, and if they move up to 30 minutes per day, on 5 days of the week, they’re meeting the minimum threshold. And if they continue that and add in some activities on the weekend, add in some light biking or add in going swimming or going for a hike, or something like that, adding in some working with elastic bands to improve their strength training.
Balintfy: That minimum threshold again is 150 minutes per week.
Dr. Troiano: The general recommendations of the guidelines are that, for adults, they should have two and a half to five hours a week of moderate intensity physical activity, or they can get a similar benefit from doing about half that amount of time of vigorous intensity activity, and they can mix-and-match.
Dr. Smith: Now, there are also tips for folks who are meeting the guidelines already, who are at that minimum level but really would like to move to the 300 minutes per week or five hours per week, and are thinking of different activities that they would like to integrate. We’ve suggested a whole host of different activities that may help people change their activities that they’re already doing, or just enhance them. We’ve also suggested that, because time becomes an element the more activity you’re doing, if you increase your activity, when you’re already meeting the guidelines, or you’re moving, doing moderate intensity activity, by doing more vigorous intensity activities, you can cut that time in half and also confer potential increased benefits.
Balintfy: Dr. Smith adds that an important factor is that for those people who are just starting, they should know that even moving toward 60 minutes per week, one hour per week, has important benefits in increasing the length of their life and their quality of life. And again, as they move up in their activities, they will only see more benefits in their health. Dr. Troiano echoes this, adding important points regarding cancer.
Dr. Troiano: We recognize that many people in the country are very inactive, and what this review emphasizes is that even moving from 30 minutes a week, not 30 minutes a day, to 90 minutes a week, there’s a reduction in all-cause mortality of 20 percent. To see the next 20 percent reduction, you have to go to seven hours a week. So a little bit of change results in a lot of benefit. For cancer prevention, the benefits tend to occur at the higher end. You need to do four, to six or seven hours a week of physical activity. But for the benefit for cancer survivors, they’ll see improvements just by, perhaps, getting out of bed, getting out of the chair, and going for a walk one or two days a week. And then working up from there.
I think one of the most important things is we reinforced, or echoed, that cancer can be prevented through physical activity, but maybe more importantly, cancer survivors — and there’s about 10 million cancer survivors in the country, anyone who’s had cancer is considered a survivor — can really benefit from increasing their physical activity. They see benefits in terms of reduction in the side effects from treatment, such as fatigue. They see an improved quality of life. And they’ll just basically feel better.
Dr. Smith: And one thing that we’d really like to let folks know is, in the absence of a chronic condition or health-related symptoms, everyone should feel comfortable moving toward and working incrementally up to the guidelines. And they don’t necessarily need their doctor’s approval for that. We don’t want people to feel like there’s a gate in the way of them starting an exercise program. However, for those people who do have chronic illnesses or symptoms, clearly they should be under a health care provider’s care, and can talk with their provider, in concert with a provider, about different activities that they can do, depending on what’s happening for them as part of their treatment plan, or whatever their situation is. But in general, for most Americans, they should feel comfortable getting out, integrating different physical activities into their lives, and will notice improvements in various ways in their health.
Balintfy: Dr. Smith also points out that one part of the guidelines focuses in on pregnant women, and in particular pregnant women who are concerned about the ability to start or maintain a physical activity program.
Dr. Smith: And what we suggest is that they can actually meet the guidelines as we have set them out in terms of 150 minutes of moderate intensity physical activity per week, but again, in consult with their physician. That is one case where we definitely are recommending discussions with one’s physician, but pregnant women can feel comfortable continuing and participating in physical activity programs.
Balintfy: Dr. Smith continues that the guidelines aren’t just about aerobic exercise either.
Dr. Smith: We recommend that Americans do muscle strengthening activities two times per week, and that includes things like working with weightlifting or working with elastic bands, doing heavy gardening or outdoor activity where you’re really moving things around. Not just kind of light planting, but really when people are hauling, and really using their muscles to build strength. And we recognize the importance for those activities for other health outcomes in addition to doing the aerobic activity. That’s a new aspect of the guidelines that has not historically been part of other physical activity recommendations. While generally we recognize the importance of strength training, this time we really said that Americans should be doing strength training activities of all of their major muscle groups, twice per week — at least twice per week.
Balintfy: Dr. Troiano sums it up:
Dr. Troiano: I think one of the key messages that came out of this guidelines process is that some is better than none, and more is better. There’s a continuum of effort. But because so many of our population are really at the very low end of activity, just getting people to move a little bit will provide a tremendous benefit. We’ve got tools, and we’re working with organizations to help motivate people, because just having the science, knowing a good number, is important. But what’s really important is to get people to change their behavior.
Balintfy: Thanks to Drs. Richard Troiano, and Ashley Wilder Smith from the National Cancer Institute. Be sure to log on to www.health.gov/PAguidelines, or healthfinder.gov for more on the Physical Activity Guidelines for Americans, and the consumer publication “Be Active Your Way: A Guide for Adults.” Also, be sure to tune in to our next episode when we discuss the guidelines for older Americans, and children and adolescents.(THEME MUSIC)
Balintfy: That’s it for this edition this episode of NIH Research Radio. Please join us again on March 6th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
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