Wood Street Clinic Blog

Amlodipine is an oral medication that doctors prescribe to treat some cardiovascular conditions. In the United States, it commonly goes under the brand name Norvasc.

Amlodipine is a type of calcium channel blocker. Doctors commonly prescribe these drugs to treat people with high blood pressure. A doctor may also prescribe amlodipine for coronary artery disease and angina.

In this article, we look at what doctors prescribe amlodipine for and its recommended dosage. We also cover the side effects, interactions, warnings, and considerations for amlodipine as well as some alternative drugs.

What is it used to treat?
Amlodipine is usually known as Norvasc in the U.S.
Image credit: Kimivanil, 2015.

A person's heart rate generally slows with age and while resting. However, athletes may also have slow heart rates. Anyone with concerns about their heart rate should talk to a doctor for help in determining whether bradycardia suggests a problem.

Heart rate changes with a person's activity level. During intense physical exertion, the heart has to pump faster and harder, so the rate goes up.

In most adults, a slow heart rate is below 60 beats per minute (bpm). However, athletes and people who are asleep may have a heart rate of below 60 bpm.

Symptoms
Bradycardia can cause a heart rate of less than 60 bpm.

January is at the heart of the cold and flu season, and whenever the sneezing and coughing hits, we tend to stock up on anti-inflammatories and decongestants to help us fight these symptoms. However, the American Heart Association warn that these drugs can have unwanted effects on the heart.

Over-the-counter drugs are most people's go-to solution for the relief of aches, mild fever, a blocked nose, and other symptoms of the flu or a seasonal cold.

Such medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and decongestants that include pseudoephedrine and phenylephrine.

While these drugs are typically safe to take as long as you follow the recommended dosages, specialists from the American Heart Association (AHA) and other institutions warn that they could worsen the cardiovascular health of certain at-risk individuals.

"People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants," cautions Sondra DePalma, who is a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Harrisburg, PA, and one of the specialists behind the AHA's and American College of Cardiology's (ACC) guidelines for the management of high blood pressure.

"And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a healthcare provider," DePalma also advises.

Increased cardiovascular risk

According to the AHA and ACC guidelines, both NSAIDs and decongestants can increase blood pressure due to the way in which they act on the body. Decongestants, particularly, tighten the blood vessels in the nose, which helps reduce inflammation in that area.

"But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels. It can exacerbate or worsen the condition," notes Dr. Erin Michos, the associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, MD.

Dr. Michos explains that the people most at risk if they were to use decongestants are those with unmanaged high blood pressure, those with heart failure, as well as individuals who have had a heart attack or stroke.

As for NSAIDs, existing studies show that they can also place people at higher cardiovascular risk.

One study paper that the AHA cite — and which the Journal of Infectious Diseases published in 2017 — focused on a cohort of 9,793 individuals who had taken treatments for respiratory infections and ended up in hospital following a heart attack.

The participants averaged 72 years of age when they experienced their heart attacks, and many of them had preexisting cardiovascular risk factors, such as high blood pressure or diabetes.

Prevention is the best approach

According to the study, those who took NSAIDs to treat their respiratory infections were in excess of three times more at risk of a heart attack within 1 week than they had been during the same period the year before when they did not use NSAIDs.

To avoid exposure to such risks, Dr. Michos advises using NSAIDs and decongestants sparingly or opting for an alternative solution where possible, such as antihistamines.

"There are effective therapies that are less risky and definitely should be tried first," notes DePalma.

"If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like heart palpitations, they should talk with their healthcare provider," she urges.

Finally, the best approach when it comes to colds and flu is prevention, and the AHA point to the Centers for Disease Control and Prevention (CDC) recommendations, which suggest getting a flu shot each year.

Hypokalemia describes a person having too little potassium in their blood. If it is severe, it can lead to muscle weakness, which can have many health consequences. The cause is usually a person's body excreting too much potassium.

Hypokalemia is always a symptom of another illness or a side effect of a medication. It is not an illness in itself. Therefore, the underlying condition requires treatment to resolve the hypokalemia. A medical professional can diagnose hypokalemia by taking a person's medical history and carrying out tests.

A person may not be aware of mild hypokalemia. However, if hypokalemia is moderate or severe, the individual is likely to have other signs of being unwell, for example, vomiting or diarrhea. If a person feels ill for an extended period, they should see a doctor.

In this article, we look at the symptoms, causes, diagnosis, and treatment of hypokalemia, as well as the outlook for people with low potassium levels.

Symptoms
Hypokalemia can cause symptoms such as low blood pressure and muscle weakness.

Time is no longer an excuse for not exercising, as new research finds that even a few minutes of stair climbing at intervals every day is enough to improve cardiovascular and overall health.

Several recent studies have pointed out the many health benefits of short bursts of exercise.

For instance, a review of existing studies, which Medical News Today reported on, shows that an acute period of exercise can immediately protect the heart against future ischemic episodes.

Results of another recent study indicate that 10 minutes of physical activity is enough to give the brain a boost, improving attention, working memory, and cognitive flexibility, among other mental skills.

Now, research suggests that even intervals of stair climbing that last a few minutes, with recovery periods between, can improve cardiorespiratory health.

Martin Gibala, Ph.D., a professor of kinesiology at McMaster University in Hamilton, Canada, is the senior author of the new study, which appears in the journal Applied Physiology, Nutrition, and Metabolism.

Prof. Gibala and the team set out to investigate whether sprint interval training — that is, short bouts of intense exercise separated by a few minutes of recovery, amounting to about 10 minutes in total — can improve cardiorespiratory fitness.

Cardiorespiratory fitness refers to "the ability of the heart, lungs, and vascular system to deliver oxygen-rich blood to working muscles" during intense physical exercise.

Research has suggested that greater respiratory fitness brings several health benefits, including better cardiovascular health, improved insulin resistance, and a lower risk of premature death.

For the current study, a group of 12 sedentary young participants climbed three flights of stairs three times a day, with 1–4 hours of recovery between sessions.

The participants engaged in this regimen three times a week for 6 weeks, while a control group of 12 age-matched, sedentary individuals did not exercise.

At the end of the intervention period, cardiorespiratory fitness "was higher in the climbers [...] suggesting that stair-climbing 'snacks' are effective in improving cardiorespiratory fitness," report the authors.

The climbers were also stronger at the end of the intervention, and they performed better in a maximal cycling test, compared to the controls.

"We know that sprint interval training works, but we were a bit surprised to see that the stair snacking approach was also effective," says study co-author Jonathan Little, Ph.D., an assistant professor of kinesiology at the University of British Columbia in Okanagan, Canada.

"Vigorously climbing a few flights of stairs on your coffee or bathroom break during the day seems to be enough to boost fitness in people who are otherwise sedentary," Little explains.

"The findings make it even easier for people to incorporate 'exercise snacks' into their day," Prof. Gibala adds.

"Those who work in office towers or live in apartment buildings can vigorously climb a few flights of stairs in the morning, at lunch, and in the evening and know they are getting an effective workout."

Prof. Martin Gibala, Ph.D.

In the future, the team plans to test the effects of various exercise "snacking" regimens, varying the duration of the recovery intervals. They also wish to study the effects of these bouts of exercise on blood pressure and blood sugar.

Millions of people in the United States and across the world have hypertension, a condition that, without proper management, can contribute to the risk of heart disease and stroke.

Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 75 million adults in the U.S. live with hypertension.

American Heart Association (AHA) guidelines from 2017 define "hypertension" as systolic blood pressure (during a heartbeat) of 130 millimeters of mercury (mm Hg) or higher and diastolic blood pressure (when the heart is resting) of 80 mm Hg or higher.

The AHA also name lack of physical activity, an unhealthful diet, high cholesterol, and stress as some of the primary modifiable factors that increase the risk of hypertension.

New research by scientists at the University of Edinburgh in the United Kingdom has now uncovered another factor that seems to play a role in the development of this condition.

The study, which the British Heart Foundation funded, found that a type of specialized immune cell could make a real difference to the risk of hypertension.

"Hypertension affects millions of people across the globe, including 70 percent of people over 70," says lead researcher Prof. Matthew Bailey.

"Our discovery sheds light on risk factors and, crucially, opens routes to investigate new drugs that could help patients," he adds.

Prof. Bailey and team's findings appear in the European Heart Journal, and they are available online.

Cellular debris-eaters and blood pressure

In the new study, the researchers worked with mouse models and zeroed in on macrophages, a type of white blood cell that forms part of the immune system.

The role of macrophages is to identify and "eat up" foreign bodies that are present due to injury and infection. The immune cells also "eat" cellular debris, which consists of the remains of cells that are no longer functional.

The current research has now uncovered a new role that macrophages play. It seems that they also consume molecules of endothelin, which is a hormone that acts as a vasoconstrictor, meaning that it can stimulate blood vessels to narrow.

Prof. Bailey and colleagues explain that, by controlling blood levels of endothelin, macrophages can ensure that blood vessels properly relax, which helps lower blood pressure.

The researchers verified this mechanism by feeding mice with lowered blood macrophage levels a high-salt diet (which increases the risk of high blood pressure) and monitoring their physiological reactions.

These rodents, the researchers soon found, experienced high blood pressure. However, when the team allowed macrophage levels to return to normal, the mice's blood pressure became healthy again, which suggests that the specialist white blood cells had an important role to play.

When they repeated the experiment in mice that they had genetically modified to have poor endothelin system functioning, the findings remained consistent.

The researchers further verified the link between macrophages and blood pressure in rodents with drug-induced hypertension.

A potential therapeutical target

To see whether these findings were also valid in humans, the research team analyzed macrophage activity in individuals who took drugs for the management of antineutrophil cytoplasmic antibody vasculitis, a condition that affects the immune system and damages blood vessels.

The scientists found that the drugs that lowered macrophage levels, such as cyclophosphamide, led to higher blood pressure readings in the people who took them.

These findings, note Prof. Bailey and team, could help doctors better identify people who are most at risk of hypertension, and they could also lead to new and improved therapies for high blood pressure.

Still, the researchers caution that further studies are necessary before the interaction between macrophages and endothelin can get the go-ahead as a therapeutic target.

"Our next steps will be to investigate the role of macrophages in people living with hypertension," says Prof. Bailey.

"[Undiagnosed high blood pressure] causes damage to the heart and blood vessels, putting you at risk of a potentially fatal heart attack or stroke. But, we still don't fully understand all the mechanisms that lead to high blood pressure," adds Jeremy Pearson, the associate medical director of the British Heart Foundation, who was not involved in the study.

"This study shows for the first time that macrophages — a type of cell that helps regulate our immune responses — can be involved in the control of blood pressure. More research is needed but these cells could be a new target for drugs to treat the condition."

Jeremy Pearson

A stent is a tiny tube that a doctor places in an artery or duct to help keep it open and restore the flow of bodily fluids in the area.

Stents help relieve blockages and treat narrow or weakened arteries. Doctors may also insert stents in other areas of the body to support blood vessels in the brain or ducts that carry urine and bile.

A stent is usually a mesh-like metal tube, although fabric stents are also available. Sometimes, doctors will use dissolvable stents coated in medication as a temporary solution.

In this article, learn about why doctors use stents, as well as the benefits and possible risks.

Uses
A stent can open up blood vessels with plaque blockages.

Many doctors and dietitians recommend a Mediterranean diet to prevent disease and keep people healthy for longer.

The Mediterranean diet emphasizes fruits, vegetables, and whole grains, and it includes less dairy and meat than a typical Western diet.

In this article, we explain what the Mediterranean diet is and provide a 7-day meal plan for people to follow.

What is a Mediterranean diet?
A Mediterranean diet includes fresh produce and some healthful fats and oils.

Recently, bone broth has enjoyed a boost in popularity. To add to its new-found fame, a recent study concludes that it could have benefits for heart health, too.

Bone broth is a soup containing brewed bones and connective tissue.

Slowly cooking the bones in vinegar releases some of the nutrients that a person might otherwise discard with the rest of the carcass.

According to some quarters, drinking bone broth carries a multitude of benefits.

From reducing inflammation to improving sleep, bone broth can seemingly do no wrong.

Although some are hailing bone broths as "the new coffee," there is little evidence to support its benefits.

It is true that bone broth delivers nutrients, including amino acids and minerals, but not in any higher quantities than might be found in many other foods.

Bone broth contains collagen, leading some supporters to claim that bone broth improves skin health and joint function. However, collagen that we consume never reaches the skin or joints because it is broken down into amino acids by the digestive system.

The authors of the most recent study into bone broth published their findings in the Journal of Agricultural and Food Chemistry. They focused on the amino acids and peptides that the bone and connective tissue produce as they break down.

Bone broth and cardiovascular health

In particular, the researchers were interested in how cooked bones might release proteins which, during digestion, are broken down further into smaller chains of amino acids, referred to as peptides.

Once broken down in this way, peptides can have very different properties from the original proteins.

The scientists, led by Leticia Mora, wanted to understand whether Spanish dry-cured ham bones could be a source of heart-beneficial peptides. To investigate, they simulated both cooking and human digestion.

Once they had the final product, they tested the resulting peptides to see if they might block particular enzymes known to be involved in heart disease.

The enzymes of interest included angiotensin 1-converting enzyme (ACE-1), endothelin-converting enzyme, dipeptidyl peptidase-4, and platelet-activating factor acetylhydrolase.

All of the enzymes above regulate aspects of the cardiovascular system. ACE-1 inhibitors, for instance, are used to treat high blood pressure and inflammation-based heart disease. If scientists could source these peptides from foods, this might be beneficial for people who have an elevated risk of developing these conditions.

According to the authors, "their inhibition can result in the reduction of high blood pressure and alleviation of disorders, including type 2 diabetes, obesity, atherosclerosis, and inflammatory diseases."

Potential heart benefits

The scientists found that peptides — predominantly derived from hemoglobin and collagen — could block the enzymes related to heart disease, even after cooking and digestion.

Additionally, they measured the presence of other peptides; many of these were chains of just two or three amino acids, making them more likely to be able to travel through the intestinal wall and be active in the body. The authors conclude:

"These results suggest that dry-cured ham bones [used in] stews and broths could have a positive impact on cardiovascular health and a possible reduction of high blood pressure for consumers."

However, as the authors note, measuring these peptides under artificial conditions is not the same as assessing their impact on living organisms. Scientists will need to do much more work before they can confirm the heart benefits of bone broth.

Understanding the chemistry of foods is only one small step toward realizing their impact on health. These findings might further boost bone broth's popularity, but the trend will probably be over before conclusive evidence rolls in.

New research suggests that following the American Heart Association's guidelines for maintaining heart health can also drastically reduce the risk of developing type 2 diabetes.

According to the American Heart Association (AHA), there are seven cardiovascular risk factors that people can change to improve their heart health.

Dubbed "Life's Simple 7," these risk factors are: "smoking status, physical activity, weight, diet, blood glucose, cholesterol, and blood pressure."

The AHA note that research has shown that maintaining a minimum of five of the seven factors at an ideal level can lower the risk of cardiovascular death by almost 80 percent.

New research, which features in Diabetologia, the journal of the European Association for the Study of Diabetes, finds that these seven modifiable risk factors can also stave off diabetes.

Coming up with new strategies for preventing diabetes is crucial as over 100 million people in the United States are currently living with the condition or with prediabetes.

According to the Centers for Disease Control and Prevention (CDC), untreated prediabetes can progress into full-blown type 2 diabetes within 5 years.

Dr. Joshua J. Joseph, an endocrinologist and assistant professor at The Ohio State University Wexner Medical Center in Columbus, led the new research.

In the new study, Dr. Joseph and colleagues evaluated diabetes status in 7,758 individuals who participated in the REasons for Geographic and Racial Differences in Stroke Study.

The team used the AHA's seven factors to assess the cardiovascular health of the participants.

The analysis revealed that participants who had at least four out of the seven factors within the ideal range were 70 percent less likely to develop diabetes over the next 10 years.

"What's interesting," reports the study's lead researcher, "is [that] when we compared people who had normal blood glucose and those who already had impaired blood glucose, [...] [t]hose in normal levels who attained four or more guideline factors had an 80 percent lower risk of developing diabetes."

However, he notes that those who already had prediabetes and met four of the seven factors did not seem to benefit from the lifestyle changes. Instead, their risk of diabetes remained the same.

This is further proof, continues the researcher, that people should use the "simple 7" to prevent the onset of diabetes.

"Healthy people need to work to stay healthy," says Dr. Joseph. "Follow the guidelines," he advises.

"Don't proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes."

Dr. Joshua J. Joseph

The physician also stresses the importance of educating the public about preventing diabetes. He and his team are actively engaged in community outreach programs that inform people about healthful practices.

"We don't wait for people to come to us as patients," Dr. Joseph says. "We're very engaged in taking our work from the lab and applying it to our populations so we can help keep our communities healthy."

The video below further details the findings and zooms in on the case of Tim Anderson, a man who has recently received a diabetes diagnosis:

New research, appearing in the European Heart Journal, suggests that lack of physical activity can drastically increase the risk of a heart attack in the long-term, even if there are no symptoms at present.

Cardiorespiratory fitness describes the body's ability to deliver oxygen to the muscles when we are engaged in physical activity. Specifically, the term refers to "the efficiency of the heart, lungs and vascular system."

A significant body of research has linked cardiorespiratory fitness with a variety of positive health outcomes, ranging from preventing cardiovascular disease and all-cause mortality to staving off diabetes and improving insulin resistance.

However, most of these previous studies have relied on the participants' self-reported levels of fitness.

New research uses more precise methods of measuring cardiorespiratory fitness and highlights another one of its benefits.

Higher fitness levels can halve the risk of heart attack, the new study finds. Conversely, suggest the researchers, poor fitness levels can raise future risk even in the absence of warning symptoms in the present.

Bjarne Nes, from the Norwegian University of Science and Technology's Cardiac Exercise Research Group in Trondheim, is the corresponding and last author of the study.

Studying fitness levels and heart attack risk

Nes and his colleagues analyzed the cardiorespiratory fitness of more than 4,500 people who took part in an extensive health survey called HUNT3.

None of the participants had a history of cardiovascular disease, lung disease, cancer, or high blood pressure at the start of the study.

Just over 50 percent of the participants were women, and more than 80 percent of all of them were at "low risk" of developing cardiovascular disease over a 10-year period.

The scientists used a "gold-standard method" — or maximum oxygen uptake — to directly measure the participants' fitness levels.

Maximum oxygen uptake refers to the maximum amount of oxygen the body can absorb during exercise. According to Nes, it is "the most precise measure of fitness."

High fitness halves the risk of heart attack

By the end of the study, 147 of the participants had heart attacks or had developed angina pectoris — two conditions caused by blocked or narrowed coronary arteries.

The analysis by the researchers revealed a correlation between declining cardiovascular risk and increased fitness levels.

"Even among people who seem to be healthy, the top 25 percent of the most fit individuals actually have only half as high a risk as the least fit 25 percent," reports Nes.

Furthermore, even a small improvement in cardiorespiratory fitness saw significant benefits for heart health. Namely, each fitness increase of 3.5 points correlated with a 15 percent lower risk of heart attack or angina.

"We found a strong link between higher fitness levels and a lower risk of heart attack and angina pectoris over the 9 years following the measurements that were taken," says Nes.

"We know that patients with low oxygen uptake are at increased risk of premature death and cardiovascular disease," he continues.

"Our study shows that poorer fitness is an independent risk factor for coronary artery disease, even among healthy women and men who are relatively fit."

Bjarne Nes

'Use training as preventive medicine'

Dr. Jon Magne Letnes, the study's first author, also further comments on the findings. "Our results should encourage people to use training as preventive medicine," Dr. Letnes says.

"A few months of regular exercise that gets you out of breath can be an effective strategy for reducing the risk of cardiovascular disease."

Dr. Letnes explains that cardiorespiratory fitness offers insights into so much more than just endurance to exercise.

"Fitness isn't just a measure of how much you've trained in your life, but it also tells you what kind of genes you have," he says.

"Other factors like obesity may also affect fitness. So we measure a lot of the body's functions, and from other studies, we know that both genes and physical activity play a role in how your heart and blood vessels function," Dr. Letnes explains.

The study's first author thinks doctors should consider fitness measurements when evaluating heart disease risk.

"Although it may be inconvenient and difficult to measure oxygen uptake at the doctor's office, some simple and relatively accurate calculators exist that can provide a good estimate of fitness and disease risk," he advises.

Can the duration and quality of your sleep affect your cardiovascular health? A new study suggests there is a connection between how much sleep you get each night — and how well you sleep — and the risk of cardiovascular problems.

Many studies have emphasized the importance of sleep in maintaining our health and well-being in general. Increasingly, however, researchers are finding out how sleep quality affects specific aspects of a person's health.

For instance, one recent study that was covered by Medical News Today found that poor sleep could well be a telltale sign of the development of Alzheimer's disease. Another study tied sleep problems with high blood pressure, at least in women.

Now, research from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, Spain, and Tufts University — with campuses in Medford and Somerville, MA — indicates that there is a link between sleep quality and the risk of atherosclerosis, a condition that doctors characterize by plaque buildup in the arteries.

"Cardiovascular disease is a major global problem, and we are preventing and treating it using several approaches, including pharmaceuticals, physical activity, and diet," says the new study's senior author, Dr. José Ordovás.

"But this study emphasizes we have to include sleep as one of the weapons we use to fight heart disease — a factor we are compromising every day," Dr. Ordovás explains.

The research team's findings now appear in the Journal of the American College of Cardiology.

All about sleep duration and quality

The researchers analyzed the medical data of 3,974 individuals who averaged 46 years of age, were based in Spain, and who took part in the Progression of Early Subclinical Atherosclerosis (PESA) study.

Essentially, PESA recorded the prevalence and rate of progression of vascular problems that were not yet clinically relevant in the participants. None of the PESA-sourced volunteers had a diagnosis of heart disease at baseline, and two-thirds of them were male.

Besides allowing doctors to assess their vascular lesions, the participants also agreed to wear a sleep actigraph — a device that helps record a person's sleep patterns — for a period of 7 days.

Using the actigraph results, the researchers split the participants into four distinct groups:

people who slept under 6 hours per night people who slept 6–7 hours per night people who slept 7–8 hours each night people who slept longer than 8 hours.

All the participants also had 3-D heart ultrasounds, as well as cardiac CT scans, to check for the presence of heart disease. Moreover, the 3-D heart ultrasounds also measured atherosclerosis throughout the body.

The study found that — after the exclusion of other risk factors for heart disease — participants who slept under 6 hours every night had a 27 percent increase in the risk for atherosclerosis when the researchers compared them with people who slept between 7 and 8 hours each night.

Poor sleep quality — for instance, waking up often during the night — was associated with similar outcomes, increasing atherosclerosis risk by 34 percent.

Some researchers have emphasized that, even if you do end up sleeping less time, the quality of that sleep will have a noticeable impact on your health.

"It is important to realize that shorter sleep duration that is of good quality can overcome the detrimental effects of the shorter length," notes Dr. Valentin Fuster who is editor-in-chief of the Journal of the American College of Cardiology, in which the current study appears.

Intriguingly, the study also found some evidence that people who slept more than 8 hours per night — especially women — also had a heightened risk of atherosclerosis, though few people reported overly long slumber times.

The first study of its kind

The study researchers also noted that participants who reported getting less sleep each night were more likely to drink more caffeinated and alcoholic drinks.

"Many people think alcohol is a good inducer of sleep, but there's a rebound effect," explains Dr. Ordovás. "If you drink alcohol," he adds, "you may wake up after a short period of sleep and have a hard time getting back to sleep. And if you do get back to sleep, it's often a poor-quality sleep."

As for the effects of coffee, the study's senior author notes that these are, most likely, down to an individual's genetic makeup, and how their body breaks down caffeine.

"Depending on your genetics, if you metabolize coffee faster, it won't affect your sleep, but if you metabolize it slowly, caffeine can affect your sleep and increase the odds of cardiovascular disease," he notes.

Dr. Ordovás believes that the current study is more accurate than previous efforts to map out the relationship between sleep and cardiovascular risk.

For one, the current study was larger than previous research. Most importantly, it reported on actigraph data to determine sleep patterns, rather than on self-reports from participants, which are subjective and can be unreliable.

"What people report and what they do are often different," Dr. Ordovás points out.

"This is the first study to show that objectively measured sleep is independently associated with atherosclerosis throughout the body, not just in the heart."

Dr. José Ordovás

Metoprolol tartrate and metoprolol succinate are different salt forms of the same active ingredient, metoprolol. Although these medications are similar, they have slightly different uses and effects.

Metoprolol belongs to a class of drugs called beta-blockers. These drugs work by slowing down a person's heart rate and lowering their blood pressure.

Doctors often prescribe beta-blockers for people with cardiovascular conditions or those who have had a heart attack. Both metoprolol tartrate and metoprolol succinate are prescription-only drugs.

In this article, we explore the differences and similarities between these two drugs.

Uses
Metoprolol tartrate and metoprolol succinate can both treat high blood pressure and angina.

Income levels, if they are unstable, can easily turn into a stressor. However, the volatility of personal income could be having a more serious effect on people's heart health.

It is often expected that a person's income will constantly rise until they reach retirement age.

However, this isn't always the case. In fact, incomes have become so unpredictable that their volatility has reached an all-time high since 1980.

When a person's income fluctuates, it can alter many other factors in their life.

It can affect everything from mental health to diet, which could result in potentially serious health problems.

A new study suggests that personal income may even be associated with an increased risk of heart disease and death.

What is most surprising is that this link is present in relatively young people. We know this because an ongoing study has been tracking the health of young people living in four cities around the United States for nearly 3 decades.

The Coronary Artery Risk Development in Young Adults (CARDIA) study started in 1990. The four cities are Minneapolis, MN, Chicago, IL, Oakland, CA, and Birmingham, AL. Each participant was aged 23–35 years when the researchers first examined them.

The risk of low income

The researchers behind the new study analyzed data from the CARDIA study to see whether there was a link between income fluctuations and risk of cardiovascular events as well as death. They first studied income levels taken from five assessments in 1990–2005.

They defined income volatility as a percentage change from one income figure to the next. They also looked at income drop, or an income decrease of 25 percent or more from the previous assessment figure.

They then tracked the number of people who experienced cardiovascular events — both fatal and non-fatal — or died of any cause in 2005–2015.

There were 106 cardiovascular events and 164 deaths. The team took into account factors such as pre-existing heart risk and sociodemographic background.

The results, now published in the journal Circulation, found that substantial fluctuations in personal income were associated with a higher risk of death and cardiovascular diseases in the decade following this income change.

The highest levels of income volatility were linked with almost double the risk of death and over double the risk of conditions such as strokes, heart failure, or heart attacks.

These findings were all compared with those of people who fell into a similar category but who had less of an alteration in their personal income.

Some people were more likely to experience high income volatility. Such people included women, African-American people, those who are unemployed, people who are not married, people who smoke, those with less than a high school education, and people with signs of depression.

Why money matters

Lead study author Tali Elfassy, Ph.D., at the University of Miami Miller School of Medicine in Florida, says that income volatility "presents a growing public health threat, especially when federal programs, which are meant to absorb unpredictable income changes, are undergoing continuous changes, and mostly cuts."

"While this study is observational in nature and certainly not an evaluation of such programs, our results do highlight that large negative changes in income may be detrimental to heart health and may contribute to premature death."

Tali Elfassy, Ph.D.

It is not clear what exactly prompts income volatility to result in an elevated risk of cardiovascular problems, death, or both. It could be that fluctuations in a person's income result in unhealthful behaviors, such as excessive alcohol consumption, a lack of exercise, stress, and high blood pressure.

All of these things are linked to lifespan and cardiovascular health.

The researchers hope that other scientists will carry out further research to understand the cause of this newly found association. They list biologic and psychosocial pathways as being two potential reasons to explore.

They also see these findings as a way to more effectively screen people, especially those who are younger, for cardiovascular disease risk.

However, these results cannot currently be applied to all identities. Other ethnic groups and people living outside of cities will also need to be studied to see whether the same association is present.

A new meta-analysis examines 40 years' worth of research in an attempt to find out the ideal amount of fiber that we should consume to prevent chronic disease and premature mortality.

Researchers and public health organizations have long hailed the benefits of eating fiber, but how much fiber should we consume, exactly?

This question has prompted the World Health Organization (WHO) to commission a new study. The results appear in the journal The Lancet.

The new research aimed to help develop new guidelines for dietary fiber consumption, as well as reveal which carbs protect the most against noncommunicable diseases and can stave off weight gain.

Noncommunicable diseases are also called chronic diseases. They typically last for a long time and progress slowly. According to WHO, there are "four main types of noncommunicable diseases:" cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.

Professor Jim Mann, of the University of Otago, in New Zealand, is the corresponding author of the study, and Andrew Reynolds, a postdoctoral research fellow at Otago's Dunedin School of Medicine, is the first author of the paper.

Prof. Mann explains the motivation for the study, saying, "Previous reviews and meta-analyses have usually examined a single indicator of carbohydrate quality and a limited number of diseases, so it has not been possible to establish which foods to recommend for protecting against a range of conditions."

To find out, the researchers performed a meta-analysis of observational studies and clinical trials.

Daily intake of 25–29 grams of fiber is ideal

Reynolds and colleagues examined the data included in 185 observational studies — amounting to 135 million person-years — and 58 clinical trials which recruited over 4,600 people in total. The studies analyzed took place over almost 40 years.

The scientists investigated the incidence of certain chronic diseases, as well as the rate of premature deaths resulting from them.

These conditions were: coronary heart disease, cardiovascular disease, stroke, type 2 diabetes, colon cancer, and a range of obesity-related cancers, such as breast cancer, endometrial cancer, esophageal cancer, and prostate cancer.

Overall, the research found that people who consume the most fiber in their diet are 15–30 percent less likely to die prematurely from any cause or a cardiovascular condition, compared with those who eat the least fiber.

Consuming foods rich in fiber correlated with a 16–24 percent lower incidence of coronary heart disease, stroke, type 2 diabetes, and colon cancer.

Fiber-rich foods include whole grains, vegetables, fruit, and pulses, such as peas, beans, lentils, and chickpeas.

The analysis also revealed that the amount of fiber that people should consume daily to gain these health benefits is 25–29 grams (g). By comparison, adults in the United States consume 15 g of fiber daily, on average.

The authors also suggest that consuming more than 29 g of fiber per day may yield even more health benefits.

However, they do caution that, while the study in itself did not find any adverse health effects of consuming fiber, eating too much of it may be damaging for people with insufficient iron or minerals.

Eating large amounts of whole grains can further deplete the body of iron, explain the researchers.

Finally, the clinical trials included in the study also revealed that consuming more fiber correlates strongly with lower weight and lower cholesterol levels.

Why fiber is so good for you

Prof. Mann comments on the significance of the findings, saying, "The health benefits of fiber are supported by over 100 years of research into its chemistry, physical properties, physiology, and effects on metabolism."

"Fiber-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favorably influence lipid and glucose levels," he adds.

"The breakdown of fiber in the large bowel by the resident bacteria has additional wide-ranging effects including protection from colorectal cancer."

"Our findings provide convincing evidence for nutrition guidelines to focus on increasing dietary fiber and on replacing refined grains with whole grains. This reduces incidence risk and mortality from a broad range of important diseases."

Prof. Jim Mann

Coenzyme Q10 is an essential chemical that the body produces naturally. A deficiency of this chemical can have adverse effects, and coenzyme Q10 supplements may offer health benefits.

In this article, we discuss the health benefits and risks of taking coenzyme Q10 (CoQ10) supplements.

What to know about CoQ10
CoQ10 is a naturally produced chemical that is available as a supplement.

In this Spotlight, we will discuss six examples of self-surgery. The stories that follow are gruesome and unusual. Although they are not for the fainthearted, they are fascinating.

Surgery is normally a skillful, delicate procedure that involves a surgeon and a patient.

However, over the years, for many reasons, one of the players in this classic duet has been absent.

In some cases, a surgeon's dedication to understanding the human body goes far beyond the walls of the library, inspiring them to cut themselves open.

In other cases, extreme situations have made extreme actions the only viable option.

Self-surgery, or autosurgery, is certainly not a frequent occurrence — especially in modern times. However, it does happen, and below are six extreme examples.

1. Cardiac catheterization

Werner Theodor Otto Forssman was studying medicine in Germany in the 1920s when a professor of his planted a question in his mind. That question was: Is it possible to reach the heart through the veins or arteries without the need for traumatic surgery?

Back then, the only way to access the heart was by conducting a fairly risky surgical procedure.

Forssman came across an article describing how a veterinarian had reached a horse's heart with a catheter via the internal jugular vein. This transports blood from the brain, face, and neck to the heart.

He came to the conclusion that in humans, he could use a ureteric catheter to reach the heart via the cubital vein, which lies close to the surface of the arm and travels to the heart.

Excited, Forssman told the chief of surgery that he planned to attempt the procedure on a patient.

The chief was rightly concerned for the patient's safety and blocked his plans. So, Forssman asked if he could carry out the procedure on himself. Once again, the chief responded in the negative.

Undeterred, the young surgeon spoke with the operating room nurse; as the keeper of the equipment, he would need to have her permission.

She was impressed with the idea and offered herself as a test subject. Despite her courage, Forssman was still determined to carry out the procedure on himself.

He strapped the nurse down and pretended to make an incision on her, but he anesthetized his own cubital vein. He managed to advance the catheter 30 centimeters up his arm before the nurse realized that she had been duped.

Forssman asked her to call in an X-ray nurse so that he could chart the catheter's internal voyage from his arm to his heart.

While they were taking pictures of the catheter, a colleague saw what Forssman had done and attempted to pull the catheter out of his arm. However, Forssman won the ensuing tussle and continued his procedure.

The first images from the X-ray showed that the catheter had reached the level of his shoulder, so he continued feeding it through. Eventually, he achieved his goal: he could see the tip of his right ventricle cavity.

The procedure was a success, but Forssman had gone against the grain and was dismissed from his residency. Unable to find any surgical position, he turned to urology.

Then, 17 years later, alongside two others, he won the Nobel Prize for Physiology or Medicine for his part in the invention of cardiac catheterization.

Forssman's self-surgery was all in the name of medical advancement, but the next was a fight for survival.

2. A most troublesome appendix

In 1960, Leonid Rogozov was a member of the 6th Soviet Antarctic expedition. He was the team's only medical professional.

Several weeks into the expedition, the 27-year-old surgeon noticed some of the telltale signs of appendicitis: fever, weakness, nausea, and significant pain in his right lower abdomen.

Drugs were not improving his situation; surgical intervention was needed. In his diary, he wrote:

"I did not sleep at all last night. It hurts like the devil! A snowstorm whipping through my soul, wailing like a hundred jackals."

As winter deepened and the sea froze, Rogozov had no hope of returning to civilization for treatment. His only option was to carry out an appendectomy on himself.

This was an operation that he had completed many times, but certainly not under these circumstances.

"Still no obvious symptoms that perforation is imminent," he wrote, "but an oppressive feeling of foreboding hangs over me...This is it...I have to think through the only possible way out: to operate on myself...It's almost impossible...but I can't just fold my arms and give up."

He recruited three of his colleagues to assist him: one held the mirror and adjusted the lamp, one handed him the surgical implements as he requested them, and one acted as a reserve in case either of the others should faint or become nauseous.

Rogozov also explained how to revive him with epinephrine in case he lost consciousness.

At 2 a.m. on May 1, 1961 — after medicating himself with local anesthetic — he made the first 10–12-centimeter long incision in his abdomen. After around 30 minutes, Rogozov became weak and needed to take regular breaks, but he persevered.

His self-surgery was successful, and after 2 weeks, he was back to full health.

3. Self-cesarian

Most of these examples involve medically trained men, but this one bucks that trend. The woman in question had no medical training.

This example of autosurgery took place in March 2000 in a remote Mexican village, where access to healthcare is virtually nonexistent. A 40-year-old mother of eight was carrying her ninth child.

Around 2 years before this case of autosurgery, the woman had lost a child during labor due to an obstruction.

After hours of unproductive labor, she was concerned that she might lose the baby again. So, in a desperate attempt to prevent this from happening again, she decided to perform a cesarian on herself.

First, she drank three strong alcoholic drinks. Then, using a kitchen knife, she opened her abdomen with three strokes. According to a paper that describes the procedure, "[S]he used her skills at slaughtering animals." In all, the procedure took 1 hour.

Once free, the newborn boy breathed immediately. The woman then asked one of her children to fetch a local nurse to patch her up. The nurse repositioned the woman's intestines and sewed up the wound using a standard sewing needle and cotton.

Then, finally, she arrived at the nearest hospital — some 8 hours away by road. She did require extensive treatment, but she recovered enough to be released after 10 days.

In the paper mentioned above, the authors write:

"The natural, innate maternal instinct for preservation of offspring may result in the mother's disregard for self-safety, and even for her own life."

4. Another troublesome appendix

Dr. Evan O'Neill Kane was the owner of Kane Summit Hospital in Pennsylvania. While awaiting the removal of his own appendix, he decided to do it himself.

Although the medical staff were less than comfortable with his decision, he was their boss, and they reluctantly allowed him to indulge in autosurgery.

In 30 minutes, Dr. Kane injected adrenalin and cocaine into his abdominal wall, cut himself open, found his appendix, and removed it.

In fact, he claimed he could have completed the surgery quicker had his staff not been so nervous.

During the surgery, Dr. Kane leaned a little too far forward and his intestines slipped through the wound in his abdomen.

Though his colleagues were shocked, he remained calm and simply pushed them back to where they belonged.

Just 2 weeks later, Dr. Kane had fully recovered and was operating again. When someone asked him why he had decided to embark on self-surgery, he told them that he wanted to know what it felt like.

Also, and perhaps more importantly, he wanted to demonstrate that it was possible to undergo minor procedures without the use of relatively dangerous general anesthetics.

This wasn't Dr. Kane's only foray into self-surgery; at age 70, he decided to repair his inguinal hernia under local anesthetic, and this time, he invited members of the press to attend.

The operation was successful, but Dr. Kane never recovered his full strength. He died of pneumonia within just 3 months.

5. The sixth stone

M. Clever Maldigny, a military surgeon, was plagued by kidney stones. By age 27, he had endured no less than five operations to remove them.

Some of these procedures had caused long-lasting complications, so, in 1824, Maldigny decided that he would remove the sixth stone himself.

Using a mirror and guided by the scars of previous procedures, he opened himself up. He located the neck of the bladder and found the offending article lodged among the scars formed by previous surgeries.

The self-surgery was successful and, according to Maldigny, 3 weeks later "he was tranquil and cheerful as if he had never been a sufferer."

When a seventh kidney stone appeared some years later, he opted for a new and minimally invasive surgery wherein a surgeon crushes the stone via a small hole.

He did not carry out the procedure himself.

6. An egg-sized hernia

Our final example of self-surgery comes from Romanian surgeon called M. Alexandre Fzaicou. He had developed an inguinal hernia, in which some of the contents of the abdominal cavity push through a weak spot in the wall of the abdomen and form a painful swelling in the groin area.

According to Fzaicou, his hernia was the size of a hen's egg.

After many attempts at anesthetizing the region with strychnine-stovain, he finally found the right injection point in the groin and got to work.

The surgery took around 1 hour and was a success. Following the procedure, Fzaicou reported headache, insomnia, and pain in the upper abdomen, which lasted 1 week. He had returned to work in just 12 days.

If nothing else, these stories remind us of the amazing things that humans are capable of.

Although it probably goes without saying, Medical News Today do not suggest or imply that autosurgery is the best course of action for anyone.

People with heart failure are more susceptible to flu complications than other people. However, a new study has revealed that flu vaccinations may have a significant impact on lifespan.

Most doctors, scientists, and other medical professionals consider flu vaccinations to be a safe and effective way of protecting people against influenza, or the flu.

The vaccine, usually given in the form of an injection, contains small amounts of deactivated flu viruses.

These viruses are not harmful in this state but do trigger the human body to produce antibodies to fight against them. This means that the next time the virus enters the body, it can produce the same response quickly.

The Centers for Disease Control and Prevention (CDC) advise that everyone over the age of 6 months has a flu vaccination. However, certain individuals are more at risk of experiencing flu-related complications or even death.

This includes people over 65 years old and over, those who are pregnant, and those who have medical conditions, such as heart disease.

A new study has examined just how much of an impact a flu shot can have on the survival rate of people diagnosed with heart failure. This group of individuals are often older and are also likely to have a range of other health issues. For these people, getting the flu can be a severe problem.

The analysis

A team of researchers from the University of Copenhagen in Denmark analyzed data from a total of 134,048 Danish people who had recently received a diagnosis of heart failure. The researchers gathered the data from several national registries that store information on hospital diagnoses, prescriptions, and causes of death.

Each person born in Denmark receives a unique personal identification number, and this number allowed researchers to follow particular people for 12 years, from 2003 to 2015.

Many findings from the study came to light. The data analysis, now published in the American Heart Association's journal Circulation, firstly showed that the number of people getting flu vaccinations had increased.

In 2003, 16 percent of people with heart failure had the flu vaccine. In 2015, this had risen to 52 percent of people.

The researchers also found a link between flu vaccinations and "an 18 percent reduced risk of premature death." This reduction existed even after taking other factors, such as medications, other health issues, and financial situations, into account.

The importance of vaccines

The research also identified the importance of having regular flu shots. For example, having an annual flu vaccination after a diagnosis of heart failure showed a 19 percent reduction in cardiovascular death and all-cause death compared to those who did not get vaccinated.

Having the flu shot less than once a year resulted in an 8 percent reduction in the risk of cardiovascular death and "a 13 percent reduced risk of all-cause death" when compared to people who had never had the vaccination.

The final factor that the researchers identified was the timing of the flu vaccination. The team found a reduction in the number of cardiovascular and all-cause deaths when people received the vaccine at the beginning of the flu season, which is usually around September or October, rather than in November and December, for example.

Heart failure's future

Scientists expect heart failure to become an increasing problem in future years, making these results potentially useful for a human population that is now living longer. One limitation of this research, however, is that the scientists only studied people newly diagnosed with heart failure. Lead author of the study Daniel Modin says:

"While this research only looked at patients with newly diagnosed heart failure, the protection from a flu shot likely benefits any patient with heart failure."

Daniel Modin

He continues, "I hope that our study can assist in making physicians and cardiologists who care for patients with heart failure aware of how important influenza vaccination is for their patients. Influenza vaccination may be regarded as a standard treatment in heart failure similar to medications."

Sticking to a strict diet can be challenging, so our eating patterns can fluctuate wildly. A new study looks at how these changes might impact cardiovascular health.

As we roll into 2019, many people will be trying out new diet regimes.

For many of us, sticking to a nut-filled, burger-free, fish-heavy Mediterranean-style diet will only last a matter of days before we return to the realms of cheesecake and cheese boards.

Though eating right over the long-term reduces the risk of cardiovascular problems, we know much less about how a fluctuating dietary regime impacts our heart health.

Because so many people choose a diet and then gradually stray from it, researchers are interested in how yo-yo dieting might influence markers of cardiovascular disease.

A team led by Prof. Wayne Campbell, of Purdue University in West Lafayette, IN, set out to investigate. The scientists recently published their findings in the journal Nutrients.

Altering eating patterns periodically

To investigate, the scientists inspected data from two previous studies into dietary interventions carried out by the same group of researchers at Purdue University.

The participants of these studies followed one of two eating patterns: a Mediterranean diet or a Dietary Approaches to Stop Hypertension (DASH) diet.

Lead study author Lauren O'Connor explains these two eating patterns, saying, "Our DASH-style eating pattern focused on controlling sodium intake, while our Mediterranean-style focused on increasing healthy fats. Both eating patterns were rich in fruits, vegetables, and whole grains."

Participants followed their eating pattern for 5 or 6 weeks. After this period, the scientists assessed their cardiovascular risk by measuring a range of parameters.

These included blood pressure and levels of fats, glucose, and insulin in the blood.

Following the 5–6 weeks of dieting, participants went back to their standard eating patterns for a further 4 weeks. Then, after another cardiovascular assessment, they were restarted on DASH or Mediterranean diet plans for an additional 5–6 weeks. Finally, they had one more checkup at the end of this period.

A cardiometabolic 'rollercoaster'

The analysis showed that, as expected, the cardiovascular markers improved when the individual stuck to the diet. Then, once they had returned to a less healthful eating regime, the biomarkers became less favorable again.

Then, once the healthful diets were restarted, the metabolic markers once again improved.

The key message is that only a few weeks of healthful eating can make measurable improvements to markers of cardiovascular health, but at the same time, it does not take long before they return to their unhealthy state once a person terminates their healthful diet.

"These findings should encourage people to try again if they fail at their first attempt to adopt a healthy eating pattern," Prof. Campbell says. "It seems that your body isn't going to become resistant to the health-promoting effects of this diet pattern just because you tried it and weren't successful the first time."

More research will be needed to explore whether yo-yo dieting has an impact on long-term health.

Some studies have shown that losing and gaining weight again in a cycle, or weight cycling, could cause stress to the cardiovascular system. However, the evidence is certainly not overwhelming, and some scientists question whether weight cycling has any adverse effects at all.

Overall, the results are bittersweet; they show that just a few weeks of dietary change can produce measurable improvements in health markers. On the flip side, after just a few weeks following the abandonment of a new diet, those benefits are lost.

However, if a person restarts their healthful eating plan, the benefits can be won back in the same short amount of time. As such, Prof. Campbell's message is one of stubborn persistence:

"The best option is to keep the healthy pattern going, but if you slip up, try again."

Millions of people live with high blood pressure, which can place them at risk of developing cardiovascular diseases. For this condition, doctors typically prescribe blood-lowering drugs, but could exercise help just as well?

According to the Centers for Disease Control and Prevention (CDC), approximately 75 million adults in the United States have to manage high blood pressure, where it exceeds the threshold of 140 millimeters of mercury (mm Hg).

The condition can increase their risk of developing heart disease or experiencing a stroke, both of which are leading causes of death in the U.S.

Moreover, high blood pressure drives an expense of around $48.6 billion per year nationally, including the cost of medication, accessed health care, and absence from work.

People with high blood pressure typically follow an antihypertensive or blood pressure-lowering treatment, which includes special medication. At the same time, specialists sometimes advise that people make lifestyle changes to help them manage their blood pressure.

One such change is to take regular, structured exercise that can be of several types:

endurance exercises, such as walking, jogging, or swimming high-intensity interval training, involving short bursts of intensive exercise dynamic resistance, including strength training isometric resistance, such as the plank exercise a combination of endurance and resistance exercises

However, no studies have yet compared the effectiveness of physical activity in lowering blood pressure with that of antihypertensive medication.

A new study in the British Journal of Sports Medicine — a BMJ publication — aims to address this gap in the literature.

Findings indicate similar effects

Since there are no studies that directly compare the effects of blood pressure medication with those of structured exercise, the study analyzed the data of various research projects that focused on one or other of these approaches.

The researchers — from institutions across Europe and the U.S., including the London School of Economics and Political Science in the United Kingdom, and the Stanford University School of Medicine in California — explain that structured exercise helps lower systolic blood pressure, which measures the blood pressure in the blood vessels as the heart beats.

In the current study, they looked at the data from 194 clinical trials that focused on antihypertensive drugs and their impact on systolic blood pressure, and another 197 clinical trials, looking at the effect of structured exercise on blood pressure measurements. In total, these trials collected information from 39,742 participants.

Dr. Huseyin Naci — from the Department of Health Policy at the London School of Economics and Political Science — and colleagues conducted several sets of analyses on the data from the trials.

First, they compared the effects of all types of antihypertensive drugs with those of all kinds of exercise. Then, they looked at specific drug types versus specific types of exercise. Finally, they compared the impact of different exercise intensities with those of different drug dosages.

In the first instance, the investigators conducted these analyses by using data from healthy participants with normal blood pressure. Then, they repeated them with data from individuals with high blood pressure only.

They found that antihypertensive drugs were more effective in lowering blood pressure than structured exercise in the case of the general population. However, when they looked specifically at people with high blood pressure, they saw that exercise was as effective as most blood-lowering medication.

Moreover, the study authors concluded that there is "compelling evidence that combining endurance and dynamic resistance training was effective in reducing [systolic blood pressure]."

More exercise is beneficial

Still, the research team cautions that they based their analyses on many small-scale trials, and others should replicate their results with more extensive studies.

Dr. Naci and colleagues also strongly advise against giving up on antihypertensive medication and replacing it with exercise.

"We don't think, on the basis of our study, that patients should stop taking their antihypertensive medications," the researcher says in a podcast in which he speaks about the current research.

"But," Dr. Naci adds, "we hope that our findings will inform evidence-based discussions between clinicians and their patients."

The lead researcher notes that many people in the U.S. and throughout Europe lead sedentary lives and that they would benefit from taking more exercise.

At the same time, however, he emphasizes that doctors should make sure their patients can adhere to prescribed exercise regimens.

"It's one thing to recommend that physicians start prescribing exercise to their patients, but we also need to be cognizant of the resource implications and ensure that the patients that have been referred to exercise interventions can adhere to them and so really derive benefit."

Dr. Huseyin Naci