Regular Exercise Relieves Symptoms of Chronic Conditions

A bird at Echodale Park. (Dr. Noorali Bharwani)
A bird at Echodale Park. (Dr. Noorali Bharwani)

There is one drug that can be free, safe and readily accessible. It is called exercise. Every person should be encouraged to take this drug to be happy and healthy. That is the message in an article published in the Canadian Medical Association Journal (Prescribing exercise interventions for patients with chronic conditions, CMAJ April 19 2016)

Experts believe exercise is under prescribed and frequently overlooked often in favour of medications or surgery. Patients find taking painkillers is an easy way out than finding time for regular exercise. We are very busy making a living and raising a family. Finding time for regular exercise means making choices and sacrifices.

What are the benefits of regular exercise?

Studies have shown regular exercise plays a big role in prevention of coronary heart disease, stroke rehabilitation, treatment for heart failure and prevention of diabetes. Benefits of exercise are substantial for conditions that are not life threatening, like chronic back pain and osteoarthritis.

Outcomes for which exercise is effective

The authors of the CMAJ article reviewed evidence for the effectiveness of exercise for the following conditions: Arthritis of the hip and knee, chronic nonspecific low-back pain, prevention of falls, heart failure, coronary heart disease, chronic obstructive pulmonary disease (COPD), chronic fatigue syndrome, and type 2 diabetes.

The evidence is clear. Exercise helps.

To make sure the exercise program works for a patient the health care provider should monitor the progress in conjunction with the exercise specialist. Without appropriate guidance exercise is unlikely to achieve the desired outcomes.

Not all patients need to see an exercise specialist. Some of these exercises may be prescribed by family physicians. These are largely self-actioned by a patient (for example for falls prevention), whereas other interventions require a referral to a health care professional with expertise in exercise prescription (e.g., cardiac rehabilitation, exercise for chronic back pain or knee osteoarthritis and pulmonary rehabilitation for COPD).

For example, a person with chronic nonspecific low-back pain should see an exercise specialist to guide through a properly planned exercise therapy.

According to the CMAJ article, a typical program would comprise 20 hours of individually supervised sessions over 8–12 weeks and a home program. The type of exercise (e.g., yoga v. graded activity) seems less important than the quality of implementation (e.g., supervision, inclusion of a home program and duration of the program have been shown to improve treatment effect).

Exercise programs normally include an education component, incorporation of psychological principles, such as pacing or goal setting, and progress in functional activities, says the article.

The authors believe exercise is an effective but neglected treatment for many chronic conditions. Exercise is beneficial for many chronic conditions and can offer benefits that are comparable to taking painkillers.

Under normal circumstances how much should the average adult exercise every day?

Regular exercise is important for everyone. This is a well-known fact. Everybody knows it. But most people have trouble finding time or are confused about the type of exercise they should do.

It is recommended that adults accumulate at least 2.5 hours of moderate to vigorous physical activity each week and children and youth accumulate at least 60 minutes per day.

Regular exercise strengthens your heart, lungs, bones and muscles. Gives you more energy and strength. Helps control your weight and blood pressure. All the things we always wanted in life… besides money!

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How to Reduce the Risk of Dementia

Columbia Icefield - the largest ice field in the Rocky Mountains. (Dr. Noorali Bharwani)
Columbia Icefield - the largest ice field in the Rocky Mountains. (Dr. Noorali Bharwani)

Dementia is not a specific illness. It is a combination of symptoms that affect memory, thinking and social abilities. It reduces a person’s ability to perform everyday activities.

According to a report in the Lancet (Prevention of dementia by targeting risk factors – April 21, 2018), dementia epidemic is the greatest global challenge for health and social care in the 21st century.

There are a number of causes of dementia. Alzheimer’s disease is the most common cause of a progressive dementia accounting for 60 to 80 per cent of dementia cases.

Over 747,000 Canadians are living with Alzheimer’s or another dementia. Worldwide, at least 44 million people are living with dementia – more than the total population of Canada – making the disease a global health crisis that must be addressed. It affects about 14 per cent of Americans over age 71.

Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behaviour.

Can we do anything about it?

Dementia involves damage of nerve cells in the brain, which can occur in several areas of the brain. Dementia affects people differently, depending on the area of the brain affected. Finding a cure for something like that is difficult.

In this new Lancet report, a team of international researchers identifies nine key risk factors that together account for about 35 percent of cases. Depending on the cause, some dementia symptoms can be reversed.

Following nine steps can reduce the risk of dementia, but researchers say they need to be undertaken over the course of one’s lifetime. Here is the summary:

1. Education. Having higher education helps. Keep learning new skills through out your life. Keep your brain active.

2. Hypertension. Dementia and high blood pressure are closely linked.

3. Obesity. Obesity is a key risk factor in mid-life. Previous report from the U.K. found that being underweight in mid-life was also associated with an increased risk of dementia. So maintain proper weight.

4. Hearing loss. Hearing loss affects nearly a third of people over 55. Hearing loss can lead to social disengagement, depression, or brain atrophy.

5. Smoking. Smoking has ill effect on cardiovascular health. Cigarette smoke also contains substances that are toxic to the brain.

6. Depression. There are definite links between depression and dementia.

7. Physical inactivity. Research has shown that older adults who exercise are more likely to maintain cognition than those who do not exercise. Studies have suggested tai chi, longer exercise sessions (at least 45 minutes at a time), and resistance training may all have particular benefits for the brain.

8. Social isolation. Loneliness and a lack of physical contact, especially later in life, are linked to dementia.

9. Diabetes. Diabetes is a potential risk for many of the same reasons as obesity.

Finally, keep your brain sharp by playing brain games. Eat healthy with fruits, vegetables and nuts. Exercise. Remember, what is good for the body is good for the brain. Dementia will compromise your lifestyle, put extra burden on your family and will compromise your longevity. Most studies seem to show that the average number of years someone will live with dementia after being diagnosed is around ten years.

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Do you feel lonely?

Loneliness - a bridge to nowhere!
Loneliness - a bridge to nowhere!

“Loneliness and the feeling of being unwanted is the most terrible poverty.”
-Mother Theresa

According to research, doctors and lawyers are the loneliest professionals. That is not good because loneliness is linked to social isolation and increased risks of cardiovascular disease, dementia, depression and anxiety.

How do you define loneliness?

I went to Wikipedia to look for a definition. It says, “Loneliness is a complex and usually unpleasant emotional response to isolation.”

People may surround you, as doctors are, and still feel lonely. It seems there is lack of connection and/or communication with other people. You may be close to them but still do not feel connected. This can create a lot of anxiety and unhappiness.

According to a survey published in the Harvard Business Review, doctors and lawyers are among America’s loneliest workers, followed by people who work in engineering and science.

Lauren Vogel’s article in the Canadian Medical Association Journal (CMAJ July 20, 2018) quotes a study that says, “Lawyers and doctors were the loneliest by far, reporting levels of loneliness 25 per cent higher than respondents with bachelor’s degrees and 20 per cent higher than those with PhDs.”

What makes doctors lonely?

After high school doctors have to go through a challenging ordeal to get into a medical school and then go through residency and specialisation. That is about 10 years. During that time the doctor gets married and has children. Starting a practice and providing dedicated service takes a lot of years. After all that the doctor has very little time to have friends to unwind with.

All the friends you had in your high school years are not around. And if you do run into them then you find there is nothing much to talk about. There is no common ground.

By contrast, workers in marketing, sales and social work are the least lonely, likely because these fields are highly social. Income is not important when it comes to loneliness. And workers with higher levels of education report higher levels of loneliness.

What are the health effects of loneliness?

Early death is one possibility, says an article in Perspect Psychol Sci. (March 2015). One study showed loneliness has similar health effects to smoking 15 cigarettes a day.

A lonely individual costs the health care system more than those who are in a socially happy environment. As mentioned earlier research has linked social isolation to increased risks of cardiovascular disease, dementia, depression and anxiety.

Social isolation is considered such a growing problem in the United Kingdom that the government appointed a Minister for Loneliness whose tasks will include helping to develop “the evidence-base around the impact of different initiatives in tackling loneliness, across all ages and within all communities.”

What can we do?

It is important for doctors and other professionals to build a social circle. It is easy to face the challenges of loneliness if you have good family and friends to stand by you.

Behaviour experts say loneliness among doctors and other professional depends on how much of a culture of social support is in the workplace. Doctors and lawyers have none of that, as they are independent practitioners.

Loneliness affects someone in every family. That should not be the case as we are biologically designed to be nourished by connections. Let us sing Buck Owens’ lyrics:

Hello happiness, goodbye loneliness
Farewell heartaches and so long strife
No more sadness only gladness…

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Risks and benefits of using melatonin for a good night’s sleep.

Happy Halloween (Dr. Noorali Bharwani)
Happy Halloween (Dr. Noorali Bharwani)

Sleep is important for mind, body, and mood. We spend roughly a third of our lives sleeping.

A poll conducted by the University of Michigan in 2017 showed nearly half of the adults between ages 65 and 80 said they often have trouble sleeping. Many of these individuals regularly seek sleep aids.

Insufficient sleep (insomnia) has been linked to an increased risk of falls, collisions, cognitive decline, and dementia. It can increase your risk of cardiovascular problems, obesity, and even cancer. It can drain your energy and affect your work performance and quality of life.

How much sleep do you need? That varies from person to person, but most adults need seven to eight hours a night. Does melatonin help to have a good night’s sleep?

Melatonin is synthesized and secreted by the pineal gland in the brain. Melatonin levels are regulated by exposure to light. Levels peak around 2 a.m. at concentrations 10 to 100 times daytime levels.

Melatonin regulates the body’s sleep cycle. It plays an important role in initiating and maintaining sleep. Natural melatonin levels slowly drop with age. Some older adults make very small amounts of it or none at all.

Melatonin balance may be disrupted if you are in a different time zone or doing shift work. Clinical trials suggest melatonin can reduce the time it takes to fall asleep, increase total sleep time and improve quality of sleep.

One study found a relatively low dose of melatonin (0.3 mg) was enough to improve nighttime sleep in older adults without drowsiness the next day. Studies have shown melatonin increases sleep time by 12.8 minutes and increased sleep efficiency by about three per cent. Is this good enough? The clinical significance of this is unclear. There is no consensus among experts regarding the use and benefits of melatonin for insomnia.

In spite of that in the U.S., sales have increased by more than 500 per cent between 2003 and 2014, and where melatonin is the second most popular natural product used by children.

Very small amounts of it are found in foods such as meats, grains, fruits, and vegetables. You can also buy it as a supplement. Melatonin supplements generally have fewer side effects than do many prescription sleep drugs. They do not produce dependence or hangover effect.

Side effects of melatonin are few but may include daytime sleepiness and tiredness on waking. Headaches, nausea and dizziness also can occur. You should avoid activities that require alertness, such as driving, for five hours after taking melatonin. These pills can also undermine the effectiveness of blood pressure drugs and diabetes medication. Do not start taking melatonin without consulting your doctor. Do not use melatonin if you have an autoimmune disease.

If you do decide to take melatonin, choose commercial supplements produced in a lab. Melatonin supplements made from animal sources may contain contaminants. Melatonin should only be taken in its man-made form (myhealth.alberta.ca).

Know what you are buying. Make sure to look for the “USP verified” label. This means product is accurately labeled and free of harmful substances (Consumer Reports February 18, 2017).

People commonly use melatonin for sleep disorders, such as insomnia and jet lag. Evidence that melatonin supplements can treat sleep disorders is shaky, and over-the-counter melatonin has been banned for years in the United Kingdom, European Union, Japan, and Australia.

Melatonin is the only human hormone available in Canada without a prescription.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!