By Christen Brownlee, Contributing Writer

Not only is it safe for people with asthma to exercise, but doing so could reduce their risk of asthma symptoms or attacks, according to a new evidence review in The Cochrane Library.

Many people with asthma report avoiding exercise because they’re afraid it could trigger symptoms including shortness of breath, wheezing or a full-blown asthma attack, said review author Kristin V. Carson.

These fears might be encouraged from misreading their symptoms, their family’s beliefs about exercise and asthma, or even from their physicians.

Over time, Carson explains, patients can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity.

“This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma , comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised—using physical training as varied as running outdoors or on a treadmill, cycling, swimming or circuit training—were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

Additionally, Carson said, their findings showed that patients in exercise programs improved their cardiovascular fitness, which in turn could reduce asthma symptoms over time.

Some limited evidence from the included studies also suggested that exercise improved patients’ quality of life, she added, which could contribute to other health benefits and improved psychological well-being.

“We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Len Horowitz, M.D., a pulmonary specialist at Lenox Hill Hospital in New York City who wasn’t involved in this review, agrees that asthma patients shouldn’t shy away from exercise.

However, even though research suggests that exercise is safe for asthmatics, he says that many people will still use their asthma as a reason to avoid physical activity.

“Not everyone wants to exercise,” he said. “When patients think exercise makes them symptomatic or makes them risk an attack, it’s a good excuse not to do it.”

Horowitz notes that may professional athletes have asthma, which hasn’t negatively affected their careers.

However, he explains, some patients do have exercise-induced asthma, in which vigorous or prolonged exercise can trigger symptoms.

He advises patients in his practice to take precautions if they’re susceptible, including pre-treating themselves with an albuterol inhaler, avoiding exercise that exposes their lungs to cold, dry air (such as running outside in the winter) and building their activity levels gradually.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Every week, a KHN reporter selects interesting reading from around the Web.

Rolling Stone: Don Berwick On The Fate Of ‘Obamacare’

Between July 2010 and December 2011, Dr. Donald Berwick was head of the Centers for Medicare and Medicaid Services, the agency that runs the government’s health insurance programs. In a sane world, he would be still. But Senate Republicans refused even to let his confirmation come up for a vote. … A pediatrician by training and a widely respected expert in health care policy, Berwick should have been a lock for the CMS job. But he was a backer of Obamacare; a believer in data and science; a proponent of universal health care. … Rolling Stone got him on the phone to talk about this week’s healthcare hearings at the Supreme Court, the importance of Obamacare, and the future of reform (Julian Brookes, 3/30).

The Economist: Full-Court Press

When the arguments came to a close at the end of March 28th, Mr Obama faced one hopeful prospect—the court might uphold the mandate—and several nightmares. … The Supreme Court is expected to issue its decision by the end of June. … However the court rules, the political consequences will be huge. Even more important, for the long term, will be the court’s articulation of congressional power. Washington subsists on hyperbole. But this time it is all true (3/31).

The Atlantic: Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up

Pharmaceutical giants, like small-town pizza parlors, have two options for making more money: convince regulars to buy more of what they obviously like, or find ways to persuade more people that they will be happier with this drug or that thin crust with extra cheese. … These “disease mongers” — as science writer Lynne Payer in her 1992 book of that name called the drug industry and the doctors, insurers, and others who comprise its unofficial sales force — spin and toil “to convince essentially well people that they are sick, or slightly sick people that they are very ill.” Changing the metrics for diagnosing a disease is one reliable technique (John-Manuel Andriote, 4/3).

Outside: The Doctor Won’t See You Now

Last year, 13 Americans died during running races, and another eight while competing in triathlons. … the rising participation and the proportional death toll—especially in cases like (Peter) Hass’s—highlight the need for quality medical care at these events. And usually that care comes from volunteer doctors. At least it used to. More and more doctors are refusing to donate their services, and it’s for one frustrating reason: they can’t get medical-malpractice insurance. Most doctors’ insurers typically won’t issue one-day policy riders for sporting events, and race organizers haven’t stepped up to offer alternative coverage (Eric Beresini, 2/28).

Photo courtesy of Griszka Niewiadomski

The New Yorker: Dentists Without Borders

One thing that puzzled me during the American health-care debate was all the talk about socialized medicine and how ineffective it’s supposed to be. … my experiences in France, where I’ve lived off and on for the past thirteen years, have all been good. A house call in Paris will run you around fifty dollars. … most of my needs are within arm’s reach. There’s a pharmacy right around the corner, and two blocks further is the office of my physician, Dr. Médioni. Twice I’ve called on a Saturday morning, and, after answering the phone himself, he has told me to come on over. These visits, too, cost around fifty dollars. … I’ve gone from avoiding dentists and periodontists to practically stalking them, not in some quest for a Hollywood smile but because I enjoy their company (David Sedaris, 4/2).

Paris by McKenna71

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Michelle Andrews

Photo by Mad Max

One in 500 kids has an inherited disorder that causes high levels of LDL (“bad”) cholesterol that may require medication to control.However, since the problem doesn’t create observable symptoms, as many as half of these kids don’t know they have the condition.

To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21.

Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed.

Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese.

Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say.

Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good.

To learn more read the LocalHealthGuide article: Should kids with high cholesterol be put on drugs? 

To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says.

The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn’t enough evidence to recommend for or against routine lipid screening in children and adolescents.

Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says.

Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines.

More From This Series: Insuring Your Health

“Family history doesn’t really catch everybody” with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children’s Hospital Boston.

In addition, she says, “Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they’re much more focused.”

That’s the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy – until Bill had a heart attack two years ago at age 47.

The pediatrician for their three children checked the kids’ cholesterol and found that while levels for the two girls – Chelsea, now 17, and Chandler, 13 – were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)

Julie Brothers, medical director of the lipid heart clinic at Children’s Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. “None of us wants to slap medication on anyone,” she says.

Maybe not. “But if you’re going to test every child, it’s a sure bet you’re going to be medicating more kids,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening.

Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven’t enrolled more than a few hundred kids, and none has followed them for more than two years, say experts.

“We don’t know what taking a 10- to 11-year-old kid and putting them on statins long term will do,” says Frederick Rivara, division chief of general pediatrics at Seattle Children’s Hospital and co-author of one of the JAMA articles.

Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents.

“The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program,” he says.

PHOTO by Mad Max – GNU Free Documentation License

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Signs that read, “Burn Calories, Not Electricity” posted in lobbies of New York City buildings, motivated more people to take the stairs and continue to use them even months later.

A new study, which appears online in the February issue of the American Journal of Preventive Medicine, observed and analyzed people making 18,462 trips up and down stairs at three sites. The signs immediately increased stair use between 9.2 and 34.7 percent at all locations.

“The gains in physical activity continued to be observed nine months after the signs were first placed,” noted Karen K Lee, M.D., author of the study at New York City Department of Health and Mental Hygiene. “We found that placing stair prompts at the point of decision is effective.”

The study is among the first to assess the effects of stair prompts on stair climbing as well as descent in different types of buildings over many months. Prompts were posted in a three-story health clinic, a 10-story affordable housing building, and an 8-story academic site and studied over several months.

“Human-made environments in everyday life offer numerous opportunities for maintaining health, controlling weight and preventing disease,” Lee said. “One of those health opportunities is stair climbing, a vigorous activity which can burn more calories than jogging.”

Instead of removing the signage after the study was completed, the prompts were purposely left in place. New York City continues to promote the health benefits of stair climbing by distributing free stair signs to owners and managers of public and private buildings who request them.

“So far, we’ve distributed over 26,000 signs to owners and managers of about 1,000 buildings including residential, worksites, hospitals and academic centers,” said Lee.

Remington sees opportunities for widespread use of prompts. “For example, a zoning law could be enacted that requires buildings to have stair prompts …like they require signs for exits.”

Remington added, “Overall, this is a great study, showing how for almost no investment we can improve health.”

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

By Randy Dotinga & Kelly Malcom

Health Behavior News Service 

We often give a chilly reception to the idea of going “cold turkey” when it comes to anything that has to do with changing behaviors and habits, even those that may be important for our health.

And no wonder: habits become habits because they give us something we think we need. Maybe they make us feel better (hello, chocolate!) or they bring comfort, familiarity or convenience to our lives.

Once we get used to doing things a certain way, the idea of changing a routine behavior can seem overwhelming. And we worry (with good reason) that we won’t be successful if we try to change our habits all at once.

Joan Christensen, a 57-year-old dance teacher from North Branford, Conn., understands. The recession and personal challenges sent her into a depression. She coped by eating more, ballooning her 5-foot-4 frame up to 204 pounds. “I was feeling sorry for myself and food became my solace,” she says. Yet, she wasn’t motivated to turn her life around.

Then a medical crisis hit. Suddenly, Christensen was ready to make changes, but didn’t know where to start. With the help of her physician, she began to take small but meaningful steps to reduce her weight. It worked.

“I’m a new woman,” Christensen says. Through a series of small steps over a period of six months, she lost 44 pounds.

What can I do to ensure my success in changing my behavior?

• Get help from your primary care doctor (or another professional, like a nutritionist)—they may have access to resources you don’t know about.

• Make changes you’re about 70 to 80 percent sure you can accomplish.

• Set up your environment to trigger the behavior you want to engage in (i.e. if you want to floss your teeth more frequently, put the dental floss next to your toothbrush).

• Focus on the positive impact of what you are doing, rather than how far you have to go.

• Think about finding or creating a support group.

It’s not just common sense that backs up her go-slow approach. Research supports it too, suggesting we’re more likely to improve our health if we don’t pressure ourselves into developing new routines overnight but instead take time to learn new habits.

“We talk as if willpower were the whole show,” says Christensen’s physician, David Katz, M.D., director of Yale University’s Prevention Research Center. “But that’s like thinking you can climb Mount Everest if you just want to badly enough. Nonsense. You need mountaineering skills.”

Tipping Points

“Rationally, you’d think motivation would be strong enough to get you to adopt a health behavior, but it’s not,” says BJ Fogg, Ph.D., director of the Persuasive Technology Lab at Stanford University.

Motivation, he explains, is important for developing the initial surge in energy to make a change, what he calls a motivational wave.

For Christensen, her motivational wave wasn’t voluntary. She became ill one particularly busy day after eating an unhealthy breakfast and skipping lunch.

Nausea, stomach pains and shortness of breath hit her all at once. “I sat down and cried,” she recalls. “I was spiraling out of control and had hit bottom. I then knew that it was now or never.”

It’s quite common for a medical crisis to serve as a tipping point, Katz notes.

“Unfortunately, tipping points do tend to come in the aftermath of calamity, such as after a heart attack or stroke. Sometimes they occur when a medical crisis strikes a family member or friend,” he says. “Sometimes they are due to other kinds of events that change our perspective-such as pregnancy. What is most powerful varies with the individual.”

If you can’t quite bring yourself to begin changing your health for the better, there are things you can do to help move in that direction. Talk to your doctor, Katz suggests, and ask about the perils of the status quo and the possible benefits of changing your habits.

Simply having motivation, wherever it originates, is not enough to develop new habits. “One of the problems is when people fail at changing their behavior they blame themselves and their lack of motivation. They are blaming the wrong thing,” says Fogg.

Online Support for Health Change

You might start out with an online health assessment like this tool from Dartmouth:http://howsyourhealth.com/

Looking for ideas about small steps that could make a big difference to your health? Check these online resources:

• General health information and guidance about healthy living is available from the U.S Department of Health and Human Services at http://www.healthfinder.gov/

• The U.S. Department of Health & Human Services offers 119 ideas about small steps you can take to improve your diet and get more exercise. Examples: Grill, steam or bake instead of frying. Choose a checkout line without a candy display. Walk to a co-worker’s desk instead of emailing or calling.

• The American Dietetic Association offers a variety of small ways to shave calories off your daily diet. Examples: Don’t eat out of a box or bag because you’ll feel like you need to finish everything. Satisfy your ice cream urge by buying brands that are slow-churned and have reduced calories.

Smoking:

• http://www.smokefree.gov/ is available from the Tobacco Control Research Branch of the National Cancer Institute to offer help with quitting smoking.

Mental health and substance abuse:

• This resource guide from a California non-profit lead by Robert and Jeanne Segal with support from Rotary International could be helpful for a wide range of health concerns including mental health and substance use information: http://www.helpguide.org/index.htm

Skill-Building over Time

Katz says some people actually prefer to make a big change in one fell swoop. They might suddenly quit smoking or start following their insulin injection routine to the letter. “It’s constitutionally who they are,” he says.

But researchers have found that most people do better with a slower, step-by-step approach, Katz says. To use this approach effectively, however, you may need an education in exactly what your options can be.

People often fail at making important changes because they lack information, adds Judith H. Hibbard, Ph.D., a professor of health policy at the University of Oregon who studies the choices people make about their health. “They don’t know what their role is in the care process, and they’re overwhelmed with the task of managing their health. It’s more like being defeated and discouraged rather than being lazy.”

With her doctor’s help, Christensen learned new weight-loss techniques. She started keeping a food diary, for instance, to give her insight into her daily diet. “You don’t realize what you are putting in [your body] until you see it on paper,” she says.

She began eating six times a day instead of going from breakfast to dinner without food. She cut down on sugar by changing brands, learned to savor her food instead of wolfing it down and tried new recipes.

“It isn’t easy…in the beginning it was very hard to give up sugar,” she says. “But you soon learn that it’s not a necessity. I can now go out and watch people have dessert around me, and it doesn’t faze me. It is empowering to know that you are in control. And I have found that gaining control over my weight and eating habits has taught me to take control in the areas of my life that were causing the overeating.”

If you’re overweight, you may think Christensen’s success is unrealistic. But a landmark 2002 study published in the New England Journal of Medicine finds that a moderate amount of weight loss, the kind you can achieve through fairly minor changes in exercise and eating habits, had a bigger positive effect on overweight people at risk for diabetes than preventive medication had.

Those who exercised a half-hour a day and lost just 5 to 10 percent of their weight-10 to 20 pounds for a 200-pound person-were almost 60 percent less likely to develop diabetes.

If 30 minutes seems like too much, Fogg suggests starting shorter. “Tiny habits grow into full behaviors over time. If you get in the tiny habit of exercising for three minutes and that becomes a true habit, you will eventually just naturally end up doing 30 minutes,” he says. “Over time, you develop the physical capabilities and arrange the world around you to make it easier.”

Building Confidence

Needles don’t bother Joan Reder, a medical transcriptionist with the Scripps Health System in San Diego. That’s a good thing: She has had type 1 diabetes for 35 years and daily insulin injections have long been part of her daily routine.

But something does make the 59-year-old Reder nervous: technology.

Recently, she was intrigued by the idea of converting to using an insulin pump that would allow greater control of her insulin levels. But it worried her, too.

For one thing, the idea of using new technology didn’t thrill her. “I’m not a techie person. I know what I need to know to use my computer, and the rest…well, I don’t want to know,” she says.

She had also heard a secondhand horror story about the pump and didn’t want to shell out money for a pump that she might not want to keep using. “So having a pump was really scary to me,” she recalls.

Then she discovered that she could enroll in a study that allowed her to get extra support from medical staff and try the pump without making a major financial commitment. It also helped that she was able to turn to other diabetics in a support group and learn tips about how to use the pump.

“They know things that your doctor can’t tell you unless your doctor has diabetes, like how to eat pizza or M&Ms with the pump,” she says.

Christensen tried the pump and loved it. Instead of giving herself insulin injections throughout the day, she programs the pump’s computer to deliver the amount she needs based on what she eats.

That’s much easier than going through the multiple injections that she used to endure to be able to safely eat certain foods.

She now regularly wears the pump, which weighs about half a pound and delivers the insulin through a tube that goes under the skin in her stomach. “There’s a lab test that I take every time before I see my endocrinologist. The ideal measurement is 7 or below. The day I started on the pump, it was 8.4. Three months later, it was a 6.7.”

That improvement wouldn’t have happened without the support that helped her gain the confidence to take the small step of simply trying the pump, she says.

Taking It Home

Confidence, it turns out, is crucial to improving health through small steps. To take advantage of the powers of confidence, it’s a good idea to make changes that you’re about 70 to 80 percent sure you can accomplish, says David Sobel, M.D., medical director of patient education and health promotion for Kaiser Permanente’s Northern California system.

Judith Hibbard said she’s heard of dieters whose first step was to eat nine donuts a day instead of 12.

Katz and Hibbard say there are many other small steps you can take if your goal is to lose weight. Don’t shop while you’re hungry, for instance, and prepare a shopping list to guide healthier choices. At work, take the stairs a few days a week instead of the elevator.

You further your chance at success if you set up your environment to help trigger the behavior you want, according to Fogg. “If you want to floss more, put the floss next to your toothbrush.

When developing habits, you should try to make something you already do become the trigger for the next thing.”

Success, if you reach it, will build your sense of confidence, but don’t stop early in the process. “The thing about small steps is that you need to keep moving forward and take the next step after that,” Hibbard says.

Luckily, Fogg points out, “In general, the more you do a behavior, the easier it is to do.”

As you move forward, remember the lessons of Christensen and Reder: it’s easier to change your life when supportive people are behind you. Friends and family can make a big difference, as can the staff at your medical office. Some people also seek out support groups.

“Social support can be helpful if the people around you already have the habit you want,” says Fogg.

If you can’t find the help you need, consider creating support systems yourself, as Reder did. She co-founded a group at Scripps Health’s Behavioral Diabetes Institute that matches diabetic patients with other similar patients who serve as mentors. The program is called Diabetes TLC, with the initials standing for “talk, listen, connect.

The idea is to give the kind of insight and support that doctors can’t provide because they don’t suffer from the condition themselves, Reder says.

“The small steps our clients have taken with support from one of our teammates have assisted many of them in making huge changes, including better lab results, weight loss, testing their glucose more often and more balanced lives,” she says. “If you give people a list of 22 things they have to do, they’ll say forget it. If you do things one or two steps at a time, you’ll experience success and get ready to do more.”

It’s a small steps-big change success story. And there’s not a cold turkey in sight.

Randy Dotinga is a Contributing Writer, and Kelly Malcom is an Editor for Health Behavior News Service.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.