Get the world on its feet:

Western societies are struggling to pay for their ever increasing medical budgets. In the US up to 393 billion US-$ were spent in 2005 for cardiovascular diseases alone. Based on epidemiologic studies in primary prevention it is reasonable to estimate that 30% of coronary heart disease and stroke could be prevented by 2.5 hours of brisk walking per week and approximately 284,886 cardiovascular deaths could be prevented per year in the US alone. With regard to metabolic disorders the figures are even more devastating: 91% of cases of diabetes type II may be attributed to high-risk behaviour including BMI>25, low fiber/high fat diet, sedentary lifestyle, and smoking.

In today's obesogenic environment regular physical exercise is more important than ever to reduce cardiovascular events. It does so (1) by modifying classical cardiovascular risk factors and (2) by direct shear stress-mediated effects on the vascular endothelium and on the release of vascular endothelial progenitor cells (EPCs). Data from epidemiologic studies are clear: ad 1) Regular physical exercise improves glycemic control and prevents the development of overt type diabetes in patients with pathologic glucose tolerance. On a molecular basis regular exercise increases the velocity of glucose uptake into the skeletal muscle which reduces glucose levels and improves insulin action. As hyperglycemia may induce endothelial dysfunction, an improved glycemic control is directly associated with improved vasoreactivity. Regular exercise also reduces hypertension and hypercholesterolemia resulting in improved endothelial function. Ad 2) the most immediate effect of exercise on the vascular endothelium is related to the intermittent increase in blood flow, which occurs necessarily during physical activities: Endothelial cells sense even minor increases in shear stress by the deformation of their cytoskeleton and of transmembrane proteins. In recent years our understanding of the biochemical pathways activated by increased shear stress has been greatly enhanced: Today we know that the expression and the activity of the nitric oxide (NO)-producing nitric oxide synthase (NOS) is increased and that detoxification of NO-degrading oxidative radicals is enhanced.

It is never too late to start exercising: Even in the presence of overt cardiovascular diseases (e.g. after acute myocardial infarction) endurance training will significantly increase your survival. As documented by meta-analysis of exercise interventions in stable coronary artery disease (CAD) cardiac mortality is reduced by one third. Among the mechanisms mediating the reduced cardiac event rate are improvement of endothelium-dependent vasodilation, reduced progression of coronary lesions, reduced thrombogenic risk, and improved collateralization.

Traditionally, training interventions were viewed as an adjunct therapy to routine interventional strategies in CAD. While this is certainly true for patients immediately post acute coronary syndromes, the prognostic benefit of percutaneous coronary interventions (PCI) is questionable among patients with stable CAD, in whom more than 50% of all interventions are performed.

Recent clinical trials compared exercise training to an interventional strategy in stable CAD patients. To investigators surprise, the 12 months exercise therapy was associated with a higher event-free survival as compared to conventional percutaneous coronary intervention. This result underscores that by treating the most significant lesion with PCI, the progression of atherosclerosis in other areas of the coronary tree is left unaltered. Exercise, on the other hand, reduces plaque progression, improves endothelial function and collateral formation, and reduces thrombogenic risk in the entire vascular bed.

"Before time runs out, we must make physical activity and health education a number one priority of our public health system. Interventions need to start as early as in childhood, when unhealthy eating habits are coined and sedentary lifestyle is copied from adults" concluded Prof Hambrecht. "The degree to which unhealthy behaviour is regarded a 'private issue' must be publicly discussed. A balance needs to be struck between a reasonable minimum effort of the individual to reduce the healthcare costs and intrusion of an investigative healthcare system into personal lifestyle. The knowledge and the guidelines are there to support regular physical activity, the major issue is implementation."

Source: Eurekalert 09

Leg movement training in premature infants demonstrates positive changes in motor skills

Early intervention can improve coordination, strength of the legs, and object exploration.

Premature infants who receive leg movement training display feet-reaching behaviors similar to that of full-term infants, according to a randomized controlled trial reported in the October issue of Physical Therapy (PTJ). This finding supports feet-reaching play as an early intervention strategy to encourage interaction with physical objects in preterm infants who have movement problems within the first months of postnatal life.

Previous studies have shown that full-term infants make contact with toys using their feet before reaching with their hands. Studies also have shown that movement training advances feet reaching in full-term infants. Certain populations of preterm infants are known to be delayed in hand reaching; however, no studies have looked at feet-reaching in premature infants.

"The presence of feet reaching and a positive training effect in this population would suggest a novel and easily implemented intervention strategy to encourage early object interaction in infants with special needs," said Jill C. Heathcock, assistant professor in the Division of Physical Therapy at Ohio State University, and lead author of the study.

In this study, 27 premature infants who were born at less than 33 weeks of gestational age and weighed less than 5 lbs 8 oz received either movement training or social training by their caregivers 5 days a week for 8 weeks. Movement training consisted of three feet games: general leg movement, moving the leg across the midline of the body, and distinct leg movements, such as holding an infant's hip at 90 degrees and encouraging knee motion to contact the toy with the foot. Caregivers of infants in the social training group positioned their infant supine on the floor and sat near the infant's feet. The caregiver interacted with their infant visually and verbally, but did not touch or present objects to their infant.

During the 8-week training period, all infants were tested and videotaped for a total of five sessions. Infants were seated in a custom-made chair with a strap placed around the chest, allowing for free movement of the arms and legs. A toy was presented to the infant at his or her midline at hip height for 30 seconds. After each trial, the toy was removed from the infant's view and then repositioned in the midline for the next trial.
Both groups of infants showed an equal number of foot-toy contacts over each session. However, infants in the movement training group out-performed infants in the social training group over time and during the last session.

"Our results suggest that premature infants display a new and potentially important ability to contact objects with their feet before their hands," said Heathcock. "This finding, coupled with a positive effect of training, provides clinicians with a new intervention strategy for encouraging object interaction within the first months of life in infants at risk for long-term motor impairments."

Source:Eurekalert.

Feet, the most dangerous bodily weapon used in assaults.

Feet, rather than fists, are the most dangerous bodily weapon available, reveals research on violent assaults, published in the journal Injury Prevention.
The researchers base their findings on an assessment of nearly 25,000 people treated in emergency care in and around Cardiff, Wales between 1999 and 2005. All had sustained injuries during acts of violence.
Injury severity was scored using validated measures, and the mode of the injury recorded. More than 31,000 injuries were treated, with men accounting for three quarters of those requiring treatment. Most had one injury.
The age at which a person was most likely to sustain a serious injury peaked at 47.
Almost two thirds reported being attacked by just one assailant, but one in four said they had been assaulted by three or more people at the same time.
Around one in five injuries were inflicted using a weapon of some sort, more or less equally divided between sharp and blunt objects.
The use of weapons was significantly more likely to cause serious injury than the use of body parts, overall, the findings showed.
But, in descending order, feet, blunt objects, other body parts, and sharp objects were significantly more likely to inflict serious injuries than the use of fists, which were involved in over half of all injuries.
While feet were used in only 7% of assaults, they were the body part most likely to inflict serious injuries considerably more so than fists.
And the results showed that kicking caused more severe injuries than the use of sharp objects, which included knives, bottles, and glasses.

Source:Eurekalert.