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EDITORIALS: Lars Bo Andersen Physical activity and health BMJ 2007; 334: 1173 [Full text]

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Exercise and Health

Hugh Mann   (9 June 2007)

Cycle lanes do not seem to improve cyclists safety

Peter W Ward   (10 June 2007)

Physical activity as therapy for people with incurable cancer: are novel approaches required?

Andrew Wilcock, Matthew Maddocks   (12 June 2007)

Exercise as a SERM-prescription

LUC BAEYENS   (27 July 2007)

Exercise and Health 9 June 2007
Hugh Mann, Physician Eagle Rock, MO 65641 USA Send response to journal: Re: Exercise and Health	Exercise is a tonic that tunes up the body. It strengthens organs, refreshes blood, relaxes nerves, and sharpens senses. But exercise must also be safe. So I recommend non-competitive, non-contact, low-impact, aerobic exercise, such as walking, stair-climbing, and swimming. Contact sports (football, soccer), impact sports (running, tennis), and anaerobic sports (weight- lifting) emphasize competition and often lead to injuries. All exercise programs require medical supervision, proper diet, comfortable clothing, warm-up, reasonable levels of exertion, fluid replacement, proper timing (no food an hour and a half before and after exercise), and adequate rest periods. The rest period is important, because it allows the body to recover from exercise. The length of the rest period depends on the type and degree of exercise. For example, short walks can be done every day, but long walks should be done every second or third day. Vigorous exercise, such as stair-climbing, may require even longer rest periods. Regardless of what kind of exercise you choose, don't overdo it. A safe, regular exercise program enhances your health, work, and relationships. Competing interests: None declared
Cycle lanes do not seem to improve cyclists safety 10 June 2007
Peter W Ward, GP Central Gateshead Medical Group, NE8 1NR Send response to journal: Re: Cycle lanes do not seem to improve cyclists safety	Andersen states a lack of cycle lanes in most countries may make it difficult to promote cycling for safety reasons. He may be misinformed about the safety effects of cycle lanes. Like footpaths even seperate cycle paths must eventually reach an intersection with roads used by vehicular traffic. They cannot remove the risk to cyclists of being struck. Evidence suggests they make little contribution to cyclists safety and may even make things worse. The Dutch experience is nicely summarised on the SWOV website (The Dutch Insitute for Road Safety Research)(1.2). It suggests segregated cycle paths lead to a reduction in vehicle-cyclist collisions on roads between intersections, but increase the risk of collisions at intersections. A study carried out in Delft in the 1990's where an entire cycle route network was constructed did not increase cyclist safety(3). The Dutch have some of the best designed cycle facilities in the world. In Britain recently thousands of cyclists wrote to their Members of Parliament out of fear that proposed Highway Code changes would in effect force them to use the awful cycle 'farcilities' built by councils. These are frequently inadequate for cycling and sometimes downright dangerous(4). Many cyclists continue to believe the safest place for us is on the road mixing with vehicular traffic. The lack of cycle lanes is no reason not to encourage cycling. Cycling gets safer as more people take it up, not due to cycle lanes(5). 1.http://www.swov.nl/uk/research/kennisbank/inhoud/20_vervoerwijze/1_langzaam/inhoud/measures_greater_safety_for_road_rider_and_bicycle.htm 2.http://www.swov.nl/rapport/Factsheets/FS_bicycle_facilities.pdf 3. Louisse, C.J.; Grotenhuis, D.H. ten & Vliet, J.M.C. van (1994). Evaluatie Fietsroutenetwerk Delft: lessen en leergeld voor integraal stedelijk beleid. In: J.M. Jager (ed.), Colloquium Vervoersplanologisch Speurwerk 1994. Implementatie van beleid. De moeizame weg van voornemen naar actie. CVS, Delft. pp. 937-956. (English summary at http://cardweb.swov.nl/swov/website_uk_detail.html?Zoek=Zoek&display=1&pg=q&q=louisse+grotenhuis+delft+lessen+CVS&start=0) 4. http://www.warringtoncyclecampaign.co.uk/ Go to Cycle facility of the month. 5. Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Injury Prevention, 2003;9:205-209. Competing interests: None declared
Physical activity as therapy for people with incurable cancer: are novel approaches required? 12 June 2007
Andrew Wilcock, Reader in Palliative Medicine and Medical Oncology Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, NG5 1PB, Matthew Maddocks Send response to journal: Re: Physical activity as therapy for people with incurable cancer: are novel approaches required?	We read the paper by Ogilvie and colleagues with interest in which they explored the practicalities and potential benefits of employing walking as a physical therapy [1]. They concluded that such an approach may be most beneficial when targeted at groups who are sedentary and motivated to change. Benefit from physical activity programmes has also been seen in people cured of cancer [2,3]. Our group is exploring if this benefit extends to patients with incurable cancer. Preliminary studies of programmes which have included walking and other forms of exercise have shown promise. However, there are acceptability and practicality issues, for example, only about two-thirds of people approached take part and only half have been able to complete the programmes [4,5]. The feasibility of using walking and other physical activities as therapy in patients with incurable cancer thus needs to be further explored. We are about to do this with a computer-based questionnaire that displays videos of various physical activities, e.g. walking, treadmill walking, cycling on an ergometer, along with a description of the programmes associated with benefit, i.e. intensity, frequency, duration. The patients will be asked to indicate their perceived ability and motivation to undertake exercise programmes based on the different activities. We have included more novel therapies such as neuromuscular electrical stimulation and whole-body vibration as these may not require such a major change in lifestyle nor high levels of motivation. Our data should help to identify the most acceptable forms of exercise to explore in future studies. If beneficial, we envisage exercise will form part of a multimodal approach to mitigate against the progressive loss of muscle bulk, strength and physical function which occurs as part of the cachexia syndrome. As the aim would be to help maintain maximal function and physical independence for as long as possible, it would be best offered as a pro-active supportive care approach soon after diagnosis. References 1. Ogilvie D, Foster C et al. Interventions to promote walking: systematic review. BMJ 2007; doi: 10.1136/bmj.39198.722720.BE. 2. Conn VS, Hafdahl AR et al. A meta-analysis of exercise interventions among people treated for cancer. Supportive Care in Cancer 2006;14(7): 699-712. 3. Stevinson C, Lawlor DA et al. Exercise interventions for cancer patients: systematic review of controlled trials. Cancer Causes & Control 2004;15(10): 1035-1056. 4. Oldervoll LM, Loge JH et al. The effect of a physical exercise program in palliative care: A Phase II study. Journal of Pain and Symptom Management 2006; 31(5):421-430. 5. Stevinson C, and Fox KR. Feasibility of an exercise rehabilitation programme for cancer patients. European Journal of Cancer Care 2006;15(4): 386-396. Competing interests: None declared
Exercise as a SERM-prescription 27 July 2007
LUC BAEYENS, Professor and head of the department of gynaecology. Sports Gynaecology Unit Brugmann University Hospital, B1020 Brussels Send response to journal: Re: Exercise as a SERM-prescription	Women between the ages of 40 and 54 have a high prevalence of sedentarity: 60% in a Belgian survey (1). Showing sedentary women the beneficial effect of exercise on their health and life expectancy (2) should be a potent stimulant to make them move more. The ability of increased daily physical activity to minimize age-related increases in abdominal obesity could be a strong incentive (3). We recommend sharing with a friend a pleasant emulating sporting activity. Wearing a podometer can also enhance the activity level (2). Medical helpers have to remind the patient at each contact to move more (4). We think that medical doctors have also to present physical activity as a SERM (Selective Estrogens Receptor Modulator) in (pre)menopausal women. These are raloxifen- type drugs that enhance the benefits of estrogens without their side effects. Indeed, regular physical activity can advantageously replace estrogenic substitution: - The beneficial effect of exercise on bone density is as well documented (5) as far as estrogenic therapy. Furthermore, walking for at least 4 hours/week lowers by 41% the risk of hip fracture compared with walking less than 1h/week (6). - The advantages of estrogens on menopausal symptoms are also met with exercise: control of a depressed mood, better sleep and, although, less pronounced, decreased vasomotor symptoms (7). - On the other hand, hormonal substitution can induce negative side effects on breast and endometrium and enhance thrombotic risk. Exercise on the contrary lowers the risk of breast cancer by about 40% (8) as does raloxifen. Even after the treatment of a breast cancer, the risk of recurrence can be decreased by regular physical activity(9). - Also on the endometrium, exercise acts more as an anti-estrogen by lowering the cancer risk (10). - In contrast to estrogen therapy and raloxifen, exercise lowers the risk of venous thrombosis (11). We do thus warmly encourage regular physical activity for the all too often sedentary women with peri-menopausal associated risks and complaints. 1/ Lefevre J., Philippaerts R., Duquet W. Hoe fit en hoe sportief is de vlaamse volwassen bevolking ? http://www.steunpuntsbg.be 2/ Ogilvie D., Foster C.E. et al. Interventions to promote walking: systematic review. BMJ 2007; 334: 1204 3/ Holcomb C.A., Heim D.L. et al. Physical activity minimizes the association of body fatness with abdominal obesity in white, premenopausal women: results from the Third National Health and Nutrition Examination Survey. J Am Diet Assoc 2004; 104:1859-62 4/ Jones L.W., Courneya K.S. et al. Effects of an oncologist’s recommendation to exercise on self-reported behavior in newly diagnosed breast cancer survivors. Ann Behav Med 2004; 28: 105-13 5/ Bonaiuti D., Shea B, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2002; 3; CD 000333 6/ Feskanich D., Willett W. et al. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 2002; 288:2300-6 7/ Pines A., Fisman E.Z. The healing properties of exercise. Menopause 2006; 13: 545 8/ Monninkhof E.M., Elias S.G. et al. Physical activity and breast cancer. A systematic review. Epidemiology 2007; 18: 137-57 9/ Holmes M.D., Chen W.Y. et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-86 10/ Cust A.E., Armstrong B.K et al. Physical activity and endometrial cancer risk: a review of the current evidence, biologic mechanisms and the quality of physical activity assessment methods. Cancer Causes Control 2007; 18: 243-58 11/ Wang J.S. Exercise prescription and thromobogenesis. J Biomed Sci 2006; 13: 753-61 Competing interests: None declared