Low Back Pain: What Works

A new study suggests that there is no value to early PT intervention in patients with low back pain.
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A Renaissance for Bike Polo in City Culture

The urban version of the sport is played on asphalt courts between hockey nets with riders on fixed-gear bikes, the better to pivot nimbly around the court. (go to article)

Troubled Training Run: To Push Or Pull Back?

Signs to look for before, during and after a difficult run to stay injury-free.
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Identifying Challenges to Exercise Adherence

Knowing the factors that make exercise adherence difficult can help you mitigate them.
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Spotlight on Sourdough

Health-promoting sourdough belongs in an entirely different category from white and even whole wheat bread.
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Diabetes Stats Illuminate Need for Prevention

U.S. adults have acquired diabetes and prediabetes at an alarming rate—and yet it is entirely preventable.
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The Clinic

After Surgery, Runners Take Caution
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Running With Osteoporosis
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Heel Pain Could Be Plantar or Achilles Related
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Hip Pain? Donít Rule Out The Back
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The Back Page

Return to X-Country Coaching - for the Joy

Weini and Drew - can they win US titles?

XC BORDER WAR turns 10
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The Complicated Role of Calcium

Once common recommendations from multiple organizations for near-universal calcium supplementation in older adults are now coming under much increased scrutiny.

Calcium and BMD
Increased calcium intake, whether from dietary sources or supplements, is unlikely to have a substantive clinical effect on bone mineral density (BMD) or fracture risk, two analyses in BMJ find.

Researchers recently looked at data from both randomized studies and cohort studies (those of groups with specific shared characteristics). They wanted to examine anew whether calcium increased bone mineral density or lowered fracture risk in people over age 50.

The study authors, reporting in BMJ, found that in the trials, comprising nearly 14,000 participants, BMD showed increases of just 1% to 2% with calcium supplements. Such increases are considered less than clinically meaningful in the reductions of fractures.

Dietary calcium increases, too, were not associated with reduced fracture risk.

The study concludes, “Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture.” (continued)

Determine Your “Heart Age”

How old is your heart? That is a question recently being asked by clinicians following the development of multivariable prediction models to predict the risk of cardiovascular disease based on a person's risk factor profile.

The thinking goes that heart age might be an effective way to communicate to people their individual-level risk of developing CVD, with heart age functioning as a wake-up call to improve health.

This new measure of risk for cardiovascular disease was created using data from something called the Behavioral Risk Factor Surveillance System (specifically, from 2011 and 2013). The BRFSS is a “state-based, random-digit-dialed telephone survey that uses a multistage sampling design to select a state-specific sample from noninstitutionalized U.S. civilian adults aged ≥18 years,” as the CDC's Morbidity and Mortality Weekly Report notes.

Weighted 2011 and 2013 BRFSS data collected from all 50 states and the District of Columbia were combined to obtain stable estimates. Among 981,660 participants, 41% were excluded for either: being less than 30 or over 75 years of age, in order to meet the recommended age range for heart age calculation; already having coronary heart disease, myocardial infarction or stroke at baseline; being pregnant; or missing covariates used for blood pressure prediction. This still left an impressive 578,525 participants for analysis.

Researchers then gathered information on age, smoking status, antihypertensive medication use, diabetes status and BMI for these nearly 600,000 adults aged 30 to 74. Systolic blood pressure was predicted with models, and this information was used to calculate people's Framingham risk score and predicted heart age.

The concept dates back to 2008, when the Framingham Heart Study first introduced the predicted age of the vascular system of a person based on his or her cardiovascular risk factor profile. The comparison of heart age to chronological age represents an alternative way to express a person's risk for having a CVD event and provides information about a person's cardiovascular health that is not clear from the more traditional 10-year risk score alone.

Until now, however, no study has provided population-level estimates of heart age and examined disparities in heart age among U.S. adults.

The heart ages of U.S. men and women are estimated to be 7.8 and 5.4 years older, respectively, than their actual ages. Roughly 44% of U.S. adults were found to have heart ages estimated to be at least 5 years older than their actual ages.

The CDC reports that cardiovascular disease is responsible for nearly 800,000 deaths in the U.S. each year. Studies have identified a number of modifiable CVD risk factors, including high blood pressure, smoking, high blood cholesterol, diabetes and overweight or obesity.

It is therefore useful to both know the alarming nationwide numbers, and also your individual heart age, which you can calculate on your own. To find out your heart age, follow the link here. Have handy your systolic blood pressure value, and your BMI, which you can calculate here.

MMWR, Vital Signs, 2015, Vol. 64, No. 34, pp. 950-958, http://tinyurl.com/MMWR-HeartAge

Framingham Heart Study, Heart Age Predictor, http://tinyurl.com/HeartAgeCalc

NIH Body Mass Index Calculator, http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm


editorial board

Kenneth Cooper, MD
Kevin Beck
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Mel Williams, PhD
Michael Yessis, PhD
Jeff Venables, Editor

board of directors

Jeff Harbison, President
Bill Young, Secretary-Treasurer
Immediate Past-President
(Vacant) Vice President
Robert Corliss
Charles L. Schulman, MD, AMAA Pres.
AMAA President
Terry Adirim, MD, MPH
Gayle Barron
Sue Golden
Senator Bill Frist, MD
Jeff Galloway
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo

Association Staff

Executive Director: Dave Watt
Project Consultant: Barbara Baldwin, MPH

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The American Running Association is a nonprofit educational organization, designated 501(c)3 by the IRS. Running & FitNews provides sports medicine and nutrition information. For personal medical advice, consult your physician.

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