More and more surgeons are embracing the idea that physical therapy after bunion surgery can improve range of motion and other functional outcomes. But some practitioners still aren’t sure it’s right for everyone.
Most surgeons will tell you outcomes of hallux valgus surgery are very good, often quoting a 90% to 100% percent success rate. A survey-based study published in the December 2001 issue of Foot and Ankle International is typically cited as evidence.
But consensus is harder to come by in determining to what degree post-operative physical therapy contributes to functional outcomes. Some doctors send patients home with a self-administered exercise and self-massage routine and nothing more. Others prescribe an extensive, twice-weekly supervised physical therapy protocol that lasts from four to eight weeks on top of home-based exercises. To complicate matters, patients start PT at various times after surgery, depending on the rate of healing and the type of procedure.
Not all practitioners are ready to accept the idea that physical therapy, and not just surgical technique, can have a substantial impact on the success of hallux valgus procedures.
“Some physicians may think if they send a patient for physical therapy after surgery, it reflects poorly on their surgical procedure,” said Juan J. Rivera, DPM, a private practice podiatrist with the Ankle + Foot Center of Tampa Bay, who views physical therapy as complementary. “In actuality, you are helping your patient optimize their ultimate results and overall post-surgical experience.”
In the last year, two studies, one published and one presented at the American College of Foot and Ankle Surgeons’ annual meeting, have revived the debate. They suggest that post-operative physical therapy can significantly improve range of motion and weight bearing outcomes.
Enter new evidence
In the September 2009 issue of Physical Therapy, investigators from the Foot and Ankle Center in Vienna, Austria, analyzed 30 patients who underwent surgical correction of mild to moderate hallux valgus deformity, including 20 Austin osteotomies and 10 Scarf osteotomies. Prior to initiating the study, the researchers had observed that despite favorable clinical results, including pain relief, the ability to wear a wider variety of shoes, and the ability to participate in recreational activities, gait patterns did not spontaneously alter after surgery.
“We noticed that patients who underwent hallux valgus surgery didn’t use their great toe for push off, even though the deformity was corrected sufficiently,” said Reinhard Schuh, MD, a first-year resident in the department of orthopaedic surgery at Innsbruck Medical University and lead author of the study.
“To achieve bony union of the osteotomy, we had to avoid loading for four weeks,” Schuh said. “But we instructed patients to perform passive ROM exercises starting two days after surgery.”
At four weeks, patients began a comprehensive, 45-minute rehabilitation program once a week for four to six weeks. The standard protocol included elevation of the leg, lymphatic drainage, and activation of the muscle pump, and cryotherapy in the first session to reduce swelling. Other modalities, such as scar tissue massage, mobilization, manual therapy, soft tissue techniques, proprioceptive training for the lower leg, strengthening exercises, and gait training, were added progressively over the next four weeks.
Although the researchers did not use a control group, they found that at six months after surgery patients experienced significant improvements in first metatarsophalangeal joint range of motion and function. Weight bearing at the great toe and first metatarsal head, specifically related to maximum force levels and force-time integral, also improved significantly. Participants’ mean functional score on the American Orthopaedic Foot & Ankle Society forefoot scale improved from 60.7 out of 100 before surgery to 94.5 out of 100 at six months. By comparison, previous plantar pressure studies have documented a lack of weight bearing in the medial forefoot and first ray after hallux valgus surgery not followed by physical therapy.
Believe it or not
In the second study, which has been submitted for publication, researchers studied 55 patients who had undergone Scarf procedures at the Weil Foot and Ankle Institute in Des Plaines, IL. The large, 16-office practice in the Chicago area handles 500 bunion surgeries a year. According to Lowell Weil, Jr., DPM, MBA, senior investigator of the study, surgeons in his practice fall into two camps.
“The advent of screws and proper screw fixation eliminated the need for complete immobilization. Patients are able to return to activities and start physical therapy earlier, which has tremendous benefits. We developed physical therapy protocols for patients undergoing these types of procedures,” he said. “Despite that, some doctors in our practice weren’t prescribing physical therapy; they didn’t believe it made a difference.”
So Weil and a few colleagues set out to investigate. Their nonbelieving colleagues’ patients, who did not receive PT, served as a control group.
They studied 44 patients (65 feet) who underwent Scarf osteotomy procedures between 2006 and 2008, followed by a program of once- or twice-weekly physical therapy sessions. The 30 to 45 minute sessions continued for one to six weeks. Another group of 11 patients (14 feet) received no post-operative therapy.
Follow up occurred between November 2009 and January 2010. The physical therapy group significantly outperformed the control group on the Foot Function Index (FFI) and the ACFAS Universal Foot and Ankle Scoring System (see table).
Opinions about post-operative physical therapy in hallux valgus cases are as varied as surgical procedures. For PT proponents, like Michael Loshigian, DPM, a podiatric foot and ankle surgeon in private practice with the Metropolitan Foot Group in New York City, the benefits are indisputable.
“My own experience is fairly clear. Patients who have some sort of formal or informal physical therapy after hallux valgus surgery have better overall results and the progression of healing is more consistent and reliable,” Loshigian said.
Getting a head start
Loshigian, who performs these surgeries at least weekly, says the physical therapy protocol often begins shortly after surgery.
“In a joint fusion case, there should not be any attempt to move the joint, obviously. But in the majority of cases, we’re reorienting the MTP joint, restoring normal range of motion and alignment and function of that joint. In those cases, I have patients start their own range of motion exercises the day after surgery,” he said.
A primary objective is to prevent the soft tissue contracture and joint stiffening that can result from cutting and repositioning of bone.
“It’s easier to maintain good range of motion from the beginning than to attempt to restore it after it has been lost,” he said. “If we give those soft tissues an opportunity to tighten up, movement becomes difficult.”
Loshigian usually starts patients on formal twice-weekly physical therapy two to three weeks after surgery, once he removes the stitches. For most patients, the complete course of therapy lasts six to eight weeks.
At three or four weeks after surgery, patients can start weight bearing without the protection of a post-op shoe; at that point, Loshigian recommends strengthening the muscles and tendons that control the great toe along with continuing ROM exercises and techniques to reduce swelling. The final stage involves strengthening the lower legs and improving patterns of gait, agility, and balance.
Contributing factors
Rivera says many factors influence his decisions about the timing and course of therapy.
“Surgical procedures —MTP joint fusion, arthroplasty, chevron, opening base wedge, closing base wedge, first metatarsal-cuneiform joint fusion—all have various timeframes to stay offloaded, which can lead to disuse atrophy,” he said. “Many patients have such low pain tolerance, they need gait retraining to overcome post-operative pain and swelling and regain joint flexibility. Older patients need more help with loss of balance and proprioception.”
Another issue is the amount of time a patient with an operable deformity has postponed surgery; long delays can lead to compensatory gait patterns that are difficult to unlearn without additional physical therapy.
“A common example for me is the patient who undergoes hallux limitus correction surgery,” he said. “The biomechanical compensation for a painful arthritic great toe joint is to ambulate with the foot in an inverted position. Post surgery, the patient continues to ambulate in that position out of habit, delaying the healing of the foot.”
Not for everyone
Donald R. Bohay, MD, a professor of orthopedic surgery at Michigan State University who is also in private practice at Orthopaedic Associates of Michigan in Grand Rapids, views hallux valgus surgery and its aftermath from a slightly different perspective.
“I’m a believer in physical therapy that can help your patient get better faster,” Bohay said. “But I don’t think we know for sure that the patient who gets physical therapy versus the patient who doesn’t is necessarily better after a year.”
Bohay, who favors tarsometatarsal arthrodesis with a modified McBride procedure, says that his patients wear a post-op splint for two weeks. They then wear a short leg cast with heel weight bearing for six weeks, followed by a weight bearing boot for two to four weeks.
Most of the surgeons interviewed for this article would prescribe supervised physical therapy for a procedure requiring so much healing time and immobilization. However, Bohay instructs most of his patients to do home-based range-of-motion exercises and soft self-massage with vitamin E oil to desensitize the foot. When he considers it necessary, he does prescribe formal physical therapy.
“You get a sense that some patients aren’t going to do the program. Those patients do well by going to PT,” he said. “Then there are patients who have a lot more done, who are very swollen, very stiff. For them, physical therapy helps reestablish control, range of motion, and desensitization.”
The therapist’s perspective
Despite the general consensus among surgeons that PT is a useful tool after bunion correction, at least in certain cases, physical therapists express frustration that surgeons don’t take full advantage of their expertise.
“It’s a misconception that physical therapy is cookie cutter,” said Clarke Brown, PT, DPT, OCS, ATC, who is in private practice in Rochester, NY, and president of the American Physical Therapy Association’s foot and ankle special interest group. “We study these procedures. We develop separate protocols for them, and adapt them for each patient.”
Physical therapy following bunion surgery, Brown said, should extend well above the ankle.
“The most challenging thing about feet is that they radically change what happens all the way up the kinetic chain. The good practitioner looks at the whole system, all the way up to the knee, the hip, and the back. We look at the range of motion in all the joints and the strength of the entire leg,” he said. “Most chronic bunion patients can’t effectively lift the bunion leg in side-lying. The hip muscles atrophy.”
Brown notes that the foot and ankle subspecialty in physical therapy is just developing. Even though it’s not something surgeons have clamored for, those who witness the benefits of specialized therapy are sold, he said.
“We found that the faster we started to move the patient’s foot and toes, the more quickly the swelling went down,” he said. “One podiatrist used to take his sutures out after two weeks. But when we moved aggressively, the incisions would sometimes open up. Now he takes the stitches out at 21 days, saying ‘I’ll leave these in longer so you guys can do more.’ The more we communicate with each other, the better.”
A proactive approach
Stephen Paulseth, PT, DPT, SCS, ATC, who runs a private practice in West Los Angeles, often sees patients who have complications or problems that he believes could have been avoided by introducing physical therapy earlier.
“If doctors would send their patients for prehab, they would be doing so much better,” said Paulseth, who preceded Brown as president of the foot and ankle SIG. “I sometimes see patients six weeks in who haven’t really done much. They’ve been told to ice, strengthen, and do some gentle motion, but they just can’t tolerate it.”
He believes proper therapy and patient training can reduce the progression of bunion surgeries.
“Calf length is number one. Inadequate dorsiflexion of the ankle leads to all kinds of distal forefoot issues, including hallux valgus. Patients should begin calf stretching as soon as possible, and they have to continue calf stretching after they’ve healed,” Paulseth said.
Surgeons contend that most patients who undergo hallux valgus surgeries are happy with the results.
“From my experience, the vast majority of patients who have gone through this procedure are very satisfied with the results and in retrospect would choose to undergo the same procedure again,” Loshigian said. “As for their initial post-op experience, the feedback I get from most patients is that it is less stressful and painful than they anticipated.”
In Brown’s estimation, that already good patient experience could be even better if the relationship between patient, doctor, and physical therapist were more collaborative.
“When patients do better quicker, the word of mouth is more positive for the doctor,” he said. “Everybody wins.”
August 2010 by Linda Weber
Showing posts with label excercise. Show all posts
Showing posts with label excercise. Show all posts
Tuesday, September 7, 2010
Tuesday, August 24, 2010
You Can Help Children Avoid Type 2 Diabetes
Type 2 diabetes is affecting kids in a big way, but diet and exercise can help children avoid or reverse this condition.
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Once upon a time, type 2 diabetes was called “adult-onset diabetes.” If children had diabetes, 99 times out of 100 it was type 1 diabetes; type 2 diabetes didn’t appear until midlife. Now, studies suggest that up to 45 percent of childhood diabetes cases are type 2 diabetes.
Type 2 Diabetes: Why the Increase?
“No one is certain why, but most experts believe that it is related in part to the obesity epidemic,” explains Frank Diamond, MD, clinical director for the University of South Florida Diabetes Center and professor of pediatrics at the University of South Florida in Tampa. “We now have approximately 17 percent of the pediatric population that is overweight. Genetically at-risk children may be acquiring the disease earlier because of the increased insulin resistance associated with their early obesity. We are seeing many children with adult weights in our pediatric clinics today.”
Dr. Diamond also notes that the increase may be due to a rise in the proportion of children with ethnic minority heritage that puts them at increased risk for type 2 diabetes.
Basically, says Paul Robertson, MD, president of medicine and science at the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington in Seattle, the causes of childhood type 2 diabetes boil down to genetic risk mixed with physical inactivity and poor eating habits.
“We know if the diets are corrected and they lose the weight, the diabetes becomes undetectable,” says Dr. Robertson.
The first step to preventing type 2 diabetes in childhood is to face the fact that it can happen to children, says Diamond. Then be on guard for symptoms and ask for diabetes screening.
“Symptoms include tiring easily, thirst, and increased urination. A darkening of the skin (acanthosis nigricans) on the back of the neck, under the arms, and in the groin area is associated with obesity and [is] a common finding with newly diagnosed type 2 diabetes children,” he says.
Also, bear in mind that if you had gestational diabetes during your pregnancy, your children are at increased risk of type 2 diabetes.
“Especially in families with a positive family history of type 2 diabetes, avoidance of excessive weight gain and encouragement of an active lifestyle are extremely important and the best tools to avoid the development of type 2 diabetes,” says Diamond. Some children may be candidates for a drug called metformin.
Type 2 Diabetes: Testing
Parents who are concerned that their child might have diabetes should ask for a fasting glucose screening test. That test determines how much sugar is in the blood before a person has eaten.
“A value over 99 mg/dL is abnormal and suggests ‘impending’ diabetes or glucose intolerance. A value equal to or greater than 126 mg/dL is diagnostic of diabetes,” says Diamond.
Any results above the normal range should be red flags for you and your family to:
• Eat a healthy diet rich in whole grains, lean proteins, fruits, and veggies. You can get help changing your family’s diet from a dietitian, if necessary.
• Get at least 30 minutes of exercise a day.
• Help your child lose at least 5 percent of his body weight if he is overweight.
Remember, childhood type 2 diabetes is within your family’s control.
“Lose weight, be active, eat the right foods,” says Robertson. “Lifestyle modifications can do a great deal in terms of staving off type 2 diabetes.”
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Once upon a time, type 2 diabetes was called “adult-onset diabetes.” If children had diabetes, 99 times out of 100 it was type 1 diabetes; type 2 diabetes didn’t appear until midlife. Now, studies suggest that up to 45 percent of childhood diabetes cases are type 2 diabetes.
Type 2 Diabetes: Why the Increase?
“No one is certain why, but most experts believe that it is related in part to the obesity epidemic,” explains Frank Diamond, MD, clinical director for the University of South Florida Diabetes Center and professor of pediatrics at the University of South Florida in Tampa. “We now have approximately 17 percent of the pediatric population that is overweight. Genetically at-risk children may be acquiring the disease earlier because of the increased insulin resistance associated with their early obesity. We are seeing many children with adult weights in our pediatric clinics today.”
Dr. Diamond also notes that the increase may be due to a rise in the proportion of children with ethnic minority heritage that puts them at increased risk for type 2 diabetes.
Basically, says Paul Robertson, MD, president of medicine and science at the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington in Seattle, the causes of childhood type 2 diabetes boil down to genetic risk mixed with physical inactivity and poor eating habits.
“We know if the diets are corrected and they lose the weight, the diabetes becomes undetectable,” says Dr. Robertson.
The first step to preventing type 2 diabetes in childhood is to face the fact that it can happen to children, says Diamond. Then be on guard for symptoms and ask for diabetes screening.
“Symptoms include tiring easily, thirst, and increased urination. A darkening of the skin (acanthosis nigricans) on the back of the neck, under the arms, and in the groin area is associated with obesity and [is] a common finding with newly diagnosed type 2 diabetes children,” he says.
Also, bear in mind that if you had gestational diabetes during your pregnancy, your children are at increased risk of type 2 diabetes.
“Especially in families with a positive family history of type 2 diabetes, avoidance of excessive weight gain and encouragement of an active lifestyle are extremely important and the best tools to avoid the development of type 2 diabetes,” says Diamond. Some children may be candidates for a drug called metformin.
Type 2 Diabetes: Testing
Parents who are concerned that their child might have diabetes should ask for a fasting glucose screening test. That test determines how much sugar is in the blood before a person has eaten.
“A value over 99 mg/dL is abnormal and suggests ‘impending’ diabetes or glucose intolerance. A value equal to or greater than 126 mg/dL is diagnostic of diabetes,” says Diamond.
Any results above the normal range should be red flags for you and your family to:
• Eat a healthy diet rich in whole grains, lean proteins, fruits, and veggies. You can get help changing your family’s diet from a dietitian, if necessary.
• Get at least 30 minutes of exercise a day.
• Help your child lose at least 5 percent of his body weight if he is overweight.
Remember, childhood type 2 diabetes is within your family’s control.
“Lose weight, be active, eat the right foods,” says Robertson. “Lifestyle modifications can do a great deal in terms of staving off type 2 diabetes.”
Monday, July 19, 2010
A revolutionary sneaker, or overhyped gimmick?
By Michael McCarthy, USA TODAY
They are, advertisements say, a game-changer in athletic footwear: sneakers that are supposed to tone muscles, promote healthy weight loss and improve the posture of those who walk, work or shop in them.
The makers of "toning shoes" say the shoes can help give wearers more shapely butts, legs and abs, often without the need for gym workouts. That's partly why toning shoes — which often have a rounded sole like a rocking chair, to stretch the wearer's leg muscles with each stride — represent the fastest-growing segment of the $17 billion-a-year athletic footwear industry. It's a market driven by a customer base that is 90% women, according to sneaker analyst Matt Powell of SportsOneSource.
YOUR HEALTH: 'Rocker' shoe put to the test
Busy moms and working women who spend much of the day on their feet — such as teachers, nurses, hairstylists and restaurant servers — are among the most devoted buyers of toning shoes, which typically sell for $100 to $250.
Skechers, the market leader, now has Pro Football Hall of Fame quarterback Joe Montana touting the shoes in an effort to attract men. Powell predicts that sales will explode 400% this year, to more than $1.5 billion.
"We've never seen a category grow this fast," he says.
But now a growing number of doctors are warning that toning shoes don't deliver on their marketing promises and could cause injuries by, among other things, changing a person's gait, or way of walking.
Claims that toning shoes can significantly contribute to a person's fitness are "utter nonsense," says Barbara de Lateur, distinguished service professor of physical medicine and rehabilitation at Johns Hopkins University's School of Medicine in Baltimore.
De Lateur and other doctors warn that toning shoes create their advertised benefit by destabilizing how a person walks and say that wearing the shoes can result in strained Achilles tendons. De Lateur also says the shoes can be a particular problem for older consumers or those who have difficulty keeping their balance.
Alison Drury of Louisville can attest to that.
She says she broke her right ankle after awkwardly rolling over the outside of her foot during her first mile-long walk in Skechers Shape-ups shoes.
"I'm afraid to ever put them on again," Drury says.
Montana said in an interview that his Shape-ups walking, cross-training and running shoes helped relieve pain in his knees and back and enabled him to start jogging for the first time in 15 years.
As for people getting hurt or doctors' warnings, the four-time Super Bowl champion says he can only talk from personal experience.
"I haven't fallen off one yet. And I've been jogging and walking for a long time in them," he says. "I can understand people's thoughts. But once you get in, and get yourself comfortable and used to the feel and the shape of the shoe, you don't even notice it."
A bright spot in the market
Toning shoes try to replicate the gentle, heel-to-toe motion of walking on a soft, sandy beach.
The instability built into them makes a wearer work harder to maintain his or her balance — effectively giving muscles a more rigorous workout, shoe companies say. This notion is explained in the instructional booklet and DVD that accompany Skechers Shape-ups.
The basic concept of shoes that result in the wearer's heels being lower than their toes is not new. Remember the Earth Shoe phenomenon in the 1970s?
But the sales and marketing by toning shoemakers such as Skechers, Reebok, MBT (Masai Barefoot Technology), Avia and New Balance are thoroughly 2010.
A growing number of companies, such as Skechers and Reebok, are moving beyond clunky-looking walking shoes and rolling out sleeker-looking toning sneakers for running, training and hiking that look more like athletic than orthopedic shoes.
Other companies, such as FitFlop, are rolling out toning sandals and clogs.
Toning shoes typically sell for more than basketball, running or cross-training shoes. That has made toning shoes a bright spot for manufacturers and retailers in the otherwise flat athletic footwear market, in which overall sales slid 1.4% in 2009, according to the NPD Group.
The only thing bigger than toning shoes' sales growth might be the claims their marketers make about them. The Skechers website says Shape-ups will help you "Shape Up While You Walk" by toning your butt, leg and abdominal muscles, burning calories, fighting cellulite, improving your posture and circulation and reducing knee joint stress.
"Get in Shape Without Setting Foot in a Gym," Skechers claims.
Reebok, on its website, says the balance-ball-inspired technology used in its EasyTone shoes generates 28% more muscle activity in the gluteus maximus muscles of test subjects and 11% more in their hamstrings and calves.
"EasyTone shoes help tone your butt and legs with every step," Reebok says.
MBT says its "Anti-Shoe" will "tone muscles your trainer never knew you had." In the movie The Joneses, Demi Moore plays a sexy suburban mom who makes the other housewives desperate for her MBTs.
'Sorry, I don't see it'
There are elements of truth to the ads, according to doctors who have questioned the effectiveness and safety of toning shoes. But many of the doctors want more independent studies on the shoes, rather than industry-financed research. Other doctors, such as de Lateur, say they have seen enough to conclude that the shoes mostly represent hype.
Her colleague at Johns Hopkins, Wendy Shore, says consumers would get the supposed health benefits of toning shoes and save money if they skipped buying the shoes, then "bought one less bagel a day — and walked an extra block."
David Davidson, national president of the American Academy of Podiatric Sports Medicine, says the shoes basically make adults learn to walk, or run, all over again by changing their gait. That's a "scary" prospect for someone with a "borderline problem" they might not know about.
Davidson says he's suspicious of any shoes that come with an instructional booklet and DVD.
"Nothing about these shoes has any redeeming value to me," he says. "Sorry, I don't see it."
Bryan Markinson, chief of podiatric medicine at Mount Sinai School of Medicine in New York, says some of his patients who are "not in the greatest of shape" have inflamed their Achilles tendons while wearing toning shoes. People thinking of buying them, he says, should begin an "active stretching program" or else risk injury.
Jonathan Deland, chief of foot and ankle service at the Hospital for Special Surgery in New York, warns the shoes can be "dangerous" for people with balance problems.
On the other hand, Deland acknowledges that he has worn Shape-ups and likes the way they make wearers use their muscles more to maintain balance.
"I don't want people to think these toning shoes are like going to the gym and feeling like you did a really great workout," Deland says.
"Can they help a bit? Yes."
Limits encouraged
Manufacturers point to thousands of unsolicited testimonials they say they've received from customers who report their shoes toned their legs and buttocks, reduced their waist or dress sizes and helped alleviate foot injuries such as heel spurs and plantar fasciitis.
Jennifer Weiderman, vice president of Skechers' Fitness Group, says she doesn't know of any customers who've injured themselves. To get used to them, people should wear them 25 to 45 minutes a day for the first couple of weeks, she says.
"It's like any new exercise program or eating plan," she says. "You don't want to go into it like gangbusters."
As for toning shoes' critics, she suggests they try a pair before making up their minds.
"We've had a lot of podiatrists, also chiropractors and medical professionals, who think they're great," she says. As with any new category, she adds, "There's always people who will have opinions."
Regarding Skechers' claim that consumers can get in shape without setting foot in the gym, she says that's meant more for people who don't have the time or money for often-pricey gym memberships.
"So if you can't get to the gym, you still can incorporate fitness into your lifestyle. I believe that's the premise behind that line," she says.
Robert Forster, a physical therapist in Santa Monica, Calif., was hired by Skechers to research the effect of Shape-ups. His conclusion: The shoes are a good way to "increase calorie burn and activate more muscles" while walking or doing daily errands.
All shoes change a person's gait, Forster says, adding that Shape-ups can improve a wearer's gait.
However, people with balance problems or tight Achilles tendons should take a "cautious approach," he says.
With air-filled pods on the bottom that sink into the shoes as the wearer walks, Reebok's EasyTone shoes look more like regular sneakers than the rounded-bottom Skechers Shape-ups.
Katrin Ley, Reebok's head of brand strategy, predicts the company will sell more than 5 million pairs in the USA this year — and a total of 10 million globally, because the brand is making strong inroads in Europe and Asia.
"It's something that is relevant around the world," Ley says.
Bill McInnis, head of Reebok's Advanced Innovation division, says the company sees EasyTones as "part of an active lifestyle," not a substitute for one. "We're not trying to say, 'Hey, this is a magic bullet. You don't have to work out again.' "
Not every athletic footwear maker is sold on toning shoes, however. Industry leader Nike has no plans to sell such shoes and is scornful of the products on the market.
"Our focus is on creating performance products that really work," Nike spokesman Derek Kent said in a statement.
"Unlike today's toning products, we won't ask the consumer to compromise on stability, flexibility or any other key performance characteristics as they train."
Mixed reactions
Such criticism might slow, but won't stop, toning shoes' popularity and sales growth, sneaker industry analyst Powell says.
Despite the reluctance of many men to buy a product that some see as "women's shoes," he expects sales of toning shoes to men to eventually become 25% of the market.
The reaction of consumers who've worn the shoes runs the gamut.
Lisa Nosseir of Monroe Township, N.J., loves the "support and comfort" she gets from Shape-ups, although she thinks the toning claims are "far-fetched."
Barb Likos of Denver says she considers her toning shoes a "cute gimmick."
Her Shape-ups help to strengthen her calf muscles, she says, but did nothing to tone her butt and thighs. Even though they are her "most comfortable pair of shoes," she says she regrets spending $120 on them.
As for Skechers trying to persuade men to buy them, well, good luck with that.
"My husband would not be caught dead in these things," Likos says.
If anyone's looking for a slightly used pair of Shape-ups, they can contact Drury in Louisville
They are, advertisements say, a game-changer in athletic footwear: sneakers that are supposed to tone muscles, promote healthy weight loss and improve the posture of those who walk, work or shop in them.
The makers of "toning shoes" say the shoes can help give wearers more shapely butts, legs and abs, often without the need for gym workouts. That's partly why toning shoes — which often have a rounded sole like a rocking chair, to stretch the wearer's leg muscles with each stride — represent the fastest-growing segment of the $17 billion-a-year athletic footwear industry. It's a market driven by a customer base that is 90% women, according to sneaker analyst Matt Powell of SportsOneSource.
YOUR HEALTH: 'Rocker' shoe put to the test
Busy moms and working women who spend much of the day on their feet — such as teachers, nurses, hairstylists and restaurant servers — are among the most devoted buyers of toning shoes, which typically sell for $100 to $250.
Skechers, the market leader, now has Pro Football Hall of Fame quarterback Joe Montana touting the shoes in an effort to attract men. Powell predicts that sales will explode 400% this year, to more than $1.5 billion.
"We've never seen a category grow this fast," he says.
But now a growing number of doctors are warning that toning shoes don't deliver on their marketing promises and could cause injuries by, among other things, changing a person's gait, or way of walking.
Claims that toning shoes can significantly contribute to a person's fitness are "utter nonsense," says Barbara de Lateur, distinguished service professor of physical medicine and rehabilitation at Johns Hopkins University's School of Medicine in Baltimore.
De Lateur and other doctors warn that toning shoes create their advertised benefit by destabilizing how a person walks and say that wearing the shoes can result in strained Achilles tendons. De Lateur also says the shoes can be a particular problem for older consumers or those who have difficulty keeping their balance.
Alison Drury of Louisville can attest to that.
She says she broke her right ankle after awkwardly rolling over the outside of her foot during her first mile-long walk in Skechers Shape-ups shoes.
"I'm afraid to ever put them on again," Drury says.
Montana said in an interview that his Shape-ups walking, cross-training and running shoes helped relieve pain in his knees and back and enabled him to start jogging for the first time in 15 years.
As for people getting hurt or doctors' warnings, the four-time Super Bowl champion says he can only talk from personal experience.
"I haven't fallen off one yet. And I've been jogging and walking for a long time in them," he says. "I can understand people's thoughts. But once you get in, and get yourself comfortable and used to the feel and the shape of the shoe, you don't even notice it."
A bright spot in the market
Toning shoes try to replicate the gentle, heel-to-toe motion of walking on a soft, sandy beach.
The instability built into them makes a wearer work harder to maintain his or her balance — effectively giving muscles a more rigorous workout, shoe companies say. This notion is explained in the instructional booklet and DVD that accompany Skechers Shape-ups.
The basic concept of shoes that result in the wearer's heels being lower than their toes is not new. Remember the Earth Shoe phenomenon in the 1970s?
But the sales and marketing by toning shoemakers such as Skechers, Reebok, MBT (Masai Barefoot Technology), Avia and New Balance are thoroughly 2010.
A growing number of companies, such as Skechers and Reebok, are moving beyond clunky-looking walking shoes and rolling out sleeker-looking toning sneakers for running, training and hiking that look more like athletic than orthopedic shoes.
Other companies, such as FitFlop, are rolling out toning sandals and clogs.
Toning shoes typically sell for more than basketball, running or cross-training shoes. That has made toning shoes a bright spot for manufacturers and retailers in the otherwise flat athletic footwear market, in which overall sales slid 1.4% in 2009, according to the NPD Group.
The only thing bigger than toning shoes' sales growth might be the claims their marketers make about them. The Skechers website says Shape-ups will help you "Shape Up While You Walk" by toning your butt, leg and abdominal muscles, burning calories, fighting cellulite, improving your posture and circulation and reducing knee joint stress.
"Get in Shape Without Setting Foot in a Gym," Skechers claims.
Reebok, on its website, says the balance-ball-inspired technology used in its EasyTone shoes generates 28% more muscle activity in the gluteus maximus muscles of test subjects and 11% more in their hamstrings and calves.
"EasyTone shoes help tone your butt and legs with every step," Reebok says.
MBT says its "Anti-Shoe" will "tone muscles your trainer never knew you had." In the movie The Joneses, Demi Moore plays a sexy suburban mom who makes the other housewives desperate for her MBTs.
'Sorry, I don't see it'
There are elements of truth to the ads, according to doctors who have questioned the effectiveness and safety of toning shoes. But many of the doctors want more independent studies on the shoes, rather than industry-financed research. Other doctors, such as de Lateur, say they have seen enough to conclude that the shoes mostly represent hype.
Her colleague at Johns Hopkins, Wendy Shore, says consumers would get the supposed health benefits of toning shoes and save money if they skipped buying the shoes, then "bought one less bagel a day — and walked an extra block."
David Davidson, national president of the American Academy of Podiatric Sports Medicine, says the shoes basically make adults learn to walk, or run, all over again by changing their gait. That's a "scary" prospect for someone with a "borderline problem" they might not know about.
Davidson says he's suspicious of any shoes that come with an instructional booklet and DVD.
"Nothing about these shoes has any redeeming value to me," he says. "Sorry, I don't see it."
Bryan Markinson, chief of podiatric medicine at Mount Sinai School of Medicine in New York, says some of his patients who are "not in the greatest of shape" have inflamed their Achilles tendons while wearing toning shoes. People thinking of buying them, he says, should begin an "active stretching program" or else risk injury.
Jonathan Deland, chief of foot and ankle service at the Hospital for Special Surgery in New York, warns the shoes can be "dangerous" for people with balance problems.
On the other hand, Deland acknowledges that he has worn Shape-ups and likes the way they make wearers use their muscles more to maintain balance.
"I don't want people to think these toning shoes are like going to the gym and feeling like you did a really great workout," Deland says.
"Can they help a bit? Yes."
Limits encouraged
Manufacturers point to thousands of unsolicited testimonials they say they've received from customers who report their shoes toned their legs and buttocks, reduced their waist or dress sizes and helped alleviate foot injuries such as heel spurs and plantar fasciitis.
Jennifer Weiderman, vice president of Skechers' Fitness Group, says she doesn't know of any customers who've injured themselves. To get used to them, people should wear them 25 to 45 minutes a day for the first couple of weeks, she says.
"It's like any new exercise program or eating plan," she says. "You don't want to go into it like gangbusters."
As for toning shoes' critics, she suggests they try a pair before making up their minds.
"We've had a lot of podiatrists, also chiropractors and medical professionals, who think they're great," she says. As with any new category, she adds, "There's always people who will have opinions."
Regarding Skechers' claim that consumers can get in shape without setting foot in the gym, she says that's meant more for people who don't have the time or money for often-pricey gym memberships.
"So if you can't get to the gym, you still can incorporate fitness into your lifestyle. I believe that's the premise behind that line," she says.
Robert Forster, a physical therapist in Santa Monica, Calif., was hired by Skechers to research the effect of Shape-ups. His conclusion: The shoes are a good way to "increase calorie burn and activate more muscles" while walking or doing daily errands.
All shoes change a person's gait, Forster says, adding that Shape-ups can improve a wearer's gait.
However, people with balance problems or tight Achilles tendons should take a "cautious approach," he says.
With air-filled pods on the bottom that sink into the shoes as the wearer walks, Reebok's EasyTone shoes look more like regular sneakers than the rounded-bottom Skechers Shape-ups.
Katrin Ley, Reebok's head of brand strategy, predicts the company will sell more than 5 million pairs in the USA this year — and a total of 10 million globally, because the brand is making strong inroads in Europe and Asia.
"It's something that is relevant around the world," Ley says.
Bill McInnis, head of Reebok's Advanced Innovation division, says the company sees EasyTones as "part of an active lifestyle," not a substitute for one. "We're not trying to say, 'Hey, this is a magic bullet. You don't have to work out again.' "
Not every athletic footwear maker is sold on toning shoes, however. Industry leader Nike has no plans to sell such shoes and is scornful of the products on the market.
"Our focus is on creating performance products that really work," Nike spokesman Derek Kent said in a statement.
"Unlike today's toning products, we won't ask the consumer to compromise on stability, flexibility or any other key performance characteristics as they train."
Mixed reactions
Such criticism might slow, but won't stop, toning shoes' popularity and sales growth, sneaker industry analyst Powell says.
Despite the reluctance of many men to buy a product that some see as "women's shoes," he expects sales of toning shoes to men to eventually become 25% of the market.
The reaction of consumers who've worn the shoes runs the gamut.
Lisa Nosseir of Monroe Township, N.J., loves the "support and comfort" she gets from Shape-ups, although she thinks the toning claims are "far-fetched."
Barb Likos of Denver says she considers her toning shoes a "cute gimmick."
Her Shape-ups help to strengthen her calf muscles, she says, but did nothing to tone her butt and thighs. Even though they are her "most comfortable pair of shoes," she says she regrets spending $120 on them.
As for Skechers trying to persuade men to buy them, well, good luck with that.
"My husband would not be caught dead in these things," Likos says.
If anyone's looking for a slightly used pair of Shape-ups, they can contact Drury in Louisville
Friday, July 2, 2010
Body Fat Linked to Diabetes Risk in Older People
To avoid Type 2 diabetes, seniors may need to watch their weight just as closely as younger individuals do, a prospective cohort study showed....
Among individuals 65 and older, several measures of adiposity and weight gain were associated with a greater risk of developing Type 2 diabetes during follow-up, according to Mary Biggs, PhD, of the University of Washington School of Public Health and Community Medicine in Seattle, and colleagues.
The hazard ratios ranged from 1.9 to 6.0 when broken down by sex.
Self-reported body mass index at age 50 and weight gain from age 50 to study baseline were both also associated with risk of incident diabetes. "We found it surprising that the relationship between adiposity or body fat and diabetes was so strong among older adults," Biggs said.
"I think the results affirm the importance of weight control during middle age and suggest that weight control remains important into older ages in terms of reducing diabetes risks."
Although overweight and obesity are well-recognized risk factors for Type 2 diabetes among young and middle-age individuals, the relationship has not been well studied in older adults, according to the researchers.
So they turned to the Cardiovascular Health Study, which prospectively followed 4,193 men and women who were at least 65 and free of diabetes at baseline from 1989 to 2007. The participants came from four counties in North Carolina, Maryland, California, and Pennsylvania.
At baseline, mean age of participants was 72 and their mean BMI was 26 kg/m2 for both men and women; 45% had prediabetes (fasting glucose of 100 to 125 mg/dL).
Through a median follow-up of 12.4 years, there were 339 incident cases of Type 2 diabetes, defined as use of diabetes medication or a fasting glucose of at least 126 mg/dL.
With increasing quintiles of various measures of adiposity, there was a corresponding greater risk of developing diabetes, with no significant differences by sex or race.
All multivariate models were adjusted for age, sex, race, smoking, alcohol consumption, physical activity, and dietary factors.
The magnitude of the increased risk associated with various measures appeared to fade with age, with about half the risk in individuals 75 and older compared with those 65 to 74. However, the interaction with age was significant only for BMI at age 50 and at baseline and for fat mass.
There are several possible reasons risk might be increased to a lesser extent in older individuals, according to the researchers.
"Among older adults, standard anthropometric measures may not adequately quantify body fat due to age-related changes in body composition, including decreases in skeletal muscle mass and height," they wrote.
In addition, among older individuals, regional fat distribution may be more important in the etiology of diabetes than absolute fat mass, the pathophysiology of diabetes may differ, and selective survival may be involved. Changes in body weight were also associated with diabetes risk.
Compared with individuals who had a weight fluctuation of no more than about 4 pounds, those who gained 20 or more pounds from age 50 to baseline or 13 pounds or more from baseline to the third follow-up visit had a two- to threefold increased risk of developing diabetes.
"Results of this study affirm the importance of maintaining optimal weight during middle age for prevention of diabetes and, while requiring confirmation, suggest that weight control remains important in reducing diabetes risk among adults 65 years of age and older," the researchers wrote.
Among individuals 65 and older, several measures of adiposity and weight gain were associated with a greater risk of developing Type 2 diabetes during follow-up, according to Mary Biggs, PhD, of the University of Washington School of Public Health and Community Medicine in Seattle, and colleagues.
The hazard ratios ranged from 1.9 to 6.0 when broken down by sex.
Self-reported body mass index at age 50 and weight gain from age 50 to study baseline were both also associated with risk of incident diabetes. "We found it surprising that the relationship between adiposity or body fat and diabetes was so strong among older adults," Biggs said.
"I think the results affirm the importance of weight control during middle age and suggest that weight control remains important into older ages in terms of reducing diabetes risks."
Although overweight and obesity are well-recognized risk factors for Type 2 diabetes among young and middle-age individuals, the relationship has not been well studied in older adults, according to the researchers.
So they turned to the Cardiovascular Health Study, which prospectively followed 4,193 men and women who were at least 65 and free of diabetes at baseline from 1989 to 2007. The participants came from four counties in North Carolina, Maryland, California, and Pennsylvania.
At baseline, mean age of participants was 72 and their mean BMI was 26 kg/m2 for both men and women; 45% had prediabetes (fasting glucose of 100 to 125 mg/dL).
Through a median follow-up of 12.4 years, there were 339 incident cases of Type 2 diabetes, defined as use of diabetes medication or a fasting glucose of at least 126 mg/dL.
With increasing quintiles of various measures of adiposity, there was a corresponding greater risk of developing diabetes, with no significant differences by sex or race.
All multivariate models were adjusted for age, sex, race, smoking, alcohol consumption, physical activity, and dietary factors.
The magnitude of the increased risk associated with various measures appeared to fade with age, with about half the risk in individuals 75 and older compared with those 65 to 74. However, the interaction with age was significant only for BMI at age 50 and at baseline and for fat mass.
There are several possible reasons risk might be increased to a lesser extent in older individuals, according to the researchers.
"Among older adults, standard anthropometric measures may not adequately quantify body fat due to age-related changes in body composition, including decreases in skeletal muscle mass and height," they wrote.
In addition, among older individuals, regional fat distribution may be more important in the etiology of diabetes than absolute fat mass, the pathophysiology of diabetes may differ, and selective survival may be involved. Changes in body weight were also associated with diabetes risk.
Compared with individuals who had a weight fluctuation of no more than about 4 pounds, those who gained 20 or more pounds from age 50 to baseline or 13 pounds or more from baseline to the third follow-up visit had a two- to threefold increased risk of developing diabetes.
"Results of this study affirm the importance of maintaining optimal weight during middle age for prevention of diabetes and, while requiring confirmation, suggest that weight control remains important in reducing diabetes risk among adults 65 years of age and older," the researchers wrote.
Obesity, Other Risk Factors for Youth Diabetes Improved by Broad, School-based Intervention Program
One of the important announcements coming out of the American Diabetes Association's 70th Scientific Sessions were the results of a little known NIH study titled, "The Healthy Study: Interventions to reduce early diabetes risk." This may be a new model of how we can prevent our children from getting diabetes....
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
Wednesday, June 16, 2010
Are Your Feet Vacation Ready?
Although rest and relaxation are the goals for most vacations, they usually involve a lot of walking and a lot of walking usually involves sore feet.
Walking is great exercise and one of the most reliable forms of transportation. But if your feet aren't in the best shape or you don't have the right shoes, too much walking can cause foot problems.
Good foot care is essential if you plan to subject your feet to long periods of walking. Some simple foot care tips include:
1. Wear thick, moisture control socks (wool or synthetic fabrics instead of cotton) and change them often!
2. Dry feet thoroughly after bathing, making sure to dry between toes. Use powder before putting on shoes and even antiperspirant on your feet if you sweat profusely.
3. Nails should be cut regularly and straight across the toe. Check for ingrown toenails and avoid cutting them too short.
4. Moisturize your feet regularly, but never between your toes. Also watch out for athlete's foot fungus infections.
5. Massage any aching muscles after exercise and apply ice to any sore joints for at least 15 minutes.
6. Bunions, hammertoes or any other serious foot problems should be evaluated by a podiatrist prior to your planned vacation. Custom orthotics can help balance your feet so your vacation can be more enjoyable and pain free!
The right shoe is also important to healthy walking. The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes will fit the bill. There are also shoes made especially for walking. Walking shoes tend to be slightly less cushioned, bulkier, and heavier than running shoes. Whether a walking or running shoe, the shoes need to feel stable and comfortable.
Never wear new shoes for the first time on vacation. Always "break them in" for at least a week to make sure the fit is proper and there are no seams rubbing! Blisters can put a damper on a vacation!
Also, two pairs of shoes can be very helpful in making your vacation more comfortable. After a vigorous day walking, your shoes need almost 24 hours to dry out so they do not smell and harbor fungus, the cause of athlete’s foot.
Warm up exercises to help alleviate any muscle stiffness or pulled muscles are advised before walking. Loosening up the heel cords (Achilles tendon and calf) and thigh muscles before a walk is especially effective.
If you're not accustomed to long walks, start slowly and rest if your feet start hurting.
Walking is great exercise and one of the most reliable forms of transportation. But if your feet aren't in the best shape or you don't have the right shoes, too much walking can cause foot problems.
Good foot care is essential if you plan to subject your feet to long periods of walking. Some simple foot care tips include:
1. Wear thick, moisture control socks (wool or synthetic fabrics instead of cotton) and change them often!
2. Dry feet thoroughly after bathing, making sure to dry between toes. Use powder before putting on shoes and even antiperspirant on your feet if you sweat profusely.
3. Nails should be cut regularly and straight across the toe. Check for ingrown toenails and avoid cutting them too short.
4. Moisturize your feet regularly, but never between your toes. Also watch out for athlete's foot fungus infections.
5. Massage any aching muscles after exercise and apply ice to any sore joints for at least 15 minutes.
6. Bunions, hammertoes or any other serious foot problems should be evaluated by a podiatrist prior to your planned vacation. Custom orthotics can help balance your feet so your vacation can be more enjoyable and pain free!
The right shoe is also important to healthy walking. The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes will fit the bill. There are also shoes made especially for walking. Walking shoes tend to be slightly less cushioned, bulkier, and heavier than running shoes. Whether a walking or running shoe, the shoes need to feel stable and comfortable.
Never wear new shoes for the first time on vacation. Always "break them in" for at least a week to make sure the fit is proper and there are no seams rubbing! Blisters can put a damper on a vacation!
Also, two pairs of shoes can be very helpful in making your vacation more comfortable. After a vigorous day walking, your shoes need almost 24 hours to dry out so they do not smell and harbor fungus, the cause of athlete’s foot.
Warm up exercises to help alleviate any muscle stiffness or pulled muscles are advised before walking. Loosening up the heel cords (Achilles tendon and calf) and thigh muscles before a walk is especially effective.
If you're not accustomed to long walks, start slowly and rest if your feet start hurting.
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