The effects of exercise and where you live on longevity
Also: Using technology for Parkinson's disease
October 1, 2021 | View PDF
It’s never too late to get active
A study in more than 30,000 heart patients shows that becoming active later in life can be nearly as beneficial to survival as continued activity.
“These encouraging findings highlight how patients with coronary heart disease may benefit by preserving or adopting a physically active lifestyle,” says study author Dr. Nathalia Gonzalez of the University of Bern, Switzerland.
This study investigated activity levels over time and their relationship to the risk of death in patients with heart disease. The meta-analysis included 33,576 patients with coronary heart disease from nine groups. The average age was 62.5 years and 34% were women. The median follow-up was 7.2 years. Activity was assessed at baseline and follow-up using validated questionnaires and participants were classified as active or inactive at the two time points.
Definitions of active and inactive varied across the studies but were in line with recommendations for healthy people: At least 150 minutes a week of moderate intensity, or 75 minutes a week of vigorous activity, or a combination. Patients were divided into four groups according to their activity status at baseline and follow-up: Inactive over time, active over time, increased activity over time, and decreased activity over time. All the studies defined “increased activity over time” as moving from the inactive to the active category and “decreased activity over time” as moving from the active to the inactive category.
Compared to patients who were inactive over time, the risk of all-cause death was 50% lower in those who were active over time, 45% lower in those who were inactive but became active, and 20% lower in those who had been active but became inactive. Similar results were observed for death due to cardiovascular disease. Compared to those who remained inactive, the risk for cardiovascular mortality was 51% lower among those who remained active and 27% lower for those whose activity increased.
“The results show that continuing an active lifestyle over the years is associated with the greatest longevity. However, patients with heart disease can overcome prior years of inactivity and obtain survival benefits by taking up exercise later in life,” said Gonzalez.
Tailoring wearable technology and telehealth for Parkinson’s disease
Wearable health technologies are vastly popular with people wanting to improve their physical and mental health. Everything from exercise, sleep patterns, calories consumed and heart rhythms can be tracked by a wearable device. But timely and accurate data are also especially valuable for doctors treating patients with Parkinson’s disease.
A new study from the Southern Medical Program (SMP), based at the University of British Columbia in Canada, has examined the use of wearable health technology and telehealth to treat patients with Parkinson’s disease. Dr. Daryl Wile, a movement disorder specialist and SMP clinical assistant professor, routinely uses telehealth to connect with Parkinson’s patients across the vast landscape.
“Even prior to the pandemic, telehealth helped deliver specialized care to patients living in remote and rural settings,” says study investigator Dr. Wile. “But with the complex nature of Parkinson’s, we wanted to enhance these appointments to better understand how movements vary throughout a patient’s entire day.”
To add a new layer of health information, Dr. Wile and his research team added wearable technology to the equation. They recruited Parkinson’s patients with either tremors or involuntary movements. The patients were then divided into two groups, with some using telehealth and device-based health tracking and others attending traditional face-to-face appointments. The telehealth group wore wearable devices to track their movements, involuntary or not, throughout waking hours. The reported data was then reviewed during telehealth appointments to identify peak times patients experienced Parkinson’s symptoms.
“With the integration of accurate and reliable data from wearable devices, we were able to tailor a patient’s medication to better manage their symptoms throughout the day,” says Dr. Wile. As part of the study, patients were asked a series of questions from the standardized Parkinson Disease Quality of Life Index. Both study groups were assessed at intervals of six weeks, three months and six months. Overall, the patients using the wearable devices reported positive experiences and health outcomes in combination with telehealth appointments to access specialized care. The study showed there is a strong case to leverage multiple technologies to improve a patient’s quality of life and limit the added stress and cost associated with travel.
Where you live may matter more than you know
Living a long and healthy life may include picking the right city. It turns out that where you live, not just how you live, can make a big difference. That’s the finding of an innovative study co-authored by an MIT economist, which examines older adults across the United States. The study showed that some locations enhance longevity more than others, potentially for multiple reasons.
When a 65-year-old moves from a metro area in the 10th percentile, in terms of how much those areas enhance longevity, to a metro area the 90th percentile, it increases that person’s life expectancy by 1.1 years. That is a notable boost, given that mean life expectancy for 65-year-olds in the U.S. is 83.3 years.
“There’s a substantively important causal effect of where you live as an elderly adult on mortality and life expectancy across the United States,” says study co-author Amy Finkelstein, a professor in MIT’s Department of Economics.
Researchers have long observed significant regional variation in life expectancy in the U.S., and often attributed it to “health capital” — tendencies toward obesity, smoking, and related behavioral factors in the regional populations. The current study was able to isolate and quantify the effect that the location itself has on residents.
This study offers a glimpse into possible drivers of longevity including climate, pollution, crime, traffic safety and more.
“We wanted to separate out the role of people’s prior experiences and behaviors, or health capital, from the role of place or environment,” Finkelstein says. The researchers analyzed Medicare records from 1999 to 2014, focusing on residents between the ages of 65 and 99. Ultimately, the research team studied 6.3 million Medicare beneficiaries. About 2 million of those moved from one U.S. “commuting zone” to another, and the rest were a random 10% sample of people who had not moved over the 15-year study period. The Census Bureau defines about 700 commuting zones nationally.
The study found that many urban areas on the East and West Coasts, including New York City, San Francisco, and Miami, have positive effects on longevity for seniors moving there. Some Midwestern metro areas, including Chicago, also score well. By contrast, a large swath of the Deep South has negative effects on longevity for seniors moving there, including much of Alabama, Arkansas, Louisiana and northern Florida. Much of the Southwest, including parts of Texas, Oklahoma, New Mexico, and Arizona, fares similarly poorly.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at email@example.com.