After The Game, Get Off The Couch

Spending too much leisure time in front of a TV or computer screen appears to dramatically increase the risk for heart disease and premature death from any cause, perhaps regardless of how much exercise one gets, according to a new study published in the January 18, 2011, issue of the Journal of the American College of Cardiology.

Data show that compared to people who spend less than two hours each day on screen-based entertainment like watching TV, using the computer or playing video games, those who devote more than four hours to these activities are more than twice as likely to have a major cardiac event that involves hospitalization, death or both.

The study -- the first to examine the association between screen time and non-fatal as well as fatal cardiovascular events -- also suggests metabolic factors and inflammation may partly explain the link between prolonged sitting and the risks to heart health.
The present study included 4,512 adults who were respondents of the 2003 Scottish Health Survey, a representative, household-based survey. A total of 325 all-cause deaths and 215 cardiac events occurred during an average of 4.3 years of follow up.

"People who spend excessive amounts of time in front of a screen -- primarily watching TV -- are more likely to die of any cause and suffer heart-related problems," said Emmanuel Stamatakis, PhD, MSc, Department of Epidemiology and Public Health, University College London, United Kingdom. "Our analysis suggests that two or more hours of screen time each day may place someone at greater risk for a cardiac event."

In fact, compared with those spending less than two hours a day on screen-based entertainment, there was a 48% increased risk of all-cause mortality in those spending four or more hours a day and an approximately 125% increase in risk of cardiovascular events in those spending two or more hours a day. These associations were independent of traditional risk factors such as smoking, hypertension, BMI, social class, as well as exercise.

The findings have prompted authors to advocate for public health guidelines that expressly address recreational sitting (defined as during non-work hours), especially as a majority of working age adults spend long periods being inactive while commuting or being slouched over a desk or computer.

"It is all a matter of habit. Many of us have learned to go back home, turn the TV set on and sit down for several hours -- it's convenient and easy to do. But doing so is bad for the heart and our health in general," said Dr. Stamatakis. "And according to what we know so far, these health risks may not be mitigated by exercise, a finding that underscores the urgent need for public health recommendations to include guidelines for limiting recreational sitting and other sedentary behaviors, in addition to improving physical activity."

Biological mediators also appear to play a role. Data indicate that one fourth of the association between screen time and cardiovascular events was explained collectively by C-reactive protein (CRP), body mass index, and high-density lipoprotein cholesterol suggesting that inflammation and deregulation of lipids may be one pathway through which prolonged sitting increases the risk for cardiovascular events. CRP, a well-established marker of low-grade inflammation, was approximately two times higher in people spending more than four hours of screen time per day compared to those spending less than two hours a day.

Dr. Stamatakis says the next step will be to try to uncover what prolonged sitting does to the human body in the short- and long-term, whether and how exercise can mitigate these consequences, and how to alter lifestyles to reduce sitting and increase movement and exercise.

Source:  American College of Cardiology and Emmanuel Stamatakis, Mark Hamer, and David W. Dunstan. Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events: Population-Based Study With Ongoing Mortality and Hospital Events Follow-Up. Journal of the American College of Cardiology, 2011; 57: 292-299 DOI: 10.1016/j.jacc.2010.05.065

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Surprising Study Says Inactivity Not The Cause Of Childhood Obesity

A new report from the EarlyBird Diabetes Study suggests that physical activity has little if any role to play in the obesity epidemic among children. Obesity is the key factor behind diabetes, heart disease and some cancers.  EarlyBird is based at the Peninsula Medical School in Plymouth, UK, and has been observing in detail a cohort of city school children for the past 11 years.

A review published in 2009 of all trials using physical activity to reduce childhood obesity showed weight loss amounting to just 90g (3oz) over three years, and the EarlyBird study wanted to know why the trials were so ineffective. So they challenged some popular paradigms.

It is well known that less active children are fatter, but that does not mean -- as most people assume it does -- that inactivity leads to fatness. It could equally well be the other way round: that obesity leads to inactivity.

And this is the question EarlyBird was uniquely placed to answer. With data collected annually over several years from a large cohort of children, it could ask the question -- which comes first? Does the physical activity of the child precede changes in fatness over time, or does the fatness of the child precede changes in physical activity over time?

And the answer, published recently in Archives of Disease in Childhood, was clear. Physical activity had no impact on weight change, but weight clearly led to less activity.

The implications are profound for public health policy, because the physical activity of children (crucial to their fitness and well-being) may never improve unless the burgeoning levels of childhood obesity are first checked. If this cannot be achieved through physical activity, the focus has to be on what -- and how much -- children consume.

EarlyBird has already shown how the trajectory leading to obesity is established very early in life, long before children go to school, and how most childhood obesity is associated with obesity in the same-sex parent.

While portion size, calorie-dense snacks and sugary drinks are all important contributors, early feeding errors seem crucial -- and physical activity is not the answer.

Source: Peninsula College of Medicine and Dentistry and Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45). Archives of Disease in Childhood, 2010

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NFL Linemen Trade Health For Super Bowl Rings

When the Arizona Cardinals met the Pittsburgh Steelers in Super Bowl XLIII, every starting offensive lineman was a member of the 300-pound club.

This season, there were more than 600 players — about 20 percent of the league — in triple donuts. Even with 6-foot plus heights, their Body Mass Index (BMI) levels are all in the range of grade 2 obesity, one step below what's called morbid obesity.

This super-sizing of NFL players has accelerated in recent years, and some studies suggest health risks are growing. But studies are conflicting on this point.

And the big question on the minds of coaches and owners: Do heavier players mean more wins? No, says one NFL executive.

Strong vs. fat
The trend towards the ever-expanding football player, especially on the offensive and defensive lines, has accelerated over the last 20 years. From 1920-1984 no more than eight players in the league were over 300 pounds.

The motivation to be bigger comes from the perceived advantages on the field. When Nick Saban, now head coach at Alabama, was drafting players for the Miami Dolphins, he said: "I always say it this way: They have weight classes in boxing for a reason. The heavyweights don't fight the lightweights. What's the reason for that? Because if a big guy is just as good as a little guy, the little guy doesn't have much of a chance."

BMI is a measure of obesity based on a height to weight ratio. Often the apparently risky BMI of large athletes is dismissed because of the percentage of muscle included in their mass. The question becomes whether "big and strong" is any less dangerous than "big and fat."

Last year, Mayo Clinic researchers studied the cardiovascular health of 233 retired NFL players, aged 35-65. They found that in players less than 50 years old, 82 percent had either plaque or carotid narrowing of their arteries greater than the 75th percentile of the population, adjusted for age, sex and race. This condition could lead to a restriction of blood flow causing a heart attack or stroke.

Conflicting results emerged from a University of Texas study later in the year. They compared the health of 201 former NFL players and compared them with the population-based Dallas Heart Study and the Aerobics Center Longitudinal Study. Compared to the control group of men, retired players had a significantly lower prevalence of diabetes, hypertension, sedentary lifestyles and metabolic syndrome.

"Despite their large body size, retired NFL players do not have a greater prevalence of cardiovascular risk factors nor CAC than community controls," Alice Y. Chang, lead author and assistant professor of Internal Medicine at the University of Texas Southwestern Medical School in Dallas. "Age and high cholesterol levels, not body size, were the most significant predictors of sub-clinical coronary atherosclerosis among retired NFL players."

Does it matter?
Jackie Buell, director of sports nutrition at Ohio State University, recently released a study focused specifically on players with metabolic syndrome. This condition is characterized by a group of symptoms that include excess fat in the abdominal area, high blood pressure, high cholesterol, diabetes and elevated levels of triglyceride. Having one or more of these symptoms increases the risk of future heart disease or attacks.

Buell's study measured these factors in 70 current college football linemen. Thirty-four players had at least three risk factors, while eight had four and one had all five risk factors.
"We understand these athletes want to be big, but they can't assume all their weight gain is lean mass just because they're lifting weights and taking protein supplements," Buell said. "The bottom line is we're seeing more and more abdominal obesity. And these findings show that athletes aren't necessarily off the hook when it comes to health risks."

Are the potential health problems worth the risk of garnering a Super Bowl ring?
Indianapolis Colts president Bill Polian recently asked that very question to help his NFL draft planning. He compared the winning percentages with the average weight of NFL teams over a recent ten year period. "We found higher weight had no bearing on winning — none," Polian said. "There was a lot of noise about 'big is the answer.' We tested it. It's not valid."

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