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In the Loop 
Issue 245 - May 6, 2020

Restless Legs Syndrome (RLS)

This neurological condition, also called Willis Ekbom disease, involves an uncontrollable and overwhelming urge to move the legs usually because of an uncomfortable sensation that occurs during the night when sitting or lying down.

Facts and risk factors
  • It can develop at any age and generally worsens with age. According to the National Organization for Rare Disorders (NORD), some reports indicate that most people do not see their doctor until middle age, but up to 40 percent may initially experience symptoms before age 20.
  • It is more common in women (about twice as common in women than men)
  • According to Harvard Medical School, researchers believe that between 3 to 8 percent of the US population may experience mild occasional RLS, and tens of thousands have RLS severe enough to cause a disruption in normal daily life. The Berkeley Wellness Letter reports that RLS affects between 5 and 10 percent of the US population.
  • It is more common in people with diabetes, nerve conditions, and back pain.
Causes
  • Primary RLS - may occur as a primary condition and it is often genetic (especially for people who experience it before 40 years of age) or occurs for unknown reasons. One idea is that the body has an imbalance of dopamine, a brain chemical, whose role is to send messages to control the movement of the muscles.
  • Secondary RLS - is due to another underlying disorder, certain medications, or other factors. Underlying disorders include iron deficiency, anemia (low levels of the oxygen-carrying component of red blood cells), and kidney failure. Sometimes people will have RLS along with peripheral neuropathy (damage to the nerves in the hands and feet from chronic conditions such as diabetes or from alcoholism). RLS may occur in people with spinal cord conditions (e.g., lesions on the spinal cord from damage or injury, or having had anesthesia of the spinal cord). Other medical problems that are sometimes linked to RLS include rheumatoid arthritis, Parkinson’s disease, and withdrawal from medications e.g., morphine, oxycodone, and heroin, but most people who see their doctor about RLS do not have these conditions. High caffeine intake (coffee, tea, cola beverages, chocolate) and some vitamin deficiencies may also be related to RLS.
Symptoms
The main symptom is the urge to move the legs, particularly at night or when falling asleep. Symptoms can fluctuate in severity and can come and go. 
  • The sensation has been described as creeping, pulling, throbbing, aching, itching, wormy and electric, and sometimes painful. Another description is that it may feel like insects are crawling inside your legs
  • People can experience the sensation in the arms, but this is less common, as well as the trunk and even the face, according to the Restless Legs Syndrome Foundation (RLSF). HealthLink BC adds that it can be experienced even with a phantom limb (the part of a limb that has been amputated)
  • After resting or being inactive for some time, the sensations begin (e.g., sitting for long periods such as watching a movie or long plane or car rides). Moving (stretching, jiggling legs, pacing, deep knee bends, or walking) can reduce the sensation, as can a leg massage or a warm bath
  • Symptoms occur mainly at night
  • RLS may occur along with a more common condition, periodic limb movement disorder (PLMD), also referred to as periodic limb movements of sleep (PLMS) where the legs twitch and kick while you sleep. The movements occur 1 to 10 times per minute, and a sleep study (polysomnogram) can assess the extent that it is interfering with sleep. According to the Harvard Health Letter, 4 out of 5 people with RLS also have PLMD.
  • A significant problem is an interruption in sleep caused by symptoms. Tufts University Medical Center includes 5 hours or less of sleep in the list of symptoms for RLS, along with irritability due to the lack of sleep. According to the National Organization for Rare Disorders, some people with severe symptoms only get a few hours of sleep a night.
  • Some medications worsen RLS symptoms e.g., antihistamines, anti-dizziness and anti-nausea medications, antidepressants, and some psychiatric medications.
  • Pregnancy or hormonal changes may worsen signs and symptoms temporarily. It occurs in up to 25 percent of pregnant women and shows up in the last trimester (but symptoms usually disappear after the baby is born).
When to see a doctor
If you experience long-lasting discomfort in any part of your body that you cannot explain, and especially if your sleep is disrupted because of the discomfort, see your doctor.

Prevention
Harvard Medical School comments that it is not possible to prevent this condition, but avoiding caffeine, alcohol, and cigarette smoking may help.

What to expect
RLS in and of itself does not lead to the development of other serious conditions, but RLS can present problems if the symptoms are severe enough to interfere with sleep and the accompanying extreme drowsiness and fatigue during the daytime, leading to a decrease in quality of life and the potential for developing depression.

Treatment
The type of treatment used to address RLS will depend on the severity of symptoms. In some cases, combining medications along with avoiding caffeine is enough to significantly reduce symptoms. For people with secondary RLS, treatment is aimed at the underlying condition e.g., iron therapy.

Mild RLS - exercising, stretching, leg massages, and taking a hot bath may reduce symptoms, along with eating a balanced diet and avoiding caffeine, alcohol, and cigarette smoking. The RLS Foundation cites a small study finding that combining moderate aerobic exercise and lower-body resistance training three days a week reduced symptom severity by about 50 percent. NORD reports that people avoid excessive exercise as it can aggravate symptoms. Berkeley Wellness Letter suggests using a hot water bottle or cold compresses or putting a pillow between your legs before falling asleep. Tufts University Medical Center also suggests asking your family doctor about wearing elastic compression socks over your calves. Follow a regular sleep routine.  Mentally stimulating activities such as crosswords or video games may help by acting as a distraction from symptoms.

Role of iron - according to Harvard Medical School, even for people who are not iron deficient, iron treatment may be helpful, but blood iron levels need to be checked regularly as too much iron can be harmful. Dr. Anthony Komaroff of Harvard Medical School reports that many doctors are not aware of the relationship between iron deficiency and RLS and are not testing for iron deficiency, especially in men where deficiency is not common.  When it comes to iron levels, RLS may be caused by low iron levels in the brain and not the blood level of iron – these are two different levels. While it is challenging to measure low brain iron, the best way to measure iron deficiency is to conduct a blood test measuring ferritin (the primary form of stored iron in the body). If blood levels are low, brain levels are probably low as well.  Someone may be low in iron because their diet is lacking iron-rich foods or because they have a condition such as cancer (stomach, colon, bladder, or kidney) causing blood loss in the body.  Menstruating women have low blood iron levels. Dr. John Winkelman, an RLS specialist at Harvard-affiliated Massachusetts General Hospital, tells the Harvard Health Letter that treating low iron by increasing iron in the diet is sometimes enough if your ferritin level is at or below 50 micrograms per litre (mcg/L). For people who have poor gut absorption of iron or who do not tolerate oral iron, an intravenous infusion of iron may be suggested. Relief from RLS symptoms is found in about one-third of people who get intravenous iron. For more information about the relationship between iron and RLS and whether this would apply to you, speak with your family doctor.

Medications - when symptoms are more severe, medications may be used to address the urge to move and to help with sleep. The Tufts University Medical Center points out that medications are helpful but not a cure. Medications may be used alone or in combination and include dopaminergic agents, benzodiazepines (sedatives for improving sleep quality), anticonvulsants (especially for people who experience pain), and others. For better sleep, HealthLink BC suggests the following tips:
  • Avoid caffeine 4 to 6 hours before bed e.g., from coffee, tea and some soft drinks and alcohol in the evening
  • Avoid smoking (tobacco) near bedtime or when you wake up during the night because nicotine is a stimulant
  • Avoid eating a heavy meal before bed
  • Get sunlight every day especially later in the afternoon
  • Do not drink too much water prior to retiring for the evening to avoid waking up to use the washroom
  • Practice relaxation before bedtime or write down troubling thoughts to avoid worrying when you are trying to sleep
  • If you have trouble falling asleep or waking up, get out of bed and go to another room until you feel sleepy so that you associate your bed with sleep
  • Keep a cool, dark, and quiet environment for sleeping
Resources

Sources: Harvard Medical School website, Restless Legs Syndrome  Foundation website, Berkeley Wellness Letter website, Tufts Medical Centre website, Tufts Medical Centre website, HealthLink BC website, HealthLink BC website, National Organization for Rare Disorders website, Harvard Heart Letter website, Mayo Clinic website
 


Weight Loss Maintenance is the Challenge

An article published in the British Medical Journal compared the relative impact of different diets with a usual diet and outcomes including weight loss and improvements in cardiovascular risk factors e.g., blood pressure and cholesterol levels.

The rate of obesity around the globe has tripled between 1975 to 2018. Because millions of people are seeking to lose weight by changing the way they eat, researchers are looking at the effect of different macronutrient eating patterns i.e., comparing diets that reduce carbohydrates, reduce fat and moderate macronutrients (similar to low fat, but slightly more fat and slightly less carbohydrate), and the effects of different popular diets e.g., Atkins, DASH (Dietary Approaches to Stop Hypertension) and the Mediterranean diets. 

A team of international researchers conducted a systematic review and meta-analysis of 121 randomized controlled trials with a total of  21,942 subjects. This research represented the first comprehensive analysis comparing the relative impact of different diets on weight and cardiovascular risk factors.  The average age of the study subjects was 49. Subjects included those who were overweight or obese with cardiovascular risk factors. Highlights of the study:
  • Compared to a usual diet, people following low carbohydrate and low-fat diets had similar modest weight loss and reduced blood pressure at 6 months whereas moderate macronutrient diets (like low fat, but a small additional amount of fat and slightly less carbohydrate) had slightly less weight loss and blood pressure reductions.
  • At six months, the Atkins, DASH, and Zone diets had the most effect on weight loss of between 3.5 and 5.5 kg and most effect on blood pressure when compared to a usual diet
  • None of the diets significantly improved HDL (good) cholesterol levels or C reactive protein (a chemical involved in inflammation)
  • After 12 months, overall weight loss diminished among all dietary patterns and popular named diets.
  • After 12 months, the cardiovascular risk benefits disappeared for all diets except the Mediterranean diet
Conclusion: Based on moderate certainty evidence, macronutrient diets (low carbohydrate such as Atkins, Zone, low fat such as the Ornish diet, and moderate macronutrient diets such as the DASH and Mediterranean diets, compared with usual diet, result in modest weight loss and substantial and potentially important improvements in cardiovascular risk factors, particularly blood pressure, at six but not 12 months. The researchers concluded that the large range of popular diets they examined “provides a plethora of choice but no clear winner.”

The bottom line: the results suggest that it is not the type of diet since the differences in benefits are generally trivial to small, but rather how to best maintain any weight loss achieved that should be the focus. Sound advice for the public is to encourage them to eat more vegetables, legumes, and whole grains while eating less sugar, salt, and alcohol. In an accompanying editorial, the authors note that regularly monitoring weight loss and incorporating daily physical activity are important activities for successfully maintaining weight loss. An infographic of the results is available. 

Sources: British Medical Journal website, British Medical Journal (Editorial) website, Science Daily website
 
 


Vegetables - Raw or Cooked? 

Vegetables are rich in vitamins, minerals, phytochemicals, and fibre. How do we maximize these nutrients to get the “biggest bang for the buck?” Regardless of whether they are raw or cooked, Canadians need to eat more vegetables. The Half Your Plate initiative cites the Statistics Canada report that in 2011, only 40.4 percent of Canadians aged 12 and older consumed fruit and vegetables five or more times per day. While consumption rose gradually from 2001-2009, reaching 45.6 percent, it has declined since then. Consumer Reports writer Jessica Branch states, “Eating vegetables in any form is something people should be doing more of.”  Helen Rasmussen, PhD, RD, a senior research dietitian at Tufts’ Jean May USDA Human Nutrition Research Center on Aging says that the best choice is to “eat vegetables however they most appeal to you.” As well, choose to eat “the rainbow” or a variety of vegetables to ensure you get all the required nutrients.

Factors affecting the nutrient levels in vegetables include how they are prepared, the temperature used in cooking and the time between harvesting and eating the vegetable. When it comes to the impact of cooking on the nutrition of vegetables, there are pros and cons, according to Rasmussen. One might assume that eating a vegetable in its raw form would have more nutrients, but this is not always the case since some nutrients are bound in cell walls and cooking breaks down those walls.  With some vegetables, cooking will increase levels of one nutrient while decreasing the levels of another nutrient e.g., cooking carrots increases the availability of beta-carotene but reduces the vitamin C levels. For some nutrients, any type of cooking method will lead to their reduction. WebMD notes that the way vegetables are prepared can “make a big difference in the nutritional punch they pack.”

Cooking methods to reduce the loss of nutrients
Jeffrey B. Blumberg, PhD, a research professor at Tufts University Friedman School of Nutrition Science and Policy, suggests the following:

Eat uncooked
  • Kale, broccoli, and bell peppers - these vegetables are high in vitamins B and C and certain phytochemicals. Phytochemicals are non-nutritive plant chemicals that have protective or disease preventive properties. Plants produce these chemicals to protect themselves, but recent research has shown they can be protective for humans against diseases. If cooked, these vegetables should be steamed, blanched, sautéed, roasted or microwaved versus boiling, as boiling leaches these nutrients into the water (so if you do boil your vegetables, use that water to make broth or sauce). If you are cooking a large amount of a vegetable, a suggestion from WebMD is to cook smaller batches to ensure that all pieces are cooked the same amount. Red bell peppers are the superstars of peppers, according to Jessica Branch of Consumer Reports, rich in antioxidants (substances that can prevent or slow damage to cells caused by free radicals which are unstable molecules that can harm your cells) and have six times as much vitamin C as citrus fruits (on an ounce to ounce comparison), or one cup providing three times more vitamin C than one orange. The vitamin C is lost when boiling or steaming, but using these methods allow the carotenoids (pigments in plants, algae, and photosynthetic bacteria that produce the bright yellow, red and orange colours in plants, vegetables, and fruits – they act as a type of antioxidant for humans) to be more easily absorbed by the body.
  • Onions - these eaten raw are better than cooked, according to Registered Dietitian Anar Allidina. In an interview with Global News, she indicates that the high heat from cooking onions reduces the phytochemicals that protect against certain cancers.
  • Garlic - WebMD suggests eating raw garlic or adding it just before cooking is finished
Eat cooked
  • Cooked tomatoes - such as tomato sauce, have higher levels of lycopene than raw tomatoes. The heat in the cooking process breaks down cell walls, which makes lycopene more available for your body to absorb. Lycopene is a phytochemical linked to lower rates of cancer and heart disease. The trade-off in cooking tomatoes is that it reduces the vitamin C content, but a 2002 study found that it raised the total antioxidant power by 62 percent and increased the levels of absorbable lycopene by 35 percent.
  • Carrots, spinach, broccoli, mushrooms, zucchini, asparagus, cabbage, and peppers - these supply more carotenoids when cooked. Registered Dietitian Anar Allidina, in an interview with Global News, notes that as much as people love eating raw carrots with dip, you’re better off cooking them for nutrients.
  • Broccoli - a tip from Consumer Reports for broccoli is that a study in 2018 found that chopping broccoli and letting it sit for 90 minutes prior to cooking allows myrosinase to activate. Myrosinase is an enzyme that needs to be active to convert glucosinolates to a variety of cancer-fighting compounds. Steaming broccoli preserves myrosinase and vitamin C.
  • Never eat raw for safety reasons - sprouts, such as alfalfa, bean, and mung can be contaminated with bacteria such as listeria and E. coli and cause foodborne illness. The warm and humid environment used to grow sprouts is the ideal environment for bacteria to thrive. Diarrhea, fever, and abdominal cramps are common symptoms that occur 12 to 72 hours after infection. Groups who should be especially careful include pregnant women, people with compromised immune systems, and the very old and very young, as they are more at risk of having a severe and life-threatening illness from consuming raw or lightly cooked sprouts. The US Centers for Disease Control and Prevention advises everyone to avoid eating uncooked sprouts. The Academy of Nutrition and Dietetics states that the safest bet for all is to thoroughly cook sprouts to reduce the risk of food poisoning.
How to cook vegetables
  • Cook with less water and less heat exposure when possible to prevent the loss of water-soluble and heat-sensitive nutrients. Do not overcook vegetables. Cooking methods using less water include steaming, blanching, or microwaving until tender-crisp to help retain colour, nutrition, and taste. Steaming, in general, maintains the most nutrients as it prevents the leaching of water-soluble compounds and reduces the heat exposure that can degrade some vitamins. Soups and stews can retain nutrients in vegetables versus boiling vegetables. Registered Dietitian Anar Allidina adds roasting to the list of cooking methods that retain the most nutrients in your vegetables.
  • Vegetables with fat-soluble vitamins (A,D, E, and K) and phytonutrients (especially beta-carotene, lycopene, and other carotenoids) are better when chopped and cooked with vegetable oil. When eating these vegetables raw, add vegetable oil (oil-based dressing), seeds, avocado, or nuts to increase the absorption of their nutrients. Examples of these vegetables include asparagus, carrots, Swiss chard, and squash.
  • For dark green leafy vegetables, adding vitamin C sources such as lemon or lime juice increases the absorption of folate (a B-vitamin that is naturally present in many foods needed to make DNA and other genetic material and for cells to divide). For plant foods, adding these juices with vitamin C will help with the absorption of iron as well.
How to prepare raw vegetables
Thoroughly wash raw vegetables to rid them of any bacteria. Rinse with cold water, use a brush for thick-skinned produce, and soak produce with nooks and crannies such as broccoli for one to two minutes in clean cold water. Soaking is also a good way to clean herbs, as the herbs will float on the top and the dirt will sink to the bottom of the container. Other tips for maintaining nutrients include: 
  • Choose in season and local produce picked fresh
  • Store non-root vegetables in the fridge to increase the length of time nutrients are retained but don’t forget about them.
  • Do not wait too long to eat produce so buy smaller quantities and shop often
  • Brushing your produce reduces nutrients
  • Freeze and can vegetables and fruits to capture their nutrients
  • Growing your own vegetables will reduce travel time from harvest to table
Resources
  • To increase your vegetable consumption, visit the Half your Plate website for recipes and tips
  • Consumer Reports website lists eight vegetables that are healthier cooked and includes cooking tips
Sources: Unlockfood website, Consumer Reports website, Tufts University Health & Nutrition Letter website, WebMD website, Healthline website, Healthline website, Global News website, Academy of Nutrition and Dietetics Eat Right website, Phytochemicals website, National Institutes of Health website, Half Your Plate website
 
 


Potatoes - A Healthy Choice?

Potatoes are a popular and inexpensive food choice. According to the World’s Healthiest Foods website, potatoes are the number one vegetable crop in the world.  

What about nutrition?
Potatoes have been linked to obesity, type 2 diabetes, and cardiovascular disease, but this can happen when they are deep-fried or smothered with add-ons such as butter, sour cream, salt, and bacon bits. Charles Mueller, a clinical associate professor with the Department of Nutrition and Food Studies at New York University, describes “undoctored” potatoes as “healthy.”

When it comes to the nutritional profile of the potato, they are an excellent source of potassium, a good source of vitamin C, as well as having fibre and folate.  They also contain a variety of phytonutrients that have antioxidant activity. A medium-sized potato has only 110 calories, considered a low amount. The World’s Healthiest Foods website describes the baked potato as “an exceptionally healthy low calorie, high fibre food that offers significant protection against cardiovascular disease and cancer.” The Unlockfood website of the Dietitians of Canada suggests you “make sure to eat the potato skins to get the most fibre.” The World’s Healthiest Foods website indicates that the skin is a concentrated dietary fibre source. To prepare the potato, scrub it with a produce brush while rinsing it under cool water. Victoria Jarzabkowski, a nutritionist at the University of Texas at Austin, explains that the best way to prepare a potato is in its whole, unprocessed form. Baking it is best or microwaving because these methods result in the least amount of nutrient loss.

A negative aspect of the potato is that it has a high glycemic index, which means it is digested easily and can cause blood sugar spikes, followed by rapid declines in blood sugar. As blood sugar declines, a person may feel hungry. This, in turn, can lead to people eating too much and raising their risk of chronic health conditions such as type 2 diabetes, heart disease, and obesity. To counter the high glycemic index issue, Mueller suggests having a potato with a healthy meal that includes protein or cooling the potatoes after cooking them and eating them cold as in a potato salad or reheating them because this changes the carbohydrate structure of the potato and causes the formation of resistant starch, a fermentable fibre. Resistant starch benefits include improved insulin sensitivity, lower blood sugar levels, reduced appetite, and digestive benefits.

Mueller says that having potatoes a couple of times a week can be part of a healthy diet, but you need to be mindful of the portion size and what you put on the potato so that you do not take away the health benefits.

Vasanti Malik of the Harvard TH Chan School of Public Health has a different take on the potato, which is not considered a vegetable on the Harvard Healthy Eating  Plate. The problem with potatoes is that they do not keep a person as full as other vegetables. Research has found that over the long term, diets that include a high amount of potatoes and other rapidly digested high carbohydrate foods can contribute to the development of chronic health conditions such as obesity, diabetes, and heart disease. A surprising fact is that one cup of white potatoes is equivalent to a can of cola or a handful of jellybeans in terms of the effect on blood sugar levels. The Harvard TH Chan School of Public Health website states, “This roller-coaster effect on blood sugar and insulin can result in people feeling hungry again soon after eating, which may then lead to overeating.” While potatoes have some nutrients, there are better vegetables to choose from e.g., compared to a potato, broccoli has nearly nine times the vitamin C content, and white beans have about twice the potassium. Sweet potatoes are a better choice than white potatoes as people are less likely to eat too many – a link has not been found between sweet potatoes and diabetes and obesity. Be mindful of the portion size with sweet potatoes. 

Sources: Unlockfood website, Medical News Today website, The World's Healthiest Foods website, Livescience website, Harvard TH Chan School of Public Health website, Harvard TH Chan School of Public Health website, Healthline website, Washington Post website, Harvard Health Beat website

 


Walking and Living Longer

During this pandemic, we are told to stay home but we are still encouraged to stay active while practicing physical distancing. Walking is an easy form of physical activity that can be done by most people. Like grocery shopping, avoid crowded spaces, and walk near your home at times of day when the streets are less busy. You can also walk around your home or march in place. 

A 10-year study involving almost 5,000 participants looked at how far people walk each day, the intensity of walking, and the relationship with the rate of death.

The study, published March 24, 2020, in the Journal of the American Medical Association, examined whether the number of steps per day and the intensity of stepping are associated with lower mortality (death). Previous research on step counters and mortality involved specific groups e.g., people with chronic conditions or older adults. Pedro Saint-Maurice, PhD, first author of the study, explained that he and his colleagues wanted to investigate this question to provide new insights that could help people better understand the health implications of the step counts they get from fitness trackers and phone apps. Researchers tracked 4,840 people, a sample representative of US adults who were over the age of 40 at the beginning of the study. The primary outcome was all-cause mortality (death from all causes), while the secondary outcomes were cardiovascular disease and cancer mortality. Study participants wore an accelerometer for up to 7 days between 2003 and 2006. Study highlights included:
  • Of those participants, 1,165 died during the study, with 689 deaths from cancer or cardiovascular disease.  
  • Walking 8,000 steps a day, compared to 4,000 steps a day (considered low) was associated with a 51 percent lower risk for all-cause mortality (death from all causes), while the percentage increased to 65 percent for those taking 12,000 steps per day. During the study period, 419 died of the 655 people who took less than 4000 steps a day. Only 82 people died of the 919 people who took more than 12,000 steps per day. 
  • No association was found between the intensity of walking (the speed at which a person walks) and the risk of death (after adjusting for the total number of steps per day) - this finding was not expected. In other words, how fast you walk was not associated with health benefits – it just mattered that you walked.
  • Looking at sub-groups, walking more was associated with lower all-cause death rates for the following groups: men and women; younger and older adults; and persons who were white, black, or Mexican American.
  • Researchers controlled for factors that could have affected the results e.g., age, demographic factors, body-mass index, self-reported health, and seven chronic conditions e.g., diabetes, heart disease, and emphysema.
  • The study is observational, meaning that it cannot prove causality i.e., living longer is correlated but not necessarily caused by walking more steps. But the results are in line with other studies finding that adults should move more and sit less throughout the day.
Eric Shiroma, PhD, a co-author of the study, states that “it’s good to see further evidence from a large study with a broad sample that the main thing is to get moving for better overall health as we age.” The good news is that even if you are at home during the pandemic you can still get benefit from walking around the house - you do not need to be running or doing vigorous exercise. If you have a step counter, and you are a healthy adult, work towards 10,000 steps daily. This has been found to be the amount of physical activity required to reduce health risks and manage weight. Catrine Tudor-Locke, a University of North Carolina-Charlotte researcher in this area, sees the goal of 10,000 steps a day as a good baseline, and she categorizes people achieving this amount of steps as "active."  For people who are sedentary or who have chronic conditions, 10,000 steps a day may be too challenging. Before starting an exercise program, speak with your family doctor. 

Source: Science Daily website, New York Times website, Very Well Fit website
 
 
 


The Value of Pedometers/Accelerometers

Many people are living with cardiometabolic conditions such as type 2 diabetes, prediabetes states (e.g., obesity), and cardiovascular disease, and the number of cases is growing worldwide. These conditions can be improved by changing unhealthy lifestyle behaviours. Physical activity is an important part of managing cardiac and metabolic conditions. Tools used to motivate people to walk are pedometers and accelerometer monitoring devices, also known as wearable technology. A pedometer is a device, usually portable and electronic or electromechanical, that counts steps that can be recorded daily. An accelerometer is a more technologically advanced device containing time-based movement sensors. It monitors time and intensity of activity and inactivity, heart rate, and calories burned.

The National Institute for Health Research (NIHR) in the UK funded a systematic review and meta-analysis (a study of studies) of the activity of people with cardiac or metabolic conditions who used wearable technology. The review included 36 studies involving data on 5,208 participants. Most studies were short-term with a follow-up period of 8 months. The criteria for study selection included being an adult 18 years of age or older, having type 2 diabetes or being at risk for type 2 diabetes, being obese or overweight, and having cardiovascular disease. The investigators found that:
  • Those studies that used monitoring devices (accelerometers or pedometers) showed a small to medium increase in physical activity compared to usual care or other interventions
  • Pedometers were superior to the accelerometers. A medium increase in physical activity was seen with pedometers with an average increase of 1,703 steps per day compared with the control group. The use of accelerometers resulted in a small increase compared with the control group
  • Augmenting the use of pedometers with meeting either face-to-face or remotely with a health care professional resulted in the largest improvement in physical activity, and less improvement with accelerometers. Without face-to-face or remote meetings, pedometers had a small effect and the accelerometers were ineffective. The investigators believe that it is likely that health care professionals providing feedback and lifestyle advice supported the effectiveness of the interventions
  • Factors such as diagnosis, age, length of intervention, and setting goals were not associated with the effectiveness of the intervention. One area, however, where the devices had a greater effect on physical activity levels was with studies that included mostly men
  • Using devices did not impact blood glucose levels, blood pressure, cholesterol, and body mass index
Bottom line: pedometers are a cheap, simple, user-friendly, and relatively quick way to enhance a physical activity program. There is no evidence, however, that a simple self-monitored intervention using either a pedometer or accelerometer is associated with improvements in physical activity i.e., using only these devices cannot replace a program. When designing physical activity programs for people with cardiometabolic conditions, developers may consider incorporating pedometers as motivating tools. Adding coaching or support from healthcare professionals can improve outcomes. Future research needs to be longer-term, as the studies in the review and meta-analysis showed that pedometers and accelerometers were associated with small to medium improvements in physical activity only over the short to medium term.  

Sources: Journal of the American Medical Association website, UK National Institute for Health Research (NIHR) website, British Journal of Sports Medicine website
 
 


Various COVID-19 Resources

Mental health
  • World Health Organization infographic on managing stress during COVID-19
  • Harvard Health infographic on managing stress during COVID-19
  • Simon Fraser University - Centre for Applied Research in Mental Health & Addiction provides the Positive Coping with Health Conditions, A Self-Care Workbook (Dan Bilsker, PhD, RPsych, Joti Samra, PhD, RPsych, Elliot Goldner, MD, FRC(P), MHSc). This self-care manual, authored by scientist-practitioners with expertise in issues relating to coping with health conditions, is designed for individuals who deal with health conditions, including patients, physicians, psychologists, nurses, rehabilitation professionals, and researchers. The workbook is available for download on the SFU website. It includes a relaxation method audio
Public health information
  • First Nations Health Authority Physical Distancing poster
  • Canadian Medical Association (CMA) Update: COVID-19 public section of the website
Healthy living 
  • Recipes - Dietitians of Canada has produced a free recipe e-book containing 12 recipes, hand-picked by dietitians to help you celebrate Nutrition Month 2020 with your family, friends, and colleagues
  • Stay active and healthy - ParticipACTION has a list of free resources  


Self-Management BC Offers Four Programs

Join a free health program and participate online, by telephone or independently. All Self-Management BC programs are open to BC adults living with one or multiple ongoing health conditions. 
  • The Better Choices, Better Health Online Self-Management Program is a web-based, 6-week program in which groups of about 25 people - all living with a variety of ongoing health conditions - participate together.
  • The Self-Management Health Coach Program is a telephone-based coaching program that supports people living with chronic conditions to become better self-managers. Health Coaches connect with participants by telephone, once a week for 30 minutes, for a period of three months.
  • The Tool Kit for Active Living with Chronic Conditions Program is an evidence-based program that includes all tools in the Chronic Disease Self-Management Program (CDSMP), packaged into a one-time mailing. 
  • The Tool Kit for Active Living with Chronic Conditions Program Plus Phone calls - participants in this 6-week program receive the materials from the Tool Kit for Active Living with Chronic Conditions Program and participate in a weekly 30-minute conference call with a Program Leader and three other participants.
For more information, please email selfmgmt@uvic.ca or call (toll-free) 1-866-902-3767.
 

 
Please send your ideas and suggestion to theloop@uvic.ca


Self-Management BC is supported and funded through a partnership with the Patients as Partners Initiative within the BC Ministry of Health.
 
IMPORTANT DISCLAIMER
This information and research are intended to be reliable, but its accuracy cannot be guaranteed. All material in this e-newsletter is provided for information only, and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this e-newsletter. Readers should consult their doctor or another qualified health professional on any matter relating to their health and well-being. The information and opinions provided in this e-newsletter are believed to be accurate and sound, based on the best judgment available to the authors. Readers who fail to consult with appropriate health authorities assume the risk of any injuries. The publisher, Self-Management BC, is not responsible for any errors or omissions. Self-Management BC is not responsible for the information in these articles or for any content included in this article which is intended as a guide only and should not be used as a substitute to seeking professional advice from either your doctor or a registered specialist for yourself or anyone else. 
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