Tag Archives: Ph.D.

Pain Medication Research at UW Medical Center and Washington State University

Overdosing on pain medication can kill and may cause pain med addiction.   For COPDers though pain management isn’t usually a part of COPD (Chronic Obstructive Pulmonary Disease) management.  Speaking as a patient – COPD isn’t painful.   Patients simply can’t breathe to different degrees and some patients de-saturate enough to be placed on supplemental oxygen allowing them to exercise further and faster for a quality life.

Trouble is – COPD is often the beginning of gathering other diseases – Other Stuff that is very painful.  Trouble is – some pain medications are known to adversely affect the respiratory system…so too often COPDers learn to live without sleep and 24/7 pain until the day comes when the thought of facing another day of such pain isn’t worth it and that is when a COPDer will take a pain pill or two for relief and to sleep.  Too, our physicians are afraid to prescribe pain meds for fear their patients will become addicted and I understand that.

I lived through the initial crushing left hip pain until now my body is letting me help myself into better hip health through water exercise but the ongoing debilitating cellulitis/Venous Stasis Dermatitis/Lymphedema sweeping lower leg pain finally sent me in desperation to the University of Washington’s Pain Management  Clinic.  On one visit I listed the pain as a 9 out of 10 being the worst.

Those were a few bad years, now is now and it is better.  For the Lymphedema, education was the key.  Thanks Melissa.  Time and exercise is helping me live in harmony with my hip… all without pain medications.

That said,  UW Medicine’s Alex Cahana, M.D., DAAPM, FIPP and the Division of Pain Medicine is doing ground-breaking work in pain management education for the physician and patient.  He was deeply involved with the “Washington State Opioid Reform Initiative, which seeks to reduce the over-prescription of narcotics.”

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“Since then, we’ve learned of two initiatives to help providers grapple with the disparate problems of addiction and pain management. ROAM (the Rural Opiate Addiction Management) Collaborative seeks to help manage the widespread issue of opiate addiction in rural Washington. COPE (Collaborative Opioid Prescribing Education) is an online educational tool that helps providers communicate to patients about how best to manage treatment of chronic, non-cancer-related pain.

ROAM and ECHO: Defeating Opiate Addiction in Rural Washington

Until recently, rural physicians have had few tools to help their patients escape opioid addiction — an epidemic health issue in rural areas, with large numbers of unintentional overdoses, even deaths. Methadone maintenance therapy, the most common treatment for opioid addiction, is often unavailable. However, a federally approved medication called buprenorphine (also known as Suboxone or Subutex), is more readily available, and it’s a viable, office-based alternative to methadone.

Despite the potential advantages of buprenorphine as opioid replacement therapy for addicted patients, however, few physicians have taken the eight-hour course that allows them to legally prescribe this medication. As of 2010, only 32 rural doctors in Washington had received the federal waiver that allows them to prescribe Suboxone.

In late March, Roger A. Rosenblatt, M.D., MPH, UW professor and vice chair of the Department of Family Medicine, and UW Medicine’s ROAM (Rural Opiate Addiction Management) Collaborative helped remedy the situation by offering the course to rural physicians and members of their practice staff in Spokane, in conjunction with the annual Regional Rural Health meetings. Physician participants are then eligible to receive a waiver from the Drug Enforcement Administration to allow the prescription of buprenorphine to treat addiction. If they wish, they can also receive further mentoring and instruction from Project ECHO (Extension for Community Healthcare Outcome), a bi-weekly video-conferencing program that covers issues such as patient management, staff training and clinical protocols.

For more information on ROAM — a collaboration between Washington State University and the University of Washington, funded by the state’s Life Sciences Discovery Fund — contact Rosenblatt at 206.685.1361 or rosenb@uw.edu.

COPE: Online Education for Chronic Opioid Therapy

UW Medicine has launched an online medical training tool for doctors and other prescribing providers who treat chronic pain. Known as COPE — Collaborative Opioid Prescribing Education — the tool is designed to improve interactions between prescribers and patients as they make shared decisions about chronic opioid therapy.

COPE was developed over the past six years by Mark Sullivan, M.D., Ph.D., a professor in UW Medicine’s Department of Psychiatry and Behavioral Sciences and adjunct professor of bioethics and humanities, and it has been clinically tested and peer-reviewed. It’s a comprehensive program, one that goes beyond typical factual content by using videotaped clinical scenarios to train providers about goal-setting and communications skills. Tutorial models are in development for nurses and for patients and families to help enhance their engagement in decision-making.

COPE focuses on the management of chronic, non-cancer pain, and its interactive modules are a timely response to legislative changes concerning chronic opioid therapy. Recently, Washington State adopted a bill that requires mandatory education and use of a prescription-monitoring program and clinical tracking tool. In addition, the U.S. Food and Drug Administration intends to issue a Risk Evaluation and Mitigation Strategy (REMS) which likely will call for a coordinated risk management plan for patients taking long-acting opioids. COPE will help prescribing providers nationwide to meet this challenge.”

For more information on COPE, contact Sullivan at: sullimar@uw.edu.

More later … thanks for listening… Sharon O’Hara

University of Washington Medical Center Excellance v Danish Air Pollution Study

Ah HA!  Ah, YES!  Air pollution does matter – finally a study proving it.

I like teaching hospitals – the attitude, the open and curious mindset that the body is more than one organ and the friendly, hospitable attitude of the medical professionals and employees is key to a patients – THIS patient – sense of wellbeing..

One of the best teaching hospitals in the nation according to US News and World Report is the University of Washington Medical Center, right across the pond from us here in Kitsap County and where I go for several medical conditions.

In all the years I’ve gone there and parked in the underground parking garage, I’ve never had a reaction to the normal car emissions.  The air seems to flow and dissipate the normal car smells.  Not so at the UWMC’s Roosevelt Building 11.

Yesterday, I had an appointment at the UWMC’s Roosevelt Building 11 and for the first time did not park in the underground parking but asked my husband to drop me off at the street level front door.

The past odor of the warm choking toxic stench in the underground garage is so bad, my eyes water.  My husband says he has never noticed the poor air quality down there but I do.

What does an air quality test show?  I called to ask.

I didn’t call to complain about the warm choking smother and forced inhaled sting of the air toxins the first or even second time we parked there – after all it IS underground parking.  When I did finally call  and did get the right person to ask when they had their last air quality check, I was politely told no one else had ever complained about it but she would find out for me.

About a month later she called to tell me what I smell must be from the helicopter landing emissions and that sometimes she even smells it in her office.

Well, how about a better filter on the helicopter or the parking garage to protect the people who park there AND work in the offices who sometimes smell it…although once inside the building, I’ve never smelled those toxins.

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Air Pollution Exposure Increases Risk of Severe COPD

ScienceDaily (Nov. 5, 2010) — Long term exposure to low-level air pollution may increase the risk of severe chronic obstructive pulmonary disease (COPD), according to researcher s in Denmark. While acute exposure of several days to high level air pollution was known to be a risk factor for exacerbation in pre-existing COPD, until now there had been no studies linking long-term air pollution exposure to the development or progression of the disease.

The research was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“Our findings have significance on a number of levels,” said lead researcher on the study, Zorana Andersen, Ph.D., post doctoral fellow at the Institute of Cancer Epidemiology of the Danish Cancer Society in Copenhagen. “Patients, primary care physicians, pulmonologists and public health officials should all take not of our findings.”

Dr. Andersen and colleagues used data from the Danish Diet, Cancer, and Health Study, which consisted of more than 57,000 individuals between the ages of 50 and 64 who lived in Copenhagen or Aarhus, the first and second largest cities in Denmark, between 1993 and 1997. A self-administered questionnaire provided data on smoking, dietary habits, education, occupational history and lifestyle. They then used the unique personal identifiers to link the cohort to the Danish Hospital Discharge Register to identify hospital admissions and discharges due to COPD, and estimated pollution exposure by linking residential addresses to outdoor levels of NO2 and NOx levels, which were used to approximate the overall level of traffic-related pollutants since 1971. They looked at exposures over 15-, 25- and 35-year periods to assess the effect of different exposure lengths on COPD incidence. Data for more than 52,000 were available from the start 1971 to the end of follow-up in 2006.

“We found significant positive associations between levels of all air pollution proxies and COPD incidence,” said Dr. Andersen. “When we adjusted for smoking status and other confounding factors, the association remained significant, indicating that long-term pollution exposure likely is a true risk factor for developing COPD.”

These associations were slightly stronger for men, obese patients and those eating less than 240 grams of fruit each day (approximately eight ounces, or just more than a single serving). But notably, the effect of air pollution on COPD was strongest in people with pre-existing diabetes and asthma.

“These results are in agreement with those of other cross-sectional studies on COPD and air pollution, and longitudinal studies of air pollution and lung function, and strengthen the conclusion that air pollution is a causal agent in development of COPD,” said Dr. Andersen.

Because the study used hospital admissions for COPD to assess incidence, it is likely that the true incidence was underestimated, and that the cases represented severe COPD, as mild and moderate COPD does not often require hospitalization. This means that the reported increase in risk associated with air pollution is probably an underestimate of the true increase in risk for COPD in general. Furthermore, while smoking is known to be the primary cause of COPD in developed countries, and majority of COPD cases were smokers or previous smokers, the effect of pollution exposure was also observed in the group of non-smokers. “This result refutes the possibility that the observed effect of air pollution was due to inadequate adjustment for smoking in our data and supports the idea that air pollution affects COPD risk, irrespective of smoking status,” said Dr. Andersen.

The enhanced association between increased risk of COPD and air pollution in asthmatics and diabetics suggests the possibility of an underlying link. “It is plausible that airflow obstruction and hyper-responsiveness in people with asthma, or systemic inflammation in people with diabetes, can lead to increased susceptibility of the lung to air pollution, resulting in airway inflammation and progression of COPD, but more research is needed in this area.” said Dr. Andersen.

“In any case, sufficient data, including the results of this study, provide evidence that traffic-related urban air pollution contributes to the burden of COPD and that reductions in traffic emissions would be beneficial to public health.”

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Thoracic Society, via EurekAlert!, a service of AAAS.

Journal Reference:

1. Z. J. Andersen, M. Hvidberg, S. S. Jensen, M. Ketzel, S. Loft, M. Sorensen, A. Tjonneland, K. Overvad, O. Raaschou-Nielsen. Chronic Obstructive Pulmonary Disease and Long-Term Exposure to Traffic-Related Air Pollution: A Cohort Study. American Journal of Respiratory and Critical Care Medicine, 2010; DOI: 10.1164/rccm.201006-0937OC

http://www.sciencedaily.com/releases/2010/10/101019111536.htm

More later (part 1 of 3 photo story of one patients Lymphedema)  Sharon O’Hara

Pain Matters – Anger, Sad Study Results

Pain matters – not only to the person feeling it – to the whole family. The idea that our own feelings of anger and sadness might increase our pain level mean we could learn to control the anger and sadness, lessening pain and – if it works on the respiratory system – we can lessen and control the breathing rough times.

Could the same Utrecht University study results apply to lung patients?  It seems a strong possibility based on my own recent experience.

For lung patients it’s important to remember that pain pills negatively affect the respiratory system – we can’t just take them as others might, for pain.  Ask your doctor or Pain Center.

The importance of the study may be seen in the next two paragraphs:

“The treatment effects were significant, showing notable positive differences in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM for the TC in comparison with the WLC. Clinically relevant improvement was found among patients in the TC group.

“Our results demonstrate that offering high-risk FM patients a treatment tailored to their cognitive behavioral patterns at an early stage after the diagnosis is effective in improving both short-and long-term physical and psychological outcomes,” says junior investigator Saskia van Koulil. “Supporting evidence of the effectiveness of our tailored treatment was found with regard to the follow-up assessments and the low dropout rates. The effects were overall maintained at 6 months, suggesting that patients continued to benefit from the treatment.””

I asked if they had done a separate study for men and discovered that few men get fibromyalgia and was not included in the study.

“Dr. van Middendorp’s response follows:

There were two reasons why men were not included in this study. First, because of the female preponderance in fibromyalgia. This makes it very difficult to include enough men with fibromyalgia to draw reliable conclusions. Second, because men and women differ in emotions, ways of dealing with their emotions, and in reported and experimental pain levels, they cannot just be regarded as one group. Resultantly, we decided to focus our study on women only. There was not a separate study done in men.”

“Anger amplifies clinical pain in women with and without fibromyalgia –

Sensitizing effect of anger and sadness not limited to fibromyalgia patients”

Researchers from Utrecht University who studied the effect of negative emotions on pain perception in women with and without fibromyalgia found that anger and sadness amplified pain equally in both groups. Full findings are now online and will publish in the October print issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

The Utrecht team theorized that specific negative emotions such as sadness and anger also would increase pain more in women with FM than in healthy women. Their study examined the effects of experimentally-induced anger and sadness on self-reported clinical and experimentally-induced pain in women with and without FM. Participants consisted of 62 women with FM and 59 women without FM. Both groups were asked to recall a neutral situation, followed by recalling both an anger-inducing and a sadness-inducing situation, in counterbalanced order. The effect of these emotions on pain responses (non-induced clinical pain and experimentally-induced sensory threshold, pain threshold, and pain tolerance) was analyzed with a repeated-measures analysis of variance.

Self-reported clinical pain always preceded the experimentally-induced pain assessments and consisted of reporting current pain levels (“now, at this moment”) on a scale ranging from “no pain at all” to “intolerable pain.” Clinical pain reports were analyzed in women with FM only. Electrical pain induction was used to assess experimentally-induced pain. Participants pressed a button when they felt the current (sensory threshold) and when it became painful (pain threshold) and intolerable (pain tolerance). Four pain assessments were conducted per condition, and very high internal consistencies were obtained.

More pain was indicated by both the clinical pain reports in women with FM and pain threshold and tolerance in both groups in response to anger and sadness induction. Sadness reactivity predicted clinical pain responses. Anger reactivity predicted both clinical and electrically-stimulated pain responses.

Both women with and women without FM manifested increased pain in response to the induction of both anger and sadness, and greater emotional reactivity was associated with a greater pain response. “We found no convincing evidence for a larger pain response to anger or sadness in either study group (women with, or without FM), said study leader Henriët van Middendorp, Ph.D. “In women with FM, sensitivity was roughly the same for anger and sadness.”

Dr. van Middendorp concludes, “Emotional sensitization of pain may be especially detrimental in people who already have high pain levels. Research should test techniques to facilitate better emotion regulation, emotional awareness, experiencing, and processing.”

In a related study, a research team from Radboud University Nijmegen Medical Centre found that tailored cognitive-behavioral therapy (CBT) and exercise training tailored to pain-avoidance or pain-persistence patterns at a relatively early stage after diagnosis is likely to promote beneficial treatment outcomes for high-risk patients with FM.

The Nijmegen team evaluated the effects of this approach in a randomized controlled trial. The study compared a waiting list control condition (WLC) with patients in a treatment condition (TC) to demonstrate improvements in physical and psychological functioning and in the overall impact of FM.

High-risk patients were selected and classified into 2 groups (84 patients were assigned to a pain-avoidance group and 74 patients to the pain-persistence group) and subsequently randomized to either the TC or WLC. Treatment consisted of 16 sessions of CBT and exercise training, tailored to the patient’s specific cognitive behavioral pattern, delivered within 10 weeks. Physical and psychological functioning and impact of FM were assessed at baseline, post-treatment, and 6-month follow-up.

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These studies are published in Arthritis Care & Research. Media wishing to receive a PDF of these articles may contact healthnews@wiley.com.

Full Citation: “The Effects of Anger and Sadness on Clinical Pain Reports and Experimentally-Induced Pain Thresholds in Women With and Without Fibromyalgia.” Henriët van Middendorp, Mark A. Lumley, Johannes W.G. Jacobs, Johannes W.J. Bijlsma, Rinie Greenen. Arthritis Care and Research; Published Online: April 21, 2010 (DOI: 10.1002/acr.20230); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/acr.20230/abstract

“Tailored Cognitive-Behavioral Therapy and Exercise Training for High-Risk Patients With Fibromyalgia.” Saskia van Koulil, Wim van Lankveld, Floris W. Kraaimaat, Toon van Helmond, Annemieke Vedder, Hanneke van Hoorn, Rogier Donders, Alphons J.L. De Jong, Joost F. Haverman, Kurt-Jan Korff, Piet L.C.M. van Riel, Hans A. Cats, Andrea W.M. Evers. Arthritis Care and Research; Published Online: June 2, 2010 (DOI: 10.1002/acr.20268); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/acr.20268/abstract

Arthritis Care & Research is an official journal of the American College of Rheumatology, and the Association of Rheumatology Health Professionals, a division of the College.

Thank you, Dawn Peters, for your assistance!

Part 2 of 2

More later…. Sharon O’Hara

University of Washington #5 Cancer Hospital and More Genotyping Patients by Vanderbilt

A little more about cancer research and treatment….

Good news for us closer to home is that our own University of Washington Medical Center is # 5 on the leading list of cancer hospitals in the nation, according to US News and World Reports.

http://health.usnews.com/best-hospitals/rankings/cancer

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“Vanderbilt-Ingram Cancer Center (VICC) has launched its new Personalized Cancer Medicine Initiative, becoming the first cancer center in the Southeast and one of the first in the nation to offer cancer patients routine “genotyping” of their tumors at the DNA level….”

Meaning patients will receive personalized treatments based on their own body changes pushing the cancer growth.

…”Vanderbilt is further leading the nation in personalizing medicine by leveraging its sophisticated Electronic Medical Record (EMR) to use the genotype information in point-of-care decision-making.
“The EMR for each patient is automatically updated to contain the latest genome-based treatment information, so that all healthcare providers at Vanderbilt caring for the patient are fully informed and guided by the latest decision support on these advanced therapies,” said Dan Masys, M.D., chair of the Department of Biomedical Informatics.

“We know that genetic differences in humans at the molecular level not only contribute to the disease process, but can also significantly impact an individual’s ability to respond optimally to drug therapy,” said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of the School of Medicine. “…Project, with highly personalized therapy for our patients.”

Vanderbilt’s Personalized Cancer Medicine Program is led by William Pao, M.D., Ph.D., Ingram Associate Professor of Cancer Research and an expert in lung cancer….”“…
“The Personalized Cancer Medicine Initiative is our commitment to providing the most cutting-edge treatment for our patients,” said Jennifer Pietenpol, Ph.D., director of Vanderbilt-Ingram and B.F. Byrd Professor of Oncology.
Jeffrey Sosman, M.D., professor of Medicine, noted that having the genotype information is also important to help patients avoid the side effects of traditional chemotherapy.

“We are starting to understand how each patient’s tumor may have specific mutations that cause the cancer, but some of those mutations may also make the cancer vulnerable to specific therapy,” said Sosman, who directs the center’s Melanoma Program. “Tumor genotyping allows us to personalize our approach. If a tumor is likely to respond to a targeted therapy then we can avoid the side effects of traditional chemotherapy.”

http://www.vicc.org/news/2010/08/personalized-cancer-therapy/

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Following are portions of a letter written by a woman to her parents during a time when her husband was dying of pancreatic cancer far off in another state – with her permission.

She once told me the timed painkillers he had available didn’t stop the pain for long and he would scream out to her with the pain and beg her to give him another shot early.

A concern of the hospital seemed to be that he would become addicted to the drugs.
I wondered then, as now – what different would it make if he became addicted to pain medications?
He was dying.

The good news about Vanderbilt’s Personalized Cancer Medicine Initiative is one more step in the battle against cancer.

‘Dated Monday, Nov 2 -87.
Dear Mom & Dad,

Received the money you sent me…thank you.
It helped a lot because his drugs he has to have are very costly.
Just his filled morphine shots I give him are $163.00 every two weeks, not counting his other medicine.
This is mixed with cocaine.

Brought him home Sat.
Got here about 1:30pm and so thankful to be home again.

The nerve blocks he went through have deadened many of his nerve endings leading to his cancer.
He knows he is dying.
His mind is still very alert.
Thank God.
He told the Dr while I was out of the room that he was afraid of dying.
God what suffering.

He is in God’s hands.
He is humble & has prayed so hard for God to take him.
His spirit will one day go back to the Lord who gave it & then his struggle & his pain will be over.
Cancer is a slow & painful death.

I wonder sometimes why humans have to suffer so much. There is no answer of course.

I’ll never forget the beautiful people at the hospital who gave me their support & hands & hearts that reached out to us, & before I left the hospital, I went around & thanked them all for giving me so much when God knows I needed it.

Two wonderful & beautiful Drs -Dr Stewart & Dr Wright, they cared too, what we are facing.

They are frustrated because they can’t stop this cancer.
There is no form of x-rays that will show the kind of cancer Kenneth has in the early stages, only after it’s too late.

They became Dr’s to help heal their patients & in Kenneth’s case, it’s too late but they both did everything medically possible to ease him.

They are both so kind.
They wished they could tell me that it wasn’t too late.

Both of them would meet me in the hallway & be on the way to surgery but they always took the time to stop & take my hand & talk to me.

Thank God, for the wonderful & beautiful people left in this world.
There will always be a dawn because of the beauty of their souls & it rubbed off on me.

I’ll never forget any of them. Everyone at the hospital knew me & put their arm around me & asked how I was; no matter where I was in the hospital, so many people came over to me.
God Bless them all.

I know God has a special place for them & I have in my heart.

Don’t worry about me, I’m all right.

God Bless my two parents that I so dearly love. I keep you close to my heart & the miles apart make no difference.
With lots of love, Karen”

More later… Sharon O’Hara

Restless Leg Syndrome, Breast Cancer Prevention, Radiation Treatment Hope for Tomorrow

Restless Leg Syndrome (RLS), Breast Cancer Prevention and Radiation Treatment effectiveness or, What do three students from the University of Alabama have in common?

Why are they so important?

For those with RLS or Breast Cancer and those who have experienced Radiation Treatment, it is an easy answer.

The more research leading to discoveries, treatment and cures, the fewer future patients.

Atbin Doroodchi, 20 is a member of the Science and Technology Honors Program and an undergraduate researcher in the lab of Yuqing Li, Ph.D., investigating a gene’s relationship to my particular interest, restless leg syndrome.

Shweta Naran Patel is 21 majoring in molecular biology. She is a member of the University Honors Program and undergraduate researcher for Trygve Tollefsbol, Ph.D studying the natural compound role in breast caner prevention.

Tamara Michelle Burleson, 20 is majoring in Chemistry and a Supplemental Instruction Leader. She is investigating the role between certain proteins and radiation treatment effectiveness in the lab of Christopher Willey, M.D..

The Barry M. Goldwater Scholarship and Excellence in Education Foundation have named Doroodchi, Patel and Burleson 2010 Goldwater Scholars.

The faculties of colleges and universities select the Goldwater Scholars based on academic merit and the one and two-year scholarships cover school expense up to $7,500 a year.

Heartfelt congratulations to all!

http://main.uab.edu/Sites/MediaRelations/articles/75341/

More later… Sharon O’Hara

New NIA Senior Walk Study

The National Institute on Aging wondered ‘What Can Prevent Walking Disability in Older People’ and awarded $29.5 million to the University of Florida’s Institute on Aging to find out.

To be a part of such a study is the greatest opportunity for us…person, patient or senior to be a part of something important for future generations, meet the most amazing people and have fun at the same time…such as the University of Washington’s Shortness of Breath Study https://www.managesob.org/RS/StudyII/

Unfortunately, our own close-by University of Washington in Seattle isn’t one of the eight sites for the study but for those seniors close enough to one of the sites of the new “Lifestyle” – get your feet wet and get involved. I’ve been lucky enough to have been part of two COPD studies and can’t recommend them highly enough.

This six year “Interventions and Independence of Elders “(LIFE) study involves about 200 people, from 70 to 89 years at each of the eight sites around the nation.

I hope those of us who get involved will keep us posted when you can… the results of the study will help millions of future seniors maintain a quality of life and save future taxpayer dollars in health care.

“There is a lot of evidence indicating that exercise can help in preventing diseases, such as diabetes, among older people. But we do not know whether and how a specific regimen might prevent walking disability in older people who are at risk of losing mobility,” said NIA Director Richard J. Hodes, M.D.

“This research is critically important at a time when the population is aging and new interventions should be sought to keep people healthy and functioning in the community longer.””

“At eight sites around the country, LIFE will involve 1,600 people aged 70 to 89, who at the start of the study meet its criteria for risk of walking disability, defined as the inability to walk a quarter of a mile or four blocks.

About 200 participants will be enrolled at each of the study sites, which include the University of Florida; the University of Pittsburgh; Northwestern University School of Medicine in Chicago; Stanford University in Palo Alto, Calif.; Pennington Biomedical Research Center in Baton Rouge, La.; Yale University in New Haven, Conn.; Tufts University in Boston and Wake Forest University School of Medicine in Winston-Salem, N.C. Wake Forest will also coordinate the data management and analysis.”

“Limitations in walking ability compromise independence and contribute to the need for assistive care,” said Evan C. Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology, whose program is overseeing the trial. “Older people with impaired walking are less likely to remain in the community, have higher rates of certain diseases and death, and experience a poorer quality of life. A successful intervention might help prevent these bad outcomes.”

“We know that many older people have chronic health problems that affect their ability to walk,” said Jack Guralnik, M.D., Ph.D., chief of the NIA’s Laboratory of Epidemiology, Demography and Biometry and co-principal investigator of the study. “Arthritis, muscle weakness and poor balance can all affect how well and how far a person can walk. And, some older people have all of these problems. We will test the LIFE intervention in this population to see how it works in a real-world setting.”

Study participants will be randomly assigned to one of two groups. One group will follow a structured intervention consisting of walking at moderate intensity, stretching, balance and lower extremity strength training; the control group will participate in a health education program. The participants will be followed for about three years.

Researchers will evaluate whether, compared to health education, the physical activity intervention reduces the risk of major walking disability, serious fall injuries and disability in activities of daily living, and whether it improves cognitive function. They will also assess the cost-effectiveness of the intervention.

“This will be the largest randomized controlled trial to prevent major mobility disability ever conducted in older persons who are at high risk of losing their physical independence,” said Marco Pahor, M.D., director of the University of Florida’s Institute on Aging and study principal investigator. “Typically, this population is excluded from large trials, and from this perspective the LIFE study is unique.”

The NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people.

For more information on research and aging, go to www.nia.nih.gov.

The NIH — the nation’s medical research agency — includes 27 institutes and centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.

For more information about NIH and its programs, visit www.nih.gov.”

More later…Sharon O’Hara