fitness obesity

Psychologists are set to reveal the results of a study into obese peoples behavioural responses to a prescription weight loss drug at the British Psychological Societys Division of Health Psychology annual conference today, 11th September 2009.

Amelia Hollywood and Jane Ogden from the University of Surrey investigated the behaviour of 572 individuals who had been prescribed the weight loss drug, orlistat (also known as Xenical). One of the most commonly prescribed obesity medications, orlistat acts on the gastrointestinal system by reducing the amount of fat absorbed into the body. This fat is instead eliminated in bowel movements so if foods high in fat are eaten there are unpleasant consequences including liquid stool and anal leakage. It is thought that orlistat also deters unhealthy eating because of these unpleasant effects. 572 people taking orlistat who had registered on the Xenical support telephone line took part in the study.

Participants completed questionnaires detailing information on their weight, the side effects of the medication they had experienced and adherence to the medication at the start of their treatment and again six months into treatment. They were also asked about their motivation to start losing weight and their beliefs about the causes and solutions of obesity.

Preliminary findings presented at the conference suggest that after six months taking orlistat, on average participants weight and BMI had significantly decreased, by 4.52kg and 1.72kg/m2 respectively. Analysis of the individuals who successfully lost weight while on orlistat showed that this decrease in BMI was predicted by a decrease in the amount of unhealthy food consumed and the belief that the unpleasant consequences of taking orlistat had made them change their behaviour.

Amelia Hollywood said “Our findings support the idea that orlistat works not only on a physical level, but also psychologically as it encourages people to see their diet as a cause of their weight problem. In addition, the side effects are so unpleasant that people avoid bad eating fatty foods and therefore lose weight.

“However, the way in which some people responded to orlistat was surprising. Some participants in this study reported that their eating behaviour became significantly unhealthier over the six month period. People also told us that they were not adhering to the medication as they should. It seemed that these people were taking orlistat as a lifestyle drug choosing to take it when they were eating foods higher in fat to reduce any weight gain or not taking it when going on holiday or out for a meal as they didnt want to experience the consequences of eating fatty foods.

“However it also indicates that the drug educates people to understand which foods are fatty and will cause the unpleasant consequences so rather than change their eating behaviour some change when they decide to take the medication.”

Need another reason to commit to a healthy diet and exercise? Think migraines are just headaches? Migraine and obesity sufferers feel more emotional pain than those dealing with lifethreatening conditions like congestive heart failure, prostate cancer, osteoporosis and high blood pressure. In fact, they tend to feel more pessimistic than those diagnosed with depression.

In a study about healthcare influencers, AdSAM®, a nonverbal process of measuring emotional response, and TNS Healthcare found that people who suffer from some severe diseases accept and handle them better than other types of sufferers.

“People suffering from prostate cancer, seem to cope better than those suffering from migraine headaches,” said Jon Morris, Ph.D., the president of AdSAM® and a communications professor at the University of Florida.

Results showed that migraine, obesity and erectile dysfunction sufferers essentially feel afraid, disgusted and saddened by their situation. Understanding the emotional impact of these and other conditions is critical to the physicians approach to condition management but also to those loved ones helping a patient through the condition.

Because of their embarrassed stateofmind, those who suffer from obesity and erectile dysfunction often feel more comfortable talking with influencers nonhealthcare professionals such as relatives, friends, coworkers, etc., rather than physicians.

Obesity sufferers in particular feel most relaxed when discussing healthcare decisions with influencers. For men or women, the research shows that influencers are most often the women in sufferers lives, such as their spouses, mothers, sisters or female friends.

“Understanding the emotions surrounding the condition and the patients emotions towards the physician, as well as other influencers, has a major impact on how to communicate effectively with a patient,” Morris said.

TNS Healthcare also conducted research into communications in healthcare. The results indicated that an integrated communications program targeted to patients, physicians and influencers is needed to reach and impact people most effectively, especially in todays digital age.

There are countless opportunities to seek healthcare information through the Internet and other channels. Discovering peoples true emotions can help physicians identify individual needs and informationseeking preferences.

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Researchers at Georgia State University have found that diets high in fructose a type of sugar found in most processed foods and beverages impaired the spatial memory of adult rats.Amy Ross, a graduate student in the lab of Marise Parent, associate professor at Georgia States Neuroscience Institute and Department of Psychology, fed a group of SpragueDawley rats a diet where fructose represented 60 percent of calories ingested during the day.She placed the rats in a pool of water to test their ability to learn to find a submerged platform, which allowed them to get out of the water. She then returned them to the pool two days later with no platform present to see if the rats could remember to swim to the platforms location.”What we discovered is that the fructose diet doesnt affect their ability to learn,” Parent said. “But they cant seem to remember as well where the platform was when you take it away. They swam more randomly than rats fed a control diet.”Fructose, unlike another sugar, glucose, is processed almost solely by the liver, and produces an excessive amount of triglycerides fat which get into the bloodstream. Triglycerides can interfere with insulin signaling in the brain, which plays a major role in brain cell survival and plasticity, or the ability for the brain to change based on new experiences.Results were similar in adolescent rats, but it is unclear whether the effects of high fructose consumption are permanent, she said.

Parents lab works with Timothy Bartness, Regents Professor of Biology, and John Mielke of the University of Waterloo in Waterloo, Ontario, Canada to examine how diet influences brain function.

Although humans do not eat fructose in levels as high as rats in the experiments, the consumption of foods sweetened with fructose which includes both common table sugar, fruit juice concentrates, as well as the muchmaligned high fructose corn syrup has been increasing steadily. High intake of fructose is associated with numerous health problems, including insulin insensitivity, type II diabetes, obesity and cardiovascular disease.

“The bottom line is that we were meant to have an apple a day as our source of fructose,” Parent said. “And now, we have fructose in almost everything.” Moderation is key, as well as exercise, she said.

Exercise is a next step in ongoing research, and Parents team will investigate whether exercise might mitigate the memory effects of high fructose intake. Her lab is also researching whether the intake of fish oil can prevent the increase of triglycerides and memory deficits. Results from that research will be presented by her graduate student Emily Bruggeman at the 2009 Society for Neuroscience meeting in Chicago this fall.

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Jeremy Craig

Nineyearold Martha sits in front of a poster that depicts a single chocolate chip sitting on top of five pounds of grapes. After several weeks participating in a University of Texas at Austin School of Nursing research program on healthy eating and weight management the message is not lost on her. The chocolate chip has the same amount of fat grams as the grapes.

She also is learning about the difference in good and bad cholesterol, the value of drinking eight glasses of water a day and eating smaller portions of food. Martha knows playing outside is better than watching television.

A single chocolate chip has the same amount of fat grams as five pounds of grapesChildren and parents in the study learn about healthy dietary habits, including the amount of fat content in various food products. Five pounds of grapes and a single chocolate chip each have .70 grams of fat. And, one chocolatecovered doughnut has the same grams of fat (21 grams) as 133 oranges.

She even takes time to read a few food labels as she walks down the grocery aisle with her mother.

Learning how to change in order to have a healthier lifestyle is the bottom line in Dr. Diane Tylers study on childrens health and weight. It is being conducted at the schools Childrens Wellness Center in Del Valle and at the Wellness Enhanced Through Lifelong Learning clinic in Hays County.

The children and families served by the clinics are predominantly Hispanic, lowincome and medically underserved.

“The number of overweight children has rapidly increased in the past three decades, with 14 million U.S. children overweight and an additional 8.6 million at risk for being overweight,” said Tyler, an associate professor of nursing. “Thats one in three children who are either overweight or at risk for being overweight.”

Among Mexican American children of lowincome families, the prevalence is higher. In fact, compared with other racial and ethnic groups, Mexican American children are among the heaviest.

“Experts agree as to why the obesity epidemic has occurred,” Tyler said. “We havent changed genetically, but our lifestyles and the environment have.”

Diane Tyler

As former director of the School of Nursing Childrens Wellness Center, Dr. Diane Tyler began to notice increases in Type 2 (adult onset) diabetes in children in the late 1990s. She believes preventive care with early intervention is the best approach to helping overweight children.

Research initiatives like Tylers focus on preventing and treating overweight children. She received funding from the National Institutes of Health to study the effects of a 12week weight management program on childrens bodymass index, their waist circumference, quality of life, blood pressure, physical fitness, and lipid, insulin and glucose levels.

Her study focuses on reasonable weightloss goals, physical activity, dietary management and most important family involvement.

“I was concerned about Martha,” said her mother, who has eight children at home. “Once we got in the program, I decided I wasnt going to prepare separate meals for everyone. We are all doing this together.”

Now, she said, Martha is playing baseball, jumping rope, running outside and eating less pizza, chips and cookies and more fruits and vegetables.

“Sometimes when I eat something she doesnt think is healthy, she tells me not to,” her mother said.

Preventive care with early intervention is the logical approach to helping overweight children, especially because there is evidence that once an individual is obese, it is very difficult to lose and maintain weight loss, Tyler said.

“Given all that is out there computers, videos, DVDs, fast food, larger food serving sizes what can we as health providers do to encourage more physical activity and better eating?” she said. “How can we help overweight children and their families make behavior changes in order to have and maintain a healthy weight?”

According to the U.S. Surgeon General, overweight children have a 70 percent chance of becoming overweight or obese adults. This increases to 80 percent if a parent or both are overweight or obese.

“It is commonly known that the average adult gains about one pound a year until he or she is 60 years old,” Tyler said. “So, if you are overweight during childhood, you are likely to have difficulty managing weight as an adult.”

As former director the Childrens Wellness Center, Tyler began to notice increases in Type 2 (adult onset) diabetes in children in the late 1990s.

Participants in the childrens health and weight study have their blood pressure checkedSister and brother Meagan and Matthew, who are participating in the childrens health and weight study, have their blood pressure regularly checked. Nurses also monitor blood cholesterol, triglycerides, insulin and glucose.

“We were beginning to see children as young as 10 years old with health conditions that previously wouldnt develop until the age of 40 or 50 or later,” she said. “Health care providers are very concerned about the impact of early onset of disease.”

Diabetes is just one of the ill effects of being obese. In turn, persons with diabetes are at risk for strokes, heart disease, blindness, hypertension and kidney failure. Nationwide, there has been an increase in children being diagnosed not only with Type 2 diabetes but sleep apnea, orthopedic problems, liver disease, hypertension and other conditions usually seen only in adult patients.

Tyler has found that most people are concerned about their overweight children once they realize they are overweight.

Children in the weight management study range from 8 to 12 years old. Assessments are made to learn about their medical history, eating and activity patterns and general healthrisk status. Weightrelated conditions, such as elevated blood pressure and cholesterol levels, have been found in many of the participants.

“We do not label children or use terms, such as obese,” Tyler said, “but rather emphasize that we are trying to help them grow into a healthy weight so they dont become overweight adults.”

In this research and in a previous pilot study at the Childrens Wellness Center, Tyler found that few of the overweight children consumed fruits and vegetables and many engaged in only sedentary activities. In the pilot study, it was found that the majority perceived themselves as “big,” wanted to make changes in their body size and wanted family members to participate in making changes with them.

Meagan exercising outside

Meagan is trying to eat healthier and has learned the importance of regular exercise.

Although many were in the very high body mass index percentile, they perceived themselves to be healthy or healthier than others.

“Many people, including Hispanics, will take action only if they perceive their health to be poor and overweight children, especially in lowincome populations, may actually be seen as an indicator of good health,” Tyler said.

She concedes that this perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention.

To help children in the study learn the value of “moving whenever you can” they are given pedometers to wear. Jump ropes, sport balls and water bottles also are handed out and the children fill out an activity log, which includes pedometer time and time viewing television and videos.

Tyler said children should try to get at least 60 minutes of moderate physical activity on most days.

Playing football, decreasing sugar drinks and drinking eight glasses of water a day have become part of 12yearold Angels routine. He has been in the program for three months.

Liz White

Liz White received her masters degree in nursing last year and now works with Diane Tyler on the research. She says some families are still eating too much fast food, but others are trying hard to make improvements.

“Since Angel has the same body build as his father and grandfather, I became worried,” said his mother, Lorena. “Now, we are learning what we need to do about different kinds of fats, what cooking oils are better to use and many other things.”

Tyler is getting a range of results from those who have been in the study for a few months.

“Some families seem to have made no change at all,” said Liz White, who received her masters degree in nursing last year and is now working with Tyler. “The families say they want to make changes, but when I do food frequency surveys, it seems like they are still eating lots of fast food. And, of course, it follows that those kids arent losing weight and in some instances are gaining weight.”

But, said White, there are other children who are trying hard to at least make changes and improvements are being seen.

“These kids may not lose a lot of weight,” White said, “but they are at least maintaining the same weight while they continue to grow, which means their body mass index is going down.”

Lab results for these children also are improving, White said.

“We monitor blood cholesterol, triglycerides, insulin and glucose,” she said, “and often it seems that we see those improve before we see improvement in the childs weight.”

Changes in parents marital status, lost jobs and income problems make it even more challenging for parents who want to make modifications in what their child eats, said White.

“Unfortunately,” she said, “there appears to be more family chaos with these particular families.”

And sometimes, said White, the mother is more concerned about the childs weight than the father “so there is some disconnect there, which also makes it harder to enforce changes at home.”

Mary Moran

Clinical nurse specialist Mary Moran also works with families in the study. She worries about pizzas and French fries served at school lunches and the fact that most children get physical education only two or three times a week.

Mary Moran, a clinical nurse specialist who also is working with Tyler, agrees that prevention and working with families are critical.

“Starting with kids who are already overweight is much harder,” she said. “Most people know that never starting bad habits is easier than trying to correct them.”

There are many factors working against the families, said Moran.

“We hear stories about what is offered for school lunch, for example,” she said. “Most of our families qualify for free school lunches and breakfasts. They cant afford to take their own healthy sack lunch to school.

“So the kids get breakfast pizzas everyday and French fries as the main vegetable. Plus, they get physical education only two or three times a week.”

But the blame does not fall totally with the schools.

“Ultimately, parents have a huge role in this because these kids are too young to go out and buy their own food,” White said. “If mom and dad are buying lots of junk food and dont buy fruits and vegetables, the kids have no chance.”

Like Tyler, the nurses are careful not to use labels with the children.

“Our aim is teaching a lifetime of healthy choices, not getting them to lose weight,” said Moran. “Putting a label on their weight status puts more emphasis on their current measurements or how they look. The goal is to make positive changes for life, not to lose 10 pounds in the next few weeks.”

It is also important for parents to be good role models for children, said Tyler.

“If they see you eating healthy and enjoying physical activity,” she said, “they will want to do the same, hopefully for the rest of their lives.”

Undertaking a supervised exercise programme can have beneficial effects on functional status and physical function, reduce the need for daily corticosteroid and antiinflammatory intake and improve levels of depression and anxiety in people with rheumatoid arthritis (RA), according to a new study presented at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.

A threemonth programme, comprising moderate aerobic and strengthening exercises, conducted for 5060 minutes three times per week, proved not only to be safe and beneficial both physically and in terms of quality of life for patients, but was also associated with a stabilising effect in disease activity measured by DAS28*. During the Portuguese studys three month period, researchers observed the following * A 33% improvement in the HAQ (Health Assessment Questionnaire) disability index measurement of physical functioning (assessing ability to undertake everyday activities such as dressing, eating and walking, and whether assistance from another person or disability aids is required) (p < 0.023) An improvement in physical function, as outlined below
55% improvement in the sit and stand test (p=0.018)
10% improvement in the righthand grip test (p=0.025) and 15% in the lefthand grip test (p=0.035)
19% improvement in the walk time test (p=0.063)

62% of patients reported a reduced need for daily corticosteroid intake, from a mean dosage of 5.3mg/day of prednisone to 3.1mg/day (p=0.038)

32% of patients reported stopping concurrent NSAID (nonsteroidal antiinflammatory drug) treatment altogether following the exercise programme (p=0.083)

Mean LDL (lowdensity lipoprotein) cholesterol increased from 90mg/dl to 125mg/dl (p=0.018)

40% improvement in the Depression Anxiety Stress Scales (DASS), a selfreported assessment of negative emotional states, with 28% in the depression and 48% in the anxiety component respectively (p=0.078) Dr Miguel Sousa of Instituto Português de Rheumatology, Lisbon, Portugal, who led the study, said “When joints are stiff and painful, proactively taking exercise might seem undesirable for people with RA. However, our study has demonstrated that regular and supervised moderate aerobic workouts and strengthening exercises may be extremely beneficial for both a patients physical and mental health, with a corresponding effect on quality of life. The challenge for physicians is to provide suitable motivation and reassurance to their RA patients in order that they initiate and stick with such a programme.”

The observational longitudinal study followed eight physicallyinactive patients (7 female; mean age of 59 (4671) years; mean disease duration of 16 (330) years) with relatively stable RA (stable medication taken for at least three months; mean dose of methotrexate 17.5mg/week) for three months.

Notes
* DAS28 (Disease Activity Score) is an index used by physicians to measure how active an individuals RA is. It assesses number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patients global assessment of global health. A higher score indicates more active disease.
Abstract number AB0724

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Rory Berrie

For people trying to maintain weight after participation in a weightloss program, support from nurses is as effective as a more expensive intensive program with dieticians and exercise specialists, found a new study by New Zealand researchers in CMAJ. It appears that regular facetoface interaction with a supportive health professional is a key success factor.

The study, a randomized controlled trial with 200 women aged 2570 years old, included women who had lost 5% or more of their body weight. Most participants were followed for 2 years after the initial weight loss.

In addition to nutritional counselling and materials provided to all participants, the people in the Nurse Support Program received 510 minute weighin visits with a nurse every 2 weeks for 2 years. On alternate weeks, they received a phone call from the same nurse to discuss progress. The intensive support program was based on the Finnish Diabetes Prevention Study.

“Although this and other intensive programs have been successful, the costs to implement these programs are considerable and well beyond the means of health budgets in many countries,” write Dr. Jim Mann from the Edgar National Centre for Diabetes Research, Dunedin, New Zealand and coauthors.

While attendance at weighins was excellent, attendance at exercise classes was poor and declined dramatically in the second year. “Many participants reported that the weighins and the enthusiastic support provided by the nurse on those occasions and on the telephone were key determinants of their success,” write the authors.

They conclude that nurseled programs with weekly or biweekly weighins could be easily introduced in many countries where general practice is the cornerstone of the health care system at a fraction of the cost of intensivesupport programs.

In a related commentary, Dr. Robert Ross from Queens University in Kingston, Ontario writes that “how and how often support is provided may be more important that who provides it” as the nurse in the study had little training in nutrition and exercise but was supportive and enthusiastic. He notes that introducing nursecoordinated programs in countries like Canada where there is a shortage of nurses may not be feasible. Exercise specialists and dieticians with relevant training can provide similar support for people wanting to maintain weight loss. He credits the study for demonstrating that clinically meaningful weight loss can be maintained over an extended period of time.

Obesity and gallstones often go hand in hand. But not in mice developed at Washington University School of Medicine in St. Louis. Even when these mice eat highfat diets, they dont get fat, but they do develop gallstones. Researchers say the findings offer clues about genetic factors related to gallstones, and they believe better understanding of those factors may one day allow physicians to monitor people at risk and even, perhaps, to intervene before gallstones become a serious problem.

Learning more about susceptibility to gallstones is an important public health issue, particularly in the United States. Between 16 million and 22 million Americans have gallstones, which are deposits of cholesterol or calcium salts that form in the gallbladder or in the bile ducts. In many cases, people require surgery, and more than half a million undergo operations to treat gallstones and remove the gallbladder each year.

“Gallstones form when cholesterol is secreted in bile from the liver at high concentrations, and that typically happens in patients who are obese, who have diabetes, take estrogens or who have lost a lot of weight very rapidly,” says senior investigator Nicholas O. Davidson, M.D., D.Sc., a Washington University gastroenterologist at BarnesJewish Hospital. “Since these mice dont become obese, we thought they might be protected against gallstones. But we found that they were dramatically more susceptible.”

The researchers studied a strain of mice without a substance called liver fatty acid binding protein (LFabp). Davidsons group compared those genetically engineered mice to their healthy, normal littermates. Both groups of mice ate either a standard chow diet or a more typical “Western” diet that provided about 20 percent of its calories in the form of fat and cholesterol.

After two weeks on the Western diet, only one in 17 of the normal mice developed gallstones, but six of the eight mice without LFabp had gallstones. Davidsons team reports its findings in the May issue of the Journal of Lipid Research.

Davidson says in addition to risk factors such as diabetes and obesity, these experiments show genetic factors play a role in gallstone risk. The LFabp gene, which both mice and humans have, may be a key to understanding how genes can predispose to cholesterol gallstone formation.

“The LFabp gene is located in a part of the mouse genome that appears likely to be involved in genetic susceptibility to gallstones,” Davidson says. “We believe it also may be involved in gallstone susceptibility in humans.”

He says that although minimally invasive gallbladder surgery has made gallstone problems much less serious than in the past, sometimes the symptoms can be severe and dramatic.

“Patients can develop acute pancreatitis or ascending cholangitis, which occurs when gallstones obstruct the pancreatic or bile duct and become infected,” he explains. “Even without those problems, gallstones can cause severe, recurrent abdominal pain in a very large number of people. So better understanding who is susceptible and learning how to safely intervene could be very important for people at risk.”

How the LFabp protein may be contributing to gallstone formation in the genetically engineered mice is likely to be complex. Davidson believes the problem may be related to abnormal processing of cholesterol and altered bile metabolism in the small intestine and liver of these genetically engineered mice. The mice also are lean, and he expects that whatever is happening in these mice to produce gallstones will involve complex interactions of other genes that regulate energy utilization and feeding behavior.

Davidson says more studies of the mice lacking LFabp may provide scientists with tools that separate obesity from obesityrelated problems. For example, prior to this gallstone finding, the team reported LFabp deficient mice on a highfat diet also develop insulin resistance like their normal littermates.

“That finding demonstrated that although these mice remain lean and have less fat in the liver, they still develop insulin resistance, a problem usually associated with obesity,” Davidson says.

Why the mice dont become obese is not yet known. Davidson says part of the reason may be the mice burn energy more efficiently or they may not eat as much as their normal littermates. He believes the mechanisms likely will take time to sort out.

Davidsons team now is working to determine how LFabp operates in the digestive tract. His group is studying mice with tissuespecific deletion of the fatty acid binding protein in either the liver or the small intestine to see how that affects gallstone risk. He also plans to study variations in the human gene to see whether those genetic changes affect the risk of gallstone development.

Xie Y, Newberry EP, Kennedy SM, Luo J, Davidson NO. Increased susceptibility to dietinduced gallstones in liver fatty acid binding protein knockout mice. Journal of Lipid Research, vol. 50, pp. 977987, May 1, 2009.

This work was supported by grants from the National Institutes of Health.

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Jim Dryden
Washington University School of Medicine

A homebased program aimed at improving exercise and diet can lead to meaningful improvements in physical function among older longterm cancer survivors, according to the results of a study led by researchers from Duke University Medical Center and The University of Texas M. D. Anderson Cancer Center.

The findings were published in the May 13 issue of the Journal of the American Medical Association. The study was funded by the National Institutes of Health.

“We know that when people are diagnosed with cancer theyre at risk for comorbid conditions and functional decline, and those over 65 may become debilitated permanently, increasing health care costs and taking a toll on family members,” said Wendy DemarkWahnefried, M.D., Ph.D., a professor in M.D. Andersons Department of Behavioral Science and senior investigator on this study.

Miriam Morey, Ph.D., a researcher in the Duke Center for Aging and at the Durham Veterans Affairs Medical Center, and lead investigator on the study, said “our study showed that by reaching out to older cancer survivors in their homes and giving them tools to improve diet and exercise, we were able to reduce the rate of functional decline in this population.”

The research team identified 641 study participants who were considered overweight or obese having a body mass index of 25 or greater and who had been diagnosed with breast, colorectal or prostate cancer but had been treated and had not experienced a recurrence for five years or more. The participants also had no medical conditions that would have prohibited moderate exercise.

A control group of 322 participants were told to go about their normal routines with no intervention, with the promise that they would receive access to the program one year later, DemarkWahnefried said. The remaining 319 received 15 telephone counseling sessions with a personal trainer throughout the intervention year, and worked toward establishing several daily goals, including performing lower body strength exercises; walking 30 minutes; using portioncontrol plates, cups and bowls; consuming fewer than 10 percent of calories from saturated fat; and eating more fruits and vegetables.

Participants also received a personallytailored workbook and a series of quarterly newsletters designed to help them maintain their exercise and diet routines.

“We found that the intervention group had higher levels of physical function, such as going up and down stairs, stepping on and off a stool, or running a short distance,” said Morey.

The researchers used scoring systems to assess function that assign points based on participants ability to perform such physical tasks, Morey said. Participants receive a score that ranges from zero to 100, with higher scores indicating better function.

Participants in the control arm had decreases in physical function of almost five points over the oneyear study period, while those in the intervention group had declines that were only slightly over two points to a level that was not even clinically detectable, Morey said.

“In 2008, the Centers for Medicare and Medicaid Services declared that research aimed at maintaining mobility and function in atrisk elders as the only aging priority,” said Morey. “The wonderful thing about this intervention is that it would be accessible to anyone with a phone in an Englishspeaking country; our study participants were in Canada, the UK and in 21 of the United States. Participants did not have to join a gym or go anywhere; they received the intervention right where they live.”

Coauthors with Morey and DemarkWahnefried are; Denise Snyder, M.S., R.D., Richard Sloane, M.S., M.P.H., Harvey Jay Cohen, M.D., and Bercedis Peterson, Ph.D., of Duke; and Terryl Hartman, Ph.D., M.P.H., Paige Miller, M.S., and Diane Mitchell, M.S., R.D., of Pennsylvania State University.

About M. D. Anderson

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the worlds most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in “Americas Best Hospitals,” a survey published annually in U.S. News & World Report.