Researchers use telehealth to head off hospitalizations and ER visits

by West Virginia University

Credit: CC0 Public Domain

According to the Centers for Disease Control and Prevention, rural Americans are more likely than their urban counterparts to die prematurely from the five most common killers: heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke. Telehealth—the use of technology to provide healthcare remotely—is an emerging way to combat these trends. And it's growing in popularity.

26 july 2019--West Virginia University researcher Steve Davis is piloting an intervention program that uses telehealth to connect rural West Virginians with nurses who can help them manage—and even prevent—conditions like these. The program will focus on individuals being discharged from long-term care facilities as they transition to life back at home.

"Can telehealth be used to help people who are in some kind of institution—and are getting ready to be discharged—to prevent them from being re-institutionalized so that they can live and thrive in their community, near their family?" said Davis, an associate professor of health policy, management and leadership in the School of Public Health.

His research team includes Jennifer Mallow from the School of Nursing, Margaret Jaynes from the School of Medicine, Nathan Pauly and Lindsay Allen from the School of Public Health and Marcus Canaday from the West Virginia Bureau for Medical Services.

The year-long program will start accepting participants this fall. The approximately 30 people who enroll will be rural West Virginians who are receiving services through Medicaid "traumatic brain injury" or "aged and disabled" waiver programs. They will have recently left a long-term care facility, such as a nursing home or an inpatient rehabilitation center. And they will likely have a range of conditions they must manage at home, including diabetes, hypertension and obesity.

"We looked at Medicaid claims data to see what some of the top reasons were for these individuals going back to an emergency department or a hospital," Davis said. "We designed the program based on what we were seeing."

Each patient will be given a scale; a thermometer and devices to track glucose levels, blood pressure and blood oxygenation. Those at risk of falling will also get a fall monitor. The patients' medical team will help them set up the equipment and instruct them how—and how frequently—to use it.

All of the devices will transmit data to nurses charged with monitoring the patients' health 24/7. If any metric deviates from a healthy range—or, in the case of fall risks, if a patient falls—a nurse will be notified, day or night.

Finding out about a medical problem as soon as it arises may prevent what Davis calls a "cascade" of events that can land someone in long-term care again. For example, if a diabetic patient's blood sugar rises to a moderately high level, a nurse can call, remind the patient to take his or her insulin, and try to prevent future spikes by pinpointing the food that triggered the increase. This way, the patient can get his or her glucose level under control promptly, before it reaches a severely high level that necessitates a trip to the emergency room.

In addition, Davis and his team plan to implement semimonthly calls from nurses to keep tabs on patients' pain and mental health. "If there's any worsening of mental health, that can lead to someone being re-institutionalized," he said.

At the end of the pilot program, the researchers will assess its cost-effectiveness based—in part—on the number of times patients are hospitalized, readmitted to long-term care facilities and seen at the emergency department or an urgent care clinic. The team expects telehealth to drive these numbers down.

"We know that telehealth does things like reduce healthcare costs and reduce ER visits, but it also makes nurses more accessible to patients, and it creates an opportunity for an adequate amount of care with fewer nurses. There's a massive, nationwide nursing shortage right now," said Mallow, an associate professor in WVU's Adult Health Department. "With telehealth, we're actually able to spend more time with patients—time that would otherwise be spent traveling or charting or running from one patient to another onsite."

That's especially true for home-health nurses who serve rural populations and may spend hours on the road to visit one patient. "In West Virginia, we call that 'windshield time,'" Mallow said. "Telehealth can give us more meaningful contact with patients, while spending less time traveling."

When the pilot program concludes, the researchers will also survey the patients and healthcare providers to determine their satisfaction with the service and how it could be improved.

"Telehealth itself—once it's up and running—is pretty easy to use, from an end user perspective, but actually designing and implementing it can be very complicated," Davis said. "You've got competing visions and goals. You've got to deal with comorbidities, all of the different types of technologies, a whole range of devices and vendors. Because of that, we believe that telehealth has not reached its widespread potential—especially in a rural environment."

What the study reveals can suggest ways to overcome these logistical obstacles and fulfill the promise of telehealth.

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Provided by West Virginia University 

Characteristics in older patients associated with inability to return home after operation

by American College of Surgeons

Older adults have a different physiology and unique set of needs that may make them more vulnerable to complications following a surgical procedure. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot Project has, for the first time, identified four factors in older patients that are associated with an inability to return home after an operation. The NSQIP Geriatric Surgery Pilot Project is unique in that it is the only specifically defined data set focused on outcomes for older surgical patients.

24 july 2019--In presenting study results at the ACS Quality and Safety Conference 2019, concluding today in Washington, DC, researchers reported on geriatric-specific conditions among Geriatric Pilot Project patients that were associated with not living at home 30 days after surgery. This information can help surgeons advise patients about the possible effects of a surgical procedure on their lifestyle as well as their clinical outcomes before an operation. It also may guide hospital quality improvement programs to address pre- and postoperative conditions that may keep elderly surgical patients from returning home soon afterward.

"When surgeons speak with older patients about the decision to operate, we discuss complication rates and the risk of mortality. We don't usually talk about whether they will have the independence they had beforehand. In this study, we looked at the NSQIP data set to find factors that influence whether patients are living at home or require support for their functional needs in some kind of facility, such as a nursing home, 30 days after surgery. This information should help us make better preoperative decisions with our patients by allowing us to tell them about the impact a surgical procedure will have on their way of life," said study coauthor Ronnie Rosenthal, MD, FACS, co-principal investigator of the ACS-led Coalition for Quality in Geriatric Surgery (CQGS) and professor of surgery and geriatrics, Yale University School of Medicine, New Haven, CT.

The NSQIP Geriatric Surgery Pilot Project was created in 2014 to measure and improve the quality of surgical care for older Americans. The project measures preoperative variables and outcome measures that specifically target elderly patients, reflect the quality of their surgical care, and identify interventions that may improve their treatment and well-being.

"Hospitals may implement protocols that improve patient function or prevent postoperative problems that make it less likely for a patient to return home," said study co-author Lindsey Zhang, MD, MS, John A. Hartford Foundation James C. Thompson Clinical Scholar in Residence at ACS, and a general surgery resident at the University of Chicago Medical Center.

The researchers looked at 3,696 patients in the NSQIP Geriatric Surgery Pilot registry who had inpatient procedures between 2015 and 2017 and whose living location 30 days after surgery was known. Eighteen percent of these patients were still living in a care facility 30 days after surgical treatment. The four characteristics identified among these older patients were: a history of a fall within the past year, preoperative malnutrition as defined by more than 10 percent of unintentional weight loss, postoperative delirium, or a new or worsening pressure ulcer after surgery.

"This information empowers physicians to have a conversation with their older surgical patients about the possibility of a stay in an extended care facility, depending on patient characteristics and the nature of the operation they are about to undergo," Dr. Zhang said.

Because this study shows geriatric risk factors that appear to be associated with an extended stay in a care facility, its results may lead to quality improvement initiatives in a hospital. "Should we consider nutrition programs for patients with malnutrition or create programs to improve function for patients who have had a fall? Do we implement protocols in the postop period to prevent delirium and pressure ulcers? Will these steps lead to more patients going home after surgery? We can't say for sure, but these results provide strong evidence to say it's worth the effort for a hospital to address these issues," Dr. Zhang said.

On July 19, the ACS introduced the Geriatric Surgery Verification (GSV) Program by releasing the GSV standards for geriatric surgical care for hospitals to review prior to enrolling in this new surgical quality improvement program in late October. These standards address many key factors in geriatric surgery, including those that may delay an older patient's return home postoperatively.

Provided by American College of Surgeons 

Music may offer alternative to preoperative drug routinely used to calm nerves

by British Medical Journal

Credit: CC0 Public Domain

Music may offer an alternative to the use of a drug routinely used to calm the nerves before the use of regional anaesthesia (peripheral nerve block), suggest the results of a clinical trial, published online in the journal Regional Anesthesia & Pain Medicine.

21 july 2019--It seems to have similar effects as the sedative midazolam in reducing anxiety before a peripheral nerve block-a type of anaesthetic procedure done under ultrasound guidance, and designed to numb a specific region of the body.

Preoperative anxiety is common, and it can raise levels of stress hormones in the body, which in turn can affect recovery after surgery.

It is usually treated with benzodiazepines, such as midazolam. But these drugs have side effects, including affecting breathing, disturbing blood flow, and paradoxically increasing levels of agitation and hostility. Use of these drugs also requires continuous monitoring by a skilled clinician.

Music medicine has been used to lower preoperative anxiety before, but it has not been directly compared with intravenous midazolam.

The researchers wanted to find out if it might offer a suitable alternative to midazolam to calm the nerves before carrying out a peripheral (regional) nerve block.

They randomly assigned 157 adults to receive either 1-2 mg of midazolam (80), injected 3 minutes before the use of a peripheral nerve block, or to listen to Marconi Union's Weightless series of music via noise cancelling headphones (77) for the same period.

This track is considered to be one of the world's most relaxing songs

Levels of anxiety were scored using a validated measure (State Trait Anxiety Inventory-6, or STAI-6 for short) before and after the use of each anxiety calming method. Satisfaction among patients and doctors were scored on a 10-point scale, with 0 reflecting the lowest level of satisfaction.

Changes in the levels of preoperative anxiety were similar in both groups, although patients in the music group were less satisfied than those given midazolam, possibly because patients were not allowed to choose the music they listened to, suggest the researchers.

But there was no difference in satisfaction levels among doctors.

Both patients and doctors thought it was harder to communicate when music was used to calm nerves, possibly because of the use of noise cancelling headphones, and not standardising the volume of the music, suggest the researchers.

They accept that a comparison lasting just 3 minutes may have been too short, but this period was chosen because that is how long it takes for midazolam to reach peak effectiveness. And they acknowledge that the measure used to assess satisfaction wasn't a validated scale.

Nevertheless, their findings prompt them to conclude that music may be offered as an alternative to midazolam before carrying out a regional nerve block.

"However," they caution, "further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers."

More information: Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study, Regional Anesthesia & Pain Medicine. (2019). DOI: 10.1136/rapm-2018-100251 
rapm.bmj.com/lookup/doi/10.1136/rapm-2018-100251

Provided by British Medical Journal 

High intensity interval training (HIIT) may prevent cognitive decline

by Dr Tom Bailey, University of Queensland

Credit: University of Queensland

High intensity interval training (HIIT) may be doing more than just keeping you fit and strong—it may also help prevent age-related cognitive illnesses, such as dementia.

16 july 2019--A University of Queensland study found high intensity interval exercise may be more effective than continuous exercise in increasing brain blood flow in older adults.

Researcher Dr. Tom Bailey from the Centre for Research on Exercise, Physical Activity and Health at UQ's School of Human Movement and Nutrition Sciences said that while high intensity interval training was popular for improving cardiovascular health, its effect on brain health and function wasn't known.

"As we age, the flow of blood to the brain and arterial function decreases," Dr. Bailey said.

"These factors have been linked to a risk of cognitive decline and cardiovascular events, such as stroke.

"Finding ways to increase brain blood flow and function in older adults is vital."

The study, conducted in collaboration with Associate Professor Christopher Askew at the University of the Sunshine Coast and neuroscientists at the German Sport University Cologne, was the first of its kind to compare the brain blood flow in younger and older men during both continuous and interval exercise.

Interval exercise is characterized by short bouts of intense activity separated by rest periods.

"One of the key takeaways from the study was that both the exercise and the rest period were important for increasing brain blood flow in older adults," Dr. Bailey said.

"This study shows that interval-based exercise was as effective as continuous exercise for increasing brain blood flow in older adults during the periods of activity, and more effective than continuous exercise when we measured the overall blood flow increases during both the exercise and the rest periods.

"The benefits of exercise on brain function are thought to be caused by the increase in blood flow and shear stress, the frictional force of blood along the lining of the arteries, which occurs during exercise.

"This study aimed to identify the type or format of exercise that causes the greatest increases in brain blood flow, so we could help to optimize exercise programs to enhance brain function."

While this study focused on short-term increases in brain blood flow, Dr. Bailey said the next step was to investigate the benefits of interval exercise on brain health in the long term.

The research is published in Medicine & Science in Sports & Exercise.

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More information: Timo Klein et al. Cerebral Blood Flow during Interval and Continuous Exercise in Young and Old Men, Medicine & Science in Sports & Exercise (2019). DOI: 10.1249/MSS.0000000000001924

Journal information: Medicine & Science in Sports & Exercise 

Provided by University of Queensland 

Muscle-wasting sarcopenia is now a recognised disease—but we can all protect ourselves

by Robin Daly And Andrea B. Maier, The Conversation

Sarcopenia is defined by a loss of muscle mass and strength, usually associated with ageing. But it can be treated. Credit: shutterstock.com

As we grow older, the size and strength of our muscles progressively deteriorates. This can affect our capacity to perform everyday activities like standing up from a chair, climbing stairs or carrying groceries.

14 july 2019--For some people, muscle wasting becomes more severe, leading to falls, frailty, immobility and a loss of autonomy.

People who experience a marked loss in their muscle mass, strength and function may be suffering from a major but poorly recognized muscle-wasting condition called sarcopenia. Sarcopenia is to our muscles what osteoporosis is to our bones.

Sarcopenia is now recognized as a disease after being added to Australia's formal list of diseases, called the (ICD-10-AM).

Given the condition may affect almost one-third of older adults in the community, it's high time its impact is recognized and talked about.

The good news is that people with sarcopenia can rebuild their muscle mass and strength via strength or resistance training and some diet modifications. In fact, these are things we can all do to protect ourselves.

What causes sarcopenia?

Ageing disrupts the body's ability to produce the proteins needed to grow or maintain muscles. As we age, fewer signals are also sent from the brain to the muscles, leading to a loss in the mass and size of our muscles.

Other causes of sarcopenia can include:

• Physical inactivity
• Malnutrition
• Changes in hormones like testosterone and growth hormones
• Increased inflammation
• The presence of other age-related diseases

Who gets sarcopenia?

It's been estimated that sarcopenia affects 10-30 percent of older adults living in the community, varying by age and ethnicity. This increases to around 40-50 percent in those aged over 80 or living in nursing homes, and up to 75 percent in older hospital inpatients.

Sarcopenia is most common in older people, but can also occur earlier in life. In our 40s, muscle mass and strength begin to decline, and without intervention such as regular exercise, this loss accelerates with age. By the age of 70, up to half of muscle mass is lost and this is often replaced with fat and fibrous tissue, particularly in people who are inactive.

Sarcopenia is common in people with other diseases such as cancer, type 2 diabetes, chronic kidney disease and chronic obstructive pulmonary disease. Many of the drugs used to treat these conditions can contribute to sarcopenia, as they can cause an imbalance in muscle metabolism and disrupt the pathways that control muscle mass.

Yet because many health professionals have little knowledge of sarcopenia and its consequences, they don't necessarily consider or treat age-, diet- or drug-related muscle wasting.

On the left, a young, healthy thigh muscle. On the right, a thigh muscle affected by sarcopenia. Author provided, Author provided

Consequences of sarcopenia

Skeletal muscle is the largest organ in the body, making up around 40 percent of body weight. It's essential for both movement and metabolic functions such as regulating blood glucose levels. So it's not surprising that sarcopenia is linked to many adverse health outcomes.

Sarcopenia has been associated with impaired mobility, osteoporosis, falls, fractures, frailty, poor outcomes after surgery, institutionalization, hospital admissions, impaired quality of life and premature death.

Treating sarcopenia

There are currently no approved medications to treat sarcopenia, and research to identify new drugs has been inconclusive. The most effective approach we have is resistance or strength training, which should be done at least twice a week in combination with a nutritional (protein-enriched) intervention.

Skeletal muscle has a remarkable ability to adapt and regenerate in response to loading. Gains in muscle mass of 5-10 percent and improvements in muscle strength or power of 30-150 percent have been observed after 12 weeks of resistance training, even in older nursing home and hospitalized patients and the very old. This is equivalent to regaining the muscle mass lost over a decade.

Everyone will respond to resistance-type exercise if it's appropriately prescribed, but fewer than 15 percent of older Australians participate in twice-weekly resistance training.

Accredited exercise physiologists are best positioned to prescribe and deliver evidence-based exercise programs for older people and those with chronic diseases including sarcopenia.

Nutritional factors, such as protein, are also important for maintaining muscle, particularly in older patients who may be malnourished. To ensure an adequate intake of protein each day, most people should aim for one to three serves of lean meat, poultry, fish/seafood, eggs, nuts/seeds, or legumes.

Low vitamin D has also been linked to muscle weakness and falls. Sunlight exposureis the main way to get vitamin D, but where appropriate, a doctor may recommend a vitamin D supplement.

Moving forward

Recognition of sarcopenia as a distinct disease in Australia is critical to raise awareness of the condition among health professionals and the wider community.

Improved awareness will lead to better routine treatment for people with sarcopenia. For example, a GP who identifies a patient with sarcopenia can refer them to an exercise physiologist under a chronic disease management plan, which includes up to five Medicare-rebated sessions with an allied health professional over a calendar year.

More broadly, recognition is an essential step if we're going to see any changes to public health policy. It will enable the collection of more rigorous data on the prevalence of sarcopenia, and pave the way for additional resources to be targeted towards prevention.

Right now, the biggest challenge in the field is accurately and consistently diagnosing the condition. The type of assessments for muscle mass, strength and function used to diagnose sarcopenia continue to be debated. We need to progress towards a single international definition that includes region- and ethnic- specific criteria.

Provided by The Conversation 

Researchers make recommendations to improve health of LGBTQ communities

by University of Toronto

Alex Abramovich is an assistant professor at U of T’s Dalla Lana School of Public Health. Credit: Dalla Lana

Trans people do not have access to adequate and inclusive medical care. Gay, bisexual and other men who have sex with men face discriminatory policies when donating blood. When measuring homelessness, researchers cannot determine how many LGBTQ youth and young adults are affected.

13 july 2019--When Canada doesn't collect data on gender identity, it's to the detriment of the community. But one researcher at the University of Toronto says that could be about to change.

Along with their Ph.D. students, Assistant Professor Alex Abramovich and Associate Professor Lori Ross—both of U of T's Dalla Lana School of Public Health—helped develop 23 recommendations that were presented to the House of Commons Standing Committee on Health in June. If enacted, the recommendations would allow the government to collect inclusive data—a significant change the LGBTQ community has been requesting.

"Trans people are often not included in national health data, such as suicide data," says Abramovich. "There is still so much that we don't know regarding LGBTQ2S health.

"Collecting this data will allow us to implement interventions and save lives."

Abramovich has been studying the issue of homelessness among LGBTQ youth and young adults for over a decade and does a lot of work in the area of trans health. With enough data, he says, public health specialists can provide safe housing for LGBTQ youth and education for health providers across Canada.

"It is also time to address the issue of LGBTQ2S youth homelessness nationally," he says. "LGBTQ2S youth are overrepresented among the youth homelessness population in Canada. However, national point-in-time counts and street needs assessments, up until very recently, have not collected inclusive data."

The report also recommends an end to all discriminatory practices related to blood, organ and tissue donation for men who have sex with men and trans people.

"I am thrilled this report has meaningfully included the research findings of community-based organizations I am fortunate to work with, including the Community-Based Research Centre (CBRC)," says Daniel Grace, an assistant professor at Dalla Lana.

In a recently published qualitative study in the journal BMC Public Health, Grace spoke to 47 Canadian men who wanted policies to catch up to evidence on HIV testing. Grace says an HIV-negative man told him his blood shouldn't be deemed "better or worse" and that we "should look more at risky sexual behavior—independently of a person's sexual orientation or gender."

To give blood just three years ago, a man had to abstain from all sexual contact with other men for at least 12 months. Today, the deferral period is three months—an incremental step in the right direction, but still discriminatory, according to Grace.

In his latest op-ed in Vancouver's Georgia Straight, Grace and his collaborators expressed the importance of a scientifically-informed blood donation policy that removes discriminatory bans while ensuring Canada's blood supply is safe and readily available.

While problems continue to persist in LGBTQ health, Abramovich says he's optimistic.

"This study on LGBTQ2S health that the committee undertook is historic. Many people have waited a long time for something like this to happen," he says.

"I am honoured to have been invited as a witness, especially as a trans-identified researcher, studying LGBTQ2S youth homelessness."

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More information: Daniel Grace et al. Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study, BMC Public Health (2019). DOI: 10.1186/s12889-019-7123-4

Journal information: BMC Public Health 

Provided by University of Toronto 

WHO mental health guidelines could better capture 'lived experience'

by University of East Anglia

Mental health patients want mental health diagnostic descriptions to better reflect what it feels like to live with their conditions in the World Health Organisation's global manual of diagnoses—according to a new Lancet Psychiatry report.

10 july 2019--The study, by UK and US researchers at Norfolk and Suffolk NHS Foundation Trust (NSFT), the University of East Anglia, and Columbia University, in collaboration with the WHO Department of Mental Health and Substance Abuse, is the first to report feedback from service users on such a major mental health diagnosis guideline.

The WHO's International Classification of Diseases (ICD) is used by 194 countries and is the most influential and widely used classification guide, with around 55,000 unique codes for injuries, diseases and causes of death.

Researchers looked at the latest revision (ICD-11), which will come into effect in 2022, and focused on its chapter on mental, behavioural and neurodevelopmental disorders.

Researchers asked patients with schizophrenia, bipolar disorder, depression, anxiety and personality disorders in the UK, US and India to compare the WHO descriptions of their diagnoses with their own experiences.

Lead researcher Dr. Corinna Hackman, from UEA's Norwich Medical School and NSFT, said: "The ICD is the most widely used system to diagnose people with mental health conditions globally. It is extremely influential in framing our understanding of mental illness, and the policy and provision of mental health services.

"Despite this, service users' perspectives have not been included in previous versions of the ICD.

"We wanted to gain feedback from service users internationally on how the WHO intends to classify mental health conditions, and in particular—whether their diagnostic descriptions resonate with the lived experiences of patients.

"We found that the WHO diagnosis descriptions didn't always resonate with people's lived mental health experiences. In particular, the descriptions focused on external symptoms, things that can be seen on the outside, rather than the internal, felt-experience.

"Our findings suggest that this may have potential unintended consequences for service users of feeling alienated and misunderstood.

"People with bipolar disorder for example thought that the WHO description only reflected negative aspects of the condition, and identified increased levels of creativity, associated with mania, as a positive aspect.

"People with schizophrenia said that the WHO diagnosis wording didn't cover things like difficulties relating to, and communicating with, other people including feelings of isolation and alienation from other people.

"In some cases the wording was confusing or objectionable—for example the use of the word 'retardation' for depression.

"This research offers a unique insight into the views of service users and it really represents an overdue watershed moment in mental health diagnosis," she added.

Participants also compared the WHO's classification wording with alternate lay translations created by the research team.

Research collaborator Dr. Caitlin Notley, also from UEA's Norwich Medical School, said: "Participants reported that the lay summaries were much more clear, accessible and easier to understand—and consequently they felt that they resonated much better with their own lived experience.

"What we have shown is that patients would benefit from a version of the WHO disease classification system that is easier to understand and includes more information about the felt-experience.

"We hope that the changes we are recommending would also help clinicians better understand and empathise with the felt experience of service users."

The study was undertaken by NSFT, UEA and the London School of Hygiene and Tropical Medicine, in collaboration with Columbia University, NYC, a peer-led service in New Jersey and the All India Institute of Medical Sciences, New Delhi.

It is hoped that the findings will help inform further ICD-11 revisions.

The findings were translated into coproduced recommendations for the WHO, which has established a process of review and consideration of incorporation into revisions of the clinical descriptions and diagnostic guideline for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders.

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More information: 'Perspectives on the International Classification of Diseases, 11th Revision (ICD-11); an international qualitative study to Understand and improve mental health Diagnosis using expertise by Experience: INCLUDE Study' is published in The Lancet Psychiatry on Monday, July 8, 2019.

Provided by University of East Anglia 

Blood-flow-restricted training: A new way to boost muscle performance

by Danny Christiansen, The Conversation

Participants undergoing a session of blood-flow-restricted training at the training facility. Author provided

Strapping a band tightly around your limbs to reduce blood flow while training may seem like an odd way to boost athletic performance, but our latest study suggests that it does just that.

08 july 2019--In our study, we show that if you do interval cycling with reduced blood flow by strapping nylon cuffs around your legs, you become markedly better at exercising to exhaustion compared with training without reduced flow. Also, your muscles take up a lot more sugar (carbohydrate) from the bloodstream, increasing the amount of fuel available for muscles to work during exercise.

This is good news for those engaged in endurance sports, such as long-distance runners, cyclists and football players, where muscle carbohydrate often becomes a limiting factor for performance.

With the Summer Olympics in Tokyo next year and many exciting endurance events in the autumn, this news is timely delivered for athletes and like-minded people to test if this new training method could boost their training response before entering the decisive period of the season.

Our study also raises the possibility that blood-flow-restricted training could be useful for people with type 2 diabetes whose muscles have a reduced carbohydrate uptake because of decreased sensitivity to insulin. (An insulin sensitive person needs smaller amounts of insulin to lower blood sugar levels than someone who has low sensitivity.) We still don't know whether training with reduced blood flow improves insulin sensitivity, but research is underway to find out.

How it works

To reach their outcomes, we had ten active men train on indoor static bikes, three times per week for six weeks. In each training session, the men completed nine two-minute cycling intervals separated by one minute of recovery. One leg performed the intervals with reduced blood flow. This was accomplished by inflating a nylon cuff around the leg to a pressure of 180 mmHg, equivalent to four to eight times the pressure you find in a compression sock for running or cycling. The other leg trained without reduced blood flow (the control).

Participants cycling with a nylon cuff around one leg while the other leg serves as the control. Training load was monitored in real time by force sensors in the cycling shoes.

To make sure the training load was the same between the legs, the men trained with force sensors in their cycling shoes so that the training load was monitored in real time.

While both legs increased performance during incremental exercise to exhaustion, the leg that trained with reduced blood flow improved 11% more than the other leg. By simply adding a nylon cuff around the legs while training, you can boost your muscles' endurance dramatically, our results suggest.

Why it works

While strapping nylon cuffs around your legs during training is not a pleasant feeling—in fact, it can be quite painful – this type of training is safe. The reason it is effective for improving muscle performance is that it creates greater muscular stress than can be achieved by exercise alone. This stress speeds up the molecular processes essential for the muscle to improve with regular physical activity.

By inserting catheters in the main blood vessels draining the legs of the study participants, combined with ultrasound measurements, we were able to determine that the leg that trained with reduced blood flow became better at taking up carbohydrate as a result of the muscle extracting more carbohydrate, rather than more carbohydrate being delivered by the bloodstream. This was probably a result of several changes within the muscle, including better blood circulation and more proteins transporting carbohydrate over the muscle membrane, among other factors.

In an earlier study, we found that blood-flow-restricted training improves how the muscle deals with potassium, a mineral involved in regulating muscular pain and fatigue. This may also contribute to the observed better performance after this type of training by reducing perceived pain and fatigue at a given workload.

Regardless of the underlying mechanisms, blood-flow-restricted training is a promising new tool to boost performance and muscle fuel availability during exercise, which may benefit athletes and people with diabetes.

Provided by The Conversation 

Promising approach: Prevent diabetes with intermittent fasting

by Deutsches Zentrum fuer Diabetesforschung DZD

Credit: CC0 Public Domain

Intermittent fasting is known to improve sensitivity to the blood glucose-lowering hormone insulin and to protect against fatty liver. DZD scientists from DIfE have now discovered that mice on an intermittent fasting regimen also exhibited lower pancreatic fat. In their current study published in the journal Metabolism, the researchers showed the mechanism by which pancreatic fat could contribute to the development of type 2 diabetes.

08 july 2019--Fatty liver has been thoroughly investigated as a known and frequently occurring disease. However, little is known about excess weight-induced fat accumulation in the pancreas and its effects on the onset of type 2 diabetes. The research team led by Professor Annette Schürmann and Professor Tim J. Schulz of the German Institute of Human Nutrition (DIfE) has now found that overweight mice prone to diabetes have a high accumulation of fat cells in the pancreas. Mice resistant to diabetes due to their genetic make-up despite excess weight had hardly any fat in the pancreas, but instead had fat deposits in the liver. "Fat accumulations outside the fat tissue, e.g. in the liver, muscles or even bones, have a negative effect on these organs and the entire body. What impact fat cells have within the pancreas has not been clear until now," said Schürmann, head of the Department of Experimental Diabetology at DIfE and speaker of the German Center for Diabetes Research (DZD).

Intermittent fasting reduces pancreatic fat

The team of scientists divided the overweight animals, which were prone to diabetes, into two groups: The first group was allowed to eat ad libitum—as much as they wanted whenever they wanted. The second group underwent an intermittent fasting regimen: one day the rodents received unlimited chow and the next day they were not fed at all. After five weeks, the researchers observed differences in the pancreas of the mice: Fat cells accumulated in group one. The animals in group two, on the other hand, had hardly any fat deposits in the pancreas.

Pancreatic adipocytes mediate hypersecretion of insulin

In order to find out how fat cells might impair the function of the pancreas, researchers led by Schürmann and Schulz isolated adipocyte precursor cells from the pancreas of mice for the first time and allowed them to differentiate into mature fat cells. If the mature fat cells were subsequently cultivated together with the Langerhans islets of the pancreas, the beta cells of the "islets" increasingly secreted insulin. "We suspect that the increased secretion of insulin causes the Langerhans islets of diabetes-prone animals to deplete more quickly and, after some time, to cease functioning completely. In this way, fat accumulation in the pancreas could contribute to the development of type 2 diabetes," said Schürmann.

Significance of pancreatic fat for diabetes prevention

Current data suggest that not only liver fat should be reduced to prevent type 2 diabetes. "Under certain genetic conditions, the accumulation of fat in the pancreas may play a decisive role in the development of type 2 diabetes," said Schulz, head of the Department of Adipocyte Development and Nutrition. Intermittent fasting could be a promising therapeutic approach in the future. The advantages: it is non-invasive, easy to integrate into everyday life and does not require drugs.

Intermittent Fasting

Intermittent fasting means not eating during certain time slots. However, water, unsweetened tea and black coffee are allowed around the clock. Depending on the method, the fasting lasts between 16 and 24 hours or, alternatively, a maximum of 500 to 600 calories are consumed on two days within a week. The best known form of intermittent fasting is the 16:8 method which involves eating only during an eight-hour window during the day and fasting for the remaining 16 hours. One meal—usually breakfast—is omitted.

Islets of Langerhans

The islets of Langerhans—also referred to as islet cells or Langerhans islets—are islet-like accumulations of hormone-producing cells in the pancreas. A healthy adult has about one million Langerhans islets. Each "islet" has a diameter of 0.2-0.5 millimeters. The beta cells produce the blood glucose-lowering hormone insulin and make up about 65 to 80 percent of the islet cells. When blood glucose levels are elevated, these secrete insulin into the bloodstream so that the levels are normalized again.

More information: Charline Quiclet et al, Pancreatic adipocytes mediate hypersecretion of insulin in diabetes-susceptible mice, Metabolism (2019). DOI: 10.1016/j.metabol.2019.05.005

Provided by Deutsches Zentrum fuer Diabetesforschung DZD

Using virtual reality could make you a better person in real life

by Thuong Hoang, The Conversation

Credit: CC0 Public Domain

If you've ever participated in a virtual reality (VR) experience, you might have found yourself navigating the virtual world as an avatar. If you haven't, you probably recognise the experience from its portrayal in film and on television.

07 july 2019--Popular media has brought us characters like Jake Sully in Avatar, Wade Watts in Ready Player One, and Danny and Karl in the Black Mirror episode Striking Vipers.

In these examples, the character's virtual alter-ego is physically different from who they are in the real world. The connection between the real person and their virtual avatar is called "embodiment". If you have a strong sense of embodiment when using VR, you might feel as if your virtual body is your own biological body.

Virtual embodiment provides an opportunity to explore the world from a different point of view. And studies have shown that experiencing new perspectives in the virtual world can alter your behaviour in real life.

How virtual embodiment works

Virtual embodiment isn't entirely new. PC or console role-playing games generate a similar effect, albeit to a lesser extent. VR technology creates a far greater sense of immersion in the virtual world than two-dimensional screen experiences.

That's because successful 3-D virtual environments use more senses, compared with just visual and audio in 2-D screen-based technologies. This approach ensures the user is fully engulfed in the synthetic world, which they experience through their virtual avatar.

Immersive visuals in VR trick the user into believing they are elsewhere, such as atop Mount Everest or at the Eiffel Tower. By presenting separate images to each eye, a 3-D effect can be achieved when the user incorporates the information from each screen in the VR headset.

These visuals are captured with 360-degree photography or video cameras. Alternatively, actual photography or video can be used in VR environments.

Appropriate 360-degree sound also plays an important role as it can help convince the user of the authenticity of the virtual world.

Touch, smell and 'body ownership'

The sense of touch is a common form of sensory feedback. Every time you feel your mobile vibrate in your pocket, you're interacting with "haptic" technology.

In VR, haptic devices simulate physical sensations that are triggered when avatars interact with virtual objects. There are devices that can alter an avatar's weight distribution or aerodynamics to mimic what is happening in the virtual environment. Real physical props can also be used to introduce real-life challenges to VR sports. Haptic sensations can even be created in mid-air.

Smell, or olfactory sense, is another important mechanism that improves engagement within a virtual world. A Kickstarter campaign for a VR mask that can simulate the sense of smell using aroma capsules has exceeded its funding target, demonstrating the level of interest in multisensory VR.

In addition to extra senses, VR gives the user a sense of body ownership over the virtual avatar. Body ownership refers to the self-attribution of a (virtual) body. This can be achieved by synchronising multiple sensory feedback.

For example, when the user can see their virtual hand being touched and can feel the haptic sensation at the same time, they are more likely to believe the virtual body is theirs. This is demonstrated by the famous rubber hand experiment.

How virtual bodies affect behaviour

People respond differently to virtual avatars depending on who they are and the characteristics of the avatar. For example, a recent study found that women dislike their virtual avatar having male hands, whereas men are more likely to accept avatar hands of any gender.

Another study found that racial bias decreases when caucasians are represented by avatars that have darker compared with lighter skin.

The body shape of the avatar also affects behaviour. Researchers found that game players showed increased physical activity in the real world if they regularly played games with thin avatars as opposed to obese ones.

This suggests that the identities of virtual avatars can take precedence over our usual identities.

Choosing the right path

The ability to embody a virtual avatar blurs the lines between what's going on in the headset and what's happening in real life. It feeds the freedom to explore and experiment, whether that's with a different personality, gender or physicality.

But the option has to be available in the first place if it's going to have an impact. PC Gamer reported this week that the developers of the medieval multiplayer game Mordhau were considering introducing female and racially diverse skin tones into the game. The suggestion (which they deny) that they were also planning to give players the option to turn off this diversity if they don't like it led to a wave of backlash within the gaming community.

Our own research with older adults has also revealed frustrations with the lack of flexibility in avatar creation tools, such as the inability to modify personal characteristics like facial features and fitness levels.

Embodiment is powerful. It can influence your self-identity, perception, and behaviours both in and outside of virtual worlds. The onus is on the future designers and developers of this technology to ensure this power is used for good.

Provided by The Conversation