Treatment of Nonalcoholic Fatty Liver Disease: The Role of Medical,Surgical, and Endoscopic Weight Loss

Nonalcoholic fatty liver disease (NAFLD) represents a rapidly growing cause of chronic liver disease in the United States and is associated with significant morbidity and mortality, including progression to liver cirrhosis and hepatocellular carcinoma. NAFLD comprises a spectrum of liver conditions, ranging from simple steatosis to steatosis with inflammation (steatohepatitis) and progressive fibrosis. Weight loss represents a first line therapeutic modality for the management of NAFLD. Herein, we review the evidence base for medical, surgical, and endoscopic approaches to weight loss and their potential impact on the natural history of NAFLD.     

The Importance of Physical Activity Level and Exercise Characteristics on Sleep Quality in Older Adults

The aim of this study was to investigate the effects of exercise characteristics and physical activity level on sleep quality in older adults. The study was completed on 349 older adults. Individuals, aged 60 years and older who scored 24 or greater on the mini mental test’s scores and who were not actively working were included. The short form of The International Physical Activity Questionnaire was used to determine the level of physical activity. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. There was a poor positive correlation between age and self-reported sleep quality in older women and older men (r = .205, p = .004, r = .317, p = .001). There was a negative correlation between physical activity and self-reported sleep quality in older women and older men (r = –.410, p = .001, r = –.488, p = .001). Living status was a factor significantly affecting sleep quality in older women (p = .016), whereas it was not significant for older men(p = .128). The presence of disease and regular exercise significantly affected sleep quality in older women and older men (p = .012, p = .003). However, no difference was found between exercise frequency, exercise duration, exercise time, exercise intensity and sleep quality in older adults (p > .05). According to these findings, regular exercise or physical activity at a minimal level may positively affect self-reported sleep quality in older adults. But exercise’s characteristic does not affect self-reported sleep quality differently.     

Body Mass Index,Waist Circumference,Physical Activity,and Risk of Hearing Loss in Women

Background

Acquired hearing loss is highly prevalent, but prospective data on potentially modifiable risk factors are limited. In cross-sectional studies, higher body mass index (BMI), larger waist circumference, and lower physical activity have been associated with poorer hearing, but these have not been examined prospectively.

Methods

We examined the independent associations between BMI, waist circumference, and physical activity, and self-reported hearing loss in 68,421 women in the Nurses' Health Study II from 1989 to 2009. Baseline and updated information on BMI, waist circumference, and physical activity was obtained from biennial questionnaires.

Results

After more than 1.1 million person-years of follow-up, 11,286 cases of hearing loss were reported to have occurred. Higher BMI and larger waist circumference were associated with increased risk of hearing loss. Compared with women with BMI <25 kg/m², the multivariate-adjusted relative risk (RR) for women with BMI ≥40 was 1.25 (95% confidence interval [CI], 1.14-1.37). Compared with women with waist circumference <71 cm, the multivariate-adjusted RR for waist circumference >88 cm was 1.27 (95% CI, 1.17-1.38). Higher physical activity was related inversely to risk; compared with women in the lowest quintile of physical activity, the multivariate-adjusted RR for women in the highest quintile was 0.83 (95% CI, 0.78-0.88). Walking 2 hours per week or more was associated inversely with risk. Simultaneous adjustment for BMI, waist circumference, and physical activity slightly attenuated the associations but they remained statistically significant.

Conclusions

Higher BMI and larger waist circumference are associated with increased risk, and higher physical activity is associated with reduced risk of hearing loss in women. These findings provide evidence that maintaining healthy weight and staying physically active, potentially modifiable lifestyle factors, may help reduce the risk of hearing loss.     

Self-Limiting Progressive Intensity to Promote Initiation and Maintenance of Physical Activity

ABSTRACT

Older adults with multiple chronic conditions face many challenges in initiating and maintaining regular physical activity. In addition to rate of perceived exertion, the utilization of self-limiting progressive intensity can play a significant role in physical activity initiation and maintenance to improve quality of life and life satisfaction in older adults. Self-limiting progressive intensity has therapeutic applications for various activity professionals in everyday practice. The purpose of this paper is to describe self-limiting progressive intensity as an alternate or adjunct method to promote the initiation and maintenance of physical activity in older adults with multiple chronic conditions.     

Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.