With Mental Health Problems, Fitness Is Tied to Reduced Risk of Death

by Dr Alex Jimenez | Diets, Fitness

For men experiencing emotional distress like depression, anxiety or thoughts of suicide, having high cardiorespiratory fitness may cut the risk of death in half compared to those in poor condition, researchers say.

“The prevalence of mental health issues is growing in the U.S. and globally,” said lead study author Mei Sui of the University of South Carolina in Columbia. “People are facing many stressors in their daily lives linked to depression, anxiety and other mental disorders.

“Medication to treat these mental problems is not only expensive but also comes with significant side effects such as weight gain,” she told Reuters Health. “Identifying modifiable factors that are beneficial to those with emotional distress has important clinical and public health applications.”

Mental health conditions cost the U.S. about $2.5 trillion in 2010 and are projected to cost the country $6 trillion by 2030, the authors write in Mayo Clinic Proceedings.

To see how cardiovascular fitness might affect healthcare costs and outcomes for people with mental health disorders, Sui and colleagues analyzed data from the Aerobics Center Longitudinal Study at the Cooper Clinic in Dallas, Texas, which conducted preventive health exams on more than 43,000 men between 1987 and 2002.

The researchers focused on 5,240 participants who reported a history of emotional distress, including 2,229 who reported more than one emotional distress condition. To measure cardiorespiratory fitness, participants ran on a treadmill until they were exhausted.

Among men who experienced emotional distress, 46 percent reported depression, 58 percent had anxiety, 51 percent had a history of mental counseling, and 8 percent reported ever having thoughts of suicide.

By the end of the follow up period, there were 128 deaths from any cause.

The researchers found that men with the lowest cardiovascular fitness tended to have higher weight, blood pressure, cholesterol and blood sugar levels and were more likely to smoke and to be sedentary.

In addition, men who reported more than one type of emotional distress were more common in the low-fitness group.

Compared to the lowest-fitness group, men with moderate cardiovascular fitness were 46 percent less likely to die of any cause during the study, and those in the high fitness group were 53 percent less likely to die.

“This significant strong inverse association between high levels of fitness and longevity in men with emotional distress is particularly interesting,” Sui said. “Clearly lifestyle behavior interventions to increase fitness levels could help those with emotional distress.”

Even moderate levels of fitness were associated with a 46 percent lower risk of dying, she noted. This moderate level of fitness means 30 minutes per day of activity such as swimming, jogging or biking, and is the current level recommended under American sports medicine guidelines.

The study mostly included non-Hispanic whites, and Sui would like to see more research about fitness in women and minority groups.

“This was the missing piece of the puzzle. We know now that assessing fitness and treating it should be at the center of mental health care,” said Davy Vancampfort of the University of Leuven Psychiatric Center in Belgium. He wasn’t involved in the current study but recently published an analysis that found people with severe mental illness are at heightened risk for heart disease

“This adds to our call to include assessment of physical activity and treatment to the standard mental health care package,” he told Reuters Health by email. “Mental health care settings and primary care settings should work closely together on this.”

Future research could also look at older populations, follow people for a longer period of time and account for medication such as psychotropic prescriptions in particular, said Brandon Stubbs of King’s College London in the UK.

“One in four of us will at some point experience a common mental illness in our lives,” Stubbs, who wasn’t involved in the study, told Reuters Health by email. “We can no longer view mental health and physical health separately given that they are so inextricably linked.”

Low Dairy Consumption Tied to Early Menopause

by Dr Alex Jimenez | Diets, Fitness

Women in their early 40s with the highest intake of vitamin D and calcium from food sources may have a lower than average risk of starting menopause before age 45, a recent study suggests.

Taking vitamin D or calcium in supplement form had no benefit in the large study of U.S. nurses, the study team writes in American Journal of Clinical Nutrition, and there may be other substances in dairy foods that also contribute to their apparent protective effect.

“Early menopause can have substantial health impacts for women. It increases their risk of cardiovascular disease and early cognitive decline and osteoporosis,” lead author Alexandra Purdue-Smithe told Reuters Health.

In addition, as women are delaying having kids into their later reproductive years, having early menopause can have a substantial impact on their ability to conceive as they wish, which can have psychological and financial consequences, said Purdue-Smithe, an epidemiologist with the School of Public Health and Health Sciences at the University of Massachusetts Amherst.

“Given that (early menopause) affects roughly 10 percent of women in the U.S. and other Western populations, it felt like a worthwhile problem to start investigating and seeing if there are any potentially modifiable risk factors for it,” she said.

Menopause, when a woman stops menstruating and her levels of hormones like estrogen decline, typically happens between the ages of 45 and 55. Menopause before age 45 is considered “early.”

Vitamin D may be involved in some of the hormonal mechanisms of early menopause, but little is known about how dietary vitamin D and calcium affect the risk, Purdue-Smithe and her colleagues write.

They analyzed data from the Nurses’ Health Study II, a long-term study of more than 100,000 U.S. registered nurses who were 25 to 42 years old in 1989 when they began answering health questionnaires every two years.

The questionnaires were designed to assess the nurses’ lifestyles, behaviors and overall health. Questions about diet were asked five times over 20 years. Researchers followed the participants until 2011, by which time 2,041 women experienced early menopause.

“The women who consumed the most vitamin D from food sources had a 17 percent lower risk of having early menopause as compared to women who consumed the least,” Purdue-Smithe said. The researchers found this association only with dairy sources of vitamin D, like milk, not with non-dairy sources like oily fish.

Women who consumed the most calcium from food sources were also about 13 percent less likely to experience early menopause compared to women who consumed the least calcium, and once again, only dairy foods seemed to provide a benefit.

“Our next direction is to look at actual individual dairy foods and see if there’s something else going on with dairy itself,” Purdue-Smithe said.

The study team also found that taking high doses of calcium in supplement form was associated with a higher risk of early menopause. But the researchers speculate that these women might have been diagnosed with osteoporosis or other conditions that are also risk factors for early menopause.

“Most of what is known about the relationship between calcium and Vitamin D and women’s issues is related to bone health,” said Sandra Arevalo, a dietitian and director of the Nutrition Services and Community Outreach for Community Pediatrics at Montefiore Medical Center in New York.

Lack of Vitamin D and calcium in a woman’s diet, mainly as age progresses, increases her risk of low bone mineral density, osteoporosis and bone fractures, said Arevalo, who wasn’t involved in the study.

The top 10 food sources of calcium are low-fat yogurt, low-fat cheese, sardines, calcium-fortified soy milk, calcium-fortified orange juice, salmon, calcium fortified ready-to-eat cereal, turnips, kale and bok choi, she noted in an email.

The top 10 sources of Vitamin D are cod liver oil, swordfish, salmon, tuna fish, vitamin D fortified orange juice, low-fat vitamin D-fortified milk, yogurt, fortified margarine, sardines and liver, Arevalo said.