Tuesday, March 26, 2019

Raise your heart rate and your mood

The 2016 summer Olympics had its share of exciting performances, upsets, and photo finishes. But for days after Michael Phelps’s first appearance at the games, it seemed all anyone could talk about was “cupping.” It’s an ancient therapy that left multiple circular discolorations on his skin. During “dry cupping,” suction is applied to the skin for several minutes; sometimes it is combined with massage, acupuncture, or other alternative therapies. (“Wet cupping” is similar except that blood is removed by making small cuts in the skin.)

Cupping is supposed to draw fluid into the area; the discoloration is due to broken blood vessels just beneath the skin, much like a bruise. Cupping has been popular in Egyptian, Chinese, and Middle Eastern cultures going back thousands of years, but increasing numbers of people worldwide have been adopting it. Celebrities and athletes have popularized it in the U.S. in recent years.
What is cupping supposed to do?

According to its advocates, cupping is supposed to promote healing and has been used extensively for sore muscles. But that’s only the beginning. Cupping has also been used for

    back and neck pain
    skin diseases such as acne and hives
    lowering cholesterol
    knee arthritis
    improving immune function.

And there are many others. If cupping does help with these problems, it’s worth asking: how? From a biological perspective, it’s not clear how the application of suction and drawing blood into an area under the skin would provide all these benefits. A recent review of the treatment describes cupping as a treatment that can strengthen the body’s resistance, restore balance between positive and negative forces, remove disease-causing factors, and promote blood circulation. But exactly how is unclear.
Does cupping work?

A number of studies have examined this question, but unfortunately don’t seem to have  convincingly answered it. In fact, a 2015 review of the evidence found that cupping might provide some relief for chronic neck or back pain, but that the quality of the evidence was too limited to draw firm conclusions.

One problem is that it’s tough to perform a high-quality study on cupping. The best studies are “blinded placebo-controlled trials” in which neither the patient nor the researcher knows which treatment (real or placebo) has been given to a study subject. When medications are studied, coming up with a placebo pill is not difficult; it can be much more difficult to create a convincing placebo comparator for cupping. In addition, pain can be a difficult thing to measure and the placebo effect — improvement related to an expectation of benefit — can be quite powerful.

Still, there have been studies comparing actual acupuncture with convincing but fake (or “sham”) acupuncture.  Similar studies of cupping could be possible. And if cupping truly helped, you may not care if it’s due to the placebo effect.
Are there risks involved with cupping?

Most experts agree that cupping is safe. As long as those treated don’t mind the circular discolorations (which fade over a number of days or weeks), side effects tend to be limited to the pinch experienced during skin suction. It’s quite unusual that cupping causes any serious problems (though, rarely, skin infections have been reported).
So, what’s next?

If you want convincing evidence of effectiveness before trying a treatment, you may want to pass on cupping for now. But if you’d like to try something that’s safe and might help with certain aches and pains (and possibly other ailments), the main downsides seem to be the temporary skin discoloration and the cost — I found estimates online of $30 to $80 per treatment. Some people have it only “as needed” but others may have it monthly or even more often. Future research could prove that cupping is as good as the claims say it is — but we’ll have to wait for the results of high-quality studies to know if it’s true.
New research has shaken up a time-honored strategy for treating advanced prostate cancer that’s begun to metastasize, or spread. Doctors ordinarily treat these cases with systemic therapies designed to kill off metastatic tumors appearing throughout the body. But they don’t use local therapy to treat the primary tumor in the prostate. That’s because the primary tumor — unlike the metastases that it spawns — is rarely lethal. So doctors have been reluctant to give local therapy, such as radiation to the prostate or surgery to remove the organ, if it’s not going to improve the odds of survival.

Now investigators are turning that assumption on its head. According to their findings, men who received local therapy while being treated for metastatic prostate cancer lived longer than those who didn’t, “and that makes a case for being more aggressive in how we manage patients who present with metastatic disease,” said Dr. Chad Rusthoven, a radiation oncologist and assistant professor at the University of Colorado School of Medicine in Denver, and the study’s first author.
Looking back

Rusthoven and his colleagues scoured eight years of data collected by a national cancer registry between 2004 and 2014. Their retrospective study identified 6,382 men who had metastatic prostate cancer at initial diagnosis. All the men were treated with systemic androgen deprivation therapy (ADT) for metastatic prostate cancer, but 538 of them were also treated with local radiation to the prostate. At just over five years of follow-up, on average the men who got local therapy had a median overall survival of 55 months compared to 37 months among those who did not. In addition, 49% of the men who were treated with both ADT and local radiation lived for five years compared to 33% of the men who got ADT alone.

Should the findings be confirmed in studies that monitor survival forward in time, “then standard therapy for metastatic prostate cancer will shift to a comprehensive strategy that includes control of the primary tumor,” said Dr. Ana Aparicio, a medical oncologist at the University of Texas MD Anderson Cancer Center in Houston, who was not involved in the study.
Why this approach might work

Aparicio said that treating the primary tumor makes sense for several reasons: First, since men now live with metastatic disease for longer than they used to, they’re more likely to develop symptoms— pain, urinary obstruction, and infections — that can be controlled with local treatment. Furthermore, mounting evidence suggests that tumors in the prostate release chemical and biological substances that promote the cancer’s spread.

Still, Rusthoven and Aparicio both emphasized that local treatments should only be given to men participating in a clinical trial. Local therapy can have significant side effects, “and moreover we need a better understanding of who benefits from the treatment most,” Aparicio said. Her team at MD Anderson is currently enrolling patients for a clinical trial that provides standard systemic therapy for metastatic disease to one group of patients, and ADT combined with either local radiation or surgery to remove the prostate to another.

Rusthoven said he would only give local therapy outside of a clinical trial to a “select group of young patients with limited metastatic burden who are interested in maximally aggressive therapy and who clearly understand the risks and benefits of that approach.”

“This study suggests a different and very novel way of thinking about how to manage men who present with metastatic prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of “There are other cancers where treating the primary cancer in the setting of metastatic disease has been associated with improvements — and this study provides an important impetus to consider this option both in the context of clinical studies and individualized patient selection.” Last month, I took a 7.5-mile hike near Harper’s Ferry National Historical Park in West Virginia. Thanks to a nearly 1,900 foot-elevation gain, my hike definitely gave me a good cardiovascular workout. But there may be some additional health benefits of hiking, as I learned from Dr. Aaron L. Baggish, associate director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital.
“The nice thing about hiking is that it exists along an entire continuum, from a gentle walk on a flat wooded path to mountain climbing,” says Dr. Baggish. Nearly everyone, regardless of age or athletic ability, can find a hike that offers the right level of personal challenge. And hiking may even offer some unique physical and mental benefits, he says.
One benefit of hiking is more for the core

Like brisk walking, hiking is a good way to improve your cardiovascular fitness, particularly if your route includes some hills, which will force your heart to work harder. Taking a hike on the slightly uneven surface of a trail also provides a natural way to engage the core muscles in your torso and to hone your balance skills. “You usually don’t get that type of lateral motion from walking on a treadmill or riding a bike,” says Dr. Baggish.

However, if you have problems with stability or vision, using walking or trekking poles can give you an added level of security on uneven terrain. Use poles with a spiked metal tip when walking on dirt or grass. Plant the pole out in front of you as you walk to take a little pressure off your knee joints.
Going for a hike can offer natural stress relief?

Yet another benefit of hiking may be the restorative and stress-relieving powers of being outside in nature. A number of small studies hint that spending time in green space — nature preserves, woodlands, and even urban parks — may ease people’s stress levels. Giving the growing consensus that stress contributes to high blood pressure and heart disease risk, anything you can do to mitigate stress is likely helpful. In that realm, the benefits of hiking remain anecdotal, but outdoor enthusiasts tend to agree. “There’s a real sense of peace and composure you get from being outside and away from everything,” says Dr. Baggish, whose own passion is not going for hikes but running on trails in the rugged peaks of New Hampshire’s White Mountains.

Here are his tips to take a and enjoyable hike:

    Bring a map and hike with a partner. A companion is good for both company and safety. If you go alone, let someone know when you plan to return.
    Wear hiking boots. Choose well-fitting footwear with good ankle support. Make sure to break them in with shorter walks so you don’t get blisters when you’re miles from a trailhead.
    Stay hydrated. Don’t forget to take plenty of water along on your hike, especially in warm, sunny weather.

Finding trails near you

Looking for hiking venues? Local, state, and national parks are a good place to start. American Trails is a national nonprofit organization that supports local, regional, and long-distance trails for hiking and other uses; check the “Trails” tab to search by state to find hikes in your area.

No comments:

Leave a comment