January Newsletter
In This Issue
Be a Weekend Warrior?
What Your Pulse Can Tell You
Is Running Bad For My Knees?
A Better Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
Quick Links
Join Our List
View my profile on LinkedIn 
Follow me on Twitter



I hope this newsletter finds you and your family well. The start a year is a time of goal setting and resolutions for many of us. One New Year resolution we often make is to exercise more. Despite our best intentions, many of us fail at hitting our goals for exercise. Most health organizations recommend 150 minutes of moderate exercise or 75 minutes of vigorous exercise weekly in 3 or more sessions. This comes out to around 30 minutes of walking 5 days/week. But what if we don't hit that goal? Can we still get some health benefits? The answer is a resounding YES! Stop beating yourself up for not sticking to your resolution and check out the first section to see the benefits of being a 'weekend warrior' (or even a wimpy warrior). 

What can your resting heart rate tell you? A lot as it turns out. As we age, a higher resting heart rate may be a sign of increased risk. The second section outlines how much risk you may have.  
I am often asked by runners if running is bad for their knees. We now have a study that may give some answers. Before you hang up the running shoes be sure to read the third section!

Click on the links the the left to check out our newly redesigned web site...

Be a Weekend Warrior?
Concentrated exercise sessions give as much benefit as regular exercise         
Routine moderate to vigorous physical activity is recommended by multiple health organizations and is a cornerstone of a healthy lifestyle. Standard physical activity (PA) recommendations are 150 minutes of moderate activity or 75 minutes of higher-intensity exercise in 3 or more sessions weekly. However, the questions remain of how much exercise do we need to get some benefit, and how much is too much and will hurt us? Using physical activity data from the Health Survey for England and the Scottish Health Survey, the authors examined all-cause, cardiovascular, and cancer mortality data with an emphasis on differentiating several key groups including: 1) people who meet PA guidelines by exercising three or more times/week (ie, those adhering to recommendations); 2) people who meet PA guideline dose recommendations via one or two exercise sessions per week, so-called "weekend warriors"; 3) people who exercise but fail to meet PA guidelines; and 4) people who abstain from moderate- and/or vigorous-intensity exercise. Remarkably, there was very little difference between the three active groups. There was approximately 30% all-cause reduction in mortality vs inactive adults, 40% reduction in cardiovascular events and 20% reduction in cancer.   
  • Importance: More research is required to clarify the association between physical activity and health in "weekend warriors" who perform all their exercise in 1 or 2 sessions per week.
  • Objective: To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause, cardiovascular disease (CVD), and cancer mortality.
  • Design, Setting, and Participants: This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for England and Scottish Health Survey with prospective linkage to mortality records. Respondents 40 years or older were included in the analysis. Data were collected from 1994 to 2012 and analyzed in 2016.
  • Exposures: Self-reported leisure time physical activity, with activity patterns defined as inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). The insufficiently active participants were also characterized by physical activity frequency.
  • Main Outcomes and Measures: All-cause, CVD, and cancer mortality ascertained from death certificates.
  • Results: Among the 63,591 adult respondents (45.9% male; 44.1% female; mean [SD] age, 58.6 [11.9] years), 8,802 deaths from all causes, 2,780 deaths from CVD, and 2,526 from cancer occurred during 561,159 person-years of follow-up. Compared with the inactive participants, the hazard ratio (HR) for all-cause mortality was 0.66 (95% CI, 0.62-0.72) in insufficiently active participants who reported 1 to 2 sessions per week, 0.70 (95% CI, 0.60-0.82) in weekend warrior participants, and 0.65 (95% CI, 0.58-0.73) in regularly active participants. Compared with the inactive participants, the HR for CVD mortality was 0.60 (95% CI, 0.52-0.69) in insufficiently active participants who reported 1 or 2 sessions per week, 0.60 (95% CI, 0.45-0.82) in weekend warrior participants, and 0.59 (95% CI, 0.48-0.73) in regularly active participants. Compared with the inactive participants, the HR for cancer mortality was 0.83 (95% CI, 0.73-0.94) in insufficiently active participants who reported 1 or 2 sessions per week, 0.82 (95% CI, 0.63-1.06) in weekend warrior participants, and 0.79 (95% CI, 0.66-0.94) in regularly active participants.
  • Conclusions and Relevance: Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines.

This study followed 63,592 men and women over the age of 40 for 18 years. Over 60% of the subjects were completely inactive. What is shocking is that by simply doing something, even if it doesn't meet the criteria set by health organizations, significant health benefits can be gained. The difference between people who met the criteria of 150 minutes of moderate activity or 75 minutes of vigorous activity in at least 3 weekly sessions, versus those who met the recommendations in 1-2 sessions (weekend warriors) or who had some activity but didn't meet criteria is really pretty small. Certainly, exercising more is better, but something is MUCH better than nothing. A 30% reduction in death rate, 40% reduction in heart disease and 20% decrease in cancer is very significant. So what are you waiting for? Take the dog for a walk. Don't beat yourself up because you aren't doing enough. If you are active only on Saturday and Sunday, you can get benefits. Just do something!
What Your Pulse Can Tell You
Higher resting heart rate associated with mortality

There have been several studies showing a higher resting heart rate and cardiovascular mortality. This Chinese study, with over 6,000 subjects and published in the Journal of the American Geriatrics Society, showed that a higher resting heart rate increased risk most significantly in people over age 60. 
  • Objectives:  To examine whether the association between resting heart rate (RHR) and all-cause mortality and cardiovascular events differs according to age.  
  • Design:  Prospective cohort.
  • Setting:  Community in Beijing, China.
  • Participants:  Individuals aged 40 and older without cardiovascular disease at baseline (N = 6,209).
  • Measurements:  Trained investigators interviewed participants using a standard questionnaire to obtain information on demographic characteristics, medical history and lifestyle risk factors in 1991. RHR was evaluated according to quartiles (<72, 72-76, 76-84, ≥84 beats/min). Cox regression models were used to assess the associations between RHR and all-cause mortality and cardiovascular events.
  • Results:  During a mean follow-up of 8.3 years, 840 subjects died, and 676 experienced a cardiovascular event. Higher RHR was significantly associated with all-cause mortality (P trend < .001) and cardiovascular events (P trend = .002) in older (≥60) but not younger (<60) participants (both P trend > .05). There were significant modifying effects of age on the association between RHR and all-cause mortality (P interaction < .001) and cardiovascular events (P interaction =.002). Similar results were observed after exclusion of individuals who died (n = 100) or had a cardiovascular event (n = 45) during the first 2 years of follow-up.
  • Conclusion:  High RHR appears to be an independent determinant of all-cause mortality and cardiovascular events in older but not younger individuals.
A higher resting heart rate (RHR) has been associated with vascular oxidative stress, endothelial dysfunction, subclinical inflammation, atherosclerosis progression, plaque disruption, ventricular arrhythmia, and myocardial ischemia (all bad things). It is also a sign of poor cardiovascular fitness and elevated sympathetic tone which may suggest emotional stress. Risk goes up over a rate of 72, first gradually, but then with a rate over 84 there is a large increase in risk. If your
RHR is 80 bpm or higher and you are over 60, you are at higher risk. Move more (see previous article), reduce your stress, and get this rate down. 

Here is a guide to checking your own pulse. Take your pulse for 15 seconds and multiply by 4. There are smart phone apps that can help as well. 
Is Running Bad For My Knees?
Running may actually lower inflammation in the knees
In this study, recently published in the European Journal of Applied Physiology, researchers, measured inflammation markers in the knee joint fluid of several healthy men and women aged 18-35, both before and after running. Not only was there no sign of inflammation, the study suggested that running actually decreased pro-inflammatory materials and had favorable effects on the joint environment. 
  • Introduction:  Regular exercise protects against degenerative joint disorders, yet the mechanisms that underlie these benefits are poorly understood. Chronic, low-grade inflammation is widely implicated in the onset and progression of degenerative joint disease.
  • Purpose:  To examine the effect of running on knee intra-articular and circulating markers of inflammation and cartilage turnover in healthy men and women.
  • Methods:  Six recreational runners completed a running (30 min) and control (unloaded for 30 min) session in a counterbalanced order. Synovial fluid (SF) and serum samples were taken before and after each session. Cytokine concentration was measured in SF and serum using a multiplexed cytokine magnetic bead array. Ground reaction forces were measured during the run.
  • Results:  There were no changes in serum or SF cytokine concentration in the control condition. The cytokine GM-CSF decreased from 10.7 ± 9.8 to 6.2 ± 5.9 pg/ml pre- to post-run (p = 0.03). IL-15 showed a trend for decreasing concentration pre- (6.7 ± 7.5 pg/ml) to post-run (4.3 ± 2.7 pg/ml) (p = 0.06). Changes in IL-15 concentration negatively correlated with the mean number of foot strikes during the run (r2 = 0.67; p = 0.047). The control condition induced a decrease in serum COMP and an increase in SF COMP, while conversely the run induced an increase in serum COMP and a decrease in SF COMP. Changes in serum and SF COMP pre- to post-intervention were inversely correlated (r2 = 0.47; p = 0.01).
  • Conclusions:  Running appears to decrease knee intra-articular pro-inflammatory cytokine concentration and facilitates the movement of COMP from the joint space to the serum.

I am often asked if running is going to 'ruin' someone's knees. This study adds to my emphatic no answer (assuming no previous knee surgeries or injuries). This study shows that exercise seems to create an anti-inflammatory environment which could potentially be beneficial long-term and perhaps delay the onset of degenerative joint disease which affects over 27 million people in the United States. So keep on running!
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.