March Newsletter
In This Issue
Can Lifting Weights Save Your Life?
Best Exercise to Control Weight Gain in Kids
Good News for Chocolate Lovers!
A New Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. It's finally sunny as I write this newsletter and hopefully we continue to warm up. It's hard to believe we are less than one week away from Opening Day! For me, it always makes me believe that Spring is here (even if the weather doesn't agree). 

Strength training is being shown to be more and more important as we age. Where most traditionally gave up "lifting weights" with age, research is showing us that it actually becomes even more important. If you are doing resistance training - keep it up. If not, you may want to start. Check out the first article for information on how to get started. 


Youth obesity is epidemic in our society. We all see it every day. Unhealthy diets combined with lack of exercise are a terrible combination. The statistics on youth obesity are really frightening. How can we combat this in an era of less recess, less PE class, and less free time activity? The second article outlines an exercise program that can help. And guess what? It's not just for the kids. We can all benefit from it. 


Finally, chocolate lovers rejoice! Your favorite food may save your life...


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

Can Lifting Weights Save Your Life?
Decreased mortality seen with strength training     
We know that strength training can improve function and reduce falls as we age. This article, from Preventive Medicine, analyzed data from over 30,000 adults over age 65 and found that strength trained adults had a 46% lower odds of mortality compared to those who did not strength train. 
Summary of findings:
  • BACKGROUND:  The relationship between strength training (ST) behavior and mortality remains understudied in large, national samples, although smaller studies have observed that greater amounts of muscle strength are associated with lower risks of death. We aimed to understand the association between meeting ST guidelines and future mortality in an older US adult population.   
  • METHODS: Data were analyzed from the 1997-2001 National Health Interview Survey (NHIS) linked to death certificate data in the National Death Index. The main independent variable was guideline-concordant ST (i.e. twice each week) and dependent variable was all-cause mortality. Covariates identified in the literature and included in our analysis were demographics, past medical history, and other health behaviors (including other physical activity). Given our aim to understand outcomes in older adults, analyses were limited to adults age 65 years and older. Multivariate analysis was conducted using multiple logistic regression analysis. 
  • RESULTS: During the study period, 9.6% of NHIS adults age 65 and older (N=30,162) reported doing guideline-concordant ST and 31.6% died. Older adults who reported guideline-concordant ST had 46% lower odds of all-cause mortality than those who did not (adjusted odds ratio: 0.64; 95% CI: 0.57, 0.70; p<0.001). The association between ST and death remained after adjustment for past medical history and health behaviors. 
  • CONCLUSIONS: Although a minority of older US adults met ST recommendations, guideline-concordant ST is significantly associated with decreased overall mortality. All-cause mortality may be significantly reduced through the identification of and engagement in guideline-concordant ST interventions by older adults.

This study used the National Health Interview Survey, a database of 30,162 adults age 65 and older. Strength training was defined as activities to strengthen muscles such as lifting weights or calisthenics done more than twice a week. While only 9.6% of people in the study did this amount of strength training exercise, those who did had a 45% reduction in mortality! This included all causes including cancer and heart disease. We know that exercise, including strength training helps to improve balance and coordination; reduce risk of falls; maintain independence; and maintain bone density. Even if you have chronic diseases, strength training can be beneficial. Now we also know it can help you live longer. A simple strength training program can be done at home with minimal to no equipment. This study only looked at people over age 65. It makes sense that those of us under 65 would be wise to incorporate strength training into our routines as well. 

If you would like to get started, a nice program can be found through Tufts University here
They have a free book you can download called Growing Stronger: Strength Training for Older Adults

This site has some nice videos of exercises you can incorporate into your program as well. 

Best Exercise to Control Weight Gain in Kids
HIIT shown to be most effective type of exercise exercise for youth weight loss
chip eating kid

Obesity is a larger and larger problem for kids today. 
  • Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. 
  • The percentage of children aged 6-11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12-19 years who were obese increased from 5% to nearly 21% over the same period. 
  • In 2012, more than one third of children and adolescents were overweight or obese. Obviously, there is a big problem here. 
  • Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. 70% of obese youth had at least one risk factor for cardiovascular disease.
    Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes. 
    Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem. 
    Children and adolescents who are obese are likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults. 
    Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin's lymphoma.

    We know there is a problem. The question is how do we change things? This study, from Obesity Reviews showed that a type of exercise known as HIIT (high-intensity interval training) was more effective in reducing risk factors than other forms of exercise. 

  • Summary of findings      
    • Background:  The scientific interest in high-intensity interval training (HIIT) has greatly increased during recent years.
    • Objective:  The objective of this meta-analysis was to determine the effectiveness of HIIT interventions on cardio-metabolic risk factors and aerobic capacity in overweight and obese youth, in comparison with other forms of exercise.
    • Data sources:  A computerized search was made using seven databases.
    • Study eligibility criteria:  The analysis was restricted to studies that examined the effect of HIIT interventions on cardio-metabolic and/or aerobic capacity in pediatric obesity (6-17 years old).
    • Participants and interventions:  Nine studies using HIIT interventions were selected (n = 274).
    • Study appraisal and synthesis methods: Standarized mean difference (SMD) and 95% confidence intervals were calculated. The DerSimonian-Laird approach was used.
    • Results: HIIT interventions (4-12 week duration) produced larger decreases in systolic blood pressure (SMD = 0.39; -3.63 mmHg) and greater increases in maximum oxygen uptake (SMD = 0.059;1.92 ml/kg/min) than other forms of exercise. Also, type of comparison exercise group and duration of study were moderators.
    • Conclusions: HIIT could be considered a more effective and time-efficient intervention for improving blood pressure and aerobic capacity levels in obese youth in comparison to other types of exercise.
    In trying to combat youth obesity, we need to utilize every tool we have. This study showed that HIIT exercise was found to be more enjoyable for kids and was more effective. Sounds like a win for all. This certainly has some ramifications for how we use the limited physical education time available in school. It seems more emphasis on these types of activities makes sense. For those of us who are no longer kids, as we have seen in previous studies, HIIT training is an effective, time-efficient exercise program. Great for busy people!

    For those of you not familiar with HIIT, the basic idea is doing multiple sets (8 is most common) of short periods of high intensity work (20-60 seconds) followed by a rest period. The most studied is the Tabata method which is 8 sets of 20 seconds of intense work followed by 10 seconds of rest for a total of 4 minutes of exercise. There are a lot of variations depending on your fitness level. Here is a nice explanation and here is another (sorry about the ads).The overall key is that the work periods need to be intense, but remember that intensity is based on where you are in your fitness, not someone else. 

    Good News for Chocolate Lovers!
    Chocolate reduces heart attacks
    This study, from BMJ, demonstrated in a prospective study of almost 70,000 Swedish adults that those who ate chocolate more than 3-4 times weekly had a 20% reduction in heart attacks.   

    Summary of findings:   
    • Objective:  To examine whether chocolate consumption is associated with a reduced risk of ischaemic heart disease, we used data from a prospective study of Swedish adults and we performed a meta-analysis of available prospective data.   
    • Methods and results: The Swedish prospective study included 67,640 women and men from the Cohort of Swedish Men and the Swedish Mammography Cohort who had completed a food-frequency questionnaire and were free of cardiovascular disease at baseline. Myocardial infarction (MI) cases were ascertained through linkage with the Swedish National Patient and Cause of Death Registers. PubMed and EMBASE databases were searched from inception until 4 February 2016 to identify prospective studies on chocolate consumption and risk of ischaemic heart disease.
    • Results: The results from eligible studies were combined using a random-effects model. During follow-up (1998-2010), 4417 MI cases were ascertained in the Swedish study. Chocolate consumption was inversely associated with MI risk. Compared with non-consumers, the multivariable relative risk for those who consumed ≥3-4 servings/week of chocolate was 0.87 (95% CI 0.77 to 0.98; p for trend =0.04). Five prospective studies on chocolate consumption and ischaemic heart disease were identified. Together with the Swedish study, the meta-analysis included six studies with a total of 6,851 ischaemic heart disease cases. The overall relative risk for the highest versus lowest category of chocolate consumption was 0.90 (95% CI 0.82 to 0.97), with little heterogeneity among studies (I2=24.3%).
    • Conclusions: Chocolate consumption is associated with lower risk of MI and ischaemic heart disease.                                  

    This large prospective study combined multiple studies. When all the data was correlated, a 10% reduction in heart attacks was seen in a population of over 150,000 people. This study combined the various types of chocolate but we know from other research that dark chocolate has been shown to have significant benefits. It may be likely that if all had eaten dark chocolate the results may have been even more dramatic. Based on this information, my recommendation is that if you enjoy chocolate, go ahead! Keep it to about 1 oz daily and preferably higher cacao content (over 70% if possible). It's good for your heart!
    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. 


    Strength training research is continuing to show the importance of this form of exercise as we age. Use it or lose it! Not only is is good for mobility and independence, it may help you live longer. 


    Youth obesity is a major problem both in our country but throughout the world. With minimal time in PE classes in the current school system, it is important to be efficient. HIIT may be the answer. 


    Chocolate lovers rejoice! You are saving your heart!


    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.