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August 1999

Vitamins And Herbs 
August 14, 1999

What you need to know about vitamins, mineral supplements, and herbs... before you take them. 

If you are reading this screen, chances are you're keen to improve your personal nutrition. The trouble is taking shortcuts isnít going to make it happen, particularly with your bodyís nutrition. Whether youíre popping vitamin supplements to ward off illnesses, or taking herbal remedies to treat them, be smart about it. 

If you want to maximize good nutrition for better health, the solution is pretty simple: eat plenty of nutrient-rich foods, like fruits, vegetables, low-fat dairy products, and whole grains, and go easy on foods that pack calories and fat and not much else: bacon cheeseburgers, triple-rich chocolate ice cream -- you know the stuff. Nothing -- no pill, no tablet, no capsule -- can substitute for a healthy diet or compensate for a bad one. 

For those of you who havenít the time, the palate, or the culinary inclination to rustle up all your nutrition in the kitchen, a daily multivitamin and mineral pill can come in handy. Just donít forget, from your bodyís point of view, itís a second-best solution. Food provides all kinds of goodies, like disease-preventing phytochemicals, that arenít contained in those pills. 

Supplements can also be a good bet if you belong to certain groups with higher-than-average nutrient needs. For instance, if youíre thinking of becoming pregnant and your diet is short on folic acid, consider taking a folic acid supplement. (Getting enough of this vitamin in early pregnancy can prevent neural tube defects in babies.) Likewise, if youíre an older adult, it might be worth taking a vitamin B-12 supplement, since it becomes more difficult to absorb this vitamin as you age. 

When it comes to herbal remedies (also known as botanicals), itís best to take them only for minor, short-term discomforts, such as colds. For anything else, see a doctor first, if only to make sure that youíre not alleviating the symptoms of a potentially serious illness. 

Here are some facts to remember if you decide to take vitamin or mineral supplements or herbal remedies: 

  • When it comes to supplements, more isnít always better. Lung cancer studies, for example, have found that the beta-carotene in fruits and vegetables can offer protection against cancer. But when researchers gave high doses of beta-carotene (in supplements) to smokers, their cancer rates went up, not down.

  • Many supplement claims are based on findings that are contradictory, inconclusive, or simply not yet available. Read them with a critical eye. 

  • Nutrition doesnít work in a vacuum. While adequate calcium can help prevent osteoporosis, for example, risk is also affected by genetics, exercise, and estrogen status. 

  • A vitaminís price doesnít reflect its potency. Higher priced vitamins arenít any better than the bargain variety. 

  • As for herbal remedies, remember that "natural" does not mean benign. Botanicals do not have to be proven safe before theyíre put on store shelves. Itís only after a problem occurs that a product is withdrawn.

  •  Generally, herbs should be avoided by women who are pregnant, trying to become pregnant, or nursing. Herbs should not be given to babies. 

  • The possibility of harm increases when herbs are taken in large amounts or over a long period of time. 

  • No herb has been checked for safety when combined with other herbs or drugs, either prescription or over-the-counter, so itís best to avoid regularly using a large variety of herbs. 

  • The most reputable products carry information on recommended dosage, side effects, and contraindications. 

  • Keep in mind that many claims for herbal remedies are not supported by scientific studies but are based instead on tradition, folklore, and anecdote. Of the roughly 600 botanicals sold in this country, fewer than a dozen have been tested in controlled clinical trials, which determine whether an herb is safe and works better than a placebo. Thereís sketchy clinical trial evidence on another 50 or so botanicals. 

  • Also, keep in mind that the herbal industry faces questions about the quality and consistency of its products. Unlike products in Germany, where herbal tinctures and extracts are standardized, herbs in this country may vary ten thousand fold in active ingredients. 

  • Itís best to get advice on herbs from knowledgeable people, such as physicians or pharmacists whoíve taken courses on herbal remedies.

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Smokers At High Cancer Risk From Radon 
August 13, 1999 

Those at highest risk from exposure to radon -- namely smokers -- are the least likely to test their homes for the presence of the carcinogenic gas, federal researchers report.

They point out that the combination of smoking and radon exposure raises risks for lung cancer to very high levels.

How radon increases lung cancer risk in smokers is unclear, but the study authors speculate that "exposure to radon may cause lung cells to be more susceptible to the harmful effects of smoking."

"Eliminating (excess) indoor radon exposures... would prevent approximately 30% of radon-attributable lung cancer deaths," 86% of which occur among smokers, report experts at the Centers for Disease Control and Prevention (CDC). Their findings are published in the August 13th issue of the agency's journal, Morbidity and Mortality Weekly Report.

Radon is a colorless, odorless gas created through the decay of naturally occurring radium, an element found in rock deposits throughout the world. According to the US Environmental Protection Agency, about 10% of US homes contain radon concentrations above acceptable levels.

According to the CDC, about 10% to 14% of all US lung cancer deaths are attributed to radon exposure -- making it the second-leading cause of lung cancer death after smoking. Health officials have long urged homeowners to obtain store-bought test kits to measure household radon exposure levels.

In their current study, the CDC examined National Health Interview Survey data on nearly 41,000 US homes.

They found that "during 1993-1994, an overall mean of 5.5 million (6.7%) households tested for radon." Households with smokers were less likely to be tested than households without smokers, according to the researchers, with testing rates of 5.9% and 7.1%, respectively.

This is unfortunate, CDC officials say, since smoking and radon exposure seem to work in 'synergy' to push lung cancer risks even higher. Earlier in the decade, US health officials set a goal of increasing radon-testing to 40% of all US homes by the year 2000, and to 50% in homes inhabited by smokers. "The findings in this report suggest that these goals probably will not be met," the authors conclude.

Home test kits for radon are available at many hardware and home supply stores. In homes with higher-than-acceptable radon levels, exposures can be reduced by such measures as sealing basement floors or improved ventilation.

SOURCE: Morbidity and Mortality Weekly Report 1999;48:683-686.

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High School Smoking On Rise In Some States 
August 13, 1999 

In 6 out of 11 states investigated, smoking among high school students has increased by as much as 50%, according to a report released Thursday by the Centers for Disease Control and Prevention (CDC) in Atlanta.

CDC researchers analyzed data from the Youth Risk Behavior Survey, conducted in 11 states during the 1990s. In six states, the number of students reporting "current smoking" and "frequent smoking" increased, survey results show. Smoking before age 13 remained stable in 9 states and declined in the other 2 states surveyed.

States in which current smoking increased were Alabama, Massachusetts, Mississippi, Montana, South Carolina, and South Dakota. Of these, South Carolina had an highest increase, 51%, with South Dakota a runner up at a 42% jump.

"Too many youth are smoking," study author Dr. Laura Kahn of the CDC told Reuters Health. She attributes the increases to sociodemographic factors, to a lack of tobacco prevention programs and to poor enforcement of tobacco product access laws, but the CDC researcher noted that "this was a study of trends and not causes."

""More than 80% of smokers begin before age 18," Kahn noted. "We can't expect immediate results from tobacco prevention programs, especially when you are reversing a trend," as seen in 6 states listed.

"To reduce tobacco use among youth, CDC recommends that states establish and sustain comprehensive tobacco-control programs," according to the report. "Comprehensive tobacco-control programs should reduce the appeal of tobacco products, implement youth-oriented mass media campaigns, increase tobacco excise taxes and reduce youth access to tobacco products... These programs are most effective when linked to community-wide programs involving families, peers and community organizations."


SOURCE: Morbidity and Mortality Weekly Report 1999;48:686-692.

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TV Linked To Poor Coping Skills In Boys 
July 27, 1999

Children who watch television for prolonged periods may be more prone to injure themselves and less likely to develop the tools to cope with stressful situations than kids whose TV-viewing is curbed, according to a new study of boys. 

While recent research suggests that children who are exposed to violent TV programs and videos are more likely to be aggressive, an ongoing study indicates that such TV programs may contribute to making kids more of a danger to themselves. 

This danger does not mean that kids are copying the dangerous stunts performed by screen heroes, but rather that they've learned that harmful actions are consequence-free, said Christine Kennedy, a professor at the School of Nursing at the University of California at San Francisco. 

In a study of Hispanic boys growing up in San Francisco's Mission neighborhood, Kennedy found that as Latino families integrated into American society, young males became more drawn to risk-taking behavior. 

"[What] changed was they were watching more TV as their families became more acclimated to American culture. The more TV boys watched, the more they had behavior [leading to injury]," said Kennedy. 

Conflict resolution on TV is usually violent or settled by an external force that fails to teach children how to cope with difficult situations, she said. Compounding this issue is the finding that extended TV-watching seems to be more prevalent in households where there is a high degree of stress, according to Kennedy's clinical observations. 

More specifically, these poor coping skills may result from the fact that TV-watching is a solo activity that may prevent children from developing relationships with others, according to Michele Cooley-Quille, a professor of mental hygiene at Johns Hopkins School of Public Health in Baltimore. 

Because TV is entertaining, children may become less motivated to pursue friendships, even though humans are social animals who greatly benefit emotionally and intellectually from interpersonal relationships, said Cooley-Quille. Instead, TV offers a "false sense of interpersonal relations" that makes viewers feel they are developing relationships with characters in TV programs. But unlike real life, these TV relationships are not reciprocated and that can contribute to a pervasive sense of loneliness, Cooley-Quille added. 

In a study published last year, Spanish researchers from the University of Granada found a parallel between the amount of time children spent watching TV and their risk of injury. In a survey of 221 children admitted to hospital for injury treatment, the researchers found that the risk of injury rose by 34 percent for every hour spent watching TV. 

Lead researcher Dr. Jose Uberos said the higher incidence of injury can be explained by the fact that children who watch TV excessively "receive a greater number of distorted messages about reality that become converted into false real-life experiences and distort the child's adaptation to his or her surrounding environment." 

Paradoxically, the children who spend most of their free time watching TV at home seem to be at greater risk of injury than those children who spend their leisure time engaged in potentially dangerous sports and activities, the Spanish researchers concluded. 

Figures from the National Center for Health Statistics in Hyattsville, Md., show that one-quarter of American children watch four of more hours of TV per day. 

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Breast-Conserving Cancer Surgeries Underutilized 
August 13, 1999

More US women with breast cancer are having breast conservation surgery, but rates of this type of surgery are still below recommended levels, report cancer researchers. 

In 1990, the National Institutes of Health (NIH) recommended breast conservation surgery, where the cancer and surrounding tissue are removed, sparing the breast, for the majority of patients with Stage I or II breast cancer. 

``Attention to specific barriers may be necessary before the majority of women with Stage I and Stage II breast carcinoma receive (breast-conserving) treatment,'' conclude researchers led by Dr. DeAnn Lazovich, of the University of Minnesota in Minneapolis. Their findings are reported in the August 15th issue of the journal Cancer. 

In a statement, Lazovich noted that one 1985 clinical trial ''showed breast conservation to be as effective as mastectomy.'' 

Rates for breast-conserving therapies rose significantly after the NIH recommendation, Lazovich said, prompted by ``the widespread publicity of (study) results through news coverage and direct mailings to physicians.'' 

Lazovich's team used data collected in National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program to examine trends in the use of breast conservation therapy with or without postoperative radiation therapy, before and after the 1990 NIH recommendation. 

According to the researchers, the proportion of women with Stage I (defined as a small tumor localized to the breast) and II (a larger tumor, or with spread to nearby lymph nodes) breast cancer who received breast conservation therapy has increased substantially since the 1990 recommendations. But despite this increase, breast conservation therapy remains underused in women with Stage II cancers, the authors say. 

Between 1985 and 1989, the proportion of women who received breast conservation therapy remained relatively constant, at 35% in women with Stage I tumors and 19% in those with Stage II breast carcinoma. Beginning in 1990, the use of breast conservation therapy increased annually to 60% in women with Stage I cancer and 39% in Stage II patients in 1995. 

Use of breast conservation therapy varies widely by region, according to the study. In Stage I patients, for instance, the proportion of women receiving breast conservation therapy in 1995 ranged from 41.4% to 71.4%, depending on where in the country they were treated. Between 1990-1995, cancer registries in Iowa and Utah reported the lowest percentage of breast-conserving therapies for women with Stage I cancers (26.7% and 35%, respectively), while Connecticut and San Francisco registries reported the highest rates (50.8% and 55.6%, respectively). Similar variation was also observed among Stage II patients. 

The findings indicate that barriers to the use of breast conservation therapy remain, Lazovich and her colleagues conclude. They list some of these barriers as a ``lack of access to facilities where radiation therapy can be given postoperatively... variation in women's preference for breast conservation surgery, and variation in physicians' attitudes about breast conservation surgery.'' 

SOURCE: Cancer 1999;86:628-637. 

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Young Women Advised To Avoid Douching 
August 13, 1999 

Teen girls and young women should be discouraged from vaginal douching because the practice increases the risk of certain disorders of the reproductive tract, say US researchers.

More than 15% of adolescents and young women in the US use douches, even though the products have been associated with a greater risk of pelvic inflammatory disease, tubal pregnancy, or bacterial vaginosis.

Although douches have not been conclusively shown to be the cause of such problems, no benefit of douching has been found either, according to the report in the August issue of the Archives of Pediatric and Adolescent Medicine.

Therefore, the practice should be discouraged in adolescent girls and young women, report study authors Jeanne Merchant and colleagues at the University of Alabama at Birmingham.

"Because of the high rates of health problems linked to douching, it is urgent that health professionals discourage this practice, particularly among adolescent girls and young women," they write.

The investigators did an analysis of available literature on douching practices and found that almost 16% of girls aged 15 to 19 surveyed in 1995 said they douched regularly, as did 28% of those aged 20 to 24.

The practice was more common among African-Americans than other ethnic groups. The same survey found that 37% of black females aged 15 to 19 reported douching compared with just 11% of whites.

Douching has been shown to change vaginal flora, the beneficial bacteria that keep the vagina at a slightly acid pH. While the normal bacteria rebound within 72 hours of douching, repeatedly using certain products may allow the overgrowth of disease-causing organisms, according to the report.

These changes may promote the development of bacterial vaginosis, an overgrowth of bacteria in the vagina that is the most common cause of discharge and odor. More seriously, douching is associated with pelvic inflammatory disease, an infection of the uterus and fallopian tubes that can damage fertility, as well as ectopic pregnancies, in which a fertilized egg implants outside the uterus, a condition that can be life-threatening.

However, it is not yet clear if women with sexually transmitted diseases -- who are at greater risk of both conditions -- are more likely to douche, or if the products themselves increase the risk of such condition.

More study is needed to answer remaining questions about the health effects of douching, according to the researchers.

"However, federal agencies and professional societies should not wait for the results of these studies," the authors conclude. "They should issue cautionary statements on the basis of research findings that are currently available."

SOURCE: Archives of Pediatric and Adolescent Medicine 1999;153:834-837.

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Women Underestimate Osteoporosis Risk 
August 13, 1999 

Most women over age 50 underestimate their risk of developing osteoporosis -- even those who already have symptoms of the bone-thinning disease, according to a new survey conducted for Prevention magazine.

Studies have shown that almost 50% of women will suffer a fracture due to osteoporosis in their lifetimes.

But a telephone poll of 1,000 women age 30 and over found that 86% of women age 50 and over did not think that it was likely that they will develop osteoporosis.

Furthermore, 82% of the group who already have symptoms of bone loss -- such as back pain, stooped posture, and loss of height -- still did not think they were at high risk for the disease.

Only 42% of older women surveyed had discussed their osteoporosis risk with their physician, and 79% said that they had never been referred for a bone mineral density test to evaluate bone strength.

The good news is that of those over age 50, 76% reported consuming a diet high in calcium and 65% said they participate in weight-bearing exercise, which reduces osteoporosis risk. But a diet with adequate calcium intake and regular exercise may not be enough to prevent osteoporosis after menopause, the survey authors say.

The survey also showed that 40% of women age 50 and over put good health and fitness at the top of their wish list, ranking it above romantic relationships, family, and career. Nearly all (98%) say that being independent is very important to them.

"Women have worked so hard to take charge of their lives -- but our survey clearly shows they don't realize how osteoporosis, a preventable disease, can take away their hard-won independence in the years ahead," Dr. Holly McCord, nutrition editor for Prevention magazine, said in a statement.

The National Osteoporosis Foundation recommends bone mineral density testing for all women over the age of 65 and for women under the age of 65 who have risk factors for bone loss other than menopause.

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Dieting May Erode Bone Mineral Density 
July 29, 1999

Dieting may reduce bone mineral density in the spine and hips -- thereby increasing the risk of osteoporosis and bone fracture, according to researchers.

The findings may have ``widespread implications,'' explain researchers led by Dr. Loran Salamone of the University of Pittsburgh, since ``about 50% of American women consume weight-reduction diets at some point.'' Their findings are published in the July issue of the American Journal of Clinical Nutrition.

Salamone's team points out that the bone mineral density (BMD) of heavier women tends to be greater than the bone density of thin women, and ``heavier women tend to have a lower risk of osteoporosis and related fractures than do slender women.''

The authors theorized that weight-reducing diets might have an impact on bone density. To test this idea, they compared the bone density of 115 premenopausal women placed on an 18-month low-fat diet with that of 121 non-dieters. Dieters lost an average of 7 pounds while on the diet.

The investigators report that ``diet- and exercise-induced weight loss was associated with a 2-fold greater rate of loss in hip BMD.'' A similar but less significant association was noted for spine bone mineral density.

Exercise has been shown to be protective of bone density. However, Salamone and colleagues found that while exercise slowed bone loss in the spines of dieting women, it did not appear to protect the bones of the hip.

How might dieting reduce bone density? Reductions in weight lead to a decrease in the stress put on bones, the authors write. This 'lightening of load' might trigger a proportional thinning of bone structure, they explain.

In a related statement, Salamone explained that ``women need to evaluate the risks and benefits of their weight-reduction program.'' Exercise can help, and Salamone believes ``the ideal program is one that achieves weight loss while maintaining skeletal integrity.''

SOURCE: American Journal of Clinical Nutrition 1999;70:97-103.

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Exercise For Low Back Pain Offers Long-Term Gains 
July 30, 1999

If you suffer from low back pain, you have probably been told that you need to be up and moving. You have probably also worried that exercise might worsen your condition. 

But according to a report published in the July 31st issue of the British Medical Journal, patients with low back pain who participate in just a few weeks of exercise classes may reap benefits that include less distressing pain and a greater level of normal activity, even one year later. 

Dr. Jennifer Klaber Moffett and colleagues from the University of York and the University of London, both in the UK, studied 187 adult men and women who had complained of low back pain for 1 to 6 months. Each patient was assigned either to a ''control'' group that received no treatment other than that provided by their general practitioner, or to a progressive exercise program that included stretching and strengthening exercises, relaxation, and education about back care. These patients attended eight 1-hour classes over a 4-week period. 

After 6 weeks, the exercise group reported less distressing pain and less disability than the other group. At 6 months, the differences between the two groups were even greater, and at 1 year, greater still. By the end of 1 year, 64% of the exercise group had improved at least 3 points on the 24-point disability questionnaire, compared with 35% of the non-exercise group. 

In addition, during the 1-year follow-up period, patients who took the exercise classes tended to make less use of healthcare resources than those in the control group, and missed significantly less work -- 378 days compared to the other group's 607. 

In an interview with Reuters Health, Moffett emphasized that ``people need to overcome their fear of damaging their backs through movement and physical activity. The back does not like static postures but it does like movement.'' 

Moffett added, ``We need to start exercise at a low level and gradually build up the amount we do. It's not about a cure -- it's about learning to cope and getting on with life in spite of back pain. When people focus less on the pain, they usually do better.'' 

SOURCE: British Medical Journal 1999;319:279-283. 

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Bone-Thinning Disease, Osteoporosis, Can Strike Teen Athletes, Anorexics 
July 30, 1999 

Teens who over-exercise or under-eat may be at risk of an early form of a debilitating condition usually associated with postmenopausal women. 

Speaking at a symposium at Stanford University in Stanford, Calif., held in conjunction with the national conference on advances in perinatal and pediatric nutrition, which ended on Wednesday, Dr. Laura Bachrach said that prevention of the bone-thinning disease osteoporosis "must begin from the first day of life." 

"We know that peak bone mass is gained between the ages of 20 and 30 and that this serves as a bone bank for the remainder of your life. The larger the bone bank account, the longer [you can withstand] withdrawals before you get into trouble," said Bachrach, who is a professor of pediatric endocrinology at Stanford University. 

According to the Washington, D.C.-based National Osteoporosis Foundation, one in two women and one in eight men older than 50 will have an osteoporosis-related fracture in their lifetime. Common sites for osteoporosis fractures are the hip, spine, wrist and ribs. One in four hip-fracture patients older than 50 die within one year of diagnosis. 

Teens at high risk of osteopenia, a precursor of osteoporosis, include girls who exercise too rigorously, a factor that can cause a decline in the production of estrogen, a hormone implicated in healthy bones. Other high-risk youngsters include anorexics, whose low-calorie intake weakens bones, and asthmatics treated with steroids, a class of drugs that can interfere with the production of a key bone matrix protein. 

While osteoporosis is marked by thin, fragile bones that can easily fracture, people diagnosed with osteopenia typically have no history of fracture despite reduced-bone density. 

Although 60 to 80 percent of an individual's susceptibility to osteoporosis is genetic, Bachrach believes it's important that physicians focus on the 20 to 40 percent factor that is lifestyle-related. 

For teens, "deposits" in the bone bank should be made by consuming a calcium quota of 1,200 to 1,500 milligrams per day, the equivalent of four to five glasses of milk, said Bachrach. Consuming food and beverages with a high salt content increases the amount of calcium lost in urine and stools. A teen who eats a ham sandwich and pickle, for example, would need to drink an additional glass of milk to compensate for calcium loss. 

Weight-bearing exercise also strengthens bones, but it's important to differentiate between activities like swimming that benefit cardiovascular health and those that maximize bone acquisition. Running, jumping and gymnastics are optimal exercises for bone health, said Bachrach. 

Once bone density is lost, it is difficult if not impossible to restore. In a study published last year in the European Journal of Endocrinology, Japanese researchers led by Dr. Mari Hotta of the Tokyo Women's Medical College found that anorexics who gained weight did not experience a parallel increase in bone density. 

Other studies have found that prescribing estrogen to athletes and anorexics with estrogen-deficiency had little or no effect on reversing osteopenia. 

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Walks Help Boost Memory, Judgment 
July 28, 1999

For many of his 88 years, Harry S. Truman left reporters gasping for breath as he offered sharp-tongued commentary during his brisk morning walk. 

John Glenn credits his celebrated return to orbit at age 77 to daily exercise, including a two-mile power walk. 

Now, brain researchers finally are catching up with senior pedestrians. 

A new study suggests that taking an invigorating walk gives older people's brains a good workout, boosting memory and sharpening judgment. 

Anaerobic exercise ó stretching and weightlifting ó did not produce similar cognitive improvements. The experiment was conducted at the University of Illinois and reported in Thursday's issue of the journal Nature. 

The mental benefits of walking were especially significant, researchers said, because the senior citizens had not exercised regularly before joining the study. 

"People who have chosen a lifetime of relative inactivity can benefit mentally from improved aerobic fitness," said the study's lead author, cognitive neuroscientist Arthur Kramer. "It's never too late." 

Researchers recruited 124 sedentary men and women ages 60 to 75. They were randomly assigned to either a walking program or an anaerobic regimen of stretching and muscle-toning. 

The experiment lasted six months. Walkers eventually were completing an hour-long loop around the university's Urbana-Champaign campus three times a week. 

Kramer and others administered a variety of simple tests to gauge the participants' ability to plan, establish schedules, make and remember choices and rapidly reconsider them if circumstances changed. 

Neurologists call these brain functions "executive control processes" because they help a person live independently. They are controlled in the brain's frontal and prefrontal lobes. 

"These areas of the brain decline the earliest with aging," Kramer said. "So executive control is more severely affected by the normal aging process than other brain functions." 

Among other things, participants were shown alternating letters and numbers, and asked to quickly determine between vowels and consonants, and odd and even numbers. The exercise is known as task switching. 

The walkers' ability to switch tasks improved by 25 percent, while the non-walkers' showed little improvement. 

Previous studies have shown that regular exercise may reduce the risk of developing Alzheimer's disease later in life, possibly because exercise enhances the production of certain hormones and other protective compounds in the brain. 

But those studies involved only people with long-term exercise habits. And Alzheimer's involves the death of brain cells, which is different from more generalized memory lapses that frequently accompany aging. 

Experts who reviewed the Illinois study said it is not clear how walking might stimulate memory and planning ability. 

"It might just be more a function of people in the study interacting with other people," said Dr. William Thies of the Alzheimer's Association. "Being isolated is bad for your health and bad for your day-to-day functioning." 

Answering that question is the goal of the Illinois experiment's second phase, which began this week. Researchers are taking magnetic resonance images of participants' brains to see if there is enhanced blood flow in their executive control centers, and if it corresponds to the walkers' improved test performance


 

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