A New Profession? Try Orthopaedic Surgeon.

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Total Knee replacement : AP view (Xray).

Total Knee replacement : AP view (Xray). (Photo credit: Wikipedia)

Should you consider a new profession then an orthopaedic surgeon specializing in knee replacements could be a very good idea. Consider the facts:

There was an extraordinary 400% increase in the number of total knee replacements from 1971 to 2003 as compared to an increase of (only) 55% in the number of hip replacements in the same period!

The number of primary knee replacements are expected to increase nearly 8 times from 450,000 to 3.48 million by 2030! But that is not all.  An increasing number of the artificial joints will have to be replaced or “revised”. From 2005 to 2030 it is estimated that the increase in revisions of total knee replacements will come to an amazing 600% compared to hip replacement revisions of (only) 137%!  (Renaissance Orthopaedics Jan. 2008).

 

More and more younger patients are involved. In 1999, 30% of knee replacements were for those under 65. In 2008 the number was already 41%.  There is a higher rate of failure and earlier revisions in younger patients. (Am. Acad. Orth. Surg. Now April 2012).  After only 5 years, 8% of the replacements in the under 55 age group had failed! (Acta Orthop. 81(4):413 2010).

What are we doing to our knees?  Overweight and obesity obviously put more strain on the knees. But population growth and obesity cannot explain the rapid growth of total knee replacements in the last decade ( J. Bone Joint Surg. 94(3):201 2012). The major causes seem uncertain.

Almost certain seems to be the expected shortfall of orthopaedic surgeons which is projected to be so dramatic that  by 2016, 72%  of those patients that require total knee replacements  will, (in the US), be unable to obtain them! (AAOS Ann. Meeting 2009)

All This Nothing We’re Doing Is Actually Killing Us

All this nothing we’re doing is actually killing us.

via All this nothing we’re doing is actually killing us.

English: On overweight man's waistline.

English: On overweight man’s waistline. (Photo credit: Wikipedia)

High praise indeed- and supporting this argument the Economist published a special report on “Obesity” (Dec. 15th 2012). Roughly 1/3 of the world’s adult population is either overweight or obese. It is estimated that this number will increase to 2/3 of the world’s adult population by 2030 (Jiang He at Tulane University).

This could have devastating consequences for the human race. What was not mentioned is the fact that obesity shrinks the brain.  It has been estimated that 4% of the brain mass is lost with overweight and a staggering 8% with obesity. What would the future for our grandchildren look like, with only a third of the world’s population having normal brains?

S.O.S. – “Save Our Sanity!”

High Intensity Resistance Training

3-d model of IGF-1

3-d model of IGF-1 (Photo credit: Wikipedia)

Although there seems to be considerable research on the benefits of mild aerobic exercises in this regard, there are suggestions that vigorous aerobic activity (A.J.H. P 26(6):333 2012),  high intensity training and diet ( J. Alzheimer’s Disease 28(1):137 2012),  or resistance training (Arch. Intern. Med. 172(8):666 2012) are beneficial.

Also insulin-like growth factor (IGF-1), hormones and second messengers encourage neurogenesis, synaptogenesis and angiogenesis in the brain, which improve brain health. (Klinik Psikofarmakoloji Bulteni suppl. 2 21:91 2011). However, increased production of IGF-1 and hormones, such as testosterone, occur as a result of or hypertrophy training and not with aerobic or endurance training.

In addition, multi-tasking  and neuromuscular training have been shown to be beneficial for cognitive functioning.

There is not enough done to promote active lifestyles of the aged.

Gym Free-weights Area Category:Gyms_and_Health...

Gym Free-weights Area Category:Gyms_and_Health_Clubs (Photo credit: Wikipedia)

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There is not enough done to promote active lifestyles of the aged. The main problem is the fact that too little is known. Research on physical activity, diet or even the effect of work on health in old old age is practically nonexistent above the age of 70. It is a shocking fact that there are far too few healthy individuals above the age of 80 to be able to conduct meaningful research.

Responsibility rests with research facilities and promotion by government as well as health agencies. Most private health clubs do little or nothing to attract older people as members in spite of the fact that the aged have sufficient time and money.

Research has shown that older people prefer to train in groups of their own age. Besides this, the older member should be tested and goals set. The member should be retested at regular intervals and the results sent to their physician.

The results would become part of the patient’s medical history. Membership could in certain cases, as in Japan, be restricted to those above 70, or have an off-peak membership for the elderly. Ideally the coaches should also be of the same age group. Treatment of disease by exercise is receiving more attention by the medical profession but there is an extreme lack of cooperation between physicians and health clubs . This could be a huge opportunity. Almost all over 65 have one or more chronic diseases.

Some clubs in Germany are licensed to treat diabetes with exercise. Clubs could institute a food service together with supplements. There is so much more that clubs could do to attract more older people and I would be happy to discuss individually with every leisure chain CEO what could be beneficial.

Marathon

Participants in the 2010 Boston Marathon in We...

Participants in the 2010 Boston Marathon in Wellesley, just after the halfway mark (Photo credit: Wikipedia)

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Although the Boston Marathon was marred by tragedy the Boston and London Marathons were glorious symbols of human endurance, determination, and perseverance.

Participation at a Marathon requires training of about 4 months prior to the event. With a peak of less than 56km per week training there seems to be a risk of some heart damage or dysfunction. Intensive training is really necessary.

Although deaths have been recorded, the number is relatively small at 1:50,000 (J. Am. Coll. Cardiol. 28(2):428 1996) and is comparable to athletics at 1:43,000 (Nat. Coll. Athletic Ass.). Women have a far lower risk of death at 1:200,000 at Marathons. (B.M.J. 47:68 2013).

However those participants with a sickle cell trait are at risk, as they have a 37 times higher death rate (Br. J. Sports Med. 46:325 2012). The average age of death was 41.   ( B.M.J. 335:1275 2007).  The oldest recorded death was at about 57.

Thus it seems that, in spite of the fact that many runners were found to be positive for the Troponin test after the race which usually indicates myocardial infarction, the old and very old Marathon participants seem to be statistically almost risk free!

While the record is just over 2hrs, most participants aim for about 4hrs.  The oldest record holders are Mr Singh at 100 at 8hrs 11mins and Ms Burrill at 92 with 9hrs 53mins. To keep going for 8-10 hours in extreme old age is truly amazing. The old that complete a marathon have exceptional endurance and extraordinary determination.

Should we, in old age, emulate and follow their example as has been suggested by some physicians?

I personally think not, in spite of the fact that risks seem to be minimal. The first runner’s source of energy is glycogen (carbohydrate). Lipids (fat) become the primary source of fuel once the glycogen stores are depleted. This is followed by glucogenisis whereby calories are made available from protein by extracting amino-acids from muscle tissue (Med. Sci. in Sports & Exercise 19:179 1987). Thus during the last phase of the Marathon, muscle protein breaks down (Adv. Nutr. & Human Met. 5th ed. 2009). In other words not only fat but muscle tissue is broken down during a Marathon.

It should be no surprise that the Marathon elite look “like matchstick men”, lacking fat and muscle mass.  Muscle glycogen depletion also causes (temporary) stress on the immune system. Given sufficient time the loss of muscle mass in the young can be compensated by hypertrophy exercises. But due to reduced protein synthesis this is extremely difficult in old age. Sarcopenia or the loss of muscle mass is the major cause of disability in old age.

As participation in a Marathon causes the loss of muscle mass and weakening of the immune system at the same time, it does not sound like something that can be universally recommended for the aged runner.

Humanity is being compromised by inactivity

Health

Health (Photo credit: 401(K) 2013)

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It seems that most attention is focused on what I do and not why I do it.  The main object of what I do is not only to have a beach body but also to draw attention to the fact that huge numbers of humans are destroying their brains and mental capacity.

There was recently a supplement in the Economist on Obesity. There is now a briefing on “Innovation Pessimism”. To summarise; Innovation and new technology have stopped driving growth! While the Economist seems to think that red tape is a culprit, in my mind the cause could be inactivity – this is a subject that no-one seems to have touched upon.

We know that physical activity has a direct impact on the brain; we know that inactivity has increased so much that it is now the 4th major cause of death; we know that in 1950, the average R&D worker in the US contributed almost 7 times more ‘total factor productivity” than in 2000 and, we know that in 1970 real output per person increased 3% per year whereas in 2000 the increase was less than 1%.

Our whole capacity to solve the huge problems that face humanity are being compromised by inactivity which affects the brain.  Slowly, more attention in the media is being given to the enormous future health costs. But almost nobody points out that we could prevent disaster just by small changes in life style

Quoting the Financial Times, Jan 22nd 2013 page 7, re America’s debt dilemma: “It is in the 2020s when the big spending will start. The baby boomers into their 70s will start getting sick….  The revenue and spending paths will become irreconcilable. Debt will pile up – and quickly”

“Fitch, the ratings agency, has served notice to many countries that an aging population threatens their credit rating.”  (Economist Vol. 406 No. 8823 Feb 16-22 2013 p.22 ).  My questions are simple;

  • Does nobody care about making older people healthier and economically productive?
  • Or turning them into a positive economic factor?

At present, old people burden the health system and in doing so, they not only cause huge costs but are also responsible for lower credit ratings!

In the UK, in the space of 10 years from 2001-2 to 2011-2, health costs have more than doubled from £59.8 billion to £121.4 billion (Economist Vol. 406 Nr.8826). The aged are probably the main cause of the enormous £60 billion increase,- and the number of the aged is continuously increasing.

Humanity is faced with huge problems that can only be solved by healthy brains in healthy bodies. Yet we are destroying our health with our lifestyle, poor diet and lack of exercise. We all can and must take more responsibility for the health of our own bodies and minds and thus humanity.