Important Articles Regarding Behavioral Interventions for Cancer, Heart Disease
and Other Diseases
1. "Cancer & Exercise: Prevention & Recovery."
The resources on this page are intended to help people with cancer, their loved
ones, and their clinicians find recent research on the relationship between
cancer and exercise, particularly the use of various kinds of exercise to reduce
the risk of cancer, to decrease fatigue and other side-effects of cancer
treatments, and to promote recovery.
This new page of resources provides full citations of 163 recent articles
published within the last 3 years.
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SEE: "Metabolic Syndrome and Mental Illness, Weight Gain and other Unhealthy
Attributes increase risk of diabetes and heart disease."
Harvard Mental Health Letter, Vol 28, Number 2, August 2011
Portions of the above referenced article are copied below from
Metabolic syndrome and mental illness
Heart disease is the No.1 killer of people with mental illness-in large part
because of the high prevalence of metabolic syndrome in this population. People
with metabolic syndrome have at least three of five closely related conditions
(see sidebar). (snip) When several occur
together, they interact to raise the stakes even higher. People with metabolic
syndrome are five times more likely than healthy adults to develop diabetes and
twice as likely to develop heart disease.
Although metabolic syndrome affects nearly a quarter of all Americans, roughly
50 million people-those with mental illnesses (snip) are especially vulnerable. Antipsychotic medications in particular can
cause significant weight gain. Other contributing factors include smoking,
inadequate nutrition, lack of exercise, and limited access to quality health
care.
(snip)
Weight gain leads to insulin resistance-a condition in which the
body cannot use insulin (the chief hormone that enables cells to convert blood
sugar into energy). As insulin resistance worsens, the pancreas works-overtime
trying to produce more insulin and eventually becomes exhausted, leading to
chronically high blood sugar levels. That can cause diabetes, which damages
blood vessels throughout the body and dramatically increases risk of heart
disease.
Increasingly, clinicians are prescribing the diabetes drug metformin
(Glucophage) to promote weight loss and reduce insulin resistance in psychiatric
patients. Metformin works by blocking the liver's release of sugar into the
bloodstream while simultaneously reducing the body's resistance to insulin.
(snip) only a few
studies have evaluated its impact on people with psychiatric disorders.
(snip)
Two randomized controlled studies suggest that metformin may help people taking
antipsychotics to lose a modest amount of weight, and may also prevent their
insulin resistance from getting worse.
In one 12-week study of participants taking an antipsychotic, those who also
took metformin lost an average of 3 pounds, while those assigned to placebo
maintained their weight. Insulin resistance remained steady in participants who
took metformin, but increased in the placebo group. In another 12-week study of
people taking an antipsychotic, insulin resistance in the metformin group
remained stable but worsened significantly in the placebo group.
Other research has explored whether combining metformin with lifestyle changes
might produce even greater benefits. In one randomized controlled study,
researchers divided patients with schizophrenia into four groups: metformin
alone, a placebo pill alone, lifestyle intervention (consisting of education,
diet changes, and regular exercise) plus placebo, and the lifestyle
intervention-combined with metformin. While both lifestyle changes and metformin
helped when given on their own, the greatest weight loss occurred in patients
who received both interventions. Patients who took metformin while making
healthy lifestyle changes lost 7% of their starting weight on average, compared
with 5% for those who took metformin alone.
(snip)
(snip) ...it (metformin) may not be enough to
prevent metabolic disorder in psychiatric patients. For now, the best advice is
for clinicians and patients to take the following steps, based on traditional
treatment advice:
• Choose antipsychotics that are least likely to increase risk of metabolic
syndrome, such as ziprasidone (Geodon) or aripiprazole (Abilify).
• Monitor risk factors (that is, regularly measure weight, waist circumference,
blood sugar and cholesterol levels, and blood pressure).
• Switch to another antipsychotic or lower dosage if necessary.
• Adopt healthy lifestyle habits such as a nutritious diet, more exercise, and
smoking cessation.
(snip)
Anyone with three or more of the following attributes has metabolic syndrome:
• a large waist size (greater than 40 inches in men or 35 inches in women)
• high blood pressure (130/85 mm Hg or higher)
• low HDL (good) cholesterol (less than 40 mg/dL in men, and less than 50 mg/dL
in women)
• high triglycerides-a form of fat in the blood (150 mg/dL or higher)
• high blood sugar (a fasting level of 100 mg/dL or higher).
Ehret M, et al. "The Effect of Metformin on
Anthropometrics and Insulin Resistance in
Patients Receiving Atypical Antipsychotic
Agents: A Meta-Analysis:” Journal of Clinical
Psychiatry (Oct. 2010): Vol. 71, No. 10,
pp. 1286-92.
Faulkner G, et al. "Interventions to Reduce
Weight Gain in Schizophrenia:' Cochrane
Database of Systematic Reviews (2007):
Doc. No. CD005148.
For more references, please see
www.health.harvard.edu/mentalextra.