The Archives of Internal Medicine has published the results of a two year study that examined the effect of physical activity on maintenance of weight loss.
201 obese women aged 21-45 years with a body mass index of 27 to 40 were randomly assigned to one of four physical activity interventions based on physical activity energy expenditure (1000 vs 2000 kcal/wk) and intensity (moderate vs vigorous) in combination with a calorie controlled diet.
Weight loss at 6 months and 2 years did not differ between any of the groups however a post-hoc analysis showed that individuals who lost more than 10% body weight over 2 years reported higher levels of activity (equivalent to 40 minutes per day) than those who lost less than 10% body weight in the same period.
The authors conclude that, "physical activity, in combination with a reduction in energy intake, is important in allowing overweight women to sustain a weight loss of more than 10%". They also point out that patients are likely to require assistance to achieve this level of physical activity.
Action: Clinicians should ensure they are aware of local programmes to encourage sustained physical activity. In combination with a healthy diet long-term weight loss is possible.
In the past two days there has been news coverage of the benefits of statins and angiotensin receptor blockers (ARBs) in the prevention of dementia.
The first story details the results of an observational study of approximately six million people treated for high blood pressure between 2001 and 2006. This study found that people treated with ARBs were 40% less likely to develop dementia. Additionally, people who already had dementia were 45% less likely to worsen as measured by development of delirium, being admitted to a nursing home or dying prematurely.
The Alzheimer's Society has responded to this promising news by recommended that a "proper clinical trial is now needed to investigate" these potential benefits.
The second story details the results of a population based study published in Neurology. The study involved 1,674 Mexican Americans aged 60 and over who did not have dementia at the start of the study. Of this group, 27% took a lipid lowering therapy at some point during the study.
After correcting for several factors including education, smoking status and history of stroke or diabetes it was found that those who had used statins were about half as likely to develop dementia. (Hazard Ratio 0.52, 95% CI 0.34 - 0.80)
Again the Alzheimer's Society has responded cautiously stating that, "jury is still out on how effective they [statins] are" and that professional medical advice should be sought.
Action: Clinicians may be asked about these developments by patients. In both cases more research is required to ensure that these observed benefits are real and that any benefits are greater than the risks of treatment.
The Department of Health has announced (PDF) that the human papillomavirus vaccination programme is to be extended to include young women aged 17-18.
The decision to use Cervarix® has been criticised but this announcement does start to explain why the programme is using an apparently inferior vaccine.
Action: Clinicians should be aware of the extension to the vaccination programme.
The European Medicines Agency has recommended restrictions for two quinolone antibiotics, moxifloxacin and norfloxacin.
The press release for moxifloxacin recommends that this antibiotic should only be prescribed in the treatment of acute bacterial sinusitis, acute exacerbation of chronic bronchitis and community-acquired pneumonia when other antibiotics cannot be used or have failed. These recommendations are in response to emerging safety concerns about an increased risk of adverse hepatic reactions. A question and answer document contains information for patients and clinicians.
The press release for norfloxacin recommends that the licence for this antibiotic in the treatment of acute or chronic complicated pyelonephritis be withdrawn because the benefits of these medicines do not outweigh their risks in this indication. Usage in other indications is unaffected. A question and answer document contains information for patients and clinicians.
Action: Clinicians should be aware of the recommendations and ensure that use of these antibiotics falls within the new recommendations.
The National Prescribing Centre (NPC) has published MeReC Extra 34 (PDF).
This MeReC covers the recent revisions to the British Asthma Guideline from SIGN and BTS, additional data from two studies adding to the growing evidence that routine self-monitoring of blood glucose is unlikely to be beneficial in patients with type 2 diabetes who are not treated with insulin.
There is also a discussion of the impact on current practice of a recent systematic review that provided limited evidence that montelukast may potentially be safer than inhaled salmeterol in the long term. Long acting beta-agonists are still first line choice at step 3 of the Asthma Guidelines however attention is drawn to recent safety advice from the Medicines and Healthcare products Regulatory Agency.
It is recommended that long acting beta agonists (formoterol and salmeterol) should:
- Be added only if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately
- Not be initiated in patients with rapidly deteriorating asthma
- Be introduced at a low dose and the effect properly monitored before considering dose increase
- Be discontinued in the absence of benefit
- Be reviewed as clinically appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved
Action: Clinicians involved in the treatment of respiratory illness or diabetes will find this MeReC Extra to be useful and informative.