Yoga can be effective for chronic low back pain
Chronic lower back pain is very common—up to 20% of adults worldwide have long-lasting or recurrent lower back pain. The pain can make walking, sleeping, working, or doing daily activities difficult in severe cases.
Clinical guidelines recommend the use of non-pharmacologic treatments first, such as physical therapy or in-person yoga classes. This study examined whether virtual yoga classes would also be effective for the treatment of chronic low back pain. The findings show that participants who practised virtual yoga classes reported reduced back pain intensity and improved back-related function.
“Attending yoga classes in person can be challenging,” said Robert Saper, M.D., MPH, chair of the Department of Wellness and Preventive Medicine at Cleveland Clinic, and senior author of the study. “This research shows that a virtual yoga class program can be a safe and effective therapeutic option for the treatment of chronic low back pain.”
Researchers performed a 24-week randomized clinical trial that involved 140 eligible participants with chronic low back pain. The average age of the participants was 48 and more than 80% were female. The study participants were members of Cleveland Clinic’s Employee Health Plan from Northeast Ohio and Florida. The study was conducted from May 2022 through May 2023.
The research team conducted assessments to determine baseline measures, such as pain intensity score and back-related function using the Roland Morris Disability Questionnaire. Participants were then randomly assigned to either the “yoga now” group or the “yoga later” control group.
Seventy-one participants were enrolled in the yoga now group, which included virtual live-streamed yoga group classes for 12 weeks followed by a 12-week assessment period. Sixty-nine participants were enrolled in the yoga later control group and continued with their usual medical care. After the research ended, the yoga later group was offered non-study yoga classes.
Cleveland Clinic yoga instructors delivered a 12-week program designed to maximize effectiveness and safety, adapted for virtual delivery, and intended for participants with chronic low back pain.
Following the baseline assessment, participants were reassessed at six weeks, 12 weeks, and 24 weeks for low back pain intensity, back-related function, pain-medication use, and sleep quality.
At the end of the 12-week virtual yoga program, yoga now participants reported six times greater reductions in pain intensity scores and 2.7 times more significant improvements in back-related function compared with participants who had not taken the yoga classes.
Additionally, 34% fewer patients in the yoga now group reported using pain medication, and they reported 10 times greater improvement in sleep quality compared to the yoga later group. At 24 weeks, the improvements in pain and back-related function were sustained.
“Yoga offers a comprehensive approach to managing low back pain, a condition for which traditional treatments often fall short,” said Hallie Tankha, Ph.D., research faculty in the Department of Wellness and Preventive Medicine at Cleveland Clinic, and first author of the study. “Now we must work to increase access to this safe and effective treatment.”
Dr Saper plans to continue this vital research with a more extensive and more diverse sample of patients from multiple healthcare systems.
‘Weekend warrior’ exercise pattern may equal more frequent sessions for lowering cognitive decline
The research concludes that just one or two sessions of physical activity at the weekend—a pattern of exercise dubbed ‘weekend warrior’—may be just as likely to lower the risk of cognitive decline, which can often precede dementia, as more frequent sessions.
And it may be more convenient and achievable for busy people, suggest the researchers.
They say it’s important to identify potentially modifiable risk factors for dementia because a 5-year delay in onset might halve its prevalence. They add that nearly all the evidence to date comes from studies in high-income countries.
They, therefore, drew on two sets of survey data from the Mexico City Prospective Study: the first, which took place between 1998 and 2004, and the second, which took place between 2015 and 2019.
Some 10,033 people (average age 51) completed both surveys, and their responses were included in the analysis.
For the first survey, respondents were asked whether they exercised or played sports, and if so, how many times a week and for how long (in minutes).
Four groups were derived from the responses: the no-exercisers, the ‘weekend warriors’ who exercised/played sports once or twice a week, the regularly active who did so three or more times a week, and a combined group comprising weekend warriors and the regularly active.
The Mini-Mental State Exam (MMSE) assessed cognitive function during the second survey. A score of 22 or less out of 30 defined MCI.
In all, 7945 respondents said they didn’t exercise; 726 fulfilled the definition of a weekend warrior; 1362 said they exercised several times a week; and 2088 made up the combined group.
During an average monitoring period of 16 years, 2400 cases of MCI were identified. MCI prevalence was 26% among non-exercisers, 14% among weekend warriors, and 18.5% among the regularly active.
After taking account of potentially influential factors including age, educational attainment, smoking, nightly sleep, diet and alcohol intake, weekend warriors were 25% less likely to develop MCI than the no exercisers, while the regularly active were 11% less likely to do so. Those in the combined group were 16% less likely to do so.
When MCI was defined as an MMSE score of 23 or below, 2856 cases were identified. And MCI prevalence rose to 30% among the no exercisers, 20% among the weekend warriors, and 22% among the regularly active.
Compared with the no exercisers, weekend warriors were 13% less likely to develop MCI, while the regularly active and those in the combined group were 12% less likely to do so. The results were similar for both men and women.
The researchers estimated that, in theory, 13% of cases might be avoided if all middle aged adults exercised at least once or twice a week.
This is an observational study, so no firm conclusions can be drawn about causal factors. And the researchers acknowledge various limitations to their findings. For example, the survey respondents might not have been truly representative of middle aged adults and there were no objective measures of physical activity.
But there are several possible explanations for the seemingly protective effect of exercise on brain health, they explain.
“For example, exercise may increase brain-derived neurotrophic factor concentrations [molecules that support the growth and survival of neurons] and brain plasticity. Physical activity is also associated with greater brain volume, greater executive function, and greater memory,” they write.
“To the best of our knowledge, the present study is the first prospective cohort study to show that the weekend warrior physical activity pattern and the regularly active physical activity pattern are associated with similar reductions in the risk of mild dementia,” they continue.
And they go on to suggest that the findings “have important implications for policy and practice because the weekend warrior physical activity pattern m
COVID-19 sharply boosts risk for blood-fat disorders
A new study conducted by researchers at Albert Einstein College of Medicine, which involved over 200,000 adults, found that the COVID-19 pandemic led to a 29% increase in the risk of developing dyslipidemia. This condition is characterized by abnormal blood lipid (fat) levels. Seniors and individuals with type 2 diabetes were particularly affected, facing nearly double the risk of developing dyslipidemia. This condition is a significant risk factor for cardiovascular diseases, including heart attacks and strokes. The research was published in the print edition of The Journal of Clinical Investigation.
“Considering the widespread impact of the pandemic, the increased risk of dyslipidemia is a global concern,” said study leader Gaetano Santulli, M.D., Ph.D., an associate professor of medicine and molecular pharmacology at Einstein. “Based on our findings, we recommend that individuals have their lipid levels monitored regularly and consult with their healthcare providers about treatment options for dyslipidemia if detected. This is especially important for elderly individuals and patients with diabetes.” He emphasized that this advice is relevant for all adults, not just those formally diagnosed with COVID-19, as many people may have been infected without realizing it.
To provide context for these findings, it is estimated that 53% of U.S. adults had dyslipidemia before the pandemic. If COVID-19 has caused a 29% increase in the incidence of dyslipidemia, this would suggest that approximately 68% of Americans may now be at risk for having lipid abnormalities.
In two previous studies, Dr. Santulli and his team found that COVID-19 increased the incidence of new cases of hypertension and type 2 diabetes. “In those analyses, we demonstrated that the risk of developing these disorders remained high three years after the pandemic. Additionally, we observed a concerning rise in total cholesterol levels, which warranted further investigation,” said Dr. Santulli. In the latest study, the researchers first identified the incidence of dyslipidemia among over 200,000 adults living in Naples, Italy, during the three years before the onset of the pandemic (2017-2019). They then examined the incidence of dyslipidemia in the same group during the COVID-19 period (2020-2022). This analysis excluded individuals who had been previously diagnosed with dyslipidemia or who had been taking lipid-lowering medications.
The investigators found that COVID-19 raised the risk for developing dyslipidemia in the entire study group by an average of 29%. The increase was even higher among people over age 65 and those with chronic conditions, particularly diabetes and obesity, cardiovascular disease, chronic obstructive pulmonary disease, and hypertension. The findings are the most definitive to date because other studies—most of them linking COVID-19 with modestly increased risks for blood-lipid problems—used as control groups different populations or people thought to have gone through the pandemic without becoming infected. However, significant numbers of people classified as “COVID-free” actually developed the disease but were either never tested or didn’t seek medical care.
“Our study did not attempt to determine whether participants had tested positive for COVID-19,” Dr. Santulli said. “Instead, because we had been following this group for many years prior to the pandemic, we were able to measure COVID’s overall impact on the population by simply comparing levels of dyslipidemia in the same group before and after the pandemic. Any increase in dyslipidemia incidence would almost certainly have to be the result of COVID-19.”
How COVID-19 might have increased the incidence of dyslipidemia remains unclear. One possible explanation is a finding Dr. Santulli made in an earlier study: that SARS-CoV-2 (the virus that causes COVID) disrupts the function of endothelial cells, which line the inside of blood vessels throughout the body and play a critical role in regulating blood lipids.
A separate study found that COVID-19 is a powerful risk factor for heart attacks and strokes for as long as nearly three years after an infection. “This investigation, published online a month after ours, essentially confirms our observations in this study, since dyslipidemia is a major contributor to cardiovascular disease,” said Dr. Santulli. “It also suggests that tackling dyslipidemia should reduce the risk of cardiovascular disease in those who have had COVID.”
The researchers are now studying the effects of COVID-19 on cardiovascular-kidney-metabolic (CKM) syndrome, a recently described condition involving four connected medical problems—heart disease, kidney disease, diabetes, and obesity—all of which involve endothelial dysfunction.
The negative effect of high-fat diet on multiple sclerosis progression
Recent research published in the journal *Glia* has uncovered important connections between dietary choices and the progression of multiple sclerosis (MS). The study, led by Patrizia Casaccia, the founding director of the Advanced Science Research Center at the CUNY Graduate Center’s Neuroscience Initiative and an Einstein Professor of Biology and Biochemistry at the same institution, investigated the role of enzymes known as ceramide synthase 5 and 6. These enzymes are linked to the harmful effects of a diet high in palm oil on neurons in the central nervous system, which may lead to an increase in the severity of MS symptoms.
Multiple sclerosis (MS) is an inflammatory autoimmune disease characterized by significant damage to the myelin sheath, which protects nerves throughout the body. Current treatments aim to control the immune system’s response, but the exact mechanisms leading to neurodegeneration in MS are still not well understood. Previous research from the Casaccia lab and others has indicated that a high-fat diet can exacerbate the severity of MS symptoms. In their study, researchers investigated potential mechanisms by which a diet high in palm oil may negatively affect neuronal health.
Neuroprotection From Palm Oil-Induced Toxicity
In the experimental autoimmune encephalomyelitis (EAE) model of inflammatory demyelination, researchers discovered that mice with diets high in palm oil had a more severe disease course.
“We hypothesized that within neuronal cells, palm oil is transformed into a toxic substance known as C16 ceramide by specific enzymes called CerS5 and CerS6,” explained principal investigator Casaccia. “This ceramide causes damage to mitochondria, depriving neurons of the energy they require to combat inflammation in the brain. Consequently, we investigated whether inactivating these enzymes could provide neuroprotection.”
The researchers found that genetically deleting the enzymes CerS6 and CerS5 in neurons could prevent neurodegeneration in an experimental model of MS.
“This was true even when mice were given a diet high in palmitic acid,” said Damien Marechal, a research associate with the Casaccia Lab and co-first author of the paper. “This new information highlights a specific metabolic pathway that shows how dietary fats can exacerbate MS symptoms.”
Significance for MS Patients and Clinicians
The paper’s findings have significant implications for individuals diagnosed with MS, clinicians treating patients, and neuroscientists researching the disease. The work reinforces that lifestyle choices, such as diet, can profoundly impact the course of the disease. The study’s results build on previous concepts about careful dietary decisions in managing the symptoms of MS. The findings also identify potential molecules that could help slow diet-induced symptom severity.
“Our research provides a molecular explanation for how to protect neurons from the palm-oil-dependent creation of molecules that harm them,” said Casaccia. “We hope this information can empower patients to make informed dietary decisions that could positively impact the course of the disease while identifying strategies to counteract the effect of cerS5 and cerS6 in a neuron-specific fashion.”