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Medical News Today: Cancer care: Are personalized exercise prescriptions the future?

As scientists design novel ways to attack cancer with chemicals, some researchers are focusing on exercise. Researchers believe that keeping active is an effective additional way to manage cancer and cancer-related health issues.A series of recent papers promotes exercise as a vital part of cancer treatment. Today, it is common knowledge that exercise provides a…

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Medical News Today: Cancer care: Are personalized exercise prescriptions the future?
As scientists design novel ways to attack cancer with chemicals, some researchers are focusing on exercise. Researchers believe that keeping active is an effective additional way to manage cancer and cancer-related health issues.

Three women exercising

A series of recent papers promotes exercise as a vital part of cancer treatment.

Today, it is common knowledge that exercise provides a range of health benefits.

For instance, being physically active can reduce the risk of obesity, diabetes, hypertension, and heart disease.

More recently, researchers have investigated whether exercise might also help prevent cancer, treat cancer-related health issues, and aid recovery.

The author of a recent paper, Prof. Kathryn Schmitz from Penn State College of Medicine in Hershey, explains how “an average person on the street will know that exercise is good for preventing and treating heart disease, but not for melanoma.”

Prof. Schmitz and her team are dedicated to raising awareness of the potential benefits of exercise. She continues:

“When researchers in the 1950s built an evidence base for exercise and heart disease, there was a shift in public knowledge about that connection. It’s now time for the same thing to happen with exercise and cancer.”

Raising awareness

According to the authors of the recent study, the American College of Sports Medicine recently updated their guidelines on using exercise to prevent cancer and treat some of the related health issues, such as fatigue and depression.

“Despite these guidelines,” the authors explain, “the majority of people living with and beyond cancer are not regularly physically active.”

In their recent paper, which they published in CA: A Cancer Journal for Clinicians, the authors outline how they believe it is possible to address this gap.

As Prof. Schmitz explains, “With more than 43 million cancer survivors worldwide, we have a growing need to address the unique health issues facing people living with and beyond cancer and better understand how exercise may help prevent and control cancer.”

Multiple organizations — including the American Cancer Society, Exercise and Sports Science Australia, Cancer Care Ontario, and the Clinical Oncology Society of Australia — have published exercise guidelines for people with cancer and those who have survived cancer.

They have based these guidelines on a wealth of studies that demonstrate the benefits of exercise for people with cancer and cancer survivors.

Despite this scientific agreement, research has shown that only about 45% of cancer survivors are physically active on a regular basis.

Although there are many reasons for this, the authors believe that it is partly because oncology clinicians often do not recommend exercise regimens. The authors write:

[S]tudies suggest that 9% of nurses and from 19% to 23% of oncology physicians refer patients with cancer to exercise programming.”

The authors believe that there are various reasons for this lack of referrals. For instance, some doctors may not be aware of the benefits, while others may feel unsure of the safety. Some oncologists might also believe that recommending exercise is outside of their “scope of practice.”

Cancer ‘exercise prescriptions’

As a standard, Prof. Schmitz and her colleagues recommend 30 minutes of moderate aerobic exercise three times each week, plus 20–30 minutes of resistance exercise two times each week. However, they note that the optimal amount depends on the individual’s abilities.

More specifically, the authors believe that healthcare professionals can tailor exercise programs to an individual.

“Through our research, we’ve reached a point where we can give specific FITT exercise prescriptions — which means frequency, intensity, time, and type — for specific outcomes like quality of life, fatigue, pain, and others,” explains Prof. Schmitz.

“For example, if we’re seeing a head and neck cancer patient with a specific set of symptoms, we could give them an exercise prescription personalized to them.”

The authors want to raise awareness among the public and healthcare practitioners, but they also want to change health policy to increase the likelihood that doctors will talk about exercise with their patients and add it into their treatment plans.

Prof. Schmitz also contributed to two other recent papers. One was a roundtable report that the American College of Sports Medicine organized, which featured in the journal Medicine & Science in Sports & Exercise.

In this paper, the authors conclude that “there is consistent, compelling evidence that physical activity plays a role in preventing many types of cancer and for improving longevity among cancer survivors.”

They end by calling for fitness professionals and healthcare providers to spread the message to the general population that cancer survivors should be as physically active as their ability, age, and cancer status allow.

The second paper outlines some exercise guidelines for cancer survivors. Although there are challenges ahead, Prof. Schmitz is dedicated to this field.

This is the center of my professional heart. My mission for a decade now has been that I want exercise to be as ubiquitous in cancer care as it is in cardiac disease care, only better. The new recommendations and guidance are a tool that can help make that a reality.”

Author Prof. Kathryn Schmitz

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Warren’s New Medicare for All Plan Is an Extremely Clever Dodge

Two weeks after Elizabeth Warren released her much-ballyhooed and Warrenishly detailed plan for how she would pay for Medicare for All, the 2020 contender released another proposal on Friday about how, as president, she would transition the country to a system under which the government provides health insurance to everyone. Like the other plans from…

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Warren’s New Medicare for All Plan Is an Extremely Clever Dodge

Two weeks after Elizabeth Warren released her much-ballyhooed and Warrenishly detailed plan for how she would pay for Medicare for All, the 2020 contender released another proposal on Friday about how, as president, she would transition the country to a system under which the government provides health insurance to everyone. Like the other plans from the “I have a plan for that” candidate, this document was long on details and full of proposals likely to have broad support on the left. But when you zoom out from those details, it amounts to an admission that Warren won’t push for Medicare for All, and instead will embrace a more cautious path to expanding insurance coverage.

One important thing about this plan is that it is less about what Warren wants the U.S. healthcare system to look like and more about specifically what she would do as president, a level of detail that is often elided in Democratic debates. She says that she will reverse Donald Trump’s executive actions that have weakened the Affordable Care Act and use the powers of the presidency to lower drug prices by cracking down on the pharmaceutical industry. She also wants the government to manufacture generic medications, and severely limit the lobbying power of Big Pharma.

But the big question facing 2020 Democratic candidates isn’t about those kinds of policies, but how hard they would push for a government-provided health insurance system, a progressive goal since the days of FDR. Warren has said she favors Medicare for All, a position that has become controversial as debate moderators and her opponents have pressed her to admit such a massive expansion of government spending would require a tax increase. In this plan, she tweaks her stance somewhat: The bill she’ll focus on early in her administration would be a “Medicare for All Option.”

That last word matters a lot. Medicare for All is sometimes a somewhat vague phrase, but generally it means putting everyone on a single government-run health insurance system, abolishing private insurance. Warren’s Medicare for All Option wouldn’t be that disruptive. Instead of forcing everyone to buy insurance from the government, Warren would expand Medicare benefits and extend coverage to everyone younger than 18 and those making up to 200 percent of the poverty level. People who earn more than that and who are uninsured would pay premiums capped at 5 percent of their incomes.

By providing government insurance to those who want it, rather than requiring everyone to have it, this proposal seems akin to the “public option” systems favored by candidates like Joe Biden and Pete Buttigieg, though as the New York Times noted, Warren’s slate of benefits is more generous than theirs. On Friday, the Buttigieg campaign attacked Warren’s plan as an effort to “paper over” Warren’s plan to “force 150 million people off their private insurance.”

Warren says this isn’t the end goal of her healthcare policy. “No later than my third year in office,” she writes, she will push for legislation moving the country into true Medicare for All, wiping out private insurance for good. Many progressives have praised this plan, including Pramila Jayapal, the Democrat who is the chief sponsor of the House’s Medicare for All bill. But the assurance that Warren will eventually get to Medicare for All wasn’t enough for her critics on the left, who saw this as a capitulation. If you aren’t willing to fight for full Medicare for All from day one of your presidency, they argue, you have no chance of getting it.

If Warren’s plan is a dodge, it’s also an extremely logical piece of political strategy. She claims that unlike Medicare for All, she could pass her bill through a Senate process known as “reconciliation,” meaning it would require 50 votes, not 60. Furthermore, Warren supporters could argue, it’s extremely unlikely that centrist Democrats like West Virginia’s Joe Manchin and Arizona’s Kyrsten Sinema would vote for Medicare for All—meaning you might not even have 50 votes for M4A—but they might vote for a slightly less radical option.

But where this pragmatism falls apart is the idea that Warren would get to Medicare for All by year three of her term. As many people have pointed out, most presidents lose seats in Congress during midterm elections and struggle to pass big pieces of legislation late in their terms as a result. A candidate saying she’ll fight for Medicare for All in 2023 rather than 2021 sounds like your parents promising to get you a puppy two birthdays from now—in other words, just putting off a tough decision.

Not that there’s anything wrong with that. Warren’s position on healthcare is still far more ambitious than anything contemplated by the Obama administration, and she’s previously said that her highest priority will be fighting political corruption (in other words, not healthcare). A President Bernie Sanders might launch a contentious, uphill battle to try to ram through Medicare for All, but a President Warren likely will not. If that wasn’t obvious before this latest plan, it’s clear now.

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Ditch Your Phone Habits, Not Your Friendships

The label “Silicon Valley trend” is a pretty good indicator that something is going to be goofy as hell, weirdly extreme, kind of dangerous, or a heady combination of the three. Dopamine fasting is an SV-home-brewed “biohack” where people do and consume nothing for anywhere from 24 hours to a week, with the misguided aim…

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Ditch Your Phone Habits, Not Your Friendships

The label “Silicon Valley trend” is a pretty good indicator that something is going to be goofy as hell, weirdly extreme, kind of dangerous, or a heady combination of the three. Dopamine fasting is an SV-home-brewed “biohack” where people do and consume nothing for anywhere from 24 hours to a week, with the misguided aim of “resetting” some kind of neurochemical imbalance (per VICE’s coverage, this is not really how any of this works). . But because the “fast” mostly focuses on things like technology, media consumption, substance use, and social behaviors like spending time with friends, talking to other people, or having sex, it isn’t quite as ill-advised and unhealthy as other, more restrictive tech-bro fasting practices can be. (Think: Twitter CEO Jack Dorsey’s infamous “3 day water fast.”) That doesn’t mean it’s without flaws of its own. As VICE previously reported, “making you feel good” isn’t the sole function of dopamine, and dopamine isn’t the only neurotransmitter that produces, dare I say, posi vibes. And it turns out dopamine fasting is based on a fundamental misconception about the value of social interaction that could stop fast participants from gleaning any real benefits.

According to scientists who spoke with Psych Central, a mental health website run by mental health professionals, the kind of social isolation that dopamine fasting entails could actually be detrimental to mental health. Kim Hellmans, a neuroscience researcher and professor at Carleton University, told Psych Central that interacting with other people, especially people you actually like, is actually good for you. “Humans have evolved as a highly social species, and as such, loneliness and very little social stimulation can be coded in the nervous system as a threat — since loneliness is one of the most potent stressors,” Hellmans said to Psych Central.

Yes, another earth-shattering dispatch from Big Science: Spending time with people you like is literally good for you. Studies have shown that social support from family, friends, and romantic partners has a wide range of benefits, like decreased stress levels, increased happiness, improvements in cardiovascular health, and boosts in the effectiveness of other healthy activities, like exercising regularly. Meanwhile, loneliness is on the rise, so much so that experts are working on creative solutions like meal-sharing to coax people away from their solitary habits. That’s because social isolation is absolutely a trend worth combatting: One study that found loneliness rivals smoking cigarettes when it comes to increasing mortality risk, and being lonely is way less fun than smoking cigarettes.

The element of dopamine fasting that researchers believe does have merit is the part where fasters disengage with technology. “We could all serve to ‘unplug’ every once in a while,” Hellemans said, but with a caveat: “To attribute any perceived benefits to reduced dopamine levels is an over-simplification and misrepresentation of the complexity of the nervous system.” Of course, the benefits of unplugging aren’t breaking news, either.

So: Meeting up with a friend, ditching your phones, and going for a walk outside while you have a meaningful conversation about life, love, and the ugly wedding dresses of mutual acquaintances? Awesome for your mental and physical well-being. Declining hangout invitations because you need to stay indoors, write a list of goals, and focus on not masturbating in pursuit of some questionable mental health benefits? Not so much. I think you know what to do with that information.

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Imagine Being Kicked off Your Health Insurance Two Months After Giving Birth

When Madavia Johnson gave birth to Donald Ray Dowless III last year, she was hit by a case of severe postpartum anxiety. She was scared to carry her son downstairs or drive him in a car. She couldn’t manage to continue law school―and could hardly leave the house―because she didn’t trust anyone to watch him.…

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Imagine Being Kicked off Your Health Insurance Two Months After Giving Birth

When Madavia Johnson gave birth to Donald Ray Dowless III last year, she was hit by a case of severe postpartum anxiety.

She was scared to carry her son downstairs or drive him in a car. She couldn’t manage to continue law school―and could hardly leave the house―because she didn’t trust anyone to watch him. Her weight dropped from 140 to 115 pounds.

“It was very stressful for me mentally,” said Johnson, now 29, who lives in Clayton, North Carolina. And she found it hard to secure medical assistance because her Medicaid coverage ran out just two months after her son’s birth. Public health advocates are pushing to change that.

The difficulties Johnson faced contribute to the United States’ dismal record on maternal and child health. The U.S. is one of only three countries where maternal deaths are on the rise, joining Sudan and Afghanistan, according to the Alliance for Innovation on Maternal Health, a program of the Council on Patient Safety in Women’s Health. And data from the Centers for Disease Control and Prevention indicates that about 700 women die in the U.S. every year from pregnancy complications. Sixty percent of those deaths are deemed preventable.

Democratic presidential candidates such as Senator Cory Booker of New Jersey and Senator Kamala Harris of California have talked about those problems on the campaign trail, offering sweeping proposals to address disparities that lead to poor health for many new mothers.

Though maternal and child health experts appreciate the attention to the issue, they also point to what they say is a fairly minor policy option that could make a major difference: increasing access to Medicaid for postpartum women.

“Given that we know that this crisis disproportionately falls on low-income people … Medicaid is a very smart starting place to make sure these people are getting access to needed care,” said Valarie Blake, an associate professor of law at West Virginia University who focuses on health care law.

Take Johnson, for instance. At the time of her pregnancy, she was eligible for Medicaid based on a rule that provides women who otherwise might not qualify under strict income restrictions with coverage during pregnancy and for 60 days after. She gave birth August 14, 2018.

But North Carolina has tight eligibility requirements. It is also one of the 14 states that have not chosen to expand Medicaid under the Affordable Care Act. So, by mid-October, Johnson was no longer “Medicaid eligible.” Because her physician was backed up on appointments, she lost her coverage before she had a “six-week” checkup.

Eventually, she reapplied for Medicaid and was able to qualify because her status changed since she had a child. But Donald was 8 months old before she was able to see a doctor.

Experts point to the 60-day timeline as a sort of clock ticking on some severe postpartum medical issues: bleeding, infections, breastfeeding issues, and mental health screening, among others.

“If you’re on postpartum Medicaid, you need to get those issues solved right away,” Blake said.

And that 60-day countdown? It is arbitrary, said Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. It has roots in a general idea across cultures that women need special care after giving birth, but the 60-day mark isn’t based on medicine.

“It comes from the same place as the six-week postpartum visit,” Stuebe said. “We don’t know where it comes from either.”

Stuebe chaired a task force for the American College of Obstetricians and Gynecologists that recommended a different approach. Providers should check women two weeks after giving birth, and then continue holistic care for 12 weeks, eventually transitioning the patient to primary care.

That prolonged contact is essential, she said. ”Postpartum depression, if untreated, can begin to spiral,” Stuebe said. “Even if you’re in treatment, after 60 days, you’re not better.”

Johnson, though, was left to wrestle with severe postpartum anxiety on her own.

She sought support from other new moms on Facebook who were coping with anxiety. Since her son had Medicaid for the first year of his life, his pediatrician was a source of help. She also got care through her local health department’s free clinics.

At the federal level, the idea of extending postpartum Medicaid is getting more attention. At a September House hearing, representatives from the American Medical Association, the Icahn School of Medicine, and the Kaiser Family Foundation called for expanding postpartum Medicaid to 12 months as a possible solution to the maternal mortality crisis. The American College of Obstetricians and Gynecologists has also recommended it. Booker’s bill would extend Medicaid coverage from 60 days to 12 months alongside other far-reaching proposals. (Kaiser Health News is an editorially independent program of the foundation.)

Beyond protecting women during the medically vulnerable time after they deliver, experts think increasing Medicaid could go a long way toward addressing the racial disparities that exist in maternal mortality rates. Black women are two to three times more likely to die from pregnancy-related causes than white women.

“It’s not a silver bullet,” said Jamila Taylor, the director of health care reform at The Century Foundation, a nonpartisan think tank. “There’s racism in the health care system. Coverage is a piece of that, but we need to transform the system.”

Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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