#GetFit: Physical Fitness and Mortality

Low levels of physical capability in middle age may signal poorer chances of survival over the next 13 years, according to a cohort study of 1355 men and 1411 women in the United Kingdom.

Nurses assessed grip strength, chair rise speed, and standing balance time of participants at age 53 years.Participants with lower physical capability scores tended to have lower socioeconomic position; less healthy lifestyles; and higher prevalence of self reported cardiovascular disease,diabetes, and severe respiratory symptoms when compared with those with higher scores.

During the follow-up period, there were 177 deaths (88 from cancer, 47 from cardiovascular disease, and 42 from other causes). The fully adjusted hazard ratio of all-cause mortality for participants in the lowest vs highest quintiles of physical capability was 3.68. Those who could not complete any of the 3 tests had death rates more than 12 times higher than those who were able to complete the tests.

Subpar performance on the tests in middle age likely reflects subclinical disease and aging processes rather than manifest diseases, making this population an important one for interventions, said the investigators. What does all of this mean? Time to hit the gym!

Empiric Antibiotics: Vancomycin-Resistant Enterococcus

Basics

  • GI or GU infections in patients with prior abx
  • Bacteremia, endocarditis in those with extensive HC exposure
  • E. faecalis: Often remains sensitive to ampicillin, beta-lactams
  • E. faecium: Often multi-drug resistant

Cystitis Rx

  • Consider Nitrofurantoin or Fosfomycin

Invasive infections Rx

  • Amp-sens VRE faecalis: Amp, Amp/Sulb, Pip/Tazo, Imi/Meropenem active
  • Linezolid, High dose Daptomycin (8-12 mg/kg daily), Tigecycline à Consult ID for assistance

#GetFit: Do Pedometers Work?

You have a fitbit, or an up, or moov, or misfit, or SOMETHING to help track your steps and encourage your to take the fabled 10,000 steps. Companies around the country are giving their employees FREE fitness trackers to promote wellness (and perhaps reduce health insurance claims in the long-term?). But the question remains, does this strategy actually work?! Does counting steps encourage fitness and improve health? Before we tackle the modern fitness trackers, with heart rate monitoring, smartphone apps, frequent notifications, etc., let’s start at the beginning, with the basic pedometer.

In 2007, before the smartphone era, a group out of Stanford asked if pedometers increase physical activity and improve health. In the systematic review of 26 studies with over 2700 participants with a median age of 49, they found that the use of a pedometer increased physical activity by a statistically significant 27%! In the randomized-controlled trials, particiapnts averaged about 2500 additional steps. In observational studies, they increased their steps about 2200 above baseline. Importantly, this increase in steps per day led to a significant decrease in both BMI and systolic blood pressure! The study suggested that simple pedometers have the potential to significantly improve health. To read the full study, click here to visit the Journal of the American Medical Association.