From The Desk Of Clarence Bass
“In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a Miracle Cure….An editorial in the BMJ, a prominent medical journal, countered that exercise wasn’t a ‘miracle cure’ [but it was] the best buy for public health. If that’s the best ‘counterpoint,’ then physical activity seems like a no-brainer.” Professor Aaron E. Carroll, Indiana School of Medicine (The New York Times, June 20, 2016)
Testosterone Replacement vs Exercise
Unproven and Potentially Dangerous vs Wonder Drug
Why roll the dice when you can have close to a sure thing? The latest findings on testosterone replacement therapy are problematic, while the mountain of support for exercise continues to grow. (Where would I be without exercise?)
The Testosterone Trials
It’s surprising how little we know about the risks and benefits of testosterone replacement therapy (TRT). Still, the number of men for which testosterone is prescribed continues to grow rapidly. Recent history suggests that many of these men may be more at risk than they know.
The US Food and Drug Administration (FDA) has approved testosterone therapy only for men with low testosterone due to specific medical conditions and not simply aging. The agency also issued a call for companies to work together on a single trial to assess cardiovascular risk. In the interim, they required that the drug carry a warning for increased heart attack and stroke risk.
In 2004, the Institute of Medicine (IOM) called for trials to assess whether testosterone benefits older men who have low testosterone levels for no reason other than age, along with clinical symptoms—decreased mobility, sexual function and energy are examples—to which testosterone might contribute. The trials were intended to “establish a clear benefit before assessing long-term risk.” Three of seven trials now underway published results in the February 18 issue of the New England Journal of Medicine. Unfortunately, the trials only scratch the surface of what we need to know—and say nothing about risk.
Peter J. Snyder, MD, professor of medicine at the University of Pennsylvania, and colleagues concluded: In symptomatic men 65 years of age or older, raising testosterone concentrations for 1 year from moderately low to the mid-normal range for men 19 to 40 years of age had a moderate benefit with respect to sexual function and some benefit with respect to mood and depressive symptoms but no benefit with respect to vitality or walking distance. The number of participants was too few to draw conclusions about the risks of testosterone treatment.
Professor Snyder et al acknowledge that previous trials have consistently shown “increased muscle mass and decreased fat mass.”
Snyder adds that the results of the other four trials—assessing cognitive function, coronary plaque volume, and other effects—could be available within a year “but that results from a subsequent safety trial would likely take years.”
So we’ll soon know more about the benefits of TRT in older men with low T, but it’s likely to be a long time before we have anything definitive about the risks.
Exercise is another thing all together. Benefits continue to pile up and the risks are few and far between.
Professor Aaron Carroll (quoted above) tells us that calling exercise a “miracle cure” is supported by “many, many randomized trials.” He catalogues much of the support in areas from arthritis to heart disease to depression and more. For the details, Google “Closest Thing to a Wonder Drug? Try Exercise”
It’s fair to say that no other remedy or “drug” can match the support for exercise. Plus, it’s accessible to practically everyone.
The British Medical Journal summed up the unmatched combination of safety and efficacy:
The most consistent finding of the meta-analyses summarised in the present work is that aerobic/functional capacity and muscle strength can be improved by exercise training among patients with different diseases without having detrimental effects on disease progression. This is important, as with population aging exercise therapy may be an important means of reducing disability and increasing the number of older people living independently. Additionally, there is accumulating evidence that in patients with chronic disease exercise therapy is effective in improving the prognostic risk factor profile and, in certain diseases, in delaying mortality. In some diseases, such as osteoarthritis, pain symptoms may also be reduced. Severe complications during the exercise therapy programs were rare.
No wonder the BMJ calls exercise the best buy for public health. Cash strapped health care plans love it.
“Physical activity seems like a no-brainer,” Dr. Carroll concludes.
As an important aside, Carroll admits that he tried the P90X and Insanity routines before finding a routine that would work for him. He says the appropriate regimen can be as simple as mowing the lawn and walking your dog. Anything that gets you moving on a regular basis. In his case it was “trekking” from his office to the clinic and to the supermarket. Look for physical activities you enjoy and are willing and able to do consistently.
For more information on the health benefits of exercise, visit the our Fitness & Health category http://www.cbass.com/fitness_health.htm
You’ll also find information on the benefits of active living spread throughout our 10 categories and 11 FAQ pages http://www.cbass.com/FAQ.HTM
With a doctorate in law—and a lifetime of exercise and study—we focus on things that healthy people can do for themselves. The options are many and growing.
New information on the miracle of exercise comes to our attention regularly. We sort it out and write about what interests us most in our monthly updates.
The latest breakthrough that caught our eye deals with the role of exercise in keeping our genes young.
Exercise Shields Telomeres
Earlier, we wrote about a study at King’s College in London which found that people who are physically active have longer telomeres. Telomeres cap DNA chromosomes in cells and protect them from damage. Unfortunately, they progressively wear and shorten with repeated cell division, eventually leaving the chromosomes unprotected. When the caps are eroded or gone, the wear begins to cut into genes which are important to bodily functions.
Scientists believe that telomeres serve as an index of biological age; that we age as telomeres shorten and more cells are damaged and discarded.
The King’s College researchers reported that subjects who spent more than 3 hours each week in vigorous physical activity (such as running, cycling, and weight training) had longer telomeres than inactive subjects 10 years younger. For more details see http://www.cbass.com/Strengthtrainingandtelomeres.htm
While the King’s College study established an apparent relationship between exercise and telomere length—and aging—the precise mechanism was yet to be determined. Enter senior researcher Anabelle Decottignies and her colleagues at the de Duve Institute in Brussels, Belgium, with a study (published July 27, 2016, in the journal Science Advances) suggesting how exercise protects telomeres and keeps us young.
By examining muscle biopsies obtained from 10 healthy young volunteers after 45 minutes of cycling at both a low- and high-intensity pace, they found that a compound called nuclear respiratory factor 1 (NRF1) appears to protect telomeres.
Production was highest after the high intensity session. (NRF1 is activated when stores of ATP are depleted during exercise.)
“The novelty and merit of this work is that the authors demonstrate, for the first time, that [telomere transcription or copying] occurs in response to physical exercise in a physiological system-human muscle,” Claus Azzalin, who studies telomere transcription at ETH Zurich in Switzerland but was not involved in the work, wrote in an email to The Scientist magazine.
“Think about NRF1 like varnish on nails,” Decottignies told TIME. “You cannot change the nail, but you can change the varnish again and again. What you’re doing is refreshing and replacing the old section with new protective molecules at the telomeres.”
With each bout of exercise, she says, the protection to the telomeres is refreshed, thus helping the DNA, and in turn the cells to remain “younger” and hold off the aging process. “The protection is constantly renewed upon exercise,” Decottignies emphasized.
Unfortunately, the Decottignies team didn’t actually measure whether the exercise led to longer telomeres over time. That remains for future and larger studies. The study does, however, provide solid support for a mechanism by which exercise helps keep our genetic material young and healthy.
(Mother Nature seems to favor those who keep moving. See Grow or Decay, Your Choice: http://www.cbass.com/YoungerNext.htm )
Finally, let’s look at my testosterone level over a decade and a half. Keep in mind that testosterone typically declines about 1 percent per year after age 30.
About a month ago, I met with a highly regarded physician and surgeon I hadn’t seen for over 50 years. We grew up in the same neighborhood, but went our separate ways after college. I heard rumors from time to time about how well he was doing, but our paths never crossed. He’s several years younger than me, tall and slim with a full head of white hair. We exchanged pleasantries and talked about people from the neighborhood and what they are doing now. He remembered that our family had the first TV in the neighborhood and that our dog bit him in the rear end. Fun to hear--and news to me.
As almost always happens when I meet an old friend, he commented on how well I look and asked if I am still lifting weights. He knew I had become a lawyer but was not aware of my second career in fitness. He was surprised--and interested--to learn that I had written 10 books on fitness and health. That led to a series of queries you might expect from a medical doctor. He felt my upper arm and asked if I'd had any work done on my face. Was I a vegetarian? Do I eat red meat? Do I include aerobic exercise along with my weight training? What’s my lipid profile? Finally, he asked about my testosterone level. He was clearly impressed that my testosterone is in the mid-range of normal and is not going down with age—with no help from testosterone therapy.
I was ready for his question about testosterone, because mine has been monitored regularly at the Cooper Clinic in Dallas over the last 15 years. I don’t know what it was when I was younger, but have no reason to believe I’ve suffered any precipitous decline. I’ve had no chronic illnesses and my body composition has been basically unchanged. I have, of course, never stopped exercising.
My testosterone was measured for the first time in 2000, when I was 62; it was normal at 483 ng/dl. The reference range was (and still is) 241-827. Interestingly, my latest test, in 2015, at 78, was slightly higher, at 494.
My low reading was an unexplained 326 in 2008; a retest showed a return to normal at 451. The high was 566 in 2011, also unexplained.
Clearly, exercise has played a major role in keeping my testosterone on an even keel--and keeping me young.
If my case is any indication, testosterone doesn’t have to fall with age. (My maximum heart rate hasn't decline as expected either.) Testosterone replacement therapy may not be necessary for those who exercise. A balance of high-intensity exercise and rest can produce as good or better results--without adverse effects.
Lifestyle change should almost always be the first option. In most cases, we can do more for ourselves than any drug can do for us, especially long-term.
For more information on testosterone and lifestyle see the following
September 1, 2016
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