Annals of Long Term Care

Alvin B. Lin, MD, FAAFP
 
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine.  He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV.  The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations.

As I was wandering through the International Consumer Electronics Show that swept through Las Vegas last week, I kept looking for ideas on how to keep our elderly healthy and in their homes (as opposed to reacting to illness and frequent hospitalizations).  However, while many products were focused on helping us get and stay active, it was the large screen, high-definition 3D televisions that garnered much of the press.  I have to admit that I was impressed, too.  So were my kids as we walked through our neighborhood big box store yesterday for our weekly grocery shopping trek - it's hard to miss an 80" flat screen TV not more than an inch or two thick that's bright & razor sharp (I still have my 20" color cathode ray tube TV from my residency days!).

Luckily, I remembered the case-control study (INTERHEART) published published early online in the European Heart Journal last week in which the authors compared 10,043 participants who had suffered an initial heart attack to 14,217 controls who had never (or at least not yet) had a heart attack.  As expected, those whose occupation required either light or moderate physical activity had a lower risk of heart attack than sedentary workers.  However, in a slight twist, those who engaged in heavy physical activity as a result of their occupation received no cardiovascular benefit.  Mild, moderate and strenuous exercise, indeed any regular leisure time physical activity, was found to be protective against heart attacks compared to those who remained sedentary away from work.  This finding was not new.

However, what I found interesting was the demographic composition of the study, consisting of participants from 52 countries in Asia, Europe, the Middle East, Africa, Australia, and both North & South Americas.  The findings were consistent across (or regardless of) income levels.  In other words, low, middle and high income populations were affected equally, regardless of industrialized or developing countries.  More striking was that ownership of cars and televisions (considered almost part and parcel of life in industrialized nations but presumably a marker of success in developing countries) was associated with increased risk of heart attack globally but especially in low and middle income countries.

Obviously, a car and television can't directly cause a heart attack; but both decrease one's need to be physically active, and this inertia then leads to heart disease.  The only way to lower one's risk (short of selling the car and television) is to make a concerted effort to get physically active (eg exercise regularly during one's leisure time, since most of us don't have the option to change our occupation to improve our health.  For starters, rather than using a remote control to channel surf, we could physically get up out of our recliner and walk to the television each time we wanted to change the television station.  Just a thought!