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March 31, 2015

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ByLindseyTanner TheAssociatedPress CHICAGO An apple a day doesn't necessarily keep the doctor away. That's accord- ing to proverb-busting re- search that found daily ap- ple eaters had just as many doctor visits as those who ate fewer or no apples. The findings don't mean apples aren't good for you but they do underscore that it takes more than just one kind of food to make a healthy diet and avoid ill- ness. About one-third of the adults studied said they had nomorethanonedoctorvisit in the previous year; the re- mainder reported at least two visits. A preliminary analysis found apple eat- ers had slightly fewer visits than apple avoiders — those whoatelessthanonedailyor no apples. Butthat difference disappeared when the re- searchers considered weight, race,education,health insur- ance and other factors that can influence frequency of medical visits. Moreaboutthestudy,pub- lished Monday in JAMA In- ternal Medicine: Studydetails The researchers looked at data on about 8,400 U.S. adults who took part in gov- ernment health surveys in 2007-08 and 2009-10. The adults answered question- naires that included queries about foods they'd eaten in the previous 24 hours and medical care in the past year. About 9 percent of adults studied ate the equivalent of at least one small apple daily. Those who ate less than that were considered apple shun- ners. Apple eaters had more ed- ucation and were less likely to smoke than apple shun- ners, and fewer of them were white. Apple eaters were slightly less likely to use pre- scriptiondrugs,butthestudy lacks information on use of over-the-counter medication and alternative medicine. Study limitations Adults' food choices in the previous 24 hours don't nec- essarily reflect usual eating habits. The study lacks in- formation on other foods people ate and it isn't rig- orous enough to determine whether people who choose to eat apples are healthier or unhealthier than those who don't. The reason for the re- ported doctor visits also isn't included in the study. Lead author Matthew Davis, a health services re- searcher at the University of Michigan, said while the study questions the proverb, "to really disprove it, you would need a different study design." How 'bout them apples? Apples are a good source of vitamin C; one medium apple has about 100 calo- ries and provides nearly 20 percent of the daily recom- mended amount of fiber. Apples also contain small amounts of vitamin A, cal- cium and iron. The proverb is thought to have originated in Wales in the 1800s. Apples, which have a long shelf life, were likely one of the few fruits that were available through- out the year, said Alice Li- chtenstein, a Tufts Uni- versity professor of nu- trition science and policy. She wasn't involved in the study. Nutritionists generally agree that apples can be a good food choice. But, said Dr. Steven Zeisel, di- rector of the University of North Carolina's Nutri- tion Research Institute, "One apple isn't going to be enough to make a dif- ference unless it's part of a healthy food pattern." A HEALTHY DIET Study:Anappleadaymaynotkeepthedoctoraway THEASSOCIATEDPRESS A study published Monday in JAMA Internal Medicine challenges the old adage: "An apple a day keeps the doctor away," finding daily apple eaters had just as many doctor visits as apple shunners. By Lauran Neergaard The Associated Press WASHINGTON The inten- sive care unit is a last fron- tier for physical therapy: It's hard to exercise patients hooked to ventilators. Some hospitals do man- age to help critically ill pa- tients stand or walk even if they're tethered to life sup- port. Now research that put sick mice on tiny treadmills shows why even a little ac- tivity may help speed recov- ery. "I think we can do a better job of implement- ing early mobility ther- apies," said Dr. D. Clark Files of Wake Forest Bap- tist Medical Center in Winston-Salem, North Carolina, who led the re- search and whose hospital is trying to get more crit- ically ill patients up, ven- tilator and all. Hospitals have long nudged less critical pa- tients out of bed, to prevent their muscles from wasting away. But over the past sev- eral years, studies in ICUs have shown that some of the sickest of the sick also could benefit — getting out of intensive care sooner, with fewer complications — once it's medically feasi- ble for them to try. This isn't just passively changing a patient's posi- tion. It could involve help- ing them sit on the side of the bed, do arm exercises with an elastic band or in- bed cycling, even walk a bit with nurses holding all the tubes and wires. It takes ex- tra staff, and especially for patients breathing through tubes down their throats, it isn't clear how often it's at- tempted outside specialized centers. At Wake Forest Baptist, a physical therapist helped Terry Culler, 54, do arm and leg exercises without dis- lodging his ventilator tub- ing, working up to the day he stood for the first time since developing respira- tory failure about three weeks earlier. "I cheered, I was clapping," his wife, Ruanne Culler of Lexing- ton, North Carolina, said after two therapists and a nurse finally helped him to his feet. Biologically, why could such mild activity help? Files focused on one espe- cially deadly reason why people wind up on a venti- lator: acute respiratory dis- tress syndrome, or ARDS, the problem Terry Culler battled. It strikes about 200,000 Americans a year, usually after someone suffers seri- ous injuries or another ill- ness such as pneumonia; it can rapidly trigger respira- tory failure. Survivors suf- fer profound muscle weak- ness. Files' team injured the lungs of laboratory mice in a way that triggered ARDS. The animals, sick but still breathing on their own, walked or ran on a tread- mill for a few minutes at a time over two days. That short amount of ex- ercise did more than coun- ter wasting of the animals' limbs. It also slowed weak- ening of the diaphragm, used to breathe. And it tamped down a danger- ous inflammatory process in the lungs that Files sus- pects fuels muscle damage on top of the wasting of en- forced bed-rest. "It's not only putting a load on the legs," Files ex- plained. "It's something sys- temic." When certain white blood cells stick inside ARDS-affected lungs too long, they slow healing. The lungs of the exercised mice contained fewer of those cells — and their blood con- tained less of the protein that activates them, Files reported in the journal Sci- ence Translational Medi- cine this month. Examining blood frozen from ARDS patients who had participated in an earlier Wake Forest Bap- tist study comparing early mobility to standard ICU care, he found patients who had gotten a little ex- ercise harbored less of that protein. The new research adds to the biologic rationale, but there's already enough evi- dence supporting early mo- bility that families should ask whether their loved one is a candidate, said ICU spe- cialist Dr. Catherine Hough of the University of Wash- ington, who wasn't involved with Files' study. She's surveying a sample of U.S. hospitals and find- ing variability in how of- ten ICUs try, from those that help a majority of crit- ically ill patients stand to others where no ventilated patients do. Obviously, key is whether the patient can tolerate movement. But so is whether hospitals keep ventilated patients sedated despite research show- ing many don't need to be, Hough said. Back at Wake Forest Bap- tist, Terry Culler began the exercises when he was med- ically stable, and he scrib- bled notes saying he wanted to participate. "It's given him something to look forward to," his wife said a few weeks before he was released from the hos- pital. "Ask about it every day," University of Washing- ton's Hough advises fami- lies, given that critical ill- ness changes frequently. "On Monday, the patient might have a good reason not to be moving forward with mobilization, but there's a very good chance it's different on Tuesday," she said. PHYSICAL THERAPY Exercising critically ill patients may help speed recovery AP PHOTO/WARREN CAMERON DENNIS III, WAKE FOREST BAPTIST MEDICAL CENTER Physical therapist Katie Kellner helps patient Terry Culler do some exercises and briefly stand despite being hooked to a ventilator, at the Wake Forest Baptist Medical Center. 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