Researchers Create Exercise Guidelines to Beat Depression

You already know (and love!) that endorphin-fueled happy feeling you get after a really great workout. Past research has even shown that exercise can be successful in treating major depressive disorder. And now a new report published in the Journal of Psychiatric Practice, which is geared toward clinicians, outlines the necessary exercise “dose” for patients to reap the antidepressant effects.

Researchers at The University of Texas Southwestern Medical Center came up with clinical guidelines based on what’s worked in past studies, says senior study author Madhukar Trivedi, MD, of the department of psychiatry. Their recommendations: Patients should do aerobic exercise or resistance training (though there’s more research evidence to support the former) for 45 to 60 minutes three to five times per week. Aerobic exercise—running, biking, walking—should be at about 50 to 85 percent of max heart rate. For resistance—something like weight-lifting—the workouts should target both upper- and lower-body muscles, and intensity should be three sets of eight repetitions at 80 percent max. The regimen should last for at least 10 to 12 weeks. “It boils down to about 150 minutes per week of exercise at moderate intensity,” says Trivedi.

While these recommendations are based on what was shown to work in past studies that have looked at the link between exercise and depressive symptoms, that doesn’t necessarily mean other regimens won’t work. These are just helpful guidelines if you want to reap the full mood-boosting benefits of exercise.

And of course, if you’re experiencing depressive symptoms and would like to try exercise as treatment, make sure you’re doing so under the guidance of a clinician, says Trivedi.

photo: Jupiterimages/Comstock/Thinkstock 

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Report: Sodium Guidelines Need to be Reconsidered

Keeping your sodium intake as low as possible may not be so smart after all: Although the current Dietary Guidelines for Americans recommend limiting yourself to between 1,500 to 2,300 mg of sodium a day, there’s no proof that consuming less than 2,300 mg a day is actually beneficial—and in fact, it may even be harmful, according to a new report from the Institute of Medicine (IOM).

The federal guidelines were set back in 2005, after an earlier IOM report concluded that 1,500 mg of sodium was the lowest possible intake that allowed people to still get all of the other nutrients they needed—and that 2,300 mg of sodium was the maximum daily intake that didn’t negatively impact blood pressure. Based off of these findings, the federal guidelines suggested that those at risk for high blood pressure (people 51 or older, African Americans, and people with hypertension, diabetes, or chronic kidney disease—a group that, combined, makes up more than half the population) limit themselves to 1,500 mg of sodium a day. The guideline for everyone else was set at 2,300 mg. The American Heart Association actually took it a step further and recommended that everyone try to cap their daily sodium intake at 1,500 mg.

“Blood pressure is very important, but it’s important because it’s closely linked to heart attacks, to strokes, to heart disease, to kidney disease to lots of other problems—and to death,” says Brian Strom, MD, MPH professor of public health and preventive medicine and executive vice dean at the School of Medicine at the University of Pennsylvania. “In the interim years, new data have come out that studied those actual heart outcomes.”

So the CDC asked a committee from the IOM chaired by Strom to investigate how recent research has shown sodium intake to affect  health outcomes like heart disease and death—rather than hypertension, an intermediate marker.

What they found: While lowering excessive salt intake can improve health outcomes, the committee didn’t find any evidence that health benefits are associated with lowering consumption to below 2,300 mg a day. This suggests that, while blood pressure is important, it’s not the only factor that affects health outcomes. What’s more, the committee found evidence that indicates going under this level—whether you’re at risk for high blood pressure or not—might lead to problems. Why? Likely because it’s difficult to get all of the other nutrients you need if you’re not taking in that much sodium, says Strom.

“You can’t change just sodium without changing your entire diet,” says Strom, pointing out that it’s extremely difficult to take in less than 1,500 mg of sodium a day; less than 1 percent of the population successfully limits themselves to this level.

“There are two studies that show benefit of going down to 2,300 mg, but there’s not one showing benefit going below that,” says Strom.

That said, the committee didn’t make any specific guideline recommendations. A different committee will take this report into consideration when assessing whether the federal guidelines should be updated; the next time the committee is scheduled to meet is in 2015.

The American Heart Association, meanwhile, is sticking to its recommendation of 1,500 mg of sodium a day or less, even in light of this new report.

“While the American Heart Association commends the IOM for taking on the challenging topic of sodium consumption, we disagree with key conclusions,” the association’s CEO Nancy Brown said in a statement.

Strom says that the IOM generally agrees with the American Heart Association, but that he hopes its leaders will reconsider their stance.

“The central point here is that people who eat diets that are too high in salt should lower it,” he says. “We don’t disagree with that at all—our only disagreement is that the target of 1,500 isn’t founded in science.”

photo: CollectionNameTK/Thinkstock

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New Guidelines Issued to Help Assault Victims

Huge news for victims of rape and sexual assault: The U.S. Department of Justice just released a new set of guidelines for how medical personnel should respond to assaults. The provisions, updated for the first time since 2004, give detailed advice on how to administer a sexual assault forensic exam (used by hospitals to provide medical care to the victim and collect evidence). The guidelines seek to address the latest research on the full psychological and physical consequences of sexual assault, as well as incorporate the latest advances in forensic science and medical care.

Keep in mind that these are just guidelines, though—hospitals don’t have to adopt them. But they do serve as an important reference for states, hospitals, and other facilities that help rape victims. “I do think it will be used to improve care, and people will look to it as a model,” says Barbara Sheaffer, medical advocacy coordinator for the Pennsylvania Coalition Against Rape. “I think there will be a lot of follow-through on it,” agrees Scott Berkowitz, president and founder of the Rape, Abuse & Incest National Network (RAINN).

So what are the major changes to the guidelines? Here’s what you need to know:

If you’re admitted to the hospital after being raped, your safety and wellbeing should take precedence over evidence collection. This is the biggest difference from the original guidelines established in 2004, which focused more on helping the justice department prosecute the perpetrator. This is a win-win for victims and law enforcement: Prioritizing the victim’s needs actually increases the odds that he or she will cooperate with police later. The hope is that a gentler, more victim-centric approach will make it easier to nab offenders and promote the healing of victims.

If you’re unsure whether you want to report the crime to police, you shouldn’t be pressured to do so. The new guidelines state that victims should call the shots about reporting, unless the victim is a minor (in which case many states are required to report the crime). No matter what you decide, you will be encouraged to have a forensic medical exam anyway. The exam will check you for injuries, provide protection against possible STDs and pregnancy, and collect evidence in case you choose to report the crime later.

During the exam, you should be offered emergency contraception to prevent pregnancy. It may sound like a no-brainer, but this is actually new advice: The 2004 guidelines were less explicit about telling hospitals to do this. If your health care provider has moral or religious objections to giving you the morning-after pill, he or she should at least tell you where you can get access to it ASAP. (Keep in mind: Plan B is most effective if taken within 120 hours of an assault.)

Use of alcohol or drugs should not mean that your assault is taken any less seriously. You know that rape is rape, regardless of whether you were drunk at the time, but it’s encouraging that it’s been added to the guidelines. Medical personnel should treat you with the same urgency and care, regardless of the circumstances surrounding your assault.

Hospitals should be sensitive to the unique needs of members of different groups. The new guidelines take care to describe the circumstances of certain populations so that hospital staff can better tailor their response to each victim—whether they’re older, disabled, American Indian or Alaska Native, or LGBT. “It’s acknowledging that violence cuts across all people, all groups,” says Shaeffer.

photo: Fuse/Thinkstock

More From Women’s Health:
How to Support Women—and Yourself
Is Your Partner Emotionally Abusive?
Slutwalk Heads to DC to “End Rape Culture”

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NEED TO KNOW: New Pap Test Guidelines

New guidelines say you may need fewer pap tests if you’re healthy. But that doesn’t mean you should stop seeing your gyno regularly.

The American College of Obstetricians and Gynecologists have released new guidelines surrounding pap and HPV (human papillomavirus) testing. Their recommendations:

– Women under age 21 are advised to postpone their first pap test until age 21.

-Women ages 21 to 29 that have had a healthy pap test at their last exam can wait three years before their next test.

-Women ages 30 to 65 are advised to request a pap test, as well as a test for the cancer-causing HPV virus. If both of those test results show no signs of trouble, it is recommended they wait five years for their next screening.

During your pap test, a doctor takes a sample of cells from the cervix, which is then sent to a lab for examination. If the sample is abnormal, your doctor may call you back for further testing. Abnormal cells may simply signify a small change in the cervix, but they could also be sign of pre-cancer, caused by a strain of HPV. If left untreated, pre-cancerous cells can develop into cervical cancer.

So why the call for fewer paps? Jennifer Ashton, MD, a New-Jersey based board-certified OBGYN and Fellow of the American College of Obstetricians and Gynecologists, says these new guidelines stem from doctors’ increased understanding of how HPV impacts the body. While virtually all cervical cancer is caused by HPV, the process can take many years to develop. In most cases, the body can clear up the HPV virus on it’s own, and extra testing can put the patient at risk medically, emotionally and financially.

The recommendation for women under age 21 to skip pap tests is due to a high probability of false alarms, Ashton says. Because of the significant incidence of HPV in the teenage population, many of those early pap tests can come out abnormal. As a result, patients are subjected to extra testing, as well as unnecessary extra stress, even though a very small percentage of those abnormalities progress to pre-cancer of the cervix, she says. The same logic applies to the recommendation for fewer tests for women in their 20s.

Women in the 30 to 65 age group need to request an HPV test, because if infected at an early age, the virus has had more time to advance, says Ashton. More importantly, Ashton says women should request the high-risk test specifically. “More than 50 percent of doctors do low-risk HPV testing, which is unjustified, a waste of money, and potentially harmful to the patient,” she says. While pap tests look specifically at the cells of the cervix, high-risk HPV tests look at sign of infection in your DNA, says Ashton. For those reasons, women should make sure they receive both, she says.

Healthy and HPV-free? No need to cancel your gyno appointments just yet. If your lady doc is also your primary care physician, there are still reasons to schedule a yearly visit, says Ashton. “Your doctor can screen for other STDs, make sure you don’t have any problems with your period, check your blood pressure, and monitor breast health,” she says.

Get overwhelmed in the waiting room? Here’s how to get the most out of your next check up.

photo: altrendo images/Stockbyte/Thinkstock

More from WH:
Gyno 101: Prep for Your Next Visit
Everything You Need to Know About HPV
Can You Get HPV from Oral Sex?
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