Publisher Health

The vast majority of people over 50 say it’s important that they keep living in their current homes for as long as possible. But a new poll shows many of them haven’t planned or prepared for “aging in place,” and a sizable percentage might have a hard time paying for in-home help.
The pandemic’s toll on older adults, especially those in nursing homes and other long-term care facilities, has brought the issue of living independently at home into the national spotlight. So have policy proposals around changing the ability of Medicare and Medicaid to pay for virtual care and in-home help.
But the new findings from the National Poll on Healthy Aging suggest many people in their 50s, 60s and 70s need to do more to modify their homes or plan for services they may need if they want to avoid or delay needing to move. The poll also shows differences in aging-in-place readiness among the 28% of older adults who told the poll that they live alone.
The poll is based at U-M’s Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center.
In all, 88% of people between the ages of 50 and 80 said it was very or somewhat important to them that they live in their homes as long as possible. But only 15% said they’ve given a lot of consideration to how their home may need to be modified as they age, while 47% have given it little or no thought.
Meanwhile, 48% of those who live alone said they don’t have someone in their lives who could help them with personal care such as bathing and dressing if needed, compared with 27% of those who live with others.

A new protein-based antiviral nasal spray developed by researchers at Northwestern University, University of Washington and Washington University at St. Louis is being advanced toward Phase I human clinical trials to treat COVID-19.
Designed computationally and refined in the laboratory, the new protein therapies thwarted infection by interfering with the virus’ ability to enter cells. The top protein neutralized the virus with similar or greater potency than antibody treatments with Emergency Use Authorization status from the U.S. Food and Drug Administration (FDA). Notably, the top protein also neutralized all tested SARS-CoV-2 variants, something that many clinical antibodies have failed to do.
When researchers administered the treatment to mice as a nasal spray, they found that the best of these antiviral proteins reduced symptoms of infection — or even prevented infection outright.
The findings were published yesterday (April 12) in the journal Science Translational Medicine.
This work was led by Northwestern’s Michael Jewett; David Baker and David Veesler at the University of Washington School of Medicine; and Michael S. Diamond at WashU.
To begin, the team first used supercomputers to design proteins that could stick to vulnerable sites on the surface of the novel coronavirus, targeting the spike protein. This work was originally reported in 2020 in the journal Science.

Despite pressure from airlines and industry groups, the Biden administration extended the requirement to wear masks while traveling on public transportation through May 3.Despite great pressure from airlines, the hospitality industry and Republican lawmakers to lift the rule requiring masks on planes and other public transportation, the Centers for Disease Control and Prevention extended the federal transportation mask requirement for two weeks on Wednesday, five days before it was set to expire. The mask mandate now expires May 3, if it is not extended yet again.Dr. Ashish K. Jha, the new White House Covid response coordinator, said in an interview that the additional time will allow the C.D.C. to assess whether BA.2, a subvariant of the coronavirus, is going to become a “ripple or a wave” in the United States. The C.D.C. will use that information to determine whether the mandate should be extended further, he said.“If the infection numbers are relatively low, as they are right now, then I think it’s reasonable to remove mask mandates,” he said, emphasizing that it’s a C.D.C. decision.In a statement announcing the extension of the divisive rule, the C.D.C. said BA.2 now makes up more than 85 percent of new U.S. virus cases.“Since early April, there have been increases in the 7-day moving average of cases in the U.S.,” the agency said. “In order to assess the potential impact the rise of cases has on severe disease, including hospitalizations and deaths, and health care system capacity, the C.D.C. order will remain in place at this time.”In recent days, new U.S. cases have started ticking up again. As of Tuesday, the nation was reporting more than 31,000 new cases a day on average, 8 percent more than two weeks earlier, according to a New York Times database, though the case counts have not approached the peak seen in the winter Omicron surge. Reported cases may be an undercount of the virus’s true spread to some degree, since access to at-home tests has increased and the results of such tests are often not officially reported.It’s not yet clear how severe the impact of these cases will be, Dr. Jha said, noting that BA.2 has caused far more hospitalizations and deaths in the United Kingdom than it has in Israel, two countries where it appeared earlier than in the United States and where it spread widely.“So the question is which path is America going to follow; will it follow the U.K. path or the Israeli path?” he asked.In recent months, airlines and the hospitality industry have been lobbying the White House to overturn both the mask rule and the requirement to test before returning to the United States from abroad. In one of the most recent letters, dated April 8, Airlines for America, an industry group representing eight airlines; the U.S. Travel Association, a trade group representing more than 1,000 public and private organizations catering to business and leisure travelers; the U.S. Chamber of Commerce, the nation’s largest business lobbying group; and the American Hotel and Lodging Association, which represents thousands of hotels, sent a letter to Dr. Jha, arguing that what they see as unnecessary measures were hurting the country economically.“While the public health benefits of these policies have greatly diminished, the economic costs associated with maintaining these measures are significant,” they wrote.On Wednesday, shortly before the C.D.C. announcement, Airlines for America sent yet another letter to Dr. Walensky, the C.D.C. director, pushing for a detailed explanation of why masks are still necessary on planes.“It is very difficult to understand why masks are still required on airplanes, but not needed in crowded bars and restaurants; in packed sports arenas; in schools full of children; or at large indoor political gatherings,” Nicholas E. Calio, the president of the group, wrote.But airlines are unlike virtually all other indoor settings, said David Freedman, the president-elect of the American Society of Tropical Medicine and Hygiene, because you can’t easily leave.“The difference with other indoor settings is that on an airplane you are trapped until the end of the flight or until everyone disembarks,” he said.Dr. Jha made a similar point.“If that person sitting next to you is coughing and clearly infected, you can’t get up and move,” he said, adding, “even if they have the best ventilation, you will not be fully protected.”Opponents of the mask mandate often point to the advanced ventilation systems on airplanes, saying they practically eliminate the risk of transmission.“It’s low, but there is no zero risk situation on an airplane,” said Dr. Aisha Khatib, the chair of a group focused on responsible travel for the International Society of Travel Medicine, adding that the risk goes up in a surge situation and while getting on and off planes if the ventilation system is not on. “Masks will definitely decrease your risk of transmission,” she said.Canada, where Dr. Khatib lives, is grappling with similar situation, she said. Masks are still required on airplanes and in airports there, but as an expiration date approaches for Canada’s mask mandate, cases have been rising in some parts of the country.By many accounts, enforcement has been one of the most challenging aspects of the mask mandate in the United States, with many passengers verbally and even physically assaulting flight attendants who reminded them to cover their nose and mouth. In 2021, more than 4,000 mask-related incidents were reported to the Federal Aviation Administration.Ahead of the decision, major unions representing flight attendants and Transportation Security Administration employees, two groups that have to deal with enforcing the rule, declined to take a stance.“Whatever the agency puts in place, we have to comply with it,” said Hydrick Thomas, the president of the union that represents T.S.A. employees, on Tuesday. He added that he believes that masks protect his employees, their families and “the flying public.”The extension provoked applause from some travelers and commuters, with some arguing that it should remain in place even longer.“The C.D.C. is extending the mask mandate for public transport for two weeks,” Dr. Lucky Tran, a scientist and activist who was one of the organizers of the March for Science in 2017, wrote on Twitter. “That’s not enough. Millions rely on public transportation every day to get to work or access essential services. While we are in a pandemic, we need mask mandates to keep society open and accessible to all.”Ari Fleischer, a media consultant who served as a White House spokesman for President George W. Bush, was among the many who took an opposite stance on the same platform.“This is absurd,” he wrote on Twitter on Wednesday. “Either there is a public health threat requiring all citizens to wear masks everywhere, or there’s not.”Follow New York Times Travel on Instagram, Twitter and Facebook. And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places for a Changed World for 2022.

Invited by George Balanchine to be the in-house orthopedic surgeon at City Ballet, he laid the groundwork for the field of dance medicine.Dr. William G. Hamilton, who as the attending orthopedic surgeon for New York City Ballet spent more than 40 years fixing bone spurs, tendinitis, bursitis, torn ligaments and what he called “the Nutcracker Fracture,” died on March 29 at his home in Croton-on-Hudson, N.Y. He was 90.His wife, Linda Hamilton, said the cause was congestive heart failure.Ballet dancers may be the “athletes of God,” as Albert Einstein supposedly said. But until Dr. Hamilton came along, they were treated more like ethereal beings than physical bodies that could crack, tear and otherwise fall apart under the extreme and often unnatural pressures of repeated pliés and grand jetés.In fact, it was George Balanchine, the choreographer who famously insisted that his dancers stoically work through their stubbed toes and sprained ankles, who asked Dr. Hamilton to become the first in-house doctor for the 100-plus members of New York City Ballet, in 1972.Dr. Hamilton immediately said yes, though he knew nothing about ballet. He immersed himself in the art, attending weekend classes and becoming close to Balanchine and, later, the dancer and choreographer Mikhail Baryshnikov, who in 1980 hired him to be the attending surgeon for American Ballet Theater as well.A courtly 6-foot-3 Southerner, Dr. Hamilton became a favorite and even revered figure around Lincoln Center. He had a disarming bedside manner that put young dancers at ease when they came to him worried that a sprained ankle might end their career.He kept a ballet barre in his examining room, and he was renowned for catching early signs of chronic, potentially debilitating problems just by asking a dancer to go through a few routine motions.Early on, he realized that while dancers suffered the same kinds of injuries athletes did, they got them in obscure ways and places. He saw, for example, that the rapid movements required by Balanchine’s ballets came with the risk of foot and ankle injury, while the leaps and bounds more common under Mr. Baryshnikov were more threatening to the hips and knees.“From the very beginning, I learned that although they get the same injuries as athletes, dancers are artists first,” he told Dance Magazine in 2011.When Dr. Hamilton started, in the early 1970s, there was no such thing as dance medicine, and indeed foot and ankle injuries were a largely understudied field of orthopedic medicine.He built up both fields through lectures and journal articles in which he diagnosed previously understudied injuries — he was among the first to describe the Nutcracker Fracture, for example, which involves multiple breaks in the cuboid bone in the foot. He served as the president of the American Orthopaedic Foot and Ankle Society from 1992 to 1993, and today every sizable dance company in the country has an orthopedic surgeon on call.“Bill was the king of orthopedic dance medicine,” Glenn Pfeffer, the co-director of the Cedars-Sinai/USC Glorya Kaufman Dance Medicine Center, said in a phone interview.Dr. Hamilton continued to perform surgery until he was 81 and consulted until a few years ago, long after most physicians would have hung up their scalpels.“I would have retired a long time ago if it wasn’t for the dancers,” he said in a 2016 interview with the magazine Princeton Alumni Weekly. “It’s very rewarding because they love what they do. They just want to dance; they wouldn’t want to do anything else.”William Garnett Hamilton did not set out to be a Manhattan doctor, let alone a balletomane. He was born on Jan. 11, 1932, in Altus, Okla., where his father, Milton Hamilton, was a salesman and his mother, Elizabeth (Garnett) Hamilton, was a homemaker.The family moved to Shreveport, La., when he was very young. After his parents divorced, his mother remarried and moved to Portage, Wis., where her new husband owned a plastics manufacturing company.William graduated from Princeton in 1954 with a degree in engineering, and after two years in the Army he joined his stepfather’s business in Wisconsin. He married and had a child; by his mid-20s, he said, he could see his entire life unfolding before him. He didn’t like what he saw.Against his parents’ wishes that he stay to run the family company, he applied to medical school. He was accepted at Columbia, one of the few schools that took older students (he was 28 when he enrolled). He decided to focus on orthopedics — a field that he said was not unlike engineering, with muscles and joints standing in for ropes and levers. He graduated in 1964 and, after several years of residency, opened a practice in Midtown Manhattan in 1969.In addition to his work with the two ballet companies, he provided the same services to the companies’ affiliated schools, the School of American Ballet and the Jacqueline Kennedy Onassis School, and he consulted for numerous Broadway shows and New York sports teams, including the Knicks and the Yankees.His first two marriages ended in divorce. He met his future third wife, Linda Homek, when she was a dancer with New York City Ballet. She later received a doctorate in psychology from Adelphi University. In 2000 she and Dr. Hamilton created a multidisciplinary wellness team, including a dietitian and a gastroenterologist, to care for the company’s dancers, a model that has since been adopted by other ballet companies.Along with his wife, Dr. Hamilton is survived by his sister, Ann Kirk; his sons, William Jr. and Lewis; and three grandchildren.

There is a steadily growing arsenal of drugs for COVID-19. Researchers from Charité — Universitätsmedizin Berlin, the Max Delbrück Center for Molecular Medicine (MDC) and Freie Universität (FU) Berlin have studied the mechanisms of action of antiviral and anti-inflammatory drugs. Their findings, which have been published in Molecular Therapy, show that treatment effects were best with combination therapy involving both types of drugs. This treatment regimen also had the additional benefit of increasing the time window available for antibody therapy.
SARS-CoV-2 infections continue to result in hospitalizations. According to estimates by the Robert Koch Institute, the current COVID-19 hospitalization rate is approximately six to seven per 100,000 of the resident population. Hospitalized COVID-19 patients now have access to a range of drugs which can reduce the severity of the disease or, in the most severe cases, reduce the risk of death. Some of these drugs target the virus itself; others fight the inflammation associated with infection.
First-line treatments include monoclonal antibodies and dexamethasone, a drug with strong anti-inflammatory properties. Antibody treatments neutralize the virus by sticking to the surface of its spike protein, preventing it from entering human cells. This type of treatment is used within seven days after symptom onset. Hospitalized COVID-19 patients who require oxygen therapy usually receive dexamethasone, a glucocorticoid which, for approximately 60 years, has been used to treat inflammatory conditions caused by an overactive immune response. In COVID-19, too, the drug has been shown to reliably dampen the body’s inflammatory response. However, as the drug is associated with various side effects, including an increased risk of fungal infections, it should only be used in a specific and targeted manner.
Researchers from Charité, the MDC’s Berlin Institute of Medical Systems Biology (BIMSB) and FU Berlin have now studied the mechanisms of action of both types of treatment. “We uncovered evidence to suggest that combination therapy of antibodies and dexamethasone is more effective than either of these treatments alone,” says first author Dr. Emanuel Wyler, a researcher at the BIMSB’s ‘RNA Biology and Posttranscriptional Regulation’ research group, which is led Prof. Dr. Markus Landthaler. As not all lung compartments can be studied using lung tissue samples obtained from patients, the research group’s first step last year was to search for a suitable model. That task fell to co-last author Dr. Jakob Trimpert, a veterinarian and research group leader at the FU Berlin’s Institute of Virology, who subsequently developed COVID-19 hamster models. As animals which both contract the same virus variants as humans and develop similar disease symptoms, hamsters have proven the most important non-transgenic model for the study of COVID-19. Symptoms and progression, however, vary between different species of hamster. While symptoms usually remain moderate in Syrian hamsters, for example, Roborovski hamsters will develop severe disease reminiscent of that seen in COVID-19 patients requiring intensive care.
“In the current study, we tested the effects of single and combined antiviral and anti-inflammatory therapies for COVID-19, meaning we used the existing models with monoclonal antibodies, dexamethasone, or a combination of the two,” explains Dr. Trimpert. The FU Berlin’s veterinary pathologists then examined infected lung tissue under a microscope to establish the extent of lung tissue damage. Dr. Trimpert and his team also determined the quantities of infectious virus and viral RNA present in the tissues at various time points. This enabled the researchers to check whether and how viral activity might change over the course of treatment. “Thanks to a detailed analysis of various COVID-19 parameters, which is only possible in an animal model, we were able to improve our understanding of the basic mechanisms of action of two important COVID-19 drugs. Moreover, we found clear evidence of the potential benefits associated with a combination therapy of monoclonal antibodies and dexamethasone,” says Dr. Trimpert.
Using single-cell analyses, the researchers demonstrated the drugs’ effects on the complex interplay of various cellular signaling pathways and the number of immune cells present. Individual cells obtained from a particular sample were loaded onto a chip, where they were first barcoded and then encapsulated into minute droplets of aqueous fluid. Once prepared, the single cells underwent RNA sequencing, a process used to establish the sequence of genetic building blocks which a cell has just read. Thanks to barcoding, this RNA is later identifiable as originating from a particular cell, enabling the researchers to determine cellular function at the single-cell level with a high degree of accuracy. “We were able to observe that the antibodies are effective at reducing the amount of virus present,” explains Dr. Wyler. He adds: “This was not much use in our model, though.” This is because it is not the virus that damages the lung tissue, but the strong inflammatory response triggered by the virus. The immune cells fighting the invading pathogens release messenger substances to call in reinforcements. When these defensive forces arrive in large numbers, the lungs can become clogged. “Obstructed blood vessels and unstable vessel walls can subsequently result in acute lung failure,” explains Dr. Wyler.
A surprise came in the shape of the well-known drug dexamethasone. “This anti-inflammatory exerts a particularly strong effect on a specific kind of immune cell known as neutrophils,” says the study’s co-last author Dr. Geraldine Nouailles, Research Group Leader at Charité’s Department of Infectious Diseases and Respiratory Medicine. Neutrophils are a type of white blood cell responsible for mounting a prompt response to viral and bacterial infections. “The corticosteroid preparation suppresses the immune system and prevents the neutrophils from producing messenger substances which would attract other immune cells,” explains Dr. Nouailles. She continues: “This makes the drug extremely effective at preventing an escalation of the immune response.”
The best treatment outcomes were achieved when the researchers administered a combination of antiviral and anti-inflammatory treatments. “This type of combination therapy is not included in existing clinical guidelines,” emphasizes Dr. Nouailles. “What is more, current guidance stipulates that, in high-risk patients, antibody therapy can only be given in the first seven days following symptom onset. In clinical practice, dexamethasone is only used once a patient requires oxygen therapy, i.e., at an extremely advanced stage of the disease. Its use in combination, however, opens entirely new treatment time windows.” This new approach must now be evaluated in clinical trials before it can be adopted in clinical practice.

Never dismiss the power of money to persuade. A study initiated before the rollout of COVID-19 vaccines has found that a $1000 incentive for the vaccine-hesitant could boost vaccine rates up to 87 percent.
At the time, that number was considered sufficient to confer herd immunity. With COVID-19 variants now proliferating globally, notions of herd immunity have changed. But the authors say their findings are still valuable, given that much of the developing world has yet to become fully vaccinated, and as public health officials continue to encourage vaccination as a powerful tool against serious health effects.
“It’s even a bigger question than vaccines and COVID. This is part of a larger set of ?dilemmas called collective action problems — such as how do we convince people to take action to mitigate climate change,” says Vivek Nandur, a doctoral student in behavioural economics at the University of Toronto’s Rotman School of Management and one of three study co-authors. “This speaks to that and how monetary incentives can be used to influence larger behaviour change.”
Some 2,500 study participants, recruited online in December 2020, were asked if they planned to get the vaccine or, if they would accept it under one of three conditions — if it were free, if it was effective against COVID-19, or if it had no side effects.,
Those who answered “yes” varied from 68 percent in the “free vaccine” category to 75 percent for those in the “no side effects” group. Some 70 percent of participants in the no conditions group said they would get vaccinated.
All participants who answered “no,” were then asked how much money would incentivize them to accept the vaccine. A $500 cash incentive brought the percentage of vaccine willing up to 80 percent. But the $1000 cash incentive, the maximum, raised that figure to nearly 87 percent.
Between 13 and 15 percent of participants were unwilling to accept the vaccine under any circumstances. But Nandur said the results support other findings that show that the vaccine hesitant are not a homogeneous group and that public health strategies need to be similarly nuanced and targeted. Even cash incentives are not a panacea, and can potentially backfire, given other conditions.
As one example, “offering the vaccine for free in our experiment seems to make people a bit warier, which is confusing and likely needs more examination,” Nandur said.
Money aside, people were more willing to take the vaccine if it was shown as effective against COVID-19, or had no side effects. Hesitancy was stronger among younger people than older ones, and among political conservatives.
The study was published in Humanities and Social Sciences Communications.
Nandur co-authored the study with David Soberman, a professor of marketing and the Canadian National Chair of Strategic Marketing at the Rotman School, and Ganesh Iyer of the Haas School of Business at the University of Berkley.
The researchers have since looked at the effects of a 2021 policy by the government of West Virginia to offer $100 savings bonds to people aged 16 to 35 who get vaccinated. The policy was introduced to boost the state’s lagging vaccination rate from 52 to beyond 70 percent.

The estimated cost of multiple sclerosis (MS) reached $85.4 billion in 2019 in the United States, according to a new report published in the April 13, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology. In addition, when researchers compared people with MS to people without MS they found that excess medical costs represent 74% of the overall economic burden of MS. The excess medical cost per person was $65,612 that year.
These costs not only reflect the cost of medications and health care. Neurologic disability can prevent people with MS from working or limit employment opportunities and reduce earnings. Also, many family members need to leave their employment to be caregivers. These costs are also reflected in this analysis as non-medical costs.
“Multiple sclerosis is an expensive disease to treat and the debilitating effects of MS can result in considerable disruption to daily living including work, physical independence, mobility and social interaction,” said study author Bruce Bebo, PhD, of the National Multiple Sclerosis Society in New York, NY. “The findings of this study help underscore the burden of MS in the US and our hope is our results will inform decision-making regarding MS-related health resources.”
Multiple sclerosis is a disease of the central nervous system which is made up of the brain, spinal cord and optic nerves. MS is chronic and can be unpredictable and disabling. Symptoms may include fatigue, numbness and tingling, loss of balance, weakness and problems with vision. An estimated 1 million people in the United States live with MS, and it affects more women than men. While there are medications to treat symptoms of the disease, there is currently no cure for MS.
For the study, researchers reviewed Medicare and insurance claims to determine direct medical costs, looking at a total of 10,589 people with MS and another 105,893 people without MS matched for age and sex. They calculated the per person direct medical costs for 2017, 2018 and 2019, and then calculated the average one-year cost. Researchers also surveyed 946 study participants and their caregivers about indirect costs, such as job loss or lost productivity on the job, cost of paid and unpaid caregivers, and home modifications.
Researchers found an estimated total economic burden in the U.S. of $85.4 billion. That amount included $63.3 billion in direct medical costs as well as $22.1 billion in indirect non-medical costs. Prescription medications were the largest component with $37.9 billion, amounting to about 54% of direct medical costs, followed by drugs administered in the clinic with $6.7 billion or about 12%, and outpatient care with $5.5 billion or 9%.
The average excess medical costs for a person with MS compared to a person without MS was $65,612. That included $35,154 for medication, the largest proportion of this cost.
The annual cost for a person taking MS medications ranged from $57,202 to $92,719.
“The costs of MS are very high not only on a personal level but a national level as well,” Bebo said. “Our results suggested a possible role for additional policy initiatives to better support individuals and families affected, in terms of providing treatment and long-term care, work-site support, employment, and occupational training. These measures could reduce the economic burden of MS and help improve the lives of those living with MS and their family caregivers.”
Bebo added, “Right now, in the U.S. there are about one million adults with MS and we estimated that by 2039, there will be nearly 1.2 million people living with MS. With this, the economic burden will increase to $108.1 billion.”
A limitation of this study was that the indirect and non-medical costs were estimated using a self-administered survey and relied on respondents’ memory, meaning some costs may have not been accurately reported.
The study was commissioned and paid for by the National Multiple Sclerosis Society.

Studies have shown that exercise helps protect brain cells. A new study looking at the mechanisms involved in this relationship suggests that the role exercise plays in maintaining insulin and body mass index levels may help protect brain volume and thus help stave off dementia. The research is published in the April 13, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“These results may help us to understand how physical activity affects brain health, which may guide us in developing strategies to prevent or delay age-related decline in memory and thinking skills,” said study author Géraldine Poisnel, PhD, of Inserm Research Center in Caen, France. “Older adults who are physically active gain cardiovascular benefits, which may result in greater structural brain integrity.”
In contrast, researchers found that the relationship between exercise and the metabolism of glucose in the brain was not affected by insulin or body mass index (BMI) levels. Reduced glucose metabolism in the brain can been seen in people with dementia.
The study involved 134 people with an average age of 69 who had no memory problems. The people filled out surveys about their physical activity over the past year. They had brain scans to measure volume and glucose metabolism. Information was gathered on BMI and insulin levels as well as cholesterol, blood pressure and other factors.
People with the most physical activity had a higher total volume of grey matter in their brains than people with the least amount of physical activity, with an average of about 550,000 cubic millimeters (mm³) compared to about 540,000 mm³. When researchers looked only at areas of the brain affected by Alzheimer’s disease, they found the same results.
Those with the most activity also had a higher average rate of glucose metabolism in the brain than those with the least amount of activity.
Higher physical activity was not associated with how much amyloid plaque people had in their brains. Amyloid plaque is a marker for Alzheimer’s disease.
Poisnel said more research is needed to understand the mechanisms behind these relationships. “Maintaining a lower BMI through physical activity could help prevent disturbed insulin metabolism that is often seen in aging, thus promoting brain health,” Poisnel said.
The study does not prove that exercise protects brain volume. It only shows an association.
A limitation of the study is that people reported their own physical activity, so they may not remember it accurately.
The study was supported by the European Union’s Horizon 2020 Research and Innovation Program, Region Normandy and MMA Foundation of Entrepreneurs of the Future.
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Materials provided by American Academy of Neurology. Note: Content may be edited for style and length.

A cell therapy developed by the executive director of the Smidt Heart Institute stabilizes weakened muscles-including the heart muscle-in Duchenne muscular dystrophy patients, a new study published in the international peer-reviewed journal The Lancet shows.
If the HOPE-2 study’s success is duplicated in the upcoming multicenter, randomized, placebo-controlled HOPE-3 clinical trial, the intravenous cell therapy could become the first Food and Drug Administration-approved treatment for Duchenne patients with advanced disease.
“This therapy is unique in that it addresses two vital needs in patients with Duchenne: physical movement and a healthy heart,” said Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, the Mark S. Siegel Family Foundation Distinguished Professor, an author on the study and the inventor of cardiosphere-derived cells (CDCs), progenitor cells derived from human heart tissue, which have been used in multiple clinical trials.
Duchenne muscular dystrophy is a rare, inherited disorder that mostly affects males. It’s caused by mutations on a gene on the X chromosome that interferes with the production of a protein called dystrophinthat muscles need to function. Children born with such mutations have muscle weakness throughout their bodies. This makes it difficult for them to do normal activities like run, jump, climb stairs, stand up after sitting and pedal a bicycle. They can also become extremely sick when muscles in their hearts and respiratory organs weaken.
The prognosis for patients with Duchenne muscular dystrophy is bleak. Most use a wheelchair by the time they are teenagers and don’t typically live into their 30s. There is no cure for the disease. Currently, the only approved medical treatments are aimed at delaying loss of the ability to walk; nothing is available for patients with more advanced disease, who now outnumber those with milder symptoms.
“The HOPE-2 trial is a game changer for muscular dystrophy,” said Craig M. McDonald, MD, the trial’s principal investigator and the professor and chair of physical medicine and rehabilitation and professor of pediatrics, from University of California, Davis Health, one of several sites participating in the trial. “For the first time, we have a treatment which markedly slows loss of arm function and preserves heart function in Duchenne patients. The cells are given intravenously, and only four times a year, so the treatment is not burdensome for patients and their families.”
Other experimental therapies aim to get the body to make dystrophin. The therapy studied in this Phase II clinical trial takes a different approach. It uses heart cells called cardiospheres, or CDCs, which are a type of progenitor cells derived from human heart tissue, to improve the function of skeletal muscle and the heart, at least partly by blunting inflammation. Skeletal muscle mediates voluntary movement, such as that of the arms, while the heart pumps blood throughout the body to sustain life.

There are thousands of apps that claim to promote mental well-being, but not all of them are safe or effective.With therapists in high demand and long waiting lists that make it challenging to find a provider, using a mental health app might seem like a tempting and relatively inexpensive way to get help.These apps claim to help with issues as varied as addiction, sleeplessness, anxiety and schizophrenia, often by using tools like games, therapy chatbots or mood-tracking diaries. But most are unregulated. Although some are considered useful and safe, others may have shaky (or nonexistent) privacy policies and a lack of high-quality research demonstrating that the apps live up to their marketing claims.Stephen Schueller, the executive director of One Mind PsyberGuide, a nonprofit project that reviews mental health apps, said the lack of regulation has created a “Wild West,” that was exacerbated when the Food and Drug Administration loosened its requirements for digital psychiatry products in 2020.It is difficult to pinpoint the exact number of mental health apps available, but one estimate from 2017 said there were at least 10,000 available for download. And these digital products are becoming a lucrative business. At the end of last year, Deloitte Global predicted that worldwide spending on mobile mental health applications would reach close to $500 million in 2022.So how do you make an informed decision about whether to add one to your phone? We asked several experts for guidance.Who might benefit from a mental health app?In general, mental health apps can help people gain insights into how their thoughts, feelings and actions interact with each other, said Dr. John Torous, the director of the digital psychiatry division at Beth Israel Deaconess Medical Center. They can also help facilitate the skills that patients learn during therapy, he added.Dr. Stephanie Collier, the director of education in the geriatric psychiatry division at McLean Hospital, noted that mental health apps “can work nicely alongside physical activity goals, such as step counters” because exercise can help reduce anxiety and depressive symptoms.“Similarly,” she said, “apps that teach skills such as deep breathing can be helpful to anyone experiencing stress — whether stress is the result of an anxiety disorder or just circumstances.”For some people, however, apps are not a great fit.Apps work best when people are motivated and have mild illness, Dr. Collier said. “People with moderate or severe depression may not have sufficient motivation because of their illness to complete modules on a mobile app.”Can mental health apps become a substitute for therapy?No, and especially not if you have impairing symptoms.“These are not stand-alone treatments,” Dr. Collier said. “But they can be effective when used in tandem with therapy.”Ideally, mental health apps teach skills or provide education, said Vaile Wright, the senior director of health care innovation at the American Psychological Association.“It could be this opening to thinking about ‘Maybe I should seek out some more professional help,’” she said.Dr. Torous offers his patients a free app called MindLAMP, which he created to augment their mental health treatments. It tracks people’s sleep patterns, physical activities and changes in symptoms; it can also customize the “homework” that therapists give their patients.Have these apps been screened by a regulatory agency?For the most part, no. The Food and Drug Administration regulates a small subset of apps that provide treatment or diagnosis, or are associated with regulated medical devices. But most mental wellness apps are not subject to government oversight.Thus, some apps make unsubstantiated marketing claims, experts warn, or even worse, offer inaccurate and potentially harmful information.“The number of products far outstrips the research evidence that’s out there,” said Dr. Schueller, who is also a clinical psychologist and associate professor at the University of California, Irvine. “Unfortunately a lot of the research that exists in this area is done internally by companies,” he added, rather than unbiased outside groups.In addition, there is no requirement that all wellness apps conform to the Health Insurance Portability and Accountability Act, known as HIPAA, which governs the privacy of a patient’s health records.In a recent paper, Dr. Torous and his colleagues examined regulatory gaps in digital health apps, revealing various problems that could arise, such as inaccurate phone numbers for suicide crisis help lines. The paper also highlighted an earlier study that found 29 of the 36 top-ranked apps for depression and smoking cessation shared user data to Facebook or Google, but only 12 accurately disclosed this in their privacy policies.And in March, a study concluded that an app created to help those with schizophrenia performed no better than a placebo (in this case, a digital countdown timer).“All these apps claiming to be effective in early or preliminary or feasibility studies likely need to study themselves with higher quality science,” Dr. Torous said.Lastly, just because an app is popular in the online marketplace doesn’t mean that it is going to be safer or more effective.How do you go about choosing one?“As a clinician who has used apps in care for well over five years, it was always tricky to understand what apps to match to patients,” Dr. Torous said. “You really have to think about how we can respect people’s individual backgrounds, preferences and needs.”Instead of looking for the “best app,” or the one with the most ratings, try to make an informed decision about which app would be the best match for you, he added.One place to start researching is the website Mind Apps, which was created by clinicians at Beth Israel Lahey Health in Massachusetts. It has reviewed more than 600 apps and is updated every six months. Reviewers look at factors like cost, security and privacy concerns and whether the app is supported by research.Another website, One Mind PsyberGuide, evaluates health apps for credibility, user experience and transparency of privacy practices. The project, which is affiliated with the University of California, Irvine, has more than 200 apps in its database, and each is reviewed annually.What should you look for in an app’s privacy policy?Although MindApps and One Mind Psyberguide both present an overview of an app’s privacy policy, but you may want to dig into the specifics yourself.Look at what kinds of information it collects, its security measures and whether it sells information to third parties or uses information for advertisements, Dr. Collier said.According to a 2019 study, fewer than half of mobile apps for depression even have a privacy policy, and most privacy policies are provided only after users enter their data.“It’s no wonder that some people have reservations about using mobile apps like this when you don’t know if or how your data is being used,” said the lead author of the study, Kristen O’Loughlin, a graduate research assistant at the Virginia Commonwealth University School of Medicine.Choose your app based on the information available and your own comfort level with disclosing personal information, she added.Which apps are reputable?The answer to this question may depend on whom you ask. But all of the experts spoke highly of the mental wellness apps developed by the federal government, like PTSD Coach; Mindfulness Coach; and CPT Coach, which is for people who are practicing cognitive processing therapy with a professional mental health care provider.These apps are not only well studied but also free, with no hidden costs. They have excellent privacy policies and state that personal information will never be shared with a third party.In addition to those apps, Dr. Collier recommends:DBT CoachCBT Thought DiaryBreathe2Relax (an app designed by an agency in the U.S. Department of Defense to teach belly breathing)Virtual Hope Box (an app produced by the Defense Health Agency that offers support in emotional regulation and stress reduction)For more suggestions, check out this list of apps on the University of California, San Francisco’s psychiatry and behavioral sciences department website. The list, which was created in consultation with Dr. Schueller, includes several free options.