Publisher Health

A study on metal concentrations in U.S. community water systems (CWS) and patterns of inequalities, researchers at Columbia University Mailman School of Public Health found that metal concentrations were particularly elevated in CWSs serving semi-urban, Hispanic communities independent of location or region, highlighting environmental justice concerns. These communitieshad the highest levels of uranium, selenium, barium, chromium, and arsenic concentrations.
Even at low concentrations, uranium in particular represents an important risk factor for the development of chronic diseases. Until now little epidemiological research had been done on chronic water uranium exposures despite the potential health effects of uranium exposure from CWSs. Uranium in particular, has been underappreciated in the literature as a public drinking water contaminant of concern. The study results are published in the journal The Lancet Planetary Health.
“Previous studies have found associations between chronic uranium exposure and increased risk of hypertension, cardiovascular disease, kidney damage, and lung cancer at high levels of exposure,” said Anne Nigra, PhD, assistant professor of Environmental Health Sciences at Columbia Mailman School of Public Health. “Our objectives were to estimate CWS metal concentrations across the U.S, and identify sociodemographic subgroups served by these systems that either reported high metal concentration estimates or were more likely to report averages exceeding the US EPA’s maximum contaminant level (MCL).”
Approximately 90 percent of U.S. residents rely on public drinking water systems, with most residents relying specifically on community water systems that serve the same population year-round. The researchers evaluated six-year EPA review records for antimony, arsenic, barium, beryllium, cadmium, chromium, mercury, selenium, thallium, and uranium to determine if average concentrations exceeded the maximum contaminant levels set by the EPA which regulates levels for six classes of contaminants. This includedapproximately 13 million records from 139,000 public water systems serving 290 million people annually. The researchers developed average metal concentrations for 37,915 CWSs across the country, and created an online interactive map of estimated metal concentrations at the CWS and county levels to use in future analyses.
According to findings 2·1 percent of community water systems reported average uranium concentrations from 2000 to 2011 in exceedance of the EPA maximum contamination levels, and uranium was frequently detected during compliance monitoring (63% of the time). Arsenic, barium, chromium, selenium, and uranium concentrations were also disproportionately elevated in CWSs serving semi-urban, Hispanic populations, raising concerns for these communities and the possibility of influencing inequalities in public drinking water.
Nigra and her colleagues note that the consistent association between elevated CWS metal concentrations and semi-urban, Hispanic communities implies that concentration disparities are a failure of regulatory policy or treatment rather than underlying geology. Hispanic/Latino populations show numerous health disparities including increased mortality due to diabetes, as well as liver, kidney, and cardiovascular disease.
“Additional regulatory policies, compliance enforcement, and improved infrastructure are therefore necessary to reduce disparities in CWS metal concentrations and protect communities served by public water systems with elevated metal concentrations,” said Nigra. “Such interventions and policies should specifically protect the most highly exposed communities to advance environmental justice and protect public health.
Co-authors are Filippo Ravalli, Kathrin Schilling Yuanzhi Yu, and Ana Navas-Acien, Columbia University Mailman School of Public Health; Benjamin C Bostick, and Steven N Chillru, Lamont Doherty Earth Observatory, Columbia University; and Anirban Basu, University of London.
The study was supported by the US National Institutes for Environmental Health Sciences, grants P42ES010349, P30ES009089, R01ES028758, R21ES029668, and 5T32ES007322; the U.S. National Institutes of Health Office Of The Director and National Institute Of Dental & Craniofacial Research, grant DP5OD031849.
Detailed interactive map of public water contaminants: https://msph.shinyapps.io/drinking-water-dashboard/

Researchers have developed a biomedical imaging system using a semiconductor detector originally developed for hard X-ray and gamma-ray space observation, and used a spectral analysis method from astronomy to take accurate images of multiple radionuclides in small animals, reports a new paper in Nature Biomedical Engineering published on April 4.
Currently, fluorescent tracers are used to image the distribution of multiple molecules in a sample under a microscope. The use of multiple tracers can reveal the distribution of numerous molecules in detail. However, when it comes to imaging molecules within the body of animals, including humans, this becomes difficult as the body tissue absorbs most of the light. So, researchers use radionuclides as probes since radiation is absorbed much less by animal tissues than optical light, allowing them to obtain images of the distribution of tracers in the body.
However, current technology makes it somewhat difficult to distinguish between two or more nuclides, and has low spatial resolution. Also, it is difficult to remove noise on the image caused by radiation from other sources.
To try and resolve this problem, a collaboration of researchers from fields who usually never meet one another, led by Project Assistant Professor Atsushi Yagishita from the Kavli Institute for the Physics and Mathematics of the Universe (Kavli IPMU), RIKEN, the Institute of Space and Astronautical Science, and the National Cancer Center Japan, started a project in 2018 to adapt technology used in space observation for medical research.
Their latest study highlights two achievements.
One of the team’s achievements was the development of an imager, named IPMU imager, which was equipped with a cadmium telluride semiconductor detector with high energy resolution, meaning it had the ability to distinguish radiations of different energies, and a multi-pinhole collimator that could achieve high spatial resolution for radionuclide imaging. The IPMU imager made it easy to distinguish between radiations with different energies.
Still, there was room for improvement. The IPMU Imager could not eliminate all noise, especially when two radionuclides released similar radioactive emissions.
So the team’s second achievement was to use “fitting,” a spectroscopic X-ray analysis method used in the field of astronomy. What they were able to find was that using the technique allowed them to identify the source of all radiation. This eliminated noise radiation and made it possible to obtain accurate images using only radiation from the target nuclide.
Once the researchers were confident with their technique, they moved onto confirming it using mice. Three types of tracers with technetium-99m, Indium-111, and Iodine-125, respectively, were used in the experiment. These tracers accumulated in the lymph nodes and thyroid, respectively. Raw images showed noise and ghosting caused by radiation from other sources. However, by using the fitting technique, the researchers were able to identify unwanted radiation sources. When imaging iodine-125, only the thyroid gland where iodine-125 accumulates could be accurately and finely delineated by eliminating background noise and ghosting.
The researchers say there is still a way to go. While this study was an experiment involving a SPECT prototype, the researchers have already developed a full spec SPECT imaging device.
The team’s method can be applied to biomedical research, radiopharmaceutical development, and clinical diagnostic techniques.

A Mount Sinai-led team has developed a reproducible and scalable method to advance maturation of human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) — cells that support heart muscle contraction, generated in the lab from human stem cell lines — which researchers say will improve approaches for disease modeling, regenerative therapies, and drug testing. A study reporting this new protocol was published in the April 7 print edition of the journal Cell Stem Cell.
Mount Sinai researchers investigated multiple metabolic modifications in hPSC-CMs. The research team also identified the role of the protein known as peroxisome proliferator activated receptor delta (PPARd) in inducing what is referred to as the metabolic switch in the lab-generated heart muscle cells. This metabolic switch is a critical part of the maturation process of the heart.
“This work will create exciting opportunities to further assess human heart biology through multi-disciplinary approaches incorporating developmental biology, transcriptomics, contractile measurements and drug testing,” said senior author Nicole C. Dubois, PhD, Associate Professor of Cell, Developmental and Regenerative Biology at the Black Family Stem Cell Institute and The Mindich Child Health and Development Institute at the Icahn School of Medicine at Mount Sinai. “Our findings provide a new avenue to generate mature hPSC-CMs for disease modeling and regenerative therapy. We are moving a step closer to understanding how to leverage our knowledge of human development to improved access to mature human cell types.”
In the study, the researchers activated different signaling pathways in vitro to replicate the metabolic changes that would occur during heart development in the organism. They found that PPARd induces the metabolic switch from glycolysis to fatty acid oxidation in the lab setting, thus influencing whether heart muscle cells generate energy from glucose or fatty acids. While the signaling effects of the protein peroxisome proliferator activated receptor alpha (PPARa) are the most active in heart muscle cells, the researchers said PPARd signaling has a separate and important role in efficiently activating the gene regulatory networks, increasing the quantity and organization of the organelles involved in energy production, and augmenting the fatty acid oxidation process. The activation of signaling regulated by PPARd can further enhance heart muscle cell size and organization, and improve contractility, all hallmarks of heart maturation.
The research team also investigated the effects of lactate exposure, where heart muscle cells are able to survive on lactate in the absence of glucose. This is frequently used to enrich hPSC-CMs. The researchers found that this method can induce an independent mechanism of cardiac maturation, and when combined with PPARd, it enhances oxidative metabolism, allowing for efficient energy generation from both carbohydrates and fatty acids. This study allowed for a detailed analysis into the long-term effects of a commonly used protocol in the heart muscle field.
In collaboration with the Ma’ayan lab at Mount Sinai, the group has generated a comprehensive and publicly accessible dataset which details the transcriptomic changes observed by the Mount Sinai-led team. This dataset allows researchers studying either PPAR-regulated signaling or lactate selection to rapidly assess future targets for research or drug testing.
Mount Sinai’s Department of Pharmacological Sciences; The Friedman Brain Institute; the Departments of Psychiatry, Oncological Sciences, and Genetics and Genomic Sciences; the Institute for Systems Biomedicine; and the Department of Obstetrics and Gynecology contributed to this research, in addition to the Children’s Hospital of Philadelphia Research Institute and the University Medical Center Hamburg-Eppendorf.
This work was supported by funding from The Mindich Child Health and Development Institute and grants R01HL134956 and R56HL128646 from the National Institute of Health (NIH)/the National Heart, Lung, and Blood Institute (NHLBI).

A recently discovered chemical compound helped elderly mice with obesity lose fat and weight, add muscle and strength, reduce age-related inflammation and increase physical activity, a new study shows.
The study, published in the Journal of Cachexia, Sarcopenia and Muscle, provides the first evidence that BAM15, a mitochondrial uncoupler, prevents sarcopenic obesity, or age-related muscle loss accompanied by an increase in fat tissue.
“Loss of muscle mass is typically not a concern in younger adults with obesity. However, as people age, that changes. Older adults with sarcopenic obesity suffer accelerated muscle loss. They become less active. As a result, they are at high risk for falls, stroke, heart disease, poorer quality of life and premature death,” said Christopher Axelrod, MS, Director of Pennington Biomedical Research Center’s Integrated Physiology and Molecular Medicine Laboratory.
The weakness and frailty common to sarcopenic obesity are offset in older mice — the equivalent of aged 60-65 in human years — given BAM15. The mice, all of whom had obesity, were fed high-fat diets. Despite that, the mice given BAM15 lost weight and got stronger and more active.
“Typically, when you lose weight, you also lose muscle, and in some circumstances, you can lose a lot of it,” Axelrod said. “In this study, the aged mice increased their muscle mass by an average of 8 percent, their strength by 40 percent, while they lost more than 20 percent of their fat.”
BAM15 works by making the mitochondria, the power plants of the cell, less efficient. The result is that the mitochondria burn more energy. The researchers are reluctant to describe BAM15 as a miracle drug. More research will be needed to determine its effectiveness for people.
However, the findings about BAM15 have important implications for improving the quality of life for older adults, especially for the rapidly growing number of people with obesity. Preventing, delaying, or reversing the causes and consequences of sarcopenic obesity may allow people to live longer and healthier lives.
“These data highlight that mitochondrial uncouplers may play an important role in improving health span — the time a person enjoys good health — in advanced age,” said Pennington Biomedical Executive Director John Kirwan, Ph.D.
BAM15 improves many of the key determinants of health and aging, including: Removing damaged mitochondria Making more healthy mitochondria, and Reducing “inflammaging,” or age-related inflammation, linked to muscle loss”Extending health span is even more important than extending lifespan,” Kirwan said. “Suppose you could add 20 or 30 years to a person’s life. What would be the point if their quality of life was awful?”
Axelrod and Kirwan are the study’s corresponding authors. Wagner Dantas, Ph.D., a Postdoctoral Researcher in Kirwan’s Integrated Physiology and Molecular Medicine Laboratory, is the lead author.
This work used core facilities that are supported in part by Pennington Biomedical’s Center for Biomedical Research Excellence through National Institutes of Health awards 5P30GM118430 and 1P20GM135002 and Nutrition Obesity Research Center through National Institutes of Health award P30DK072476. This research was supported in part by the National Institutes of Health award U54GM104940. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Researchers make a compelling, evidence-based case for expanding the diagnostic workup to include cardiac arrhythmias when a normally continent individual experiences enuresis nocturna (involuntary urination during sleep). Their recommendations appear in Heart Rhythm, the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society, published by Elsevier.
When a normally continent individual experiences enuresis nocturna, treating physicians typically consider a differential diagnosis of urinary tract infections, anatomic malformations, emotional disturbances, epilepsy, sleep apnea, and the effects of diuretic or sedative medications. Despite the fact that involuntary urination during sleep can be a symptom ofcertain potentially lethal cardiac arrhythmias, they are rarely considered in the diagnostic evaluation.
The sudden death from long QT syndrome type 2 of a 23-year-old female who had experienced two isolated bedwetting episodes but no other symptoms, prompted researchers to examine the prevailing protocols among physicians likely to encounter patients with unexplained enuresis. They conducted an anonymous internet-based survey asking physicians to select the diagnostic tests they would perform for a patient with unexpected and unexplained bedwetting and no other symptoms. The 346 respondents included 102 pediatricians, 73 family physicians, 57 internal medicine specialists, 35 residents, 37 interns, and 42 advanced medical students. Of these, 114 were senior physicians with more than three years of experience.
Most of the survey respondents said they would perform urinalysis and kidney ultrasound following events of enuresis to search for an underlying urinary disease. Many also selected testing for diabetes and abnormalities in urinary flow. While 19% recommended performing an encephalogram, an indication that they considered the possibility of nocturnal epileptic seizures as a potential cause, only 1% thought that performing an electrocardiogram was indicated. This finding demonstrates that arrhythmic seizures are practically never considered part of the differential diagnosis of unexplained enuresis.
“We are very surprised and extremely concerned by the lack of awareness among primary physicians about the possibility of nocturnal arrhythmogenic seizures caused by long QT syndrome,” noted lead investigator Sami Viskin, MD, Sourasky Tel Aviv Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. “The condition, which is highly lethal when left undiagnosed and untreated, is easy to detect with an electrocardiogram and is highly responsive to appropriate therapy.”
The medical community recognizes that arrhythmias are an important cause of daytime syncope, and the electrocardiogram is considered an essential tool for its evaluation. It is important to raise the awareness to the fact that the same arrhythmias known to cause syncope in the “awake patient” may also cause nocturnal seizures during sleep. If these nocturnal seizures are not witnessed, then unexplained bedwetting may be the only clue remaining from the dramatic event.
Dr. Viskin explained that the underlying diagnosis for most cases of enuresis will not be an arrhythmic syncope, especially with young patients. However, it is important to explore this possibility, particularly when the events are highly sporadic, noting that “An electrocardiogram is an inexpensive and easily performed test that is invaluable for diagnosing potentially fatal diseases that can be easily cured.”
“Inquiring about a familial history of sudden death should be an integral part of every medical consultation,” Dr. Viskin added. Failing to recognize a malignant family history can be pivotal: Post-mortem investigation about their patient uncovered family history including genetic predisposition and instances of sudden death.
In an accompanying editorial, Dr. Patrina H.Y. Caldwell, FRACP, PhD, and Professor Jonathan R. Skinner, MBChB, MRCP(UK), FRACP, MD, FHRS, of Sydney Children’s Hospital (Randwick and Westmead, Australia), agreed that taking a family history for early death, in combination with an electrocardiogram, is recommended as a quick, cheap, universally available, and effective way to prevent a rare lethal outcome.
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Frontotemporal dementia patients with extrapyramidal symptoms have brainstem atrophy and reduced metabolism in certain areas of the brain significantly more often than patients without extrapyramidal symptoms, a new study from the University of Eastern Finland shows. This observation can facilitate differential diagnostics in frontotemporal dementia. The findings were published in Journal of Neurology.
Frontotemporal dementia, FTD, is an umbrella term for degenerative brain diseases that affect behaviour and cognition. Sometimes, FTD comes with extrapyramidal symptoms, such as those in Parkinson’s disease, and this makes the diagnosis of FTD challenging. However, the new study now shows that accurate imaging and analysis of the brain may make it possible to distinguish between FTD and other diseases that cause extrapyramidal symptoms.
Extrapyramidal symptoms refer to involuntary movements, typically tremor, slowness, stiffness, loss of facial expressions and automatic movements, such as arm swing when walking. They are often associated with extrapyramidal disorders such as Parkinson’s disease and atypical parkinsonism. Examples of atypical parkinsonism include progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). They share disease mechanisms with frontotemporal dementia, which is why they are nowadays considered to be part of the same spectrum of diseases. Frontotemporal dementia is traditionally divided into two main categories: the more common variant with behavioural changes as an early symptom, and the rarer primary progressive aphasia (PPA) with problems related to speech as an early symptom.
Neurodegeneration associated with progressive memory disorders is typically imaged in two ways: magnetic resonance imaging of the brain provides accurate information on brain structures and volumes of the different parts of the brain, whereas positron emission tomography, or a PET scan, provides information on metabolism in different areas of the brain. Degeneration of the brain tissue is often preceded by slow or missing metabolism.
The researchers analysed Kuopio University Hospital’s medical records on a total of 139 patients with frontotemporal dementia, PSP or CBD, focusing in particular on their diagnosis and the presence of extrapyramidal symptoms. The patients’ MRI and PET images were analysed using automated analysis software.
The researchers found that patients with extrapyramidal symptoms also had atrophy of the basal ganglia in the midbrain, and of the brainstem. When looking at patients with frontotemporal dementia alone, it was found that patients with extrapyramidal symptoms had brainstem atrophy considerably more often than patients without extrapyramidal symptoms. In addition, PET image analyses showed reduced metabolism in the superior cerebellar peduncle and the frontal lobes in patients with extrapyramidal symptoms.
The study showed, for the first time, that significant structural and metabolic differences can be detected in the brain of frontotemporal dementia patients with extrapyramidal symptoms, compared to patients without these symptoms.
“If our findings are confirmed in other cohorts, they can be used in early diagnostics to distinguish between frontotemporal dementia and Parkinson’s disease, for example. These findings will also provide us with a better understanding of the mechanisms of these diseases,” says Doctoral Researcher Sami Heikkinen, the lead author of the article.
“Although the treatment of these diseases is symptomatic at the moment, an early and accurate diagnosis is an important step towards the development of disease modifying treatments.”
The study was conducted in the research group on Frontotemporal Lobar Degeneration and Early Onset Dementia, led by Adjunct Professor Eino Solje.
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Chromosomal abnormalities are found in most multiple myeloma (MM) patients. While myeloma patients have generally benefited from the advancement of treatment modalities over the years, the treatment outcome for patients having two or more high-risk prognostic events remains poor. In a novel step forward, a research team led by Professor Chng Wee Joo from the Cancer Science Institute of Singapore (CSI Singapore) at the National University of Singapore (NUS) embarked on a study which aims to address the unmet clinical need in this group of patients.
The deletion of chromosome 17p13 (17p13(del)) and the gain of chromosome 1q21 (1q21(gain)) are long-standing independent high-risk biomarkers. However, the biological significance underlying the poor outcome in MM patients having co-occurrence of both chromosomal abnormalities has never been interrogated.
In the study recently published in Oncogene in February 2022, Prof Chng and his team uncovered that MM cells of patients harbouring concomitant 17p13(del) with 1q21(gain) have loss of functional p53 and NEIL1 respectively, both of which are important DNA repair genes. MM cells of this high-risk patient group demonstrated defective DNA damage response (DDR) associated with high genomic instability signature and persistent activation of Chk1 pathway.
Findings revealed that in the event of NEIL1 and p53 inactivation, cells would be highly dependent on the Chk1 pathway, suggesting a synthetic lethal relationship between p53-NEIL1-Chk1 abnormalities. Interestingly, this proof-of-concept study is one of the first in this high-risk myeloma patient subgroup.
Their findings present the biological and therapeutic relevance of Chk1 inhibition in targeting DDR and genomic instability, both of which are characteristic traits of high-risk patients with co-occurrence of the two chromosomal abnormalities. More importantly, discovering the Achilles’ heel of this disease has opened doors for more effective and novel treatment modalities to address an unmet medical need of myeloma.
Moving forward, Prof Chng and his team are hoping to establish Chk1 inhibitors as the standard of care and targeted treatment for 17p13(del)-1q21(gain) high-risk patients. The team plans to further investigate the leverage of this genomic instability on the armamentarium of novel therapies in myeloma, including immune-based and cell therapy products.
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Much of the cell-to-cell communication is facilitated in humans by 58 cell surface receptor tyrosine kinases (RTKs). In a study published in the EMBO Reports, Finnish research team led by Dr. Markku Varjosalo from the Institute of Biotechnology, University of Helsinki, report a systematic mapping of the molecular interactions of the RTKs.
The RTKs are proteins located at the cell surface. In response to stimuli such as growth factors, RTKs phosphorylate specific target proteins within the cell called ‘substrates’ — and by doing so, modulate the substrate activity or functions. Thus, RTKs play central roles in cell-to-cell signalling and are essential in coordinating complex biochemical pathways and cellular processes. RTKs are involved in several diseases, including cancer and developmental disorders.
Despite the central function and key role of RTKs in human diseases, many of them are still poorly characterized. To resolve the lack of systematic knowledge on the RTKs, the researchers from the University of Helsinki applied three complementary methods to map the molecular context and substrate profiles of the RTKs. First, researchers characterized stable binding partners and the RTK-formed protein complexes, and then identified transient and proximal interactions and the RTK substrates. Finally, they studied how the identified RTK interactions depend on its kinase activity.
“Our data represent a comprehensive, systemic mapping of RTK interactions and substrates. This resource adds information regarding well-studied RTKs, offers insights into the functions of less well-studied RTKs, and highlights RTK-RTK interactions and shared signaling pathways, Dr. Varjosalo states.
The information provided in the study can also help understanding diseases stemming from the abnormal functions of the RTKs.
“The RTKs have proven to be excellent drug targets for therapeutic intervention in the treatment of various diseases, especially cancer,” Dr. Varjosalo states.
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As medical and surgical treatments have improved and survival has increased, the majority of people with congenital heart disease are now adults rather than children, yet disparities driven by social determinants of health (SDOH) limit access to the lifelong specialty care needed, according to a new American Heart Association scientific statement published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the Association.
An American Heart Association scientific statement is an expert analysis of current research and may inform future guidelines. The new statement focuses on the impact of SDOH — the conditions in which people are born and live, such as education, employment, housing, income, and access to food and safety — among people born with congenital heart defects. Societal factors impact the ability of people born with congenital heart disease to get appropriate specialty treatment throughout their lives and particularly when they are transitioning from pediatric to adult care.
The word congenital means existing at birth. The terms “congenital heart defect” and “congenital heart disease” are often used to mean the same thing and are used interchangeably in the scientific statement. It’s important to note, however, that while “disease” is more commonly used, “defect” is more correct because the heart problem is a defect or abnormality, not a disease. A congenital heart defect results when the heart or blood vessels near the heart don’t develop normally before birth. These structural problems can usually be surgically addressed; however, for many, the condition is not completely cured. People with a congenital heart defect (CHD) — particularly those with complex heart problems — may require multiple operations and need specialty heart care throughout their lives.
“Social determinants of health affect every single facet of CHD — from who is born with a heart abnormality to who is diagnosed prenatally, to outcomes of surgery, to clinical follow-up as well as transitioning to adult care,” said the Chair of the statement writing group Keila N. Lopez, M.D., M.P.H., an associate professor of pediatrics and medical director of the transition medicine division of pediatric cardiology at Texas Children’s Hospital/Baylor College of Medicine in Houston.
This statement follows a 2020 presidential advisory from the Association, published as a call to action to confront structural racism as a fundamental driver of health disparities.
“When people think about individuals with poorer health outcomes, they often assume that these are the direct result of individual choices that people make; however, that is often not the case. Differences in the social determinants of health are often directly linked to worse health outcomes,” said Lopez. “Disparities in health outcomes, such as life expectancy differences, are in large part due to long-standing systemic and structural racism factors across society that affect the communities in which people live and the care that is available, all of which negatively affects their lifelong health.”
At the population level of care, the statement points out that while there has been overall improvement in outcomes due to advances in surgical and medical care for congenital heart defects, there has been minimal improvement in equitable access across the U.S. to that care. Specialty care services are concentrated in urban areas, making access difficult for those who live in rural or smaller communities. Availability of care also refers to an individual’s access to transportation and working at a job with the flexibility to have time off for health care needs, which tends to be more challenging for people with a complex disease and who have a lower socioeconomic status. Referral patterns to specialty care can also affect access to care.

Stroke survivors who practiced a seated form of Tai Chi had equal or greater improvement in hand and arm strength, shoulder range of motion, balance control, symptoms of depression and activities of daily living after three months, compared to those who participated in a standard stroke rehabilitation exercise program, according to new research published today in Stroke.
The American Heart Association’s/American Stroke Association’s Guidelines for the Early Management of Patients with Acute Ischemic Stroke recommend people start stroke rehabilitation within seven days and continue for up to six months after a stroke. However, many survivors opt out of rehabilitation therapy because they lack physical stability or are unable to fully use their arms. The Association also notes in a Scientific Statement about Physical Activity and Exercise Recommendations for Stroke Survivors that flexibility and muscle strength training, including yoga and Tai Chi, are reported to be beneficial for stroke survivors in improving balance, quality of life and mental health, while reducing the fear of falling.
Tai Chi, a traditional Chinese martial art, consists of a series of slow, careful movements of the hands, arms, neck, legs and core combined with deep breathing. The novelty of this study is that researchers developed a sitting routine of Tai Chi exercises for people who had a recent ischemic stroke (blocked blood vessel to the brain) and experienced hand and arm weakness or partial paralysis.
“Tai Chi has a long history as a form of exercise in China. We revised the Tai Chi movements for people who have weakness or partial limb paralysis. It is tailored so that participants can move one arm with the help of the healthy arm,” said Jie Zhao, Ph.D., lead study author and a lecturer at Yunnan University of Traditional Chinese Medicine in Yunnan, China.
The study was conducted at two traditional Chinese medicine hospitals in Kunming, China. Researchers recruited 160 adults (average age of 63 years; 81 men and 79 women) who had suffered their first-ever ischemic stroke within six months of joining the study and retained their use of at least one arm. Among the study participants, half were randomly assigned to the sitting Tai Chi program, and the other half were part of the control group that practiced a standard stroke rehabilitation exercise program (hospital-recommended upper limb movements; the amount, implementation strategies and caregiver responsibilities were similar to the Tai Chi group).
The participants in the sitting Tai Chi group received individual training from a Tai Chi instructor for one week during hospitalization and a self-guided video to practice at home for three days a week for 11 weeks. The control group received a self-guided exercise video of standard exercises to practice at home for 12 weeks. Family members and caregivers supervised the at-home exercise for both study groups. Sixty-nine people in the sitting Tai Chi group and 65 people in the control group completed the 12-week program and 4-week follow-up. Physical function and psychological state were measured for all study participants via questionnaires and assessment tools at the start of the study and at four additional times during the 16-week program, and the outcomes of the two groups were compared.
Researchers analyzed the questionnaires and assessment tools and found: Those in the sitting Tai Chi group had better hand and arm function and sitting balance control compared to those in the standard stroke rehabilitation group. The participants in the sitting Tai Chi group had significant reductions in symptoms of depression, better shoulder range of motion and showed significant improvements in activities of daily living and quality of life compared with the control group. More than half the people in the Tai Chi group continued to practice after the 12-week intervention. Improvement in these measures continued during the 4-week follow-up period for the Tai Chi group.”Sitting Tai Chi can be practiced in a chair or wheelchair and is very convenient since it can be done in your home. The program costs almost nothing to practice, and it doesn’t require any special equipment or travel time,” Zhao said.
This is the first randomized controlled trial focused on a modified sitting Tai Chi routine and found improved short-term outcomes in a group who may struggle to adhere to a standard stroke rehabilitation exercise program. The results demonstrate this mind-body practice is an effective option to enhance balance, coordination, strength and flexibility, particularly for stroke survivors with hand and arm weakness or partial paralysis.
“My follow-up study will measure the long-term effects of sitting Tai Chi,” Zhao said. “People will most likely need to adhere to the sitting Tai Chi exercise beyond 12 weeks to get the beneficial long-term effects.”
One of the limitations is that the study was conducted at only two centers. In addition, the physicians and health care professionals at the centers are trained in traditional Chinese medicine and are supportive of the study, so the results may not be representative of the rehabilitation available to stroke survivors who receive care at other hospitals.
According to the American Heart Association, stroke is the fifth leading cause of death in the United States, and a leading cause of long-term disability.
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