Is Standing Worse Than Sitting?

happy man white male smiling elderly senior older

We know that sitting all day is bad for your health. But could standing for long periods of time be worse? Moving every 30 minutes for at least one minute can reduce the health harms of too much sitting and sedentary behavior, and from any prolonged static posture (including standing) at work.

Have a job that requires standing for long periods of time? In retail as a sales clerk or cashier, or banking as a teller? You may be twice as likely to develop heart disease, as compared to someone who spends their days in a chair, at least according to a recent study from Ontario, Canada. Researchers looked at 7.300 employed individuals in the Canadian Community Health Survey. None had heart disease the start of the study, and researchers followed the group for over 12 years. Those required to stand for long periods of time had double the risk of heart disease (adjusted for age, education, marital status, body mass index and other health factors such as diabetes and high blood pressure), as compared to their sitting colleagues.

Why might this be? If you are I stand for hours at a time, blood can pool in our legs, making your body work harder against gravity to move it back to the heart. This in turn can increase pressure in the veins, which over time can increase your chances of developing heart disease.

These findings point to standing on the job as an often overlooked carddiovascular risk factor. Hopefully, you are in an environment that allows you to change body positions throughout the day. The fix for those who sit too much is not to stand for long periods, but rather to be active. Even walking one minute every 30 minutes should help reduce your risk. I’m Dr. Michael Hunter.

Glowing tumor technology helps surgeons remove hidden cancer cells

Key Point: In a study from the University of Pennsylvania, surgeons were able to identify and remove a greater number of cancerous nodules from lung cancer patients when combining intraoperative molecular imaging (IMI) — through the use of a contrast agent that makes tumor cells glow during surgery — with preoperative positron emission tomography (PET) scans.


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Background: Pulmonary nodules are small growths in the lung. Doctors discover them in about 250,000 Americans each year. In 80,000 of those patients, the nodules are suspicious enough to warrant surgery. PET scans are standard before these procedures, and studies have shown they can detect malignancies in the nodules 90 percent of the time. But research has also shown these scans have limitations. They can’t usually show tumors smaller than a centimeter. They also can’t distinguish between cancerous growths and benign inflammatory diseases like infections. And importantly, scans taken before surgery don’t give surgeons real-time guidance once the procedure begins.

In order to get live imaging during surgery, Penn researchers used a near-infrared contrast agent called OTL38 that makes tumor cells glow. In past studies, they’ve shown it can detect malignant nodules as small as three millimeters — roughly one-third of the length of a shirt button. For this study, they combined PET imaging and IMI for 50 patients having surgery to remove lung nodules. All of the patients underwent a pre-operative PET scan within 30 days of their procedure. These scans identified a total of 66 nodules.

Results: During the operation, IMI identified 60 of the 66 previously known nodules, or 91 percent. In addition, doctors used IMI to identify nine additional nodules that were undetected by the PET scan or by traditional intraoperative monitoring. Between PET and IMI, a total of 75 nodules were identified. Researchers found that PET was accurate in determining if nodules were cancerous in 51 of them (68 percent). By comparison, IMI alone was accurate in 68 cases (91 percent).

IMI further improved diagnostics in 30 percent of the patients evaluated with this approach. In about 10 percent of patients, IMI helped surgeons find cancer that would have otherwise been missed by standard imaging like CT or PET.

“This shows the contrast agent is allowing us to remove more cancer from the patient than we would have with PET imaging alone,” said the study’s senior author Sunil Singhal, MD, the William Maul Measey Associate Professor in Surgical Research and director of the ACC’s Center for Precision Surgery.

This study lays the groundwork for future research involving OTL38. Researchers are currently evaluating this technology in a formal, multi-center trial that will be the first Phase II study of molecular imaging in the United States. They’re also exploring the effectiveness of additional contrast agents, some of which they expect to be available in clinic within a few months. They will also keep track of these patients to find out if these improved surgeries help patients live longer. These cancers also come back within five years in 25 to 30 percent of cases, so they hope to show these procedures lower that recurrence rate.

I’m Dr. Michael Hunter.

Story Source:


Journal Reference:

  1. Jarrod D. Predina, Andrew D. Newton, Jane Keating, Eduardo M. Barbosa, Olugbenga Okusanya, Leilei Xia, Ashley Dunbar, Courtney Connolly, Michael P. Baldassari, Jack Mizelle, Edward J. Delikatny, John C. Kucharczuk, Charuhas Deshpande, Sumith A. Kularatne, Phillip Low, Jeffrey Drebin, Sunil Singhal. Intraoperative Molecular Imaging Combined With Positron Emission Tomography Improves Surgical Management of Peripheral Malignant Pulmonary Nodules. Annals of Surgery, 2017; 1 DOI: 10.1097/SLA.0000000000002382


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How Exercise Reduces Dementia Risk

women walking exercise
Key Point: Physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age, numerous studies have shown. Now researchers have explored in one of the first studies worldwide how exercise affects brain metabolism. Their conclusion: Regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.

Background: Numerous studies have shown that physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age. Researchers at Goethe University Frankfurt explored how exercise affects brain metabolism. They examined the effects of regular exercise on brain metabolism and memory of 60 participants ages between 65 and 85 in a randomised controlled trial.

The Study: Researchers examined participants in the SMART study (Sport and Metabolism in Older Persons, an MRT Study) by assessing movement-related parameters, cardiopulmonary fitness and cognitive performance. In addition, they used magnetic resonance tomography (MRT) and magnetic resonance spectroscopy (MRS) to measure brain metabolism and structure.

Following this examination, participants rode an exercise bike three times a week over 12 weeks. The 30-minute training sessions were individually adapted to each participant’s performance level. Researchers then re-examined the participants to understand the effects of the physical activity on brain metabolism, cognitive performance and brain structure. The researchers also investigated to what extent exercise had led to an improvement in the participants’ physical fitness.

Results: As expected, physical activity influenced brain metabolism: It prevented an increase in choline. The concentration of this metabolite often rises as a result of the increased loss of nerve cells, which typically occurs in the case of Alzheimer’s disease. Physical exercise led to stable cerebral choline concentrations in the training group, whereas choline levels increased in the control group. Physical fitness also improved, with better cardiac efficiency after the training period. Overall, these findings suggest that physical exercise not only improves physical fitness but also protects cells.

I’m Dr. Michael Hunter.


The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.



  1. S Matura, J Fleckenstein, R Deichmann, T Engeroff, E Füzéki, E Hattingen, R Hellweg, B Lienerth, U Pilatus, S Schwarz, V A Tesky, L Vogt, W Banzer, J Pantel. Effects of aerobic exercise on brain metabolism and grey matter volume in older adults: results of the randomised controlled SMART trial. Translational Psychiatry, 2017; 7 (7): e1172 DOI: 10.1038/tp.2017.135

Poor adolescent diet associated with premenopausal breast cancer

“During adolescence and early adulthood, when the mammary gland is rapidly developing and is therefore particularly susceptible to lifestyle factors, it is important to consume a diet rich in vegetables, fruit, whole grains, nuts, seeds, and legumes and to avoid soda consumption and a high intake of sugar, refined carbohydrates, and red and processed meats.”

– lead author Karin B. Michels, ScD, PhD, professor and chair of the Department of Epidemiology at the UCLA Fielding School of Public Health, Los Angeles

Key points: Women who consumed a diet associated with chronic inflammation  as adolescents or young adults appear to have a higher risk of developing premenopausal breast cancer, as compared with those who had a diet not linked to inflammation.

Background: Researchers used data from 45,204 women in the Nurses’ Health Study II who had completed a food frequency questionnaire in 1998, when they were ages 33 to 52, about their diet during high School. The investigators then assed adult diet by first using a food frequency questionnaire in 1991, when participants were ages 27 to 44, and then every 4 years thereafter. They gave each woman’s diet an inflammatory score using a previously method that links diet with inflammatory markers in the blood.

During 22 years of follow-up, 870 of the women who completed the high school food frequency questionnaire were diagnosed with premenopausal breast cancer and 490 were diagnosed with postmenopausal breast cancer. When women were divided into five groups based on the inflammatory score of their adolescent diet, those in the highest score group had a 35 percent higher risk for premenopausal breast cancer relative to those in the lowest score group. When the same analysis was done based on early adulthood diet, those in the highest inflammatory score group had a 41 percent higher risk for premenopausal breast cancer relative to those in the lowest score group.

I’m Michael Hunter, the Breast Cancer Doctor.

Immunotherapy for Cancer

The latest approval of a cancer drug by the US Food and Drug Administration (FDA) changes the paradigm of cancer treatment — the new indication specifies a genetic defect without any mention of tumor types. It allows the drug to be used in any cancer that harbors the specified genetic defect, wherever the tumor appears in the body.

What: Historically, the US Food and Drug Administration (FDA) has approved cancer treatments based on where in the body the cancer started — for example, prostate or breast cancers. For the first time, the FDA approved a drug based on a tumor’s biomarker without regard to the tumor’s original location.

Details: The new approval is for the immunotherapy pembrolizumab (Keytruda, Merck & Co), which is already approved for use in several different tumor types, including melanoma and lung cancer. But this latest approval covers the use of pembrolizumab in tumors that have microsatellite instability-high (MSI-H) or are mismatch repair deficient (dMMR). These defects are found most commonly in colorectal, endometrial, and gastrointestinal cancers but also less commonly appear in cancers arising in the breast, prostate, bladder, thyroid gland, and other places, the agency notes.

Microsatellite instability & immunotherapy: It’s not just colorectal cancer: The results from that trial showed that patients with colorectal cancer with normal DNA repair (microsatellite stable) had zero response to pembrolizumab, whereas those with MSI and deficient DNA repair had a 50% response rate, she said. In addition, about 20% had stable disease. This is much higher than has been seen with immunotherapy in other tumor types, where fewer than 20% patients respond. But the trial also included patients with any solid tumor and MSI, and these patients also showed the 50% response rate and 20% stable disease results.

Downsides: Common side effects of pembrolizumab include fatigue, itchiness, diarrhea, decreased appetite, rash, fever, cough, dyspnea, musculoskeletal pain, constipation, and nausea. The drugs can also cause serious immune-mediated side effects, including lung, liver, kidney, or colon inflammation, endocrine problems.

Action point: All patients with advanced cancer who have had at least one standard therapy should be tested to see if their tumor harbors these genetic defects.

I’m Dr. Michael Hunter.