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News Tips

Living Well

Health and wellness tips from Indiana University

Living Well for June addresses the following topics:

How Viagra affects the partner
Vigorous- v. moderate-intensity exercise and weight loss
The maturing and rapidly growing adventure tourism industry
A patient-physician communication check up

When it comes to sex: He said AND she said. The findings in a new study on Viagra might seem obvious -- the sexual satisfaction of couples involving a male with erectile dysfunction improved significantly when the man took Viagra. The novelty is that researchers cared what the woman thought. Sex research involving pharmaceutical treatments, unlike treatments involving therapy, often is limited to effects only on the person taking the medication. One should not assume, however, that partners like or dislike a change in sexual functioning. "The nice thing about this study is that it reminds us that when people engage in a treatment, even taking a pill, it doesn't stop at the edge of their skin. It can, and often does, affect others," said Julia Heiman, lead author of the study and director of The Kinsey Institute for Research in Sex, Gender and Reproduction. "In this study, changes in one partner were correlated with changes in another. If one partner improved than so did the other."

Here are some of the key findings:

• For the men with erectile problems, the younger they were, the more their sexual satisfaction improved with the use of Viagra.
• For women, those who were generally satisfied in their overall relationship but dissatisfied with their sexual relationship reported greater sexual satisfaction when their partner used Viagra.
• The women whose partners took Viagra reported a significant improvement in their sexual satisfaction and in their arousal and orgasms.
• Men in the Viagra group showed significant improvement/changes in erectile functioning, intercourse satisfaction, overall sexual satisfaction and frequency of intercourse satisfaction. Their orgasm function did not increase significantly.

"We are always interested in the health effects of sexuality, and the motivations for seeking treatment," said Heiman, whose research over the years has examined the development and impact of different sexual treatments on individuals and couples. "Maybe it's the partner's response that is most important in predicting long-term treatment gains as well as general health gains. It would be worthwhile knowing that." The study, funded by Pfizer, Inc., involved 176 couples in which the male had erectile dysfunction and the female expressed dissatisfaction with their sex life. The male partner in each couple was randomly assigned to either receive Viagra or placebo for 12 weeks, at the end of which 79 Viagra and 76 placebo group couples actually finished the entire study. The mean age for men was 58, with ages ranging from 30 to 86. Most of the women were postmenopausal, with ages ranging from 20 to 79 and an average age of 58. The study, "Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: a multicentre, randomized, double-blind, placebo-controlled trial," appears in the journal BJOG: An International Journal of Obstetrics and Gynaecology. The article is available online at: http://www.blackwell-synergy.com/doi/full/10.1111/j.1471-0528.2006.01228.x.

To speak with Heiman, contact Jennifer Bass at 812-855-7686 or jbass@indiana.edu. Top

Ready to walk off the pounds this summer? Think again. According to a national study published this month in the American Journal of Health Education, moderate-intensity physical activity, such as slow walking, might not be helpful in losing weight. "Although moderate-intensity physical activity does provide numerous health benefits, such as reducing blood pressure and risks for systemic inflammation and type 2 diabetes, you better increase the intensity of your activity to lose weight unless you exercise more than an hour almost every day," said Dong-Chul Seo, lead author of the article and an assistant professor in Indiana University Bloomington's Department of Applied Health Science.

Here are some of the major findings and observations in the study, titled "Differences in vigorous and moderate physical activity by gender, race/ethnicity, age, education, and income among U.S. adults," coauthored by Mohammad Torabi, chair of the Department of Applied Health Science:

• People who reported meeting the guidelines for vigorous physical activity were less likely to be overweight or obese. There was no such relationship, however, between people who met moderate physical activity guidelines and their overweight or obesity status.
• "Given the lack of evidence about the efficacy of moderate-intensity physical activity on reducing body weight, health practitioners need to be cautious against providing expectations that people could lose substantial weight by engaging in moderage physical activity," the authors wrote.
• The study confirmed findings by the national Centers for Disease Control and Prevention that a higher percentage of Americans are meeting the moderate physical activity guideline. Seo's study found that 48 percent of Americans reported meeting this guideline, up from just 15 percent in 1997. "We still have a long way to go," Seo said. "Less than a half of Americans meet either the vigorous or moderate physical activity guideline."
• Note: For the study, researchers used physical activity guideline recommended by the U.S. Department of Health and Human Services and reflected in Healthy People 2010, the health objectives for the nation to achieve over the first decade of the 21st century. Vigorous physical activity: Exercise for at least 20 minutes in a manner that makes one sweat or breathe hard, doing this three or more days in a week. Moderate physical activity: Exercise for at least 30 minutes in a manner that does not make one sweat or breathe hard, doing this for five or more days in a week.

Seo cautioned that making an active lifestyle a habit, regardless of the intensity of the exercise, is more important than exercising vigorously. "Many obese or older adults would benefit more through moderate-intensity physical activity. Research indicates that obese or elderly people tend to adhere more to moderate activity than to vigorous activity." For a copy of the study, contact Amy Feinberg, afeinberg@aahperd.org.

Seo can be reached at 812-855-9379 and seo@indiana.edu. Top

Mountain climbing anyone? Adventure tourism and adventure education have become two of the fastest growing sectors of the tourism industry. With exotic locales, built-in excitement, affordable price tags and activities designed to foster not only good memories but heightened levels of resilience and empowerment, these trips have a growing appeal. But vacationers need to be aware of three issues that could sour their experience: Qualifications of tour guides, attributes of a quality program or experience, and the risks, whether they are real or perceived. "Bad experiences could range from mild disappointment to catastrophe. It's not a buyer beware kind of mentality," said Alan Ewert, professor in IU Bloomington's Department of Recreation, Park and Tourism Studies. "There are a number of organizations that seek to monitor levels of quality and standards of behavior and risk management. It's not like the frontier anymore."

Ewert offers the following suggestions and considerations:

• Check guides' qualifications: Check to see if guides are specifically certified in the actual activity. Does the rafting guide, for example, have a rafting certificate? Guides also should have, at a minimum, a wilderness first responder level of medical training.
• Ask questions: Does the program appear to be well-designed? Are the goals of the client actually considered and do they match what the program is delivering? Potential clients can ask for references and evaluations as well as a safety report that would list complaints regarding injuries and other legal issues.
• Know the risks: Check to see if major potential risks and dangers are clearly stated or if the company appears to be glossing over them. Check to see how physically challenging the activities will be and if special skills are required.
• Adventure tourism: With roots in ecotourism, adventure tourism includes such activities as rock-climbing, cattle drives, white water boating, cave scuba diving, covered wagon trips and other activities designed for individuals, families or groups, such as church or work groups. Potential adventure tourists can research possible getaways by reading travel magazines or visiting Web sites for professional organizations, such as the Professional Association of Diving Instructors, http://www.padi.com/padi/Default.aspx; and the American Mountain Guides Association, http://www.amga.com/. "The adventure travel industry has matured in many ways, with activities once thought of as crazy now considered legitimate leisure pursuits," Ewert said. "There's a whole infrastructure built to support it -- providing food, guides, transportation and other needs."
• Adventure education: With adventure education trips, the scenic locales typically become a place to learn "through" not just about. Ewert will be an instructor this summer for an educational course for teachers. He and the students will canoe down the Missouri River, retracing some of the route taken by explorers Lewis and Clark. The teachers will discuss history, for sure, but they will focus more on reflections designed to improve their role as teacher. Vacation planners can get more information about these trips by visiting Web sites for such groups as Outward Bound, http://www.outwardbound.org/, Wilderness Inquiry http://www.wildernessinquiry.org/ and IU's Bradford Woods, http://www.indiana.edu/~bradwood/.

Ewert said that people who participate in adventure tourism or adventure education often develop a growing sense of empowerment, experience heightened levels of resilience and return home with a sense of achievement. "Vacationers can experience 'some' of these on adventure tourism trips," Ewert said. "Adventure education programs are often designed specifically to help vacationers develop these positive experiences. Research supports the occurrence of these outcomes but now we want to find out how this occurs, how long it lasts and whether these new skills transfer to the greater community."

Ewert can be reached at 812-855-8116 and aewert@indiana.edu. Top

Making the most of a visit to the doctor. For many patients, a visit to the primary care physician tends to be a one-sided conversation. Patients begin by stating one medical problem, and immediately the doctor takes over. It doesn't have to be that way, said Richard Frankel, professor of medicine and geriatrics at the IU School of Medicine and a senior research scientist at the Regenstrief Institute, Inc. Frankel has studied patient-physician communication and ways to improve it. He said research shows that patients who take a more active role in their own care have better medical outcomes, including improved blood pressure readings in hypertensives, resolution of chronic headaches and lower blood sugar values in diabetics. "Ask questions, and don't be afraid to ask," Frankel said. "Doctors are trained to question their patients. But questions are pretty rare from patients, so they need practice in asking them." Frankel offers the following suggestions for patients and their doctors:

Patients

• Make a list. Patients can write down their questions before going to see the doctor so they will have something to prompt their memory.
• Practice. Frankel suggested practicing questions with a friend or family member to figure out the best way to ask them. This saves valuable time at the doctor's office, and it may make a busy doctor more inclined to listen than if the patient seems to be tongue-tied.
• Stray from the list. At some point during the visit to the doctor, the patient probably will need to improvise. A common example is when the doctor's instructions are not clear. Frankel's advice is the same: ask questions.
• Ask how to interact. If it is the patient's first visit to a particular physician, it can be very helpful to ask, "How do you work with your patients?" "In the long run it will be a tremendous time-saver," Frankel said. "Many doctors will offer a free first visit for this reason."
• Give feedback. One of the great gifts patients can give their doctors is to help them improve their communication skills by giving them feedback, Frankel said. "Tell the doctor, 'It really bothered me that I couldn't get a word in edgewise,' for example," he said. The common practice if patients have a bad experience is to say nothing about it, because people don't want to be rude or insulting. But then doctors have no way of knowing that they need to improve their communication skills.
• Supplements. If patients are taking nutritional supplements or alternative medical treatments, they need to mention these because the doctor is not likely to ask about them."In addition to listing current prescription medications during a first visit, the patient needs to raise these other topics along with any questions he or she may have. It may feel awkward and difficult, but it is critically important to avoid harmful drug interactions that could occur if the doctor is unaware of all the medications that are being taken," Frankel said. "In return, the doctor should be respectful about nutritional supplements -- not say, 'You're taking what?!'"

Physicians

• Listen and then ask. Physicians need to do their part for a genuine conversation to take place. "Listening skills are really helpful for doctors," Frankel said. "If a patient comes in and begins by saying, 'I don't feel well' and then pauses, don't immediately quiz him or her, because then it turns into an interrogation. Keep listening and wait for the patient to say more. This is counter-intuitive, because doctors are taught as professionals to ask questions to bring out relevant details about the patient's condition. In terms of timing, there's a small difference between an interrogation and a genuine, open-ended question that lets patients say what's on their mind." He suggested that physicians try counting to five before beginning to respond to a patient's statement of concern. "It's surprising the difference in quality of information and patient satisfaction that follows from this simple communication technique," he said.
• Anything else? The final question is also important, he said. "At the end of the session, the physician should ask the patient, 'Is there anything else we should talk about or that you didn't understand?'"

To speak with Frankel, contact Cindy Fox Aisen at 317-274-7722 or caisen@iupui.edu. Top

For further assistance with these tips, contact Tracy James at 812-855-0084 or traljame@indiana.edu.

EDITORS: This monthly tip sheet is based on Indiana University faculty research, teaching and service. "Living Well Through Healthy Lifestyles" is the guiding philosophy of IU Bloomington's School of Health, Physical Education and Recreation. In keeping with that philosophy, this tip sheet offers information related to both physical and mental well-being. Faculty in other IU schools and departments also contribute their expertise in this area.

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