Drug Slows Prostate Cancer Growth

According to a new study, a drug that is commonly used to treat men with enlarged prostates may also delay the growth of prostate cancer.

The drug, dutasteride, works by blocking the conversion of testosterone to dihydrotestosterone, the male sex hormone implicated in the development of prostate cancer.

For the study – published in the Jan. 24 online edition of The Lancet – 302 men ages 48 to 82 with low-risk localized prostate cancer were assigned either once daily dutasteride or a placebo for 3 years.

Patients were given biopsies at 18 months and 3 years, and given a questionnaire about cancer-related anxiety.

The results showed that treatment with dutasteride significantly delayed prostate cancer progression – 38 percent versus 48 percent progression in those given the placebo.

What’s more, men treated with dutasteride were also less likely to have cancer detected in their final biopsy – 36 percent with no cancer detected, versus 23 percent of those who had been given the placebo.

Men treated with dutasteride also reported significantly lower anxiety throughout the study.

The study authors concluded that duasteride “provides a treatment option for men with low-risk, localized disease.” In an accompanying comment to the study, Chris Parker from the Royal Marsden National Health Service Foundation Trust warned that dutasteride “has no effect, or even an adverse effect, on the progression of high-grade disease.

Thus, although reducing overall prostate cancer detection, dutasteride could plausibly have no effect (or possibly a deleterious one) on prostate cancer mortality.”

“I think the study has profound implications for us,” Dr. Leonard G. Gomella, of Jefferson University in Philadelphia, told reporters.

“We are looking for better ways to manage men on active surveillance for prostate cancer. I think the fact that some men in the dutasteride arm had a reduction in the amount of prostate cancer is very encouraging.”

Nearly 242,000 men in the U.S. will be diagnosed with prostate cancer in 2012, according to the National Cancer Institute.

Unsafe Abortions Numbers Increasing

Unsafe abortions are on the rise across the world, according to a new global analysis by the Guttmacher Institute and the World Health Organization.

After a period of significant decline in the global abortion rate as a whole, researchers found that those numbers had begun to plateau.

From 2003 to 2008, the abortion rate per 1,000 women of childbearing age (15 to 44) changed slightly, from 29 to 28 per 1,000 women.

However, the proportion of unsafe abortions that took place across the world rose 44 percent in 1995 to 49 percent in 2008.

“The stall in the abortion rate coincides with a plateau in the level of contraceptive use, which had been increasing in prior years,” said Dr. Gilda Sedgh, lead author of the study and senior researcher at the Guttmacher Institute in New York. “Before the abortion rate stalled, it was declining, and contraceptive use was increasing. Also more abortions are unsafe because a growing proportion of abortions are taking place in the developing world.”

Researchers defined unsafe abortion according to the WHO description when analyzing data.

The WHO considers an abortion unsafe when a procedure for terminating pregnancy is performed by a person who is lacking the necessary skills or in an environment that does not conform to minimal medical standards.

Scientists based the data on national surveys, official statistics, hospital records and research papers from across the globe.

Despite the decline in the overall abortion rate, the number of abortions increased, from 41.6 million in 2003 to 43.8 million in 2008 because of an increasing global population, according to the report.

While almost all reported abortions were deemed safe in North America and Europe, nearly all abortions (97 percent) in Africa were considered unsafe in 2008.

Nearly all abortions were performed under safe conditions in East Asia, but 65 percent were considered unsafe across south central Asia.

Over the past three decades, about 20 percent of all pregnancies around the world have ended in abortion, according to the research.

“What we clearly know is that making abortion less available does not make it performed less often,” said Dr. Lauren Streicher, assistant clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “It’s just more unsafe. Condemning abortion is a cruel and failed strategy.”

Even in the U.S., where abortion is currently legal, Streicher said access can be limited based on someone’s insurance plan and where they live.

“Fifty percent of undesired pregnancies are due to failed contraception,” said Streicher. “Of those unplanned pregnancies, 50 percent resolve in abortion, so the need for abortion is always going to be there. By criminalizing it, you’re just increasing the amount of women who have poor and dangerous outcomes.

Experts said the key to keeping women safe requires an improvement in the availability of a full range of contraceptive methods to allow women to choose the method that is best for them.

Very few countries have complete bans on abortions, but women and families are often unclear of those laws, so public health advocates and policymakers must provide more education that is readily available to women, health care providers and society as a whole.

Alcohol and Pregnancy Study

Results of a recetn study showed that any alcohol consumption during pregnancy, especially during the second half of the first trimester, puts the newborn at risk for fetal alcohol syndrome (FAS).

For every additional drink a day on average during those early months, there were increased risks of 25% for smooth philtrum, 22% for thin vermilion, 12% for microcephaly, 16% for lower birth weight, and 18% for reduced birth length, reported Haruna Sawada Feldman, PhD, MPH, of the University of California San Diego in La Jolla, and colleagues.

Per the study, there were similar findings for each additional episode of binge drinking and each additional drink in the maximum number consumed per occasion.

The study appeared online ahead of print in Alcoholism: Clinical and Experimental Research.

Although FAS was first identified in 1973, little is known about the specific dose and timing of exposure to alcohol that increases the risk for birth defects.

To further clarify the issue, researchers undertook a prospective study involving 992 women.

Data for the study was obtained from women enrolled in the California Teratogen Information Service and Clinical Research Program from 1978 to 2005.

After getting counseling, women who reported exposure to at least 1 of 70 different agents, including alcohol, were interviewed in greater detail.

Pregnant women who reported no exposure to these agents were also asked if they would like to participate in the study.

At the end of the pregnancy, various outcome data were obtained. Timing of exposures was evaluated at 0 to 6 weeks after conception, 6 to 12 weeks following conception and then in the second and third trimesters.

For all live births, mothers were asked to participate in a standardized, blinded dysmorphological assessment of the child. The assessors, who were blinded for mother’s status, looked for a standardized checklist of 132 malformations.

Multiple gestations were excluded and, if the women had more than one pregnancy, only the first eligible birth was included in the analysis.

When women consuming one or more drinks per day were compared to those consuming less during the first trimester, higher risk was seen with higher dose for microcephaly, thin vermillion border, and smooth philtrum, as well as reduced birth length and weight.

These outcomes did not exclusively occur in the higher-dose group, the researchers noted.

During the second trimester, significant associations were seen with smooth philtrum, and weight and length. By the last trimester, only birth length was associated with average drinks per day and maximum number at one occasion.

Higher prenatal exposure to alcohol was significantly associated with incidence of smooth philtrum, but not with short palpebral fissures.

The strongest associations were found during the second half of the first trimester in both average drinks per day (RR: 1.25; 95% CI 1.14 to 1.36) and maximum number of drinks in one episode (RR: 1.17; 95% CI: 1.09 to 1.26),

Nonlinear relationships for the various outcomes measured did not show evidence of clustering, and quadratic models constructed showed no nonlinear relationships. There was no indication of any safe level of alcohol exposure, the authors noted.

Among the limitations of the study was that its participants were volunteers and may not be representative of the population. In addition, the use of maternal reports of alcohol consumption may have led to an underreporting or misreporting of consumption.

“Based on our findings, there is no safe threshold for alcohol consumption during pregnancy with respect to selected alcohol-related physical features,” the authors concluded. “Women who are of childbearing age and who are contemplating or at risk for becoming pregnant should be encouraged to avoid drinking, and women who are pregnant should abstain from alcohol throughout the pregnancy.”

Insulin Shots and Diabetes Research

A new type of stem cell treatment for people with type 1 diabetes appears to help re-educate rogue immune system cells, which allows cells in the pancreas to start producing insulin again.

The treatment, which combines a patient’s immune system cells with stem cells from a donor’s cord blood, even worked in people with long-standing diabetes who were believed to have no insulin-producing ability.

Although the treatment didn’t wean anyone off insulin completely, average blood sugar levels dropped significantly, which would reduce the risk of long-term complications.

“Our study brings a new hope for people with type 1 diabetes. If we can control the autoimmunity, we may reverse the diabetes. We showed that the islets 1/8cells3/8 can start to work again,” said Dr. Yong Zhao, an assistant professor in the section of endocrinology, diabetes and metabolism at the University of Illinois at Chicago.

This treatment could potentially be useful in other autoimmune diseases, such as lupus and rheumatoid arthritis.

“It’s quite remarkable that this approach, based on the re-education of immune cells, might work so well. The concept is very intriguing, and the treatment seems to be so simple and so safe,” said Dr. Luca Inverardi, deputy director of translational research at the Diabetes Research Institute, University of Miami School of Medicine.

But he’s also “reasonably cautious,” he said. “The follow-up is long, up to 40 weeks, but it’s not long enough to declare victory against diabetes yet,” said Inverardi.

Also, he noted that the study involved only 15 Chinese people, and that type 1 diabetes is a bit different in that population. He said he’d like to see larger studies with a more diverse population, followed for a longer time.

Results of the study were published online Jan. 9 in the journal BMC Medicine.

Type 1 diabetes, an autoimmune disease, occurs when the body’s immune system cells mistakenly attack the insulin-producing (beta) cells in the pancreas. Because their beta cells don’t produce enough or any insulin, people with type 1 diabetes have to replace the lost insulin through injections to survive.

Stopping that autoimmune attack appears to be crucial to any treatment that hopes to cure or reverse type 1 diabetes.

Zhao’s team developed a completely new approach. They take blood from a patient and separate out the immune system cells (lymphocytes). They briefly expose those cells to stem cells from umbilical cord blood from an unrelated infant and return the lymphocytes alone to the patient’s body.

The researchers have dubbed this “Stem Cell Educator Therapy,” because while exposed to the stem cells, the lymphocytes seem to relearn how they should behave.

The average daily dose of insulin dropped almost 39 percent after 12 weeks for the group with some beta cell function and 25 percent in those with no beta cell function, suggesting that the group with no beta cell function now produced insulin.

Both experts said the treatment appears safe, with no risk of rejection. No significant side effects were reported during the trial, other than some arm soreness where blood was taken and returned.

New Fitness Pill

A new drug that could provide new treatment for a range of obesity related disorders without a need to hit the gym has been developed by scientists.

Researchers claim to have created the pill, which they claim provides all the same benefits of exercising without the exertion.

They claim that a hormone naturally found in muscle cells that triggers the calorie-burning benefits of exercise, may have potential as an obesity-fighting drug.

The newly identified hormone, called irisin, increases in the body during exercise, boosting energy expenditure and controlling blood glucose levels.

Medical experts from Harvard Medical School said the new hormone could lead to treatments for obesity, diabetes and even cancer as well as other disorders in which exercise may benefit weaker patients.

But doctors warned that the pill should not be used to replace exercising.

The chemical, named after the Greek messenger goddess Iris, also helps to produce ‘healthy’ brown fat that burns off weight but largely disappears as we age. It is replaced by “bad” white fat which typically sits around a person’s waist.

Prof Bruce Spiegelman, who led the study, believes harnessing irisin will lead to better therapies for any illness that can be combated by exercise.  Prof Spiegelman said: “There has been a feeling in the field that exercise ‘talks to’ various tissues in the body. But the question has been, how?”

“Whether longer treatments with irisin and/or higher doses would cause more weight loss remains to be determined.

“The worldwide, explosive increase in obesity and diabetes renders attractive the therapeutic potential of irisin in these and related disorders.”

He added: “Another potentially important aspect of this work relates to other beneficial effects of exercise, especially in some diseases for which no effective treatments exist.

“The clinical data linking exercise with health benefits in many other diseases suggests that irisin could also have significant effects in these disorders.”

The breakthrough is an important first step in understanding the biological mechanisms that translate physical exercise into beneficial changes throughout the body, both in healthy people and in preventing or treating disease.

The researchers, whose findings are published online in Nature, said the best effects of exercise on muscle are caused by a protein known as PGC1-alpha. They found expression of this molecule in mice stimulated another chemical called FNDC5 that is secreted as irisin in the outer membrane of muscle cells.

Experiments showed irisin is helps the ‘browning’ of white fat, which increases energy expenditure and improves resistance to obesity linked diabetes. Relatively short treatments of obese mice with irisin improved their glucose control and caused a small amount of weight loss, which the researchers believe highlights its therapeutic potential.

According to their study, the irisin hormone has direct and “powerful effects” on adipose, or fatty, tissue – subcutaneous deposits of white fat that store excess calories and which contribute to obesity.

When irisin levels rise through exercise – or when the hormone was injected into mice – it switches on genes that convert white fat into “good” brown fat. This is beneficial because brown fat burns off more excess calories than does exercise alone.

Only a small amount of brown fat is found in adults, but infants have more – an evolutionary echo of how mammals keep themselves warm while hibernating.

In the wake of findings, there has been a surge of interest in the therapeutic possibilities of increasing brown fat in adults. Along with stimulating brown fat development, irisin was shown to improve glucose tolerance, a key measure of metabolic health, in mice fed a high fat diet.

Prof Spiegelman warned the discovery will not allow people to skip the gym and build muscles by taking irisin supplements, because the hormone does not appear to make muscles stronger.

“We’re not trying to replace diet and exercise. That is still important,” he added.

In part because it is a natural substance and because the mouse and human forms of the protein are identical, Prof Spiegelman said it should be possible to move an irisin-based drug rapidly into clinical testing – perhaps within two years.

FDA Approves HIV Drug

The US Food and Drug Administration has announced that it approves the expanded use of an important anti viral drug used to treat HIV infections.

Isentress is an antiretroviral drug produced my Merck & Co.

It was first approved in October 2007 and was the first of a new class of anti HIV drugs known as integrase inhibitors.

Known pharmaceutically as raltegravir, Isentress targets an HIV enzyme called integrase, which allows the virus to combine genetic code into human chromosomes.

It is thought to be a critical step in breaking the secrets of the HIV virus.

Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research said :

“Many young children and adolescents are living with HIV and this approval provides an important additional option for their treatment.”

The drug is taken twice daily, with or without food, and has been seen to slow and inhibit the spread of the virus, thus, at least prolonging the time taken for full blown AIDS to affect the body.

The chewable form of the tablet is now approved for children from 2 to 11 years.

A single, multi-center clinical trial of 96 children and adolescents aged 2-18 years with HIV-1 infection evaluated the safety and effectiveness of Isentress. These patients previously received treatment for HIV-1 infection.

After 24 weeks of treatment with Isentress, 53 percent of these patients had an undetectable amount of HIV in their blood.

Unfortunately, there are some side effects from the drug which can include insomnia and headache. It does appear though that adults and children are affected in similar proportions.

One patient in the trial reported severe insomnia, while another had a skin rash caused by the drug.

It should be noted that Isentress does not cure HIV infection and patients must stay on a continuous anti HIV therapy to avoid the virus becoming full blown AIDS.

At the same time, Merck & Co. has announced that it will be providing additional discounts to low income patients who have limited or no insurance. The cuts will be effective Jan 1st and run through end 2013.

At minimum, Isentress must be taken with at least two other anti-HIV drugs as part of an effective antiretroviral treatment regimen, pushing the overall price of one Isentress patient’s yearly anti-HIV drugs to between $20,000 and $30,000.

Unsafe Sex and Drinking Study

Not surprising to many, how much alcohol a person drinks directly affects how likely they are to have unsafe sex, a new study has recently confirmed.

On average, every 0.1 milligram per milliliter increase in study participants’ blood alcohol levels raised their likelihood of having unprotected sex by 5 percent, the researchers found.

Canadian researchers looked at 12 studies that examined the link between people’s blood alcohol content (BAC) and how likely they were to say they would use a condom during intercourse.

In all of the experiments, researchers had split the study participants into two groups, and asked one group consume alcohol, while the other group did not drink. Participants were then reported whether they would engage in unsafe sex.

The findings help explain why people who’ve been drinking engage in unsafe sex despite knowing better, study researcher Jürgen Rehm, the director of the Social and Epidemiological Research at Canada’s Centre for Addiction and Mental Health, said in a statement. “Alcohol is influencing their decision processes.”

In all of the 12 studies that the researchers reviewed, the more alcohol participants consumed, the higher their willingness to engage in unsafe sex, according to the analysis.

This link between the role of alcohol consumption and risky sex intentions can be applied to better understanding important public health issues, such as the transmission of HIV and other sexually transmitted infections, according to the researchers.

“Drinking has a causal effect on the likelihood to engage in unsafe sex, and thus should be included as a major factor in preventive efforts for HIV,” Rehm said.

Because the participants reported their own likeliness of having sex without a condom, there is the potential for bias, or underreporting regarding participants’ willingness to have unprotected sex.

The researchers noted that not all studies that have examined this link have been published, and after they accounted for this, the increased likelihood of having sexafter drinking may be only 3 percent.

The results, which will be published in the January 2012 issue of the journal Addiction, should be taken into account in HIV/AIDS prevention programs, because efforts to reduce drinking may also lower the chance of engaging in unsafe sex, thereby reducing the number of new HIV infections, according to the study.

The conclusion: Drinking alcohol may directly affect a person’s intention to have unprotected sex.

Bone Drug Spurs Breast Cancer Survival

Hopeful news and reports have been released from a recent breast cancer conference.

Breast cancer doctors hoped the bone drugs they prescribed patients would prevent complications from the disease.

Seven years later, the doctors saw the bone drugs did in fact improve breast cancer survival in women.

What’s especially impressive is that the women were treated only once every six months for three years.

“The benefit persists” long after treatment ends, said Dr. Michael Gnant of Austria’s Medical University of Vienna, who presented his research last week at the San Antonio Breast Cancer Symposium.

Gnant’s study showed women who received the bone drug Zometa were 37 percent less likely to die than women who didn’t. That means that 4 to 5 more women with breast cancer out of every 100 were alive seven years later because of the treatment.

Some cancer specialists are now calling for Zometa to be offered to all patients like those in this study – younger women forced into early menopause by hormone-blocking cancer treatments.

“It’s a new standard of care,” said Dr. James Ingle, a Mayo Clinic breast specialist.

Bone drugs called bisphosphonates – sold as Fosamax, Boniva and Actonel – have long been prescribed as daily pills for treating osteoporosis. Zometa, made by Swiss-based Novartis AG, is given intravenously to treat cancer that has spread to the bone.

Gnant’s hopes were raised that the drug could do more in 2008, when he reported that it lowered the risk of cancer recurrence in a study of 1,800 premenopausal women with early-stage breast cancer.

After years of follow-up, Gnant and fellow researchers saw that Zometa not only helped keep cancer from coming back, but it also improved survival. There were 33 deaths among women taking Zometa and 49 among those who weren’t.

That large benefit is comparable to many chemotherapy treatments. Researchers think because Zometa strengthens bones, it’s tougher for cancer to spread there and the drug may also prevent cancer cells or microscopic tumors from spreading.

Zometa’s side effects were mostly bone and joint pain and fever. Doctors saw no cases of jawbone decay, a serious side effect linked to bisphosphonates. Zometa costs more than $1,000 in the U.S., though the price may drop when its U.S. patent expires in 2013.

The bone drug proved disappointing last year in a large study last of older postmenopausal women, who account for three-fourths of all breast cancers. But there’s still hope for the oldest patients.

“They benefitted substantially as long as they were well past menopause,” said Dr. Peter Ravdin, director of the breast cancer program at the UT Health Science Center in San Antonio.

Other studies reported at the conference this week strengthen the view that Zometa works best in women with little estrogen. Ravdin said that signals the emergence of a consistent treatment pattern.

PlanB Morning-After Pill

The Obama administration’s top health official stopped plans Wednesday to let the Plan B morning-after pill move onto drugstore shelves next to the condoms.

Overruling scientists at the Food and Drug Administration, Health and Human Services Secretary Kathleen Sebelius decided that young girls shouldn’t be able to buy the pill on their own, saying she was worried about confusing 11-year-olds.

For now, Plan B will stay behind pharmacy counters, available without a prescription only to those 17 and older who can prove their age.

It was the latest twist in a nearly decade-long push for easier access to pills that can prevent pregnancy after unprotected sex, and one with election-year implications. The move shocked women’s health advocates, a key part of President Barack Obama’s Democratic base, as well as major doctors groups that argue over-the-counter sales could lower the nation’s high number of unplanned pregnancies.

“Secretary Sebelius took this action after careful review,” Obama spokesman Nick Papas said. “As the secretary has stated, Plan B will remain available to all women who need it, and the president supports the secretary’s decision.”

Sebelius’ decision is “medically inexplicable,” said Dr. Robert Block of the American Academy of Pediatrics.

“I don’t think 11-year-olds go into Rite Aid and buy anything,” much less a single pill that costs about $50, added fellow AAP member Dr. Cora Breuner, a professor of pediatric and adolescent medicine at the University of Washington.

Instead, putting the morning-after pill next to the condoms and spermicides would increase access for those of more sexually active ages “who have made a serious error in having unprotected sex and should be able to respond to that kind of lack of judgment in a way that is timely as opposed to having to suffer permanent consequences,” she said.

The move will anger many Democrats. Sen. Patty Murray of Washington, a member of the Senate leadership, already was asking Sebelius to explain her decision. But it also could serve to illustrate to independents, whose support will be critical in next fall’s presidential election, that Obama is not the liberal ideologue Republicans claim.

Nor will this end the emergency contraception saga. In 2009, a federal judge said the FDA had let politics, not science, drive its initial behind-the-counter age restrictions and said it should reconsider. At a hearing scheduled in federal court in New York next Tuesday, the Center for Reproductive Rights will argue the FDA should be held in contempt.

“Take the politics out of it and it’s a decision that reflect the concerns that many parents in America have,” said Wendy Wright, an evangelical activist who helped lead the opposition to Plan B.

“This is the right decision based on a lack of scientific evidence that it’s safe to allow minors access to this drug, much less over-the-counter,” said Sen. Chuck Grassley, R-Iowa.

FDA Commissioner Dr. Margaret Hamburg made clear that the decision is highly unusual. She said her agency’s drug-safety experts had carefully considered the question of young girls and she had agreed that Plan B’s age limit should be lifted.

“There is adequate and reasonable, well-supported and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential,” Hamburg wrote.

Pediatrician Breuner said taking Plan B, which contains a higher dose of the female progestin hormone that is in regular birth control pills, wouldn’t harm even young adolescents.

Sebelius didn’t raise safety concerns. She said maker Teva Pharmaceuticals hadn’t proved that the very youngest girls who might try Plan B would understand how to use it properly.

A Teva-funded study tracked 11- to 17-year-olds who came to clinics seeking emergency contraception. Nearly 90 percent of them used Plan B safely and correctly without professional guidance, said Teva Vice President Amy Niemann. But Teva wouldn’t say how many of the youngest girls were part of the study.

Taking Plan B within 72 hours of rape, condom failure or just forgetting regular contraception can cut the chances of pregnancy by up to 89 percent. But it works best within the first 24 hours. There are two other emergency contraception pills: a two-pill generic version named Next Choice that also is sold behind the counter, and a prescription-only pill named ella.

If a woman already is pregnant, the morning-after pill has no effect. It prevents ovulation or fertilization of an egg. According to the medical definition, pregnancy doesn’t begin until a fertilized egg implants itself into the wall of the uterus. Still, some critics say Plan B is the equivalent of an abortion pill because it may also be able to prevent a fertilized egg from attaching to the uterus.

Yoga Health Benefits

Both weekly yoga classes and regular stretching classes eased pain and improved functioning in people with chronic lower back ailments, according to a U.S. study.

The study, published in the Archives of Internal Medicine, looked at over 200 adults with lower back pain and found that participants in both types of classes reported more improvement in symptoms after three months than patients who were only given a book with advice on preventing and managing pain.

“Here is an option that is worth trying,” said Karen Sherman from the Group Health Research Institute in Seattle, who led the study.

Finding that yoga and stretching had about equal effects means it was probably the stretching in yoga, and not the relaxation or breathing components of the practice, that helped improve functioning and pain symptoms, researchers said.

For the study, they divided 228 adults with long-lasting back pain into three groups.

Patients in the first two groups went to either weekly yoga or stretching classes for 12 weeks and were asked to practice on their own between the classes, which focused on stretching and strengthening the lower back and legs.

Patients in the third group were given a book with back pain-related exercise and lifestyle advice, and information on managing flare-ups.

After the 12-week program, people who had gone to the group classes reported significantly lower scores on a questionnaire measuring how much pain interferes with daily activities.

The questionnaire rated daily “disability” level on a scale of zero to 23, with 23 being the most severe. At the 12-week mark, the exercise groups had dropped from an initial average score of 10 in the yoga group or nine in the stretching group to between four and five in both groups.

The people who received the book started with an average score of nine and at 12 weeks had dropped to about a seven.

Sixty percent of people in the yoga group reported improvements in pain, compared to 46 percent in the stretching classes and just 16 percent of people who only got the books.

Three months after the end of classes, symptom improvements were similar in people who had done either stretching or yoga, and were better than in the non-exercise group.

“We’ve known for a while … that exercise is good for back pain,” said Timothy Carey, from the University of North Carolina, Chapel Hill, who wrote a commentary published with the study.