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ADHD in adults linked to higher risk of cardiovascular diseases

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  • A large population-based study in Sweden recently showed individuals that with attention deficit hyperactivity disorder (ADHD) were at a two-fold higher risk of all types of cardiovascular diseases than those without ADHD.
  • Among adults with ADHD, men, younger people, and those with comorbid psychiatric conditions exhibited increased cardiovascular risk.
  • The study underscores the importance of monitoring individuals with ADHD for cardiovascular risk and developing targeted strategies to reduce their risk of cardiovascular disease.

There is growing evidence to suggest a link between mental health disorders and cardiovascular disease (CVD risk. Still, there is limited evidence to suggest a similar association between attention deficit hyperactivity disorder (ADHD) and cardiovascular risk.

A recent nationwide study published in World Psychiatry shows that individuals with ADHD were at an increased risk of cardiovascular disease compared to those without ADHD, even after accounting for cardiovascular risk factors.

dr Carl Lavie, a cardiologist at the University of Queensland School of Medicine in Australia, not involved in the study, told Medical News Today:

“The study is huge with long follow-up and even considering potential errors in maintaining such a huge data bank, the study certainly suggests that ADHD is associated with possibly doubling the risk of CVD. Considering that this condition[ADHD}appearstobeincreasingalongwithearlydruguseandphysicalinactivitythesedatacertainlyraiseredflagsregardinglong-termCVDrisksinthispatientpopulation”[ADHD}appearstobeincreasingalongwithearlydruguseandphysicalinactivitythesedatacertainlyraiseredflagsregardinglong-termCVDrisksinthispatientpopulation”

ADHD is a mental health disorder characterized by deficits in attention, hyperactivity, and increased impulsivity. As one of the most common mental health conditions in children, ADHD also affects adults. Worldwide, the prevalence of ADHD in children is 2.2% and 2.5% in adults.

Individuals with ADHD often have co-occurring psychological conditions, such as anxiety and depression, and physical conditions, such as obesity.

Previous studies have shown that various mental health conditions, such as autism, anxiety disorders, and depression, are associated with an increased risk of cardiovascular disease. However, there is limited data suggesting an association between ADHD and an increased risk of cardiovascular disease.

There is also a lack of data on whether individuals with ADHD are at increased risk of specific cardiovascular conditions, including stroke, cardiac arrest, arrhythmias, arteriosclerosis, and heart failure. The preventive and treatment strategies for the different types of cardiovascular diseases can vary, making it essential to understand the association between ADHD and the different cardiovascular diseases.

Furthermore, the extent to which cardiovascular risk factors in individuals with ADHD influence the risk of cardiovascular diseases in these individuals is not fully understood. Some of the risk factors for cardiovascular disease include:

  • level of education
  • family history of cardiovascular disease
  • sleep problems
  • obesity
  • diabetes
  • smoking

Due to the prevalence of comorbid psychiatric conditions, individuals with ADHD simultaneously receive medications for other mental health conditions.

Previous studies suggest that medications used for ADHD and other mental health conditions such as anxiety and depression could increase the risk of cardiovascular disease. Thus, using these medications or the presence of mental health conditions could potentially elevate the risk of cardiovascular diseases in individuals with ADHD.

Characterizing the impact of cardiovascular risk factors could help individuals identify with ADHD at increased risk of cardiovascular disease early.

In the present study, the researchers used data on over 5.4 million Swedish adults born between 1941 and 1983 without a previous cardiovascular disease diagnosis.

The researchers used the Swedish national registries to identify individuals in the study population with a diagnosis of ADHD. They also obtained data on other mental health conditions and cardiovascular risk factors, including diabetes, obesity, sleep problems, and smoking, from these registries.

Using the national healthcare registries, the researchers tracked the occurrence of cardiovascular disease in the study population over a follow-up period of 13 years, from January 2001 to December 2013. The researchers found that the proportion of individuals who developed cardiovascular diseases was higher in Individuals with ADHD than in their counterparts without ADHD.

After controlling for age and sex, the analysis showed individuals that with ADHD were twice as likely to develop cardiovascular diseases than those without ADHD.

The researchers found that cardiovascular risk factors such as heavy smoking, obesity, diabetes, sleep problems, lower educational attainment, and psychiatric conditions were more prevalent in individuals with ADHD. Yet controlling for these cardiovascular risk factors only slightly weakened the association between ADHD and the risk of cardiovascular diseases.

Moreover, excluding individuals with ADHD who were using medications for ADHD or other mental health conditions also did not influence the strength of the association between ADHD and cardiovascular disease risk.

These results suggest that ADHD, independent of cardiovascular risk factors such as obesity, smoking, and comorbid psychiatric conditions could be a risk factor for cardiovascular disease.

The study also found that ADHD was associated with an increased risk of all types of cardiovascular diseases. The strongest association was observed between ADHD and cardiac arrest, hemorrhagic stroke, and arteriosclerosis.

The severity of core ADHD symptoms tends to decrease with age, whereas the risk of cardiovascular disease increases with aging. Moreover, ADHD and cardiovascular diseases are more prevalent in males than females.

Hence, the researchers categorized the study population by age and sex to assess the impact of these factors on the risk of cardiovascular disease in individuals with ADHD. They found that the association between ADHD and cardiovascular risk was stronger in males than females and younger individuals than their older counterparts.

In a separate analysis, the researchers found that individuals with ADHD and co-occurring psychiatric conditions, such as eating disorders and substance use disorders, were also at increased risk of cardiovascular disease than individuals with only ADHD.

The study’s findings suggest that clinicians should monitor the cardiovascular health of individuals with ADHD early to facilitate the implementation of strategies to reduce cardiovascular risk. Among individuals with ADHD, younger adults, males with ADHD, and those with comorbid psychiatric conditions could be especially at a higher risk of cardiovascular disease.

The study’s co-author Henrik Larsson, Ph.D., a professor of epidemiology at Örebro University, said in a press release:

“Clinicians need to carefully consider psychiatric comorbidity and lifestyle factors to help reduce the CVD risk in individuals with ADHD, but we also need more research to explore plausible biological mechanisms, such as shared genetic components for ADHD and cardiovascular disease.”

The study authors acknowledged that the new research has a few limitations. Due to its observational design, this study does not establish a causal role for ADHD in increasing the risk of cardiovascular disease.

The authors used national registries to identify individuals with ADHD and cardiovascular disease, which may only account for individuals with severe symptoms of ADHD or cardiovascular disease. This may have resulted in underestimating the number of individuals with less severe symptoms of ADHD or cardiovascular disease.

Conversely, individuals with ADHD are more likely to frequent healthcare facilities and may be more likely to be diagnosed with cardiovascular disease.

The average age of the study population was around 50 years. Thus, it is likely that the study accounted for individuals with early onset cardiovascular disease, diagnosed at or before the age of 60 years. As a result, there is a need for additional studies involving older adults to examine the association between ADHD and late-onset cardiovascular disease.

In addition, data on certain cardiovascular risk factors were either incomplete or missing. dr Lavie noted that “details on medications and doses are not known. There was also no robust data on physical activity, sedentary behavior, or fitness, as well as alcohol and drug use.”

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Men’s Health

The Most American Flex Is a Fitness Fad

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As exercise equipment maker Peloton Interactive Inc. struggles to reinvent itself, investors must decide whether it’s worth giving the fallen Wall Street star a second chance. Let history be their guide.

Not just the company’s history. Modern humans’ relationship with physical fitness provides a cautionary tale for future investors in the next big exercise craze — and rest assured, there will be another.

Why do Americans go to such extravagant lengths to stay in shape? The rise of the so-called physical culture movement in the late 1800s, along with its close cousin, “Muscular Christianity,” marked a newfound obsession with fitness in Western nations, particularly the United States.

These movements grew out of a strange amalgam of pseudoscience, theology and anxiety about the future of native-born Whites in late 1800s. Enormous numbers of immigrants were flooding into the US and many of these Whites expressed unease that “Anglo-Saxons,” as they referred to themselves, had become “overcivilized” and soft.

Thus native-born Whites increasingly embraced team sports, outdoor activities and mandatory physical education in public schools. Private groups like the Young Men’s Christian Association, or YMCA, also promoted exercise, opening a network of gyms that mixed religion and fitness.

Still, most Americans had little interest in gyms and regimented exercise. After all, they had limited leisure time in those days and got plenty of exercise in their everyday life by walking or doing manual labor.

Moreover, some figures in the physical culture movement seemed, well, weird. Consider Bernard McFadden, a sickly child who renamed himself Bernarr because it evoked the roar of a lion. He made a fortune promoting a regimen of weight-lifting, calisthenics, restrictive diets and brisk walks. He also published a magazine called Physical Culture that became the unofficial voice of the movement. “Weakness Is a Crime,” it declared to would-be readers. “Are you a criminal?”

The eccentric bodybuilder, who courted controversy by promoting exercise for both men and women, was eventually overshadowed by another fanatic with an exclusively male clientele: the Italian immigrant Angelo Siciliano, better known as Charles Atlas. Both men gained fame and fortune hawking their programs, but they would soon be eclipsed by developments in the post-World War II era, when fitness became an abiding obsession of the White middle class.

The new ethos owed much to the suburban ideal of the 1950s. Initially, everything about the suburbs worked against fitness, from the growing dependence on the automobile, the use of buses to shuttle children to centralized schools and the advent of television. Even the single-story ranch houses that defined the era put an end to the exercise provided by going up and down stairs.

In her insightful account of this shift, historian Shelly McKenzie argues that much of the ensuing debate over fitness was framed by a new problem confronting the White middle class: “How could they enjoy the fruits of post-war affluence while also managing their bodies for optimal health?” The solution, McKenzie observed, was “the invention of exercise.”

The movement arguably began with a report by the US National Institutes of Health in 1952 that called attention to obesity as a serious health problem. A year later, a widely read study found an alarming gap between the levels of fitness in American and European children, with 56% of American children failing a standard set of tests versus only 8% of European kids.

The reason, the author concluded, was simple: European children walked a lot, climbed stairs instead of taking the elevator and spent much of their free time playing outside; Americans did not.

This article eventually came to the attention of Dwight Eisenhower, who responded by forming the President’s Council on Youth Fitness. Its leaders, working with advertising executives and other corporate allies, orchestrated an effective public relations campaign that yoked physical fitness to the imperatives of the Cold War, arguing that American boys and men had to get into fighting shape if they were to defeat the Soviets.

But the campaign targeted girls and mothers as well. One spokesman for the program declared that it not only aimed to produce “healthful, vital, masculine men,” but also “active, healthful, vital, feminine women who can mother a vigorous generation.”

All of this marked a sea change in how many Americans viewed exercise and fitness. What had formerly been a subculture associated with eccentric impresarios like Bernarr MacFadden and Charles Atlas was quickly becoming a mainstream preoccupation.

It was also becoming a big business. One of the first to see the potential was the fitness fanatic Jack LaLanne, who opened his first gym in the 1930s. In the 1950s, LaLanne launched several televised programs in which he would perform exercises — he dubbed them “trimnastics” — with the audience following along.

LaLanne, who wore a form-fitting jumpsuit to show off his sculpted body, worked on a set that resembled a suburban living room, much like those occupied by his overwhelmingly suburban, female audience. He preached the virtues of exercise for maintaining “zest” in the “marital bed.” Long before the “Peloton wife” ad stirred controversy, LaLanne’s exhortations openly connected a woman’s physical condition to her sex appeal.

The 1950s also marked the moment when commercial gyms entered the mainstream. A new generation of entrepreneurs like Vic Tanny opened gleaming temples filled with the latest exercise equipment. Tanny, who believed that “good health can be merchandized just like automobiles,” counted half a million men and women as members by decade’s end.

Other fitness chains sought to overturn the age-old adage, “no pain, no gain.” High-end salons like Slenderella, which counted three million clients in 1956, promised women that their machines, which used vibrations or rollers, held out the promise of what McKenzie, the author and historian, has called “effortless exercise.”

A paradox defined these developments. The ease of suburban life left Americans out of shape. But if modern consumer society caused the problem, it could also solve it. For a price, Americans could buy fitness via gyms, exercise programs and other pursuits.

Some of these began modestly. The jogging craze, which required a relatively minimal investment, quickly grew into an entire industry worth half a billion dollars by the end of the 1970s. Other fitness fads, like the workout program founded by Jane Fonda, wedded celebrity culture to new videotape technology to build a mass following.

The fitness business, which encompassed everything from books, tapes, equipment, apparel and gym memberships, kept growing through the 1970s and beyond. Everything from Jazzercise to Nautilus weight-training machines to Pilates gained a following in subsequent years.

In 2022, the fitness business is bigger than it has ever been. In the US, gyms and fitness clubs generate annual revenue of nearly $40 billion; home fitness equipment makers generate nearly $5 billion more.

Set against this backdrop, Peloton is nothing more than the latest entry in a decades-long quest of affluent Americans to stay fit, no matter the price.

More From Other Writers at Bloomberg Opinion:

Peloton’s New Strategy Spins All Over the Place: Andrea Felsted

Peloton’s Real Rival Is Doing Laps of Central Park: Tim Culpan

Will New York’s Fitness Scene Stay Home?: Tara Lachapelle

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Stephen Mihm, a professor of history at the University of Georgia, is coauthor of “Crisis Economics: A Crash Course in the Future of Finance.”

More stories like this are available on bloomberg.com/opinion

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The MGTOW Movement Explained

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3 Heavy Barbell Back Squat Alternative Exercises for Workouts

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We’ll never say barbell back squats are a terrible exercise—especially since some will argue, convincingly, that the movement is the king of all exercises. But for the average gymgoer wants, this heavyweight staple might not be the best move for their training and needs.

It may sound like leg-day lunacy to even question whether we should be squatting, especially considering the multitude of benefits—from building strength and power, burning fat, improving both core strength and posture to name a few. But unless you’re a pro athlete or a powerlifter whose sole pursuit in the weight room is to lift as heavy as possible (specifically in the back squat!), there may not be as much need for you to rely on the back squat as the backbone of your leg day.

You might even be putting yourself at a disadvantage, especially if your physiology isn’t ideal for the movement, or your goals don’t align with exactly what the back squat will do. According to Men’s Health fitness director Ebenezer Samuel, CSCS, and Mathew Forzaglia, NFPT, CPT, founder of Forzag Fitness, there are plenty of effective lower-body exercise options that can provide the same benefits and possibly even do more for you to increase your leg day gains.

“There’s a very, very good chance that for all your leg goals, whether you’re trying to get more athletic, whether you’re trying to get stronger, whether you just want to burn some calories and just want to move a little bit that there are a bunch of exercises aside from the back squats that will be safer than the back squat and still get you all your goals,” Samuel says.

Why Back Squats Might Not Work for You

You Don’t Need to Back Squat if Athletics Isn’t Your Goal

Sorry to break the news to you, but unless it’s your goal to squat religiously like a powerlifter or you’re a top-level professional or amateur athlete who’s training for a particular sport or activity, the back squat don’t necessarily have to be your go to leg exercise. They do it because it’s part of their job or goals. You on the other hand, can benefit from any other variation without having to get too tied down to squat mechanics.

“Very specific athletes learn the back squat because the back squat itself is a combination of two ideas,” Samuel says. “We have the idea of ​​a squat where we’re driving down, but we also have the idea of ​​a hinge where we’re pushing our butt back slightly and you have to understand completely both of those mechanics before you even think about jumping into the back squat that takes time that is not something you do on your first personal training session.”

Back Squats Might Drag Down the Rest of Your Workout

Back squats are hard. Beginning from the setup and holding the bar on your back can be challenging, especially if you have shoulder mobility issues. Stacking a pile of 45s on your back will not only accelerate the discomfort of your shoulders; the stress will target your lower back as well.

“It opens a window for us to shift as we go down into the squat. And when that happens, we start to overload that lower back and it’s not really needed,” Forzaglia says.

Back Squats Are Limited for Athleticism

You may see NFL athletes loading crazy weight to the squat bar for a few reps, but besides these feats meant to test their max strength, their workouts aren’t strictly dictated by back squats. What you won’t see on social media are the specific leg and core movements that promote athleticism—they’re not as visually appealing as a 500-pound squat, but equally as necessary. That’s why when it comes to athleticism, you need more than just back squats for your training.

Try these 3 back squat alternatives

● Goblet Squat

3 to 4 sets of 8 to 10 reps

Holding a dumbbell or kettlebell in front of you forces you to work from a more upright position while also focusing on keeping your core nice and tight. That makes this variation more spine-friendly than loading a bar with heavy weights on your back. At the same time, you’re also able to blast your legs like a heavy back squat day.

Safety bar squat

3 to 4 sets of 5 to 8 reps

This specialty bar, which provides handles to help manage the load, eliminates the potential discomfort you may get from the back squat. The safety bar squat gives you more freedom to move your shoulders while still forcing you to create tons of core tension. And like the back squat, you can pile on the weight without the shoulder stress.

Rear foot elevated split squat

3 to 4 sets of 8 to 10 reps

You might know this move as the Bulgarian split squat. This single-leg exercise is extremely useful for helping to eliminate muscle imbalances. And although a pro career might not be in your future, rear foot elevated split squats can certainly help to improve your everyday athleticism and functional fitness. You can even go heavy with this move as well.

Jeff Tomko is a freelance fitness writer who has written for Muscle and Fitness, Men’s Fitness, and Men’s Health.

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