Q: Health-related topics seem to be constantly in the news with apparently often contradictory conclusions and recommendations. With all the sources of information available, trying to find the “truth” can be overwhelming and confusing. Any suggestions?
A: A simple Yahoo search for “health” listed 471,000,000 results, and Google reported more than 1 billion potential sources to review (search conducted on July 25, 2014). Narrowing down the search to “health and fitness” dropped the number of results to 103,000,000 and 331,000,000, respectively. Obviously, interest in issues related to health and fitness is high! This especially is true at the beginning of another new year when resolutions related to physical activity, diet, and other health-oriented behaviors are made. Unfortunately, sifting through information can, as stated in the question, be overwhelming. Brief headlines may be eye catching but short on needed details. When health- and fitness-related questions arise, the key is to dig deeper to find accurate answers.
Technology, including accessing information on the Internet or via cell phones, is used by many to answer health-related questions (see Box 1 for insights on the public’s use of technology) (4,5). Although online searches are a convenient way to seek answers, being a critical consumer requires carefully scrutinizing Web sites. For helpful tips on evaluating sites on the Internet (8), see Box 2; for an interactive tutorial on evaluating Internet health information (12), see http://www.nlm.nih.gov/medlineplus/webeval/webeval.html.
Regardless of whether a source is found in electronic or print form or is heard on the local or national news, the focus should be on finding quality information and on understanding the methods by which conclusions are reached. This involves digging deeper into the research (e.g., see the U.S. National Library of Medicine Web page “Behind the Headlines,” which is devoted to reviewing the science behind health stories in the news (11): http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/). One must decipher if the information has a credible basis and if that information is used in an appropriate context. Taken out of context, conclusions drawn may be inappropriate or misleading. As an example, consider a review article entitled, “Cigarette Smoking: An Underused Tool in High-Performance Endurance Training” (9). Clearly, the article is satire because it promotes smoking as an ergogenic aid! The basis for the article is “supported” by research showing the impact of smoking on serum hemoglobin, lung volume (caused by chronic obstructive pulmonary disease!), and weight loss. Although humorous, the point of the satire was to demonstrate a more serious point: “…if research results are chosen selectively, a review has the potential to create a convincing argument for a faulty hypothesis. Improper correlation or extrapolation of data can result in dangerously flawed conclusions” (9).
Even with the best of intentions, drawing definitive conclusions can be challenging; research related to health and fitness is extensive, and new studies constantly are providing fresh insights. No one study can answer all questions on a given topic, but each study contributes in distinctive ways to broaden the knowledge base. What may seem to be contradictory information actually may be an extension of prior understanding or may be specific to a given population or condition. For an example, see Box 3 for background on apparent “changes” in exercise recommendations related to sleep.
Although media reports provide interesting snapshots and can promote awareness on a topic, taking the time to check original sources provides better understanding (see Box 4 for items to check when reviewing a source). More detailed information on evaluating scientific publications is available (3,14,15). Different types of research provide unique perspectives and are used to answer distinctive kinds of questions (Table). Some studies are observational, meaning that researchers are observing a group without any treatment or manipulation of the situation. Examples of observational research are cross-sectional (e.g., looking at the activity level of third graders, fourth graders, and fifth graders) and cohort studies (e.g., tracking the activity level of a group of children from third grade through fifth grade). With observational research, potential relationships can be studied but a cause-and-effect relationship is difficult to establish because other factors might explain a particular link (e.g., activity level might be impacted by an environmental factor unknown to the researchers). Experimental research includes randomized controlled studies in which individuals are assigned randomly to a treatment group or control group (e.g., one group receives a new medication whereas the other group receives a placebo that appears similar but contains no active ingredients). With the assumption that the groups are similar at the start of the study, other than the researchers’ intervention, differences in the outcomes can be attributed more strongly to the intervention (i.e., cause-and-effect relationship).
Practicality may impact selection of a particular research methodology. Consider the American Heart Association (AHA) scientific statement on “Pet Ownership and Cardiovascular Risk,” which reviewed the influence of pet ownership on risk factors for cardiovascular disease (7). Throughout the findings, the words “associated” and “relationship” are used. This is because most studies compared individuals who were already dog owners with nonowners rather than randomly assigning dogs to individuals (not a very practical situation). Thus, other factors could influence the relationship between owning a dog and health-related issues, such as lower blood pressure and lower incidence of obesity; potentially, healthier, more active people decide to obtain a pet. Although a cause-and-effect relationship cannot be stated (i.e., that having a dog will lower your risk of heart disease), the AHA does point out various mechanisms for causation in the scientific statement (7); for additional information on dog walking and health, see the January/February 2014 Wouldn’t You Like to Know article “Dogs: Can They Help Promote Human Health?” (1).
Respected sources of information, such as the scientific statement provided by AHA on pet ownership and cardiovascular risk, are valuable treasure troves. Box 5 provides a list of links related to various organizations (including the American College of Sports Medicine) that provide information for both consumers and professionals. This is by no means an all-inclusive list but may be a helpful starting point in developing a personalized “go-to” list of resources. Accessing authoritative sources is one way to stay abreast of the constantly advancing field of health and fitness.
Although, at times, the amount of new information in the area of health and fitness can be overwhelming, these are exciting times for exercise professionals as new research becomes available. To be educated consumers, health and fitness professionals should move beyond flashy headlines and simplified sound bites to review sources of information carefully, including a critical review of accessed Web sites and of research study publications. A key to finding “truth” is to never stop questioning and seeking more detailed answers.
1. Bushman BA. Wouldn’t You Like to Know: Dogs — Can they help promote human health? ACSM Health Fitness J. 2015; 18 (1): 5–8.
2. Bushman BA. Wouldn’t You Like to Know: Exercise and sleep. ACSM Health Fitness J. 2013; 17 (5): 5–8.
3. du Prel J-B, Rohrig B, Blettner M. Critical appraisal of scientific articles: Part 1 of a series on evaluation of scientific publications. Deutsches Aerzteblatt International. 2009; 106 (7): 100–5. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696241/
. Accessed on August 7, 2014.
4. Fox S, Duggan M. Health Online 2013. Pew Research Center’s Internet & American Life Project; Washington (DC); [cited 2014 Jul 25]. Available from: http://http://www.pewinternet.org
5. Fox S, Duggan M. Mobile Health 2012. Pew Research Center’s Internet & American Life Project; Washington (DC); [cited 2014 Jul 25]. Available from: http://http://www.pewinternet.org
6. Gerber M, Brand S, Holsboer-Trachsler E, Puhse U. Fitness and exercise as correlates of sleep complaints: is it all in our minds? Med Sci Sports Exerc. 2010; 42 (5): 893–901.
7. Levine GN, Allen K, Braun LT, et al Pet ownership and cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2013; 127: 2353–63.
8. MedlinePlus. MedlinePlus Guide to Health Web Surfing. U.S. National Library of Medicine; Bethesda (MD); [cited 2014 Aug 4]. Available from: http://http://www.nlm.nih.gov
9. Myers KA. Cigarette smoking: an underused tool in high-performance endurance training. Can Med Assoc J. 2010; 182 (18): E867–9. Available from: http://www.cmaj.ca/content/182/18/E867.full
10. Myllymäki T, Kyröläinen H, Savolainen K, et al Effects of vigorous late-night exercise on sleep quality and cardiac autonomic activity. J Sleep Res. 2011; 20: 146–53.
11. National Library of Medicine. Behind the Headlines. U.S. National Library of Medicine; Bethesda (MD); [cited 2014 Aug 6]. Available from: http://http://www.ncbi.nlm.nih.gov
12. National Library of Medicine. Evaluating Internet Health Information: A Tutorial From the National Library of Medicine. U.S. National Library of Medicine; Bethesda (MD); [cited 2014 Aug 6]. Available from: http://http://www.nlm.nih.gov
13. National Sleep Foundation. 2013 Sleep in America Poll: Exercise and Sleep. National Sleep Foundation; Arlington (VA): 2013. [cited 2014 Aug 7]. Available from: http://http://www.sleepfoundation.org
14. Rohrig B, du Prel JB, Blettner M. Study design in medical research: Part 2 of a series on the evaluation of scientific publications. Deutsches Aerzteblatt International. 2009; 106 (11): 184–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19568374
. Accessed on August 7, 2014.
15. Rohrig B, du Prel JB, Wachtlin D, Blettner M. Type of study in medical research: Part 3 of a series on evaluation of scientific publications. Deutsches Aerzteblatt International. 2009; 106 (15): 262–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19547627
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16. Youngstedt SD. Effects of exercise on sleep. Clin Sports Med. 2005; 24: 355–65.
17. Youngstedt SD, Kripki DF, Elliott JA. Is sleep disturbed by vigorous late-night exercise? Med Sci Sports Exerc. 1999; 31 (6): 864–9.