Getting steps in one long walk a day cuts risk of death and CVD better than multiple short walks

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Getting steps in one long walk a day cuts risk of death and CVD better than multiple short walks

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01547

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03529

URL goes live when the embargo lifts             

A prospective population-based cohort study of suboptimally active adults (<8,000 steps per day) assessed whether individuals who accumulate their daily steps in shorter or longer bouts are at greater risk for all-cause mortality and cardiovascular disease (CVD), regardless of the total number of steps taken. The study found that those who accumulate their daily steps in longer bouts had a lower risk for mortality and CVD than those taking steps in shorter bouts. The findings are published in Annals of Internal Medicine.  

 

Researchers studied data from 33,560 adults in the UK Biobank who engaged in 8000 or fewer daily steps. Participants were grouped into four categories based on their step accumulation patterns: shorter than 5 minutes, 5 to shorter than 10 minutes, 10 to shorter than 15 minutes, and 15 minutes or longer. Participants had a median of 5,165 steps per day, and 42.9% of participants accumulated most of their daily steps in bouts lasting less than 5 minutes, whereas 33.5% accumulated most of their daily steps in 5- to 10-minute bouts, 15.5% in 10- to 15-minute bouts, and 8.0% in 15-minute bouts or longer. The all-cause mortality risk at 9.5 years was 4.36% (95% CI, 3.52% to 5.19%) among participants who accumulated most of their steps in bouts shorter than 5 minutes, 1.83% (CI, 1.29% to 2.36%) for 5- to 10-minute bouts, 0.84% (CI, 0.13% to 1.53%) for 10- to 15-minute bouts, and 0.80% (CI, 0.00% to 1.89%) for 15-minute bouts or longer. These risks were more pronounced for CVD, as participants who accumulated most of their steps in bouts shorter than 5 minutes had a cumulative risk for CVD at 9.5 years of 13.03% (CI, 11.92% to 14.14%), compared with 11.09% (CI, 9.88% to 12.29%) for 5- to 10-minute bouts, 7.71% (CI, 5.67% to 9.70%) for 10- to 15-minute bouts, and 4.39% (CI, 1.89% to 6.83%) for bouts of 15 minutes or longer. In sedentary participants (<5,000 steps per day), the researchers observed more pronounced associations between longer stepping bouts and lower risk of death and CVD. These results can inform physical activity recommendations for individuals—particularly those who are otherwise sedentary or low-active—to incorporate longer, purposeful walking sessions into their daily routines to optimize health outcomes. 

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Borja del Pozo Cruz, PhD please email borja.delpozo@universidadeuropea.es.

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2. Mediterranean diet could be an effective first-line intervention for IBS

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01519

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01519-PS

URL goes live when the embargo lifts             

A randomized clinical trial evaluated if the Mediterranean diet is noninferior to traditional dietary advice in managing irritable bowel syndrome (IBS) symptoms. The trial found that the Mediterranean diet is noninferior and superior to traditional diet advice in managing IBS symptoms, suggesting that it could be considered a viable first-line dietary intervention for IBS. The study is published in Annals of Internal Medicine.  

 

Researchers from the University of Sheffield studied data from 110 adults aged 18 to 65 years who had IBS across the United Kingdom. Trial participation was selective, with exclusion criteria including history of eating disorders, inflammatory bowel disease, and celiac disease. Participants were randomly assigned to follow either a Mediterranean diet or traditional diet for 6 weeks, with traditional diet advice following guidance from the British Dietetic Association. The primary end point was the proportion of participants achieving clinical response, defined as a 50-point or greater reduction in IBS Symptom Severity Scale (IBS-SSS). Secondary endpoints included changes in IBS-SSS scores, quality of life, and Mediterranean Diet Adherence Screener (MEDAS). At week 6, a 50-point or greater reduction in IB-SSS score was achieved by 62% (95% CI, 50% to 73%) assigned a Mediterranean diet versus 42% (CI, 31% to 55%) of participants assigned traditional diet. At week 6, there was also a greater reduction in the mean IBS-SSS after a Mediterranean diet than traditional diet. Frequency of abdominal pain was statistically significantly improved among participants with a Mediterranean diet versus traditional diet.

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Imran Aziz, MBChB (Honours), MRCP, MD please email Amy Huxtable, Media Relations Manager at University of Sheffield, at a.l.huxtable@sheffield.ac.uk.

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3. ACP provides ethical guidance amid controversies and changing practices in organ transplantation

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01738

URL goes live when the embargo lifts             

The American College of Physicians issued a position paper on ethical considerations surrounding organ transplantation, saying the needs of the donor patient and family must be prioritized and the process should be trustworthy and transparent. In the paper, ACP clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on their best interests independent of organ donation potential. ACP also emphasizes the importance of truly informed consent for organ donation. The paper is published in Annals of Internal Medicine. 

 

Current organ transplantation practices can prioritize the benefit to the community at the expense of patient-centered care. According to ACP, physicians must always act in the best interests of the patient, and that care must align with the patient’s wishes and preferences.  Recent advancements and controversies—and growing criticism – of the current transplantation system and practices underscore the need for reaffirmation of long-standing ethical principles and examination of conflicts between current practices and the best interests of patients, especially the potential donor.  Recent press accounts have documented troubling organ procurement practices; the United Network for Organ Sharing and the system it manages have been criticized as unfair, ineffective, and opaque; and an overhaul of the system, the Organ Procurement and Transplantation Network (OPTN) Modernization Initiative, is underway.

 

ACP says that increasing the number of organs for transplant does not override physicians’ duties and responsibilities to patients and suggests in the paper’s positions that:

 

When caring for a patient who may become a donor, the physician’s obligation is to that patient first and foremost. The physician’s primary duties are to the patients under their care. End of life decision making for prospective donor patients must center on the best interests of the patient, regardless of the organ donation potential. Discussions about organ donation should support the patient or their family in making the best possible decision for the donor, while also ensuring the process is open, honest, and trustworthy. Physicians should respect and act on patients' and families' fully informed, voluntary decisions. Advance care planning should help patients express their future medical treatment preferences and/or choose someone to make decisions for them if they can’t do so themselves. Organ donation should not take priority over the patient’s preferences for end-of-life care. Metrics or financial/other incentives must not override the physician’s primary responsibility to always act in the best interest of the patient. Patients come first, regardless of any outside pressures or institutional interests. Fair and equitable access to organ donation and transplantation should be a top priority. The system must be built on trust and use fair, transparent, and ethical practices.  

In a 2023 paper, ACP’s Ethics, Professionalism and Human Rights Committee emphasized how determination of death is a distinct issue that must be kept separate from organ transplantation,  reaffirming the fundamental ethical importance of the dead donor rule and raising ethical concerns about practices such as thoracoabdominal normothermic regional perfusion (TA-NRP, commonly called NRP).

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please contact Angela Collom at acollom@acponline.org. 

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4. Physicians outline strategies to mitigate public health harms from increased ICE activity in communities

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03151

URL goes live when the embargo lifts             

In an opinion article published in Annals of Internal Medicine, physicians discuss the negative public health consequences from operations from the U.S. Immigration and Customs Enforcement (ICE), particularly regarding children. They argue that clinicians should respond when actions undertaken by the government, businesses, individuals, or all of these entities threaten the health of the public. They outline four key advocacy recommendations for physicians and organizations in the wake of the increased activity by ICE within communities. These recommendations include developing institutional policies protecting patient confidentiality from immigration inquiries; implementing trauma-informed care protocols sensitive to immigration-related stress; and expanding telehealth services for patients unable to attend in-person visits. The authors assert that these actions would not politicize medicine, as many critics argue, but instead promote the foundational principle of medicine to ‘first, do no harm.’

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Jeremy W. Jacobs, MD, MHS please email jeremy.w.jacobs@vumc.org. 

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