The new rules, mandated by the FDA, are making sunscreen more informative with less misleading information. For example, the term “sunblock” is banned because none of these products can block all of the sun’s ultraviolet rays. “Waterproof” is also banned, replaced by “water-resistant”—which must be accompanied by a set time for reapplication. Another big change has to do with SPF, or sun protection factor.

When sunlight hits your skin, it is being exposed to ultraviolet A (UVA) and ultraviolet B (UVB) rays. UVB rays are the main cause of sunburn, while UVA can prematurely age and wrinkle skin. Both contribute to skin cancer. Sunscreens vary in their ability to protect against UVA and UVB.

The best protection comes from a sunscreen that provides broad spectrum protection, meaning it filters out much of the UVA and UVB. Under the new FDA rules, if a label says “broad spectrum,” the product must pass tests proving that it truly protects against both UVA and UVB rays.

SPF is a measurement of how much longer it takes for your skin to turn red from the sun after applying the sunscreen. Say your skin turns red after 10 minutes in the sun. Sunscreen with an SPF of 15 would prevent your skin from turning red for 150 minutes under the same conditions. You’d think that an SPF of 30 would work twice as well as an SPF of 15. But that’s not necessarily the case. While SPF 15 filters out approximately 93% of all incoming UVB rays, SPF 30 filters out 97% and SPF 50 boosts that to 98%.

Sunscreen products that don’t meet an SPF of 15 or higher for both UVA and UVB must now carry a warning like this: Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to prevent sunburn, not skin cancer or early skin aging.

The FDA says there’s no evidence that sunscreens with an SPF above 50 offer any additional protection. It had initially wanted to ban sunscreen makers from including SPFs higher than 50 on labels, but blowback from the industry has so far tabled that.

To reduce your risk of skin cancer and early aging, the American Academy of Dermatology recommends using a sunscreen with the following features listed on the label:

• “Broad spectrum,” which means the sunscreen protects against both UVA and UVB rays
• SPF of 30 or higher
• Water-resistant for up to 40 or 80 minutes

Wise sunscreen use

Nonchalantly slapping on some sunscreen here and there will miss spots and often provide insufficient protection against sunburn and skin cancer. Be systematic when using sunscreen:

• Apply it before you go out.
• Make sure you apply enough and apply frequently. Use 1 ounce of sunscreen (a shot glass full) to cover your body and face.
• Reapply sunscreen immediately after swimming or heavy sweating, using the time guide on the label.
• Apply every 2 hours if you don’t get in the water and don’t sweat.

Even the best sunscreen can’t protect you from all of the sun’s rays. Here are some other ways to protect yourself from skin cancer, sunburn, and early aging of skin:

• Wear clothing made from tightly woven fabrics or those that absorb UVA and UVB.
• Avoid the sun from 10:00 a.m. to 4:00 p.m., when its rays are most intense.
• Wear a wide-brimmed hat to keep ultraviolet rays off your face.
• Stay in the shade.
• Pay attention to reflection from water, sand, and snow (in the winter).
• Watch for news reports that give the UV index in your area. A UV index reading of 2 or less means low danger from the sun’s ultraviolet rays for the average person.
• Examine your skin regularly for any new moles or changes in moles. Ask your doctor about any changes you see.

Neither I nor anyone I know can give a confident answer to that question. What makes flu viruses so unpredictable is that they are constantly changing or mutating their genes. They also are constantly swapping their genes with the genes of other flu viruses. When they change or swap their genes, they change their character.

When I hear about a new flu virus, I want to know two things about it: how easily is it spread from one person to another, and how sick does it make the people it infects?

A report from the U.S. Centers for Disease Control and Prevention (CDC), and another from a team from China in this week’s New England Journal of Medicine, indicate that so far the new H7N9 virus has not clearly spread from one person to another, and has not spread outside of Eastern China. But things can change quickly with flu viruses.

H7N9 has made people very sick, however. Indeed, all three of the people infected with virus described in the New England Journal of Medicine died.

As of the end of April, the CDC said that China had reported 126 human cases of the new flu. The people tend to be older (average age in their 60s) and many have had chronic illnesses. Fewer children and young adults have been infected, so far.

The world is full of different flu viruses. Most of them infect just animals, often just one type of animal. Sometimes a flu virus “jumps” from one animal to another. Sometimes, it is even able to jump from animals to humans. That’s what has happened with H7N9. It has jumped from chickens and ducks to humans.

So far, none of the health care workers caring for people stricken with the new virus have contracted the virus. No travelers from China to the U.S. have been found carrying the virus.

In other words, as I write this article, there does not appear to be a clear threat to people outside of Eastern China. But every public health agency around the world is keeping a close eye on China. That’s because a virus that cannot spread easily from one person to another can change or swap genes—and suddenly be capable of spreading easily. We know of no reason why this could not happen with H7N9. And we know that it can produce severe, even fatal, illness.

How bad can a flu virus be? The worst flu outbreak for which we have good records occurred in 1918. A new virus emerged that spread easily between people and made people very sick.

How easily, and how sick? In the course of a few months, 30% of the people in the world caught the virus, and at least 20 million people died. That’s more than were killed in World War I.

Here in Boston, at the height of the pandemic, 200 dead people every day were carried through the streets in horse-drawn wagons, and often buried in mass graves. As in many other cities around the world, overnight there were hundreds and thousands of orphans. The grandmother of one of my colleagues on the faculty here was one of those orphans. I am not being melodramatic: the worse influenza pandemics can be truly awful.

The CDC and scientists at the National Institutes of Health (NIH) are working overtime to protect our health. But these two critically important federal agencies have just had their budgets slashed by the “sequester.”

Regardless of what you think about federal spending in general, if you share my view that we should not be cutting funding for health research and public health, you could do what I have done. Write your representatives in Congress to restore cuts in the CDC and NIH budgets.

Why does sodium matter? Too much of it can increase blood pressure and make the kidneys work harder. High blood pressure is a leading cause of stroke, heart attack, heart failure, kidney disease, and more. Current recommendations urge us to consume less than 2,300 milligrams (mg) of sodium a day, equivalent to about a teaspoon of table salt. The bar is set lower—1,500 mg a day—for those with cardiovascular disease or high blood pressure. Yet the average American takes in about 3,400 mg a day.

Harvard researchers recently conducted a study that assessed the cumulative health effects of excess sodium. They estimated that excess sodium accounts for the 2.3 million deaths each year around the world. The U.S. ranked 19th out of the 30 largest countries, with 429 deaths per million adults due to taking in too much sodium. That represents one in 10 U.S. deaths due to heart attack, stroke, and other cardiovascular diseases.

Counting the milligrams

For the JAMA Internal Medicine study, researchers with the Center for Science in the Public Interest (CSPI) in Washington, DC, evaluated the sodium in 78 foods served at fast food and chain restaurants between 2005 and 2011, collecting nutritional information from the company websites. They did the same for foods plucked from shelves at stores in Washington, DC, and at one Walmart in Elverston, Pennsylvania.

The average sodium in chain restaurant items increased 2.6% between 2005 and 2011. In packaged foods, it fell on average 3.5%. The sodium in some products fell as much as 30%, although a greater number increased by more than 30%.

Food manufacturers have developed lower-sodium foods—none of which were included in the JAMA Internal Medicine study—and have reduced sodium in other products. So far these efforts, plus continuing public education campaigns, have failed to change this sobering fact: the average American still takes in far more sodium that their bodies need.

CSPI, which sponsored the study, has called for tighter government regulation on the sodium content in processed and restaurant foods, including phasing in ever-stricter limits on how much sodium foods may contain.

“Stronger action…is needed to lower sodium levels and reduce the prevalence of hypertension and cardiovascular diseases,” wrote Michael F. Jacobson, Ph.D., and colleagues, the authors of the JAMA Internal Medicine study.

When applied to millions of people, even small changes in sodium consumption can save lives. “The evidence is convincing that substantially reducing sodium intakes from current levels will have significant population benefits,” says Dr. Dariush Mozaffarian, associate professor of medicine at Harvard-affiliated Brigham and Women’s Hospital. “The data justify government intervention to reduce sodium levels in all processed, pre-prepared, restaurant, and other commercial foods.”

How to reduce your sodium

You don’t need to wait for more government regulations to keep the sodium in your diet in check. There is the obvious solution, says Dr. Helen Delichatsios, an assistant professor of medicine at Harvard Medical School. “Eat out less and cook at home more. There is much less sodium in home cooking than in prepared or restaurant foods.” Here are some other options:

• When shopping, check nutrition labels and limit foods that deliver a lot of sodium. The five top processed food sources of sodium are bread and rolls, cold cuts and cured meats, pizza, poultry, and soups. “Better yet, avoid foods with labels, and instead eat real food like fruits, vegetables, legumes, and whole grains,” says Dr. Delichatsios.
• When dining out, ask for information on calories, fat, and sodium. Chain restaurants commonly post the nutritional profile of their products online.
• Cook more. Base your meals on fresh and whole foods that you cook yourself, not processed warm-and-serve products, since they tend to be loaded with sodium.

Jolie underwent what’s called a prophylactic double mastectomy. That means she had both of her breasts removed even though she hadn’t been diagnosed with breast cancer. She said she did this because she carries a gene, called BRCA1, that significantly increases the odds of developing breast or ovarian cancer.

A related gene, BRCA2, also greatly boosts the chances of developing breast cancer. (Men with these mutations also have an increased risk of breast cancer.) You can learn more about BRCA1 and BRAC2 at the National Cancer Institute’s website.

In the general population, about 12 out of 100 women (12%) will develop breast cancer at some point during their lives. Among women who have inherited a harmful mutation in BRCA1 or BRCA2, 60 out of 100 (60%) will develop breast cancer. Women who have at least two close relatives—a mother, sister, or daughter—who have had breast or ovarian cancer are also at much higher risk. (Jolie’s mother died of ovarian cancer at age 56.) These women are good candidates for prophylactic mastectomy.

Some women, like Jolie, undergo prophylactic mastectomy before they have ever been diagnosed with breast cancer. Others have both breasts removed when a tumor is found in one breast.

The use of prophylactic mastectomy doubled between 1998 and 2005, according to a report in the journal Current Oncology Reports, and is likely still rising. One reason is more widespread use of genetic tests for BRCA1 and BRCA2.

It’s also possible that high-visibility celebrities who undergo prophylactic mastectomy because they are at high risk for developing breast cancer, like Jolie and Sharon Osbourne, and those like Christina Applegate, who had a double mastectomy after a tumor was found in one breast, are making women more aware of this option.

Get good information

If you or a loved one has been diagnosed with breast cancer, it’s important to take some time to weigh your options. A University of Michigan study showed that nearly three-quarters of women who opted to have prophylactic mastectomy were actually at very low risk of developing cancer in the healthy breast. According to the researchers, those women didn’t have a good medical reason for doing it and were “not expected to benefit in terms of disease-free survival.”

That’s not to say their decisions were wrong. They made the best personal choices for their physical and mental health. About 90% of the women who had a preventive mastectomy said they were “very worried” about facing cancer again, and the prophylactic mastectomy eased this fear. A new study from the University of Pittsburgh indicates that most women who undergo prophylactic mastectomy were glad they did it and would recommend to other women in their situation.

But the University of Michigan research suggests that women diagnosed with breast cancer be given more and better information about their chances of developing cancer in the other breast and about the risks and benefits of prophylactic mastectomy. All surgery carries the risk for complications and the recovery for mastectomy—and reconstructive surgery should a woman opt for that—take a toll, albeit usually a temporary one.

Taking time to make the decision, and talking it over with a trusted and knowledgeable expert, is an important part of the decision-making process. Having as much information as possible before choosing prophylactic mastectomy is as empowering as making the decision itself.

Yet in the past decade, a remarkable series of experiments from laboratories all over the world has begun to challenge that “law.” In both simple animals like worms and in more complicated animals like mice, scientists are discovering what causes aging—and how to slow it. The life spans of several simple animals have been extended greatly by simple biological manipulations. More important, during that extra time alive, the animals remain quite strong and fertile.

The latest example of such aging research was just reported in the prestigious scientific journal Cell by two of my Harvard Medical School colleagues. Cardiologist Richard T. Lee (co-editor in chief of the Harvard Heart Letter) and stem cell biologist Amy Wagers and their teams have found a substance that rejuvenates aging hearts in mice. (You can see a video of the researchers discussing their work below.) The discovery could someday lead to a treatment that prevents or reverses the most common kind of heart failure in humans: age-related diastolic dysfunction. There is currently no specific treatment that prevents or reverses this condition.

In diastolic dysfunction, the heart muscle becomes thicker and stiffer. As a result, when blood enters the heart, its muscular walls can’t stretch enough to accept all the blood flowing into it. That means the heart pumps less blood with each beat, making it difficult to circulate blood to every cell in the body. Blood backs up into the lungs, causing difficulty breathing. It also backs up into the rest of the body, causing fatigue and swelling, particularly in the legs and feet. That’s heart failure.

Young helps old

Mice have a similar condition. It develops as the animals get older, just like it does in humans. The team led by Lee and Wagers wondered if something was present in the blood of young mice that kept the heart young. To pursue that possibility, they joined the circulation of an old mouse to that of a young mouse. As a result, the two animals shared the same blood. After 4 weeks, the thickened and stiff heart muscle of the old mouse became dramatically thinner and more flexible.

In other words, it looked like Lee and Wagers’ hunch was right: some substance was present in the blood of young mice that rejuvenates the heart muscle of old mice. Most likely, that substance had been in the blood of the old mice when they were younger, but had decreased as the mice aged.

The team then identified a substance called growth differentiation factor 11 (GDF11) as a good candidate to be the “anti-aging” substance: it was at high levels in the blood of young mice but not old mice. To prove its role, Lee and Wagers gave old mice enough GDF11 so they had the same blood levels of it as young mice. Again, the thickened, stiff heart muscle of the old mice became rejuvenated. So at least in mice, a common kind of aging of the heart could be reversed by a particular anti-aging substance.

Will this discovery in mice offer any help to humans with heart failure? It will take a lot more research to know. It may not work in humans the way it works in mice. It may work in humans, but cause unacceptable side effects. Any beneficial effects might not last.

On the other hand, it also is possible that this substance has anti-aging effects in more organs than just the heart—and not only in mice, but maybe also in humans. So the discovery could have even greater potential than it now appears.

For me, what is important about this study is not whether it will help human health: we just can’t know if it will until much more research is performed.

What I find important is that the work by Lee and Wagers, like a number of studies before it, reveals a remarkable new truth: there are substances naturally present in all living things that cause aging and that retard it. In other words, aging is not a mystical process. Aging is chemistry. By understanding that chemistry, we may someday be able to slow aging.

What is driving this migration to retail health clinics? “For the majority of patients it is convenience,” says lead study author, Dr. Ateev Mehrotra, associate professor of medicine at the University of Pittsburgh and health policy researcher at the nonprofit RAND Corporation (he’ll be joining Harvard Medical School’s Department of Health Care Policy in June). You can walk into a retail health clinic without an appointment, and many clinics are open nights and weekends. In fact, nearly half of the visits in the study were on the weekends or other off-hours when doctors’ offices are typically closed.

The other attraction of retail health clinics is price, Dr. Mehrotra and his colleagues found. “Not the actual price, but the transparency of the cost,” he says. Clinics offer a menu of prices and services, which means there are fewer surprises when the bill arrives. And health insurance covers all—or a percentage of—the costs of services provided at these clinics, just as it does for care delivered at a doctor’s office.

As consumers increasingly turn to retail health clinics, the number of clinics has grown to meet demand—up to 1,423 this year and an estimated 3,200 by the end of 2014. And the types of services they offer has expanded beyond immunizations and common ailments such as strep throat and sinus infections. Last month, for example, Walgreens’ announced that its Take Care Clinics will now help manage chronic conditions such as high blood pressure, diabetes, high cholesterol, and asthma.

Quality comparison

Retail health clinics are often staffed by nurse practitioners instead of doctors. That’s not an issue for people who are visiting for routine vaccinations or an antibiotic prescription for an ear infection—but are these clinics equipped to manage chronic conditions?

The research comparing nurse practitioners with doctors on several measures of care has been reassuring, Dr. Mehrotra says. “People who went to the nurse practitioner did just as well as those who went to a doctor.”

In some aspects of care, retail health clinics may actually outperform physician’s offices. “Whatever they do is guided by evidence-based protocols,” says Regina Herzlinger, Nancy R. McPherson Professor of Business Administration at Harvard Business School, and author of Who Killed Health Care? Not only are nurse practitioners required to follow specific care guidelines, but they must also keep meticulous records on the care they’ve provided, she says. “They have a record of what they’ve done that’s very detailed.”

A key outstanding question is whether visiting retail health clinics might interrupt continuity of care between doctors and their patients. Dr. Mehrotra found that individuals who received care at a retail clinic were less likely to follow up within the year with their primary care doctor, although that lack of follow-up didn’t seem to affect the quality of care they received overall.

In the retail health clinic setting, the burden of continuity in record keeping often falls on the patient. Although clinics can send health records to a patient’s primary care doctor, there’s a good chance the two offices use incompatible electronic medical record systems, rendering the clinic’s records unusable to the physician. “It’s really up to the patient to make sure that the excellent records these retail medical clinics keep is embedded in their personal health record with their primary health care provider,” Professor Herzlinger says. Getting a printed copy of your record from the retail health clinic and bringing it to your doctor can help prevent any discontinuity of care.

Retail health clinics in the future

Today, retail health clinics are most appropriate for people with simple, acute health conditions such as a respiratory or urinary tract infection. “It’s generally people who don’t have a primary care doctor and who overall are healthier,” Dr. Mehrotra says.

That target group might change as more retail clinics expand their services to offer chronic disease care, and as the number of primary care doctors shrinks. “There is a tremendous shortage of primary care doctors,” says Professor Herzlinger. “Many of the people who use these clinics don’t have physicians, and can’t get physicians.”

What will happen to retail health clinics as the Affordable Care Act rolls out and the number of insured Americans rises? “We can only speculate,” Dr. Mehrotra says. “My own instinct is that as more people get insurance, they will increase the demand for primary care physicians. Given our fixed supply of doctors, wait times are likely to go up. This may drive demand to retail clinics.”

Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital.

On the South Side of Chicago, where I grew up, one hospital’s charge for implanting a pacemaker to keep the heart beating at a steady rhythm was $49,601, while another hospital charged $63,979 to do it. In Boston, a hospital not far from where I work charged $76,121 to implant a pacemaker while another hospital less than three miles away charged $55,687.

According to The New York Times, the Keck Hospital of the University of Southern California charged an average of $123,885 for a major artificial joint replacement (six times the average amount that Medicare reimbursed for the procedure) while Centinela Hospital Medical Center, also in Los Angeles, charged $220,881 for the same type of joint replacement surgery.

The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011.

The data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.

Keep in mind that these “charges” aren’t hard and fast. Medicare doesn’t pay the full charge. Insurers don’t either, as many of them negotiate lower charges. As NPR’s Robert Siegel said about the database, “it sounds like what you’ve got is a survey of the sticker prices in car lots all around America, but every deal is a special deal.”

At least for now, the database isn’t especially easy to use. It’s just an Excel spreadsheet listing the hospitals by state along their charges for the 100 procedures. The Washington Post created a nifty interactive tool that you can use to look at charges in your state for 10 conditions. Choose your state and the tool shows how its hospitals stack up against the national average, as well as the highest and lowest charges for these ten procedures. Expect other creative apps incorporating this information to be coming along soon.

If you decide to dive into the data, be aware—especially if you have private insurance (not Medicare)—that appearances can be deceiving. It may look like Hospital A charges more than Hospital B, but that may not be so. Your insurer and Hospital may have actually agreed on a lower payment. So the data don’t necessarily say what your insurance company is actually going to pay.

Reverberations

A few weeks ago, I finally finished reading “Bitter Pill,” Steven Brill’s extraordinary Time magazine article on the crazy cost of healthcare in America. I say “crazy” because, according to Brill, how hospitals set their prices has little rhyme or reason. The database from the Centers for Medicare and Medicaid Services reinforces that notion.

Publishing this information is one small step toward making the cost of healthcare more transparent. While it will be a long time before most of us will be able to figure out how much an operation or a hospital stay costs, the database could nudge hospitals with exorbitant charges to bring them in line.

Although weight-loss surgery, also known as bariatric surgery, should be considered a last resort when diet and exercise don’t work, it can do some amazing things. Among people who are severely overweight, it can yield a 25% to 35% weight loss within two years. In many people who undergo the surgery, type 2 diabetes, high blood pressure, high cholesterol, and the disruptive and potentially harmful snoring pattern known as sleep apnea disappear. It can also improve a number of other health problems, ranging from arthritis and heartburn to infertility and incontinence.

Good candidates

In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease, and sleep apnea.

Much of the speculation about Christie’s surgery was whether he did it for political reasons or concerns about his future health. But there shouldn’t be any speculation about whether he was a good candidate for it. While the Governor never made public his exact weight, the estimate is over 300 pounds. At just under 6 feet tall, that gives him a body mass index of at least 41. Christie also acknowledged trying to lose weight many times, using different weight loss programs. He had some initial success. But like most obese people, he regained all the lost pounds and more.

Even if Christie’s claims of otherwise being in good health are correct, he was at high risk of developing problems directly related to his weight. I believe his choice was a good one for his health.

Types of weight-loss surgery

Christie underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery.

Gastric banding is done laparoscopically, meaning through small holes made in the abdomen. The surgeon wraps an adjustable silicone band about two inches in diameter around the upper part of the stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The small size of the upper stomach make a person feel full much sooner than before. Depending on the person’s rate of desired weight loss and how he or she feels, the band can be easily tightened or loosened as needed by injecting or withdrawing sterile salt water saline through a port implanted just under the skin. Compared with gastric bypass, the surgery is simpler and has a lower risk of complications immediately following the operation.

Gastric bypass, also known as the Roux-en-Y procedure, shrinks the size of the stomach by more than 90%. This makes a person feel full after eating very small amounts of food. In addition, the body absorbs fewer calories because food bypasses most of the stomach and upper small intestine. The operation is done through an incision made in the abdomen or laparoscopically. The surgeon converts the upper part of the stomach into a small pouch about the size of an egg. The small intestine is then cut. One end is connected to the stomach pouch and the other is reattached to the small intestine, creating a Y shape. This allows food to bypass most of the stomach and the upper part of the small intestine, although both continue to produce the gastric juices, enzymes, and other secretions needed for digestion. These drain into the intestine and mix with food at the crook of the Y. Gastric bypass surgery is not reversible.

The gastric sleeve technique transforms the stomach into a small, narrow tube by removing the curved side of the organ creates a small pouch using the side of the stomach rather than the bottom. One advantage is that no rearrangement of the intestines is needed. The vertical pouch the sleeve procedure creates is less prone to stretching compared to the pouch left by a gastric bypass. Like gastric bypass, the gastric sleeve technique is not reversible.

After surgery

For the first few months after surgery, appetite is usually turned down. Eating too quickly or too much overfills the stomach pouch. That can cause vomiting or pain in the chest and upper abdomen. After a high-carbohydrate meal, a person who has had gastric bypass surgery may suffer from “dumping syndrome,” a reaction that causes flushing, sweating, severe fatigue, nausea, vomiting, diarrhea, and intestinal gas. To prevent nutritional deficits, it’s also a good idea to take vitamins (especially vitamins B12 and D) and minerals (especially calcium and iron).

If you are considering weight loss surgery, realize that you must commit to a life-long change in the way you eat. Surgery without lifestyle change will either make you miserable or not result in successful weight reduction. Likely both.

Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body.

A national survey conducted by the federal Centers for Disease Control and Prevention showed that more than half of people with arthritis (53%) didn’t walk at all for exercise, and 66% stepped out for less than 90 minutes a week. Only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Delaware had the highest percentage of regular walkers (31%) while Louisiana had the lowest (16%). When the CDC tallied walking for less than 90 minutes a week, Tennessee led the list, with 76% not walking that much per week, compared to 59% in the  District of Columbia.

This map shows the percentage of adults with arthritis in each state who walked less than 90 minutes per week during 2011.

The findings were published in the journal Morbidity and Mortality Weekly Report, one of its contributions to Arthritis Awareness Month.

Beyond walking

Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function. “Swimming or bicycling tend to be better tolerated than other types of exercise among individuals with arthritis in the hips or knees,” says rheumatologist Dr. Robert H. Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

Exercise programs aim to help people with arthritis:

• increase the range of motion in the affected joint
• strengthen muscles
• build endurance
• improve balance

You can create an exercise program of your own, with help from a trusted doctor, nurse, or physical therapist. Or you can try one that’s been developed by arthritis experts. Examples include the Fit and Strong! program from the University of Illinois at Chicago, or one of several programs developed by the Arthritis Foundation: its Exercise Program, Walk with Ease program, or Aquatics program.

The fatigue, pain, and stiffness caused by many types of arthritis present a barrier to exercise—but these are the same symptoms that tend to improve with regular exercise.

If you have arthritis and don’t currently exercise, start slow. Take a five-minute stroll around your block, swim, or workout on an exercise bicycle. Do it every day, and then gradually increase the time spent exercising or how hard you exercise, but not both at once. If you have heart disease or other health issues, check with your doctor before embarking on an exercise program.

“If exercise was a newly developed medicine, it would be a blockbuster,” says Dr. Shmerling. “It has an excellent safety profile, and enormous benefits for people with arthritis, heart disease, and a long and growing list of other health problems.”

That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Other interesting results:

• Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover.
• Few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members.
• Many people support public policy options for financing long-term care, either through tax incentives to encourage saving for long-term care or a government-administered plan.

Mismatch between perception and reality

As a primary care doctor, I see my patients struggle with how the cost of age-related care affects their lives and their financial realities. Long-term care costs are huge. We can’t afford not to think about them.

The U.S. Census Bureau estimates that $217 billion will be spent in 2015 on nursing home and residential care. This includes assisted living facilities and board and care homes. Currently, about 25% of these costs are paid out-of-pocket by older adults and their families. Almost two-thirds of the cost is paid by Medicaid and Medicare combined.

Medicare only pays for short-term care—20 days in a nursing home—when illness causes disability. After that, patients or their families must meet these costs out-of-pocket. Most older adults with chronic needs then “spend down” their funds to pay for long-term care until the money runs out. At that point, at poverty level, Medicaid support may be available.

Start early

Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

1. Talk with your family. Nearly 60% of older people who need long-term nursing or personal care rely fully on unpaid caregivers, usually their children or spouses. Sometimes this is an obvious arrangement. But your family must be flexible and committed. If a caregiver must stay at home, some family income will be lost. This is rarely a comfortable situation if everyone did not agree ahead of time.

2. Consider long-term-care insurance. Fewer than 3% of American adults have purchased a long-term care insurance policy. The average cost is high. A typical plan might cost $3,300 a year for a healthy 60-year-old couple. And it might pay only a $150 a day for up to 3 years. For a person who buys this insurance at age 65, there is a 45% chance of making a claim. If you never need long-term care, the payments you made to the plan are lost.

3. An “age in place” retirement arrangement might be right for you. Some campus-like retirement communities are designed to permit an older adult to “age in place.” This means you can go from a relatively independent life to a more dependent life while staying in the same community. Services often include recreation for the active elderly and 24-hour skilled nursing or rehabilitation services for the frail elderly. These organizations are called continuing care retirement communities. They are always expensive. Usually, they charge an up-front fee of $25,000 to $500,000. Then you pay a membership fee or rent each month.

4. Build up your savings. Making ends meet is a challenge. But in your working years, don’t underestimate how much you need to save. Many of us think, “After we no longer have our mortgage, we should be able to live on our savings.” It’s a good idea to factor long-term care into your savings plan. If disability strikes, you will need it.

5. Write an advance directive (“living will”). Some people receive intensive medical care after they become profoundly disabled. By then, some people who are in this situation are no longer able to communicate their wishes to family members and doctors. If you know that you would not want life-sustaining treatments in this condition, it is wise to record your wishes in a legal “advance directive.”