BDNF-based synaptic repair as a disease-modifying strategy for neurodegenerative diseases

Increasing evidence suggests that synaptic dysfunction is a key pathophysiological hallmark in neurodegenerative disorders, including Alzheimer's disease. Understanding the role of brain-derived neurotrophic factor (BDNF) in synaptic plasticity and synaptogenesis, the impact of the BDNF Val66Met polymorphism in Alzheimer's disease-relevant endophenotypes - including episodic memory and hippocampal volume - and the technological progress in measuring synaptic changes in humans all pave the way for a 'synaptic repair' therapy for neurodegenerative diseases that targets pathophysiology rather than pathogenesis. This article reviews the key issues in translating BDNF biology into synaptic repair therapies.

Treatment of neck injuries

Spinal cord injuries are uncommon in sports. Planning and practice for their occurrence, however, remains an essential component of Sideline Medical Team preparedness. Evaluation of cervical nerve injury, cervical cord injury, and cervical disc disease can be complex. Medical management, diagnostic imaging techniques and surgical recommendations in this setting continue to evolve. Most published guidance offers occasionally opposed expert opinion with sport participation after Cervical Cord Neuropraxia in the setting of Cervical Spinal Stenosis appearing particularly polarizing. Such conflicts can present challenges to clinicians in forming management and Return to Play decisions for the health of their athletes.

Aerobic capacity reference data in 3816 healthy men and women 20-90 years

Purpose

To provide a large reference material on aerobic fitness and exercise physiology data in a healthy population of Norwegian men and women aged 20–90 years.

Methods

Maximal and sub maximal levels of VO₂, heart rate, oxygen pulse, and rating of perceived exertion (Borg scale: 6–20) were measured in 1929 men and 1881 women during treadmill running.

Results

The highest VO_2max and maximal heart rate among men and women were observed in the youngest age group (20–29 years) and was 54.4±8.4 mL·kg⁻¹·min⁻¹ and 43.0±7.7 mL·kg⁻¹·min⁻¹ (sex differences, p<0.001) and 196±10 beats·min⁻¹ and 194±9 beats·min⁻¹ (sex differences, p<0.05), respectively, with a subsequent reduction of approximately 3.5 mL·kg⁻¹·min⁻¹ and 6 beats·min⁻¹ per decade. The highest oxygen pulses were observed in the 3 youngest age groups (20–29 years, 30–39 years, 40–49 years) among men and women; 22.3 mL·beat⁻¹±3.6 and 14.7 mL·beat⁻¹±2.7 (sex differences, p<0.001), respectively, with no significant difference between these age groups. After the age of 50 we observed an 8% reduction per decade among both sexes. Borg scores appear to give a good estimate of the relative exercise intensity, although observing a slightly different relationship than reported in previous reference material from small populations.

Conclusion

This is the largest European reference material of objectively measured parameters of aerobic fitness and exercise-physiology in healthy men and women aged 20–90 years, forming the basis for an easily accessible, valid and understandable tool for improved training prescription in healthy men and women.

Oxidative stress in the pathogenesis of colorectal cancer: cause or consequence?

There is a growing support for the concept that reactive oxygen species, which are known to be implicated in a range of diseases, may be important progenitors in carcinogenesis, including colorectal cancer (CRC). CRC is one of the most common cancers worldwide, with the highest incidence rates in western countries. Sporadic human CRC may be attributable to various environmental and lifestyle factors, such as dietary habits, obesity, and physical inactivity. In the last decades, association between oxidative stress and CRC has been intensively studied. Recently, numerous genetic and lifestyle factors that can affect an individual's ability to respond to oxidative stress have been identified. The aim of this paper is to review evidence linking oxidative stress to CRC and to provide essential background information for accurate interpretation of future research on oxidative stress and CRC risk. Brief introduction of different endogenous and exogenous factors that may influence oxidative status and modulate the ability of gut epithelial cells to cope with damaging metabolic challenges is also provided.

An economic evaluation of resistance training and aerobic training versus balance and toning exercises in older adults with mild cognitive impairment

Background

Mild cognitive impairment (MCI) represents a critical window to intervene against dementia. Exercise training is a promising intervention strategy, but the efficiency (i.e., relationship of costs and consequences) of such types of training remains unknown. Thus, we estimated the incremental cost-effectiveness of resistance training or aerobic training compared with balance and tone exercises in terms of changes in executive cognitive function among senior women with probable MCI.

Methods

Economic evaluation conducted concurrently with a six-month three arm randomized controlled trial including eighty-six community dwelling women aged 70 to 80 years living in Vancouver, Canada. Participants received twice-weekly resistance training (n = 28), twice weekly aerobic training (n = 30) or twice-weekly balance and tone (control group) classes (n = 28) for 6 months. The primary outcome measure of the Exercise for Cognition and Everyday Living (EXCEL) study assessed executive cognitive function, a test of selective attention and conflict resolution (i.e., Stroop Test). We collected healthcare resource utilization costs over six months.

Results

Based on the bootstrapped estimates from our base case analysis, we found that both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. Compared with the balance and tone group, the resistance-training group had significantly improved performance on the Stroop Test (p = 0.04).

Conclusions

Resistance training and aerobic training result in health care cost saving and are more effective than balance and tone classes after only 6 months of intervention. Resistance training is a promising strategy to alter the trajectory of cognitive decline in seniors with MCI.

Trial Registration

ClinicalTrials.gov NCT00958867.

Effects of pacing, status and unbalance in time motion variables, heart rate and tactical behaviour when playing 5-a-side football small-sided games

OBJECTIVES

To compare time-motion variables, heart rate and players' tactical behaviour according to game pace (slow, normal or fast), status (winning and losing) and team unbalance (superiority and inferiority) in football 5-a-side small-sided games. To identify the most discriminating variables in classifying performances according to these constraints.

DESIGN

Cross-sectional field study.

METHODS

The data were gathered using global positioning systems (5 Hz) in 5-a-side small-sided games (7 × 5 min) played by twenty-four footballers. The tactical performance was measured using dynamical positioning variables, processed by non-linear signal processing techniques (approximate entropy). ANOVA models were used to compare between constraints and discriminant analyses to identify the variables that best discriminate between pacing and status × unbalance constraints.

RESULTS

The fast paced games had the highest mean speed value, followed by normal and slow paced games (8.2 ± 0.6 km h(-1), 7.8 ± 0.5 km h(-1) and 6.2 ± 0.4 km h(-1), respectively). The stronger predictor variables of pacing were the randomness in distance to team centroid and the distances covered above 13 km h(-1). The results also changed according to game status and team unbalance. The strongest predictor variables were the distance covered below 6.9 km h(-1), distance and randomness to team centroid, with higher values when winning in superiority conditions.

CONCLUSIONS

Practice task design manipulating game pace, status and team unbalance significantly influenced the emergent behavioural dynamics. Collective positioning variables were more accurate in discriminating these constraints and, therefore, need to be considered when planning and monitoring performance.

Injury initiates unfavourable weight gain and obesity markers in youth

OBJECTIVE

The purpose of this study was to examine the association of knee injuries with subsequent changes in body mass index and body composition during maturation in young females.

METHODS

A prospective longitudinal study design was employed to evaluate young females active in soccer or basketball (N=862). Participants who completed at least 1-year follow-up to provide consecutive annual measures of BMIZ and %fat were included in the study analysis to determine the effect of knee injuries on the trajectory of these obesity markers in youth.

RESULTS

Of the 71 reported knee injuries, 12 (17%) occurred in athletes at the prepubertal stage, 24 (34%) in athletes at the pubertal stage, and 35 (49%) in postpubertal athletes. Controlling for the effects of maturation, female athletes who reported knee injury demonstrated a greater yearly increase in BMIZ (LS means and 95% CI for the injured group=0.039 (-0.012 to 0.089), for the non-injured group=-0.019 (-0.066 to 0.029), and group difference=0.057 (0.005 to 0.11), p=0.03) and in %body fat (LS means and 95% CI for the injured group=1.05 (0.45 to 1.65), for the non-injured group=0.22 (-0.21 to 0.064), and group difference=0.83 (0.21 to 1.45), p=0.009), compared to those without knee injuries. This indicates that the athletes with knee injuries will increase their body mass index percentile by up to 5 units more than someone of the same age without an injury, and in body fat by up to 1.5%, compared to their non-injured peers.

CONCLUSIONS

The present findings indicate that knee injury during the growing years may be associated with unfavourable changes in body composition.

Physical activity and self-reported health status among adolescents: a cross-sectional population-based study

OBJECTIVES

Little is known about the dose-response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population.

DESIGN

Cross-sectional study.

SETTING

All regions of Spain.

PARTICIPANTS

Students aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected.

MAIN OUTCOMES

The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose-response relationship.

RESULTS

As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males.

CONCLUSIONS

A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.

Ectopic fat, insulin resistance and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is now recognised as the hepatic component of metabolic syndrome (MetS). NAFLD is an example of ectopic fat accumulation in a visceral organ that causes organ-specific disease, and affects risk of other related diseases such as type 2 diabetes and CVD. NAFLD is a spectrum of fat-associated liver conditions that can culminate in end stage liver disease, hepatocellular carcinoma and the need for liver transplantation. Simple steatosis, or fatty liver, occurs early in NAFLD and may progress to non-alcoholic steatohepatitis, fibrosis and cirrhosis with increased risk of hepatocellular carcinoma. Prevalence estimates for NAFLD range from 2 to 44% in the general population and it has been estimated that NAFLD exists in up to 70% of people with type 2 diabetes. Although many obese people have NAFLD, there are many obese people who do not develop ectopic liver fat. The aim of this review which is based on a presentation at the Royal Society of Medicine, UK in December 2012 is to discuss development of NAFLD, ectopic fat accumulation and insulin resistance. The review will also describe the relationships between NAFLD, type 2 diabetes and CVD.

Transitions into and out of intercollegiate athletic involvement and risky drinking

OBJECTIVE

Cross-sectional data show that college athletes consume more alcohol and experience more general alcohol-related problems than those not participating in athletics. To our knowledge, the current study is the first to use a longitudinal design to examine the extent to which the course of drinking and alcohol-related problems relates to involvement in intercollegiate athletics, including transitioning into and out of athletic involvement.

METHOD

Participants were drawn from a sample of 3,720 college students from the Intensive Multivariate Prospective Alcohol College-Transitions Study who completed a survey every semester through their fourth year. Four groups were created based on athletic involvement status at baseline (freshman year) and follow-up (senior year): nonathlete, nonathlete (no reported athletic involvement at either time point), nonathlete, athlete (nonathlete at freshman year, athlete at senior year), athlete, nonathlete (athlete at freshman year, nonathlete at senior year), and athlete, athlete (athlete at freshman year, athlete at senior year).

RESULTS

A series of repeated measures analyses were then conducted to test for developmental differences among the athlete groups involving alcohol consumption and alcohol-related problems. Although findings differed as a function of alcohol outcome and comparison among various groups with differing athletic involvement, the general pattern of results showed that individuals who were more athletically involved demonstrated sharper increases in problem drinking (i.e., heavy drinking, frequency of intoxication, alcohol-related problems) during the college years.

CONCLUSIONS

These findings highlight the apparent risk associated with participation in intercollegiate athletics on college drinking.

Effects of implementing an ergonomic work schedule on heart rate variability in shift-working nurses

OBJECTIVES

The aim of this study was to compare the psychophysiological strain related to a conventional shift schedule and new ergonomically improved two- and three-shift schedules using heart rate variability (HRV) analysis. The specific aim was to determine whether the introduced ergonomic shift arrangement had any positive effects on the psychophysiological strain such as increased HRV or decrease in the sympathovagal balance of the autonomic nervous system (ANS).

METHODS

Questionnaire data and 24-hour HRV recordings were gathered from 48 female shift-working nurses once while working the conventional shift schedule (baseline) and again after one year working an ergonomic shift schedule during the morning shift.

RESULTS

Comparisons between conventional and ergonomic shift schedules (baseline and follow-up, respectively) revealed significant differences in frequency-domain parameters. Implementing an ergonomic shift schedule resulted in decreased normalized low frequency (LF) power, increased normalized high frequency (HF) power, and decreased LF/HF ratio at the beginning of the shift. Furthermore, at baseline, mean RR interval, root mean square of successive RR interval differences (RMSSD) and normalized HF power were increased at the end of the shift compared with the values at the beginning of the morning shift. In contrast, at the follow-up, LF power was increased between the end and beginning of the morning shift.

CONCLUSIONS

The psychophysiological strain measured by HRV analysis was lower at the beginning of the work shift for the ergonomic shift schedules compared with the conventional schedule. This indicates that an ergonomic shift schedule may have a positive effect on the ANS recovery occurring between successive work shifts.

Chronic musculoskeletal conditions associated with the cycling segment of the triathlon; prevention and treatment with an emphasis on proper bicycle fitting

Cycling-related injuries account for 20% of all injuries occurring during triathlons. Traumatic injuries caused by falls or accidents are thankfully rare but can be highly variable and very serious in nature. The best approach to these injuries is prevention. The majority of complaints arising from cycling are due to overuse or poor technique. The knee joint, lower back, neck, and Achilles tendon are the most frequently affected anatomic sites. Anterior knee pain, lower back and neck myofascial pain, iliotibial band friction syndrome, and Achilles tendonitis are the most common diagnoses. Initial treatment should always use rest, ice, compression, and elevation. Muscle strengthening and stretching as well as other physical modalities are helpful in the subacute setting. The need for surgery is rare. Improper bike fit contributes to the causation of a significant number of these conditions. Bike geometry may also be altered to alleviate symptoms.

American rural women's exercise self-efficacy and awareness of exercise benefits and safety during pregnancy

Though the positive link between physical activity and maternal health is well documented, physical activity declines during pregnancy and, internationally, rural mothers are less likely than urban mothers to engage in physical activity. Some evidence suggests that self-efficacy is related to sustained engagement in physical activity. The purpose of this study was to examine self-efficacy, perceived benefits, and knowledge of safe exercise among 88 rural pregnant women in a southeastern region of the United States. Exercise self-efficacy was significantly related to maternal age and gestation. Women over age 26 years, and those in the second and third trimesters, scored significantly higher than younger women or those in the first trimester. Fifty-two percent (n = 46) of participants perceived that activity would decrease energy levels, 37.5% (n = 33) did not know that exercise can decrease the risk of gestational diabetes, and 47.6% (n = 41) were unaware that a mother who is overweight is more likely to have an overweight child. Results confirm a need for education to improve women's knowledge about health benefits and safety information related to physical activity during pregnancy.

Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing

The advent of microprocessed "metabolic carts" and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses' reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.

Objectively measured physical activity in the 1993 Pelotas (Brazil) birth cohort

INTRODUCTION

Data on physical activity levels of adolescents are mostly derived from self-reported instruments, and the vast majority of studies using objective measures are from high-income countries. The aim of this study was to describe the patterns of objectively measured physical activity in Brazilian adolescents.

METHODS

In 2004-2005 (mean age of 13.3 yr), a subsample of the 1993 Pelotas (Brazil) Birth Cohort with data on all previous visits was approached. Physical activity was measured using the ActiGraph GT1M accelerometer (ActiGraph Corporation, Pensacola, FL). Demographic and other variables were assessed by self-report.

RESULTS

A total of 486 individuals (51% boys) provided valid data on objectively measured physical activity (response rate = 95.1%). The mean registered time of accelerometer data was 1191 min·d (SD = 112). The mean times (in minutes) spent in sedentary, light, moderate, and vigorous activities were 962 (SD = 114), 176 (SD = 46), 36 (SD = 16), and 17 (SD = 10) min·d, respectively. More than 30% of the adolescents accumulated ≥60 min·d of moderate-to-vigorous physical activity (MVPA). Physical activity intensity (counts per minute) and the prevalence of accumulation ≥60 min·d of MVPA were higher among boys and in those who walked or cycled to school. The prevalence of accumulation >60 min·d of MVPA was 125% higher in those from lower economic levels compared with higher economic levels (P < 0.001).

CONCLUSION

A large proportion of Brazilian adolescents of the 1993 Pelotas Birth Cohort do not achieve the current recommendation for health-related physical activity, and active commuting to school may be a target for interventions aimed at increasing physical activity. Physical activity levels are higher in lower socioeconomic groups than that in higher groups.

Factors Affecting Ankle Support Device Usage in Young Basketball Players

This cross-sectional study explores factors affecting the decision of basketball players to wear ankle support devices (ASDs). A questionnaire regarding attitudes towards ASD usage was developed based on the Health Belief Model (HBM). The questionnaire assessed HBM perceptions (susceptibility, severity, benefits, and barriers) and modifying factors (demographic, personal history of ankle injury, influence of coach to preventive action) that may affect an athlete's decision to wear ASDs. One hundred forty basketball players competing at the recreational, high school, or university levels completed the questionnaire, with the questionnaires being completed at the basketball gymnasium or at home. It was found that athletes whose coaches enforced ASD use were significantly more likely to wear them (OR: 35.71; 95% CI: 10.01, 127.36), as were athletes who perceived ankle injuries to be severe (OR: 2.77; 95% CI: 1.04, 7.37). Previous injury did not significantly increase the odds of using an ASD. The combined influence of coach enforcement and previous injury had the greatest effect on increasing ASD use. The largest barrier to ASD use was a lack of aesthetic appeal. Strategies aimed at increasing players' willingness to wear ankle protection should be emphasized among coaches and parents as this may increase use of ASDs.

Effect of an antipronation foot orthosis on ankle and subtalar kinematics

INTRODUCTION/PURPOSE

The aim of this study was to describe the effect of an antipronation foot orthosis on motion of the heel relative to the leg and explore the individual contributions of the ankle and subtalar joints to this effect.

METHODS

Five subjects were investigated using invasive intracortical pins to track the movement of the tibia, talus, and calcaneus during walking with and without a foot orthosis.

RESULTS

The antipronation foot orthosis produced small and unsystematic reductions in eversion and abduction of the heel relative to the leg at various times during stance. Changes in calcaneus-tibia motion were comparable with those described in the literature (1°-3°). Changes at both the ankle and subtalar joints contributed to this orthotic effect. However, the nature and scale of changes were highly variable between subjects. Peak angular position, range of motion, and angular velocity in frontal and transverse planes were affected to different degrees in different subjects. In some cases, changes occurred mainly at the ankle; in other cases, changes occurred mainly at the subtalar joint.

CONCLUSION

The changes in ankle and subtalar kinematics in response to the foot orthosis contradict existing orthotic paradigms that assume that changes occur only at the subtalar joint. The kinematic changes due to the orthosis are indicative of a strong interaction between the often common function of the ankle and subtalar joints.

Neuromuscular function, hormonal and redox status and muscle damage of professional soccer players after a high-level competitive match

The main aim was to analyse the impact of an official match on hormonal and redox status, muscle damage and inflammation and neuromuscular function. Seven high-level male soccer players from the same team performed an official match and data were collected 72 h before, 24, 48 and 72 h post-match. Plasma testosterone/cortisol ratio (T/C), creatine kinase (CK), superoxide dismutase (SOD), glutathione peroxidase (GPX) and reductase (GR) activities, myoglobin (Mb), C-reactive protein (CRP), uric acid (UA), protein sulfhydryls (-SH), malondialdehyde (MDA) concentrations and total antioxidant status (TAS) were measured. Sprint, jump and change of direction performance, and maximal isokinetic knee extension and flexion were obtained as neuromuscular functional parameters. Cortisol increased and T/C decreased until 48 h recovery (P < 0.05). Mb, CRP and -SH (P < 0.05) increased at 24 h and CK, TAS, SOD and MDA (P < 0.05) increased up to 48 h recovery. GR increased and GPX decreased at 24 h recovery (P < 0.05). Jump performance decreased 24 h post-match (P < 0.05), but no significant alterations in sprint, change of direction and muscle strength were observed. In conclusion, an official match resulted in changes in plasma biomarkers until 48 h of recovery period, without major impact on performance.

Assessing volume of accelerometry data for reliability in preschool children

PURPOSE

This study examines what volume of accelerometry data (h·d) is required to reliably estimate preschool children's physical activity and whether it is necessary to include weekday and weekend data.

METHODS

Accelerometry data from 493 to 799 (depending on wear time) preschool children from the Melbourne-based Healthy Active Preschool Years study were used. The percentage of wear time each child spent in total (light-vigorous) physical activity was the main outcome. Hourly increments of daily data were analyzed. t-tests, controlling for age and clustering by center of recruitment, assessed the differences between weekday and weekend physical activity. Intraclass correlation coefficients estimated reliability for an individual day. Spearman-Brown prophecy formula estimated the number of days required to reach reliability estimates of 0.7, 0.8, and 0.9.

RESULTS

The children spent a significantly greater percentage of time being physically active on weekend compared with weekdays regardless of the minimum number of hours included (t = 12.49-16.76, P < 0.001 for all). The number of days required to reach each of the predetermined reliability estimates increased as the number of hours of data per day decreased. For instance, 2.7-2.8 d of data were required to reach a reliability estimate of 0.7 with 10 or more hours of data per day; 3.3-3.4 d were required to meet the same reliability estimate for days with 7 h of data.

CONCLUSIONS

Future studies should ensure they include the minimum amount of data (hours per day and number of days) as identified in this study to meet at least a 0.7 reliability level and should report the level of reliability for their study. In addition to weekdays, at least one weekend day should be included in analyses to reliably estimate physical activity levels for preschool children.

The effects of exercise under hypoxia on cognitive function

Increasing evidence suggests that cognitive function improves during a single bout of moderate exercise. In contrast, exercise under hypoxia may compromise the availability of oxygen. Given that brain function and tissue integrity are dependent on a continuous and sufficient oxygen supply, exercise under hypoxia may impair cognitive function. However, it remains unclear how exercise under hypoxia affects cognitive function. The purpose of this study was to examine the effects of exercise under different levels of hypoxia on cognitive function. Twelve participants performed a cognitive task at rest and during exercise at various fractions of inspired oxygen (FIO₂: 0.209, 0.18, and 0.15). Exercise intensity corresponded to 60% of peak oxygen uptake under normoxia. The participants performed a Go/No-Go task requiring executive control. Cognitive function was evaluated using the speed of response (reaction time) and response accuracy. We monitored pulse oximetric saturation (SpO₂) and cerebral oxygenation to assess oxygen availability. SpO₂ and cerebral oxygenation progressively decreased during exercise as the FIO₂ level decreased. Nevertheless, the reaction time in the Go-trial significantly decreased during moderate exercise. Hypoxia did not affect reaction time. Neither exercise nor difference in FIO₂ level affected response accuracy. An additional experiment indicated that cognitive function was not altered without exercise. These results suggest that the improvement in cognitive function is attributable to exercise, and that hypoxia has no effects on cognitive function at least under the present experimental condition. Exercise-cognition interaction should be further investigated under various environmental and exercise conditions.

Differences in Selected Lifestyle Risk Factors for Cardiovascular Disease Between Sri Lankans in Oslo, Norway, and in Kandy, Sri Lanka

Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.

Plane of nutrition x tick burden interaction in cattle: effect on fecal composition

Effective tick management on grazing animals is facilitated by accurate noninvasive detection methods. Fecal analysis provides information about animal health and nutrition. Diet affects fecal composition; stress may do likewise. The constituents in feces that may be affected by tick burdens and in turn affect near-infrared spectra have not been reported. Our objective was to examine the interaction between plane of nutrition and tick burden on fecal composition in cattle. Angus cross steers (n = 28; 194 ± 3.0 kg) were assigned to 1 of 4 treatments (n = 7 per group) in a 2 × 2 factorial arrangement: moderate (14.0 ± 1.0% CP and 60 ± 1.5% TDN) vs. low (9.0 ± 1.0% CP and 58 ± 1.5% TDN) plane of nutrition and control (no tick) vs. tick treatment [infestation of 300 pair of adult Lone Star ticks (Amblyomma americanum) per treated animal]. Fecal samples were collected at approximately 0700 h on d -7, 0, 7, 10, 14, 17, and 21 relative to tick infestation. Fecal constituents measured were DM, OM, pH, Lactobacillus spp., Escherchia coli, acetate, propionate, butyrate, isobutyrate, valerate, isovalerate, IgA, and cortisol. Experimental day affected (P < 0.05) all constituents measured. Plane of nutrition affected (P < 0.05) DM, OM, VFA, and IgA. Tick treatment numerically (P = 0.13) reduced cortisol. A multivariate stepwise selection model containing cortisol and E. coli values on d 10 and d 14 accounted for 33% of the variation in daily adult female tick feeding counts across both planes of nutrition (P < 0.07). Within the moderate plane of nutrition, a model containing only cortisol on d 10 and d 14 described 59% of the variation in the number of feeding ticks (P < 0.02). Similarly, a model including cortisol, propionate, isovalerate, and DM at d 10 and d 14 d described 95% of the variation in total feeding ticks in the low plane of nutrition. Of the constituents measured, fecal cortisol offers the best possibility of noninvasively assessing stress by way of a single assay but the presence of ticks would still need to be confirmed visually. Although several constituents measured in this study should exist in sufficient quantity to directly affect near-infrared spectra, none stood out as a clear descriptor of prior observed differences in fecal spectra between tick-treated versus non-tick-treated animals. There were, however, groups of fecal constituents related to daily adult female tick feeding numbers (as a visual estimation of tick stress).

Physical activity, measures of obesity, and cardiometabolic risk: the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

The influence of higher physical activity on the relationship between adiposity and cardiometabolic risk is not completely understood.

METHODS

Between 2000-2002, data were collected on 6795 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Self-reported intentional physical activity in the lowest quartile (0-105 MET-minutes/week) was categorized as inactive and the upper three quartiles (123-37,260 MET-minutes/week) as active. Associations of body mass index (BMI) and waist circumference categories, stratified by physical activity status (inactive or active) with cardiometabolic risk factors (dyslipidemia, hypertension, upper quartile of homeostasis model assessment of insulin resistance [HOMA-IR] for population, and impaired fasting glucose or diabetes) were assessed using logistic regression analysis adjusting for age, gender, race/ethnicity, and current smoking.

RESULTS

Among obese participants, those who were physically active had reduced odds of insulin resistance (47% lower; P < .001) and impaired fasting glucose/diabetes (23% lower; P = .04). These associations were weaker for central obesity. However, among participants with a normal waist circumference, those who were inactive were 63% more likely to have insulin resistance (OR [95% CI] 1.63 [1.24-2.15]) compared with the active reference group.

CONCLUSIONS

Physical activity was inversely related to the cardiometabolic risk associated with obesity and central obesity.

Reliability of a new supination resistance measurement device and validation of the manual supination resistance test

BACKGROUND

Kinematic observations are inconsistent in predicting lower-extremity injury risk, and research suggests that kinetic variables may be more important in this regard. Before kinetics can be prospectively investigated, we need reliable ways of measuring them clinically. A measurement instrument was manufactured that closely mirrors a manual test used to clinically estimate supination resistance force. The reliability of the instrument and the validity of the clinical test were investigated.

METHODS

The left feet of 26 healthy individuals (17 men and 9 women; mean ± SD age, 25.9 ± 9.2 years; mean ± SD weight, 77.7 ± 13.3 kg) were assessed. Foot Posture Index (FPI-6), manual supination resistance, and machine supination resistance were measured. Intrarater and interrater reliability of all of the measurements were calculated. Correlations of the supination resistance measured by the device with FPI-6, the manual supination resistance test, and body weight were investigated.

RESULTS

Interrater reliability of all of the measurements was generally poor. The supination resistance machine correlated highly with the manual supination test for the rater experienced with its use. Supination resistance measurements correlated poorly with the FPI-6 and weakly with body weight.

CONCLUSIONS

The supination resistance machine was shown to have sufficient limits of agreement for the study, but improvements need to be made for more meaningful research going forward. In this study, the force required to supinate a foot was independent of its posture, and approximately 12% of it was explained by body weight. Further work is required with a much larger sample size to build regression models that sufficiently predict supination resistance force and that will be of clinical use. The manual supination test is a valid clinical test for clinicians experienced in its use.

Sodium nitrate supplementation does not enhance performance of endurance athletes

PURPOSE

Supplementation with inorganic nitrate has been suggested to be an ergogenic aid for athletes as nitric oxide donor. The purpose of this study was to determine whether ingestion of inorganic sodium nitrate benefits well-trained athletes performing a 40-min exercise test in laboratory conditions. In addition, we investigated the effect of this supplement on plasma levels of endothelin-1 (ET-1) and in nitrated proteins.

METHODS

Thirteen trained athletes participated in this randomized, double-blind, crossover study. They performed a 40-min cycle ergometer distance-trial test after two 3-d periods of dietary supplementation with sodium nitrate (10 mg·kg of body mass) or placebo.

RESULTS

Concentration of plasma nitrate (256 ± 35 μM) and nitrite (334 ± 86 nM) increased significantly (P < 0.05) after nitrate supplementation compared with placebo (nitrate: 44 ± 11 μM; nitrite: 187 ± 43 nM). In terms of exercise performance, there were no differences in either the mean distance (nitrate: 26.4 ± 1.1 km; placebo: 26.3 ± 1.2 km; P = 0.61) or mean power output (nitrate: 258 ± 28 W; placebo: 257 ± 28 W; P = 0.89) between treatments. Plasma ET-1 increased significantly (P < 0.05) just after exercise in nitrate (4.0 ± 0.8 pg·mL) and placebo (2.4 ± 0.4 pg·mL) conditions. This increase was significantly greater (P < 0.05) in the nitrate group. Levels of nitrated proteins did not differ between treatments (nitrate: preexercise, 91% ± 23%; postexercise, 81% ± 23%; placebo: preexercise, 95% ± 20%; postexercise, 99% ± 19%).

CONCLUSION

Sodium nitrate supplementation did not improve a 40-min distance-trial performance in endurance athletes. In addition, concentration of plasma ET-1 increased significantly after exercise after supplementation with sodium nitrate.

Vitamin D3 supplementation modulates inflammatory responses from the muscle damage induced by high-intensity exercise in SD rats

Vitamin D is an important factor for calcium and phosphorus homeostasis. A negative relationship has been observed between vitamin D status and diseases such as cancer, arthritis, diabetes, and muscle fiber atrophy. However, the relationship between vitamin D and prevention of skeletal muscle damage has not been clearly elucidated. The purpose of this study was to investigate the effects of vitamin D on exercise-induced muscle changes. Rats were divided into 3 groups: (1) sedentary control (C: n=10), (2) high-intensity exercise (HE: n=10), and (3) high-intensity exercise with vitamin D supplementation (HED: n=10; i.p. 1000 IU/kg body weight). Rats were trained for 30 min/day on treadmills (5 days/week for 8 weeks) with the running speed gradually increased up to 30 m/min at a 3° incline. At the end of the training period, the running speed was 38 m/min at a 5° incline. The high-intensity exercise significantly increased plasma creatine kinase (CK) and lactate dehydrogenase (LDH) activity. In addition, IL-6 and TNF-α levels as well as phosphorylation of AMPK, p38, ERK1/2, IKK, and IκB were significantly increased. Vitamin D-treated rats showed a significant decrease in plasma CK level, phosphorylation of AMPK, p38, ERK1/2, IKK, and IκB, and gene expression of IL-6 and TNF-α. Furthermore, the protein expression of vitamin D receptor (VDR) was highly increased in the muscles of HED-treated rats, respectively. Therefore, we concluded that vitamin D may play a pivotal role in exercise-induced muscle damage and inflammation through the modulation of MAPK and NF-κB involved with VDR.

Bone density, structure and strength, and their determinants in aging sprint athletes

PURPOSE

This study was undertaken to examine bone properties in masters sprinters of different ages and younger reference subjects. In addition, the association of sport-specific ground reaction force, muscle, training, and hormone characteristics with the bone parameters was evaluated in the athletes.

METHODS

Bone densitometric, structural, and strength parameters were assessed by peripheral quantitative computed tomography at the distal and midtibia in 83 male sprinters (40-85 yr) and 19 physically active referents (31-45 yr). Between-group differences were analyzed by ANCOVA with body mass and height as covariates.

RESULTS

Bone values were generally greater in athletes than referents, the greatest differences being in bending strength of the tibia shaft as estimated by maximum moment of inertia (Imax). Among athletes, trabecular volumetric bone mineral density of distal tibia was 12% (P < 0.05) lower in the oldest (≥70 yr) versus youngest group, whereas the total bone mineral content, total cross-sectional area, and compressive bone strength index did not differ between the groups. At midtibia, no age group differences were present in the total bone mineral content, total cross-sectional area, cortical wall thickness, cortical volumetric bone mineral density, polar mass distribution, minimum moment of inertia, or maximum moment of inertia. After controlling for age, body mass, and height, most loading-related characteristics, knee extensor muscle thickness, and hormone concentrations correlated with the bone parameters. Multivariate regression models explained 12%-67% (mean, 47.5%) of the variance of the bone parameters. Mechanical power in the eccentric phase of the hopping and body mass were consistently the strongest independent predictors in the models.

CONCLUSION

The results suggest that regular sprint training has positive (direction-specific) effects on bone strength and structure in middle- and older-aged athletes. Interindividual differences in bone traits seem to be due to combined effects of exercise loading, body size, and hormonal characteristics.

Contribution of central vs. peripheral factors to the force loss induced by passive stretch of the human plantar flexors

The purpose of the present research was to identify the contribution of central vs. peripheral factors to the force loss after passive muscle stretching. Thirteen men randomly performed both a 5-min constant-torque stretch of the plantar flexors on an isokinetic dynamometer and a resting condition on 2 separate days. The triceps surae electromyogram (EMG) was recorded simultaneously with plantar flexor isometric torque. Measures of central drive, including the EMG amplitude normalized to the muscle compound action potential amplitude (EMG/M), percent voluntary activation and first volitional wave amplitude, and measures of peripheral function, including the twitch peak torque, 20-to-80-Hz tetanic torque ratio and torque during 20-Hz stimulation preceded by a doublet, were taken before and immediately and 15 min after each condition. Peak torque (-15.7%), EMG/M (-8.2%), and both twitch (-9.4%) and 20-Hz peak torques (-11.5%) were reduced immediately after stretch but recovered by 15 min. There were strong correlations between the torque loss and the reductions in central drive parameters (r = 0.65-0.93). Torque recovery was also strongly correlated with the recovery in EMG/M and percent voluntary activation (r = 0.77-0.81). The moderate decreases in measures of peripheral function were not related to the torque loss or recovery. These results suggest that 1) central factors were strongly related to the torque reduction immediately after stretch and during torque recovery; and 2) the muscle's contractile capacity was moderately reduced, although these changes were not associated with the torque reduction, and changes in excitation-contraction coupling efficiency were not observed.

Overview of environmental and occupational vanadium exposure and associated health outcomes: an article based on a presentation at the 8th International Symposium on Vanadium Chemistry, Biological Chemistry, and Toxicology, Washington DC, August 15-18, 2012

Vanadium (V) has a variety of applications that make it suitable for use in ceramic production and decoration, production of pigments for a variety of products, an accelerator for drying paint, production of aniline black dye, and as a mordant in coloring textiles. Taking advantage of its hardness, resilience, ability to form alloys, and its resistance to corrosion, V is also used in the production of tools, steel, machinery, and surgical implants. V is employed in producing photographic developers, batteries, and semi-conductors, and in catalyst-based recycling processes. As technologies have evolved, the use of V has increased in jet aircraft and space technology, as well as in manufacture of ultraviolet filter glass to prevent radiation injury. Due to these myriad uses, the potential for occupational exposure to V is ever-evident. Similarly, there is an increased risk for environmental contamination by V agents themselves or as components of by-products released into the environment. For example, the use of V in sulfuric acid production results in the release of soot and/or fly ash rich in vanadium pentoxide. Petroleum refinery, smelting, welding, and cutting of V-rich steel alloy, the cleaning and repair of oil-fired boilers, and catalysis of chemical productions are other sources of increased airborne V-bearing particles in local/distant environments. Exposure of non-workers to V is an increasing health concern. Studies have demonstrated associations between exposure to airborne V-bearing particles (as part of air pollution) and increased risks of a variety of pathologies like hypertension, dysrhythmia, systemic inflammation, hyper-coagulation, cancers, and bronchial hyper-reactivity. This paper will provide a review of the history of V usage in occupational settings, documented exposure levels, environmental levels of V associated with pollution, epidemiologic data relating V exposure(s) to adverse health outcomes, and governmental responses to protect both workers and non-workers from exposure to this metal.

Exercise training in solid organ transplant recipients: a systematic review and meta-analysis

BACKGROUND

Exercise training is effective in improving the cardiovascular risk profiles of nontransplanted patients, but the health benefits and potential harms of routine exercise training after solid organ transplantation are unclear. This study aims to assess the health benefits and harms of supervised exercise training programs in solid organ recipients.

METHODS

We systematically reviewed all randomized controlled trials (RCTs) comparing the outcomes of exercise training programs in solid organ recipients against standard care. MEDLINE, EMBASE, the Transplant Library from the Centre for Evidence in Transplantation, and the Cochrane Central Register of Controlled Trials were searched to June 2012.

RESULTS

In total, 15 eligible RCTs involving 643 patients (9 cardiac transplants [n=250 patients], 2 kidney transplants [n=164 patients], 3 lung transplants [n=110 patients], and 1 liver transplant [n=119 patients]) were included. Cardiac transplant recipients who engaged in an exercise program after transplantation showed significant improvement in maximal oxygen uptake (standardized mean difference, 0.77; 95% confidence interval, 0.10-1.45) but no improvement in the overall serum lipid profile, blood pressure, and glycemic control compared with standard care. Among other solid organ transplant recipients, no significant improvements in exercise capacity or cardiovascular risk factors such as incidence of new-onset diabetes after transplantation were observed, but all effect estimates were very imprecise.

CONCLUSIONS

Exercise training is a promising but unproven intervention for improving the cardiovascular outcomes of solid organ transplant recipients. Existing trials are small, of relatively short duration, and focused on surrogate outcomes. Large-scale RCTs are urgently required if resources are to be directed toward exercise programs.

[Stress reactions in bones of the foot in sport: diagnosis, assessment and therapy]

Stress reactions and stress fractures are defined as structural damage to bone caused by repetitive stress or stereotypical loading. The balance between loading and unloading of bone is disrupted in stress reactions and stress fractures through the sport-specific demands and by the exogenous or endogenous risk factors present. In sports orthopedics the localization of stress reactions and stress fractures are subdivided into high risk fractures and low risk fractures. Conventional diagnostic radiology can initially be inconclusive. With symptoms persisting over 2 weeks further diagnostics using magnetic resonance imaging (MRI) should be performed. In the area of the foot stress reactions and stress fractures can often occur bilaterally or multifocally and most commonly affect the second metatarsals followed by the third metatarsals. Fractures of the fifth metatarsal, second metatarsal base, medial malleolus as well as navicular and sesamoid fractures are high risk fractures requiring special clinical and radiological monitoring. Basically, conservative treatment using the 2-phase model is the treatment of choice. In delayed union or severe pain surgical treatment is indicated.

Perceived benefits and barriers to leisure-time physical activity during pregnancy in previously inactive and active women

This study compared perceived benefits and barriers to leisure-time physical activity during pregnancy among women who were insufficiently active or inactive before pregnancy. Eighty-two pregnant women completed questionnaires assessing leisure-time physical activity benefits/barriers, exercise self-efficacy, social support, depressed mood, pre-pregnancy and current physical activity and fatigue. Multivariable regression analyses identified factors associated with exercise benefits/barriers for the two pre-pregnancy leisure-time physical activity groups. Both pre-pregnancy leisure-time physical activity groups reported more benefits than barriers to exercise during pregnancy. Previously inactive women reported fewer perceived benefits and greater perceived barriers to leisure-time physical activity during pregnancy. Higher self-efficacy for exercise during pregnancy was significantly associated with greater benefits of leisure-time physical activity during pregnancy for both groups. Less family support for exercise and lower self-efficacy for exercise were significantly related to greater leisure-time physical activity barriers during pregnancy for previously inactive women. Lower self-efficacy for exercise, higher depressed mood scores, and younger age were associated with greater leisure-time physical activity barriers for active women. Findings suggest that the intensities of perceived leisure-time physical activity benefits and barriers during pregnancy differ for women, depending on their pre-pregnancy leisure-time physical activity status. Consideration of pre-pregnancy leisure-time physical activity status may thus be important when tailoring strategies to overcome barriers to promote initiation and maintenance of physical activity during pregnancy.

Female upper body and breast skin temperature and thermal comfort following exercise

Breast support reduces breast pain and movement during exercise, however, an extra layer of clothing may affect thermoregulation. This preliminary study investigated female upper body and breast skin temperature and thermal comfort following short-duration exercise. Eight female participants with C-cup breasts had thermal images (infra-red camera, FLIR systems) of the bare breasts, the breasts in two sports bras (composite and polyester) and the abdomen, taken before and after 20 min of exercise at 28(o)C. Following exercise, bare-breast, bra and abdomen temperatures reduced by 0.61(o)C, 0.92(o)C and 2.06(o)C, respectively. The polyester sports bra demonstrated greater thermal comfort and enabled a greater change in skin temperature than the composite sports bra. It is concluded that following short-duration exercise, sports bras reduced the cooling ability of the breast. Material properties of the bras affect thermal comfort and post-exercise skin temperature; this should be an important consideration for sports bra manufacturers.

PRACTITIONER SUMMARY

This study investigates the effect of sports bras on thermal regulation of the breast following exercise. Sports bras negatively affected the cooling ability of the skin on the breast, with the material properties of the bra affecting thermal comfort following exercise. These results present important considerations for sports bra manufacturers.

Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations

Athletes frequently injure their hips and core muscles. Accurate diagnosis and proper treatment of groin pain in the athlete can be tricky, frequently posing vexing problem for trainers and physicians. Clinical presentations of the various hip problems overlap with respect to history and physical examination. This article reviews clinical presentations and magnetic resonance imaging findings specific to the various causes of groin pain in the athlete. The focus is on the core muscle injuries (athletic pubalgia or "sports hernia"). The goal is to raise awareness about the variety of injuries that occur and therapeutic options.

Surgical management of PCL injuries: indications, techniques, and outcomes

The ideal treatment for posterior cruciate ligament (PCL) injuries is controversial and remains an active area of orthopedic research. The indications for surgery and the ideal method of reconstruction continue to be evaluated in biomechanical and clinical studies. Recent research has provided information on the anatomy and biomechanics of the PCL, and the merits and drawbacks of the transtibial compared with the tibial inlay technique, the use of single vs double-bundle reconstruction, and different graft options for reconstruction. This review discusses important factors in the surgical treatment of PCL injuries, with attention to the most current literature on these topics.

Thickness and fit of mouthguards according to heating methods

The purpose of this study was to examine the difference in the thickness and fit of mouthguards made by four different heating methods of the mouthguard sheet material. A Sports Mouthguard(®) of 3.8-mm thickness was used in this study. Four heating methods were performed. In one method, the sheet was heated only one side. In the other methods, one side of the sheet was heated first until the center of the sheet was displaced by 0.5 cm, 1.0 cm, and 1.5 cm from the baseline, and then turned upside down and heated. The sheets were adapted using a vacuum former when the heated sheets hung 1.5 cm from the baseline. We measured the thickness and fit of the mouthguard at the areas of the central incisor and first molar. The difference in thickness at the central incisor and first molar regions was analyzed by two-way anova. The difference in fit with different heating methods was analyzed by one-way anova. The results showed that the thickness of the mouthguard differed in the central incisor and first molar areas (P < 0.01 or P < 0.05), but not with the heating methods. The fit of the mouthguard at the central incisor and first molar areas was significantly different among the heating methods (P < 0.01 and P < 0.05). These results suggested that the fit of the mouthguard was superior when the heated surface of the sheet contacted the surface of the working model. This finding may help to fabricate accurate mouthguards.

Ipsi- and contralateral H-reflexes and V-waves after unilateral chronic Achilles tendon vibration

Chronic Achilles tendon vibration has previously shown its effectiveness in improving plantar flexor's strength and activation capacities. The present study investigated the related neural mechanisms by analyzing H-reflexes and V-waves of the soleus (SOL) and gastrocnemii (GM gastrocnemius medialis; GL gastrocnemius lateralis) muscles under maximal isometric plantar flexion. Moreover, recordings were conducted bilaterally to address potential crossed effects. 11 subjects were engaged in this study. Maximal voluntary contraction and superimposed H-reflexes and V-waves were quantified in both legs at baseline (PRE) and 2 weeks later to verify repeatability of data (CON). Then, subjects were retested after 14 days of daily unilateral Achilles tendon vibration (VIB; 1 h per day; frequency: 50 Hz). No changes were reported between PRE and CON data. In the VIB condition, there was an increase in MVC for both the vibrated (+9.1 %; p = 0.016) and non-vibrated (+10.2 %; p = 0.009) legs. The H-reflex increased by a mean 25 % in the vibrated SOL (p < 0.001), while it remained unchanged for the contralateral side (p = 0.531). The SOL V-wave also increased in the vibrated limb (+43.3 %; p < 0.001), as well as in the non-vibrated one (+41.9 %; p = 0.006). Furthermore, the GM V-wave increased by 37.8 % (p = 0.081) in the vibrated side and by 39.4 % (p = 0.03) in the non-vibrated side. However, no changes were reported for the GL muscles. While the present study confirmed the strength gains induced by chronic Achilles tendon vibration, the results indicated a cross-education phenomenon with differences in neural adaptations between the vibrated leg and non-vibrated leg.

Update on the female athlete triad

Updated prevalence estimates of all 3 components of the Female Athlete Triad, a syndrome characterized by low energy availability, functional hypothalamic amenorrhea, and osteoporosis, is low (0 %-16 %), however, estimates of 1 or 2 concurrent components approach 50 %-60 % among certain athlete groups. Recent research identifies components of the Triad among female adolescent athletes, particularly those participating in leanness sports, such as endurance running. This is alarming, as adolescents require adequate nutrition and normal hormone function to optimize bone mineral gains during this critical developmental period. Current literature highlights new assessments, such as measurements of bone microarchitecture and hormone levels to better evaluate bone strength and the hormonal and metabolic profile of athletes with and at risk for the Triad. Recent data also provides support for additional potential consequences of the Triad, such as endothelial dysfunction and related cardiovascular effects, stress fractures, and musculoskeletal injuries. Additional prospective research is needed to evaluate long-term indicators and consequences of the Triad and identify effective behavioral treatment strategies.

Knee osteoarthritis in women

Osteoarthritis is a disease that progresses over time and culminates in the destruction of articular cartilage and joints. Thus, with an increasing elderly population the treatment of knee osteoarthritis has become a major healthcare issue. It has been shown that women are more severely impacted by knee osteoarthritis. Differences in knee anatomy, kinematics, previous knee injury, and hormonal influences may play a role. Sex difference with respect to osteoarthritis presentation, treatment, and the allocation of resources also exists. In general, women present for treatment in more advanced stages of osteoarthritis and have more debilitating pain than their male counterparts. In addition, healthcare providers are more likely to recommend total joint arthroplasty for their male patients. Understanding how and why these gender differences occur is instrumental in formulating an inclusive strategy for combating osteoarthritis in the future.