The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women

Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review

OBJECTIVE

Our goal was to explore the range and characteristics of published papers on therapeutic walking programs for menopausal women and to identify program features that resulted in successful outcomes including reduced symptoms and improved long-term wellness.

METHODS

We searched biomedical and exercise-related databases for articles published up to June 1, 2017, using keywords related to menopause and walking. Data were collected into EndNote X8 reference manager to identify and remove duplicates. The final selection included all articles that studied walking as a health intervention for women in menopause transition or postmenopausal.

RESULTS

A total of 3,244 papers were collected from the six databases. After removing duplicates and applying inclusion and exclusion criteria, 96 articles were charted, including 77 different walking programs. Walking interventions ranged from 4 weeks to 3 years with an average weekly frequency of 3.8 ± 1.8 and were applied to a variety of symptoms and their biological markers and risk factors. Overall, 91% of the programs showed a beneficial outcome in at least one menopause-related medical issue. Information on menopause-specific symptoms, especially vasomotor symptoms and sleep problems, was scarce.

CONCLUSION

The scoping review highlights the growing interest in walking programs as therapies for menopause and related symptoms and provides evidence of their possible benefit as a wellness option for women in menopause and beyond. Further research would be recommended to establish the therapeutic value of walking programs for women with specific focus on typical menopause symptoms at different stages of menopause. : Video Summary:http://links.lww.com/MENO/A587.

The Relationship between Convenience of Destinations and Walking Levels in Older Women

Purpose.

To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood “walkability” rating.

Design.

Cross-sectional analysis of data obtained in 1999.

Setting.

Community in southwest Pennsylvania.

Subjects.

Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%.

Measures.

Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer.

Results.

Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings ( p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire ( p < .01). There was also a positive trend between participants' neighborhood “walkability” rating and activity levels measured by pedometer and questionnaire ( p < .01).

Conclusion.

These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.

Role of exercise and nutrition in menopause

Menopause and the aging process itself cause many physiologic changes, which explain the increased prevalence of chronic diseases observed in postmenopausal women. Exercise and nutrition play important roles in the prevention and treatment of cardiovascular disease, cancer, obesity, diabetes, osteoporosis, and depression.

Relationships among body composition measures in community-dwelling older women

OBJECTIVE

To examine whether simple anthropometric measures provide a good estimate of total and visceral fat in 146 community-dwelling, older white women (mean age, 74.0 +/- 4.1 years).

RESEARCH METHODS AND PROCEDURES

Total body fat and visceral fat were measured using electron beam computed tomography (EBT). Anthropometric parameters (height, weight, BMI, sagittal diameter, and waist circumference) were measured using standard techniques. Total percentage body fat was assessed using DXA. Spearman correlations were used to examine the association between the measures. Linear regression, controlling for age, was used to examine the associations between the anthropometric parameters and total and visceral body fat measured by EBT.

RESULTS

Correlations among body composition measures ranged from rho = 0.46 to 0.93 (p < 0.0001). EBT total fat was strongly correlated with both DXA estimates of total percentage fat (rho = 0.86) and BMI (rho = 0.89). Separate linear regression models indicated that BMI, waist circumference, sagittal diameter, and DXA total percentage fat were each independently related to EBT total fat. BMI had the strongest linear relationship, explaining 80% of the model variance (p < 0.0001). Linear regression indicated that BMI, waist circumference, and sagittal diameter were each independently related to EBT visceral fat, with BMI and sagittal diameter explaining approximately 53% of the model variance (p < 0.0001).

DISCUSSION

The use of simple anthropometric measures such as BMI, sagittal diameter, and waist circumference may be an appropriate alternative for more expensive techniques when assessing total fat but should be used with caution when estimating visceral body fat.

Effects of walking-only interventions on bone mineral density at various skeletal sites: a meta-analysis

BACKGROUND AND PURPOSE

Osteoporosis, a common disease in postmenopausal women and the elderly, is associated with decreases in bone mineral density (BMD) and fractures. As weight-bearing activity such as walking has the potential to maintain or increase BMD, I sought in this meta-analysis to mathematically consolidate research on the effects of walking interventions on BMD.

METHODS

A literature search for studies examining the effect of walking on BMD in postmenopausal women and men and women aged 50 years and older was conducted. Search strategies included online literature searches, hand-searches of journals, and examination of the reference lists of articles selected for inclusion. Effect sizes were calculated for each article selected for inclusion and a meta-analysis was conducted for these articles.

RESULTS

Ten articles met the inclusion criteria for the meta-analysis. Walking had a significant (P < or = .03) positive effect (.32) on lumbar BMD but not on the femur or the calcaneus.

DISCUSSION AND CONCLUSION

The results of this meta-analysis do not suggest that walking interventions alone will limit demineralization at all skeletal sites. Perhaps other forms of exercise in addition to walking should be incorporated into training regimens for patients at risk for osteoporosis.

Alternative therapies for osteoporosis

A variety of common complementary and alternative medicine therapies are now being examined for effectiveness in the management of osteoporosis. Short-term studies in postmenopausal women show beneficial effects of soy isoflavone supplementation on bone density, but its long-term effects require clarification. Prospective controlled trials have shown that physical training can increase bone density to varying degrees. Other therapies that have been examined include herbal formulae, essential fatty acids and vitamins A, C, and K, but few data regarding their effectiveness, mechanisms and safety have been published. Further randomized controlled trials are needed.

Physical activity and decreased risk of clinical gallstone disease among post-menopausal women

BACKGROUND

Physical activity may play a role in preventing gallstone disease.

METHODS

The activity/gallstone relationship was examined in post-menopausal women from the Study of Osteoporotic Fractures (SOF; 1986-1988), a prospective study of fracture risk factors in 8010 women (mean age = 71.1 years, SD = 4.9).

RESULTS

Multivariate logistic regression indicated women in the lowest two quartiles of physical activity, according to questionnaire, had a 59% {OR = 1.59 (1.11-2.29), P = 0.02} and a 57% higher risk {OR = 1.57 (1.11-2.23), P = 0.01} of developing gallstone disease compared to women in the highest quartile of activity (PTrend = <0.0001). Additionally, this relationship was examined in a cohort of 182 post-menopausal women (mean age 74.2 years, SD = 4.1) who participated in a randomized controlled trial of a walking intervention. Women in the randomized clinical trial in the lowest tertile of physical activity determined by a physical activity monitor had a higher risk of developing gallstone disease than women in the highest tertile of physical activity, 13% {OR-1.13 (1.01-1.28), P = 0.05, PTrend = <0.04}.

CONCLUSION

Physical activity appears to be inversely related to the development of gallstone disease in post-menopausal women independent of body mass index.

Validity of a Questionnaire to Assess Historical Physical Activity in Older Women

PURPOSE

To compare historical physical activity recall to original physical activity questionnaires collected at four time points over a 17-yr period in postmenopausal women.

METHODS

This study examined the recall of physical activity (PA) data collected as part of a clinical trial of a walking intervention and subsequent follow-up in 163 white postmenopausal women (74 +/- 4 yr). Physical activity levels were measured with a modified version of the Paffenbarger Physical Activity Questionnaire (1982, 1985, 1995, 1999) throughout the duration of the study. The interviewer-administered historical physical activity questionnaire (HPAQ) asked participants to recall in the year 2000 what PA they performed in 1982, 1985, 1995, and over the past year. Spearman correlation coefficients were used to compare subjects' historical recall of activity for each time period with the actual questionnaire data collected during that time period.

RESULTS

Statistically significant correlations were found between the historical PA recall and the original PA questionnaires at each of the time points measured (rho = 0.39-0.62, P < 0.0001). The magnitude of the correlations increased as the time length of recall decreased.

CONCLUSION

It appears that historical recall of leisure physical activity can be reasonably estimated by questionnaire over a substantial time period in older women.

The relationship among physical activity, obesity, and physical function in community-dwelling older women

BACKGROUND

The relationship between obesity and physical function is not well understood. Physical activity may be a key factor impacting on the relationship between obesity and physical function.

METHODS

Subjects included 171 community-dwelling women (mean age = 74.3, SD = 4.3) participating in a 14-year follow-up study to a walking intervention trial. Measures of obesity [body mass index (BMI)] and physical activity (Modified Paffenbarger Questionnaire) were collected in 1982, 1985, 1995, and 1999. Physical function was assessed in 1999 using the Functional Status Questionnaire (FSQ) and gait speed.

RESULTS

Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999. However, hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995, and not obesity from 1982 to 1995, was an independent predictor of physical function (FSQ: adjusted R2 = 0.09, F = 4.68, P < 0.001; gait speed: adjusted R2 = 18.0, F = 9.41, P < 0.0001.

CONCLUSION

Physical activity appears to be as important if not more important than body weight in predicting future physical function.

Identifying Early Decline of Physical Function in Community-Dwelling Older Women: Performance-Based and Self-Report Measures

Background and Purpose. The ability to identify early decline in physical function is important, but older people experiencing decline may fail to report the early changes in physical function. The purpose of this study was to compare the descriptions of physical function in community-dwelling older women obtained using performance-based and self-report measures. Subjects and Methods. One hundred seventy community-dwelling women with a mean age of 74.3 years (SD=4.3, range=56.6–83.6) completed the activities of daily living (ADL), instrumental activities of daily living (IADL), and social activity (SA) sections of the Functional Status Questionnaire (FSQ). They also completed performance-based measures of gait speed and the 7-item Physical Performance Test (PPT). Results. The majority of the women scored at the ceiling for the self-report measures of function (ADL=77%, IADL=61%, SA=94%), whereas only 7% scored at the ceiling for the PPT and 30% scored at the ceiling for gait speed (defined as &gt;1.2 m/s). For 2 items of the FSQ, sensitivity was low (8% and 9%) and specificity was high (97% and 98%) compared with performance on the PPT. Discussion and Conclusion. In this sample of community-dwelling older women, performance-based measures identified more limitations in physical function than did self-report measures.

A new approach of measuring muscle impairment during a functional task: quadriceps muscle activity recorded during chair stand

BACKGROUND

Biologic changes are expected to occur prior to disability. Compared with physical disability measures, measures of muscle impairment may be an earlier indicator of functional decline. The purpose of this study was to describe a new approach of measuring muscle impairment during a functional task.

METHODS

Right quadriceps muscle activity was recorded using surface electromyography (sEMG) from 160 older women (age 73.9 +/- 3.9 years, mean +/- SD). Specific patterns of muscle activity during the chair stand task were determined using an exploratory principal components factor analysis (PCFA). Muscle activity parameters were validated by comparison to the Physical Performance Test, gait speed, and the Functional Status Questionnaire.

RESULTS

The PCFA indicated two factors (magnitude and timing) that represented important components of quadriceps muscle activity during chair stand, explaining 68.6% of the variance in performance. The slope of the rise of muscle activity represents a combination of the magnitude and timing components of muscle activity. Compared with women with a slope <1, women with a slope > or = 1 walked faster (1.17 m/s vs 1.09 m/s; p = .02) and reported less difficulty with activities of daily living (ADL) (98.6 vs 95.8; p = .003) and instrumental ADL (97.3 vs 92.2; p = .001).

CONCLUSIONS

Quadriceps muscle activity recorded during chair stand is a valid and reliable measure of muscle performance during a functional task. As a biologic measure of muscle activation, sEMG may identify muscle impairment, which could indicate functional decline earlier than measures of functional status.

Moderate physical activity is associated with higher bone mineral density in postmenopausal women

OBJECTIVES

To determine the associations between different levels of habitual physical activity, hormone replacement therapy (HRT), and bone mineral density (BMD) in postmenopausal women.

DESIGN

Cross-sectional.

SETTING

Academic medical center.

PARTICIPANTS

Twenty sedentary women, 20 active nonathletic women, and 23 endurance-trained athletes, all of whom were postmenopausal, with half of each group on and half not on HRT.

MEASUREMENTS

BMD and body composition determined by dual energy x-ray absorptiometry, maximal oxygen consumption (VO2max), dietary history by questionnaire, and vitamin D receptor (VDR) genotyping on deoxyribonucleic acid.

RESULTS

Body weight was higher in the active nonathletic than in the sedentary and athletic women. Body fat was lower and VO2max higher in the athletic women than in the sedentary and the active nonathletic women. Physical activity level was significantly associated with BMD in three of the five measurements taken (L1-L4 lumbar spine, trochanter, total body; all P < .05). These differences were also generally significant after adjusting for body weight. The association between physical activity status and BMD at the neck of the femur and Ward's triangle bordered on significance (P = .07-.09). At most sites, the active nonathletic women had higher BMD than did the sedentary and athletic women. HRT was significantly associated only with total body BMD (P < .05). The groups were similar in terms of dietary habits (protein, calcium, sodium, phosphorus intake); VDR genotypes; and family, smoking, and nutritional histories.

CONCLUSION

Given the similarity of the groups with respect to other factors that affect BMD, it appears that prolonged low-to-moderate-intensity physical activity, but not the same number of years of higher-intensity training for competitive events, was independently associated with higher BMD.

Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index

Dietary calcium intake and physical activity are considered practical measures for prevention of osteoporosis. However, their associations with bone mineral density (BMD) in the elderly are not clear. The present study examined the association between osteoporosis and these two factors in relation to body mass index (BMI) in a cross-sectional, epidemiological study involving 1075 women and 690 men, aged 69 +/- 6.7 years (mean +/- SD). Dietary calcium intake (median of 580 mg/day) was inversely related to age (p = 0.01), positively related to physical activity index (PAI) (p = 0.01), femoral neck BMD (p = 0.01) in women, and higher lumbar spine (p = 0.003) and femoral neck BMD (p = 0.03) in men. Quadriceps strength was negatively associated with age (p < 0.0001) and positively related to BMI (p < 0.0001) and BMD (p < 0.0001) in both men and women. The PAI was associated with quadriceps strength (p < 0.0001) and femoral neck and lumbar spine BMD in women (p < 0.001) and with femoral neck BMD in men (p = 0.04); however, these associations were not significant after adjusting for age, BMI, quadriceps strength, and dietary calcium. Women in the top tertile of quadriceps strength (> or =23 kg) and dietary calcium intake (> or =710 mg/day) had 15% higher BMD than those in the lowest tertiles (< or =15 kg and < or =465 mg/day); the difference was comparable in men (11%). Among subjects with the lowest tertiles of BMI (< or =23 kg/m2 for women and < or =24 kg/m2 for men), quadriceps strength (< or =15 kg for women and < or =28 kg for men), and dietary calcium intake (< or =465 mg/day), 64% and 40% of women and men, respectively, were classified as having osteoporosis (based on a 2.5-SD reduction from the young-normal mean). The prevalence was only 12% in women and 1.5% in men among those in the highest tertiles of the three factors. Adequate dietary calcium intake and maintaining a physically active lifestyle in late decades of life could potentially translate into a reduction in the risk of osteoporosis and hence improve the quality and perhaps quantity of life in the elderly population.

Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis

BACKGROUND

The effects of aerobic exercise on bone density at the hip in postmenopausal women in the absence of estrogen replacement therapy are not currently known. The purpose of this study was to examine the effects of aerobic exercise on bone density at the hip in postmenopausal women.

METHODS

Using the meta-analytic approach, studies dealing with the effects of aerobic exercise on bone density at the hip in postmenopausal women were searched for using computerized literature searches (MEDLINE, January 1978 to December 1995) as well as cross-referencing from retrieved review articles and original investigations.

RESULTS

A total of 18 effect sizes were derived from six studies. Using a fixed-effects model and bootstrap resampling (5,000 iterations) overall changes in bone density at the hip yielded an average effect size of 0.43 (95% CI = 0.04 to 0.81), equivalent to an overall change of approximately 2.42% (exercise = 2.13%; nonexercise = -0.29%). Statistically significant differences were observed when effect sizes were partitioned by country in which studies were conducted (United States, mean = 1.03, 95% CI = 0.48 to 1.68; other countries, mean = 0.18, 95% CI = -0.27 to 0.54; Qb = 5.44, P = 0.04) and calcium intake (> or =1,000 mg/day, mean = 0.83, 95% CI = 0.49 to 1.23; <1,000 mg/day = -0.23, 95% CI = -0.85 to 0.21; Qb = 10.64, P = 0.002).

CONCLUSIONS

The overall results of this study suggest that site-specific aerobic exercise has a moderately positive effect on bone density at the hip in postmenopausal women. However, a need exists for additional, well-designed studies before a final recommendation can be made regarding the efficacy of aerobic exercise as a nonpharmacologic intervention for optimizing bone density at the hip in postmenopausal women.

Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study

The present study examined the effects of physical activity, weight, and weight change on femoral bone loss in relation to age in elderly women. Baseline and follow-up measurements at an average interval of 2.7 years of femoral neck bone mineral density (BMD) were reanalyzed for 827 women who were part of the Dubbo Osteoporosis Epidemiology Study. Physical activity was assessed based on hours per day spent in each of various activities according to its expected oxygen consumption. The rate of loss of BMD progressively increased with age, i.e., -0.6+/-0.1, -1.1+/-0.2, and -2.1+/-0.6% per year (mean +/- SEM) for the 60-69, 70-79, and > or = 80 age groups, respectively (p < 0.001). After adjustment for age, physically inactive women lost more (-1.4+/-0.2% per year; p < 0.001), compared with physically active women (-0.5+/-0.3% per year, p = 0.15). Thinner women experienced more rapid bone loss, and women whose weight decreased (> or =5%) over the study period lost more bone (-1.7+/-0.4% per year) than those whose weight was stable (-0.8+/-0.1% per year) or increased (+0.1+/-0.3% per year, p < 0.01, analysis of variance). Furthermore, women whose BMD was high (>0.81 g/cm2) at baseline experienced greater loss (-1.1+/-0.2%) compared with those in the middle tertile (1.0+/-0.2%) or lowest tertile (-0.5+/-0.3%). Independent predictors of rate of bone loss included age, baseline BMD, weight, weight change, and physical activity; collectively these factors accounted for 13% of total variance of bone loss by multiple regression analysis. It is concluded that a physically active lifestyle and stable weight in the later decades of life may retard proximal femur bone loss and thus contribute to reduction of fracture risk.

Effect of physical training on bone mineral density in prepubertal girls: a comparative study between impact-loading and non-impact-loading sports

Physical activity is known to have an anabolic effect on bone tissue. It has been shown to increase the bone mineral density (BMD) in young adults, as well as in teenagers. But there is little information about the effect of intensive physical activity in childhood, particularly at the prepubertal stage. To examine the influence of an early intensive physical training on BMD, we have studied a group of elite prepubertal girls, at the starting phase of their peak bone mass acquisition. Subjects were engaged either in sport requiring significant impact loading on the skeleton, or in sport without impact loading. Forty-one healthy prepubertal girls took part in this study. The sport group consisted of 10 swimmers (10.5 +/- 1.4 years old) and 18 gymnasts (10.4 +/- 1.3 years old), who had performed 3 years of high-level sport training (8-12 h per week for swimmers, 10-15 h per week for gymnasts). Thirteen girls (10.7 +/- 1 years old) doing less than 3 h per week of physical activity served as a control group. BMD measurements were done using dual-energy X-ray absorptiometry. There was no statistical significant difference between groups as regards age, body height and weight, and body composition. There was no statistical significant difference between swimmers and controls for all the BMD measurements. Mean BMD in gymnasts was statistically higher than in the control group for mid-radius (+15.5%, p < 0.001), distal radius (+33%, p < 0.001), L2-4 vertebrae (+11%, p < 0.05), femoral neck (+15%, p < 0.001) and Ward's triangle (+15%, p < 0.01). Moreover, in gymnasts, BMD at radius, trochanter and femoral neck was above normative values. We conclude that physical activity in childhood could be an important factor in bone mineral acquisition in prepubertal girls, but only if the sport can induce bone strains during a long-term program: gymnastics has such characteristics, unlike swimming. Such acquisition could provide protection against risks of osteoporosis in later life, but this remains debatable.

What is the optimal type of physical activity to enhance health?

This review examines the potential of active daily living as a means of gaining the cardiovascular and health rewards previously sought through vigorous aerobic fitness programmes. Cross-sectional studies of occupational and leisure activity show encouraging associations between such activity and good health; in workers, the gross intensity of effort needed for health benefits has seemed to be 20 kJ/min. There has been less unanimity on the threshold intensity needed in leisure activities, but various recent "position statements" have decreased the recommendation to 50% of an individual's maximal oxygen intake, sustained for one hour three to five times per week. Life-style activities such as walking seem likely to reach this intensity in older individuals, but are unlikely to do so in young adults. A growing number of controlled longitudinal studies of walking programmes have demonstrated gains in aerobic fitness, modest reductions in blood pressure, improvements in lipid profile, increased bone density, and enhanced mood state, with less consistent reductions of body fat. However, gains have been greatest in the elderly, sedentary, and obese populations. The main component of active living, fast walking, seems likely to enhance health in such populations, but it is unlikely to be effective in young adults who are in good initial health.

A weight-bearing, water-based exercise program for osteopenic women: its impact on bone, functional fitness, and well-being

OBJECTIVE

To evaluate the effects of a weight-bearing, water-based, exercise program designed for women with low bone mass.

DESIGN

A test-retest cross-sectional, prospective study.

SETTING

Community-dwelling women from a Canadian city.

PARTICIPANTS

Seventy-seven postmenopausal women, 50 to 70 years of age, with spinal or femoral bone density below the fracture threshold.

INTERVENTION

Subjects exercised in a pool with waist-high water for 60 minutes, 3 days a week, over a 12-month period. Forty minutes of each session were devoted to successive jumps and muscular exercises designed to promote bone accretion, strength, and endurance.

MAIN OUTCOME MEASURES

Spinal and femoral bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, functional fitness (flexibility, coordination, agility, strength/endurance, and cardiorespiratory endurance) assessed with the American Alliance for Health, Physical Education, Recreation and Dance battery, and psychological states evaluated with Dupuy's General Well-Being Schedule.

RESULTS

Spinal BMD decreased significantly (p < .001), whereas there was no change in femoral neck BMD (p = .90). Four of the parameters chosen to assess functional fitness, namely, flexibility, agility, strength/endurance, and cardiorespiratory endurance, were affected positively by the exercise program (all p values < .001). Psychological well-being also improved significantly after participation in the exercise program (p < .001).

CONCLUSION

The intervention was successful in improving the functional fitness and psychological well-being of the participants, despite a lack of effect on the skeletal system. Future studies are needed to identify water exercises that are safe yet exert enough stress on the bones to initiate a bone response.

Factors influencing an ultrasound-estimated bone mass in postmenopausal women

OBJECTIVE

There are various methods for determining bone-mineral density for diagnosing osteoporosis. The most accurate method among them is dual-energy X-ray absorptiometry (DEXA), and the simplest one utilizes an ultrasound bone densitometer. We investigated factors influencing the correlation between bone-density values determined by dual-energy X-ray absorptiometry and by the use of an ultrasound bone densitometer.

METHODS

Sixty-seven postmenopausal Japanese women aged from 31 to 68 years old were enrolled in the study. Bone-mineral densities (BMDs) of the lumbar spine (L2-4) measured by DEXA and broadband ultrasound attenuation (BUA) of the right os calcaneus measured by an ultrasound bone densitometer were subjected to statistical analysis.

RESULTS

Multivariate analysis indicated that the patient's exercise history was useful-following the number of years since menopause and body weight-for determining lumbar spine bone-mineral density. The influence of hormone replacement therapy (HRT) on bone mass in postmenopausal women is also considered to be marked, but the results of the present multivariate analysis showed almost no influence on BUA or the L2-4 BMD.

CONCLUSIONS

The patient's exercise history should be taken into consideration when lumbar spine bone-mineral density is estimated using an ultrasound bone densitometer instead of DEXA.

Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women

A meta-analysis was done to measure the effect of physical activity on the bone mass of healthy postmenopausal women. All studies published between 1966 and 1996, in French or English, were reviewed for inclusion from Medline search, bibliographies of relevant studies, review articles and books. Studies had to be prospective intervention trials, randomized or not, evaluating the effectiveness of an exercise program of any duration, frequency and intensity, with a control group. Studies had to measure bone parameters and involve healthy postmenopausal women over 50 years of age who were free of symptomatic osteoporosis at the time of study entry. Effect sizes (ES) were calculated for each bone parameter and site measured in every eligible study according to Hedges and Olkin. DerSimonian and Laird's model was used to estimate overall effect sizes when combining studies. All analyses were bone parameter and site specific. Of 217 papers extracted from the literature, 187 did not meet eligibility criteria and 12 others were rejected. The two main reasons for rejection were that both genders were combined in the analyses and no exercise group without drug interaction was present. Eighteen studies were included for meta-analysis. Taking into account the frequency, duration, compliance rate and average age of the subjects, the programs were judged of moderate intensity and focused on walking, running, physical conditioning and aerobics. A significant effect of physical activity was detected on the bone mineral density at the L2-4 level of the lumbar column in studies published after 1991 (ES = 0.8745, p < 0.05). No effect could be seen, however, on forearm and femoral bone mass. Although applied to a small number of studies, this meta-analysis suggests that exercise programs in a population of postmenopausal women over 50 years of age are effective for preventing spinal bone mineral density loss at the L2-4 level. However, such programs do not have any effect on the forearm or femoral bone mass.

Effects of moderate endurance exercise on calcium, parathyroid hormone, and markers of bone metabolism in young women

We investigated the short-term (1 hour-3 days) effects of a 45 minute run on calcium, parathyroid hormone, the carboxyterminal propeptide of type I procollagen (PICP), and the immunoactive carboxyterminal telopeptide of type I collagen in serum (ICTP) in young females. Fourteen healthy young women, aged 25.2 +/- 0.6 years (mean +/- SEM) with regular menstruations, participated. The test was outdoor jogging for 45 minutes at an intensity of 50% of VO2 max. Blood samples were collected 15 minutes before the test and 1, 24, and 72 hours after the test. The measured values were adjusted for changes in plasma volume. A significant decrease of ionized calcium was observed at 1 hour (P < 0.001) and 72 hours (P < 0.05) and a significant increase of parathyroid hormone (PTH) was noted 24 (P < 0.01) and 72 hours (P < 0.05) after the test. A significant decrease of PICP at 1 hour (P < 0.05) was followed by an increase after 24 (P < 0.01) and 72 hours (P < 0.001) and a significant increase in ICTP was noted at 24 and 72 hours (P < 0.05). A strong positive correlation was found between serum levels of PICP and ICTP (r = 0. 55-0.84; P < 0.05) throughout the experiment. In conclusion, young females showed biochemical signs of increased bone collagen turnover and altered homeostasis of calcium and PTH after a single bout of moderate endurance exercise.

Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density

Results of trials on the effects of physical activity on bone mineral density (BMD) are conflicting. The current hypothesis was that calcium intake modifies the bone response to physical activity. Published trials on physical activity and bone density were reviewed, and the results of 17 trials are summarized. Physical activity has beneficial effects on BMD at high calcium intakes, with no effect at mean calcium intakes less than a mean of 1000 mg/day. The modifying effect of calcium intake on BMD among exercise groups is more pronounced in the lumbar spine than in the radius. This analysis may explain conflicting results of trials on physical activity and calcium effects on bone. Controlled trials designed to test adequately this hypothesis are needed.

[Physical exercise and the skeleton]

The skeleton provides more than only a framework for the body. Bone is a calcified conjunctive tissue sensitive to various mechanical stimuli, mainly to those resulting from gravity and muscular contractions. Numerous animal and human studies demonstrate the importance of weight-bearing physical activity as well as mechanical loading for maintaining skeletal integrity. Lack of weight-bearing activity is dangerous for the skeleton: a decrease in bone mineral density (BMD) has been demonstrated in animals and humans under conditions of weightlessness or immobilization. Other studies have also reported a lower vertebral BMD among young amenorrheic athletes than among athletes with regular cycles and/or non athletes. The main factor responsible for this lower BMD in the amenorrheic athletes is the persistent low level of endogenous estrogen observed among these women. However this does not represent a premature and irreversible loss of bone mass since the resumption of menses following a decrease in training is the primary factor for a significant increase in vertebral BMD in these formerly amenorrheic athletes. A weight-bearing exercise is likely to be more beneficial at weight-bearing than at non weight-bearing sites, and hypogonadism resulting from very intensive training and exercise is more detrimental to trabecular than cortical bone. Bone deficit at non weight-bearing sites may be attenuated by maintenance of body weight. Nevertheless the etiology of "stress fractures" among athletes remains poorly understood, and the exact relationship between soft tissue mass and BMD is not clear. Osteoporosis, the most common bone disorder in France, is a pathological condition associated with increased loss of bone mass, resulting in a greater risk of fracture. Although symptoms of osteoporosis do not generally occur until after menopause, recent evidence suggests that bone loss starts much earlier in life. Therefore osteoporosis might be prevented by increasing peak bone mass and/or by slowering bone loss after menopause. Exercise such as resistance training or weight-bearing activities like running or walking have an osteogenic effect on increasing BMD in young people, and the decrease in BMD is slower in exercised than in non-exercised post-menopausal women. Nevertheless the influence of the length and of the intensity of such physical activities remain to be determined.

Body composition and bone mineral density in premenopausal and early perimenopausal women

Body composition appears to be an important determinant of bone mineral density (BMD). BMD at the femoral neck, lumbar spine, and whole-body and the whole-body soft-tissue composition were measured cross-sectionally in 334 healthy premenopausal and early perimenopausal women, aged 44-50 years, using a Hologic QDR densitometer. Correlations between lean mass and BMD at the hip, spine, and whole-body were greater (r = 0.40, r = 0.44, and r = 0.45, respectively, p < 0.0001) than those for fat mass (r = 0.19, r = 0.16, and r = 0.16, respectively, p < 0.01). There was a significant linear trend in femoral BMD from the lowest to highest category of lean mass (0.75 +/- 0.10 g/cm2, 0.80 +/- 0.10 g/cm2, and 0.86 +/- 0.09 g/cm2, p < 0.0001). Similar trends were demonstrated for spinal and whole-body density. For categories of fat mass, there was a significant linear trend at the hip (0.78 +/- 0.10 g/cm2, 0.79 +/- 0.10 g/cm2, and 0.83 +/- 0.10 g/cm2, p = 0.0106), but not at the spine or whole body. There was a 5.00% (3.62, 6.38; 95% confidence limits) difference in hip BMD per unit (standard deviation) of lean mass, while only a 0.73% (-0.66, 2.11) difference in hiP BMD per unit (SD) of fat mass. Differences in BMD were examined by categories of lean and fat mass (low, medium, high) for a total of nine possible combinations of lean and fat measures. BMD at the hip, spine, and whole-body were significantly higher in those with high lean mass than in those with low lean mass, irrespective of fat mass. Women with high lean/low fat had similar hip, spinal, and whole-body BMD as those with high lean/high fat, despite their significantly lower body weight (62.5 +/- 3.3 kg vs 85.7 +/- 5.4 kg, respectively, p < 0.0001). In premenopausal and early perimenopausal women, body weight alone may not be associated with increased bone mass unless a significant proportion of that weight is comprised of lean mass. The stronger association between lean mass and BMD than that for fat mass may be attributed to differences in determinants of lean mass, such as exercise, lifestyle factors, estrogen levels, or a combination of these factors.

A comparison of bone mineral densities among female athletes in impact loading and active loading sports

The purpose of this study was to compare bone mineral densities (BMD) of collegiate female athletes who compete in impact loading sports; volleyball players (N = 8) and gymnasts (N = 13), to a group of athletes who participate in an active loading sport; swimmers (N = 7), and a group of controls (N = 17). All of the volleyball, swimming, and control subjects were eumenorrheic (10-12 cycles/year), whereas two of the gymnasts were amenorrheic (0-3 cycles/year), eight were oligomenorrheic (4-8 cycles/year), and three were eumenorrheic (10-12 cycles/year). Lumbar spine, proximal femur, and total body BMD were measured with dual-energy X-ray absorptiometry. The groups were compared with respect to the following regions: lumbar spine (L1-4); femoral neck; Ward's triangle; right and left arms; right and left legs; pelvis; and torso. When controlling for differences in height and weight the impact loading group (volleyball and gymnastic) had significantly greater BMD at the lumbar spine, femoral neck, Ward's Triangle, and total body when compared to the active loading (swimming) and control groups. The regional analysis from the total body scan revealed that the gymnasts had significantly (p < 0.05) greater BMD than all other groups at the right and left arm sites. The impact loading groups (gymnastic and volleyball) had a greater BMD in the legs and pelvis than the active loading (swimming) and control groups. Furthermore, the impact loading group had a greater torso BMD than the control group. There were no differences at any site between the active loading group (swimming) and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone mass at lumbar spine and tibia in young males--impact of physical fitness, exercise, and anthropometric parameters: a prospective study in a cohort of military recruits

Bone mineral density (BMD) and bone mineral content (BMC) were measured using DXA at lumbar spine and tibial diaphyses at the beginning and at the end of a 15-week training period in 151 military recruits of the Swiss army belonging to 5 different troop categories (infantry grenadiers, tank drivers, tank gunners, signalmen, and privates) who each were exposed to physical training of various intensity. At baseline, height, body mass index, and degree of physical fitness independently correlated with vertebral and tibial BMD. Over the 15 weeks of physical training BMD at tibial diaphyses increased by 2.2 +/- 0.3% at the left leg (p = 0.0001) and by 1.1% at the right leg (p = 0.002) with differences between troop categories. At lumbar spine, BMD decreased significantly in tank drivers (-1.2 +/- 0.4%, p = 0.001) and particularly in infantry grenadiers (-2.1 +/- 0.4%) who had the most strenuous weight-bearing training, but not in other troop categories. This decrease was twice as large at the center of the vertebra than for the whole vertebra. These BMD changes were associated with increments in serum levels of osteocalcin and alkaline phosphatase activity. From the initial cohort, 48 subjects volunteered for a third investigation carried out 2 years after the end of the military training period. At this time, lumbar BMD and BMC had risen back to baseline, whereas at tibial diaphyses bone width and BMC but not BMD increased by 5.8 +/- 1.1% and 6.2 +/- 0.9%, respectively, vs. baseline (p = 0.0001 for both).(ABSTRACT TRUNCATED AT 250 WORDS)

A two-year program of aerobics and weight training enhances bone mineral density of young women

Previous research suggests that physical activity may have a beneficial effect on bone mineral density (BMD) in women. This relationship was explored in a 2-year, randomized, intervention trial investigating the efficacy of exercise and calcium supplementation on increasing peak bone mass in young women. One hundred and twenty-seven subjects (ages of 20-35 years) were randomly assigned either to an exercise program that contained both aerobics and weight training components or to a stretching program. Calcium supplementation (up to 1500 mg/day including dietary intake) or placebo was given in a double-blinded design to all subjects. Spinal trabecular BMD was determined using quantitative computed tomography (QCT). Spinal integral, femoral neck, and trochanteric BMD were measured by dual X-ray absorptiometry (DXA) and calcaneal BMD by single photon absorptiometry (SPA). Fitness variables included maximal aerobic capacity (VO2max), and isokinetic muscle performance of the trunk and thigh. Measurements were made at baseline, 1 year, and 2 years. Sixty-three subjects (32 exercise, 31 stretching) completed the study, and all the measured bone parameters indicated a positive influence of the exercise intervention. There were significant positive differences in BMD between the exercise and stretching groups for spinal trabecular (2.5%), femoral neck (2.4%), femoral trochanteric (2.3%), and calcaneal (6.4%) measurements. The exercise group demonstrated a significant gain in BMD for spinal integral (1.3 +/- 2.8%, p < 0.02), femoral trochanteric (2.6 +/- 6.1%, p < 0.05), and calcaneal (5.6 +/- 5.1, p < 0.01) measurements. In contrast to exercise, the calcium intervention had no positive effect on any of the bone parameters. In regard to fitness parameters, the exercise group completed the study with significant gains in VO2max and isokinetic (peak torque) values for the knee flexion and extension and trunk extension. This study indicates that over a 2-year period, a combined regimen of aerobics and weight training has beneficial effects on BMD and fitness parameters in young women. However, the addition of daily calcium supplementation does not add significant benefit to the intervention.

The site-specific effects of long-term unilateral activity on bone mineral density and content

This study assessed the site-specific effects of long-term tennis playing on the bone mineral density (BMD) and content (BMC) of upper extremities in male Finnish top-level players using a dual energy x-ray absorptiometric (DXA) scanner. In players (n = 20), the BMDs and BMCs were significantly higher in each bone of the playing right extremity (p < 0.05-0.001), the side-to-side difference being largest in the humeral shaft (BMD + 25.4%, BMC + 28.7%) and proximal humerus (BMD + 14.4%, BMC + 20.5%), and smallest in the ulnar shaft (BMD + 3.1%, BMC + 7.5%) and distal ulna (BMD + 6.3%, BMC + 7.8%). In sex-, age-, weight-, and height-matched controls (n = 20), the right-to-left differences were small ranging from 0.0% to + 6.4% (average +3%). The number of training sessions per week was the only variable in muscle strength and training history assessment which showed, in several anatomic sites, a significant correlation with the relative bone mineral variables (r = 0.460-0.627, p < 0.05-0.001). In conclusion, long-term unilateral tennis activity had a clearly positive effect on the BMD and BMC of the bones of the playing extremity. The effect was very site-specific, being greatest in the humerus and smallest in the ulna. The effect was always greater in BMC than BMD indicating that the excess mineral was used not only for condensation of the bone tissue, but also for enlargement of bone dimensions.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term unilateral loading and bone mineral density and content in female squash players

We examined 19 female Finnish national level squash players and 19 healthy female controls with a dual energy x-ray absorptiometric (DXA) scanner for the determination of the association between long-term unilateral activity and bone mineral density (BMD) and content (BMC) of the upper extremities. In players, the BMDs and the BMCs were significantly higher in each bone site of the playing extremity. The side-to-side difference was largest in the proximal humerus (BMD 15.6%, BMC 17.8%) and smallest in the ulnar shaft (BMD 5.6%, BMC 7.3%). In sex-, age-, weight-, and height-matched controls, the side-to-side differences were significantly smaller, ranging from 1.6% to 4.1%. The number of training years and elbow flexion strength correlated positively with the relative BMD and BMC in the humerus of the playing arm (r = 0.632-0.685). The starting age of training in turn correlated negatively (r = -0.483 to -0.577) with these bone parameters. Significantly larger side-to-side differences (average 22%) were found in players who had started their career before or during menarche than in those who had begun the training 1 year or more after the menarche (9%). These findings suggest that the bones of the playing extremity clearly benefit from active squash playing. The benefit is largest in humerus and smaller in the bone of the forearm. The benefit of playing is stronger if the athlete has started the training at or before menarche than after it.(ABSTRACT TRUNCATED AT 250 WORDS)

Intact serum parathyroid hormone levels increase during running exercise in well-trained men

The purpose of this study was to examine the influence of exercise on the serum concentrations of intact parathyroid hormone (PTH). Serum PTH and plasma lactate were measured in 15 well-trained men, 9 long-distance runners and 6 fire-fighters, during two running exercises. Test one consisted of 40-minute treadmill running with a step-wise increased load and test two consisted of 50-minute treadmill running with a constant velocity. When the load was step-wise increased, the PTH concentrations increased moderately at the slower running paces but reached a final value that was about 50% higher than the starting value. This rise occurred despite a concomitant increase of total serum calcium from 2.38 +/- 0.06 to 2.49 +/- 0.05 mmol/liter (P < 0.01). During the constant running exercise, the long-distance runners, but not the fire-fighters, displayed a significant increase in PTH concentrations although the rise in total serum calcium was similar in both groups. There was a weak correlation between the changes in PTH and lactate in both exercises. The findings demonstrate that both high and low intensity exercise enhance release of PTH in long-distance runners through a mechanism that does not involve serum calcium. This relationship might be of importance for bone mass in men performing long-distance training.

Physical activity epidemiology as applied to elderly populations

Physical activity epidemiological studies provide one of many types of research evidence that are necessary to assess the importance of physical activity to health. Available epidemiological evidence, when coupled with relevant experimental and clinical research, suggests that physical activity has the potential to favourably influence the development and progression of a variety of chronic diseases and conditions that are a burden to public health. The evidence is only beginning to emerge for elderly populations, however, thereby highlighting an important void in our scientific knowledge. Attempting to increase the level of physical activity of elderly people raises three important issues. First, improving adherence to a physically active life-style requires assistance of behavioural scientists, either through direct intervention, or through research that can help the elderly identify and overcome impediments to physical activity. Second, many elderly people have diseases that can limit their physical ability, but exercise scientists can assist by prescribing exercise that is both efficacious and safe given the level of limitation. Third, the number of injuries may increase with increased physical activity in elderly persons. Epidemiologists and exercise scientists working in the area of injury control can determine which activities are safe at specific levels of physical ability and function. To quote one of the originators of exercise physiology, Per Olaf Astrand (1992), 'As a consequence of diminished exercise tolerance, a large and increasing number of elderly people will be living below, at, or just above "thresholds" of physical ability, needing only a minor intercurrent illness to render them completely dependent'. Physical activity can help to push back that 'threshold of physical ability' and thereby improve physical functioning. As physical function improves, there is a propensity to perform even greater amounts of physical activity that may be essential to the quality and perhaps quantity of life for an elderly person.

Walking is related to bone density and rates of bone loss

PURPOSE

To determine if walking, independently of other types of physical activity, influences bone density and rates of bone loss from the lumbar spine and whole body.

PATIENTS AND METHODS

Healthy, white, postmenopausal women (n = 239) participating in a 1-year, placebo-controlled trial of vitamin D supplementation were studied. Bone densities of the lumbar spine and whole body were measured semiannually by dual-energy x-ray absorptiometry. Current and historical participation in outdoor walking and other leisure-time physical activities was assessed by questionnaire.

RESULTS

Women who walk more than 7.5 miles per week had higher mean bone density of the whole body and of the legs and trunk regions of the body than women who walk less than 1 mile per week. The current level of walking activity was reflective of lifelong walking habits. The number of miles walked per week was also correlated with longitudinal rates of change in bone density at the legs (rp = 0.16, p = 0.03).

CONCLUSIONS

Healthy postmenopausal women who walk approximately 1 mile each day have higher whole-body bone density than women who walk shorter distances. Walking is also effective in slowing the rate of bone loss from the legs. These results strongly support the widely held belief that walking is a beneficial form of physical activity for maintaining skeletal integrity.

Optimizing peak bone mass: what are the therapeutic possibilities?

Bone mass in the elderly depends on the rate of involutional bone loss and on the peak bone mass, i.e. the bone mass present around the third decade of life. Factors relating to the attainment of peak bone mass include congenital factors, diet, hormones, physical activity, life-style factors, drugs and diseases. A therapeutic intervention aimed at increasing peak bone mass is conceivable only by controlling factors such as estrogen status, dietary calcium intake and physical activity. Calcium intake appears to be relevant up to the so-called threshold intake (1000 mg/day), but higher allowances do not seem to offer additive advantages. Exercise affects only the regions of the skeleton under mechanical stress. Estrogen administration is realistic only in conditions characterized by severe hypoestrogenism.

Bone mass and exercise

The overall role of exercise as an integral part of osteoporosis prevention and treatment remains unclear and controversial. Comparatively well accepted are the facts that disuse results in bone mass loss, that sedentary individuals in general have less bone mass than exercising individuals (from cross-sectional study data), that exercise may produce a modest increase in bone mass (from longitudinal study data), and that exercise cannot compensate for estrogen loss. However, numerous questions regarding exercise and the skeleton remain to be answered, such as how the apparent osteogenic effect of exercise is mediated, what is the relationship of exercise in reducing fractures, how to reconcile the discrepancy between exercise-induced bone mass gain (lesser) and disuse bone loss (greater). At present, it seems reasonable to recommend avoidance of a sedentary existence, and participation in a moderate exercise program, for individuals seeking to prevent or treat osteoporosis, recognizing that much of the benefit may be in the resultant increase in muscle strength, in coordination, and in flexibility associated with such a program.

Cross-sectional geometrical properties and bone mineral contents of the human radius and ulna

The mechanical strength of the human radius and ulna depends on their geometrical and material properties. This study quantifies the cortical bone cross-sectional properties of the adult radius and ulna (cross-sectional area, thickness, centroids, area moments of inertia and section moduli) using computerized tomographic (CT) scanning coupled with image processing along the lengths of eight human cadaveric forearms. Bone mineral mass and apparent ash density were also quantified at serial locations. Sites of significant variation of selected geometric and mineral properties along the length of each forearm bone were determined. Our results show that interpolation of CT measurements made at 10 and 30% of the radial length in the radius and 30 and 90% of the radial length in the ulna can provide approximate geometric values over the 10-90% region. This information can be used to develop a protocol using the fewest sites to clinically assess changes in forearm bone geometry. Regression analyses did not show significant linear relationships between geometric properties and apparent cortical ash density. Thus, CT derived geometric properties are not helpful in estimating the extent of changes in bone density. Area moment of inertia results suggest that the junction of the middle and distal third of the radius, and the ulnar shaft region may have increased vulnerability to fractures. The former is likely due to the change in moment of inertia values, whereas the latter is due to the relatively small magnitude of cross-sectional moments along the ulnar shaft as compared to the proximal or distal ends. This is consistent with fracture patterns observed clinically when a single forearm bone is fractured: Galeazzi fracture of the radius and nightstick fracture of the ulna.

One-year psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial

On the premise that bone response to exercise is locally controlled, we conducted a randomized trial to evaluate the effects of a 1-year training of psoas muscles (treatment group: TG) versus a 1-year training of deltoid muscles (control group: CG) on the lumbar trabecular bone mineral density (TBMD). TBMD was measured with computed tomography scan. Seventy-eight subjects were included and 67 completed the study. Intention to treat analysis revealed no significant change in TBMD from 0 to 12 months. Data analysis in the 67 remaining women, including both assiduous and nonassiduous subjects, revealed greater bone loss in CG than in TG although the difference was not significant. Similar analysis in a subgroup of subjects who performed the exercises assiduously (TG: n = 23, CG: n = 26) showed that the mean bone loss of all four vertebrae from 0 to 12 months was significantly greater in the CG (-8.87 +/- 12.75 mg/cm3, mean +/- SD) than in the TG (0.14 +/- 11.21 mg/cm3, mean +/- SD, P = 0.01). These results suggest that continuous 1-year psoas training can prevent lumbar bone loss in postmenopausal women and support the hypothesis of local action of physical activity.

Prophylaxis of falls and treatment of fractures

This review has highlighted important preventive measures for falls and fractures in elderly osteopenic patients, and has discussed the therapeutic possibilities after an osteoporotic fracture has occurred. Assuming that a large proportion of osteoporotic fractures are a consequence of traumatic falls, and are not spontaneous, due to osseous weakness, preventive measures in elderly people are best directed to counteract muscular weakness, improve agility and correct visual impairment. It is also important to guard against unnecessary obstacles in the home and the reflex habits of doctors to prescribe hypnotics and tranquillizers, as well as their occasional tendency to overtreat hypertension. Practical examples of rational measures to protect against these causes of fractures have been given. In the second part of the review, the treatment of fractures has been delineated. The goals are adequate pain relief, early immobilization of the patient, avoidance of overtreatment and fast restoration of the quality of life. Three stages of pain relief by drugs are outlined. The first consists of a simple non-narcotic analgesic, such as paracetamol. In a second stage, either the combination of paracetamol with a muscle relaxant or the administration of a narcotic analgesic of medium potency is proposed. As a third stage, several therapeutic approaches to the administration of potent narcotic analgesics have been discussed. Non-drug measures, such as the use of heat, ultra-soft mattresses, walking frames, crutches and sticks, as well as active forms of physiotherapy, have been discussed both in terms of pain relief and early mobilization.

The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women

The purpose of this study was to determine the optimal intensity of exercise necessary to prevent the postmenopausal bone loss on the basis of anaerobic threshold (AT). Thirty-three postmenopausal women were randomized to control (group C: n = 12) or two exercise groups (group H and group M). All women performed a treadmill exercise test, and the AT was measured by expired gas analysis. The exercise regimen consisted mainly of walking at a speed that kept the exercise heart rate above the AT (group H: n = 12) or below the AT (group M: n = 9). Exercise was performed for 30 minutes, three times a week for 7 months. The bone mineral density (BMD) of the lumbar vertebrae was measured using dual energy X-ray absorptiometry. The BMD level in group C decreased by 1.7 +/- 2.7%, but there was a significant increase of 1.1 +/- 2.9% in group H. In group M there was a decrease of 1.0 +/- 3.1% which did not differ from group C. In group C, serum osteocalcin and urinary hydroxyproline excretion were significantly increased, but no changes were seen in either of the exercise groups. Urinary calcium significantly decreased in the exercise groups. We conclude that short-term (7 months) exercise with intensity above the AT is safe and effective in preventing postmenopausal bone loss.

Bone mineral density in relation to anthropometric properties, physical activity and smoking in 75-year-old men and women

Bone mineral content (BMC, g.cm-2) and density (BMD, g.cm-3) were studied in 75-year-old men and women in relation to anthropometric and certain life-style factors. This study covered all the men and women born in 1914 who were residents in the city of Jyväskylä in 1989 (N = 388). A hundred and three men and 188 women participated in bone measurements performed at the calcaneus using a 125I-photon absorption method. BMC was on average 36% and BMD 17% higher in the men than in the women. BMC and BMD associated with body mass in both sexes, and with body fat and use of estrogen in the women. There was a negative correlation between the BMD values and the number of cigarettes smoked over the entire life course in both sexes. Moderate physical activity was related to higher BMC in men. Men and women who had been physically active earlier in their life tended to show higher BMD values than those who had been more sedentary.

A screening and counseling program for prevention of osteoporosis

Prevention of osteoporosis is an increasingly salient public health concern as our society ages. This report describes the procedures used at an osteoporosis center to which people come for screening and counseling. The patients on whom this report is based were 53 non-smoking women, 1-10 years postmenopausal at the time of their first visit to the center, who chose not to undertake estrogen therapy, and who returned for a second visit in 12-18 months. They were classified as to adequacy of calcium intake (at least 750 mg/day) and exercise (at least 3 h/week of weight-bearing exercise) at both visits; complete data on calcium intake and exercise were available on 46 of the women. Bone densities were measured at the femoral neck and lumbar spine with dual energy X-ray absorptiometry, and at the distal radius with single photon absorptiometry. At the first visit, 67% of the women reported adequate exercise and 43% reported adequate calcium intake. At the second visit, the percentages in the adequate categories had increased to 74% for exercise (p = 0.06) and 70% for calcium intake (p = 0.02). Age at the first visit was inversely correlated with femoral (r = -0.40, p = 0.003) and spinal (r = -0.36, p = 0.009) bone densities; the correlation with radial bone density did not achieve significance (r = -0.27, p = 0.55). Rather than declining, as would be expected in early postmenopausal women, bone density rose slightly, but not significantly, between visits for all three sites.(ABSTRACT TRUNCATED AT 250 WORDS)