Preventive health care for older women: life-style recommendations and new directions

High-frequency vibration training increases muscle power in postmenopausal women1,21Stratec Medizintechnik, Novotec, and Unitrem provided the peripheral quantitative computerized tomograph and the forceplates.2No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To test whether training on a high-frequency (28Hz) vibrating platform improves muscle power and bone characteristics in postmenopausal women.

DESIGN

Randomized controlled trial with 6-month follow-up.

SETTING

Outpatient clinic in a general hospital in Italy.

PARTICIPANTS

Twenty-nine postmenopausal women (intervention group, n=14; matched controls, n=15).

INTERVENTION

Participants stood on a ground-based oscillating platform for three 2-minute sessions for a total of 6 minutes per training session, twice weekly for 6 months. The controls did not receive any training. Both groups were evaluated at baseline and after 6 months.

MAIN OUTCOME MEASURES

Muscle power, calculated from ground reaction forces produced by landing after jumping as high as possible on a forceplate, cortical bone density, and biomarkers of bone turnover.

RESULTS

Over 6 months, muscle power improved by about 5% in women who received the intervention, and it remained unchanged in controls (P=.004). Muscle force remained stable in both the intervention and control groups. No significant changes were observed in bone characteristics.

CONCLUSION

Reflex muscular contractions induced by vibration training improve muscle power in postmenopausal women.

Preventive health care for older patients

This chapter addresses key components of screening and preventive care for the older population. The older population is heterogeneous, ranging from the competent, active, well individual to the frail, demented individual. Certain preventive measures are important for all individuals such as counseling on exercise and screening for high blood pressure. However, universal cancer, cholesterol, or dementia screening may not be cost effective and beneficial in all older adults. These preventive measures should be guided by the individuals' circumstances including their life expectancy, co-morbid illnesses, functional capacity, and quality of life. Clinicians may be able to individualize preventive medicine decisions by stratifying their patients into well and frail using the guidelines we have provided. The goal of prevention and screening in older patients is to improve function and quality of life. Primary care physicians should facilitate discussion of preventive measures with their older patients as part of their ongoing health care.

Understanding the physiological and functional consequences of menopause: the PROSALMEN study. PROgetto SALute MENopausa

BACKGROUND AND AIMS

Women live longer and are more often affected by disability and poor health than men. The mechanism underlying this sex-related "mortality-morbidity" paradox is still unclear but it has been suggested that the physiological and functional changes occurring during the menopausal transition play an important role. The aim of PROSALMEN (PROgetto SALute MENopausa: Health in Menopause Project) is to study in great detail how these changes affect the integrity and function of the physiologic subsystems that are relevant to the maintenance of an active and healthy life-style during the aging process.

METHODS

PROSALMEN is a cross-sectional comparison of age-matched pre- and post-menopausal women. Thirty post-menopausal women, aged 48-58 years, were enrolled in the study together with 30 age-matched pre-menopausal controls. A number of clinical, biological and functional parameters were collected assessing the integrity and level of function of the physiological subsystems that are important for mobility. Furthermore, we collected information on risk factors, medical conditions and symptoms that frequently develop or become clinically evident after menopause, including the most important elements of the classical post-menopausal syndrome.

CONCLUSIONS

This rich dataset will be used to start dissecting the causal pathway leading from menopause to damages in the musculoskeletal system and, in turn, to reduced physical function. The final goal is to understand how and to what extent changes in health behavior and pharmacological treatments in addition to hormone replacement therapy (HRT) may counteract these processes.