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

Effects of land vs water jump exercise: Implications for exercise design targeting bone health

PURPOSE

To quantify ground reaction force (GRF), osteogenic index (OI), muscle activity, and blood lactate levels during continuous jumping performed in water and on land.

METHODS

Thirteen post-menopausal women (59.5 ± 6.8 years) performed two bouts of jumping, on land (LND) and in water at a depth of 1 m (WEX). Each 10-minute, 40-second bout consisted of 2 consecutive sets of squat, lunge, jumping jax, countermovement, and single legged jumps as intervals: 10 seconds maximal effort and 60 seconds recovery at 50% of heart rate reserve (HRR). Pre- and post-exercise lower extremity rate of perceived exertion (RPE) was recorded, and 10-µL earlobe blood samples were collected to assess lactate concentration. During exercise, data were collected for electromyography, GRF, and heart rate. Total GRF (TGRF) and total muscular activity (TMA) during each 10 seconds of jumping were measured. OI for one bout of continued jumps was determined by averaging GRF·ln (number of jumps + 1).

RESULTS

There were no differences between WEX and LND for percent HRR and RPE. TGRF, OI, TMA, and lactate concentration on LND jumps were significantly higher than WEX.

CONCLUSION

At similar cardiorespiratory and RPE levels, the lower impact loading of 10 minutes 40 seconds of interval continuous jumping exercise in 1-m depth was less osteogenic than on land. However, one daily bout of water jumping, 5 days per week resulted in a similar OI as 3 days of jumping on land. WEX might substitute or provide an adjunct to LND exercise to promote bone health.

The role of physical activity in early adulthood and middle-age on bone health after menopause in epidemiological population from Silesia Osteo Active Study

BACKGROUND

Osteoporosis is a growing problem in women after menopause. Among factors protecting from this disease is a physical activity (PA).

AIM

The objective of the study was to evaluate the influence of PA in early adulthood and at middle-age on bone health after menopause.

MATERIAL AND METHODS

The study group consisted of 362 randomly recruited postmenopausal women after menopause. Mean age was 65.2±6.9 years. Medical history was collected from all participants, and they completed questionnaires assessing PA in early adulthood and at middle-age. Physical capacity was estimated using the Duke scale. Bone status was measured with use of densitometry (DXA) for lumbar spine and hip and calcaneus quantitative ultrasound (QUS) measurements.

RESULTS

Physical activity and healthy lifestyle activity in early adulthood did not correlate with bone health, but current PA did (for QUS parameters r=.11; P<.05). Physical capacity correlated with all QUS parameters (r=.2 to .22; P<.05) and femoral neck (FN) BMD and T-score (for both r=.16; P<.05). Current PA frequency at the level of several times a week has the highest positive impact on FN DXA results (P=.01). Bone mass in DXA and QUS variables is related to the type of exercises (P<.05).

CONCLUSION

Physical activity, especially several times a week, at middle-age is a major factor influencing bone health in women after menopause. Further studies concerning the type of exercises are needed.

The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials

We assessed the impact of weight loss strategies including calorie restriction and exercise training on BMD in adults using a systematic review of randomized controlled trials. Weight reduction results in reduced BMD at the hip, but has less effect on the spine. Both calorie restriction and a combination of calorie restriction and exercise result in a decrease in hip bone density, whereas weight loss response to exercise training without dietary restriction leads to increased hip BMD.

INTRODUCTION

Findings are not consistent on the effect of weight loss on bone mineral density (BMD). We conducted a systematic review on the randomized controlled trials to assess the effect of weight loss strategies, including calorie restriction and exercise programs on BMD in adults.

METHODS

A structured and comprehensive search of MEDLINE and EMBASE databases was undertaken up to March 2016. Study-specific mean differences (MD) were pooled using a random-effects model. Subgroup analysis and meta-regression were used to find possible sources of between-study heterogeneity.

RESULTS

Thirty-two randomized controlled trials met predetermined inclusion criteria. The meta-analysis revealed no significant difference on total BMD (MD 0.007, 95 % CI -0.020-0.034, p = 0.608). In contrast, the pooled data of studies showed a significant effect of weight loss on hip BMD (MD -0.008, 95 % CI -0.09 to -0.006 g/cm(2), p < 0.001) and also lumbar spine BMD (MD -0.018 g/cm(2), 95 % CI -0.019 to -0.017, p < 0.001). BMD in the hip site decreased after more than 4 months, especially in those who were obese. Moreover, calorie restriction interventions longer than 13 months showed a significant decreased in lumbar spine BMD.

CONCLUSION

Weight loss led to significant decreases at the hip and lumbar spine BMD but not at the total. Weight loss response following calorie restriction resulted in a decrease in hip and lumbar spine bone density especially more than 1 year; whereas an exercise-induced weight loss did not.

Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial

Objective: To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis (OA). Design: A quasi-experimental design consisting of an exercise group and an age-matched control group.

Setting: Public community swimming pool in Sheffield, UK. Subjects: One hundred and six community-dwelling sedentary older people, with confirmed knee-hip osteoarthritis, enrolled in an experimental controlled trial for 12 months. Sixty-six subjects in the exercise group were offered a water-exercise programme. Forty age-matched, nonexercising, ‘control’ subjects received monthly education material and quarterly telephone calls. Interventions: Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors.

Main measures: Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Secondary outcomes included a battery of performance-based physical function tests.

Results: Adherence to exercise averaged 70% (±14%) over the year: 77% of the exercising subjects and 89% control subjects completed both pre- and post-outcome measures. After one year, participants in the exercise group experienced a significant improvement in physical function (4.0 ± 9.1 versus -0.4 ± 7.3 units; 95% confidence interval (CI) 0.96–7.96, p < 0.05) and reduction in the perception of pain (1.3 ± 3.7 versus 0.2 ± 2.5 units; 95% CI -0.19-2.52, p < 0.05) compared with the control group, as measured by the WOMAC Osteoarthritis Index. In addition, the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05), had significantly greater improvements in knee range of movement ( p < 0.01) and hip range of movements ( p < 0.005). There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being (Arthritis Impact Measurement Scales 2 questionnaire).

Conclusions: Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function, pain, general mobility and flexibility after participating in 12 months of community-based water exercise.

Effect of swimming exercise on three-dimensional trabecular bone microarchitecture in ovariectomized rats

Swimming is generally considered ineffective for increasing bone mass in humans, at least compared with weight-bearing sports. However, swimming exercise has sometimes been shown to have a strong positive effect on bone mass in small animals. This study investigated the effects of swimming on bone mass, strength, and microarchitecture in ovariectomized (OVX) rats. OVX or sham operations were performed on 18-wk-old female Fisher 344 rats. Rats were randomly divided into four groups: sham sedentary (Sham-CON), sham swimming exercised (Sham-SWI), OVX sedentary (OVX-CON), and OVX swimming exercised (OVX-SWI). Rats in exercise groups performed swimming in a water bath for 60 min/day, 5 days/wk, for 12 wk. Bone mineral density (BMD) in right femurs was analyzed using dual-energy X-ray absorptiometry. Three-dimensional trabecular architecture at the distal femoral metaphysis was analyzed using microcomputed tomography (μCT). Geometrical properties of diaphyseal cortical bone were evaluated in the midfemoral region using μCT. The biomechanical properties of femurs were analyzed using three-point bending. Femoral BMD was significantly decreased following ovariectomy. This change was suppressed by swimming. Trabecular bone thickness, number, and connectivity were decreased by ovariectomy, whereas structure model index (i.e., ratio of rod-like to plate-like trabeculae) increased. These changes were also suppressed by swimming exercise. Femurs displayed greater cortical width and maximum load in SWI groups than in CON groups. Together, these results demonstrate that swimming exercise drastically alleviated both OVX-induced decreases in bone mass and mechanical strength and the deterioration of trabecular microarchitecture in rat models of osteoporosis.

The osteogenic effects of swimming on bone mass, strength, and microarchitecture in rats with unloading-induced bone loss

The effect of nonweight-bearing exercise on osteoporotic bones remains controversial and inconclusive. The purpose of this study was to evaluate the effects of swimming on osteoporotic tibias of rats submitted to hindlimb suspension. Initially, 20 Wistar rats were used to confirm a significant bone loss following 21 days of unloading. Thirty rats were then divided into 3 groups and followed during 51 days: CON (nonsuspended rats), S + WB (suspended rats for 21 days and then released for regular weight-bearing) and, S + Swim (suspended rats for 21 days and then released from suspension and submitted to swimming exercise). We observed that swimming exercise was effective at fully recovering the bone deterioration caused by suspension, with significant increments in BMD, bone strength and bone volume. On the other hand, regular weight-bearing failed at fully restoring the bone loss induced by unloading. These results indicate that swimming exercise may be a potential tool to improve bone density, strength, and trabecular volume in tibias with bone loss induced by mechanical unloading in suspended rats. We conclude that this modality of activity could be beneficial in improving bone mass, strength, and architecture in osteoporotic individuals induced by disuse, such as bed rest or those exposed to microgravity, who may not be able to perform weight-bearing exercises.

Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research

PURPOSE

Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health.

METHODS

A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness).

RESULTS

In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence.

CONCLUSION

Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

Differential effects of water-based exercise on the cognitive function in independent elderly adults

BACKGROUND

Physical exercise has been reported to be the most effective method to improve cognitive function and brain health, but there is as yet no research on the effect of water-based exercise.

AIMS

The aim of the present study was to compare the effects of water-based exercise with and without cognitive stimuli on cognitive and physical functions.

METHODS

The design is a single-blind randomized controlled study. Twenty-one participants were randomly assigned to a normal water-based exercise (Nor-WE) group or a cognitive water-based exercise (Cog-WE) group. The exercise sessions were divided into two exercise series: a 10-min series of land-based warm-up, consisting of flexibility exercises, and a 50-min series of exercises in water. The Nor-WE consisted of 10 min of walking, 30 min of strength and stepping exercise, including stride over, and 10 min of stretching and relaxation in water. The Cog-WE consisted of 10 min of walking, 30 min of water-cognitive exercises, and 10 min of stretching and relaxation in water. Cognitive function, physical function, and ADL were measured before the exercise intervention (pre-intervention) and 10 weeks after the intervention (post-intervention).

RESULTS

Participation in the Cog-WE performed significantly better on the pegboard test and the choice stepping reaction test and showed a significantly improved attention, memory, and learning, and in the general cognitive function (measured as the total score in the 5-Cog test). Participation in the Nor-WE dramatically improved walking ability and lower limb muscle strength.

CONCLUSION

Our results reveal that the benefits elderly adults may obtain from water-based exercise depend on the characteristics of each specific exercise program. These findings highlight the importance of prescription for personalized water-based exercises to elderly adults to improve cognitive function.

The benefits of a high-intensity aquatic exercise program (HydrOS) for bone metabolism and bone mass of postmenopausal women

This study aimed to evaluate the 24-week effects of a high-intensity aquatic exercise program on bone remodeling markers and bone mass of postmenopausal women. In this randomized, controlled trial we studied 108 women (58.8 ± 6.4 years), randomized into Aquatic Exercise Group (AEG), n = 64, performing 24 weeks of aquatic exercises, and Control Group (CG), n = 44, sedentary. They had their fasting morning blood sample collected for the measures of intact parathyroid hormone (iPTH), procollagen type 1 amino-terminal propeptide (P1NP) and carboxy-terminal cross-linking telopeptide of type I collagen (CTx). Bone mass was measured by dual-energy X-ray absorptiometry before and after the intervention. Participants of both groups received a daily supplementation of 500 mg of elementary calcium and 1,000 IU of vitamin D (cholecalciferol). Results showed an augment in bone formation marker (P1NP) only in the AEG (15.8 %; p = 0.001), and although both groups experienced significant enhancements in bone resorption marker (CTx), this increase was less considerable in the AEG (15 % in the AEG and 29 % in the CG). IPTH was increased by 19 % in the CG (p = 0.003) at the end. The femoral trochanter BMD presented a 1.2 % reduction in the CG (p = 0.009), whereas in the AEG no change was observed (p = 0.069). The proposed aquatic exercise program was efficient in attenuating bone resorption raise and enhancing bone formation, which prevented the participants in the AEG from reducing the femoral trochanter BMD, as happened in the CG.

The osteogenic effects of swimming, jumping, and vibration on the protection of bone quality from disuse bone loss

We assessed and compared the effects of swimming, jumping, and vibration therapies on the prevention of bone loss because of unloading. Eighty Wistar rats were randomly divided into eight groups: S, permanent hind limb-suspended rats; CON, control rats; S + Swim, unloading interrupted by swimming exercise; S + C(Swim), suspension interrupted by regular weight-bearing with the same duration as in the S + Swim protocol; S + Jump, unloading interrupted by jumping exercise; S + C(Jump), suspension interrupted for regular weight-bearing as in the S + Jump group; S + Vibr, unloading interrupted by vibration; and S + C(Vibr), suspension with interruptions for regular weight-bearing with the same protocol as that used for the S + Vibr rats. At the end of the experiment, the bone mineral density, bone strength, histomorphometric parameters, and serum levels of the bone markers were analyzed. The hind limb-suspended rats exhibited bone quality loss. In contrast, the trained rats showed a significant increase in bone mass, bone strength, bone formation, and serum levels of bone markers compared with the respective controls. Although we did not find a significant difference among the three physical exercises, the osteogenic effect of vibration was slightly lower than that of swimming and jumping. Thus, all physical exercises were efficient in preventing bone loss because of unloading and preserving bone quality.

The effect of 8 mos of twice-weekly low- or higher intensity whole body vibration on risk factors for postmenopausal hip fracture

OBJECTIVE

Whole body vibration is a potential therapy for age-related loss of musculoskeletal competence. Vibration has improved bone in animal models, but evidence in humans is limited. Relative efficacy of low- vs. high-intensity whole body vibration is also unknown. Our goal was to observe the effect of brief low- and higher intensity whole body vibration on risk factors for hip fracture in postmenopausal women.

DESIGN

We used an 8-mo randomized controlled trial design to examine the influence of twice-weekly low-intensity whole body vibration (15 mins, 30 Hz, 0.3 g) or higher intensity whole body vibration (2 × 3 mins, 12.5 Hz, 1 g) on anthropometrics, bone (whole body, hip, spine, forearm, and heel), muscle (wall squat and chair rise), and balance (tandem walk and single leg stance). Physical activity, daily calcium, and compliance were recorded. Effects were examined by repeated-measures analysis of covariance, controlling for age, height, weight, calcium, physical activity, compliance, and baseline values.

RESULTS

Forty-seven women (71.5 ± 9.0 yrs) completed the trial. There were no between-group differences in any measure at 8 mos, but within-group effects were evident. Controls lost bone at the trochanter (-6%, P = 0.03) and lumbar spine (-6.6%, P = 0.02), whereas whole body vibration groups did not. Whole body vibration subjects improved wall squat (up to 120%, P = 0.004) and chair rise performance (up to 10.5%, P = 0.05).

CONCLUSIONS

Eight mos of twice-weekly whole body vibration may reduce bone loss at the hip and spine and improve lower limb muscle function. These changes may translate to a decreased risk of falls and hip fracture.

Força de reação do solo como subsídio para prescrição de exercícios aquáticos: estudo de caso

OBJETIVO: Comparar a componente vertical da força de reação do solo nos exercícios de caminhada, corrida com deslocamento, corrida estacionária e salto vertical, realizados em ambiente aquático em diferentes níveis de imersão. MÉTODO: Participou deste estudo de caso um sujeito do sexo masculino (27 anos, 1,80 m e 84,3 kg). Utilizou-se para a coleta de dados uma plataforma subaquática de força posicionada no fundo de uma piscina térmica. O sujeito realizou 30 tentativas válidas de cada exercício, imerso nos níveis do processo xifoide e do quadril. Os dados foram analisados com a utilização da estatística descritiva, teste "t" de Student para amostras pareadas e ANOVA, para medidas repetidas (p < 0,05). RESULTADOS: Os valores máximos da força para os níveis do processo xifoide e do quadril (em % do peso corporal do sujeito) foram de, respectivamente: 39% e 48% para a caminhada; 138% e 156% para a corrida com deslocamento; 139% e 202% para a corrida estacionária; 194% e 195% para a propulsão no salto; e 222% e 387%, para a aterrissagem no salto. CONCLUSÃO: Ao variar o tipo de exercício podemos realizar um aumento de carga gradual, desde a caminhada no nível do processo xifoide até o salto no nível do quadril. Para tanto, deve ser analisado o objetivo do trabalho a ser realizado para a escolha do exercício correto, com o aumento da carga sendo realizado não somente pela diminuição do nível de imersão, como também pelo tipo e pela velocidade/cadência do exercício executado.

Aquatic therapy: scientific foundations and clinical rehabilitation applications

The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.

Effects of a short-term aquatic resistance program on strength and body composition in fit young men

This study was designed to analyze the effects of a short-term periodized aquatic resistance program (PARP) on upper-limb maximum strength, leg muscular power, and body composition (BC) in fit young men. Twenty subjects (21.2 +/- 1.17 years) were randomly assigned to an exercise or control group; 12 subjects completed the study. The aquatic exercise group (AEG; n = 7) participated in an 8-week supervised program of 3 d x wk, and the control group (CG; n = 5) maintained their regular activities. The PARP consisted of a total-body resistance exercise workout using aquatic devices that increased drag force, with a cadence of movement controlled and adjusted individually for each exercise and subject. The volume and intensity of the program were increased progressively. Submaximal tests were carried out to determine the change in upper-limb maximum strength, as well as a squat-jump test to determine the change in leg muscular power. Four skinfold sites, 6 circumference sites, body weight, and stature were used to determine changes in BC. A significant increase in upper-limb maximum strength and leg muscular power was observed for the AEG. A significant increase also was noted in the circumference and muscular area of the arm, and there were significant decreases in pectoral and abdominal skinfolds. Nevertheless, the circumference, muscular area, and local fat of the lower limbs did not change. There were no significant changes in any variables in the CG. These results indicate that the PARP produces significant improvements in muscular strength, power, and fat-free mass and, thus, seems to be a very effective form of resistance exercise.

Acute effects of a single session of aerobic exercise with or without weight-lifting on bone turnover in healthy young women

This study aimed to investigate the acute effects of exercise on bone turnover and to determine whether brisk walking with or without weight-lifting makes a difference on bone metabolism. Nine healthy women performed two exercise bouts: brisk walking on a treadmill for 30 min (E), and similar exercise carrying 5 kg of weight in a backpack (WE). Serum parathyroid hormone (PTH), osteocalcin (OC), calcitonin (CT), procollagen type 1 carboxy terminal propeptide (PICP), procollagen type 1 amino terminal propeptide (PINP), type 1 collagen carboxy terminal telopeptide (ICTP), total alkaline phosphatase (ALP), and urine deoxypyridinoline (D-Pyr) levels were studied. Resting values served as control. Significant variances were observed only in serum ALP and PTH values. Variances in ALP values within subjects after exercise were statistically significant (analysis of variance in repeated measurements [AVRM], P=0.000). E caused a significant decrease, while WE caused a significant increase in ALP values at the 24th h (Bonferroni pairwise comparisons tests [BPC t-test]: P=0.028, P=0.000, respectively). Variances in PTH values within subjects after exercise were statistically significant (AVRM, P=0.029), while diurnal variation was not significant (P=0.981). E caused significant alterations in PTH levels (an increase at the 30th min, turned towards baseline at the 45th min) (BPC t-test, P=0.007). WE also caused alterations in PTH levels, though insignificant (BPC t-test, P=1.00). Brisk walking for 30 min has stimulating effects on bone turnover by various mechanisms without any additive effect of weight bearing.

Oxygen Saturation and Hemoglobin Level in the Muscles of Hypertensive Patients during Exercise in Water

To clarify whether exercise therapy in a water environment is appropriate therapy for hypertensive patients, we investigated oxygen saturation and hemoglobin level in the vastus medialis muscle using a laser tissue blood oxygen monitor. Seven hypertensive patients (52 to 77 years of age, hypertensive group) and five healthy volunteers (44 to 69 years of aged, control group) participated in this study. Subjects maintained resting postures for about 5 minutes each in a standing position, a sitting position on a chair, a lying position out of water, and a position in water below the navel and to the chest level. Subjects performed flexion/extension movement of the knee joint (30 times/min) in and out of water. Oxygen saturation level (SaO2), oxygenated hemoglobin level (HbO2), deoxygenated hemoglobin level (HbD), and total tissue hemoglobin level (HbT) were measured in the muscle tissue. Blood pressure (BP) and pulse rate (PR) were monitored simultaneously. In the hypertensive group, SaO2 in muscle tissue in water was significantly increased compared with that in a standing position out of water (p<0.05), and returned to the level in the control group. HbD in the hypertensive group was significantly reduced in the position in water to the chest level compared to that in a standing position (p<0.05). In both groups, the ratios of HbD and HbO2 (O2/D ratio) was significantly increased in water environment compared with that out of water (p<0.05). The O2 /D ratio, which indicates oxygenation within the tissue, increased during exercise in water in the hypertensive group. This study demonstrated that oxygen saturation in the muscles of the hypertensive group was lower than that in controls out of water, but the level was increased in water. Our findings suggest that water provides a good exercise environment for hypertensive patients from the perspective of oxygen saturation in hypertensive muscle tissue.

Initiation and maintenance of exercise behavior in older women: predictors from the social learning model

The purpose of the present study was to determine the extent to which modifiable social learning constructs predicted long-term adherence to an exercise program in older individuals. Participants were 189 women aged 59 to 78 years and diagnosed with low bone density. Exercise behavior was assessed at 3-month intervals. Self-efficacy, readiness for change, orientation toward exercise, social support in general, and support specifically for exercise were measured at baseline and at 12-month follow-up. Analyses indicated that initial adoption of exercise behavior was best predicted by readiness to change. Maintenance was predicted by self-efficacy for exercise, and exercise behavior at 12 months was predicted by social support for exercise. The results were seen as supportive of the stages and processes of change model of health behavior change. Implications of the findings for interventions to enhance adoption and maintenance of exercise programs by older women are discussed.

Facilitators and barriers to elders' practice of t'ai chi. A mind-body, low-intensity exercise

Research has documented the positive effects that t'ai chi has on the well-being of elders. However, the reasons that elders practice t'ai chi have not been explored. The purpose of this study was to describe the facilitators and barriers to t'ai chi practice in elderly populations. Taiwanese community-dwelling elders (40 of whom practiced t'ai chi and 40 who did not) aged 65 and older, matched on age and gender, were interviewed. Results showed that encouragement from others was the most important factor for elders to practice t'ai chi, whereas positive health outcomes were the reason they continued to practice it. Most of the non-t'ai chi group participants had never thought about practicing t'ai chi because they felt they were too weak to practice. Because t'ai chi can be helpful in promoting the well-being of elders, it is essential for health care professionals to overcome the barriers to its uses in elderly populations.

Clinical use of tai chi in elderly populations

Tai chi, a type of low-intensity exercise, has received growing attention in both eastern and western cultures, especially its use with the most rapidly increasing segment of the population-elders. Previous research findings further supported the idea that tai chi is appropriate for elderly populations and helps promote their well-being. In this article, the beneficial effects of tai chi for elders are summarized, resources to increase awareness about the exercise are provided, and ways to promote tai chi in elderly populations are suggested.

Effect of physical activity during teenage years, based on type of sport and duration of exercise, on bone mineral density of young, premenopausal Japanese women

In this cross-sectional study, 91 healthy premenopausal women aged 20-39 years were investigated to determine the effect of physical activities during their teenage years on their current bone mineral densities (BMD). We measured whole-body BMD (WBMD), lumbar BMD (LBMD), and radial BMD (RBMD) with dual energy X-ray absorptiometry (DXA). Using a questionnaire, we asked the women about their physical activities during junior and senior high school and at present. We also asked about their current nutritional status and past and current milk intake. After adjusting for age, body mass index (BMI), current total calorie and calcium (Ca) intake, and milk intake when they were teenagers and at present, we determined that subjects who exercised during extracurricular activities at each of the three periods (during junior and senior high school and at present) had significantly higher WBMD and LBMD (P <0.01, respectively) than did those who did not exercise at those times. Subjects who played high-impact sports at each period had significantly higher WBMD and LBMD than did subjects who played low-impact sports (P <0.05, respectively). Subjects who had exercised regularly from their teenage years to the present had significantly higher BMD at all sites than BMD in other subjects after adjusting for the potential confounders described above (P <0.05, respectively). Our data suggest that continuous exercise beginning in junior high school, especially high-impact sports, may be associated with greater current bone mass. It is important to incorporate adequate exercise beginning in the teenage years to lower one's future risk for osteoporosis.

The role of physiotherapy in the prevention and treatment of osteoporosis

Osteoporosis is an increasing public health problem that causes loss of life and reduced quality of life in sufferers. Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis. Physiotherapists have a role to play in this condition through exercise prescription, therapeutic modalities, specific techniques and education. Appropriate treatment goals can be established following a thorough assessment of signs and symptoms, risk factors for osteoporosis and functional status. Levels of bone density measured from dual energy X-ray absorptiometry can help guide patient management. Since the aim is to maximize peak bone mass in children and adolescents, participation in a variety of high-impact activities should be encouraged. In the middle adult years, small increases in bone mass may be achieved by structured weight-training and weight-bearing exercise. In the older adult years, particularly if osteopenia or osteoporosis is present, the aim is to conserve bone mass, reduce the risk of falls, promote extended posture, reduce pain, and improve mobility and function.