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Healy RD, Smith C, Woessner MN, Levinger I. Relationship between VO2peak, VO2 Recovery Kinetics, and Muscle Function in Older Adults. Gerontology 2023; 69:1278-1283. [PMID: 37660695 PMCID: PMC10634273 DOI: 10.1159/000533920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The efficiency of the cardiovascular system to recover following an exercise bout is measured by oxygen (VO2) recovery kinetics. In older adults with a chronic disease, a higher aerobic capacity (VO2peak) and faster VO2 recovery kinetics are associated with higher muscle strength and physical capacity. Yet, this relationship in healthy older adults remains unclear. The aim of this cross-sectional study was to determine whether a higher VO2peak and faster VO2 recovery kinetics are associated with higher muscle strength and physical performance in healthy community-dwelling older adults. METHODS Thirty-five healthy older adults (female 25/male 10, mean age 73 ± 6 years) performed a graded exercise test on a cycle ergometer. VO2peak and VO2 recovery kinetics were assessed through gas exchange analysis. Muscle strength was determined by maximal leg (one-repetition maximum on leg press; 1RM) and grip strength, and physical performance was determined by the physical performance test (PPT) which assessed gait speed, stair ascent and descent, and timed up-and-go. RESULTS Higher VO2peak was associated with stronger leg (r = 0.59, p < 0.001) and grip strength (r = 0.39, p < 0.03), but no relationship to PPT (p > 0.05). There was also no relationship between VO2 recovery kinetics and leg and grip strength or PPT (p > 0.05). CONCLUSION In healthy community-dwelling older adults, VO2peak, but not VO2 recovery kinetics, is associated with muscle strength. This suggests that muscle strength may be an important factor related to aerobic capacity that could assist in identifying older adults who should be prioritized for resistance training.
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Affiliation(s)
- Rhiannon D. Healy
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Cassandra Smith
- Institute for Nutrition Research, School of Health and Medical Sciences, Edith Cowan University, Perth, WA, Australia
| | - Mary N. Woessner
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
- Institute for Nutrition Research, School of Health and Medical Sciences, Edith Cowan University, Perth, WA, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC, Australia
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2
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Alonso N, Meinitzer A, Fritz-Petrin E, Enko D, Herrmann M. Role of Vitamin K in Bone and Muscle Metabolism. Calcif Tissue Int 2023; 112:178-196. [PMID: 35150288 PMCID: PMC9859868 DOI: 10.1007/s00223-022-00955-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/26/2022] [Indexed: 01/25/2023]
Abstract
Vitamin K, a cofactor for the γ-glutamyl carboxylase enzyme, is required for the post-translational activation of osteocalcin and matrix Gla protein, which play a key role in bone and muscle homeostasis. In vivo and in vitro models for osteoporosis and sarcopenia suggest the vitamin K could exert a positive effect in both conditions. In bone, it increases osteoblastogenesis, whilst decreases osteoclast formation and function. In muscle, it is associated with increased satellite cell proliferation and migration and might play a role in energy metabolism. Observational trials suggest that high levels of vitamin K are associated with increased bone mineral density and reduced fracture risk. However, interventional studies for vitamin K supplementation yielded conflicting results. Clinical trials in sarcopenia suggest that vitamin K supplementation could improve muscle mass and function. One of the main limitations on the vitamin K studies are the technical challenges to measure its levels in serum. Thus, they are obtained from indirect sources like food questionnaires, or levels of undercarboxylated proteins, which can be affected by other environmental or biological processes. Although current research appoints to a beneficial effect of vitamin K in bone and muscle, further studies overcoming the current limitations are required in order to incorporate this supplementation in the clinical management of patients with osteosarcopenia.
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Affiliation(s)
- N Alonso
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - A Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - E Fritz-Petrin
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - D Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - M Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
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3
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Smith C, Hiam D, Tacey A, Lin X, Woessner MN, Zarekookandeh N, Garnham A, Chubb P, Lewis JR, Sim M, Herrmann M, Duque G, Levinger I. Higher bone remodeling biomarkers are related to a higher muscle function in older adults: Effects of acute exercise. Bone 2022; 165:116545. [PMID: 36108920 DOI: 10.1016/j.bone.2022.116545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/14/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
Bone and muscle are closely linked mechanically and biochemically. Bone hormones secreted during bone remodeling might be linked to muscle mass and strength maintenance. Exercise elicits high mechanical strain and is essential for bone health. However, the relationship between commonly used bone turnover markers (BTMs) and muscle function in community dwelling older adults remains unclear. It is also unknown how acute exercise with differing mechanical strain may affect BTMs, and whether baseline muscle function alters BTM responses differently. We tested the hypothesis that BTMs are associated with muscle function, and that acute exercise could change the circulating levels of BTMs. Thirty-five older adults (25 females/10 males, 72.8 ± 6.0 years) participated. Baseline assessments included body composition (DXA), handgrip strength and a physical performance test (PPT) (gait speed, timed-up-and-go [TUG], stair ascent/descent). Leg muscle quality (LMQ) and stair climb power (SCP) were calculated. Participants performed (randomized) 30 min aerobic (AE) (cycling 70%HRPeak) and resistance (RE) (leg press 70%RM, jumping) exercise. Serum β-isomerized C-terminal telopeptides (β-CTX), procollagen of type I propeptide (P1NP), total osteocalcin (t)OC and ucOC were assessed at baseline and post-exercise. Data were analyzed using linear mixed models and simple regressions, adjusted for sex. At baseline, higher muscle strength (LMQ, handgrip) was related to higher P1NP, higher SCP was related to higher P1NP and β-CTX, and better physical performance (lower PPT) related to higher P1NP and β-CTX (p < 0.05). Exercise, regardless of mode, decreased β-CTX and tOC (all p < 0.05), while P1NP and ucOC remained unaltered. Higher baseline handgrip strength, SCP and LMQ was associated with lower post-exercise β-CTX responses, and poorer baseline mobility (increased TUG time) was associated with higher post-exercise β-CTX. Independently of exercise mode, acute exercise decreased β-CTX and tOC. Our data suggest that in older adults at baseline, increased BTM levels were linked to better muscle function. Altogether, our data strengthens the evidence for bone-muscle interaction, however, mechanisms behind this specific component of bone-muscle crostalk remain unclear.
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Affiliation(s)
- Cassandra Smith
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Danielle Hiam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Alexander Tacey
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia
| | - Xuzhu Lin
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Mary N Woessner
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Navabeh Zarekookandeh
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Andrew Garnham
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Paul Chubb
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Australia; Medical School, University Western Australia, Perth, WA, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia; Medical School, University Western Australia, Perth, WA, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia; Medical School, University Western Australia, Perth, WA, Australia
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
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Abreu EL, Vance A, Cheng AL, Brotto M. Musculoskeletal Biomarkers Response to Exercise in Older Adults. FRONTIERS IN AGING 2022; 3:867137. [PMID: 35821851 PMCID: PMC9261344 DOI: 10.3389/fragi.2022.867137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
Exercise is an essential component of any good health style, being particularly important for older adults to counteract the effects of aging, including sarcopenia and osteoporosis, which can result in lower fall probability. Exercise programs for older adults are especially designed for that population. A rigorous evaluation of those programs is necessary to assure most benefit is achieved. Serum biomarkers of proteins intrinsic to musculoskeletal homeostasis could contribute objectively to the assessment of the benefits of exercise. In this work, in addition to the usual physical fitness and balance tests, ELISA assays quantified the serum levels of six proteins and one polysaccharide important for the homeostasis of muscle (troponin T and alpha-actinin), tendon/ligament (tenomodulin), cartilage (cartilage oligomeric matrix protein and hyaluronan) and bone (osteocalcin and sclerostin), before and after 8 weeks of an exercise program tailored to older adults, Stay Strong Stay Healthy, offered at a Community Center and at an Independent Senior Living facility. Statistical significance was determined by non-parametric tests (Wilcoxon Signed Ranks and Mann-Whitney U). Physical fitness and balance improved as expected along with a significant decrease in sclerostin, pointing to less inhibition of bone deposition. However, when considering each type of dwelling separately, older adults always saw a significant decrease of the isoform of troponin T associated with fast-twitch muscles, suggesting that daily levels of physical activity may also have a role in the benefit of older adults from exercise.
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Affiliation(s)
- Eduardo L. Abreu
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amy Vance
- University of Missouri Extension, Columbia, MO, United States
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Marco Brotto
- Bone-Muscle Research Center, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
- *Correspondence: Marco Brotto,
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Seale K, Horvath S, Teschendorff A, Eynon N, Voisin S. Making sense of the ageing methylome. Nat Rev Genet 2022; 23:585-605. [PMID: 35501397 DOI: 10.1038/s41576-022-00477-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 12/22/2022]
Abstract
Over time, the human DNA methylation landscape accrues substantial damage, which has been associated with a broad range of age-related diseases, including cardiovascular disease and cancer. Various age-related DNA methylation changes have been described, including at the level of individual CpGs, such as differential and variable methylation, and at the level of the whole methylome, including entropy and correlation networks. Here, we review these changes in the ageing methylome as well as the statistical tools that can be used to quantify them. We detail the evidence linking DNA methylation to ageing phenotypes and the longevity strategies aimed at altering both DNA methylation patterns and machinery to extend healthspan and lifespan. Lastly, we discuss theories on the mechanistic causes of epigenetic ageing.
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Affiliation(s)
- Kirsten Seale
- Institute for Health and Sport (iHeS), Victoria University, Footscray, Melbourne, Victoria, Australia
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Altos Labs, San Diego, CA, USA
| | - Andrew Teschendorff
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China.,UCL Cancer Institute, University College London, London, UK
| | - Nir Eynon
- Institute for Health and Sport (iHeS), Victoria University, Footscray, Melbourne, Victoria, Australia.
| | - Sarah Voisin
- Institute for Health and Sport (iHeS), Victoria University, Footscray, Melbourne, Victoria, Australia.
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Woessner MN, Hiam D, Smith C, Lin X, Zarekookandeh N, Tacey A, Parker L, Landen S, Jacques M, Lewis JR, Brennan-Speranza T, Voisin S, Duque G, Eynon N, Levinger I. Osteoglycin Across the Adult Lifespan. J Clin Endocrinol Metab 2022; 107:e1426-e1433. [PMID: 34850904 DOI: 10.1210/clinem/dgab861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Osteoglycin (OGN) is a proteoglycan released from bone and muscle which has been associated with markers of metabolic health. However, it is not clear whether the levels of circulating OGN change throughout the adult lifespan or if they are associated with clinical metabolic markers or fitness. OBJECTIVE We aimed to identify the levels of circulating OGN across the lifespan and to further explore the relationship between OGN and aerobic capacity as well as OGN's association with glucose and HOMA-IR. METHODS 107 individuals (46 males and 61 females) aged 21-87 years were included in the study. Serum OGN levels, aerobic capacity (VO2peak), glucose, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed. T-tests were used to compare participant characteristics between sexes. Regression analyses were performed to assess the relationship between OGN and age, and OGN and fitness and metabolic markers. RESULTS OGN displayed a nonlinear, weak "U-shaped" relationship with age across both sexes. Men had higher levels of OGN than women across the lifespan (β = 0.23, P = .03). Age and sex explained 16% of the variance in OGN (adjusted R2 = 0.16; P < .001). Higher OGN was associated with higher VO2peak (β = 0.02, P = .001); however, those aged <50 showed a stronger positive relationship than those aged >50. A higher OGN level was associated with a higher circulating glucose level (β = 0.17, P < .01). No association was observed between OGN and HOMA-IR. CONCLUSION OGN was characterized by a U-shaped curve across the lifespan which was similar between sexes. Those with a higher aerobic capacity or higher glucose concentration had higher OGN levels. Our data suggest an association between OGN and aerobic fitness and glucose regulation. Future studies should focus on exploring the potential of OGN as a biomarker for chronic disease.
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Affiliation(s)
- Mary N Woessner
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Danielle Hiam
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Cassandra Smith
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Xuzhu Lin
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Navabeh Zarekookandeh
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Alexander Tacey
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Lewan Parker
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Shanie Landen
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Macsue Jacques
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
- The University of Sydney, School of Public Health, Sydney Medical School, Centre for Kidney Research, Children's Hospital at Westmead, NSW, Australia
| | | | - Sarah Voisin
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Nir Eynon
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
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Feehan J, Smith C, Tripodi N, Degabrielle E, Al Saedi A, Vogrin S, Duque G, Levinger I. Higher Levels of Circulating Osteoprogenitor Cells Are Associated With Higher Bone Mineral Density and Lean Mass in Older Adults: A Cross-Sectional Study. JBMR Plus 2021; 5:e10561. [PMID: 34761152 PMCID: PMC8567483 DOI: 10.1002/jbm4.10561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
Circulating osteo progenitor (COP) cells are a heterogeneous population of cells that circulate within the peripheral blood with characteristics of the bone marrow mesenchymal stem and progenitor pool. Little is known about the behavior of this cell population in humans. The aim of this study was to identify whether a relationship exists between COP cells (as a percentage of the peripheral blood monocytic cells) and musculoskeletal morphometry and to identify if COP have potential clinical utility as a biomarker for osteoporosis. We recruited 57 older adults (median age: 69 years; IQR: 65, 75 years) living independently in the community and performed cross‐sectional analysis to identify associations between the percentage of COP cells and body composition parameters, and through receiver operating characteristic analysis, we evaluated their ability to act as a biomarker of osteoporosis. COP cells were moderately associated with whole‐body bone mineral density (BMD) (r = 0.323, p = 0.014) and bone mineral content (BMC) (r = 0.387, p = 0.003), neck of femur BMD (r = 0.473, p < 0.001), and BMC (r = 0.461, p < 0.001) as well as appendicular lean mass (ALM) (p = 0.038) and male sex (p = 0.044) in univariable analysis. In multivariable analysis controlling for age, gender, height, and weight, COP cells remained strongly associated with neck of femur BMD (p = 0.001) and content (p = 0.003). COP cells were also a good predictor of osteoporosis (dual‐energy X‐ray absorptiometry [DXA] T‐score < −2.5) at the neck of femur (cutoff: 0.4%; sensitivity: 100%; specificity 79%) and total body (cutoff: 0.35%; sensitivity: 80%; specificity: 81%). This study shows strong relationships between bone parameters and COP cell number and male sex. They also have potential as a biomarker of osteoporosis, which may provide a new tool for advanced detection and screening in clinical settings. Future larger evaluation studies should verify the cutoffs for biomarker use, and further explore the relationship between COP cells and muscle. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jack Feehan
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia.,Institute for Health and Sport (IHES) Victoria University Melbourne VIC Australia
| | - Cassandra Smith
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia.,Institute for Health and Sport (IHES) Victoria University Melbourne VIC Australia
| | - Nicholas Tripodi
- Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia.,Institute for Health and Sport (IHES) Victoria University Melbourne VIC Australia
| | - Elizabeth Degabrielle
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia
| | - Ahmed Al Saedi
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia
| | - Sara Vogrin
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia
| | - Gustavo Duque
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia.,Institute for Health and Sport (IHES) Victoria University Melbourne VIC Australia
| | - Itamar Levinger
- Department of Medicine - Western Health The University of Melbourne Melbourne VIC Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Western Health The University of Melbourne and Victoria University Melbourne VIC Australia.,Institute for Health and Sport (IHES) Victoria University Melbourne VIC Australia
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