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McGee AE, Alibegashvili T, Elfgren K, Frey B, Grigore M, Heinonen A, Jach R, Jariene K, Kesic V, Küppers V, Kyrgiou M, Leeson S, Louwers J, Mazurec M, Mergui J, Pedro A, Šavrova A, Siegler E, Tabuica U, Trojnarska D, Trzeszcz M, Turyna R, Volodko N, Cruickshank ME. European consensus statement on expert colposcopy. Eur J Obstet Gynecol Reprod Biol 2023; 290:27-37. [PMID: 37716200 DOI: 10.1016/j.ejogrb.2023.08.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.
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Affiliation(s)
- A E McGee
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK.
| | - T Alibegashvili
- Department of Gynaecology, Georgian National Screening Center, Tbilisi, Georgia
| | - K Elfgren
- Karolinska Institutet, Stockholm, Sweden
| | - B Frey
- Frauenklinik Baselland, Switzerland
| | - M Grigore
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - A Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital
| | - R Jach
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - K Jariene
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V Kesic
- Faculty of Medicine, University of Belgrade, Clinic of Obstetrics and Gynaecology, Clinical Center of Serbia, Belgrade, Serbia
| | - V Küppers
- Frauenheilkunde & Geburtshilfe, Zytologisches Labor, Dysplasie-Sprechstunde, Düsseldorf, Germany
| | - M Kyrgiou
- IRDB, MDR & Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - S Leeson
- West London Gynaecological Cancer Centre, Imperial College NHS Trust, UK; Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Wales, UK
| | - J Louwers
- Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, the Netherlands
| | - M Mazurec
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - J Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
| | - A Pedro
- Department of Obstetrics and Gynaecology, CUF Sintra Hospital, Sintra, Portugal
| | - A Šavrova
- Gynaecology Centre, North Estonia Medical Centre, Estonia
| | - E Siegler
- The Israeli Society of Colposcopy and Cervical and Vulvar Pathology, Peretz Berenstein St, Haifa, Israel
| | - U Tabuica
- Department of Obstetrics and Gynaecology, State University of Medicine and Pharmacy, Referral Center of Colposcopy, Chisinau, Moldavia
| | - D Trojnarska
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - M Trzeszcz
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - R Turyna
- Institute for the Care of Mother and Child, Prague 4, Czech Republic; Third Faculty of Medicine, Charles University, Prague 10, Czech Republic; Institute of Postgraduate Education in Health Care - IPVZ, Prague 10, Czech Republic
| | - N Volodko
- Department of Oncology and Radiology, Danylo Halytsky Lviv national medical university, Lviv, Ukraine
| | - M E Cruickshank
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK
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Rossi MK, Pasanen K, Heinonen A, Äyrämö S, Räisänen AM, Leppänen M, Myklebust G, Vasankari T, Kannus P, Parkkari J. Performance in dynamic movement tasks and occurrence of low back pain in youth floorball and basketball players. BMC Musculoskelet Disord 2020; 21:350. [PMID: 32503505 PMCID: PMC7275454 DOI: 10.1186/s12891-020-03376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players. METHODS Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox's proportional hazard models with mixed effects and time-varying risk factors were used for analysis. RESULTS We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks. CONCLUSIONS Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation. LEVEL OF EVIDENCE Prognosis, level 1b.
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Affiliation(s)
- M K Rossi
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland.
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - K Pasanen
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - A Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - S Äyrämö
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - A M Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - M Leppänen
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland
| | - G Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Sciences, Norwegian School of Sport Sciences, Oslo, Norway
| | - T Vasankari
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland
| | - P Kannus
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland
- Department of Orthopedics & Traumatology, Tampere University Hospital, Tampere, Finland
| | - J Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, 33501, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
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Rossi MK, Pasanen K, Heinonen A, Myklebust G, Kannus P, Kujala UM, Tokola K, Parkkari J. Incidence and risk factors for back pain in young floorball and basketball players: A Prospective study. Scand J Med Sci Sports 2018; 28:2407-2415. [DOI: 10.1111/sms.13237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Affiliation(s)
- M. K. Rossi
- Tampere Research Center of Sports Medicine; Tampere Finland
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - K. Pasanen
- Tampere Research Center of Sports Medicine; Tampere Finland
- UKK Institute for Health Promotion Research; Tampere Finland
- Faculty of Kinesiology; Sport Injury Prevention Research Centre; University of Calgary; Calgary Canada
| | - A. Heinonen
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - G. Myklebust
- Department of Sports Sciences; Oslo Sports Trauma Research Center; Norwegian School of Sport Sciences; Oslo Norway
| | - P. Kannus
- Injury and Osteoporosis Research Center; UKK Institute; Tampere Finland
| | - U. M. Kujala
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - K. Tokola
- Tampere Research Center of Sports Medicine; Tampere Finland
| | - J. Parkkari
- Tampere Research Center of Sports Medicine; Tampere Finland
- UKK Institute for Health Promotion Research; Tampere Finland
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Päivärinne V, Kautiainen H, Heinonen A, Kiviranta I. Relations between subdomains of physical activity, sedentary lifestyle, and quality of life in young adult men. Scand J Med Sci Sports 2018; 28:1389-1396. [PMID: 29095553 DOI: 10.1111/sms.13003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/31/2022]
Abstract
To assess the relationship between physical activity (PA) in work, transport, domestic, and leisure-time domains (with sitting time included) and health-related quality of life (HRQoL) among young adult men. The long version of IPAQ and SF-36 Health Survey were used to assess PA and HRQoL, respectively, in 1425 voluntary 20- to 40-year-old Finnish male participants. Participants were divided into tertiles (MET-h/week): Lowest tertile (<38 MET-h/week), Middle tertile (38-100 MET-h/week), and Highest tertile (>100 MET-h/week). The IPAQ domain leisure-time PA predicted positively the Physical Component Summary (PCS) (β = 0.11, 95% CI: 0.06 to 0.16) and Mental Component Summary (MCS) (β = 0.11, 95% CI: 0.05 to 0.16) dimensions. Occupational PA predicted negative relationships in the PCS (β = -0.13, 95% CI: -0.19 to -0.07), and sitting time predicted negative relationships in the MCS dimension (β = -0.13, 95% CI: -0.18 to -0.07). In addition, a linear relationship was found between total PA level (including sitting time) and all of the IPAQ domains (<0.001). The Middle tertile had the highest leisure-time PA (38% of total PA), whereas the highest sitting time (28%) and lowest occupational PA (8%) were found in the Lowest tertile. The Highest tertile had the highest occupational PA (61%), while the leisure-time PA was the lowest (16%). Different PA domains appear to have positive and negative relationships to mental and physical aspects of HRQoL. Relatively high leisure-time PA indicated a better HRQoL regardless of the amount of total PA, while occupational PA and higher daily sitting time related negatively to HRQoL.
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Affiliation(s)
- V Päivärinne
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland
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Hirvasniemi J, Thevenot J, Multanen J, Haapea M, Heinonen A, Nieminen MT, Saarakkala S. Association between radiography-based subchondral bone structure and MRI-based cartilage composition in postmenopausal women with mild osteoarthritis. Osteoarthritis Cartilage 2017; 25:2039-2046. [PMID: 28964891 DOI: 10.1016/j.joca.2017.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our aim was to investigate the relation between radiograph-based subchondral bone structure and cartilage composition assessed with delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 relaxation time. DESIGN Ninety-three postmenopausal women (Kellgren-Lawrence grade 0: n = 13, 1: n = 26, 2: n = 54) were included. Radiograph-based bone structure was assessed using entropy of the Laplacian-based image (ELap) and local binary patterns (ELBP), homogeneity indices of the local angles (HIAngles,mean, HIAngles,Perp, HIAngles,Paral), and horizontal (FDHor) and vertical fractal dimensions (FDVer). Mean dGEMRIC index and T2 relaxation time of tibial cartilage were calculated to estimate cartilage composition. RESULTS HIAngles,mean (rs = -0.22) and HIAngles,Paral (rs = -0.24) in medial subchondral bone were related (P < 0.05) to dGEMRIC index of the medial tibial cartilage. ELap (rs = -0.23), FDHor,0.34 mm (r = 0.21) and FDVer,0.68 mm (r = 0.24) in medial subchondral bone were related (P < 0.05) to T2 relaxation time values of the medial tibial cartilage. FDHor at different scales in lateral subchondral bone were related (P < 0.01) to dGEMRIC index (r = 0.29-0.41) and T2 values of lateral tibial cartilage (r = -0.28 to -0.36). FDVer at larger scales were related (P < 0.05) to dGEMRIC index (r = 0.24-0.25) and T2 values of lateral tibial cartilage (r = -0.21). HIAngles,Paral (r = -0.25) and FDVer,0.68 mm (rs = 0.22) in the lateral tibial trabecular bone were related (P < 0.05) to dGEMRIC index of the lateral tibial cartilage. CONCLUSION Our results support the presumption that several tissues are affected in the early osteoarthritis (OA). Furthermore, they indicate that the detailed analysis of radiographs may serve as a complementary imaging tool for OA studies.
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Affiliation(s)
- J Hirvasniemi
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland.
| | - J Thevenot
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland.
| | - J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M Haapea
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - A Heinonen
- Faculty of Sports and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Infotech Oulu, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Suominen TH, Korhonen MT, Alén M, Heinonen A, Mero A, Törmäkangas T, Suominen H. Effects of a 20-week high-intensity strength and sprint training program on tibial bone structure and strength in middle-aged and older male sprint athletes: a randomized controlled trial. Osteoporos Int 2017. [PMID: 28623425 DOI: 10.1007/s00198-017-4107-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED This randomized, controlled, high-intensity strength and sprint training trial in middle-aged and older male sprint athletes showed significant improvements in mid-tibial structure and strength. The study reveals the adaptability of aging bone, suggesting that through a novel, intensive training stimulus it is possible to strengthen bones during aging. INTRODUCTION High-load, high-speed and impact-type exercise may be an efficient way of improving bone strength even in old age. We evaluated the effects of combined strength and sprint training on indices of bone health in competitive masters athletes, who serve as a group of older people who are likely to be able to participate in vigorous exercise of this kind. METHODS Seventy-two men (age 40-85) were randomized into an experimental (EX, n = 40) and a control (CTRL, n = 32) group. EX participated in a 20-week program combining heavy and explosive strength exercises with sprint training. CTRL maintained their usual, run-based sprint training schedules. Bone structural, strength and densitometric parameters were assessed by peripheral QCT at the distal tibia and tibial midshaft. RESULTS The intervention had no effects on distal tibia bone traits. At the mid-tibia, the mean difference in the change in cortical thickness (ThCO) in EX compared to CTRL was 2.0% (p = 0.007). The changes in structure and strength were more pronounced in the most compliant athletes (training adherence >75%). Compared to CTRL, total and cortical cross-sectional area, ThCO, and the area and density-weighted moments of inertia for the direction of the smallest flexural rigidity (I minA , I minD ) increased in EX by 1.6-3.2% (p = 0.023-0.006). Polar mass distribution analysis revealed increased BMC at the anteromedial site, whereas vBMD decreased (p = 0.035-0.043). CONCLUSIONS Intensive strength and sprint training improves mid-tibia structure and strength in middle-aged and older male sprint athletes, suggesting that in the presence of high-intensity loading exercise, the adaptability of the bone structure is maintained during aging.
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Affiliation(s)
- T H Suominen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M T Korhonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - M Alén
- Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - A Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A Mero
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - T Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - H Suominen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Waller B, Munukka M, Rantalainen T, Lammentausta E, Nieminen MT, Kiviranta I, Kautiainen H, Häkkinen A, Kujala UM, Heinonen A. Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up. Osteoarthritis Cartilage 2017; 25:1238-1246. [PMID: 28263901 DOI: 10.1016/j.joca.2017.02.800] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/31/2017] [Accepted: 02/21/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the effects of 4-months intensive aquatic resistance training on body composition and walking speed in post-menopausal women with mild knee osteoarthritis (OA), immediately after intervention and after 12-months follow-up. Additionally, influence of leisure time physical activity (LTPA) will be investigated. DESIGN This randomised clinical trial assigned eighty-seven volunteer postmenopausal women into two study arms. The intervention group (n = 43) participated in 48 supervised intensive aquatic resistance training sessions over 4-months while the control group (n = 44) maintained normal physical activity. Eighty four participants continued into the 12-months' follow-up period. Body composition was measured with dual-energy X-ray absorptiometry (DXA). Walking speed over 2 km and the knee injury and osteoarthritis outcome score (KOOS) were measured. LTPA was recorded with self-reported diaries. RESULTS After the 4-month intervention there was a significant decrease (P = 0.002) in fat mass (mean change: -1.17 kg; 95% CI: -2.00 to -0.43) and increase (P = 0.002) in walking speed (0.052 m/s; 95% CI: 0.018 to 0.086) in favour of the intervention group. Body composition returned to baseline after 12-months. In contrast, increased walking speed was maintained (0.046 m/s; 95% CI 0.006 to 0.086, P = 0.032). No change was seen in lean mass or KOOS. Daily LTPA over the 16-months had a significant effect (P = 0.007) on fat mass loss (f2 = 0.05) but no effect on walking speed. CONCLUSIONS Our findings show that high intensity aquatic resistance training decreases fat mass and improves walking speed in post-menopausal women with mild knee OA. Only improvements in walking speed were maintained at 12-months follow-up. Higher levels of LTPA were associated with fat mass loss. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- B Waller
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M Munukka
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
| | - I Kiviranta
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - A Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - U M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - A Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Multanen J, Rantalainen T, Kautiainen H, Ahola R, Jämsä T, Nieminen MT, Lammentausta E, Häkkinen A, Kiviranta I, Heinonen A. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: a 12-month RCT. Osteoporos Int 2017; 28:1323-1333. [PMID: 28035445 DOI: 10.1007/s00198-016-3875-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 12/07/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED It is uncertain whether subjects with mild knee osteoarthritis, and who may be at risk of osteoporosis, can exercise safely with the aim of improving hip bone strength. This RCT showed that participating in a high-impact exercise program improved femoral neck strength without any detrimental effects on knee cartilage composition. INTRODUCTION No previous studies have examined whether high-impact exercise can improve bone strength and articular cartilage quality in subjects with mild knee osteoarthritis. In this 12-month RCT, we assessed the effects of progressive high-impact exercise on femoral neck structural strength and biochemical composition of knee cartilage in postmenopausal women. METHODS Eighty postmenopausal women with mild knee radiographic osteoarthritis were randomly assigned into the exercise (n = 40) or control (n = 40) group. Femoral neck structural strength was assessed with dual-energy X-ray absorptiometry. The knee cartilage region exposed to exercise loading was measured by the quantitative MRI techniques of T2 mapping and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Also, an accelerometer-based body movement monitor was used to evaluate the total physical activity loading on the changes of femoral neck strength in all participants. Training effects on the outcome variables were estimated by the bootstrap analysis of covariance. RESULTS A significant between-group difference in femoral neck bending strength in favor of the trainees was observed after the 12-month intervention (4.4%, p < 0.01). The change in femoral neck bending strength remained significant after adjusting for baseline value, age, height, and body mass (4.0%, p = 0.020). In all participants, the change in bending strength was associated with the total physical activity loading (r = 0.29, p = 0.012). The exercise participation had no effect on knee cartilage composition. CONCLUSION The high-impact training increased femoral neck strength without having any harmful effect on knee cartilage in women with mild knee osteoarthritis. These findings imply that progressive high-impact exercise is a feasible method in seeking to prevent hip fractures in postmenopausal women whose articular cartilage may also be frail.
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Affiliation(s)
- J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Center for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Melbourne, Melbourne, Australia
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - R Ahola
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - T Jämsä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Department of Radiology, University of Oulu, Oulu, Finland
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - A Heinonen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
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Hakala S, Rintala A, Immonen J, Karvanen J, Heinonen A, Sjögren T. Effectiveness of technology-based distance interventions promoting physical activity: Systematic review, meta-analysis and meta-regression. J Rehabil Med 2017; 49:97-105. [DOI: 10.2340/16501977-2195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pasanen K, Ekola T, Vasankari T, Kannus P, Heinonen A, Kujala UM, Parkkari J. High ankle injury rate in adolescent basketball: A 3-year prospective follow-up study. Scand J Med Sci Sports 2016; 27:643-649. [PMID: 28033652 DOI: 10.1111/sms.12818] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 12/22/2022]
Abstract
This prospective study investigated the incidence and pattern of acute time-loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow-up study (2011-2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23-3.05). Injury rate was 34.47 (95% CI 26.59-42.34) in basketball games and 1.51 (95% CI 1.19-1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71-31.29). Seventy-eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty-three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.
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Affiliation(s)
- K Pasanen
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - T Ekola
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - T Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - P Kannus
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - A Heinonen
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - U M Kujala
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - J Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
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Munukka M, Waller B, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Sipilä S, Peuna A, Kautiainen H, Selänne H, Kiviranta I, Heinonen A. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage 2016; 24:1708-1717. [PMID: 27211862 DOI: 10.1016/j.joca.2016.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/19/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA). DESIGN Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire. RESULTS After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010). CONCLUSIONS Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness. TRIAL REGISTRATION NUMBER ISRCTN65346593.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - B Waller
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - T Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - A Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.
| | - M T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital.
| | - E Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - U M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - J Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - S Sipilä
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Gerontology Research Center, University of Jyväskylä, Finland.
| | - A Peuna
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
| | - H Selänne
- Mehiläinen Sports Medical Clinic, Jyväskylä, Finland.
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Giangregorio LM, Papaioannou A, Heinonen A, Cheung AM, Laprade J, Ashe MC, MacIntyre NJ, Shipp K, McGill S, Ravi J, Keller H, Wark JD. Intensity is a subjective construct. Osteoporos Int 2016; 27:2391-2392. [PMID: 26860501 PMCID: PMC5094884 DOI: 10.1007/s00198-016-3507-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Schlegel-UW Research Institute for Aging, Wareloo, ON, Canada.
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Laprade
- Division of Anatomy, University of Toronto, Toronto, ON, Canada
| | - M C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - N J MacIntyre
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - K Shipp
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | - S McGill
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada
| | - J Ravi
- Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, Canada
| | - H Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2K 2N1, Canada
- Schlegel-UW Research Institute for Aging, Wareloo, ON, Canada
| | - J D Wark
- University of Melbourne Department of Medicine, and Bone and Mineral Medicine, Royal Melbourne Hospital, Victoria, Australia
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Kulmala JP, Korhonen MT, Kuitunen S, Suominen H, Heinonen A, Mikkola A, Avela J. Whole body frontal plane mechanics across walking, running, and sprinting in young and older adults. Scand J Med Sci Sports 2016; 27:956-963. [DOI: 10.1111/sms.12709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J-P. Kulmala
- Department of Biology of Physical Activity; University of Jyväskylä; Jyväskylä Finland
| | - M. T. Korhonen
- Department of Health Sciences; University of Jyväskylä; Jyvaskyla Finland
| | - S. Kuitunen
- Research Institute for Olympic Sports; Jyväskylä Finland
| | - H. Suominen
- Department of Health Sciences; University of Jyväskylä; Jyvaskyla Finland
| | - A. Heinonen
- Department of Health Sciences; University of Jyväskylä; Jyvaskyla Finland
| | - A. Mikkola
- Department of Mechanical Engineering; Lappeenranta University of Technology; Jyväskylä Finland
| | - J. Avela
- Department of Biology of Physical Activity; University of Jyväskylä; Jyväskylä Finland
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Heinonen A, Aaltonen K, Joensuu J, Lähteenmäki J, Pertovaara M, Romu M, Hirvonen H, Similä A, Blom M, Nordström D. THU0213 Effectiveness of TNF-Inhibitors in the Treatment of Ankylosing Spondylitis: A Prospective Cohort Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Valtonen A, Pöyhönen T, Manninen M, Heinonen A, Sipilä S. Effects of preoperative aquatic resistance training on knee pain, mobility limitation and muscle impairments in people with late-stage knee osteoarthritis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Karihtala T, Heinonen A, Manninen M, Pöyhönen T, Sipilä S, Valtonen A. Effects of preoperative group-based aquatic training on health related quality of life in persons with late stage knee osteoarthritis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Multanen J, Heinonen A, Häkkinen A, Kautiainen H, Kujala U, Lammentausta E, Jämsä T, Kiviranta I, Nieminen M. Bone and cartilage characteristics in postmenopausal women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis. J Musculoskelet Neuronal Interact 2015; 15:69-77. [PMID: 25730654 PMCID: PMC5123610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the association between radiographically-assessed knee osteoarthritis and femoral neck bone characteristics in women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis. METHODS Ninety postmenopausal women (mean age [SD], 58 [4] years; height, 163 [6] cm; weight, 71 [11] kg) participated in this cross-sectional study. The severity of radiographic knee osteoarthritis was defined using Kellgren-Lawrence grades 0=normal (n=12), 1=doubtful (n=25) or 2=minimal (n=53). Femoral neck bone mineral content (BMC), section modulus (Z), and cross-sectional area (CSA) were measured with DXA. The biochemical composition of ipsilateral knee cartilage was estimated using quantitative MRI measures, T2 mapping and dGEMRIC. The associations between radiographic knee osteoarthritis grades and bone and cartilage characteristics were analyzed using generalized linear models. RESULTS Age-, height-, and weight-adjusted femoral neck BMC (p for linearity=0.019), Z (p for linearity=0.033), and CSA (p for linearity=0.019) increased significantly with higher knee osteoarthritis grades. There was no linear relationship between osteoarthritis grades and knee cartilage indices. CONCLUSIONS Increased DXA assessed hip bone strength is related to knee osteoarthritis severity. These results are hypothesis driven that there is an inverse relationship between osteoarthritis and osteoporosis. However, MRI assessed measures of cartilage do not discriminate mild radiographic osteoarthritis severity.
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Affiliation(s)
- J. Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland,Corresponding author: J. Multanen, Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland E-mail:
| | - A. Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A. Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - H. Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - U.M. Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - E. Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - T. Jämsä
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland,Department of Medical Technology, Institute of Biomedicine, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - I. Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - M.T. Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland,Department of Radiology, University of Oulu, Oulu, Finland
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Giangregorio LM, McGill S, Wark JD, Laprade J, Heinonen A, Ashe MC, MacIntyre NJ, Cheung AM, Shipp K, Keller H, Jain R, Papaioannou A. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int 2015; 26:891-910. [PMID: 25510579 PMCID: PMC5101068 DOI: 10.1007/s00198-014-2881-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided. INTRODUCTION The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. METHODS The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed. RESULTS Response rates were 52% (39/75) and 69% (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10 lbs, no twisting), but for those with vertebral fracture, especially in the presence of pain, multiple fractures, or hyperkyphosis, the risks of many activities may outweigh the benefits-physical therapist consultation is recommended. Examples of spine-sparing techniques and exercise prescription elements are provided. CONCLUSIONS Our recommendations guide health care providers on assessment, exercise prescription, and safe movement for individuals with osteoporosis.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada,
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Munukka M, Waller B, Multanen J, Rantalainen T, Häkkinen A, Nieminen MT, Lammentausta E, Kujala UM, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Relationship between lower limb neuromuscular performance and bone strength in postmenopausal women with mild knee osteoarthritis. J Musculoskelet Neuronal Interact 2014; 14:418-424. [PMID: 25524967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate whether neuromuscular performance predicts lower limb bone strength in different lower limb sites in postmenopausal women with mild knee osteoarthritis (OA). METHODS Neuromuscular performance of 139 volunteer women aged 50-68 with mild knee OA was measured using maximal counter movement jump test, isometric knee flexion and extension force and figure-of-eight-running test. Femoral neck section modulus (Z, mm(3)) was determined by data obtained from dual-energy X-ray absorptiometry. Data obtained using peripheral quantitative computed tomography was used to asses distal tibia compressive (BSId, g(2)/cm(4)) and tibial mid-shaft bending (SSImax(mid), mm(3)) strength indices. RESULTS After adjustment for height, weight and age, counter movement jump peak power production was the strongest independent predictor for Z (β=0.44; p<0.001) and for BSId (β=0.32; p=0.003). This was also true in concentric net impulse for Z (β=0.37; p=0.001) and for BSId (β=0.40; p<0.001). Additionally, knee extension force (β=0.30; p<0.001) and figure-of-eight-running test (β= -0.32; p<0.001) were among strongest independent predictors for BSId after adjustments. For SSImax(mid), concentric net impulse (β=0.33; p=0.002) remained as the strongest independent predictor after adjustments. CONCLUSIONS Neuromuscular performance in postmenopausal women with mild knee OA predicted lower limb bone strength in every measured skeletal site.
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Affiliation(s)
- M Munukka
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Giangregorio LM, MacIntyre NJ, Heinonen A, Cheung AM, Wark JD, Shipp K, McGill S, Ashe MC, Laprade J, Jain R, Keller H, Papaioannou A. Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise. Osteoporos Int 2014; 25:1465-72. [PMID: 24610579 PMCID: PMC5094885 DOI: 10.1007/s00198-014-2652-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED An international consensus process identified the following research priorities in osteoporosis and exercise: study of exercise in high-risk cohorts, evaluation of multimodal interventions, research examining translation into practice and a goal to examine fracture outcomes. INTRODUCTION To identify future research priorities related to exercise for people with osteoporosis with and without osteoporotic spine fracture via international consensus. METHODS An international expert panel and representatives from Osteoporosis Canada led the process and identified opinion leaders or stakeholders to contribute. A focus group of four patient advocates identified quality of life, mobility, activities of daily living, falls, bone mineral density, and harms as outcomes important for decision-making. Seventy-five individuals were invited to participate in an online survey asking respondents to define future research priorities in the area of osteoporosis and exercise; the response rate was 57%. Fifty-five individuals from seven countries were invited to a half-day consensus meeting; 60% of invitees attended. The results of the online survey, knowledge synthesis activities, and results of the focus group were presented. Nominal group technique was used to come to consensus on research priorities. RESULTS Research priorities included the study of exercise in high-risk cohorts (e.g., ≥ 65 years, low BMD, moderate/high risk of fracture, history of osteoporotic vertebral fractures, hyperkyphotic posture, functional impairments, or sedentary), the evaluation of multimodal interventions, research examining translation into practice, and a goal to examine fracture outcomes. The standardization of outcomes or protocols that could be evolved into large multicentre trials was discussed. CONCLUSIONS The research priorities identified as part of the Too Fit To Fracture initiative can be used to inform the development of multicentre collaborations to evaluate and implement strategies for engaging individuals with osteoporosis in a safe and effective exercise.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada,
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Leppänen M, Aaltonen S, Parkkari J, Heinonen A, Kujala UM. INTERVENTIONS TO PREVENT SPORTS RELATED INJURIES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Giangregorio LM, Papaioannou A, Macintyre NJ, Ashe MC, Heinonen A, Shipp K, Wark J, McGill S, Keller H, Jain R, Laprade J, Cheung AM. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 2014; 25:821-35. [PMID: 24281053 PMCID: PMC5112023 DOI: 10.1007/s00198-013-2523-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/17/2013] [Indexed: 11/25/2022]
Abstract
SUMMARY A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended. INTRODUCTION The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s). METHODS The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations. RESULTS The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training. CONCLUSIONS The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada,
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Ristolainen L, Kettunen JA, Waller B, Heinonen A, Kujala UM. Training-related risk factors in the etiology of overuse injuries in endurance sports. J Sports Med Phys Fitness 2014; 54:78-87. [PMID: 24445548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The purpose of this study was to clarify training-related risk factors for overuse injuries. METHODS This was twelve-month retrospective study which was done by self-reported postal questionnaire. The study group consisted of 446 men and women top-level Finnish athletes representing three different endurance sports (cross-country skiing, swimming, long-distance running) between the ages of 15-35. Self-reported anthropometric and training-related variables (such as starting age of training, years of active training, hours trained yearly, competition hours and weekly resting days) and occurrence of overuse injuries. RESULTS Athletes with less than 2 rest days per week during the training season had 5.2-fold risk (95% confidence intervals [CI] 1.89-14.06, P=0.001) for an overuse injury, and athletes who trained more than 700 hours during a year had 2.1-fold risk (95% CI 1.21-3.61, P=0.008) for an overuse injury compared to the others. Athletes who reported a tendon injury were on average two years older than athletes without such an injury (P<0.001). CONCLUSION We found that low number of recovery days and a high amount of training are training-related risk factors for overuse injuries in top-level endurance athletes. The higher number of tendon overuse injuries in older than younger athletes may indicate that age-related degeneration plays an important role in the etiology of tendon injuries. These findings should be taken into account when planning exercise programs for endurance athletes.
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Affiliation(s)
- L Ristolainen
- ORTON Orthopaedic Hospital ORTON Foundation, Helsinki, Finland -
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Peurala S, Karttunen A, Sjögren T, Paltamaa J, Heinonen A. Evidence for the effectiveness of walking training on walking and self-care after stroke: A systematic review and meta-analysis of randomized controlled trials. J Rehabil Med 2014; 46:387-99. [DOI: 10.2340/16501977-1805] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Degens H, Rittweger J, Parviainen T, Timonen KL, Suominen H, Heinonen A, Korhonen MT. Diffusion capacity of the lung in young and old endurance athletes. Int J Sports Med 2013; 34:1051-7. [PMID: 23771831 DOI: 10.1055/s-0033-1345137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lung diffusion capacity (D LCO) declines with age. A significant proportion of older endurance athletes develop exercise-induced hypoxemia (SaO2<95%). We hypothesised that master endurance athletes have a lower D LCO than age-matched non-athletes. We recruited 33 control (16 young; 17 old) and 29 male endurance athletes (13 young; 16 old) during the World Masters Athletics Indoor Championships, 2012 (Jyväskylä, Finland). To measure D LCO the participant exhaled to residual volume and then quickly inhaled to ≥ 90% total lung capacity from a gas source with 0.3% carbon monoxide. The D LCO and transfer coefficient (K CO) were corrected for the actual haemoglobin concentration. Spirometric function was similar in athletes and age-matched controls. D LCO and K CO were 33% and 25% lower in old and young controls, respectively (P<0.001). Although predicted D LCO and K CO were 11%-points higher in athletes than age-matched controls (P<0.001), they were 23% and 16% lower in old athletes than young controls, respectively (P<0.001). D LCO did not correlate with age-graded performance or weekly training hours. The better lung diffusion capacity in male endurance athletes than age-matched controls might be an adaptation to training, self-selection and/or attrition bias. However, the diffusion capacity of the older athlete is lower than that of the young non-athlete.
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Affiliation(s)
- H Degens
- Institute for Biophysical and Clinical Research into Human Movement, Manchester Metropolitan University, Manchester, United Kingdom
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Paltamaa J, Sjögren T, Peurala S, Heinonen A. Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. J Rehabil Med 2012; 44:811-23. [DOI: 10.2340/16501977-1047] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ireland A, Korhonen M, Heinonen A, Suominen H, Baur C, Stevens S, Degens H, Rittweger J. Side-to-side differences in bone strength in master jumpers and sprinters. J Musculoskelet Neuronal Interact 2011; 11:298-305. [PMID: 22130138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION This study evaluated side-to-side difference in tibial bone structure, calf muscle cross-sectional area (CSA) and hopping force in master athletes as a result of training for sports with different magnitudes of inter-leg loading difference. METHODS Tibial bone parameters (at 4%, 14%, 38% and 66% tibial length proximal to distal end), muscle CSA (at 66% tibial length) and hopping forces of both legs of 51 master athletes (conditioned jumpers, conditioned triple jumpers, unconditioned jumpers, hurdlers and sprinters) were examined using pQCT. In epiphyseal 4% slice bone CSA (Ar.tot), total BMC (vBMC.tot), trabecular BMC (vBMC.tb) cortical BMC (vBMC.ct), and trabecular BMD (vBMD.tb) were measured. In diaphyseal slices, Ar.tot, vBMC.ct, cortical density (vBMD.ct), cross-sectional moment of inertia (CSMI) and calf muscle CSA (MuscA) were examined. RESULTS In conditioned jumpers, side-to-side differences in favour of take-off leg were found in 4% slice in vBMC.tb (+4.1%) (P<0.05). A side-to-side difference was found in 66% slice vBMC.ct and CSMI (both P<0.05), with conditioned jumper (+2.8% and 6.6%) and triple jumper (+2.7% and 7.2%) values higher than other groups. CONCLUSION The results suggest that regular training in high-impact sports with uneven lower limb loading results in side-to-side differences in skeletal adaptation independent of age and gender, suggesting that high-impact exercise is effective in maintaining bone strength throughout human lifespan.
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Affiliation(s)
- A Ireland
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Manchester, United Kingdom.
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Al Nazer R, Rantalainen T, Heinonen A, Sievänen H, Mikkola A. Comments on the article titled ‘Component mode synthesis approach to estimate tibial strains in gait’, Journal of Medical Engineering & Technology, 33, pp. 488–495, 2009. J Med Eng Technol 2011; 35:441-2. [DOI: 10.3109/03091902.2011.602462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rantalainen T, Nikander R, Heinonen A, Daly RM, Sievanen H. An open source approach for regional cortical bone mineral density analysis. J Musculoskelet Neuronal Interact 2011; 11:243-248. [PMID: 21885899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Cortical porosity, particularly at the endocortical region, is recognised to play a central role in the pathogenesis of bone fragility. Therefore, the purpose of this study was to: 1) demonstrate how cortical volumetric BMD (vBMD) distribution can be analysed from (p)QCT images and 2) highlight the clinical significance of assessing regional density distribution of cortical bone. METHODS We used pQCT to compare mid-tibial cortical volumetric BMD distribution of 20 young (age 24(SD2) years, mass 77(11) kg, height 178(6) cm) and 25 elderly (72(4) years, 75(9) kg, 172(5) cm) men. Radial and polar cortical vBMD distributions were analysed using a custom built open source analysis tool which allowed the cortex to be divided into three concentric cortical divisions and in 36 cortical sectors originating from the centroid of the bone. RESULTS Mean vBMD did not differ between the groups (1135(16) vs. 1130(28) mg/cm, P = 0.696). In contrast, there was a significant age-group by radial division interaction for radial cortical vBMD (P<0.001). CONCLUSIONS The proposed analysis method for analysing cortical bone density distribution of pQCT images was effective for detecting regional differences in cortical density between young and elderly men, which would have been missed by just looking at mean vBMD values.
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Affiliation(s)
- T Rantalainen
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC 3125, Australia.
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Paavonen J, Heinonen A, Gissler M, Tapper AM, Jakobsson M. LBP-1.13 LEEP conisation and the risk for preterm birth: new health registry based data from Finland. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050119.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Al Nazer R, Klodowski A, Rantalainen T, Heinonen A, Sievänen H, Mikkola A. A full body musculoskeletal model based on flexible multibody simulation approach utilised in bone strain analysis during human locomotion. Comput Methods Biomech Biomed Engin 2011; 14:573-9. [DOI: 10.1080/10255842.2010.488223] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rantalainen T, Nikander R, Daly RM, Heinonen A, Sievänen H. Exercise loading and cortical bone distribution at the tibial shaft. Bone 2011; 48:786-91. [PMID: 21122824 DOI: 10.1016/j.bone.2010.11.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/18/2010] [Accepted: 11/20/2010] [Indexed: 11/26/2022]
Abstract
Cortical bone is not a uniform tissue, and its apparent density [cortical volumetric density (vBMD)] varies around the bone cross-section as well as along the axial length of the bone. It is not yet known, whether the varying vBMD distribution is attributable to modulation in the predominant loads affecting bone. The aim of the present study was to compare the cortical bone mass distribution through the bone cortex (radial distribution) and around the center of mass (polar distribution) among 221 premenopausal women aged 17-40 years representing athletes involved in high impact, odd impact, high magnitude, repetitive low impact, repetitive non-impact sports and leisure time physical activity (referent controls). Bone cross-sections at the tibial mid-diaphysis were assessed with pQCT. Radial and polar vBMD distributions were analyzed in three concentric cortical divisions within the cortical envelope and in four cortical sectors originating from the center of the bone cross-section. MANCOVA, including age as a covariate, revealed no significant group by division/sector interaction in either radial or polar distribution, but the mean vBMD values differed between groups (P<0.001). The high and odd-impact groups had 1.2 to 2.6% (P<0.05) lower cortical vBMD than referents, in all analyzed sectors/divisions. The repetitive, low-impact group had 0.4 to 1.0% lower (P<0.05) vBMD at the mid and outer cortical regions and at the anterior sector of the tibia. The high magnitude group had 1.2% lower BMD at the lateral sector (P<0.05). The present results generate a hypothesis that the radial and polar cortical bone vBMD distributions within the tibial mid-shaft are not modulated by exercise loading but the mean vBMD level is slightly affected.
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Affiliation(s)
- T Rantalainen
- Department of Mechanical Engineering, Lappeenranta University of Technology, Finland.
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Rantalainen T, Hoffrén M, Linnamo V, Heinonen A, Komi PV, Avela J, Nindl BC. Three-month bilateral hopping intervention is ineffective in initiating bone biomarker response in healthy elderly men. Eur J Appl Physiol 2011; 111:2155-62. [DOI: 10.1007/s00421-011-1849-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/20/2011] [Indexed: 11/29/2022]
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Nikander R, Kannus P, Rantalainen T, Uusi-Rasi K, Heinonen A, Sievänen H. Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings. Osteoporos Int 2010; 21:1687-94. [PMID: 19921084 DOI: 10.1007/s00198-009-1101-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED The association of long-term sport-specific exercise loading with cross-sectional geometry of the weight-bearing tibia was evaluated among 204 female athletes representing five different exercise loadings and 50 referents. All exercises involving ground impacts (e.g., endurance running, ball games, jumping) were associated with thicker cortex at the distal and diaphyseal sites of the tibia and also with large diaphyseal cross-section, whereas the high-magnitude (powerlifting) and non-impact (swimming) exercises were not. INTRODUCTION Bones adapt to the specific loading to which they are habitually subjected. In this cross-sectional study, the association of long-term sport-specific exercise loading with the geometry of the weight-bearing tibia was evaluated among premenopausal female athletes representing 11 different sports. METHODS A total of 204 athletes were divided into five exercise loading groups, and the respective peripheral quantitative computed tomographic data were compared to data obtained from 50 physically active, non-athletic referents. Analysis of covariance was used to estimate the between-group differences. RESULTS At the distal tibia, the high-impact, odd-impact, and repetitive low-impact exercise loading groups had approximately 30% to 50% (p < 0.05) greater cortical area (CoA) than the referents. At the tibial shaft, these three impact groups had approximately 15% to 20% (p < 0.05) greater total area (ToA) and approximately 15% to 30% (p < 0.05) greater CoA. By contrast, both the high-magnitude and repetitive non-impact groups had similar ToA and CoA values to the reference group at both tibial sites. CONCLUSIONS High-impact, odd-impact, and repetitive low-impact exercise loadings were associated with thicker cortex at the distal tibia. At the tibial shaft, impact loading was not only associated with thicker cortex, but also a larger cross-sectional area. High-magnitude exercise loading did not show such associations at either site but was comparable to repetitive non-impact loading and reference data. Collectively, the relevance of high strain rate together with moderate-to-high strain magnitude as major determinants of osteogenic loading of the weight-bearing tibia is implicated.
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Affiliation(s)
- R Nikander
- Bone Research Group, UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33501, Tampere, Finland.
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Rantalainen T, Nikander R, Heinonen A, Suominen H, Sievänen H. Direction-specific diaphyseal geometry and mineral mass distribution of tibia and fibula: a pQCT study of female athletes representing different exercise loading types. Calcif Tissue Int 2010; 86:447-54. [PMID: 20383493 DOI: 10.1007/s00223-010-9358-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 03/24/2010] [Indexed: 11/30/2022]
Abstract
Bones adapt to prevalent loading, which comprises mainly forces caused by muscle contractions. Therefore, we hypothesized that similar associations would be observed between neuromuscular performance and rigidity of bones located in the same body segment. These associations were assessed among 221 premenopausal women representing athletes in high-impact, odd-impact, high-magnitude, repetitive low-impact, and repetitive nonimpact sports and physically active referents aged 17-40 years. The whole group mean age and body mass were 23 (5) and 63 (9) kg, respectively. Bone cross sections at the tibial and fibular mid-diaphysis were assessed with peripheral quantitative computed tomography (pQCT). Density-weighted polar section modulus (SSI) and minimal and maximal cross-sectional moments of inertia (Imin, Imax) were analyzed. Bone morphology was described as the Imax/Imin ratio. Neuromuscular performance was assessed by maximal power during countermovement jump (CMJ). Tibial SSI was 31% higher in the high-impact, 19% in the odd-impact, and 30% in the repetitive low-impact groups compared with the reference group (P < 0.005). Only the high-impact group differed from the referents in fibular SSI (17%, P < 0.005). Tibial morphology differed between groups (P = 0.001), but fibular morphology did not (P = 0.247). The bone-by-group interaction was highly significant (P < 0.001). After controlling for height, weight, and age, the CMJ peak power correlated moderately with tibial SSI (r = 0.31, P < 0.001) but not with fibular SSI (r = 0.069, P = 0.313). In conclusion, observed differences in the association between neuromuscular performance and tibial and fibular traits suggest that the tibia and fibula experience different loading environments despite their anatomical vicinity.
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Affiliation(s)
- T Rantalainen
- Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä, Finland.
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Mänty M, Heinonen A, Viljanen A, Pajala S, Koskenvuo M, Kaprio J, Rantanen T. Self-reported preclinical mobility limitation and fall history as predictors of future falls in older women: prospective cohort study. Osteoporos Int 2010; 21:689-93. [PMID: 19415371 DOI: 10.1007/s00198-009-0950-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED We studied if self-reported preclinical mobility limitation, described as modification of task performance without perception of difficulty, predicts future falls in older women with and without fall history. Our results suggest that combined measure of self-reported preclinical mobility limitation and fall history may offer one possibility for inexpensive fall-risk evaluation in clinical practice. INTRODUCTION We studied if self-reported preclinical mobility limitation predicts future falls in older women with and without fall history. METHODS The study population consisted of 428 community-living 63-76-year-old women. At baseline, those who expressed no difficulty walking 2 km but reported that it took longer than before or that they did it less often were categorized as having preclinical mobility limitation. Those reporting difficulty in 2-km walk were categorized as having manifest mobility limitation. Fall history was recalled for previous 12 months and dichotomized. The incidence of future falls over 12 months was followed up with fall calendars. RESULTS During the fall follow-up, a total of 440 falls were reported by 201 participants. Among those with fall history, women with preclinical mobility limitation had almost 4-fold (incidence rate ratios 3.77; 95% CI 1.02-13.92) and those with manifest mobility limitation almost 15-fold (14.66; 2.72-79.00) adjusted risk for future falls compared to those with no mobility limitation and no previous falls. Among women without fall history, preclinical and manifest mobility limitation did not predict future falls nor did fall history without mobility limitation. CONCLUSIONS Already, early signs of mobility decline with history of falls increase the risk of further falls and should be considered as indications for fall prevention interventions.
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Affiliation(s)
- M Mänty
- The Finnish Centre for Interdisciplinary Gerontology, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Rantalainen T, Linnamo V, Komi PV, Selänne H, Heinonen A. Seventy-year-old habitual volleyball players have larger tibial cross-sectional area and may be differentiated from their age-matched peers by the osteogenic index in dynamic performance. Eur J Appl Physiol 2010; 109:651-8. [PMID: 20195627 DOI: 10.1007/s00421-010-1400-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
The osteogenicity of a given exercise may be estimated by calculating an osteogenic index (OI) consisting of magnitude and rate of strain. Volleyball involves repetitive jumping and requires high power output and thus may be expected to be beneficial to bone and performance. The purpose of the present study was to examine if habitual volleyball playing is reflected in OI. Ten elderly habitual volleyball players [age 69.9 (SD 4.4) years] and ten matched controls volunteered [age 69.7 (4.2) years] as subjects. Distal tibia (d), tibial mid-shaft (50) and femoral neck (FN) bone characteristics were measured using pQCT and DXA. To estimate skeletal rigidity, cross-sectional area (ToA(50)), and compressive (BSI(d)) and bending strength indices (SSImax(50)) were calculated. Maximal performance was assessed with eccentric ankle plantar flexion, isometric leg press and countermovement jump (CMJ). A fast Fourier transform (FFT) was calculated from the acceleration of the center of mass during the CMJ. Maximal acceleration (MAG) and mean magnitude frequency (MMF) were selected to represent the constituents of OI. OI was calculated as the sum of the products of magnitudes and corresponding frequencies. Volleyball players had 7% larger ToA(50) and 37% higher power in CMJ, 15% higher MAG and 36% higher OI (P <or= 0.047) than the matched controls. No difference was observed in leg press, plantar flexion or the MMF (P >or= 0.646). In conclusion, habitual volleyball players may be differentiated from their matched peers by their dynamic jumping performance, and the differences are reflected in the magnitude but not rate of loading.
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Affiliation(s)
- T Rantalainen
- Neuromuscular Research Centre, Department of Biology of Physical Activity, University of Jyväskylä, P. O. Box 35, 40014 Jyväskylä, Finland.
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Rantalainen T, Sievänen H, Linnamo V, Hoffrén M, Ishikawa M, Kyröläinen H, Avela J, Selänne H, Komi PV, Heinonen A. Bone rigidity to neuromuscular performance ratio in young and elderly men. Bone 2009; 45:956-63. [PMID: 19631780 DOI: 10.1016/j.bone.2009.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/23/2009] [Accepted: 07/15/2009] [Indexed: 11/15/2022]
Abstract
Given the adaptation of bone to prevalent loading, bone loss should follow, but lag behind, the decline in physical performance during aging. Furthermore, bone responsiveness to load-induced strains is believed to decrease with aging. However, the relationship between bone and lean body ( approximately muscle) mass appears to remain rather constant throughout adulthood. The purpose of this study was to examine the association between age and bone to neuromuscular performance ratio. Young (N=20, age 24 SD+/-2 years, body mass 77+/-11 kg, height 178+/-6 cm) and elderly (N=25, 72+/-4 years, 75+/-9 kg, 172+/-5 cm) men served as subjects. Bone structural traits were measured at the right distal tibia and tibial mid-shaft with peripheral quantitative computed tomography (pQCT). Maximal section modulus (Z(max50)), total area (ToA(d)), cortical area (CoA(50)), total density (ToD(d)) and cortical density (CoD(50)) were determined from the pQCT images. Neuromuscular performance was measured by recording vertical ground reaction force (GRF) in maximal bilateral hopping. Load-induced strains were estimated by calculating appropriate indices for compressive and tensile loading that took into account both the bone structure and apparent biomechanics of the given bone site. Young subjects had significantly higher maximal GRF compared to older men (4260+/-800 N vs. 3080+/-600 N, P<0.001). They also had smaller ToA(d) (1100+/-170 mm(2) vs. 1200+/-100 mm(2), P=0.028) while their ToD(d) was higher (370+/-46 g/cm(3) vs. 330+/-22 g/cm(3), P=0.002). The Z(max50) did not differ significantly between young (1660+/-320 mm(3)) and elderly men (1750+/-320 mm(3)) (P=0.224). Compressive (0.484+/-0.102 vs. 0.399+/-0.078, P=0.016) and tensile (0.107+/-0.016 vs. 0.071+/-0.018, P<0.001) strain indices were significantly higher in the younger group. In conclusion, the difference in bone to loading ratio at the tibial mid-shaft is bigger than expected from the delay in bone adaptation alone. Potential candidates to explain this phenomenon include a decrease in mechanosensitivity with aging, inability of maximal physical performance to adequately represent the bone loading environment, or the need to maintain constant safety factors to functional strains.
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Affiliation(s)
- T Rantalainen
- Neuromuscular Research Centre, Department of Biology of Physical Activity, University of Jyväskylä, Finland.
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Nikander R, Kannus P, Dastidar P, Hannula M, Harrison L, Cervinka T, Narra NG, Aktour R, Arola T, Eskola H, Soimakallio S, Heinonen A, Hyttinen J, Sievänen H. Targeted exercises against hip fragility. Osteoporos Int 2009; 20:1321-8. [PMID: 19002370 DOI: 10.1007/s00198-008-0785-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 10/15/2008] [Indexed: 12/11/2022]
Abstract
SUMMARY Compared to high-impact exercises, moderate-magnitude impacts from odd-loading directions have similar ability to thicken vulnerable cortical regions of the femoral neck. Since odd-impact exercises are mechanically less demanding to the body, this type of exercise can provide a reasonable basis for devising feasible, targeted bone training against hip fragility. INTRODUCTION Regional cortical thinning at the femoral neck is associated with hip fragility. Here, we investigated whether exercises involving high-magnitude impacts, moderate-magnitude impacts from odd directions, high-magnitude muscle forces, low-magnitude impacts at high repetition rate, or non-impact muscle forces at high repetition rate were associated with thicker femoral neck cortex. METHODS Using three-dimensional magnetic resonance imaging, we scanned the proximal femur of 91 female athletes, representing the above-mentioned five exercise-loadings, and 20 referents. Cortical thickness at the inferior, anterior, superior, and posterior regions of the femoral neck was evaluated. Between-group differences were analyzed with ANCOVA. RESULTS For the inferior cortical thickness, only the high-impact group differed significantly (approximately 60%, p = 0.012) from the reference group, while for the anterior cortex, both the high-impact and odd-impact groups differed (approximately 20%, p = 0.042 and p = 0.044, respectively). Also, the posterior cortex was approximately 20% thicker (p = 0.014 and p = 0.006, respectively) in these two groups. CONCLUSIONS Odd-impact exercise-loading was associated, similar to high-impact exercise-loading, with approximately 20% thicker cortex around the femoral neck. Since odd-impact exercises are mechanically less demanding to the body than high-impact exercises, it is argued that this type of bone training would offer a feasible basis for targeted exercise-based prevention of hip fragility.
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Affiliation(s)
- R Nikander
- Bone Research Group, UKK Institute for Health Promotion Research, 33501 Tampere, Finland
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Ristolainen L, Heinonen A, Turunen H, Mannström H, Waller B, Kettunen JA, Kujala UM. Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports 2009; 20:384-93. [PMID: 19602191 DOI: 10.1111/j.1600-0838.2009.00955.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This 12-month retrospective questionnaire compared the occurrence of sports injuries in 149 cross country skiers, 154 swimmers, 143 long-distance runners and 128 soccer players aged 15-35 years. Soccer had significantly more injuries (5.1 injuries/1000 exposure hour) than other sports (2.1-2.8, P<0.001). More runners than soccer players reported overuse injuries (59% vs 42%, P=0.005), locating typically in the foot in runners, soccer players and skiers. Swimmers reported overuse injuries in the shoulder more commonly than skiers (40% vs 1%, P<0.001), who also intensively load shoulders. Acute injuries in skiers (80%) and in swimmers (58%), and overuse injuries in skiers (61%), occurred during exercise other than own event. In soccer and running the absence time from sport because of injuries was significantly longer than in skiing and swimming. No severe permanent disabilities occurred due to injury but seven women quit sports because of injury. In conclusion, type of loading is strictly associated with the anatomical location of an overuse injury as shown by the difference in shoulder injury incidence between swimmers and cross country skiers. In some sports, a significant proportion of acute injuries occur in other than the main event.
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Affiliation(s)
- L Ristolainen
- ORTON Orthopaedic Hospital, ORTON Foundation, Helsinki, Finland.
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Multanen J, Rauvala E, Lammentausta E, Ojala R, Kiviranta I, Häkkinen A, Nieminen MT, Heinonen A. Reproducibility of imaging human knee cartilage by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at 1.5 Tesla. Osteoarthritis Cartilage 2009; 17:559-64. [PMID: 19121954 DOI: 10.1016/j.joca.2008.12.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the day-to-day reproducibility of the delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) measurement at different knee joint surfaces in healthy subjects at 1.5 Tesla (T). METHODS The dGEMRIC experiment was repeated for 10 asymptomatic volunteers three times with an average interval of 5 days between scans. The measurement was performed from a single sagittal slice through the center of the lateral femoral condyle and from the center of the patella in the axial plane. Cartilage was manually segmented into superficial, deep and full-thickness regions of interests (ROIs) at different topographical locations of the femur, tibia and patella. The reproducibility was evaluated separately for each ROI as well as for the entire bulk cartilage in the slice of each joint surface. RESULTS The reproducibility at various ROIs expressed by root-mean-square average coefficient of variation (CV(RMS)) ranged between 4.7-12.9%. Thirty out of thirty-three ROIs showed a CV(RMS) less than 10%. Intraclass correlation coefficient (ICC) ranged between 0.45 and 0.98. The CV(RMS) and ICC for bulk dGEMRIC were 4.2% and 0.95 for femur, 5.5% and 0.87 for tibia, and 4.8% and 0.97 for patella. CONCLUSIONS The dGEMRIC technique showed good day-to-day reproducibility, on the average 8% for small deep or superficial segments, 7% for full-thickness ROIs and 5% for bulk ROIs covering all visible cartilage in a single joint surface. We conclude that dGEMRIC imaging at field strength 1.5 T can be used as a reliable instrument for the assessment of articular cartilage when staff has been carefully trained.
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Affiliation(s)
- J Multanen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Karinkanta S, Heinonen A, Sievänen H, Uusi-Rasi K, Fogelholm M, Kannus P. Maintenance of exercise-induced benefits in physical functioning and bone among elderly women. Osteoporos Int 2009; 20:665-74. [PMID: 18696173 DOI: 10.1007/s00198-008-0703-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 06/20/2008] [Indexed: 12/14/2022]
Abstract
SUMMARY This study showed that about a half of the exercise-induced gain in dynamic balance and bone strength was maintained one year after cessation of the supervised high-intensity training of home-dwelling elderly women. However, to maintain exercise-induced gains in lower limb muscle force and physical functioning, continued training seems necessary. INTRODUCTION Maintenance of exercise-induced benefits in physical functioning and bone structure was assessed one year after cessation of 12-month randomized controlled exercise intervention. METHODS Originally 149 healthy women 70-78 years of age participated in the 12-month exercise RCT and 120 (81%) of them completed the follow-up study. Self-rated physical functioning, dynamic balance, leg extensor force, and bone structure were assessed. RESULTS During the intervention, exercise increased dynamic balance by 7% in the combination resistance and balance-jumping training group (COMB). At the follow-up, a 4% (95% CI: 1-8%) gain compared with the controls was still seen, while the exercise-induced isometric leg extension force and self-rated physical functioning benefits had disappeared. During the intervention, at least twice a week trained COMB subjects obtained a significant 2% benefit in tibial shaft bone strength index compared to the controls. A half of this benefit seemed to be maintained at the follow-up. CONCLUSIONS Exercise-induced benefits in dynamic balance and rigidity in the tibial shaft may partly be maintained one year after cessation of a supervised 12-month multi-component training in initially healthy elderly women. However, to maintain the achieved gains in muscle force and physical functioning, continued training seems necessary.
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Affiliation(s)
- S Karinkanta
- The UKK Institute for Health Promotion Research, Tampere, Finland.
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Al Nazer R, Rantalainen T, Heinonen A, Sievänen H, Mikkola A. Flexible multibody simulation approach in the analysis of tibial strain during walking. J Biomech 2008; 41:1036-43. [DOI: 10.1016/j.jbiomech.2007.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 12/05/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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Nikander R, Sievänen H, Heinonen A, Karstila T, Kannus P. Load-specific differences in the structure of femoral neck and tibia between world-class moguls skiers and slalom skiers. Scand J Med Sci Sports 2007; 18:145-53. [PMID: 18067528 DOI: 10.1111/j.1600-0838.2007.00643.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bone structure of weight-bearing proximal femur and tibia was examined among the Finnish world-class moguls skiers and slalom skiers. We hypothesized that these bones, during typical sport-specific performance, had been subjected not only to extreme loading but also to distinct loading in terms of rate and primary direction. Bone [dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), magnetic resonance imaging] and muscle performance data of the lower extremities were obtained from the five Finnish male moguls skiers and six slalom skiers competing at the World Cup level. Data (DXA, pQCT) from 12 age- and weight-matched normally active men were used for comparison. The ANCOVA with body height as a covariate was used for statistical analysis. The weight-bearing bones of the athletes were 10-60% stronger than those of the normally active men. Compared with the moguls skiers, the slalom skiers showed an average 43% thicker anterior cortex at the narrowest region of the femoral neck. This study suggests that the bone structure at skiers' heavily loaded lower extremities was very robust. A specific finding was the thick anterior cortex of the femoral neck among the slalom skiers. Apparently, the predominant loading type had modulated the site-specific skeletal response to physical exertion.
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Affiliation(s)
- R Nikander
- Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland.
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Rantalainen T, Heinonen A, Komi PV, Linnamo V. Neuromuscular performance and bone structural characteristics in young healthy men and women. Eur J Appl Physiol 2007; 102:215-22. [DOI: 10.1007/s00421-007-0575-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2007] [Indexed: 10/22/2022]
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Mikkola T, Sipilä S, Portegijs E, Kallinen M, Alén M, Kiviranta I, Pekkonen M, Heinonen A. Impaired geometric properties of tibia in older women with hip fracture history. Osteoporos Int 2007; 18:1083-90. [PMID: 17323107 DOI: 10.1007/s00198-007-0352-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED This study evaluated side-to-side differences in tibial mineral mass and geometry in women with previous hip fracture sustained on average 3.5 years earlier. Both tibial mineral mass and geometry were found to be reduced in the fractured leg. INTRODUCTION The purpose of this study was to evaluate side-to-side differences in tibial mineral mass and geometry after hip fracture and to assess the determinants of such differences. METHODS Thirty-eight 60- to 85-year-old women with a previous hip fracture and 22 same-aged control women without fractures participated in the study. Bone characteristics of the distal tibia and tibial shaft of both legs were assessed using pQCT in order to compare the side-to-side differences of tibias between the two groups. RESULTS The subjects with fracture history had significantly (p < OR = 0.05, analysis of covariance) larger side-to-side differences than the controls in tibial shaft BMC (-4.9% vs. -0.5%), cortical area (-5.2% vs. 0.1%) and polar moment of inertia (I(polar)) (-5.6% vs. -0.8%) and in distal tibia BMC (-5.1% vs. -1.4%) and I(polar) (-7.5% vs. -2.4%). In the fracture patients, the side-to-side differences in muscle characteristics explained 23 to 44% of the variances in the side-to-side differences in bone mass and geometry. CONCLUSIONS Hip fracture results in reduced bone mass and impaired bone geometry in the tibia of the affected limb in older women. Muscle-induced loading may have a considerable role in the recovery of bone mineral mass and geometry after hip fracture.
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Affiliation(s)
- T Mikkola
- Department of Health Sciences, University of Jyväskylä, P.O. Box 35, Viveca, 40014 Jyväskylä, Finland.
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Karinkanta S, Heinonen A, Sievänen H, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 2007; 18:453-62. [PMID: 17103296 DOI: 10.1007/s00198-006-0256-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 10/09/2006] [Indexed: 11/25/2022]
Abstract
SUMMARY This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women. The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems. INTRODUCTION This 1-year randomized, controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women. METHODS One hundred and forty-nine healthy women aged 70-78 years were randomly assigned into: group 1-resistance training (RES), group 2-balance-jumping training (BAL), group 3-combination of resistance and balance-jumping training (COMB), and group 4-controls (CON). Self-rated physical functioning, leg extensor force, dynamic balance, and bone mass and structure were measured. RESULTS Self-rated physical functioning improved in the COMB group, but was reduced in the CON group; the mean inter-group difference was 10% (95% CI: 0-22%). Mean increase in the leg extensor force was higher in the RES (14%; 4-25%) and COMB (13%; 3-25%) compared with the CON groups. Dynamic balance improved in the BAL (6%; 1-11%) and in the COMB (8%; 3-12%) groups. There were no inter-group differences in BMC at the proximal femur. In those COMB women who trained at least twice a week, the tibial shaft structure weakened 2% (0-4%) less than those in the CON group. CONCLUSIONS Strength, balance, agility, and jumping training (especially in combination) prevented functional decline in home-dwelling elderly women. In addition, positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility.
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Affiliation(s)
- S Karinkanta
- UKK Institute for Health Promotion Research, Tampere, Finland
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Heinonen A, Oja P, Slevänen H, Vuori I. Effects of equivolume strength training programmes of low, medium and high resistance on maximal isometric strength in sedentary women. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1993.tb00370.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oja P, Mänttäri A, Heinonen A, Kukkonen-Harjula K, Laukkanen R, Pasanen M, Vuori I. Physiological effects of walking and cycling to work. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1991.tb00288.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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