Marjo Rinne

Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures

BACKGROUND Osteoporotic fractures among the elderly are common, and without preventive measures the burden of these fractures on health-care systems will increase further. The purpose of this randomised controlled study was to evaluate, in premenopausal women, the effects of high-impact loading on several determinants osteoporotic fractures. METHODS 98 healthy, sedentary female volunteers aged 35-45 years were randomly assigned to either a training (n = 49) or a control group (n = 49). Progressive high-impact exercises were done three times per week for 18 months. We measured bone mineral density (BMD) in specific axial and lower-limb sites, by dual-energy X-ray absorptiometry, at baseline and after 12 and 18 months. Maximum isometric strength, muscular and cardiovascular performance, and dynamic balance were also assessed. FINDINGS BMD at the femoral neck, a weightbearing site, increased significantly more in the training group (mean 1.6% [95% CI 0.8-2.4]) than in the control group (0.6% [-0.2 to 1.4], p = 0.006). By contrast, at non-weightbearing sites, such as the distal radius, there was no significant difference between the training and control groups (-1.5% [-2.7 to -0.3] vs -0.7% [-1.9 to -0.5], p = 0.60). In the training group there was a significant improvement in vertical jump and predicted oxygen consumption per min at maximum exercise compared with controls. INTERPRETATION High-impact exercises that load bones with a rapidly rising force profile in versatile movements improve skeletal integrity, muscular performance, and dynamic balance in premenopausal women. If done on a regular basis, this type of exercise may help decrease the risk of osteoporotic fractures in later life. Long-term studies are required to show whether these 18-month results can be translated into long-term benefit.

Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12-month randomized controlled study.

Study Design. A randomized controlled study with 12 months intervention. Objective. To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone (NZ) and behavior modeling as secondary prevention of low back pain (LBP) and disability. Summary of Background Data. Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability. In addition, cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability. Methods. Middle-aged working men with recent LBP but without severe disability were randomly allocated to either a training (TG, n = 52) or control group (CG, n = 54). The aim was to exercise twice a week for 12 months, once guided and once independently. The outcome measures were the changes in intensity of LBP, disability, self-evaluated future work ability, and neuromuscular fitness. Results. The intensity of LBP decreased significantly more (39%) in the TG than in CG at 12 months. The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months; however, the proportion was significantly bigger in TG compared with CG (P = 0.028). There effects on disability indexes and fitness were not statistically significant. Conclusions. Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men.

Association of physical fitness with health-related quality of life in Finnish young men

BackgroundCurrently, there is insufficient evidence available regarding the relationship between level of physical fitness and health-related quality of life (HRQoL) in younger adults. Therefore, the aim of the present study was to investigate the impact of measured cardiovascular and musculoskeletal physical fitness level on HRQoL in Finnish young men.MethodsIn a cross-sectional study, we collected data regarding the physical fitness index, including aerobic endurance and muscle fitness, leisure-time physical activity (LTPA), body composition, health, and HRQoL (RAND 36) for 727 men [mean (SD) age 25 (5) years]. Associations between HRQoL and the explanatory parameters were analyzed using the logistic regression analysis model.ResultsOf the 727 participants who took part in the study, 45% were in the poor category of the physical fitness, while 37% and 18% were in the satisfactory and good fitness categories, respectively. A higher frequency of LTPA was associated with higher fitness (p < 0.001). Better HRQoL in terms of general health, physical functioning, mental health, and vitality were associated with better physical fitness. When the HRQoL of the study participants were compared with that of the age- and gender-weighted Finnish general population, both the good and satisfactory fitness groups had higher HRQoL in all areas other than bodily pain. In a regression analysis, higher LTPA was associated with three dimensions of HRQoL, higher physical fitness with two, and lower number of morbidities with all dimensions, while the effect of age was contradictory.ConclusionsOur study of Finnish young men indicates that higher physical fitness and leisure-time physical activity level promotes certain dimensions of HRQoL, while morbidities impair them all. The results highlight the importance of health related physical fitness while promoting HRQoL.

Effect of Long-Term Endurance and Strength Training on Metabolic Control and Arterial Elasticity in Patients With Type 2 Diabetes Mellitus

Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 +/- 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. All exercise sessions were controlled by heart rate and intensity. Glycated hemoglobin A1c, insulin, leptin, blood lipids, blood pressure, maximal oxygen consumption in spiroergometry, and muscle strength were measured every 6 months. Arterial stiffness was assessed by measuring pulse wave velocity. Maximal oxygen consumption in spiroergometry (E 31.9 to 34.8 vs C 32.6 to 31.8 ml/kg/min; p = 0.003), muscle strength (sit-up test, E 12.7 to 20.8 vs C 14.6 to 13.1 times; p <0.001), hemoglobin A1c (E 8.2% to 7.6% vs C 8.0% to 8.3%; p = 0.006), and leptin (E 7.4 to 6.7 vs C 7.4 to 7.9 microg/L; p = 0.013) improved significantly in the E group, but no change or worsening in these variables occurred in the C group. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.

Long-term recreational gymnastics, estrogen use, and selected risk factors for osteoporotic fractures

The purpose of this cross‐sectional study was to examine whether long‐term participation in recreational gymnastics or folk dancing or estrogen replacement therapy (ERT) is associated with mechanically more competent bones and improved muscular strength and body balance. One hundred and seventeen healthy, female postmenopausal recreational gymnasts (mean age 62.1 [SD 4.7] years) and 116 sedentary controls (mean age 61.5 [4.6] years) were enrolled in the study. Bone mineral content (BMC) of the distal radius, femoral neck, and trochanter were measured with dual‐energy X‐ray absorptiometry. BMC of the midshaft and distal tibia and trabecular density (TrD) of the distal tibia were measured with peripheral computed quantitative tomography. Maximal isometric strength, muscular power, cardiorespiratory fitness, and body balance of the participants were also assessed. The cardiorespiratory fitness, muscular strength, and dynamic balance of the recreational gymnasts and folk dancers combined were significantly better than those of the controls, the average group difference ranging from 7.5% (95% confidence interval 5.0–9.9%) in dynamic balance to 12.8% (6.6–19.4%) in dynamic muscular power. ERT was not associated with the fitness indicators, muscular power, or balance, but was significantly associated with the BMC at all the measured bone sites, the mean group difference between estrogen users and nonusers ranging from 6.5% (3.7–9.3%) for the tibial shaft to 11.8% (6.4–17.0%) for the distal radius. Recreational gymnastics, in turn, was significantly associated with higher BMC at the tibia only, the mean group difference being 3.9% (0.9–6.9%) for the tibial shaft and 7.7% (3.7–11.9%) for the distal tibia. Recreational gymnastics was also associated with higher TrD at the distal tibia (5.2%; 1.2–9.2%), whereas estrogen usage did not show such association. The results indicate that ERT seems especially effective in preventing postmenopausal bone loss, whereas recreational gymnastics and folk dancing improve muscular performance and body balance in addition to increased bone mass and bone size in the tibia. All these factors are essential in prevention of fall‐related fractures of the elderly.

Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes

BackgroundMyocardial diastolic tissue velocities are reduced already in newly onset Type 2 diabetes mellitus (T2D). Poor disease control may lead to left ventricular (LV) systolic dysfunction and heart failure. The aim of this study was to assess the effects of exercise training on myocardial diastolic function in T2D patients without ischemic heart disease.Methods48 men (52.3 ± 5.6 yrs) with T2D were randomized to supervised training four times a week and standard therapy (E), or standard treatment alone (C) for 12 months. Glycated hemoglobin (HbA1c), oxygen consumption (VO2max), and muscle strength (Sit-up) were measured. Tissue Doppler Imaging (TDI) was used to determine the average maximal mitral annular early (Ea) and late (Aa) diastolic as well as systolic (Sa) velocities, systolic strain (ε) and strain rate (έ) from the septum, and an estimation of left ventricular end diastolic pressure (E/Ea).ResultsExercise capacity (VO2max, E 32.0 to 34.7 vs. C 32.6 to 31.5 ml/kg/min, p = .001), muscle strength (E 12.7 to 18.3 times vs. C 14.6 to 14.7 times, p < .001), and HbA1c (E 8.2 to 7.5% vs. C 8.0 to 8.4%, p = .006) improved significantly in the exercise group compared to the controls (ANOVA). Systolic blood pressure decreased in the E group (E 144 to 138 mmHg vs. C 146 to 144 mmHg, p = .04). Contrary to risk factor changes diastolic long axis relaxation did not improve significantly, early diastolic velocity Ea from 8.1 to 7.9 cm/s for the E group vs. C 7.4 to 7.8 cm/s (p = .85, ANOVA). Likewise, after 12 months the mitral annular systolic velocity, systolic strain and strain rate, as well as E/Ea were unchanged.ConclusionExercise training improves endurance and muscle fitness in T2D, resulting in better glycemic control and reduced blood pressure. However, myocardial diastolic tissue velocities did not change significantly. Our data suggest that a much longer exercise intervention may be needed in order to reverse diastolic impairment in diabetics, if at all possible.

Promoting walking among office employees ― evaluation of a randomized controlled intervention with pedometers and e-mail messages

BackgroundThe purpose of the study was to evaluate a 6-month intervention to promote office-employees’ walking with pedometers and e-mail messages.MethodsParticipants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months).ResultsThe intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in “walking for transportation” (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in “walking for leisure” (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of “walking stairs” at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in “walking stairs” (OR 2.24, 95%CI 0.94 to 5.31) and in “walking for leisure” (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.ConclusionsThe findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment.Trial registerationISRCTN79432107

Eight-year-old children with high cardiorespiratory fitness have lower overall and abdominal fatness

OBJECTIVE 1) To examine whether cardiorespiratory fitness (CRF) is associated with waist circumference (WC) and overall and abdominal fatness in eight-year-old girls and boys. 2) To determine whether children with high CRF have lower WC, overall and abdominal fatness within the same body mass index (BMI) category compared with those with low CRF. DESIGN A cross-sectional study of 304 eight-year-old children in Tampere, Finland whose parents responded to a postal invitation and participated in measurements. MEASUREMENTS Total body fat percentage (BF%), abdominal region fat percentage (AF%), and fat-free mass (FFM) were assessed by dual-energy X-ray absorptiometry (DXA). WC, height and weight were measured. International BMI sex- and age-specific cut-off points were used for overweight and obesity definition, and participants were divided into two categories: normal weight or overweight/obese. CRF was assessed with a maximal multistage 20-m shuttle run test (20-mSRT). RESULTS Of the children, 81% were normal weight and 19% were overweight/obese. CRF was inversely associated with WC (p<0.011), BF% (p<0.001) and AF% (p<0.001) independent of age, sex and BMI. Within the same BMI category, children with high CRF had significantly lower WC (p=0.001), BF% (p<0.001) and AF% (p<0.001) compared with children with low CRF. CONCLUSION Eight-year-old children with high CRF had lower overall and abdominal fatness compared with children with low CRF, independent of age, sex and BMI. CRF should be an important target already at a young age in preventing overall and abdominal obesity.

Is generic physical activity or specific exercise associated with motor abilities

PURPOSE Evidence of the effect of leisure time physical activity (LTPA) modes on the motor abilities of a mature population is scarce. The purpose of this study was to compare the motor abilities of physically active and inactive men and women and to examine the associations of different exercise modes and former and recent LTPA (R-LTPA) with motor ability and various physical tests. METHODS The LTPA of the participants (men n = 69, women n = 79; aged 41-47 yr) was ascertained by a modified Physical Activity Readiness Questionnaire, including questions on the frequency, duration, and intensity of R-LTPA and former LTPA and on exercise modes. Motor abilities in terms of balance, agility, and coordination were assessed with a battery of nine tests supplemented with five physical fitness tests. Multiple statistical methods were used in analyses that were conducted separately for men and women. RESULTS The MET-hours per week of R-LTPA correlated statistically significantly with the tests of agility and static balance (rs = -0.28, P = 0.022; rs = -0.25, P = 0.043, respectively) among men and with the static balance (rs = 0.41), 2-km walking (rs = 0.36), step squat (rs = 0.36) (P < or = 0.001, respectively), and static back endurance (rs = 0.25, P = 0.024) among women. In the stepwise regression among men, the most frequent statistically significant predictor was the playing of several games. For women, a history of LTPA for more than 3 yr was the strongest predictor for good results in almost all tests. CONCLUSIONS Participants with long-term and regular LTPA had better motor performance, and especially a variety of games improve components of motor ability. Diverse, regular, and long-term exercise including both specific training and general activity develops both motor abilities and physical fitness.

The test–retest reliability of motor performance measures after traumatic brain injury

Physically well recovered traumatically brain injured (TBI) patients complain of impaired motor performance, which may not be apparent in conventional neurological examination. A reliable test battery measuring mild physical impairment in TBI populations would be a welcome tool for clinical practice. The aim of this study was to evaluate the test–retest reliability of static and dynamic balance, running in a figure-of-eight (agility) and rhythm co-ordination tests. Thirty-four well-recovered TBI inpatients and 36 healthy male volunteers were tested on two occasions. The change in the mean, the typical error and the intra-class correlation coefficient (ICC) were used as statistics of reliability for continuous measurements and Cohens kappa coefficient for categorical variables. The best result of consecutive trials within each test showed the best reliability. In the tandem walking tests and running figure-of-eight tests, the reliability was lower in the TBI group than in the controls but still good. The repeatability of static balance and the rhythm co-ordination was moderate in both groups. A slight training effect from test to retest session was observed in most of the performance tests. Balance, rhythm co-ordination and agility tests proved to be reliable for testing TBI men, and can therefore be used in clinical setting.