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Exercise Mode Specificity for Preserving Spine and Hip Bone Mineral Density in Prostate Cancer Patients.
Newton, RU, Galvão, DA, Spry, N, Joseph, D, Chambers, SK, Gardiner, RA, Wall, BA, Bolam, KA, Taaffe, DR
Medicine and science in sports and exercise. 2019;(4):607-614
Abstract
PURPOSE Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects, including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine the effects of targeted exercise modes on BMD in men with PCa undergoing ADT. METHODS Between 2009 and 2012, 154 PCa patients 43-90 yr old on ADT were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training [ImpRes], n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training, n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). End points were lumbar spine, hip and whole-body BMD measured by dual-energy x-ray absorptiometry with secondary end points of lean and fat mass, appendicular skeletal muscle mass, and neuromuscular strength. ANOVA was used to compare the exercise groups with DelAer at 6 and 12 months. RESULTS There was a between-group difference in BMD for ImpRes and DelAer at the spine (6 months, P = 0.039; 12 months, P = 0.035) and femoral neck (6 months, P = 0.050), with decline attenuated in ImpRes (~-1.0% vs ~-2.0%). Compared with DelAer, ImpRes increased appendicular skeletal muscle at 6 months (0.3 kg, P = 0.045) and improved muscle strength at 6 and 12 months (P ≤ 0.012) by 9%-34%. A limitation was inclusion of well-functioning patients. CONCLUSION Combined impact loading and resistance exercise attenuates bone loss at the spine and enhances overall musculoskeletal function in PCa patients undergoing ADT.
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Lower risk of hip fractures among Swedish women with large hips?
Klingberg, S, Mehlig, K, Sundh, V, Heitmann, BL, Lissner, L
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2018;(4):927-935
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Abstract
UNLABELLED In women, a large hip circumference (HC) related to lower hip fracture risk, independent of age and regardless if HC was measured long before or closer to the fracture. In older women, body mass index (BMI) explained the protection. INTRODUCTION In postmenopausal women, HC has been suggested to inversely associate with hip fracture while this has not been investigated in middle-aged women. We examined the association between HC, measured at two different time points, and hip fracture in a Swedish female population-based sample monitored for incident hip fractures over many years. METHODS Baseline HC, measured in 1968 or 1974 (n = 1451, mean age 47.6 years), or the HC measures that were the most proximal before event or censoring (n = 1325, mean age 71.7 years), were used to assess the effects of HC on hip fracture risk in women participating in the Prospective Population Study of Women in Gothenburg. HC was parameterized as quintiles with the lowest quintile (Q1) as reference. Incident hip fractures over 45 years of follow-up (n = 257) were identified through hospital registers. RESULTS Higher quintiles of HC at both baseline and proximal to event were inversely associated with hip fracture risk in age-adjusted models, but only baseline HC predicted hip fractures independently of BMI and other covariates (HR (95% CI) Q2, 0.85 (0.56-1.27); Q3, 0.59 (0.36-0.96); Q4, 0.57 (0.34-0.96); Q5, 0.58 (0.31-1.10)). CONCLUSIONS A large HC is protective against hip fracture in midlife and in advanced age, but the association between proximal HC and hip fracture was explained by concurrent BMI suggesting that padding was not the main mechanism for the association. The independent protection seen in middle-aged women points to other mechanisms influencing bone strength.
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Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis.
Zhang, H, Zhu, XH, Dong, W, Wang, QM
Annals of nutrition & metabolism. 2018;(2):121-130
Abstract
BACKGROUND This study evaluates the effect of vitamin D status in patient outcomes after hip or knee joint surgery. METHOD Literature search was carried out in electronic databases, and study selection followed predetermined eligibility criteria. Data were extracted from relevant studies and meta-analyses of standardized mean differences between hypovitaminosis D (vitamin D deficiency or insufficiency) and euvitaminosis D in assessment scores of patient-reported outcomes were performed. RESULTS A total of 12 studies (2,593 patients; age 69.89 years [95% CI 68.07-71.70]; 35.95% [29.43-42.46] males) were included in the meta-analysis. The prevalence of hypovitaminosis D (vitamin D deficiency or insufficiency) was 33.18% [25.10-41.26], but the combined prevalence of deficiency and insufficiency was 46.99 [34.02-59.96]. Hospital stay was 1.09 days [-0.39 to 2.56] longer in the hypovitaminosis D group compared to the euvitaminosis D group. Preoperatively, Harris Hip Score (HHS) and Knee Society Score were significantly lower (p = 0.001 and p = 0.00001, respectively) in the hypovitaminosis D group than in the euvitaminosis D group. Postoperatively, HHS (p = 0.004) score was significantly lower in the hypovitaminosis D group than in the euvitaminosis D group. CONCLUSION The prevalence of hypovitaminosis D is high in osteoarthritis patients undergoing knee or hip surgery. Vitamin D deficiency may affect the outcomes of orthopedic joint surgery. However, randomized trial/s will be required to confirm these findings.
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Effects of changes in muscle activation level and spine and hip posture on erector spinae fiber orientation.
Harriss, AB, Brown, SH
Muscle & nerve. 2015;(3):426-33
Abstract
INTRODUCTION During lumbar flexion, the fiber orientation of the lumbar erector spinae (LES) muscle becomes oriented more along the spine compressive axis. It is unknown how changes in LES activation effect fiber orientation. METHODS Ultrasound images of LES were collected during 2 sets of experimental conditions: (1) varying levels of LES activation while lying prone; and (2) varying spine and hip angles while seated. Electromyographic activity and lumbar spine and hip angles were also recorded. RESULTS As LES activation increased, increases in fiber orientation (signifying increased orientation along the posterior shear axis) were found (P<0.001). Compared with the relaxed sitting posture, decreases in fiber orientation were found with full spine flexion and combined spine and hip flexion (P<0.001), but there were no changes with full hip flexion alone. CONCLUSIONS Activation magnitude and spine posture both affect LES fiber orientation, thus modifying its ability to protect the spine against anterior shear forces.
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Prevalence and possible risk factors of low bone mineral density in untreated female patients with systemic lupus erythematosus.
Sun, YN, Feng, XY, He, L, Zeng, LX, Hao, ZM, Lv, XH, Pu, D
BioMed research international. 2015;:510514
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic inflammation. Different studies have shown decreased bone mineral density (BMD) in patients with SLE. The objective of this study was to investigate the prevalence and possible risk factors of low BMD in untreated female patients with SLE in Chinese population. A total of 119 untreated female patients with SLE were included. BMD was measured at lumbar spine and at total hip by dual-energy X-ray absorptiometry. The associations between decreased BMD and demographic variables, clinical variables, and bone metabolism variables were analyzed. These SLE patients had the following characteristics: mean age was 32.6 ± 11.9 years, mean disease duration was 22.1 ± 34.5 months, and mean SLEDAI was 11.4 ± 5.4. Osteopenia was present in 31.1% of the patients and osteoporosis in 8.5%. A significant negative association between low density lipoprotein cholesterol (LDL-c) and BMD at the lumbar spine (correlation coefficient = -0.242; P = 0.023) and total hip (correlation coefficient = -0.259; P = 0.019) was shown. These results seem to indicate that increased LDL-c may be an important risk factor for low BMD at lumbar spine and total hip in untreated female SLE patients.
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Altered mechano-chemical environment in hip articular cartilage: effect of obesity.
Travascio, F, Eltoukhy, M, Cami, S, Asfour, S
Biomechanics and modeling in mechanobiology. 2014;(5):945-59
Abstract
The production of extracellular matrix (ECM) components of articular cartilage is regulated, among other factors, by an intercellular signaling mechanism mediated by the interaction of cell surface receptors (CSR) with insulin-like growth factor-1 (IGF-1). In ECM, the presence of binding proteins (IGFBP) hinders IGF-1 delivery to CSR. It has been reported that levels of IGF-1 and IGFBP in obese population are, respectively, lower and higher than those found in normal population. In this study, an experimental-numerical approach was adopted to quantify the effect of this metabolic alteration found in obese population on the homeostasis of femoral hip cartilage. A new computational model, based on the mechano-electrochemical mixture theory, was developed to describe competitive binding kinetics of IGF-1 with IGFBP and CSR, and associated glycosaminoglycan (GAG) biosynthesis. Moreover, a gait analysis was carried out on obese and normal subjects to experimentally characterize mechanical loads on hip cartilage during walking. This information was deployed into the model to account for effects of physiologically relevant tissue deformation on GAG production in ECM. Numerical simulations were performed to compare GAG biosynthesis in femoral hip cartilage of normal and obese subjects. Results indicated that the lower ratio of IGF-1 to IGFBP found in obese population reduces cartilage GAG concentration up to 18 % when compared to normal population. Moreover, moderate physical activity, such as walking, has a modest beneficial effect on GAG production. The findings of this study suggest that IGF-1/IGFBP metabolic unbalance should be accounted for when considering the association of obesity with hip osteoarthritis.
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Effective exercises for targeting the gluteus medius.
Hamstra-Wright, KL, Huxel Bliven, K
Journal of sport rehabilitation. 2012;(3):296-300
Abstract
CLINICAL SCENARIO The gluteus medius (GM) is thought to play an important role in stabilizing the pelvis and controlling femoral adduction and internal rotation during functional activity. GM weakness, resulting in decreased stabilization and control, has been suggested to be related to lower extremity dysfunction and injury. Many clinicians focus on strengthening the GM to improve lower extremity kinematics for the prevention and rehabilitation of injury. An indirect way to measure GM strength is through electromyography. It is generally assumed that exercises producing higher levels of activation will result in greater strengthening effects.3 Understanding what exercises result in the greatest level of GM activation will assist clinicians in their injury prevention and rehabilitation efforts. FOCUSED CLINICAL QUESTION In a healthy adult population, what lower extremity exercises produce the greatest mean GM activation, expressed as a percentage of maximum voluntary isometric contraction?
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Regional bone metabolism at the lumbar spine and hip following discontinuation of alendronate and risedronate treatment in postmenopausal women.
Frost, ML, Siddique, M, Blake, GM, Moore, AE, Marsden, PK, Schleyer, PJ, Eastell, R, Fogelman, I
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2012;(8):2107-16
Abstract
UNLABELLED The aim of this study was to examine the effects of bisphosphonate discontinuation on bone metabolism at the spine and hip measured using (18) F-fluoride PET. Bone metabolism at the spine remained stable following discontinuation of alendronate and risedronate at 1 year but increased in the hip in the alendronate group only. INTRODUCTION Bisphosphonates such as alendronate (ALN) or risedronate (RIS) have persistent effects on spine BMD following discontinuation. METHODS Positron emission tomography (PET) was used to examine regional bone metabolism in 20 postmenopausal women treated with ALN (n = 11) or RIS (n = 9) for a minimum of 3 years at screening (range 3-9 years, mean 5 years for both groups). Subjects underwent a dynamic scan of the lumbar spine and a static scan of both hips at baseline and 6 and 12 months following treatment discontinuation. (18) F-fluoride plasma clearance (K(i)) at the spine was calculated using a three-compartment model. Standardised uptake values (SUV) were calculated for the spine, total hip, femoral neck and femoral shaft. Measurements of BMD and biochemical markers of bone turnover were also performed. RESULTS With the exception of a significant decrease in spine BMD in the ALN group, BMD remained stable. Bone turnover markers increased significantly from baseline by 12 months for both study groups. Measurements of K(i) and SUV at the spine and femoral neck did not change significantly in either group. SUV at the femoral shaft and total hip increased significantly but in the ALN group only, increasing by 33.8% (p = 0.028) and 24.0% (p = 0.013), respectively. CONCLUSIONS Bone metabolism at the spine remained suppressed following treatment discontinuation. A significant increase in SUV at the femoral shaft and total hip after 12 months was observed but for the ALN group only. This study was small, and further clinical studies are required to fully evaluate the persistence of BP treatment.
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Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome: a randomized controlled clinical trial with 1-year follow-up.
Fukuda, TY, Melo, WP, Zaffalon, BM, Rossetto, FM, Magalhães, E, Bryk, FF, Martin, RL
The Journal of orthopaedic and sports physical therapy. 2012;(10):823-30
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES To determine if adding hip-strengthening exercises to a conventional knee exercise program produces better long-term outcomes than conventional knee exercises alone in women with patellofemoral pain syndrome (PFPS). BACKGROUND Recent studies have shown that a hip-strengthening program reduces pain and improves function in individuals with PFPS. However, there are no clinical trials evaluating long-term outcomes of this type of program compared to conventional knee-strengthening and -stretching exercises. METHODS Fifty-four sedentary women between 20 and 40 years of age, with a diagnosis of unilateral PFPS, were randomly assigned knee exercise (KE) or knee and hip exercise (KHE). The women in the KE group (n = 26; mean age, 23 years) performed a 4-week conventional knee-stretching and -strengthening program. The women in the KHE group (n = 28; mean age, 22 years) performed the same exercises as those in the KE group, as well as strengthening exercises for the hip abductors, lateral rotators, and extensors. An 11-point numeric pain rating scale, the Lower Extremity Functional Scale, the Anterior Knee Pain Scale, and a single-hop test were used as outcome measures at baseline (pretreatment) and 3, 6, and 12 months posttreatment. RESULTS At baseline, demographic, pain, and functional assessment data were similar between groups. Those in the KHE group had a higher level of function and less pain at 3, 6, and 12 months compared to baseline (P<.05). In contrast, the KE group had reduced pain only at the 3- and 6-month follow-ups (P<.05), without any changes in Lower Extremity Functional Scale, Anterior Knee Pain Scale, or hop testing (P>.05) through the course of the study. Compared to the KE group, the KHE group had less pain and better function at 3, 6, and 12 months posttreatment (P<.05). For the Lower Extremity Functional Scale, the between-group difference in change scores from baseline at 3, 6, and 12 months posttreatment favored the KHE group by 22.0, 22.0, and 20.8 points, respectively. CONCLUSION Knee-stretching and -strengthening exercises supplemented by hip posterolateral musculature-strengthening exercises were more effective than knee exercises alone in improving long-term function and reducing pain in sedentary women with PFPS.
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Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones.
Shah, K, Armamento-Villareal, R, Parimi, N, Chode, S, Sinacore, DR, Hilton, TN, Napoli, N, Qualls, C, Villareal, DT
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2011;(12):2851-9
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Abstract
Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30 kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p < 0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p < 0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p < 0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p = 0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p = 0.001). Multivariate analyses revealed that changes in lean body mass (β = 0.33), serum osteocalcin (β = -0.24), and one-repetition maximum (1-RM) strength (β = 0.23) were independent predictors of changes in hip BMD (all p < 0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.