Low back pain in healthy postmenopausal women and the effect of physical activity: A secondary analysis in a randomized trial.

Epidemiological studies on the prevalence of musculoskeletal pain have consistently shown that this is a relevant health problem, with non-specific low back pain (LBP) being the most commonly reported in adult females. Conflicting data on the association between LBP symptoms and physical activity (PA) have been reported. Here, we investigated the prevalence of LBP and the effect of a 24-month non-specific PA intervention on changes in LBP prevalence in a series of Italian healthy postmenopausal women. We performed a secondary analysis in the frame of the DAMA trial, a factorial randomized intervention trial aimed to evaluate the ability of a 24-month intervention, based on moderate-intensity PA, and/or dietary modification, in reducing mammographic breast density in healthy postmenopausal women. The PA intervention included at least 1 hour/day of moderate PA and a more strenuous weekly activity, collective walks and theoretical group sessions. A self-administered pain questionnaire was administered at baseline and at the end of the intervention. The questionnaire was specifically structured to investigate the occurrence of musculoskeletal pain, the body localization, intensity and duration of the pain. Two hundred and ten women (102 randomized to PA intervention, 108 not receiving the PA intervention) filled out the questionnaires. At baseline LBP was present in 32.9% of the participants. Among women randomized to the PA intervention, LBP prevalence at follow up (21.6%) was lower than at baseline (33.3%) (p = 0.02), while in women who did not receive the PA intervention the LBP prevalence at baseline and follow up were 32.4% and 25.9%, respectively (p = 0.30). Overall, there was no significant between-group effect of PA intervention on LBP. Further studies are needed to understand the role of non-specific PA intervention, aimed to improve overall fitness, on LBP prevalence

Musculoskeletal pain in women from DAMA Trial: role of a physical activity intervention

Epidemiological studies showed that prevalence of musculoskeletal pain is higher in women than in men (Bracci et al. 2007; Salaffi et al. 2005) and low back pain is the most commonly reported whereas conflicting evidence exists for the association between physical activity and low back pain symptoms (Heneweer et al. 2011; Sitthipornvorakul et al. 2011). In this study, we investigated the prevalence of musculoskeletal pain and the role of a non-specific physical activity (PA) intervention in prevention/reduction of pain in the frame of the DAMA Trial. DAMA (n° ISRCTN28492718, funded by Istituto Toscano Tumori and Ministry of Health ) is a 24-month factorial randomized trial in post-menopausal women with high-Mammographic Breast Density (MBD), a risk factor for breast cancer (Masala et al. 2006), aimed to evaluate the ability of a structured intervention based on a moderate-intensity physical exercise and/or specific dietary modification, to reduce MBD. Participants were post-menopausal women, 50-69 yrs, with MBD>50%. Exclusion criteria were: current/recent HRT; current smokers; diabetes and/or other co-morbidities contraindicating dietary and PA intervention. After the baseline visit in which blood and urine samples, anthropometry, dietary and lifestyle information were collected, participants (234 women) were randomized by age- and BMI-stratified blocks, to one of the four arms: dietary intervention, PA intervention, dietary+PA intervention or control. The PA intervention included one hour/week exercise program carried out by exercise specialist, individual and group sessions to explain PA benefits, group walks and at least 1 hour/day of individual moderate PA (i.e. walking, biking, home exercise). The control arm received general advice on healthy diet and PA. To evaluate physical fitness of all participants, at baseline and follow-up (FU), specific visits were performed and a specific questionnaire on pain was self-administered to investigate body site of pain, pain intensity and duration. Baseline and FU pain questionnaires were completed by 210 women (102 randomised to PA intervention*, 108 to control arm§). At baseline pain was reported by 154 women (73%), among them 75% reported back, 29% shoulder and 29% leg pain. After the 24-month intervention a significant effect emerged for low back pain in women randomised to PA intervention, in term of reduced prevalence of women with pain and prevention of new cases (p=0.02 in PA arm, 0.30 in control arm) suggesting also a beneficial effect of non-specific PA

Glycemic Index, Glycemic Load and Mammographic Breast Density: The EPIC Florence Longitudinal Study

<div><p>A few studies have evaluated the association between diet and mammographic breast density (MBD) and results are inconsistent. MBD, a well-recognized risk factor for breast cancer, has been proposed as a marker of cumulative exposure to hormones and growth factors. Diets with a high glycemic index (GI) or glycemic load (GL) may increase breast cancer risk, via an effect on the insulin-like growth factor axis. We have investigated the association between carbohydrate intake, GI, GL and MBD in a prospective study. We identified a large series of women, in the frame of the EPIC-Florence cohort, with a mammogram taken five years after enrolment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Mammograms have been retrieved (1,668, 83%) and MBD assessed according to Wolfe’s classification. We compared women with high MBD (P2+DY Wolfe’s categories) with those with low MBD (N1+P1) through logistic models adjusted for age, education, body mass index, menopause, number of children, breast feeding, physical activity, non-alcohol energy, fibers, saturated fat and alcohol. A direct association between GL and high MBD emerged in the highest quintile of intake in comparison with the lowest quintile (OR = 1.73, 95%CI 1.13–2.67, p for trend = 0.048) while no association with glycemic index was evident. These results were confirmed after exclusion of women reporting to be on a diet or affected with diabetes, and when Hormone Replacement Therapy at the date of mammographic examination used to assess MBD was considered. The effect was particularly evident among leaner women, although no interaction was found. A positive association was suggested for increasing simple sugar and total carbohydrates intakes limited to the highest quintiles. In this Italian population we observed an association between glycemic load, total and rapidly absorbed carbohydrates and high MBD. These novel results warrant further investigations.</p></div

Association between energy-adjusted GI and GL and high MBD by menopausal status and BMI (1,628 EPIC-Florence women).

*<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non -alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles and, alternatively, body mass index (normal weight/overweight/obese) and menopausal status (pre-/post-menopausal).</p

Mean and median values of selected lifestyle and dietary variables of 1,668 participants by low and high MBD (EPIC-Florence).

*<p>Metabolic equivalents (METs) for non occupational physical activity (including recreational and household activities).</p>**<p><i>P</i>-values were calculated from GLM.</p

Association between energy-adjusted GI, GL and high MBD (1,628 EPIC-Florence women).

*<p>Crude ORs obtained by models including only the variable of interest (classified in quintiles).</p>**<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), body mass index (normal weight/overweight/obese), menopausal status (pre−/post-menopausal), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non-alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles.</p

Association between energy-adjusted total carbohydrate, simple sugars and starches and high MBD (1,628 EPIC-Florence women).

*<p>Crude ORs obtained by models including only the variable of interest (classified in quintiles).</p>**<p>Adjusted ORs obtained by multivariate logistic models including terms for age (years), education (university and secondary school yes/no), body mass index (normal weight/overweight/obese), menopausal status (pre−/post-menopausal), number of children (0; 1–2; ≥3), duration of breast feeding (≤8 months/>8 months), non-alcohol energy intake (kcal/day, continuous), leisure time physical activity (MET/week in continuous), alcohol (g/day), fiber (g/day) and saturated fat (g/day) intakes in quintiles.</p>∧<p>Included simultaneously in the crude and adjusted models.</p

Up to one-third of breast cancer cases in post-menopausal Mediterranean women might be avoided by modifying lifestyle habits: the EPIC Italy study

Breast cancer (BC) is the most frequent cancer among women in developed countries. Physical activity (PA), body mass index (BMI), and alcohol intake have been identified as relevant lifestyle modifiable risk factors for post-menopausal BC. We aimed to evaluate the role of these factors in modulating post-menopausal BC risk and to estimate the proportion of BC cases attributable to low PA, high BMI, and alcohol taking into account non-modifiable factors

Baseline prevalence (percentage) of different types of back pain in the 210 study women.

<p>Baseline prevalence (percentage) of different types of back pain in the 210 study women.</p

Prevalence and body localization of pain reported by study women at baseline, overall and according to physical activity (PA) intervention.

<p>Prevalence and body localization of pain reported by study women at baseline, overall and according to physical activity (PA) intervention.</p