Physical activity levels in female rheumatoid arthritis patients on long term anti-TNF therapy compared to patients with active rheumatoid disease and healthy controls. [Abstract]

Background: Anti-TNF therapy has revolutionised the management of rheumatoid arthritis (RA) with rapid and sustained improvements in pain, function and quality of life. However, we do not know how this impacts upon habitual daily physical activity and whether treated patients attain activity levels seen in healthy controls. This study aimed to compare the physical activity levels of patients whose RA was well controlled on long-term anti-TNF therapy to RA patients with active arthritis and non-RA controls. Methods: Participants were patients on anti-TNF for more than two years (tRA) with DAS3.2 (aRA) and healthy controls (C), matched for age and BMI. Physical activity was assessed using the Actigraph GT3x+ accelerometer, worn throughout waking hours for seven days to determine time spent in light activity, moderate to vigorous physical activity (MVPA) and sedentary time. The International Physical Activity Questionnaire (IPAQ) was also completed. Groups were compared using analysis of variance with Bonferroni post hoc tests; Kruskal-Wallis or Mann-Whitney U- test as appropriate. Results: RA disease duration was significantly greater in tRA than aRA. Groups did not differ significantly in age, height, weight or body mass index (Table). Daily step count was significantly lower in aRA than tRA and C. Sedentary time (as a proportion of wear time) was significantly greater in aRA than tRA, whilst the reverse was true for light activity time. MVPA time was significantly lower in both RA groups than in controls. IPAQ questionnaires demonstrated significant differences between groups, with substantially higher values in C than RA groups in total METs and MET-minutes per week in domestic and garden, leisure, walking activities as well as total moderate and vigorous activities. RA patients had lower moderate to vigorous activity time than controls, regardless of treatment. aRA had lower light activity time, and more sedentary time, than tRA Conclusion: Moderate to vigorous physical activity should be promoted in all RA patients as even those with well controlled disease exhibit a deficit in comparison to control

Physical activity and sedentary behavior in women with rheumatoid arthritis: a comparison of patients with low and high disease activity and healthy controls

Objective: In rheumatoid arthritis (RA) patients, low levels of physical activity (PA) and high levels of sedentary behavior (SB) may play a role in enhancing cardiovascular risk. We do not know how long-term control of disease activity impacts upon daily PA levels and if treated patients attain PA levels seen in healthy controls. We therefore compared habitual levels of PA and SB between female RA patients with low disease activity achieved by anti-tumor necrosis factor (TNF) therapy, those with active arthritis (aRA) and non-RA controls. Methods: We carried out a cross-sectional comparison of 40 RA patients on anti-TNF therapy for >2 years with DAS28<3.2 (tRA), 32 patients on conventional disease modifying anti-rheumatic drugs with DAS28>3.2 (aRA) and 34 healthy controls (C) with the groups matched for age and body mass index. PA was assessed using the ActiGraph accelerometer to determine step count and time spent in moderate-to-vigorous physical activity (MVPA), light activity and sedentary time. Results: Daily step count was 72% higher in tRA and 40% higher in C in comparison to aRA (p<0.01). Sedentary time (as a proportion of wear time) was 10% less in tRA than aRA (p=0.03), while light activity time was 18% higher (p=0.014). Both RA groups had 40% lower MVPA time than C (p=0.001). Only half of either RA group fulfilled current WHO guidelines for PA compared with 82% of controls. Conclusion: RA patients who had long-term disease suppression were more physically active with less SB compared to RA patients with active disease. They had similar light PA and SB to controls although lower MVPA. Behavioral change interventions are likely to be needed in order to restore moderate exercise, further reduce SB and to meet guidelines for daily PA

High impact exercise increased femoral neck bone mineral density in older men: a randomised unilateral intervention

Introduction: There is little evidence as towhether exercise can increase BMD in oldermenwith no investigation of high impact exercise. Lifestyle changes and individual variability may confound exercise trials but can be minimised using a within-subject unilateral design (exercise leg [EL] vs. control leg [CL]) that has high statistical power. Purpose: This study investigated the influence of a 12 month high impact unilateral exercise intervention on femoral neck BMD in older men. Methods: Fifty, healthy, community-dwelling older men commenced a 12 month high impact unilateral exercise intervention which increased to 50 multidirectional hops, 7 days a week on one randomly allocated leg. BMD of both femurswasmeasured using dual energy X-ray absorptiometry (DXA) before and after 12 months of exercise, by an observer blind to the leg allocation. Repeated measures ANOVAwith post hoc tests was used to detect significant effects of time, leg and interaction. Results: Thirty-five men (mean±SD, age 69.9±4.0 years) exercised for 12 months and intervention adherence was 90.5±9.1% (304±31 sessions completed out of 336 prescribed sessions). Fourteen men did not complete the 12 month exercise intervention due to: health problems or injuries unrelated to the intervention (n=9), time commitments (n=2), or discomfort during exercise (n=3), whilst BMD data were missing for one man. Femoral neck BMD, BMC and cross-sectional area all increased in the EL (+0.7, +0.9 and +1.2 % respectively) compared to the CL (−0.9,−0.4 and −1.2%); interaction effect Pb0.05. Although the interaction term was not significant (P>0.05), there were significantmain effects of time for sectionmodulus (P=0.044) and minimum neck width (P=0.006). Sectionmodulus increased significantly in the EL (P=0.016) but not in the CL (P=0.465); mean change+2.3% and+0.7% respectively, whereasminimumneck width increased significantly in the CL (P=0.004) but not in the EL (P=0.166); mean changes being +0.7% and +0.3% respectively. Conclusion: A 12 month high impact unilateral exercise intervention was feasible and effective for improving femoral neck BMD, BMC and geometry in older men. Carefully targeted high impact exercises may be suitable for incorporation into exercise interventions aimed at preventing fractures in healthy community-dwelling older men

Risk factors for stress fracture in female endurance athletes: a cross-sectional study

Objective: To identify psychological and physiological correlates of stress fracture in female endurance athletes. Design: A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit. Methods: Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ², analysis of variance and Mann-Whitney U tests. Results: Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively). Conclusions: Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk

Bone geometry according to menstrual function in female endurance athletes

Athletes have higher bone mineral density (BMD) relative to nonathletes. In amenorrheic athletes BMD may be compromised by estrogen deficiency, but it is unknown whether this is accompanied by structural differences. We compared femoral neck bone geometry and density of a-/oligomenorrheic athletes (AAs), eumenorrheic athletes (EAs), and eumenorrheic controls (ECs). We recruited 156 women: (68 endurance athletes and 88 controls). Femoral neck BMD, section modulus (Z), and width were measured using dual-energy X-ray absorptiometry. Menstrual function was assessed by questionnaire and classified as EA(C10 periods/year) or AA(B9periods/year): 24 athletes were AA and 44 EA. Femoral neck BMD was significantly higher in EA than AA (8 %, difference) and EC (11 % difference): mean [SE] 1.118 [0.015], 1.023 [0.020] and 0.999 [0.014] g cm-2, respectively; p\0.001. Z was significantly higher in EA than EC (11 % difference): EA 667 [19], AA 625 [21], and EC 592 [10] cm3; p\0.001. Femoral neck width did not differ between groups. All differences persisted after adjustment for height, age, and body mass. The higher femoral neck Z and BMD in athletes, despite similar width, may indicate that exercise-related bone gains are endosteal rather than periosteal. Athletes with amenorrhea had smaller increments in bone mass rather than structural adaptation. The maintained femoral neck width in controls may be an adaptive mechanism to conserve bone strength in bending despite inactivity-related bone decrement

Brief high impact exercise increased cortical mass and trabecular density at regions predictive of femoral neck and trochanteric fracture [Abstract]

Brief high impact exercise increased cortical mass and trabecular density at regions predictive of femoral neck and trochanteric fracture [Abstract

The influence of high impact exercise on cortical and trabecular bone mineral content and 3D distribution across the proximal femur in older men: a randomised controlled unilateral intervention

Regular exercisers have lower fracture risk, despite modest effects of exercise on BMC. Exercise may produce localised cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical computed tomography (CT). Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localised cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualised and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional ROIs, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whilst femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; P 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; P 12% at the anterior femoral neck, trochanter and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localised rather than being evenly distributed across the proximal femur. This article is protected by copyright. All rights reserved

Stress fracture injury in female endurance athletes in the United Kingdom: a 12-month prospective study

Studies of stress fracture (SF) incidence are limited in number and geographical location; this study determined the incidence of SF injury in female endurance athletes based in the United Kingdom. A total of 70 athletes aged between 18 and 45 years were recruited and prospectively monitored for 12 months. Questionnaires at baseline and 12 months assessed SF, menstrual and training history, eating psychopathology, and compulsive exercise. Peak lower leg muscle strength was assessed in both legs using an isometric muscle rig. Bone mineral density (BMD) of total body, spine, hip, and radius was assessed using dual X-ray absorptiometry. Among the 61 athletes who completed the 12-month monitoring, two sustained a SF diagnosed by magnetic resonance imaging, giving an incidence rate (95% confidence intervals) of 3.3 (0.8, 13.1) % of the study population sustaining a SF over 12 months. The SF cases were 800m runners aged 19 and 22 years, training on average 14.2h a week, eumenorrheic with no history of menstrual dysfunction. Case 1 had a higher than average energy intake and low eating psychopathology and compulsive exercise scores, while the reverse was true in case 2. BMD in both cases was similar to mean values in the non-SF group. The incidence of SF in our female endurance athlete population based in the United Kingdom was 3.3%, which is lower than previously reported. Further work is needed to confirm the current incidence of SF and evaluate the associated risk factors

Increases in proximal femur bone strength estimated using finite element models from computed tomography scans following brief, high impact exercise in older men [Abstract]

Increases in proximal femur bone strength estimated using finite element models from computed tomography scans following brief, high impact exercise in older men [Abstract