INFLUENCE OF EXERCISE HISTORY ON FALL-INDUCED HIP FRACTURE RISK

Hip fracture is a major public health problem. Thin superolateral cortex of the femoral neck experiences unusually high stress in a sideway fall, contributing to hip fracture risk. The aim of this study is to examine how exercise based loading history, known to affect the femoral neck cortical structure, influences fall-induced fracture risk. For this purpose, finite element models were created from the proximal femur MRI of 91 young athletic and 20 control females. Fall-induced superolateral cortical safety factors (SF) were estimated in the distal volume of femoral neck. Significantly higher (p \u3c 0.05) SFs were observed from femoral necks with high impact (H-I), odd impact (O-I), and repetitive impact (R-I) exercise history, indicating lower fracture risk. The results indicate that it is advisable to include some impact exercise in a fracture preventive exercise progra

Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

Background. Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age. Methods. We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies. Results. Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported. Conclusions. The findings from our meta-analysis of RCTs indicate that exercise can significantly enhance bone strength at loaded sites in children but not in adults. Since few RCTs were conducted to investigate exercise effects on bone strength, there is still a need for further well-designed, long-term RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.peerReviewe

Neck–Shoulder Region Training for Chronic Headache in Women : A Randomized Controlled Trial

Objectives: We investigated whether a specific exercise program for the neck–shoulder region reduces headache intensity, frequency, and duration, and how it influences neck disability among women with chronic headache compared to a control group. Design: Two-center randomized controlled trial. Subjects: 116 working-age women. Intervention: The exercise group (n = 57) performed a home-based program with six progressive exercise modules, over 6 months. The control group (n = 59) underwent six placebo-dosed transcutaneous electrical nerve stimulation sessions. Both groups performed stretching exercises. Main measures: The primary outcome was pain intensity of headache, assessed using the Numeric Pain Rating Scale. Secondary outcomes were frequency and duration of weekly headaches, and neck disability assessed using the Neck Disability Index. Generalized linear mixed models were used. Results: Mean pain intensity at baseline was 4.7 (95% CI 4.4 to 5.0) in the exercise group and 4.8 (4.5 to 5.1) in the control group. After 6 months the decrease was slight with no between-group difference. Headache frequency decreased from 4.5 (3.9 to 5.1) to 2.4 (1.8 to 3.0) days/week in the exercise group, and from 4.4 (3.6 to 5.1) to 3.0 (2.4 to 3.6) in the control group (between-group p = 0.017). Headache duration decreased in both groups, with no between-group difference. Greater improvement in the Neck Disability Index was found in the exercise group (between-group change −1.6 [95% CI −3.1 to −0.2] points). Conclusion: The progressive exercise program almost halved headache frequency. The exercise program could be recommended as one treatment option for women with chronic headache.publishedVersionPeer reviewe

Differential effects of exercise on tibial shaft marrow density in young female athletes

Context:Increased mechanical loading can promote the preferential differentiation of bone marrow mesenchymal stem cells to osteoblastogenesis, but it is not known whether long-term bone strength-enhancing exercise in humans can reduce marrow adiposity.Objective:Our objective was to examine whether bone marrow density (MaD), as an estimate of marrow adiposity 1) differs between young female athletes with contrasting loading histories and bone strengths and 2) is an independent predictor of bone strength at the weight-bearing tibia.Design:Mid-tibial MaD, cortical area (CoA), total area, medullary area, strength strain index (SSI), and cortical volumetric bone mineral density (vBMD) (total, endocortical, midcortical, and pericortical) was assessed using peripheral quantitative computed tomography in 179 female athletes involved in both impact and nonimpact loading sports and 41 controls aged 17&ndash;40 years.Results:As we have previously reported CoA, total area, and SSI were 16% to 24% greater in the impact group compared with the controls (all P &lt; .001) and 12% to 18% greater than in the nonimpact group (all P &lt; .001). The impact group also had 0.5% higher MaD than the nonimpact and control groups (both P &lt; .05). Regression analysis further showed that midtibial MaD was significantly associated with SSI, CoA, endocortical vBMD, and pericortical vBMD (P &lt; .05) in all women combined, after adjusting for age, bone length, loading groups, medullary area, muscle cross-sectional area, and percent fat.Conclusion:In young female athletes, tibial bone MaD was associated with loading history and was an independent predictor of tibial bone strength. These findings suggest that an exercise-induced increase in bone strength may be mediated via reduced bone marrow adiposity and consequently increased osteoblastogenesis.<br /

Exercise loading and bone structure

The objective of this dissertation was to determine the types of exercise loading that are associated with the strength of bones. Four cross-sectional studies were conducted between 2004 and 2008 including 378 athletes and their 62 referents. Sixteen different sports were classified into five specific categories for the lower extremities and three categories for the upper extremities according to the type of exercise loading.Besides planar DXA-derived hip structural analysis, pQCT, and MRI methods allowing the assessment of true bone cross-sections were used for the bone structure analyses of the tibia, proximal femur, radius, and humerus. At the lower extremity, the high-impact exercise loading group (volleyball, hurdling, moguls skiing, triple jump, and high jump) and the odd-impact exercise loading group (soccer, racket games, speed skating, slalom skiing, step aerobics) had 13 to 60% stronger tibia and femoral neck than the reference group. Athletes in high-magnitude exercise loading (weightlifting, powerlifting) did not have more rigid tibia and femoral neck than those in the reference group, while athletes in the repetitive, low-impact loading group (endurance running, orienteering, and cross country skiing) had some 20 to 30% stronger tibia and their femoral neck also seemed to be 10% stronger than those in the reference group.A novel finding of this study was that, compared to the reference group, the athletes in the high- and odd-impact exercise loading groups had about 20% thicker cortex at the anterior and supero-lateral regions of the femoral neck, the regions that are especially vulnerable in terms of hip fragility.In the dominant forearm, athletes in both the impact (volleyball and racket games) and high-magnitude (functional weightlifting in soccer and hurdling) exercise loading groups had approximately 15 to 30% stronger radius and humerus than those in the reference group. In the non-dominant forearm, no such difference was found between athletes in impact exercise loading group (racket games) and the reference group, suggesting that there were no substantial inborn differences between these groups.In conclusion, the type of exercise loading seems to be an important external determinant of the structure of bone. At the lower extremity, the rigid bone structure is especially clear among those engaged with high-impact or odd-impact exercise loading, and, at the upper extremity, among those with impact loading in general. However, the findings of these cross-sectional studies should be tested in randomized controlled trials.Lonkan kuoriluu ohenee iän ja vähentyneen fyysisen aktiivisuuden seurauksena erityisesti reisiluun kaulan ylä- ja etuseinämissä. Nämä kohdat ovat myös alttiina kaatumisen aiheuttamille murtumille. Riku Nikander selvitti tutkimuksessaan, minkä tyyppistä liikuntaa harrastavilla kilpaurheilijoilla on vahva luuston rakenne. Urheilulajien edustajat jaettiin viiteen liikuntakuormitustyyppiin: iskukuormitus (muun muassa kolmiloikka ja korkeushyppy); vaihtuvasuuntainen kuormitus (mm. jalkapallo ja squash); voimakuormitus (mm. voimanosto); toistokuormitus (mm. kestävyysjuoksu) sekä painoa kantamaton kuormitus (mm. uinti).Tutkimuksen osallistujilta mitattiin reisiluun kaulan luuntiheys (DEXA-mittaus). Lisäksi heille tehtiin luun rakenteen analyysi (magneettikuvaus). Urheilijoiden tuloksia verrattiin kolme kertaa viikossa liikuntaa harrastavien kuntoliikkujien arvoihin.Tulokset osoittivat, että voimakasta iskukuormitusta aiheuttavien lajien urheilijoilla ja vaihtuvasuuntaista kuormitusta sisältävien lajien pelaajilla oli kymmeniä prosentteja suurempi reisiluun tiheys kuin kuntoliikunnan harrastajilla. Yksityiskohtainen luun rakenteen analyysi paljasti, että voimakasta iskukuormitusta saavien urheilijoiden lonkan vahvuus sijoittui osin luun alapinnalle, joka ei ole luun murtumakestävyyden kannalta tärkein alue. Vauhdikkaiden pelien pelaajilla oli sen sijaan tasaisesti paksu kuoriluu myös murtumien kannalta tärkeissä etu- ja yläseinämissä.Maltillinen, suunnanmuutoksia ja vauhdikkaita kiihdytyksiä sekä jarrutuksia sisältävä liikunta vahvistaa reisiluun kriittisiä kohtia ja siten ehkäisee lonkkamurtumia. Tällaisen liikunnan on aiemmin todettu kehittävän myös lihasvoimaa, ketteryyttä ja tasapainoa. - Vauhdikkaat tanssit, maila- ja pallopelit sekä voimistelu ovat erityisen tehokkaita ehkäisemään murtumia, koska ne vaikuttavat monipuolisesti ja ehkäisevät sekä luukatoa että kaatumisia, Nikander suosittelee

Kuntoutuksen järjestämiseen liittyy monikanavaisesta rahoituksesta johtuvia ongelmia

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Harjoittelun vaikuttavuus ja toteutus kroonisen niskakipupotilaan kuntoutuksessa

Kroonisen niskakivun syynä on aiemmin pidetty lihasjännitystä, ja siksi hoidot ovat olleet lähinnä passiivisia tai kevyeen lihaskuormitukseen perustuvia harjoitteita. Krooniseen niskakipuun liittyy lihasten aineenvaihdunnan ja rakenteen muutoksia, jotka eivät korjaudu lääkityksellä vaan spesifisellä niskalihaksia vahvistavalla harjoittelulla. Vähintään puolen vuoden ajan toteutettu säännöllinen venyttely ja niska-hartiaseudun nousujohteinen lihasvoimaharjoittelu vähentää kroonista niskakipua, lisää liikkuvuutta ja lihasvoimaa merkitsevästi.Chronic non-specific neck pain is a common condition affecting about 6% of adults in Finland. Degenerative changes in cervical vertebrae and discs are common even among healthy people and increase with age. The diagnosis of chronic non-specific neck pain is based mainly on symptoms and clinical examination. It is well established that the incidence and severity of spinal degeneration on radiographs and MRI scans are poorly related to the levels of pain and disability. Previously, chronic neck pain was believed to be related to increased tension in neck muscles, and “tension neck” was also a commonly used diagnosis. Thus, passive physical therapies and rest have been commonly used for treatment of chronic non-specific neck pain. However, these have not proved to have significant effect in the long-term. No correlation has been found between neck pain and electrical activity (EMG) in neck muscles, which may well explain the poor results. However, cognitive and multimodal rehabilitation programmes have not been able to produce better results either. Patients with chronic neck pain have been shown to have lower neck strength and endurance compared to healthy controls. This is thought to be related to decreased local muscle circulation and metabolism, which has been demonstrated in controlled studies. Neck muscle atrophy has also been shown to be present in chronic conditions. The results of several randomized studies have shown that exercising involving specific neck muscle training combined with stretching of the neck muscles with adequate support and follow-up are effective rehabilitation methods for patients with chronic non-specific neck pain. Proper intensity, frequency and length of exercise periods are essential to achieve long-term results. At the start some people may also need passive physiotherapy for treatment of severe pain in order to make effective exercising possible. However these therapies cannot be recommended for all patients as they may even slow down the rehabilitation process in some people. The present health care system needs to change as primary health care increasingly refers patients to queues for specialist services provided by public health care, which causes steadily increasing costs. These do not arise from consultations and unnecessary diagnostic imaging alone, but also from sick leave during long waiting times. Moreover, the current practice causes unnecessary suffering due to postponed rehabilitation. Thus it is suggested that direct access to physiotherapy should be implemented in the whole country according to the model of the Central Finland Health Care District.peerReviewe