Throwing enhances humeral shaft cortical bone properties in pre-pubertal baseball players: a 12-month longitudinal pilot study

Objectives: To explore throwing athletes as a prospective, within-subject controlled model for studying the response of the skeleton to exercise. Methods: Male pre-pubertal throwing athletes (n=12; age=10.3±0.6 yrs) had distal humerus cortical volumetric bone mineral density (Ct.vBMD), cortical bone mineral content (Ct.BMC), total area (Tt.Ar), cortical area (Ct.Ar), medullary area (Me.Ar), cortical thickness (Ct.Th) and polar moment of inertia (IP) assessed within their throwing (exercised) and nonthrowing (control) arms by peripheral quantitative computed tomography at baseline and 12 months. Throwing-to-nonthrowing arm percent differences (i.e. bilateral asymmetry) were compared over time. Results: Over 12 months, the throwing arm gained 4.3% (95% Cl=1.1% to 7.5%), 2.9% (95% Cl=0.3% to 5.4%), 3.9% (95% Cl=0.7% to 7.0%), and 8.2% (95% Cl=2.0% to 6.8%) more Ct.BMC, Ct.Ar, Tt.Ar, and IP than the nonthrowing arm, respectively (all p<0.05). There was no significant effect of throwing on Ct.vBMD, Ct.Th and Me.Ar (all p=0.18-0.82). Conclusion: Throwing induced surface-specific cortical bone adaptation at the distal humeral diaphysis that contributed to a gain in estimated strength. These longitudinal pilot data support the utility of throwing athletes as a within-subject controlled model to explore factors influencing exercise-induced bone adaptation during the critical growing years

Tibial Bone Strength is Enhanced in the Jump Leg of Collegiate-Level Jumping Athletes: A Within-Subject Controlled Cross-Sectional Study

An efficient method of studying skeletal adaptation to mechanical loading is to assess side-to-side differences (i.e., asymmetry) within individuals who unilaterally exercise one side of the body. Within-subject controlled study designs have been used to explore skeletal mechanoadaptation at upper extremity sites; however, there is no established model in the lower extremities. The current study assessed tibial diaphysis and distal tibia asymmetry in collegiate-level jumping athletes (N = 12). To account for normal crossed asymmetry, data in jumping athletes were compared to asymmetry in a cohort of athletic controls not routinely exposed to elevated unilateral lower extremity loading (N = 11). Jumpers exhibited side-to-side differences between their jump and lead legs at both the tibial diaphysis and distal tibia, with differences at the former site persisting following comparison to dominant-to-nondominant leg differences in controls. In particular, jump-to-lead leg differences for cortical area and thickness at the tibial diaphysis in jumpers were 3.6% (95% CI 0.5-6.8%) and 3.5% (95% CI 0.4-6.6%) greater than dominant-to-nondominant differences in controls, respectively (all p < 0.05). Similarly, jump-to-lead leg differences in jumpers for tibial diaphysis maximum second moment of area and polar moment of inertia were 7.2% (95% CI 1.2-13.2%) and 5.7% (95% CI 1.7-9.8%) greater than dominant-to-nondominant differences in controls, respectively (all p < 0.05). Assessment of region-specific differences of the tibial diaphysis in jumpers indicated that the jump leg had greater pericortical radii on the medial and posterior sides and greater radial cortical thickness posteromedially when compared to the lead leg. These data suggest that athletes who perform repetitive and forceful unilateral jumping may be a useful and efficient within-subject controlled model for studying lower extremity skeletal mechanoadaptation

Exercise during growth provides lifelong benefit to bone structure and strength: a case study

poster abstractExercise induces greatest gains in bone health during skeletal development, yet reduced bone strength is predominantly an age-related phenomenon. This dichotomy has raised the question of whether exercise-induced changes in bone health when young persist into late adulthood where they may have benefits on bone health and fracture risk. Previous work has suggested exercise-induced gains in bone mass are lost with aging; however, 1) exercise during growth predominantly influences bone structure rather than mass to increase bone strength and 2) mechanisms exist for the long-term maintenance of exercise effects on bone structure. The aim of the current case was to explore whether exercise-induced gains in bone structure and strength accrued when young persist lifelong. The subject was a 94-year-old former Major League Baseball (MLB) pitcher who played competitively for 20 years before ceasing play in 1955. Throwing athletes are a unique model to investigate the skeletal effects of exercise as: 1) the unilateral upper extremity loading associated with throwing enables the contralateral side to serve as an internal control site and 2) throwing athletes have large dominant-to-nondominant (D-to-ND) differences in midshaft humeral bone properties. Peripheral quantitative computed tomography slices of the subject’s dominant and nondominant humerii were taken at 50% humeral length, and D-to-ND percent differences in bone properties calculated and compared to those observed previously in non-throwing controls. Exercise when young had no lasting effects on D-to-ND difference in cortical bone mass or area; however, Dto-ND difference in total area was nearly 3-times that observed in controls. The maintenance of exercise effects on total area resulted from persistence of benefits on periosteal perimeter, with the loss of cortical bone mass and area benefits being due to greater endosteal expansion (perimeter). As a result of the maintenance of exercise-induced benefits on bone structure, D-to-ND difference in ability to resist torsional forces (polar moment of inertia) was nearly double that observed due to habitual loading associated with arm dominance in controls. The maintenance of exercise-induced benefits on bone structure in the current case, despite exercise ceasing 56 years ago, supports the hypothesis that exercise when young can have lasting benefits on bone strength independent of maintenance of bone mass effects. This question is being further explored in a cohort of 100 former MLB players and 100 matched controls

Ultrasound imaging for measuring the material and mechanical properties of the Achilles tendon: inter-day reliability and correlation with a functional calf length test

poster abstractPurpose/Hypothesis: The ability to objectively assess Achilles tendon length and mechanical properties can be challenging because other factors such as muscle and joint mechanics can complicate standard clinical tests. Ultrasound imaging has the ability to provide isolated objective measures of the material and mechanical properties of the Achilles tendon. The primary aim of this study was to assess the inter-day reliability of the material and mechanical properties of the Achilles tendon in a single rater. A secondary aim was to investigate whether there was any relationship between measured tendon properties and calf muscle length measured with a lunge test. Number of subjects: Ten Achilles tendons in 5 subjects (all subjects were 24 years old; 80% female). Material/Methods: Healthy subjects attended 2 identical measurement sessions, 2 days apart. Subjects were measured at the same time of day and were encouraged to perform the same pre-test activities. Immediately prior to the ultrasound imaging, functional calf length was measured in standing with a lunge test. Subjects were then positioned prone with the knee extended and ankle held at 0 degrees of dorsiflexion, and measurements of the resting tendon length and tendon cross-sectional area were obtained from static ultrasound images. Tendon elongation was measured during isometric dynamometry through imaging the proximal movement of the musculotendinous junction of the medial gastrocnemius. Tendon strain was measured at maximum isometric torque. Intra-class correlation coefficients (ICCs) were calculated to determine the reliability of the ultrasound measures. The correlation between tendon properties and the lunge test were examined using a Pearson correlation coefficient, with the level of significance set at 0.05. Results: Reliability analysis demonstrated high inter-day test-retest reliability for resting Achilles tendon length (ICC = 0.95), cross-sectional area (ICC = 0.96) and strain (ICC = 0.95). Tendon elongation measured with ultrasound imaging during peak isometric force had good reliability (ICC = 0.81). A moderate correlation was found between resting tendon length and the lunge test on each day of testing; Day 1 (r=0.67, r2=0.45, p=0.034) and Day 2 (r=0.66, r2=0.44, p=0.038). Conclusion: Ultrasound imaging measurements of the material and mechanical properties of the Achilles tendon has good-to-high inter-day reliability in a single rater. It was also determined that Achilles tendon resting length accounted for ~45% of the variance in the lunge test, indicating other factors contribute to lunge test performance. The later may include talocrural and subtalar joint motion, and length of the gastrocnemius and soleus muscles. Clinical relevance: Ultrasound imaging can be used as a reliable, safe and cost-effective tool to measure isolated Achilles tendon properties. This may allow future studies to explore intervention effects on the material and mechanical characteristics of the tendon

A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls among Breast Cancer Survivors

Objective The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments. Design This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1-T2 and T2-T3 were the control and intervention periods, respectively. Results All outcomes, except the tandem walk test, significantly improved after the intervention period (p 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (p = 0.04), but not after the control period. Conclusions A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings

Exercise Completed When Young Provides Lifelong Benefit to Cortical Bone Structure and Estimated Strength

poster abstractExercise induces greatest bone gains during growth, yet reduced bone strength is an age-related phenomenon. This raises the question of whether exercise-induced bone changes when young persist into adulthood. The current studies used Major/Minor League Baseball (MLB/MiLB) players to explore whether exercise-induced gains in humeral bone structure and strength accrued when young persist lifelong. MLB/MiLB players are a unique model as the unilateral upper extremity loading associated with throwing enables the contralateral side to serve as an internal control site and former MLB/MiLB players were consistently exposed to extreme loading reducing secular variations in exercise levels between generations. Dominant-to-nondominant (D-to-ND) differences in humeral cross-sectional properties in MLB/MiLB players were normalized to matched controls to correct for side-to-side differences due to elevated habitual loading associated with arm dominance. Exercise when young induced significant skeletal benefits, with active MLB/MiLB players having nearly double the estimated ability to resist torsion (polar moment of inertia, IP) in the humerus of their dominant arm. The cortical bone mass and area benefits of exercise observed in active MLB/MiLB players were lost in former MLB players following 40-49 years of detraining as a result of elevated medullary expansion and endocortical trabecularization. However, 42% of the total bone area benefit persisted following 50+ years of detraining and contributed to the maintenance of 24% of the benefit on IP. In MLB players who continued to exercise during aging, medullary expansion and endocortical trabecularization were reduced and there was maintenance of the cortical bone mass and area benefits of exercise. These cumulative data indicate: 1) the extreme plasticity of the growing skeleton to exercise; 2) that exercise when young has lifelong benefits on cortical bone size and estimated strength, but not bone mass, and; 3) exercise continued during aging maintains the bone mass benefits of exercise

Baseball and softball pitchers are distinct within-subject controlled models for exploring proximal femur adaptation to physical activity

Purpose: Within-subject controlled models in individuals who preferentially load one side of the body enable efficient exploration of the skeletal benefits of physical activity. There is no established model of physical activity-induced side-to-side differences (i.e., asymmetry) at the proximal femur. Methods: Proximal femur asymmetry was assessed via dual-energy x-ray absorptiometry in male jumping athletes (JMP, n=16), male baseball pitchers (BB, n=21), female fast-pitch softball pitchers (SB, n=22), and controls (CON, n=42). The jumping leg was the dominant leg in JMP, whereas in BB, SB and CON the dominant leg was contralateral to the dominant/throwing arm. Results: BB and SB had 5.5% (95%CI, 3.9 to 7.0%) and 6.5% (95%CI, 4.8 to 8.2%) dominant-to-nondominant leg differences for total hip areal bone mineral density (aBMD), with the asymmetry being greater than both CON and JMP (p8%) dominant-to-nondominant leg differences in cross-sectional area, cross-sectional moment of inertia and section modulus, which were larger than any other group (p≤0.02). Conclusion: Male baseball and female softball pitchers are distinct within-subject controlled models for exploring adaptation of the proximal femur to physical activity. They exhibit adaptation in their dominant/landing leg (i.e., leg contralateral to the throwing arm), but the pattern differs with softball pitchers exhibiting greater femoral neck adaptation

Age-Related Changes in Proximal Humerus Bone Health in White Males

poster abstractThe proximal humerus is a common site for osteoporotic fracture during aging, accounting for up to 5% of fractures to the appendicular skeleton. While falls onto an outstretched hand are usually physically responsible for proximal humerus fractures, the ability of the underlying bone to resist applied loads must also play a role. Few studies have assessed proximal humerus bone health with aging. The aim of the current study was to explore age-related bone changes at the proximal humerus in men. A cross-sectional study design was used to assess peripheral quantitative computed tomography (pQCT)-derived bone properties of the proximal humerus in a cohort of 112 white males (age range = 30-85 yrs). A tomographic slice of the non-dominant upper extremity was acquired at 80% of humeral length proximal from its distal end—a location corresponding to the surgical neck of the humerus. Images were assessed for cortical (Ct.BMC) and trabecular (Tb.BMC) BMC, total (Tt.Ar), cortical (Ct.Ar) and medullary (Me.Ar) area, periosteal (Ps.Pm) and endosteal (Es.Pm) perimeter, cortical thickness (Ct.Th), and bone strength index for compression (BSIc). BSIc was calculated as the product of Tt.Ar and the square of total volumetric BMD. Data were plotted against age and linear regression lines assessed for their slope. Slopes were subsequently converted to percent change in the bone property per year. During aging, the proximal humerus expanded with Tt.Ar and Ps.Pm increasing at rates of 0.40%/yr and 0.19%/yr, respectively. However, Me.Ar (0.62%/yr) and Es.Pm (0.34%/yr) expanded at faster rates such that there was net loss of both Ct.BMC (-0.23%/yr) and Tb.BMC (-1.08%/yr). Also, the more rapid expansion of Me.Ar relative to Tt.Ar meant that Ct.Ar (-0.15%/yr) and Ct.Th (-0.34%/yr) both decreased with age. The net result of these mass and structural changes was progressive loss of bone strength with age, as indicated by a 0.44%/yr decline in BSIc. These data provide a picture of bone changes at the proximal humerus during aging. They suggest that between age 30 and 80 yrs, approximately 54% and 11% of Tb.BMC and Ct.BMC at the proximal humerus is lost, respectively. They also suggest that compressive strength of the proximal humerus declines by 22% between age 30 and 80 years. These declines in proximal humerus bone health have implications for fracture risk at this location during aging

Bone Microarchitecture and Strength Adaptation to Physical Activity: A Within-Subject Controlled, HRpQCT Study

Purpose Physical activity benefits bone mass and cortical bone size. The current study assessed the impact of chronic (≥10 years) physical activity on trabecular microarchitectural properties and micro-finite element (μFE) analyses of estimated bone strength. Methods Female collegiate-level tennis players (n=15; age=20.3±0.9 yrs) were used as a within-subject controlled model of chronic unilateral upper-extremity physical activity. Racquet-to-nonracquet arm differences at the distal radius and radial diaphysis were assessed using high-resolution peripheral computed tomography (HRpQCT). The distal tibia and tibial diaphysis in both legs were also assessed, and cross-country runners (n=15; age=20.8±1.2 yrs) included as controls. Results The distal radius of the racquet arm had 11.8% (95% confidence interval [CI], 7.9 to 15.7%) greater trabecular bone volume/tissue volume, with trabeculae that were greater in number, thickness, connectivity, and proximity to each other than in the nonracquet arm (all p<0.01). Combined with enhanced cortical bone properties, the microarchitectural advantages at the distal radius contributed a 18.7% (95% CI, 13.0 to 24.4%) racquet-to-nonracquet arm difference in predicted load before failure. At the radial diaphysis, predicted load to failure was 9.6% (95% CI, 6.7 to 12.6%) greater in the racquet vs. nonracquet arm. There were fewer and smaller side-to-side differences at the distal tibia; however, the tibial diaphysis in the leg opposite the racquet arm was larger with a thicker cortex and had 4.4% (95% CI, 1.7 to 7.1%) greater strength than the contralateral leg. Conclusion Chronically elevated physical activity enhances trabecular microarchitecture and μFE estimated strength, furthering observations from short-term longitudinal studies. The data also demonstrate tennis players exhibit crossed symmetry wherein the leg opposite the racquet arm possesses enhanced tibial properties compared to in the contralateral leg