Functional fitness and bone mineral density in the elderly.

UNLABELLED: Bone quality has been associated with genetic factors and several environmental influences. This study suggests that although functional fitness should be considered in clinical assessments of bone health, body composition appears to have a higher relevance in the explanation of bone health/strength in older people. PURPOSE: This study aims to describe the association between functional fitness (FF), other constitutive factors, and bone health/strength in a large community-dwelling sample of elderly active Portuguese. METHODS: This cross-sectional study included 401 males and 401 females aged 60-79 years old. Bone mineral density (BMD) of the total body, lumbar spine (LS), and hip region was determined by dual-energy X-ray absorptiometry (DXA). In addition, femur strength index (FSI) was determined. FF was assessed using the Senior Fitness Test. Demographic information and a health history were obtained by telephone interview through questionnaire. RESULTS: Aerobic endurance and body strength were positively related with hip BMD region in males (0.10 < r < 0.16; p < 0.01-0.05) and females (0.13 < r < 0.28; p < 0.01). No significant correlation was found between any FF test and LS BMD, except for upper-body strength in females. After controlling for other constitutive predictors (sex, age, height, body mass (BM), total fat mass (TFM), and total lean tissue mass (TLTM)), FF had a minor contribution only in prediction of BMD at multisites and FSI. The total explained variance for all determinants was moderate (R² = 0.35 for femoral neck (FN) BMD, R² = 0.27 for LS BMD, R² = 0.49 total body BMD, and R² = 0.22 for FSI). CONCLUSIONS: Sex, age, height, BM, TLTM, and TFM entered as the most significant contributors for BMD and FSI. Although FF parameters are typically considered in clinical assessments of bone health/strength in older people, body composition appears to have a higher relevance in the explanation of BMD and strength.

Sex-specific developmental changes in muscle size and bone geometry at the femoral shaft.

INTRODUCTION: When expressed as a percentage of the average result in young adults, bone mineral content lags behind bone length before puberty. Even though this observation has led to speculation about bone fragility in children, such relationships could simply be due to scaling effects when measures with different geometrical dimensions are compared. METHODS: The study population comprised 145 healthy subjects (6-25 years, 94 females). Magnetic resonance imaging and dual-energy X-ray absorptiometry were used to determine femur length, bone mineral content, cortical bone mineral density, cross-sectional bone geometry (bone diameter; cortical thickness; total, cortical and medullary areas; cross-sectional and polar moments of area; bone strength index) and muscle area at the proximal one-third site of the femur. Results were dimensionally scaled by raising two-, three- and four-dimensional variables to the power of 1/2, 1/3 and 1/4, respectively. Sex-differences were also assessed before and after functionally adjusting variables for femur length and weight or muscle size. RESULTS: In prepubertal children, unscaled results expressed as percentages of adult values were lowest for variables with the highest dimensions (e.g., moments of area

Gender differences in habitual activity in children with cystic fibrosis.

AIMS: (1) To compare habitual activity levels in prepubescent and pubescent boys and girls with different degrees of CF lung disease severity and healthy controls. (2) To assess the relation between habitual activity levels and measures of fitness, lung function, nutrition, pancreatic status, and quality of life. METHODS AND RESULTS: A total of 148 children (75 girls and 73 boys) with CF and matched controls were studied. Regardless of disease severity, there were no differences in habitual activity between prepubescent boys and girls with CF. Pubescent boys with CF were significantly more active than girls with the same degree of disease severity. There were no significant differences in habitual activity between prepubescent children with CF and controls. Pubescent children with mild CF were significantly more active than controls, but those with moderate to severe disease were less active than controls. The best correlates with habitual activity levels were anaerobic power, aerobic capacity, and quality of life. In children with moderate to severe disease, nutrition status correlated significantly with activity levels. The impact of pancreatic status on activity levels and other measures of fitness was most apparent in pubescent girls. CONCLUSION: Gender differences in habitual activity were evident only after the onset of puberty. The impact of pancreatic insufficiency on measures of fitness and habitual activity was greatest in pubescent females. The reason for this gender difference may be an interplay of genetic, hormonal, and societal factors and is the focus of a longitudinal study.

A comparison of bone geometry and cortical density at the mid-femur between prepuberty and young adulthood using magnetic resonance imaging.

In upper extremity bones, a sexual dimorphism exists in the development of periosteal and endocortical bone surfaces during growth. Little is known about developmental patterns of bone geometry at weight-bearing bones like the femur. Using MRI and dual energy X-ray absorptiometry (DXA), this study assessed the differences in mid-femoral total (TA), cortical (CA) and medullary areas (MA), cortical thickness, and cortical density (BMD(compartment)) between prepuberty and young adulthood in 145 healthy subjects (94 females) 6 to 25 years old. Additionally, agreement between mid-femoral total bone volume (TV) measurements by DXA and MRI were investigated. In both sexes, TA, CA, MA, and cortical thickness were significantly larger in adults compared to prepubertal subjects (P < 0.001), and males had greater values than females. This sex difference persisted for TA, CA, and cortical thickness (P < 0.05), but not MA, after adjusting for femur length and weight. Mean (SD) cortical BMD increased from 1.05 (0.07) and 1.09 (0.10) g/cm(3) in prepubertal children to 1.46 (0.14) and 1.42 (0.1) g/cm(3) in young adults, females and males, respectively (P < 0.001). TV measurements by DXA were significantly greater than by MRI (P < 0.001) in young adults. In conclusion, periosteal and endocortical expansion and increasing cortical BMD are the growth processes found at the mid-femur in both sexes. Our findings contrast to that in upper extremity bones, where MA is constant in females during growth. The difference in femoral bone development may be due to higher strains caused by weight bearing and genetic factors. DXA, in contrast to MRI, is inaccurate in the determination of mid-femoral TV measures.

Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis.

The aim of this study was to compare aerobic and resistance training in children with cystic fibrosis (CF) admitted to hospital with an intercurrent pulmonary infection with a control group. The subjects were randomized into three groups on the first day of admission. The fat-free mass (FFM) was calculated, using the skin fold thickness from four sites (biceps, triceps, subscapular, and iliac crest). Pulmonary function tests were performed within 36 hr of admission and repeated on discharge from the hospital, and again at 1 month after discharge. All subjects performed an incremental treadmill exercise test, using a modified Bruce protocol. Lower limb strength was measured using a Cybex dynamometer. An assessment of quality of life was made using the Quality of Well Being Scale, as previously reported. Activity levels were measured using a 7-day activity diary, and subjects also wore an accelerometer on their hips. There were no significant differences between the three groups in terms of disease severity, and length of stay in hospital. Subjects in all three groups received intravenous antibiotics and nutritional supplementation as determined by the physician. Children randomized to the aerobic training group participated in aerobic activities for five sessions, each of 30-min duration, a week. The children randomized to the resistance training group exercised both upper and lower limbs against a graded resistance machine. Subjects in the control group received standard chest physiotherapy. Our study demonstrated that children who received aerobic training had significantly better peak aerobic capacity, activity levels, and quality of life than children who received the resistance training program. Children who received resistance training had better weight gain (total mass, as well as fat-free mass), lung function, and leg strength than children who received aerobic training. A combination of aerobic and resistance training may be the best training program, and future studies to assess optimal training programs for CF patients are indicated.

Effect of altered physical loading on bone and muscle in the forearm.

Cast immobilization of injured forearms is common clinical practice yet little is known about the effect of reduced skeletal loading in the absence of pathology. This study reports the changes in the forearms of nine healthy young adults owing to six weeks in a plaster cast followed by 1 year of either habitual activity or a strengthening program. Both groups exhibited similar patterns of change in wrist mobility, forearm muscle strength, and bone variables. Because of small sample size and poor compliance with the exercise protocol, no conclusions can be drawn about the effect of exercise. In all subjects, reduced loading caused a decrease in wrist mobility (p < 0.02) and grip strength (p = 0.01) with full recovery following 3 months of remobilization. Six months after removing the cast, bone size was reduced in the middle region of the radius (p = 0.02) and recovered after 1 year of remobilization. Given that radial bone mass tended to decrease while bone density was unchanged, we conclude that the effect of casting was modulated by changes in gross bone morphology rather than in material characteristics.

Predictive power of individual genetic and environmental factor scores.

This study explores the use of an individual's genetic (IGFS) and environmental factor score (IEFS), constructed using genetic model fitting of a multivariate strength phenotype. Maximal isometric and dynamic strength measures, one maximal repetition load (1RM) and muscle cross-sectional area (MCSA) were measured in 25 monozygotic and 16 dizygotic twin pairs. The use of IGFS and IEFS in predicting the sensitivity to environmental stress was evaluated by the association of the scores with strength training gains after a 10-week high resistance strength training programme. Results show a high contribution of genetic factors to the covariation between maximal strength and muscle cross-sectional area (84-97%) at pre-training evaluation. Individual factor scores explained the largest part of the variation in IRM and other strength measures at pre-training and post-training evaluation respectively. Genes that are switched on due to training stress (gene-environment interaction) could explain the decrease in explained variation over time. A negative correlation was found between IGFS and strength training gains (-0.24 to -0.51, P < 0.05); individuals with a high IGFS tend to gain less strength than individuals with low IGFS. Individual environmental factor scores have lower differential power. The predictive value of the IGFS has potential utility in identifying an individual's susceptibility to environmental stress in a variety of multifactorial characteristics, eg diseases and impairments, and for selection of sib pairs for QTL analyses.

Inheritance of static and dynamic arm strength and some of its determinants.

Maximal static, eccentric and concentric torques and arm components estimated by anthropometry and measured by computed tomography were evaluated in 25 male monozygotic twins and 16 dizygotic twins (22.4 +/- 3.7 years). The importance of genetic and environmental factors in the observed variation in these measurements was estimated by genetic model-fitting techniques. In this sample of young adult male twins, genetic factors were significant in most of the strength measurements, arm muscle components and muscle activation variables. The contribution of genetic factors in strength measures depended on the angle, contraction type and to some extent on contraction velocity. For isometric strength, angle-specificity in genetic and environmental variation could be attributed to the degree of variability in muscle activation and performance discomfort at each specific angle, with the highest unique environmental impact at extreme angles. The high genetic contribution at 170 degrees, but not at 50 degrees, possibly expressed different contributions of genetic factors in the muscle-length factor and moment arm in torques at both angles. The importance of genetic factors in eccentric arm flexor strength (62-82%) was larger than for concentric flexion (29-65%), as the pattern of genetic determination followed the torque-velocity curve. Genetic variations in contractile and elastic components, contributing differently to eccentric and concentric torques, together with velocity-dependent actin-myosin binding factors, could account for the observed differences. The broad heritability was very high for all anthropometric and arm cross-sectional area measurements (> 85%) and common environmental factors were only significant for anthropometrically estimated mid-arm muscle tissue are (48%). Heritability estimates of different arm muscularity measurements were comparable.

Strength training: importance of genetic factors.

PURPOSE: This study focuses on the quantification of genetic and environmental factors in arm strength after high-resistance strength training. METHODS: Male monozygotic (MZ, N = 25) and dizygotic (DZ, N = 16) twins (22.4 +/- 3.7 yr) participated in a 10-wk resistance training program for the elbow flexors. The evidence for genotype*training interaction, or association of interindividual differences in training effects with the genotype, was tested by a two-way ANOVA in the MZ twins and using a bivariate model-fitting approach on pre- and post-training phenotypes in MZ and DZ twins. One repetition maximum (1RM), isometric strength, and concentric and eccentric moments in 110 degree arm flexion at velocities of 30 degrees x s(-1), 60 degrees x s(-1), and 12 degrees x s(-1) were evaluated as well as arm muscle cross-sectional area (MCSA). RESULTS: Results indicated significant positive training effects for all measures except for maximal eccentric moments. Evidence for genotype*training interaction was found for 1RM and isometric strength, with MZ intra-pair correlations of 0.46 and 0.30, respectively. Bivariate model-fitting indicated that about 20% of the variation in post-training 1RM, isometric strength, and concentric moment at 120 degrees x s(-1) was explained by training-specific genetic factors that were independent from genetic factors that explained variation in the pretraining phenotype (30-77%). CONCLUSIONS: Genetic correlations between measures of pre- and post-training strength were indicative for high pleiotropic gene action and minor activation of training-specific genes during training.

Gymnastic training and bone density in pre-adolescent females.

Bone mineral density (BMD) was compared between 7-11-yr-old female gymnasts (GYM: N = 16) with a history of high volume impact loading (minimum of 15 h.wk-1 for past 2 yr) and healthy nonathletic controls (CON: N = 16). Whole body (WB) and regional areal BMD measures were determined by dual energy x-ray absorptiometry (DXA) normalized for height and body mass and also converted to bone mineral apparent density (BMAD). Volumetric BMD and bone cross-sectional areas were also measured by peripheral QCT (pQCT) at the left distal radius. GYM were significantly (P < 0.01) shorter (129.3 +/- 5.7 vs 136.7 +/- 4.4 cm; means +/- SD) and leaner (15.1 +/- 1.9 vs 19.6 +/- 4.3% body fat from DXA), and had significantly (P < 0.05) greater femoral neck (0.698 +/- 0.058 vs 0.648 +/- 0.064 g.cm-2) and trochanter (0.616 +/- 0.060 vs 0.530 +/- 0.084 g.cm-2) areal BMD than CON. GYM also had significantly higher whole body (0.101 +/- 0.009 vs 0.094 +/- 0.007 g.cm-3), femoral neck (0.245 +/- 0.060 vs 0.205 +/- 0.049 g.cm-3) and lumbar spine (0.227 +/- 0.014 vs 0.210 +/- 0.026 g.cm-3) BMAD compared with CON. Height normalized areal BMD measures were also significantly higher at all sites in GYM. Radial total (367.7 +/- 51.6 vs 307.4 +/- 27.6 mg.cm-3), trabecular (207.9 +/- 45.3 vs 163.8 +/- 31.4 mg.cm-3), and cortical (496.9 +/- 67.5 vs 429.8 +/- 33.8 mg.cm-3) BMD were also significantly greater in the GYM compared with the CON. In conclusion, high volume impact loading was associated with greater (compared with controls) whole body and regional bone mineral density in pre-adolescent female gymnasts.

Multivariate genetic analysis of maximal isometric muscle force at different elbow angles.

The maximal isometric moment at five different elbow joint angles was measured in 25 monozygotic and 16 dizygotic male adult twin pairs (22.4 +/- 3.7 yr). Genetic model fitting was used to quantify the genetic and environmental contributions to individual differences in isometric strength. Additive genetic factors explained 66-78% of the variance in maximal torque at 170-140-110 and 80 degrees flexion (extension = 180 degrees). At 50 degrees flexion, common and subject-specific environmental factors contributed equally to the variation. The contribution of unique environmental factors concurs with the level of variability in muscle activation and (dis)-comfort of torque production in the specific angle. The relative contribution of lever arm and force-length relationship in torque varies according to the angle. Because these factors might be genetic, this variability is reflected in the genetic contribution at the extreme angles of 170 and 50 degrees. Multivariate analyses suggested a general set of genes that control muscle area and isometric strength, together with a more specific strength factor. Genetic correlations were high (0.82-0.99). Genes responsible for arm-segment lengths did not contribute to muscle area nor to isometric strength.

Effects of resistance training on bone mineral content and density in adolescent females.

Postmenarcheal adolescent girls performed resistance training (RT) for 26 weeks, which consisted of 4 sets of 13 exercises of varying and progressive intensity performed 3 times weekly on hydraulic resistance machines. Bone mineral was assessed by dual photon absorptiometry. Resistance training resulted in significant increases (pre-post) in biceps curl (21.4%), triceps press (21.5%), knee extension (25.1%), knee flexion (52.8%), and squat press (21.5%) strength. There were no significant differences between RT and control (C) groups initially, and no significant effects of training (pre-post) for total body (TB) or lumbar spine (LS) bone mineral content (BMC) or bone mineral density (BMD). The largest increases in LS bone mineral occurred during the first 13 weeks, and although not significant, the increases in LS BMC (g) (3.9 vs. 5.9%), LS BMC (g.cm-1) (2.6 vs. 5.9%), LS areal BMD (g.cm-2) (1.48 vs. 4.75%), and LS bone mineral apparent density (BMAD, g.cm-3) (0.47 vs. 4.13%) were greater in the RT compared with the C group during this period. In conclusion, resistance training resulted in a trend towards a transient increase in LS bone mineral during the first 13 weeks, but despite significant strength gains, there were no significant changes in TB or LS bone mineral after 26 weeks of training.

Stability of Metacarpal II dimensions in boys during adolescence.

The stability of radiogrammetrically determined Metacarpal II (M II) bone dimensions was determined in 184 Belgian boys between 13 and 18 years of age. Stability was assessed by Fisher z transformations of Pearson correlations between discrete measurement intervals and by structured covariance analysis incorporating compound, banded, and autoregressive models. Adjacent-age stability (1-year measurement interval) was high (0.82 ⩽ r ⩽ 0.97) for all metacarpal dimensions for all approaches, but stability coefficients decreased with increasing measurement interval for the correlational, banded, and autoregressive analyses. Despite the interval-related decline, correlations remained moderate to high, ranging between 0.65 and 0.97 for the correlational analyses and 0.58 and 0.91 for the covariance analyses, indicating a moderate to high degree of stability of M II dimensions in males during adolescence. Periosteal diameter demonstrated the greatest stability of all metacarpal variables for all statistical analyses. Of the covariance models, the compound model provided the poorest fit to the data, and only for metacarpal length and periosteal diameter did the more complex (6 parameters) banded model provide a significantly better fit than the simpler (2 parameters) autoregressive model. These results indicate that M II bone dimenions are fairly stable in males between 13 and 18 years of age and that the autoregressive model, with the exception of metacarpal length and periosteal diameter, provides as good a fit to the metacarpal data as the more complex banded model. © 1994 Wiley-Liss, Inc.

Correlates and determinants of bone mineral content and density in healthy adolescent girls.

The relationships between whole-body and lumbar spine bone mineral content and density, and measures of chronologic age, body composition, physical activity, cardiorespiratory and strength fitness, gynecologic attributes, sexual maturity, and endocrine status were studied in 35 healthy menarcheal girls (14-18 years of age). Body mass (0.464 < r < 0.704), growth hormone (-0.34 < r < -0.42), and one-repetition maximum double-leg press strength (0.343 < r < 0.467) were significantly (p < 0.05) correlated with each of the five bone mineral measures. Multiple regression analysis indicated that body mass accounted for the largest significant proportion of the explained variance (30.2-68.2%) in each of the five bone mineral measures. Age at first menses accounted for a smaller but still significant proportion of the variance in whole-body bone mineral content (4.05%) and lumbar spine bone mineral content (8.06%). Growth hormone entered the regression model as an important predictor of whole-body bone mineral content, accounting for 3.51% of the explained variance in this variable. Age, cardiorespiratory fitness, level of habitual activity, and strength did not contribute significantly to the explained variance in any of the bone mineral measures. Body mass appears to be the single most important determinant of bone mineral among females during this developmental period.

Fractures, physical activity, and growth velocity in adolescent Belgian boys.

The relationship of fractures to physical activity and growth velocity in stature and metacarpal II bone dimensions was investigated in adolescent Belgian boys. Peak fracture incidence occurred between 12 and 14 yr of age and preceded the age at peak height velocity. The peak fracture rate occurred during mid adolescence (+/- 2 SD of the age at peak height velocity) and was twice as high as the rates before and after this period. The majority of fractures occurred during active participation in sports and general physical activities. The age at peak growth velocity for metacarpal cortical thickness, an indirect measure of bone mineral content, was about 6 months later than the ages at peak height velocity and peak growth velocity for metacarpal length. Peak fracture incidence occurred during a period when the amount of time spent in sports physical activity was low compared with later years. A lag in cortical bone thickness and mineralization, relative to linear skeletal growth, and unknown factors associated with active participation in sports, rather than an increase in the amount of physical activity, appear to be the predominant factors associated with the increased fracture incidence in Belgian boys during the growth spurt.

Comparison of three techniques for body composition analysis in cystic fibrosis.

Body composition analysis is an important component of nutritional assessment in cystic fibrosis (CF). No gold standard of measurement exists, and techniques applicable to healthy populations may be unsuitable for CF patients. We assessed lean body mass (LBM) in 12 children with CF by skinfold (SK) measurements, bioelectrical impedance analysis (BIA), and dual-photon absorptiometry (DPA) and repeated these measures in 10 subjects 6 mo later. SK and DPA measures in eight older CF patients and eight healthy controls were compared to evaluate any effect of disease on estimates of LBM by use of DPA. Good agreement between the measures was seen at baseline and 6 mo by use of concordance plots. However, the limits of agreement between measures ranged up to 19% of SK-derived LBM measures (baseline: SK and DPA, 2.63 to -3.93 kg; SK and BIA, 2.36 to -1.24 kg; BIA and DPA, 1.88 to -4.28 kg; 6 mo: SK and DPA, 2.10 to -3.58 kg; SK and BIA, 6.28 to -5.49 kg; BIA and DPA, 5.53 to -7.79 kg). The change in LBM over 6 mo did not correlate among the three measures. Only BIA change in LBM correlated with weight change (r = 0.716, P < 0.02), probably due to the inclusion of weight in the regression equations for determining LBM from impedance. The relationship between SK and DPA measures did not differ between the CF and control groups, suggesting that there was no effect of disease on the DPA measure. The results suggest that none of these methods is precise enough to follow short-term changes in the nutritional status of CF patients longitudinally.

Resistance training during preadolescence. Issues and controversies.

High intensity resistance training appears to be effective in increasing strength in preadolescents. Children make similar relative (percentage improvement), but smaller absolute, strength gains compared with adolescents and young adults in response to similar resistance training programmes. Resistance training appears to have little if any effect on muscle size, and strength gains during training have been associated with increases in levels of neuromuscular activation and changes in intrinsic contractile characteristics of muscle. Although unsubstantiated, improved motor coordination probably also contributes to the increase in strength, especially for more complex strength manoeuvres. On the basis of limited information, training-induced strength gains are lost during detraining, and the decay in strength has been associated with a reduction in neuromuscular activation. Short term resistance training appears to have no effect on somatic growth (height or weight) and body composition, and no proven positive influence on sports performance, injury rate or recovery from injury during preadolescence. Weightlifting has proved injurious to some children, especially when unsupervised and without instruction in proper weightlifting technique and load selection. In contrast, the risk of injury from prudently prescribed and closely supervised resistance training appears to be low during preadolescence. Lastly, short term resistance training appears to have no detrimental effect during preadolescence on either cardiorespiratory fitness or resting blood pressure.

Relationships among nutritional status and skeletal and respiratory muscle function in cystic fibrosis: does early dietary supplementation make a difference?

Relationships among nutritional status and skeletal and respiratory muscle function were examined in 16 children with cystic fibrosis (CF) and mild lung disease (FEV1 95 +/- 16% predicted). Subjects were randomly assigned to receive (or not) noninvasive nutritional supplementation at 25% of normal energy recommendations for 6 mo. Skeletal muscle strength and power were similar to those of healthy children as were respiratory muscle strength and endurance. Stepwise-regression analysis indicated that changes in skeletal muscle strength and energy intake correlated significantly with growth [weight (kg) = 1.90 - 0.60 (Tanner Stage) + 0.49 (maximum voluntary strength (Nm) + 0.03 (energy intake, % RNI), r = 0.76, P < 0.05], though body composition, protein biochemistry, muscle power, respiratory muscle strength, and use of dietary supplements did not. Thus, changes in skeletal muscle strength may be a functional index of changes in nutritional status in CF. Dietary supplementation per se was not associated with functional improvement.

Resistance training during pre- and early puberty: efficacy, trainability, mechanisms, and persistence.

Resistance training, under conditions of high intensity and volume loading, is effective in increasing strength in pre- and early pubertal children. The mechanisms underlying strength gain with resistance training in this population have not been established unequivocally. However, resistance training appears to have little if any effect on muscle size (hypertrophy), but it has resulted in neurological (percent motor unit activation and increased integrated EMG activity) changes and changes in intrinsic muscle function (twitch torque), which could account for part of the training-induced increases in voluntary strength. Changes in motor skill coordination (synchronization of muscle action) probably also contribute substantially to resistance-training-induced strength increases in children, particularly for multijoint, complex strength manoeuvres. Most, but not all, studies indicate that pre- and early pubertal children make similar relative strength gains compared to adolescents and adults, but usually demonstrate smaller absolute strength gains following training. Training-induced strength gains appear to decay during detraining, and maintenance training consisting of only one training session per week appears to be ineffective in preserving prior strength gains.