Evaluating the effects of hormone therapy termination on skeletal muscle and physical independence in postmenopausal women.

OBJECTIVE: In women, the age-related decline in skeletal muscle structure and function is accelerated after menopause, which implicates the role of decreased circulating estrogen levels. Indeed, boosting estrogen, by means of postmenopausal hormone therapy (HT), generally proves beneficial to skeletal muscle. The evidence regarding whether these benefits persist even after cessation of HT is limited, nor is it clear how physical behavior (PB) impacts on benefits. Hence, this exploratory study focused on the interplay between HT administration/cessation, PB and in vivo skeletal muscle structure and function. METHODS: Fifty healthy women (≥60 y) were included; 19 had an HT administration history (≥9 mo, with now ~8-y hiatus in treatment) and 31 no such history. On seven continuous days, PB data were collected using triaxial accelerometry and analyzed using compositional data analysis. Gastrocnemius medialis muscle volume, architecture, and function were determined using ultrasonography, electromyography, dual x-ray absorptiometry, and dynamometry. Current serum estradiol levels were measured using ELISA. RESULTS: Only fascicle length and duration of HT administration were positively associated. With respect to PB levels, we found a pattern suggesting greater vitality (higher physical activity and lower sedentarism) in previous HT users, compared with nonusers, despite the two groups currently no longer exhibiting significantly different levels of circulating estradiol. CONCLUSIONS: After an 8-year hiatus in treatment, HT provides limited advantages in gastrocnemius medialis muscle properties. Interestingly, it perhaps enhances vitality despite prolonged cessation, which in the longer term would facilitate greater physical independence, especially considering the association of sedentary behavior with greater frailty.

Displacing Sedentary Behaviour with Light Intensity Physical Activity Spontaneously Alters Habitual Macronutrient Intake and Enhances Dietary Quality in Older Females.

Displacing Sedentary Behaviour (SB) with light intensity physical activity (LIPA) is increasingly viewed as a viable means of health enhancement. It is, however, unclear whether any behavioural compensations accompany such an intervention. Therefore, the aim of this study was to identify any dietary changes that accompany SB displacement. We hypothesised that SB displacement would improve dietary quality. Thirty-five elderly females (73 ± 5 years) were randomly allocated to one of three groups: (1) sedentary behaviour fragmentation (SBF) (n = 14), (2) continuous LIPA (n = 14), or (3) control (n = 7). Habitual diet (four-day food diary) and physical behaviour (accelerometery) were assessed at weeks 0 and 8. Out of 45 nutrients examined, only glucose exhibited a group × time interaction (p = 0.03), mediated by an exclusive reduction following SBF (-31%). SBF was also the sole experimental group to increase nutrients promoting bone health (SBF: 17%, LIPA: -34%. control: 21%), whereas both experimental groups consumed more nutrients promoting anabolism (SBF: 13%, LIPA: 4%, control: -34%) (z-scores). New ambulators (n = 8) also consumed more nutrients promoting bone health (16%)/anabolism (2%) (z-scores), including significantly increased Zinc intake (p = 0.05, 29%). Displacing SB with LIPA improves dietary quality in older females. Furthermore, SB fragmentation appears advantageous for various dietary outcomes.

Whole-body and segmental analysis of body composition in adult males with achondroplasia using dual X-ray absorptiometry.

Achondroplasia is a condition characterized by a genetic mutation affecting long bone endplate development. Current data suggests that the bone mineral content (BMC) and bone mineral density (BMD) of achondroplasic populations are below age matched individuals of average stature (controls). Due to the disproportionate limb-to-torso length compared to controls however, the lower BMC and BMD may be nullified when appropriately presented. The aim of this study was to measure whole-body and segmental body composition in adult males with achondroplasia (N = 10, 22 ±3 yrs), present data relative to whole-body and whole-limb values and compare all values to age matched controls (N = 17, 22 ±2 yrs). Dual X-ray absorptiometry (DEXA) was used to measure the in vivo mass of the whole-body and 15 segments, from which BMD, BMC, fat free mass (FFM) and body fat mass were measured. BMC of lumbar vertebrae (L1-4) was also measured and presented as a volumetric BMD (BMDVOL). The achondroplasic group had less BMC, BMD and FFM, and more body fat mass than controls as a whole-body measure. The lower achondroplasic BMC and BMD was somewhat nullified when presented relative to whole-body and whole-limb values respectively. There was no difference in lumbar BMDVOL between groups. Whole-body BMD measures presented the achondroplasic group as 'osteopenic'. When relative to whole-limb measures however, achondroplasic BMD descriptions were normal. Further work is needed to create a body composition database for achondroplasic population's, or for clinicians to present achondroplasic body composition values relative to the whole-limb.

Relationships between muscle size, strength, and physical activity in adults with muscular dystrophy.

BACKGROUND: Muscular dystrophy (MD) is characterized by progressive muscle wasting and weakness, yet few comparisons to non-MD controls (CTRL) of muscle strength and size in this adult population exist. Physical activity (PA) is promoted to maintain health and muscle strength within MD; however, PA reporting in adults with MD is limited to recall data, and its impact on muscle strength is seldom explored. METHODS: This study included 76 participants: 16 non-MD (CTRL, mean age 35.4), 15 Duchenne MD (DMD, mean age 24.2), 18 Becker's MD (BMD, mean age 42.4), 13 limb-girdle MD (LGMD, mean age 43.1), and 14 facioscapulohumeral MD (mean age 47.7). Body fat (%) and lean body mass (LBM) were measured using bioelectrical-impedance. Gastrocnemius medialis (GM) anatomical cross-sectional area (ACSA) was determined using B-mode ultrasound. Isometric maximal voluntary contraction (MVC) was assessed during plantar flexion (PFMVC) and knee extension (KEMVC). PA was measured for seven continuous days using triaxial accelerometry and was expressed as daily average minutes being physically active (TPAmins ) or average daily percentage of waking hours being sedentary (sedentary behaviour). Additionally, 10 m walk time was assessed. RESULTS: Muscular dystrophy groups had 34-46% higher body fat (%) than CTRL. DMD showed differences in LBM with 21-28% less LBM than all other groups. PFMVC and KEMVC were 36-75% and 24-92% lower, respectively, in MD groups than CTRL. GM ACSA was 47% and 39% larger in BMD and LGMD, respectively, compared with CTRL. PFMVC was associated with GM ACSA in DMD (P = 0.026, R = 0.429) and CTRL (P = 0.015, R = 0.553). MD groups were 14-38% more sedentary than CTRL groups, while DMD were more sedentary than BMD (14%), LGMD (8%), and facioscapulohumeral MD (14%). Sedentary behaviour was associated with LBM in DMD participants (P = 0.021, R = -0.446). TPAmins was associated with KEMVC (P = 0.020, R = 0.540) in BMD participants, while TPAmins was also the best predictor of 10 m walk time (P < 0.001, R2  = 0.540) in ambulant MD, revealed by multiple linear regression. CONCLUSIONS: Quantified muscle weakness and impaired 10 m walking time is reported in adults with MD. Muscle weakness and 10 m walk time were associated with lower levels of TPA in adults with MD. Higher levels of sedentary behaviour were associated with reduced LBM in DMD. These findings suggest a need for investigations into patterns of PA behaviour, and relevant interventions to reduce sedentary behaviour and encourage PA in adults with MD regardless of impairment severity.

Specific force of the vastus lateralis in adults with achondroplasia.

Achondroplasia is a clinical condition defined by shorter stature and disproportionate limb length. Force production in able-bodied individuals (controls) is proportional to muscle size, but given the disproportionate nature of achondroplasia, normalizing to anatomical cross-sectional area (ACSA) is inappropriate. The aim of this study was to assess specific force of the vastus lateralis (VL) in 10 adults with achondroplasia (22 ± 3 yr) and 18 sex-matched controls (22 ± 2 yr). Isometric torque (iMVCτ) of the dominant knee extensors (KE) and in vivo measures of VL muscle architecture, volume, activation, and patella tendon moment arm were used to calculate VL physiological CSA (PCSA), fascicle force, and specific force in both groups. Achondroplasic muscle volume was 53% smaller than controls (284 ± 36 vs. 604 ± 102 cm3, P < 0.001). KE iMVCτ was 63% lower in achondroplasia compared with controls (95 ± 24 vs. 256 ± 47 N⋅m, P < 0.001). Activation and moment arm length were similar between groups ( P > 0.05), but coactivation of bicep femoris of achondroplasic subjects was 70% more than controls (43 ± 20 vs. 13 ± 5%, P < 0.001). Achondroplasic subjects had 58% less PCSA (43 ± 10 vs. 74.7 ± 14 cm2, P < 0.001), 29% lower fascicle force (702 ± 235 vs. 1704 ± 303 N, P < 0.001), and 29% lower specific force than control subjects (17 ± 6 vs. 24 ± 6 N⋅cm-2, P = 0.012). The smaller VL specific force in achondroplasia may be attributed to infiltration of fat and connective tissue, rather than to any difference in myofilament function. NEW & NOTEWORTHY The novel observation of this study was the measurement of normalized force production in a group of individuals with disproportionate limb length-to-torso ratios.

A review of facial protective equipment use in sport and the impact on injury incidence.

Sporting activities have an inherent risk of facial injury from traumatic impacts from fellow competitors, projectiles, and collisions with posts or the ground. This retrospective review systematically describes the interplay between the type of sport (including the level at which specific sports are played), the sex of the players and their musculoskeletal characteristics, the technology behind the materials used, the protective devices commonly used, the anatomical site, and the regularity of incidence of fractures. We describe how variations in sporting activities induce different orofacial fracture patterns, and critically consider the methods used to test protective headgear against more contemporary techniques. Facial injuries can have a profound psychological effect on those injured, can take a long time to heal, and have been known to end promising careers. Use of properly fitted protective head or facial equipment could reduce the number of facial fractures commonly seen in sports. We recommend that individual sports should have full risk assessments, and that mandatory standards should be agreed about protective devices that would be appropriate.

Is there a morning-to-evening difference in the acute IL-6 and cortisol responses to resistance exercise?

Exercise training is known to induce a molecular adaptation process involving inflammatory responses. However any time-of-day effect of exercise on inflammatory responses remains unknown. The aim of the present study was to investigate whether acute bouts of intense exercise performed at different times of the day would affect the release Interleukin-6 (IL-6), one of the most abundant cytokines in mammalian endocrine response to exercise. Cortisol levels were measured as a confirmation of correct timing of exercise and to determine any impact it may have on the cytokine release. Twelve healthy male participants carried out 30 min of intense exercise (3 sets of 8-12 repetitions for 4 resistance exercises at 70% of 1RM) in morning (08:15-09:00 h), and evening (18:15-19:00 h) sessions. An 8h fasting period was required before each exercise session. Blood samples were taken immediately pre and post each exercise sessions to determine IL-6 and cortisol levels. Our data show that whilst the training group showed no post-exercise changes in serum_IL-6 levels (P>0.05), the control group on the other hand showed significant time-of-day modifications in serum_IL-6 levels (P=0.008). Moreover, a significant interaction between intervention phase (pre-post training, AM vs. PM) and group (Exercise vs. Control) is evidenced in terms of serum_IL-6 levels (P=0.014). This interaction however was nullified when the between group differences at baseline were partialled out in a covariate analysis (P>0.05). We also found that the main effect of experimental phase on Cortisol was present in both the trained (P=0.004) and control groups (p<0.001) with no significant interaction (P>0.05). Based on the current data, we would propose that exercise and/or time-of-day would not interfere with clinical endocrine profiling of IL-6 in a population.

Influences of carbohydrate plus amino acid supplementation on differing exercise intensity adaptations in older persons: skeletal muscle and endocrine responses.

Losses in physiological function in healthy ageing occur partly as a consequence of reduced protein intake and partly as a consequence of less than 30-min/day of moderate to vigorous physical activity. The current study aimed to compare the effects of two different intensities of resistance training in healthy older adults, whose habitual dietary intake was supplemented with carbohydrate and amino acid preparations. We hypothesised that although intensive exercise with appropriate carbohydrate and amino acid supplementation would result in the most profound impact on in vivo markers of healthy physiologic and endocrine functions in previously sedentary older individuals, the effectiveness of the less intense exercise prescription with supplementation would also result in beneficial adaptations over and above findings of previous studies on low intensity exercise alone. Twenty-nine older adults (out of 32) completed the study after being randomly assigned to low (SUP_LowR, i.e., approximately 40% 1RM; n = 16) versus high resistance training (SUP_HighR, i.e., approximately 80% 1RM; n = 13) for 12 weeks. A carbohydrate supplement was ingested immediately before and during every exercise session and an amino acid cocktail was ingested post-exercise. Neither intervention significantly impacted upon body composition assessed using: Body mass index, waist/hip ratio and bioelectric impedance. Muscle strength increased similarly in the two groups with the SUP_HighR protocol showing 46 +/- 8%, 10.8 +/- 4.4% and 26.9 +/- 4.9% (P < 0.01) improvements in 1-RM strength, unilateral and bilateral knee extension torque, respectively, compared with 39 +/- 2%, 9.4 +/- 3.7% and 29.5 +/- 8.2% (P < 0.01) increments in the same measures in the SUP_LowR group. Lean muscle thickness however, showed a greater benefit of the SUP_LowR protocol (8.7 +/- 3.9% increase, P < 0.05) compared with the SUP_HighR protocol, which elicited no significant change. In terms of functional abilities, only the standing-from-lying (SFL) test exhibited an improvement in rate in the SUP_HighR group (-11.4%, P < 0.05). The SUP_LowR group, on the other hand, showed significant improvements in the get-up-and-go (-8.7 +/- 3.6%, P < 0.05), the SFL (-4.7% change, P = 0.05) and the 6-min walk (7.2 +/- 2.2% increase in distance covered, P < 0.01) tests. Following overnight fasting, serum levels of glucose changed significantly (-13 +/- 4.7% decrease, P < 0.01) in SUP_LowR. Serum levels of insulin (-25 +/- 5.3% decrease, P = 0.05), neuropeptide Y (-24 +/- 15.3% decrease, P = 0.02), and IGFBP-3 (-11 +/- 6.6% decrease, P = 0.03), changed significantly in SUP_HighR. Circulating levels of interleukin-6, tumour necrosis factor-alpha and insulin-like growth factor 1 did not alter significantly in either intervention group. These data suggest that whilst both interventions were beneficial in older persons, the end targets as well as metabolic and hormonal adaptations are different. The supplementation plus low exercise regimen tended to impact on muscle hypertrophy combined with increased habitual function. Supplementation plus high-intensity exercise regimen improved markers of strength, but not to a significantly greater extent than supplementation plus low intensity exercise.

Influence of exercise intensity in older persons with unchanged habitual nutritional intake: skeletal muscle and endocrine adaptations.

Long-term adherence to training programmes is difficult to attain. Yet, the benefits of exercise to general health and well-being are undeniable. Any measure to demonstrate the minimum required exercise for maximal benefit to a person is a promising avenue towards increasing the uptake and adherence to physical activity for the general public. The purpose of this study was to compare the effects of two different intensities of resistance training in healthy older adults. We hypothesised that compared to high-intensity resistance exercise, relatively low training intensity could also improve in vivo markers of healthy physiologic and endocrine functions in previously sedentary older individuals. Thirty (out of a possible 34 recruited) older adults were randomly assigned to low (LowR, i.e. approximately 40% one repetition maximum (1RM)) versus high-resistance training (HighR, i.e. approximately 80% 1RM) for 12 weeks. Neither intervention significantly impacted upon body composition markers including: body mass index (BMI), waist/hip ratio and bioelectric impedance. Muscle strength data showed an advantage for the HighR protocol with 51 +/- 4% and 22.4 +/- 10.2% (P < 0.05) improvements in 1RM strength and bilateral knee extension torque, respectively, compared with 17 +/- 1% and 10.3 +/- 4.7% (P < 0.05) increments in 1RM strength and bilateral torque in the LowR group. Unilateral torque did not change significantly in either group. Quadriceps muscle thickness data also showed a significantly greater benefit of the HighR protocol (5.8 +/- 2.6% increase) compared with the LowR protocol (no change). Functional ability tests, including Get-up-and-go (GUG), Standing from lying and the 6-min walk, showed changes of -11.6 +/- 4.8%, -15.6% and 8.5 +/- 1.7% (P < 0.05), respectively, in HighR compared with only one significant improvement in the LowR, namely a -10.8 +/- 3% (P < 0.05) improvement in the GUG test. Overnight fasting serum levels of IGFBP-3 increased, NPY decreased and TNF-alpha decreased significantly in the LowR group. Serum levels of glucose increased and NPY decreased significantly in HighR. Circulating levels of I, IL-6 and IGF-1 did not change with either intervention. In vivo physiologic changes show functional advantages for older persons carrying out high-resistance training. At the endocrine level, such an advantage is not clear. In fact, in terms of changes in sera levels of fasting glucose, IGFBP-3 and TNF-alpha, there appears to be an advantage to carrying out the lower intensity exercises for the aged populations where endocrine adaptations are key.