The Added Value of Remote Technology in Cardiac Rehabilitation on Physical Function, Anthropometrics, and Quality of Life: Cluster Randomized Controlled Trial.

BACKGROUND: Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies' high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation. OBJECTIVE: We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation. METHODS: Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test. RESULTS: Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P<.001) and increment in self-assessed QoL were greater (environmental factors: 0.5; P=.02) in the remote technology intervention group than the reference group. Both groups achieved statistically significant improvements in the 6-minute walk test in both time frames (P=.01-.03). Additionally, the remote technology intervention group achieved statistically significant changes in the environmental domain at 0-6 months (P=.03) and waist circumference at both time frames (P=.01), and reference group achieve statistically significant changes in waist circumference at 0-6 months (P=.02). CONCLUSIONS: Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required. TRIAL REGISTRATION: ISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589.

Age-Related Declines in Lower Limb Muscle Function are Similar in Power and Endurance Athletes of Both Sexes: A Longitudinal Study of Master Athletes.

The age-related decline in muscle function, particularly muscle power, is associated with increased risk of important clinical outcomes. Physical activity is an important determinant of muscle function, and different types of physical activity e.g. power-based versus endurance-based exercise appear to have differential effects on muscle power. Cross-sectional studies suggest that participation in power-based exercise is associated with greater muscle power across adulthood but this has not been investigated longitudinally. We recruited eighty-nine male and female power and endurance master athletes (sprint and distance runners respectively, baseline age 35-90y). Using jumping mechanography, we measured lower limb muscle function during a vertical jump including at least two testing sessions longitudinally over 4.5 ± 2.4y. We examined effects of time, discipline (power/endurance) and sex in addition to two- and three-way interactions using linear mixed-effects models. Peak relative power, relative force and jump height, but not Esslingen Fitness Index (indicating peak power relative to sex and age-matched reference data) declined with time. Peak power, force, height and EFI were greater in power than endurance athletes. There were no sex, discipline or sex*discipline interactions with time for any variable, suggesting that changes were similar over time for athletes of both sexes and disciplines. Advantages in lower limb muscle function in power athletes were maintained with time, in line with previous cross-sectional studies. These results suggest that improvements in lower limb function in less active older individuals following power-based training persist with continued adherence, although this requires further investigation in interventional studies.

Physical activity and ability to meet different work requirements among adult working men with or without current depressive symptoms.

PURPOSE: To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms. METHODS: We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH). RESULTS: When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, ß = 0.10 (95% CI 0.03-0.18)] and BTH [p = 0.027, ß = 0.19 (95% CI 0.03-0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, ß = 0.20 (95% CI 0.03-0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI. CONCLUSION: Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study.

OBJECTIVES: The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. METHODS: A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. RESULTS: Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (ß=0.14 [95% CI: 0.02-0.26] for linearity = 0.024). CONCLUSION: Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Altered hip control during a standing knee-lift test is associated with increased risk of knee injuries.

A few prospective studies have investigated hip and pelvic control as a risk factor for lower extremity (LE) injuries. The purpose of this study was to investigate whether deficits in hip and lumbopelvic control during standing knee-lift test are associated with increased risk of acute knee and LE injuries in youth team sports. At baseline, 258 basketball and floorball players (aged 12-21 years) participated in a standing knee-lift test using 3-dimensional motion analysis. Two trials per leg were recorded from each participant. Peak sagittal plane pelvic tilt and frontal plane pelvic drop/hike were measured. Both continuous and categorical variables were analyzed. New non-contact LE injuries, and match and training exposure, were recorded for 12 months. Seventy acute LE injuries were registered. Of these, 17 were knee injuries (eight ACL ruptures) and 35 ankle injuries. Risk factor analyses showed that increased contralateral pelvic hike was significantly associated with knee injury risk when using categorical variable (HR for high vs low group 4.07; 95% CI 1.32-12.6). Furthermore, significant association was found between high lateral pelvic hike angles and ACL injury risk in female players (HR for high vs low group 9.10; 95% CI 1.10-75.2). Poor combined sensitivity and specificity of the test was observed. In conclusion, increased contralateral pelvic hike is associated with non-contact knee injury risk among young team sport players and non-contact ACL injuries among female players. More research to determine the role of pelvic control as a risk factor for knee injuries is needed.

Absence of an aging-related increase in fiber type grouping in athletes and non-athletes.

The aging-related loss of muscle mass is thought to be partly attributable to motor neuron loss and motor unit remodeling that result in fiber type grouping. We examined fiber type grouping in 19- to 85-year-old athletes and non-athletes and evaluated to which extent any observed grouping is explained by the fiber type composition of the muscle. Since regular physical activity may stimulate reinnervation, we hypothesized that fiber groups are larger in master athletes than in age-matched non-athletes. Fiber type grouping was assessed in m. vastus lateralis biopsies from 22 young (19-27 years) and 35 healthy older (66-82 years) non-athletes, and 14 young (20-29 years), 51 middle-aged (38-65 years), and 31 older (66-85 years) athletes. An "enclosed fiber" was any muscle fiber of a particular type surrounded by fibers of the same type only. A fiber type group was defined as a group of fibers with at least one enclosed fiber. Only type II fiber cross-sectional area (FCSA) showed an age-related decline that was greater in athletes (P < .001) than in non-athletes (P = .012). There was no significant age-related effect on fiber group size or fiber group number in athletes or non-athletes, and the observed grouping was similar to that expected from the fiber type composition. At face value, these observations do 1) neither show evidence for an age-related loss and remodeling of motor units nor 2) improved reinnervation with regular physical activity, but 3) histological examination may not reveal the full extent of aging-related motor unit remodeling.

Effects of progressive aquatic resistance training on symptoms and quality of life in women with knee osteoarthritis: A secondary analysis.

OBJECTIVE: To conduct a secondary analysis to study the effects, those 4 months of aquatic resistance training have on self-assessed symptoms and quality of life in post-menopausal women with mild knee osteoarthritis (OA), after the intervention and after a 12-month follow-up period. METHODS: A total of 87 post-menopausal volunteer women, aged 60-68 years, with mild knee OA were recruited in a randomized, controlled, 4-month aquatic training trial (RCT) and randomly assigned to an intervention (n = 43) and a control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 4 months while the control group maintained their usual level of physical activity. Additionally, 77 participants completed the 12-month post-intervention follow-up period. Self-assessed symptoms were estimated using the OA-specific Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Health-related Quality of life (HRQoL) using the generic Short-form Health Survey (SF-36). RESULTS: After 4 months of aquatic resistance training, there was a significant decrease in the stiffness dimension of WOMAC -8.5 mm (95% CI = -14.9 to -2.0, P = .006) in the training group compared to the controls. After the cessation of the training, this benefit was no longer observed during the 12-month follow-up. No between-group differences were observed in any of the SF-36 dimensions. CONCLUSIONS: The results of this study show that participation in an intensive aquatic resistance training program did not have any short- or long-term impact on pain and physical function or quality of life in women with mild knee OA. However, a small short-term decrease in knee stiffness was observed.

Minimal clinically important difference and minimal detectable change of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) amongst patients with chronic musculoskeletal pain.

OBJECTIVES: The aim of this study is to estimate a minimal clinically important difference (MCID) and a minimal detectable change (MDC) of the 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. DESIGN: Cross-sectional cohort study. SETTING: Outpatient Physical and Rehabilitation Medicine clinic. SUBJECTS: A total of 1988 consecutive patients with musculoskeletal pain. INTERVENTIONS: A distribution-based approach was employed to estimate a minimal clinically important difference, a minimal detectable change, and a minimal detectable percent change (MDC%). RESULTS: The mean age of the patients was 48 years, and 65% were women. The average intensity of pain was 6,3 (2.0) points (0-10 numeric rating scale) and the mean WHODAS 2.0 total score was 13 (9) points out of 48. The minimal clinically important difference ranged between 3.1 and 4.7 points. The minimal detectable change was 8.6 points and minimal detectable % change was unacceptably high 66%. CONCLUSIONS: Amongst patients with chronic musculoskeletal pain, the 12-item WHODAS 2.0 demonstrated a high minimal detectable change of almost nine points. As the minimal detectable change exceeded the level of minimal clinically important difference, nine points were considered to be the amount of change perceived by a respondent as clinically significant.

Physical function and lean body mass as predictors of bone loss after hip fracture: a prospective follow-up study.

BACKGROUND: Predictors of bone deterioration after hip fracture have not been well characterized. The aim of this study was to examine the associations of physical function and lean body mass (LBM) with loss of bone density and strength in older people recovering from a hip fracture. METHODS: A total of 81 over 60-year-old, community-dwelling men and women operated for a hip fracture participated in this 1-year prospective follow-up study. Distal tibia total volumetric bone mineral density (vBMDTOT, mg/cm3) and compressive strength index (BSI, g2/cm4) and mid-tibia cortical vBMD (vBMDCO, mg/cm3) and bending strength index (SSI, mm3) were assessed in both legs by peripheral quantitative computed tomography (pQCT) at baseline (on average 10 weeks after fracture) and at 12 months. At baseline, LBM was measured with a bioimpedance device and physical function with the Short Physical Performance Battery (SPPB) and perceived difficulty in walking outdoors. Robust multivariable linear regression models were used to estimate the associations of physical function and LBM with the change in bone parameters at 12-months. RESULTS: The mean change in distal tibia vBMDTOT and BSI in both legs ranged from - 0.9 to - 2.5%. The change in mid-tibia vBMDCO and SSI ranged from - 0.5 to - 2.1%. A lower SPPB score, difficulty in walking outdoors and lower LBM predicted greater decline in distal tibia vBMDTOT in both legs. A lower SPPB score and difficulty in walking outdoors were also associated with a greater decline in distal tibia BSI in both legs. At the midshaft site, a lower SPPB score and lower LBM were associated with greater decline in SSI on the fractured side. CONCLUSIONS: Older hip fracture patients with low physical function and lower LBM may be at risk for greater decline in tibia bone properties during the first post-fracture year. Acknowledgement of the risk factors could assist in developing interventions and care to promote bone health and overall recovery. TRIAL REGISTRATION: ISRCTN, ISRCTN53680197. The trial was registered retrospectively but before the recruitment was completed. Registered March 3, 2010.

Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke. DATA SOURCES: A systematic literature search was conducted in 6 databases from January 2000 to May 2018. STUDY SELECTION: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies. DATA EXTRACTION: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable. DATA SYNTHESIS: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low. CONCLUSIONS: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.

Relationships of leisure-time physical activity and work ability between different occupational physical demands in adult working men.

PURPOSE: Leisure-time physical activity (LTPA) is known to be associated with positive health benefits, but the role of occupational physical demands remains inconsistent. The purpose of the current study was to assess the relationship between LTPA and work ability in different occupational physical activity (OPA) levels between young adult men. METHODS: We performed physical activity measurements in work and leisure time with the long version of International Physical Activity Questionnaire (IPAQ) and work ability with the Work Ability Index (WAI) in 921 Finnish employed male volunteer participants. The participants were divided into LTPA tertiles I (< 8 MET-h/week), II (8-28 MET-h/week), and III (> 28 MET-h/week) and OPA tertiles I (0 MET-h/week), II (< 64 MET-h/week), and III (≥ 64 MET-h/week). RESULTS: There was a significant relationship between LTPA and WAI in OPA tertiles (adjusted for age, alcohol consumption, working class status, BMI, and employment years). Moreover, each LTPA tertile showed significant linear associations with WAI (P < 0.001). CONCLUSION: LTPA is positively associated with work ability among young adult men. More specifically, the relationships between LTPA and WAI were significantly greater in physically demanding jobs than in more passive jobs. Our results indicate the importance of LTPA, particularly with individuals under higher work-related physical strain.

Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials.

OBJECTIVE: To summarise all meta-analyses of randomised controlled trials that have evaluated the effects of exercise therapy on functional capacity in patients with chronic diseases. DESIGN: Umbrella review of meta-analyses of randomised controlled trials. DATA SOURCES: We systematically searched the CENTRAL, CINAHL, DARE, Medline, OTSeeker, PEDro, SPORTDiscus, ProQuest Nursing & Allied Health Database, Web of Science, Scopus, OpenGrey and BMC Proceedings from database inception to 1 September 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included meta-analyses that compared the effects of exercise therapy with no treatment or usual care in adults with non-communicable chronic diseases and included outcomes related to functional capacity. We excluded meta-analyses with less than 100 patients. RESULTS: Eighty-five meta-analyses with 22 different chronic diseases were included. The exercise interventions resulted in statistically significant (p<0.05) improvements for 126 of 146 (86%) functional capacity outcomes, compared with the control group. The standardised mean differences were small in 64 (44%), moderate in 54 (37%) and large in 28 (19%) of the 146 functional capacity outcomes. The results were similar for aerobic exercise, resistance training, and aerobic and resistance training combined. There were no significant differences in serious adverse effects between the intervention and control groups in any of the meta-analyses. CONCLUSION: Exercise therapy appears to be a safe way to improve functional capacity and reduce disability in individuals with chronic disease.

Epidemiology of Overuse Injuries in Youth Team Sports: A 3-year Prospective Study.

Prospective studies on overuse injuries and their impact on athletic training among youth team sports are scarce. The purpose of this study was to investigate the incidence, severity and player related risk factors of overuse injuries among young (12-20 years) basketball and floorball players. A total of 387 players participated in a 3-year prospective study. Each player completed a baseline questionnaire regarding their background information. Overuse injuries that prevented players to fully or partly participate in their regular training were collected. In all, 204 overuse injuries were registered (injury incidence 1.51 injuries/1 000 h of exposure; 95% CI 1.35-1.78). Most of the injuries involved the knee (35%) and lower back (21%), and were classified as severe (44%). Injury incidence was 1.51 (95% CI 1.2-1.82) and 1.61 (95% CI 1.32-1.91) in basketball and floorball, respectively. Incidence was significantly higher among female compared with male players (incidence rate ratio 1.58; 95% CI 1.20-2.09). Previous injury and playing at adult level were the strongest factors associated with occurrence of an overuse injury. In conclusion, overuse injuries of the knee and low back are relatively common in youth basketball and floorball. Effective prevention strategies as well as training load monitoring is needed in youth team sports.

Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years.

BACKGROUND: There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis. METHODS: Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered. RESULTS: The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up. CONCLUSIONS: Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.

The effect of aquatic exercise on physical functioning in the older adult: a systematic review with meta-analysis.

BACKGROUND: ageing and sedentary behaviour cause negative changes in the neuromuscular systems of healthy older adults resulting in a decrease in physical functioning. Exercising in water (aquatic exercise, AE) has been shown to be effective at improving physical functioning in this population; however, no systematic review with meta-analysis has been published. PURPOSE: to investigate the effect of AE on physical functioning in healthy older adults compared to control or land-based exercise (LE) through a systematic review with meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, Cinahl, PEDro, SPORTDiscus, Web of Science, Cochrane Library, published before 31st December 2015. STUDY SELECTION: in total, 28 studies met the inclusion criteria and were included in the systematic review; 24 studies with 1,456 subjects (89% female) and with mean age 66.4 years were included in the meta-analysis. DATA EXTRACTION: data were extracted and checked for accuracy by three independent reviewers. DATA SYNTHESIS: size of treatment effect was measured using the standardised mean difference with 95% confidence intervals (CIs). RESULTS: compared to control interventions, AE had a moderate positive effect on physical functioning 0.70 [95% CI 0.48 to 0.92]. Compared to LE, AE had a small positive effect on physical functioning 0.39 [0.12 to 0.66]. LIMITATIONS: there is a high risk of bias and low methodological quality in the studies particularly when comparing AE to LE with possible over estimation of the benefit of AE. CONCLUSIONS: AE may improve physical functioning in healthy older people and is at least as effective as LE.

What Makes a 97-Year-Old Man Cycle 5,000 km a Year?

BACKGROUND: The nature versus nurture debate is one of the oldest issues in the study of longevity, health and successful aging. OBJECTIVE: We present a 97-year-old man (I.K.) as an example of the effects of habitual exercise on the aging process. METHODS: Extensive assessments included medical examinations, interviews, musculoskeletal structure, performance characteristics, cognitive function and gut microbiota composition. RESULTS: I.K. suffers from iatrogenic hypogonadism, prostate cancer, hypothyroidism and a history of deep popliteal thrombosis. Notwithstanding, he cycles up to 5,000 km a year and participates in competitive sports. His musculoskeletal properties, athletic performance, cognitive function and gut microbiota are outstanding. Some traits even exceed those seen in middle-aged men. CONCLUSIONS: His long-term physically and intellectually active lifestyles combined with extensive social interactions have most likely contributed to his exercise capacity, despite his medical history.

Low Back Pain in Young Basketball and Floorball Players.

OBJECTIVE: The aim of the study was to investigate the prevalence and risk factors of low back pain (LBP) in young female and male basketball and floorball players. DESIGN: Cross-sectional study. SETTING: Nine basketball teams and 9 floorball teams from Tampere city district, Finland. PARTICIPANTS: Four hundred one young female and male players (mean age: 15.8 ± 1.9 years). ASSESSMENT OF RISK FACTORS: Age, gender, sport, and family history of musculoskeletal disorders were assessed as risk factors for LBP. Adjustment was made on team level to avoid random effects associated with a team. MAIN OUTCOME MEASURES: Information of players' background factors and LBP episodes was collected by a structured questionnaire. RESULTS: Forty-four percentage of the basketball players and 62% of floorball players had suffered from LBP during the previous 12 months. Prevalence of LBP during the previous year was significantly higher among floorball players (P = 0.001). In both sports, prevalence of pain symptoms was the highest during the competitive playing season. Family history of musculoskeletal disorders [OR (odds ratio), 2.02, 95% confidence interval (CI), 1.22-3.34] and higher age (OR, 1.22, 95% CI, 1.05-1.41) were associated with LBP in players. CONCLUSIONS: The study attested that LBP is a relatively common complaint in young team sport players. Targeted measures to examine causes, risk factors, and prevention of LBP in youth sports are needed.

Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study.

BACKGROUND AND OBJECTIVE: previously, a randomised controlled exercise intervention study (RCT) showed that combined resistance and balance-jumping training (COMB) improved physical functioning and bone strength. The purpose of this follow-up study was to assess whether this exercise intervention had long-lasting effects in reducing injurious falls and fractures. DESIGN: five-year health-care register-based follow-up study after a 1-year, four-arm RCT. SETTING: community-dwelling older women in Finland. SUBJECTS: one hundred and forty-five of the original 149 RCT participants; women aged 70-78 years at the beginning. METHODS: participants' health-care visits were collected from computerised patient register. An injurious fall was defined as an event in which the subject contacted the health-care professionals or was taken to a hospital, due to a fall. The rate of injured fallers was assessed by Cox proportional hazards model (hazard ratio, HR), and the rate of injurious falls and fractures by Poisson regression (risk ratio, RR). RESULTS: eighty-one injurious falls including 26 fractures occurred during the follow-up. The rate of injured fallers was 62% lower in COMB group compared with the controls (HR 0.38, 95% CI 0.17 to 0.85). In addition, COMB group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97). CONCLUSIONS: home-dwelling older women who participated in a 12-month intensive multi-component exercise training showed a reduced incidence for injurious falls during 5-year post-intervention period. Reduction in fractures was also evident. These long-term effects need to be confirmed in future studies.

Knee extensor and flexor muscle power explains stair ascension time in patients with unilateral late-stage knee osteoarthritis: a cross-sectional study.

OBJECTIVES: To determine the extent of asymmetrical deficits in knee extensor and flexor muscles, and to examine whether asymmetrical muscle deficits are associated with mobility limitations in persons with late-stage knee osteoarthritis (OA). DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: A clinical sample (N=56; age range, 50-75y) of eligible persons with late-stage knee OA awaiting knee replacement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Knee extensor and flexor power and torque assessed isokinetically; thigh muscle cross-sectional area (CSA) assessed by computed tomography; mobility limitation assessed by walking speed and stair ascension time; and pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. RESULTS: The asymmetrical deficits in knee extensor and flexor power and torque were between 18% and 29% (P<.001). Regarding the thigh muscle CSA, the asymmetrical deficit was 4% (P<.001). Larger asymmetrical knee extensor power deficits and weaker knee extensor and flexor power on the contralateral side were associated with slower stair ascension times. Moreover, weaker knee extensor and flexor power on the ipsilateral side were associated with slower stair ascension times. Greater knee pain in the OA joint was independently associated with slower stair ascending time in both models. CONCLUSIONS: The knee extensor and flexor muscle power of both the ipsilateral and contralateral sides and the pain in the OA knee were independently associated with stair ascension times. These results highlight the importance of assessing muscle power on both sides and knee pain in the prevention of mobility limitations in patients with knee OA.

Health benefits of different sport disciplines for adults: systematic review of observational and intervention studies with meta-analysis.

The aim was to assess the quality and strength of evidence for the health benefits of specific sport disciplines. Electronic search yielded 2194 records and the selection resulted in 69 eligible studies (47 cross-sectional, 9 cohort, 13 intervention studies). 105 comparisons between participation and non-participation groups in 26 different sport disciplines were reported. Moderately strong evidence showed that both running and football improve aerobic fitness and cardiovascular function at rest, and football reduces adiposity. Conditional evidence showed that running benefits metabolic fitness, adiposity and postural balance, and football improves metabolic fitness, muscular performance, postural balance, and cardiac function. Evidence for health benefits of other sport disciplines was either inconclusive or tenuous. The evidence base for the health benefits of specific sports disciplines is generally compromised by weak study design and quality. Future research should address the health effects of different sport disciplines using rigorous research designs.