Sedentary time associates detrimentally and physical activity beneficially with metabolic flexibility in adults with metabolic syndrome.

Metabolic flexibility (MetFlex) describes the ability to respond and adapt to changes in metabolic demand and substrate availability. The relationship between physical (in)activity and MetFlex is unclear. This study aimed to determine whether sedentary time, physical activity (PA), and cardiorespiratory fitness associate with MetFlex. Sedentary time, standing, and PA were measured with accelerometers for 4 weeks in 64 sedentary adults with metabolic syndrome [37 women, 27 men; 58.3 (SD 6.8) years]. Fitness (V̇o2max; mL·kg-1·min-1) was measured with graded maximal cycle ergometry. MetFlex was assessed with indirect calorimetry as the change in respiratory exchange ratio (ΔRER) from fasting to insulin stimulation with hyperinsulinemic-euglycemic clamp and from low-intensity to maximal exercise. Carbohydrate (CHOox) and fat oxidation (FATox) were calculated from respiratory gases. High sedentary time associated with higher fasting RER [ß = 0.35 (95% confidence interval: 0.04, 0.67)], impaired insulin-stimulated MetFlex (ΔRER) [ß=-0.41 (-0.72, -0.09)], and lower fasting FATox [ß=-0.36 (-0.67, -0.04)]. Standing associated with lower fasting RER [ß=-0.32 (-0.62, -0.02)]. Higher standing time and steps/day associated with higher fasting FATox [ß = 0.31 (0.01, 0.61), and ß = 0.26 (0.00, 0.53)]. Light-intensity and total PA associated with better insulin-stimulated MetFlex [ß = 0.33 (0.05, 0.61)], and ß = 0.33 (0.05, 0.60)]. Higher V̇o2max associated with higher CHOox during maximal exercise [ß = 0.81 (0.62, 1.00)], as well as during insulin stimulation [ß = 0.43 (0.13, 0.73)]. P values are less than 0.05 for all associations. Sedentary time and PA associate with MetFlex. Reducing sitting and increasing PA of even light intensity might aid in the prevention of metabolic diseases in risk populations through their potential effects on energy metabolism.NEW & NOTEWORTHY High accelerometer-assessed sedentary time associates with metabolic inflexibility measured during hyperinsulinemic-euglycemic clamp in adults with metabolic syndrome, and more light-intensity and total physical activity associate with more metabolic flexibility. Physical activity behaviors may thus play an important role in the regulation of fuel metabolism. This highlights the potential of reduced sedentary time and increased physical activity of any intensity to induce metabolic health benefits and help in disease prevention in risk populations.

Long-term effects of aromatase inhibitor withdrawal on bone mineral density in early breast cancer patients: 10-year follow-up results of the BREX study.

PURPOSE: We aimed to provide long-term bone mineral density (BMD) data on early breast cancer patients of the BREX (Breast Cancer and Exercise) study. The effects of exercise and adjuvant endocrine treatment 10 years after randomization were analyzed, with special emphasis on aromatase inhibitor (AI) therapy discontinuation at 5 years. METHODS: The BREX study randomized 573 pre- and postmenopausal breast cancer patients into a 1-year supervised exercise program or a control group. 372 patients were included into the current follow-up analysis. BMD (g/cm2) was measured by dual-energy X-ray absorptiometry at lumbar spine (LS), left femoral neck (FN), and the total hip. Separate groups were displayed according to baseline menopausal status, and whether the patient had discontinued AI therapy at 5 years or not. RESULTS: The BMD change from 5 to 10 years did not significantly differ between the two randomized arms. AI discontinuation at 5 years had statistically significant BMD effects. The FN BMD continued to decrease in patients who discontinued AI therapy during the first 5-year off-treatment, but the decrease was three-fold less than in patients without AI withdrawal (- 1.4% v. - 3.8%). The LS BMD increased (+ 2.6%) in patients with AI withdrawal during the first 5 years following treatment discontinuation, while a BMD decrease (-1.3%) was seen in patients without AI withdrawal. CONCLUSION: This study is to our knowledge the first to quantify the long-term impact of AI withdrawal on BMD. Bone loss associated with AI therapy seems partially reversible after stopping treatment. TRIAL REGISTRATION: http://www. CLINICALTRIALS: gov/ (Identifier Number NCT00639210).

Periodic mobile application (eMOM) with self-tracking of glucose and lifestyle improves treatment of diet-controlled gestational diabetes without human guidance: a randomized controlled trial.

BACKGROUND: Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes. OBJECTIVE: This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel. STUDY DESIGN: Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks' gestation to the intervention or the control arm. The intervention arm received standard care in combination with use of the periodic eMOM, whereas the control arm received only standard care. The intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to 35 to 37 weeks' gestation. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes, such as macrosomia. RESULTS: In total, 148 women (76 in the intervention arm, 72 in the control arm; average age, 34.1±4.0 years; body mass index, 27.1±5.0 kg/m2) were randomized. The intervention arm showed a lower mean change in fasting plasma glucose than the control arm (difference, -0.15 mmol/L vs -2.7 mg/mL; P=.022) and lower capillary fasting glucose levels (difference, -0.04 mmol/L vs -0.7 mg/mL; P=.002). The intervention arm also increased their intake of vegetables (difference, 11.8 g/MJ; P=.043), decreased their sedentary behavior (difference, -27.3 min/d; P=.043), and increased light physical activity (difference, 22.8 min/d; P=.009) when compared with the control arm. In addition, gestational weight gain was lower (difference, -1.3 kg; P=.015), and there were less newborns with macrosomia in the intervention arm (difference, -13.1 %; P=.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (P=.0006) and postprandial glucose levels (P=.017), weight gain (P=.028), intake of energy (P=.021) and carbohydrates (P=.003), and longer duration of the daily physical activity (P=.0006). There were no significant between-arm differences in terms of pregnancy complications. CONCLUSION: Self-tracking of lifestyle factors and glucose levels without additional guidance improves self-management and the treatment of gestational diabetes, which also benefits newborns. The results of this study support the use of digital self-management and education tools in maternity care.

Physical activity has decreased in Finnish children and adolescents from 2016 to 2022.

BACKGROUND: Varying trends in children's and adolescents' physical activity (PA) have been reported during the last 10-20 years. Trends in sedentary behavior (SB) have been studied only rarely. The purpose of the present study was to describe population-based trends in accelerometer-measured PA, standing and SB, among Finnish 7-15-year-old children and adolescents, and to evaluate the potential influence of the COVID-19 pandemic on these behaviors. METHOD: A cross-sectional population-based Finnish school-aged physical activity Study (FSPA) measured daily steps, vigorous (VPA), moderate (MPA), moderate-to-vigorous (MVPA), light physical activity (LPA), standing, and SB by an accelerometer for seven consecutive days in 2016, 2018, and 2022 (n = 7.080, 57% girls). The data was analyzed by multivariate regression analysis. RESULTS: In 2016, participants took on average 10.305 steps per day, and spent 0:15 (h: min) in VPA, 1:37 in MPA, 1:52 in MVPA, 3:48 in LPA, 0:55 in standing and 7:52 in SB. From 2016 to 2018, daily steps, MPA, LPA, and standing increased [229 steps (95% Confidence Interval, CI 70-387), 0:03 (CI 0:01 - 0:04), 0:11 (CI 0:09 - 0:14), and 0:07 (CI 0:05 - 0:08), respectively], while VPA and SB decreased [0:01 (CI 0:00-0:02) and 0:20 (CI 0:16 - 0:24), respectively]. From 2018 to 2022, daily PA and standing declined [751 steps (CI 562-939), VPA 0:02 (CI 0:01 - 0:03), MPA 0:09 (CI 0:07 - 0:11), MVPA 0:11 (CI 0:09 - 0:14), LPA 0:08 (CI 0:05 - 0:11), and standing 0:01 (CI 0:01 - 0:03)] while SB increased 0:21 (CI 0:16 - 0:25) indicating potential influence of the pandemic. CONCLUSIONS: Children and adolescents became physically less active from 2016 to 2022. The potential effects of the COVID-19 were seen as declined PA and increased sedentariness from 2018 to 2022.

Elective Cardiac Procedure Patients Have Low Preoperative Cardiorespiratory Fitness.

Preoperative cardiorespiratory fitness may influence the recovery after cardiac procedure. The aim of this study was to investigate the cardiorespiratory fitness of patients scheduled for elective cardiac procedures, using a six-minute walk test, and compare the results with a population-based sample of Finnish adults. Patients (n=234) awaiting percutaneous coronary intervention or coronary angiography, coronary artery bypass grafting, aortic valve replacement or mitral valve surgery performed the six-minute walk test. VO2max was calculated based on the walk test. The patients were compared to a population-based sample of 60-69-year-old Finnish adults from the FinFit2017 study. The mean six-minute walk test distances (meters) and VO2max (ml/kg/min) of the patient groups were: 452±73 and 24.3±6.9 (coronary artery bypass grafting), 499±84 and 27.6±7.2 (aortic valve replacement), 496±85 and 27.4±7.3 (mitral valve surgery), and 519±90 and 27.3±6.9 (percutaneous coronary intervention or coronary angiography). The population-based sample had significantly greater walk test distance (623±81) and VO2max (31.7±6.1) than the four patient groups (all p-values<0.001). All patient groups had lower cardiorespiratory fitness than the reference population of 60-69-year-old Finnish adults. Particularly the coronary artery bypass grafting group had a low cardiorespiratory fitness, and therefore might be prone to complications and challenging rehabilitation after the operation.

Novice providers' success in performing lumbar puncture: a randomized controlled phantom study between a conventional spinal needle and a novel bioimpedance needle.

BACKGROUND: Lumbar puncture (LP) is an important yet difficult skill in medical practice. In recent years, the number of LPs in clinical practice has steadily decreased, which reduces residents' clinical exposure and may compromise their skills and attitude towards LP. Our study aims to assess whether the novel bioimpedance needle is of assistance to a novice provider and thus compensates for this emerging knowledge gap. METHODS: This randomized controlled study, employing a partly blinded design, involved 60 s- and third-year medical students with no prior LP experience. The students were randomly assigned to two groups consisting of 30 students each. They performed LP on an anatomical lumbar model either with the conventional spinal needle or the bioimpedance needle. Success in LP was analysed using the independent samples proportion procedure. Additionally, the usability of the needles was evaluated with pertinent questions. RESULTS: With the conventional spinal needle, 40% succeeded in performing the LP procedure, whereas with the bioimpedance needle, 90% were successful (p < 0.001). The procedures were successful at the first attempt in 5 (16.7%) and 15 (50%) cases (p = 0.006), respectively. Providers found the bioimpedance needle more useful and felt more confident using it. CONCLUSIONS: The bioimpedance needle was beneficial in training medical students since it significantly facilitated the novice provider in performing LP on a lumbar phantom. Further research is needed to show whether the observed findings translate into clinical skills and benefits in hospital settings.

Measurement of Sedentary Behavior-The Outcomes of the Angle for Posture Estimation (APE) Method.

Hip-worn accelerometers are commonly used to assess habitual physical activity, but their accuracy in precisely measuring sedentary behavior (SB) is generally considered low. The angle for postural estimation (APE) method has shown promising accuracy in SB measurement. This method relies on the constant nature of Earth's gravity and the assumption that walking posture is typically upright. This study investigated how cardiorespiratory fitness (CRF) and body mass index (BMI) are related to APE output. A total of 3475 participants with adequate accelerometer wear time were categorized into three groups according to CRF or BMI. Participants in low CRF and high BMI groups spent more time in reclining and lying postures (APE ≥ 30°) and less time in sitting and standing postures (APE < 30°) than the other groups. Furthermore, the strongest partial Spearman correlation with CRF (r = 0.284) and BMI (r = -0.320) was observed for APE values typical for standing. The findings underscore the utility of the APE method in studying associations between SB and health outcomes. Importantly, this study emphasizes the necessity of reserving the term "sedentary behavior" for studies wherein the classification of SB is based on both intensity and posture.

The effects of a 6-month intervention aimed to reduce sedentary time on skeletal muscle insulin sensitivity: a randomized controlled trial.

Sedentary behavior (SB) and physical inactivity associate with impaired insulin sensitivity. We investigated whether an intervention aimed at a 1-h reduction in daily SB during 6 mo would improve insulin sensitivity in the weight-bearing thigh muscles. Forty-four sedentary inactive adults [mean age 58 (SD 7) yr; 43% men] with metabolic syndrome were randomized into intervention and control groups. The individualized behavioral intervention was supported by an interactive accelerometer and a mobile application. SB, measured with hip-worn accelerometers in 6-s intervals throughout the 6-mo intervention, decreased by 51 (95% CI 22-80) min/day and physical activity (PA) increased by 37 (95% CI 18-55) min/day in the intervention group with nonsignificant changes in these outcomes in the control group. Insulin sensitivity in the whole body and in the quadriceps femoris and hamstring muscles, measured with hyperinsulinemic-euglycemic clamp combined with [18F]fluoro-deoxy-glucose PET, did not significantly change during the intervention in either group. However, the changes in hamstring and whole body insulin sensitivity correlated inversely with the change in SB and positively with the changes in moderate-to-vigorous PA and daily steps. In conclusion, these results suggest that the more the participants were able to reduce their SB, the more their individual insulin sensitivity increased in the whole body and in the hamstring muscles but not in quadriceps femoris. However, according to our primary randomized controlled trial results, this kind of behavioral interventions targeted to reduce sedentariness may not be effective in increasing skeletal muscle and whole body insulin sensitivity in people with metabolic syndrome at the population level.NEW & NOTEWORTHY Aiming to reduce daily SB by 1 h/day had no impact on skeletal muscle insulin sensitivity in the weight-bearing thigh muscles. However, successfully reducing SB may increase insulin sensitivity in the postural hamstring muscles. This emphasizes the importance of both reducing SB and increasing moderate-to-vigorous physical activity to improve insulin sensitivity in functionally different muscles of the body and thus induce a more comprehensive change in insulin sensitivity in the whole body.

Effects of reducing sedentary behavior on cardiorespiratory fitness in adults with metabolic syndrome: A 6-month RCT.

INTRODUCTION: Poor cardiorespiratory fitness (CRF) is associated with adverse health outcomes. Previous observational and cross-sectional studies have suggested that reducing sedentary behavior (SB) might improve CRF. Therefore, we investigated the effects of a 6-month intervention of reducing SB on CRF in 64 sedentary inactive adults with metabolic syndrome in a non-blind randomized controlled trial. MATERIALS AND METHODS: In the intervention group (INT, n = 33), the aim was to reduce SB by 1 h/day for 6 months without increasing exercise training. Control group (CON, n = 31) was instructed to maintain their habitual SB and physical activity. Maximal oxygen uptake (VO2max ) was measured by maximal graded bicycle ergometer test with respiratory gas measurements. Physical activity and SB were measured during the whole intervention using accelerometers. RESULTS: Reduction in SB did not improve VO2max statistically significantly (group × time p > 0.05). Maximal absolute power output (Wmax ) did not improve significantly but increased in INT compared to CON when scaled to fat free mass (FFM) (at 6 months INT 1.54 [95% CI: 1.41, 1.67] vs. CON 1.45 [1.32, 1.59] Wmax /kgFFM , p = 0.036). Finally, the changes in daily step count correlated positively with the changes in VO2max scaled to body mass and FFM (r = 0.31 and 0.30, respectively, p < 0.05). DISCUSSION: Reducing SB without adding exercise training does not seem to improve VO2max in adults with metabolic syndrome. However, succeeding in increasing daily step count may increase VO2max .

Associations of sedentary time, physical activity, and fitness with muscle glucose uptake in adults with metabolic syndrome.

OBJECTIVE: The objective of the study was to investigate the associations of sedentary time, physical activity, and cardiorespiratory fitness with skeletal muscle glucose uptake (GU). METHODS: Sedentary time and physical activity were measured with accelerometers and VO2 max with cycle ergometry in 44 sedentary adults with metabolic syndrome. Thigh muscle GU was determined with [18 F]FDG-PET imaging. RESULTS: Sedentary time (ß = -0.374), standing (ß = 0.376), steps (ß = 0.351), and VO2 max (ß = 0.598) were associated with muscle GU when adjusted for sex, age, and accelerometer wear time. Adjustment for body fat-% turned all associations non-significant. CONCLUSION: Body composition is a more important determinant of muscle GU in this population than sedentary time, physical activity, or fitness.

Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women.

BACKGROUND: Falls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed. AIMS: The predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form. METHODS: A subsample (n = 384) of community-living older women (aged 72-84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants' falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates. RESULTS: During the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the "moderate fall risk" group had 1.47-fold (95% CI 0.74-2.91; nonsignificant), in "substantial fall risk" 4.00-fold (1.93-8.3; p < 0.001) and in "high fall risk" 3.00-fold (0.97-9.22; nonsignificant) higher risk of falls compared to the "low fall risk" group. Performance in physical tests did not account for future falls. CONCLUSIONS: The KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.

Floating Epoch Length Improves the Accuracy of Accelerometry-Based Estimation of Coincident Oxygen Consumption.

Estimation of oxygen consumption (VO2) from accelerometer data is typically based on prediction equations developed in laboratory settings using steadily paced and controlled test activities. These equations may not capture the temporary changes in VO2 occurring in sporadic real-life physical activity. In this study, we introduced a novel floating epoch for accelerometer data analysis and hypothesized that an adaptive epoch length provides a more consistent estimation of VO2 in irregular activity conditions than a 6 s constant epoch. Two different activity tests were conducted: a progressive constant-speed test (CS) performed on a track and a 6 min back-and-forth walk test including accelerations and decelerations (AC/DC) performed as fast as possible. Twenty-nine adults performed the CS test, and sixty-one performed the AC/DC test. The data were collected using hip-worn accelerometers and a portable metabolic gas analyzer. General linear models were employed to create the prediction models for VO2 that were cross-validated using both data sets and epoch types as training and validation sets. The prediction equations based on the CS test or AC/DC test and 6 s epoch had excellent performance (R2 = 89%) for the CS test but poor performance for the AC/DC test (31%). Only the VO2 prediction equation based on the AC/DC test and the floating epoch had good performance (78%) for both tests. The overall accuracy of VO2 prediction is compromised with the constant length epoch, whereas the prediction model based on irregular acceleration data analyzed with a floating epoch provided consistent performance for both activities.

Performance of Different Accelerometry-Based Metrics to Estimate Oxygen Consumption during Track and Treadmill Locomotion over a Wide Intensity Range.

Accelerometer data can be used to estimate incident oxygen consumption (VO2) during physical activity. Relationships between the accelerometer metrics and VO2 are typically determined using specific walking or running protocols on a track or treadmill. In this study, we compared the predictive performance of three different metrics based on the mean amplitude deviation (MAD) of the raw three-dimensional acceleration signal during maximal tests performed on a track or treadmill. A total of 53 healthy adult volunteers participated in the study, 29 performed the track test and 24 the treadmill test. During the tests, the data were collected using hip-worn triaxial accelerometers and metabolic gas analyzers. Data from both tests were pooled for primary statistical analysis. For typical walking speeds at VO2 less than 25 mL/kg/min, accelerometer metrics accounted for 71-86% of the variation in VO2. For typical running speeds starting from VO2 of 25 mL/kg/min up to over 60 mL/kg/min, 32-69% of the variation in VO2 could be explained, while the test type had an independent effect on the results, except for the conventional MAD metrics. The MAD metric is the best predictor of VO2 during walking, but the poorest during running. Depending on the intensity of locomotion, the choice of proper accelerometer metrics and test type may affect the validity of the prediction of incident VO2.

How adherence to the updated physical activity guidelines should be assessed with accelerometer?

BACKGROUND: The aerobic part of the recently updated physical activity (PA) guidelines for adults recommends at least 150 min of moderate or at least 75 of vigorous-intensity PA or an equivalent combination of both. PA can be accumulated of any bout duration. On an absolute scale, moderate-intensity threshold is 3 metabolic equivalents (METs) and vigorous 6 METs. On a scale relative to individual's personal capacity, moderate-intensity threshold is 40% and vigorous 60% of the oxygen uptake reserve. In this study, the adherence to the new guidelines was evaluated using both absolute and relative thresholds. METHODS: Totally, 1645 adults aged 20-64 years, participated in this population-based study and their cardiorespiratory fitness (CRF) was estimated with 6-min walking test. The participants with estimated maximal oxygen uptake <7.9 MET were categorized as low CRF group and the others as adequate CRF group. The participants were instructed to wear a triaxial hip-worn accelerometer for 1 week and their adherence to PA guidelines was assessed from the accelerometer data. RESULTS: The adequate CRF group had higher adherence to PA guidelines with the absolute thresholds, but the use of relative thresholds inverted the results. The adherence varied from 20% to 99% in the total sample depending on the analysis parameters of accelerometer data. CONCLUSIONS: The absolute thresholds provide a more appropriate basis to assess the adherence to PA guidelines in population-based samples and interventions. The use of individually determined relative thresholds may be more useful for individual exercise prescriptions in PA counseling.

Incidence of Traumatic Lumbar Punctures in Neonates and Infants.

OBJECTIVE: The objective of this study is to examine factors accounting for the incidence of traumatic lumbar puncture (TLP) in infants younger than 1 year old. STUDY DESIGN: Retrospective analysis of cerebrospinal fluid (CSF) data from 1,240 neonatal (≤28 days) and 399 infant lumbar puncture (LP) procedures was conducted. Data from two successive LP procedures were obtained from 108 patients. Logistic regression analysis was used to assess factors accounting for the incidence of TLP in the second LP procedure. The following categorical variables were entered into the model: whether the first procedure was traumatic according to criteria of ≥500 and ≥10,000 erythrocytes/µL, whether the LP procedures were performed within a week, and whether the patient was neonatal at the first procedure. RESULTS: The incidences of TLP were 42.9% in neonates and 22.5% in infants for the criterion of ≥500 erythrocytes/µL, and 16.6 and 10.3% for the criterion of ≥10,000 erythrocytes/µL. Compared with a nontraumatic first LP procedure, if the first procedure was traumatic according to the criterion of ≥10,000 erythrocytes/µL, the odds ratio (OR) of TLP in the second procedure was 5.86 (p = 0.006). Compared with a longer time, if the successive procedures were performed within a week, the OR of TLP was 9.06 (p < 0.0001) according to the criteria of ≥500 erythrocytes/µL and 3.34 (p = 0.045) according to the criteria of ≥10,000 erythrocytes/µL. If the patient was neonatal at the first procedure, the OR of TLP at the second puncture was 0.32 (p = 0.031) according to the criterion of ≥500 erythrocytes/µL. CONCLUSIONS: The incidence of TLP in neonates is twice as high as that in infants. Successive LP procedures performed within a week and a highly blood-contaminated CSF sample in the first procedure each multiplied the odds of TLP in the second procedure, whereas being a neonate at the time of the first procedure reduced the odds of TLP. KEY POINTS: · Traumatic LPs increase diagnostic uncertainty.. · Traumatic LPs are twice as common in neonates as in infants.. · Two LPs performed within a week multiplied the odds of traumatic LP.. · Erythrocyte-based criteria for traumatic LP affect the incidence of TLP..

Traumatic lumbar punctures in diagnostic and intrathecal treatment punctures of pediatric hemato-oncology patients.

Successful first diagnostic lumbar puncture (LP) is crucial because intrathecal chemotherapy has not yet protected the central nervous system against cancer cells. If blood contaminates the cerebrospinal fluid (CSF) with blasts, they may enter the central neural system and compromise the patient's health. We retrospectively determined the incidence of traumatic lumbar punctures (TLP) in 2,507 LPs of 250 pediatric hemato-oncology patients aged from one to 18 years, including both diagnostic and intrathecal treatment procedures, and 2,617 LPs of 1,525 other age-matched pediatric patients. We used ≥10 erythrocytes/µL in the CSF sample as the criterion of TLP. TLPs were less frequent in hemato-oncology patients than in other patients (31.6% vs. 48.5%, p < 0.0001). The incidence of TLP was significantly lower in the first diagnostic LP than in subsequent intrathecal treatment LPs (20.5% vs. 31.6%, p = 0.0046). According to logistic regression analysis, the odds of TLP was 1.6-fold if the LP procedure was not performed in the hemato-oncology department. The odds of the patient's next LP being traumatic were threefold if the previous first LP was traumatic. A week or less time between the first and next LP tripled the odds of TLP as well. The patient's age category was not significantly associated with the incidence of TLP. Given the risks of TLP, hemato-oncology patients' first diagnostic LP should include administration of chemotherapy, as generally recommended, and be performed under general anesthesia or deep sedation by an experienced physician to optimize not only the success of the first LP procedure but also following procedures.

Intensity Paradox-Low-Fit People Are Physically Most Active in Terms of Their Fitness.

Depending on their cardiorespiratory fitness (CRF), people may perceive the exertion of incident physical activity (PA) differently. Therefore, the use of relative intensity thresholds based on individual fitness have been proposed to evaluate the accumulation of PA at different intensity levels. A subsample of the FinFit2017-study, 1952 adults (803 men and 1149 women) aged 20-69 years, participated in this study. Their maximal oxygen uptake (VO2max) was predicted with a 6 min walk test, and they were instructed to wear a triaxial hip-worn accelerometer for one week. The participants were divided into CRF tertiles by five age groups and sex. Raw acceleration data were analyzed with the mean amplitude deviation method in 6 s epochs. Additionally, the data were smoothed with 1 min and 6 min exponential moving averages. The absolute intensity threshold for moderate activity was 3.0 metabolic equivalent (MET) and for vigorous 6.0 MET. Correspondingly, the relative thresholds were 40% and 60% of the oxygen uptake reserve. Participants in the lowest CRF tertile were the most active with relative thresholds, and participants in the highest CRF tertile were the most active with absolute thresholds. High-fit people easily reached the absolute thresholds, while people in the lowest CRF tertile had to utilize most of their aerobic capacity on a daily basis simply to keep up with their daily chores or peers.

Motives for physical activity in older men and women: A twin study using accelerometer-measured physical activity.

Motives for physical activity may vary considerably by age, sex, and the level of physical activity. We aimed to examine motives for physical activity in older men and women with different physical activity levels as well as whether genetic and/or environmental factors explain those motives. Finnish twins (mean age 72.9 years, 262 full twin pairs) self-reported their motives for physical activity. Time spent on moderate-to-vigorous physical activity was monitored using a hip-worn accelerometer. Comparisons between the different physical activity groups of older twins (n = 764-791/motive dimension) were analyzed using the Wald test, and effect sizes were calculated as Cohen's d. Quantitative genetic modeling was used to estimate genetic and environmental contributions. For both sexes, the most frequently reported motives for physical activity were physical fitness, health maintenance, and psychological well-being. Conforming to others' expectations was more important for men than for women (P < .001, Cohen's d = 0.38), while appearance (P = .001 Cohen's d = -0.24) and psychological well-being (P = .02, Cohen's d = -0.17) were highlighted by women. Most of the motive dimensions differed significantly between the physically active and inactive individuals. It was estimated that 5%-42% of the variation in motives was contributed by genetic factors and 58%-95% by environmental factors. The result that environmental factors contribute in a great deal to motives indicates that interventions to motivate physically inactive older individuals to be physically active can be successful. However, personalized interventions are needed because sex and the level of physical activity were found to be associated with older individuals' motives for physical activity.

Does long-term recreational gymnastics prevent injurious falls in older women? A prospective 20-year follow-up.

BACKGROUND: Exercise interventions focusing on balance and strength training have been shown to be effective for falls prevention. The aim of this 20-year register-based follow-up was to examine whether long-term participation in recreational female gymnastics is associated with a lower risk of medically-attended injurious falls. METHODS: Health care register data of 187 women (103 recreational gymnasts and 84 sedentary controls) from the original cohort of 243 women were assessed. The mean age (sd) at baseline was 62.8 (5.4) years and the mean follow-up time was 19.4 (2.7) years (range from 5.6 to 21.0 years). Injurious falls were scrutinized from medical records. An injurious fall was defined as an event in which falling was mentioned as a reason for making contact with health-care professionals. Negative binomial regression was used to estimate incidence rate ratios (IRR) for injurious falls, and Cox-regression models for calculating hazard ratios (HR) for injured fallers with the control group as reference. RESULTS: Recreational gymnasts had about 30% less injurious falls compared to controls, the mean IRR (95% CI) being 0.71 (0.51 to 0.96). The HR for injured fallers was 0.73 (0.52 to 1.02) favoring the recreational gymnasts. There were no statistically significant between-group differences for fractures. CONCLUSIONS: Long-term recreational gymnastics appears to reduce the risk of injurious falls in old age.

Do bone geometric properties of the proximal femoral diaphysis reflect loading history, muscle properties, or body dimensions?

OBJECTIVES: The aim of this study was to investigate activity-induced effects from bone geometric properties of the proximal femur in athletic vs nonathletic healthy females by statistically controlling for variation in body size, lower limb isometric, and dynamic muscle strength, and cross-sectional area of Musculus gluteus maximus. METHODS: The material consists of hip and proximal thigh magnetic resonance images of Finnish female athletes (N = 91) engaged in either high jump, triple jump, soccer, squash, powerlifting, endurance running or swimming, and a group of physically active nonathletic women (N = 20). Cross-sectional bone geometric properties were calculated for the lesser trochanter, sub-trochanter, and mid-shaft of the femur regions. Bone geometric properties were analyzed using a general linear model that included body size, muscle size, and muscle strength as covariates. RESULTS: Body size and isometric muscle strength were positively associated with bone geometric properties at all three cross-sectional levels of the femur, while muscle size was positively associated with bone properties only at the femur mid-shaft. When athletes were compared to nonathletic females, triple jump, soccer, and squash resulted in greater values in all studied cross-sections; high jump and endurance running resulted in greater values at the femoral mid-shaft cross-section; and swimming resulted in lower values at sub-trochanter and femur mid-shaft cross-sections. CONCLUSIONS: Activity effects from ground impact loading were associated with higher bone geometric values, especially at the femur mid-shaft, but also at lesser and sub-trochanter cross-sections. Bone geometric properties along the femur can be used to assess the mechanical stimuli experienced, where ground impact loading seems to be more important than muscle loading.