Physical capability, physical activity, and their association with femoral bone mineral density in adults aged 40 years and older: The Tromsø study 2015-2016.

Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women. INTRODUCTION: Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population. METHODS: A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures. RESULTS: In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm2, CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm2, CI = 0.008 to 0.002). CONCLUSION: Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women.

Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study.

Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway. INTRODUCTION: To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. METHODS: The study population constituted 6565 participants aged 50-79 years at baseline in the Tromsø Study wave 4 conducted in 1994-1995. Forearm BMD measured by SXA was categorized as "normal," "osteopenia," or "osteoporosis" following WHO's definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. RESULTS: During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. CONCLUSION: Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.

Assessing the relative and absolute reliability of the Falls Efficacy Scale-International questionnaire in elderly individuals with increased fall risk and the questionnaire's convergent validity in elderly women with osteoporosis.

UNLABELLED: The Falls Efficacy Scale-International (FES-I) is a highly reliable questionnaire for assessing fear of falling in elderly individuals with increased fall risk and has low or no convergent validity with balance performance tests and health-related quality of life (HRQL) among elderly women with osteoporosis, which indicates that both measurements should be included as they are measuring different components. INTRODUCTION: Fear of falling is increased in elderly individuals with osteoporosis and FES-I is a widely used questionnaire to assess fear of falling. There is limited evidence of the reliability and convergent validity in elderly with increased risk of falling and osteoporosis. METHODS: Reliability and validity study of the FES-I. Community-dwelling elderly with increased fall risk, 59 subjects, were recruited to the reliability assessment, and 81 women with osteoporosis, in the validity assessment. For the reliability assessment, two postal surveys were used. For the validity assessment, we used baseline data from an on-going study in women with osteoporosis. The FES-I was correlated to a single-item question regarding fear of falling, self-reported history of falls, balance performance tests and health-related quality of life. RESULTS: The FES-I had very good relative reliability (intra-class correlation 0.88) and internal consistency reliability (Cronbach's alpha 0.94). The value for absolute reliability was a standard error of measure 2.9 (10.6 %), smallest real difference 7.9 (29 %). There was "little if any" to "low" correlation between the FES-I and the single-item question regarding fear of falling and self-reported history of falls, HRQL and balance performance tests. CONCLUSION: The FES-I seems to be a highly reliable questionnaire for assessing fear of falling in elderly with increased fall risk but has low relation to/convergent validity with balance performance and HRQL among elderly women with osteoporosis.

Does a physical activity referral scheme improve the physical activity among routine primary health care patients?

Physical activity referral (PAR) schemes or concepts occur in varying forms. Because few physical activity intervention studies have been carried out in routine health care settings, it is difficult to translate research findings into daily practice. The aim of this study was to analyze the effectiveness of a PAR scheme implemented in routine primary health care. The study did not include a control group and was based on the ordinary staff's work efforts and follow-up measures. During a 2-year period, 6300 PARs were issued. Effectiveness was measured by an increase in self-reported physical activity. Half of the patients reached reported increased physical activity both at 3 months (49%) and at 12 months (52%). The proportion of inactive patients decreased from 33% at baseline to 17% at 3 months and 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 33% at 3 months and 32% at 12 months. Neither the patient's age nor the profession of the prescriber was associated with differences in effectiveness. The patient's activity level at baseline, the type of physical activity as well as the reason for the prescription were associated with increased physical activity.

Physical activity referrals in Swedish primary health care - prescriber and patient characteristics, reasons for prescriptions, and prescribed activities.

BACKGROUND: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Ostergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries. METHODS: Prospective prescription data were obtained for 90% of the primary health care centres in Ostergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff. RESULTS: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45-64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1-2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%). CONCLUSION: Ostergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

Combination therapy with pegylated liposomal doxorubicin and carboplatin in gynecologic malignancies: a prospective phase II study of the Arbeitsgemeinschaft Gynäekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and Kommission Uterus (AGO-K-Ut).

OBJECTIVE: A multicenter non-randomized phase II study was initiated to evaluate tolerability and efficacy of pegylated liposomal doxorubicin (PLD) in combination with carboplatin in gynecologic malignancies. METHODS: One hundred forty women with recurrent or advanced endometrial (n=31), cervical or vaginal cancer (n=31), uterine sarcomas (n=11), or recurrent platinum-sensitive ovarian cancer (n=67) received six courses of PLD 40 mg/m2 and carboplatin (AUC 6) every 28 days. RESULTS: Hematological toxicities with NCI-CTC grade 3/4 were anemia in 8%, thrombocytopenia in 14%, neutropenia in 24%, and febrile neutropenia in 2% of 652 cycles. Grade 3/4 non-hematological toxicities included fatigue (14% of patients), pain (10%), dyspnea (9%), palmar-plantar erythrodysesthesia (7%), and nausea/vomiting (7%). Dose intensity reached 87.2% for PLD and 88.2% for carboplatin. Seventy-four percent of all non-progressive patients received at least 5 cycles. Overall response rates were (116 patients evaluable for response): ovarian cancer (n=54) 68%, endometrial cancer (n=27) 44%, uterine sarcomas (n=9) 33%, and cervical/vaginal cancer (n=26) 12%. Median progression-free survival was 11.6 months (95%CI 9.6-14.1) for ovarian cancer and 9.5 months (95%CI 6.6-12.6) for endometrial cancer. Median overall survival was 23.8 months (95%CI 19.0-30.2) and 21.4 months (95%CI 11.9-), respectively. CONCLUSIONS: The combination of PLD and carboplatin was well tolerated and feasible in patients with gynecologic malignancies. Efficacy was low in cervical/vaginal cancer, but promising in patients with endometrial cancer. Efficacy was within the expected range in recurrent platinum-sensitive ovarian cancer and is currently under further investigation in a prospective randomized phase III trial comparing PLD/carboplatin with paclitaxel/carboplatin (CALYPSO-trial; AGO-OVAR 2.9).

Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris--results from the European Angina Registry Link Study (EARL).

OBJECTIVE: To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation. METHODS: During 2003-2005, all patients with refractory angina referred for SCS treatment at 10 European centres were consecutively included in the European registry for refractory angina (European Angina Registry Link, EARL), a prospective, 3-year follow-up study. In the present study, the SCS-treated patients were followed-up regarding angina symptoms and quality of life assessed was with a generic (Short Form 36, SF-36) and a disease-specific (Seattle Angina Questionnaire, SAQ) quality of life questionnaire. RESULTS: In total, 235 patients were included in the study. After screening, 121 patients were implanted and followed up 12.1 months after implantation. The implanted patients reported fewer angina attacks (p<0.0001), reduced short-acting nitrate consumption (p<0.0001) and improved Canadian Cardiovascular Society class (p<0.0001). Furthermore, quality of life was significantly improved in all dimensions of the SF-36 and the SAQ. Seven (5.8%) of the implanted patients died within 1 year of follow up. CONCLUSIONS: SCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.

Influence of spontaneous pursed lips breathing on walking endurance and oxygen saturation in patients with moderate to severe chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate how spontaneously used pursed lips breathing influences walking endurance, oxygen saturation and dyspnoea in patients with moderate to severe chronic obstructive pulmonary disease. DESIGN: A randomized open-label, cross-over study of chronic obstructive pulmonary disease patients participating in a rehabilitation programme. SETTING: Outpatient pulmonary rehabilitation centre at a university hospital. SUBJECTS: Thirty-two patients with moderate to severe chronic obstructive pulmonary disease. INTERVENTION: All patients performed two endurance shuttle walking tests in random order. During endurance shuttle walking test I a mouthpiece was used in order to prevent spontaneous pursed lips breathing. During endurance shuttle walking test II spontaneous pursed lips breathing was used freely. Heart rate, oxygen saturation and the patients' estimated dyspnoea and leg fatigue on a Borg Category Ratio 10 scale were recorded before, directly after, and 5 and 10 minutes after the tests. RESULTS: When spontaneous pursed lips breathing was used the patients walked on an average for 37 seconds (16%) longer (P<0.01) than when pursed lips breathing was prevented. The patients desaturated considerably during both walking tests but the average drop in oxygen saturation was 1.2% less when spontaneous pursed lips breathing was employed. There were no significant differences in rated degree of dyspnoea or leg fatigue with or without pursed lips breathing. CONCLUSION: Spontaneous pursed lips breathing can be a useful technique to increase walking endurance and reduce oxygen desaturation during walking in patients with moderate to severe chronic obstructive pulmonary disease.

Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life.

To examine whether physical activity on prescription in routine primary care patients would influence physical activity level and quality of life 6 months later. In 2001-2003, 13 Swedish primary health care units took part in an uncontrolled clinical study. If a patient in primary health care needed physical activity preventively or for treatment of a disease and patient-centered motivational counseling found physical activity to be suitable, individualized physical activity could be prescribed. Patients (n=481) of both sexes and all ages [75% women, mean age 50 (12-81)] participated in the study. Self-reported physical activity, readiness to change to a more physically active lifestyle and quality-of-life data were collected through questionnaires. The follow-up rate was 62% at 6 months. Intention-to-treat analysis showed a significant increase (P<0.01) in self-reported physical activity level, the stages of action and maintenance of physical activity as well as quality of life. Physical activity level, stages of change and quality of life increased analogically, indicating that physical activity on prescription may be suitable as a conventional treatment in an ordinary primary health care setting to promote a more physically active lifestyle.

Physical activity, body composition and physical self-esteem: a 3-year follow-up study among adolescents in Sweden.

AIMS: To measure physical activity by means of daily pedometer steps, body composition, expressed as body mass index (BMI) and bioelectrical impedance as percent body fat, and perceived physical self-esteem and additionally, to evaluate eventual predictors for a healthy lifestyle i.e., highly physically active, normal weighted and a high physical self-esteem in a follow-up group. METHODS: During autumn 2000 physical activity level was assessed and BMI was calculated in 871 children aged 7-14 in south eastern Sweden and in 501 of these, physical self-esteem were also assessed. During autumn 2003 a total of 375 adolescents aged 15-18 were assessed using the same methodology and additionally percent body fat was measured. Ninety-three of these adolescents (46 girls), were also measured in 2000 and they formed the follow-up group. RESULTS: In the follow-up group a significant increase in BMI and stability in physical self-esteem in boys and girls, and in boys a significant decrease in daily steps was found 3 years later. Strongest predictor to be highly physically active, maintain normal BMI and high self-esteem 3 years later, i.e., to have a healthy lifestyle, was for girls increased self-esteem and for boys a decreased BMI. CONCLUSION: Consequently, for a healthy lifestyle, promoting physical self-esteem in girls and weight control in boys is of great importance in early adolescence.

Neuroprotection with amifostine in the first-line treatment of advanced ovarian cancer with carboplatin/paclitaxel-based chemotherapy--a double-blind, placebo-controlled, randomized phase II study from the Arbeitsgemeinschaft Gynäkologische Onkologoie (AGO) Ovarian Cancer Study Group.

GOALS OF WORK: Neurotoxicity is a common side effect of platinum/taxane-based therapy of ovarian cancer. We performed a double-blind randomized placebo-controlled trial to evaluate the influence of the cytoprotectant amifostine on the neurotoxicity of first-line therapy of ovarian cancer with paclitaxel/carboplatin with or without epirubicin. PATIENTS AND METHODS: Of 72 patients randomized, 71 were treated with paclitaxel 175 mg/m2 and carboplatin AUC5 with or without epirubicin 60 mg/m2 (q21 x 6) and randomized for i.v. premedication with amifostine 740 mg/m2 or placebo. Assessment included a questionnaire, NCI-CTC, tendon reflex activity (TRA), two-point discrimination (2-PD), measurement of vibration perception threshold (VPT) and vibration disappearance threshold (VDT), and quality of life. RESULTS: The majority of neurotoxicity criteria showed a significant impairment during therapy in both treatment arms. A significant protective effect of amifostine was observed for 2-PD, TRA, VPT and VDT. Amifostine failed to improve the 'global health status quality of life' score significantly. Toxicities according to NCI-CTC showed improved sensory neuropathy (P = 0.0046) but a worsening in terms of nausea (P = 0.0005) and vomiting (P = 0.0083). No significant differences were observed for single sensory and motor symptoms, except for a better skilfulness in the amifostine group (P = 0.0404). CONCLUSION: Amifostine improved sensory neuropathy according to NCI-CTC and with regard to objective neurological assessment, but there were almost no differences in self-estimated specific sensory or motor symptoms. Disadvantages with regard to non-neurological toxicities and inconsistent results for quality of life demand further evaluation of neuroprotection with amifostine as well as alternative approaches to prevent platinum-taxane induced neurotoxicity.

Important factors for physical activity among elderly patients one year after an acute myocardial infarction.

The aim of this study was to identify and describe the factors of importance for elderly (> or =65 years) patients in being physically active one year after acute myocardial infarction. Forty-three consecutive elderly patients with a recent myocardial infarction were randomized either to a supervised outpatient-group training programme, 50 min three times a week for 3 months, or to a control group. An independent observer interviewed the patients 12 months after randomization in order to elucidate the factors that motivated the patients into being physically active. Both groups were identical at the start. The patients in the training group stated that the programme had made them more self-confident regarding physical activities and this seems to be an important factor for continuing to be physically active. Body mass index, age, gender and support from a physically active partner were of minor importance compared to the training programme or earlier experience of regular physical activity.

Aerobic group training improves exercise capacity and heart rate variability in elderly patients with a recent coronary event. A randomized controlled study.

AIMS: Reduced heart rate variability is associated with an unfavourable prognosis in patients with ischaemic heart disease. Whether physical training can modify this risk factor is not definitely proven. Our hypothesis was that training might increase both physical capacity and heart rate variability in elderly patients recovering from an acute coronary event, i.e. acute myocardial infarction (n=38) or an episode of unstable angina (n=27). METHODS AND RESULTS: 24 h ambulatory ECG recordings were obtained from 65 patients randomized to either a 3 months supervised outpatient group training programme 50 min three times a week (n=29) or to a control group (n=36). The two groups were well balanced as regards demographic data and pharmacological treatment at the time of randomization. Body mass index and pharmacological therapy remained unchanged during the study. Heart rate variability was analysed in the time and frequency domains. At the 3 month follow-up, exercise tolerance had increased from 103 to 120 W in the training group (P<0.001), and from 102 to 106 W in the control group (ns). The time-domain heart rate variability measures SDNN (standard deviation of all filtered RR intervals over the analysed time period) and SDANN (standard deviation of the means of all filtered RR intervals for all 5 min epochs of the analysed time period) increased significantly during the daytime in the training group (P<0.01 and P<0.05, respectively), but not in the control group. A significant improvement in night-time heart rate variability was observed among controls. There was a statistically significant correlation (P<0.05) between changes in 24 h overall power (frequency domain measure) and changes in maximal exercise capacity in the training group. CONCLUSION: A regular aerobic group training programme after an acute coronary event can significantly improve exercise capacity and modify heart rate variability in a prognostically favourable direction in elderly low-to-intermediate risk patients, recovering from an acute coronary event.

Physical activity level and body mass index among schoolchildren in south-eastern Sweden.

AIM: The aims of this study were to identify current levels of physical activity and to study the relationship between physical activity and body mass index (BMI) using international cut-off points. METHODS: 871 children, aged 7-14 y, were measured for height and weight and the activity levels were analysed using pedometers to measure mean step counts for 4 consecutive days. RESULTS: Step counts were significantly higher in boys than in girls, and showed stability over age and large in-group differences. BMI showed that 13.2% of the boys and 14.5% of the girls were overweight and 4.5% of both boys and girls were obese. Analysis of step counts and BMIs for boys and girls revealed no significant correlations in any age group. CONCLUSION: Pedometers differentiate among age groups and gender concerning physical activity and facilitate individual goal-setting. The result of this study provide baseline information, useful as reference data, on youth physical activity as daily step counts, as well as on youth BMI levels according to new international cut-off points.

Effects of organized aerobic group training in elderly patients discharged after an acute coronary syndrome. A randomized controlled study.

The aim of this study was to compare the physiological effects of an individually adjusted outpatient group training programme to the standardized recommendations of walking in elderly patients (>65 years) discharged after an acute coronary episode. In all, 101 patients, 20 women and 81 men, aged 65-84 (mean 71) years, were randomized either to a supervised outpatient group training programme during three months (n = 50) or to a control group (n = 51). Exercise tolerance increased from 104 watts to 122 watts (p < 0.001) in the training group and from 102 watts to 105 watts (n.s.) in the control group. Self-estimated level of physical activity was higher in the patients in the training group than in the control group (p < 0.001), as was graded well-being (p < 0.05). Organized aerobic group training can easily be performed in elderly patients after acute coronary syndrome, with results of improved exercise tolerance and a higher self graded well-being.

Improved physical fitness and quality of life following training of elderly patients after acute coronary events. A 1 year follow-up randomized controlled study.

AIMS: Cardiac rehabilitation including exercise training is of proven value in ischaemic heart disease. However, elderly patients frequently are not encouraged to participate in such programmes. This study evaluates the physiological effects and self-reported quality of life after an aerobic outpatient group-training programme in subjects above the age of 65 years. METHODS AND RESULTS: A consecutive series of 101 patients (males 80%) aged 65-84 (mean 71) years recovering from an acute coronary event were randomized to either a supervised out patient group-training programme (n=50) or to a control group (n=51). The two groups were well balanced as regards clinical characteristics. The compliance in the training group was 87%. Exercise tolerance increased in the trained group from 104 to 122 and 111 W after 3 and 12 months respectively. The corresponding values were 102, 105 and 105 W among controls. Parameters, such as quality of life, self-estimated level of physical activity, fitness and well-being were graded higher by the trained patients than those who served as controls on the two occasions of follow-up. CONCLUSIONS: Aerobic group-training of elderly patients recovering from an acute coronary event beneficially influences physical fitness and several parameters expressing quality of life. Great care has to be taken to preserve the initial effects by continued training.