Just a phase? Causal probing reveals spurious phasic dependence of sustained attention.

For over a decade, electrophysiological studies have reported correlations between attention / perception and the phase of spontaneous brain oscillations. To date, these findings have been interpreted as evidence that the brain uses neural oscillations to sample and predict upcoming stimuli. Yet, evidence from simulations have shown that analysis artefacts could also lead to spurious pre-stimulus oscillations that appear to predict future brain responses. To address this discrepancy, we conducted an experiment in which visual stimuli were presented in time to specific phases of spontaneous alpha and theta oscillations. This allowed us to causally probe the role of ongoing neural activity in visual processing independent of the stimulus-evoked dynamics. Our findings did not support a causal link between spontaneous alpha / theta rhythms and behaviour. However, spurious correlations between theta phase and behaviour emerged offline using gold-standard time-frequency analyses. These findings are a reminder that care should be taken when inferring causal relationships between neural activity and behaviour using acausal analysis methods.

Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications for breastfeeding equity.

BACKGROUND: Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults' beliefs regarding breastfeeding among mothers infected with COVID-19. METHODS: We conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults' beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status. RESULTS: A total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status. CONCLUSIONS: While the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression.

BACKGROUND: Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES: Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS: Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. CONCLUSIONS: There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.

A telephone intervention to achieve differentiation in dietary intake: a randomized trial in paediatric primary care.

BACKGROUND: Telehealth offers opportunities to extend clinical and research interventions for paediatric obesity. OBJECTIVES: To assess utility of a telephone intervention, implemented through a national primary care paediatric research network, for promoting differentiation in dietary intake, consistent with either a low-glycemic load (Low GL) or Low Fat prescription, among overweight/obese school-age children. METHODS: Five-week telephone dietary counselling intervention for parents of overweight/obese school-age children recruited through the Slone Center Office-based Research Network. Parent-child dyads were randomized to Low GL or Low Fat diet. Primary outcomes were dietary GL and dietary fat, adjusted for energy intake and assessed by 24-h dietary recall. RESULTS: Subjects were randomized to Low GL (n = 11, 8.1 ± 1.7 years, 45.5% male) or Low Fat (n = 11, 8.2 ± 2.0 years, 36.4% male), with no baseline differences. Overall, 86% of subjects attended at least four of five counselling sessions, and study completion rate was 91% (based on completion of the final dietary recalls). Reported satisfaction was high. In adjusted analyses limited to 'recall completers,' reduction in dietary GL (g/1000 kcal) achieved within the Low GL group was significant (p = 0.01) and greater than the change in dietary GL in the Low Fat group (mean ± SE; -12.9 ± 4.4 vs. 5.1 ± 4.9, p = 0.03). Similarly, reduction in dietary fat (% of total energy) within the Low Fat group was significant (-5.6 ± 2.5, p = 0.046) but with no difference between groups (p = 0.25). CONCLUSION: A telephone-based dietary intervention for overweight/obese children, implemented through a national paediatric research network, fostered prescribed dietary changes. ClinicalTrials.gov registration: NCT00620152.

Outcomes from an orientation model to reduce attrition in paediatric weight management.

We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.

Addressing noncommunicable diseases in primary care: the case of type 2 diabetes.

The rapid growth of noncommunicable diseases represents a formidable global health challenge. Here we use type 2 diabetes as a case study to illustrate the rise of noncommunicable diseases and call attention to the important role of primary care systems in addressing these diseases in low- and middle-income countries. Comprehensive screening for diabetes should be implemented through primary care systems to increase early detection of prediabetes and undiagnosed diabetes - a first step to diabetes prevention and management. In addition, primary care systems should strengthen and expand capacity to link patients to appropriate interventions based on their diabetes status and provide care coordination (e.g. leveraging task-shifting and technology), and integrate clinic and community resources for diabetes prevention and control. Additional strategies should include continuous quality improvement, health systems strengthening, workforce development, and affordable and sustainable financing. Together, these actions could elevate the role of primary care in addressing diabetes in low- and middle-income countries and help advance global progress towards reducing diabetes complications, and also preventing or delaying diabetes among those at risk.

Species composition, monitoring, and feeding injury of stink bugs (Heteroptera: Pentatomidae) in blackberry.

Blackberry (Rubus spp.) production in Florida has increased > 100% within the past two decades. and several insect pests, including stink bugs (Heteroptera: Pentatomidae), have been observed feeding on this crop. The objectives for this study were to determine the stink bug species present in blackberry; to develop monitoring tools for stink bugs in blackberry; and to describe feeding injury to blackberries by Euschistus quadrator Rolston, a relatively new stink bug pest to Florida, that has spread throughout the state. In a field survey, E. quadrator was the most abundant stink bug species, followed by Euschistus servus Say, Euschistus obscurus (Palisot de Beauvois), Thyanta custator (F.), Proxys punctulatus (Palisot de Beauvois), and Podisus maculiventris Say. Yellow pyramid traps caught more stink bugs than tube traps with or without the addition of Euschistus spp. pheromone lures. There were no statistical differences between traps baited with a Trécé Pherocon Centrum lure, a Suterra Scenturion lure, and an unbaited trap. These results were supported by Y-tube olfactometer assays with E. quadrator where there were no differences between pheromone baited lures and a control. Injury to berries caused by E. quadrator adults and third instars was similar, and both adults and third instars fed more on green berries compared with turning berries. In addition, adults fed more on green berries compared with ripe fruit. The most common injury to green berries was discoloration. In contrast, misshapen drupelets were commonly seen on turning and ripe berries. The potential for managing stink bugs in blackberries to prevent them from reaching damaging levels is discussed.

Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus.

AIMS: To estimate remaining life expectancy (RLE), quality-adjusted life expectancy (QALE), causes of death and lifetime cumulative incidence of microvascular/macrovascular complications of diabetes for youths diagnosed with Type 2 diabetes. METHODS: A Markov-like computer model simulated the life course for a hypothetical cohort of adolescents/young adults in the USA, aged 15-24 years, newly diagnosed with Type 2 diabetes following either conventional or intensive treatment based on the UK Prospective Diabetes Study. Outcomes included RLE, discounted QALE in quality-adjusted life years (QALYs), cumulative incidence of microvascular/macrovascular complications and causes of death. RESULTS: Compared with a mean RLE of 58.6 years for a 20-year-old in the USA without diabetes, conventional treatment produced an average RLE of 43.09 years and 22.44 discounted QALYs. Intensive treatment afforded an incremental 0.98 years and 0.44 discounted QALYs. Intensive treatment led to lower lifetime cumulative incidence of all microvascular complications and lower mortality from microvascular complications (e.g. end-stage renal disease (ESRD) death 19.4% vs. 25.2%). Approximately 5% with both treatments had ESRD within 25 years. Lifetime cumulative incidence of coronary heart disease (CHD) increased with longer RLE and greater severity of CHD risk factors. Incorporating disutility (loss in health-related quality of life) of intensive treatment resulted in net loss of QALYs. CONCLUSIONS: Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average RLE and may experience severe, chronic complications of Type 2 diabetes by their 40s. The net clinical benefit of intensive treatment may be sensitive to preferences for treatment. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of CHD.

The cutest little baby face: a hormonal link to sensitivity to cuteness in infant faces.

We used computer image manipulation to develop a test of perception of subtle gradations in cuteness between infant faces. We found that young women (19-26 years old) were more sensitive to differences in infant cuteness than were men (19-26 and 53-60 years old). Women aged 45 to 51 years performed at the level of the young women, whereas cuteness sensitivity in women aged 53 to 60 years was not different from that of men (19-26 and 53-60 years old). Because average age at menopause is 51 years in Britain, these findings suggest the possible involvement of reproductive hormones in cuteness sensitivity. Therefore, we compared cuteness discrimination in pre- and postmenopausal women matched for age and in women taking and not taking oral contraceptives (progestogen and estrogen). Premenopausal women and young women taking oral contraceptives (which raise hormone levels artificially) were more sensitive to variations of cuteness than their respective comparison groups. We suggest that cuteness sensitivity is modulated by female reproductive hormones.

Neanderthal exploitation of marine mammals in Gibraltar.

Two coastal sites in Gibraltar, Vanguard and Gorham's Caves, located at Governor's Beach on the eastern side of the Rock, are especially relevant to the study of Neanderthals. Vanguard Cave provides evidence of marine food supply (mollusks, seal, dolphin, and fish). Further evidence of marine mammal remains was also found in the occupation levels at Gorham's Cave associated with Upper Paleolithic and Mousterian technologies [Finlayson C, et al. (2006) Nature 443:850-853]. The stratigraphic sequence of Gibraltar sites allows us to compare behaviors and subsistence strategies of Neanderthals during the Middle Paleolithic observed at Vanguard and Gorham's Cave sites. This evidence suggests that such use of marine resources was not a rare behavior and represents focused visits to the coast and estuaries.

Genetic and molecular characterization of a dental pathogen using genome-wide approaches.

Actinobacillus actinomycetemcomitans causes periodontitis, a costly chronic infection that affects a large number of patients. The pathogenesis of this dental infection is a multifactorial process that results in a serious degenerative disease of the periodontium. Although significant progress has been achieved after the identification of this Gram-negative bacterium as the etiological agent of this infection, much remains to be done to understand in detail the bacterial factors and host-pathogen interactions involved in the pathogenesis of this disease. Classic research approaches have resulted in the identification of important virulence factors and cellular processes, although they have provided a rather narrow picture of some of the steps of this complex process. In contrast, a much wider picture could be obtained with the application of tools such as bioinformatics and genomics. These tools will provide global information regarding the differential expression of genes encoding factors and processes that lead to the pathogenesis of this disease. Furthermore, comparative genomics has the potential of helping us to understand the emergence and evolution of this human pathogen. This genome-wide approach should provide a more complete picture of the pathogenesis process of this disease, and will facilitate the development of efficient diagnostic, preventive, and therapeutic measures for this disease.

Emotional intelligence and interpersonal relations.

In 7 studies, the authors examined the link between emotional intelligence and interpersonal relations. In Studies 1 and 2, the participants with higher scores for emotional intelligence had higher scores for empathic perspective taking and self-monitoring in social situations. In Study 3, the participants with higher scores for emotional intelligence had higher scores for social skills. In Study 4, the participants with higher scores for emotional intelligence displayed more cooperative responses toward partners. In Study 5, the participants with higher scores for emotional intelligence had higher scores for close and affectionate relationships. In Study 6, the participants' scores for marital satisfaction were higher when they rated their marital partners higher for emotional intelligence. In Study 7, the participants anticipated greater satisfaction in relationships with partners described as having emotional intelligence.

Factors affecting performance in an ultraendurance triathlon.

In the recent past, researchers have found many key physiological variables that correlate highly with endurance performance. These include maximal oxygen uptake (VO2max), anaerobic threshold (AT), economy of motion and the fractional utilisation of oxygen uptake (VO2). However, beyond typical endurance events such as the marathon, termed 'ultraendurance' (i.e. >4 hours), performance becomes harder to predict. The ultraendurance triathlon (UET) is a 3-sport event consisting of a 3.8 km swim and a 180 km cycle, followed by a 42.2 km marathon run. It has been hypothesised that these triathletes ride at approximately their ventilatory threshold (Tvent) during the UET cycling phase. However, laboratory assessments of cycling time to exhaustion at a subject's AT peak at 255 minutes. This suggests that the AT is too great an intensity to be maintained during a UET, and that other factors cause detriments in prolonged performance. Potential defeating factors include the provision of fuels and fluids due to finite gastric emptying rates causing changes in substrate utilisation, as well as fluid and electrolyte imbalances. Thus, an optimum ultraendurance intensity that may be relative to the AT intensity is needed to establish ultraendurance intensity guidelines. This optimal UET intensity could be referred to as the ultraendurance threshold.

Physiological and cardiovascular changes associated with deep water running in the young. Possible implications for the elderly.

The increased number of people taking part in deep water running (DWR) is attributable to the weight-independent characteristic of this form of exercise. Deep water runners should, however, be aware of the respiratory and cardiovascular repercussions that result from exercising in water. It has been well documented that water immersion (WI) alone results in decrements in respiratory and cardiovascular parameters in young individuals immersed in water to the neck. These decrements become more pronounced with exercise, such that maximal oxygen consumption and heart rate (HR) are lower during DWR compared with running on land. Age also seems to influence these parameters; Derion et al. found little to no change in cardiac output, stroke volume and HR during WI in older individuals compared with the decrease experienced in younger individuals. In contrast, gender appears to have no effect on WI or DWR response. Although differences in acute metabolic responses have been observed in numerous studies, training studies examining the effectiveness of using a DWR training programme found that DWR produced equivocal training responses when compared with fit and highly trained individuals running on land. Less convincing evidence has been provided for untrained individuals seeking benefits from a DWR training programme, as some studies showed significant improvements while others did not. There is a current lack of knowledge regarding the use of this form of exercise by frail elderly individuals and/or those with osteoporosis.

The role of hyperbaric oxygen therapy in sports medicine.

During the past decade, we have seen a growing number of individuals participating in sport and recreational activities. All indications show an increase in sport participation at every age level. However, the number of sport and recreational injuries as a result of this increase has also risen. Unfortunately, a primary cost related to injury recovery is the time lost from participating in and resuming normal functional activity. This has compelled health care professionals to seek more efficient and effective therapeutic interventions in treating such injuries. Hyperbaric oxygen (HBO) therapy may serve to provide a means of therapy to facilitate a speedier resumption to pre-injury activity levels as well as improve the short and long term prognosis of the injury. Although a growing interest in sports medicine is becoming evident in the literature, the use of HBO as an intervention in this field has received a great deal of cynicism. To date, numerous professional athletic teams, including hockey (NHL), football (NFL), basketball (NBA) and soccer (MLS), utilise and rely on the use of HBO as adjuvant therapy for numerous sports-related injuries acquired from playing competitive sports. However, to date, very little has been published on the application benefits of hyperbaric therapy and sports injuries. The majority of clinical studies examining the efficacy of HBO in treating soft tissue injuries have been limited in their sample size and study design. Further research needs to be conducted suggesting and validating the significant effects of this treatment modality and further grounding its importance in sports medicine.

The effects of 3000-m swimming on subsequent 3-h cycling performance: implications for ultraendurance triathletes.

The purpose of this study was to examine the physiological effects of 3000-m swimming on subsequent 3-h cycling time trial performance in ultraendurance triathletes. Eight highly trained ultraendurance triathletes [mean (SEM) age 34 (2) years, body fat 12.5 (0.8)%, maximum oxygen consumption 63.2 (2.1) ml x kg(-1) x min(-1)] completed two randomly assigned trials 1 week apart. The swim/bike trial (SB) involved 3000 m of swimming [min:s 52:28 (1:48)] immediately followed by a 3-h cycling performance at a self-selected time-trial pace. The control trial (CON) consisted of an identical 3-h cycling time trial but without prior swimming. Subjects consumed an 8% carbohydrate (CHO)/electrolyte beverage during both trials at the rate of 60 g CHO x h(-1) and 1 l x h(-1). No significant differences were evident between CON and SB on the dependent measures (CON vs. SB): power output [W, 222 (14) W vs. 212 (13) W], heart rate [fc, 147 (5) beats x min(-1) vs. 143 (4) beats min(-1); %fcmax 80.0 (1.6)% vs. 78.4 (1.5)%], oxygen uptake [3.10 (0.12) l x min(-1) vs. 2.97 (0.15) l x min(-1)], minute ventilation [82.5 (4.4) l x min(-1) vs. 77.3 (3.7) l x min(-1)], rating of perceived exertion [14.6 (0.4) vs. 14.0 (0.1)], blood lactate [6.1 (0.5) mmol x l(-1) vs. 4.8 (0.5) mmol x l(-1)], and blood glucose [5.0 (0.2) mmol x l(-1) vs. 5.3 (0.1) mmol x l(-1); all non-significant at the P>0.05 level]. However, the CON respiratory exchange ratio was significantly greater than for SB [0.91 (0.01) vs. 0.89 (0.01); P<0.05], suggesting that the SB trial required a greater reliance on lipid as a fuel substrate. Hence, the main finding in the present study was that 3000 m of swimming had no significant performance effect (in terms of W) on subsequent 3-h cycling performance in ultraendurance triathletes.

Managed care, time pressure, and physician job satisfaction: results from the physician worklife study.

OBJECTIVE: To assess the association between HMO practice, time pressure, and physician job satisfaction. DESIGN: National random stratified sample of 5,704 primary care and specialty physicians in the United States. Surveys contained 150 items reflecting 10 facets (components) of satisfaction in addition to global satisfaction with current job, one's career and one's specialty. Linear regression-modeled satisfaction (on 1-5 scale) as a function of specialty, practice setting (solo, small group, large group, academic, or HMO), gender, ethnicity, full-time versus part-time status, and time pressure during office visits. "HMO physicians" (9% of total) were those in group or staff model HMOs with > 50% of patients capitated or in managed care. RESULTS: Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than HMO physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians (P <.05), and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years (P <.05). Time pressure detracted from satisfaction in 7 of 10 satisfaction facets (P <.05) and from job, career, and specialty satisfaction (P <.01). Time allotted for new patients in HMOs (31 min) was less than that allotted in solo (39 min) and academic practices (44 min), while 83% of family physicians in HMOs felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices (P <.05 after Bonferroni's correction). CONCLUSIONS: HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that HMO physicians' satisfaction with staff, community, resources, and the duration of new patient visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice settings remains to be determined.

A review of the concept of the heart rate deflection point.

The heart rate deflection point (HRDP) is a downward or upward change from the linear HR-work relationship evinced during progressive incremental exercise testing. The HRDP is reported to be coincident with the anaerobic threshold. In 1982, Conconi and colleagues suggested that this phenomenon could be used as a noninvasive method to assess the anaerobic threshold. These researchers developed a field test to assess the HRDP, which has become popularised as the 'Conconi test'. Concepts used to define and assess the anaerobic threshold as well as methodological procedures used to determine the HRDP are diverse in the literature and have contributed to controversy surrounding the HRDP concept. Although the HRDP may be assessed in either field or laboratory settings, the degree of HR deflection is highly dependent upon the type of protocol used. The validity of HRDP to assess the anaerobic threshold is uncertain, although a high degree of relationship exists between HRDP and the second lactate turnpoint. The HRDP appears to be reliable when a positive identification is made; however, not all studies report 100% reproducibility. Although the physiological mechanisms explaining the HRDP are unresolved, a relationship exists between the degree and direction of HRDP and left ventricular function. The HRDP has potential to be used for training regulation purposes. Clinically, it may be incorporated to set exercise intensity parameters for cardiac rehabilitation.

Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women.

OBJECTIVES: There is a paucity of long term studies on exercise training in elderly women. The purpose of this study was to investigate the effects of one year of progressive resistance exercise (PRE) on dynamic muscular strength and the relations to bone mineral density (BMD) in elderly women. METHODS: Forty four healthy sedentary women (mean age 68.8 years) volunteered for this study and were randomly assigned to either an exercise group or a control group. The exercise group were involved in three one hour sessions a week for 52 weeks of supervised PRE to strengthen the large muscle groups of the body, while the control group were instructed to continue their normal lifestyle. The exercise circuit included three sets of eight repetitions at 75% of one repetition maximum focused on the large muscle groups. BMD was measured by dual energy x ray absoptiometry (Lunar DPX) at the lumbar spine and at three sites in the proximal femur. Other selected parameters of physical fitness were also measured. RESULTS: Statistical analyses (analysis of covariance) showed significant strength gains (p < 0.01) in bilateral bench press (> 29%), bilateral leg press (> 19%), and unilateral biceps curl (> 20%). No significant difference between groups was evident in body weight, grip strength, flexibility, waist to hip ratio, or the sum of eight skinfolds. Significant relations (p < 0.05) were recorded between dynamic leg strength and the BMD of the femoral neck, Ward's triangle, and the lumbar spine. CONCLUSIONS: Significant strength changes, after one year of PRE, were evident in elderly women, and the muscle increases may parallel changes in BMD; however, correlation coefficients were moderate.