Adaptation of muscle to exercise. Increase in levels of palmityl Coa synthetase, carnitine palmityltransferase, and palmityl Coa dehydrogenase, and in the capacity to oxidize fatty acids.

The capacity of gastrocnemius and quadriceps muscles to oxidize palmitate, oleate, linoleate, palmityl CoA, and palmityl carnitine doubled in rats subjected to a program of treadmill running. The rate of palmitate oxdation by whole homogenates of, or the mitochondrial fraction from, leg muscles was twice as great per gram wet weight of muscle in the trained as in the sedentary animals over a wide range (0.125-1.5 mM) of palmitate concentrations. The levels of activity of carnitine palmityltransferase, palmityl CoA dehydrogenase, and mitochondrial ATP-dependent palmityl CoA synthetase expressed per gram of muscle doubled in gastrocnemius and quadriceps muscles in response to the running program. The protein content of the mitochondrial fraction from these muscles was increased approximately 60%.

Between-day and within-day variability in the relation between heart rate and oxygen consumption: effect on the estimation of energy expenditure by heart-rate monitoring.

Estimation of energy expenditure (EE) by heart-rate (HR) monitoring (HRM) assumes that the relation between HR and oxygen consumption (VO2) is stable between days and within a day. To evaluate this assumption, 12 healthy subjects underwent an HR-VO2 calibration session on two mornings and two afternoons, with one morning and one afternoon session on the same day. Measurements were made while subjects were supine, sitting, standing while shifting body weight side-to-side, and walking at four intensities. Subjects wore an HR monitor during waking hours on another day (15.1 +/- 1.5 h). Regression analysis was used to determine the relation between HR and VO2 in the sedentary and active HR ranges, and four EE values (HRM-EE) based on the four calibration sessions were calculated for each subject. The four group mean HRM-EE values were nearly identical (CV: 1.1%). The regression equations generated from the four calibration sessions did not differ significantly for the group as a whole, but for some subjects there were significant differences among sessions in the slope of the active regression equation (P = 0.005). Intraindividual CVs for HRM-EE were generally < 10%, but ranged from 0.1% to 24.7%. In general, within an individual, HR was more variable than was VO2, and intraindividual variability in EE was associated with intraindividual variability in the flex HR and sedentary HR range. HRM is appropriate for assessment of EE for a group; however, caution is recommended when HRM is used for individual determinations of EE.

Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance.

BACKGROUND: Limiting postpartum weight retention is important for preventing adult obesity, but the effect of weight loss on lactation has not been studied adequately. OBJECTIVE: We evaluated whether weight loss by dieting, with or without aerobic exercise, adversely affects lactation performance. DESIGN: At 12+/-4 wk postpartum, exclusively breast-feeding women were randomly assigned for 11 d to a diet group (35% energy deficit; n = 22), a diet plus exercise group (35% net energy deficit; n = 22), or a control group (n = 23). Milk volume, composition, and energy output; maternal weight, body composition, and plasma prolactin concentration; and infant weight were measured before and after the intervention. RESULTS: Weight loss averaged 1.9, 1.6, and 0.2 kg in the diet, diet + exercise, and control groups, respectively (P < 0.0001) and was composed of 67% fat in the diet group and nearly 100% fat in the diet + exercise group. Change in milk volume, composition, and energy output and infant weight did not differ significantly among groups. However, there was a significant interaction between group and baseline percentage body fat: in the diet group only, milk energy output increased in fatter women and decreased in leaner women. The plasma prolactin concentration was higher in the diet and diet + exercise groups than in the control group. CONCLUSIONS: Short-term weight loss (approximately 1 kg/wk) through a combination of dieting and aerobic exercise appears safe for breast-feeding mothers and is preferable to weight loss achieved primarily by dieting because the latter reduces maternal lean body mass. Longer-term studies are needed to confirm these findings.

Linear and nonlinear characteristics of oxygen uptake kinetics during heavy exercise.

We assessed the linearity of oxygen uptake (VO2) kinetics for several work intensities in four trained cyclists. VO2 was measured breath by breath during transitions from 33 W (baseline) to work rates requiring 38, 54, 85, and 100% of maximal aerobic capacity (VO2max). Each subject repeated each work rate four times over 8 test days. In every case, three phases (phases 1, 2, and 3) of the VO2 response could be identified. VO2 during phase 2 was fit by one of two models: model 1, a double exponential where both terms begin together close to the start of phase 2, and model 2, a double exponential where each of the exponential terms begins independently with separate time delays. VO2 rose linearly for the two lower work rates (slope 11 ml.min-1 W-1) but increased to a greater asymptote for the two heavier work rates. In all four subjects, for the two lighter work rates the double-exponential regression reduced to a single value for the time constant (average across subjects 16.1 +/- 7.7 s), indicating a truly monoexponential response. In addition, one of the responses to the heaviest work rate was monoexponential. For the remaining seven biexponential responses to the two heaviest work rates, model 2 produced a significantly better fit to the responses (P less than 0.05), with a mean time delay for the slow component of 105 +/- 46 s.(ABSTRACT TRUNCATED AT 250 WORDS)

Simulation of pulmonary O2 uptake during exercise transients in humans.

Computer simulation of blood flow and O2 consumption (QO2) of leg muscles and of blood flow through other vascular compartments was made to estimate the potential effects of circulatory adjustments to moderate leg exercise on pulmonary O2 uptake (VO2) kinetics in humans. The model revealed a biphasic rise in pulmonary VO2 after the onset of constant-load exercise. The length of the first phase represented a circulatory transit time from the contracting muscles to the lung. The duration and magnitude of rise in VO2 during phase 1 were determined solely by the rate of rise in venous return and by the venous volume separating the muscle from the lung gas exchange sites. The second phase of VO2 represented increased muscle metabolism (QO2) of exercise. With the use of a single-exponential model for muscle QO2 and physiological estimates of other model parameters, phase 2 VO2 could be well described as a first-order exponential whose time constant was within 2 s of that for muscle QO2. The use of unphysiological estimates for certain parameters led to responses for VO2 during phase 2 that were qualitatively different from QO2. It is concluded that 1) the normal response of VO2 in humans to step increases in muscle work contains two components or phases, the first determined by cardiovascular phenomena and the second primarily reflecting muscle metabolism and 2) the kinetics of VO2 during phase 2 can be used to estimate the kinetics of muscle QO2. The simulation results are consistent with previously published profiles of VO2 kinetics for square-wave transients.

VO(2) kinetics of mild exercise are altered by RER.

We propose that variations in fat and carbohydrate (CHO) oxidation by working muscle alter O(2) uptake (VO(2)) kinetics. This hypothesis provides two predictions: 1) the kinetics should comprise two exponential components, one fast and the other slow, and 2) their contribution should change with variations in fat and CHO oxidation, as predicted by steady-state respiratory exchange ratio (RER). The purpose of this study was to test these predictions by evaluating the VO(2) kinetic model: VO(2)(t) = alpha(R) + alpha(F)(1 - exp[(t - TD)/-tau(F)]) + alpha(C)(1 - exp[(t - TD)/-tau(C)]) for short-term, mild leg cycling in 38 women and 44 men, where VO(2)(t) describes the time course, alpha(R) is resting VO(2), t is time after onset of exercise, TD is time delay, alpha(F) and tau(F) are asymptote and time constant, respectively, for the fast (fat) oxidative term, and alpha(C) and tau(C) are the corresponding parameters for the slow (CHO) oxidative term. We found that 1) this biexponential model accurately described the VO(2) kinetics over a wide range of RERs, 2) the contribution of the fast (alpha(F), fat) component was inversely related to RER, whereas the slow (alpha(C), CHO) component was positively related to RER, and 3) this assignment of the fast and slow terms accurately predicted steady-state respiratory quotient and CO(2) output. Therefore, the kinetic model can quantify the dynamics of fat and CHO oxidation over the first 5-10 min of mild exercise in young adult men and women.

Discrepancy in stoichiometry of steady-state muscle [Pi] and [PCr] induced by exercise.

Phosphorus nuclear magnetic resonance was used to quantify the relations between metabolic phosphates, intracellular pH, and work rate in forearm muscle of six adult men over a range of work rates from 1.0 to 3.5 W. Three work rates were studied in each of four sessions (either 1.0, 2.0, and 3.0 or 1.5, 2.5, and 3.5 W), with measurements made before and during each bout, thereby permitting the partition of the variance attributable to rest, work-dependent, and time-dependent metabolic functions by regression analysis. There were no time-dependent changes in either [ATP] or intracellular [H+] as assessed during the rest intervals between bouts of exercise. In contrast, the total nuclear magnetic resonance (NMR)-visible phosphorus pool (TVPP) decreased with time, with both phosphocreatine (PCr) and inorganic phosphate (Pi) contributing significantly to TVPP reduction. Muscle [ATP] was unchanged by work at all intensities. Intracellular [H+] increased moderately and proportionately to work rate. [PCr] decreased and [Pi] increased in proportion to work rate, with the work-dependent coefficient for PCr consumption approximately 1.5 times that of Pi production. Neither Pi line width nor motion artifact accounted for the decrease in TVPP, so the reduced Pi accumulation in exercise may represent its sequestering in some NMR-invisible muscle pool and/or loss to the blood. Whatever the process involved, it is proportional to work rate and persists for at least 10-15 min after exercise.

Body composition by air-displacement plethysmography by using predicted and measured thoracic gas volumes.

The BOD POD, a new air-displacement plethysmograph for measuring human body composition, utilizes the inverse relationship between pressure and volume (Boyle's law) to measure body volume directly. The quantity of air in the lungs during tidal breathing, the average thoracic gas volume (Vtg), is also measured by the BOD POD by using a standard plethysmographic technique. Alternatively, the BOD POD provides the use of a predicted Vtg (Vtgpred). The validity of using Vtgpred in place of measured Vtg (Vtgmeas) to determine the percentage of body fat (%BF) was evaluated in 50 subjects (36 women, 14 men; ages 18-56 yr). There was no significant difference between Vtgmeas and Vtgpred (mean difference +/- SE, 53.5 +/- 63.3 ml) nor in %BF by using Vtgmeas vs. Vtgpred (0.2 +/- 0.2 %BF). On an individual basis, %BF measured by using Vtgmeas vs. Vtgpred differed within +/-2.0% BF for 82% of the subjects; maximum differences were -2.9 to +3.0% BF. For comparison, data from 24 subjects who had undergone hydrostatic weighing were evaluated for the validity of using predicted vs. measured residual lung volume (VRpred vs. VRmeas, respectively). Differences between VRmeas and VRpred and in %BF calculated by using VRmeas vs. VRpred were significant (187 +/- 46 ml and 1.4 +/- 0.3% BF, respectively; P < 0.001). On an individual basis, %BF determined by using VRmeas vs. VRpred differed within +/-2.0% BF for 46% of the subjects; maximum differences were -2.9 to +3.8% BF. With respect to %BF measured by air displacement, our findings support the use of Vtgpred for group mean comparisons and for purposes such as screening in young to middle-aged individuals. This contrasts with the use of VRpred in hydrostatic weighing, which leads to significant errors in the estimation of %BF. Furthermore, although the use of Vtgpred has some application, determining Vtgmeas is relatively simple in most cases. Therefore, we recommend that the use of Vtgmeas remain as standard experimental and clinical practice.

Effects of caffeine on blood pressure, heart rate, and forearm blood flow during dynamic leg exercise.

This study examined the acute effects of caffeine on the cardiovascular system during dynamic leg exercise. Ten trained, caffeine-naive cyclists (7 women and 3 men) were studied at rest and during bicycle ergometry before and after the ingestion of 6 mg/kg caffeine or 6 mg/kg fructose (placebo) with 250 ml of water. After consumption of caffeine or placebo, subjects either rested for 100 min (rest protocol) or rested for 45 min followed by 55 min of cycle ergometry at 65% of maximal oxygen consumption (exercise protocol). Measurement of mean arterial pressure (MAP), forearm blood flow (FBF), heart rate, skin temperature, and rectal temperature and calculation of forearm vascular conductance (FVC) were made at baseline and at 20-min intervals. Plasma ANG II was measured at baseline and at 60 min postingestion in the two exercise protocols. Before exercise, caffeine increased both systolic blood pressure (17%) and MAP (11%) without affecting FBF or FVC. During dynamic exercise, caffeine attenuated the increase in FBF (53%) and FVC (50%) and accentuated exercise-induced increases in ANG II (44%). Systolic blood pressure and MAP were also higher during exercise plus caffeine; however, these increases were secondary to the effects of caffeine on resting blood pressure. No significant differences were observed in heart rate, skin temperature, or rectal temperature. These findings indicate that caffeine can alter the cardiovascular response to dynamic exercise in a manner that may modify regional blood flow and conductance.

In vivo 31P-NMR in human muscle: transient patterns with exercise.

Evaluation of dynamic changes in pH and concentrations of adenosine 5'-triphosphate (ATP), phosphocreatine (PCr), and inorganic phosphate (Pi) during the transition from rest to steady-state exercise in the human has been methodologically limited. Previous work has relied on muscle biopsy of exercising subjects at different times in different exercise bouts. Chemical evaluation of metabolites has been hampered by continuing change in metabolic concentration during the biopsy procedure. Recently, Fourier-transformed 31P nuclear magnetic resonance (31P-NMR), employing surface coils, has made evaluation of phosphorus metabolites possible by noninvasive atraumatic means in human muscle. Relative concentrations of PCr, Pi, and ATP, together with pH, have been obtained with 31P-NMR from the flexor digitorum superficialis muscle on two occasions in four adult men during the transition from rest to exercise. [PCr] rapidly fell and was mirrored by a rise in [Pi]. The former temporarily exceeded the latter with the discrepancy apparently being absorbed by a transient rise in [ATP], which was itself mirrored by alteration in [H+].

Evaluation of urinary oestrogen assays after the menopause and their potential for screening.

Urinary oestrone-3-glucuronide, oestradiol-3-glucuronide, oestrone and oestradiol were measured by radioimmunoassay methods adapted for the very low levels found in postmenopausal women. Oestrogen concentrations related to creatinine in morning urine samples from ten postmenopausal women were found to correlate well with total oestrogen excreted in 24 h (r = 0.934, 0.867, 0.947, 0.909, respectively; p less than 0.002). Day to day variation in five individuals, measured over 5 weeks, showed random fluctuations, with no obvious cyclical variation. Reference ranges, based on two consecutive morning urine samples from 131 postmenopausal women, were 0.73-4.57 mumol/mol creatinine for oestrone-3-glucuronide, 0.66-3.00 mumol/mol creatinine for oestradiol-3-glucuronide, 4.8-30.9 nmol/mol creatinine for oestrone and 3.8-16.8 nmol/mol creatinine for oestradiol. We suggest that such assays may have a part to play in the screening for women at greatest risk of developing osteoporotic fractures.

Impact of energy intake and exercise on resting metabolic rate.

Resting metabolic rate is modulated by the amount of calories consumed in the diet relative to energy expenditure. Excessive consumption of energy appears to increase resting metabolic rate while fasting and very low calorie dieting causes resting metabolic rate to decrease. Since the metabolic rate at rest is the primary component of daily energy expenditure, its reduction with caloric restriction makes it difficult for obese individuals to lose weight and to maintain weight that is lost. Whether exercise has a carry-over effect on resting metabolic rate remains controversial, even though this question has been studied extensively during the last 90 years. Reasons for contradictory results include variations in control of prior diet and exercise patterns, inadequate exercise frequency, intensity and duration, and the possibility of response to exercise varying between individuals. Several lines of evidence suggest exercise may modulate resting metabolic rate. Bed rest in sedentary individuals leads to a reduction in resting metabolic rate. Similarly, in highly trained runners, cessation of daily exercise training lowers resting metabolic rate by about 7 to 10%. Resting metabolic rate is depressed in previously sedentary obese individuals on a very low calorie diet, but it quickly returns to the predieting level when exercise of sufficient frequency, intensity and duration is undertaken while dieting. These findings suggest caloric intake and daily exercise can modulate resting metabolic rate. Exercise of adequate intensity and duration may also enhance resting metabolic rate.

Energetics of myocardial function.

The question of whether the heart in humans is resistant to deterioration during prolonged exercise is addressed in this review. An evaluation of the available data in the literature shows: 1) whole body VO2 increases during vigorous prolonged exercise, primarily due to an increase in O2 consumption of working muscles; 2) heat exacerbates the rise in VO2; 3) these factors, hard exercise and heat, induce cardiovascular drift which involves progressive decreases in mean arterial pressure and stroke volume, with heart rate increasing to maintain cardiac output; 4) the fall in stroke volume appears to occur, at least in part, because ventricular filling pressure is lowered with a fall in central venous volume as cutaneous venous volume increases; 5) there is some limited indirect evidence that the inotropic state of the heart may also decrease with prolonged exhaustive exercise; and (6) neither estimates of heart work nor myocardial energetics appear to change in healthy men after 1 h of exercise under temperate conditions.

Phosphocreatine kinetics in humans during exercise and recovery.

System linearity was assessed for exercise induced changes in energetics of forearm exercise. 31P-NMR spectroscopy techniques, with 12.5-s serial measurements of [PCr], [Pi], [ATP], and [H+] were employed during exercise and recovery transitions in four untrained men for moderate (1.7 W) and heavy (3.6 W) exercise. Signal averaging was applied and data were analyzed by regression analysis using a first-order exponential model. The time constants for both [PCr] and [Pi] responses to moderate exercise and recovery were not different both within and between nuclei ranging from 32 to 35 s (P > 0.05). The time constants derived from moderate exercise and recovery, when employed to construct predictive equations for heavy exercise and recovery, did not adequately describe [PCr] dynamics. Underestimation of the net hydrolysis of PCr during heavy exercise was associated with increases in [H+] as predicted by the creatine kinase equilibrium reaction (CKeq). Calculation of [ADP] by CKeq revealed steady state [ADP] was achieved during moderate exercise and during recovery for both intensities much earlier than during heavy exercise. We conclude that the metabolic system does not behave as a linear system. Therefore, the time constant and the net change in [PCr].W-1 must themselves be determined by work dependent combinations of other system variables.

Effect of suspending exercise training on resting metabolic rate in women.

We tested the hypothesis that enhanced resting metabolic rate (RMR) in highly trained endurance athletes is an acute effect of prior exercise induced by catecholamines and not serum thyroxine. RMR and energy-regulating hormones were studied in nine highly trained women runners during habitual training (period I), and suspension of training (period II). Data were collected during the follicular phase of two consecutive menstrual cycles, confirmed by serum progesterone and estradiol. Subjects maintained training between the two periods. Total energy intake and diet composition, body weight, and oral temperature did not change from period I to period II (P greater than 0.05). With suspension of training, urinary epinephrine and nonrepinephrine excretion dropped (P less than 0.022) while serum TSH rose (P = 0.011) and free T4 did not change (P = 0.182). RMR (mean +/- SEM) was 274 +/- 6.2 and 252 +/- 7.8 kJ.h-1 for periods I and II, respectively, with repeated measures ANOVA indicating a drop in RMR occurred with cessation of exercise (P = 0.048). The augmentation of RMR by exercise lasted more than 15 h but less than 39 h post-exercise. The results suggest that the drop in catecholamines may partly explain the lower RMR following suspension of training.

Body composition analysis by bioelectrical impedance: effect of skin temperature.

Bioelectrical impedance analysis (BIA) was used to estimate body water and composition under both cool (14.4 degrees C, dry bulb) and warm (35.0 degrees C) ambient conditions in eight healthy adult men. The prediction equation provided with the commercially available instrument (RJL Systems) was used with the BIA measurements to estimate body composition. Skin temperature increased from 24.1 +/- 1.81 degrees C in the cool condition to 33.4 +/- 1.36 degrees C in the warm condition. (Mean increase was 9.3 +/- 1.75 degrees C, t = 15.05, P less than 0.01). The corresponding BIA resistances were 461 +/- 48 omega and 426 +/- 47 omega, respectively. (Mean reduction was 35.0 +/- 9.8 omega, t = 10.13, P less than 0.01). This resulted in a significant increase in predicted total body water (cool 47.4 +/- 5.5 l vs. warm 49.9 +/- 5.6 l, t = 3.88, P less than 0.01). Consequently, predicted fat mass was significantly lower in the warm than in the cool condition (8.8 +/- 3.2 kg vs. 11.0 +/- 3.7 kg; mean difference 2.23 +/- 0.69 kg, t = 9.22, P less than 0.01). These findings indicate that varying skin temperature by altering ambient temperature significantly changes resistance measurements and the estimation of total body water and percent fat by BIA. The observed changes in resistance are consistent with an apparent expansion of conductor volume in the warm environment and a reduction in the cooler condition. In this regard, the temperature-induced change in resistance could be due to alterations in cutaneous blood flow and/or compartmental distribution of body water. Thus, BIA measurements should be taken only under well-standardized ambient conditions.

Evaluation of a new air displacement plethysmograph for measuring human body composition.

A new air displacement plethysmograph, the BOD POD (BP), was evaluated in comparison to hydrostatic weighing (HW). Sixty-eight adult subjects (26 F, 42 M) varying widely in age (range 20-56 yr), ethnicity, and fatness participated in this study. Same-day test-retest reliability was assessed in a subsample of 16 subjects (9 F, 7 M) and validity was assessed in all subjects (N = 68). The test-retest coefficients of variation (CV) for %FAT measured by BP (%FATBP) and HW (%FATHW) were not significantly different (1.7% +/- 1.1% and 2.3% +/- 1.9% for BP and HW, respectively (mean +/- SD)), indicating excellent reliability for both methods. Validity of percent fat measured by the BP (%FATBP) was also excellent. The mean difference in %FAT (BP - HW) was -0.3 +/- 0.2 (SEM), with a 95% confidence interval of -0.6 to 0 %FAT. The regression equation (%FATHW = 1.86 + 0.94 %FATBP; r2 = 0.93, SEE = 1.81) was not significantly different from the line of identity (%FATHW = %FATBP), and did not differ by gender. These findings indicate that the BOD POD is a highly reliable and valid method for determining %FAT in adult humans in comparison to HW. This new method has several advantages over HW in that it is quick, relatively simple to operate and may be able to accommodate special populations such as the obese, elderly, and disabled.

Exercise reverses depressed metabolic rate produced by severe caloric restriction.

The effects of caloric restriction and exercise on resting metabolic rate (RMR) were studied in five obese humans. Subjects consumed a 500 kcal.d-1 diet for 4 wk, with the subjects remaining sedentary during the first 2 wk and then exercising 30 min daily at 60% VO2max during the last 2 wk of caloric restriction. After 2 wk of dieting, RMR decreased to approximately 87% of the pre-dieting control value. Over the last 2 wk of dieting with the addition of daily exercise, the fall in RMR was reversed as it returned to the pre-dieting level. In summary, daily exercise reversed the drop in RMR associated with severe caloric restriction.

Endogenous factors affecting bone mineral content in post-menopausal women.

Eighty-eight healthy post-menopausal women were divided into two groups, one of 35 subjects who had undergone menopause up to 9 years previously and the second of 53 subjects who were 10 or more years post-menopausal. In each individual we related the bone mineral content (BMC), measured by single photon absorptiometry in the distal forearm, to anthropometric variables and urinary oestrogen excretion. There was a positive association between BMC and both urinary oestrogen excretion and anthropometric variables, but this was statistically significant only in the older women. As expected, BMC in the distal forearm decreased with advancing age, the fall being greatest in the first 9 years after the menopause. We concluded that although a single measurement of urinary oestrogen and anthropometric variables does not provide enough information to predict an individual's BMC, the values obtained may prove of use, along with a single BMC determination, in helping to predict the rate of bone loss.

Evaluation of peripheral dual energy X-ray absorptiometry: comparison with single photon absorptiometry of the forearm and dual energy X-ray absorptiometry of the spine or femur.

An evaluation of the Osteoscan peripheral dual energy X-ray absorptiometer (pDXA) was carried out to compare its performance with those of a single photon absorptiometer (SPA) (Molsgaard Medical ND1100A) and a dual energy X-ray absorptiometer (DXA) (Lunar DPX alpha) of the spine or femur. In 57 patients, correlation between bone mineral content (BMC) of the forearm at the ultradistal (UD) site by pDXA and by SPA was high (r = 0.94). Comparisons were also made with spine and femur bone mineral density (BMD) DXA measurements. The correlation of z-scores of UD BMD with z-scores for lumbar spine L2-L4 was r = 0.63 (n = 73 patients); and with z-scores for neck of femur was r = 0.72 (n = 33). With the Osteoscan the measurement error coefficient of variation in vivo was 2.6% for BMC, 1.8% for BMD at the ultradistal site; 2.1% for BMC and 1.9% for BMD at the mid-distal site. Repeat measurements were made of the European forearm phantom; precision for SPA was slightly better than either pDXA or Lunar DXA. The Osteoscan has the potential for a rapid throughput of patients and is not affected by calcification and degenerative changes that can corrupt DXA measurements on the anteroposterior spine in older women.