Sleep patterns before, during, and after deployment to Iraq and Afghanistan.

STUDY OBJECTIVES: To determine the associations between deployment in support of the wars in Iraq and Afghanistan and sleep quantity and quality. DESIGN: Longitudinal cohort study SETTING: The Millennium Cohort Study survey is administered via a secure website or US mail. PARTICIPANTS: Data were from 41,225 Millennium Cohort members who completed baseline (2001-2003) and follow-up (2004-2006) surveys. Participants were placed into 1 of 3 exposure groups based on their deployment status at follow-up: nondeployed, survey completed during deployment, or survey completed postdeployment. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Study outcomes were self-reported sleep duration and trouble sleeping, defined as having trouble falling asleep or staying asleep. Adjusted mean sleep duration was significantly shorter among those in the deployed and postdeployment groups compared with those who did not deploy. Additionally, male gender and greater stress were significantly associated with shorter sleep duration. Personnel who completed their survey during deployment or postdeployment were significantly more likely to have trouble sleeping than those who had not deployed. Lower self-reported general health, female gender, and reporting of mental health symptoms at baseline were also significantly associated with increased odds of trouble sleeping. CONCLUSIONS: Deployment significantly influenced sleep quality and quantity in this population though effect size was mediated with statistical modeling that included mental health symptoms. Personnel reporting combat exposures or mental health symptoms had increased odds of trouble sleeping. These findings merit further research to increase understanding of temporal relationships between sleep and mental health outcomes occurring during and after deployment.

Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.

OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.

OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. PROCESS: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

Epidemiology of musculoskeletal injuries among sedentary and physically active adults.

PURPOSE: This study describes the types and frequencies of musculoskeletal injuries among a cohort of adults with above average activity levels who were enrolled in the Aerobics Center Longitudinal Study (Dallas, TX). METHODS: Participants were adults aged 20-85 yr who completed a baseline clinical examination (1970-1982) and returned a mailed follow-up survey in 1986. Participants (5,028 men, 1,285 women) were measured for aerobic fitness, height, and body weight during the baseline examination. They reported detailed information about their physical activity levels and injury experiences on the follow-up survey (1986). An injury was defined as any self-reported soft tissue or bone injury that occurred within the previous 12 months. Activity-related injuries were those injuries participants attributed to participation in a formal exercise program. RESULTS: A quarter of all participants reported a musculoskeletal injury. Of these, 83% were activity-related. More than 66% of activity-related injuries occurred in the lower extremity; the knee was listed as the joint most often affected. There were no significant sex differences in the prevalence of injury, regardless of cause. Sport participants had the highest proportion of all-cause and activity-related musculoskeletal injuries among both men and women. Self-perceived severe injuries had a significant negative impact on physical activity levels since almost 1/3 of subjects reported permanently stopping their exercise program after injury. CONCLUSION: These results suggest the need for developing and implementing injury prevention programs targeted toward moderately active adults.

Self-reported smoking and musculoskeletal overuse injury among male and female U.S. Marine Corps recruits.

The association between self-reported smoking and overuse injury in a cohort of young men (n = 900) and women (n = 597) undergoing 12 weeks of standardized military instruction, after adjustment for physical activity, health history, and incoming fitness tests was examined. The outcome includes all International Classification of Diseases, 9th Revision codes related to injuries resulting from cumulative microtrauma (overuse injuries). The short survey asked about the subject's demographics, smoking habits, prior injuries sustained, physical activity level, self-perceived fitness, and (for women) menstrual history. From the survey, 4 questions established smoking behavior: smoked at least 100 cigarettes in lifetime, age smoked a whole cigarette for the first time, how many cigarettes smoked during the last 30 days, and how many cigarettes smoked per day during the last 30 days. None of the adjusted hazard ratios for the smoking questions were associated with an increased risk of overuse injury for either sex. Furthermore, this study did not find a significant association with respect to smoking and all injuries in either men or women. In conclusion, smoking does not appear to be an independent risk factor for overuse injury in either young men or women during 12 weeks of standardized military instruction.

Influence of physical activity-related joint stress on the risk of self-reported hip/knee osteoarthritis: a new method to quantify physical activity.

BACKGROUND: The relationship between physical activity (PA) and the development of hip/knee osteoarthritis (OA) has not been clearly defined. The purpose of this study was to develop a method to quantify PA-related joint stress and to assess its influence on the risk of hip/knee OA. METHODS: Participants in a large longitudinal study, without knee/hip OA (n = 5284), were asked about their PA participation in 1986. PA-related joint stress was calculated using information on the frequency, intensity, and duration of individual types of PA, and incorporated a quantification of joint stress. Self-reported, physician-diagnosed hip/knee OA was ascertained by survey in 1990, 1995, and 1999 (average length of follow-up: 12.8 years). METHODS: The joint stress PA score was not associated with an increased risk of hip/knee OA. Also, among walkers and runners there was no association between the frequency, pace, or weekly training mileage and hip/knee OA. Older age, previous joint injury and surgery, and higher body mass index were confirmed as independent risk factors for hip/knee OA. CONCLUSIONS: Participation in PA as an adult does not increase the risk of hip/knee OA and there does not seem to be a threshold of increasing risk with increased training among walkers and runners.

Predictors of lower extremity injury among recreationally active adults.

OBJECTIVE: To identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DESIGN: Prospective cohort study. SETTING: Cooper Clinic Preventive Medicine Center, Dallas, Texas. PARTICIPANTS: Participants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. MAIN OUTCOME MEASURES: An injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. RESULTS: Among men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93-2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). CONCLUSIONS: For healthy adults, walking at a brisk pace for 10-20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.