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Lauren A. Burt, David A. Greene and Geraldine A. Naughton

-rays and are associated with a low dose of ionizing radiation, whereas QUS assesses bone health without radiation exposure ( 32 ). DXA is the gold standard for assessing areal bone mineral density (aBMD) and is able to complete scans quickly at a relatively low cost and with high precision ( 32 ). A major

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Ana Torres-Costoso, Dimitris Vlachopoulos, Esther Ubago-Guisado, Asunción Ferri-Morales, Iván Cavero-Redondo, Vicente Martínez-Vizcaino and Luis Gracia-Marco

bone outcomes. Quantitative ultrasound (QUS) measurement is considered a valid, safe, easy-to-use, portable, cost-effective, cheaper than DXA, and radiation-free method to assess bone health ( 1 ). The calcaneus site is the most frequent measurement site due to its trabecular content and accessibility

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Eric Tsz-Chun Poon, John O’Reilly, Sinead Sheridan, Michelle Mingjing Cai and Stephen Heung-Sang Wong

safety concern that high-speed falls and bone fractures are frequent ( Rueda et al., 2010 ), achieving optimal bone health is of paramount importance for jockeys. However, previous research suggested that extreme dietary weight-making practices can result in an inadequate intake of macronutrients and

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Saori I. Braun, Youngdeok Kim, Amy E. Jetton, Minsoo Kang and Don W. Morgan

The purpose of this study was to determine if bone health at the femoral neck (FN) and lumbar spine (LS) can be predicted from objectively-measured sedentary behavior and physical activity data in postmenopausal women. Waist-mounted ActiGraph GT1M and GT3X devices were used to quantify levels of sedentary and moderate-to-vigorous intensity behavior during a 7-day period in 44 older females. Bone health (normal and osteopenia/osteoporosis) of FN and LS was derived from T scores generated using dual energy x-ray absorptiometry. Binomial logistic regression analysis indicated that sedentary time and number of breaks in sedentary behavior were significant predictors of osteopenia/osteoporosis at the FN, but not at the LS. Adherence to physical activity guidelines was not a significant predictor of bone health at the FN or LS. Our findings suggest that more frequent interruptions in sedentary behavior are associated with improved bone health in postmenopausal women.

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Shijun Zhu, Eun-Shim Nahm, Barbara Resnick, Erika Friedmann, Clayton Brown, Jumin Park, Jooyoung Cheon and DoHwan Park

team has implemented a Bone Power Intervention to improve older adults’ participation in bone-health behaviors such as exercise and calcium intake ( Nahm et al., 2015a , 2015b ). The intervention study was approved by the institutional review boards at the University of Maryland, Baltimore, and the U

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Shreela V. Sharma, Deanna M. Hoelscher, Steven H. Kelder, Pamela M. Diamond, R. Sue Day and Albert C. Hergenroeder

Background:

The purpose of this study was to identify pathways used by psychosocial factors to influence physical activity and bone health in middle-school girls.

Methods:

Baseline data from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study collected in 2001 to 2003 were used. IMPACT was a 1 1/2 years nutrition and physical activity intervention study designed to improve bone density in 717 middle-school girls in Texas. Structural Equations Modeling was used to examine the interrelationships and identify the direct and indirect pathways used by various psychosocial and environmental factors to influence physical activity and bone health.

Results:

Results show that physical activity self-efficacy and social support (friend, family engagement, and encouragement in physical activity) had a significant direct and indirect influence on physical activity with participation in sports teams as the mediator. Participation in sports teams had a direct effect on both physical activity (β= 0.20, P < .05) and bone health and (β=0.13, P < .05).

Conclusion:

The current study identified several direct and indirect pathways that psychosocial factors use to influence physical activity and bone health among adolescent girls. These findings are critical for the development of effective interventions for promoting bone health in this population.

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Alex V. Rowlands, John M. Schuna Jr., Victoria H. Stiles and Catrine Tudor-Locke

Background:

Previous research has reported peak vertical acceleration and peak loading rate thresholds beneficial to bone mineral density (BMD). Such thresholds are difficult to translate into meaningful recommendations for physical activity. Cadence (steps/min) is a more readily interpretable measure of ambulatory activity.

Objective:

To examine relationships between cadence, peak vertical acceleration and peak loading rate during ambulation and identify the cadence associated with previously reported bone-beneficial thresholds for peak vertical acceleration (4.9 g) and peak loading rate (43 BW/s).

Methods:

Ten participants completed 8 trials each of: slow walking, brisk walking, slow running, and fast running. Acceleration data were captured using a GT3×+ accelerometer worn at the hip. Peak loading rate was collected via a force plate.

Results:

Strong relationships were identified between cadence and peak vertical acceleration (r = .96, P < .05) and peak loading rate (r = .98, P < .05). Regression analyses indicated cadences of 157 ± 12 steps/min (2.6 ± 0.2 steps/s) and 122 ± 10 steps/min (2.0 ± 0.2 steps/s) corresponded with the 4.9 g peak vertical acceleration and 43 BW/s peak loading rate thresholds, respectively.

Conclusions:

Cadences ≥ 2.0 to 2.6 steps/s equate to acceleration and loading rate thresholds related to bone health. Further research is needed to investigate whether the frequency of daily occurrences of this cadence is associated with BMD.

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Jason D. Vescovi and Jaci L. VanHeest

This observational case study examined the association of inter- and intraday energy intake and exercise energy expenditure with bone health, menstrual status and hematological factors in a female triathlete. The study spanned 7 months whereby energy intake and exercise energy expenditure were monitored three times (13 d); 16 blood samples were taken, urinary hormones were assessed for 3 months, and bone mineral density was measured twice. Energy availability tended to be sustained below 30 kcal/kg FFM/d and intraday energy intake patterns were often “back-loaded” with approximately 46% of energy consumed after 6 p.m. Most triiodothyronine values were low (1.1–1.2nmol/L) and supportive of reduced energy availability. The athlete had suppressed estradiol (105.1 ± 71.7pmol/L) and progesterone (1.79 ±1.19nmol/L) concentrations as well as urinary sex-steroid metabolites during the entire monitoring period. Lumbar spine (L1-L4) bone mineral density was low (age-matched Z-score −1.4 to −1.5). Despite these health related maladies the athlete was able to perform typical weekly training loads (swim: 30–40 km, bike: 120–300 km, run 45–70 km) and was competitive as indicated by her continued improvement in ITU World Ranking during and beyond the assessment period. There is a delicate balance between health and performance that can become blurred especially for endurance athletes. Education (athletes, coaches, parents) and continued monitoring of specific indicators will enable evidence-based recommendations to be provided and help reduced the risk of health related issues while maximizing performance gains. Future research needs to longitudinally examine how performance on standardized tests in each discipline (e.g., 800-m swim, 20-km time trial, 5-km run) is impacted when aspects of the female athlete triad are present.

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Kathleen F. Janz and Shelby L. Francis

Although there is strong and consistent evidence that childhood and adolescent physical activity is osteogenic, the evidence concerning its sustained effects to adult bone health is not conclusive. Therefore the value of interventions, in addition to beneficial bone adaptation, could be exposure to activities children enjoy and therefore continue. As such, interventions should provide skills, pleasure, and supportive environments to ensure continued bone-strengthening physical activity with age. Until the dose-response as well as timing of physical activity to bone health is more fully understood, it is sensible to assume that physical activity is needed throughout the lifespan to improve and maintain skeletal health. Current federal guidelines for health-related physical activity, which explicitly recommend bone-strengthening physical activities for youth, should also apply to adults.

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Richard D. Lewis and Christopher M. Modlesky

Calcium and vitamin D can significantly impact bone mineral and fracture risk in women. Unfortunately, calcium intakes in women are low and many elderly have poor vitamin D status. Supplementation with calcium (~1000 mg) can reduce bone loss in premenopausal and late postmenopausal women, especially at sites that have a high cortical bone composition. Vitamin D supplementation slows bone loss and reduces fracture rates in late postmenopausal women. While an excess of nutrients such as sodium and protein potentially affect bone mineral through increased calcium excretion, phytoestrogens in soy foods may attenuate bone loss ihrough eslrogenlike activity. Weight-bearing physical activity may reduce the risk of osteoporosis in women by augmenting bone mineral during the early aduli years and reducing the loss of bone following menopause. High-load activities, such as resistance training, appear to provide the best stimulus for enhancing bone mineral; however, repetitive activities, such as walking, may have a positive impact on bone mineral when performed at higher intensities. Irrespective of changes in bone mineral, physical activities that improve muscular strength, endurance, and balance may reduce fracture risk by reducing the risk of falling. The combined effect of physical activity and calcium supplementation on bone mineral needs further investigation.