Towards human exploration of space: the THESEUS review series on muscle and bone research priorities.

Without effective countermeasures, the musculoskeletal system is altered by the microgravity environment of long-duration spaceflight, resulting in atrophy of bone and muscle tissue, as well as in deficits in the function of cartilage, tendons, and vertebral disks. While inflight countermeasures implemented on the International Space Station have evidenced reduction of bone and muscle loss on low-Earth orbit missions of several months in length, important knowledge gaps must be addressed in order to develop effective strategies for managing human musculoskeletal health on exploration class missions well beyond Earth orbit. Analog environments, such as bed rest and/or isolation environments, may be employed in conjunction with large sample sizes to understand sex differences in countermeasure effectiveness, as well as interaction of exercise with pharmacologic, nutritional, immune system, sleep and psychological countermeasures. Studies of musculoskeletal biomechanics, involving both human subject and computer simulation studies, are essential to developing strategies to avoid bone fractures or other injuries to connective tissue during exercise and extravehicular activities. Animal models may be employed to understand effects of the space environment that cannot be modeled using human analog studies. These include studies of radiation effects on bone and muscle, unraveling the effects of genetics on bone and muscle loss, and characterizing the process of fracture healing in the mechanically unloaded and immuno-compromised spaceflight environment. In addition to setting the stage for evidence-based management of musculoskeletal health in long-duration space missions, the body of knowledge acquired in the process of addressing this array of scientific problems will lend insight into the understanding of terrestrial health conditions such as age-related osteoporosis and sarcopenia.

[Health effects of living habits]. / Elintapojen terveysvaikutukset.

Single healthy living habits such as non-smoking and regular physical activity decrease the risk of common non-communicable diseases, unsuccessful aging and premature death to a small to moderate degree. Their cumulative effects are, however, large. Only a small minority of people adhere well to all healthy living habits or even the healthiest ones. Consequently, the population attributable fractions of major public health problems due to unhealthy lifestyles are large. Substantial improvement of public health calls for policies and programs to influence the root causes of the lifestyles in the multiple environments and systems where they are developed, maintained, and changed.

Physical activity promotion in the health care system.

Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.

Promoting cycling: a review of interventions.

OBJECTIVE: To determine which approaches promote cycling, the size of the effects, and whether there are associated benefits on physical activity or anthropometric measures, by means of a systematic review. DATA SOURCES: Intervention studies with a cycling outcome measure were identified from searches of 13 databases, previous systematic reviews, Web sites, and reference lists of selected articles. International experts were asked to identify further relevant published or unpublished studies. The search was completed in January 2010. STUDY SELECTION: The selection criteria were controlled trials and "before and after" studies of the effect of any intervention on cycling behavior; studies had to include a minimal or no intervention comparison group or a similar population; and a specific measure of cycling before and after the intervention was required. Studies using stationary bicycles were excluded. Of 32,916 records retrieved, 118 full-text articles were assessed, and 25 were included in the quantitative analysis. Each step in the selection process was independently reviewed by a second reviewer, and disagreements were resolved. DATA EXTRACTION: Details of the study setting, objective, intervention, sample, duration, outcome measures, and results were extracted and checked by 2 reviewers, who also assessed validity (evaluated in summary as yes/no on randomization, representativeness, comparability, measurement, and use of statistical test). Disagreements were resolved by discussion. Outcomes were summarized as absolute changes in cycling after adjustment for changes in the control group. Meta-analysis was not possible because of heterogeneity and statistical inadequacies in the studies. MAIN RESULTS: Six studies [2 randomized controlled trials (RCTs), 1 cohort study, and 3 controlled repeat cross-sectional studies, all meeting ≥3 validity criteria] included interventions primarily intended to promote cycling. An RCT using individual counseling and incentives as interventions found that Swedish women with abdominal obesity in the intervention group were more likely to report cycling >2 km per day after 18 months than the control group [odds ratio, 7.8; 95% confidence interval (CI), 4.0-15.0]. Increase in cycling was not associated with greater reductions in waist circumference in women in the intervention group than in the control group. A cluster RCT (Bike-Texas Safe Routes to School) using combined educational and promotional activities as interventions found no difference after 1 semester in cycling to school among fourth and fifth graders and their parents compared with control schools, but the prevalence of recreational cycling increased (net increase + 2.54 days per week; P = 0.02). In a controlled repeat cross-sectional study in the Netherlands, improving the connectivity of 1 area of Delft was associated with an increase from 40% to 43% in household cycle trips after 3 years, compared with a change from 38% to 39% in an unimproved area. In Odense, Denmark, promotion and improved infrastructure were associated, after 3 years, with a 3.4% net increase in bicycle trips (adjusted for regional trends). In a cohort study in Australia, residents in 1 area were encouraged by a wide-ranging promotional program, including cycle training and free bike hire, to use existing cycle paths. After 2 years, residents of the intervention area reported more use of the cycle paths than the comparison group (net change in prevalence, +5.1%; P < 0.01), and bicycle counters also showed greater cycle path use in the intervention area (net increase, 7.9%), but no increase in the prevalence of cycling in the population occurred. In English towns, media campaigns, services for cyclists, and improvements to infrastructure were associated with increased proportions of residents who reported cycling more frequently (net increase in proportions cycling ≥12 times per month in 2 areas, 0.97% and 1.65%, and net increase in proportions cycling for ≥30 minutes once per month, 2.78% and 1.89%) compared with control towns. There was a reduction in the proportion of residents in intervention areas who were classified as inactive (-2.6%; 95% CI, -3.7% to -1.5%), but no increase in the proportion who were more than moderately active. The effects of individualized marketing of walking, cycling, and public transit use as an alternative to car use were investigated in 16 studies (2 cohort studies and 14 controlled repeat cross-sectional studies; 13 studies met 2 validity criteria). Most studies included individualized information and incentives to households interested in changing their travel behavior and were associated with modest but generally consistent increases in self-reported cycling trip frequency (median, +8 trips per person per year; range, 0 to +21). CONCLUSIONS: Individual and community intervention programs, improving infrastructure, and marketing to households all increased cycling (usually self-reported) to a small extent. Environmental changes combined with advice and support may be needed to increase cycling substantially and in a sustainable way in the population.

Developing a national physical activity plan: the Kuwait example.

A rapid increase in economic well-being and urbanization in Kuwait have been accompanied by profound changes in lifestyle, including low levels of physical activity in all population groups. These changes have contributed to a high prevalence of overweight and obesity and to the escalation of the non-communicable disease rates, particularly coronary heart disease, stroke, hypertension and diabetes. The evolution of physical activity promotion, internationally, and a series of related meetings in Kuwait and neighboring countries, have started to generate an awareness among health authorities of the importance of physical activity in health promotion and disease prevention. A National Physical Activity Committee has been formed to design and implement a National Physical Activity Plan, which could also serve as a model for other countries. The authors describe the background and principles behind the development of the National Plan, summarize a template based upon the Kuwait experience and share the lessons learned from these efforts.

Cost-effectiveness of interventions based on physical exercise in the treatment of various diseases: a systematic literature review.

OBJECTIVES: The aim of this study was to review studies reporting cost-effectiveness of exercise-based interventions in treatment of various diseases. METHODS: Systematic literature search using several databases. Abstracts initially screened independently by two authors, full-text articles again evaluated by two authors, who decided whether an article should be included. Included were scientifically valid articles describing controlled studies that included an exercise-based intervention in the treatment of an established medical condition, and also reported on the cost-effectiveness of the intervention, or its effect on the utilization of health services. Quality was assessed with an established approach. RESULTS: A total of 914 articles were identified, of them 151 were obtained for closer review. Sixty-five articles describing sixty-one studies were included. Most (82 percent) were randomized trials. Twenty-eight studies dealt with musculoskeletal disorders, fifteen with cardiology, four with rheumatic diseases, four with pulmonary diseases, three with urinary incontinence, and two with vascular disorders. There was one study each in the fields of oncology, chronic fatigue, endocrinology, psychiatry, and neurology. Exercise interventions in musculoskeletal disorders were deemed to be cost-effective in 54 percent, in cardiology in 60 percent, and in rheumatic diseases in 75 percent of the cases. There was some evidence that exercise might be cost-effective in intermittent claudication, breast cancer patients, diabetes, and schizophrenia. CONCLUSIONS: The number of studies assessing cost-effectiveness of exercise interventions in various diseases is still limited. The results show large variation but suggest that some exercise interventions can be cost-effective. Most convincing evidence was found for rehabilitation of cardiac and back pain patients; however, even in these cases, the evidence was partly contradictory.

Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus.

Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 +/- 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. All exercise sessions were controlled by heart rate and intensity. Glycated hemoglobin A1c, insulin, leptin, blood lipids, blood pressure, maximal oxygen consumption in spiroergometry, and muscle strength were measured every 6 months. Arterial stiffness was assessed by measuring pulse wave velocity. Maximal oxygen consumption in spiroergometry (E 31.9 to 34.8 vs C 32.6 to 31.8 ml/kg/min; p = 0.003), muscle strength (sit-up test, E 12.7 to 20.8 vs C 14.6 to 13.1 times; p <0.001), hemoglobin A1c (E 8.2% to 7.6% vs C 8.0% to 8.3%; p = 0.006), and leptin (E 7.4 to 6.7 vs C 7.4 to 7.9 microg/L; p = 0.013) improved significantly in the E group, but no change or worsening in these variables occurred in the C group. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.

The association of myeloperoxidase promoter polymorphism with carotid atherosclerosis is abolished in patients with type 2 diabetes.

OBJECTIVES: Type 2 diabetes mellitus (DM) enhances the development of atherosclerosis and reduces the activity of the oxidative myeloperoxidase (MPO) enzyme. MPO gene has a functional promoter polymorphism -463G/A which leads to high- (GG) and low-expression (AG, AA) genotypes. DESIGN AND METHODS: We studied the association of MPO polymorphism with carotid artery intima-media thickness (IMT) in 198 randomly selected Finnish men of Caucasian origin, 161 non-diabetics and 37 with type 2 DM. Their carotid IMT was measured by high-resolution ultrasonography, and the overall mean IMT value was calculated. MPO genotypes were determined by the PCR-RFLP method. RESULTS: We found significant MPO genotype-by-study-group (control/DM) interactions with the overall mean IMT and internal carotid IMT (p=0.05 and p=0.04, respectively). Among non-diabetic subjects, the overall carotid IMT was 7.3% higher in subjects with the low-activity genotype when compared to the high-activity (G/G) group. The results remained significant after adjustment for total cholesterol and smoking (p=0.015). No similar genotypic association was found for the subjects with type 2 DM. CONCLUSIONS: This data suggests that in subjects with normal glucose metabolism, MPO gene variation may modify the carotid artery IMT.

Exercise training does not improve myocardial diastolic tissue velocities in Type 2 diabetes.

BACKGROUND: Myocardial diastolic tissue velocities are reduced already in newly onset Type 2 diabetes mellitus (T2D). Poor disease control may lead to left ventricular (LV) systolic dysfunction and heart failure. The aim of this study was to assess the effects of exercise training on myocardial diastolic function in T2D patients without ischemic heart disease. METHODS: 48 men (52.3 +/- 5.6 yrs) with T2D were randomized to supervised training four times a week and standard therapy (E), or standard treatment alone (C) for 12 months. Glycated hemoglobin (HbA1c), oxygen consumption (VO2max), and muscle strength (Sit-up) were measured. Tissue Doppler Imaging (TDI) was used to determine the average maximal mitral annular early (Ea) and late (Aa) diastolic as well as systolic (Sa) velocities, systolic strain (epsilon) and strain rate (epsilon) from the septum, and an estimation of left ventricular end diastolic pressure (E/Ea). RESULTS: Exercise capacity (VO2max, E 32.0 to 34.7 vs. C 32.6 to 31.5 ml/kg/min, p = .001), muscle strength (E 12.7 to 18.3 times vs. C 14.6 to 14.7 times, p < .001), and HbA1c (E 8.2 to 7.5% vs. C 8.0 to 8.4%, p = .006) improved significantly in the exercise group compared to the controls (ANOVA). Systolic blood pressure decreased in the E group (E 144 to 138 mmHg vs. C 146 to 144 mmHg, p = .04). Contrary to risk factor changes diastolic long axis relaxation did not improve significantly, early diastolic velocity Ea from 8.1 to 7.9 cm/s for the E group vs. C 7.4 to 7.8 cm/s (p = .85, ANOVA). Likewise, after 12 months the mitral annular systolic velocity, systolic strain and strain rate, as well as E/Ea were unchanged. CONCLUSION: Exercise training improves endurance and muscle fitness in T2D, resulting in better glycemic control and reduced blood pressure. However, myocardial diastolic tissue velocities did not change significantly. Our data suggest that a much longer exercise intervention may be needed in order to reverse diastolic impairment in diabetics, if at all possible.

Nationwide decline in incidence of hip fracture.

UNLABELLED: This epidemiologic study determined the trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, between 1970 and 2004. The results show that the alarming rise in the fracture incidence from early 1970s until late 1990s has been now followed by declining fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns could partly explain the phenomenon. INTRODUCTION: Although osteoporotic fractures of older adults are said to be a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is limited. MATERIALS AND METHODS: This epidemiologic study determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, by taking into account all persons >or= 50 years of age who were admitted to our hospitals for primary treatment of such fracture in 1970-2004. RESULTS: The number of hip fractures among >or= 50-year-old Finns rose very constantly between 1970 (1857 fractures) and 1997 (7122 fractures), but since then, the rise has leveled off (7083 fractures in 2004). After this and because of a continuous rise in population at risk, the crude incidence of hip fracture (showing a clear rise in 1970-1997) decreased between 1997 and 2004, from 438 (per 100,000 persons) in 1997 to 374 in 2004. Concerning the age-adjusted fracture incidence, findings were similar. Until 1997, the age-adjusted incidence of hip fracture clearly increased in both women and men, but thereafter, this incidence declined in both sexes: in women, from 494 in 1997 to 412 in 2004, and in men, from 238 in 1997 to 223 in 2004. CONCLUSIONS: The rise in the incidence of hip fracture in Finland from the early 1970s until the late 1990s has been followed by declining fracture rates. Exact reasons for this are unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns cannot be ruled out.

Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial.

BACKGROUND AND PURPOSE: Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause. SUBJECTS AND METHODS: The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs. RESULTS: One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking. DISCUSSION AND CONCLUSION: Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.

Impaired myocardial function in newly onset type 2 diabetes associates with arterial stiffness.

AIM: The aim of this study was to evaluate myocardial function using pulsed and color-coded tissue Doppler imaging (TDI) and vascular wall elasticity using whole-body impedance cardiography (ICG) in patients with newly diagnosed Type 2 diabetes mellitus (DM2), and to compare the measurements with those of healthy controls. METHODS: Systolic (SBP) and diastolic (DBP) blood pressure and glycosylated hemoglobin (HbA1c) were measured in 49 men (mean age 52.3+/-5.6 years, duration of DM2 1.8 years), and 15 healthy male control subjects (48.3+/-7.4 years). Mitral annular peak systolic (Svm), early (Evm), and late (Avm) diastolic velocities as well as myocardial peak systolic (Sv), early (Ev) and late diastolic (Av) velocity from middle segments of the anterior, inferior and lateral wall and the inferior septum were measured by TDI. ICG at rest was used to measure cardiac index (CI) and pulse wave velocity (PWV). RESULTS: The patients had higher body mass index (BMI 29.1+/-3.7 vs. 25.2+/-2.4 kg/m(2), p=0.000) and SBP (142+/-15 vs. 120+/-7 mmHg, p=0.005) than the controls, CI was comparable (2.8+/-0.5 vs. 2.8+/-0.6l/min/m(2)). The patients had lower age adjusted myocardial Sv (3.8+/-1.1 vs. 4.8+/-1.1cm/s, p=0.002) and Ev (4.6+/-1.6 vs. 6.2+/-1.7 cm/s, p=0.011), and also mitral annulus peak early diastolic velocity (Evm 7.8+/-1.9 vs. 10.4+/-2.6 cm/s, p=0.001). In diabetic patients PWV (14.2+/-2.7 vs. 10.0+/-1.7 m/s, p=0.002) was higher. Age (r=-0.39, p=0.001), BMI (r=-0.44, p=0.000) and PWV (r=-0.52, p=0.000) correlated significantly with Evm. PWV correlated with age (r=0.50, p=0.000), SBP (r=0.67, p=0.000), and HBA1c (r=0.36, p=0.010). In stepwise regression analysis, PWV (beta=-0.39, p=0.000) was the major determinant of Evm. CONCLUSION: Myocardial function is impaired in asymptomatic patients with newly detected DM2 consistent with diabetic heart muscle disease. Arterial stiffness is strongly related to myocardial dynamics, and both may have the same pathophysiologic background.

Blood leukocyte count is a risk factor for intima-media thickening and subclinical carotid atherosclerosis in middle-aged men.

Leukocytosis is known to predict future cardiovascular events even in subjects without coronary heart disease (CHD), but its association with early atherosclerotic changes has remained less certain. The aim of the present study was to investigate how the blood leukocyte count compares with several other risk factors for CHD in determining carotid artery intima-media thickness (IMT) and subclinical carotid atherosclerosis in a population sample. Both carotid arteries were investigated with high-resolution B-mode ultrasound in a community-based sample of 219 randomly selected men aged 50-59 years to calculate the mean maximum IMT (MMax IMT) of 12 standard sites. Risk factor assessment included several traditional biochemical risk factors, blood pressure, maximal oxygen consumption and work load on ergometry, life-style habits and hematologic parameters. As genetic determinants, apolipoprotein E and A-IV polymorphisms were studied. According to multivariate regression analysis, age (P<0.0001), blood leukocyte count (P<0.0001) and systolic blood pressure (P<0.042) were the only significant predictors of MMax IMT. MMax IMT increased linearly from the lowest tertile of blood leukocyte count (1.14+/-0.20mm) to the second (1.18+/-0.25 mm) and to the highest tertile (1.25+/-0.27 mm, P=0.019). This difference remained significant after adjustment with age, systolic blood pressure and smoking (P=0.032). Leukocytes seem to have an independent role in the early arterial damage and they may reflect subclinical disease. This implies that leukocyte count is undervalued in the diagnostics and prognostics of carotid atherosclerosis.

Associations of leisure-time physical activity with mobility difficulties among middle-aged and older adults.

The authors investigated the associations of the amount, frequency and intensity, and type of leisure-time physical activity (LTPA) with the risk of self-reported difficulty in walking (WD) and stair climbing (SCD) over 16 years in a population-based cohort age 40-64 years at the onset of the study. Their results indicated that the risk for SCD was highest among men and women with a low amount of weekly LTPA. The risk was high also among women with weekly light LTPA compared with women with weekly vigorous LTPA. The risk for WD was highest among men who engaged in fitness activity once a week compared with men who engaged in fitness activity at least three times a week. A low amount of weekly LTPA, light LTPA twice or more a week, and LTPA for keeping fit and healthy less than three times a week are associated with future risk of mobility difficulties among middle-aged and older adults.

Serum TRACP 5b is a useful marker for monitoring alendronate treatment: comparison with other markers of bone turnover.

UNLABELLED: We studied clinical performance of serum TRACP 5b and other bone turnover markers, including S-CTX, U-DPD, S-PINP, S-BALP, and S-OC, for monitoring alendronate treatment. TRACP 5b had higher clinical sensitivity, area under the ROC curve, and signal-to-noise ratio than the other markers. INTRODUCTION: The purpose of this study was to compare the clinical performance of serum TRACP 5b (S-TRACP5b) with that of other markers of bone turnover in the monitoring of alendronate treatment. MATERIALS AND METHODS: This double-blinded study included 148 healthy postmenopausal women that were randomly assigned into two groups: one receiving 5 mg alendronate daily (n=75) and the other receiving placebo (n=73) for 12 months. All individuals in both groups received calcium and vitamin D daily. The bone resorption markers S-TRACP5b, serum C-terminal cross-linked telopeptides of type I collagen (S-CTX), and total urinary deoxypyridinoline (U-DPD), and the serum markers of bone formation procollagen I N-terminal propeptide (S-PINP), bone-specific alkaline phosphatase (S-BALP), and total osteocalcin (S-OC) were assessed at baseline and at 3, 6, and 12 months after initiation of treatment. Lumbar spine BMD (LBMD) was measured at baseline and 12 months. RESULTS: Compared with the placebo group, LBMD increased, and all bone markers decreased significantly more in the alendronate group (p<0.001 for each parameter). The decrease of S-TRACP5b after first 3 months of alendronate treatment correlated significantly with the changes of all other markers except S-OC, the best correlation being with S-CTX (r=0.60, p<0.0001). The changes of LBMD at 12 months only correlated significantly with the changes of S-TRACP5b (r=-0.32, p=0.005) and S-CTX (r=-0.24, p=0.037) at 3 months. Based on clinical sensitivity, receiver operating characteristic (ROC) curves, and signal-to-noise ratio, S-TRACP5b, S-CTX, and S-PINP were the best markers for monitoring alendronate treatment. Clinical sensitivity, area under the ROC curve, and signal-to-noise ratio were higher for S-TRACP5b than for the other markers. CONCLUSION: These results show that S-TRACP5b, S-CTX, and S-PINP are useful markers for monitoring alendronate treatment.

Characteristics of leisure time physical activity associated with risk of decline in perceived health--a 10-year follow-up of middle-aged and elderly men and women.

BACKGROUND: Leisure time physical activity (LTPA) has been found to prevent several diseases, but little is known about its protective effect against decline in perceived health. The purpose of the present study is to analyze the protective effect of LTPA against the risk of decline in perceived health in a cohort of 19- to 63-year-old Finnish men (n = 1205) and women (n = 1148) with good perceived health. METHODS: The incidence rate of decline in perceived health was monitored by self-administered questionnaire data from March 1980 through March 1985 through December 1990. LTPA was assessed by (1) a single-item self-assessment of global LTPA; (2) a compiled intensity-frequency measure of LTPA; (3) a total energy expenditure index of LTPA; and (4) three indexes of LTPA (i.e., commuting, fitness, and sport). The association between LTPA and risk of decline in perceived health was assessed using the Cox proportional hazard regression model. RESULTS: Among men, the multivariate analyses revealed an increased risk of decline in perceived health with no weekly vigorous global LTPA (RR = 1.49; 95% CI 1.12-1.98) and with no monthly sport activity (RR = 1.62; 95% CI 1.12-2.35). Among women, the results only showed an increased risk of decline in perceived health with fitness activity at less than once a week (RR = 1.62; 95% CI 1.06-2.48). The total energy expenditure of weekly LTPA and the index of commuting were not associated with the risk of decline in perceived health. CONCLUSIONS: Although energy expenditure of weekly LTPA did not prove to be a protective factor against the risk of decline in perceived health, global level, intensity, and type of weekly LTPA did. Physical activity interventions may need to emphasize the amount, intensity, and type of weekly LTPA, rather than energy expenditure of weekly LTPA, for promoting overall public health among middle-aged and older men and women with good perceived health.

The association of the apolipoprotein E gene promoter polymorphisms and haplotypes with serum lipid and lipoprotein concentrations.

BACKGROUND: Apolipoprotein E (ApoE) is known to modulate lipoprotein transport and metabolism. The common APOE epsilon2/epsilon3/epsilon4 polymorphism explains part of the variation in plasma cholesterol levels. Polymorphisms of the APOE gene regulatory region are suggested to be involved in explaining variation of lipoprotein levels within the APOE epsilon2/epsilon3/epsilon4 genotypes. OBJECTIVES: To study the associations of the APOE gene promoter polymorphisms -219G/T and +113G/C and their haplotypes with serum lipid and lipoprotein concentrations, especially within the most common APOE epsilon3/epsilon3 genotype group. SUBJECTS AND METHODS: From 219 middle-aged Finnish men, APOE genotypes were determined and haplotypes estimated. Plasma lipoproteins were isolated by ultracentrifugation and their lipids were measured. RESULTS: The studied APOE promoter polymorphisms and haplotypes associated with certain lipid variables independently of the APOE epsilon2/epsilon3/epsilon4 genotype. Within the APOE epsilon3/epsilon3 group, both -219G/G and +113G/G genotypes associated statistically significantly with higher levels of very low-density lipoprotein (VLDL) cholesterol, apoB and triglycerides, and tended to associate with lower HDL-cholesterol concentrations than the other genotypes. Compared with the -219T/+113C/epsilon3 haplotype, the more common -219G/+113G/epsilon3 haplotype was found more frequently among the group having high (over median) VLDL-cholesterol and triglyceride concentrations (OR 2.6, p<0.001 and OR=2.1, p=0.009, respectively). CONCLUSIONS: In addition to the APOE epsilon2/epsilon3/epsilon4 polymorphism, the promoter polymorphisms -219G/T and +113G/C as well as their haplotype modulate lipid and lipoprotein concentrations in middle-aged Finnish men.