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QUESTION: In postmenopausal women, does exercise slow bone loss or have an effect on axial and appendicular bone density?Data sources:Studies were identified by searching Medline, EMBASE/ Excerpta Medica, CINAHL, HealthSTAR, Sports Discus, the Cochrane Controlled Trials Register, PEDro, and the specialised registry of the Cochrane Musculoskeletal Croup (all from 1966 to January 2000). Bibliographies of relevant articles were reviewed, and experts in the field were contacted for additional studies and data.Study selection:Studies published in any language were selected if they were randomised controlled trials (RCTs) comparing an exercise programme (eg, walking, callisthenics, resisted strengthening) assumed to be adequate to improve aerobic capacity or adequate to improve both aerobic capacity and muscle strength with standard treatment (eg, usual activity or placebo with or without drug consumption), and participants were healthy postmenopausal women 45-70 years of age.Data extraction:Data were extracted on sample size, details of the intervention, study quality, and outcomes. Main outcomes included percent change (loss) from baseline of bone mineral density (BMD) per year and number of fractures of the hip, vertebrae, and wrist at 1 and 2 years of follow up.Main results:18 RCTs (n=1423) met the selection criteria. Meta-analyses were done using a fixed effects model for homogeneous outcomes and a random effects model for outcomes with significant heterogeneity. (1) Aerobic exercise and weight bearing. Bone loss was lower in the exercise group than in the control group for lumbar spine measurements (table). The groups did not differ for hip and wrist measurements (table). (2) Aerobic exercise. Bone loss was lower in the exercise group than in the control group for lumbar spine and wrist measurements (table). The groups did not differ for hip measurements (table). (3) Resistance exercises for specific muscles. Bone loss was lower in the exercise group than in the control group for lumbar spine measurements (table). The groups did not differ for hip and wrist measurements (table). (4) Simple walking. Bone loss was lower in the exercise group than in the control group for hip measurements (weighted mean difference 0.92, 95% CA 0.21 to 1.64). The groups did not differ for lumbar spine measurements.Conclusions:In postmenopausal women, aerobic, aerobic and weight bearing, and resistance exercises reduce bone loss from the spine. Aerobic exercise also reduces bone loss from the wrist. [ABSTRACT FROM AUTHOR]

How do women experience routine screening by health visitors (HVs) using the Edinburgh Postnatal Depression Scale (EPDS)?DESIGNIndepth interviews.SETTING22 general practices in Oxford, UK.PARTICIPANTS39 women (mean age 34 y) were selected based on their registered general practice, EPDS scores at 8 weeks and 8 months, and whether listening visits were recorded (a proxy measure for postnatal depression). Exclusion criteria were inadequate English, age <16 years, learning disability, or infant death.METHODSWomen were interviewed at 11-19 months after delivery and asked about how they felt in the first 3 months after the birth and about completing the EPDS. Screening was judged 'acceptable' if women gave positive or neutral responses to questions about the EPDS. Interviews were tape recorded, transcribed verbatim, and analysed using constant comparison. Data saturation was achieved.MAIN FINDINGS21 women (54%) found screening for postnatal depression unacceptable. 3 themes explained this. (1) Women with negative views of screening found the process of screening to be simplistic and preferred open questions or au opportunity to talk. Women felt ill prepared for screening, were anxious about the consequences, and were reluctant to answer questions honestly. 13 women (33%) felt the baby clinic was an inappropriate place to complete the EPDS, citing reasons of stress and inadequate time and privacy. Most preferred screening at home. One third of women received little feedback from HVs and felt dissatisfied. Even non-depressed women felt distress, yet 'normal' EPDS results prevented discussions about troublesome symptoms. (2) To some women, the EPDS seemed like a personal intrusion, which was pointless and frustrating. They attributed their distress to their social situation rather than illness. The women saw no medical solution to their distress and therefore resented intrusive questions from health professionals. (3) Stigma. Many felt that postnatal depression was stigmatising, and they did not want to admit to it. This reluctance was related to their image of a good mother. Some covered up their feelings to avoid being 'found out' (and risk 'losing' their baby) and lied deliberately on the questionnaire.Regardless of their emotional state, women felt threatened by a questionnaire to 'diagnose' this stigmatising illness.CONCLUSIONSOver half of the participants found routine screening with the Edinburgh Postnatal Depression Scale to be unacceptable. Unacceptability was explained by the inadequacy of the screening process, the intrusiveness of the questions, and the stigma of postnatal depression. Women preferred talking about how they felt rather than completing a questionnaire, and many admitted to giving unreliable responses. [ABSTRACT FROM AUTHOR]

QUESTION: Are weight change and intention to lose weight associated with all cause mortality in adults who are overweight or obese?DesignProspective cohort study with 9 years of follow up (mean follow up 8 y).SettingUSA.Participants6391 adults >/= 35 years of age (mean age 54 y, 55% men, 87% white) with a body mass index (BMI) >/= 25 kg/m2 before weight loss.Assessment of risk factorsWeight loss intention and weight change during the previous year were assessed by self report in a supplemental survey to the 1989 National Health Interview Survey. The same survey was used to determine age, ethnicity, sex, smoking status, self rated health, hospital admissions, physician visits, chronic and acute conditions, limitations in activities or work, and height and weightMain outcome measureData on all cause mortality were obtained from the computerised National Death Index.Main results57% of participants reported trying to lose weight in the previous year. 58% reported no weight change, 12% reported weight gain, and 30% reported weight loss in the previous year. During follow up, 892 participants (145) died. Compared with participants not trying to lose weight and reporting no weight change, all cause mortality was lower in participants with an intention to lose weight, independent of actual weight change but was higher in participants with unintentional weight loss (table).ConclusionIn adults who were overweight or obese, intention to lose weight was associated with reduced all cause mortality, independent of actual weight change; unintentional weight loss was associated with increased all cause mortality. [ABSTRACT FROM AUTHOR]

QUESTION: In patients with fibromyalgia, is exercise training effective for improving symptoms such as physical function, pain, and tender points?Data sources:Studies were identified by searching Medline (1966-2000), CINAHL (1982-2000), EMBASE/Excerpta Medica (1974-2000), HealthSTAR (1990-2000), Sports Discus (1975-2000), the Cochrane Controlled Trials Register (2000, Issue 4), and reviewing bibliographies of relevant articles.Study selection:Studies published in any language were selected if they were randomised controlled trials (RCTs) comparing an intervention that included an exercise component with an untreated control or other non-exercise interventions and patients had a diagnosis of fibromyalgia based on published criteria.Data extraction:2 reviewers independently extracted data on sample size, details of the intervention, study quality, and outcomes. Main outcomes included pain, tender points, physical function, global wellbeing or perceived improvement, self efficacy, psychological function, fatigue, and sleep.Main results;16 RCTs that evaluated 23 exercise interventions for fibromyalgia met the selection criteria. Types of interventions included aerobic training, flexibility training, strength training, and mixed or composite training. 13 RCTs were of moderate to high methodological quality, and 8 met the American College of Sports Medicine training guidelines. 4 RCTs (also classified as high quality training studies) with similar interventions (cycle ergometry, aerobic dance, whole body aerobics, indoor walking) and similar outcome measures were included in the meta-analysis using a random effects model. The aerobic exercise group showed greater improvement than the control group for cardiovascular fitness (standardised mean difference [SMD] 0.79, 95% CI 0.37 to 1.21) and tender points (SMD 1.19, CI 0.64 to 1.75). The groups did not differ for pain (SMD 0.57, CI -1.20 to 0.06).Conclusion:In patients with fibromyalgia, aerobic exercise training is effective for improving cardiovascular fitness and tender points. [ABSTRACT FROM AUTHOR]