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Summary: An international consensus process resulted in exercise and physical activity recommendations for individuals with osteoporosis. Emphasis was placed on strength, balance, and postural alignment. Rather than providing generic restrictions, activity should be encouraged while considering impairments, fracture risk, activity history, and preference, and guidance on spine sparing techniques should be provided. Introduction: The objectives of this study were to establish expert consensus on key questions posed by patients or health care providers regarding recommended assessment domains to inform exercise prescription, therapeutic goals of exercise, and physical activity and exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Methods: The Too Fit To Fracture expert panel identified researchers and clinicians with expertise in exercise and osteoporosis and stakeholder groups. We delivered a modified online Delphi survey (two rounds) to establish consensus on assessment, exercise, and physical activities for three cases with varying risk (osteoporosis based on bone mineral density; 1 spine fracture and osteoporosis; multiple spine fractures, osteoporosis, hyperkyphosis, and pain). Duplicate content analyses of free text responses were performed. Results: Response rates were 52 % (39/75) and 69 % (48/70) for each round. Key consensus points are the following: (a) Current physical activity guidelines are appropriate for individuals with osteoporosis without spine fracture, but not for those with spine fracture; (b) after spine fracture, physical activity of moderate intensity is preferred to vigorous; (c) daily balance training and endurance training for spinal extensor muscles are recommended for all; (d) providing guidance on spine-sparing techniques (e.g., hip hinge) during activities of daily living or leisure, considering impairments, fracture risk, activity history, and preference, is recommended rather than providing generic restrictions (e.g., lifting <10 lbs, no twisting), but for those with vertebral fracture, especially in the presence of pain, multiple fractures, or hyperkyphosis, the risks of many activities may outweigh the benefits-physical therapist consultation is recommended. Examples of spine-sparing techniques and exercise prescription elements are provided. Conclusions: Our recommendations guide health care providers on assessment, exercise prescription, and safe movement for individuals with osteoporosis. [ABSTRACT FROM AUTHOR]

Summary: An international consensus process identified the following research priorities in osteoporosis and exercise: study of exercise in high-risk cohorts, evaluation of multimodal interventions, research examining translation into practice and a goal to examine fracture outcomes. Introduction: To identify future research priorities related to exercise for people with osteoporosis with and without osteoporotic spine fracture via international consensus. Methods: An international expert panel and representatives from Osteoporosis Canada led the process and identified opinion leaders or stakeholders to contribute. A focus group of four patient advocates identified quality of life, mobility, activities of daily living, falls, bone mineral density, and harms as outcomes important for decision-making. Seventy-five individuals were invited to participate in an online survey asking respondents to define future research priorities in the area of osteoporosis and exercise; the response rate was 57 %. Fifty-five individuals from seven countries were invited to a half-day consensus meeting; 60 % of invitees attended. The results of the online survey, knowledge synthesis activities, and results of the focus group were presented. Nominal group technique was used to come to consensus on research priorities. Results: Research priorities included the study of exercise in high-risk cohorts (e.g., ≥ 65 years, low BMD, moderate/high risk of fracture, history of osteoporotic vertebral fractures, hyperkyphotic posture, functional impairments, or sedentary), the evaluation of multimodal interventions, research examining translation into practice, and a goal to examine fracture outcomes. The standardization of outcomes or protocols that could be evolved into large multicentre trials was discussed. Conclusions: The research priorities identified as part of the Too Fit To Fracture initiative can be used to inform the development of multicentre collaborations to evaluate and implement strategies for engaging individuals with osteoporosis in a safe and effective exercise. [ABSTRACT FROM AUTHOR]

Risk management measures (RMMs) are a broad set of tools used in global treaties and national regulations to manage, ban or restrict the use of toxic chemicals. Per- and polyfluoroalkyl substances (PFAS) are a group of chemicals that are persistent, bioaccumulate, biomagnify and are inherently toxic to the environment and human health. For these reasons global RMMs have been imposed on the manufacture and use of select PFAS. To evaluate the occurrence and potential current risk of PFAS in the Ontario environment, PFAS were quantitatively measured in source waters pre- (2005-2007) and post- (2012-2016, 2018-2019) implementation of RMMs. Source water samples were collected pre- (n = 105), and post-RMMs (n = 326) from lake, river and groundwater and analyzed for up to 14 PFAS. Pre-RMMs, the most frequently detected PFAS in source water were perfluorooctanoic acid (PFOA; 83%) and perfluorooctane sulfonate (PFOS; 76%) followed by perfluorohexane sulfonate (PFHxS; 47%) and the maximum ∑PFAS 10 was 42.1 ng/L. Post-RMMs, the maximum ∑PFAS 10 (which includes PFOS) was statistically significantly reduced to 15.5 ng/L, well below the Federal Environmental Quality Guidelines for PFOS. To evaluate post-RMMs risk to human health, 226 drinking water samples were collected from 25 drinking water systems with conventional and advanced treatment. All individual (or ∑PFAS) concentrations are well below current and proposed Health advisory levels or regulatory guidelines/standards for PFAS in drinking water with calculated Risk Quotients (RQ) <0.02. This survey indicates that the implementation of RMMs for select PFAS have made a significant difference to the concentrations detected in source waters in Ontario, Canada., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.)

Purpose: This study was conducted to quantify the normalized amplitudes of the abdominal wall and back extensor musculature during a variety of push-up styles. We also sought to quantify their impact on spinal loading by calculating spinal compression and torque generation in the L4-5 area., Methods: Ten university-age participants, nine males and one female, in good to excellent condition, volunteered to participate in this study. All participants were requested to perform a maximum of 12 different push-up exercises, three trials per exercise. Surface electromyographic data (EMG) were collected bilaterally on rectus abdominis, external oblique, internal oblique, latissimus dorsi, and erector spinae muscles, and unilaterally (right side) on pectoralis major, triceps brachii, biceps brachii, and anterior deltoid muscles. Spine kinetics were obtained using an anatomically detailed model of the torso/spine., Results: This study revealed that more dynamic push-ups (i.e., ballistic, with hand movement) required more muscle activation and higher spine load, whereas placing labile balls under the hands only resulted in modest increases in spine load. Right rectus abdominis (RA) activation was significantly higher than left RA activation during the left hand forward push-up and vice versa for the right hand forward push-up (P < 0.001). External oblique (EO) demonstrated the same switch in dominance during staggered hand push-ups (P < 0.01). The one-arm push-up resulted in the highest spine compression. Skilled participants showed greater synchronicity with peak muscle activation (plyometric type of contractions) during ballistic push-ups., Conclusion: These data will help guide exercise selection for individuals with differing training objectives and injury history.