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Background: Population based studies have shown large differences in the estimated prevalence of complementary and integrative health (CIH) usage between studies. This is in part due to there being no golden standard definition for CIH. In Finland, an updated and internationally comparable study on the prevalence of CIH usage is needed. In the present study, a modified Finnish version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-QFI) was utilised to examine prevalence of use of different CIH modalities and the experienced helpfulness in the general Finnish population. Methods: Respondents (n = 3244) aged 16 and above were invited to take part in the I-CAM-QFI through an online panel in December 2022. The usage of CIH and the experienced helpfulness were described as the proportion of users per each modality. The data were weighted based on gender, age and place of residence. Results: CIH was used by 51.1% (95%CI: 49.4-52.8) of the respondents in the 12 months prior to the survey. Self-help practices were the most used category of CIH (28.8%; 95%CI: 27.3-30.4). The prevalence of usage of CIH natural remedies excluding vitamins and minerals was 27.0% (95%CI: 25.5 -28.6). CIH providers were visited by 20.4% of the respondents (95%CI: 19.0-21.8). CIH was generally used more by women compared to men. The large majority found the modalities they used helpful. Conclusions: The results increase current understanding on CIH usage in Nordic countries. As the majority of users experience CIH as helpful, there is a need to study CIH in the context of public health policies. The estimates of CIH usage are highly dependent on what is considered as CIH, and this should be paid attention to in future studies.

Objective: To explore the relationship between cognitive and motor performance in physically well-recovered men with traumatic brain injury. Design: Cross-sectional explorative study in a national neurorehabilitation centre. Subjects: Men with post-acute traumatic brain injury (n = 34; aged 19–55 years) who had recovered well physically. Methods: Cognitive performance (attention, information processing, cognitive flexibility, motor regulation, praxis of the upper limbs) and motor performance (postural balance, agility, rhythm-co-ordination) were assessed. Partial rank correlation coefficients and analyses of covariance were used to assess the associations between these tests. Results: Associations were found between the time taken in both Trail Making tests and performance time in the agility test (r = 0.57). The score on the Digit Symbol test correlated with time in the agility test (r = –0.52). Patients with normal performance in verbal fluency performed the tests of dynamic balance and agility 26% more quickly than those with abnormal performance. Moreover, patients with normal performance in the reproduction of rhythmic structures were 20% faster in the dynamic balance test. Motor functions of the hands associated with all the motor-performance test results. Conclusion: Measures of information processing, attention and executive functioning may be associated with motor performance. Apart from the theoretical relevance, the finding of an association between cognitive and motor performance may have clinical relevance with regard to rehabilitation.

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.

Purpose: Evidence of the effect of leisure time physical activity (LTPA) modes on the motor abilities of a mature population is scarce. The purpose of this study was to compare the motor abilities of physically active and inactive men and women and to examine the associations of different exercise modes and former and recent LTPA (R-LTPA) with motor ability and various physical tests. Methods: The LTPA of the participants (men n = 69, women n = 79; aged 41-47 yr) was ascertained by a modified Physical Activity Readiness Questionnaire, including questions on the frequency, duration, and intensity of R-LTPA and former LTPA and on exercise modes. Motor abilities in terms of balance, agility, and coordination were assessed with a battery of nine tests supplemented with five physical fitness tests. Multiple statistical methods were used in analyses that were conducted separately for men and women. Results: The MET-hours per week of R-LTPA correlated statistically significantly with the tests of agility and static balance (rs = -0.28, P = 0.022; rs = -0.25, P = 0.043, respectively) among men and with the static balance (rs = 0.41), 2-km walking (rs = 0.36), step squat (rs = 0.36) (P = 0.001, respectively), and static back endurance (rs = 0.25, P = 0.024) among women. In the stepwise regression among men, the most frequent statistically significant predictor was the playing of several games. For women, a history of LTPA for more than 3 yr was the strongest predictor for good results in almost all tests. Conclusions: Participants with long-term and regular LTPA had better motor performance, and especially a variety of games improve components of motor ability. Diverse, regular, and long-term exercise including both specific training and general activity develops both motor abilities and physical fitness

Associations between childhood obesity and adult bone traits were assessed among 62 obese premenopausal women, of which 12 had been obese since childhood (ObC), and 50 had gained excess weight in adulthood (ObA). Body composition and bone mineral content (BMC) of the total body, spine, and proximal femur were assessed with DXA. Total cross-sectional area and cortical (diaphyseal CoD) and trabecular (epiphyseal TrD) bone density of the radius and tibia were measured with pQCT. Compared to ObA-group, ObC-group was 5.2 cm taller having 2.5 and 3.5 kg more lean and fat mass, respectively. Depending on the statistical adjustment, ObC-group had 5–10% greater TrD both in tibia and in radius. The remaining bone traits did not significantly differ between the groups. Current preliminary observations bring up an interesting question whether childhood obesity can result in denser trabecular bone in adulthood. However, prudence must be exercised in the statistical adjustment. Hindawi Open access

Objective: To investigate whether a 6-month neuromuscular warm-up programme could improve muscle power, balance, speed and agility. Design: Cluster randomised controlled study. Setting: 27 top level female floorball teams in Finland. Participants: 222 players (mean age 24 years); 119 in the intervention group and 103 in the control group were followed-up for one league season (6 months). Intervention: A neuromuscular warm-up programme included sports-specific running technique, balance, jumping and strengthening exercises. The teams were advised to use the programme 1–3 times per week through the league season. One training session took ∼25 min. Main outcome measures: Performance tests were assessed before and after the 6-month intervention and included static jump, countermovement jump, jumping over a bar, standing on a bar and figure-of-eight running. Results: At 6 months, significant between-group differences were found in two outcome measures: jumping over a bar (number of jumps in 15 s) and standing on a bar (number of balance losses in 60 s). These differences were 2.3 jumps (95% CI 0.8 to 3.8, p = 0.003), favouring the intervention group, and −0.4 balance losses (95% CI −0.8 to 0.0, p = 0.050), again in favour of the intervention group. Conclusion: A neuromuscular warm-up programme improved the floorball players’ sideways jumping speed and static balance. The exercises were also safe to perform and can thus be recommended for weekly training of floorball players. Trial registration number: ISRCTN26550281.

Objective To investigate whether a neuromuscular training programme is effective in preventing non-contact leg injuries in female floorball players. Design Cluster randomised controlled study. Setting 28 top level female floorball teams in Finland. Participants 457 players (mean age 24 years)—256 (14 teams) in the intervention group and 201 (14 teams) in the control group—followedup for one league season (six months). Intervention A neuromuscular training programme to enhance players’ motor skills and body control, as well as to activate and prepare their neuromuscular system for sports specific manoeuvres. Main outcome measure Acute non-contact injuries of the legs. Results During the season, 72 acute non-contact leg injuries occurred, 20 in the intervention group and 52 in the control group. The injury incidence per 1000 hours playing and practise in the intervention group was 0.65 (95% confidence interval 0.37 to 1.13) and in the control group was 2.08 (1.58 to 2.72). The risk of non-contact leg injury was 66% lower (adjusted incidence rate ratio 0.34, 95% confidence interval 0.20 to 0.57) in the intervention group. Conclusion A neuromuscular training programme was effective in preventing acute non-contact injuries of the legs in female floorball players. Neuromuscular training can be recommended in the weekly training of these athletes. Trial registration Current Controlled Trials ISRCTN26550281.

Background:Low levels of physical activity (PA) and poor fitness tend to predict a decline in mobility. The current study investigated whether PA modifies the predictive value of health-related fitness (HRF) tests on difficulty in walking 2 km (WD).Methods:PA was assessed by self-reported questionnaires in 1990 and 1996. Subjects age 55 to 69 years and free of self-reported WD participated in assessment of HRF in 1996. Occurrence of WD was assessed by questionnaire in 2002 (n = 537).Results:There were no statistically significant interactions between PA and HRF tests; thus, PA and HRF were both independent predictors of WD. Regardless of the PA level, the subjects in the poorest performing third in each HRF test had higher risk of WD than the subjects in the best performing third.Conclusions:PA and HRF seemed to be independent predictors of WD, although the association of PA with WD was weaker than the association of HRF. Thus, PA did not modify the predictive value of HRF on WD.

This 10-year follow-up evaluated the effect of physical activity and calcium intake on proximal femur bone mass (BMC) and structural indices (CSA and Z) and physical performance. A cohort of 133 premenopausal and 134 postmenopausal women with contrasting levels of physical activity (high [PA+]) and low [PA-]) and calcium intake (high [Ca+] and low [Ca-]) was measured with DXA at baseline and 5 and 10 years thereafter. Among premenopausal women, the mean (95% CI) femoral neck BMC was 3.8% (-0.1 to 7.8%) and the trochanter BMC 6.7% (2.4 to 11.3%) greater in the PA+ group than the PA- group. There was no difference between the Ca-intake groups. Among postmenopausal women, the mean femoral neck BMC was 4.2% (-0.2 to 8.8%) greater in the Ca+ group than in the Ca- group and 6.9% (2.2 to11.8%) greater in the PA+ group than in the PA- group. For trochanter BMC, the corresponding differences were 2.7% (-1.6 to 7.2%) and 5.5% (0.9 to 10.3%). The mean differences in CSA and Z were 3.8% (-0.9 to 8.7%) and 4.4% (-2.1 to 11.4%) in favor of the Ca+ group and 6.8% (1.9 to 12.0%) and 9.6% (2.5 to 17.1%) in favor of the PA+ group, respectively. Proximal femur BMC declined generally, but the initial differences between the physical activity and the calcium intake groups were maintained. High calcium intake seemed to slow the decline in trochanter BMC in premenopausal women, while high physical activity was beneficial for proximal femur, particularly among older women.

Background and aims: Health-related fitness (HRF) tests are valid predictors of self-reported mobility difficulties among high-functioning older adults. The aim of the present study was to identify optimal cut-off values for HRF tests predicting self-reported difficulties in walking 2 km (WD). Methods: Subjects were 55- to 69-year-old men and women who were free of WD at baseline. The HRF assessment in 1996 included seven test items, and postal questionnaires were used to assess occurrence of new WD in 2002. Analysis of covariance and receiver-operating characteristic analysis were used as statistical methods. Results: In a 1-km walk, the sensitivity and specificity at the optimal cut-off 10:15 (min:s) for men were 63% and 75%, and at the cut-off 10:47 for women 70% and 71%. In dynamic back extension, the sensitivity and specificity at the optimal cut-off 16.5 (repetitions) were 67% and 65% in men and 82% and 59% at cut-off 13.5 in women. Correspondingly, in backward walking, the sensitivity and specificity at the optimal cut-off 27.7 (seconds) were 65% and 69% in men and 74% and 61% at cut-off 35.0 in women. Conclusions: The 1-km walk, dynamic back extension and backward walking tests had the best predictive value for WD. These tests, with identified cut-off values, can be used to screen individuals who are at increased risk of WD. Tests can also be used in physical activity counseling to target activity to those components of HRF that indicate poor fitness and are important for good walking ability.

This 5-year prospective study assessed changes in trabecular and cortical volumetric bone density at the non-weight-bearing radius and weight-bearing tibia among clinically healthy pre- and postmenopausal women. Altogether 79 premenopausal (mean age +/- SD at baseline 33 +/- 2 years) and 108 postmenopausal (68 +/- 2 years) women participated in the baseline and follow-up measurements. Trabecular density (TrD) of the distal radius and tibia and cortical density (CoD) of the radial and tibial shafts were assessed by peripheral quantitative computed tomography (pQCT). Repeated measures analysis of variance was used to analyze differences of means and mean changes between the age groups. As expected, TrD and CoD values were greater among premenopausal than postmenopausal women. Changes in radial TrD were similar in both age groups: mean (95% confidence interval) TrD of the distal radius declined by 3.0 mg/cm(3) (-0.9 to 7.0) and 5.1 mg/cm(3) (1.8-8.5) in the younger and older age groups, respectively. The respective declines in TrD of the distal tibia were 4.1 mg/cm(3) (2.1-6.0) and 2.8 mg/cm(3) (1.2-4.3). Decline in CoD was greater in the older than younger age group at both the radial and tibial shafts (P0.001). The mean absolute declines in radial CoD were 33.3 mg/cm(3) (27.9-38.7) and 49.4 mg/cm(3) (44.9-53.9) in younger and older women, and the declines in tibial CoD were 16.5 mg/cm(3) (12.6-20.2) and 28.1 mg/cm(3) (25.0-31.2), respectively. In conclusion, volumetric TrD in the weight-bearing tibia and non-weight-bearing radius showed similar age-related declines among pre- and postmenopausal women, while the decline in CoD was greater among postmenopausal women.

To evaluate the validity of a health-related fitness (HRFI) test battery with respect to physical activity (PA), we studied how PA patterns of adults are related to different components off HRFI with special interest in musculoskeletal and motor fitness. Subjects (n = 498) were middle-aged (37-57 years) men and women, evenly selected from five age cohorts of a representative population sample. PA was assessed with a questionnaire and classified into three PA groups. Fitness assessment included 9 simple field tests. The odds ratio of low fitness (least fit 40 %) of the measured dimension of HRFI for three PA groups with reference to inactive group were analysed. All PA groups were strongly related to Walk Test results in both genders, and to BMI in women. Muscular type exercise was associated with modified push-ups strength and static back extension endurance in both genders, and with one-leg standing balance in women. One-leg squat for leg strength, jump-and-reach for leg power, trunk side-bending flexibility and hamstring muscle extensibility tests were not associated with PA. Five of the nine fitness tests demonstrated plausible associations with PA patterns among adults suggesting activity-related validity. An exercise intervention study is needed to evaluate the sensitivity of the tests to fitness changes.

A 2-km walking test was developed previously to predict maximal oxygen uptake (Vo2max) in field conditions. The prediction is based on the time required for the 2-km fast walk, heart rate at the end of the walk, age and body mass index. This study examined the effects of the walking speed on the prediction of Vo2max in 111 moderately to highly active 35- to 55-year-old adults. The Vo2max was determined in an uphill walk-run on a treadmill. Five 2-km walking tests were conducted on a flat outdoor course. The first two were performed at the maximal speed and the remaining at submaximal speeds of 60%, 70% and 80% of the maximal heart rate. All tests underpre-dicted the measured Vo2max. A walking speed corresponding to 80% of the maximal heart rate or more resulted in the most accurate prediction of maximal aerobic power.

The health-related physical activity of Finns was studied during the 1980s by analysing changes in activity in a 10-year follow-up of a representative population cohort aged 20–65 years at the onset of the study. The proportion of apparently healthy people exercising at least twice a week for fitness and health increased from about 40% to over 50%. The increase was particularly large among women and young people. Occupational physical activity, education and marital status did not affect the trends. In contrast, regular vigorous exercise remained unchanged. These findings are consistent with other observations showing a steady increase in health-related physical activity among adult Finns during the past 20 years. However, in terms of the health potential of exercise, a majority of the population remains less than optimally active.

This work examined whether prediction models based on a 2-km walking test are valid for predicting the Vo2max of middle-aged, healthy, moderately to highly physically active adults. Sixty-seven 35- to 45-year-old moderately active men and women and 44 35- to 55-year-old healthy men who participated regularly in marathon-long sports competitions were studied. Vo2max was determined in an uphill walk-run on a treadmill. The 2-km walking test was conducted on a flat outdoor course. The subjects walked the distance as fast as they could. Walking time, heart rate at the end of the walk, age and body mass index were entered in the prediction formulas as established in the original study. The total errors of prediction and the correlation coefficients between the measured and predicted Vo2max (ml-kg−1 min−1) for the moderately active women and men and for the competitors were 5.2, 5.7 and 7.7 ml kg−1 min−1 and 0.55, 0.79 and 0.60, respectively. The measured relative Vo2max was slightly underpredicted in all groups. The results suggest that the 2-km walk test is a reasonably valid test of maximal aerobic power for moderately fit men and women, but less valid for very fit individuals.

This study showed that combination of strength, balance, agility and jumping training prevented functional decline and bone fragility in home-dwelling elderly women. The finding supports the idea that it is possible to maintain good physical functioning by multi-component exercise program and thus postpone the age-related functional problems. This 1-year randomized, controlled exercise intervention trial assessed the effects of two different training programs and their combination on physical functioning and bone in home-dwelling elderly women. One hundred and forty-nine healthy women aged 70–78 years were randomly assigned into: group 1—resistance training (RES), group 2—balance-jumping training (BAL), group 3—combination of resistance and balance-jumping training (COMB), and group 4—controls (CON). Self-rated physical functioning, leg extensor force, dynamic balance, and bone mass and structure were measured. Self-rated physical functioning improved in the COMB group, but was reduced in the CON group; the mean inter-group difference was 10% (95% CI: 0–22%). Mean increase in the leg extensor force was higher in the RES (14%; 4–25%) and COMB (13%; 3–25%) compared with the CON groups. Dynamic balance improved in the BAL (6%; 1–11%) and in the COMB (8%; 3–12%) groups. There were no inter-group differences in BMC at the proximal femur. In those COMB women who trained at least twice a week, the tibial shaft structure weakened 2% (0–4%) less than those in the CON group. Strength, balance, agility, and jumping training (especially in combination) prevented functional decline in home-dwelling elderly women. In addition, positive effects seen in the structure of the loaded tibia indicated that exercise may also play a role in preventing bone fragility.

Study design A randomized controlled study with 12 months intervention. Objective To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone (NZ) and behavior modeling as secondary prevention of low back pain (LBP) and disability. Summary of background data Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability. In addition, cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability. Methods Middle-aged working men with recent LBP but without severe disability were randomly allocated to either a training (TG, n = 52) or control group (CG, n = 54). The aim was to exercise twice a week for 12 months, once guided and once independently. The outcome measures were the changes in intensity of LBP, disability, self-evaluated future work ability, and neuromuscular fitness. Results The intensity of LBP decreased significantly more (39%) in the TG than in CG at 12 months. The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months; however, the proportion was significantly bigger in TG compared with CG (P = 0.028). There effects on disability indexes and fitness were not statistically significant. Conclusions Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men.

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.

Background and aims: The functional independence of elderly populations deteriorates with age. Several tests of physical performance have been developed for screening elderly persons who are at risk of losing their functional independence. The purpose of the present study was to investigate whether several components of health-related fitness (HRF) are valid in predicting the occurrence of self-reported mobility difficulties (MD) among high-functioning older adults. Methods: Subjects were community-dwelling men and women, born 1917–1941, who participated in the assessment of HRF [6.1-m (20-ft) walk, one-leg stand, backwards walk, trunk side-bending, dynamic back extension, one-leg squat, 1-km walk] and who were free of MD in 1996 (no difficulties in walking 2km, n=788; no difficulties in climbing stairs, n=647). Postal questionnaires were used to assess the prevalence of MD in 1996 and the occurrence of new MD in 2002. Logistic regression analysis was used as the statistical method. Results: Both inability to perform the backwards walk and a poorer result in it were associated with risk of walking difficulties in the logistic model, with all the statistically significant single test items included. Results of 1-km walk time and one-leg squat strength test were also associated with risk, although the squat was statistically significant only in two older birth cohorts. Regarding stair-climbing difficulties, poorer results in the 1-km walk, dynamic back extension and one-leg squat tests were associated with increased risk of MD. Conclusions: The backwards walk, one-leg squat, dynamic back extension and 1-km walk tests were the best predictors of MD. These tests are recommended for use in screening high-functioning older people at risk of MD, as well as to target physical activity counseling to those components of HRF that are important for functional independence.

Isothermal vapor−liquid equilibrium of the six binary systems 2-propanone + n-butane, + 2-methylpropane, + 1-butene, + cis-2-butene, + 2-methylpropene, + trans-2-butene were measured from (364.1 to 365.46) K with an automated static total pressure apparatus. Measured pTz data was reduced into pTxy data using the Barker method. Error analysis was conducted for all measured and calculated data. All measured systems exhibited positive deviation from Raoult's law, and an azeotropic point was found for the n-butane + 2-propanone system. Parameters of Wilson and UNIQUAC activity coefficient models were regressed with the experimental VLE data. Results obtained with two predictive methods, UNIFAC and COSMO-RS, were compared with measured data.

Objectives To examine the effectiveness of prescription-based counseling and self-monitoring in the promotion of physical activity in primary health care. Methods The study was conducted in Finland during 2003–2004. Physicians from 24 health care units (N = 67) were randomized to a prescription or a non-prescription group. The patients (N = 265) were assigned to the groups according to their physician. Every other patient of the non-prescription physicians received a pedometer and a physical activity log (MON) and feedback about their 5-day-recordings, the rest served as controls (CON). PA was assessed prior and 2 and 6 months after the physician's appointment with a questionnaire. Results The mean increase in weekly overall physical activity at 2 months was 1.0 (95% CI 0.0 to 2.0) session more in the prescription group than in controls. In at least moderate-intensity physical activity, the mean difference in changes was 0.8 (95% CI 0.1 to 1.5) sessions at 2 months and 0.9 (95% CI 0.2 to 1.5) sessions at 6 months for the favor of the prescription group. Compared to controls, self-monitoring increased the weekly duration of overall PA at 2 months on average by 217 min (95% CI 23 to 411). Conclusions Prescription can be recommended as a tool for primary health care physicians to promote physical activity. Self-monitoring with an expert feedback can be useful in increasing especially the weekly duration of overall physical activity in the short term.

Physically well recovered traumatically brain injured (TBI) patients complain of impaired motor performance, which may not be apparent in conventional neurological examination. A reliable test battery measuring mild physical impairment in TBI populations would be a welcome tool for clinical practice. The aim of this study was to evaluate the test–retest reliability of static and dynamic balance, running in a figure-of-eight (agility) and rhythm co-ordination tests. Thirty-four well-recovered TBI inpatients and 36 healthy male volunteers were tested on two occasions. The change in the mean, the typical error and the intra-class correlation coefficient (ICC) were used as statistics of reliability for continuous measurements and Cohen's kappa coefficient for categorical variables. The best result of consecutive trials within each test showed the best reliability. In the tandem walking tests and running figure-of-eight tests, the reliability was lower in the TBI group than in the controls but still good. The ...

Isothermal VLE for six binary systems 1-propanol + 1-butene, + cis-2-butene, + 2-methyl-propene, + trans-2-butene, + n-butane, and + 2-methyl-propane was measured from (318.6 to 331.9) K with a static total pressure apparatus. The Barker method was used to calculate the concentrations of vapor and liquid phases from measured pressure and the total amounts of components injected into the measurement cell. Error analysis was conducted for measured pTz data. Binary interaction parameters were optimized for the Legendre polynomial, Wilson, and UNIQUAC activity coefficient models. Interaction parameters for the relatively new UNIQUAC association model were also fit. Good agreement was found between literature VLE data and values measured in this work. The performance of the UNIQUAC association model was found to be better than that of the traditional UNIQUAC model for all measured mixtures.

Exercise is recommended to enhance bone health but data on the maintenance of the exercise-induced bone benefit is sparse. The purpose of the study was to assess the maintenance of the musculoskeletal benefits obtained in an 18-month intervention of high-impact exercise in premenopausal women (34 former trainees and 31 controls). Physical performance and areal bone mineral density (aBMD, g/cm2) were measured at baseline, after 18 months, and after 5 years. All significant 18-month improvements relative to controls in the trainees' neuromuscular performance (isometric leg press, and vertical jump with and without additional 10% weight of the body mass) had been lost at the 5-year follow-up. However, since the changes in aBMD in both former trainees and controls by time were similar, the exercise-induced aBMD gain (i.e. the mean statistically significant intergroup differences of 1-3% in favor of the trainees) was maintained at the femoral neck, distal femur, patella, proximal tibia, and calcaneus at the 5-year follow-up. At lumbar spine, the difference was 1.7% at both 18-month and at the 5-year follow-ups but the difference was not statistically significant (NS) in the latter follow-up. At the trochanter and unloaded distal radius, the intergroup aBMD differences were NS at both the 18-month and 5-year follow-ups. In conclusion, the bone sites aBMD increased in response to the 18-month intervention, also demonstrated maintenance of this gain 3.5 years after the intervention. In contrast, the exercise-induced improvements in the neuromuscular performance vanished during the post intervention follow-up. These findings suggest the possibility of long-term bone benefits of high-impact training in women.

Malmberg JJ, Miilunpalo SI, Vuori IM, Pasanen ME, Oja P, Haapanen-Niemi NA. A health-related fitness and functional performance test battery for middle-aged and older adults: feasibility and health-related content validity. Arch Phys Med Rehabil 2002;83:666-77. Objective: To evaluate the feasibility and health-related content validity of 6 health-related fitness (HRF) and 3 functional performance (FP) tests among middle-aged and older persons. Design: Cross-sectional methodologic study. Setting: Field laboratories in 3 communities of northeast Finland. Participants: A regionally representative, community-based cohort of 55- to 79-year-old men (n=501) and women (n=632). Interventions: Not applicable. Main Outcome Measures: Health-related test exclusion rates (%) by age groups and odds ratios (ORs) of subjective health outcomes by fitness categories (least 20%, next 40%, most fit 40%). Results: The health-related test exclusion rates increased with age, mainly because of musculoskeletal health limitations among the women and cardiovascular and musculoskeletal health limitations among the men. With the exception of dynamic back extension, 1-leg squat, 1-leg standing balance, and the 1-km walk among the women 75 years and older, 85% or more of the subjects qualified for the HRF tests and 95% or more for the FP tests. Strong and graded associations were found for cardiorespiratory and musculoskeletal fitness and the FP test levels with perceived health and functional ability status among both the men and the women (OR range, 2-31). The motor fitness test level was primarily associated with functional ability status. Conclusions: All the HRF and FP tests showed health-related content validity, and 4 of 6 of the HRF tests and all of the FP tests proved to be safe, with minor health-related test exclusions for middle-aged and older adults. The findings may help to target physical activity intervention toward persons at high risk for declining health and functional ability. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

We compared the effects of one vs two daily bouts of walking on aerobic fitness and body composition in postmenopausal women. One hundred and thirty-four subjects were randomized into exercise groups or a control group and 130 completed the study. The subjects walked 5 d/week for 15 weeks at 65% of their maximal aerobic power expending 300 kcal (1255 kJ) in exercise in one (Group S1) or two daily sessions (Group S2). VO(2max) was measured in a direct maximal treadmill test. Body mass index (BMI) was calculated and the percentage of body fat (fat%) estimated using skinfold measurements. The net change in the VO(2max) was 2.5 mL min/kg (95% CI 1.5, 3.5) (8.7%) in Group S1 and 2.5 mL min/kg (95% CI 1.5, 3.5) (8.8%) in Group S2. The net change in body mass was -1.2 kg (95% CI-1.9, -0.5) in Group S1 and -1.1 kg (95% CI -1.8, -0.4) in Group S2. The net fat% change was -2.1% (95% CI-2.7, -1.4) in Group S1 and -1.7% (95% CI-2.3, -1.0) in Group S2. Exercise improved the maximal aerobic power and body composition equally when walking was performed in one or two daily bouts.

The purpose of this cross-sectional study was to examine the impact of long-term physical activity (PA) and calcium intake on non-weight-bearing radius and weight-bearing tibia. Altogether, 218 healthy, nonsmoking women, [92 premenopausal women, mean age, 32.6 years (SD, 2.2 years), and 126 postmenopausal women, mean age, 67.3 years (SD, 2.0 years)] participated. The subjects were divided according to their habitual levels of physical activity (PA+ or PA-) and calcium intake (Ca+ or Ca-). The distal end and shaft regions of the radius and tibia were evaluated with peripheral quantitative tomography (pQCT). For the shaft regions, bone mineral content (BMC), cortical cross-sectional area (CoA), cortical density (CoD), and bone strength index, that is, 1-11.9% of the density-weighted section modulus (BSI) were determined. For the distal ends, BMC, total cross-sectional area (ToA), trabecular density (TrD), and BSI were determined. The BMC at the distal radius in the young PA+ group was 6.6% (95% CI, 1- to 11.9%) lower than that of the PA- group. A similar nonsignificant trend was found for the radial shaft. The radial shaft showed a mechanically more competent structure among the older subjects with a BSI 8.5% (95% CI, 1.8-15.6%) higher in the older PA+ group than in the older PA- group. The associations between calcium intake and the radial bone characteristics were systematically positive in both age groups. PA seemed to benefit the distal tibia. In the younger age group the TrD was 6.9% (95% CI, 1.8-12.4%) higher in the PA+ group, and in the elderly the BMC was 5% (95% CI, 0.3-9.9%) higher in the PA+ group than in the PA- group. Note that in the younger age group the ToA was 5.1% (95% CI, 0-9.1%) smaller in the PA+ group than in the PA- group, and in the older age group the ToA was 4.2% (95% CI, -0.3-8.9%) greater in the PA+ group than in the PA- group. The association of PA and bone characteristics at the tibial shaft was positive in both age groups (statistically significant for the older subjects). The tibial shaft BSI of the older PA+ group was 8.6% (95% CI, 2.6-14.9%) better than that of the old PA- group. There was no association between calcium intake and the tibial bone characteristics in either age group. In conclusion, high calcium intake was positively associated with a mechanically competent structure in the radius among both younger and older women, whereas the influence of PA did not become apparent until older ages. PA seemed to benefit particularly the weight-bearing tibia, whereas calcium intake was not associated with the tibia.

Summary This randomized cross-over study was designed to investigate the effects of a 4-min vibration bout on muscle performance and body balance in young, healthy subjects. Sixteen volunteers (eight men, eight women, age 24‐33 years) underwent both the 4-min vibration- and sham-interventions in a randomized order on different days. Six performance tests (stability platform, grip strength, isometric extension strength of lower extremities, tandem-walk, vertical jump and shuttle run) were performed 10 min before (baseline), and 2 and 60 min after the intervention. The effect of vibration on the surface electromyography (EMG) of soleus, gastrocnemius and vastus lateralis muscles was also investigated. The vibration-loading, based on a tilting platform, induced a transient (significant at the 2-min test) 2AE5% net benefit in the jump height (Pa 0AE019), 3AE2% benefit in the isometric extension strength of lower extremities (Pa 0AE020) and 15AE7% improvement in the body balance (Pa 0AE049). In the other 2-min or in the 60-min tests, there were no statistically significant differences between the vibration- and sham-interventions. Decreased mean power frequency in EMG of all muscles during the vibration indicated evolving muscle fatigue, while the root mean square voltage of EMG signal increased in calf muscles. We have shown in this study that a single bout of whole body vibration transiently improves muscle performance of lower extremities and body balance in young healthy adults.

The purpose of this study was to evaluate the test-retest and inter-rater reliability of nine selected tests for the following basic motor skills: balance, orientation, sense of rhythm, kinaesthetic precision and flexibility. Twenty-five healthy, non-sporting volunteers (14 men, 11 women, aged 36-72 years) were tested in three sessions at one-week intervals by two raters. For the tests of balance on a bar, tandem walking backwards and forwards and ball bouncing, the within-participant and between-session repeatability, as assessed by the intraclass correlation coefficient (ICC), was high (ICC 0.83-0.96), and for the rhythm test it was fair (ICC 0.70). The inter-rater reliability was also high for all the tests (ICC 0.88-0.96) except that for rhythm (ICC 0.76). In a test-retest design, these tests were sensitive enough to produce sufficient variation between participants in terms of differentiating between individuals. The learning effect was the most remarkable between the pretest and test sessions, and the reliability was better for the test-retest session although a statistically significant difference existed only for tandem walking forwards (p

This prospective study focused on lifestyle factors and weight maintenance that may modulate the rate of bone loss at the weight-bearing proximal femur and non-weight-bearing distal radius in elderly women. Altogether 128 women of 134 subjects participated in this study with a mean follow-up time 3.9 years (range 2.9–5.3 years). The initially 60- to 65-year-old subjects were originally selected by their level of physical activity [high (PA+) and low (PA–)] and calcium intake [high (Ca+) and low (Ca–)], and the original groups were maintained in this study. Physical fitness and bone mineral content (BMC) decreased significantly at a similar rate in all four study groups without any statistically significant between-group difference. The mean change in the muscle strength of leg extensors was −3.3% (95% CI −5% to −1.5 %) at follow-up when including all individuals. The leg extension strength was still 9.2% (95% CI 2.7% to 16.1%) better in the PA+ groups compared with PA– groups at follow-up. The mean change in the forearm flexion strength was −14% (95% CI −16.5% to −11.3%) at follow-up with no difference in the strength level between PA+ and PA– groups. The mean change in the estimated oxygen uptake was −3.4% (95% CI −5.6% to −1.1%) at follow-up. The PA+ groups were still fitter, the between-group difference in the estimated oxygen uptake being 11.9% (95% CI 4.8% to 19.5%). The mean changes in BMC at follow-up were −2.1% (95% CI −3.0% to −1.2%) at the femoral neck, −1.9% (95% CI −3.2% to −0.5%) at the trochanter, and −12.4% (95% CI −15.4% to −9.4%) at the distal radius, indicating mean annual losses of 0.6% (95% CI 0.3% to 0.8%), 0.5% (95% CI 0.1% to 0.8%), and 3.2% (95% CI 2.4% to 4.0%), respectively. Decreased body weight was associated with higher bone loss in all measured bone sites. High calcium intake and better preservation of physical fitness were associated with a smaller decrease in femoral neck BMC.

Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external hip protector on the risk of these age-related fractures.We randomly assigned 1801 ambulatory but frail elderly adults (1409 women and 392 men; mean age, 82 years), in a 1:2 ratio, either to a group that wore a hip protector or to a control group. Fractures of the hip and all other fractures were recorded until the end of the first full month after 62 hip fractures had occurred in the control group. The risk of fracture in the two groups was compared, and in the hip-protector group the risk of fracture was also analyzed according to whether the protector had been in use at the time of a fall.During follow-up, 13 subjects in the hip-protector group had a hip fracture, as compared with 67 subjects in the control group. The respective rates of hip fracture were 21.3 and 46.0 per 1000 person-years (relative hazard in the hip-protector group, 0.4; 95 percent confidence interval, 0.2 to 0.8; P=0.008). The risk of pelvic fracture was slightly but not significantly lower in the hip-protector group than in the control group (2 subjects and 12 subjects, respectively, had pelvic fracture) (relative hazard, 0.4; 95 percent confidence interval, 0.1 to 1.8; Por = 0.05). The risk of other fractures was similar in the two groups. In the hip-protector group, four subjects had a hip fracture (among 1034 falls) while wearing the protector, and nine subjects had a hip fracture (among 370 falls) while not wearing the protector (relative hazard, 0.2; 95 percent confidence interval, 0.05 to 0.5; P=0.002).The risk of hip fracture can be reduced in frail elderly adults by the use of an anatomically designed external hip protector.

Endurance-trained athletes have increased heart rate variability (HRV), but it is not known whether exercise training improves the HRV and baroreflex sensitivity (BRS) in sedentary persons. We compared the effects of low- and high-intensity endurance training on resting heart rate, HRV, and BRS. The maximal oxygen uptake and endurance time increased significantly in the high-intensity group compared with the control group. Heart rate did not change significantly in the low-intensity group but decreased significantly in the high-intensity group (−6 beats/min, 95% confidence interval; −10 to −1 beats/min, exercise vs. control). No significant changes occurred in either the time or frequency domain measures of HRV or BRS in either of the exercise groups. Exercise training was not able to modify the cardiac vagal outflow in sedentary, middle-aged persons.

Genetic polymorphism of apolipoprotein E (apoE) is an important factor in the development of coronary artery disease but the results concerning apoE genotype and carotid artery atherosclerosis remain controversial. We investigated a random sample of 189 Finnish middle aged men (mean age 54 years, range 50-59) to assess the role of apoE in the process of carotid atherosclerosis. Intima-media thickness (IMT) of the carotid artery wall was measured at three standardised segments (common carotid artery, bifurcation and internal carotid artery) by B-mode ultrasonography. Overall mean IMT value was also calculated. The carriers of E3/2 (n=20) genotype had significantly lower (P

To investigate the independent associations and the possible interaction of body mass index (BMI), leisure time physical activity (LTPA) and perceived physical fitness and functional capability with the risk of mortality.Prospective 16y follow-up study.A regionally representative cohort of 35-63-y-old Finnish men (n= 1,090) and women (n= 1,122).All-cause, cardiovascular disease (CVD) and coronary heart disease (CHD) mortality were derived from the national census data until the end of September 1996 while the initial levels of BMI, LTPA, physical fitness and function were determined from self-administered questionnaires.After adjustment for age, marital and employment status, perceived health status, smoking and alcohol consumption, the Cox proportional hazards model showed that BMI was not associated with the risk of death among the men or the women. Compared with the most active subjects the men and women with no weekly vigorous activity had relative risks of 1.61 (95% confidence interval, CI, 0.98-2.64) and 4.68 (95% CI, 1.41-15.57), respectively, for CVD mortality, and for the men there was a relative risk of 1.66 (95% CI, 0.92-2.99) for CHD mortality. When compared with the men who perceived their fitness as better than their age-mates, the men with the 'worse' assessment had a relative risk of 3.29 (95% CI, 1.80-6.02) for all-cause mortality and 4.37 (95% CI, 1.80-10.6) for CVD mortality. Men with at least some difficulty in walking a distance of 2 km had a relative risk of 1.62 (95% CI, 1.05-2.50) for all-cause mortality when compared with those who had no functional difficulties. In addition, in the comparison with subjects with no functional difficulties, the men and women who had some difficulty climbing several flights of stairs had relative risks of 1.47 (95% CI, 0.97-2.23) and 2.39 (95% CI, 1.25-4.60) for all-cause mortality, respectively. For CVD mortality the relative risks were 1.85 (95% CI, 1.04-3.30) and 3.38 (1.22-9.41), respectively.Although BMI did not prove to be an independent risk factor for mortality from CVD, CHD or from all causes combined, perceived physical fitness and functional capability did. An increase in LTPA seems to have a similar beneficial effect on the mortality risk of obese and nonobese men and women, and the effect also seems to be similar for fit and unfit subjects.

The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (chi 2 = 43.6, d.f. = 15, p0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen 'obliquely forward' (43% and 38%) or 'to the side' (29% and 26%), whereas in the wrist fracture group the main fall direction was also 'obliquely forward' (34%) but the other fall directions (i.e., 'forward', 'to the side', 'obliquely backward' and 'backward') were quite equally represented (13-19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4-9.2), as compared with the fall directions of the controls and the 'obliquely backward' fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0-7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14-0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19-1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection.

To study the effects of regular walking during a golf game on various health and fitness indicators in middle-aged men.Study subjects were 55 healthy male golfers aged 48 to 64 years who had been sedentary during the 7 months before the study, and 55 age-matched, similarly sedentary controls. During the 20-week study, those in the intervention group were encouraged to play golf two to three times a week; the controls were not. Measurements of body composition, cardiorespiratory performance, motor and musculoskeletal fitness, blood pressure, and serum lipid, glucose, and insulin levels were obtained at baseline and after the 20-week study.Walking during a golf game was a practical and safe form of physical activity with high adherence. It significantly increased aerobic performance and trunk muscle endurance, with a net difference (pretraining to posttraining change between the golfers and controls) of 36 seconds (95% confidence interval [CI]: 19 to 53 seconds, P0.001) for treadmill walking time and 13 seconds (95% CI: 2 to 24 seconds, P = 0.02) for static back extension. In addition, regular walking favorably affected body composition, including reductions in weight of 1.4 kg (95% CI: 0.6 to 2.1 kg, P0.001), in waist circumference of 2.2 cm (95% CI: 1.0 to 3.3 cm, P0.001), and in abdominal skin fold thickness of 2.2 cm (95% CI: 0.9 to 3.4 cm, P = 0.001). Golfers also had significantly greater increases in serum high-density lipoprotein (HDL) cholesterol levels and in the ratio of HDL cholesterol to total cholesterol.Regular walking had many positive effects on the health and fitness of sedentary middle-aged men. Walking during a golf game is characterized by high adherence and low risk of injury and is therefore a good form of health-enhancing physical activity.

To determine the long-term outcome of patients treated nonoperatively for acute or subchronic (duration of the symptoms before initiation of the treatment less than 6 months) Achilles tendinopathy, we performed a follow-up analysis on 83 of 107 patients an average 8 2 (SD) years after the initial contact. The analysis included a questionnaire, clinical examination, performance tests, muscle strength measurement, and ultrasonographic examination. Twenty-four of the 83 patients (29%) had to be operated on during the follow-up period. Seventy patients (84%) had full recovery of their activity level, and at 8 years' follow-up 78 patients (94%) were asymptomatic or had only mild pain with strenuous exercise. However, a clear side-to-side difference between the involved and the uninvolved sides was observed on the performance test, clinical examination, and ultrasonography. Also, 34 patients (41%) started to suffer from overuse symptoms in the initially uninvolved Achilles tendon. The results of our 8-year follow-up showed that the long-term prognosis of patients with acute-to-subchronic Achilles tendinopathy is favorable as determined by subjective and functional assessments. In the clinical and ultrasonographic examinations, mild-to-moderate changes were observed rather frequently in both the involved and initially uninvolved Achilles tendons, but the occurrence of these changes was not clearly related to the patients' symptoms.

This study evaluated the ability to use the relationship between heart rate (HR) and oxygen uptake (VO2) to estimate energy expenditure during physical activity (AEE). General prediction equations were established based on the individual relations between HR and AEE. Forty-two women, (mean age 38.1 [SD 9.8] years, BMI 23.9 [SD 4.4]), and 45 men (40.3 [SD 9.2] years, BMI 24.7 [SD 2.9]), carried out two incremental tests, one with a cycle ergometer and another on a treadmill. Subjects also performed a 10 minute steady-state exercise, cycling and walking. Respiratory gases were obtained from indirect calorimetry. AEE was calculated from VO2 and carbon dioxide production (VCO2). The predicted AEE was compared with the AEE measured during the steady-state exercise. Using the generalised linear model, two alternative models were found to predict AEE and HR. The first showed a three-way interaction between HR, body weight and gender (p = 0.022) and also between HR age and gender (p=0.083). The second produced a three-way interaction between HR, body weight and gender (p=0.057). For cycling and walking, respectively, the predicted AEE overestimated the actual AEE by 17.7 (SD 23.2)% and 6.2 (SD 19.3)% in the first model and by 17.9 (SD 22.7)% and 6.6 (SD 19.8)% in the second during the steady-state exercise. It was concluded that at least gender and body weight should be included when HR is used to predict AEE.

The purpose of this cross-sectional study was to examine whether long-term participation in recreational gymnastics or folk dancing or estrogen replacement therapy (ERT) is associated with mechanically more competent bones and improved muscular strength and body balance. One hundred and seventeen healthy, female postmenopausal recreational gymnasts (mean age 62.1 [SD 4.7] years) and 116 sedentary controls (mean age 61.5 [4.6] years) were enrolled in the study. Bone mineral content (BMC) of the distal radius, femoral neck, and trochanter were measured with dual-energy X-ray absorptiometry. BMC of the midshaft and distal tibia and trabecular density (TrD) of the distal tibia were measured with peripheral computed quantitative tomography. Maximal isometric strength, muscular power, cardiorespiratory fitness, and body balance of the participants were also assessed. The cardiorespiratory fitness, muscular strength, and dynamic balance of the recreational gymnasts and folk dancers combined were significantly better than those of the controls, the average group difference ranging from 7.5% (95% confidence interval 5.0-9.9%) in dynamic balance to 12.8% (6.6-19. 4%) in dynamic muscular power. ERT was not associated with the fitness indicators, muscular power, or balance, but was significantly associated with the BMC at all the measured bone sites, the mean group difference between estrogen users and nonusers ranging from 6.5% (3.7-9.3%) for the tibial shaft to 11.8% (6.4-17. 0%) for the distal radius. Recreational gymnastics, in turn, was significantly associated with higher BMC at the tibia only, the mean group difference being 3.9% (0.9-6.9%) for the tibial shaft and 7.7% (3.7-11.9%) for the distal tibia. Recreational gymnastics was also associated with higher TrD at the distal tibia (5.2%; 1.2-9.2%), whereas estrogen usage did not show such association. The results indicate that ERT seems especially effective in preventing postmenopausal bone loss, whereas recreational gymnastics and folk dancing improve muscular performance and body balance in addition to increased bone mass and bone size in the tibia. All these factors are essential in prevention of fall-related fractures of the elderly.

The purpose of this study was to evaluate whether premenopausal women's voluntary unsupervised aerobic and step training could maintain the skeletal benefits obtained by an 18-month supervised high-impact training, and if so, to what extent. Thirty women of the original 39 study subjects (i. e., persons who completed the preceding 18-month randomized training intervention and who volunteered to continue the training on their own for a further 8 months) and 19 women of the 45 original control subjects (i.e., persons who volunteered to continue as controls) were included. The study group trained an average of twice per week and the training consisted of regular aerobic and step classes provided by local fitness centers. Areal bone mineral density (BMD, g/cm2) was measured from the lumbar spine, femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, calcaneus, and dominant distal radius at baseline and after 18 and 26 months. During the extended 8-month follow-up, the BMD of the study group increased more at the femoral neck (the intergroup change was +0.9% at 18 months and +2.8% at 26 months, p = 0.004 for the change between 18 and 26 months) and remained at the 18-month level at the distal femur, patella, proximal tibia, and calcaneus. In these sites, the statistically significant changes during the entire 26 months of training were 1.7-4.0% in the training group as compared with the changes of -0.9-1.5% in the control group. In the lumbar spine, BMD decreased from the 18-month level in both groups. In conclusion, the significant BMD increases that were obtained by supervised 18-month high-impact training were effectively maintained with subsequent unsupervised regular aerobic and step classes (twice per week). The finding emphasizes the effectiveness and feasibility of self-controlled aerobic and step exercises in the primary prevention of osteoporosis among healthy premenopausal women.

High peak bone mass in early adulthood is an important protective factor against osteoporotic fractures in later life, but little is known about the effects of exercise on growing bone. The purpose of this cross-sectional study was to determine at which state of maturity (Tanner stage), the areal bone mineral density (BMD) differences between the playing and nonplaying arms of junior tennis players become obvious, and to clarify in each developmental stage which training and background variables, if any, could explain the interindividual differences in bones' response to mechanical loading. Ninety-one 7- to 17-year-old female tennis players and 58 healthy female controls were measured. In each Tanner stage, differences in BMD in playing and nonplaying (dominant and nondominant) arms (proximal humerus, humeral shaft, and distal radius) and BMD of the lumbar spine and nondominant distal radius were compared between the controls and players. Within each Tanner stage of players, the associations between training and background variables and BMD differences were analyzed with Spearman rank correlation coefficients. In players, BMD differences between the playing and nonplaying arms were significant (P < 0.05- < 0.001) in all Tanner stages, with the mean difference ranging from 1.6 to 15.7%. In controls, these dominant-to-nondominant arm differences were clearly smaller (ranging from -0.2 to 4.6%), but significant at some measured sites. In comparison with the relative side-to-side arm differences between the players and controls (i.e., examination of the training effect), the mean difference was not obvious and significant until the adolescent growth spurt (i.e., the girls in Tanner stage III with a mean age of 12.6 years). In the lumbar spine, significant BMD differences between players and controls were not found until Tanner stage IV (mean age 13.5 years; 8.7%, P < 0.05) and V (mean age 15.5 years; 12.4%, P < 0.05). In a nonloaded site of the skeleton (nondominant distal radius), no significant BMD differences were found between the players and controls in any Tanner stage. In the correlation analysis, the Tanner I and II players (mean ages 9.4 and 10.8 years) showed no significant associations between any of the predictive variables and the side-to-side BMD differences, while in Tanner stages III, IV, and V, such associations could be found; the total amount of training hours during the playing career and the number of training sessions per week showed a significant and systematic correlation (rs ranging from 0.43 to 0.80) with the side-to-side BMD differences in several measured bone sites. In conclusion, this study suggests that in a majority of female junior tennis players, the benefit of unilateral activity on bone density does not become clearly evident until the adolescent growth spurt or Tanner stage III. The total amount of training during the player's career and the current training frequency (sessions per week) seem to best explain the training effect on bone tissue, leaving, however, room for speculation on the still unknown factors that modulate the loading response of a growing bone.

Background and Purpose. Health-related fitness (HRFI) assessment may be useful in promoting physical activity. Health-related fitness refers to those components of fitness that are related to health status. The safety and feasibility of a test battery designed for the assessment of HRFI were evaluated. Subjects and Methods. Middle-aged men (n=246) and women (n=254), evenly selected from five age cohorts of a random sample (N=826), were tested. The subjects had a mean age of 47.0 years (SD=7.9, range=37–57). Screening to identify subjects with health limitations was conducted by fitness testers who had master's degrees in sport or health sciences. Safety was assessed in terms of acute complications, delayed-onset muscle soreness (DOMS), and heart rate after each test. Subject exclusion and time costs were evaluated for feasibility. Results. No acute complications occurred. The leg function test caused severe DOMS among inactive women. The overall exclusion rate increased with age. Up to 27% of subjects aged 52 and 57 years were excluded from muscle endurance tests, mainly due to self-reported heart disease or elevated blood pressures. Over 90% of the subjects, however, qualified for balance, flexibility, muscle force, and walk tests. Conclusion and Discussion. The test battery offers a safe and feasible method for the assessment of HRFI in working-aged adults, with the limitation that the one-leg squat function test may cause DOMS, particularly in inactive women.

The hypothesis that a history of one or more weight reductions and regains (weight cycling) is associated with lower site-specific bone mineral density (BMD) was examined in 169 premenopausal women, aged 29-46 years. Data on the previous 10-years' weight cycling history, present weight-bearing physical exercise, number of deliveries, present use of contraceptive pills or hormone-releasing coils, age at menarche and present menstrual status were collected by a self-administered questionnaire. Dietary intake was calculated from food records. The areal BMD (g/cm2) was measured with dual-energy X-ray absorptiometry (Norland XR-26). The lumbar spine (L2-4) BMD, adjusted to weight and age at menarche (ANCOVA), was 0.062 g/cm2 (95% confidence interval: 0.015 to 0.011 g/cm2; p = 0.01) higher in the non-cyclers (n = 68) than in subjects with reported weight-cycling history (n = 101). The corresponding difference for femoral neck BMD was 0.019 g/cm2 (-0.018 to 0.056; p = 0.30), for trochanter BMD 0.013 g/cm2 (-0.025 to 0.05 g/cm2; p = 0.50) and for distal radius BMD 0.022 g/cm2 (0.006 to 0.397 g/cm2; p = 0.008). A pairwise comparison of 34 weight-matched subjects (non-cycler vs cycler) gave similar BMD differences as found in the above (ANCOVA) analyses. The results suggest that weight cycling might be associated with lower spine and distal radius BMD.

The validity of various self-reported health assessments in predicting physician contracts and all-cause mortality was investigated in a prospective study in Finland. The follow-up periods were one year for the use of physician services and ten years ten months for the mortality. The study cohort comprised 1340 men and 1500 women, 35-63 years of age at the beginning of the study. The initial health assessments were derived from postal questionnaires in 1980 (response rate 77.5%). The survey was repeated one year later to verify the stability of the respondents' perceived health status. The data on the physician contacts and mortality were registered independently. The stability of perceived health status was relatively good and the perceived health was inversely associated with the number of physician contacts per year. A consistent inverse association, standardized by age, sex and social status, was observed between perceived health status and perceived physical fitness and mortality, while the predictive value of self-reported chronic diseases was low. The results suggest that the subjective health assessments are valid health status indicator in middle-aged populations, and they can be used in cohort studies and population health monitoring.

OBJECTIVE: To determine whether habitual leisure time physical activity and body mass change of working-aged men and women are associated. DESIGN: Prospective 10 y follow-up study. SUBJECTS: A regionally representative cohort of 19–63 y old men (n=2564) and women (n=2695) in three municipalities in Finland. MEASUREMENTS: The main outcome measures were average body mass change during the 10 y of follow-up and the clinically significant body mass gain defined as a body mass gain of 5 kg or more during the follow-up and a body mass index of 26 or higher at the end of the follow-up. Leisure time physical activity was determined from self-administered questionnaires. RESULTS: After adjustment for the potential confounders, the logistic regression analysis showed that the men and women with no regular weekly activity at the end of the follow-up had an odds ratio of 2.59 (95% confidence interval, 1.69–3.97) and 2.67 (1.65–4.31), respectively for clinically significant body mass gain in comparison with the most active groups. The men who had decreased their activity during the 10 y follow-up had an odds ratio of 1.96 (1.39–2.75), and the men who were physically inactive all the time had an odds ratio of 1.62 (1.18–2.20) for clinically significant body mass gain when compared with the subjects who were active all the time. Among the women the odds ratios for clinically significant body mass gain after adjustment for potential confounders were 2.49 (1.72–3.60) and 1.61 (1.17–2.21), respectively. CONCLUSION: These findings are consistent with the hypothesis that regular physical activity prevents body mass gain and physical inactivity is a risk factor for body mass gain and obesity among adults.

To improve knowledge of the current trends in the number and incidence of age-related minor trauma knee fractures, we selected from the National Hospital Discharge Register all patients 60 years old or older who were admitted to Finnish hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985, 1988-1989 and 1991-1994 for primary treatment of first knee fracture. The knee fracture was defined to be a "minor trauma" fracture if it had occurred as a result of a fall from standing height or less. We also predicted fracture development until the year 2020 by a regression model, which took into account the predicted changes in fracture incidences and population at risk. The number and incidence (per 100,000 persons) of minor trauma knee fractures in Finnish women aged 60 years or more clearly increased during the study period, from 219 (number) and 55 (incidence) in 1970 to 579 and 100 in 1994. Women's age-adjusted incidence of these fractures also showed an increase, from 58/100,000 in 1970 to 93/100,000 in 1994. If this trend continues, there will be about 2 times more minor trauma knee fractures in Finnish women in the year 2020 than there were in 1994. In Finnish men aged 60 years or more the absolute numbers and incidences of these fractures did not show consistent trend changes over time. We conclude that the number of minor trauma knee fractures in elderly Finnish women in increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures should urgently be adopted to control the increasing burden of these age-related fractures.

To improve the knowledge of the current trends in the number and incidence of osteoporosis-related pelvic fractures, patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first osteoporotic pelvic fracture were selected from the National Hospital Discharge Register. The overall incidence (per 100,000 inhabitants) of osteoporosis-related pelvic fractures (high energy traumas were excluded) in a population aged 60 years or more was 20 in 1970 and 63 in 1991. The increase was most pronounced in the older age groups (patients aged 80 years or more) and was observed in both sexes. The proportion of these osteoporotic pelvic fractures of all pelvic fractures increased from 18% in 1970 to 52% in 1991. Similarly, the proportion of patients over 60 years of age increased from 28% in 1970 to 62% in 1991. In 1991, 78% of the patients with an osteoporotic pelvic fracture were women. Across the study period, the age-adjusted total incidence of osteoporotic pelvic fractures also increased in both women and men 60 years of age and over. The proportional increase was more pronounced in men. We conclude that the number of osteoporotic pelvic fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and that effective preventive measures are urgently needed to control the increasing number of these age-related fractures.