Cochrane Review on exercise for preventing and treating osteoporosis in postmenopausal women.
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Journal Article↗
Biomedical subjects
H C Kemper
Publications and source records attributed to H C Kemper.
Exercise for preventing and treating osteoporosis in postmenopausal women.
BACKGROUND: Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Prevention of osteoporotic-related fractures is dependent on the ability to detect individuals with low bone mass, including those women who are asymptomatic. Treatment of osteoporosis involves the use of either anti-resorptive (e.g. estrogen and bisphosphonate) or bone formation agents (e.g. fluoride and PTH). The value of exercise as an intervention for the prevention of postmenopausal bone loss is a controversial subject. OBJECTIVES: To examine the effectiveness of exercise therapy at preventing bone loss and fractures in postmenopausal women. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group's specialised register, MEDLINE, EMBASE, Current Contents and the Cochrane Controlled Trials Registry up to January 2000 according to the methods suggested by Dickersin et al and Haynes et al and the Cochrane Handbook. We hand searched reference lists and consulted content experts. SELECTION CRITERIA: This review was proceeded by a peer reviewed protocol published in the Cochrane Library. Two reviewers independently selected all randomized controlled trials (RCTs) which met our predetermined inclusion criteria. DATA COLLECTION AND ANALYSIS: The same two reviewers abstracted the data using predetermined forms and assessed trial quality using a validated assessment tool. For dichotomous outcomes (fractures), relative risks were calculated using fixed effects models. For continuous data, weighted mean differences (WMD) of the percentage change from baseline were calculated. Where heterogeneity existed (determined by a chi square test), a random effects model was used. MAIN RESULTS: Eighteen randomized controlled trials (RCTs) met the inclusion criteria. The trials had a mean methodological quality score of 2.53. Aerobics, weight bearing and resistance exercises were all effective on the BMD of the spine. The WMD for the combined aerobics and weight bearing program on the spine was 1.79 [95%CI (0.58, 3.01)]. The analyzed results showed walking to be effective on both BMD of the spine 1.31[95%CI (-0.03, 2.65) and the hip 0.92[95%CI (0.21, 1.64). Aerobic exercise was effective in increasing BMD of the wrist 1.22[95%CI (0.71, 1.74)]. REVIEWER'S CONCLUSIONS: Aerobics, weight bearing and resistance exercises are all effective in increasing the BMD of the spine in postmenopausal women. Walking is also effective on the hip. The quality of the reporting of the trials in the meta-analysis was low, in particular, in the areas of allocation concealement and blinding.
Exercise↗
Dutch Musculoskeletal Questionnaire: description and basic qualities.
A questionnaire ('Dutch Musculoskeletal Questionnaire', DMQ) for the analysis of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms in worker populations is described and its qualities are explored using a database of 1575 workers in various occupations who completed the questionnaire. The 63 questions on musculoskeletal workload and associated potentially hazardous working conditions can be categorized into seven indices (force, dynamic and static load, repetitive load, climatic factors, vibration and ergonomic environmental factors). Together with four separate questions on standing, sitting, walking and uncomfortable postures, the indices constitute a brief overview of the main findings on musculoskeletal workload and associated potentially hazardous working conditions. Homogeneity of the indices is satisfactory. The divergent validity of the indices is fair when compared with an index of psychosocial working conditions and discomfort during exposure to physical loads. Worker groups with contrasting musculoskeletal loads can be differentiated on the basis of the indices and other factors. With respect to the concurrent validity, it appears that most indices and factors show significant associations with low back and/or neck-shoulder symptoms. This questionnaire can be used as a simple and quick inventory for occupational health services to identify worker groups in which a more thorough ergonomic analysis is indicated.
Adult↗
A 15-year physical activity pattern is positively related to aerobic fitness in young males and females (13-27 years).
The purpose of this paper is to test the hypothesis that daily physical activity over a period of 15 years has been beneficial to aerobic fitness in young male and female participants (13-27 years) in the Amsterdam Growth and Health Longitudinal Study. Only subjects with the maximal data of six sets of measurements were included (83 male and 98 female participants). Daily physical activity was assessed using a standardized interview on activity and expressed as a weighted activity score. Aerobic fitness was assessed using a maximal running test on a treadmill and measuring the maximal oxygen uptake (VO2max) and the maximal slope of the track (Smax). To assess the longitudinal relationship between daily physical activity and aerobic fitness a real longitudinal analysis was carried out with generalized estimating equations, adjusting for differences in initial aerobic fitness at age 13, and for other lifestyle (dietary intake, smoking and alcohol consumption) and biological parameters (biological age, body fat, blood pressure and concentration of serum cholesterol). A significant relationship (P < 0.01) was observed between daily physical activity and both VO2max and Smax. It can be concluded that the development of aerobic fitness between the age of 13 and 27 years is independently and positively related to daily physical activity in this group of male and female participants in the study. The functional implications, however, are small: a relatively high increase in the weighted physical activity score of 30% over a period of 15 years results in a 2%-5% increase in aerobic fitness.
Adolescent↗
Clustering of risk factors for coronary heart disease. the longitudinal relationship with lifestyle.
PURPOSE: The purpose of this study was to investigate whether or not clustering of biological coronary heart disease (CHD) risk factors exists and to investigate the longitudinal relationship between lifestyle parameters (dietary intake, daily physical activity, smoking behaviour, alcohol consumption) and a biological CHD risk factor clustering score. This was defined as belonging to one or more gender specific 'high risk' quartiles for the following CHD risk factors: ratio between total serum cholesterol and high density lipoprotein cholesterol (TC:HDL), mean arterial blood pressure (MABP), body fatness [sum of skinfolds (SSF)], and cardiopulmonary fitness (VO2-max). METHODS: The data were derived from the Amsterdam Growth and Health Study, an observational longitudinal study in which six repeated measurements were carried out over a period of 15 years covering adolescence and young adulthood. The longitudinal relationships were analysed with generalized estimating equations. RESULTS: The results showed significant clustering for the TC:HDL ratio, SSF, and VO(2)-max. MABP was not significantly associated with the other CHD risk factors. Daily physical activity and alcohol consumption (only for males) were both inversely related to the clustering score. None of the other lifestyle parameters showed significant relationships with the clustering score. CONCLUSIONS: Based on this small longitudinal study, it can be stated that during adolescence and young adulthood both daily physical activity and alcohol consumption were related to a healthy CHD risk profile.
Adolescent↗
Effects of health measurements and health information in youth and young adulthood in dietary intake--20-y study results from the Amsterdam Growth and Health Longitudinal Study.
BACKGROUND: The Amsterdam Growth and Health Longitudinal Study (AGAHLS) is a 20 y observational study concerning biological, psychological and lifestyle risk factors for cardiovascular disease and osteoporosis. In the AGAHLS two cohorts can be distinguished: the so-called Multi-Measurement Group (MMG), which received eight repeated measurements, and a Bi-Measurement Group (BMG), which received two measurements, one at the beginning and one at the end of the 20 y period. OBJECTIVE: In health-related longitudinal research, the outcomes of the study may be influenced by the measurements themselves and the health information provided. It was hypothesized that the repeated measurements and the health information given to the MMG would result in a more healthy dietary intake in comparison to the BMG. DESIGN: The MMG consisted of 164 subjects and the BMG consisted of 90 subjects. At the start of the study, subjects were teenagers of 13-y-old. The hypothesis was tested with use of regression analysis, analysing group differences in mean individual change scores. RESULTS: Only the MMG showed a significantly larger decrease in the intake of mono- and disaccharides compared to the BMG. CONCLUSIONS: The effect of the repeated measurements and the health information provided on dietary intake was relatively small, since it was only one out of the 14 nutrients that differed between the MMG and the BMG.
Adolescent↗
Is calculating pack-years retrospectively a valid method to estimate life-time tobacco smoking? A comparison between prospectively calculated pack-years and retrospectively calculated pack-years.
AIMS: To investigate the relative validity of retrospectively calculated pack-years (py-retro) by comparing py-retro with prospectively calculated pack-years (py-pro). DESIGN: A 23-year ongoing cohort study (1977-2000). PARTICIPANTS: One hundred and fifty-four males and females, 13 years old in 1977 and 36 years old in 2000. SETTING: Amsterdam, the Netherlands. MEASUREMENTS: To calculate py-pro, current smoking and quitting efforts were investigated nine times in a period of 23 years with the help of an interview or a questionnaire. At the age of 36, subjects filled out a comprehensive questionnaire about their smoking history, to calculate py-retro. Individual differences between py-pro and py-retro were calculated. In addition, Cohen's kappa was calculated after categorising py-pro and py-retro into three groups. FINDINGS: (1) Py-retro does not under- or overestimate life-time tobacco smoking. (2) The relative validity of py-retro was moderate due to large individual differences between py-pro and py-retro. (3) The individual differences between py-pro and py-retro became larger, the higher the number of pack-years. (4) Mean difference (and 95% limits of agreement) between py-pro and py-retro was -0.039 (-5.23, 5.32) when average pack-years was < 5.2 and -1.17 (-10.00, 14.65) when pack-years > or = 5.2. 5. Cohen's kappa between categorized py-pro and py-retro was 0.79. CONCLUSIONS: Future researchers in the field of smoking should be aware of the moderate relative validity of py-retro. Categorizing py-retro into smoking groups results in a misclassification error that is smaller than the quantitative error in continuous py-retro, but goes together with a loss of information.
Adolescent↗
Longitudinal trends in and tracking of energy and nutrient intake over 20 years in a Dutch cohort of men and women between 13 and 33 years of age: The Amsterdam growth and health longitudinal study.
The purpose of the present study was to describe the longitudinal development of nutrient intake and to determine the stability of this intake from adolescence into adulthood. Longitudinal data of the Amsterdam Growth and Health Longitudinal Study were analysed; the dietary intake of 200 subjects (males and females) was repeatedly measured (eight times) over a period of 20 years, covering the age period of 13-33 years. Dietary intake was determined with the detailed crosscheck dietary history interview. With use of multivariate ANOVA for repeated measurements, trends in macro- and micronutrients over time and differences between genders were analysed. Furthermore, stability coefficients, corrected for time-dependent (biological age) and time-independent covariates (gender) were calculated, taking into account all the measurements. The results showed significant time and gender effects for energy intake (kJ) and the following macronutrients: protein (g and % total energy supply), fat (g) and carbohydrate (g). Interaction effects between time and gender diminished when the macronutrients were calculated as a percentage of total energy intake. The micronutrients Ca, Fe and vitamins changed significantly over time and showed an interaction effect with gender, with the exception of cholesterol intake (mg/MJ), which did not show an interaction effect of time and gender. The tracking of the nutrient intake showed relatively low but significant stability coefficients for all macro- and micronutrients (0.28-0.52). In conclusion, dietary intake does change considerably over time, with the exception of polyunsaturated fat intake (% total energy supply) for both males and females and fat intake in females. Furthermore, stability coefficients for nutrients appeared to be low to moderate. Although these coefficients may be somewhat attenuated as a result of the relatively large measurement error of the dietary intake measurement, they suggest moderate stability of diet over time. These findings may imply that dietary intake is changeable and suggest that disease prevention measures can be implemented in adulthood.
Adolescent↗
Personality characteristics and alcohol consumption: longitudinal analyses in men and women followed from ages 13 to 32.
OBJECTIVE: The purpose of the present study was to investigate the relation between personality characteristics and alcohol consumption. Using a general population of young and generally healthy men and women, the focus was not on alcoholism but on the full scope of alcohol consumption, including abstinence and moderate levels of consumption. Modification of the relation between personality and alcohol consumption by gender, age and type of beverage was investigated. METHOD: The population consisted of 483 (259 female) subjects from the Amsterdam Growth and Health Longitudinal Study; they were aged 13 to 32 years over the 20-year course of the study, during which span measurements were taken between two and seven times. The longitudinal relation between five subscales of the Dutch Personality Inventory (DPI) and alcohol consumption were assessed with generalized estimating equations. RESULTS: Low prevalence of heavy alcohol consumption was found in this population. Abstinence from alcohol was more common among subjects who scored higher on Social Inadequacy, Rigidity and Self-sufficiency subscales. The amount of alcohol consumed was higher in drinkers who scored low on Rigidity and Social Inadequacy. Gender, age and type of alcoholic beverage modified some of the found relationships (e.g., adult women who scored high on Dominance were more likely to be the firmer wine drinkers). No significant relationships were found between alcohol consumption and the DPI Inadequacy subscale. CONCLUSIONS: Alcohol consumption was associated with lower scores on Social Inadequacy, Rigidity and Self-sufficiency.
Adolescent↗
[Roaming through the methodology. XXVIII. More problems with longitudinal studies: dropouts, head-start effects and interval correlations].
The Amsterdam Growth and Health Longitudinal Study with about 300 teenage boys and girls illustrates a number of problems that can occur in a longitudinal study. By adopting a more complex study design (multiple birth cohorts and a separate control group without longitudinal measurements) confounding factors may be found. A problem with the longitudinal design are the dropouts: by comparing their study results in the period before the dropout with the results of the 'stayers' in the same period, selective dropout may be identified. In a multiple longitudinal design with overlapping cohorts, head-tail effects may occur: the most reliable results are found in the middle area where there is the most overlap. Interperiod correlations may assist in determining the stability and the accuracy of the measurements.
Adolescent↗
[Roaming through methodology. XXVII. Problems with longitudinal studies: confounding of the relationship between age, time of measurement and birth cohort].
Nowadays, age-related research questions are investigated using longitudinal study designs where measurements are repeated over time in the same subjects. Cross-sectional studies are used less often for this purpose, as they provide measurements at only one point in time thus making it more difficult to establish relationships between variables and outcomes. However, longitudinal measurements also have drawbacks, even in investigations that, for example, are aimed at age-related changes in physical and psychosocial characteristics during growth and development in young people. In the study of age-related trends, several types of confounding may occur: birth cohort effects, time-of-measurement effects, and test-and-learning effects. If control measurements are carefully collected, for example, in a multiple longitudinal design, or by not repeatedly measuring a control group, the confounding may be quantified and the study results corrected accordingly.
Age Factors↗
[Practice of systematic reviews. VI. Searching, selection and methodological evaluation of etiological research].
Optimal search strategies for the identification of publications on aetiological research are currently not available. The definition of adequate selection criteria is necessary to limit the harvest to a relevant and homogeneous set of publications. Yet, the harvest should be high in order to prevent many relevant papers being missed. The methodological assessment of aetiological research should be aimed at the estimation of the presence of selection bias, information bias, and confounding. Important items of the methodological assessment are independent and standardised assessment of exposure and outcome, high response rate, no selective dropout, and adjustment for confounding in the analysis.
Confounding Factors, Epidemiologic↗
The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations.
OBJECTIVES: To assess the association between leisure time physical activity and musculoskeletal morbidity, as well as possible interactions with physical activity at work. METHODS: A literature search was performed to collect all studies on musculoskeletal disorders in which physical activity was involved as a variable. Next, an analysis was made of questionnaire data on a group of 2,030 workers in various occupations, on self-reported physical activity in leisure time and at work, musculoskeletal symptoms (from low back, neck-shoulder and lower extremity) and sick leave due to these symptoms. A logistic regression analysis was carried out to estimate the association between musculoskeletal morbidity and four physical-activity indices (participation in sports and sedentary activities, active life style, sedentary life style), adjusted for age, gender, education and work load. Interaction of leisure activities with age and work load was tested too. RESULTS: Available literature data (39 studies) showed inconsistent results. Most studies did not show any effects. Some studies indicated favourable effects of physical activity, both on low back and neck pain. Participation in some vigorous sports seemed associated with unfavourable effects. The empirical data showed no association between participation in sports and/or other physical activities in leisure time and musculoskeletal symptoms. Sedentary activity in leisure time was associated with higher prevalence rates of low back symptoms and sick leave due to low back symptoms. CONCLUSIONS: Stimulation of leisure time physical activity may constitute one of the means of reducing musculoskeletal morbidity in the working population, in particular in sedentary workers.
Adult↗
Positive and negative life events: the relationship with coronary heart disease risk factors in young adults.
OBJECTIVE: to investigate the influence of positive and negative life events (including daily uplifts and daily hassles) on several biological and lifestyle coronary heart disease (CHD) risk factors. METHODS: from the Amsterdam Growth and Health Longitudinal Study (AGHLS), a cross-section sample of 207 males and 231 females aged 32/33 years was used. RESULTS: hardly any associations were found between both positive and negative life events and biological CHD risk factors. On the other hand, daily uplifts and positive life events were positively related to lifestyle. For both positive and negative life events coping behaviour played a role in these relationships. Furthermore, it was shown that the associations of health-related variables with daily uplifts and hassles were comparable to those found for major positive and negative life events. CONCLUSION: This study could not fully determine whether or not different mechanisms play a role in the health benefits of positive life events compared to the health burdens of negative life events.
Adaptation, Psychological↗
Blood cholesterol levels of 32-year-old alcohol consumers are better than of nonconsumers.
Blood cholesterol levels are expected to be important factors in the causal pathway between alcohol consumption and CHD. The relation between alcohol consumption and blood cholesterol levels is investigated in 130 men and 145 women aged 32.4 years old (+/-1.0), from the Amsterdam Growth and Health Longitudinal Study. When controlled for gender, cholesterol levels at age 13.1 years, and lifestyle at adult age (smoking, physical activity, dietary habits), no significant differences were found for total cholesterol (TC) levels between alcohol consumers and nonconsumers. Serum high-density lipoprotein (HDL) cholesterol levels were 0.12 mmol/l higher in subjects consuming >/=100 grams of alcohol per week than in nonconsumers (p < 0.05). Regression coefficients of subjects consuming 10 to 50, or 50 to 100 g alcohol per week did not differ statistically from those of nonconsumers. The positive relation between alcohol consumption and serum HDL was modified by smoking (found in nonsmokers, but not in smokers). No differences between beer, wine, and spirits were found for their relation with serum HDL. In conclusion, 32.4-year-old nonsmoking subjects who consumed >/=100 g of alcohol per week had improved HDL levels compared with nonconsumers, whereas the protective effect of drinking smaller amounts of alcohol did not reach statistical significance.
Adult↗
A fifteen-year longitudinal study in young adults on the relation of physical activity and fitness with the development of the bone mass: The Amsterdam Growth And Health Longitudinal Study.
Although positive effects of physical activity are often reported, there are still uncertainties about the type, intensity, duration, and frequency of these activities that are most effective for (re)modeling bone mass during youth. In the Amsterdam Growth and Health Longitudinal Study, daily physical activity and fitness were monitored from age 13 to 29 years in a group of 182 males and females. At a mean age of 28 years, bone mineral density (BMD) was measured at three sites with dual X-ray absorptiometry (DXA): in the lumbar region (lumbar BMD), the femoral neck (hip BMD), and the distal radius (wrist BMD). Physical activity (PA) was estimated from a cross-check activity interview taking in consideration all daily physical activities during the last 3 months; PA was scored in two different ways: (1) metabolic physical activity score (METPA) by weighting the intensity (multiples of basic metabolic rate [METs]) and duration (minutes per week); and (2) mechanic physical activity score (MECHPA) by weighting the peak strain (ground reaction forces as multiples of body mass) irrespective of frequency and duration of the physical activities. Physical fitness was measured with a neuromotor fitness test (composite of six strength, flexibility, and speed tests) and as cardiopulmonary fitness (maximal oxygen uptake). The physical activity and fitness scores were calculated over two age periods: during adolescence (13-16 years) and during adulthood (21-27 years). The standardized regression coefficients (corrected for gender, biological age, body composition, and calcium intake) show that weight, physical activity (both METPA and MECHPA), and neuromotor fitness during adolescence and in young adulthood are significantly and positively related with the lumbar BMD (beta = 0. 11-0.40) and hip BMD (beta = 0.18-0.26), measured at the mean age of 28 years. This was not the case for cardiorespiratory fitness. No significant correlations at all are found with wrist BMD, a bone site that is less involved in physical activity and fitness. It can be concluded that daily physical activity during adolescence and in the young adult period is significantly related to the BMD at the lumbar spine and femoral neck at age 28 of males and females. Only neuromotor fitness and not cardiopulmonary fitness during adolescence and young adulthood is related to the BMD of males and females at age 28 years.
Adolescent↗
Role of the pediatric exercise scientist in physical education, sports training and physiotherapy.
The purpose of this article is to present an overview of the research devoted to the relations of physical activity in children and exercise. The results of experimental studies on the benefits of extra, more intensive physical activity or with different styles of teaching are summarized. Most valid studies using the school environment do not reveal significant and beneficial effects. Longitudinal studies contrasting physically active and inactive children always show higher physiological characteristics in the highly active groups; however, these results are not conclusive because self-selection may have caused the differences. Training studies on aerobic power and on muscle strength show always significant improvements in both sexes, regardless of their level of biologic maturation. The general lack of physical activity in youths nowadays needs strategies to promote physical activity. Motivationally oriented programs with emphasis on the determinants of physical activity behavior of children are supposed to be the most effective and also to be long lasting.
Child↗
Effect of commuter cycling on physical performance of male and female employees.
PURPOSE: The purpose of this study was to determine the effect of commuter cycling on physical performance. Eighty-seven male and 35 female employees volunteered to cycle regularly to their work. METHODS: Sixty-one participants went commuter cycling for 1 yr (cycling group); the others cycled only in the second half year (control group). A maximal exercise test on a cycle ergometer was carried out at the start of the study, after 6 months, and after 1 yr to measure maximal external power (Wmax) and maximal oxygen uptake (VO2max). RESULTS: After the first 6 months of commuter cycling, with a mean single trip distance of 8.5 km and a mean frequency of more than three times a week, a significant increase of 13% was found in the Wmax per kilogram body weight (Wmax x kg(-1)) in both sexes of the cycling group. The improvement in VO2max x kg(-1) was significant for the male participants (6%) but not for the female participants (-2%). At the end of the second half year, the control group also showed a mean gain in Wmax x kg(-1) of 13%. Their VO2max x kg(-1) declined in the first half year, but this was counteracted in the second half year. A dose-response relationship was found between two independent variables and the physical performance; the lower the physical performance at the start of the study and the higher the total amount of kilometers cycled, the higher the gain in Wmax. For subjects with a low initial fitness level, a single trip distance of only 3 km turned out to be enough to improve physical performance. CONCLUSION: Commuter cycling can yield much the same improvement in physical performance as specific training programs.
Adult↗