Controlled trial of weight bearing exercise in older women in relation to bone density and falls

Abstract

Objective: To investigate the effect of socioeconomic group (with reference to age and sex) on the rate of, course of, and survival after coronary events. Design: Community coronary event register from 1985 to 1991. Setting: City of Glasgow north of the River Clyde, population 196 000. Subjects: 3991 men and 1551 women aged 25-64 years on the Glasgow MONICA coronary event register with definite or fatal possible or unclassifiable events according to the criteria of the World Health Organisation's MONICA project (monitoring trends and determinants in cardiovascular disease). Main outcome measures: Rate of coronary events; proportion of subjects reaching hospital alive; case fatality in admitted patients and in community overall. Results: Event rates increased with age for both sexes and were greater in men than women at all ages. The rate increased 1.7-fold in men and 2.4-fold in women from the least (Q1) to the most (Q4) deprived socioeconomic quarter. The socioeconomic gradient decreased with age and was steeper for women than men. The proportion treated in hospital (66%) decreased with age, was greater in women than men, and decreased in both sexes with increasing deprivation (age standardised odds ratio 0.82 for Q4 v Q1) Case fatality in hospital (20%) increased with age, was greater for women than men when age was standardised, and showed no strong socioeconomic pattern. Overall case fatality in the community (50%) increased with age, was similar between the sexes, and increased from Q1 to Q4 (age standardised odds ratio 1.12 in men, 1.18 in women). Conclusions: Socioeconomic group affects not only death rates from myocardial infarction but also event rates and chance of admission. This should be taken into account when different groups of patients are compared. Because social deprivation is associated with so many more deaths outside hospital, primary and secondary prevention are more likely than acute hospital care to reduce the socioeconomic variation in mortality.

Site-Specific Effects of Strength Training on Bone Structure and Geometry of Ultradistal Radius in Postmenopausal Women

“…Anyway, our results, taking into account the duration and the intensity of the program load on the spine and femur, should not be considered discordant from those reported by others. (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) More surprising is the lack of effects on bone mass and density of the ultradistal radius, measured by both traditional DXA and pQCT. From this point of view, our study cannot be easily compared with others.…”

“…In some studies, no beneficial effects were observed (5)(6)(7)(8) in others the increase in bone mineral density (BMD) were very limited. (9)(10)(11)(12)(13) The most striking and consistent increases in bone mass in postmenopausal women are observed after prolonged high intensity training (14)(15)(16)(17)(18) and in those on hormone replacement therapy (HRT). (11) The discrepancy in the range of BMD changes are likely due the heterogeneity of the exercise program and of the method of evaluation.…”

Evidence-Based Guidelines for the Secondary Prevention of Falls in Older Adults

“…When this exercise program was tested in a sample of community-dwelling men and women over the age of 65, the adjusted analysis was not significant, however the point estimate (relative hazard = 0.87) may be clinically important [84]. The Cochrane meta-analysis of four studies [60][61][62][63] (three community and one nursing home) concluded that untargeted exercise alone had no evidence of effectiveness. A later study [94] found that a 12-week program of exercises (strength, endurance, mobility and balance) in the community did not prevent falls at 12 weeks in older men (mean age 75 years) with at least one fall risk factor.…”

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

“…Mortalität (van Haastregt, Diederiks, van Rossum, de Witte, Voorhoeve, & Crebolder, 2000;van Rossum, Frederiks, Philipsen, Portengen, Wiskerke, & Knipschild, 1993;Carpenter & Demopoulos, 1990), Muskelkraft (Woo, Hong, Lau, & Lynn, 2007;Lord, Ward, Williams, & Strudwick, 1995), Koordinationsfähigkeit (Woo et al, 2007;Lord et al, 1995), Reaktionszeit (Lord et al, 1995), Gehgeschwindigkeit (Steadman, Donaldson, & Kalra, 2003;Liu-Ambrose, Khan, Eng, Lord, & McKay, 2004;Woo et al, 2007), posturale Balance (Swanenburg, De Bruin, Stauffacher, Mulder, & Uebelhart, 2007), StandSitz-Performance (Lord et al, 2005), Knochendichte (Harwood, Sahota, Gaynor, Masud, & Hosking, 2004;Greenspan, Resnick, & Parker, 2003;Swanenburg et al, 2007) und allgemeiner Gesundheitsstatus (McMurdo, Mole, & Paterson, 1997;Carter et al, 2002;Barnett, Smith, Lord, Williams, & Baumand, 2003). Jedoch berücksichtigt die Begrenzung der Endpunkte auf klinische Parameter die Präferenzen der Zielgruppe nicht ausreichend (Langer et al, 2012;Nilsen, Myrhaug, Johansen, Oliver & Oxman, 2006;PCORI, 2012).…”

“…Zu den bedeutenden klientenzentrierten Endpunkten zählen z.B. die Anzahl an Stürzen (McMurdo et al, 1997;Harwood et al, 2005;Lord et al, 2005;Porthouse et al, 2005;Swanenburg et al, 2007), die Anzahl an Gestürzten (McMurdo et al, 1997;Harwood et al, 2005;Porthouse et al, 2005), die Sturzangst (Porthouse et al, 2005;Lannin, Clemson, McCluskey, Lin, Cameron, & Barras, 2007;Lin, Wolf, Hwang, Gong, & Chen, 2007) sowie die Lebensqualität (Gallagher & Brunt, 1996;Harwood, Foss, Osborn, Gregson, Zaman, & Masud, 2005;Lannin et al, 2007) und Mobilität (Lannin et al, 2007). Da die individuelle Partizipation und Teilhabe von Klienten/-innen am Leben in der Gesellschaft Handlungsmaxime und fester Bestandteil der Sozialgesetzgebung (SGB IX) sind, sind Endpunkte, die soziale Partizipation und Wertvorstellungen abbilden, stärker in den Fokus zu rücken (BAR, 2008;Welti, & Fuchs, 2007).…”